As a clinician, you will encounter a challenge every day: many patients are in the dilemma of “multiple diseases”/”multiple coexisting diseases”/”multiple illnesses”. The dilemma of “multiple diseases”/”multiple illnesses” is very complicated in terms of diagnosis, treatment planning, and specific drug selection. The patient surnamed Zhang cited earlier, two years ago, now, three years and five years later or even ten years later, it can be said that these diseases will always exist, and there are more diseases such as kidney disease, coronary heart disease, cerebral infarction, cirrhosis of the liver, etc. will come one after another, each disease may require several kinds of drug treatment, and the interaction between different drugs is extremely complex and uncontrollable and unpredictable, what kind of Chinese and Western medicine should be given to such patients? What kind of treatment plan should be given to these patients? Undoubtedly, the different treatment options for these patients will definitely result in different prognosis. As a clinician, how to face this challenge, whether you are a Chinese or a Western doctor, a small doctor or a big specialist, is an important issue of practical clinical needs that cannot be avoided. When we open a hospital record, especially for middle-aged and elderly patients, including community health care and unit physical examination reports, many of them are in a state of “multi-morbidity/multi-morbidity/multi-morbidity”. In a study conducted in the Saguenay River region of Quebec, Canada, with 21 community hospitals participating, the prevalence of multimorbidity was 69% in the 18-44 age group, 93% in the 45-64 age group, and 98% in the 65+ age group; the number of chronic diseases was 2.8 in the younger group and rose to 6.4 in the older group. 2. Conceptually, the term “multiple diseases” refers to the “diseases” of Western medicine. However, it cannot be equated with “multiple organ failure”, which is often seen in the end stage of acute and critical illnesses or chronic serious illnesses, and the difference between the two is that the aim of the latter is to preserve life. Some of them do not require immediate medication, some of them are not treatable at all, and many of them require symptomatic medication. The choice of treatment plan, the priority of medication and drug overlap, the interaction between drugs, and the corresponding unpredictable adverse effects and high medical expenses are all unimaginable! In the face of “multi-morbidity/multi-disease coexistence/multi-morbidity”, most clinicians often give “biased” solutions, such as the patient surnamed Zhang cited in the introduction, the nationally renowned hepatologist is just standing in the usual thinking of chronic hepatitis drugs In fact, this patient has been told many times by Western hepatologists that “there is no medicine for your condition”. Indeed, most doctors can only consider the problem from the point of view of their own specialty, and the patient was already “at his wits’ end” after multiple recommendations from the appropriate specialists for several diseases! A May 2007 article in the Chinese edition of the British Medical Journal, “The multiple challenges of multimorbidity: the time has come – focusing on the needs of a growing vulnerable population,” focuses on this issue, suggesting that the adverse effects of multiple chronic disease states include Outcomes include reduced quality of life, mental depression, increased hospital days, longer hospital stays, increased post-operative complications, increased health care costs and increased mortality. Multiple disease states also affect the implementation of health care measures and may lead to more complex self-care needs, challenges to provider functions (e.g., accessibility, coordination, and consultation schedules), multiple medications, increased use of emergency facilities, difficulties in applying treatment guidelines, and discontinuous, expensive, and ineffective treatment. In this regard, I think the domestic situation is actually worse, because of the characteristics and status of the domestic medical level, medical market and medical system. 3. Faced with the challenge of “multiple diseases/multiple coexisting/multiple diseases”, there is no ready-made medical model available? Previously, most scientific studies and clinical practices were almost always based on single disease models, which are not suitable for patients with complex conditions and overlapping health problems. For example, randomized controlled trials (RCTs), the primary source of evidence for evidence-based medicine, inherently randomize study subjects, emphasize the efficacy of measure inputs, and exclude patients with multiple coexisting conditions to minimize bias, thus limiting the validity and rationality of their findings when applied to population extrapolation. Often, special attention has been paid to the complexity of a particular disease, from the onset etiology to the disease evolution process. For example, there are guidelines for many common diseases both at home and abroad, but the value of the guidelines for clinical guidance is far from satisfactory because of the considerable complexity of a single disease – for example, a hypertension, a diabetes has many drugs and many programs. Then, when clinicians are faced with “multiple diseases/multiple