1.Discussion on the postgraduate education of Chinese and western integrative medicine based on the major scientific research projects
Xiaoling CHI ; Huanming XIAO ; Yubao XIE ; Meijie SHI
Chinese Journal of Medical Education Research 2015;(7):698-701
The high quality of Chinese and western integrative medicine talents is the premise of the integrated Chinese and Western medicine to the world. Postgraduate education is directly related to the development of Chinese and Western medicine. The Second Clinical Medical College of Guang-zhou University of Chinese Medicine integrated the declaration and organization and implementation of the national major scientific research projects with Chinese and Western Medicine. By building ech-elon team model and establishing a platform for the exchange of research and communication platform, which covers the academic, technical, scientific and technological innovation, and so on, it cultivated high-level, complex and integrated Chinese and Western Medicine talents from knowledge and skills, innovation ability, interpersonal ability, and comprehensive management ability, etc.
2.Sensitivity and Specificity of MDFS Scoring System in Diagnosis of Liver Fibrosis in Chronic Hepatitis B
Guangjun TIAN ; Hongcai LIANG ; Zehao LU ; Minling CAO ; Yubao XIE ; Yingxian LI ; Xiaoling CHI ; Pengtao ZHAO ; Huanming XIAO ; Shuduo WU ; Junmin JIANG
Journal of Guangzhou University of Traditional Chinese Medicine 2017;34(4):469-474
Objective To establish a simple scoring system for the diagnosis of liver fibrosis in chronic hepatitis B (CHB), and to observe its sensitivity and specificity. Methods Two hundred and thirty-three patients diagnosed as CHB by liver biopsy were divided into model group (N = 154) and validation group (N = 79). The general information, biochemical parameters and imaging data of all patients were observed. With hepatic fibrosis being obvious or not as the end point of primary study in the model group, we established a simple scoring system for the diagnosis. The cut-off, sensitivity and specificity of the system were tested in the model group by ROC curve, and its diagnostic efficacy was tested in the validation group. Results(1) A simple scoring system for the diagnosis of liver fibrosis called MDFS was established in the model group, and the dimensions of the system included sex, HBV-DNA, Fibroscan (FS) value and splenomegaly. In MDFS, male, HBV-DNA≥ 107 U/mL,FS value≥7.3 kPa, and splenomegaly were assigned 1 point, -2 points, 3 points, and 2 points respectively. (2) The best cut-off value in MDFS was 2 points.(3) ROC curve of the model group indicated that the specificity and sensitivity were 92.86% and 54.76% respectively, the area under curve(AUC) was 0.790, and the Youden index was 0.4762. In the validation group, the diagnostic cut-off value was over 2 points, and the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 52.17%, 82.35%, 2.96, and 0.58 respectively. (4) The scoring results of MDFS for different traditional Chinese medical syndromes of CHB showed that the scores of blood stasis blocking collaterals > damp-heat accumulation > deficiency of spleen and kidney yang> liver depression and spleen deficiency = stagnation of liver Qi. Conclusion The MDFS diagnostic scoring system has medium efficiency. The specificity of MDFS is relatively high and MDFs has a relatively low misdiagnosis rate for the diagnosis of obvious hepatic fibrosis in CHB. The MDFS is expected to be a noninvasive and simple diagnosing way for hepatic fibrosis in CHB.
