中医干预类临床证据分级系统构建思路探讨  

Exploration on the Development of Evidence-based Grading System for Chinese Medicine Interventional Clinical Evidence

作　　者：刘少南 郭新峰 吴大嵘 ZHANG Anthony Lin XUE Charlie Changli 温泽淮 LIU Shaonan;GUO Xinfeng;WU Darong;ZHANG Anthony Lin;XUE Charlie Changli;WEN Zehuai(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Chinese Medicine,Guangzhou,510120;State Key Laboratory of Dampness Syndrome of Chinese Medicine,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine;China-Australia International Research Center for Chinese Medicine,School of Health and Biomedical Sciences,RMIT University;Science and Technology Innovation Center,Guangzhou University of Chinese Medicine)

机构地区：[1]广州中医药大学第二附属医院/广东省中医院,广东省广州市510120 [2]省部共建中医湿证国家重点实验室(广州中医药大学第二附属医院) [3]China-Australia International Research Center for Chinese Medicine,School of Health and Biomedical Sciences,RMIT University [4]广州中医药大学科技创新中心

出　　处：《中医杂志》2023年第18期1885-1889,共5页Journal of Traditional Chinese Medicine

基　　金：国家重点研发计划(2022YFC3501001);广东省中医院中医药科学技术研究专项(YN2019QL16);2021年广东省科技厅“海外名师”项目。

摘　　要：证据分级水平是进行临床决策的重要考虑因素。中医药领域完全照搬国际常用证据评价体系存在一定局限性,故提出中医临床证据分级思路,即在遵循国际证据分级标准基础上,充分考虑中医药临床实践特点,以GRADE(Grades of Recommendation,Assessment,Development,and Evaluation)证据评价系统为基础,结合中医古籍证据及现代名医经验证据分级标准,进而整合形成中医干预类临床证据分级系统,其中古籍证据从医案来源、诊疗内容的全面性和传承性三方面进行评价,现代名医经验证据根据名医的资质、经验内容完整性、经验传承性进行评价。针对中医古籍、现代名医经验及现代研究多来源证据的整合,以定性综合为主,多来源证据的分级水平与现代研究GRADE证据评价保持一致,而中医古籍及现代名医经验作为辅助证据呈现,以期更加客观、全面地评价中医临床证据,进而指导临床实践。The grading of evidence is an important factor in clinical decision-making. The current evidence grading system based on western medicine is limited in the clinical practice of traditional Chinese medicine(TCM), therefore we propose the solutions to the development of grading system for TCM interventional evidence, following the international evidence grading standards, taking into considerations of the unique characteristics of TCM practice, based on the Grades of recommendation, assessment, development and evaluation(GARDE) evaluation system, and integrating with grading system regarding TCM classical literature and empirical evidence from modern famous doctors. The evidence from classical literature is suggested to be evaluated from three aspects including source of ancient medical records, comprehensive of treatment details, and the inheritance. The qualification of famous doctors, content integrity, and inheritance of experiences will be used to evaluate the evidence from famous doctors' experience. The multi-sourced evidence such as TCM classical literature, experience of modern famous doctors, and modern researches is mainly integrated in a qualitative way, and the overall level of evidence of TCM interventions will be graded consistently with the GRADE system based on modern research. The evidence from classical literature and modern famous doctors' experience will be assessed and considered as supplementary evidence, which will make the evaluation of clinical evidence more objectively and comprehensively, thereby guiding clinical practice further.

关 键 词：干预类临床证据 中医古籍 名医经验 GRADE 

分 类 号：R2-0[医药卫生—中医学]