The route of administration is the way to introduce drugs into the human body. The overall selection goal is to be conducive to synergy and detoxification. The traditional ways of administration of traditional Chinese medicine include oral administration and skin administration, as well as inhalation, sublingual administration, rectal administration, nasal administration, and * * * administration. After 1930s, the administration routes of traditional Chinese medicine have been increased by subcutaneous injection, intramuscular injection, acupoint injection and intravenous injection, and the order of absorption rate from low to high is: skin administration, mucosal surface administration, rectal administration, oral administration, sublingual administration, subcutaneous injection, intramuscular injection, inhalation administration and intravenous injection administration.
Oral administration: It is simple, safe, without the help of special instruments and medical personnel, and the preparation of drugs is simpler than injection, and it has always been the main route of administration of traditional Chinese medicine. However, the absorption of oral drugs is slow and irregular, and comatose patients can't take it on their own initiative, which makes it difficult for children to cooperate. Some drugs have * * * on the stomach, and their application is also limited.
Skin administration: In addition to the treatment according to the lesion, the predecessors also advocated distinguishing the meridians and acupoints, painting, sticking, moxibustion and ironing. For example, foot-smearing can induce diseases and reduce fire, and can be used to treat aphtha, nosebleed, headache, etc. Tu fontanelle, in order to treat children with cold and convulsion; Sticking the navel to unblock the obstruction, treat constipation, edema, or warm and tonify deficiency and cold. According to modern research, drugs for local skin diseases should be used directly on the affected parts, and drugs for visceral or systemic diseases should be used behind the ear, navel and acupoint through skin administration. The least sebum in human body is the back of the ear, and the drug seepage velocity is the fastest; The most sebum is the thigh, and the drug diffusion resistance is the biggest; The umbilical skin is directly connected with fascia and peritoneum. There are abdominal arteries and veins on both sides of the umbilicus, and there is a rich capillary network, and the forward branch of the tenth intercostal nerve passes through. The arterial wall of the umbilical region also has a special structure, and the barrier function of the umbilical region is the weakest, and the sensitivity is high, so the medicine in the umbilical region can easily penetrate through the skin and enter the abdomen, and reach the therapeutic effect of the disease. Drugs absorbed rarely pass through the liver, which is better than oral administration to some extent.
Acupoint administration: It can produce a special therapeutic effect similar to acupuncture on visceral or systemic diseases through the * * * of drugs on acupoints.
Mucosal surface administration: It covers a wide range, including digestive tract, respiratory tract and body cavity administration, such as from conjunctiva, nasal cavity, oral cavity, throat, urethra, especially nasal cavity administration, which can not only treat local diseases of nasal cavity, but also treat paranasal sinus, throat, oral cavity, ear, eye and systemic diseases. * * * Administration mainly produces a local effect, but when the mucosa is damaged, the drug is easily absorbed, and the speed is faster and the effect is stronger. When using toxic drugs, absorption poisoning should be prevented.
Intrarectal administration: The application in ancient times was limited, mainly using honey, pig bile, sweet potato root and so on to guide stool. Modern applications have been expanded, such as reducing fever and treating acute renal failure by rectal perfusion, and its curative effect is better than oral administration.
Sublingual administration: Sublingual administration is a special form of mucosal surface administration. Because sublingual blood vessels are abundant, drugs can be quickly absorbed by oral mucosa and play a role, and drugs can be prevented from being destroyed by liver and gastrointestinal digestive juice. Therefore, it has been used in the eastern Han Dynasty since Zhang Zhongjing created it, but sublingual administration is only suitable for a few drugs that can be absorbed by oral mucosa.
Inhalation administration: smoke inhalation is the main method, and aromatic drugs can also be used to decoct and smoke the nose, or to wear sachets and sachets, and aerosol is used in modern development. Such as Datura flower, etc., are used to prevent asthma by lighting tobacco, and inhaling the gas of aromatic drugs to treat nasal sinus headache or cold and stuffy nose.
Administration by injection: Traditional Chinese medicine was made into injection for administration in the early 1940s, with a short history, but its application gradually increased. There are several methods, that is, subcutaneous injection, in which the liquid medicine is injected into the soft tissue between the dermis and the muscle, and the part is mostly selected outside the upper arm, and the pain is more obvious; Intramuscular injection is the injection of liquid medicine into muscle tissue, which is relatively widely used; Acupoint injection is a special intramuscular injection, which produces special curative effect on specific acupoints through drugs; Intravenous injection is the direct injection of drugs into venous blood vessels without absorption. In order to make drugs slowly enter the blood stream and maintain the concentration of drugs in the blood for a long time, intravenous drip can be used.
