| Background:Traditional Chinese medicine and conventional medicine are legal in China, and this kind of situation is unique in the medical field in global.Chinese government has always been devoted to encouraging and promoting the combination of TCM and western medicine, as well as TCM and folk medicine. Chinese medicine circulates on the market and has been known and used by public. Currently, the unreasonable use of Chinese patent medicine is alarming. According to an incomplete statistics, general hospitals in Beijing prescribed 60% of Chinese patent medicine by physicians of western medicine.Another survey seeking to investigate the status of Chinese patent medicine usage, organized by Beijing municipal administration of traditional Chinese medicine and Beijing institute of traditional Chinese medicine investigation, found that unreasonable utilization rate of proprietary Chinese medicine reached up to 40% in clinical practices.As clinical practice guidelines have been always used to guide doctors and heatlth workers for clinical practice, thus we wondered:(1) What is the condition of TCM recommendation in western medicine clinical practice guidelines? (2) Is there any difference between the evidence of TCM recommendation given by western medicine as well as TCM clinical practice guidelines, when compared with TCM clinical evidence by literature retrieval?Those are the problems in this study that need to be solved.Objectives:This article mainly focused on the TCM recommendation in western guidelines developed by three professional academic institutions in China-- the ministry of health of the People’s Republic of China, the Chinese medical association, and the Chinese medical doctor association. The qualities of western guidelines will be evaluated. For western medicine guidelines which have recommended TCM therapies, the corresponding TCM guidelines will be included, and then be analyzed by comparing the evidence of TCM recommendation in guidelines with that obtained through literature searching.By adopting the methods of literature investigation, epidemiological investigation and internationally recognized guideline evaluation by AGREE Ⅱ, this study aims at investigating the recognition of TCM therapy in western medicine clinical practice guidelines, the difference between evidence of TCM recommendation in guidelines and clinical evidence, as well as the quality of the included guidelines.There have not been comparative researches to explore the TCM recommendations in western medicine and TCM clinical practice guidelines in China. Further more, such kind of study can provide references for developing integrated traditional Chinese and western medicine clinical guidelines and TCM guidelines as well based on evidence, to promote TCM working in clinical medical systems.Materials and methods:By literature searching, the guidelines were screened by reading titles and abstracts, and full texts when needed. According to inclusion and exlusion criteria, the guidelines were included at last. The data of the included guidelines were extracted and then evaluated by AGREE II for quatliy. The corresponding TCM practice guidelines were included for those which recommended TCM therapy, searching as diseases. The evidence listed in guidelines as for TCM recommendation was compared with the results potential for guideline developing by literature retrieval.Specific information as follows:ResultsA total of 604 western medicine clinical practice guidelines by three institutions were retrieved, and 74(12%) were included as they recommended TCM therapy. In terms of guidelines publishing time, there was no clear trend but with a decrease in 2011.74 guidelines involveed 58 diseases belonging to 13 disease systems according to ICD-10,mostly distributed in the respiratory system, digestive system, cancer and other chronic diseases. TCM was recommended for treatment in 99%circumstances, of which Chinese herbal medicine (single herb or formula based on syndrome differentiation) accounted for 58%.5 guidelines (7%) provided recommendation level in addition.11 western medicine clinical practice guidelines offered references for TCM recommendation. The recommendation of TCM in Western medicine clinical practice guidelines was obviously insufficient in evidence supporting.According to AGREEII evaluation,74 guidelines qualities were generally low; the comprehensive conclusion of 74 guidelines is not to give recommend. The scope and purpose aspect scored 41.0%on average; the score in regards to participants was at an average of 25.2%; in terms of strictness, the average score was 25.0%;the clarity and readability scored 48.2%on average; applicability shoot an average score of 18.9%;Editorial independence on average scored 16.7%. All of the western medicine clinical practice guidelines qualities were low.Grouped by publisheing time, there was significant difference in staff. Grouped by guideline publishing institutionsthe statistically difference of strictness part was found, and the Chinese medical association scored highest.18 diseases resulted from the first part of the study were all found to have corresponding clinical guidelines of TCM and western medicine respectively.4224 articles including 3898 randomised controlled trials and 326 systematic reviews were included after the literature retrieval.252 systematic reviews and 3819 RCTs were published in China, while 74 SRs and 79 RCTs in foreign countries.Only 1(4%) clinical guideline of western medicine gave reference when givng recommendations of TCM, while the other 20 guidelines didn’t give any reference or evidence.In terms of 18 clinical guidelines of TCM,9 guidelines (50%) developed by CACMS all offered grading of evidence and strength of evidence. Besides,1 out of 9 guidelines by China Association of Chinese Medicine provided evidence for TCM recommendation as well.By comparing the retrieval results with the recommendation evidence of TCM therapy in clinical guidelines, we found that there was a big difference which meant that the clinical guidelines should be developed by collecting and referring to systematic and comprehensive clinical evidence.Conclusion:The recommendations and evidence supports of Chinese medicine in clinical practice guideline of western medicine are relatively less. The guidelines of western medicine which recommended Chinese medicine have low scores of AGREE II.Guidelines of Chinese medicine and guidelines of Western Medicine are not evidence-based when recommending Chinese medcine.The guidelines should be composed by methods of evidence-based medicine and attentions should be taken to the recommended guidelines for evidence in future.
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