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6The Ideal of Establishing an Evaluation System for combination programs of traditional Chinese and western pharmaceutical
Yun-song Yang
Teaching and Research section of Medical History, Basic Medical School, Heilongjiang University of Traditional Chinese Medicine, Harbin (150040), China
Abstracts : The necessity of establishing an evaluation system about combination programs of Chinese medical pharmacy and Western medical pharmacy was addressed in this paper. Besides, its contents were systematically clarified.Moreover,existent problems and its future development trend were also explained. The author thinks that the research on constructing the evaluation system is necessary based on the needs of patients, as well as the responsibility of the doctor, The ultimate goal of this system is to produce a best combination program of traditional Chinese and Western medicine for a specific disease, which is the results of comparing and analyzing different combination programs from clinical therapeutic effect, In this program, traditional Chinese medicine and western medicine combined together, on the one hand, it is safe for the body, on the other hand, they do not produce adverse reaction. Its therapeutic effect is synergetic, Traditional Chinese medicine can not only increase the treatment effect of western medicine alone, and also can supply insufficient of western medicine treatment for syndrome, Of course, the author put forward some assumptions in the article only from the perspective of clinical applications, and the evaluation system will be increasingly improved with the continuous study of basic science research,.
Keywords : combination of traditional Chinese and Western medicine; evaluation; system construction
Combination use of traditional Chinese and western pharmaceutical is one kind of present domestic clinical medical form, which is that Traditional Chinese medicine and western medicine are used together in clinical under the guidance of their respective theory. This usually have two kinds of cases: one is in the course of disease development we use traditional Chinese and western pharmaceutical in a certain stage at the same time; Another kind of circumstance is that we choose traditional Chinese or western pharmaceutical therapy according to the characteristic of different stages in the disease process in order to improve curative effect. This combination form of traditional Chinese and western pharmaceutical appeared as early as in Huitong period, A famous medical scientist Zhang Xi-chun [1] had tried to use gypsum and aspirin together in treatment of fever, In 1954 Zhong nan tong ji medical college reported [2]that they had used betel nut and quinacrine effectively in therapy of beef tapeworm, and the controlled clinical research proved that the curative effect of two drugs' combination is better than that of single drug. Until today, the combination form of traditional Chinese and western pharmaceutical use have be still widely used in clinical. However, could we combine traditional Chinese and western pharmaceutical optionally? According to a specific disease speaking, what drugs of Chinese traditional medicine and western medicine can or should be combined? How should two drugs be combined to achieve the best curative effect? They are the problems we need to think about. The author gives his own opinions as follows for communication.
I The necessity of constructing evaluation system for combination programs of traditional Chinese and western pharmaceutical.
Through the clinical research, the author finds that, although the current clinical traditional Chinese and western pharmaceutical combination is applied very generally, but there's the phenomenon of random combination. For example, some doctors give patients a Western medicine drop, meanwhile, let the patient eat Chinese traditional medicine soup; some doctors prescribe
proprietary Chinese medicine and western medicine for the patients in clinic, and tell patient it can cure disease fundamentally to eat two kinds of medicine together. These are not rare phenomenon in today's clinical. However, the combination use of traditional Chinese and western pharmaceutical is reasonable? Two drugs are applied together, which is no problem telling from reason, because the two drugs each have advantages and disadvantages for disease treatment, so they should be combined for complementary length. As we all know, no matter traditional Chinese medicine and western medicine treatment for disease, it is through scientific mechanism of drug effective constituent structure to role in cause and pathological link of disease. This effect usually has two kinds of case: a kind of circumstance is constituent structure of drug is able to eliminate cause of disease, correct pathological link; Another kind of circumstance is drug's composition structure not only can't eliminate the cause and correct pathological link, sometimes also can promote disease progression, and even add new etiology and pathology link. For traditional Chinese medicine or western medicine speaking, if it cures disease effectively, so it must conform to the first kind of circumstance. However, a single drug is effective, which can not mean that traditional Chinese and western pharmaceutical combination use would be effective. We need to study the relationship between two drugs and between their roles for the same disease. The effect of disease treatment by combination of Traditional Chinese medicine and western medicine usually have three kinds of case: first, there is no interaction between traditional Chinese pharmaceutical and western pharmaceutical in treatment progress, and they both effect on different etiology and pathology link through their drug constituent structure, so the total effect of its treatment is