s*******n
发帖数: 10426 | 1 中西医辩论的这么久，俺突然发现，其实对科学的不理解只是一方面，还有更重要的一
方面是对西医的治病思路不理解。
比如说什么西医是治标不治本，说什么西医不是整体的思路。
其实持这样的观点的人基本是因为没有系统学过西医，然后根据传言，或者是自己的看
病感受，或者是跟搞生物的有一点合作，然后就以为那些研究就是西医治病了。
其实这些都是错的离谱，当你去看西医的时候，你受到的治疗或不治疗等等手段时，你
接触到的只是一个表面的东西，你当然不能理解那背后的原理，因为你没必要了解那么
多，医生也不会为了让你明白他的治疗来拿本生理学或病理学来给你详细解释，如果那
样的话，等你明白要讲好几年的时间。
俺也没法在这里科普基础医学，所以俺能做的就是说说西医治病的思路究竟是什么样的
，让大家知道医生是怎么思考问题的。至于知识部分，那你只能去念医学院了。
首先是西医怎么看待人体，西医看待人体是在大体、器官、组织、细胞、分子这样不同
的水平来看待的，而且各个水平之间是相互联系的，而不是割裂的。相关知识自己去看
《解剖学》《生理学》《组织与胚胎学》《细胞生物学》《分子生物学》《免疫学》这
些书去吧。
然后是西医怎么看待疾病，西医看待疾病也是从不同层次和角度的。比如大的层面上，
疾病的潜伏、前驱、症状明显期、转归期这样的疾病进程。再比如更细的层次上，在器
官、组织、细胞水平上的病变是什么样的，过程又是什么。在致病因素这个角度上，又
有原发性的、外源性的等等，同样，在一个角度上还有不同层次的观察。具体知识去看
《病理学》《病例生理学》《病毒学》《微生物学》这些书吧。
以上这些都是来源于基础医学对人体和疾病的科学认识。
然后是治病。这里面就是误解最多的了，对于“治好了”这个定义，很多人也都想象的
太美好了，以为把病毒或细菌彻底从体内排除，或者让某器官功能跟新的一样才叫治好
,或者是把原因彻底纠正过来了。对于这样的想法，俺只能说你的理想太美好了。现在
很多病因还不清楚呢，你连对象都没有，怎么治好？不要说中医治好了啥啥的，一方面
你所谓的中医的治好，也是你自己的“感觉”这个就是症状没了，另一方面，中医连病
因都不清楚，还谈什么治好？最可笑的是中医所谓治本，连“本”是啥都不知道，就叫
治本？
在这个不完美的状态下，西医的努力方向就是：了解病因并去除之，不能去除的就尽量
消除症状、维持机体正常功能。
所以，大体上，医生一方面想的是疏导疾病进程向好的方向发展（内科），对出现的不
可逆性改变进行人为干预（外科）。
举例来说，现在能“治好”的艾滋病。
对艾滋来说，现在最新的药物可以完全控制病毒复制，你的免疫系统功能跟正常人一样
，患者的血液、体液内差不到病毒，病人跟正常人一样。唯一不一样的就是你要终生服
药，因为病毒会躲到细胞里，你不吃药它就出来了。
很多人就说了，这个不是治好，病毒还在体内。西医只是治标不治本。
那很多人小时候出过水痘吧，那你现在的水痘算是好了还是没好？
其实你看到的其他疾病的所谓治愈，也根本不像是你想的那样把病毒完全清除了，比如
水痘的带状疱疹病毒，小孩水痘下去了你以为病好了，其实病毒一样流在身体里，50-
60年不会发作，那是因为你的免疫系统强悍，能一直压制病毒，但是当你很老的时候，
免疫力不行了，那时候病毒就又出来了。
所以，对于艾滋病来说，用药物压制病毒和上面的用免疫系统压制病毒没有啥区别，只
不过由于HIV的作用机理，医生无法利用免疫系统压制病毒，才只好要用药物帮忙。
其他的病也是一样，医生首选的是利用免疫系统或器官的代偿功能控制疾病，大多数治
好的病就是你挺过去了，如果你自身不行然后才会用外力辅助的方法，其实所谓外力辅
助，也是辅助你的免疫系统或器官功能。 | a*******g
发帖数: 2813 | 2 谢谢这么大段的解释，西医也吸取了中医的三分治七分养，比如护理。康复医学。
西医和中医不是对立的，一方不灭另一方不涨似的 | I*********t
发帖数: 5258 | 3 其实正因为西医做很多事情太便利了，才导致不少头痛医头脚痛医脚的事发生。典型的
就是割阑尾，太小意思了，结果健康的也随手割了。 | h*****9
发帖数: 4028 | 4 只要不是傻子，任何民族的医学都有养病养生一说。现代西医的康复护理食疗等跟中医
有个屁的半毛钱关系？还吸取中医的？改天就成了西医是中医发明的了。
【在 a*******g 的大作中提到】
: 谢谢这么大段的解释，西医也吸取了中医的三分治七分养，比如护理。康复医学。
: 西医和中医不是对立的，一方不灭另一方不涨似的
| a*******g
发帖数: 2813 | 5
只要不是傻子，就知道任何民族的医学都有养病养生一说，
有些傻子就只信别的民族才有的养病养生，要废除自己民族的养病养生
【在 h*****9 的大作中提到】
: 只要不是傻子，任何民族的医学都有养病养生一说。现代西医的康复护理食疗等跟中医
: 有个屁的半毛钱关系？还吸取中医的？改天就成了西医是中医发明的了。
| h*****9
发帖数: 4028 | 6 有些傻子，一听废医验药。就好像死了干爹。别人祖上的放血疗法四体液学说不是说丢
就就丢了？丢的是垃圾，又不是精华。非得上升到民族高度。
【在 a*******g 的大作中提到】
:
: 只要不是傻子，就知道任何民族的医学都有养病养生一说，
: 有些傻子就只信别的民族才有的养病养生，要废除自己民族的养病养生
| p********3
发帖数: 5750 | 7 啥子意思？ 你是说阑尾割不得？ 炎症了就让它穿孔烂肚肚？ 为了保护您的阑尾，你
舍命？
【在 I*********t 的大作中提到】
: 其实正因为西医做很多事情太便利了，才导致不少头痛医头脚痛医脚的事发生。典型的
: 就是割阑尾，太小意思了，结果健康的也随手割了。
| p********3
发帖数: 5750 | 8 西医怎么吸收中医的三分治七分养来着？求科普。要是张口就说来的就不强求你解释啦。
【在 a*******g 的大作中提到】
: 谢谢这么大段的解释，西医也吸取了中医的三分治七分养，比如护理。康复医学。
: 西医和中医不是对立的，一方不灭另一方不涨似的
| p********3
发帖数: 5750 | 9 咱们不也丢过女人的裹脚，割过男人猪尾巴的长辫子么？
【在 h*****9 的大作中提到】
: 有些傻子，一听废医验药。就好像死了干爹。别人祖上的放血疗法四体液学说不是说丢
: 就就丢了？丢的是垃圾，又不是精华。非得上升到民族高度。
| a*******g
发帖数: 2813 | 10
有些傻子，一听废医验药，就要像找到了亲爹。一样的养生，别人养生方法就是养生，
自己的养生方法就是错误。
【在 h*****9 的大作中提到】
: 有些傻子，一听废医验药。就好像死了干爹。别人祖上的放血疗法四体液学说不是说丢
: 就就丢了？丢的是垃圾，又不是精华。非得上升到民族高度。
| | | c******n
发帖数: 5697 | 11 你三步多少分？
【在 a*******g 的大作中提到】
:
: 有些傻子，一听废医验药，就要像找到了亲爹。一样的养生，别人养生方法就是养生，
: 自己的养生方法就是错误。
| h*****9
发帖数: 4028 | 12 中医养生养了几千年。得出的结论像吃啥补啥，吃猴脑补人脑，吃JB补JB。最推崇的营
养补品燕窝鱼翅熊掌都是扯淡的玩意。难道不该去掉这些糟粕？上升到民族高度就占理
了？
你今天的衣食住行所学所做所享受的99%都是以西方文明为基础的，你怎么就接受了？
【在 a*******g 的大作中提到】
:
: 有些傻子，一听废医验药，就要像找到了亲爹。一样的养生，别人养生方法就是养生，
: 自己的养生方法就是错误。
| p********3
发帖数: 5750 | 13 给你科普一下西医是怎么养生的，免得你挨了几闷棒也不知道别人在说啥。
西医讲究一级二级三级预防。
有病治病， 有糖耐病高血压就治疗， 饮食控制作为辅助， 整体Life Style Change配
合药物治疗。 预防疾病进一步发展，比如DASH Diet推荐给有心血管疾病危险因子的病
人。当然, 有病调理上西医还有Physical Therapy, occupational Therapy, Speach
pathologist therapy, Dietitian等等 Team综合评估你的问题， 解决你的问题。 还
有social woker 来解决影响你健康的社会因素。
预防疾病， 防患于未然， 这就有了你听说的看到的如果不知道我今天讲给你听的WIC
Program， 就是科研发现母亲，幼儿营养不良（包括吃垃圾食品导致的表面看来的营养
过剩， 但是在临床上我们也称他们为营养不良），导致孩子成年以后有很多疾病的危
险比如高血压糖尿病等， 于是政府认为如果给孕妇和孩子五岁以前提供良好的营养，
那么每花政府一块钱实际上为以后治病省了三块钱。还有高胆固醇饮食调理等。
但是以上都已经是比较低级的了。我们提倡Health Promotion。 这就是提倡了很多年
的五份（蔬菜水果每天量）运动。 当然也有人提出拉人DASH Diet的理念，达到九份。
你看到的Food 金字塔，这些年也改进为”一半一半“了。 你每天买的食品上面的营
养标签也是养生的 一部分。
你就别那中医那套沾沾自喜了，别拿来证明你的民族自尊心， 过度敏感就是自卑，好
的就学不好的就摒弃， 这才能真正的自强之路。
【在 a*******g 的大作中提到】
:
: 有些傻子，一听废医验药，就要像找到了亲爹。一样的养生，别人养生方法就是养生，
: 自己的养生方法就是错误。
| f****s
发帖数: 5631 | 14 long
【在 s*******n 的大作中提到】
: 中西医辩论的这么久，俺突然发现，其实对科学的不理解只是一方面，还有更重要的一
: 方面是对西医的治病思路不理解。
: 比如说什么西医是治标不治本，说什么西医不是整体的思路。
: 其实持这样的观点的人基本是因为没有系统学过西医，然后根据传言，或者是自己的看
: 病感受，或者是跟搞生物的有一点合作，然后就以为那些研究就是西医治病了。
: 其实这些都是错的离谱，当你去看西医的时候，你受到的治疗或不治疗等等手段时，你
: 接触到的只是一个表面的东西，你当然不能理解那背后的原理，因为你没必要了解那么
: 多，医生也不会为了让你明白他的治疗来拿本生理学或病理学来给你详细解释，如果那
: 样的话，等你明白要讲好几年的时间。
: 俺也没法在这里科普基础医学，所以俺能做的就是说说西医治病的思路究竟是什么样的
| p********3
发帖数: 5750 | 15 人参怎么样？
【在 h*****9 的大作中提到】
: 中医养生养了几千年。得出的结论像吃啥补啥，吃猴脑补人脑，吃JB补JB。最推崇的营
: 养补品燕窝鱼翅熊掌都是扯淡的玩意。难道不该去掉这些糟粕？上升到民族高度就占理
: 了？
