Clinical efficacy of comprehensive therapy based on traditional Chinese medicine patterns on patients with pneumoconiosis: a pilot double-blind, randomized, and placebo-controlled study
1. Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of China, Henan University of Chinese Medicine, Zhengzhou 450046, China 2. Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou 450046, China 3. Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China 4. Department of Pneumoconiosis, Henan Hospital for Occupational Diseases, Zhengzhou 450052, China 5. Department of Respiratory Diseases, Jiaozuo Coal Industry Group Co., Ltd. Central Hospital, Jiaozuo 454000, China 6. Department of Pneumoconiosis, Yima Coal Industry Group Co., Ltd. General Hospital, Yima 472300, China
Effective therapy options for pneumoconiosis are lacking. Traditional Chinese medicine (TCM) presents a favorable prospect in the treatment of pneumoconiosis. A pilot study on TCM syndrome differentiation can evaluate the clinical efficacy and safety of TCM and lay a foundation for further clinical research. A double-blind, randomized, and placebo-controlled trial was conducted for 24 weeks, in which 96 patients with pneumoconiosis were randomly divided into the control and treatment groups. Symptomatic treatment was conducted for the two groups. The treatment group was treated with TCM syndrome differentiation, and the control group was treated with placebo. The primary outcomes were the six-minute walking distance (6MWD) and the St. George Respiratory Questionnaire (SGRQ) score. The secondary outcomes were the modified British Medical Research Council Dyspnea Scale (mMRC), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and pulmonary function. Only 83 patients from the 96 patients with pneumoconiosis finished the study. For the primary outcome, compared with the control groups, the treatment group showed a significantly increased 6MWD (407.90 m vs. 499.51 m; 95% confidence interval (CI) 47.25 to 135.97; P <0.001) and improved SGRQ total score (44.48 vs. 25.67; 95% CI −27.87 to −9.74; P <0.001). The treatment group also significantly improved compared with the control group on mMRC score (1.4 vs. 0.74; 95% CI −1.08 to −0.23; P =0.003), CAT score (18.40 vs. 14.65; 95% CI −7.07 to −0.43; P =0.027), and the total symptom score (7.90 vs. 5.14; 95% CI −4.40 to −1.12; P <0.001). No serious adverse events occurred. This study showed that TCM syndrome differentiation and treatment had a favorable impact on the exercise endurance and quality of life of patients with pneumoconiosis.
. [J]. Frontiers of Medicine, 2022, 16(5): 736-744.
Jiansheng Li, Hulei Zhao, Yang Xie, Jieya Li, Qingwei Li, Xuexin Chen, Weiyu Zhang. Clinical efficacy of comprehensive therapy based on traditional Chinese medicine patterns on patients with pneumoconiosis: a pilot double-blind, randomized, and placebo-controlled study. Front. Med., 2022, 16(5): 736-744.
