INTRODUCTION

Systematic healthc are reviews,often involving Meta-analyses,are a major source of evidence required when compiling guidelines or policies.The production and maintenance of such evidence necessitates the effective identification of relevant studies.This identification of studies can be greatly enhanced by good classification systems.Classification systems are especially important when reviewing interventions,as there are such large numbers of intervention types.Classification systems can potentially reduce confusion regarding terms,bring order to a complex interrelated group of treatments,and enable effective identification of the same,similar,or related interventions.

Since the 1970s,international health and medical communities have worked to classify medical terms regarding interventions.The medical subject headings(MeSH)thesaurus of the National Library of America(NLM)is a large,generic,medical classification system.1,2MeSH terms are employed within PubMed,which is a large general medical database.The MeSH thesaurus is highly structured,and serves the whole medical community;however,there are limitations to the level of detail to which specific parameters are classified.Hence,each medical subspecialty,although served by the MeSH thesaurus,is not necessarily fulfilled by it.The inclusion of new indexing within MeSH is a dynamic process,but not necessarily a rapid one.Specialist databases outside of PubMed tend to evolve their own controlled languages,which add further levels of classification to their highly specific subject areas.These controlled languages serve the same purposes as the original NLM MeSH classification,but service a more specialist user group.

Swift accurate identification of relevant work is essential for those undertaking systematic reviews.However,the sophistication of classifications varies.The present study explores this variation in the classification of interventions within TraditionalChinese Medicine(TCM).TCM has been in clinical use for more than 3000 years,and has accumulated a large number of interventions based on Chinese traditional culture and unique medical theory.A system of classification for interventions in TCM is necessary to meet the increasing demand for international communication,as well as for its own internal development.

METHODS

We collected and screened information on TCM intervention classifications from the libraries in Shanghai University of TCM and the University of Nottingham.Our pilot studies on this subject suggested that the main classifications were developed and distributed by large medical health organizations and institutes,such as the World Health Organization(WHO),the NLM,and the China Academy of Chinese Medical Sciences;therefore,we retrieved the latest progress news and documents from the relevant websites for these organizations.We used the term'acupuncture'as a search word,and listed and compared all results returned by the classifications or thesauruses to evaluate the TCM terms and structure included in each system.

RESULTS

Medical subject headings

5 Medical classification.Wikipedia,2016-01-18,cited 2016-03-10;1 screen(s).Available from URL:https://en.wikipedia.org/wiki/Medical_classification.

As early as 1967,the TCM term'moxibustion'was introduced into the MeSH thesaurus as'the burning of a small,thimble-sized,smoldering plug of dried leaves on the skin at an acupoint,usually the plugs contain leaves of Mugwort or moxa',and subsequently TCM was accepted as a type of medical system catalogued under'Medicine,East Asian Traditional'in 1984.3Most TCM descriptors are listed in the'complementary medicine therapy','culture',and'drug'categories.The TCM descriptors fall into broad general terms such as'Yin Yang'and'Qi',therapy terms such as'acupuncture','moxibustion',and'massage',terms relevant to Chinese Materia Medica such as'Drugs,Chinese Herbal',and then many Supplementary Concept Records of chemical compositions of herbs or TCM prescriptions.TCM interventions are mainly listed in the branch of'Analytical,Diagnostic and Therapeutic Techniques and Equipment[E]-Therapeutics[E02]-Complementary Therapies[E02.190]'.There are 10 items comprising interventions related to acupuncture and moxibustion in the MeSH thesaurus.4

Within the MeSH thesaurus,the classification of TCM is more detailed and systematic compared with other traditional medicines,but the coverage of all relevant TCM interventions is still far from comprehensive.Furthermore,some hierarchical relationships within the MeSH thesaurus are problematic.For example,'Moxibustion[E02.190.044.588]'is currently a subordinate concept of'Acupuncture Therapy [E02.190.044]',but in reality they are parallel concepts in both theory and practice(Figure 1).

International classification of diseases(ICD)-9-clinical modification(volume 3),ICD-10-procedure coding system,and international classification of health interventions5

99.91 Acupuncture for anesthesia(in 99.9 Other miscellaneous procedures)

Figure 1 Structure of acupuncture and moxibustion interventions in the Medical Subject Headings(MeSH)thesaurus

6 National Center for Health Statistics.Centers for Disease Control and Prevention,2015-12-06,cited 2016-03-10;1 screen(s).Available from URL:http://www.cdc.gov/nchs/icd/icd9cm.htm.