Timing medication
Timing medication is an important content of chronopharmacology research in traditional Chinese medicine. It is required to distinguish zang-fu organs according to the four-season alternation, yin-yang change and rhythm change proposed in classic works such as Huangdi Neijing and Shennong Materia Medica Classic, to clarify the primary and secondary relationship between time and symptoms according to the development and change of illness, to master the principle that time and symptoms are related and complementary, and to synchronize and coordinate the use of drugs with human rhythm as far as possible. Referring to the experience of the ancients and their neighbors, as well as the textual research of relevant materials, there are roughly the following requirements:
Legislation of medication according to the four-season rhythm: that is, "the combination of human beings is governed by the four seasons and five elements." That is to say, there are four seasons in a year, namely, spring, summer, autumn and winter, and the legislation on drug dispatch should also be different. First of all, "heat does not cause heat, and cold does not cause cold". Generally, hot drugs are not needed in spring and summer, and cold drugs are not needed in autumn and winter. When it is necessary to use them, anti-adjuvant drugs should be combined or cold drugs should be taken hot or cold. Secondly, we should follow the principle of "vomiting in spring, sweating in summer, falling in autumn and supplementing in winter" according to the rhythm of the ups and downs of Qi in four seasons. Third, we should use the seasonal law of the five zang-organs to determine the therapeutic principles, such as soothing the liver and nourishing the spleen in spring, suppressing fire and consolidating gold in summer, saving acid in autumn to nourish liver qi, and saving salt and increasing bitterness in winter to nourish heart qi, so as not to cut the sky and prevent it from going too far; Fourth, we should master the requirements of seasonal drugs and seasonal bans, not only to mix seasonal drugs according to the different seasons to adapt to the climate characteristics of the four seasons, but also to understand some drugs that are taboo to be mixed in different climates of the four seasons, such as "no white tiger in winter and no green dragon in summer". Even when using the same prescription, you should add or subtract it at any time.
Legislation of drug use according to monthly rhythm: the monthly rhythm of human body can be divided into endogenous rhythm and exogenous rhythm. First of all, drugs should be treated in stages according to endogenous rhythm. For example, menstrual cycle can be divided into four stages: menstrual period, late menstrual period, inter-menstrual period and premenstrual period. During menstrual period, purging heart and removing blood stasis are the main stages, while during late menstrual period, tonifying kidney and strengthening body resistance are the main stages, during inter-menstrual period, invigorating spleen and eliminating dampness are the main stages, and before menstruation, soothing liver and regulating qi are the main stages. Secondly, the prescription is selected according to exogenous rhythm, that is, periodic change and moon profit and loss. For example, in the treatment of gynecological diseases, someone puts forward: "winding and regulating menstruation, mainly warming and nourishing;" Looking at the moon to remove blood stasis, regulating qi and eliminating it is the law; The lower chord is safe, and the security is the most important; Stop leukorrhagia when it is new, remove dampness, strengthen the spleen and tonify the kidney. "
Legislation of medication according to the circadian rhythm: that is, the best time to take medication in a day should be considered, which can be summarized as the following nine aspects:
Spitting drugs should be taken before noon in the morning. Because "from Pingdan to Japan, the sun is in the sky, and the sun in the sun is also ... the weather is on the rise, and the popularity is also on the rise ... so it is better to stay early than at night. In this regard, many physicians in the past dynasties have practiced it. For example, the prescriptions for stopping malaria, such as Changshan Drink and Qibao Drink, contained in Dong Yi Bao Jian, all emphasize that drugs should be used before noon to stop vomiting, although their indications are different.
Drugs for relieving exterior syndrome and sweating should be taken before noon. In Yuan Dynasty, Wang Haogu said in "It's Hard to Know" that the time should be divided before noon when sweating in traditional Chinese medicine is used. Li Muyan's Treatise on Exogenous Febrile Diseases, such as Mahuang Decoction, Guizhi Decoction, Jiuwei Qianghuo Decoction, Gegen Jieji Decoction, etc., all suggested that it is advisable to sweat before noon, and it is not advisable to divide the yin in the afternoon. This is true not only of antiperspirant drugs, but also of drugs that show the exterior and reveal evil. " The reason is that the use of exterior-relieving drugs or exterior-removing drugs at this time can conform to the rising and floating state of yang, which is helpful to the turning point of drug efficacy and disease recovery.