: 你今天的衣食住行所学所做所享受的99%都是以西方文明为基础的，你怎么就接受了？
| a*******g
发帖数: 2813 | 16
99%怎么来的，有文献支持么？有数据统计么？你天天吃西餐么？
我一直说的去伪存真，我没否认过有糟粕，我是说不能把精华也倒了
【在 h*****9 的大作中提到】
: 中医养生养了几千年。得出的结论像吃啥补啥，吃猴脑补人脑，吃JB补JB。最推崇的营
: 养补品燕窝鱼翅熊掌都是扯淡的玩意。难道不该去掉这些糟粕？上升到民族高度就占理
: 了？
: 你今天的衣食住行所学所做所享受的99%都是以西方文明为基础的，你怎么就接受了？
| a*******g
发帖数: 2813 | 17
WIC
谢谢您科普，最后一句话我很同意。不好的就要去除，只不过在我们眼里，不好的概念
不同
至于自尊心的问题，您没有，不代表别人不能有。
【在 p********3 的大作中提到】
: 给你科普一下西医是怎么养生的，免得你挨了几闷棒也不知道别人在说啥。
: 西医讲究一级二级三级预防。
: 有病治病， 有糖耐病高血压就治疗， 饮食控制作为辅助， 整体Life Style Change配
: 合药物治疗。 预防疾病进一步发展，比如DASH Diet推荐给有心血管疾病危险因子的病
: 人。当然, 有病调理上西医还有Physical Therapy, occupational Therapy, Speach
: pathologist therapy, Dietitian等等 Team综合评估你的问题， 解决你的问题。 还
: 有social woker 来解决影响你健康的社会因素。
: 预防疾病， 防患于未然， 这就有了你听说的看到的如果不知道我今天讲给你听的WIC
: Program， 就是科研发现母亲，幼儿营养不良（包括吃垃圾食品导致的表面看来的营养
: 过剩， 但是在临床上我们也称他们为营养不良），导致孩子成年以后有很多疾病的危
| p********3
发帖数: 5750 | 18 西方文明为基础的养生不是说吃中餐就不算其中之一了。 不管西餐中餐印度餐， 还是
非洲餐， 都由碳水化合物蛋白质脂肪，维生素微量元素，等营养物质和目前未归入营
养物质的抗氧化剂等构成。 健康的饮食只看比例。 临床上只看比例， 营养干预的时
候还提倡Cultural Sensitive， 不能硬让人家改变饮食种类。只做量上的调整。
【在 a*******g 的大作中提到】
:
: WIC
: 谢谢您科普，最后一句话我很同意。不好的就要去除，只不过在我们眼里，不好的概念
: 不同
: 至于自尊心的问题，您没有，不代表别人不能有。
| a*******g
发帖数: 2813 | 19
我在和他讨论什么问题啊，看都看不懂就来辩，你说的我都同意啊，
我没有说西方文明养生只有吃中餐，更不是说中国养生也只有吃中餐。
我实在无法和你继续讨论下去了，您说的我都同意，都正确，不是反语。
【在 p********3 的大作中提到】
: 西方文明为基础的养生不是说吃中餐就不算其中之一了。 不管西餐中餐印度餐， 还是
: 非洲餐， 都由碳水化合物蛋白质脂肪，维生素微量元素，等营养物质和目前未归入营
: 养物质的抗氧化剂等构成。 健康的饮食只看比例。 临床上只看比例， 营养干预的时
: 候还提倡Cultural Sensitive， 不能硬让人家改变饮食种类。只做量上的调整。
| h*****9
发帖数: 4028 | 20 意思是绝大多数。你吃的各种粮食大都是用西方科技发明的化肥，农药，灌溉工具，除
草剂，收割机，播种机，磨面机，煤气炉，电炉，精/碘盐包括现代的运输工具等等产
生的。中式烹调那一步占得比例小得很。别太无知了。
现在知道改口了？去伪存真？
【在 a*******g 的大作中提到】
:
: 我在和他讨论什么问题啊，看都看不懂就来辩，你说的我都同意啊，
: 我没有说西方文明养生只有吃中餐，更不是说中国养生也只有吃中餐。
: 我实在无法和你继续讨论下去了，您说的我都同意，都正确，不是反语。
| | | D*******l
发帖数: 5462 | 21 真闲，有空可以去打牌啊。
【在 a*******g 的大作中提到】
: 谢谢这么大段的解释，西医也吸取了中医的三分治七分养，比如护理。康复医学。
: 西医和中医不是对立的，一方不灭另一方不涨似的
| a*******g
发帖数: 2813 | 22
这是我一直的观点，改口？真是笑话，您认错人了吧
我有否认过西医么？我否认过西方科技么？
我有说过废除西医么？
支持中医就非要喝现代文明作对？这就是中医黑的逻辑啊？
【在 h*****9 的大作中提到】
: 意思是绝大多数。你吃的各种粮食大都是用西方科技发明的化肥，农药，灌溉工具，除
: 草剂，收割机，播种机，磨面机，煤气炉，电炉，精/碘盐包括现代的运输工具等等产
: 生的。中式烹调那一步占得比例小得很。别太无知了。
: 现在知道改口了？去伪存真？
| a*******g
发帖数: 2813 | 23
恩横！
【在 D*******l 的大作中提到】
: 真闲，有空可以去打牌啊。
| h*****9
发帖数: 4028 | 24 一听说废医验药是谁像XXXXX一样悲愤？都上升到民族的高度了。这么快都忘了？
【在 a*******g 的大作中提到】
:
: 恩横！
| g**r
发帖数: 397 | | a*******g
发帖数: 2813 | 26
废医验药和去伪存真这八个字哪个字长的像啊？
诬陷也找个近义词可以么？
当然，你觉得医是伪，药才是真，那就是大家一直在争论的话题，几十个贴几十页
不再重复了
表明一下我的立场：
中医西医，都有好有坏，都有需要进步的地方，都需要去伪存真
至于某些人觉得中医的医全是假的，我对这种有知识没文化的行为表示无语，
对于自己不了解的领域，请不要这么大言不惭
【在 h*****9 的大作中提到】
: 一听说废医验药是谁像XXXXX一样悲愤？都上升到民族的高度了。这么快都忘了？
| k*****e
发帖数: 22013 | 27 中医粉最喜欢说的就是：你对中医不了解。
言下之意好像自己很了解似的。
一问到关键问题，比如人体内阴阳的定义是什么，
立刻就谦虚起来：我又不是学中医的，我哪儿知道...
【在 a*******g 的大作中提到】
:
: 废医验药和去伪存真这八个字哪个字长的像啊？
: 诬陷也找个近义词可以么？
: 当然，你觉得医是伪，药才是真，那就是大家一直在争论的话题，几十个贴几十页
: 不再重复了
: 表明一下我的立场：
: 中医西医，都有好有坏，都有需要进步的地方，都需要去伪存真
: 至于某些人觉得中医的医全是假的，我对这种有知识没文化的行为表示无语，
: 对于自己不了解的领域，请不要这么大言不惭
| p********3
发帖数: 5750 | 28 废医验药基本上还是比较谦虚的说法，本人的观点是废医废药。 那个中药怎么验？ 每
个中医生开的处方不一样， 然后药材产地不一样即使是有效成分的含量也不一样，导
致严重无重复性。 要验药你怎么验。
中药的Lead Poison有证可查， 中药的肾脏毒性现在的流行病调查超过原先估计的。
我说的这些话都是有科研数据的。 这些科研有很多还是中国人（在美国的中国人）的
中医内行做的，以及在中国的科研资料。
即使是有效的中医（有效一点效的也算）， 也是千分之一万分之一， 得不偿失。
每年浪费的人力物力财力，以及耽误病情导致病人没有按照科学的治疗方式来进行造成
的损失，不可估量。
所以，本人的观点废除中医， 解放思想，中国人会得到更大的利益。
好了，中医粉，开骂吧。
【在 a*******g 的大作中提到】
:
: 废医验药和去伪存真这八个字哪个字长的像啊？
: 诬陷也找个近义词可以么？
: 当然，你觉得医是伪，药才是真，那就是大家一直在争论的话题，几十个贴几十页
: 不再重复了
: 表明一下我的立场：
: 中医西医，都有好有坏，都有需要进步的地方，都需要去伪存真
: 至于某些人觉得中医的医全是假的，我对这种有知识没文化的行为表示无语，
: 对于自己不了解的领域，请不要这么大言不惭
| p********3
发帖数: 5750 | 29 我从来没有看到一个有理有利的中医粉说过有技术含量的话。 你要是说没有技术含量
，人家又说了中医是文化是哲学，这个世界不是只有科学才能运转滴！
【在 k*****e 的大作中提到】
: 中医粉最喜欢说的就是：你对中医不了解。
: 言下之意好像自己很了解似的。
: 一问到关键问题，比如人体内阴阳的定义是什么，
: 立刻就谦虚起来：我又不是学中医的，我哪儿知道...
| p********3
发帖数: 5750 | 30 对了顺便感谢版主， 发包子，没想到水版吵架也有包子吃！
Yeah！
【在 p********3 的大作中提到】
: 我从来没有看到一个有理有利的中医粉说过有技术含量的话。 你要是说没有技术含量
: ，人家又说了中医是文化是哲学，这个世界不是只有科学才能运转滴！
| | | d*******r
发帖数: 806 | 31 废医废药…千分之一的有效率…
不会骂你，只会同情你，默默的祝福你，希望你的病一点点好起来。你放心，社会在发
展，科学在进步，总有一天，心理疾病都是可以治愈的！被门夹过的脑袋也是可以复原
的！
【在 p********3 的大作中提到】
: 废医验药基本上还是比较谦虚的说法，本人的观点是废医废药。 那个中药怎么验？ 每
: 个中医生开的处方不一样， 然后药材产地不一样即使是有效成分的含量也不一样，导
: 致严重无重复性。 要验药你怎么验。
: 中药的Lead Poison有证可查， 中药的肾脏毒性现在的流行病调查超过原先估计的。
: 我说的这些话都是有科研数据的。 这些科研有很多还是中国人（在美国的中国人）的
: 中医内行做的，以及在中国的科研资料。
: 即使是有效的中医（有效一点效的也算）， 也是千分之一万分之一， 得不偿失。
: 每年浪费的人力物力财力，以及耽误病情导致病人没有按照科学的治疗方式来进行造成
: 的损失，不可估量。
: 所以，本人的观点废除中医， 解放思想，中国人会得到更大的利益。
| a*******g
发帖数: 2813 | 32
同祝福.哈哈
记得一个笑话:
一个精神病人去看医生,医生说:你有精神病.
那个病人很不耐烦:你都说了多少遍了,没有别的么?
医生说:有,你长得真TM丑
【在 d*******r 的大作中提到】
: 废医废药…千分之一的有效率…
: 不会骂你，只会同情你，默默的祝福你，希望你的病一点点好起来。你放心，社会在发
: 展，科学在进步，总有一天，心理疾病都是可以治愈的！被门夹过的脑袋也是可以复原
: 的！
| a*******g
发帖数: 2813 | 33
言下之意就是比你了解
http://baike.baidu.com/view/147097.htm
给出你定义,你偏说那不叫定义,还有什么好讨论.
