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| EDITORIAL |
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| Year : 2015 | Volume
: 2
| Issue : 1 | Page : 1-3 |
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Development bottleneck and countermeasure of TCM treatment for nephropathy
Liqun He
Department of Nephropathy, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| Date of Web Publication | 23-Jan-2015 |
Correspondence Address:
Liqun He
Department of Nephropathy, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200021
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2225-1243.149987
How to cite this article:
He L. Development bottleneck and countermeasure of TCM treatment for nephropathy. J Integr Nephrol Androl 2015;2:1-3 |
The robust development of traditional Chinese medicine (TCM) pharmacology and its fusion and complementation with modern medicine have become a rapidly progressing trend, which serves not only as a powerful boost for the development of medical science, but also as a cost-effective measure to enhance healthcare standard and to lower medical and social costs.
It has become a marked tendency that modern science and technology has been transforming itself from pure analytical to a more comprehensive approach, focusing on novel theories and methods like multidisciplinary connections, applied informatics science, systematic science, complicated science and so forth, to understand the mystery of life and disease. This transformation helps us to provide a valuable opportunity to have a deeper understanding of the basics in TCM, like holistic thinking, treating the disease according to different signs and patients, and compound prescription.
With the development and internationalization of TCM, the theoretical breakthrough in systemic and complicated scientific issues may lay a great impact on the development of biomedical science, life science, and as far as modern science, breeding multidisciplinary integration and new subspecialties, and our knowledge to life and diseases will be further elevated and improved.
| Development Bottleneck of Tcm Treatment for Nephropathy | |  |
With the clinical practice of the "modern TCM" theory, the side effects of TCM have gradually been revealed by western medicine practitioners. TCM has met a vital moment for theoretical breakthrough and innovations. Therefore, the heritage and promotion of "Shanghai-style" TCM has come in a very timely occasion. The "Shanghai-style" TCM has unique clinical thoughts, practical methods, and a good number of intellectual and experienced doctors, but has yet to establish a comprehensive and distinguished system due to lack of systematic conclusion and investigation.
TCM and Chinese herb have abundant theories in critically treating chronic kidney diseases and proteinuria, which not only involves medication prescribed by experienced TCM experts, but also specialized prescription and investigational approach of a single drug, which can be administered in different routes, methods, and targets, with distinct advantage in relieving clinical symptoms and postponing disease progression. Recent studies have gained certain achievements and increased treatment efficacy, but some issues still exist. On one hand, different doctors have different viewpoint, experience and preference in the pathogenesis, classification, treatment and therapeutical standard that still need further connection and comparison, and a unified treatment and evaluation standard is needed; on the other hand, it was also challenging to perform randomized, controlled, multi-center perspective clinical research due to limited sample and short treatment course. A lot of researches involve clinical observations with a small sample or review of personal experience. With disconnected treatment and efficacy standard, short treatment course, and lack of repeatability and scientific standard in experiment design, previous TCM researches are still weak in the support of evidence-based medicine; therefore, it is a great challenge to practice a wide clinical application.
| Countermeasures to boost the development of tcm treatment for nephropathy | | |
Explore and promote the academic thought of "Shanghai-style" TCM doctors
Shanghai was once a city with numerous renowned TCM doctors gathered. In 1930s to 1940s, there used to be as many as 50 to 60 TCM genres, but nowadays, only one third of those genres are well preserved. Protection, further research and promotion of Shanghai-style TCM have therefore become a pressing and challenging issue for us. The Ding (Ganren)'s internal medicine is the cradle of Shanghai-style TCM, and he is a master of modern TCM doctor in Shanghai. The Ding's School of TCM has a very broad influence, a unique academic thought and proposal. Dr. Ding has made remarkable contribution for TCM teaching in China and for the development of Shanghai TCM specialty. Professor Tong Shaobo, one of Dr. Ding's outstanding successors, has mastered the essence of Ding's theory. With his exquisite diagnostic and therapeutical knowledge, he delivers distinguished treatment outcome and advantage in treating difficult and complicated diseases with TCM, including urological, cardiovascular, digestive and respiratory diseases, and was honored then as the "versatile person in TCM." Over these years, though with some further conclusion and heritage, his students have yet to comprehend his entire legacy. With the current secondary specialty classification system, we still have a long way to go.
