Drug addiction has become a common social topic worldwide and a serious public health problem, causing very large economic and social burdens worldwide. Addictive drugs are also known as psychoactive substances, including alcohol, nicotine, opioids, marijuana, cocaine, amphetamine-type stimulants, and hallucinogens. Among these drugs, heroin, marijuana, hallucinogens, cocaine, etc., which are prohibited by law, are called illegal drugs (illegal/illicit drugs) [
Drug addiction is a type of chronic recurrent encephalopathy. Due to long-term repeated use of addictive substances such as heroin, marijuana, and morphine, patients have a strong physical and mental dependence, which leads to persistent cravings for drugs, compulsive use of drugs, and relapse behaviour after withdrawal [
Currently, interventions for relapse prevention in patients with drug addiction mainly include drug detoxification treatment and psychological behaviour interventions. Drug detoxification treatment includes alternative medicine treatments and nonalternative medicine treatments, mainly focusing on the physical dependence of the addicted individual and on reducing the withdrawal symptoms of the patient [
Since the late 19th century, Chinese medical practitioners began to study opium addiction [
According to the
A total of 150 male youths who were forced to abstain from drugs in the Fujian Juvenile Judicial Forced Isolation Drug Detoxification Center from November 2017 to February 2019 were considered for inclusion in the study. A total of 142 male youths undergoing drug detoxification met the inclusion criteria and were randomly divided into the intervention group (
Flow of participants through the trial.
① Drug addiction: drug abuse was defined by the World Health Organization as nonmedical use of drugs with long-term repetitive, compulsive self-medication behaviour characterized by increasing doses [
① Patients in forced isolation who abstained from drugs; ② male youth aged 13–25; ③ those who would continue staying in the rehabilitation center for more than 3 months; ④ those with a TCM syndrome element differentiation defined as yang-qi deficiency syndrome or yin-blood deficiency syndrome; and⑤ those who agreed to sign the informed consent form for this study were included. ⑥ Participants with other diseases or comorbidities, such as diabetes, primary hypertension, or other serious primary diseases were excluded; ⑦ those with cancer, infections, active inflammation, and immune system and haematopoietic system diseases were excluded; ⑧ those who were allergic or intolerant to the nutritional diet were excluded; and ⑨ those with unconsciousness, dementia, or psychosis or people who were unable to cooperate with the study were excluded.
The intervention was conducted in two phases, and each phase lasted for three months.
Patients with yang-qi deficiency syndrome were provided a TCM-guided diet that warms yang and invigorates qi; one staple food or side dish was replaced with a TCM-guided dietary component every day. The intervention group with yin-blood deficiency syndrome was provided a TCM-guided diet that nourished yin and blood, with one staple food or side dish replaced with a TCM-guided dietary component every day. To fully assess the advantages of the prescriptions, to take into account the balance of nutrition, and improve participants’ compliance, 42 medicinal meals were screened, which were circulated every 21 days; the meals included 21 dishes in the warms-yang-and-invigorates-qi diet and 21 dishes in the nourishes-yin-and-blood diet, and the menus of TCM-guided diets are described in Table
TCM-guided diet menu for male youth undergoing drug detoxification with yang-qi deficiency and yin-blood deficiency.
Warms yang and invigorates qi diet | Steamed duck of Sijun, Miqin of Huaishan. Solid lean broth, black rice dangshen porridge, red Qitian Qiji, Shenqi beef soup, fried walnut with leek, Huangqi yam porridge, dangshen cooked rabbit meat, Angelica ginger and mutton soup, Chinese yam porridge, Guiqi stewed chicken, Chinese yam eel soup, lotus seed stewed pork belly, millet jujube porridge, Chinese yam steamed carrot, crucian carp stewed tofu, lotus seed and lily yam porridge, Angelica Duzhong mutton soup, steamed chicken, Astragalus steamed carp, Astragalus steamed carp and carp fish soup, reinforcing deficiency and reinforcing qi congee |
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Nourishing yin and blood diet |
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TCM-guided diet prescription was performed with reference to the diet of TCM [
The control group received a routine support diet in the drug detoxification center.
