Narrow Results

The major purpose of this paper was to develop a model for the use of complementary and alternative health care options. Chinese-American families were selected due to their large proportion among all ethnic populations in the United States. Andersen's (1973 and 1995) perception of predisposing and enabling was adopted to test study variables singly and interactively on their health care use. The dependent variable was defined as health behavior preference towards Chinese treatment (also known as complementary and alternative medicine treatment) or Western treatment, and a combination of Chinese and Western treatment (also known as integrative medicine treatment). Data were randomly collected from 240 adult Chinese-American respondents out of 1080 members of the Chinese American Association in the greater Cleveland area. Findings both in the full and partial research models reveal that the factors contributing the most to their medical preferences were their acculturation level and health beliefs. Inter-generational differences in health care use were also discussed.

Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

As of 22 February 2020, more than 77662 cases of confirmed COVID-19 have been documented globally with over 2360 deaths. Common presentations of confirmed cases include fever, fatigue, dry cough, upper airway congestion, sputum production, shortness of breath, myalgia/arthralgia with lymphopenia, prolonged prothrombin time, elevated C-reactive protein, and elevated lactate dehydrogenase. The reported severe/critical case ratio is approximately 7–10% and median time to intensive care admission is 9.5–10.5 days with mortality of around 1–2% varied geographically. Similar to outbreaks of other newly identified virus, there is no proven regimen from conventional medicine and most reports managed the patients with lopinavir/ritonavir, ribavirin, beta-interferon, glucocorticoid and supportive treatment with remdesivir undergoing clinical trial. In China, Chinese medicine is proposed as a treatment option by national and provincial guidelines with substantial utilization. We reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine. We have also reviewed the clinical evidence generated from SARS and H1N1 management with hypothesized mechanisms and latest in silico findings to identify candidate Chinese medicines for the consideration of possible trials and management. Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19.

Chinese medicine (CM) was extensively used to treat COVID-19 in China. We aimed to evaluate the real-world effectiveness of add-on semi-individualized CM during the outbreak. A retrospective cohort of 1788 adult confirmed COVID-19 patients were recruited from 2235 consecutive linked records retrieved from five hospitals in Wuhan during 15 January to 13 March 2020. The mortality of add-on semi-individualized CM users and non-users was compared by inverse probability weighted hazard ratio (HR) and by propensity score matching. Change of biomarkers was compared between groups, and the frequency of CMs used was analyzed. Subgroup analysis was performed to stratify disease severity and dose of CM exposure. The crude mortality was 3.8% in the semi-individualized CM user group and 17.0% among the non-users. Add-on CM was associated with a mortality reduction of 58% (HR = 0.42, 95% CI: 0.23 to 0.77, $p$ = 0.005) among all COVID-19 cases and 66% (HR = 0.34, 95% CI: 0.15 to 0.76, $p$ = 0.009) among severe/critical COVID-19 cases demonstrating dose-dependent response, after inversely weighted with propensity score. The result was robust in various stratified, weighted, matched, adjusted and sensitivity analyses. Severe/critical patients that received add-on CM had a trend of stabilized D-dimer level after 3–7 days of admission when compared to baseline. Immunomodulating and anti-asthmatic CMs were most used. Add-on semi-individualized CM was associated with significantly reduced mortality, especially among severe/critical cases. Chinese medicine could be considered as an add-on regimen for trial use.

Integrative medicine has become a vital component of patient care. It provides patient-centered care that is focused on prevention and overall well-being. As there has been a growing number of patients favoring a blend of conventional, complementary and alternative approaches, integrative medicine has exceeded beyond the evaluation of complementary therapies. However, it is noteworthy that there has been a dilemma of providing substantial evidence supporting the efficacy of some complementary and alternative therapies. This study’s goals were to analyze publication trends, most productive journals, most productive funding agencies, most productive authors, most relevant keywords, and countries in the field of integrative medicine research. Additionally, science mapping included country collaboration analysis and thematic evolution analysis. The findings from this study showed a constant rise in annual growth of publications from 2000 to 2019; the United States was dominant in various analysis categories. In conclusion, a comprehensive review of the evolution of research of integrative medicine will help healthcare providers understand an overview of the present status while encouraging more evidence-based research for the betterment of integrative patient care.

