关于中医药疗效评价和机理研究的思考

Thoughts on Assessment and Study of Mechanisms of Curative Effectivenessof Traditional Chinese Medicine

中药和西药两种疗效评价体系各有其优缺点,应当相互借鉴、取长补短,循证医学疗效评价体系可作为二者有益的补充和借鉴。选择西药无计可施而中医药疗效确切的常见病、多发病、疑难病,借鉴循证医学的原理和方法,收集、整理中医药治疗的现有临床研究资料,建立中医药临床疗效数据库,对其中高质量的文献进行系统评价;根据回顾性研究的结果,针对现有研究的不足设计严格规范的前瞻性临床试验(RCT),以常用西医疗法为对照,从有效性、安全性、卫生经济学、伦理学等方面综合评价中医药临床疗效。此举将最大限度地展示中医药疗效优势,有助于建立能体现中医药治疗的优势和特色、同时被国际认可的疗效评价体系。经循证医学严格评价确证中医药临床疗效后,充分运用基因组、蛋白质组、生物信息学等现代先进科技手段,探讨中药的复合作用,最终以“国际通用的医学语言”阐明中药、特别是复方中药的作用机制和规律。

Cheng Feng and Feng Li (National Key Laboratory of Transplantation Engineering and Immunologyunder the Ministry of Public Health, Huaxi Hospital of Sichuan University, Sichuan Province, China)The two assessment Systems of traditional Chinese medicine (TCM) and Western medicine have their own strong and weak points and should use each others experience for reference, learning from the other ones strong points to make up for its own weak ones. The assessment system of evidence-based medicine can be regarded as the useful supplement and reference for the above-mentioned two systems. This article maintains that the materials from the clinic treatment and studies of common diseases, frequently-occurring diseases and refratory diseases, for which traditional Chinese medicine has definitely curative effectiveness but Western medicine can do nothing, should be collected and sorted out to establish the database of TCM clinic effectiveness by making use of the principles and methodology of evidence-based medicine,in which the literatures with high quality should go through systematic assessment, and perspective clinic tests standardized strictly should be designed according to the results of retrospective studies and with the aim at the deficiencies of the present studies. The TCM clinic effectiveness should be comprehensively assessed in accordance with its offectiveness, safety, sanitary economics and ethics in comparision with the commonly-used therapies of Western medicine. In so doing, the superiority of TCM effectiveness would be demonstrated to its full extent and would contribute to the establishment of an assessment system of curative effectiveness, which would be able to present the advantages and features of TCM treatment and be recognized internationally. After TCM clinic effectiveness is confirmed by the strict assessment of evidence-based medicine, the compound actions of TCM can be explored by making full use of such modern scientific and technologic ways and means as genome, proteinome and bio-informatics so as to expound the action mechanisms and the regularities of TCM, especially TCM compounds, with 'internationally-used medical language' finally.