Method for identifying and selecting search terms for the classical literature 60

Searches were conducted of relevant books in the Library at Guangdong Provincial Hospital of Chinese Medicine or Beijing University of TCM, books in Xin Hua Book store in Beijing, China and books and dictionaries held at RMIT University in Melbourne.

Step 1: Book Searches

A workshop was held at Guangdong Provincial Chinese Medicine Hospital from October 7-14, 2010 that focused on methods used for analysis of the classical CM literature. More than ten books were located in the library at Guangdong Provincial Chinese Medicine Hospital. These included books on Chinese internal medicine, clinical Chinese internal medicine and specialty books on respiratory diseases, which contained chapters on COPD and/or pulmonary diseases associated with COPD and listed in Appendix 4.

The TCM disease names commonly related to COPD in these chapters were Ke sou (咳嗽), Chuan zheng (喘证) and Fei zhang (肺胀). Ke sou was further divided into Bao ke (暴咳) and

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Jiu ke (久咳) in two books written by Wu and Zhu (296, 297). The former term refers to a suddenly occurring violent cough of short duration and the latter term refers to a long-term cough. In addition, syndrome names like Tan ke (痰咳) and Tan sou (痰嗽) were described in the book written by Wang in 2009 (248). The term Zhi yin (支饮) was also found in the book by Wu (296), but it was not classified under pulmonary diseases. Fei zhang was mentioned in all of the books (Appendix 4).

Step 2: Dictionary Searches

The words pertaining to major symptoms, syndromes and disease names for COPD and related disorders were looked up in dictionaries, including Zhong Yi Da Ci Dian (中医大辞 典), Jian Ming Zhong Yi Ci Dian (简明中医辞典) and Xin Pian Jian Ming Zhong Yi Ci Dian (新编简明中医辞). These terms are listed in (Table 4. 1). The TCM disease names associated with COPD found in these dictionaries included the following: Ke sou; Chuan zheng; and Chuan sou (喘嗽). The syndrome names included the following: Ke ni (咳逆) Chuan man (喘 满); Chuan tan (喘痰); Fei zhang; Tan ke (痰咳); Tan sou (痰嗽); Tan chuan (痰喘); Tan yin ke sou (痰饮咳嗽); Tan yin chuan ji (痰饮喘急); and Tan yu sou (痰瘀嗽) (Table 4.1).

Table 4. 1 Traditional disease names related to COPD found in dictionaries

First Author,

date Dictionary name (in

English) Dictionary name (in

Chinese) Disease names relevant to COPD

Li, 2004 Concise Chinese Medicine

Dictionary 简明中医辞典 (修订本) Ke sou, Chuan zheng,

Fei zhang Li, 2005 Great Dictionary of Chinese

Medicine 中医大辞典 Ke sou, Chuan zheng,

Fei zhang, Tan yin Yan, 2007 New Concise Dictionary of

Chinese Medicine 新编简明中医辞典 Ke sou, Chuan zheng,

Fei zhang

Step 3: Journal Database Searches

As discussed in Chapter 4, 102 articles were included in the systematic review based on searches of several journal databases, including CNKI, CQVIP and Wanfang. COPD was considered to belong to the Chinese medicine category of Chuan zheng (including Jiu chuan 久喘 and Xu chuan 虚喘) in 57 articles, to the category of Fei zhang in 57 articles, to the category of Ke sou (including Jiu ke and Ke sou by internal impairment, 内伤咳嗽) in 35 articles, to the category of Tan yin in 15 articles and to Xiao zheng (哮证) in 12 articles.

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In addition, the terms Ke chuan (咳喘), Duan qi (短气) and Xu lao (虚劳) were reported in one article each. Chuan zheng and Fei zhang were simultaneously mentioned in 52 articles, while the three terms Ke sou, Chuan zheng and Fei zhang were all mentioned in 28 articles.

Step 4 Categorization of the classical terms

Cough is one of the most common symptoms not only for COPD, but also for other lung and non-lung diseases. Thus, it is not a symptom unique to COPD. Cough in and of itself does not lead to a diagnosis of COPD, even if it is chronic. A positive diagnosis of COPD is made when cough also presents with terminal bronchiectasis (i.e. emphysema as a result of partial blockage of terminal bronchioles).