Diabetes and chronic kidney disease (CKD) are pandemic, requiring more therapeutic options. This retrospective cohort evaluated the effectiveness, safety profile and prescription pattern of a pilot integrative medicine service program in Hong Kong. Data from 38 patients with diabetes and CKD enrolled to receive 48-week individualized add-on Chinese medicine (CM) were retrieved from the electronically linked hospital database. A 1:1 cohort was generated with patients from the same source and matched by propensity score. The primary outcomes are the change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) analyzed by analysis of covariance and mixed regression model adjusted for baseline eGFR, age, gender, duration of diabetes history, history of hypertension, diabetic retinopathy, and the use of insulin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The rate of adverse events and the change of key biochemical parameters were analyzed. After a median of 51 weeks, patients who received add-on CM had stabilized eGFR (difference in treatment period: 0.74 ml/min/1.73m², 95% CI: –1.01 to 2.50) and UACR (proportional difference in treatment period: 0.95, 95% CI: 0.67 to 1.34). Add-on CM was associated with significantly preserved eGFR (Inter-group difference: 3.19 ml/min/1.73m², 95%CI: 0.32 to 6.06, $p=$ 0.030) compared to standard care. The intergroup ratio of UACR was comparable (0.70, 95% CI: 0.45 to 1.08, $p=$ 0.104). The result is robust in sensitivity analysis with different statistical methods, and there was no interaction with CKD stage and UACR. The rate of serious adverse events (8.1% vs. 18.9%, $p=$ 0.174), moderate to severe hyperkalemia (8.1% vs. 2.7%, $p=$ 0.304) and hypoglycemia (13.5% vs. 5.4%, $p=$ 0.223), and the levels of key biochemical parameters were comparable between groups. The top seven most used CMs contained two classical formulations, namely Liu-wei-di-huang-wan and Si-jun-zi-tang. Individualized add-on CM was associated with significant kidney function preservation and was well tolerated. Further randomized controlled trials using CM prescriptions based on Liu-wei-di-huang-wan and Si-jun-zi-tang are warranted.

Can Chinese Medicine and Biomedicine Converge?

Integrative Medicine: East Meets West.

Ginseng: Nature’s “Cure-All”.

Objective: This study aims to systematically evaluate the efficacy and safety of catgut implantation at acupoints (CIA) treating asthma, extracting data from the published clinical trials.

Methods: The Cochrane Library, PubMed, Chinese Biomedical Database (CBM), CNKI, WANFANG and VIP databases were searched up to February 2017. Randomized controlled trials (RCTs) involving CIA or CIA plus conventional medicine treatment (CMT) were selected with CMT as control. We assessed the methodological quality of RCTs using the Cochrane Handbook for Systematic Review of Interventions. The outcome data of trials were analyzed using RevMan5.3.

Results: A total of 12 studies ($n=861$) were included. Most of the included studies were assessed to have high risk of bias with low quality of methodology. CIA application significantly improved the overall therapeutic efficacy ($p<0.001$) and pulmonary function (forced expiratory volume in 1s (FEV1) and FEV1%, $p<0.05$ and $p<0.001$) and reduced the overall scores of TCM symptoms ($p<0.05$). Further, it significantly relieved several TCM symptoms including shortness of breath, chest distress and cough ($p<0.05$). However, CIA only exerted a protective tendency for expectoration and wheezing without significant difference and had no effects on recurrence rate (all $p>0.05$).

Conclusions: CIA treatment could improve the overall efficacy and pulmonary function and relief several symptoms. However, the evidence remains weak. Rigorous and larger trials will be the basis of the effectiveness and long-term effects of CIA therapies.

This book aims to provide views of complementary and alternative medicines (CAMs) from multiple perspectives to enable the reader to come to their own informed conclusions. Practitioners of conventional medicine range from those who highlight the dangers of treatments that lack conventional evidence to those who wish to integrate CAMs into conventional practice. The authorship also includes educators and researchers into CAMs, those involved in public policy, regulators and consumers. The term CAMs encompasses a wide range of treatments from the biological and the physical to the mental and energy therapies. Mechanisms of action may not be known and should not be subject to pseudoscientific explanations. There are methodological challenges in researching CAMs. Also, CAMs are regulated differently to conventional medicines and yet the public must understand that CAMs can have side-effects and should know upon what evidence claims of efficacy are based and how often it is known to be effective. Medical practitioners should be familiar with CAMs so they can respond to their patients' questions and know if there are any problematic interactions between CAMs and conventional therapies. How to integrate CAMs and conventional medicine is a challenge being explored by some medical centres.

Government regulation and registration of health practitioners aims to ensure a minimal level of education and training, appropriate standards of professional behaviour and effective and efficient complaint-handling mechanisms. Although medical practitioners, pharmacists, nurses and some other categories of health practitioners are registered by government, most have received little or no training in complementary and alternative medicine (CAM). Some doctors who practise “integrative medicine” are an exception. CAM practitioners such as naturopaths, herbalists and homeopaths have not yet achieved national registration, in part because of division in their ranks, but also because of their extremely varied training.