Diarrhea drugs should be taken in the afternoon and evening. Some people have textual research on the works such as Criterion of Syndrome and Treatment, and found that a large number of newly recorded medical records all point out that when using the purgative method, it should be taken in the afternoon and evening according to the theory of "the popularity of the day declines". Article 198 of Treatise on Febrile Diseases says: "If you want to solve Yangming disease, you should start from Shen to E". Zhang Zihe's pills, such as Shuidao Pill, Yugong Powder, Tongjing Powder and Shenyou Pill, were all marked as "Pro-recumbent clothing". Because it is cloudy at noon, the qi begins to sink, and taking medicine at this time can follow the downward trend of the qi and achieve the purpose of medication.
Yiqi Buyang medicine should be taken in the morning or early morning. In three books, Spleen and Stomach, Differentiation of Internal and External Injuries, and Lanshi Secret Collection, Li Dongyuan formulated Buzhong Yiqi Decoction, Shenshu Tiaozhong Decoction and other prescriptions for invigorating qi and raising yang, and all of them emphasized that they should be taken in the morning or before noon, and thought that taking medicine at this time would be miraculous. Luo Tianyi, a disciple of Luo Tianyi, followed the example and further pointed out that supplementing qi and promoting yang should be taken before noon, which means that yang is easy to reach when yang is flourishing.
Nourishing yin and nourishing blood should be taken at night. Drugs for nourishing yin and blood, including drugs for calming nerves, reducing fire and astringing yang based on nourishing yin and blood, should be taken at night. According to records, the analgesic powder made by Liu Hejian with the main effect of nourishing yin and reducing fire; Li Dongyuan's Danggui Liuhuang Decoction for treating night sweats due to yin deficiency; Wang Kentang used human milk to soak phellodendron amurense to treat water deficiency and fire inflammation; Tianwang Buxin Dan benefits blood, consolidates essence, calms the mind and nourishes the heart; Mai Jian San is indicated for the treatment of bone steaming due to yin deficiency and internal heat at night. The reason lies in the fact that yin medicine is easy to exert its effect when yin is flourishing.
Take the medicine for removing dampness in the morning. For example, Jiming Powder, which is used to treat edema and beriberi, takes medicine at the fifth watch; Gong Tingxian's "Chenxiang Kuaipi Pill", which can activate yang, promote water circulation and eliminate facial swelling, also suggested that it should be taken with scallion, dried tangerine peel and mulberry bark in the fifth watch.
Antipsychotic drugs should be taken before going to bed. Xu Shuwei, the first person who put forward this view, created Cinnabar Yuanzhi Pill and Mother-of-Pearl Pill, all of which indicated that they should be taken when lying down. Later generations of physicians followed this theory in the use of sedatives. In modern times, some people have made clinical observation on this method, and it has also been confirmed that it is of practical significance to take sedatives at night.
Regular paroxysmal diseases should be taken before onset. For example, malaria, cough due to five shifts, damp-warm disease, etc., it is mainly used to cut off evil paths when the disease is not tense, so as to give full play to the drug effect.
Take medicine according to the objective index of modern research. The administration time can be adjusted according to the daily rhythm of hormone excretion or cyclic nucleotide metabolism. For example, for all kinds of kidney (spleen) yang deficiency syndromes with low adrenocortical function, when applying the prescription of warming kidney (spleen) yang, we can consider giving it once at the peak of adrenocortical hormone (6-8 am); For the diseases with low levels of prolactin and thyroxine, when applying the prescription of promoting blood circulation and promoting lactation or supplementing qi and nourishing blood, it can be considered to give it once during each peak period; For diseases such as tumor, coronary heart disease, asthma, psoriasis, etc., which have been clarified that the level of cyclic nucleotide has directional changes, it can be considered to be administered at their peak time (that is, when the level of CAMP is increased at 15~ 18, the level of CGMP is increased at 23 ~ 24 hours).
It can be predicted that, according to the theory of chronopharmacology of traditional Chinese medicine, taking medicine at the right time can conform to the seasonal changes and meet the timeliness of the body's demand for yin and yang, and can induce the disordered human rhythm to return to normal with the help of the ascending and descending trend of the body's qi, prevent or reduce the adverse reactions of drugs, improve the curative effect of drugs, and increase the cure probability and ways of some difficult diseases.