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1、中国中医科学院西苑医院心血管中心 史大卓Shi Dazhuo Xiyuan Hospital,China Academy of Chinese Medical sciences,补充替代医学与现代医学Complementary and Alternative Medicine&Western Medicine,现代医学的迅速发展Development of Contemporary medicine传统中医学的优势Superiorities of TCM传统中医药学对现代医学发展的启示The illumination for contemporary medical development,V
2、arious interventions for diseases including modern mechanical measurements and new drugs bring new hope for prevention and treatment.However,looking at the whole picture of modern medicine we find that what we can do is still very limited.,现代各种干预疾病的机械措施和新药物，为疾病预防和治疗带来了新的希望，但环顾现代疾病谱的整个画面，发现我们能够做的还非常局
3、限。,中国糖尿病人数超过印度,不要说肿瘤、AIDS、糖尿病，即使普通病毒性感冒，西药也是对症治疗，对病理过程基本无作用。,Dont mention cancer,AIDS,diabetes,even though the common viral influenza,the western medicine has no obvious effect on the pathological process.,1.冠心病(Coronary heart disease),血运重建治疗(Revascularization Treatments),新药物和新技术不断出现，并应用于临床，尤其是抗血小板和
4、调节脂质代谢方面,基因治疗、干细胞移植、生物支架技术的应用，显示有良好的应用前景,Gene therapy,stem cell transplantation and biological stentshow a good prospect.,New drugs and new technologies,especially antiplatelet and regulation of lipid metabolism are emerging and applying in clinical practice.,炎症反应(inflammation reaction),氧化应激损伤(oxida
5、tive stress),内皮功能障碍(endothelial dysfunction),抗药性(Drug resistance),无复流慢复流(no reflow&slow reflow),再灌注损伤(ischemia-reperfusion injury),冠脉内血栓(thrombus formation in coronary artery),远期血管狭窄(long term vascular stenosis),(interventional therapy)(conventional treatment of western medicine),缺乏理想干预手段，成为影响长期预后的瓶
6、颈(No good treatments&bottleneck of long-term prognosis),Lim SY,et al.Circ J.2004;68(10):928-932,存在问题(Problems),介入治疗,西药常规,冠心病(CHD),发病率和死亡率不断增加(Incidence and mortality increased constantly)发病年龄年轻化(Incidence become much younger)公共卫生的首要重大疾病之一(One of the most major diseases of public health),心脏病中住院人数第一la
7、rgest number in inpaiteints with heart disease,住院疾病平均费用第一First average cost for inpatients,在心脏病中死亡率第一First mortality of heart disease,心脏病院外死亡比例第一First mortality in outside the hospitals,ACS,介入治疗后1年心脏事件的发生率18(The incidence of cardiac events after 1 year intervention was 18%.)（N Engl J Med 2006;355(1)
8、:1093）,心血管病致残和死亡主要原因(leading cause of cardiovascular disability and death),介入治疗和药物涂层支架(Interventional therapy and DES),不稳定心绞痛(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年的死亡率达到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
9、律失常药，除受体阻滞剂外的病因治疗外，直接抑制心律失常的药物对长期预后皆有负面作用。心律失常目前基本是病因治疗、对症治疗、介入治疗,Antiarrhythmic drugs,except the-blocker,drugs for direct inhibition of arrhythmia have negative effects on long-term prognosis.The current treatment of arrhythmia is etiological,symptomatic treatment and intervention therapy,4.恶性肿瘤(ma
10、lignancy),手术、化疗、放疗(operation,chemotherapy,radiotherapy)肿瘤血管靶向治疗(tumor vascular targeting therapy)生物疗法(biotherapy)介入治疗(interventional therapy)我国肿瘤患者5年的生存率仅10%左右，90%以上恶性肿瘤患者，死于肿瘤的扩散、转移(5-year survival rate of cancer in China was only 10%.90%cancer patients were died of tumor proliferation and metastas
11、is),现代医学迅速发展的主要方面 Main aspects of the development of modern medicine,诊断技术 Diagnostic techniques影像学指导下的介入技术 Interventional technologies under the guidance of imaging)外科手术(Surgery)靶向和定位干预 Targeting and positioning intervention)预防医学 Preventive Medicine,难解决全身病理生理改变 Difficult to resolve the systemic path