coexisting/multiple diseases”, it is undoubtedly even more complicated, so that few people have paid attention to this problem before. Since the development of “evidence-based medicine” has brought unlimited benefits to many patients around the world, it is obvious that every clinician, including myself, would benefit greatly if he or she could update and grasp some evidence of evidence-based medicine to guide his or her clinical medical decisions; “somatic theory In the past 20 to 30 years, the “body constitution theory” has emerged, initially with the most research by Professor Kuang Tongyuan in Shanghai, and more in-depth system by Professor Wang Qi in Beijing in the past decade or so, and continues to receive more scholars’ response, so far, the research results related to the body constitution theory have also begun to guide the clinical beneficial clinical. In the face of “multi-disease/ multi-disease coexistence/ multi-disease”, the existing “evidence-based medicine” and “somatic theory” appear to be “dull”. This is because the evidence of evidence-based medicine is mostly from large samples of single diseases; multiple diseases are a more complex malady than constitution; and the most emerging so-called “translational medicine” has no “match” with it. “. International research on “multimorbidity/multiple coexistence/multiple illnesses” is still in its infancy, but many studies have been conducted so far to investigate its epidemiological characteristics, its effects on somatic functioning, and its measurement methods. However, little research has been done on the impact of multimorbidity on the medical process and how to provide “optimal care” for these patients. Little attention has been paid to both Chinese and Western medicine! This is related to the limitations of previous scientific research ideas and methods. 4. How to deal with “multi-morbidity/multi-morbidity/multi-morbidity”? It is gratifying to note that as early as 2006.12, Professor Cheng Ungfu of Hunan University of Traditional Chinese Medicine published “On the treatment of multiple diseases” (Chinese Medicine Herald), in which Professor Cheng discussed the following aspects from the perspective of TCM: “(1) Chronic diseases and stroke diseases coexist, and stroke diseases are treated first, (2) light diseases and heavy diseases coexist, and (3) the treatment of stroke diseases is not limited. (2) the coexistence of light and serious diseases, treating serious diseases first, (3) cross-disease diagnosis and treatment, seeking common ground among differences, (4) treating diseases and treating people, taking a peaceful period. The general idea is that when multiple diseases coexist, the treatment should not be confined by the concept of “disease”, but should be weighed comprehensively, grasp the whole, distinguish the main and minor, and treat them flexibly, or even discard the disease from the evidence and treat across diseases. It is indeed a good article, saving me a lot of ink, but in clinical practice, and far more than that. It is important to know that the complexity, variability and individuality of “multiple diseases/coexistence of multiple diseases/multiple diseases” are far from being clear in a few words or a few research papers. In both Chinese and Western medicine, it is impossible for a patient to go to each doctor separately and have the patient make a choice when faced with the complexity of “multiple illnesses/multiple coexisting/multiple diseases”. In other words, the first thing a doctor needs to do is to be a knowledgeable doctor, preferably a general practitioner, but not a general practitioner with “all the tricks of the trade”. First of all, as a doctor, you need to know what stage of the patient’s disease is in. What is the condition and prognosis of each? What are the commonalities, individualities and significant or potential associations between these diseases in terms of pathogenesis? Which disease or diseases affect the patient’s long-term prognosis, which disease or diseases may have serious adverse events at any time or in the near future, and what is the likelihood of their occurrence? How can they be prevented? Does each disease have to be treated for life, and can medication refinement be maximized? What is the priority of medication use? Can one medicine treat multiple diseases or multiple diseases? Secondly, in terms of Chinese medicine, there are many elements to think about, and the ideas of Prof. Cheng in the previous section are available for reference, but there is one point that, based on the characteristics of the compound action of Chinese medicine, the holistic view of Chinese medicine, and the dynamically evolving idea of discriminatory treatment, it is actually possible to deal with such difficulties. The ideas of “the theory of symptoms”, “to guard the disease mechanism, each in its own way”, and “to dredge its blood and qi, so that it can be regulated and brought to peace” in the Huangdi Neijing are sufficient. Thirdly, as a doctor, it should be clear that Chinese and Western medicine have different advantages and shortcomings for different diseases and different stages of the same disease or different treatment goals, how to choose Chinese medicine and Western medicine flexibly, Western medicine still has medical and surgical interventions radiotherapy infusion oral difference, Chinese medicine still has