Background: Colorectal cancer (CRC) imposes a heavy disease burden. Besides physical morbidity, some patients might still experience long-term psychological distress. Our previous study demonstrated that physical symptoms and psychological distress of CRC improved following traditional Chinese medicine (TCM) combined online group psychotherapy. However, the multidimensional nature of these experiences warrants deeper exploration of patients’ lived perspectives. Methods: We designed a single-arm phase I clinical trial, in which 40 CRC patients (aged between 18 and 75) who have received radical surgery (stage I-III) were recruited. This 6-week intervention of TCM combined online group psychotherapy included 90 minutes’ communication on various topics for each week. The video of each online group psychotherapy session was saved, and the 38 patient’s’ speech was analyzed by thematic analysis in the qualitative study. Results: We identified 4 themes and 13 subthemes. The patients mainly displayed foundational outlook transformation and tangible lifestyle reformation. The physical symptoms and psychological symptoms also had a certain degree of relief. In addition, patients also showed an increased demand for medical advice and health care information, which indicates that they were more concerned about their health condition, and the needs of patients were responded to in treatment, resulting in corresponding benefits. Conclusion: During TCM combined online group psychotherapy interventions—including education, skill-building, TCM lifestyle coaching, and peer-exchange platforms—patients developed sustained self-health management practices, improving psychological resilience and physical symptoms. This holistic, tailored and culturally sensitive approach fostered long-term recovery and independence of CRC survivors.

BackgroundMore than 50% of colorectal cancer(CRC) patients experience cancer-related psychological burden after radical surgery, which can seriously affect their physical wellness, quality of life and even survival outcomes. Our research team developed a six-week Traditional Chinese Medicine Combined Online Group Psychotherapy (TCM-eRhab) and proved its efficacy on relieving cancer-related anxiety, depression and fear of cancer recurrence though phase I single arm clinical trial (n = 40). Large sample size randomized controlled clinical trial(RCT) is necessary to further evaluate TCM-eRhab's role on improving quality of life and survival outcomes among this population.MethodsWe design a phase II RCT study, in which 210 CRC patients who have received radical surgery (stage I-III) will be recruited. Eligible patients will be randomly assigned to TCM-eRhab group or usual care group by 2:1 ratio. Patients in the intervention group will receive the structured TCM-eRhab program for six weeks, while patients in control group will receive usual care only. The primary outcomes are quality of life, severity of anxiety, depression and fear of cancer recurrence. Cancer recurrence rate will also be calculated according to long term follow-up data.DiscussionAs one of the first RCTs to evaluate the impacts of TCM combined psychological therapy to improve CRC patients' quality of life after surgery, the results from this study will provide innovative knowledge and evidence on integrating TCM into CRC survivorship care and mind-body intervention model.

This article takes the narrative medicine practice of traditional Chinese medicine (TCM) in the treatment of Ben Tun Qi (sic) as an example to illustrate the characteristics of narrative medicine in TCM diagnosis and treatment, and strives to form a simple, easy to implement, and practical process of narrative medicine of TCM, which can help doctors provide more comprehensive, detailed, and humanistic care for diagnosis and treatment activities, and achieve doctor-patient harmony.

To evaluate the efficacy and feasibility of utilizing Traditional Chinese Medicine (TCM) combined group psychotherapy intervention on psychological distress management and gut micro-biome regulation for colorectal (CRC) survivors. A single-arm phase I clinical trial was conducted between December 2020 and December 2021 in Xiyuan Hospital and Beijing Cancer Hospital in China. Inclusion criteria included stage I–III CRC survivors after radical surgery with age between 18 and 75. The intervention was a 6-week online TCM combined group psychotherapy intervention including 90-min communication, TCM lifestyle coaching, self-acupressure guidance, and mindfulness practice led by TCM oncologist and psychiatrist each week. Outcomes were measured by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Fear of Cancer Recurrence Inventor (FCRI), and Quality of Life Questionnaire (QLQ-C30). Fecal samples before and after intervention were collected for 16Sr RNA analysis. We recruited 40 CRC survivors and 38 of them finally completed all interventions with average age of 58±13 years’ old. Paired t-test showed that SAS at week 2(35.4±5.8), week 4 (37.9±10.5) and week 6 (31.3±6.4) during the intervention was significantly lower than baseline (42.1±8.3, p<0.05 respectively). SDS score also declined substantially from baseline (38.8±10.7) to week 2 (28.3±8.8, p<0.001) and week 6 (25.4±7.7, p<0.001). FCRI decreased from 19.4±7.2 at baseline to 17.5±7.1 at week 4 (p=0.038) and 16.3±5.8 at week 6 (p=0.008). Although changes of QLQ-C30 were not statistically prominent, symptom burden of insomnia and fatigue significantly alleviated. The abundances of gut microbiota Intestinibacter, Terrisporobacter, Coprobacter, and Gordonibacter were all significantly elevated after intervention. TCM combined group psychotherapy intervention is feasible and effective to reduce CRC survivors’ psychological distress and modulate certain gut bacteria which might be associated with brain-gut axis effect. It is necessary to carry out with phase II randomized controlled clinical trial.

