補充替代醫(yī)學與現(xiàn)代醫(yī)學中英文對照.ppt

1、中國中醫(yī)科學院西苑醫(yī)院心血管中心 史大卓 Shi Dazhuo Xiyuan Hospital, China Academy of Chinese Medical sciences,補充替代醫(yī)學與現(xiàn)代醫(yī)學 Complementary and Alternative Medicine 68(10): 928-932,存在問題 (Problems),介入治療,西藥常規(guī),冠心病 (CHD),發(fā)病率和死亡率不斷增加(Incidence and mortality increased constantly) 發(fā)病年齡年輕化 (Incidence become much younger ) 公共衛(wèi)生的首要

2、重大疾病之一(One of the most major diseases of public health ),心臟病中住院人數(shù)第一 largest number in inpaiteints with heart disease,住院疾病平均費用第一 First average cost for inpatients,在心臟病中死亡率第一 First mortality of heart disease,心臟病院外死亡比例第一 First mortality in outside the hospitals,ACS,介入治療后1年心臟事件的發(fā)生率18 (The incidence of c

3、ardiac events after 1 year intervention was 18%. ) （N Engl J Med 2006;355(1):1093）,心血管病致殘和死亡主要原因 (leading cause of cardiovascular disability and death),介入治療和藥物涂層支架 (Interventional therapy and DES ),不穩(wěn)定心絞痛 (Unstable angina ),非ST段抬高心梗 (NSTEMI ),ST段抬高心梗 (STEMI ),2.慢性心衰 (Chronic heart failure ),5年的死亡率達到

4、67%左右 (5-year mortality rate was 67% ),N Engl J Med 2010;362:228-38,3.心律失常 (Arrhythmia),抗心律失常藥，除受體阻滯劑外的病因治療外，直接抑制心律失常的藥物對長期預后皆有負面作用。心律失常目前基本是病因治療、對癥治療、介入治療,Antiarrhythmic drugs, except the -blocker, drugs for direct inhibition of arrhythmia have negative effects on long-term prognosis. The current t

5、reatment of arrhythmia is etiological, symptomatic treatment and intervention therapy,4.惡性腫瘤(malignancy ),手術、化療、放療(operation, chemotherapy, radiotherapy ) 腫瘤血管靶向治療(tumor vascular targeting therapy ) 生物療法 (biotherapy ) 介入治療 (interventional therapy ) 我國腫瘤患者5年的生存率僅10%左 右， 90%以上惡性腫瘤患者，死于腫 瘤的擴散、轉移 (5-yea

6、r survival rate of cancer in China was only 10%. 90% cancer patients were died of tumor proliferation and metastasis),現(xiàn)代醫(yī)學迅速發(fā)展的主要方面 Main aspects of the development of modern medicine,診斷技術 Diagnostic techniques 影像學指導下的介入技術 Interventional technologies under the guidance of imaging) 外科手術(Surgery ) 靶向和定

7、位干預 Targeting and positioning intervention) 預防醫(yī)學 Preventive Medicine,難解決全身病理生理改變 Difficult to resolve the systemic pathophysiological changes,不得已而為之的 預防醫(yī)學,The medicine has to be the preventive medicine,現(xiàn)代醫(yī)學的迅速發(fā)展 Development of Contemporary medicine 傳統(tǒng)中醫(yī)學的優(yōu)勢 Superiorities of TCM 傳統(tǒng)中醫(yī)藥學對現(xiàn)代醫(yī)學發(fā)展的啟示 The

8、illumination for contemporary medical development,It has been somewhat surprising in this era of triumph for modern medicine to see the rapid growth of alternative/complementary medicine, which is used by as many as one in three Americans. Although most of those still refrain from informing their re

9、gular physicians about that use, there is a growing tendency among physicians to acknowledge and even embrace certain forms of alternative/complementary medicine Science 2002; 295(11):233.,1.傳染病 infectious disease,上世紀50年代石家莊、北京流行乙型腦炎，用傷寒論指導治療取得很好治療效果； 50s of last century, treatment of Japanese encep

10、halitis in Shijiazhuang and Beijing with TCM showed a better effects than with WM. 上世紀60年代流行麻疹并發(fā)肺炎，中醫(yī)治療結果不僅療效優(yōu)于西醫(yī)； 60s of last century, treatment of measles complicated by pneumonia with TCM showed a better effects than WM,國家“七五”項目流行性出血熱研究，中藥組病死率為1.1，西醫(yī)組病死率為5.08（P0.01）； National Seventh Five project

