Analysis of the Characteristics of Dominant Diseases in Traditional Chinese Medicine: Based on 95 Diseases
Background. Traditional Chinese medicine (TCM) has been widely used all over the world and has shown its superiority in some diseases. However, there are no clear evaluation criteria for TCM. In 2019, a list of TCM dominant diseases was published by the Chinese National Administration of Traditional Chinese Medicine. This study aimed to systematically summarize the characteristics of 95 TCM dominant diseases and provide a reference for the establishment of evaluation criteria for TCM dominant diseases. Methods. The diagnosis and treatment protocols of all the 95 TCM dominant diseases were screened. The data of disease classification, diseases’ code of TCM, length of hospital stay, treatment protocols, and clinical pathways were reviewed and summarized. Results. The diseases of the genitourinary and nervous systems accounted for 14.74% and 12.73% of the TCM dominant diseases, respectively. The length of hospital stay for 55 (57.89%) diseases was no more than less than 14 days. Each disease had its specific Chinese herbal decoction pieces and Chinese patent drugs. Chinese medical injections were not widely used. TCM external treatments for these diseases are abundant, with hundreds optional. Conclusion. Some potentially promising TCM dominant diseases remain to be identified and deserve further research to establish the evaluation criteria of TCM dominant diseases.
TCM has been widely used in the treatment of various diseases in China for thousands of years and has shown its potential and superiority in many diseases such as leukemia, irritable bowel syndrome, and angina pectoris [1–5]. Therefore, the conception of TCM dominant diseases was born. The dominant diseases of TCM mainly refer to diseases for which there is currently no targeted western medical treatment and TCM has a definite effect, or the toxic side effects and drug-induced, iatrogenic disorders of TCM were less than western therapy . For example, some chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), are commonly treated with corticosteroids, which are often accompanied by side effects . Based on conventional therapies, the application of TCM not only significantly improved the symptom of acute exacerbations of COPD (AECOPD) but also reduced hospital stay (mean difference, −1.21 days; ) and the number of AECOPD readmissions (RR, 0.41; ), greatly reducing the overall burden of disease .
The evaluation criteria of dominant diseases of TCM are used to define a certain disease as the dominant disease of TCM. However, the criteria should be recognized by the majority of medical workers before it is beneficial for better clinical promotion and application of TCM to provide patients with better curative medical services. Currently, the consensus within countries or industries concerning the evaluation criteria and evaluation tools for dominant diseases of TCM has not been reached yet . There are no mature evaluation systems for the definition of TCM’s dominant diseases.
Commissioned by the Chinese National Administration of Traditional Chinese Medicine, the China Association of Chinese Medicine assembled a panel of TCM experts from across the country in 2018 to systematically collect and summarize opinions on dominant diseases of TCM. In 2019, a list of 95 dominant diseases of TCM was published by the Chinese National Administration of Traditional Chinese Medicine with the diagnosis, treatment program, and clinical pathway of these diseases . Definite Chinese medical treatment options, clinical pathway, and objective evaluation criteria of the clinical efficacy were established for these diseases through clinical practice, with broad consensus. This study was conducted to comprehensively summarize the classification of these TCM dominant diseases and the application of TCM treatment, aiming to identify the characteristics of the 95 dominant diseases of TCM and provide a reference for the further selection of TCM dominant diseases and establishment of clear evaluation criteria.
2.1. Data Sources
The 95 TCM dominant diseases, promulgated by the Chinese National Administration of Traditional Chinese Medicine, were selected as the subjects of this study. Basic information about the International Classification of Diseases (ICD) 10 code , ICD 11-code , disease classification, and length of hospital stay was collected. Chinese medical treatment protocols were categorized as TCM (oral TCM decoction, oral Chinese patent medicine, and TCM injection) and external treatment of TCM (including external treatment of TCM, acupuncture, moxibustion, manipulation, anorectal of TCM, special therapy of TCM, and comprehensive therapy of TCM).
ICD is a health statistics coding tool and is widely used in clinical practice. Based on ICD 10, substantial improvement was made in ICD 11. More unique codes for injuries and diseases and a new chapter focusing on traditional medicine were also included in ICD 11 .
2.2. Data Extraction
The diagnosis and treatment protocols of each disease were screened and data were extracted by two researchers independently using a standard data extraction table. Then, they crosschecked the table after primary extraction. Disagreements were resolved through discussion or the suggestion of a third reviewer. The main contents of the table were as follows: disease, classification of diseases, diseases’ code of TCM, length of hospital stay, diseases’ name in western medicine, code in ICD-10 and ICD-11, optional TCM therapies, and optional TCM external therapies.