the difference between the medicine soup acupuncture massage psychological comfort, and so on, such as, various means and methods, how can be properly applied to a specific patient When, indeed, the patient himself can not do, and not a specialist doctor can do well. 5. Prospects for research on “multiple diseases/coexistence of multiple diseases/multiple diseases” The current state of complexity of “multiple diseases/multiple diseases/multiple diseases” should be addressed in medical education, medical training (continuing education) and hospital management system in the future. We should pay attention to the curriculum of higher education in Chinese medicine and require students to learn not only Western medicine but also to use it well; for example, we can establish clinical research centers or consultation centers for multiple diseases in hospitals, or make it mandatory for Western medical specialists to attend “Western learning in Chinese” training, etc. This will definitely benefit more patients! In the future, if the medical profession can make this as the key research content of clinical medicine, it will be a good thing for the patients, an important initiative for the progress of medical science, and even more beneficial to the fundamental “purpose of medicine”. “The study of the purpose of medicine (GOM) has led to a philosophical understanding of the root causes of the global medical crisis and the right direction to solve it. The challenge of the complex state of “multimorbidity”/”multimorbidity” is also a fascinating state. I remember I said a few years ago that the future “medical sage” should be someone who can master both Chinese and Western medicine and can apply them flexibly to the extreme. In fact, now it seems that the “sage of medicine” should be someone who is able to deal with the highly complex medical science problem of “multiple diseases / multiple coexisting / multiple diseases”. So I remembered the late Professor Ye Rengao, a well-known nephrologist at home and abroad, who was the editor-in-chief of the textbook “Internal Medicine” in the fifth edition of Western medicine, as well as a family practitioner of traditional Chinese medicine with a deep knowledge of books. To this day, I still think: if there is a person like Professor Ye Rengao who has a good understanding of both Chinese and Western medicine, he can basically become a modern medical sage! 6. Taking the patient surnamed Zhang mentioned at the beginning as an example, among “cerebral infarction, hypertension, diabetes, chronic hepatitis C and glaucoma”, glaucoma does not need to be considered for treatment for the time being; diabetes and hypertension focus on lowering sugar and blood pressure to maintain long-term stability of blood sugar and blood pressure, and require lifelong medication to reduce the risk of cerebral infarction, coronary heart disease, kidney disease and other complications. In the case of hepatitis C, this case has lost the application of the international standard antiviral (long-acting interferon + ribavirin) program, and the patient is close to 70 years old has not yet developed to the evidence of liver fibrosis cirrhosis, so even if later transformed into cirrhosis decompensated stage, usually still It takes 10-20 years or even longer to transform into cirrhosis, so there is no need to overdose for this. Therefore, in general, the focus of Western medical treatment is on the prevention and treatment of hypertension and diabetes mellitus and their complications, but of course, in the subsequent course of the disease, it is necessary to adjust the program at any time according to the priority of each disease. In terms of TCM, the patient’s “multiple illnesses” occur in one person, and a holistic view and dynamic evolutionary mode of thinking is used to treat the patient according to the evidence. Combining the information from the four diagnoses, it is easy to determine that the patient is in a state of “mixed deficiency and reality”, and the core of the disease mechanism is “phlegm, dampness, stasis, heat and deficiency of both qi and yin”. Therefore, TCM treatment can be given to benefit Qi and nourish Yin, clear dampness, heat, stasis and toxicity, etc., and “make prescriptions according to the evidence” and “use medicine at any time”, so that several diseases and their related complications can be better prevented and treated. What’s not to like? If a hepatitis doctor only gives consistent decoction with pendula based on experience, if an endocrinologist only focuses on diabetes based on experience to benefit qi, nourish yin and clear dry heat, or if a cardiovascular doctor only focuses on hypertension based on experience to nourish the kidney, calm the liver and subdue yang, not only will it be difficult to get the best results for this disease, but other diseases will surely come one after another. These are the inertia of the specialist’s thinking on the treatment of the disease! As far as the patient is concerned, the above treatment of Western medicine cannot be replaced by Chinese medicine, and the treatment of Chinese medicine cannot be replaced by Western medicine, which cannot be called the combination of Chinese and Western medicine, but as two medical tools, from different sides to solve or respond to the same patient’s actual healing needs, as far as reality is concerned, are indispensable!