For better inheritance of Shanghai-style TCM, we must follow the rule of critically treating diseases according to different signs, while adequately making use of modern science and technology to investigate personalized treatment by Shanghai-style TCM doctors, and dynamic advancement of diseases based upon the clinical practice of Prof. Tong's successors; also, we must combine retrospective and perspective researches together, in order to deliver a comprehensive and systematic study based on their clinical experience and academic thoughts. A distinct TCM School in Shanghai would further enrich the theory of TCM, elaborate the core idea of Tong's School, define its pattern of heritage and development, create a platform for inheritance research, compose treatise that reflects a larger system of TCM school, so as to help provide better future development, increase treatment efficacy, and compensate for western medicine in diagnosing and treating difficult and complicated diseases. Meanwhile, a valuable teaching material that inherits the experience of Shanghai-style TCM masters and preserves TCM treasure would definitely benefit clinical doctors and generate vast social and economic value.
Therefore, Prof. Zhong Nianwen, Prof. Cai Gan from the department of nephrology, Shanghai Shuguang Hospital, and Prof Huang Jigeng, a successor of Prof. Tong, are elected to be the leading inheritors of Dong Shaobo's Clinical Inheritance and Research Center. The center also recruits Chief He Liqun as the major inheritor, Deputy Chief Chen Gang and Attending Zhang Xinxian as backup academic inheritors. Relying on the department of nephrology in Shuguang Hospital, a key discipline and specialty of National TCM Administration Bureau, the center will provide academic improvement and increase the level of preventing and treating diseases, especially for difficult and complicated diseases, a solution for the inheritance of TCM experience, a foundation for training TCM elites, improving clinical diagnosis and treatment, and establishing a clinical research platform.
Enhancing and promoting the characteristics and advantages of preventing and treating kidney diseases with TCM
Chronic kidney diseases are common and frequently encountered diseases. Passively treated, it will progress to end-stage renal disease and become life threatening. [1],[2],[3] Therefore, enhancing the preventive measures and medical investigation for chronic kidney diseases has long been a focus for Chinese and western medical practitioners, as well as local health administration departments.
To improve TCM clinical efficacy, we should insist on our characteristics and advantages in preventing and treating kidney diseases with TCM, focus on worldwide medical issues, and assure our main objective as treating kidney fibrosis, chronic renal failure accompanied with massive proteinuria, and chronic renal tubular and interstitial lesions. [4] Under the guidance of "inheritance, innovation, modernization, internationalization," we should also adopt traditional Chinese methods, modern technologies, and universally recognized standards, and with multidisciplinary cooperation, we may better prevent and treat common, critical and complicated diseases and explore innovations and applicative researches to serve for the healthcare of people. Also, we should improve the scientificity and strictness in scientific research and the standardization of management and follow principles of randomized, controlled, blind, and repetitive researches. The DME (design, measurement, and evaluation) requirements should be met to conduct clinical scientific experiments to ascertain the authenticity of the experimentation and promote the research standard of TCM. Also, we must promptly deal with the relation between inheritance and innovation; we should not only inherit the characteristics and advantages of TCM, but also actively import and make use of modern scientific and technological theories and methods. With multidisciplinary research, we must organically combine clinical with basic scientific research and TCM research to better reveal the mechanism, discover new phenomena and rules, hoping to provide our unique contribution in treating kidney fibrosis and delaying progress of early chronic kidney failure to promote the medical advancement of mankind and modernization of TCM.
To prevent early- to mid-stage chronic renal failure, chronic renal failure with massive proteinuria, IgA nephropathy, chronic renal tubular interstitial lesions, we must also maximize the advantage of holistic and personalized treatment of TCM, aim at enhancing treatment efficacy, continue in adopting universally-accepted outcome evaluation standard and advanced index to observe kidney fibrosis, as well as investigate new theories, programs and methods to increase the comprehensive capability of TCM in preventing and treating major disorders, and in promoting the academic development of TCM. [4] Further, we must boost national and international exchange and cooperation, publish high-quality papers on national and international core journals, and raise the impact of our specialty in academic circles, in order to lay a firm basis for the theory and concoctions of TCM treatment for nephropathy to go to the western world.