12、ophysiological changes,不得已而为之的预防医学,The medicine has to be the preventive medicine,现代医学的迅速发展Development of Contemporary medicine传统中医学的优势Superiorities of TCM传统中医药学对现代医学发展的启示The illumination for contemporary medical development,It has been somewhat surprising in this era of triumph for modern medicine
13、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 regular physicians about that use,there is a growing tendency among physicians to acknowledge and even embrace certain forms of a
14、lternative/complementary medicine Science 2002;295(11):233.,1.传染病 infectious disease,上世纪50年代石家庄、北京流行乙型脑炎，用伤寒论指导治疗取得很好治疗效果；50s of last century,treatment of Japanese encephalitis in Shijiazhuang and Beijing with TCM showed a better effects than with WM.上世纪60年代流行麻疹并发肺炎，中医治疗结果不仅疗效优于西医；60s of last centur
15、y,treatment of measles complicated by pneumonia with TCM showed a better effects than WM,国家“七五”项目流行性出血热研究，中药组病死率为1.1，西医组病死率为5.08（P0.01）；National Seventh Five project-study of epidemic hemorrhagic fever,mortality was 1.1%in TCM,5.08%in WMSARS的中医研究，获得国家科技进步二等奖。The study TCM on SARs won the State Scien
16、ce and Technology Progress Award,335 cases enrolled 335例入选,Control group对照组 169 cases,Treatment group治疗组 166 cases,308 cases completed with 145 repeat angiography 308例完成试验，145例重复冠脉造影,Randomize随机,3 cases lost脱落,12 cases exclude剔除,3 cases lost脱落,9 cases exclude剔除,154 cases,154 cases,2.中药预防PCI后再狭窄Preve
17、nting restenosis after PCI with TCM,Note:Compared with control group，*P0.05,随访半年两组冠脉造影结果比较(Comparison of six months follow-up results of coronary angiography),注:与对照组比较，*P0.05,两组冠脉造影结果比较(Comparison of coronary angiography in two groups),注:与对照组比较，*P0.05,Comparison of recurrent angina(RA)两组复发心绞痛的比较,*,*
18、,Comparison of clinical end-point event 两组临床终点事件的比较,Note:There was significant difference between the two groups(p0.05).,多中心、双盲随机、安慰剂对照方法，证明活血化瘀中药制剂预防冠心病介入治疗后再狭窄形成和心绞痛复发，改善患者长期预后。,Multi-center,double-blind,randomized,placebo-controlled methods proved that TCM can prevent the restenosis after PCI and
19、 recurrence of angina,and improve long-term prognosis of patients.,在IRA恢复再通冠脉血流灌注良好的情况下仍有25以上患者发生微循环血流Noreflow After restoring coronary reperfusion of IRA,there are more than 25%of patients without microcirculatory blood flow,3.益气养阴活血法改善AMI血运重建后心肌灌注Tonifying Qi,nourishing yin and promoting the blood
20、 circulation to improve myocardial perfusion after revascularization for AMI,临床设计：多中心、双盲随机、安慰对照 Design:A multicenter,double-blind,randomized,controlled placebo)治疗方法：治疗组100例在西医的基础上加心悦胶囊、丹参片；对照组采用西医常规治疗 Treatment:Treatment group,100 cases,adding Danshen Tablet and Xinyue capsule to western medicine;Co
21、ntrol group,conventional Western medicine观察指标：声学超声造影显示的心肌组织灌注、生命质量和终点事件 Index:acoustic ultrasound imaging showed myocardial perfusion,the quality of life and end-point events,实际入选例数(actual number of selected cases)：182例（91）脱落例数(number of loss follow-up cases)：11例（6.04）,心脏事件发生率(Incidence of heart eve
22、nt),SAQ生活质量积分SAQ life quality score,负荷正常心肌百分比The percentage of normal myocardium,声学造影结果(Acoustic imaging results),半年临床观察结果(clinical observation results of half year),改善左室收缩功能和心肌运动 Improving the left heart function&myocardial movement增加正常心肌比率 Increasing the ratio of normal myocardium改善微循环血流灌注 Improvi
23、ng the microcirculation perfusion减少心血管事件的发生 Reducing the cardiovascular incidence提高患者的生活质量 Improving the life quality of patients,3.其他(others),清热开窍、活血解毒通腑治疗中风病 Treating stroke with cleaning heat&enlighten,promoting circulation&detoxification 清热通腑、活血解毒治疗急腹症 Treating surgical abdomen promoting circula
