Chinese traditional medicine: difficulties and solutions (2)

At present, China is the only country in the world that combines modern medicine, traditional Chinese medicine and ethnic medicine (such as Mongolian medicine and Tibetan Western Medicine) in the health care system China's health care system is based on the three-level prevention system established in the 1950s, including hospitals, health service centers and clinics Generally speaking, hospitals have the best equipment and resources, while health service centers provide most health services, especially for the diagnosis and treatment of common diseases, chronic diseases and minor health diseases In response to Chairman Mao Zedong's call for the theory of integration of traditional Chinese and Western medicine, Chinese hospitals can be divided into: 1) traditional Chinese medicine hospitals; 2) integrated Chinese and western hospitals; 3) general hospitals At present, although the outpatient volume of TCM department in general hospitals only accounts for 8% of the total, about 90% of general hospitals have TCM department In the integrated hospital of traditional Chinese and Western medicine, both traditional Chinese medicine and Western medicine diagnosis and treatment are provided The treatment related to traditional Chinese medicine accounts for about 40% - 45% of all treatments All the large tertiary hospitals named after the traditional Chinese medicine hospital are equipped with modern clinical laboratory and modern machine equipment, such as X-ray, CT, MRI, etc Besides stethoscope and biomedical diagnosis, modern medical surgery for liver, stomach, kidney, breast cancer and other diseases is also a common treatment in TCM hospitals With the continuous development of science, technology and economy, modern medicine in China has made rapid progress In 1949, there were only 541240 health talents in China, including 314000 qualified doctors (less than 30000 Western doctors); by 2010, the number of health talents reached 8207502, including 2413259 qualified doctors However, the proportion of TCM practitioners gradually decreased from 800000 in the early Republic of 1912 to 500000 in 1949 Today, there are only 300000 practitioners of traditional Chinese medicine, and less than 30000 of them adhere to the concept of traditional Chinese medicine In order to promote the development of traditional Chinese medicine and the modernization of traditional Chinese medicine, in December 1986, the Chinese government established a special organization, the State Administration of traditional Chinese medicine (SATCM), which is subordinate to the Ministry of health It manages the whole management system of traditional Chinese medicine, including legislation, supervision, hospital administrative policies, drug monitoring, international economic and academic cooperation Because the material used in traditional Chinese medicine is usually a kind of mixed herbal medicine different from modern chemical medicine, when approving traditional Chinese medicine, the State Food and drug administration adopts different approval procedures for traditional Chinese medicine In this way, China's drug approval has a special phenomenon: one country, two systems The main challenge facing TCM is "survival or destruction, which is a problem" Hamlet's words in Shakespeare's works are the best comment on the current development of traditional Chinese medicine Professor Zhang Qicheng of Beijing University of traditional Chinese medicine also made the following comments on traditional Chinese medicine: "I feel lonely, fewer and fewer people under 60 years old can adhere to the traditional Chinese medicine like me, but more and more young people are proposing to modernize traditional Chinese medicine." The reason why traditional Chinese medicine is in a dilemma is that it faces the following challenges 1 Is traditional Chinese medicine clinically effective? Whether traditional Chinese medicine is effective or not is a big proposition We'd better be able to decompose this big problem into different small problems On the whole, traditional Chinese medicine treatment includes: 1 Chinese herbal medicine treatment, 2 Acupuncture, 3 Diet therapy, 4 Massage, 5 Cupping, 6 Scraping therapy, etc The third, fourth, fifth and sixth methods do not need special educational theory, nor involve complex skills Ordinary people have some life experience, and with the guidance of professionals, patients can practice their own medical treatment These measures are called alternative therapy in foreign countries, It can help some patients to alleviate the discomfort symptoms, not for disease treatment, so it can not be used for standardized treatment of special diseases in medicine, and can be used as auxiliary treatment In the past, most of the traditional Chinese medicine research focused on acupuncture Although the National Institutes of health of the World Health Organization and the American Medical Association do not agree with the standard and evidence-based interpretation of acupuncture, after research, acupuncture is generally considered to be relatively safe However, the validity of acupuncture is still controversial in the scientific community Therefore, the further study of acupuncture therapy is extremely necessary In 1997, the National Institutes of health of the United States made the following evaluation on acupuncture and Moxibustion: Acupuncture and moxibustion therapy has achieved prospective results, such as it is effective for nausea and vomiting caused by adult surgery, chemotherapy and postoperative dental pain In addition, for addiction, stroke rehabilitation, headache, dysmenorrhea, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, lumbago, carpal tunnel syndrome and asthma, acupuncture can be used as a useful auxiliary treatment, or an acceptable alternative treatment, or included in the comprehensive treatment However, after reviewing acupuncture related papers in 2008, Singh and Ernst concluded that the concept of meridians has no scientific basis, and there is no high-quality evidence that acupuncture is more effective than placebo They found that early clinical trials of acupuncture lacked appropriate controls They cited recent trials and found that several fake or unconventional acupuncture treatments (using unconventional acupoints and retractable needles) were as effective as traditional acupuncture in alleviating pain Compared with acupuncture, there is more controversy about the study of Chinese herbal medicine Historically, Chinese herbal medicine production and marketing did not require rigorous randomized controlled trials All commercial