Formulation of international standards of Chinese medicine technology: clinical practice guide of Chinese medicine for cough

doi:10.19852/j.cnki.jtcm.20231016.001

Journal of Traditional Chinese Medicine ›› 2024, Vol. 44 ›› Issue (2): 396-402.DOI: 10.19852/j.cnki.jtcm.20231016.001

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Formulation of international standards of Chinese medicine technology: clinical practice guide of Chinese medicine for cough

FANG Hanyu¹^,²^,³, HONG Zheng¹^,²^,³, LI Deming⁴, ZHANG Hongchun¹^,²^,³(), SHI Yihang⁵^,⁶, LI Xiaojuan⁵^,⁶, SUN Zengtao⁵^,⁶(), CHEN Wei⁷, ZHANG Chuchu⁸, ZU Yaqi⁸

1 Beijing University of Chinese medicine, Beijing 100029, China
2 Department of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029
3 National Center for Respiratory Medicine, Beijing 100029, China
4 Department of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
5 Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
6 Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300250, China
7 Center for Evidence-based Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
8 Institute of Information on Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China

Received:2022-12-24 Accepted:2023-04-27 Online:2024-04-15 Published:2023-10-16
Contact: Prof. ZHANG Hongchun, Beijing University of Chinese medicine, Beijing 100029,China; Department of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029; National Center for Respiratory Medicine, Beijing, 100029, China. 13701226664@139.com; Prof. SUN Zengtao, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300250, China. zengtaosun2021@126.com Telephone: +86-13701226664; +86-13512018056
Supported by:
National Key R & D Plan: Development of International Standards for Traditional Chinese Medicine Technology(2017ZZ008)

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Abstract

Abstract:

OBJECTIVE: To formulate the first clinical practice guideline for the treatment of cough using Chinese medicine based on the grading of recommendations assessment, development, and evaluation (GRADE) systematic approach, including clinical evidence, evaluation of ancient literature, and expert consensus.

METHODS: In the process of development, the regulation of "evidence-based, consensus-assisted, and empirical" was followed, and a comprehensive systematic approach of recommendation assessment, GRADE, evidence-based evaluation, expert consensus, and the Delphi method was used. In the process of guideline development, evidence-based evaluation of ancient literature was included for the first time, and clinical evidence was fully integrated with clinical expert consensus.

RESULTS: The clinical practice guidelines for the treatment of cough with Chinese herbal medicine were developed after a comprehensive consideration of evidence-based evaluation and expert opinions. The guideline recommendations focused on recommending herbal compound decoctions and Chinese patent medicines for cough in different conditions. Based on the GRADE systematic approach, we conducted an evidence-based evaluation of the recommended Chinese patent medicines one by one; meanwhile, the expert consensus method was used to unify the recommendations of both.

CONCLUSION: Based on clinical evidence, ancient literature evaluation, and expert consensus, a clinical practice guideline for Traditional Chinese Medicine (TCM) in the treatment of cough was developed, providing the first current clinical practice guideline for domestic and foreign TCM and Western medicine practitioners, especially respiratory professionals at home and abroad.

Key words: Medicine, Chinese Traditional, clinical practice, cough practice guide, international standard

FANG Hanyu, HONG Zheng, LI Deming, ZHANG Hongchun, SHI Yihang, LI Xiaojuan, SUN Zengtao, CHEN Wei, ZHANG Chuchu, ZU Yaqi. Formulation of international standards of Chinese medicine technology: clinical practice guide of Chinese medicine for cough[J]. Journal of Traditional Chinese Medicine, 2024, 44(2): 396-402.

Figures/Tables 4

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Grade	Code	Definition
High	A	The authors have a lot of confidence that the true effect is similar to the estimated effect.
Moderate	B	The authors believe that the true effect is probably close to the estimated effect.
Low	C	The true effect might be markedly different from the estimated effect.
Very low	D	The true effect is probably markedly different from the estimated effect.