连什么是医学都不懂就叫嚣着废除中医, 真正的西医都没说废除中医,反而是什么都不懂的门外汉叫的欢
【在 k*****e 的大作中提到】
: 中医粉最喜欢说的就是：你对中医不了解。
: 言下之意好像自己很了解似的。
: 一问到关键问题，比如人体内阴阳的定义是什么，
: 立刻就谦虚起来：我又不是学中医的，我哪儿知道...
| p********3
发帖数: 5750 | 34 你给个数据， 我有科研证明我说的话，当然不是千分之一的比例， 因为我根本没有查
到什么有效的药物，给你个千分之一是给你面子的说法。 举例来说你们中医粉最爱说
的中医治疗癌症， 目前多中心科研根本就没有显示有效。还有治疗什么过敏反应， 根
本就是扯蛋， 科研发现弊大于利，根本就不推荐。还有其他好多科研都有。 更多的中
药是没法做，因为根本就没有重复性，不同的中医医生开的药物里面的成分根本没法比
较， 因为他们开的要都不同。 还有同一个医生不同时间不同地点开的方子药物成分也
不一样， 因为药材的质量根本没有重复性。
你别老在那里叫唤一些口号， 你做了什么调查？ 有资格来放屁？当然Lead是啥你也不
知道，估计你小时候喝中药Lead过度， 脑子给毁了， 这是一个要废除中药的Case
Report.不知道你肾脏受累没有，建议你门诊随访，要透析的时候就去透析，别老是喝
些汤汤水水的， 连来和我吵架的机会都没有了。
我再说明一下， 在医学管理发达的国家，可以允许中医在一定规定范围以内可以存在
，这样不至于成为社会毒瘤。好比巫术也可以存在。 但是很可惜，中医的存在在医疗
管理还很混乱的中国还并不适合中国国情，很讽刺！事实就是这样的无情。
【在 d*******r 的大作中提到】
: 废医废药…千分之一的有效率…
: 不会骂你，只会同情你，默默的祝福你，希望你的病一点点好起来。你放心，社会在发
: 展，科学在进步，总有一天，心理疾病都是可以治愈的！被门夹过的脑袋也是可以复原
: 的！
| p********3
发帖数: 5750 | 35 晚上有空闲的时候，我把科研（多中心，非单个Study）的文献公布上来， 其中大量的
还是我们中国人自己做的。
【在 p********3 的大作中提到】
: 你给个数据， 我有科研证明我说的话，当然不是千分之一的比例， 因为我根本没有查
: 到什么有效的药物，给你个千分之一是给你面子的说法。 举例来说你们中医粉最爱说
: 的中医治疗癌症， 目前多中心科研根本就没有显示有效。还有治疗什么过敏反应， 根
: 本就是扯蛋， 科研发现弊大于利，根本就不推荐。还有其他好多科研都有。 更多的中
: 药是没法做，因为根本就没有重复性，不同的中医医生开的药物里面的成分根本没法比
: 较， 因为他们开的要都不同。 还有同一个医生不同时间不同地点开的方子药物成分也
: 不一样， 因为药材的质量根本没有重复性。
: 你别老在那里叫唤一些口号， 你做了什么调查？ 有资格来放屁？当然Lead是啥你也不
: 知道，估计你小时候喝中药Lead过度， 脑子给毁了， 这是一个要废除中药的Case
: Report.不知道你肾脏受累没有，建议你门诊随访，要透析的时候就去透析，别老是喝
| p********3
发帖数: 5750 | 36 你光在那里说相声有啥用，来点科研精神，你自称自己学过西医， 你说点有技术含量
的话。 大思考着就是个想多了的有点犯病了的，不过人家是门外汉也可以原谅。你西
医出生，现在也在做科研，一点科研精神都没有， 一点医学知识也没有，啥都没有。
【在 a*******g 的大作中提到】
:
: 言下之意就是比你了解
: http://baike.baidu.com/view/147097.htm
: 给出你定义,你偏说那不叫定义,还有什么好讨论.
: 连什么是医学都不懂就叫嚣着废除中医, 真正的西医都没说废除中医,反而是什么都不懂的门外汉叫的欢
| a*******g
发帖数: 2813 | 37
。
跟你说了千百遍了,你说不过我了就说你在玩幽默
我和你玩不起幽默,你自己翻帖子去
【在 p********3 的大作中提到】
: 你光在那里说相声有啥用，来点科研精神，你自称自己学过西医， 你说点有技术含量
: 的话。 大思考着就是个想多了的有点犯病了的，不过人家是门外汉也可以原谅。你西
: 医出生，现在也在做科研，一点科研精神都没有， 一点医学知识也没有，啥都没有。
| p********3
发帖数: 5750 | 38 我说不过你了？你在说梦话吧，还有这么自以为是的人！ 你的帖子我基本上都看过了
，除了空喊口号，攻击网友外，基本上没有啥价值。
你自称学西医的，连母婴血液是相通的P也能放出来。 你和那个Kalegee（如果没拼写错
的话），胡搅蛮惨，我都替别人不值。 你自以为是跑去怀疑一个名牌医科院校临床医
学院毕业的高材生不是学医的，（自己却没有表现出一点医学才华）。 你混淆视听，
在某个帖子里面自诩“拥有中美认可的MD执照” 以期望不认真挖掘的人认为你是美国
的MD。 你不仅没有才华，连起码的人品都有问题。
中医有你这样的粉， 离死期也不远了。 中医这种社会毒瘤， 你都不配去粉它。
【在 a*******g 的大作中提到】
:
: 。
: 跟你说了千百遍了,你说不过我了就说你在玩幽默
: 我和你玩不起幽默,你自己翻帖子去
| a*******g
发帖数: 2813 | 39
写错
原来这样子啊，中国的MD就不是MD，美国的才是，我没资格是MD，
恩，您硬了
中国的西医就不是西医，美国的才是。
您没有攻击网友，您没有空喊口号，您表现出令人敬佩的医学才华，让万众仰慕着呢。
【在 p********3 的大作中提到】
: 我说不过你了？你在说梦话吧，还有这么自以为是的人！ 你的帖子我基本上都看过了
: ，除了空喊口号，攻击网友外，基本上没有啥价值。
: 你自称学西医的，连母婴血液是相通的P也能放出来。 你和那个Kalegee（如果没拼写错
: 的话），胡搅蛮惨，我都替别人不值。 你自以为是跑去怀疑一个名牌医科院校临床医
: 学院毕业的高材生不是学医的，（自己却没有表现出一点医学才华）。 你混淆视听，
: 在某个帖子里面自诩“拥有中美认可的MD执照” 以期望不认真挖掘的人认为你是美国
: 的MD。 你不仅没有才华，连起码的人品都有问题。
: 中医有你这样的粉， 离死期也不远了。 中医这种社会毒瘤， 你都不配去粉它。
| p********3
发帖数: 5750 | 40 MD = Doctorate Of Medicine
你的Transcript上面写着：
Bachalor Of Medicine
差得十万八千里。 中国的MD实际上等于BM加个PHD， 我估计你没有这个学位。
美国承认你的医学教育， 只要你通过Borad可以做住院医， 不等于承认你的执照， 当
然我也不完全明白你说承认你MD是啥子意思。
Understand？
在 awakening (云上小竹) 的大作中提到: 】 | | | p********3
发帖数: 5750 | 41 以下有文献是讲中药Lead中毒的：我懒得去筛选， 先发这个。 还有很多其他的比如癌
症的， 肾脏毒性的， 单个疾病双盲单盲科研的。我就不一一列举了。
参看50， 51， 70， 73-75.
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39 National policy on traditional medicine and regulation of herbal medicines: report of a WHO global survey. WHO, Geneva, 2005.
40 Ernst E. Harmless herbs? A review of the recent literature. Am J Med 1998; 104:170.
41 Newall, CA, Anderson, LA, Phillipson, JD. Herbal Medicines. A Guide For Health-Care Professionals, The Pharmaceutical Press, London 1996. p.6.
42 Crone CC, Wise TN. Use of herbal medicines among consultation-liaison populations. A review of current information regarding risks, interactions, and efficacy. Psychosomatics 1998; 39:3.
43 Harkey MR, Henderson GL, Gershwin ME, et al. Variability in commercial ginseng products: an analysis of 25 preparations. Am J Clin Nutr 2001; 73:1101.
44 www.consumerlab.com (Accessed September 7, 2005).
45 Garrard J, Harms S, Eberly LE, Matiak A. Variations in product choices of frequently purchased herbs: caveat emptor. Arch Intern Med 2003; 163:2290.
46 Müller WE, Singer A, Wonnemann M, et al. Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharmacopsychiatry 1998; 31 Suppl 1:16.
47 Singer A, Wonnemann M, Müller WE. Hyperforin, a major antidepressant constituent of St. John's Wort, inhibits serotonin uptake by elevating free intracellular Na+1. J Pharmacol Exp Ther 1999; 290:1363.
48 Gilroy CM, Steiner JF, Byers T, et al. Echinacea and truth in labeling. Arch Intern Med 2003; 163:699.
49 Weiger WA, Smith M, Boon H, et al. Advising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med 2002; 137:889.
50 Ko RJ. Adulterants in Asian patent medicines. N Engl J Med 1998; 339:847.
51 Saper RB, Kales SN, Paquin J, et al. Heavy metal content of ayurvedic herbal medicine products. JAMA 2004; 292:2868.
52 Kew J, Morris C, Aihie A, et al. Arsenic and mercury intoxication due to Indian ethnic remedies. BMJ 1993; 306:506.
53 Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA 2008; 300:915.
54 Kanowski S, Herrmann WM, Stephan K, et al. Proof of efficacy of the ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi-infarct dementia. Pharmacopsychiatry 1996; 29:47.
55 Le Bars PL, Katz MM, Berman N, et al. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. JAMA 1997; 278:1327.
56 Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2007; :CD003120.
57 Saper RB, Eisenberg DM, Phillips RS. Common dietary supplements for weight loss. Am Fam Physician 2004; 70:1731.
58 Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000; 343:1833.
59 Astrup A, Breum L, Toubro S, et al. The effect and safety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial. Int J Obes Relat Metab Disord 1992; 16:269.
60 Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord 2002; 26:593.
61 Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003; 289:1537.
62 Peters CM, O'Neill JO, Young JB, Bott-Silverman C. Is there an association between ephedra and heart failure? a case series. J Card Fail 2005; 11:9.
63 Bent S, Ko R. Commonly used herbal medicines in the United States: a review. Am J Med 2004; 116:478.
64 Sales of Supplements Containing Ephedrine Alkaloids (Ephedra) Prohibited. Available at www.fda.gov/oc/ (Accessed August 16, 2005).
65 Nykamp DL, Fackih MN, Compton AL. Possible association of acute lateral-wall myocardial infarction and bitter orange supplement. Ann Pharmacother 2004; 38:812.
66 Bouchard NC, Howland MA, Greller HA, et al. Ischemic stroke associated with use of an ephedra-free dietary supplement containing synephrine. Mayo Clin Proc 2005; 80:541.
67 Larrey D. Hepatotoxicity of herbal remedies. J Hepatol 1997; 26 Suppl 1:47.
68 Huxtable RJ. New aspects of the toxicology and pharmacology of pyrrolizidine alkaloids. Gen Pharmacol 1979; 10:159.
69 Dammin GJ. Endemic nephropathy in Yugoslavia. Arch Pathol 1972; 93:372.
70 Cronin AJ, Maidment G, Cook T, et al. Aristolochic acid as a causative factor in a case of Chinese herbal nephropathy. Nephrol Dial Transplant 2002; 17:524.
71 Arlt VM, Stiborova M, Schmeiser HH. Aristolochic acid as a probable human cancer hazard in herbal remedies: a review. Mutagenesis 2002; 17:265.
72 Buettner C, Mukamal KJ, Gardiner P, et al. Herbal supplement use and blood lead levels of United States adults. J Gen Intern Med 2009; 24:1175.
73 Centers for Disease Control and Prevention (CDC). Lead poisoning associated with ayurvedic medications--five states, 2000-2003. MMWR Morb Mortal Wkly Rep 2004; 53:582.
74 Ernst E. Heavy metals in traditional Indian remedies. Eur J Clin Pharmacol 2002; 57:891.
75 Kales SN, Christophi CA, Saper RB. Hematopoietic toxicity from lead-containing Ayurvedic medications. Med Sci Monit 2007; 13:CR295.
76 Siegel RK. Ginseng abuse syndrome. Problems with the panacea. JAMA 1979; 241:1614.
77 Newall, CA, Anderson, LA, Phillipson, JD. Herbal Medicines. A Guide For Health-Care Professionals, The Pharmaceutical Press, London 1996. p.9.
78 Brazier NC, Levine MA. Drug-herb interaction among commonly used conventional medicines: a compendium for health care professionals. Am J Ther 2003; 10:163.
79 Bailey DG, Arnold JM, Spence JD. Grapefruit juice and drugs. How significant is the interaction? Clin Pharmacokinet 1994; 26:91.
80 Lown KS, Bailey DG, Fontana RJ, et al. Grapefruit juice increases felodipine oral availability in humans by decreasing intestinal CYP3A protein expression. J Clin Invest 1997; 99:2545.
81 Eisenberg DM, Kessler RC, Van Rompay MI, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001; 135:344.
82 Joint Commission on Accreditation of Healthcare Organizations. 2005 National Patient Safety Goals FAQs. Available at www.jcaho.org/ (Accessed August 16, 2005).
83 Ashar BH, Rowland-Seymour A. Advising patients who use dietary supplements. Am J Med 2008; 121:91.
84 Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med 1997; 127:61.
85 Gardiner P. Dietary supplement use in children: concerns of efficacy and safety. Am Fam Physician 2005; 71:1068, 1071.