Standardizing the clinical research of preventing and treating kidney diseases with TCM and exploring new mechanisms for international cooperation
Efforts should be made in (1) basic scientific research and clinical efficacy in delaying advancement of early- to mid-stage chronic kidney failure, innovating the pathogenesis of chronic renal failure, and intensifying basic and clinical research on kidney fibrosis, in order to make new efforts for the foundation of treating kidney fibrosis with TCM; (2) making breakthrough in preventing and treating chronic renal failure with massive proteinuria; and (3) further promote the translational work on the regulation of phenotype transformation of bone marrow-originated myofibroblast by TCM, based upon novel model of kidney tubule interstitium, to increase treatment efficacy.
The current treatment for chronic renal insufficiency is featured with strengthening body resistance, such as strengthening the spleen and tonifying the kidney, invigorating the Qi and warming the Yang, or with eliminating evils, such as promoting blood circulation and removing blood stasis, clearing up heat and draining dampness, removing toxicity and clearing foulness, etc. We have observed that the patients are typically presented with reduced vitality and lingered evil, and blood stasis takes up a crucial role in the advancement of chronic renal failure, thereby inventing a concoction that both promotes vitality and circulation. In this concoction, Huang Qi invigorates Qi and consolidates superficies, induces diuresis and removes edema, which is sweet and warm in nature; Dan Shen invigorates Qi, replenishes and invigorates blood, which is slightly cold in nature; Tao Ren removes hemostasis and invigorates blood, which is neutral in nature; Niu Xi replenishes the kidney and invigorates blood, which is also neutral in nature; Processed Da Huang clears heat and dampness while invigorates blood, which is cold in naturel; Xian Ling Pi warms the kidney and boosts Yang, which is spicy, sweet and warm in nature. The entire concoction focuses on invigorating blood while it strengthens body resistance and also removes foulness, attacks and replenishes in the same time, and is both warm and cold in nature, which removes evils without harming the uprightness of the body, and replenishes without holding the evils. It is a perfect representation of the spirit of "Searching for the primary cause of disease in treatment" of TCM. [5],[6]
The method follows the principle of randomized clinical trial, encourages large sample, multi-center, perspective, randomized, double-blind and controlled clinical research, with adequate regulations in patient inclusion, classification and differentiation, treatment strategy, outcome evaluation and course observation. Chinese patent drugs (granules) are administered according to the signs and classification of the disease and can be adjusted accordingly. The clinical observation for proteinuria is about 2 months, which is rather difficult to observe the long-term outcome; therefore, the clinical research is required to last at least 6 months. A perspective angle can be adopted, which may be more convincing and significant for the publicity of such method.
In all, we should promote international academic exchange and cooperation, publish high standard papers on national and international core journals to increase the impact of treating kidney diseases with TCM in the society, and boost the development of academic, theoretical and pharmaceutical research, to establish a solid foundation.
| References | | |
| 1. | Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, et al. Prevalence of chronic kidney disease in China: A cross-sectional survey. Lancet 2012;379:815-22.  |
| 2. | Johnson DW, Jones GR, Mathew TH, Ludlow MJ, Chadban SJ, Usherwood T, et al. Chronic kidney disease and measurement of albuminuria or proteinuria: A position statement. Med J Aust 2012;197:224-5. |
| 3. | Phoon RK. Chronic kidney disease in the elderly-Assessment and management. Aust Fam Physician 2012;41:940-4. |
| 4. | Song Y, Wei S, Yu M. Chinese medicine treatment development of chronic glomerulonephritis proteinuria. J Liaoning Univ TCM 2008;10:46-8. |
| 5. | He L, Sun F. My opinion on the experience of the treatment of chronic nephritis through spleen from famous Shanghai-style doctor Shaobo Tong. Chin J Integr Tradit West Nephrol 2013;14:941-3. |
| 6. | Cheng J, He L. Study on clinical treatment of chronic nephritis by the thought "deficiency of yang affecting yin" from Shaobo Tong. Chin J Integr Tradit West Nephrol 2013; 14:1038-9. |
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