1 general information
The data comes from the prescription of Chinese and western medicines in our hospital.
1000 cases of prescriptions belong to the following three types: ① 423 cases diagnosed as diseases by first-time doctors and combined with Chinese and western medicines; ② 328 cases of 1 disease were treated with integrated traditional Chinese and western medicine. ③ Treating two or more diseases with combination of traditional Chinese and western medicine. There are three forms of integration of traditional Chinese and western medicine: ① 347 cases of compatibility of traditional Chinese medicine decoction with western medicine; ② 365,438+05 cases of compatibility between Chinese patent medicine and western medicine; ③ 338 cases of Chinese and western medicine injections were used separately or simultaneously.
2 Follow-up results
① 508 cases of synergy of integrated traditional Chinese and western medicine; ② The combination of traditional Chinese and western medicine reduced 32 1 case of adverse reactions; ③ Adverse reactions caused by irrational drug use were 17 1 case.
3 analysis
3. 1 Mutual restraint to reduce adverse reactions.
Many western medicines used in clinic are single in composition, and although the curative effect is obvious, the adverse drug reactions are large, and the corresponding western medicines are not effective in confrontation or treatment. Practice has proved that effective Chinese medicine can achieve ideal results. For example, most anti-tumor chemicals have serious digestive tract reactions and leukopenia caused by bone marrow suppression. Mixing with Os Sepiae, Rhizoma Bletillae, Fructus Ligustri Lucidi, Folium Pyrrosiae, Fructus Psoraleae, Fructus Corni, etc. It can effectively reduce the adverse reactions in chemotherapy, especially protect gastric mucosa, prevent leukopenia and improve immunity. The mechanism is that cuttlebone contains a lot of calcium sulfate and bletilla striata. Fructus Ligustri Lucidi, Folium Pyrrosiae, Fructus Psoraleae and Fructus Corni contain Ligustrum lucidum glycoside, flavonoid glycoside and other glycosides respectively. Combined with chemotherapy drugs such as cyclophosphamide, it can prevent the decrease of white blood cells caused by bone marrow suppression.
At present, chlorpromazine, an antipsychotic drug, has adverse reactions that damage liver function. If it is used together with pearl powder in the treatment of diseases, it can improve patients with impaired liver function. Its mechanism of action is that pearl powder contains more than 20 kinds of amino acids, copper, iron, zinc, magnesium and other elements, which has the functions of calming the nerves, clearing away heat and detoxifying. The combination of the two can not only increase the sedative effect, but also protect the liver with amino acids.
Streptomycin is widely used in antibacterial and anti-inflammatory treatment, but its adverse reactions are also great. Therefore, the combined application of licorice and streptomycin can reduce or eliminate the toxicity of streptomycin [1]. By this method, 80% of patients who cannot continue to use streptomycin due to its toxic effect can continue to use it.
3.2 play a synergistic role to improve the curative effect.
3.2. 1 Chinese medicine and its preparations are combined with antibiotics, and the effect is good.
Coptidis Rhizoma, Scutellariae Radix, Cortex Phellodendri, Herba Taraxaci, Flos Lonicerae, Herba Andrographis and many other Chinese herbal medicines have the functions of clearing away heat and toxic materials and inhibiting bacteria, such as berberine in Coptidis Rhizoma, baicalin in in Scutellariae Radix, chlorogenic acid in Flos Lonicerae, andrographolide in Herba Andrographis, etc., all of which have antibacterial components and have inhibitory effects on Shigella, typhoid Bacillus, Staphylococcus aureus, Streptococcus, Mycobacterium tuberculosis and so on. Scutellaria baicalensis Georgi and Lonicera japonica Thunb have synergistic effect in inhibiting the synthesis of drug-resistant bacteria protein, and the combined use of penicillin can enhance the inhibitory effect of penicillin on drug-resistant Staphylococcus aureus. This set of data proves that in most cases of acute upper respiratory tract infection, patients who combine the above Chinese herbal medicines with antibiotics recover better than those who use antibiotics alone, and the medication time can generally be shortened by 2 ~ 3 days. In addition, Radix Isatidis, Folium Isatidis and Radix Bupleuri have strong antiviral components, and their compatibility with western medicine in the treatment of influenza and hepatitis at the peak period has also received good results.
3.2.2 The combination of traditional Chinese medicine and its preparation with drugs for treating coronary heart disease can improve the curative effect.
For example, the combination of Notoginseng Radix, Radix Paeoniae Rubra and Clonidine Lactate can increase coronary blood flow, dilate blood vessels, lower blood pressure, reduce heart load and reduce blood lipid. The combination of Shengmai powder, Danshen injection and scopolamine can not only improve heart rate, but also improve blood circulation and relieve myocardial ischemia, thus achieving the efficacy of treating both the symptoms and root causes and bringing out the best in each other.
3.3 Compatibility Contraindications of Chinese and Western Medicine
3.3. 1 and hypoglycemic agents cannot be used together with traditional Chinese medicine.