2.3. Statistical Methods
Statistical analyses were performed using the SPSS software (SPSS Standard version 23.0, SPSS Inc., Chicago, IL). Continuous variables were presented as means ± SD, minimum value, and maximum value. Categorical variables were classified and shown as numbers and percentages. Differences between groups were tested by Student’s t-test, chi-square test, or rank-sum test, respectively. Significant differences were defined as .
3.1. Basic Characteristics
Diseases were classified using ICD-10. Of the 95 included diseases, diseases of the genitourinary system accounted for the largest proportion (n = 14, 14.74%); other classifications proportional from high to low in turn were diseases of the nervous system (n = 12, 12.63%), diseases of the digestive system (n = 10, 10.53%), diseases of the respiratory system (n = 8, 8.42%), neoplasms (n = 8, 8.42%), certain infectious and parasitic diseases (n = 7, 7.37%), diseases of the musculoskeletal system and connective tissue (n = 7, 7.37%), diseases of the skin and subcutaneous tissue (n = 7, 7.37%), diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (n = 7, 7.37%), diseases of the circulatory system (n = 5, 5.26%), diseases of the eye and adnexa (n = 4, 4.21%), mental and behavioral disorders (n = 3, 3.16%), endocrine, nutritional, and metabolic diseases (n = 2, 2.11%), and diseases of the ear and mastoid process (n = 1, 1.05%). The 95 dominant diseases covered almost all disease systems.
Although there was specific TCM therapy for each disease, not every one of them had a TCM disease code. The results showed that 33 (34.74%) of the 95 diseases had no TCM disease name and used a western medicine name in clinical practice.
Length of hospital stay ranged from ≤7 days to ≤35 days. As is shown in Table 1, a total of 50 (52.63%) diseases’ average length of stay was ≤14 days and maximally not exceeding 35 days.
3.2. Application of TCM
The application of TCM was summarized in Table 2; Chinese herbal decoction pieces and Chinese patent drugs were all used in the 95 dominant diseases of TCM. However, the utilization of Chinese medical injections varied from 28.57 to 100.00%, with a total rate of 63.16%. The lowest rate (2/7) of Chinese medical injections use was seen in diseases of the skin and subcutaneous tissue.
3.3. Application of TCM External Treatment
Table 3 and Table 4 indicated that, for each of included diseases, there was at least one TCM external therapy, and the number of external therapies can reach a maximum of 10. Acupuncture, moxibustion, manipulation, and Chinese medical plastering therapy were most widely applied in these diseases. Among them, acupuncture included ear acupuncture, collateral pricking, cutaneous needle, plum-blossom needle, and many other techniques. Uncommon characteristic therapies of TCM such as acupoint injection, TCM ion introduction, TCM enema, and TCM positive ridge were also widely used in these diseases.
Our study found that the 95 TCM dominant diseases covered multiple systems, mainly the genitourinary, nervous, and digestive systems. However, the diseases’ code of TCM was incomplete and remained to be revised and improved. The length of hospital stay was mainly ≤14 days. Each disease has its own Chinese herbal decoction pieces and Chinese patent drugs. Although therapeutically effective [13–15], Chinese medical injections have not been widely used, which may be because of the controversy on their safety . For the 95 TCM dominant diseases, there were many alternative external treatments of TCM. Therapies such as acupuncture and moxibustion have been widely recognized for their efficacy, easy operation, and low cost and played an important role in the therapy process of many diseases [17–19].
For thousands of years, TCM has been widely used in clinical practice in China. How to inherit and develop the advantages of TCM in the diagnosis and treatment of diseases and health maintenance is still a hot topic . Some scholars have proposed that strategy should, with clinical efficacy at the core, be developed based on a single disease. A study conducted in a TCM hospital indicated that, in health economics, the TCM dominant diseases are characterized by difficulties in treatment, a longer length of hospital stay, and higher hospitalization costs . But evidence from other research suggested that because of the long-term therapeutic effect of TCM, the number of readmissions and total expenses of treatment reduced with the participant of Chinese medical treatment . For example, in the TCM treatment of acute myocardial infarction, the readmission rate due to angina during the 6-month follow-up in the treatment group (2.96%) was significantly lower than that in the control group (7.88%) . Therefore, TCM dominant diseases are ubiquitous and need us to excavate through research.