We performed a pilot single-blinded, two-group, randomized controlled trial. The allocation procedure ensured that participants, outcomes assessors, data collectors, and statisticians were blinded to the intervention throughout the trial.
The TCM syndrome elements were determined by the TCM Syndrome Scale for Drug Addicts. The four diagnostic methods of TCM were introduced, and the corresponding syndrome element integrals were obtained in the information collection and syndrome differentiation systems. We evaluated the improvement in TCM health status according to the integral changes of four main pathogenic syndromes: yang deficiency, qi deficiency, yin deficiency, and blood deficiency. The specific diagnostic criteria of the syndrome elements [
Diagnostic criteria of syndrome elements.
Diagnostic criteria of disease location syndrome elements | Diagnostic criteria of disease venereal syndrome elements | Significance |
---|---|---|
Integral of disease location syndrome elements ≥100 | Integral of disease venereal syndrome elements ≥100 | The severity of symptoms is moderate |
Quantitative diagnostic value multiplied by 1.5 for severe symptoms | ||
Quantitative diagnostic value multiplied by 0.7 for mild symptoms | ||
Grade | Contribution integral of differentiation elements | |
Level 0 | Integral < 70 | No pathological changes |
Level 1 | 70 ≤ Integral < 100 | Mild pathological changes |
Level 2 | 100 ≤ Integral < 150 | Moderate pathological changes |
Level 3 | Integral ≥ 150 | Severe pathological changes |
The vital signs of participants, height, weight, blood pressure, and pulse were observed.
According to the literature report and preliminary preexperimental results, it was assumed that the statistically significant difference (mean) of the TCM syndrome element improvement between the two groups was 84, and the standard deviation was 120. The incidence probability of type I error was 5%, and the statistical power was 80%. The proportion of the two groups was 1 : 1. According to the formula
SPSS statistical software 21.0 was used for statistical analysis. The normally distributed measurement data were all expressed as the mean ± standard deviation, while the nonnormally distributed data were expressed as the median (interquartile range) and the counting data were expressed as the frequency. For the measurement data among groups, the syndrome element scores and differences (
There were no significant differences in the demographic characteristics (age, nationality, occupation, marital status, educational level, family economic status, and medical form) between the two groups (Table
Demographic characteristics of the two groups at baseline.
Index | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
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Age | 22.10 ± 2.63 | 21.88 ± 2.90 | 0.442 | 0.660 |
|
1.068 | 0.301 | ||
Han | 61 (98.4) | 58 (95.1) | ||
Ethnic minority | 1 (1.6) | 3 (4.9) | ||
|
1.432 | 0.698 | ||
Worker | 6 (9.7) | 3 (4.9) | ||
Farmer | 2 (3.2) | 2 (3.3) | ||
Self-employed | 9 (14.5) | 12 (19.7) | ||
Other | 45 (72.6) | 44 (72.1) | ||
|
0.359 | 0.549 | ||
Unmarried | 61 (98.4) | 59 (96.7) | ||
Married | 1 (1.6) | 2 (3.3) | ||
|
2.877 | 0.237 | ||
Elementary school | 21 (33.9) | 14 (23.0) | ||
Secondary school | 35 (56.5) | 36 (59.0) | ||
Junior high school or secondary specialized school and above | 6 (9.7) | 11 (18.0) | ||
|
0.002 | 0.999 | ||
Low (<10000 RMB) | 11 (17.7) | 11 (18.0) | ||
Medium (10000∼30000 RMB) | 48 (77.4) | 47 (77.0) | ||
High (>30000 RMB) | 3 (4.8) | 3 (4.9) | ||
|
4.615 | 0.329 | ||
Self-pay | 34 (54.8) | 28 (45.9) | ||
Medical insurance for urban workers | 20 (32.3) | 27 (44.3) | ||
Rural cooperative medical service | 1 (1.6) | 3 (4.9) | ||
Commercial medical insurance | 1 (1.6) | 1 (1.6) | ||
Missing | 6 (9.7) | 2 (3.3) |
Drug abuse characteristics of the two groups at baseline.
