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基于病证结合的经典中药方剂上市后评价要点

[Key points of post-marketing evaluation of classic traditional Chinese medicine prescriptions based on combination of disease and syndrome].

作者信息

Wang Xin-Lu, Zhu Ming-Jun, Wang Jian-Ru, Li Bin, Yu Rui, Peng Guang-Cao, Zhao Qi-Fei, Wang Yong-Xia

机构信息

the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2021 Apr;46(8):2004-2009. doi: 10.19540/j.cnki.cjcmm.20210213.502.

Abstract

Classic prescriptions, hospital preparations and famous traditional Chinese medicine(TCM) experience prescriptions are the main sources of new drug development and innovation. The multi-components and multi-targets treatment characteristics of TCM are advantages, but at the same time, broad indications, unclear clinical positioning and lack of evidence-based evidence support are the key problems affecting the play of TCM efficacy and restricting its promotion and application. The hot in recent research was to how to break through the bottleneck, precise clinical positioning, highlight the advantages of the classic TCM prescriptions, and complete the transformation from clinical practice, clinical research to clinical evidence, but at the same time, it is also the difficulty. The clinical research model of the combination of disease and syndrome can fully reflect the ancient medical case evidence of classic TCM prescriptions, the historical experience of human used and the characteristics of syndrome differentiation and treatment, and highlight the advantages of Chinese medicine. At the same time, under the modern disease classification system and research mode, is conducive to established the standardized clinical evidence report and evaluation system, is conducive to promote the integration of clinical research evidence, and avoids excessive attenuation of information. Based on the previous work of our team, the intention of this study was to make a comment about the key points of the post-marketing evaluation of the classic TCM prescriptions under the combination of disease and syndrome and includes key points:(1)With the syndrome as the carrier, connected with the classical prescription and clinical diseases, focused on the clinical positioning on macroscopically.(2)The combination of syndrome visualization, standardization and pharmacological molecular basis, focus on clinical precise positioning in microscopic.(3)Innovating therapeutic effect evaluation methods, reflecting the curative effect characteristics based on syndrome differentiation.(4)The combination of "randomized controlled evidence-based studies" and "real world evidence-based evaluation", focusing on clinical advantages, fully evidence-based evidence.(5)Make full use of clinical registration studies and pay attention to safety.

摘要

经典方剂、医院制剂和著名中医经验方是新药研发与创新的主要来源。中医多成分、多靶点的治疗特点是优势,但同时,适应证宽泛、临床定位不明确以及缺乏循证医学证据支持是影响中医疗效发挥、制约其推广应用的关键问题。近年来研究的热点在于如何突破瓶颈,精准临床定位,突出经典中医方剂优势,完成从临床实践、临床研究到临床证据的转化,但这同时也是难点。病证结合的临床研究模式能够充分体现经典中医方剂的古代医案证据、人类用药历史经验及辨证论治特点,突出中医优势。同时,在现代疾病分类体系和研究模式下,有利于建立规范的临床证据报告与评价体系,有利于促进临床研究证据的整合,避免信息过度衰减。基于本团队前期工作,本研究旨在对病证结合模式下经典中医方剂上市后评价的要点进行阐述,要点包括:(1)以证为载体,连接经典方剂与临床疾病,宏观上聚焦临床定位;(2)证的可视化、规范化与药理分子基础相结合,微观上聚焦临床精准定位;(3)创新疗效评价方法,体现基于辨证的疗效特点;(4)“随机对照循证研究”与“真实世界循证评价”相结合,聚焦临床优势,充分循证;(5)充分利用临床注册研究并关注安全性。

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