Acupuncture with smoldering moxa(in 93.35 Other heat therapy)

The International Statistical Classification of Diseases and Related Health Problems,usually referred to as ICD,was originally designed in 1949(ICD-6)as a healthcare classification system that aimed to provide a system of diagnostic codes for classifying diseases.The ICD is maintained and published by the WHO,and is used worldwide to promote international comparability in health services data collection,processing,classification,and presentation.The ICD is revised periodically,and its ninth revision(ICD-9)was developed in 1975.

99.92 Other acupuncture(in 99.9 Other miscellaneous procedures)

The ICD-9-CM has been used in the US since 1979,and the structure of volume 3 of the ICD-9-CM has not allowed the effective incorporation of new procedures associated with rapidly changing technology as new codes.As a result,in 1992 the US Centers for Medicare and Medicaid Services funded a project to design a replacement for volume 3 of the ICD-9-CM.

The new system is the ICD-10 Procedure Coding System(ICD-10-PCS)(Table 1).The ICD-10-PCS was initially released in 1998,and has been updated annually since then.The ICD-10-PCS has a multi-axial,seven-character,alphanumeric code structure that provides a unique code for all substantially different procedures and interventions,and allows new procedures to be easily incorporated as new codes.For example,'acupuncture'is coded as'8E0H30Z'.

综上所述，与气管插管相比，喉罩对于烧伤手术患者刺激小，应激反应轻，对血流动力学影响更小，生命体征平稳；喉水肿、喉和支气管痉挛及术后咽喉部不适等并发症发生率低，更有利于气道保护及术后恢复，具有明显的优势。

The ICD-10-PCS system also has few contents concerning TCM.We searched the codes for the term'acupuncture',which retrieved only the following two results:Procedure Code 8E0H300 Acupuncture using Anesthesia

Table 1 International classification of diseases-10 procedure code

Code 8 E 0 H 3 0 Z Designation Section Body system Root operation Body region Approach Method Qualifier Label Other procedures Physiological systems and anatomical regions Other procedures Methodologies which attempt to remediate or cure a disorder or disease Integumentary system and breast Percutaneous Acupuncture No qualifier

Procedure Code 8E0H30Z Acupuncture

When the ICD-9 was published by the WHO,the International Classification of Procedures in Medicine(ICPM)was also developed.Many countries have adapted and translated the ICPM,and have been using it with amendments since then,but the ICPM has never received the same international acceptance as the ICD-9.Due to difficulties in the consultation processes,international development of the ICPM was effectively stopped in 1989.As a replacement for the ICPM,the WHO designed the International Classification of Health Interventions(ICHI).The initial basis of the ICHI(alpha version)was largely derived from the Australian Classification of Health Interventions,a portion of the ICD-10 Australian Modification,which in turn was largely derived from the ICD-10 and the US extension of the ICD-9-CM.The ICHI was built around three axes:target,action,and means;and the coding scheme comprise a seven-character structure for these three axes.There is only an action of'DA'for'acupuncture'in the ICHI.Examples of ICHI Medical Interventions:

FMG DA ZZ(Acupuncture for movement functions)ICHI Target:FMG(Movement functions)

由于地下管线的材料的不同，城市地下管线的探测采用的技术也有区别。采用相应的探测方式，才能取得良好的探测效果。例如通过高频电磁波，能够有效辨识非金属材料，提高辨识准确性。

ICHI Action:DA(Acupuncture)

ICHI Means:ZZ(Intervention using other method,without approach or not otherwise specified)

Chinese Traditional Medicine and Materia Medica Subject Headings(TCMeSH)

TCMeSH thesaurus is China's first specialized controlled vocabulary of TCM.Since 1987,the TCMeSH thesaurus has been published and revised continually by the Institute of Information on TCM,China Academy of Chinese Medical Sciences.This vocabulary was developed specifically to enable indexing,cataloguing,and searching for TCM interventions.The third version of the TCMeSH thesaurus contains a total of 13 905 items,including 8307 headings and 5598 entry terms.7Each heading has a definition,code,English translation,annotation(labelling,history,searching),and entry terms.The latest online fourth version has been available since December 2015.8

The TCMeSH thesaurus is designed to cover all TCM terms,and arranges these terms into a 15 root-and-tree structure reflecting traditional TCM theory and practices(Figure 2).Most TCM interventions are listed in the TCM Diagnostic and Therapeutic Techniques and Equipment[TE]-Therapeutics[TE02]branch.More than 250 TCM interventions are catalogued into a seven-level classification system.