Index | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
|
1.256 | 0.869 | ||
1 year | 2 (3.2) | 3 (4.9) | ||
2 years | 7 (11.3) | 8 (13.1) | ||
3 years | 18 (29.0) | 20 (32.8) | ||
4–6 years | 28 (45.2) | 26 (42.6) | ||
7–15 years | 7 (11.3) | 4 (6.6) | ||
|
||||
|
23.741 | 0.254 | ||
Methamphetamine | 62 | 60 | ||
Ecstasy | 16 | 7 | ||
Ketamine (K powder) | 37 | 36 | ||
Heroin (yellow peel/white powder) | 1 | 2 | ||
Opium | 1 | 0 | ||
Cocaine | 0 | 1 | ||
Marijuana | 12 | 11 | ||
Ephedrine | 4 | 4 | ||
Pethidine | 0 | 1 | ||
Morphine | 1 | 0 | ||
Methadone | 1 | 0 | ||
Somedon | 1 | 0 | ||
Tramadol | 0 | 1 | ||
GHB | 0 | 2 | ||
Other | 0 | 1 | ||
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||||
|
31.611 | 0.386 | ||
Smoke gun suction | 42 | 37 | ||
Ironing suction | 24 | 32 | ||
Nasal suction | 19 | 23 | ||
Pipe suction | 20 | 26 | ||
Cigarette smoking | 5 | 8 | ||
Oral administration | 3 | 6 | ||
Dissolve in beverage | 3 | 6 | ||
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||||
|
1.859 | 0.602 | ||
0.1–0.5 g | 21 (33.9) | 20 (32.8) | ||
0.5–1.0 g | 26 (41.9) | 32 (52.5) | ||
1.0–2.0 g | 10 (16.1) | 8 (13.1) | ||
2 g or more | 3 (4.8) | 1 (1.6) | ||
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||||
|
6.801 | 0.079 | ||
1 time | 57 (91.9) | 56 (91.8) | ||
2 times | 0 (0.0) | 4 (6.6) | ||
3 times | 4 (6.5) | 1 (1.6) | ||
4 times | 1 (1.6) | 0 (0.0) |
There was no statistically significant difference between the intervention group and the control group in terms of the score of the yang deficiency syndrome element before the intervention (
Score changes in yang deficiency syndrome elements in the two groups.
Indicators | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
Baseline value | 251.37 ± 112.39 | 224.52 ± 112.81 | 1.322 | 0.189 |
Postintervention | 239.71 ± 121.46 | 281.23 ± 149.28 | −1.693 | 0.093 |
Postintervention difference (post-pre) | −13.95 (−76.95, 52.36) | 40.70 (−22.80, 139.75) | −3.059 |
0.003 |
Improvement (%) | 4.63 | −25.26 | ||
Intragroup |
0.923 (0.359) | −3.075 (0.003) |
Intragroup
There was no statistically significant difference between the intervention group and the control group in terms of the score of the qi deficiency syndrome element before the intervention (
Changes in qi deficiency syndrome element scores in the two groups.
Indicators | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
Baseline value | 264.41 ± 106.65 | 227.77 ± 99.88 | 1.966 | 0.052 |
Postintervention | 235.29 ± 115.47 | 264.68 ± 137.56 | −1.284 | 0.202 |
Postintervention difference (post-pre) | −28.85 (−77.30, 37.50) | 20.90 (−29.90, 108.15) | −3.303 |
0.003 |
Improvement (%) | 11.01 | −16.20 | ||
Intragroup |
2.690 (0.009) | −2.196 (0.032) |
Intragroup
There was no statistically significant difference between the intervention group and the control group in terms of the sum of the scores of the yang-qi deficiency syndrome element before the intervention (
Change in the sum of scores of yang-qi deficiency syndrome elements in the two groups.
Indicators | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
Baseline value | 515.78 ± 215.61 | 452.29 ± 210.08 | 1.654 | 0.101 |
Postintervention | 475.00 ± 233.86 | 545.91 ± 284.95 | −1.510 | 0.134 |
Postintervention difference (post-pre) | −38.05 (−131.48, 82.13) | 67.80 (−47.85, 244.90) | −3.225 |
0.003 |
Improvement (%) | 7.91 | −20.70 | ||
Intragroup |
1.785 (0.079) | −2.686 (0.009) |
Intragroup
There was no statistically significant difference between the intervention group and the control group in terms of the yin deficiency syndrome element score before the intervention (
Score changes in yin deficiency syndrome elements in the two groups.