11、 - study of epidemic hemorrhagic fever, mortality was 1.1% in TCM, 5.08% in WM SARS的中醫(yī)研究，獲得國家科技進步二等獎。 The study TCM on SARs won the State Science and Technology Progress Award,335 cases enrolled 335例入選,Control group對照組 169 cases,Treatment group治療組 166 cases,308 cases completed with 145 repeat angiog

12、raphy 308例完成試驗，145例重復冠脈造影,Randomize隨機,3 cases lost脫落,12 cases exclude剔除,3 cases lost脫落,9 cases exclude剔除,154 cases,154 cases,2. 中藥預防PCI后再狹窄Preventing restenosis after PCI with TCM,Note: Compared with control group，*P0.05,隨訪半年兩組冠脈造影結果比較 (Comparison of six months follow-up results of coronary angiogra

13、phy),注: 與對照組比較，*P0.05,兩組冠脈造影結果比較 (Comparison of coronary angiography in two groups),注: 與對照組比較，*P0.05,Comparison of recurrent angina (RA) 兩組復發(fā)心絞痛的比較,*,*,Comparison of clinical end-point event 兩組臨床終點事件的比較,Note: There was significant difference between the two groups(p0.05).,多中心、雙盲隨機、安慰劑對照方法，證明活血化瘀中藥制劑

14、預防冠心病介入治療后再狹窄形成和心絞痛復發(fā)，改善患者長期預后。,Multi-center, double-blind, randomized, placebo-controlled methods proved that TCM can prevent the restenosis after PCI and recurrence of angina, and improve long-term prognosis of patients.,在IRA恢復再通冠脈血流灌注良好的情況下仍有25以上患者發(fā)生微循環(huán)血流Noreflow After restoring coronary reperfus

15、ion of IRA, there are more than 25% of patients without microcirculatory blood flow,3.益氣養(yǎng)陰活血法改善AMI血運重建后心肌灌注 Tonifying Qi, nourishing yin and promoting the blood circulation to improve myocardial perfusion after revascularization for AMI,臨床設計：多中心、雙盲隨機、安慰對照 Design: A multicenter, double-blind, randomi

16、zed, controlled placebo) 治療方法：治療組100例在西醫(yī)的基礎上加心悅膠囊、丹參片；對照組采用西醫(yī)常規(guī)治療 Treatment: Treatment group, 100 cases, adding Danshen Tablet and Xinyue capsule to western medicine; Control group, conventional Western medicine 觀察指標：聲學超聲造影顯示的心肌組織灌注、生命質量和終點事件 Index: acoustic ultrasound imaging showed myocardial perf

17、usion, the quality of life and end-point events,實際入選例數(shù)(actual number of selected cases )：182例（91） 脫落例數(shù)(number of loss follow-up cases)：11例（6.04）,心臟事件發(fā)生率(Incidence of heart event),SAQ生活質量積分 SAQ life quality score,負荷正常心肌百分比 The percentage of normal myocardium,聲學造影結果(Acoustic imaging results ),半年臨床觀察結果

18、(clinical observation results of half year),改善左室收縮功能和心肌運動 Improving the left heart function 306(22): 640-643,一個功能基因改變會引起多少蛋白變化？ How many protein changes induced by single functional gene changes? 一個功能蛋白改變是多少基因調控的結果？ How many gene regulation resulted in a single functional protein change? 目前檢測到的基因、蛋白

19、，哪些發(fā)揮了作用？哪些屬潛在變化？誰是原發(fā)基因？誰是繼發(fā)基因？ Which gene or protein detected currently takes action? Which one belongs to standbyer? Which one is original gene or secondary gene? 當藥物干預某一基因、蛋白時，機體會發(fā)生哪些適應性變化？ When gene or protein was intervened by drugs, what adaptive changes occur? 現(xiàn)代生物技術仍難以辨識清楚。 Modern biotechnol

20、ogy is still difficult to identify clearly.,對單基因疾病，可嘗試改變或糾正基因結構；對于多基因復雜疾病，則需要從基因和蛋白質的功能調控入手，提高或激發(fā)機體自我修復能力，使其達到相對有序狀態(tài)。 As for single-gene disorders, we can try to change or correct the gene structure; for more complex multi-genes disease, we need to control the functions of genes and proteins, increa

21、se or stimulate the body to repair itself, to reach the relative order.,人類在漫長的演化過程中，形成了識別和適應自然界的屬性。 Human beings have the attributes of distinguish and fitting the nature during the endless evolvement. 毋庸置疑，其基因、蛋白質的多態(tài)性和自然界變化存在著相容性，或者說人體的生物信息平衡和自然界息息相關。 without doubt, both gene and protein polymorphi

