.
Liao Shurong (Beijing Tibetan Hospital, Beijing, 100029)
Abstract Objective: The integration of traditional Chinese and western medicine combines the knowledge and methods of traditional Chinese medicine with the knowledge and methods of modern western medicine, clarifies the mechanism and obtains new medical understanding for the purpose of improving clinical effectiveness. The integration of traditional Chinese and western medicine is the blending of the fields of traditional Chinese and western medicine. Precision medicine is the principle and practice of integrating modern scientific and technological means with traditional medical methods, scientifically recognizing human function and pathology, and systematically optimizing the principles and practice of disease prevention and health promotion into a new health medical service paradigm that maximizes individual and social health benefits with efficient, safe and economical health care ser- vices. In clinical practice, precision medicine pursues the correct selection and accurate application of appropriate diagnosis and treatment methods for each patient, so as to minimize iatrogenic damage and cost, and maximize patient benefits. In the prevention and treatment of COVID- 19 infection, the effect of integrated traditional Chinese and western medicine is significantly better than that of simple traditional Chinese medicine or simple western medicine.The combination of traditional Chinese and western medicine in the prevention and treatment Covid- 19 has truly achieved precision and maximized individual benefits.
The combination of Chinese and Western medicine is the combination of traditional medical knowledge and methods with Western medical knowledge and methods to improve clinical efficacy, elucidate the disease mechanisms and gain new medical understanding. Integrating Chinese and Western medicine is a cross disciplinary field of both Chinese and Western medicine which was developed in clinical practice and gradually evolved into an aca- demic system with clear goals and methodologies.
Keywords Integrative medicine, precision medicine; Prevention and treatment of COVID- 19 infection;
In the 21st century, the development of modern technology and biomedicine has brought about comprehensive technological advances in clinical medicine, allowing physicians to no longer rely on intuition and experience for disease diagnosis and treatment, leading to the novel concepts in clinical practice and improvements for medical standards. Internationally, on November 1, 2011, the American Academy of Sciences, the American Academy of Engineering, the National Institutes of Health, and the American Council on Science jointly launched the “Toward Precision Medicine” initiative [1], the main point of which is the “symptomatic medicine” based on the reclassification of diseases. This is the origin of the concept of precision medicine. This is the origin of the concept of precision medicine.
Precision medicine is a new health care service paradigm that integrates modern technology and traditional medical methods to scientifically recognize the nature of human body functions and diseases, systematically optimize the principles and practices of disease prevention and treatment and health promotion, and obtain the maximum health benefits for individuals and society with efficient, safe and economical health care services. In clinical practice, precision medicine pursues the correct selection and precise application of appropriate treatment methods for each patient to achieve minimal side effects and costs and maximum patient benefits. Under the guiding principle of precision medicine, the trans- formation of medical paradigm and the return of medical humanism are leading modern medicine from “technology first” and “market worship” back to the value of human-centeredness and the ultimate goal of maximizing the benefits to patients.
When combined, Chinese and Western medicine have their own characteristics.The theory of Chinese medicine comes from the summary of medical experience and the ancient Chinese idea of yin and yang and the five elements. Its content includes the doctrine of essence, the doctrine of yin and yang and the five elements, qi, blood, fluids, visceral manifestation, channels, physique, etiology, pathogenesis, disease mechanism, treatment rules, and health maintenance. The Yellow Emperor’s Classic of Internal Medicine, a monograph on Chinese medicine, was published more than two thousand years ago, laying the foundation of Chinese medicine. Chinese medicine takes the five elements of yin and yang as its theoretical basis, and regards the human body as a unified body of qi, form and spirit. Through the method of “looking, smelling, asking and inspection of the pulse”, the four diagnoses are combined to explore the cause, nature and location of the disease, analyze the disease mechanism and the changes of the five internal organs, meridians, joints, qi, blood and fluids in the human body, determine the evolution of pernicious and upright qi, and then derive the name of the disease and summarize the evidence. Chinese medicine focuses on the holistic concept, that is, unity and integrity. The holistic concept is the embodiment of ancient Chinese materialism and dialectical thinking in Chinese medicine; it is integrated into all aspects of Chinese medicine, including physiology, pathology, diagnosis, identification and treatment. Guided by the holistic concept, TCM believes that the normal physiological activities of the human body rely on the functional role of each internal organ on the one hand, and on the other hand, it depends on the comple- mentary synergistic and opposite restraining effects between the internal organs to maintain its physiological balance. Each internal organ has its own function, but it is a division of labor and an organic cooperation within the overall activity of the body, which is the unity that underlies Chinese medicine’s view of the human body’s local and overall functional nature.
