Many patients who have been sick for a long time and cannot get rid of their illnesses and have taken all the medications but cannot get well, are ruthless enough to pay more for the registration fee to find a doctor who has the best skills to get out of their misery. But after listening to the patient’s rambling statements, carefully analyzing the patient’s test results and reviewing the patient’s records, we found that the diagnosis was correct, the medication was good, but the treatment was not effective. What was the problem? So ask the patient how to take the medication, a question dawned on me, ask the patient to bring out the drugs prescribed by the doctor for many times (often a large bag), pick out a few, instructed to need so and so, the new drugs will not be prescribed. Patients are often skeptical and leave with disappointment, thinking that they have come across a charlatan and are not getting a good deal. But two weeks later, they came rushing to say they had met a miracle doctor, and once their 100-day troubles had disappeared, they thanked him profusely, making the doctor laugh and cry. So where is the mystery? It is in the combination of drugs and the time and method of taking them. Here are a few common examples, the patient may be enlightened by reading. Aluminum thioglycollate preparations (Shukojie, Sukefi, etc.) and acid-suppressing drugs (cimetidine, ranitidine, famotidine, omeprazole, pantoprazole, etc.) used in combination This is a common combination for the treatment of gastric diseases. Aluminum thioglycollate must be dissociated into negatively charged sucrose sulfate in an acidic environment to form a colloid to cover the surface of gastric mucosa for protection. Bismuth potassium citrate preparations (Lizudra, bismuth gum, etc.) are used in combination with acid-suppressing drugs. This drug does not neutralize gastric acid nor inhibit it, but forms a solid bismuth oxide colloid precipitate covering the ulcer surface in the acidic ph environment of gastric juice, which protects the ulcer surface from the attack of gastric acid and digestive enzymes. Therefore, acid suppressants should not be taken within 1 hour before taking this drug. Milk should also not be consumed while taking bismuth citrate potassium preparations, as it also prevents the formation of a protective layer of gastric mucosa. Gastrofacial and anticholinergics (belladonna, probenecid, emmenagogue, etc.) Gastrofacial is often used to control emesis and enhance gastric emptying. The pharmacological effect of anticholinergics is to slow down gastrointestinal motility. The two are opposite in action and it is not reasonable to use them in patients with vomiting and diarrhea at the same time. Pepsin and antacids are used together. Patients with gastritis often suffer from indigestion and sometimes need pepsin-containing drugs to help digestion. Pepsin needs to be activated by gastric acid in order to have a digestive effect, but patients often use drugs that neutralize or inhibit gastric acid secretion at the same time, which prevents pepsin from playing a therapeutic role. Sometimes the combination of some acidic drugs or food effect when better. Pancreatic enzymes and acidic drugs used together Chronic gastritis, chronic pancreatitis, cholecystitis, cholecystectomy, chronic liver disease patients often have indigestion, pancreatic enzyme preparations, such as the DEVITON is very helpful, but pancreatic enzymes have a characteristic, in an alkaline environment to maintain activity, so pancreatic enzyme preparations are packed in enteric capsules to prevent swallowing after the stomach is destroyed by gastric acid, so take this drug must not bite through the capsule or open the capsule to take. Some patients think that drinking some vinegar or taking vitamin C at the same time will help digestion, which is a misconception. The combination of gastrointestinal motility drugs and acid suppressants for reflux esophagitis is now a standard treatment. However, if these two drugs are used together, the time between doses must be 1 hour, because studies have shown that gastrofacial can reduce the biological efficiency of cimetidine by 20%-30%. Anticholinergics and ranitidine together Anticholinergics such as probenecid, atropine and belladonna are very effective for gastrointestinal spasm pain, but they will slow down the absorption of ranitidine and reduce its effectiveness, so the two drugs should be used together with an interval of more than 1 hour.