24、tion&detoxification cleaning heat&smoothing large intestine detoxification靛玉红治疗慢性粒细胞白血病 Treating Chronic myeloid leukemia by dianyuhong“癌灵1号”（三氧化二砷）治疗M3 Treating M3 with“ailing1”Arsenic trioxide川芎嗪注射液、丹参酚酸防治心脑血管病 Treating Cardiovascular disease with Ligustrazine Injection and Salvianolic acid B康莱特（薏
25、苡仁）治疗肿瘤 Treating Tumor with kanglaite(Coix Seed)青蒿素治疗疟疾 Treating malaria with Arteannuin,“医者意也”，经验性、科学性和艺术性，继承和重复的困难性 Difficult inheritance&repeat due to empirical,scientific and artistic,认识方法的整体、辨证模式，文化和哲学的层面的差异，传播的困难 The communicating difficulties due to the differences of understanding cultural a
26、nd philosophy,存在问题(Problems),现代医学的迅速发展Development of Contemporary medicine传统中医学的优势Superiorities of TCM传统中医药学对现代医学发展的启示The illumination for contemporary medical development,许多疾病是机体代谢、衰老伴随的病理生理变化；The diseases itself are the metabolism,pathophysiological changes associated with aging参与疾病的基因及转录蛋白质在疾病过程中
27、相互联系、影响，主次难以辨别；It is difficult to distinguish genes and transcription protein involved in diseases which interacted during the progression of diseases.代谢、免疫、神经内分泌失调等相互并存，局部病变是全身疾病在局部的反应。Metabolic,immune,neuroendocrine disorders coexist,the local response is a local response of systemic disease.,现代慢性
28、疾病复杂性(The complexity of chronic diseases),前列腺癌基因和mRNA变化：一个2千万多个mRNA标签的正常前列腺组织和雄性激素敏感癌症细胞株的数据库，证明典型早期癌症阶段和典型的晚期阶段相比，有2000余种mRNA 表达发生改变。Gene and mRNA changes in prostate cancer:over 2 million mRNA labels of the normal and androgen-sensitive prostate cancer cell line database,show that compared with th
29、e typical early cancer stage and late stage of the typical,more than 2,000 mRNA expression have changed.,复杂基因、蛋白变化的难预知性Difficult predictability of complex gene and protein changes,Science 2004;306(22):640-643,一个功能基因改变会引起多少蛋白变化？How many protein changes induced by single functional gene changes?一个功能蛋白
30、改变是多少基因调控的结果？How many gene regulation resulted in a single functional protein change?目前检测到的基因、蛋白，哪些发挥了作用？哪些属潜在变化？谁是原发基因？谁是继发基因？Which gene or protein detected currently takes action?Which one belongs to standbyer?Which one is original gene or secondary gene?当药物干预某一基因、蛋白时，机体会发生哪些适应性变化？When gene or pro
31、tein was intervened by drugs,what adaptive changes occur?现代生物技术仍难以辨识清楚。Modern biotechnology is still difficult to identify clearly.,对单基因疾病，可尝试改变或纠正基因结构；对于多基因复杂疾病，则需要从基因和蛋白质的功能调控入手，提高或激发机体自我修复能力，使其达到相对有序状态。As for single-gene disorders,we can try to change or correct the gene structure;for more comple
32、x multi-genes disease,we need to control the functions of genes and proteins,increase or stimulate the body to repair itself,to reach the relative order.,人类在漫长的演化过程中，形成了识别和适应自然界的属性。Human beings have the attributes of distinguish and fitting the nature during the endless evolvement.毋庸置疑，其基因、蛋白质的多态性和自
33、然界变化存在着相容性，或者说人体的生物信息平衡和自然界息息相关。without doubt,both gene and protein polymorphism and the natural change exist compatibility,or biological transformation is closely related to natural balance.,人体是一个有机的整体，构成人体的各个组成部分在结构上不可分割，在功能上相互协调、互为补充，在病理上则相互影响。把人体疾病作为整体来研究是目前医学发展的一个重要的方向。,Chin J Intern Med 2010;4
34、9(7)导读,Human beings are a organic whole body,all parts composed the human indivisibility 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.,传统中医药学，用自然界“阴”、“阳”动态平衡指导人体观察，认为