Compound therapy is a characteristic and an advantage of TCM treatment. Compound therapy refers to the combination of two or more medicinals in accordance with the principles of four diagnoses, the eight principles, and evidence-based treatment in TCM, which is different from the western medical approach of using a single medication. This characteristic of Chinese medicine is an advantage in clinical use, and also the beginning and end point of Chinese medicine research. More than two thousand years of clinical practice has provided a thorough screening of many Chinese medicinal prescriptions. Many classical and famous prescriptions are safe and effective, and their use has endured for a long time. In recent years, the WHO’s biomedicine experts have advocated for a more individualized and specific approach to treatment, and consider this individualized treatment approach as the highest level of clinical treatment. Chinese medicine compound prescriptions often have multi-vectored efficacy and wide indications, and can play a comprehensive role in regulating, modifying and recuperating from illness. Chinese medicine has flexible treatment principles and abundant treatment options, which are not only effective but also have few side effects. The symptoms of most diseases are in line with the nature of the disease, and the maxim “treat the cold with heat, treat the hot with cold, treat deficiency with supplementation, treat repletion with dispersion”, a thing is treated with its opposite. Chinese medicine is based on the principle of diagnosis and treatment, and the treatment principles are “sweating, vomiting, downward draining, harmonizing, warming, clearing, supplementing, and eliminating”, using various methods such as herbal medicine, acupuncture, massage, cupping, qigong, and dietary therapy to make the body achieve harmony between yin and yang and recover from illness.
Western medicine as modern medicine is characterized by more than 100 years of Western culturally intuitive thinking, linear thinking, reductionism, logical analysis of the respiratory, circulatory, digestive, urinary, endocrine, neurological and other systems, cellular, genetic, molecular, and even the quantum aspects of human diseases. Western medicine’s perception of the human body is that the various components are structurally inseparable, physio- logically interconnected, mutually supportive, and yet mutually constraining, and pathologically interacting with each other. However, the treatments offered byWestern medicine are mostly allopathic and localized, often criticized as “treating the head when it hurts, and treating the foot when it hurts”, with symptoms and signs as the guide, instrumentation, laboratory tests, chemical drug treatment and surgery as the main means of treatment, repairing the deficiency and removing the excess.
“The advantages of combined Chinese and Western medical treatment services are in the prevention of the disease and chronic dis-ease management, while also having the ability to respond to major public health emergencies. ” [2] The discipline of integrated medicine combines the systematic functions of prevention, diagnosis and treatment, internal medicine and surgery from Western and Chinese medicine, clinical research, research and translation, teaching and personnel training, etc., and has a systematic ability to prevent and treat the whole disease process, from the early preventative stage, to the end stage. Much of the research on evidence-based medicine shows that the effect of combining Chinese and Western medicine is significantly better than that of Chinese medi- cine or Western medicine on their own, and that combining Chinese and Western medicine is the only way to develop Chinese medicine. “Today, the world of modern medicine is moving from micro to macro, while Chinese medicine is moving from macro to micro. Chinese and Western medicine are moving in opposite directions and converging with one another, not as a simple fusion reflecting the increased use of technology, but also the bi directional exchange of original thinking from the positions of Chinese medicine and modern technology.” [3]
During the 3-year epidemic, in terms of the prevention and control of the novel coronavirus infection, the combination of Chinese and Western medicine has played an important role. Western medicine defines COVID as an epidemic infectious viral disease which is principally characterized by damage to the respiratory tract, and causing inflammatory responses in the respiratory system. This, in turn, can cause multiorgan damage in severe cases. Symptomatic treatment such as antipyretic, cough suppressants, bronchodilators, and oxygenation are the main therapeutic measures. In Chinese medicine, the etiology and pathogenesis of the coronavirus infection have not changed in the past few years. The disease is defined as an epidemic toxin which is located in the lung, with the pathogenesis of damp-heat accumulation in the lung or damp toxins depressing the lung. Diagnosis is based on the appearance of the tongue, the pulse image, divided into various syndromes: damp toxin depressing the lung, cold dampness blocking the lung. Pestiliential toxin combined with dryness, pestilential toxin blocking the lung. Qi and ying burning, and vacuous and feeble yang qi. [4]
Three years of clinical practice against this epidemic has proved the combination of Chinese and Western medicine and individualized treatment is fully reflected in the prevention and treatment of coronavirus infection. In western medicine the prevention of epidemic and infectious diseases is to find the source of infection, cut off transmission routes, and protect the susceptible population; however, in the case of such a large surface of coronavirus infection, it is difficult to rely solely on cutting off the transmission routes and protecting the susceptible population. Chinese herbal medicine can provide prophylactic decoctions, with 10 traditional Chinese medicines, which can be drunk as tea [5], which is simple, cheap and effective. In the treatment of patients with coronavirus infection, fever can be controlled with ibuprofen, oxygen supplementation for hypoxia, and intravenous fluid rehydration for patients who have difficulty eating, can all help to support and stabilize.
