Skip to main content

Advertisement

Log in

Syndrome pattern and its application in parallel randomized controlled trials

  • Feature Article
  • Published:
Chinese Journal of Integrative Medicine Aims and scope Submit manuscript

Abstract

Syndrome pattern (SP) is a core concept of Chinese medicine (CM) and is used to diagnose and treat patients based on an overall analysis of symptoms and signs. This study aimed to systematically review randomized controlled trials (RCTs) using the SP concept and to demonstrate how the SP concept could be applied to the study design of parallel RCTs, considering a gold standard of clinical research. After conducting a brief systematic review by way of a PubMed search, we analyzed how the SP concept was applied to the design of RCT in a CM herbal medicine trial. We then formulated possible research questions, applied the SP concept to answer the research questions, and suggested possible RCT designs to be used for conducting future trials. Fourteen RCTs were included in our systematic review, and three key points of the SP concept were formulated for the design of parallel RCTs: the time point of SP diagnosis between before and after randomization; the relationship between the international classification of diseases (ICD) and SP for the inclusion of target population; and the proper diagnostic method of SP. In this study, we formulated three possible research questions and then suggested perspectives for five possible RCT models arrived at using SP concepts. Future trials applying SP concept to RCTs should overcome the shortcomings of past SP trials, moving CM forward from experience-based to evidence-based medicine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Jiang M, Lu C, Zhang C, Yang J, Tan Y, Lu A, et al. Syndrome differentiation in modern research of traditional Chinese medicine. J Ethnopharmacol 2012;140:634–642.

    Article  PubMed  Google Scholar 

  2. Berle CA, Cobbin D, Smith N, Zaslawski C. A novel approach to evaluate traditional Chinese medicine treatment outcomes using pattern identification. J Altern Complement Med 2010;16:357–367.

    Article  PubMed  Google Scholar 

  3. Lu A, Jiang M, Zhang C, Chan K. An integrative approach of linking traditional Chinese medicine pattern classification and biomedicine diagnosis. J Ethnopharmacol 2012;141:549–556.

    Article  PubMed  Google Scholar 

  4. Lu C, Zha Q, Chang A, He Y, Lu A. Pattern differentiation in traditional Chinese medicine can help define specific indications for biomedical therapy in the treatment of rheumatoid arthritis. J Altern Complement Med 2009;15:1021–1025.

    Article  PubMed  Google Scholar 

  5. Wang LM, Zhao X, Wu XL, Li Y, Yi DH, Cui HT, et al. Diagnosis analysis of 4 TCM patterns in suboptimal health status: a structural equation modelling approach. Evid Based Complement Alternat Med 2012;2012:970–985.

    Google Scholar 

  6. Feng Y, Wu Z, Zhou X, Zhou Z, Fan W. Knowledge discovery in traditional Chinese medicine: state of the art and perspectives. Artif Intell Med 2006;38:219–236.

    Article  PubMed  Google Scholar 

  7. Jiang M, Zhang C, Zheng G, Guo H, Li L, Yang J, et al. Traditional Chinese medicine Zheng in the era of evidence-based medicine: a literature analysis. Evid Based Complement Alternat Med 2012;2012:409–568.

    Google Scholar 

  8. Lu AP, Jia HW, Xiao C, Lu QP. Theory of traditional Chinese medicine and therapeutic method of diseases. World J Gastroenterol 2004;10:1854–1856.

    PubMed  Google Scholar 

  9. Manchikanti L, Hirsch JA, Smith HS. Evidence-based medicine, systematic reviews, and guidelines in interventional pain management. Part 2: randomized controlled trials. Pain Physician 2008;11:717–773.

    PubMed  Google Scholar 

  10. Chou PB, Morse CA, Xu H. A controlled trial of Chinese herbal medicine for premenstrual syndrome. J Psychosom Obstet Gynaecol 2008;29:185–192.

    Article  PubMed  Google Scholar 

  11. Yang W, Ouyang J, Zhu K, Zhou S, Peng Z. TCM treatment for 40 cases of rheumatoid arthritis with channel blockage due to yin deficiency. J Tradit Chin Med 2003;23:172–174.