Ginseng, Chinese Magnoliavine Fruit, Epimedium Herb, Rose-Boot, Tendrilleaf Fritillary Bulb, Tree Peony Root Bark, Coix Seed, Perilla Seed
Tab.1
Fig.1
Variable
ITT analysis
PP analysis
Treatment group (N=48)
Control group (N=48)
Treatment group (N=43)
Control group (N=40)
Age, year, mean±SD
53.96±9.01
57.40±10.13
54.40±9.18
57.23±10.75
Disease type
Anthracosis, n (%)
34 (70.83)
34 (70.83)
32 (74.42)
27 (67.50)
Silicosis, n (%)
8 (16.67)
9 (18.75)
6 (13.95)
9 (22.50)
Anthracosilicosis, n (%)
6 (12.50)
5 (10.42)
5 (11.63)
4 (10.00)
Course of disease, month, median (IQR)
57.00 (31.50,117.00)
65.00 (24.00,156.75)
49.00 (29.00,120.0)
60.00 (24.00,156.75)
Western medicine treatment
Symptomatic treatment, n (%)
15 (31.25)
15 (31.25)
12 (27.91)
12 (30.00)
Cetylcysteine, n (%)
10 (22.83)
11 (22.92)
9 (20.93)
8 (20.00)
Tiotropium, n (%)
4 (8.33)
10 (22.83)
2 (4.65)
9 (22.50)
Doxofylline, n (%)
0 (0.00)
2 (4.17)
0 (0.00)
1 (2.50)
Tetrandrine, n (%)
10 (22.83)
12 (25.00)
10 (23.26)
9 (22.50)
Pulmonary function, mean±SD
FEV1 (L)
2.67±0.95
2.61±1.07
2.76±0.73
2.63±1.17
FVC (L)
3.54±1.24
3.54±1.15
3.59±0.91
3.57±1.25
FEV1/FVC (%)
74.47±10.28
73.17±12.05
76.45±8.07
73.15±13.18
FEV1%
83.05±29.39
80.04±31.74
86.74±21.49
81.18±33.92
PEF (L/s)
7.13±2.61
7.16±2.75
7.36±2.42
7.20±2.90
DLCO (mL/mmHg/min)
7.45±2.50
7.22±1.76
7.75±2.20
7.35±1.73
Tab.2
Variable
ITT analysis
PP analysis
Treatment group (N=48)
Control group (N=48)
Treatment group (N=43)
Control group (N=40)
Hypertension disease, n (%)
4 (8.33)
4 (8.33)
4 (9.30)
4 (10.00)
Amlodipine, n (%)
1 (2.08)
0 (0.00)
1 (2.33)
0 (0.00)
Captopril, n (%)
1 (2.08)
0 (0.00)
1 (2.33)
0 (0.00)
Nimodipine, n (%)
0 (0.00)
1 (2.08)
0 (0.00)
1 (2.50)
Indapamide, n (%)
1 (2.08)
0 (0.00)
1 (2.33)
0 (0.00)
Nifedipine, n (%)
2 (4.17)
2 (4.17)
2 (4.65)
2 (5.00)
Valsartan, n (%)
0 (0.00)
1 (2.08)
0 (0.00)
1 (2.50)
Chronic obstructive pulmonary disease, n (%)
0 (0.00)
1 (2.08)
0 (0.00)
1 (2.50)
Tiotropium, n (%)
0 (0.00)
1 (2.08)
0 (0.00)
1 (2.50)
Diabetes, n (%)
2 (4.17)
3 (6.25)
2 (4.65)
3 (7.50)
Acarbose, n (%)
0 (0.00)
1 (2.08)
0 (0.00)
1 (2.50)
Metformin, n (%)
1 (2.08)
2 (4.17)
1 (2.33)
2 (5.00)
Gliclazide, n (%)
0 (0.00)
2 (4.17)
0 (0.00)
2 (5.00)
Insulin glargine, n (%)
1 (2.08)
0 (0.00)
1 (2.33)
0 (0.00)
Gastric Ulcer, n (%)
1 (2.08)
0 (0.00)
1 (2.33)
0 (0.00)
Omeprazole, n (%)
1 (2.08)
0 (0.00)
1 (2.33)
0 (0.00)
Cimetidine, n (%)
1 (2.08)
0 (0.00)
1 (2.33)
0 (0.00)
Tab.3
Variable
Treatment group (N=43)
Control group (N=40)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
6MWD, mb
447.12±108.23
499.51±99.39
437.31±107.66
407.90±103.72
91.61 (47.25 to 135.97)
16.883
< 0.001
SGRQ symptoms scoreb
50.47±22.68
36.94±22.25
55.15±17.93
47.75±20.27
−10.811 (−20.13 to −1.49)
5.328
0.024
SGRQ activity scoreb
44.76±23.63
28.20±23.30
46.61±23.87
47.53±25.31
−19.33 (−29.95 to −8.71)
13.125
0.001
SGRQ impacts scoreb
36.59±27.44
20.27±18.53
43.56±26.19
41.18±24.45
−20.92 (−30.35 to −11.49)
19.464
