Is traditional Chinese medicine recommended in Western medicine clinicalpractice guidelines in China? A systematic analysis.

Journal article

Ren, J, Xun, Li, Sun,, J, Han, M, Yang, G-Y., Li, W-Y., Robinson, N. and Lewith, G. (2015). Is traditional Chinese medicine recommended in Western medicine clinicalpractice guidelines in China? A systematic analysis. BMJ Open. 5 (6), pp. e006572-e006572. https://doi.org/10.1136/bmjopen-2014-006572
AuthorsRen, J, Xun, Li, Sun,, J, Han, M, Yang, G-Y., Li, W-Y., Robinson, N. and Lewith, G.
Abstract

Background: Evidence-based medicine promotes and relies on the use of evidence in developing clinical practice guidelines (CPGs). The Chinese healthcare system includes both traditional Chinese medicine (TCM) and Western medicine, which are expected to be equally reflected in Chinese CPGs. Objective: To evaluate the inclusion of TCM-related information in Western medicine CPGs developed in China and the adoption of high level evidence. Methods: All CPGs were identified from the China Guideline Clearinghouse (CGC), which is the main Chinese organisation maintaining the guidelines issued by the Ministry of Health of China, the Chinese Medical Association and the Chinese Medical Doctors' Association. TCM-related contents were extracted from all the CPGs identified. Extracted information comprised the institution issuing the guideline, date of issue, disease, recommendations relating to TCM, evidence level of the recommended content and references supporting the recommendations. Results: A total of 604 CPGs were identified, only a small number of which (74/604; 12%) recommended TCM therapy and only five guidelines (7%) had applied evidence grading. The 74 CPGs involved 13 disease systems according to the International Classification of Diseases 10th edition. TCM was mainly recommended in the treatment part of the guidelines (73/74, 99%), and more than half of the recommendations (43/74, 58%) were related to Chinese herbal medicine (single herbs or herbal treatment based on syndrome differentiation). Conclusions: Few Chinese Western medicine CPGs recommend TCM therapies and very few provide evidence grading for the TCM recommendation. We suggest that future guideline development should be based on systematic searches for evidence to support CPG recommendations and involve a multidisciplinary approach including TCM expertise.

KeywordsHumans; Drugs, Chinese Herbal; Medicine, Chinese Traditional; Evidence-Based Medicine; Delivery of Health Care; China; Practice Patterns, Physicians'
Year2015
JournalBMJ Open
Journal citation5 (6), pp. e006572-e006572
PublisherBMJ
ISSN2044-6055
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2014-006572
Publication dates
Online03 Jun 2015
Publication process dates
Accepted03 Jun 2015
Deposited10 Nov 2020
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Qu, F, Wang, FF, Robinson, N. and Hardiman, P (2017). Women’s health and Chinese integrative medicine. Journal of Zhejiang University: Science B. 18 (3), pp. 183-185. https://doi.org/10.1631/jzus.B17ed001
TRANSCUTANEOUS ELECTRICAL ACUPOINT STIMULATION IMPROVES THE OUTCOMES OF IN VITRO FERTILIZATION: A PROSPECTIVE, RANDOMIZED AND CONTROLLED STUDY
Qu, F, Wang, F-F, Wu, Y, Zhou, J, Robinson, N., Hardiman, P, Pan, J-X, He, Y-J, Zhu, Y-H, Wang, H-Z, Ye, X-Q, He, K-L, Cui, L, Zhao, H-L and Ye, Y-H (2017). TRANSCUTANEOUS ELECTRICAL ACUPOINT STIMULATION IMPROVES THE OUTCOMES OF IN VITRO FERTILIZATION: A PROSPECTIVE, RANDOMIZED AND CONTROLLED STUDY. Explore: The Journal of Science & Healing. 13 (5), pp. 306-312. https://doi.org/10.1016/j.explore.2017.06.004
The effects of acupuncture on polycystic ovary syndrome: A systematic review and meta-analysis
Qu, F., Yan, W., Hu, X-Y., Barry, J.A., Zhou, J., Wang, F-F., Ye, Y-H., Han, S-P., Li, R., Taw, M.B., Hardiman, P.J. and Robinson, N. (2016). The effects of acupuncture on polycystic ovary syndrome: A systematic review and meta-analysis. European Journal of Integrative Medicine. 8 (1), pp. 12-18. https://doi.org/10.1016/j.eujim.2016.02.001
The role of complementary and alternative medicine (CAM) in sexual and reproductive health
Qidwai, W, Wong, W, Nanji, K and Robinson, N. (2016). The role of complementary and alternative medicine (CAM) in sexual and reproductive health. European Journal of Integrative Medicine. 8 (1), pp. 1-3. https://doi.org/10.1016/j.eujim.2016.02.003
The Importance of Evidence for the Integration of Traditional and Complementary Medicine into Western Healthcare?