    PubMed  Google Scholar 

  12. Chen JX, Ji B, Lu ZL, Hu LS. Effects of Chai Hu (Radix burpleuri) containing formulation on plasma beta-endorphin, epinephrine and dopamine on patients. Am J Chin Med 2005;33:737–745.

    Article  PubMed  Google Scholar 

  13. Cheng CW, Bian ZX, Zhu LX, Wu JC, Sung JJ. Efficacy of a Chinese herbal proprietary medicine (Hemp Seed Pill) for functional constipation. Am J Gastroenterol 2011;106:120–129.

    Article  PubMed  Google Scholar 

  14. Huang Y, Guo JW. Outcome and safety assessment of an herbal medicine treatment protocol for yin pattern of acute ischemic stroke. J Chin Integr Med (Chin) 2010;8:417–426.

    Article  Google Scholar 

  15. Leung WK, Wu JC, Liang SM, Chan LS, Chan FK, Xie H, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol 2006;101:1574–1580.

    Article  PubMed  Google Scholar 

  16. Liu YF, Yu HM, Zhang C, Yang RX, Yan FF, Liu Y, et al. Effects of Quyu Xiaoban Capsules on clinical outcomes and platelet activation and aggregation in patients with unstable angina pectoris. J Altern Complement Med 2007;13:571–576.

    Article  PubMed  Google Scholar 

  17. Shen BQ, Situ Y, Huang JL, Su XM, He WT, Zhang MW, et al. A clinical study on the treatment of chronic pelvic inflammation of qi-stagnation with blood stasis syndrome by Penyanqing Capsule. Chin J Integr Med 2005;11:249–254.

    Article  PubMed  Google Scholar 

  18. Wu H, Jing Z, Tang X, Wang X, Zhang S, Yu Y, et al. To compare the efficacy of two kinds of Zhizhu Pills in the treatment of functional dyspepsia of Spleen-deficiency and qi-stagnation syndrome: a randomized group sequential comparative trial. BMC Gastroenterol 2011;11:81.

    Article  PubMed  Google Scholar 

  19. You WH, Wang P, Li MQ, Zhang Y, Peng YL, Zhang FL. Therapeutic effects of modified Danggui Sini Decoction on plasma level of advanced glycation end products in patients with Wagner grade 0 diabetic foot: a randomized controlled trial. J Chin Integr Med (Chin) 2009;7:622–628.

    Article  CAS  Google Scholar 

  20. Zhang T, Ma SL, Xie GR, Deng QH, Tang ZZ, Pan XC, et al. Clinical research on nourishing yin and unblocking meridians recipe combined with opioid analgesics in cancer pain management. Chin J Integr Med 2006;12:180–184.

    Article  PubMed  Google Scholar 

  21. Zhang Y, Chang J, Chi HH, Mao B, Tang WF, Wang L, et al. Randomized controlled trial on treatment of bronchial asthma of qi-deficiency cold syndrome type by Pingchuan Yiqi Granule. Chin J Integr Med 2007;13:27–32.

    Article  PubMed  CAS  Google Scholar 

  22. Zhou FS, Hu LJ, Wang RJ, Huang ZX, Luo Q. Study on clinical effect and mechanism of Jianpi Qingre Huayu Recipe. Chin J Integr Med 2007;13:22–26.

    Article  PubMed  Google Scholar 

  23. Min ZH, Zhou Y, Zhang HM. Effect of treatment based on syndrome differentiation by Chinese medicine on posttraumatic elbow arthritis. Chin J Integr Med 2010;16:264–269.

    Article  PubMed  Google Scholar 

  24. He Y, Lu A, Lu C, Zha Y, Yan X, Song Y, et al. Symptom combinations assessed in traditional Chinese medicine and its predictive role in ACR20 efficacy response in rheumatoid arthritis. Am J Chin Med 2008;36:675–683.

