Analysis of the evidence characteristics of recommendations in integrated traditional Chinese and Western medicine_Chinese Journal of Evidence-Based Medicine

Authors：

LIANG Liang ¹ , CHEN Yixuan ¹ , ZHANG Jie ¹ , XU Xinyu ¹ , LIU Mengjia ¹ , LIU Sihan ² , LIU Chang ³ ,  LIU Yali ³

1. Department of pediatrics, Capital Medical University Affiliated Beijing Children's Hospital, Beijing 100045, P. R. China;
2. School of Chinese Materia Medica, Shenyang Pharmaceutical University, Benxi 117004, P. R. China;
3. Center for Clinical Epidemiology and Evidence-Based Medicine, Capital Medical University Affiliated Beijing Children's Hospital, Beijing 100045, P. R. China;

Corresponding?author：

LIU Yali, Email: lyl_201006@126.com

Keywords：

Clinical practice guidelines; Integration of traditional Chinese and Western medicine; Quality of evidence; Recommendations; Human experience

DOI：

10.7507/1672-2531.202412124

Video：

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Objective To analyze the quality of evidence and the use of evidence grades in evidence-based integrated Chinese and Western medicine (ICWM) guidelines, especially the recommendations that include human experience evidence, and then provide references for future guideline development and the grading standards of human experience. Methods The literature search was conducted on the PubMed、SinoMed、CNKI、VIP、WanFang Data databases from January 1, 2021 to January 31, 2024, to conduct descriptive statistics on the integrated Chinese and Western medicine guidelines included. In addition, the recommendations that include human experience evidence were further analyzed. Results A total of 46 integrated Chinese and Western medicine guideline documents were included, of which 35 were evidence-based. A total of 1 189 recommendations were formed (including 492 TCM recommendations, 265 Western medicine recommendations, 338 integrated Chinese and Western medicine recommendations and 94 other recommendations). Among the 1 189 recommendations, 21.36% were not found in modern research evidence, of which 88.58% did not provide clear supporting evidence, 5.12% and 7.48% were based on ancient books and modern masters' experience, respectively. In addition, there were 29 recommendations with evidence from famous masters in 5 guidelines (1 evidence-based guideline), 16 of which only included famous masters' experience as independent evidence support, and 15 guidelines (10 evidence-based guidelines) included 84 recommendations with evidence from ancient books, with only 10 of them including ancient books as independent evidence support. Conclusion The phenomenon of lack of clinical research evidence in recommendations in integrated Chinese and Western medicine guidelines is common. A few integrated Chinese and Western medicine guidelines include ancient books and masters' experience as the evidence for recommendations. However, the integration of human experience evidence into the evidence-based system is not uniform, and the results of the quality evaluation of the recommendations are also quite different.

Citation： LIANG Liang, CHEN Yixuan, ZHANG Jie, XU Xinyu, LIU Mengjia, LIU Sihan, LIU Chang, LIU Yali. Analysis of the evidence characteristics of recommendations in integrated traditional Chinese and Western medicine. Chinese Journal of Evidence-Based Medicine, 2026, 26(4): 461-466. doi: 10.7507/1672-2531.202412124 Copy