< 0.001
SGRQ total scoreb
41.25±24.16
25.67±18.94
45.63±23.37
44.48±22.54
−18.81 (−27.87 to −9.74)
17.025
< 0.001
Tab.4
Variable
Treatment group (N=48)
Control group (N=48)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
6MWD, mb
439.25±111.96
486.19±109.14
432.53±102.40
407.08±100.12
79.10 (36.66 to 121.55)
13.693
< 0.001
SGRQ symptoms scoreb
51.55±24.99
34.22±22.52
53.90±17.97
45.33±21.38
−11.11 (−20.01 to −2.21)
6.143
0.015
SGRQ activity scoreb
46.43±25.60
25.26±23.68
47.98±22.31
42.60±27.34
−17.34 (−27.71 to −6.98)
11.040
0.001
SGRQ impacts scoreb
38.69±28.55
18.63±18.17
44.48±24.60
37.58±25.02
−18.95 (−27.81 to −10.08)
18.014
< 0.001
SGRQ total scoreb
43.08±25.80
23.42±19.11
46.43±21.80
40.39±24.06
−16.97 (−25.78 to −8.17)
14.644
< 0.001
Tab.5
Variable
Treatment group (N=48)
Control group (N=48)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
mMRC scoreb
1.46±0.87
0.90±1.08
1.37±0.98
1.45±1.01
−0.56 (−0.98 to −0.14)
6.881
0.010
CAT scoreb
17.00±9.26
15.42±9.54
18.37±7.65
17.9±6.47
−2.48 (−5.78 to 0.82)
2.221
0.140
HADS-anxiety scoreb
7.00±3.88
4.35±3.56
7.17±3.47
6.06±3.72
−1.71 (−3.19 to −0.23)
5.276
0.024
HADS-depression scoreb
6.50±4.38
5.27±4.04
7.38±3.31
5.56±3.73
−0.29 (−1.28 to 1.87)
0.135
0.714
Tab.6
Variable
Treatment group (N=43)
Control group (N=40)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
mMRC scoreb
1.37±0.76
0.74±0.93
1.35±1.05
1.40±1.01
−0.66 (−1.08 to −0.23)
9.526
0.003
CAT scoreb
16.33±8.29
14.65±8.52
18.08±8.03
18.40±6.44
−3.75 (−7.07 to −0.43)
5.05
0.027
HADS-anxiety scoreb
6.79±3.78
4.86±3.42
7.00±3.65
6.75±3.38
−1.89 (−3.38 to −0.40)
6.398
0.013
HADS-depression scoreb
6.29±4.10
5.88±3.81
7.22±3.50
6.15±3.50
−0.27 (−1.87 to 1.34)
0.109
0.742
Tab.7
Variable
Treatment group (N=48)
Control group (N=48)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
Cough scoreb
1.00 (1.00,2.00)
0.50 (0.00,1.00)
2.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (0.00 to 0.00)
1.771
0.077
Expectoration scoreb
1.00 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
2.429
0.015
Wheezing scoreb
2.00 (1.00,2.00)
1.00 (0.00,2.00)
1.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
3.508
< 0.001
Chest tightness scoreb
2.00 (1.00,2.00)
1.00 (0.25,1.00)
1.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
2.408
0.016
Shortness of breath scoreb
1.50 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
2.380
0.017
Fatigue scoreb
2.00 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (1.00,2.00)
1.00 (1.00,1.00)
0.00 (−1.00 to 0.00)
2.822
0.005
Cyanosis scoreb
1.00 (0.00,1.00)
0.00 (0.00,1.00)
1.00 (0.00,1.00)
1.00 (0.00,1.00)
0.00 (0.00 to 0.00)
1.117
0.264
Total clinical symptom scorec
8.83±3.57
5.58±4.20
8.73±3.19
8.06±3.35
−2.48 (−4.02 to −0.94)
10.222
0.002
Tab.8
Variable
Treatment group (N=43)
Control group (N=40)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
Cough scoreb
1.00 (1.00,2.00)
0.00 (0.00,1.00)
2.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