86 Destro MW, Speranzini MB, Cavalheiro Filho C, et al. Bilateral haematoma after rhytidoplasty and blepharoplasty following chronic use of Ginkgo biloba. Br J Plast Surg 2005; 58:100.
87 Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. J Intern Med 2001; 250:167.
88 Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA 2001; 286:208.
©2
【在 p********3 的大作中提到】
: 晚上有空闲的时候，我把科研（多中心，非单个Study）的文献公布上来， 其中大量的
: 还是我们中国人自己做的。
| d*******r
发帖数: 806 | 42 什么乱七大八糟的
亏得我还去专门去找你说的论文去看
列一个超长的论文列表
里面就没有和中医有关的
你说的参看里的那六篇文章
五篇是说印度药材的
只有一篇讲中药
而且这六篇都是讲成药的
根本不是在解析中医印医而是分析当代中印两国将中医印医将草药合成为成药的制成过
程，何况古代草药大多野生，当代规模化量产使得当代中药印药是如何种植的，有没有
用到现代的农药你都不知道，怎么肯定一定就是药物本身的问题？？？？
可惜我还花那么多时间去看
你要喷也有点水准
这么混淆视听，栽赃陷害显得十分低级
你已经让我不屑于再回你的帖子了
I am done with this crazy woman
treatment of benign prostatic hyperplasia: a systematic review. JAMA 1998;
280:1604.
Council/Thieme, New York 2003.
2002; 136:374.
Bull World Health Organ 1985; 63:965.
publication Number 04-5568. National Center for Complementary and
Alternative Medicine, Gaithersburg, MD 2004.
the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993
; 328:246.
use in the United States, 1990-1997: results of a follow-up national survey
. JAMA 1998; 280:1569.
【在 p********3 的大作中提到】
: 以下有文献是讲中药Lead中毒的：我懒得去筛选， 先发这个。 还有很多其他的比如癌
: 症的， 肾脏毒性的， 单个疾病双盲单盲科研的。我就不一一列举了。
: 参看50， 51， 70， 73-75.
: REFERENCES 1 Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA 1998; 280:1604.
: 2 Blumenthal M (Ed). The ABC Clinical Guide to Herbs. American Botanical Council/Thieme, New York 2003.
: 3 Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med 2002; 136:374.
: 4 Farnsworth NR, Akerele O, Bingel AS, et al. Medicinal plants in therapy. Bull World Health Organ 1985; 63:965.
: 5 Expanding Horizons of Health Care: Strategic plan 2005-2009. NIH publication Number 04-5568. National Center for Complementary and Alternative Medicine, Gaithersburg, MD 2004.
: 6 Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993; 328:246.
: 7 Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998; 280:1569.
| a*******g
发帖数: 2813 | 43
混淆视听和栽赃陷害是他们唯一能做的了
我也没精力去反驳了,弄的自己一身脏,还让他们很快乐
【在 d*******r 的大作中提到】
: 什么乱七大八糟的
: 亏得我还去专门去找你说的论文去看
: 列一个超长的论文列表
: 里面就没有和中医有关的
: 你说的参看里的那六篇文章
: 五篇是说印度药材的
: 只有一篇讲中药
: 而且这六篇都是讲成药的
: 根本不是在解析中医印医而是分析当代中印两国将中医印医将草药合成为成药的制成过
: 程，何况古代草药大多野生，当代规模化量产使得当代中药印药是如何种植的，有没有
| a*******g
发帖数: 2813 | 44
呵呵,不明白就让其他中国来的医生去给你解释吧.
既然我说什么你都不信,那对话没有必要继续下去.
【在 p********3 的大作中提到】
: MD = Doctorate Of Medicine
: 你的Transcript上面写着：
: Bachalor Of Medicine
: 差得十万八千里。 中国的MD实际上等于BM加个PHD， 我估计你没有这个学位。
: 美国承认你的医学教育， 只要你通过Borad可以做住院医， 不等于承认你的执照， 当
: 然我也不完全明白你说承认你MD是啥子意思。
: Understand？
: 在 awakening (云上小竹) 的大作中提到: 】
| k**o
发帖数: 15334 | 45 人参其实就是一种植物兴奋剂，能给人rush，人一rush起来，就会大幅度减少
痛感，有精神。所以病危的的人吃人参能“吊命”，普通人吃了也能自我
感觉良好。其实没有实际改善健康。
【在 p********3 的大作中提到】
: 人参怎么样？
| s*******n
发帖数: 10426 | 46 晕....
人参的活性成分是人参皂甙，抗氧化，对心脑血管疾病有一定作用。
【在 k**o 的大作中提到】
: 人参其实就是一种植物兴奋剂，能给人rush，人一rush起来，就会大幅度减少
: 痛感，有精神。所以病危的的人吃人参能“吊命”，普通人吃了也能自我
: 感觉良好。其实没有实际改善健康。
| s*******n
发帖数: 10426 | 47 如果你在国内有执业医师执照，美国是承认的，但是你还是不能practice medicine,还
是要考board才行。
【在 a*******g 的大作中提到】
:
: 呵呵,不明白就让其他中国来的医生去给你解释吧.
: 既然我说什么你都不信,那对话没有必要继续下去.
| f******x
发帖数: 949 | 48 这就是婊子和牌坊，两边好处都要。。。
【在 h*****9 的大作中提到】
: 中医养生养了几千年。得出的结论像吃啥补啥，吃猴脑补人脑，吃JB补JB。最推崇的营
: 养补品燕窝鱼翅熊掌都是扯淡的玩意。难道不该去掉这些糟粕？上升到民族高度就占理
: 了？
: 你今天的衣食住行所学所做所享受的99%都是以西方文明为基础的，你怎么就接受了？
| f******x
发帖数: 949 | 49 中国的西医比美国的西医落后，而且很多人比如你还受中医的影响。
【在 a*******g 的大作中提到】
:
: 呵呵,不明白就让其他中国来的医生去给你解释吧.
: 既然我说什么你都不信,那对话没有必要继续下去.
| p********3
发帖数: 5750 | 50 50， 70， 71； 大家注意一下和这几篇文献相关的话题。 另外， 73-75我本人没有看，确实是谈的印度药材， 我在查阅参考文献的时候在搜索Chinese Medicine的时候， 显示有这些文献，我本人没有亲自看这些文献， 也许其中有讲中药的地方。不过这不影响我要表达的意思。
慢慢看：
INTRODUCTION — Plants have been used for medicinal purposes for thousands
of years. All major cultures including Native American, European, South
American, Asian, and African cultures have used botanicals for healing
purposes. As an example, saw palmetto was used for urinary symptoms in men
from Egypt in the 15th century BC [1]. Hippocrates documented the use of St.
John's wort for mood ailments in the 5th century BC [2]. The Inner Classic
of the Yellow Emperor around 100 BC describes complex traditional Chinese
herbs [3]. Herbal medicines flourished in Europe in the 17th century, then
showed a decline with the Scientific Revolution. European immigrants brought
to North America their own herbal medicine traditions as well as acquiring
many from Native Americans. Two-thirds of entries in the first edition of
the United States Pharmacopoeia (USP) published in 1820 were botanical
substances [2]. After about 1920, standardized pharmaceutical drugs
increasingly replaced herbal therapies in the US. Synthetic drugs were found
to have larger pharmacologic effects and greater profitability [2].
Over 120 conventionally used pharmaceuticals are derived from plant species
(table 1) [2,4].
In the US, in response to increased public interest and use of complementary
and alternative medicines, Congress established the National Institutes of
Health (NIH) Office of Alternative Medicine (OAM) in 1992. The NIH Office of
Dietary Supplements was created in 1994 to conduct and coordinate research
in herbs and supplements. In 1998, the NIH OAM was upgraded to the National
Center for Complementary and Alternative Medicine (NCCAM). NCCAM has
prioritized evaluating mechanisms, efficacy, and safety of botanical
medicines through basic science studies, clinical research, and the
establishment of dedicated botanical research centers [5].
An overview of herbs is provided here. Specific herbs are discussed in
detail separately. (See "Clinical use of St. John's wort" and "Clinical use
of echinacea" and "Clinical use of ginkgo biloba" and "Clinical use of saw
palmetto".)
UNITED STATES
Epidemiology
Prevalence of use — In the US, use of herbal medicine declined in the early
1900s only to experience a resurgence beginning in the 1960's that was part
of a larger movement towards using natural nonconventional approaches to
healthcare [2]. A 1990 national telephone survey of complementary and
alternative medicine use by US adults demonstrated that 2.5 percent of
respondents used herbal medicines [6]. A follow-up 1997 national survey
showed almost a five-fold increase with 12.1 percent of US adults reporting
herbal medicine use in the previous year [7].
One factor contributing to this dramatic increase was congressional passage
of the Dietary Supplement Health and Education Act (DSHEA) in 1994. DSHEA
allowed manufacturers to market their herbal products without prior
demonstration of safety or efficacy (see 'Regulation' below).
Data from the 2007 National Health Interview Survey (NHIS) Alternative
Medicine Supplement showed that 17.7 percent of US adults had used natural
products in the previous year, including herbs and other naturally occurring
non botanical supplements such as glucosamine sulfate (derived from
crustacean shells) and fish oils [8]. The following natural products were
the most commonly used by US adults in the NHIS survey (percentages are the
rate of use among Americans using natural products):
Fish oil (37.4 percent)
Echinacea (19.8 percent)
Flax seed oil (15.9 percent)
Ginseng (14.1 percent)
Ginkgo biloba (11.3 percent)
Garlic (11.0 percent)
Coenzyme Q-10 (8.7 percent)
Fiber or psyllium (6.6 percent)
Green tea pills (6.3 percent)
Cranberry (6.0 percent)
Saw palmetto (5.1 percent)
Soy supplements (5.0 percent)
Market sales — Herbal sales have shown slow growth since 2004. Obtaining
accurate market data that captures all of US herbal sales is difficult. This
is due in part to the multiple channels available for purchasing
supplements such as drug stores, supermarkets, warehouse buying clubs,
natural food stores, multilevel marketing, health professionals, and the
Internet. Nonetheless, using multiple survey methods, total sales of herbal
and dietary supplements in the US were estimated to be $4.8 billion for 2008
, a 10.6 percent increase from 2004 [9].
Reasons for use — Americans reported their top reasons for using herbs and
supplements as enhancing health, and helping with common chronic symptoms or
diseases such as memory loss, arthritis, and fatigue [10]. In this way,
herbs are similar to other complementary and alternative medicines in that
they are frequently used for chronic conditions for which conventional
medicine does not offer straightforward answers or cures.
Herbs are also appealing to those who perceive nature as benevolent and
healing [11]. Associated with this is the mistaken perception that a
naturally-derived product is always safe.
Regulation — In the first half of the 20th century, medicinal herbs were
included in the US National Formulary and the US Pharmacopoeia. In 1962,
outrage over limb defects from thalidomide prompted Congress to pass the
Kefauver-Harris Drug Amendment. This required proof of safety and efficacy
for all prescription and over-the-counter drugs, and reassigned herbal
medicines to the category of food supplements which have a lower threshold
of required evidence for safety [12].
In the early 1990s the Food and Drug Administration (FDA) attempted to
develop more strict regulations for herbal products. This was opposed in a
campaign by consumers, supplement manufacturers, and political advocates.
The result was a 1994 bill passed by Congress called the Dietary Supplement
Health and Education Act (DSHEA). DSHEA defined dietary supplements as a
product containing one or more of the following: a vitamin, mineral, amino
acid, herb, other botanical, concentrate, metabolite, constituent, or
extract [12]. DSHEA placed dietary supplements in a distinct category from
drugs. Labels of dietary supplements are required to state: "this product in
not intended to diagnose, treat, cure, or prevent any disease." However,
product labels are allowed to make health claims, such as "promotes prostate
health" or "supports the circulatory system."
Importantly, makers of dietary supplements are not required to prove
efficacy, safety, or quality of a product prior to marketing. Supplement
manufacturers are also not obligated to report postmarketing adverse events
to the FDA. DSHEA therefore moved the burden of proving that a product is
unsafe or ineffective to the FDA. For various reasons, the FDA has
infrequently removed a dietary supplement product from marketing. Products
containing ephedra, androstenedione, and PC-SPES are notable exceptions.