叙事医学于2001年兴起于美国,是新兴的医学人文实践方式,通过阅读和写作,用语言的方式表达医学人文的共情与反思.中医学具有浓厚的人文内涵,作为《黄帝内经》中的重要篇章,《疏五过论》《征四失论》指出了医者可能会犯的五种过错和四种过失,除了有很多深刻的医理之外,还有丰富的人文反思.研究者从对病因反思角度,分析了两文中对问社会生活变化及重大负性生活事件的反思、对问情绪的反思、对问饮食居处生活方式的反思,以及对问个性体质的反思.从对医者自身的反思角度,分析了对医理掌握不精的反思,对从医态度不够专注的反思,对医者轻率、自大、贪婪等心理的反思.两文充满了对医道的反思,具有叙事医学主体间性、重视共情及反思性的特点,对叙事医学的在地化发展具有启示作用.

Objective To explore the relationship between five-pattern personality of traditional Chinese medicine(TCM)and college students'psychological crisis ideation.Methods A group sampling method was used to select 656 college students from a certain university as research objects.The survey was conducted using the Five-Pattern Personality Inventory,the Pittsburgh Sleep Quality Index Questionnaire,the Beck Depression Inventory,and the Beck Scale for Suicide Ideation-Chinese Version.The relationships between the five-pattern personality,sleep disorders,depressive symptoms and suicidal ideation in the samples were analyzed by Pearson product difference correlation and mediating effect test.Results There was significant correlation among Taiyin personality,Pinghe personality,sleep disorder,depressive symptoms and suicidal ideation.The direct prediction effect of Taiyin personality on suicidal ideation was significant,the direct effect value is 0.042.Sleep disorder and depressive symptoms mediated the relationship between Taiyin personality and suicidal ideation(Bootstrap 95%confidence interval-95%CI:0.016～0.039,0.018～0.042),with effect values of 25.24%and 28.43%,respectively.Meanwhile,sleep disorder and depressive symptoms played a chain mediating role between Taiyin personality and suicidal ideation(95%CI:0.003～0.010),with an effect value of 5.83%.The direct prediction effect of Pinghe personality on suicidal ideation was significant(the direct effect value was-0.092).Sleep disorder and depressive symptoms mediated the relationship between Pinghe personality and suicidal ideation(95%CI:-0.088～-0.037,-0.087～-0.039),with effect values of 26.55%and 26.11%,respectively.Meanwhile,sleep disorder and depressive symptoms played a chain mediating role between Pinghe personality and suicidal ideation(95%CI:-0.024～0.008),with an effect value of 6.64%.Conclusion Taiyin personality,Pinghe personality can directly affect the sleep disorder,depressive symptoms,suicidal ideation and other psychological crisis,and can also indirectly affect the suicidal ideation through the chain mediation effect of sleep disorder and depressive symptoms.

我国癌症患者普遍存在着心理康复需求,中医药对其有良好的干预效果.目前已有肿瘤相关西医心理指南及标准治疗方案发表,然而中西医结合及中医干预方案仍有待规范.结直肠癌作为中国高发病率、长生存期的肿瘤,其根治术后的时期作为中西医结合心理康复的良好切入点,前期已有一定基础的研究发表.为规范该类疾病的诊疗及随访,提高中西医结合治疗早中期结直肠癌根治术后心理问题的效果,2022 年中华中医药学会发布《早中期结直肠癌根治术后中西医结合心理康复干预指南》,包含 12 条推荐意见.该指南为结直肠癌领域首个中西医结合心理干预指南,但受限于相关研究的数量与质量,未来尚需要更多高质量研究结果的发表以促进其更新完善.