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2.	吳相君, 趙珊珊. 現代中醫藥發展面臨的挑戰、機遇與對策思考. 疑難病雜志, 2017, 16(10): 973-976.
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6.	夏鴻杰, 趙崢嶸, 郭靜, 等. 中醫相關證據質量及推薦意見分級體系的系統評價. 中國循證醫學雜志, 2022, 22(02): 187-195.
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13.	劉建平. 傳統醫學證據體的構成及證據分級的建議. 中國中西醫結合雜志, 2008, 27(12): 1061-1065.
14.	汪受傳, 陳爭光, 徐珊, 等. 建立循證中醫臨床實踐指南證據分級體系的構想. 世界科學技術(中醫藥現代化), 2013, 15(7): 1488-1492.
15.	李慧, 陳耀龍, 謝秀麗, 等. 中醫(中西醫結合)臨床實踐指南制修訂方法—推薦意見與共識. 中華中醫藥雜志, 2016, 31(7): 2657-2661.
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17.	Dalkey NC, Helmer O. An experimental application of the Delphi method to the use of experts. Manage Sci, 1963, 9(3): 458-467.
18.	陳旭, 申琳, 柏冬. 醫療機構制劑在人用經驗中藥創新藥研發的關鍵問題與思考. 中國新藥雜志, 2020, 29(16): 1830-1835.
19.	黎欣盈, 楊忠奇, 唐洪梅, 等. 中藥人用經驗數據應用的倫理學考量. 中國臨床藥理學雜志, 2021, 37(14): 1883-1886.
20.	孫昱, 孫國祥, 李煥德. 人用經驗在中藥新藥申報中的應用研究與中藥新藥申報的拓展思考. 中南藥學, 2020, 18(12): 1941-1944.
21.	劉福棟, 龐博, 花寶金. 基于中醫經典與人用經驗構建胰腺癌防治方藥發掘體系思路探析. 北京中醫藥, 2021, 40(9): 929-933.
22.	楊忠奇, 湯慧敏, 唐雅琴, 等. 指導中藥新藥研發的理論思考. 中國中藥雜志, 2021, 46(7): 1686-1690.
23.	李翔, 路雪婧, 葉河江, 等. 廖品正治療糖尿病視網膜病變經驗. 遼寧中醫雜志, 2011, 38(2): 228-229.
24.	宋軍, 陳可冀. 盡早制定傳統醫學臨床治療指南. 中國中西醫結合雜志, 2006, 26(7): 581-584.
25.	梁偉雄. 中醫和中西醫結合臨床治療指南存在的問題與對策. 中西醫結合學報, 2008, 6(1): 1-4.
26.	王鳳蘭. 對中醫古籍知識的評價思考. 光明中醫, 2019, 34(12): 1775-1777.
27.	中華中醫藥學會. 肩袖損傷中西醫結合診療指南(2023年版). 中醫正骨, 2024, 36(1): 1-9.
28.	王雪峰, 董丹, 梁茂新, 等. 基于數據挖掘技術建立的兒童肺炎中醫辨證規范量表的信度和效度研究. 中國循證兒科雜志, 2010, 5(1): 15-24.
29.	劉孟宇, 楊偉, 趙學堯, 等. 中醫臨床診療指南應用評價方法研究. 中華中醫藥雜志, 2016, 31(2): 552-554.
30.	陳耀龍, 劉蕭, 王燕平, 等. 西醫指南與中醫藥指南: 在相互學習中共同提高. 協和醫學雜志, 2020, 11(5): 615-620.
31.	趙國楨, 李慧珍, 梁寧, 等. 中醫臨床實踐指南聯合真實世界研究模式的方法學思考. 中國實驗方劑學雜志, 2024, 30(22): 87-93.

