Review Article

Methodological Considerations in N-of-1 Trials of Traditional Chinese Medicine

Table 1

Characteristics of some representative N-of-1 trials of TCM.

AuthorReasons for conducting N-of-1 trialsnRun-in periodTreatmentControlPairsObservation periodRandomization and blindingPrimary outcome measuresStatistical methodsConclusion

Yuhong et al. 2013 [10]Providing evidence for rational use of LDD.50NoLDDPlacebo34 weeksYesLikert scale, individual completion rate, response rate, and posttrial decision-makingIndividuals: the self-designed criteria; population: meta-analysisNonresponders ceased the LDD. The positive significance is to avoid the unreasonable drugs use.
Huang et al. 2018 [7]Exploring the establishment of clinical efficacy evaluation methods in line with the characteristics of individualized diagnosis and treatment of TCM.17YesIndividualized herbal decoctionStandard decoction for stable bronchiectasis34 weeksYes7-point Likert scaleIndividuals: paired t test; population: mixed effects modeOptimizing the combined analysis of individual and group data, the improvement of statistical models may make contribution in establishing a method of evaluating clinical efficacy in line with the characteristics of TCM.
Wang et al. 2010 [4]To study the dose-effect relationship of Bezoar antihypertensive capsules and explore the individualized diagnosis, treatment, and evaluation of TCM.11NoHigh-dose Bezoar antihypertensive capsulesLow-dose Bezoar antihypertensive capsules34 weeksYesBlood pressure, TCM symptom scorePaired t test, meta-analysisBezoar antihypertensive capsule can be used for mild to moderate hypertension particularly for lowering systolic blood pressure.
Chen et al. 2020 [11]N-of-1 trials can provide more flexible clinical trial design for TCM and require a smaller sample size.10NoModified SJZD with mesalazine placeboMesalazine with SJZD placebo38 weeksYesVisual analogue scale (VAS) of symptom scoreMixed effects modeThis article is a protocol and there is no conclusion.
Liu et al. 2018 [15]To evaluate the efficacy of TCM syndromes by N-of-1 trials.24YesLiuwei Dihuang capsulePlacebo22 weeksYes5-point Likert scalet test, ANOVA for repeated measurement, and meta-analysisN-of-1 trials can be used to evaluate the therapeutic effects of TCM syndromes.
Zhang et al. 2012 [21]N-of-1 trials enable scientific evaluation of the individualized diagnosis and treatment of TCM.4NoIndividualized herbal decoction and basic treatmentBasic treatment and Chinese medicinal decoction placebo34 weeksYesTCM symptom score, serum IL-6t testIt is feasible to apply N-of-1 trials in clinical research of TCM.
Wang et al. 2016 [9]To evaluate the feasibility of N-of-1 trails of TCM.1YesIndividualized herbal decoctionStandard decoction for stable bronchiectasis34 weeksYes7-point Likert scalePaired t testN-of-1 trails reflected the advantage of TCM individualized treatment in this patient, providing with the highest rank of evidence for the patient.
Yu et al. 2012 [24]Individualized treatment of TCM is the unique advantage.3NoIndividualized herbal decoctionThe basic treatment34 weeksRandomization but no blindingTCM symptom score, SCr, and Ccrt testN-of-1 trails for the clinical studies of TCM are useful and feasible.

Abbreviations: TCM, traditional Chinese medicine; LDD, Liuwei Dihuang decoction; ANOVA, analysis of variance; SJZD, Sijunzi Decoction; SCr, serum creatinine; Ccr, creatinine clearance rate.