With the continuous penetration of modern science and technology into medicine, medical staff and patients are calling more and more eagerly for the return of medical humanities, and narrative medicine comes into being. Traditional Chinese medicine contains the germination of narrative medicine, which is rich in medical humanistic thoughts. The connotation of the spirit of benevolence includes four levels: affinity, benevolence, love of things and benevolence. By listening to patients’ narratives, paying attention to neglected emotional factors, and reproducing what patients have said, narrative medicine aims to empathize with patients, establish correlation and belonging relationship, and pay attention to the relationship between people, which is in line with the humane spirit of traditional Chinese medicine. The origin of benevolence comes from the mutual understanding between people of the same kind, which is the idea of empathy emphasized by narrative medicine. On the other hand, the love spirit of self and others has a hierarchy and difference, reflecting the emotional transmission sequence of starting from oneself, and then caring for others from inside to outside, from near to far. The highest level of benevolence is “integrated benevolence”. The essence of the spirit of benevolence and the spirit of narrative medicine share some similarities. Narrative medicine has a rich philosophical theoretical basis, and the spirit of benevolence, based on the traditional wisdom of the Chinese nation, on the basis of the overall natural medical model and thousands of years of practical experience, will play an important guiding role in the localized development of narrative medicine in China.

"病为本,工为标"是中医对医疗活动中医患的主从关系的论述,强调患者的地位及医患配合的重要性,这与叙事医学理论构建中的"主体间性"理念有着相似之处.文章旨在通过对"病为本,工为标"进行阐释,结合叙事医学原理钩沉,尤其侧重对主客间性进行挖掘,拓展其现代价值,为中国叙事医学发展助力.

目的 探讨中医专业研究生的叙事医学实践体验及对其职业认同感的影响.方法 采用 目的性抽样选取了某高校中医专业硕博士研究生一年级的56位学生,进行为期16学时的叙事医学课程培训和4周叙事医学临床实践,并要求在临床实践结束后完成一份关于实践体验的开放式书写作业.随后采用质性研究中的主题分析法对作业内容进行分析.结果 学生们学习了叙事医学之后,在临床中的实践体验包括3大主题和9个副主题:适用范围广(全诊疗阶段、多科室及病种)、融合多方面沟通技巧及诊疗方式(沟通技巧、心理学技术、反思、中医人文诊疗方式)以及增加职业认同感(实现相互疗愈、构建和谐医患关系、提升中医自信).主题被进一步整合形成叙事医学实践循环与职业认同感的关系,并以图表的形式呈现.结论 通过探讨中医专业研究生的叙事医学实践体验,发现通过在全诊疗阶段及多学科病种中,运用多种方法技巧,能够促进医患关系和谐、实现相互疗愈、增强中医自信,这些内化的认可和成就感进而有助于提高职业认同感.可为提高医学生职业认同感、探索叙事医学实践在地化之路提供新思路.

By searching for the Canadian Licensed Natural Health Products Database, (LNHPD), this paper analyzed the characteristics and current status of 92 Chinese patent medicines successfully registered and listed in Canada, and found that the enterprises of successfully registered enterprises are mainly located in areas with better development condition of Traditional Chinese Medicine (TCM) such as Beijing, Guangdong and Tianjin; The successfully registered Chinese patent medicines include 64 kinds of single medicine or medicine with single active ingredient (69.6%) and 28 kinds of compound medicine (30.4%), the forms of the dosage are mainly tablets and capsules, which have the characteristics of accuracy in dosage and stable physicochemical properties. There are also granules, solutions, powders and other dosage forms, which can be preserved for a long time and have low requirements on technic and environment. These Chinese patent medicines are mainly used to treat respiratory and circulatory system diseases, some are used to treat urogenital and digestive system diseases, and few are used to treat difficuilt diseases like tumors, diabetes. There are some other health care products. It is suggested to strengthen the connection between domestic standards of TCM registration and international standards, and promote the scientific and technological capacity of relevant enterprises, and encourage enterprises to strengthen international registration of advantageous products, so as to accelerate the speed of international development of TCM in China.