1.896
0.058
Expectoration scoreb
1.00 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (0.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
2.339
0.019
Wheezing scoreb
2.00 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (1.00,2.00)
1.00 (1.00,2.00)
−1.00 (−1.00 to 0.00)
3.331
0.001
Chest tightness scoreb
2.00 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
2.033
0.042
Shortness of breath scoreb
1.00 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (1.00,2.00)
1.00 (1.00,2.00)
0.00 (−1.00 to 0.00)
2.008
0.045
Fatigue scoreb
2.00 (1.00,2.00)
1.00 (0.00,1.00)
1.00 (1.00,2.00)
1.00 (0.25,1.75)
−1.00 (−1.00 to 0.00)
3.009
0.003
Cyanosis scoreb
1.00 (0.00,1.00)
0.00 (0.00,1.00)
1.00 (0.00,1.00)
1.00 (0.00,1.00)
0.00 (0.00 to 0.00)
1.286
0.198
Total clinical symptom scorec
8.72±3.38
5.14±3.88
8.60±3.30
7.90±3.60
−2.76 (−4.40 to −1.12)
11.159
< 0.001
Tab.9
Variable
Treatment group (N=48)
Control group (N=48)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
Physical function scoreb
75.00 (46.25,85.00)
75.0 0 (55.00,85.00)
60.00 (45.00,85.00)
60 (50.00,80.00)
0.00 (−5.00 to 10.00)
−0.735
0.462
Role physical scoreb
12.50 (0.00,75.00)
0.00 (0.00,100.00)
0.00 (0.00, 75.00)
0.00 (0.00,50.00)
0.00 (0.00 to 0.00)
−1.726
0.084
Bodily pain scoreb
62.00 (52.00,84.00)
74.00 (62.00,100)
62.00 (52.00,74.00)
74.00 (62.00,96.00)
0.00 (0.00 to 10.00)
−1.038
0.229
General health scoreb
37.50 (26.25,50.00)
51.00 (35.00,64.25)
40.00 (26.25,50.00)
35.00 (30.00,45.00)
10.00 (5.00 to 15.00)
−3.159
0.002
Vitality scoreb
50.00 (45.00,63.75)
55.50 (50.00,65.00)
50.00 (45.00,63.75)
50.00 (50.00,60.00)
0.00 (0.00 to 5.00)
0.682
0.495
Social functionb
62.50 (50.00,87.50)
75.00 (53.13,87.50)
75.00 (50.00,87.50)
62.50 (50.00,87.50)
0.00 (0.00 to 12.50)
−0.992
0.321
Role emotional scoreb
33.00 (0,100.00)
33.30 (0.00,100.00)
0.00 (0.00,66.70)
0.00 (0.00,66.70)
0.00 (0.00 to 0.00)
0.242
0.808
Mental health scoreb
52.00 (48.00,60.00)
52.00 (48.00,56.00)
52.00 (49.00,56.00)
52.00 (52.00,56.00)
0.00 (−4.00 to 0.00)
0.844
0.398
Health change score
25.00 (25.00,50.00)
50.00 (25.00,75.00)
25.00 (20.00,50.00)
50.00 (25.00,50.00)
0.00 (0.00 to 25.00)
−1.137
0.255
Tab.10
Variable
Treatment group (N=43)
Control group (N=40)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
Physical function scoreb
75.00 (55.00,85.00)
80.00 (60.00,85.00)
60.00 (41.25, 88.75)
65.00 (46.25,80.00)
0.00 (−5.00 to 10.00)
−0.549
0.583
Role physical scoreb
25.00 (0.00,75.00)
0.00 (0.00,100.00)
0.00 (0.00, 75.00)
0.00 (0.00,50.00)
0.00 (0.00 to 25.00)
−1.707
0.088
Bodily pain scoreb
62.00 (52.00,84.00)
74.00 (62.00,100.00)
62.00 (52.00,81.50)
74.00 (62.00,100.00)
0.00 (0.00 to 10.00)
0.872
0.383
General health scoreb
40.00 (30.00,50.00)
55.00 (35.00,65.00)
40.00 (21.25, 50.00)
35.00 (30.00,45.00)
10.00 (5.00 to 17.00)
−3.061
0.002
Vitality scoreb
50.00 (45.00,65.00)
55.00 (50.00,65.00)
50.00 (45.00,65.00)
50.00 (50.00,60.00)
0.00 (−5.00 to 5.00)