The evaluation criterion of TCM dominant diseases exactly follows the principle of focusing on a single disease and with clinical efficacy at the core. Under the guidelines of these evaluation criteria, the potential TCM dominant diseases can be evaluated one by one, and the scope of TCM dominant diseases can be continuously expanded and enriched according to the criteria of the evidence grade of evidence-based medicine. Currently, the level of evidence from TCM trials is generally low . Moreover, a large number of diseases were considered TCM dominant diseases by experts but lacked high-quality evidence. Therefore, it is important to establish mature evaluation criteria for TCM dominant diseases as soon as possible. With the guidance of evaluation criteria of TCM dominant diseases, finding the direction of the topic of high-quality original clinical research will also be easier [25, 26].
However, the concept of TCM dominant diseases has been put forward for decades and a large number of clinical trials have also demonstrated the superiority of TCM in the treatment process of some diseases. There have been no clear regulations to elucidate which diseases belong to the dominant diseases of TCM until the list of dominant diseases of TCM issued by the Chinese State Administration of Traditional Chinese Medicine in 2019, which systematically summarized the dominant diseases of TCM on a national scale for the first time and described their diagnosis and treatment protocols and clinical pathways in detail, providing important references for clinical practice. As the list is derived from the collective views of experts, there is a level of subjectivity in the process of developing the list.
Future studies could start with diseases in which TCM was widely used with clear therapeutic effect and an accepted TCM treatment to unearth more TCM dominant diseases. On the other hand, high-quality original research is also warranted to reinforce its theoretical basis.
For all the 95 TCM dominant diseases, there were definite TCM treatment protocols, clinical pathways, length of hospital stay, specific Chinese herbal decoction pieces, and Chinese patent drugs. Various characteristic TCM external therapies were widely applied in these diseases. This study may offer some reference for the establishment of the evaluation criterion of TCM dominant diseases.
The datasets analyzed during the current study are available from the corresponding author on reasonable request.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
L. Zhao, D. Li, H. Zheng et al., “Acupuncture as adjunctive therapy for chronic stable Angina: a randomized clinical trial,” JAMA Internal Medicine, vol. 179, no. 10, pp. 1388–1397, 2019.View at: Publisher Site | Google Scholar
J. L. Chen, H. T. Chen, W. H. Hou, H. T. Ma, Q. Wang, and L. Han, “Clinical influence of shexiangbaoxin pill on NO, NOS, SOD in patients with angina pectoris,” Circulation, vol. 122, no. 2, 2010.View at: Google Scholar
H. H. Zhu and X. J. Huang, “Oral arsenic and retinoic acid for non-high-risk acute promyelocytic leukemia,” New England Journal of Medicine, vol. 371, no. 23, pp. 2239–2241, 2014.View at: Publisher Site | Google Scholar
R. Hoessel, S. Leclerc, J. A. Endicott et al., “Indirubin, the active constituent of a Chinese antileukaemia medicine, inhibits cyclin-dependent kinases,” Nature Cell Biology, vol. 1, no. 1, pp. 60–67, 1999.View at: Publisher Site | Google Scholar
A. Bensoussan, N. J. Talley, M. Hing, R. Menzies, A. Guo, and M. Ngu, “Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial,” JAMA, vol. 280, no. 18, pp. 1585–1589, 1998.View at: Publisher Site | Google Scholar
P. Li, Q. He, G. Sun et al., “Discussion on “dominant diseases in traditional Chinese medicine” by national Chinese medicine master sun guangrong,” Journal of Hunan University of Chinese Medicine, vol. 38, no. 1, pp. 1–3, 2018.View at: Google Scholar
R. Buhl, “Local oropharyngeal side effects of inhaled corticosteroids in patients with asthma,” Allergy, vol. 61, no. 5, pp. 518–526, 2006.View at: Publisher Site | Google Scholar
J. Li, H. Zhang, H. Ruan et al., “Effects of Chinese herbal medicine on acute exacerbations of COPD: a randomized, placebo-controlled study,” International Journal of Chronic Obstructive Pulmonary Disease, vol. 15, pp. 2901–2912, 2020.View at: Publisher Site | Google Scholar
Y. Lin, X. Wang, H. Zhao, J. Liu, and Y. Zhang, “Discussion on methodology of evaluating the dominant diseases of traditional Chinese medicine,” Journal of Traditional Chinese Medicine, vol. 62, no. 19, pp. 1663–1667, 2021.View at: Google Scholar
China Association of Chinese Medicine: Clinical Pathway and Diagnosis and Treatment Protocols of 95 Dominant Traditional Chinese Medicine (TCM) Disease. 2019.
