中药药性认知与临床合理用药的思考

Cognition of traditional Chinese medicine properties and thinking of clinical rational use of drug

基于对中药药性认知化学成分、机体状态和生物学效应的分析,思考中药临床合理用药。用现代科学理论和技术手段诠释中药药性实质和内涵,用现代医学语言阐明中医药治疗疾病的机制,促进临床合理、安全用药。基于化学成分要素,从药物源头筛选优质道地药材,规范采收和制备,炮制配伍扩大中药功效主治,增利除弊,适应临床辨证灵活安全用药的需求。基于机体状态要素,以患者为中心,辨证、辨症、辨病相结合,三因制宜,兼顾特殊人群用药禁忌;结合"量-效-毒"关系,选择适宜剂型,把控药量与疗程,疾病诊疗中平衡药物的获益与风险,中病即止,适度医疗。基于生物效应要素,根据中药对病体作用靶点、通路等调节机制,加强中药精准定位,实施中医药精准治疗;评价中药联合用药的安全性,探讨不良反应机制,加强中药临床安全性监护,指导临床合理用药,以期保障中药使用的安全性,最大化的发挥中药临床治疗效果。

This paper discusses the rational use of traditional Chinese medicine based on chemical composition, body state and biological effect. The essence and connotations of traditional Chinese medicine are explained by modern scientific theory and technical means, and the mechanism of traditional Chinese medicine in the treatment of diseases is defined in modern medicine language, which is conducive to promoting rational and safe clinical use of drugs. Based on the chemical composition of traditional Chinese medicine,the selected genuine medicinal materials were collected and processed in a standardized way, and then used in the combination with other traditional Chinese medicines, with the aim to improve the efficacy of traditional Chinese medicine in clinical indications, increase the advantages, eliminate the disadvantages, and adapt to flexible and safe clinical drug demands. Based on the body state elements, clinical diagnosis and treatment shall be patient-centered, and doctors shall distinguish the differences of pathogenesis, symptoms and diseases, and consider the drug contraindications of special groups. According to the " dose-effect-toxicity" relationship, doctors shall select the appropriate dosage form, control the drug dosage, balance the benefits and risks of drugs, and carry out appropriate medical treatment. Based on the biological effect elements and the regulatory mechanism of traditional Chinese medicine on the target and pathway of disease, traditional Chinese medicine shall strengthen the precise positioning, provide accurate treatment;evaluate the safety of traditional Chinese medicine combination, explore the adverse reaction mechanism, strengthen the clinical safety monitoring of traditional Chinese medicine, and guide the clinical rational use of drugs, in the expectation of ensuring the safe use of traditional Chinese medicine and maximize the clinical efficacy of traditional Chinese medicine.