Increasing research, case reports, and publicity of adverse effects and
harmful drug-herb interactions have prompted many physicians, physician
organizations such as the Institute of Medicine, and consumer groups such as
the Center for Science in the Public Interest to call for reform of DSHEA [
13-15]. National surveys found that 81 percent of Americans believed
evidence of safety should be required before allowing the sale of a
supplement [16]. However, more than half did not understand that current
regulations do not require such evidence. Thus, the public appears to be
sensitive to safety issues and supportive of greater regulation.
In 2007, the US Food and Drug Administration (FDA) issued new rules
requiring Good Manufacturing Practices (GMPs) for dietary supplements to be
phased in from 2008 to 2010 [17]. The new GMPs require dietary supplements
be properly labeled, free of adulterants, and manufactured according to
specified standards for personnel and equipment. Production controls and
appropriate documentation are required. However, the new rules allow
manufacturers, in particular smaller companies, significant flexibility to
specify the quality criteria they will follow. As an example, there are no
specified maximum acceptable concentrations or daily dose limits for heavy
metals such as lead [17].
INTERNATIONAL
Epidemiology — Herbs are commonly used for medicinal purposes throughout
the world. Data on this usage comes from convenience samples, national
surveys, ethnographic studies, market data, and toxicity reports from Canada
, Europe, Asia, Australia, the Caribbean, South and Central America, and
Africa [18-32].
Europe — In Europe, herbal medicine is frequently referred to as
phytotherapy and is commonly integrated with conventional medicine in many
countries within the European Union (EU). Sales of over-the-counter herbal
medicines in Europe in 2003 were over $5 billion [33].
Herbal products are often used as a first line therapy for conditions such
as benign prostatic hyperplasia (BPH) in Germany, Italy, and elsewhere.
Other studies of use include:
A nationally representative survey of the German general public found that
65 percent used herbal medicines [34]. German physicians receive medical
school training in medicinal herbs and must pass a test on herbal medicine
to become licensed. Approximately 80 percent of German physicians regularly
prescribe herbs.
A survey of 21,923 adults in the Northwest region of England found 12.8
percent used one or more herbs [19].
Half of Danish preoperative patients reported taking herbal medicines,
including ginkgo and echinacea [20].
Twenty-seven percent of outpatients in a Spanish gastroenterology clinic had
used herbs in the previous year [21].
Asia — Alongside acupuncture and massage, herbs play a significant role in
traditional Chinese medicine [35]. Ayurveda, the most common traditional
medicine practiced in India, uses over 6000 herbal combinations in its
pharmacopoeia [36]. Vietnam, Malaysia, Korea, and other Southeast Asian
countries have their own systems of traditional medicine. (See "Chinese
herbal medicine for the treatment of allergic diseases".)
Developing world — In developing countries, herbal medicines are often less
expensive and more accessible than conventional pharmaceuticals. As an
example, 78 percent of households in a low income neighborhood of Managua,
Nicaragua reported herbal use [25]. Almost two-thirds of respondents from
Brazilian urban primary care clinics reported use of herbal therapies, often
due to inability to obtain conventional medicines [26].
Recommendations for herbal use are often given by family members, community
elders, village health workers, midwives, or healers. Herbal formulations
are often prepared individually for the patient from raw plant materials,
instead of being commercially available.
In many developing countries, the administering of traditional medicines is
often part of an elaborate healing ritual with spiritual or supernatural
components [37].
Regulation — In general, regulation of the quality of herbal products is
significantly greater in the EU than in the US. A 2004 EU directive requires
manufacturers of all over-the-counter herbal products to register and
license the product with the European Agency for the Evaluation of Medicinal
Products. A premarket evaluation of quality and safety of the product is
required. Companies need to carry out post-marketing surveillance and report
serious adverse events. Indications for these OTC herbal products are for
minor conditions not usually requiring a physician's care. Instead of
requiring new rigorous efficacy studies to market a new product,
documentation from the medical literature of safety for the relevant
condition and reasonable plausibility of efficacy is needed. In countries
such as Germany and France herbal medicines are partially or fully
reimbursed.
The World Health Organization (WHO) developed a Traditional Medicine
Strategy "to promote the integration of traditional medicine and CAM (
complementary and alternative medicine) into national health care systems
where appropriate" [38]. As part of this effort, the WHO distributed a
survey about national policies and regulations for herbal medicines to help
frame regulatory policies, enhance quality, safety and efficacy, ensure
access, and support rational use of these remedies; 141 of 191 member states
from all WHO regions responded [39]. Thirty-seven percent of responding
nations had herbal medicine regulations in place. Approximately half of the
remaining nations were considering implementing regulations. Over two-thirds
of countries sold herbal medicines without requiring a prescription. There
are relatively few herbal medicines available by prescription only (eg, saw
palmetto, ginkgo, St. John's wort).
QUALITY AND EFFICACY — Given the regulatory structure for herbal medicines,
there is substantial variation in the quality of commercially available
products in the United States and elsewhere. Variability in product quality
can impact the product's efficacy and safety. The clinical usefulness of an
herbal medicine for a particular patient or condition therefore depends on
its evidence for quality, efficacy, and safety.
Quality — There are multiple determinants of the quality of an herbal
product. These factors all impact the ability to insure consistency and
standardization of herbal products.
Plant species used — Several common herbal products are drawn from closely
related species. As an example, studies of echinacea for the treatment and
prevention of the common cold utilize Echinacea purpurea, E. pallida, and/or
E. angustifolia. The relative pharmacologic activity of these different
species is unclear. Serious injury also has resulted from the
misidentification of other plant species and subsequent mislabeling [40].
Plant parts used — Different plant parts from the same species may have
different pharmacologic activity. As an example, echinacea products vary
according to the proportion of root and aerial parts used. The relative
activities of these different parts of the same plant are uncertain. Other
inherent problems involve contamination by plant parts not normally utilized
[41].
Harvesting and storage conditions — The strength of a plant's pharmacologic
activity may also vary according to where it was raised, when it was
harvested, and the length of time it was stored [42]. Plant products and
their active constituents can vary from year to year due to climatic changes
involving rainfall, sunlight, and even genetic composition [41]. Problems
with prolonged storage may also lead to microbial contamination.
Processing — Herbs can be processed and formulated multiple ways. Whole
herbs can be homogenized and extracted using solvents (eg, alcohol, glycerol
, acetone, water). These extracts can be dried and encapsulated, or made
into liquid tinctures. Whole herbs can also be eaten or consumed as teas.
Topical applications can be made using poultices or creams. Different
processing techniques can result in different chemical composition of the
final product.
Accuracy of labeling — Multiple reports of inaccurate herb labeling have
been documented. As an example, a study of commercially available Asian
ginseng products showed that among products with a labeled concentration of
ginsenosides, the actual measured ginsenoside varied from zero to over 300
percent of labeled concentrations [43]. Similarly, in a study of valerian
products, 4 out of 17 products tested had no detectable levels of the
expected valerenic acids, while another four had only one-half the expected
amount [44].
Furthermore, many brands of the same herb have labeling recommendations that
vary greatly [45]. Among 880 commercial products of the 10 most commonly
purchased herbs, 43 percent were consistent with generally accepted
benchmarks and 37 percent were either not consistent or were insufficiently
labeled to determine whether or not it was consistent with generally
accepted benchmarks. Cost per recommended daily dose was a significant
predictor of consistency with the benchmark, but store type (ie, grocery,
retail pharmacy, discount store, health food store) was not [44].
Standardization — Herbs are complex substances with dozens or hundreds of
chemical constituents. Often it is unclear which of these chemicals play an
important role in the herb's pharmacologic activity. Some herbal products
are standardized to contain a specified amount of one or two chemicals or
chemical groups thought to be the active ingredients for the herb. Examples
include ginkgo extracts standardized to 24 percent flavonoid glycosides and
6 percent terpenoids, and St. John's wort standardized to 0.3 percent
hypericin. The latter is an example of a product standardized to a component
that many experts believe is not the most important component for
antidepressant activity [46,47]. (See "Clinical use of St. John's wort".)
Even when herbal preparations are labeled "standardized," there may be
significant variation. One study of echinacea found that the content did not
match the labeling in 47 percent of samples labeled "standardized" [48].
Purity — Reports of herbal medicines containing pharmaceuticals have
occurred. Notable examples include the combination product PC-SPES used for
prostate cancer that was found to contain DES, warfarin, and indomethacin [
49]. Reports of lead, mercury, and arsenic contamination in imported
traditional Chinese [50] and Indian [51-53] herbal products have also
occurred. (See "Adult lead poisoning" and "Arsenic exposure and poisoning".)
Efficacy — Several well-defined herbal products have shown promise in
controlled trials:
Ginkgo biloba extract has shown promise in several clinical trials for the
treatment of both Alzheimer and vascular dementia [54-56]. (See "Clinical
use of ginkgo biloba" and "Treatment of dementia".)
Soy products (Glycine max) have been found to be modestly effective in
treating hypercholesterolemia. (See "Lipid lowering with diet or dietary
supplements".)
Ginger (Zingiber officinale) has been studied mostly for its antiemetic
properties in various situations that can produce nausea and vomiting (eg,
postoperative, chemotherapy, motion sickness, pregnancy). The majority show
ginger to be more effective than placebo, although safety in pregnancy has
not been adequately proven. (See "Motion sickness" and "Clinical features
and diagnostic evaluation of nausea and vomiting of pregnancy (hyperemesis
gravidarum and morning sickness)".)
SAFETY — Safety issues for herbs include adverse effects and drug-herb
interactions.
Adverse effects — Our knowledge about adverse effects of herbs comes
predominantly from case reports and clinical trials. Few systematic studies
of safety have been completed. Notable examples of adverse effects include:
Ephedra alkaloids (derived from Ephedra sinica or Ma huang) have been
commonly combined with caffeine and marketed for weight loss and athletic
enhancement [57]. A review of adverse events possibly associated with
ephedra use between 1997 and 1999 found episodes of hypertension,
arrhythmias, myocardial infarction, stroke, and seizures [58]. Ten events
led to death and 13 led to permanent disability. Of these 23 reports, nine
occurred at recommended ephedra doses in individuals without significant
preexisting cardiovascular or neurologic risk factors. Although double-blind
randomized controlled trials of ephedra-caffeine combinations have shown
modest efficacy over placebo for weight loss [59,60], data from 50 ephedra
trials showed an estimated 2.2 to 3.6 fold increase in the odds of
psychiatric, autonomic, cardiovascular, and gastrointestinal symptoms [61].
There have also been case reports of heart failure in patients taking
ephedra [62].
Despite ephedra products comprising only 0.8 percent of all dietary
supplement sales in 2001, they were responsible for 64 percent of all herb-
related adverse events reported to US Poison Control Centers during the same
year [63]. In part based upon these data, the FDA on April 12, 2004 banned
manufacturers from the sale of products containing ephedra [64]. Some
manufacturers subsequently substituted bitter orange (citrus aurantium) for
ephedra in weight loss products. Citrus aurantium contains synephrine, an
adrenergic agonist similar to phenylephrine and ephedrine, that has been
associated with serious cardiovascular and neurological side effects [65,66].
Plants containing pyrrolizidine alkaloid constituents can lead to liver
toxicity secondary to venoocclusive lesions, resulting in parenchymal
necrosis, fibrosis, and even cirrhosis (table 2) [67]. The precise mechanism
of hepatic injury is unknown, but appears to result from the accumulation
of toxic metabolites produced via the cytochrome system [68]. The increased
concentration of CYP enzymes in the centrilobular region of the liver
correlates with the changes seen pathologically. (See "Hepatotoxicity due to
herbal medications and dietary supplements".)
Some herbal treatments are known to be nephrotoxic and should be avoided [69
]. (See "Nephropathy induced by aristolochic acid (AA) containing herbs".)
Aristolochia is a Chinese herb included in weight loss herbal formulas
associated with over 100 cases of nephropathy [70]. It is also a probable
human carcinogen associated with urothelial cancers [71].