Robinson, N. (2016). The Importance of Evidence for the Integration of Traditional and Complementary Medicine into Western Healthcare? World Journal of Traditional Chinese Medicine. 2 (1), pp. 74 - 79. https://doi.org/10.15806/j.issn.2311-8571.2015.0029
Harmonising data collection from osteoarthritis studies to enable stratification: Recommendations on core data collection from an Arthritis Research UK clinical studies group
Kingsbury, SR, Corp, N, Watt, FE, Felson, DT, O'Neill, TW, Holt, CA, Jones, RK, Conaghan, PG, Arden, NK, Adams, J, Appleyard, I, Birrell, F, Blank, M, Callaghan, MJ, Cumming, J, Chapman, GJ, Halstead, J, Hamilton, DF, Hurley, M, Martin, K, Mason, DJ, Nuki, G, Redmond, AC, Reilly, K, Robinson, N., Roddy, E, Simpson, H, Smith, TO, Thomas, C, Thomas, E, Wilkinson, J and Wise, E (2016). Harmonising data collection from osteoarthritis studies to enable stratification: Recommendations on core data collection from an Arthritis Research UK clinical studies group. Rheumatology (United Kingdom). 55 (8), pp. 1394-1402. https://doi.org/10.1093/rheumatology/kew201
Introducing “Evidence for clinical practice” [Editorial]
Alper, BS, Malone-Moses, M, Manheimer, EW and Robinson, N. (2016). Introducing “Evidence for clinical practice” [Editorial]. European Journal of Integrative Medicine. 8 (3), pp. 147-149. https://doi.org/10.1016/j.eujim.2016.04.008
Pediatric integrative medicine needs research evidence to guide decision-making
Gardiner, P and Robinson, N. (2016). Pediatric integrative medicine needs research evidence to guide decision-making. European Journal of Integrative Medicine. 8 (2), pp. 79 - 80. https://doi.org/10.1016/j.eujim.2016.03.015
Bromelain and Cardiovascular Risk Factors in Diabetes: An Exploratory Randomized, Placebo Controlled, Double Blind Clinical Trial
Ley, C., NI, Q, Liao, X, Gao, H-L and Robinson, N. (2016). Bromelain and Cardiovascular Risk Factors in Diabetes: An Exploratory Randomized, Placebo Controlled, Double Blind Clinical Trial. Chinese Journal of Integrative Medicine. 22 (10), pp. 728-737. https://doi.org/10.1007/s11655-016-2521-2
General Practitioners’ use of and attitudes to acupuncture in relation to the UK’s National Institute for Health and Care Excellence (NICE) clinical guidelines—A pilot study
Czarnawska-Iliev, I and Robinson, N. (2016). General Practitioners’ use of and attitudes to acupuncture in relation to the UK’s National Institute for Health and Care Excellence (NICE) clinical guidelines—A pilot study. European Journal of Integrative Medicine. 8 (4). https://doi.org/10.1016/j.eujim.2016.07.004
Evidence is in the Eye of the Beholder: The case of the 2016 draft NICE Guidelines for Low Back Pain [editorial]
Hopper Koppelman, M, Bovey, M and Robinson, N. (2016). Evidence is in the Eye of the Beholder: The case of the 2016 draft NICE Guidelines for Low Back Pain [editorial]. European Journal of Integrative Medicine. 8 (4).