Unlike conventional medicines, the Australian Therapeutic Goods Administration does not evaluate complementary medicines for efficacy. They do ensure that AUST L-labelled products contain “relatively safe” ingredients and are manufactured according to Good Manufacturing Practice. However, claims made for complementary medicines are often far in advance of the scientific evidence available, whereas information about possible adverse effects, including interaction with conventional medicines, is often lacking. A similar situation exists for diagnostic and therapeutic devices used by CAM practitioners. The majority are regarded as “low risk” by the regulator and are not assessed to see if they work. A complaint system exists, but it is underresourced, overloaded and lacks effective sanctions. As a consequence, numerous claims that have been proven to breach the Therapeutic Goods Advertising Code continue to be made about CAM medicines and devices. The government has acknowledged these problems and several working groups are currently discussing possible regulatory reform. Meanwhile, caveat emptor applies (let the buyer beware).

Considering the prevalence of use of complementary and alternative medicine (CAM) in the community and the growing evidence base for effectiveness, medical students need to develop informed and balanced attitudes, skills and knowledge about this field that are going to prepare them adequately for future medical practice. However, the teaching of CAM content in conventional medical curricula has tended to be tokenistic and piecemeal at best or, at worst, totally absent. Where it does appear, CAM content is often marginalised rather than being seen as an integral part of the core knowledge and skills required of a well-rounded and informed doctor. This is problematic for a number of reasons including that the new graduate is less aware of which therapies are potentially useful or harmful and is therefore less able to help patients make informed and safe decisions regarding this aspect of their health-care. It can also potentially impede the therapeutic relationship and communication between doctor and patient especially if a patient has a disposition towards using CAM. This chapter will review some of the background issues regarding the teaching of CAM in medical education and make some suggestions about what should be minimal content in modern medical curricula. At a minimum, this content should include teaching on the common CAM modalities, ethics, economics of CAM, evidence, safety and risks including interactions, clinical applications, clinical skills in history-taking and communication around CAM, and how to find and assess further information. Rather than being taught as a separate discipline, CAM is best integrated into the wider curriculum and grounded in a philosophy of medical education based upon integrative medicine principles.

Popular and scientific interest in complementary and alternative medicine (CAM) appears to increase with every passing year. Despite (or perhaps because of) this, CAM is a highly contested, even controversial, entity, and prompts strong evaluative responses, both positive and negative. In this chapter I examine some of the judgements and debates associated with CAM, CAM users and CAM providers, drawing on published sources including medical and scientific opinion, and research examining media accounts, the perspectives of patients (including users and non-users of CAM), as well as those of medical and CAM practitioners. I begin with a brief examination of the debate regarding the definition of CAM, arguing that this is integral to the different and evolving perceptions and evaluations of CAM. This is followed by an examination of CAM via a very simplistic categorisation of CAM is good and CAM is bad. Some consideration is also given to the changing position of CAM with regard to the medical profession, particularly as the latter moves to define and promote ‘integrative medicine’ as incorporating the best of both healthcare systems for the greater good of the populace.

As of 22 February 2020, more than 77662 cases of confirmed COVID-19 have been documented globally with over 2360 deaths. Common presentations of confirmed cases include fever, fatigue, dry cough, upper airway congestion, sputum production, shortness of breath, myalgia/arthralgia with lymphopenia, prolonged prothrombin time, elevated C-reactive protein, and elevated lactate dehydrogenase. The reported severe/critical case ratio is approximately 7–10% and median time to intensive care admission is 9.5–10.5 days with mortality of around 1–2% varied geographically. Similar to outbreaks of other newly identified virus, there is no proven regimen from conventional medicine and most reports managed the patients with lopinavir/ritonavir, ribavirin, beta-interferon, glucocorticoid and supportive treatment with remdesivir undergoing clinical trial. In China, Chinese medicine is proposed as a treatment option by national and provincial guidelines with substantial utilization. We reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine. We have also reviewed the clinical evidence generated from SARS and H1N1 management with hypothesized mechanisms and latest in silico findings to identify candidate Chinese medicines for the consideration of possible trials and management. Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19.

About 5000 years, the major traditional medicines were created: Chinese medicine, Ayurveda and Unani, in China, India and the Arab region, respectively.

In order to realize the medical dreams of personalized and preventive medicine, and also to solve problems such as economical and social educational matters, modern Western medicine is integrated with traditional medicine (TM) and complementary and alternative medicine (CAM) — collectively termed as integrative medicine. In this chapter, the key elements such as TM, CAM and their models and problems will be discussed.