An evidence-based practice method according to literature retrieval through PICO (Patients,Intervention,Comparison,Outcome) questions and complementary and alternative medicine (CAM) topics,which can obtain helpful evidence for guiding clinical practice,was introduced with a practical example in this paper.The knowledge of diseases and Western medicine treatment can be acquired by literature retrieval through PICO question,while searching by CAM topics may provide evidence for Chinese medicine (CM).Thus the author held that literature retrieval through both PICO question and CAM topics was an ideal evidencebased practice method for integrative Chinese and Western medicine (ICWM).However,since the standard in CM evidence hierarchy is still under study,the value of the CAM thematic retrieval method remains very limited.In the future,studies on the definition and hierarchy of CM evidences and the herb-drug interaction between Western and Chinese medicine during a combination therapy should be strengthened to improve the status of ICWM evidence-based practice.
Objective:To analyze the correlation of Chinese medicine syndrome evolvement and cardiovascular events in patients with stable coronary heart disease(CHD).Methods:This prospective cohort study investigated and collected the clinical information of patients with stable CHD and observed the syndrome type at the baseline and6-month at follow-up,as well as the cardiovascular events during the 6-month and 12-month follow-up.The patients were divided into the event group and the non-event group.The interaction and the impact of syndrome evolvement on cardiovascular events were examined through multifactor dimensionality reduction(MDR)analysis and the results were verified by Chi-square test.Results:Totally 1,333 of 1,503 stable CHD patients enrolled met the inclusion criteria of MDR analysis.Among them,959(71.9%)cases were males and 374(28.1%)cases were females.Thirty seven cases had cardiovascular events during 6 to 12 months after the study began.The results of the MDR analysis and verification using Chi-square test showed that the development of cardiovascular events was positively correlated with interaction between blood stasis and toxic syndrome at the baseline,blood stasis at the baseline and qi deficiency at the 6-month follow-up,toxic syndrome at the baseline and qi deficiency at the 6-month follow-up,toxic syndrome at the base line and blood stasis at the 6-month follow-up,qi deficiency and blood stasis at the 6-month follow-up(P<0.05for all).Conclusions:Blood stasis,toxic syndrome and qi deficiency are important factors of stable CHD.There are positive correlation between cardiovascular events and syndrome evolution from blood stasis to qi deficiency,from toxic syndrome to qi deficiency and from toxic syndrome to blood stasis,indicating the pathogenesis of toxin consuming qi,toxin leading to blood-stasis in stable CHD patients prone to recurrent cardiovascular events.
Objective:To explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease(CHD) according to the acute cardiovascular events(ACEs) in one-year follow-up which based on the pathogenesis hypothesis of 'blood-stasis and toxin causing catastrophe'.Methods: Totally 254 stable CHD cases were enrolled after diagnosed by coronary angiography,their tongue appearances were recorded by the digital camera of uniform type,29 cases with ACEs during one-year follow-up were assigned in ACEs group.The non-ACEs were matched in proportion of 2:1 according to the gender,age(±2.5 years), diabetes mellitus history and previous acute coronary syndrome hospitalization history in the non-ACEs group, and 54 cases were eligibly included.The differences of tongue appearance between the ACEs and non-ACEs group were compared.Results:Fifteen cases manifested with bluish tongue(including bluish-grounding or bluish purple tongue),among which 11 cases(37.9%) in the ACEs group and four cases(7.4%) in the non-ACEs group, and there was significant difference(P<0.002).Twenty six cases showed yellow tongue coating in the non-ACEs group,which was significantly higher than that in the ACEs group(48.1 vs.10.3%,P=0.001).The tongue of sticky greasy coating was more frequently occurred in the non-ACEs group than that in the ACEs group(66.7%vs. 41.4%,P=0.026).The proportion of purplish-red sublingual vessel was higher in the ACEs group than that in the non-ACEs group(41.4%vs.20.4%,P=0.041).Odd ratio(OR) analysis showed that the patients with bluish tongue, purplish-red sublingual vessel,dry-greasy or dirty greasy coating were more likely to experience ACEs during one-year follow-up(OR:11.67,95%CI:3.34-40.81,P<0.001;OR:2.76,95%CI:1.02-7.44,P<0.05;OR:3.12,95%, CI:0.89-10.92,P=0.066).Conclusions:The bluish tongue(including bluish-grounding or bluish purple tongue) and purplish-red sublingual vessel were potential tongue manifestations of blood-stasis and toxin.The tongue coating changing from sticky