Grade	Code	Definition
High	A	The authors have a lot of confidence that the true effect is similar to the estimated effect.
Moderate	B	The authors believe that the true effect is probably close to the estimated effect.
Low	C	The true effect might be markedly different from the estimated effect.
Very low	D	The true effect is probably markedly different from the estimated effect.

Recommended grade	Recommended terms in this guide	Code
Strong recommendations to support the use of certain therapies	Strong recommendation	1
Weak recommendation to support the use of certain therapies	Weak recommendation	2
Uncertain	Not recommended	3
Strong recommendation against using certain therapies	opposition	4
Weak recommendation against the use of certain therapies	Not recommended	5

Recommended grade	Recommended terms in this guide	Code
Strong recommendations to support the use of certain therapies	Strong recommendation	1
Weak recommendation to support the use of certain therapies	Weak recommendation	2
Uncertain	Not recommended	3
Strong recommendation against using certain therapies	opposition	4
Weak recommendation against the use of certain therapies	Not recommended	5

Level of evidence	TCM prescriptions	Source
High	Xiaoqinglong decoction (小青龙汤)	Treatise on Febrile Diseases
High	Erchen decoction (二陈汤)	Tai Ping Hui Min He Ji Ju Fang
High	Xingsu powder (杏苏散)	Treatment of Epidemic Febrile Disease
High	San-ao decoction (三拗汤)	Tai Ping Hui Min He Ji Ju Fang
High	Maxing Shigan decoction (麻杏石甘汤)	Treatise on Febrile Diseases
Moderate	Sangju decoction (桑菊饮)	Treatment of Epidemic Febrile Disease
Moderate	Zhisou powder (止嗽散)	Yi Xue Xin Wu
Moderate	Sangxing Powder (桑杏汤)	Treatment of Epidemic Febrile Disease
Moderate	Shashen Maidong decoction (沙参麦冬汤)	Treatment of Epidemic Febrile Disease
Moderate	Sanzi Yangqin decoction (三子养亲汤)	Han Shi Yi Tong
Moderate	Xuanfu Daizhe decoction (旋覆代赭汤)	Treatise on Febrile Diseases
Moderate	Daige powder (黛蛤散)	Wei Sheng Hong Bao
Moderate	Qingjin Huatan decoction (清金化痰汤)	Yi Xue Tong Zhi
Low	Huangqin Xiebai powder (黄芩泻白散)	Zheng Yin Mai Zhi

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Figures/Tables 4

References 72.

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TCM syndrome	Recommended medication	Level of evidence	Recommended level
Wind and cold attacking lungs	San-ao decoction (三拗汤)	C	1
Wind and cold attacking lungs	Zhisou powder (止嗽散)	B	1
External cold and internal drink	Xiaoqinglong decoction (小青龙汤)/ Xiaoqinglong granules (小青龙胶囊)	B	1
Wind and heat attacking lungs	Sangju decoction (桑菊饮)	C	1
Warm dryness damaging lungs	Sangxing powder (桑杏汤)	C	1
Cold dryness damaging lungs	Xingsu powder(杏苏散)	D	1
Wind excessiveness and spasm	Suhuang Zhike soup (苏黄止咳汤) /Suhuang Zhike granules (苏黄止咳胶囊)	B	1
Phlegm-dampness accumulating in lungs	Erchen decoction (二陈汤)	B	1
Phlegm-dampness accumulating in lungs	Sanzi Yangqin decoction (三子养亲汤)	D	1
Phlegm-heat confined in lungs	Qingjin Huatan decoction (清金化痰汤) ^a	B	1
Phlegm-heat confined in lungs	Feilike granules (肺力咳胶囊)^b	C	2
Abnormal rising of stomach Qi	Xuanfu Daizhe decoction (旋覆代赭汤)	D	1
Liver fire invading lungs	Huangqin Xiebai powder (黄芩泻白散)	(Based on experts consensus)	2
Liver fire invading lungs	Daige powder (黛蛤散)	(Based on experts consensus)	2
Lung Yin deficiency	Shashen Maidong decoction (沙参麦冬汤)	B	1