Herbal products can contain harmful contaminants including heavy metals (see
'Purity' above). These may be incidental contaminants from plant raw
materials or the manufacturing process. However, they may be sometimes
intended constituents of the product since several non-Western healing
traditions such as traditional Indian (Ayurvedic) and Chinese medicine
systems use heavy metals including lead for their purported therapeutic
efficacy [50,51]. Use of Ayurvedic and/or traditional Chinese medicine herbs
, as well as St. John's wort, has been associated with higher blood lead
levels among women [72]. At least 80 cases of heavy metal toxicity have been
reported from traditional Indian (Ayurvedic) herbal medicine products that
contain lead, mercury, and arsenic [51,73-75]. The majority of these cases
involve lead and involve products manufactured outside of the US. (See "
Adult lead poisoning" and "Arsenic exposure and poisoning".)
The belief among some patients that "more is better" leads to significant
side effects and potential harm from ingesting large quantities of herbal
products [76]. Toxicities due to overuse have been documented with ginseng
and licorice [77].
Asking patients about herbal medicine use and potential side effects will
improve their recognition. In the US, adverse events related to herbal
products can be reported to the FDA MedWatch program via telephone (800-FDA-
1088), online (www.fda.gov/safety/medwatch/), fax (800-FDA-0178), or mail.
Herb-drug interactions — Increasing data show the potential for herbal
medicines to interact with prescription and nonprescription pharmaceuticals.
Several of these interactions have been documented to occur through case
reports. Other interactions have been theorized through in vitro studies but
not documented with case reports. Specific interactions of natural and
alternative drugs with other medications may be determined using the drug
interaction tool (Lexi-Interact™ Online). This can be accessed from
the UpToDate online search page or through the individual drug information
topics, section on Drug interactions.
A 2003 systematic review identified 51 unique herb-drug pairs that have been
reported to potentially interact [78]. Of these, 43 percent were supported
by clinical data. The remaining were theoretical based on in vitro data.
Warfarin was the most frequent pharmaceutical implicated and St. John's wort
was the most common herbal product reported. Herb-induced alteration in the
metabolism of cytochrome P450 enzymes was the most common mechanism
implicated in herb-drug interactions.
Specific examples of documented herb-drug interactions include:
The hyperforin component of St. John's wort induces the CYP3A4 system which
metabolizes a number of drugs including protease inhibitors, cyclosporine,
oral contraceptives, irinotecan, warfarin, and digoxin. Failure of anti-
retroviral therapy, transplant rejection, and contraceptive failure have
been reported. In addition, St. John's wort may produce the serotonin
syndrome when taken with other serotonergic medications. (See "Clinical use
of St. John's wort", section on 'Herb-drug interactions'.)
Ginkgo biloba has antiplatelet and antithrombotic effects and therefore has
the potential to interact with anticoagulants such as warfarin, NSAIDs, and
aspirin, leading to an increased risk for spontaneous hemorrhage and
bleeding. (See "Clinical use of ginkgo biloba", section on 'Interactions'.)
Concomitant ingestion of grapefruit juice and certain dihydropyridine
calcium channel blockers may elevate the plasma concentration of the latter,
possibly leading to hypotension [79]. Grapefruit juice increases the
bioavailability of certain calcium channel blockers by inhibiting the
cytochrome P450 3A4 (CYP3A4) isoenzyme found in the liver and gut wall. The
result of this inhibition is that more drug is absorbed and plasma
concentrations increase [80].
INTERNET EVIDENCE-BASED RESOURCES — There are a number of web-based
resources aimed at providing health care practitioners and consumers with
evidence-based information on herbal medicine.
Natural Medicines Comprehensive Database
(www.naturaldatabase.com)
Natural Standard
(www.naturalstandard.com)
ConsumerLab.com
(www.consumerlab.com)
Medline Plus Drugs and Supplement Directory
(www.nlm.nih.gov/medlineplus/druginformation.html)
NIH National Center for Complementary and Alternative Medicine Herb Fact
Sheets (nccam.nih.gov/health/herbsataglance.htm)
NIH Office of Dietary Supplements (www.ods.od.nih.gov)
COUNSELING PATIENTS
Asking about use — Surveys have found that the majority of patients who use
herbal medicines and other forms of complementary and alternative medicine
do not disclose this to their health care providers [81]. Of complementary
alternative medicine users who did not disclose such use to their physicians
, 61 percent reported that a reason for not telling their physician was "it
wasn't important for my doctor to know" and 60 percent also reported that "
the doctor never asked."
There are several important reasons for asking patients about the use of
herbal medicines:
Herbs are pharmacologically active and therefore can positively and
negatively impact patient health. Positive effects may include improvement
of disease-specific outcomes. Negative effects may include adverse effects
and drug-herb interactions. For these reasons, the Joint Commission on
Accreditation of Healthcare Organizations in the US now requires that herb
and supplement use be recorded as part of the medication list in the
hospital medical record [82].
Discussion of herbal medicine use may open dialogue about patient concerns
that may be amenable to management with well-studied conventional therapies.
For example, further questioning of a patient who uses multiple supplements
such as garlic, Vitamin E, and Coenzyme Q-10 might reveal intense anxiety
of myocardial infarction due to a family history of premature heart disease.
Measuring cardiovascular risk markers and educating the patient about
conventional cardiac risk factor reduction and therapy could then be
initiated.
Providers may need to consider herb-drug interactions when prescribing and
dosing conventional medications.
Asking about herb use can be done during the medication history by asking: "
What prescription medications, over the counter medicines, vitamins, herbs,
or supplements do you use?"
This encourages communication by demonstrating the practitioner's interest
in the information and willingness to discuss herb and supplement use. It is
also appropriate to put a question like this into medical intake
questionnaires filled out prior to the appointment.
When the ingredients of a commercial herbal product are unknown,
practitioners can consult the Dietary Supplement Labels Database http://dietarysupplements.nlm.nih.gov/dietary/ or the product's website.
Patients who use herbs should be asked about their reasons for use.
Motivation for herb use is often not based on scientific data [16]. Of
herbal users surveyed, 72 percent stated they would continue using
supplements despite a negative government scientific study. Instead patients
often get their information about herbs from family, friends,
advertisements, and the Internet. Patients can be directed to Medline plus (
see above) for free evidence-based information about many herbal products.
Advising patients — The schema in the table (table 3), can be used to
develop an approach to advising patients about an herbal product based upon
the evidence for that product's quality, efficacy, and safety [49,57].
If there is strong evidence for an herbal product's quality, safety, and
efficacy, it may be reasonable to proactively recommend that product and
closely monitor the patient for effectiveness and safety. Given the frequent
uncertainty in herbal product quality, which impacts the product's efficacy
and safety, few (if any) herbal products currently fit these criteria.
In contrast, it would be appropriate to discourage use of products when
there is strong evidence for either lack of quality, inefficacy, or
harmfulness. Examples of products that should be discouraged include
traditional herbal medicines known to contain toxic heavy metals, St. John's
wort when taken with medicines metabolized by CYP3A4, and ephedra-related
products [61].
The majority of herbal products do not fall into either the recommend or
discourage category due to uncertain, insufficient, or contradictory
evidence regarding quality, efficacy, and/or safety. For these products,
physicians should counsel and caution patients regarding the uncertainty of
the evidence. The impact of uncertain quality on efficacy and safety should
be emphasized. If the patient chooses to proceed with an herbal product, a
plan should be agreed on for ongoing monitoring for both benefits and
adverse effects. These discussions should be documented clearly in the
medical record.
Physicians need to take into account patients' individual health conditions,
concerns, and preferences [83]. Patients seeking or already using herbal
treatments should have an appropriate evaluation for their condition such
that proven conventional treatments can be offered for any diagnosed
conditions [84].
For the patient who decides to use an herbal product against the advice of
his or her physician, a nonjudgmental attitude should be maintained. This
will allow channels of communication to remain open for monitoring and
future discussion. A patient's decision to pursue herbal therapy against
medical advice or in lieu of conventional therapy is not an acceptable
justification for a physician to terminate care of a patient.
Choice of brand — Patients who use herbs often ask their providers what
brand should be used. Lack of regulatory reform in the herbal industry makes
it difficult for the clinician to provide an informed response. One option
is to recommend formulations used in clinical trials showing a positive
benefit. Consulting independent sources such as Consumer Labs (www.
consumerlab.com) for commercial products that meet minimum quality criteria
is another reasonable strategy. For ethical reasons, supplements sold
through practitioners' offices or multilevel marketing plans should be
discouraged.
Special populations
Pregnancy and nursing — Few animal or human studies have been conducted on
the safety of herbal medicines in pregnancy or while nursing. Given the
current paucity of data for these populations as well as the uncertainty in
product quality, women who are pregnant, contemplating pregnancy, or
lactating should generally be discouraged from using herbal treatments.
Infants and children — Parents should be cautioned about the relative lack
of studies demonstrating efficacy and safety of herbal medicines in infants
and children [85]. Additional concerns are proper dosing in this age group,
greater susceptibility to potential contaminants, and uncertainty of product
quality.
Elderly — Caution should be exercised in the use of herbs in the elderly
due to possible decreased renal and hepatic clearance of herb and drug
metabolites. Additionally, for elderly individuals taking multiple
medications, there is a greater potential for herb-drug interactions [42].
Surgical patients — No large prospective study of the impact of
perioperative herb use on surgical outcomes has been completed. Herbs may
theoretically impact surgery through altered coagulation (eg, ginkgo,
ginseng, garlic), cardiovascular stability (eg, ephedra), glucose control (
ginseng), anesthesia (eg, valerian, kava), and increased metabolism of
perioperative medication (eg, St. John's wort). Case reports of
perioperative bleeding associated with ginkgo biloba [86] and saw palmetto [
87] have been reported. Authors have recommended avoiding herbs for at least
two weeks prior to surgery [88].
SUMMARY AND RECOMMENDATIONS — Herbal treatments are widely used by patients
in the United States and elsewhere. They have the potential for both
benefit and harm.
Patients should be asked about use of herbal treatments in a nonjudgmental
manner as part of the medication history (see 'Asking about use' above).
Patients can be advised about herbal product use or avoidance based upon a
product's quality, efficacy, and safety (table 3); (see 'Advising patients'
above).
Uncertainty in quality and the relatively few well-designed studies make it
difficult for physicians to proactively recommend herbal therapies for most
patients (see 'Advising patients' above).
When patients decide to use herbal therapies they should be monitored for
evidence of benefits and harmful effects, including side effects (see '
Advising patients' above).
We suggest that pregnant and nursing patients be advised to avoid herbal
therapies (Grade 2C). (See 'Pregnancy and nursing' above.)
Options for counseling patients who seek advice about what brand of herbal
medicine to use include recommending brands that have been used in clinical
trials or that have been tested by independent sources such as Consumer Labs
(www.consumerlab.com) (see 'Choice of brand' above).
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significant is the interaction? Clin Pharmacokinet 1994; 26:91.
80 Lown KS, Bailey DG, Fontana RJ, et al. Grapefruit juice increases
felodipine oral availability in humans by decreasing intestinal CYP3A
protein expression. J Clin Invest 1997; 99:2545.
81 Eisenberg DM, Kessler RC, Van Rompay MI, et al. Perceptions about
complementary therapies relative to conventional therapies among adults who
use both: results from a national survey. Ann Intern Med 2001; 135:344.
82 Joint Commission on Accreditation of Healthcare Organizations. 2005
National Patient Safety Goals FAQs. Available at www.jcaho.org/ (Accessed
August 16, 2005).
83 Ashar BH, Rowland-Seymour A. Advising patients who use dietary
supplements. Am J Med 2008; 121:91.
84 Eisenberg DM. Advising patients who seek alternative medical therapies.
Ann Intern Med 1997; 127:61.
85 Gardiner P. Dietary supplement use in children: concerns of efficacy and
safety. Am Fam Physician 2005; 71:1068, 1071.
86 Destro MW, Speranzini MB, Cavalheiro Filho C, et al. Bilateral haematoma
after rhytidoplasty and blepharoplasty following chronic use of Ginkgo
biloba. Br J Plast Surg 2005; 58:100.
87 Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated
with the use of extract of Saw Palmetto herb: a case report and review of
literature. J Intern Med 2001; 250:167.
88 Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care.
JAMA 2001; 286:208.