Indicators | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
Baseline value | 239.92 ± 98.19 | 208.66 ± 88.60 | 1.852 | 0.066 |
Postintervention | 201.57 ± 106.39 | 229.82 ± 122.63 | −1.365 | 0.175 |
Postintervention difference (post-pre) | −36.85 (−82.70, 15.38) | 12.00 (−35.45, 80.15) | −3.538 |
0.001 |
Improvement (%) | 15.98 | −10.14 | ||
Intragroup |
4.034 (0.001) | −1.525 (0.133) |
Intragroup
There was no statistically significant difference between the intervention group and the control group in terms of the score of the blood deficiency syndrome element before the intervention (
Score changes in blood deficiency syndrome elements in the two groups.
Indicators | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
Baseline value | 233.19 ± 99.61 | 207.82 ± 85.15 | 1.517 | 0.132 |
Postintervention | 205.98 ± 106.20 | 233.96 ± 119.73 | −1.372 | 0.173 |
Postintervention difference (post-pre) | −22.40 (−72.23, 13.53) | 20.00 (−45.95, 79.50) | −3.173 |
0.005 |
Improvement (%) | 11.67 | −12.58 | ||
Intragroup |
2.888 (0.005) | −1.877 (0.065) |
Intragroup
There was no statistically significant difference between the intervention group and the control group in terms of the sum of the scores of the yin-blood deficiency syndrome element before the intervention (
Change in the sum of scores of yin-blood deficiency syndrome elements in the two groups.
Indicators | Intervention group ( |
Control group ( |
|
|
---|---|---|---|---|
Baseline value | 473.11 ± 194.16 | 416.49 ± 170.29 | 1.718 | 0.088 |
Postintervention | 407.55 ± 209.53 | 463.78 ± 240.57 | −1.383 | 0.169 |
Postintervention difference (post-pre) | −57.20 (−155.20, 21.93) | 23.50 (−76.40, 157.30) | −3.419 |
0.002 |
Improvement (%) | 13.86 | −11.35 | ||
Intragroup |
3.579 (0.001) | −1.723 (0.090) |
Intragroup
There were no statistically significant differences between the intervention group and the control group in height, weight, blood pressure, or pulse at baseline and after 3 months (Table
The vital signs before and after the intervention in the two groups.
Index | Baseline | After 3 months | ||||
---|---|---|---|---|---|---|
Intervention group ( |
Control group ( |
|
Intervention group ( |
Control group ( |
|
|
Height (cm) | 169.80 ± 5.95 | 168.87 ± 6.39 | 0.646 (0.520) | 169.72 ± 5.97 | 168.81 ± 6.42 | 0.633 (0.529) |
Weight (kg) | 70.26 ± 11.02 | 68.28 ± 8.68 | 0.861 (0.392) | 72.16 ± 11.73 | 69.14 ± 10.53 | 1.169 (0.246) |
Systolic pressure (mmHg) | 124.92 ± 11.20 | 128.61 ± 13.26 | −1.289 (0.201) | 124.94 ± 12.82 | 122.40 ± 12.04 | 0.882 (0.381) |
Diastolic pressure (mmHg) | 76.08 ± 10.30 | 74.97 ± 8.25 | 0.513 (0.610) | 76.81 ± 9.41 | 74.55 ± 11.57 | 0.916 (0.363) |
Pulse (times/points) | 70 ± 11 | 68 ± 10 | 0.741 (0.461) | 73 ± 14 | 73 ± 10 | 0.020 (0.984) |
Intragroup
At present, because the target of chemical drug detoxification is relatively focused, the side effects are many, most drugs cause new dependence, and the problem cannot be solved fundamentally [
In accordance with the holistic view of the basic theory of TCM, Chinese medical practitioners using TCM-guided diets regard the human body as an organic whole centring on the five viscera with the six hollow organs, five body constituents (tendon vessel, muscle, hair, skin, and bone), five sense organs, nine orifices, and limbs and bones being connected by meridians. Since the functional activities of the human body are governed by the functions of the essential essence, qi, blood, and body fluids, the viscera and organs of the human body are inseparable in structure, are coordinated in function and mutual restriction, reinforce each other, and are mutually influential to each other in pathological development [
Based on the TCM syndrome element differentiation theory, yang-qi deficiency syndrome caused by drug addiction is mostly related to “renal function,” and the yin and yang of the kidney are the fundamental elements of yin and yang in the viscera. Therefore, the kidney is regarded by Chinese medical theory as the congenital foundation. The growing development of the body depends on kidney essence [