companies argue that there are many reasons why it is difficult to carry out TCM research, such as personalized treatment, no control group, etc In addition, in terms of patent protection, traditional Chinese medicine products are not as easy to obtain as new synthetic chemicals, so no manufacturer will conduct clinical trials of traditional Chinese medicine at a high cost Therefore, in the past, few high-quality clinical research results support the efficacy of traditional Chinese medicine However, it is ironic that in the discussion of scientificity, herbal medicine manufacturers say that they can't make high-quality clinical, while in the promotion of products, many commercial companies have sponsored many so-called irregular clinical trials in order to sell their products, so that in recent years, many positive results of these sponsored herbal medicine clinical trials have been reported Scientists such as Vickers A and Goyal n found that some countries specially published positive results, especially the published Chinese clinical trials which almost never reported the equivalent or inferior research reports to the control group Dr Wang Mingwei, director of the national drug screening center of Shanghai Pharmaceutical Research Institute, said: "in the past, most of the research on traditional Chinese medicine was of low quality, only published in Chinese medical journals, lacking an appropriate peer review process." According to the above discussion, we can see that the fact that Chinese people believe that Chinese herbal medicine is effective and safe for thousands of years is mostly empirical and has not been verified by the relevant randomized controlled trial data There are many who may argue that certain pharmaceutical compounds have been isolated from Chinese herbal medicines For example, artemisinin found in Artemisia annua in China is used to treat malaria In fact, artemisinin extracted from Artemisia annua is one of many substances used to treat fever selected by Chinese scientists from more than 200 kinds of Chinese herbal medicines Based on the physical characteristics of artemisinin, we believe that the traditional use of artemisinin - boiled in boiling water, and then let patients drink soup medicine, has no effect on malaria treatment, because artemisinin is unstable in high-temperature boiling water This explains why the success rate of malaria treatment in China was very low before the 1960s, and malaria became the main fatal disease in the tropics It was not until the introduction of quinine sulfate for effective treatment and the use of preventive methods (such as killing mosquitoes, using mosquito nets, etc.) that malaria was well controlled Therefore, we can infer that artemisinin case is a typical case of the success of modern Chinese medicine, but it can not be used to demonstrate the effectiveness of traditional Chinese medicine Modern medicine requires that the mechanism and components of any method to treat diseases must be confirmed by scientific data In fact, the discovery of artemisinin proves that the traditional Chinese medicine treatment of boiling traditional Chinese medicine may not be effective In the face of the dispute between practitioners of traditional Chinese medicine and modern doctors, there is no unified standard to evaluate the safety and effectiveness of modern traditional Chinese medicine In order to solve this problem and develop traditional Chinese medicine, the State Administration of traditional Chinese Medicine issued a guideline for clinical research norms of traditional Chinese medicine (GCP) in December 2007 ] At the same time, the State Food and drug administration has independently established a special approval system for traditional Chinese medicine As a result, a strange phenomenon of medical confusion arises: when people are worried about the disappearance of traditional Chinese medicine, through this special regulatory organization in the past 20 years, thousands of traditional Chinese medicine preparations have been approved in China Let's think about it Since it's traditional Chinese medicine, why do we suddenly have so many new Chinese medicine preparations, The combination of Chinese and Western medicine can meet the needs of Chinese people for the market of traditional Chinese medicine As a result, the approval of Chinese drug regulatory agencies is almost a form As long as we carry the banner of innovation of traditional Chinese medicine, we can have all kinds of new traditional Chinese medicine The infusion of traditional Chinese medicine can be regarded as a wonderful work in the medical field 2 Is traditional Chinese medicine safe? Most laymen believe that natural things are safe, especially most Chinese believe that traditional Chinese medicine is natural things, so it is safe But in science, Paracelsus said, "dose determines toxicity." In fact, the theory of traditional Chinese medicine has the concept of "attacking poison with poison" Potential toxins and carcinogenic compounds (such as arsenic trioxide and cinnabar) are sometimes used as part of the prescription, and unprocessed herbs are sometimes mixed with effective chemicals At present, it is found that some traditional Chinese medicine prescription drugs are banned by some western countries because they contain toxin components For example, in July 2004, a drug called compound aloe capsule was found to contain 11% - 13% mercury and was removed from the shelves in the UK In 2004, the U.S Food and Drug Administration banned Ephedra in the United States because of its unreasonable risk to consumers On October 6, 2008, China's State Food and drug administration received a report from Yunnan food and drug administration that six patients in the province had serious adverse reactions after infusion of two batches of Acanthopanax senticosus injection, and three of them died After that, the State Food and Drug Administration suspended the use of the drug In a word, in the market economy society of large-scale production, we must strictly supervise the use of traditional Chinese medicine The safety of traditional Chinese medicine has prompted China to improve its ADR monitoring system 3 Is it a good thing that the market of traditional Chinese medicine develops vigorously? When some medical staff of traditional Chinese medicine are worried about the future development of traditional Chinese medicine, the commercial market of traditional Chinese medicine develops rapidly under the condition of lax supervision, which can be said to be unprecedented prosperity In the 1990s, we often saw many retired people (some are not retired doctors at all) sitting in white coats