探讨中医四诊之首——望诊的叙事要素,以望诊中的"关注"为切入点,从其内容、特点、作用与优势三方面阐述了医者可通过望诊关注到望形-望神-望性三个层次的内容,并通过这样的诊疗过程体现医患互动性和医患一体的整体性,由此利于医患间相互了解对方的反应,医者全面掌握患者多维度的状态及变化,使医患间产生共情,有助于提高疗效,以达到身心并治并建立起长期、稳定的医患信任关系.为叙事医学临床实践在我国本土化的发展提供借鉴及新思路.

At present, the registration process of Traditional Chinese Medicine (TCM) in Canada is refering to the requirements of Natural Health Products (NHPs). In terms of registration material, both NHPs and TCM include plants, animals and minerals with medicinal components, but the fundamental difference between them is that TCM is guided by the basic theory of TCM. As for the registration classification of TCM in Canada, first of all, judge whether the product to be applied for is NHPs; Secondly, we should clarify the types and ways of registration, mainly including simple application, traditional application and non-traditional application, and provide application forms, label texts, summary reports, evidence, animal tissue forms, finished product specifications and other materials according to different requirements. At present, the successful registration experience of TCM products in Canada mainly mainly includes applying for superior varieties, selecting appropriate application channels, communicating with local health management units and providing sufficient scientific evidence and good clinical application records. The regulations on the registration of NHPs in Canada have not fully considered the particularity of TCM and the registration of TCM products is still facing some difficulties. In the future, we can learn from the registration process and requirements of the Health Canada, promote the interconnection and mutual recognition of the Pharmacopoeia of the People's Republic of China and the NNHPD monographs in Canada, reduce the obstacles to the local application for registration of TCM, and promote the further improvement of the international standards of TCM.

抑郁症是常见的情绪情感障碍,其核心症状表现为显著而持久的情绪低落、兴趣减退等.中医治疗抑郁症的非药物方法有情志相胜治疗、音乐疗法、低阻抗意念导入疗法、气功、针刺、艾灸等.上述疗法治疗抑郁症及抑郁相关疾病疗效较为明确,并具有副作用较小、患者依从性高等优势,但临床操作规范性均有待提高.本文梳理了中医非药物方法干预抑郁症及相关疾病的研究进展,以期对抑郁症的临床治疗提供参考,其中音乐、气功等疗法对于临床医师专业技能要求较高,针灸疗法常与药物等常规方法联合使用,具有多靶点、整体调节、无依赖性等优势.目前关于中医非药物方法治疗抑郁症的研究以观察临床疗效为主,少见作用机理的探讨及大样本临床试验研究,相关疗法临床操作的规范化也有待进一步研究.

This paper analyzes the laws, regulations and concre measures of Traditional Chinese Medicine (TCM) in Canada, so as to provide reference for TCM products to enter Canada, and for the establishment of TCM regulation system and the improvement of its detailed rules in China. The regulation of TCM in Canadian, on the one hand, supervision is to provide guidance for the protection of consumers' rights and interests, including the guidance of rational drug use and rational purchase for consumers; on the other hand, it is to supervise enterprises, including the safety, effectiveness and quality certification of TCM products, labeling and packaging requirements, as well as the site certification of product manufacturing, packaging, labeling and import. The Ministry of health of Canada takes evidence as the core of evaluation, and ensures the safe and effective use of TCM products in Canada through product and site licensing evaluation. In the supervision of TCM, relevant departments in China should further strengthen the protection of consumers' drug rights and interests, strengthen the construction of TCM registration evidence system, and pay attention to the risk management of drug production quality.

Traditional Chinese Medicine (TCM) products could be registered as natural health products (NHPs) in Canada. Its registration process could be mainly divided into simple-application, traditional-application and non-traditional application. By analyzingi the TCM registration evidence system and its safety, effectiveness and quality required by different registration categories in Canada, we found that "simple-application" procesure needs to submit evidence based on the parameters of a component in the monograph. As for "traditional application", TCM products need to be used at least 50 years with, traditional material or Pharmacopoeia can be used as evidence; As for non-traditional application, TCM products need to provide evidence according to the disease risk level, and most of them need to provide scientific experiment evidence. Therefore, from the experience of TCM registration evidence system in Canada, the registration of TCM products should pay attention to improve the its classification method, refining its evidence requirements and data types, promoting the formulation of monograph of TCM, realizing the scientific evaluation and rapid review of classic famous prescriptions, and promoting the inheritance and innovative development of TCM in China.