According to TCM, narcotics belong to the material of warmth and dryness that reduces yin. Long-term and excessive drug use may lead to an unnoticeable consumption of yin fluid, resulting in loss and deficiency of yin fluid. When the body loses moisture and nourishment, it becomes yin deficient with noticeable symptoms. Benzedrine-based drugs are central nervous stimulants. The excessive intake of these drugs will lead to irreversible brain damage, and the patient will behave differently from ordinary people, with symptoms such as reduced sleep, excessive self-confidence, mania, delusions, and other abnormal mental symptoms. According to
In this study, there was no significant difference between the intervention group and the control group in the syndromes of yang deficiency, qi deficiency, or yang-qi deficiency before the intervention, which indicated baseline equilibrium comparability. After the intervention of the TCM-guided diet, all the
In summary, the analysis of the results showed that the yang-warming and qi-tonifying TCM-guided diet can improve the syndrome of qi deficiency in male youths with drug addiction, but the improvement in the accumulated syndrome elements of yang-qi deficiency was not so apparent. However, the TCM-guided diet could delay the deterioration associated with the syndrome of yang-qi deficiency. The reasons for the improvement may be summarized as follows: ① After using benzedrine-based drugs, an individual with drug addiction exhibits an elated state driven by adrenaline surges that are extremely qi consuming. After abstinence, the body loses the power of the drugs to support yang qi, and then the syndrome of yang-qi deficiency appears. The TCM-guided diet tonifies qi and gradually adds vitality to the body after abstinence. This might be the reason for the improvement in the syndrome of qi deficiency. ② According to TCM, it is better to reach a balance between yin and yang. Therefore, the fundamental goal in TCM is to adjust yin and yang, remedy defects, rectify errors, and rebalance yin and yang to make sure yin and yang are in equilibrium. Yin and yang are interdependent and mutually promoting. Those who are good at supplementing yang must seek yang in yin. When yang is assisted by yin, it can generate infinite benefits. It is difficult to achieve a balance between yin and yang when only warming yang and tonifying qi without supplementing yin fluid. That might be the reason the treatment effect obtained by only tonifying yang is not as good. ③ The food and drugs that warm yang and tonify qi are more or less warm and dry in nature. A long-term use of these kinds of foods and drugs may damage yin liquid and result in both yin deficiency and yang deficiency. The therapy that only tonifies yang-qi is therefore ineffective. ④ Addictive drugs or narcotics easily consume yang qi. Unfortunately, there are fewer products for strengthening and invigorating the spleen in the yang-warming and qi-tonifying medicinal diets. When the water and grain essence is not strong enough to generate vitality, the diet without strength to generate vitality could hardly reach efficacy in absorption. We may conclude that although the yang-warming and qi-tonifying medicinal diet could not completely improve the syndrome of yang-qi deficiency, it could delay the deterioration process associated with the syndrome of yang-qi deficiency in male youths with drug addictions. In the future, we can consider adjusting the prescription of the diet, adding some ingredients that are good for tonifying yin, and invigorating the spleen when appropriate. In this way, we can further explore the curative effect of a TCM-guided diet for people with drug addiction with yang-qi deficiency syndrome.