This is a manifestation of the saying “in an emergency treat the symptoms” in traditional Chinese medicine. And western medicine was used to treat the acute symptoms, while Chinese medicine preparations were added, particularly during the recovery period from coronavirus infection. During the recovery period, Chinese medicine complements the deficits of western medicine, by supporting the right qi, it helps to gradually restore the body’s resources, and slowly but steadily strengthens the immunity.
In a more general way, the combination of Chinese and Western medicine has changed the routine practice of Western medicine and formed a novel therapy with Chinese characteristics, which not only improves the effectiveness, and reduces mortality, but also helps some patients avoid surgery and reduces the comorbidities and side effects of medical treat- ment. In elucidating the essence of the theories of yin and yang, internal organs, qi and blood, exploring the norms of various symptoms, and studying the mechanisms of treatment methods such as activating blood circulation and removing blood stasis, acupuncture and analgesia, all of them can more fully reflect the combination of traditional Chinese medicine academic and modern scientific experimental methods. The combination of Chinese and Western medicine will certainly become a medicine for the future, to better benefit human health.
References:
1. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. National Research Council (US) Committee on A Framework for Developing a New Taxonomy of Disease. Washington (DC): National Academies Press (US); 2011.2. [China Youth Daily] At the unveiling ceremony of the China National Center for Integrative Traditional Chinese and Western Medicine, Zhou Jun, the president of the China-Japan Friend- ship Hospital, gave a speech. October 25, 2022
3. [China Youth Daily] Speech with Academician Xiaolin at the unveiling ceremony of China National Center for Integrative Traditional Chi- nese and Western Medicine. October 25, 2022