【在 a*******g 的大作中提到】
:
: 呵呵,不明白就让其他中国来的医生去给你解释吧.
: 既然我说什么你都不信,那对话没有必要继续下去.
| | | p********3
发帖数: 5750 | 51 再让你长长见识：大家看和文献3-6相关的那句话，专门提出了中药的肾脏毒性问题，表明实际上的肾脏毒性比原先预期想象的还要普遍。
大家没有忘记在对Herb Medicine管制更严格的欧盟对中药 Ban了吧。 我上篇文献里面说了欧盟对Herb的管理对美国严格， 谈得比较细，有兴趣的可以仔细阅读。
Author
Marc E De Broe, MD, PhD Section Editor
Gary C Curhan, MD, ScD Deputy Editor
John P Forman, MD, MSc
Last literature review version 19.2: May 2011 | This topic last updated:
June 15, 2010
INTRODUCTION — In 1991, physicians in Belgium noted an increasing number of
women who presented with acute, often near end-stage renal disease
following exposure to aristolochic acid (AA) at a weight reduction clinic [1
,2]. An initial survey of seven nephrology centers in Brussels identified 14
women under the age of 50 who had presented with advanced renal failure due
to biopsy proven chronic tubulointerstitial nephritis over a three year
period; nine of these patients had been exposed to the same slimming regimen
[1]. A total of more than 300 cases have been identified, a third of whom
have already undergone renal transplantation.
The epidemiology is unknown, as is the risk for development of severe renal
damage. However, the publication of case reports from several countries in
Europe and Asia, particularly in China, indicate that the incidence of
herbal medicine-induced nephrotoxicity is more common than previously
thought [3-6].
PATHOLOGY — The major lesion, which is located principally in the cortex,
is extensive interstitial fibrosis with atrophy and loss of the tubules.
Cellular infiltration of the interstitium is scarce. Thickening of the walls
of the interlobular and afferent arterioles result from endothelial cell
swelling. The glomeruli are relatively spared and immune deposits are not
observed. These findings suggest that the primary lesions may be centered in
the vessel walls, thereby leading to ischemia and interstitial fibrosis.
An extremely high incidence of cellular atypia and urothelial (transitional
cell) carcinoma of the renal pelvis, ureter, and bladder has been associated
with AA nephropathy [7-9].
PATHOGENESIS — The pathogenesis of AA nephropathy is not completely
understood. A plant nephrotoxin, AA, has been proposed as a possible
etiologic agent. Support for this hypothesis is provided by findings in
animal models (rabbit, rat and mice) of disease [10-14]. In one study, for
example, rabbits were given intraperitoneal injections of AA (0.1 mg AA/kg 5
days a week for 17 to 21 months) [10]. Histologic examination of the
kidneys and genitourinary tract revealed renal hypocellular interstitial
fibrosis, and atypical and malignant uroepithelial cells.
However, it is not clear if AA has been part of the herbal preparations used
by all patients [1]. Furthermore, AA (0.15 mg/tablet) has been used as an
immunomodulatory drug for 20 years in Germany by thousands of patients,
sometimes in doses comparable to that found in AA-containing slimming
regimens; despite this exposure, there is no report relating chronic
tubulointerstitial nephritis to AA in Germany.
In addition to AA, patients with AA nephropathy also received the appetite
suppressants, fenfluramine and diethylpropion; these agents have
vasoconstrictive properties [15].
Together, these observations suggest that the fast-developing chronic
tubulointerstitial renal disease may have been caused by combined exposure
to both a potent nephrotoxic substance, AA, and to renal vasoconstrictors,
fenfluramine/diethylpropion. However, studies in animals found that the
combination of AA and high doses of fenfluramine resulted in a comparable
degree of interstitial fibrosis as AA alone [16].
The necessity to stimulate the intrarenal renin-angiotensin system (salt
deprivation) to obtain fibrointerstitial lesions are consistent with the
combined exposure concept observed with several potential nephrotoxins [15].
Blockade of the renin-angiotensin system, however, does not prevent renal
interstitial fibrosis by AA [17]. How far transdifferentiation and apoptosis
play an important role in this fast developing type of chronic
tubulointerstitial disease of the kidneys is still not clear [18]. One study
suggests that AA induces tubular epithelial cell death via apoptosis by
dephosphorylation of STAT3 and posttranslational activation of p53,
supporting the hypothesis that p53 promotes renal injury in AA nephropathy [
19].
Another uncertain factor is why only some patients exposed to the same
herbal preparations develop renal disease. Women appear to be at greater
risk than men. Other possibly important factors include toxin dose, batch-to
-batch variability in toxin content, individual differences in toxin
metabolism, and a genetically determined predisposition toward
nephrotoxicity and/or carcinogenesis [20].
In one of the two studies showing a link between AA and carcinogenesis, an
increased dose of AA was associated with an enhanced risk of carcinoma [8].
Tissue samples revealed AA-related DNA adducts, indicating a possible
mechanism underlying the development of malignancy. The presence of these
adducts was noted in another report of two patients with urothelial
malignancy and AA nephropathy [21].
Another possible factor is the abnormal function of p53, a known tumor
suppressor gene. In the second study showing a link between the nephropathy
and carcinogenesis, all atypical cells were found to overexpress this
protein, thereby suggesting the presence of a mutation in the gene [7]. (See
"Balkan endemic nephropathy".)
It was found that, in vitro (opossum kidney cell line) and in vivo (rat),
proximal tubular injury occurs early after AA intoxications. There is a link
between specific AA – DNA adduct formation and decreased megalin
expression and inhibition of receptor/mediated endocytosis of low molecular
weight proteins [22]. Cytotoxicity data suggest that the nitro and methoxy
groups are critical determinants of the nephrotoxic potency of AA [23].
PRESENTATION AND PROGNOSIS — Affected patients typically present with renal
insufficiency with other findings that are typical of a primary
tubulointerstitial disease. The blood pressure is either normal or only
mildly elevated, protein excretion is only moderately increased (less than 1
.5 g/day), and the urine sediment reveals only a few red and white cells.
The elevation in protein excretion consists of both albumin and low
molecular weight proteins that are normally filtered and reabsorbed by
proximal tubular cells [24]. Thus, tubular dysfunction contributes to the
proteinuria.
The plasma creatinine concentration at presentation has ranged from 1.4 to
12.7 mg/dL (123 to 1122 µmol/L) [2]. Follow-up studies have revealed
relatively stable renal function in most patients with an initial plasma
creatinine concentration below 2 mg/dL (176 µmol/L) [25]. However,
progressive renal failure resulting in eventual dialysis or transplantation
may ensue in patients with more severe disease even if further exposure to
AA is prevented. The risk for progressive disease increases with the
duration of exposure.
An extremely similar clinical and pathologic process has been reported in a
group of patients from Taiwan who had ingested a selection of uncontrolled
traditional AA that differed from those of the slimming regimen [3]. Despite
discontinuation of these remedies, progressive renal failure was common.
Although the exact correlation between this disorder and traditional AA
nephropathy associated with the slimming regimen is unclear, toxins common
to different herbal remedies may cause interstitial renal fibrosis [26].
TREATMENT — There is no proven effective therapy for this disorder, which
typically presents with marked interstitial fibrosis but not prominent
inflammation. An uncontrolled study suggested that corticosteroids may slow
the rate of loss of renal function [27].
The high incidence of cellular atypia of the genitourinary tract suggests
that, at a minimum, these patients should undergo regular surveillance for
abnormal urinary cytology. Whether more aggressive management strategies,
such as bilateral native nephroureterectomies (particularly in those
undergoing renal transplantation), are required is unclear. Findings from
one report support the more aggressive option [7].
Renal transplantation is an effective modality for those who progress to end
-stage renal disease. One report noted no recurrence in five such patients [
25].
SUMMARY AND RECOMMENDATIONS
Aristolochic acid (AA) nephropathy is an interstitial nephritis related to
AA that was first described in 1991. A high incidence of cellular atypia and
urothelial (transitional cell) carcinoma of the renal pelvis, ureter, and
bladder has been associated with this disease. (See 'Introduction' above and
'Pathology' above.)
The major histologic lesion in the kidney is interstitial fibrosis with
atrophy and loss of the tubules in the renal cortex. Thickening of the walls
of the interlobular and afferent arterioles may be observed. Cellular
infiltration of the interstitium is scarce and glomeruli are spared. Immune
deposits are not present. (See 'Pathology' above.)
Aristolochic acid (AA) in combination with the vasoconstrictive appetite
suppressants, fenfluramine and diethylpropion, may underlie AA nephropathy.
Stimulation of the intrarenal renin-angiotensin system likely contributes to
the lesion. (See 'Pathogenesis' above.)
Risk factors for development of AA nephropathy include female gender, toxin
dose, and a genetically determined predisposition toward nephrotoxicity and/
or carcinogenesis. (See 'Pathogenesis' above.)
Affected patients typically present with renal insufficiency and normal or
only mildly elevated blood pressure. Protein excretion is only moderately
increased (less than 1.5 g/day), and the urine sediment reveals only a few
red and white cells. The elevation in protein excretion consists of both
albumin and low molecular weight proteins. (See 'Presentation and prognosis'
above.)
There is no specific therapy for AA nephropathy although one uncontrolled
study suggests that corticosteroids may slow the rate of loss of renal
function. Renal transplantation is an effective modality for those who
progress to end-stage renal disease. (See 'Treatment' above.)
Given the high incidence of cellular atypia of the genitourinary tract,
patients should undergo regular surveillance for abnormal urinary cytology.
(See 'Treatment' above.)
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REFERENCES 1 Vanherweghem JL, Depierreux M, Tielemans C, et al. Rapidly
progressive interstitial renal fibrosis in young women: association with
slimming regimen including Chinese herbs. Lancet 1993; 341:387.
2 Depierreux M, Van Damme B, Vanden Houte K, Vanherweghem JL. Pathologic
aspects of a newly described nephropathy related to the prolonged use of
Chinese herbs. Am J Kidney Dis 1994; 24:172.
3 Yang CS, Lin CH, Chang SH, Hsu HC. Rapidly progressive fibrosing
interstitial nephritis associated with Chinese herbal drugs. Am J Kidney Dis
2000; 35:313.
4 Wu Y, Liu Z, Hu W, Li L. Mast cell infiltration associated with
tubulointerstitial fibrosis in chronic Aristolochic Acid Nephropathy. Hum
Exp Toxicol 2005; 24:41.
5 Guy, JY, Chen, HC, Tsai, JF, Chuang, LY. Herbal therapy is associated with
the risk of CKD in adults not using analgesics in Taiwan. Am J Kidney Dis
2007; 49:628.
6 Debelle FD, Vanherweghem JL, Nortier JL. Aristolochic acid nephropathy: a
worldwide problem. Kidney Int 2008; 74:158.
7 Cosyns JP, Jadoul M, Squifflet JP, et al. Urothelial lesions in Chinese-
herb nephropathy. Am J Kidney Dis 1999; 33:1011.
8 Nortier JL, Martinez MC, Schmeiser HH, et al. Urothelial carcinoma
associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J
Med 2000; 342:1686.
9 Isnard Bagnis C, Deray G, Baumelou A, et al. Herbs and the kidney. Am J
Kidney Dis 2004; 44:1.
10 Cosyns JP, Dehoux JP, Guiot Y, et al. Chronic aristolochic acid toxicity
in rabbits: a model of Chinese herbs nephropathy? Kidney Int 2001; 59:2164.
11 Debelle FD, Nortier JL, De Prez EG, et al. Aristolochic acids induce
chronic renal failure with interstitial fibrosis in salt-depleted rats. J Am
Soc Nephrol 2002; 13:431.
12 Van Vleet TR, Schnellmann RG. Toxic nephropathy: environmental chemicals.
Semin Nephrol 2003; 23:500.
13 Nortier JL, Vanherweghem JL. For patients taking herbal therapy--lessons
from aristolochic acid nephropathy. Nephrol Dial Transplant 2007; 22:1512.
14 Zhou L, Fu P, Huang XR, et al. Mechanism of chronic aristolochic acid
nephropathy: role of Smad3. Am J Physiol Renal Physiol 2010; 298:F1006.