    Article  PubMed  CAS  Google Scholar 

  25. Kang BK, Park TY, Moon TW, Lee JA, Ko MM, Choi J, et al. Reliability and validity of a pattern identification questionnaire for Korean stroke patients. BMC Complement Altern Med 2012;12:55.

    Article  PubMed  Google Scholar 

  26. Guyatt G CJ, Churchill D, Cook D, Haynes D, Hirsh J, et al. Evidenced-Based Medicine Working Group. Evidencebased medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420–2425.

    Article  Google Scholar 

  27. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71–72.

    Article  PubMed  CAS  Google Scholar 

  28. Salmond SS. Randomized controlled trials: methodological concepts and critique. Orthop Nurs 2008;27:116–122; quiz 123–124.

    Article  PubMed  Google Scholar 

  29. Grossman J, Mackenzie FJ. The randomized controlled trial: gold standard, or merely standard? Perspect Biol Med 2005;48:516–534.

    Article  PubMed  Google Scholar 

  30. Kaptchuk TJ. The double-blind, randomized, placebo-controlled trial: gold standard or golden calf? J Clin Epidemiol 2001;54:541–549.

    Article  PubMed  CAS  Google Scholar 

  31. Mao J, Hou Y, Shang H, Wang H, Wang X, Zhao Y, et al. Study on the evaluation of the clinical effects of traditional Chinese medicine in heart failure by complex intervention: protocol of SECETCM-HF. Trials 2009;10:122.

    Article  PubMed  Google Scholar 

  32. Zhang C, Jiang M, Lu A. A traditional Chinese medicine versus Western combination therapy in the treatment of rheumatoid arthritis: two-stage study protocol for a randomized controlled trial. Trials 2011;12:137.

    Article  PubMed  CAS  Google Scholar 

  33. Kalauokalani D, Sherman KJ, Cherkin DC. Acupuncture for chronic low back pain: diagnosis and treatment patterns among acupuncturists evaluating the same patient. South Med J 2001;94:486–492.

    PubMed  CAS  Google Scholar 

  34. Zell B, Hirata J, Marcus A, Ettinger B, Pressman A, Ettinger KM. Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners. Menopause 2000;7:129–134.

    Article  PubMed  CAS  Google Scholar 

  35. Zhang GG, Bausell B, Lao L, Handwerger B, Berman BM. Assessing the consistency of traditional Chinese medical diagnosis: an integrative approach. Altern Ther Health Med 2003;9:66–71.

    PubMed  Google Scholar 

  36. Zhang GG, Lee WL, Lao L, Bausell B, Berman B, Handwerger B. The variability of TCM pattern diagnosis and herbal prescription on rheumatoid arthritis patients. Altern Ther Health Med 2004;10:58–63.

    PubMed  Google Scholar 

  37. Zhang GG, Lee W, Bausell B, Lao L, Handwerger B, Berman B. Variability in the traditional Chinese medicine (TCM) diagnoses and herbal prescriptions provided by three TCM practitioners for 40 patients with rheumatoid arthritis. J Altern Complement Med 2005;11:415–421.

    Article  PubMed  CAS  Google Scholar 

  38. Chen RQ, Wong CM, Cao KJ, Lam TH. An evidence-based validation of traditional Chinese medicine syndromes. Complement Ther Med 2010;18:199–205.

    Article  PubMed  CAS  Google Scholar 

  39. Kim HJ, Bae HS, Park SU, Moon SK, Park JM, Jung WS. Clinical approach to the standardization of oriental medical diagnostic pattern identification in stroke patients. Evid Based Complement Alternat Med 2011;2011.

    Google Scholar 

  40. WHO. http://apps.who.int/classifications/icd11/browse/f/en.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Byung-Cheul Shin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shin, BC., Kim, S. & Cho, YH. Syndrome pattern and its application in parallel randomized controlled trials. Chin. J. Integr. Med. 19, 163–171 (2013). https://doi.org/10.1007/s11655-012-1256-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11655-012-1256-y

Keywords

Navigation