−0.656
0.512
Social functionb
62.00 (50.00,87.00)
75.00 (62.00,87.00)
75.00 (50.00,87.00)
62.50 (50.00,87.50)
0.00 (0.00 to 12.50)
−0.961
0.337
Role emotional scoreb
33.30 (0,100.00)
33.30 (0.00,100.00)
0.00 (0.00,91.68)
0.00 (0.00,100.00)
0.00 (0.00 to 0.00)
−0.264
0.792
Mental health scoreb
52.00 (48.00,60.00)
52.00 (48.00,56.00)
52.00 (52.00,59.00)
56.00 (52.00,56.00)
0.00 (−4.00 to 0.00)
0.815
0.415
Health change score
25.00 (25.00,50.00)
50.00 (25.00,75.00)
25.00 (25.00,50.00)
50.00 (25.00,50.00)
0.00 (0.00 to 25.00)
−1.137
0.255
Tab.11
Variable
Treatment group (N=48)
Control group (N=48)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
FEV1 (L)b
2.67±0.95
2.65±0.82
2.61±1.07
2.62±0.77
0.03 (−0.29 to 0.36)
0.045
0.832
FVC (L)b
3.54±1.24
3.63±1.08
3.54±1.15
3.60±1.01
0.03 (−0.39 to 0.46)
0.025
0.875
FEV1/FVC(%)b
74.47±10.28
72.99±10.34
73.17±12.05
72.97±11.47
0.02 (−4.41 to 4.44)
0.000
0.994
FEV1%b
83.05±29.39
82.51±24.88
80.04±31.74
82.08±26.54
0.43 (−9.99 to 10.86)
0.007
0.934
PEF (L/s)b
7.13±2.61
6.75±2.36
7.16±2.75
6.99±2.38
−0.24 (−1.20 to 0.73)
0.237
0.628
DLCO (mL/mmHg/min)b
7.45±2.50
8.68±5.43
7.22±1.76
8.31±4.25
0.38 (−1.60 to 2.35)
0.143
0.706
Tab.12
Variable
Treatment group (N=43)
Control group (N=40)
95% CI for the difference
Statistics
Pa
Pre
Post
Pre
Post
FEV1 (L)b
2.76±0.73
2.71±0.61
2.63±1.17
2.64±0.83
0.07 (−0.24 to 0.39)
0.206
0.651
FVC (L)b
3.59±0.91
3.66±0.73
3.57±1.25
3.65±1.10
0.10 (−0.40 to 0.41)
0.002
0.966
FEV1/FVC (%)b
76.45±8.07
74.22±8.45
73.15±13.18
72.47±12.17
1.76 (−2.79 to 6.30)
0.589
0.445
FEV1%b
86.74±21.49
85.29±17.11
81.18±33.92
83.48±27.92
1.81 (−8.23 to 11.84)
0.129
0.721
PEF (L/s)b
7.36±2.42
7.00±2.09
7.20±2.90
7.07±2.44
−0.07 (−1.06 to 0.92)
0.020
0.889
DLCO (mL/mmHg/min)b
7.75±2.20
9.13±5.46
7.35±1.73
8.66±4.51
0.47 (−1.72 to 2.67)
0.184
0.669
Tab.13
1
Lung Disease Group of Labor Hygiene Occupational Diseases Branch of Chinese Preventive Medicine Association Occupational. Consensus of Chinese experts on pneumoconiosis treatment (2018). J Environ Occup Med (Huan Jing Yu Zhi Ye Yi Xue) 2018; 35( 8): 677− 689 (in Chinese)
2
Health National Planning Commission of the People’s Republic of China Family. National occupational health standards: GBZ 70–2015. Beijing: China Quality and Standards Publishing & Media Co., Ltd., 2015
3
M Mlika R Adigun SB Beenish. Silicosis (Coal Worker Pneumoconiosis). Treasure Island (FL): StatPearls Publishing, 2020
DJ Blackley, CN Halldin, AS Laney. Continued increase in prevalence of coal workers’ pneumoconiosis in the United States, 1970–2017. Am J Public Health 2018; 108( 9): 1220– 1222 https://doi.org/10.2105/AJPH.2018.304517
6
Health Commission of the People’s Republic of China National. Statistical bulletin on the development of health care in China in 2018. (accessed July 6, 2020)
7
QY Yang HJ Wang LH Liu XJ Zhang XX Zou. Prevalence of silicosis among workers exposed to silica dust in China during 2002–2016: a meta-analysis. Chin J Ind Med (Zhongguo Gong Ye Yi Xue Za Zhi) 2018; 31( 4): 307− 308 (in Chinese)