Licorice, velvet antler, Ophiopogon japonicus, Scutellaria baicalensis, Fritillaria, etc. Contains glucocorticoid-like substances, which have the opposite effect on glucose metabolism to insulin, can promote gluconeogenesis and raise blood sugar, so the combination of the above Chinese and western medicines can weaken the hypoglycemic effect.
3.3.2 Traditional Chinese medicine that cannot be combined with iron.
Iron is easily absorbed and utilized in acidic environment. Corydalis yanhusuo contains alkaloids, which can inhibit the secretion of gastric acid, reduce the acidity of gastric juice and affect the absorption of iron. Almond, peach kernel, dark plum, etc. It contains amygdalin and amygdalin, which can react with iron agent to generate ferrocyanide, thus affecting the absorption and utilization of iron agent.
3.3.3 Traditional Chinese Medicine that cannot be used with pepsin
Pepsin can only play a role in acidic environment. Rhizoma corydalis, Fructus Gardeniae, Poria, Radix Platycodi, Radix Bupleuri and Radix Glycyrrhizae can inhibit gastric acid secretion, reduce gastric acidity and inhibit pepsin activity. Alkaline traditional Chinese medicines, such as borax, cuttlebone, Chinese patent medicine Qi Xing powder, etc., can neutralize gastric acid and increase its pH value, thus reducing the curative effect of pepsin. Alum contains potassium aluminum sulfate, which can coagulate the enzyme and inactivate it, so pepsin can't be used with it, so as not to reduce or lose the therapeutic effect and delay the illness.
3.3.4 Traditional Chinese medicine that cannot be combined with metoclopramide.
Metoclopramide has a strong cholinergic effect, which can significantly accelerate gastric emptying and improve the symptoms of gastroparesis. Datura flower, scopolamine and belladonna containing scopolamine alkaloids can antagonize cholinergic nerves and delay gastric emptying; Papaver shell can also delay gastric emptying, and has antagonistic effect on metoclopramide in pharmacological action.
3.3.5 Traditional Chinese medicine cannot be combined with aminoglycosides, sulfonamides and drugs for treating ulcer.
Acidic (alkaline) Chinese patent medicine is not easy to be compatible with alkaline (acidic) western medicine, so as not to cause neutralization reaction and reduce the curative effect [2]. Such as hawthorn, Schisandra chinensis, dark plum, Cornus officinalis, hawthorn pill, Baohe pills and other Chinese patent medicines are rich in organic acids [3], which will increase the acidity of urine after entering the body. If they are used together with sulfonamides, the acidic environment caused by organic acids will reduce the solubility of acetylated sulfonamides. Aminoglycoside antibiotics have strong antibacterial activity in alkaline urine. If the acidic traditional Chinese medicine is used, the pH value of urine is less than 4, and there is almost no antibacterial effect. Most drugs used to treat gastric ulcer and duodenal ulcer are alkaline. If the above-mentioned traditional Chinese medicines containing acidic components are taken at the same time, the efficacy of these western medicines is easily reduced or lost due to acid-base neutralization reaction.
3.3.6 Traditional Chinese medicine that cannot be combined with aminophylline and antihypertensive drugs.
Aminophylline has an exciting effect on the central nervous system, and ephedrine, the effective component of ephedra, can increase the toxicity of aminophylline, that is, a small dose of ephedrine can increase the toxicity of aminophylline; In addition, ephedrine is an adrenergic drug, which can weaken the antihypertensive effect of reserpine and guanidine through competitive inhibition.
3.3.7 Traditional Chinese medicine that cannot be combined with anti-tuberculosis drugs.
When rifampicin is combined with Sanguisorba officinalis, Polygonum cuspidatum and other traditional Chinese medicines and preparations containing more tannins, it will hinder the absorption of rifampicin, reduce the blood concentration and affect the curative effect; There are ligands in the molecular structure of isoniazid, which can easily react with metal ions such as calcium, iron, magnesium and aluminum to form chelates. Therefore, gypsum, cuttlebone, oyster, magnet, native copper, talc and alum plasma-based Chinese medicines and preparations are not suitable for isoniazid, so as not to affect the drug absorption and reduce the curative effect.
3.3.8 Traditional Chinese medicine that cannot be combined with erythromycin.
Erythromycin is easily destroyed by gastric acid. Scopolamine can inhibit gastric peristalsis, delay gastric emptying and prolong the residence time of erythromycin in the stomach. Ginger, Endothelium Corneum Gigeriae Galli, Radix et Rhizoma Rhei, Cortex Cinnamomi, Flos Caryophylli and Semen Strychni can promote the secretion of gastric juice and gastric acid, and also increase the damage of erythromycin. The purgative effect of croton, morning glory, Trichosanthes kirilowii and Polygonum Multiflori Radix can accelerate intestinal peristalsis, shorten the retention time of erythromycin in the intestine and affect absorption; Sanguisorba officinalis, Polygonum cuspidatum, pomegranate peel, Lysimachia christinae, etc. It contains more tannins and can be combined with erythromycin, which affects antibacterial activity; Charcoal Chinese medicine can also absorb erythromycin in gastrointestinal tract, which affects absorption and reduces bioavailability.