Common mistakes when using plant names and how to avoid them
Dauncey, EA, Irving, J, Allkin, R and Robinson, N. (2016). Common mistakes when using plant names and how to avoid them. European Journal of Integrative Medicine. 8 (5), pp. 597-601. https://doi.org/10.1016/j.eujim.2016.09.005
Integrating acupuncture: are there positive health outcomes for women?
Robinson, N. (2016). Integrating acupuncture: are there positive health outcomes for women? Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology). 18 (3), pp. 233-238. https://doi.org/10.1631/jzus.B1600260
Integrating complementary and alternative medicine (CAM) and conventional diagnoses.
Lewith, G and Robinson, N (2016). Integrating complementary and alternative medicine (CAM) and conventional diagnoses. European Journal of Integrative Medicine. 8 (6), pp. 879-880. https://doi.org/10.1016/j.eujim.2016.11.019
Traditional Chinese Medicine - challenges for research
Robinson, N. (2015). Traditional Chinese Medicine - challenges for research. in: McCarthy, P.W. and Langweiler, M. (ed.) Methodologies for Effectively Assessing Complementary and Alternative Medicine (CAM) London Singing Dragon.
Acupuncture for the treatment of phantom limb syndrome in lower limb amputees: a randomised controlled feasibility study
Trevelyan, EG, Turner, WA, Summerfield-Mann, L and Robinson, N. (2015). Acupuncture for the treatment of phantom limb syndrome in lower limb amputees: a randomised controlled feasibility study. Trials. 16, p. 158. https://doi.org/10.1186/s13063-015-0668-3
The politics of integrative medicine: The case of CAM
Saks, M and Robinson, N. (2015). The politics of integrative medicine: The case of CAM. European Journal of Integrative Medicine. 7 (6), pp. 557-560. https://doi.org/10.1016/j.eujim.2015.11.019
GAP: From sound design to practical implementation in clinical trials for traditional chinese medicine
Shang, H, Zhang, B, Bian, Z, Li, Y, Clarke, M and Robinson, N (2014). GAP: From sound design to practical implementation in clinical trials for traditional chinese medicine. Evidence-based Complementary and Alternative Medicine. 2014, pp. 1-2. https://doi.org/10.1155/2014/560838
The quest for modernisation of traditional Chinese medicine
Xu, Q, Bauer, R, Hendry, BM, Fan, TP, Zhao, Z, Duez, P, Simmonds, MSJ, Witt, CM, Lu, A, Robinson, N, Guo, DA and Hylands, PJ (2013). The quest for modernisation of traditional Chinese medicine. BMC Complementary and Alternative Medicine. 13 (1), pp. 132-. https://doi.org/10.1186/1472-6882-13-132
A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy.
Franconi, G, Manni, L, Schröder, S, Marchetti, P and Robinson, N. (2013). A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evidence-Based Complementary and Alternative Medicine (eCAM). 2013, p. 516916. https://doi.org/10.1155/2013/516916
The evidence for Shiatsu: A systematic review of Shiatsu and acupressure
Robinson, N, Lorenc, A and Liao, X (2011). The evidence for Shiatsu: A systematic review of Shiatsu and acupressure. BMC Complementary and Alternative Medicine. 11 (1), pp. 88-. https://doi.org/10.1186/1472-6882-11-88
The RCCM 2009 survey: Mapping doctoral and postdoctoral CAM research in the United Kingdom
Robinson, N and Lewith, G (2011). The RCCM 2009 survey: Mapping doctoral and postdoctoral CAM research in the United Kingdom. Evidence-based Complementary and Alternative Medicine. 2011, pp. 1-4. https://doi.org/10.1093/ecam/nep184
How parents choose to use CAM: A systematic review of theoretical models
Lorenc, A, Ilan-Clarke, Y, Robinson, N and Blair, M (2009). How parents choose to use CAM: A systematic review of theoretical models. BMC Complementary and Alternative Medicine. 9 (1), pp. 9-. https://doi.org/10.1186/1472-6882-9-9