Parallel Session 8 - Evidence-based Research at Chinese Medicine Clinics

Knee osteoarthritis (KOA) is a common degenerative joint condition that causes disability and pain in the elderly population. The prevalence of KOA among persons aged 63 or above is approximately 30%. Previous studies have reported the positive effects of Tui-na treatment and the Chinese herbal formula Du-Huo-Ji-Sheng Decoction (DHJSD) for KOA treatment. The current study aims to evaluate the add-on therapeutic effect of oral administration of DHJSD on KOA in addition to Tui-na. 


This was a prospective, randomized, controlled clinical trial. Seventy study subjects with KOA were randomly assigned to the treatment and control groups in a 1:1 ratio. Both two groups received eight sessions of Tui-na manipulation for 4 weeks. The DHJSD was only administered to the study subjects in the treatment group. The primary outcome measure was rated using the WOMAC at the end of treatment (4 weeks). Secondary outcomes were assessed using EQ-5D-5L, a health-related quality of life (QOL) with 5-level EQ-5D version at week 2, at the end of treatment (week 4) and follow-up (week 8). 


For the results, no statistically significant difference was found between two groups on WOMAC scores at the end of treatment. The mean WOMAC Pain subscale score was significantly lower in the treatment group than control group at week 8 follow up. The mean WOMAC Stiffness subscale score was significantly lower in the treatment group than in the control group at week 2 and week 8 follow up. The mean EQ-5D index value was significantly improved in the treatment group than in the control group at week 2. The analysis of WOMAC scores and EQ-5D-5L in both groups showed statistically significant improvement with time. No significant adverse effect was found during the trial. 


In conclusion, DHJSD may have an add-on effect in addition to Tui-na manipulation relieving pain and improving stiffness as well as QOL in patients with KOA. The combined treatment was generally safe and well tolerated.

Background 
Postprandial distress syndrome is traditionally regarded as the "Wei-Pi" syndrome in Chinese medicine (CM). Banxia Xiexin decoction (BXD) is one of the empirical treatment. The current study aims to evaluate the efficacy of a modified BXD in the management of "Wei-Pi" syndrome. 


Methods 
88 patients with "Wei-Pi" syndrome were randomized into the BXD or waitlist control groups in a ratio of 1:1. The patients in the BXD group received the semi-individualized BXD on the basis of the syndrome differentiation in CM for three weeks and were under follow-up for further three weeks. Patients in waitlist control group received the same BXD intervention and follow-up after a three-week waiting period. The primary outcome was the variation in the scores pertaining to the global scale of the Quality of Life Questionnaire for Functional Digestive Disorders (FDDQL) after three weeks. The secondary outcomes included the variations in the scores pertaining to the Hospital Anxiety and Depression Scale (HADS) and the EuroQoL 5-dimension 5-level questionnaire (EQ-5D-5L), and the results of the liver and kidney function tests. 


Results 
Compared to the waitlist group, the total score, activity score, diet score, discomfort score, and coping with disease score in the FDDQL of BXD group at week 3 was significantly improved. Also the depression score in HADS was significantly improved in the BXD group, but not the anxiety score. BXD significantly improved the visual analogue scale (VAS) of EQ-5D-5L. 
The BXD and delayed BXD from the waitlist group had significant improved total score of FDDQL at week 3 and 6 compared to week 0. BXD had significantly improved the score of HADS and EQ-5D-5L at week 3 and 6 compared to week 0, but not the delayed BXD group.


Conclusion 
BXD significantly improves the quality of life of the patients of "Wei-Pi" syndrome.

Objective: To further understand and compare the effectiveness of pattern differentiation treatment and fixed prescription treatment in perimenopausal syndrome.


Methods: The study was conducted in Hong Kong Federation of Trade Unions Workers' Medical Clinics, Hong Kong Baptist University Chinese Medicine Clinic cum Training and Research Centre (Hong Kong, China). One hundred Chinese women, aged 45-55 years had been recruited. The participants were randomized into 2 groups. The intervention group was administered medication, based on pattern differentiation, by qualified traditional Chinese medicine (TCM) practitioners. After each evaluation, TCM practitioners evaluated and revised the prescription, based on the participants' patterns. The control group was given the standard formula, i.e., the Erxian decoction. The treatment period and the follow-up period were 8 weeks each. The primary assessment outcome measure was the Kupperman Index (KI), and the secondary outcome measure was the Menopause-specific Quality of Life Questionnaire score (MENQOL). 


Result: This study found both of the intervention group and the control group can effectively treat the clinical symptoms of perimenopausal syndrome, and the intervention group had a higher effective rate in treating perimenopausal syndrome than the control group. According to the Kupperman Index score, there was a significant statistical difference between two groups in the treatment at the 6th and the 8th week (P=0.008, P=0.00), and the MENQOL score also showed statistical significance from the 4th to the 8th week (P=0.01, P=0.007, P=0.001). In the KI subdivision items, there were significant statistical differences in nervousness (P=0.007), sleep problem (P=0.003), depressive mood (P=0.03), physical and mental exhaustion (P=0.00), headache (P=0.003), joint pain and muscular discomfort (P=0.003) after 8 weeks of treatment. The psychosocial (P=0.001), physical (P=0.00) and sexual (P=0.003) domains of MENQOL showed significant statistical differences after 4 weeks of treatment between two group. In most of the measurement index, both intervention and control group have significant statistical difference after 8 weeks' treatment (P=0.00), and treatment efficiency can continue to the follow-up period.


Conclusion: Pattern-differentiated treatment is the basic principle of TCM to understand and treat diseases. The study showed the pattern-differentiated treatment was more effective than the fixed prescription.