Evidence-based Clinical Chinese Medicine

The following sections are included:

• Disclaimer
• Foreword
• Purpose of the Monograph
• Authors and Contributors
• Members of Advisory Committee and Panel
• Distinguished Professor Charlie Changli Xue, PhD
• Professor Chuanjian Lu, MD
• Acknowledgements
• Contents
• List of Figures
• List of Tables

This chapter introduces rhinosinusitis (RS) from the perspective of modern medicine. It outlines the classification of the types and sub-types of RS and presents the diagnostic features of each type based on major clinical guidelines. The epidemiology of the disease is summarised along with the burden of disease, co-morbidities and risk factors, and pathological process that underly the disease. Treatments are summarised for each type using medical therapies and/or surgery. There is a summary of management in complementary medicine.

This chapter introduces the contemporary Chinese medicine approach to the management of rhinosinusitis. It includes an outline of the aetiology, pathogenesis and diagnosis of acute and chronic rhinosinusitis from the Chinese medicine perspective and the main syndromes based on clinical guidelines and major textbooks. For each syndrome a guiding herbal formula is provided with additional formulae from major textbooks presented in a table. Treatments using manufactured herbal medicine, nasal herbal preparations, acupuncture and related therapies, and Chinese massage therapies are included.

References to nasal disorders are found throughout the classical literature of Chinese medicine. In addition, some of the ancient terms used for these conditions remain in use in modern Chinese. However, it is likely that the scope of meaning of these terms has changed over time. This chapter reports the results of searches of the classical Chinese medicine texts included in Zhong Hua Yi Dian 中华医典. The search terms were names of disorders considered relevant to rhinosinusitis (RS) including: bi yuan 鼻渊, nao lou 脑漏, nao shen 脑渗, nao beng 脑崩, nao xie 脑泻 and kong nao sha 控脑砂 plus the symptoms zhuo ti 浊涕 (turbid nasal discharge) and bi chu chou qi 鼻出臭气 (foul nasal odour). These identified 678 citations that included treatments with herbal medicines, acupuncture, moxibustion and massage for conditions that were broadly consistent with chronic RS.

This section describes the methods used to identify and evaluate clinical studies of Chinese medicine (CM) interventions for rhinosinusitis (RS). Studies were identified through a comprehensive search strategy and were screened against predefined eligibility criteria. The methodological quality of included studies was assessed using the risk of bias tool. Results for the specified outcomes were evaluated using statistical methods to provide estimates of the effects of each type of Chinese medicine therapy.

The searches identified 92 randomised controlled trials (RCTs), 17 controlled clinical trials and three non-controlled studies. These examined the effects of orally administered and/or nasally administered Chinese herbal medicines (CHMs) for the management of acute and chronic rhinosinusitis (RS) and for recovery after surgery for rhinosinusitis. Results are presented and analysed for a range of outcome measures, data on the safety of the Chinese herbal interventions are presented, and there are assessments of the certainty of the evidence for major comparisons and outcome measures.

This section reviews the available experimental evidence for the 10 Chinese herbs most frequently used in the orally administered formulae for chronic rhinosinusitis (RS) included in section 2 of Chapter 5. Their anti-inflammatory, anti-allergic, antimicrobial and antioxidant activities of relevance to RS are summarised and discussed.

The searches identified five randomised controlled trials (RCT), two non-randomised controlled clinical studies (CCT) and three non-controlled studies of acupuncture therapies for rhinosinusitis (RS). The main interventions were acupuncture or electro-acupuncture on traditional points, ear acupressure, and acupuncture plus moxibustion. Control groups included sham acupuncture, conventional pharmacotherapy and usual post-surgical care. The main outcomes that provided data suitable for meta-analysis were for pain, nasal symptoms and quality of life.

In addition to Chinese herbal medicine (CHM) and acupuncture, other therapies are used in Chinese medicine (CM). These include forms of remedial massage, exercise therapies and special dietary interventions. This chapter aimed to review and assess the evidence for these other therapies in rhinosinusitis (RS). However, only two studies of an mo 按摩 remedial massage could be included.

The searches identified five randomised controlled trials (RCTs) and two non-controlled studies. One RCT was for chronic rhinosinusitis (RS) without surgery and four RCTs were for post-surgical recovery. There were no studies of acute RS. Oral Chinese herbal medicine (CHM) was used as one component of the combination therapy in two studies, nasal CHM in three studies, acupuncture in two studies, ear acupressure in two studies and an mo remedial massage in two studies.

This chapter summarises and discusses the main findings of the previous chapters. The tables provide cross-references between chapters for syndrome differentiation, Chinese herbal formulae, acupuncture and related therapies, acupuncture points and other Chinese medicine (CM) therapies. The main results of the clinical trials, the associated meta-analyses and the grading of the evidence are discussed, as well as the limitations of the available evidence. The implications of the findings of the chapters for the clinical management of rhinosinusitis (RS) using CM are discussed followed by suggestions for future clinical and experimental research.

The following sections are included:

• Glossary
• Index