中药临床学的现状与发展思考

中药临床学是新兴起的一种中药学科,意在培养药学人才,促使药学人才参与到临床医疗服务中,提高临床用药合理性,减少用药不合理现象的发生,保障用药安全,改善用药效果。但是,中药临床学应用可以看出,中药处方点评、中药炮制、中药调剂以及中药用药不良反应均是中药临床学关注的重点。但是,从这些重点关注内容可以看出,中药临床学还村在很多问题,这些问题是影响中药临床学继续发展的重要原因之一。基于此,笔者简单阐述中药临床学的发展现状以及未来发展前景。

中药临床药学研究面临的挑战

中药临床药学在遵循中医药理论的前提下,运用现代科学技术和方法研究中医中药,取得了较大成绩,但同时也面临一些挑战,笔者对此进行了具体的分析。

浅谈中药炮制对中药临床作用的影响

中药炮制是中华民族的诸多医药学家通过二千余年丰富的临床经验和对药物的深入研究，根据中医辨证论治的需要和药物的自身性质，对自然界的植物、动物、矿物等采用净选、切制、炒法、炙法、煅法、蒸煮、焊法、发酵、发芽等方法加工处理后，使其药性发生适合临床应用的变化，从而发挥药物其针对某种病证的特殊疗效。清代张仲岩认为炮制在中医药学中非常重要，他说：“炮制不明，药性不确，则汤方无准而病症无验也。可见，中药炮制在我国中医药发展和临床应用中发挥着非常重要的作用。

儿科临床常用药物组合介绍

小儿＂脏腑娇嫩、形气未充＂,其＂五脏六腑成而未全、全而未壮＂（宋·钱乙《小儿药证直诀》）,为＂稚阴稚阳＂（清·吴鞠通《解儿难》）,其发病容易,变化迅速。又小儿服药难入口下肚,用药时间不可过长,这些特点决定了儿科临床用药有别于其它学科,处方用药力求＂稳、准、狠＂。常用药物组合正是根据以上这些儿科临床特点使用总结的经验体会。笔者现就多年在儿科临床实践中使用的常用药物组合整理介绍如下,以供各位同仁参考使用。

Question & Answer

Chinese insect drugs are drastic in nature, capable ofclearing channels and collaterals to promote a freeflow of qi and blood, and effective in someintractable and obstinate diseases due to long-termstagnation of phlegm and blood, which are hard to betreated by ordinary Chinese drugs. In clinic, properuse of insect drugs can often help raise thetherapeutic effects. Some commonly used pairs ofinsect drugs are introduced in the following.

Comparison of Traditional Chinese Medicine with Western Medicine Cancer Therapy

The interactions among drugs,tumor and host are critical for a response to therapy and for outcome.Anticancer herbs used in Chinese medicine are classified into 4 groups based on their target (tumor,patient and drug) as follows:eliminating pathogenic factors,strengthening the body resistance,enhancing effects of chemotherapy and detoxication of chemotherapy. Correspondingly,anticancer drugs used in Western medicine can be classified into 4 groups as follows:cytotoxic drugs,biological response modifiers,chemosensitizers and chemoprotectants. Based on the theory of Chinese medicinal formulas,prescriptions are composed of four constituents,namely,primary constituent (main component of the formula prescription),minister constituent (second component of formula prescription),adjuvant constituent (adjuvant component of the formula prescription) and messenger constituent (component making the formula prescription targeting pathological tissues).To control the interaction among drugs and to modulate the interaction among the tumor,patient and drugs,we suggest that combined therapy for Western medicine might include 4 constituents,i.e.,primary,cooperative,adjuvant and modulatory constituent. Cytotoxic drugs frequently are used as primary and cooperative constituents,whereas biological response modifiers and biochemical modulators are usually regarded respectively as adjuvant drugs and modulatory constituents. We believe these new concepts may be helpful for the aim of appropriately designing,evaluating or providing combination therapy.

Prof. Zhou Xuewen's Experience in Treating Superior Mesenteric Artery Syndrome

Prof. Zhou Xuewen (周学文), a veteran TCM doctor,is an expert in treating miscellaneous internaldiseases. I have the honor to follow him and havebenefited from his teaching. The following is hisexperience in treating superior mesenteric arterysyndrome that I would like to introduce below.

New direction for clinical pharmacy in China: adopting a “form follows function” approach to improve future healthcare outcomes

Clinical pharmacy is an important development in modern pharmacy practice. In China, the recent recognition of clinical pharmacists by the Ministry of Health is an important step that can lead to a successful change in the functional role of the pharmacists to directly improve the health care outcomes. To optimize this role change, we propose that a ＂form follows function＂ structure be implemented. We believe that a ＂form＂ consisting of three components is highly desirable and should be established with careful coordination：（1） a formal education/training curriculum;（2） a professional organization to lead the clinical improvements in practice/research; and（3） an accrediting body for quality education/training and practice. By incorporating the clinical pharmacy experiences in USA and other countries as well as adopting this ＂form follows function＂ approach, we predict a bright future for the clinical pharmacists in China as valuable members of health care team to positively impact the health care outcomes.

Study on Traditional Chinese Medicine theory of lung being connected with large intestine

OBJECTIVE:The theory of lung being connected with large intestine,which is a major topic in Traditional Chinese Medicine(TCM),has guided clinical practice for thousands of years in China.METHODS:In this study,we analyzed the history,main contents,clinical application,and material basis of the theory,to attempt to improve the potential clinical significance of "lung being connected with large intestine" in China.RESULTS:The lung being connected with large intestine was first described in "Huang Di Nei Jing",and formed one of the basic theories of TCM.For thousands of years,the majority of TCM practitioners explored this theory continuously,leading to its development and use as an important theory in the guidance of TCM clinics In the last decade,researchers in the field of integrated TCM and Western medicine have studied clinical applications and biomedical mechanisms with experimental methods to explore the implications of the theory.CONCLUSION:With the further development of science and technology,research concerning the theory of lung being connected with large intestine will be greatly stimulated and contribute to the modernization of TCM.

Assessing the Quality of the First Batch of Evidence-Based Clinical Practice Guidelines in Traditional Chinese Medicine

Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Methods: Evidence-based CPGs in TCM supported by the World Health Organization Western Pacific Regional Office (WHO/WPRO) and whose development was organized by the China Academy of Chinese Medical Sciences were identified and manually retrieved. CPGs were assessed using the AGREE instrument, and the data in each CPG were analyzed in terms of the six domains in the AGREE instrument: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Results: Twenty-eight CPGs were identified, of which 26 were included in the study. The AGREE instrument rated the 26 CPGs in terms of the six domains. The assessment results showed the following average scores: for editorial independence, 84.16%; for rigor of development, 80.95%; for scope and purpose, 79.96%; for clarity and presentation, 70.88%; for stakeholder involvement, 61.28%; for applicability, the average score was only 27.09%. In summary, nine CPGs were rated as "strongly recommended", six as "recommended with provision or alternation", and 11 as "unsure". Conclusion: Most of the first batch of Chinese evidence-based CPGs in TCM had significant shortcomings in applicability. It is suggested that special attention be paid to enhancing the quality of applicability when developing evidence-based CPGs in TCM.