Before the intervention, there was no significant difference in the syndromes of yin deficiency, blood deficiency, or yin-blood deficiency between the intervention group and the control group, which indicated baseline equilibrium and comparability. After intervention with the TCM-guided diet,
The outcomes unveiled that the yin-tonifying and blood-nourishing TCM-guided diet could improve the syndromes of yin deficiency and blood deficiency in male youths with drug addiction in rehabilitation, and the curative effect was better than those associated with conventional diets. Long-term and excessive use of benzedrine-based drugs could lead to yin-blood deficiency. The yin-tonifying and blood-nourishing diet could moisten yin liquid and reduce the consumption of yin liquid caused by addictive drugs. According to TCM, the spleen and stomach are the source areas of qi and blood. When the spleen and stomach are damaged, the generation of qi and blood is insufficient and blood deficiency is difficult to replenish. Qi and blood are of the same origin. In the treatment of blood deficiency syndrome, both qi and blood should be supplemented at the same time because qi supplementation can facilitate the operation of blood. When treating those who are suffering from yin-blood deficiency, we can add some ingredients that will strengthen the spleen and stomach, tonify qi, and supplement blood when tonifying yin and nourishing blood to improve the functions of the spleen and stomach. In this way, we can make the generating sources, the spleen and stomach, more powerful, resulting in sufficient generation of blood. Only when blood deficiency is remedied can the syndrome of blood deficiency be improved. TCM basic theory insists that when supplementing yin, one must try to strengthen yin while consolidating yang. Only when yin is improved and yang is increased can the generation fountain never be exhausted. It is suggested that in future research, some yang-tonifying ingredients be added in the yin-tonifying and blood-nourishing diet prescription to promote the balance of yin and yang.
Based on TCM theory, persons with different body constitutions are required to eat different foods by taking into account their dietary habits. According to individual tastes, foods are cooked into different types, such as soups or congee [
Our study had some limitations: the sample size was small, and it was not a multicenter and double-blind experiment. Therefore, the influence of psychological factors may exist in regard to the collection of accumulated TCM syndrome elements. At present, the understanding of TCM in regard to the mechanism of new addictive drugs has not been unified, and research is needed in the future to further study their aetiology and pathogenesis.
The innovation of this research lies in the TCM-guided diet intervention for male youths with yang-qi deficiency and yin-blood deficiency in the rehabilitation period. According to the principle of syndrome differentiation, Chinese medicine is used to increase the physical function of the compulsory isolation and detoxification of male youths during rehabilitation. The TCM-guided diet assists the youths in compulsory isolation with detoxification as a model of good public health value and social benefits.
In conclusion, through baseline comparison, the intervention group was worse, the control group was better, although there was no significant difference. After the TCM-guided diet intervention, the intervention group improved, but the control group unchanged or even worsened. The change between the two groups was statistically significant. Therefore, a TCM-guided diet can delay the worsening of yang-qi deficiency syndrome, improve yin-blood deficiency syndrome, and improve the prognosis of male youths undergoing drug detoxification during the rehabilitation period.
The data used to support the findings of this study are available from the corresponding author upon request.
The study passed the ethical review of the Hangzhou Normal University Ethics Review Committee (no. HNU20170904001). The study was registered in the Chinese Clinical Trial Registry (No.
All the subjects signed informed consent. For those under 18 years old, parents or legal guardians were informed and agreed to sign the informed consent.
The authors declare that they have no conflicts of interest.
Li-wan Zhang, Qing Guo, and Rui Fang contributed equally to this work. Li-wan Zhang, Qing Guo, Ji-qian Fang, and Can-dong Li designed the study and performed the statistical analysis. Li-wan Zhang, Rui Fang and Li Lin wrote the study protocol. Li-wan Zhang, Li Lin, Bin-hua Ye, and Kai-lin Zheng designed the TCM-guided diet. Li-wan Zhang and Min Lin delivered the intervention. Li-wan Zhang, Rui Fang and Zhao-yang Yang reviewed the monitoring data and made recommendations for improvement. Li-wan Zhang, Qing Guo, Ji-qian Fang, and Can-dong Li reviewed the manuscript and provided critical feedback and approval for submission. Ji-qian Fang and Can-dong Li had final responsibility for the decision to submit for publication. All authors read and approved the final manuscript.
This trial was supported by grants from the National Natural Science Foundation Project (81373553) in China.