Keywords:Classification;Intervention;Medicine,Chinese Traditional;Medical subject headings

In addition to the classifications and thesauruses discussed above,there are some common systems related to the classification of TCM interventions,such as the Chinese Thesaurus,12Chinese Library Classification,13and NLM Classification.14However,none of these systems include enough terms and categories to cover all TCM interventions,and none show features in line with TCM characteristics,just like the ICD-9-CM(volume 3),ICD-10-PCS,ICHI,and MeSH do.

卖一送一（同类商品）是商业企业常见的一种销售行为，企业对赠送的同类商品虽然不确认销售收入，但应该根据税法和会计准则的规定确认销项税额和销售成本，且销售成本应计入“销售费用”账户，同时应确认销项税会计凭证。下面将通过案例来介绍销售赠送同类商品的业务核算流程。

There are also many procedure and intervention classifications developed by individual countries,such as the Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4,the Nursing Interventions Classification,and the Systematized Nomenclature of Medicine Clinical Terms.But none of these classifications even cover basic TCM concepts,and cannot be used directly as classification of interventions in TCM.

CONCLUSIONS

TCM classification is currently very limited,and flawed.Reviews of TCM outcomes that do not include searches of Chinese databases will be incomplete.Using a database that employs the detail and power of the TCMeSH thesaurus may be useful to compile core literature.These records could then be studied to create a free text search of the highest possible specificity/sensitivity for use in databases that employ less refined or no controlled language for TCM.A good understanding of the English language is not a prerequisite for those searching PubMed,as the MeSH thesaurus helps to bridge the language barrier.The TCMeSH thesaurus should help those who are not fluent in Mandarin to access Chinese literature,but the value of searches using TCMeSH would likely be improved by collaborative working with Information Specialists who are fluent in Mandarin and understand TCM.

REFERENCES

Figure 2 Structure of the acupuncture and moxibustion interventions in theTCMeS H

Table 2 Main classification systems ofTraditional Chinese Medicine interventions

Notes:MeSH:Medical Subject Headings;ICD-9-CM-3:International Classification of Diseases-9 Clinical Modification volume 3;ICD-10-PCS:ICD-10 Procedure Coding System;ICHI:International Classification of Health Interventions;TCMeSH:Chinese Traditional Medicine and Materia Medica Subject Headings;NCHS:US National Center for Health Statistics;WHO:World Health Organization;CACMS:Chinese Academy of Chinese Medical Sciences.

Feature System name Creator Type MeSH NLM(US)Thesaurus Tree structure"Acupuncture"item 10 items in 3 levels Note Most widely accepted in biomedical information and documents.Classification system for surgical,diagnostic and therapeutic procedures Provides a unique code for all substantially different procedures and interventions Classification and coding system of procedures in medicine Developed specifically for indexing,cataloguing,and searching for tcm ICD-9-CM-3WHO and NCHS Classification Alphabetic index and tabular list ICD-10-PCS WHO Classification 3 items Multi-axial seven character alphanumeric code structure ICHI WHO Classification 2 codes Three axes and the coding scheme comprises a seven-character structure TCMeSH CACMS Thesaurus Tree structure One action of'da'for'acupuncture'64 items in 4 levels

1 Medical Subject Headings.U.S.National Library of Medicine,2015-09-01,cited 2016-03-10;1 screen(s).Available from URL:https://www.nlm.nih.gov/mesh/.

传统基层并机双层摊铺技术在保障路基质量、加快施工进度等方面均存在一定不足，本文通过分析超厚宽幅摊铺施工工艺的技术优势，并结合实际工程总结超厚宽幅摊铺技术施工工艺，然后对其应用效果进行检测分析，结果表明：超厚宽幅水泥稳定碎石基层的平整度在路面全幅范围内较均匀，且有效解决上下基层层间黏结不足问题，在车辆荷载作用基层结构内部应力及应变随深度增加呈直线降低趋势，基层结构整体性较好。

2 Medical Subject Headings(MeSH).US.National Library of Medicine,2015-09-01,cited 2016-03-10;1 screen(s).Available from URL:https://en.wikipedia.org/wiki/Medical_Subject_Headings.

在传统的STAP方法中，认为所有训练单元对于目标单元杂波的估计贡献是一致的，将训练单元的协方差矩阵求和取平均作为目标单元杂波协方差矩阵的近似，如式(9)所示：

在构建财务共享平台的过程中，需重视规则与流程，这主要是因为其属于企业对财务工作进行处理的有效方式，和企业经营紧密相关，因此在构建前就需要将相应的规则与制度制定好，避免由于规则的不完善而导致企业在经营的过程中遇到风险。在制定规则时需涉及风险控制节点、使用规范、操作过程清单、会计和财管的范围以及输入输出标准等，确保各项职责的明确。

3 Xie Q,Fan W,Li S.Discussion to the definition and classification of complementary therapies in MeSH.Int J Trad Chin Med 2009;31(5):445-447.