3.Clinical Experience of Treating Metabolic Associated Fatty Liver Disease with Huangqi (Radix Astragali) in Lingnan (岭南) Area
Zhiheng CHEN ; Bowen GAO ; Chaozhen ZHANG ; Meijie SHI ; Huanming XIAO ; Yubao XIE ; Xiaoling CHI
Journal of Traditional Chinese Medicine 2023;64(17):1819-1823
Based on the unique syndrome characteristics of metabolic associated fatty liver disease (MAFLD) in Lingnan (岭南) area, this paper discussed the clinical experience of Huangqi (Radix Astragali) in the treatment of MAFLD in Lingnan area. It is summarized that spleen deficiency and yang weakness, and internal accumulation of damp-turbidity are the source of the disease, and at the early stage, Huangqi, commonly 15~30 g, could be used to fortify the spleen and warm the earth, thereby making the deficiency fire latent, as well as raise the clear and warm the exterior so as to inhibit damp-turbidity; medication needs to be progressively supplemented, and can be used together with Taizishen (Radix Pseudostellariae), Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Poria), and Fangfeng (Radix Saposhnikoviae) to back up the earth and inhibit dampness. Qi stagnation and blood constraint, yin dampness and heat accumulation are the pathogenesis of disease progression. Huangqi should be taken to invigorate the spleen and flourish the liver, unblock yang, and move stagnation. The dosage is often maintained at 30~60 g, to circulate the qi and unblock yang qi in the middle jiao (焦), usually combined with Chaihu (Radix Bupleuri), Baishao (Radix Paeoniae Alba) and Yujin (Radix Curcumae) integrating warm and cool medicinals. Stubborn turbid and fat condensing in the liver is a severe stage of the disease and may be concurrent with various pathogens such as dampness, phlegm, and heat, for which 60~90 g Huangqi should be used to invigorate blood and disperse fat, reinforce healthy qi and expel pathogens, often with medicinals that can disperse fat and direct the turbid downward such as Shanzha (Fructus Crataegi), Juemingzi (Semen Cassiae), Lulutong (Fructus Liquidambaris) and Zexie (Rhizoma Alismatis). When prescribing, it is suggested to combine with other medicinals according to the season, thereby adjusting the ascending and descending of the property of Huangqi, thereby conforming to the nature of the four seasons.
4.Advances and thoughts in traditional Chinese medicine diagnosis and treatment of chronic hepatitis B-related liver fibrosis
Huanming XIAO ; Meijie SHI ; Yubao XIE ; Xiaoling CHI
Journal of Clinical Hepatology 2023;39(2):260-266
Liver fibrosis is a necessary intermediate process from the progression of chronic hepatitis B to liver cirrhosis and liver cancer. In recent years, breakthroughs have been made in the research on traditional Chinese medicine (TCM) for the prevention and treatment of chronic hepatitis B liver fibrosis. For the purpose of improving clinical outcome, multidisciplinary industry-university-research studies are conducted to explain the biological basis of TCM syndromes of chronic hepatitis B liver fibrosis, and establishment and development of a non-invasive diagnostic model with TCM characteristics, optimization of TCM/integrated traditional Chinese and Western medicine treatment regimens, and elaboration on the scientific connotation of TCM treatment can help TCM for the prevention and treatment of liver fibrosis to enter the global world.