equal to additive effect of two medicine independent; Second, traditional Chinese pharmaceutical and western pharmaceutical happened synergy, or it created a new active substance through action, and achieved better effect; or in the treatment process of disease even though two kinds of medicine may be applied to same or different etiology and pathology link, but their role issynergistic and interdependent. The total effect of treatment is greater than a single drug effect. Third, combination of two drugs is applied in the process, and there occur antagonistic or offset function between them. This kind of situation is very complicated. Sometimes, two drugs interact to produce adverse material for disease treatment or our body; Sometimes two drugs' role for diseases treatment may have mutual antagonism or offset, In other words, effect of a single drug is good, but if we combine two drugs, treatment effect will be weakened even worse than that of any single drug, or disappear. [3] Based on above analysis, we can draw the conclusion: combination of traditional Chinese and western pharmaceutical use is not random, they should be organically combined in accordance with law of the natural science, so that we can not only protect our body in disease treatment, but also can obtain the best treatment effect. In addition, from the patient's perspective, on the one hand, they hope doctor can cure his disease, on the other hand, they also hope to reduce medical costs. Of course, this also is what each medical workers request oneself try our best to do. In the combination, how to use two drugs reasonably and effectively to cure the disease, then we can obtain the best treatment effect and still can reduce unnecessary medical cost, which is not only each patient's requirement, but also each doctor's responsibility. In view of this, the author believes it is very necessary to establish an evaluation system for combination programs of traditional Chinese and western pharmaceutical.
H The idea of constructing evaluation system for combination programs of traditional Chinese and western pharmaceutical.
According to a certain specific diseases, how should we choose the best reasonable combination program of traditional Chinese and western pharmaceutical? On the basis of my scientific research practice in recent years, I want to talk about my own ideas.
The first step, I think we should do safety testing and evaluation of clinical curative effect to traditional Chinese and western pharmaceutical which are combined to use against a particular disease need, Here, drug's safety testing includes two single drugs' testing for body safety, and two combined drugs' testing for body safety. The evaluation of clinical curative effect mainly refers to
two single drugs' respective treatment effect evaluation for a disease. Therefore, by this step the drugs selected must be both safe and effective.
The second step, we should clear western medicine's treatment mechanism for a disease. Because western medicine's composition structure is single clear, so its treatment mechanism is easy to study. In addition to injection outside, traditional Chinese medicine's constituent structure is complicated and hard to study clearly. Therefore, before combination use of traditional Chinese and western pharmaceutical, it is necessary and feasible to clear western medicine's treatment mechanism. For traditional Chinese medicine, according to clinical treatment effect, we need to divide drugs into two kinds: drugs for disease treatment, drugs for syndrome treatment. The first kind of drug's treatment effect is throughout the whole process of disease, theoretically, it accords with essence of disease, and aims at basic disease pathology and etiology, The other kind of drug's treatment effect is at a certain stage of disease development, theoretically, it accords with essence of syndrome, aiming at disease symptoms, physical signs of a certain stage.
The third step, according to different effect of traditional Chinese medicine between disease treatment and syndrome treatment, we analyze and study the different combination programs of traditional Chinese and western pharmaceutical. To drugs for syndrome treatment, because it only combined western medicine in a certain stage of disease, we must firstly clear that which stage of disease development it is suitable to combine western medicine, secondly, with the aid of animal experiments, we can judge if adverse reactions will happen when two drugs are combined, and finally, with the aid of controlled clinical trial, we can evaluate if combination of traditional Chinese medicine and western medicine would affect western medicine's treatment effect, If no influence, then this combination program can use. To drugs for disease treatment, because it usually combine western medicine in the whole process of disease, we also need to judge trough animal experiments if adverse reactions will happen when two drugs are combined, and then, with the aid of controlled clinical trial, we evaluate if the combination will increase curative effect of western medicine, or weak, counteract effect of western medicine, or have no effect, If increasing the curative effect, then the combination program can be applied. To drugs for disease and syndrome treatment, we need comprehensive consideration from two aspects above, Under the premise of no adverse reaction, if the combination program can cure disease, and increase western medicine's treatment effect, or can cure syndrome, and does not affect western medicine 's effect, or both can do, so it can be applied.
The fourth step, with the aid of mathematical statistics analysis, we can select reasonable combination programs of traditional Chinese and western pharmaceutical for a disease. These programs are all confirmed to be effective through clinical research.