4 Medical Subject Headings.US.National Library of Medicine,2015-09-01,cited 2016-03-10;1 screen(s).Available from URL:https://www.nlm.nih.gov/mesh/MBrowser.html.

1.讲求政治性。政治性是党内政治生活的灵魂。党内政治生活要具有政治性就必须把握政治方向。要增强政治定力，树立正确的世界观、人生观、价值观，坚定对马克思主义的信仰、对共产主义的信念、对中国特色社会主义的信心，坚持党的基本路线不动摇，站稳以人民为中心、全心全意为人民服务的政治立场。要坚持党的领导，强化政治意识、大局意识、核心意识、看齐意识，在思想上行动上始终同以习近平为核心的党中央保持一致，维护党中央权威，维护党的团结和集中统一。

The MeSH thesaurus is a comprehensive controlled vocabulary thesaurus that was created by the US NLM in 1954.The MeSH thesaurus is currently the most widely accepted tool for indexing,cataloguing,and searching for biomedical and health-related information and documents.It consists of sets of terms naming descriptors,subheadings,entry terms,and Supplementary Concept Records.From its inception,the MeSH thesaurus was designed to be a dynamic list,with procedures in place for recommending and examining the need for new headings.There are 27 883 descriptors in the latest 2016 version,with over 87 000 entry terms to assist in identification of the most appropriate MeSH term.All MeSH descriptors are arranged in a hierarchical or'tree'structure.The roots of the tree are 16 very broad concepts such as'Diseases[C]'or'Phenomena and Processes[G]',with more specific headings branching off into 13 subheadings.

The US National Center for Health Statistics created the ICD-9 Clinical Modification(ICD-9-CM),which is an adaption used for assigning diagnostic and procedure codes in the U.S.6The ICD-9-CM consists of three volumes;volumes 1 and 2 contain diagnosis codes,while volume 3 contains a classification system for surgical,diagnostic,and therapeutic procedures(with an alphabetical index and a tabular list).The tabular list of procedures includes a limited number of procedures and interventions related to TCM.We searched the table with the keyword'acupuncture',which retrieved only the following three items:

7 Wu L.Chinese Traditional Medicine and Materia Medica Subject Headings,Beijing:Chinese Ancient Books Publishing House,2008:Preface.

8 Institute of Information on Traditional Chinese Medicine,CACMS.Tcmesh,cited 2016-03-10;1 screen(s).Available from URL:http://tcmesh.org.

9 Institute of Medical information/Medical Library,CAMS&PUMC.SinoMed,cited 2016-03-10;1 screen(s).Available from URL:http://www.sinomed.ac.cn.

传统外贸企业要想做好跨境电子商务，一方面需要国家的政策支持；另一方面需要企业自身的努力，方能在国际市场中取得成功。综述学者们的建议，主要有复合型跨境电商人才的培养、跨境物流的完善、跨境平台的选择、支付方式的选择、信用安全体系的完善等。

10 Institute of Information on Traditional Chinese Medicine,CACMS.Traditional Chinese Medical Database System,cited 2016-03-10;1 screen(s).Available from URL:http://cowork.cintcm.com/engine/windex.jsp.

11 Xia J,Judith W,Clive A.Five large Chinese biomedical bibliographic databases:accessibility and coverage.Health Info Libr J,2008;25(1):55-61.

民俗旅游的开发，其本质是通过旅游的形式，促进民俗文化的传承，且以此带动地区经济发展，而开发者大多将经济作为重点，将文化传承放在一边，因此，在民俗旅游项目开发时，政府必须明确其开发目的，并对民俗文化的开发及资源保护做出正确的指示，而对于已经成型的且不符合标准的，要严令整改，进而保证民俗旅游项目的民族性。

12 Institute of Scientific and Technical Information of China,Beijing Library.Chinese Thesaurus.Beijing:Scientific and Technical Documentation Press,1980:1-1722.

13 Chinese Library Classification.Cited 2016-03-10;1 screen(s).Available from URL:http://www.clcindex.com.

14 NLM Classification 2016.U.S.National Library of Medicine,2015-09-01,cited 2016-03-10;1 screen(s).Available from URL:https://www.nlm.nih.gov/class.