4. [Chinese Traditional Medicine] Diagnosis and Treatment Program for Novel Coronavirus Infection (Trial Version 10), Chinese Medicine Treatment Part, published in Beijing on January 8, 2023
5. The Beijing Municipal Administration of Traditional Chinese Medicine’s Urgent Notice on Adjusting the Preventive Prescriptions of Traditional Chinese Medicine for the Novel Coronavirus at the Current Stage, December 8, 2022
淺析新冠病毒感染的中西醫結合治療
廖淑蓉(北京藏醫院，北京，100029)
摘要:中西醫結合，是將傳統的中醫中藥知識和方法與現代西醫學的知識和方法結合起來，在提高臨床療效的基礎上，闡明機理進而獲得新的醫學認識，中西醫結合是中、西醫學的交叉領域。 精準醫療，是整合應用現代科技手段與傳統醫學方法，科學認知人體機能與疾病本質，系統優化人類疾病防治和健康促進的原理和實踐，以高效、安全、經濟的健康醫療服務獲取個體和社會最大化健康效益的新型健康醫療服務範式。在臨床實踐中，精準醫療追求針對每個病人正確選擇 和精確應用適宜的診療方法，實現醫源性損害最小化、醫療耗費最低化以及病患獲益最大化。在防治新冠病毒感染時，中西醫結合治療的效果顯著優於單純中醫或是單純西醫。中西醫結合對新冠病毒感染的防治真正達到了精準和個體獲益最大化。
關鍵詞：中西醫結合；精準醫療；防治新冠病毒感染；
中西醫結合，是將傳統的中醫中藥知識和方法西醫西藥的知識和方法結合起來，在提高臨床療效的基礎上，闡明機理進而獲得新的醫學認識。 中西醫結合是中、西醫學的交叉領域，中西醫結合發展於臨床實踐，以後逐漸演進為有明確發展目標和獨特方法論的學術體系。
進入21世紀，現代科技和生物醫學的發展，帶來臨床醫學領域的全面技術進步，使醫生不再依賴於直覺和經驗進行疾病診斷和治療，從而推動了臨床實踐理念的革新和醫療水平的提升。在國際上， 2011年11月1日，美國科學院、美國工程院、美國國立衛生研究院及美國科學委員會共同 發出“邁向精準醫學”的倡議[1] ，其要點是在疾病重新“分類”基礎上的“對症用藥”。這是精準醫療概念的由來。
精準醫療，是整合應用現代科技手段與傳統醫學 方法，科學認知人體機能與疾病本質，系統優化人類疾病防治和健康促進的原理和實踐，以高效、安全、經濟的健康醫療服務獲取個體和社會 最大化健康效益的新型健康醫療服務範式。在臨床實踐中，精準醫療追求針對每個病人正確選擇和精確應用適宜的診療方法，實現醫源性損害最小化、醫療耗費最低化以及病患獲益最大化。在精準醫療的引領下，醫學模式的轉變和醫學人文的回歸正在引導現代醫學從“技術至上”和“市場崇拜”重回以人為本、以病患利益最大化為終極目標的價值理性。
在中西醫結合治療中，中、西醫學各有其特點。 中醫理論來源於對醫療經驗的總結及中國古代的陰陽五行思想。其內容包括精氣學說、陰陽五行學說、氣血津液、藏象、經絡、體質、病因、發 病、病機、治則、養生等。早在兩千多年前中醫專著《黃帝內經》問世，奠定了中醫學的基礎。 中醫學以陰陽五行作為理論基礎，將人體看成是 氣、形、神的統一體，通過“望聞問切”四診合 參的方法，探求病因、病性、病位、分析病機及 人體內五臟六腑、經絡關節、氣血津液的變化、 判斷邪正消長，進而得出病名，歸納出證型。中醫學注重整體觀念，即統一性和完整性。整體觀 念是中國古代唯物論和辯證思想在中醫學中的體 現；它貫串於中醫學的生理、病理、診法、辨證 和治療等各個方面。中醫學在整體觀念指導下， 認為人體正常的生理活動一方面依靠各臟腑組織發揮自己的功能作用，另一方面則又要靠臟腑組 織之間相輔相成的協同作用和相反相成的製約作用，才能維持其生理上的平衡。每個臟腑都有其各自不同的功能，但又是在整體活動下的分工合作、有機配合，這就是中醫學之人體局部與整體的統一。