8
XJ Zhu P Xiao D Wang HF Wang YH Wang Y Yu P Yin J Li J Li MG Zhou T Li. Analysis on disease burden of pneumoconiosis in Chinese population from 1990 to 2017. Chin J Ind Med (Zhongguo Gong Ye Yi Xue Za Zhi) 2019; 32( 05): 341− 346 (in Chinese)
9
H Tang, YD Wang, H Chen, JJ Xu, BP Li. Case fatality rate in patients with pneumoconiosis in China: a meta-analysis. Chin J Ind Hyg Occu Dis (Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi) 2015; 33( 3): 229– 232
10
G Zhao. The analysis of social and economic impact of pneumoconiosis in our country. Master thesis. Beijing: China University of Geosciences, 2011 (in Chinese)
11
XY Wang JB Zhang CL Wei WJ Wan YC Han BW Zhang. Effect of large volume whole lung lavage on respiratory function of patients with pneumoconiosis: a systematic review and meta-analysis. J Changzhi Med Coll (Changzhi Yi Xue Yuan Xue Bao) 2016; 30( 2): 104– 107 (in Chinese)
12
WJ Mao, JY Chen, MF Zheng, SG Ye, F Liu, YJ He, B Wu, J Zhang. Lung transplantation for end-stage silicosis. J Occup Environ Med 2011; 53( 8): 845– 849 https://doi.org/10.1097/JOM.0b013e3182260e50
13
P Spitalieri, MC Quitadamo, A Orlandi, L Guerra, E Giardina, V Casavola, G Novelli, C Saltini, F Sangiuolo. Rescue of murine silica-induced lung injury and fibrosis by human embryonic stem cells. Eur Respir J 2012; 39( 2): 446– 457 https://doi.org/10.1183/09031936.00005511
14
DJ Weiss. Stem cells, cell therapies, and bioengineering in lung biology and diseases. Comprehensive review of the recent literature 2010–2012. Ann Am Thorac Soc 2013; 10( 5): S45– S97 https://doi.org/10.1513/AnnalsATS.201304-090AW
15
PP Song, J Liu, H Xiao, XY Ma, SQ Zhang, YX Chen. Clinical study on traditional Chinese medicine syndrome differentiation and treatment of pneumoconiosis. Chin J Ind Hyg Occup Dis (Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi) 2019; 37( 3): 186– 188
16
HJ Wang, GQ Ma. Introduction to Professor Ma Guiqin’s experience in treatment of occupational pneumoconiosis. China J Chin Materia Medica (Zhongguo Zhong Yao Za Zhi) 2019; 44( 13): 2871– 2874
17
CY Tang XX Qiu HZ Zhou DH Wu WZ Gan. Influencing factors and quality of life in patients with occupational pneumoconiosis. China Occup Med (Zhongguo Zhi Ye Yi Xue) 2016; 43( 03): 292− 295 (in Chinese)
18
MH Wang, JS Li, SY Li, Y Xie. Effects of comprehensive therapy based on traditional Chinese medicine patterns on older patients with chronic obstructive pulmonary disease: a subgroup analysis from a four-center, randomized, controlled study. Front Med 2014; 8( 3): 368– 375 https://doi.org/10.1007/s11684-014-0360-0
19
R Shao, FJ Wang, M Lyu, J Yang, P Zhang, Y Zhu. Ability to suppress TGF-β-activated myofibroblast differentiation distinguishes the anti-pulmonary fibrosis efficacy of two danshen-containing Chinese herbal medicine prescriptions. Front Pharmacol 2019; 10 : 412 https://doi.org/10.3389/fphar.2019.00412