1. Graham R, Mancher M, Miller WD, et al. Institute of medicine: clinical practice guidelines we can trust. Washington DC: National Academies Press (US), 2011.
2. 吳相君, 趙珊珊. 現代中醫藥發展面臨的挑戰、機遇與對策思考. 疑難病雜志, 2017, 16(10): 973-976.
3. 趙玉男. 中西醫結合的未來: 從聯合走向融合. 上海: 科技出版社, 2016.
4. 饒映月, 靳英輝, 謝穎蘭, 等. 中西醫真正融合了嗎. —一個基于中西醫結合臨床實踐指南的系統評價. 中國循證醫學雜志, 2023, 23(10): 1156-1164.
5. 王聰慧, 馮哲, 尹智煒, 等. 新形勢下中西醫結合醫學的發展思考. 中國工程科學, 2021, 23(2): 169-174.
6. 夏鴻杰, 趙崢嶸, 郭靜, 等. 中醫相關證據質量及推薦意見分級體系的系統評價. 中國循證醫學雜志, 2022, 22(02): 187-195.
7. World Health Organization. WHO handbook for guideline development 2nd edition. Geneva: WHO Press, 2014.
8. 李慧, 陳耀龍, 韋當, 等. 中醫(中西醫結合)臨床實踐指南制修訂方法—臨床問題的構建. 中華中醫藥雜志, 2016, 31(6): 2202-2205.
9. 陳士奎. 關于“中西醫結合”及“中西醫結合醫學”定義的討論. 中西醫結合學報, 2003, 1(4): 241-243.
10. 李慧, 陳耀龍, 王琪, 等. 中醫(中西醫結合)臨床實踐指南制修訂方法—證據獲取與系統評價. 中華中醫藥雜志, 2016, 31(6): 2206-2209.
11. Shea BJ, Hamel C, Wells GA, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol, 2009, 62(10): 1013-1020.
12. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
13. 劉建平. 傳統醫學證據體的構成及證據分級的建議. 中國中西醫結合雜志, 2008, 27(12): 1061-1065.
14. 汪受傳, 陳爭光, 徐珊, 等. 建立循證中醫臨床實踐指南證據分級體系的構想. 世界科學技術(中醫藥現代化), 2013, 15(7): 1488-1492.
15. 李慧, 陳耀龍, 謝秀麗, 等. 中醫(中西醫結合)臨床實踐指南制修訂方法—推薦意見與共識. 中華中醫藥雜志, 2016, 31(7): 2657-2661.
16. Jaeschke R, Guyatt GH, Dellinger P, et al. Use of GRADE grid to research decisions on clinical practice guidelines when consensus is elusive. BMJ, 2008, 337: a744.
17. Dalkey NC, Helmer O. An experimental application of the Delphi method to the use of experts. Manage Sci, 1963, 9(3): 458-467.
18. 陳旭, 申琳, 柏冬. 醫療機構制劑在人用經驗中藥創新藥研發的關鍵問題與思考. 中國新藥雜志, 2020, 29(16): 1830-1835.
19. 黎欣盈, 楊忠奇, 唐洪梅, 等. 中藥人用經驗數據應用的倫理學考量. 中國臨床藥理學雜志, 2021, 37(14): 1883-1886.
20. 孫昱, 孫國祥, 李煥德. 人用經驗在中藥新藥申報中的應用研究與中藥新藥申報的拓展思考. 中南藥學, 2020, 18(12): 1941-1944.
21. 劉福棟, 龐博, 花寶金. 基于中醫經典與人用經驗構建胰腺癌防治方藥發掘體系思路探析. 北京中醫藥, 2021, 40(9): 929-933.
22. 楊忠奇, 湯慧敏, 唐雅琴, 等. 指導中藥新藥研發的理論思考. 中國中藥雜志, 2021, 46(7): 1686-1690.
23. 李翔, 路雪婧, 葉河江, 等. 廖品正治療糖尿病視網膜病變經驗. 遼寧中醫雜志, 2011, 38(2): 228-229.
24. 宋軍, 陳可冀. 盡早制定傳統醫學臨床治療指南. 中國中西醫結合雜志, 2006, 26(7): 581-584.
25. 梁偉雄. 中醫和中西醫結合臨床治療指南存在的問題與對策. 中西醫結合學報, 2008, 6(1): 1-4.
26. 王鳳蘭. 對中醫古籍知識的評價思考. 光明中醫, 2019, 34(12): 1775-1777.
27. 中華中醫藥學會. 肩袖損傷中西醫結合診療指南(2023年版). 中醫正骨, 2024, 36(1): 1-9.
28. 王雪峰, 董丹, 梁茂新, 等. 基于數據挖掘技術建立的兒童肺炎中醫辨證規范量表的信度和效度研究. 中國循證兒科雜志, 2010, 5(1): 15-24.
29. 劉孟宇, 楊偉, 趙學堯, 等. 中醫臨床診療指南應用評價方法研究. 中華中醫藥雜志, 2016, 31(2): 552-554.
30. 陳耀龍, 劉蕭, 王燕平, 等. 西醫指南與中醫藥指南: 在相互學習中共同提高. 協和醫學雜志, 2020, 11(5): 615-620.
31. 趙國楨, 李慧珍, 梁寧, 等. 中醫臨床實踐指南聯合真實世界研究模式的方法學思考. 中國實驗方劑學雜志, 2024, 30(22): 87-93.

Chinese Journal of Evidence-Based Medicine

Analysis of the evidence characteristics of recommendations in integrated traditional Chinese and Western medicine

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