The fifth step, in view of a particular disease, with the aid of controlled clinical trial and animal experiments, we can choose appropriate indexes to evaluate curative effect of different combination programs of traditional Chinese and western pharmaceutical, and screen out an optimal scheme for disease treatment.
IE Problems and future prospects on establishing evaluation system for combination programs of traditional Chinese and western pharmaceutical
In this paper, with the aid of animal experiments and clinical control experiment research, the combination programs we get can only solve the problem of clinical application. As for the reason why these programs can apply like this and its reliability, its clinical use range, all these questions need to be answered. On to a certain concrete disease speaking, how do we combine traditional Chinese and western pharmaceutical to obtain the best clinical treatment effect? To answer this question, we still need to do a lot of work. First, we need to find out cause and pathology for a kind of disease; secondly, the mechanism, through which traditional Chinese medicine or western medicine treats the disease effectively, must also be understood. To Western medicine 'treatment mechanism, we can clear in some degree based on the present research condition. To traditional Chinese medicine, I'm afraid this problem will be very difficult, because its composition is too complex, and what is the relationship among each component in disease treatment, and what
changes will happen in the body, which all need to be further studied. Finally, how does the interaction occur between traditional Chinese medicine and western medicine? What is the mutual effect? After drug enters the body, what kind of change will happen upon two drugs, and what is the influence between them? In the process of disease treatment, by what mechanism does the synergy or antagonistic action happen between them? On these issues I'm afraid all medical research practice can only give limited answer in the future. Although we need very long time to clear these problems, but I believe people will make it clear one day in the future with the deepening of medical studies. If these problems really research clearly, I think traditional Chinese pharmaceutical and western pharmaceutical may appear in one prescription in future clinical treatment, and the former probably won't appear in a traditional drug forms, but in modern drug forms in the prescription. At that time we will truly achieve "a dialectical medicine". [4] References:
[1]. Ni Cheng. Clinical research prospects about rational use of combining traditional Chinese and western pharmaceutical [J]. Chinese Journal of Information On Traditional Chinese Medicine, 1999, (12): 22-23.
[2] Xu Xian-dian. the preliminary report on treating beef tapeworm trough combining Betel nut and quinacrine [J], National Medical Journal of China, 1954, 12 (9) : 715-716.
[3] Yang Yun-song. Several problems need to be considered in combining Traditional Chinese and western pharmaceutical [J]. Harbin Medical Journal, 2012, (4) : 299-300.
[4] Yang Yun-song, discussion and analysis about the guiding ideology's success or failure for combining traditional Chinese and western medicine, [J]. Information On Traditional Chinese Medicine, 2009, 26 (6) : 136-139.
Author introduction: YangYun-Song (1979 - ), male, medical doctor. Main research areas: scientific research design about combination of traditional Chinese and western medicine; theclinical path to control medical miscellaneous disease bycombining traditional Chinese and western medicine.
Correspondence address: No.24#,HepingRoad, Xiang Fang District, Harbin City, Hei Long-jiang Prov.China. Teaching and research section of Medical History, BasicMedicalSchool, Heilong-jiangUniversity of Traditional Chinese Medicine. Zip code: 150040. Telephone: 13624505169
Preparation of Cnidium monnieri Emulsion and Investigation of itsin vitro Antitrichomonas Vaginalis
YANG Jing, QIU Jin-shuang, JIANG Ji-ming, WANG Ya-xian, WANG Rui
HeilongjiangUniversity Of Chinese Medicine,Harbin 150040,China
Abstracts Objective:To prepare o/w type emulsion with total coumarin from Cnidium monnieri, and investigate its in vitro anti-trichomonas vaginalis activity.Methods:Total coumarin from C. monnieri was extracted by ultrasonic method with emulsification time,times and pressure,adding order of emulsifier as factors,single factor test was used to optimize preparation technology of C. monnieri emulsion,and its pharmacodynamic trial of in vitro anti-trichomonas vaginalis was investigated. Result:Preparation technology of C. monnieri emulsion was ascertained as follows: emulsification 3 times at 150 MPa,15 min each time,adding order of emulsifier with oil phase added to aqueous phase;and this emulsion had good inhibition on trichomonas vaginalis.Conclusion:This preparation technology was stable and feasible,minimum drug