20
H Du, YH Wang, YM Shi, J Yu, W Sun, YQ Zhang. Effect of traditional Chinese medicine on inflammatory mediators in pediatric asthma. Mediators Inflamm 2016; 2016 : 5143703 https://doi.org/10.1155/2016/5143703
21
X Wang. Clinical study on treatment of pneumoconiosis with Xuanfei Dichen Tang. Master thesis. Jinan: Shandong University of Traditional Chinese Medicine Shandong University of Traditional Chinese Medicine, 2011 (in Chinese)
22
J Hu. Effect of TCM syndrome differentiation on quality of life and biological index of pneumoconiosis. Master thesis. Qingdao: Qingdao University, 2017 (in Chinese)
23
RY Zhang, D Wang, JP Wu, XL Li, CX Li, CF Guo. Randomized controlled clinical trials for acupuncture treatment of pneumoconiosis. Acupunct Res (Zhen Ci Yan Jiu) 2016; 41( 2): 163– 168
24
HL Zhao, Y Xie, JS Li. Analysis of registration data for clinical trials of pneumoconiosis. Chin J Indl Hyg Occup Dis (Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi) 2020; 38( 1): 20– 23
25
AE Holland, CJ Hill, T Rasekaba, A Lee, MT Naughton, CF McDonald. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2010; 91( 2): 221– 225 https://doi.org/10.1016/j.apmr.2009.10.017
26
SD Nathan, Bois RM du, C Albera, WZ Bradford, U Costabel, A Kartashov, PW Noble, SA Sahn, D Valeyre, D Weycker, TE Jr King. Validation of test performance characteristics and minimal clinically important difference of the 6-minute walk test in patients with idiopathic pulmonary fibrosis. Respir Med 2015; 109( 7): 914– 922 https://doi.org/10.1016/j.rmed.2015.04.008
27
YH Ma P Cui P Li GF Liu YW Jia X Zhou XX Gu WG Su. Observation on the efficacy of compound cream mulberry leaf mixture combined with traditional Chinese medicine constitutional intervention on pneumoconiosis. Mod J Integr Tradit Chin West Med (Xian Dai Zhong Xi Yi Jie He Za Zhi) 2020; 29( 12): 1284– 1287, 1330 (in Chinese)
28
SC Sun WT Li DW Lin SS Hou XW Wu XJ Shen YW Li MM Zhang. Clinical observation on the crude herb moxibustion combined with Bufei Huoxue Capsule in the treatment of syndrome of phlegm and blood stasis obstructing lung stage I silicosis. Chin J New Drugs (Zhongguo Xin Yao Za Zhi) 2019; 28( 09): 1099− 1103 (in Chinese)
29
SQ Niu YX Hu YC Cui HG Zheng YP Shi HJ Wang. Therapeutic observation of acupuncture plus Shengmai Dihuang Decoction for coalminer’s pneumoconiosis due to lung-kidney qi deficiency. Shanghai J Acupunct Moxibustion (Shanghai Zhen Jiu) 2019; 38( 09): 987− 991 (in Chinese)
30
MR Zhang L Tang LB Shao XH Yan J Li. Investigation on anxiety and depression of pneumoconiosis patients and related influencing factors. China Occup Med (Zhongguo Zhi Ye Yi Xue) 2013; 40( 01): 52− 54 (in Chinese)
31
XX Qiu YT Hao ZP Liang SJ Xiao XF Wu CS Chen AH Lin. Study on correlative factors of the quality of life of pneumoconiosis patients. Chin J Health Stat (Zhongguo Wei Sheng Tong Ji Za Zhi) 2011; 28( 03): 233− 236 (in Chinese)