22、sm and the natural change exist compatibility, or biological transformation is closely related to natural balance.,人體是一個有機的整體，構成人體的各個組成部分在結構上不可分割，在功能上相互協(xié)調、互為補充，在病理上則相互影響。把人體疾病作為整體來研究是目前醫(yī)學發(fā)展的一個重要的方向。,Chin J Intern Med 2010;49(7)導讀,Human beings are a organic whole body, all parts composed the human in

23、divisibility in the structure, coordinated supplementary in the function, and interaction in pathology. Studying the human diseases as a whole is the direction of the current medical development.,傳統(tǒng)中醫(yī)藥學，用自然界“陰”、“陽”動態(tài)平衡指導人體觀察，認為機體活動皆處在對立統(tǒng)一的“陰”、“陽”變化中，且在變化過程中相互聯(lián)系，維持著生命動態(tài)平衡。 TCM observed the human body

24、 by using natural dynamic equilibrium “Yin ” and Yang“. Bodys activities are in the unity of changes of opposites Yin“ and yang, and irrelated in the process of change which maintain the dynamic of life balance. 傳統(tǒng)中醫(yī)學治療疾病的重點在于根據(jù)機體“陰”、“陽”動態(tài)變化不同，將“陰”、“陽”屬性不同的藥物有機組織一起，調節(jié)機體“陰”、“陽”的偏盛、偏衰。 Treatment of TC

25、M focuses on organizing different drugs with Yin” and Yang attributes and regulating the Yin“ and Yang for treating diseases, according to the dynamic changes of Yin” and Yang .,傳統(tǒng)中醫(yī)診療模式(Diagnosis and treatment mode of TCM) 注重機體的整體功能(pay attention to the whole function of the body) 注重疾病的動態(tài)變化(pay att

26、ention to the dynamic change of the diseases) 將機體生理病理變化和自然界納入一個整體系統(tǒng)中去認識問題(realize problems in whole system of both pathophysiology and the nature),傳統(tǒng)中醫(yī)學幾千年臨床實踐，積淀了大量有效的診 療疾病方法。雖然尚不能闡釋清楚治病的機理，但傳 統(tǒng)中醫(yī)學用“陰”、“陽”認識方法論指導整體辨證診療 疾病的模式具有極為重要的醫(yī)療價值取向。,TCM with thousands of years of clinical practice accumulates

27、 a great deal of effective methods for disease diagnosis and treatment. Although the mechanism of treatment was not yet clearly explained, Applying recognizing methodology of “Yin“ 110:1219-1225.,人參皂苷能Rg1導致血管生成，促進功能性的新生 血管進入傷口部位和內皮細胞形成血管形成； Rb1則 具有相反的作用， 抑制傷口早期愈合階段的血管和 內皮細胞的衍化,Ginsenoside Rg1 could

28、lead to angiogenesis, promote functional neovascularizationin to the wound site and the formation of vascular endothelial cells ; Rb1 has the opposite effect, inhibiting the early wound healing phase of the blood vessels and endothelial cells derived.,Arterioscler Thromb Vasc Biol. 2003;23:1559-1566

29、.,Ginkgo biloba extract not only has action on platelet activation, but also has immune and inflammatory regulation, lower blood lipids, anti-lipid peroxidation effects.,銀杏葉提取物除抗血小板活化活性外，還有免疫 炎癥調節(jié)、降低血脂、抗脂質過氧化等藥理作用。,一種植物有如此多的作用環(huán)節(jié)，甚至是截然相反的藥理作用， 這在化學合成藥物中是極其罕見的。,正是這種動物和離體實驗中表現(xiàn)出的多環(huán)節(jié)或截然不同的作用， 發(fā)揮了有利于機體整體恢

30、復動態(tài)平衡的效果。,A plant has so many roles, or even opposite pharmacological action, which is extremely rare in chemical synthetic drugs.,It is the multi-link or different roles shoed in animal and in vitro experiments, which plays a beneficial effect on the the dynamic balance of body.,面對自然藥物眾多化學成分的有序組合（尤

31、其是中藥或其復方）及與人體內環(huán)境錯綜復雜的作用聯(lián)系，人們的認知還是膚淺的。 Facing many chemical compositions of natural substances (especially traditional Chinese medicine or its compounds) and with the complex role of the body contact environment, cognition of people is superficial. 機體內部復雜的生物聯(lián)系相對于人們認識能力永遠是一個黑箱，自然界藥物所含有的大量生物信息對人體病理生理的影

32、響永遠值得探索。 Comparing with cognitive ability of people, the connection within the complex biological organism is always a black box, natural drugs with a large number of biological information effecting on pathophysiology of the human body is always worth exploring.,無論現(xiàn)代醫(yī)學如何發(fā)展，都需將人體作為一個黑箱整體，利用現(xiàn)代科學技術探索人體適應自然界