Tong Xiaolin: “state target syndrome differentiation” — the future road of traditional Chinese medicine (2)

First of all, the “carving” is strong but the “axis” is weak. The traditional “regulating state” only pays attention to the symptoms of the disease, but not the whole process of the disease. This is because the diagnosis and treatment of ancient Chinese medicine was limited by historical conditions and lacked systematic observation of a large number of diseases, especially the whole process of the development of chronic diseases. < p > < p > the second is “individual” strong and “group” weak. Traditional Chinese medicine “regulating state” treatment focuses on individualization, lacks the research process of collectivization, and lacks the refinement and induction of disease regularity and generality. < p > < p > finally, the “state” is strong while the “target” is weak. The “target” is divided into “symptom target” and “target”. The so-called “symptom target” refers to the direct treatment of symptoms, and “target” is the direct treatment index. “Target” is the short board of modern Chinese medicine. As a traditional Chinese medicine practitioner, after years of exploration, the most prominent short board is the adjustment of objective indicators. For “symptom target”, traditional Chinese medicine literature, including the experience of modern famous and old Chinese medicine, has a lot to learn from. For the “target” problem, what drug can reduce transaminase? What medicine can drop uric protein? What medicine can fall creatinine? What drugs can reduce blood pressure, blood sugar, uric acid and so on, the ancients did not study, also did not record. Therefore, “target” is a short board in modern Chinese medicine diagnosis and treatment. < / P > < p > as a traditional Chinese medicine, it is necessary to adjust the objective indicators in the process of treating diseases. However, under the background of modern medicine, the traditional diagnosis and treatment mode of traditional Chinese medicine is difficult to effectively solve the problem of insufficient target shooting! Historically, traditional Chinese medicine, like Chinese culture, is eclectic and good at learning. The development of modern science and technology and modern medicine makes the diagnosis of chronic diseases earlier and more accurate. Traditional Chinese medicine can be based on the diagnosis of Western medicine, syndrome differentiation and treatment, modern pharmacology research of traditional Chinese medicine also provides the possibility of targeting. < p > < p > in order to make up for the shortcomings of traditional Chinese medicine “state modulation”, such as weak strong axis, weak individual strong group, strong state and weak target, and to achieve the goal of combining disease with syndrome, macro and micro integration under the background of modern science and technology, “state target syndrome differentiation” diagnosis and treatment mode came into being. The aim of “TCM syndrome differentiation and treatment” is to achieve the goal of “combination of TCM syndrome differentiation and syndrome differentiation” It is emphasized that the clinical regression of the research results of modern Chinese medicine pharmacology has achieved a breakthrough in the “clinical medication direction” of traditional Chinese medicine, while the dose effect relationship of Chinese medicine has been introduced into the study of the relationship between the dose effect toxicity of traditional Chinese medicine, and the breakthrough of “clinical prescription dosage” of traditional Chinese medicine has been realized. They have built a bridge between modern medicine “disease” and traditional Chinese medicine “syndrome”, macro and micro. < p > < p > taking diabetes as an example, we draw lessons from the understanding of the whole process of disease in western medicine, and introduce the concept of TCM classification and staging in the middle of “disease” and “syndrome”. The common syndrome of disease is assigned to each stage, which endows syndrome differentiation and treatment with dynamic attribute of time, which effectively solves the docking problem of diagnosis and treatment of traditional Chinese and Western medicine. < p > < p > we divided diabetes into spleen pain and Xiaoluo, and divided it into four stages according to “depression heat deficiency damage”. We innovatively applied traditional classical prescriptions to treat each stage of diabetes, and used evidence-based medicine to verify its effectiveness. The research results have been recognized by both Chinese and Western medicine peers. The new system of TCM diagnosis and treatment of diabetes and its series of evidence-based evidences based on the framework of “core pathogenesis classification staging syndrome differentiation” were written into the first evidence-based guideline for diabetes mellitus in China and the first international guideline for specialized diseases of traditional Chinese medicine in the world, and were integrated into the special chapter of “diabetes and traditional Chinese medicine” by western medicine The effective way of combination and integration. < / P > < p > in the aspect of state target combination, we re classified the target drugs of modern Chinese medicine pharmacology according to the properties of traditional Chinese medicine, that is, emphasizing the clinical regression of the research results of modern Chinese medicine pharmacology, which can not only treat the macroscopic “syndrome” of traditional Chinese medicine, but also play the micro “target” of Western medicine, which makes TCM reduce blood sugar, blood pressure, lipid, uric acid, urine protein, creatinine and trans ammonia Some breakthroughs were made in enzyme and other indicators. < p > < p > such as traditional Chinese medicine hypoglycemic. The hot state of diabetes can be divided into intestinal damp heat, liver and stomach heat stagnation, spleen and kidney yang deficiency and other types, and the corresponding hypoglycemic target drugs are different. Coptis chinensis is used for intestinal damp heat syndrome, Radix Paeoniae Rubra is used for liver and stomach stagnation heat syndrome, and cinnamon is used for spleen and kidney yang deficiency syndrome. In addition, hypertension is divided into five states of “dampness”, “cold”, “depression”, “water” and “deficiency”. Modern pharmacological studies have found that cassia seed, Pueraria lobata, Uncaria rhynchophylla, Weizi and Achyranthes bidentata have antihypertensive effects. However, in the treatment of “water” hypertension, we choose “Weizi” rather than Achyranthes bidentata, because based on the idea of state target combination, Weizi can promote water and reduce blood pressure, while Achyranthes bidentata focuses on blood induced hypotension. In terms of dose effect, we found that the target drug needs to reach a certain dose to achieve significant effect. Different doses have different clinical effects. For example, Coptis chinensis used 1.5-6g to regulate the spleen and stomach, and 15-30g to reduce blood glucose. We selected a series of representative clinical trials on acute and critical diseases, which confirmed that the traditional Chinese medicine has a clear dose-response relationship and a wide range of dosage, Thus, the dosage strategy of dosage according to symptoms was put forward, and the change law of dose effect such as “quantity change leads to new” and “quantity change causes reversal” is revealed, and a theoretical framework of dose effect with “dosage following symptoms” and “dose threshold” as the core is constructed, which provides theoretical and evidence-based evidence for safe, effective and reasonable dosage.

today faces many challenges such as geriatric diseases, chronic diseases, metabolic diseases, psychogenic diseases, drug-induced diseases, and new outbreaks of major infectious diseases. How to make progress with the times, achieve &quot, inherit the essence, and keep up with the innovation of &quot are the important subjects we are faced with and need to solve. The essence of

‘s inheritance is to give full play to the advantages of TCM’s “modulation”; to keep up with innovation is to take account of the deficiency of “targeting” in Chinese medicine on the basis of “adjustment”, and to innovate and develop the advantage of diagnosis and treatment of “combination of state and target”. < p > < p > we should give full play to the advantages of “regulating state” of traditional Chinese medicine, and solve the shooting problem at the same time. The key is to reconstruct the diagnosis and treatment system of traditional Chinese medicine with the idea of “state target syndrome differentiation”, reconstruct the modern herbal system with the symptom target as the core, and make full use of the achievements of modern Chinese medicine pharmacology, so that it can return to the clinical practice of traditional Chinese Medicine and become a “sharp weapon” for targeting! 08/16/2020