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Exclusive view | Step out of a path of precision medicine with Chinese characteristics
The "Precision Medicine" program was first proposed by the United States. Subsequently, China established the “National Precision Medical Strategy Expert Committee” and the “Chinese version of the Precision Medical Plan” will also be launched. As a result, "precise medical care" has become a new climax of medical development sweeping the world, and the medical profession may move from precision medicine to precision medicine.
As a traditional Chinese medicine with thousands of years of history, how to recognize precision medicine, how to apply precision medicine to the clinic, and to embark on a path of precision medicine with Chinese characteristics is a new topic that the Chinese medical community needs to ponder and explore.
According to the definition of the National Institutes of Health, precision medicine is an emerging disease treatment and prevention method based on understanding individual genes, environment and lifestyle.
The basis is personalized diagnosis, the core is personalized medicine, and is supported by the maturity of detection and diagnosis technologies such as gene sequencing and the rapid development of artificial intelligence and big data analysis technology. Through genetic screening, diagnosis or prevention of hereditary diseases, detection of changes in disease spectrum and gene-environment interactions, and epidemiological interventions.
Enlightenment from precision medicine
Set up a platform for communication
Quasi-medicine has begun to pay attention to the role of external factors such as human and related lifestyles and living environment in the process of disease development. This is the beginning of the development trend of system theory and holism.
The holistic view and system theory are the characteristics of traditional Chinese medicine, which fully shows that in the research mode, modern medicine is close to the traditional Chinese medicine, rather than denying the traditional Chinese medicine model, which is also a side test of the value and charm of traditional Chinese medicine. At the same time, this development trend has established a communication platform between traditional Chinese medicine and modern medicine.
In order to achieve disease prediction, it is necessary to clearly understand the genetic and genomics information of individuals, such as genetic diseases, tumors and other genetic sequencing screening.
Each person (or patient) has different internal factors and external influences such as genome, proteomics, and metabolomics. Therefore, it is necessary to develop personalized prevention programs and treatment programs, such as pharmacogenetics and biomarker core support technology. An important reference for the use of drugs.
Therefore, precision medicine emphasizes the concept of individual differences and individualized treatment, which is in line with the traditional Chinese medicine individualized treatment thinking. Because each person (or patient) has different yin and yang qi and blood and different traits, the cause, pathogenesis and development will not be the same, so individualized treatment is needed. It varies from person to person and from disease to disease. It varies from syndrome to test and varies from time to time.
Concealing the corresponding thoughts of Chinese medicine and human beings
In addition to focusing on individuals, precision medicine also studies the environment in which individuals exist, because the disease is not only related to individual genes, but also closely related to genes and the external environment. Studies have shown that in addition to genetic diseases (such as rare diseases), most diseases are multi-gene related and have a certain relationship with the acquired environment.
According to WHO research, among the many factors affecting health, the weight of genes is actually not large, only 15% to 20%, while non-genetic factors such as lifestyle account for up to 60%. This content is consistent with the Chinese-speaking theory of Chinese medicine. Chinese medicine believes that human beings are part of nature, and human beings are important, but it is more important to conform to time and space. Just as "Lingshu·Yuelu" said: "People and heaven and earth also participate, and the sun and the moon also correspond." "Five runs on the theory" "From its qi, and it is ill, it is sick." Therefore, the content of precision medicine is in line with the corresponding thinking of Chinese medicine and human beings.
Combine traditional Chinese medicine to achieve maximum development
The development of "precise medicine" has greatly advanced human control and treatment of certain diseases, especially diseases that are determined by local factors.
However, there is still a long way to go to the clinic. For example, the integration of genomic data and clinical medical information, genomic data can not be searched, shared and understood by doctors; for example, big data intelligent analysis methods need to be improved, because of the high degree of macro data between genes and genomes, disease occurrence factors, etc. Linearity is incapable of current analytical methods; the research on new intelligent statistical analysis systems is not yet mature, and it needs to be timed.
Compared with modern medicine, traditional Chinese medicine has a relatively complete theoretical system and mature concept methods for “precision”. It has been verified and implemented in the long-term clinical practice, and it helps the foundation of precision medicine with the help of traditional Chinese medicine ideas and methods. Research and application technology directionality, drug targeting accuracy, and promote its development.
Through the above analysis, the guiding ideology of precision medicine is in line with the corresponding concept of traditional Chinese medicine, and the individualized concept coincides with the individualized treatment of traditional Chinese medicine. The theoretical system and method contribute to the research direction of precision medicine. This determines that traditional Chinese medicine will surely follow a path of precision medicine that conforms to Chinese characteristics and has a place in the world of precision medicine.
Exploration and Reflection on TCM Precision Medicine
Accurate medical exploration with syndrome differentiation and treatment as the core
Syndrome differentiation and treatment embodies individualized medicine. For example, Chinese medicine emphasizes syndrome differentiation in diagnosing diseases, emphasizing the influence of individual traits on diseases; when treating diseases, there is a difference between “different disease treatment” and “different disease treatment”; considering the environment, Seasons and individual differences, in the treatment of the combination of "adapted to local conditions", "just in time for treatment" and "adoption for people." This concept or theory has certain representativeness and practicality. However, there are some problems that need to be deeply considered in the treatment of syndrome differentiation.