15 De Broe ME. On a nephrotoxic and carcinogenic slimming regimen. Am J
Kidney Dis 1999; 33:1171.
16 Debelle F, Nortier J, Arlt VM, et al. Effects of dexfenfluramine on
aristolochic acid nephrotoxicity in a rat model for Chinese-herb nephropathy
. Arch Toxicol 2003; 77:218.
17 Debelle FD, Nortier JL, Husson CP, et al. The renin-angiotensin system
blockade does not prevent renal interstitial fibrosis induced by
aristolochic acids. Kidney Int 2004; 66:1815.
18 Pozdzik AA, Salmon IJ, Debelle FD, et al. Aristolochic acid induces
proximal tubule apoptosis and epithelial to mesenchymal transformation.
Kidney Int 2008; 73:595.
19 Zhou L, Fu P, Huang XR, et al. Activation of p53 promotes renal injury in
acute aristolochic acid nephropathy. J Am Soc Nephrol 2010; 21:31.
20 Diamond JR, Pallone TL. Acute interstitial nephritis following use of
tung shueh pills. Am J Kidney Dis 1994; 24:219.
21 Lord GM, Cook T, Arlt VM, et al. Urothelial malignant disease and Chinese
herbal nephropathy. Lancet 2001; 358:1515.
22 Lebeau C, Arlt VM, Schmeiser HH, et al. Aristolochic acid impedes
endocytosis and induces DNA adducts in proximal tubule cells. Kidney Int
2001; 60:1332.
23 Balachandran P, Wei F, Lin RC, et al. Structure activity relationships of
aristolochic acid analogues: toxicity in cultured renal epithelial cells.
Kidney Int 2005; 67:1797.
24 Kabanda A, Jadoul M, Lauwerys R, et al. Low molecular weight proteinuria
in Chinese herbs nephropathy. Kidney Int 1995; 48:1571.
25 Reginster F, Jadoul M, van Ypersele de Strihou C. Chinese herbs
nephropathy presentation, natural history and fate after transplantation.
Nephrol Dial Transplant 1997; 12:81.
26 Vanherweghem JL. Nephropathy and herbal medicine. Am J Kidney Dis 2000;
35:330.
27 Vanherweghem JL, Abramowicz D, Tielemans C, Depierreux M. Effects of
steroids on the progression of renal failure in chronic interstitial renal
fibrosis: a pilot study in Chinese herbs nephropathy. Am J Kidney Dis 1996;
27:209.
【在 a*******g 的大作中提到】
:
: 呵呵,不明白就让其他中国来的医生去给你解释吧.
: 既然我说什么你都不信,那对话没有必要继续下去.
| p********3
发帖数: 5750 | 52 再让你看看这几句话： 多了怕你看不懂， 这个只是一个综述里面的一段。
This approach was assessed in a double-blind, placebo-controlled trial, in
which 120 patients receiving adjuvant chemotherapy for breast or colon
cancer were evaluated by a qualified Chinese herbalist [34]. Treatment was
prescribed and the active herbs or a matched control were dispensed in a
blinded fashion. There was no difference between the two groups in
hematologic toxicity, which was the primary end point. Among 16 non-
hematologic parameters assessed, the only statistically significant
difference was a reduction in the severity of nausea with active treatment.
A systematic review was conducted of four trials in which 270 patients with
advanced or late stage gastric cancer were randomly assigned to the
traditional Chinese medicinal herb Huachansu plus chemotherapy compared with
the same chemotherapy alone [35]. The authors concluded that there was
relatively weak evidence that Huachansu improved leukopenia when used
together with chemotherapy, but it did not improve any other side effect or
the short-term efficacy of chemotherapy。
还有很多Study，另外还有很多文献说明科研没法做，因为药物成分不稳定，原因我前
面说了， 不同的中医生开的药方不一样， 每个医生开的药在不同地点因为药材质量不
一样无法质控科研。 不过 我懒得贴了。
。
已经有人愿意写一篇关于中药的文章了，将会采用这些文献包括我这里没有公布出来的太多的文献了。 感兴趣的同学可以等待。
【在 d*******r 的大作中提到】
: 什么乱七大八糟的
: 亏得我还去专门去找你说的论文去看
: 列一个超长的论文列表
: 里面就没有和中医有关的
: 你说的参看里的那六篇文章
: 五篇是说印度药材的
: 只有一篇讲中药
: 而且这六篇都是讲成药的
: 根本不是在解析中医印医而是分析当代中印两国将中医印医将草药合成为成药的制成过
: 程，何况古代草药大多野生，当代规模化量产使得当代中药印药是如何种植的，有没有
| p********3
发帖数: 5750 | 53 好吧， 既然你不愿意和我对话我们就不对话。 我一开始的时候因为你是MM所以对你是
比较客气的，我一般只对WSN不客气， 但是我们的对话成今天这个样子，真是一步一步
的只能这样了。
【在 a*******g 的大作中提到】
:
: 呵呵,不明白就让其他中国来的医生去给你解释吧.
: 既然我说什么你都不信,那对话没有必要继续下去.
| a*******g
发帖数: 2813 | 54
开始讽刺我学艺不精转行了，然后说我煤炭学校毕业，然后说我攻击网友，然后说我自
称MD，
你对我这么客气啊。那我还真是没有体会到您的良苦用心。
有人说出没有月经就是怀孕的话，她都知道自己口误武断了不吭声，你因为站在同一边
就添油加醋给多少如果来解释。
您太客气了。
至于那几个屏蔽，谁会不知道啊，先不说脉搏的事情，先说说相通的定义，选择性透过
也是透过，细胞膜稳定了细胞内环境，但你不能说细胞内部和外界“根本不相通”
如果你也真是学医的，就不会因为立场不同就这么简单的去否定别人，还觉得没有咬文
嚼字歪曲别人。
对于别人的不同意见，我向来都是在说理，只有那些胡搅蛮缠强词夺理的我没太大耐心
，至于攻击，只能说人不犯我我不犯人，我从来没有主动攻击过别人，只是做不到被攻
击了还忍气吞声。
我的反驳也是把对方原话反回去，对方怎么侮辱我就相当于说他自己，你要觉得我反驳
的重了，也先去看看原帖他们怎么说话。
好了就到这里，我没什么力气继续了，也没什么好讨论的，我对你也没恶意。
【在 p********3 的大作中提到】
: 好吧， 既然你不愿意和我对话我们就不对话。 我一开始的时候因为你是MM所以对你是
: 比较客气的，我一般只对WSN不客气， 但是我们的对话成今天这个样子，真是一步一步
: 的只能这样了。
| p********3
发帖数: 5750 | 55 呵呵，为这个也要争啊。 记不记得那天晚上我一开始还和你嘻嘻哈哈的闹着玩，当然
你也有可以一不小心伤了我（比如讽刺我针灸扎错了）， 然后我就升级了些， 彼此就
一句一句升级了。。。
其实那人不是口误不吭声了，人家周末外出了， 根本就没有看到你们三个人在那里说
相声，那人刚好我是俺的偶像级人物哪，我哪能看到自己的偶像被人嘲笑呢， 女的说
说嘛还行，WSN就太叽叽歪歪了。所以我冒出来了的。
至于中医粉或者中医黑，我们可以都保留自己的意见。
好啦， 这些都是小女人的Talk啦。 如果我说话过分了， 我当众向你道歉。 并且以后
对MM类的女ID不轻易恶言相向。
不过我的道歉不包括对WSN的。
【在 a*******g 的大作中提到】
:
: 开始讽刺我学艺不精转行了，然后说我煤炭学校毕业，然后说我攻击网友，然后说我自
: 称MD，
: 你对我这么客气啊。那我还真是没有体会到您的良苦用心。
: 有人说出没有月经就是怀孕的话，她都知道自己口误武断了不吭声，你因为站在同一边
: 就添油加醋给多少如果来解释。
: 您太客气了。
: 至于那几个屏蔽，谁会不知道啊，先不说脉搏的事情，先说说相通的定义，选择性透过
: 也是透过，细胞膜稳定了细胞内环境，但你不能说细胞内部和外界“根本不相通”
: 如果你也真是学医的，就不会因为立场不同就这么简单的去否定别人，还觉得没有咬文
| p********3
发帖数: 5750 | 56 还能增加免疫细胞提高免疫功能（不记得是T细胞还是B细胞了）
【在 s*******n 的大作中提到】
: 晕....
: 人参的活性成分是人参皂甙，抗氧化，对心脑血管疾病有一定作用。
| a*******g
发帖数: 2813 | 57
不管坑不吭声，就是口误，况且我也不知道她背景，因为很多医学知识匮乏的人还真就
以为不来月经就是怀孕，但你不得不承认她的那句话欠妥。很多论战其实都是口误，然
后对方就抓住一点小辫子不放，就慢慢升级了，升到最后在辩论什么都忘了。
我还记得原来看你舌战外F贴，也有和你一起大战WSN的。好了就和解吧，我也道歉一下。
我不同意你的意见，但是尊重你保留自己意见的权利。
还有就是dathinker，不管他的立场是否和你一致，不可否认的是他说话一直有礼有节
，有论有据（不管这个论据你信不信），最后的升级也都是大家太针锋相对了。
哦了，版主再发一次包子吧！
哈哈，上次没吃饱啊。。。。。
【在 p********3 的大作中提到】
: 呵呵，为这个也要争啊。 记不记得那天晚上我一开始还和你嘻嘻哈哈的闹着玩，当然
: 你也有可以一不小心伤了我（比如讽刺我针灸扎错了）， 然后我就升级了些， 彼此就
: 一句一句升级了。。。
: 其实那人不是口误不吭声了，人家周末外出了， 根本就没有看到你们三个人在那里说
: 相声，那人刚好我是俺的偶像级人物哪，我哪能看到自己的偶像被人嘲笑呢， 女的说
: 说嘛还行，WSN就太叽叽歪歪了。所以我冒出来了的。
: 至于中医粉或者中医黑，我们可以都保留自己的意见。
: 好啦， 这些都是小女人的Talk啦。 如果我说话过分了， 我当众向你道歉。 并且以后
: 对MM类的女ID不轻易恶言相向。
: 不过我的道歉不包括对WSN的。
| p********3
发帖数: 5750 | 58 啊！原来是老友啊，误伤啊误伤啊！更加该道歉了。
Dathinker早期的帖子确实人很谦和有礼貌， 那个帖子你没有参与，是关于针灸的。
我还觉得他人品不错，不过我也觉得他被几个中医黑骂狠了点，半个月不见， 人都变
形啦， 看来买买提真是培养WSN的圣地了。哈哈
下。
【在 a*******g 的大作中提到】
:
: 不管坑不吭声，就是口误，况且我也不知道她背景，因为很多医学知识匮乏的人还真就
: 以为不来月经就是怀孕，但你不得不承认她的那句话欠妥。很多论战其实都是口误，然
: 后对方就抓住一点小辫子不放，就慢慢升级了，升到最后在辩论什么都忘了。
: 我还记得原来看你舌战外F贴，也有和你一起大战WSN的。好了就和解吧，我也道歉一下。
: 我不同意你的意见，但是尊重你保留自己意见的权利。
: 还有就是dathinker，不管他的立场是否和你一致，不可否认的是他说话一直有礼有节
: ，有论有据（不管这个论据你信不信），最后的升级也都是大家太针锋相对了。
: 哦了，版主再发一次包子吧！
: 哈哈，上次没吃饱啊。。。。。
| d*******r
发帖数: 806 | 59 妹妹姐姐都这么惦记着本人
吾甚感欣慰啊....
不过还是妹妹说得好，听着开心，俺今晚可以睡个好觉了
俺也不怪姐姐，我了解姐姐，姐姐需要安神补脑, 养心顺气，欢迎常光临中医版 | p********3
发帖数: 5750 | 60 算了，去你们中医版就是去炸版，我还是让你们在那块飘忽的世外桃源活得风生水起快
活自在吧。
【在 d*******r 的大作中提到】
: 妹妹姐姐都这么惦记着本人
: 吾甚感欣慰啊....
: 不过还是妹妹说得好，听着开心，俺今晚可以睡个好觉了
: 俺也不怪姐姐，我了解姐姐，姐姐需要安神补脑, 养心顺气，欢迎常光临中医版
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