5.TCM constitution distribution and clinical features of patients with hepatitis B cirrhosis and dysplastic nodules
Mengbing FANG ; Cheng LIU ; Yu ZHANG ; Jiayi ZENG ; Zhiheng CHEN ; Sheng LI ; Xiaoling CHI ; Huanming XIAO
Journal of Clinical Hepatology 2024;40(5):961-967
ObjectiveTo investigate the characteristics of TCM constitution distribution in hepatitis B cirrhosis patients with dysplastic nodules (DN), and to provide a basis for the prevention and treatment of precancerous lesions of liver cancer. MethodsThis study was conducted among 113 hepatitis B cirrhosis patients with DN, 105 hepatitis B cirrhosis patients with regenerative nodules (RN), and 70 hepatitis B cirrhosis patients with small hepatocellular carcinoma (sHCC) who were hospitalized in Guangdong Provincial Hospital of Traditional Chinese Medicine from May 2015 to March 2023. Related data were collected, including age, sex, liver function Child-Pugh class, TCM constitution type, and laboratory markers. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between groups, and the Bonferroni correction method was used for further comparison between two groups. ResultsThe main TCM constitution types of hepatitis B cirrhosis patients with DN were Qi-deficiency constitution (27 patients, 23.89%), blood-stasis constitution (26 patients, 23.01%), and phlegm-dampness constitution (23 patients, 20.35%). There were significant differences between the three groups in the proportion of patients with phlegm-dampness constitution or damp-heat constitution (χ2=6.822 and 6.383, both P<0.05); the hepatitis B cirrhosis patients with RN had the highest proportion of patients with phlegm-dampness constitution (30.48%), followed by those with DN (20.35%) and those with sHCC (14.29%), while the hepatitis B cirrhosis patients with sHCC had the highest proportion of patients with damp-heat constitution (27.14%), followed by those with DN (16.81%) and those with RN (12.38%). There were significant differences between the hepatitis B cirrhosis DN patients with different TCM constitution types in sex, age, Child-Pugh class, prealbumin, albumin (Alb), aspartate aminotransferase, total bilirubin (TBil), total bile acid, and alpha-fetoprotein (all P<0.05). Compared with the male hepatitis B cirrhosis DN patients, female patients showed a significantly higher proportion of patients with Qi-deficiency constitution (χ2=4.895, P=0.027). Among the patients with Qi-deficiency constitution, the patients with Child-Pugh class A liver function accounted for a significantly lower proportion than those with Child-Pugh class B liver function (χ2=6.380, P=0.012), while among the patients with phlegm-dampness constitution, the patients with Child-Pugh class A liver function accounted for a significantly higher proportion than those with Child-Pugh class B liver function (χ2=8.515, P=0.004). The patients with phlegm-dampness constitution had significantly higher levels of prealbumin and Alb than those with the other four constitutions (all P<0.05), as well as significantly lower levels of TBil and total bile acid than those with damp-heat constitution (P<0.05); the patients with Yin-deficiency constitution had a significantly lower level of Alb than those with qi-deficiency constitution, blood-stasis constitution, or phlegm-dampness constitution (all P<0.05); the patients with Yin-deficiency constitution had a significantly lower proportion of patients with abnormal alpha-fetoprotein than those with non-Yin-deficiency constitutions (χ2=4.448, P=0.035). ConclusionHepatitis B cirrhosis patients with DN mainly have the TCM constitution types of Qi deficiency, blood stasis, and phlegm dampness. The patients with phlegm-dampness constitution seem to have a low probability of carcinogenesis, while those with damp-heat constitution and Yin-deficiency constitution have a relatively high risk of carcinogenesis.
6.Role of traditional Chinese Medicine in prevention and treatment of chronic hepatitis B liver fibrosis: Current status, challenges, and thoughts
Meijie SHI ; Huanming XIAO ; Yubao XIE ; Sheng LI ; Folai ZENG ; Xiaoling CHI
Journal of Clinical Hepatology 2023;39(6):1280-1286
In recent years, significant breakthroughs have been made in the research on the role of traditional Chinese medicine (TCM) in the prevention and treatment of chronic hepatitis B liver fibrosis. In terms of clinical research, several multicenter randomized double-blind controlled studies have been conducted with liver pathological changes as the main efficacy evaluation indicator, which have improved the level of evidence in clinical research on the TCM prevention and treatment of liver fibrosis. As for basic research, in-depth studies have been conducted on the mechanism of action of TCM in intervening against liver fibrosis at various levels, including the effect on HSC activation, apoptosis and autophagy, inhibition of liver inflammatory injury, immunoregulation, and inhibition of hepatic sinusoidal capillarization, thereby highlighting the advantages and research difficulties of TCM through "multiple components, targets, and pathways". Under the guidance of Implementation Plan for the Major Projects of Revitalizing and Developing TCM, it is crucial to conduct high-quality clinical and basic research on TCM in the treatment of liver fibrosis, produce high-quality industry achievements, and thus help TCM to be recognized around the world.