複方治療，是中醫治療的特色和優勢，複方治療係指兩種或兩種以上的藥物，按照中醫的四診八綱、辨證論治的原則，針對病情有機地組合而成的方劑，是與單味藥相對而言。中藥複方是中醫臨床用藥的特點和優勢，也是中醫藥研究的出發點和歸宿。兩千多年的臨床實踐，就是對許多中 藥方劑的最好篩選。很多經典名方安全有效，使用經久不衰。近年來， WHO的生物醫學專家們倡導臨床醫學的個體化具體治療方法，認為個體化具體治療方法是臨床治療的最高層次。中藥複 方具備了功效的多向性和適應證的廣泛性，能夠起到調節、調養、調攝等綜合作用。中醫具有靈活的治療原則，豐富的治療手段，不僅療效好，而且副作用小。多數疾病的症象與疾病的性質相符，採用“寒者熱之，熱者寒之虛則補之，實則 瀉之”，即逆者正治。中醫以辨證論治原則，制 定“汗、吐、下、和、溫、清、補、消”等治法，使用中藥、針灸推拿、按摩、拔罐、氣功、 食療等多種治療手段，使人體達到陰陽調和而康復。
作為現代醫學的西醫學的特點，以100多年來的西方文化直觀思維，線性思維還原論，呼吸、循 環、消化、泌尿、內分泌、神經等器官、細胞、 基因、分子，甚至量子人的疾病邏輯分析。西醫學對人體的認知是，人體各個組成部分之間，在 結構上不可分割、在生理上相互聯繫、相互支持而又相互制約，在病理上相互影響。然而西醫學的治療多以對抗性、局部治療為主，經常被詬病為“頭痛醫頭，腳痛醫腳”，治療特點以症狀、 體徵為指引，儀器檢查，化驗檢測、化學藥物治療和手術為主要治療手段、缺如的修補、多餘的切除。
“中西醫結合診療服務的突出優勢表現在‘治未病’和‘慢病管理’等方面，同時具備應對重 大突發公共衛生事件的醫療救治能力。”[2]中西醫結合學科集預防、診斷、治療，內科與外科，西醫與中醫，基礎與臨床研究，研究與轉化，教學與人才培養等系統功能於一體，具備從 疾病早期預防到終末期的全過程防治體系和能力。許多循症醫學研究證明，中西醫結合治療的 效果顯著優於單純中醫或是單純西醫，中西醫結合是中國醫學發展的必由之路。“當今，世界現代醫學從微觀走向宏觀，而中醫從宏觀走向微觀。中西醫相向而行，相互滲透，不僅是技術的簡單融合併用，更是中醫藥原創思維與現代科技的雙向奔赴。”[3]
在3年新冠病毒感染疫情防控過程中，中西醫結合治療發揮了及其重要的作用。西醫 學將新冠病感染定義為流行性、病毒性傳染 性疾病，以損害呼吸道、引起呼吸系統炎症 反應為主要表現，嚴重者可造成多器官功能 損害，以對症治療如退熱、止咳平喘、吸氧 為主要措施。而中醫學幾年來對新冠病毒感 染的病因學、病機學的認識一直沒有改變， 定義是疫毒性疾病，病位在肺，病機為濕熱 蘊肺、濕毒鬱肺等，證型根據舌像、脈象、 症狀不同，區分為疫毒束表證、寒濕鬱肺證、濕熱蘊肺證、濕毒鬱肺證、寒濕阻肺證、疫毒夾燥證、疫毒閉肺證、氣營兩燔證及陽氣虛衰、疫毒侵肺證。[4] 3年抗疫的臨床實踐證明，中西醫結合精準治療在新冠病毒感染的預防和治療中得到充 分體現。在西醫學的認知體系中，對流行性、傳染性疾病的預防是尋找傳染源、切斷 傳播途徑、保護易感人群；而在新冠病毒感 染面如此大的情況下，僅僅依靠切斷傳播途 徑、保護易感人群是難以奏效的，而中醫可以提供“預防的湯劑，10味中藥，煎以代茶飲”[5] ，簡便易行，價廉物美還有效。在對發熱的新冠病毒感染者治療中，西藥布洛芬緩釋膠囊快速退熱、對缺氧的患者吸氧、 對進食困難的患者靜脈補液等，充分實現了中醫“急則治其標”的提法，以西醫西藥針對急症處理，同時加服中藥製劑，尤其在新冠病毒感染恢復期的治療中，中醫藥補充發 揮了西醫西藥缺乏的手段，扶正、逐漸恢復人體正氣，緩慢而穩定的加強人體免疫力。中西醫結合治療，改變了西醫的傳統常規，形成了具有中國特點的新療法，不僅提高治 愈率，降低死亡率，且使部分病人免除手 術，減少合併症和副作用。在闡明陰陽、臟 腑、氣血等理論的實質，探討各種證候的規 範，研究活血化瘀、針刺鎮痛等治法的機制，都能較充分地體現出傳統中醫學術與現代科學實驗方法的結合。中西醫結合必將成為一門未來醫學，更好的造福於人類健康。
參考文獻：
1 ， Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. National Research Council (US) Committee on A Framework for Developing a New Taxonomy of Disease.Washington (DC): National Acade- mies Press (US); 2011.
2 ，【中国青年报】中国国家中西医结合医学中心揭牌仪式上，中日友好医院院长周军 讲话。 2022年10月25日
3 ，【中国青年报】中国国家中西医结合医学中心揭牌仪式上，仝小林院士讲话。 2022 年10月25日
4 ，【中国中医】新型冠状病毒感染诊疗方案(试行第十版)中医治疗部分， 2023年1月8日发表于北京
5 ，北京市中医管理局关于调整现阶段新冠 病毒中药预防方的紧急通知2022年12月8日