Similarly, wheezing is a syndrome that can be observed in many different diseases, such as cardiac or renal insufficiency, both of which may present with breathing difficulties. Tan Yin, a by-product of a disturbance in water metabolism, can stagnate in any Zang fu (viscera and bowels) organs causing various types of disease. In Chinese medicine, the condition of Tan yin is not classified within the category of pulmonary diseases. Also, the three presentations of Cough, Wheezing and Tan yin described above actually encompass a wide range of medical conditions.

The important issue was how to differentially identify the circumstances when these terms were relevant to the diagnosis of COPD. Identifying conditions that were likely to have been COPD was based on the age of the patient, descriptions of the symptoms and their onset (whether the condition was acute or chronic) and other aspects (see details below).

Step 5 Search procedures for ZHYD

When the ZHYD is opened, two separate window panes are displayed to the left and right of the interface. These interact with each other as the user navigates through the different sections of the CD-ROM. The pane on the left-hand side shows the outline of the dictionary and a catalogue of books. The pane on the right-hand side shows the contents of relevant works. There are five functions on the top of the right pane that include the search field and buttons for book search, headings search, content search and results exchange.

The following figures show the procedure for searching the ZHYD using a particular search term. In Figure 4.1, Ke sou was entered into the search field, the categories/headings (Mu lu) search was selected and 839 hits were found for this term in the categories/headings in the

63 books (shown in red text).

Select the ‘Heading search’

button

Figure 4. 1 Search procedure for the ZHYD using Ke sou as the search term and showing the initial results

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After this, the ‘show results’ button is selected to display all of the book headings in which results were found in the left-hand pane (see Figure 4.2).

Figure 4. 2 Search procedure for the ZHYD using Ke sou as the search term, showing the book headings that contain results (left pane)

Select the ‘show results’ button

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By selecting the arrow key at the right bottom corner, one can scroll down to see all of the contents in the book that are shown under each heading displayed in the right-hand pane (see Figure 4.3).

Select the arrow

Figure 4. 3 Search procedure for the ZHYD using Ke sou as the search term, showing the book contents in the right pane for each heading in results left pane.

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Results of trial searches of the ZHYD for search term selection

Trial searches of the ZHYD were conducted for each candidate search term to determine its utility and specificity (see Table 4.2). For example, the terms Tan yin (phlegm, sputum) and Ke sou (cough) were entered into the ZHYD. Both search terms were found to be too broad.

There were 297 results found in a headings search for Tan yin. These included a wide variety of conditions that involved Tan yin as a symptom or as part of the aetiology. Similarly, there were 839 results found when searching the term Ke sou, which involved many kinds of Ke sou (cough) with numerous instances of children with Ke sou. Some of these results referred to long-term or many years cough that were described as Jiu ke sou, Jinian kesou (积年咳嗽), Yuannian kesou ( 远 年 咳 嗽 ) or Tanyin kesou. Thus, these more specific terms were considered to be more suitable as search terms for COPD.

Table 4. 2 Results from heading searches and content searches for candidate search terms

Search terms Heading search Content search

Ke sou (cough) 839 10,830

Jiu ke sou (long-term cough) 11 94

Jiu ke (chronic cough) 21 609

Jiu sou (chronic sputum) 39 1083

Chuan zheng (dyspnoea) 20 72

Chuan sou (dyspnoea and sputum 46 1845

Ke chuan (cough and dyspnoea) 13 629

Fei zhang (lung distension) 13 656

Zhi yin (Thoracic fluid retention) 8 520

Tan yin (phlegm-fluid retention) 297 4318

Tanyin kesou

(phlegm-fluid retention causing cough) 25 84

4.1.1.3 Finalisation of search terms

Based on the steps discussed above, the following list of search terms was identified: Jiu ke;

Jiu sou; Ke chuan; Chuan sou; Chuan zheng; Fei zhang; Zhi yin; and Tan yin ke sou. The majority of these search terms are disease names in Chinese medicine, in addition to some syndrome names that are related to cough and dyspnoea. Zhi yin also belongs to the category of Tan yin with a presentation of either cough, dyspnoea, sputum or chest tightness.

According to respiratory experts’ opinions on the correlation between terms used in CM and COPD, the term Zhi yin was suggested by Guangdong Provincial Hospital as a suitable search term.

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