From the corresponding to the heavens
Everything (including human beings) exists in nature (the universe), and it is related to the whole nature (the universe), as stated in the book "Ask the Truth to Truth": "The heavens and the earth are united, and the six parts are divided into objects." "Oysters", "Nine-polar Chinese Medicine" said: "The composition of the human body and life activities are part of the whole nature, consistent with the natural world, compatible, and closely related."
Everything (including people) is made naturally. Just like the consistency of the menstrual cycle of menstruation and the cycle of moon and moon; the qi and blood of the human body are corresponding to the ups and downs of the yin and yang of the day and night, and so on. These are not only determined by the human form itself, but also by the sun, the moon, and the night. Therefore, the phenomenon level of things (including people) is not only the shape of the thing itself, but also the "mapping" of the universe as a whole.
However, syndrome differentiation is the entry point of symptoms and signs, and these phenomena (symptoms) are the result of human beings' natural time and space.
Because of the loss of the traditional Chinese medicine holistic view (the corresponding concept of heaven and man), the error in the cognition between the phenomenon and the essence also determines that there is a certain one-sided and partial cognition from the beginning. It can be seen that it is difficult to reflect the essence of the problem (cause) by summarizing the syndromes of these symptoms, which ultimately leads to the lack of precision in the conclusion of the diagnosis and treatment.
2. Undocumented and confusing
The premise of the syndrome differentiation system of modern Chinese medicine is that there is a syndrome (symptom) that can be distinguished. If the patient is a symptom or symptom of a potential disease treatment or health care, the syndrome differentiation system is weak, especially in the face of modern medical disease spectrum and The diagnosis and treatment assistive technology has gradually revealed the "undocumented" or insufficiently accurate and accurate defects, and lacks objective "quantitative" indicators without being recognized by the academic community.
Exploration of precision medicine represented by modern scientific research
Modern medicine based on the concept of reduction analysis, from macro to micro, from the system, organ, organization, cell, and molecular level, has formed a huge disciplinary system. This process has deeply affected the thinking of Chinese medicine practitioners, and even thinks Only the understanding of human tissues, cells and molecules based on visible and tangible is scientific, and different forms of scientific research have been carried out on this road, such as the use of mathematical theory and data mining methods to quantify Chinese medicine. It also includes the establishment of mathematical models in Chinese medicine, law, prescriptions, etc., the use of mathematical methods to study Chinese medicine and quantitative research on traditional Chinese medicine.
In some ways, these studies have indeed provided methods and references for precision medicine in Chinese medicine. But for this special, physical and mental coexisting human body, the precise grasp of its state is not achievable by the measurement method and the "precision" of the measuring instrument, and more of the hierarchy of the state description system with us as the frame of reference. The total number of containing state variables has a more critical link.
The lower the level of a state description system, the greater the total number of parameters introduced, and the more difficult it is to achieve "precise" identification. From this perspective, this scientific research path that deviates from the traditional Chinese humanistic thinking mode is bound to fail.
The direction of future Chinese medicine precision medicine
Maintain Chinese medicine characteristics
To achieve precision medicine in traditional Chinese medicine, we must respect the thinking of Chinese medicine, maintain the characteristics of Chinese medicine, and implement the corresponding overall concept of heaven and humanity into the clinical. Respect for individual differences, specializing in individualized treatment; one-on-one method, one person.
Precision theory and practice system
In order to maintain the characteristics of traditional Chinese medicine and achieve precise medical goals, we must have a complete and systematic theoretical and clinical system to embody and practice the above concepts.
For the corresponding thoughts of heaven and man, in clinical practice, it is necessary to express the corresponding connotation of heaven and man, and how to express and describe the space and time, how to express the human body, how to correspond to the heavens and the humans, etc. by means of certain symbols (such as dry branches, calendars, etc. Explain and embody, form the corresponding space-time model and physique model.
At the same time, the "precise" drugs for pathological conditions also use the above symbols to illustrate the drug taste and efficacy, establish a drug model similar to the Cartesian coordinate system with the symbol of the dry branch; and through the physical and pathological, including certain diseases such as diabetes With the above symbols and the space-time one-to-one correspondence, a disease model is formed, so that precise medicine can be realized through the process of the prescription. In this way, it not only conforms to the thought of traditional Chinese medicine, but also maintains the characteristics of traditional Chinese medicine. It is also theoretical, practical, feasible and operable.
Prognosis outcome and treatment
In addition to precise diagnosis and treatment, the clinic must also raise the prognosis of the disease to a certain height. At the same time, with the corresponding overall view of the human being as the guiding ideology, establish a systematic and accurate method for treating disease. As the theoretical physicist Stephen Hawking said in his book: on the basis of a model containing some arbitrary elements, the theory should be able to accurately describe a large number of observations, and it should also be able to clearly predict future observations.