35、机体活动皆处在对立统一的“阴”、“阳”变化中，且在变化过程中相互联系，维持着生命动态平衡。TCM observed the human body 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.传统中医学治疗疾病的重点在于根据机体“阴”、“
36、阳”动态变化不同，将“阴”、“阳”属性不同的药物有机组织一起，调节机体“阴”、“阳”的偏盛、偏衰。Treatment of TCM 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.,传统中医诊疗模式(Diagnosis and treatment mode of TCM)注重机体的整体功能(pay atte
37、ntion to the whole function of the body)注重疾病的动态变化(pay attention to the dynamic change of the diseases)将机体生理病理变化和自然界纳入一个整体系统中去认识问题(realize problems in whole system of both pathophysiology and the nature),传统中医学几千年临床实践，积淀了大量有效的诊疗疾病方法。虽然尚不能阐释清楚治病的机理，但传统中医学用“阴”、“阳”认识方法论指导整体辨证诊疗疾病的模式具有极为重要的医疗价值取向。,TCM wit
38、h thousands of years of clinical practice accumulates 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“&Yang of TCM to guides differentiating and treating diseases will be a
39、 significant mode in modern clinical practice.,Circulation.2004;110:1219-1225.,人参皂苷能Rg1导致血管生成，促进功能性的新生血管进入伤口部位和内皮细胞形成血管形成；Rb1则具有相反的作用，抑制伤口早期愈合阶段的血管和内皮细胞的衍化,Ginsenoside Rg1 could lead to angiogenesis,promote functional neovascularizationin to the wound site and the formation of vascular endothelial c
40、ells;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.,Ginkgo biloba extract not only has action on platelet activation,but also has immune and inflammatory regulation,lower blood
41、lipids,anti-lipid peroxidation effects.,银杏叶提取物除抗血小板活化活性外，还有免疫炎症调节、降低血脂、抗脂质过氧化等药理作用。,一种植物有如此多的作用环节，甚至是截然相反的药理作用，这在化学合成药物中是极其罕见的。,正是这种动物和离体实验中表现出的多环节或截然不同的作用，发挥了有利于机体整体恢复动态平衡的效果。,A plant has so many roles,or even opposite pharmacological action,which is extremely rare in chemical synthetic drugs.,It i
42、s 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.,面对自然药物众多化学成分的有序组合（尤其是中药或其复方）及与人体内环境错综复杂的作用联系，人们的认知还是肤浅的。Facing many chemical compositions of natural substances(especially traditional Chinese medicine or
43、its compounds)and with the complex role of the body contact environment,cognition of people is superficial.机体内部复杂的生物联系相对于人们认识能力永远是一个黑箱，自然界药物所含有的大量生物信息对人体病理生理的影响永远值得探索。Comparing with cognitive ability of people,the connection within the complex biological organism is always a black box,natural drugs
44、with a large number of biological information effecting on pathophysiology of the human body is always worth exploring.,无论现代医学如何发展，都需将人体作为一个黑箱整体，利用现代科学技术探索人体适应自然界（包括食物、药物和生态环境等）输入、输出生物信息变化的规律。No matter how the development of modern medicine has achieved,the human body should be regarded as a black b
45、ox.We should explore the regulation of inputting and outputting biological information which the human body adapt to the natural world(including food,medicines and ecological environment)by using modern science and technology.,传统中医药防治疾病经验及其将自然界药物和人体纳入一个整体系统，辨识疾病变化的方法，对现代医学发展有很多启示：Experience of TCM a
46、nd a whole system including both the natural drugs and the human body and methods of identifying diseases bring many inspirations to the development of modern medicine:从自然药物发现有效治疗疾病的化学成分及其有效的组合方法；Chemical constituents and their effective combination methods discovered from natural drugs to treat dis
47、ease effectively.从复杂基因、蛋白的表达改变中，发现治疗疾病新的靶向；New direction of diseases treatments from changes of complex genes and protein expression.从基因蛋白网络联系调节方面，揭示疾病复杂机理。Complex mechanisms of diseases from regulation of network of gene and protein.,Wish everyone has a good stay in Beijing,thank you for listening,Summer palace,
