Asserted and neglected issues linking evidence-based and Chinese medicines for cardiac rehabilitation

Table 1 Summary description of studies on the asserted issues linking evidence-based and Chinese medicines

Ref.	Study characteristics	Main results	Main limitation
Natural history of patterns
Luiz et al[12]	Cross-sectional observational design Forty-three patients with hypertension grades I, II and III	Patterns were strongly or moderately associated with target-organ damage Manifestations were at most weakly associated with hemodynamic variables	Target-organ damages were not confirmed by laboratory or imagery methods Patients were under antihypertensive drug therapy
Chan et al[20]	Systematic review (8 studies) Seven randomized controlled trials and one non-randomized controlled clinical trial	Qigong improved physical symptoms in patients with coronary artery disease Qigong improved functional capacity of cardiac patients Qigong reduced blood pressure levels No adverse effects reported	Overall poor quality of most studies included in the review Study heterogeneity
Yeh et al[21]	Systematic review (26 studies) Nine randomized controlled trials, thirteen non-randomized controlled trials, and four observational studies	Taijiquan reduced blood pressure levels No adverse effects reported	Overall poor quality of most Chinese studies included in the review Study heterogeneity
Pulse palpation
Luiz et al[12]	Cross-sectional observational design Forty-three patients with hypertension grades I, II and III	Frequency analysis of clinical manifestations and pulse images of patterns Most frequent pulse image: wiry pulse (52% of the cases)	Patients were under antihypertensive drug therapy
Ferreira et al[25]	Cross-sectional observational study Twenty-nine healthy subjects and twenty-three patients with hypertension grades I, II or III	Higher pulse wave velocity and lower arterial compliance of the brachial-radial artery segment in hypertension	Arterial tonometry was subjected to transducer set-up and manual positioning Patients were under antihypertensive drug therapy
Ferreira et al[26]	Cross-sectional observational study Sixty-three healthy subjects and fifty-two patients with hypertension grades  I, II or III	Lower arterial compliance of the brachial-radial artery segment in hypertension Hypertrophic remodeling of medium-sized arteries in hypertension	Arterial tonometry was subjected to transducer set-up and manual positioning Patients were under antihypertensive drug therapy
Ferreira et al[27]	Cross-sectional observational study Sixty-three healthy subjects and fifty-two patients with hypertension grades I, II or III	Impaired flow-mediated vasodilation in hypertension	Arterial tonometry was subjected to transducer set-up and manual positioning Patients were under antihypertensive drug therapy
Ferreira et al[28]	Cross-sectional observational study Sixty-three healthy subjects and fifty-two patients with hypertension grades I, II or III	Increased peripheral vascular resistance immediately after ischemic occlusion Slower response to flow-mediated vasodilation	Arterial tonometry was subjected to transducer set-up and manual positioning Patients were under antihypertensive drug therapy
Lu[29]	Cross-sectional observational study Fifty-nine patients with hypertension grades I, II or III	Higher amplitudes for harmonics #0 (heart), #1 (liver), #3 (spleen), #4 (lung), and #6 (gallbladder) in hypertension	Poor description of the studied sample Patients were under antihypertensive drug therapy
Ferreira[30]	Computational simulation study Model of the radial artery during "simultaneous pressing"	Lack of correspondence between pressure pulse spectral harmonics and Chinese medicine theory of pulse palpation	No experimental data from patients with hypertension
Herbal therapy
Xiong et al[32]	Narrative review	Herbal therapy may potentially reduce blood pressure variability, inhibit sympathetic activity, prevent target-organ damage, and improve insulin resistance	Potentially biased (selection and report bias) Some results outcome from animal studies not yet tested in humans

Table 2 Summary description of studies on the neglected issues linking evidence-based and Chinese medicines

Ref.	Study characteristics	Main results	Main limitation
Anatomical variations of vessels
Chen et al[43]	Cross-sectional observational study One hundred healthy subjects, forty-six with pancreatitis, forty-two with duodenal bulb ulcer, twenty-two with appendicitis, and third-eight with acute appendicitis	Accuracy of 82% for classification of normal or abnormal pulses using an auto-regressive model for analysis of wrist pulse signals (blood flow signal) and a support vector machine	Ultrasound-based blood flow measurements was subjected to manual positioning and operator experience Only one position was investigated (above the styloid process) Pattern differentiation was performed (in either group) and the results were not related to Chinese medicine theory
Huang et al[44]	Cross-sectional observational study Thirty normal subjects and thirty patients with palpitation	Higher spectral harmonic energy ratio in patients	Only 10 s were evaluated at each position Palpitation was only characterized by the evidence-based medicine and no correspondence to patterns was established Pattern differentiation was performed in either group and the results were not related to Chinese medicine theory Lack of relationship between spectral harmonic energy ratio and Chinese medicine theory for pulse palpation
Hu et al[45]	Cross-sectional observational study Six normal subjects (all male)	No significant difference was observed on pulse waveform parameters obtained with single or array sensors Significant differences were observed among depths	Only one position was investigated (above the styloid process) Pattern differentiation was performed in either group and the results were not related to Chinese medicine theory