J. DiSantostefano, “International classification of diseases 10th revision (ICD-10),” The Journal for Nurse Practitioners, vol. 5, no. 1, pp. 56-57, 2009.View at: Publisher Site | Google Scholar
“The lancet: ICD-11,” Lancet, vol. 393, no. 10188, p. 2275, 2019.View at: Google Scholar
L. Chen, L. Wang, Q. Zhuo et al., “Effect of shenmai injection on cognitive function after cardiopulmonary bypass in cardiac surgical patients: a randomized controlled trial,” BMC Anesthesiology, vol. 18, no. 1, p. 142, 2018.View at: Publisher Site | Google Scholar
B. Xie, Q. Wang, C. Zhou, J. Wu, and D. Xu, “Efficacy and safety of the injection of the traditional Chinese medicine puerarin for the treatment of diabetic peripheral neuropathy: a systematic review and meta-analysis of 53 randomized controlled trials,” Evidence-based Complementary and Alternative Medicine, vol. 2018, Article ID 2834650, 14 pages, 2018.View at: Publisher Site | Google Scholar
Y. Xing, Y. R. Hua, J. Shang, W. H. Ge, and J. Liao, “Traditional Chinese medicine network pharmacology study on exploring the mechanism of xuebijing injection in the treatment of coronavirus disease 2019,” Chinese Journal of Natural Medicines, vol. 18, no. 12, pp. 941–951, 2020.View at: Publisher Site | Google Scholar
W. R. Zheng, X. Wang, E. Li, and S. Peng, “Tu Youyou winning the nobel prize: ethical research on the value and safety of traditional Chinese medicine,” Bioethics, vol. 34, no. 2, pp. 166–171, 2020.View at: Publisher Site | Google Scholar
S. S. Awad, “Chinese cupping: a simple method to obtain epithelial grafts for the management of resistant localized vitiligo,” Dermatologic Surgery, vol. 34, no. 9, pp. 1186–1193, 2008.View at: Publisher Site | Google Scholar
W. Q. Wang, H. Sun, Y. S. Ye, Z. Shao, and Y. Xiao, “Influence and effect of acupoint application of Chinese medicine on height and bone age of children with short stature,” Evidence-based Complementary and Alternative Medicine, vol. 2021, Article ID 7459593, 7 pages, 2021.View at: Publisher Site | Google Scholar
J. c. Dong, L. Qi, J. Li, J. J. Le, L. Shao, and X. Du, “Moxibustion upregulates hippocampal progranulin expression,” Neural Regeneration Research, vol. 11, no. 4, pp. 610–616, 2016.View at: Publisher Site | Google Scholar
Y. Liu, Z. Yang, J. Cheng, and D. Fan, “Barriers and countermeasures in developing traditional Chinese medicine in Europe,” Frontiers of Medicine, vol. 10, no. 3, pp. 360–376, 2016.View at: Publisher Site | Google Scholar
J. I. Cong-hua, “Advantages of TCM diseases in health economics evaluation,” Chinese health economics, vol. 31, no. 11, pp. 67–69, 2012.View at: Google Scholar
M. D. Naylor, K. B. Hirschman, A. L. Hanlon et al., “Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults,” Journal of Comparative Effectiveness Research, vol. 3, no. 3, pp. 245–257, 2014.View at: Publisher Site | Google Scholar
W. H. Duan, F. Lu, L. Z. Li et al., “Clinical efficacy of traditional Chinese medicine on acute myocardial infarction: a prospective cohort study,” Chinese Journal of Integrative Medicine, vol. 18, no. 11, pp. 807–812, 2012.View at: Publisher Site | Google Scholar
Y. L. Chen, C. Zhao, L. Zhang et al., “Toward evidence-based Chinese medicine: status quo, opportunities and challenges,” Chinese Journal of Integrative Medicine, vol. 24, no. 3, pp. 163–170, 2018.View at: Publisher Site | Google Scholar
Y. Shi, H. Zheng, S. Zhou et al., “Efficacy and safety of acupuncture for patients with chronic urticaria: study protocol of a randomized, sham-controlled pilot trial,” Trials, vol. 20, no. 1, p. 326, 2019.View at: Publisher Site | Google Scholar
Z. Di, S. Jiang, Y. Tian, and X. M. Lin, “The present-stage advantage diseases of abdominal acupuncture from reports of clinical randomized controlled trial,” Zhongguo Zhen Jiu, vol. 33, no. 9, pp. 836–839, 2013.View at: Google Scholar