The “poison” of medicine is far from the harm of medicine (poison) – the realm of rational use of drugs Abstract: Drugs are designed to cure diseases, but they have two sides, both the efficacy of curing diseases, but also the side effects of causing diseases. Clinical use of drugs, must be reasonable use, the correct combination, not biased, the drug to the disease, the disease that is to stop, that is, the use of drugs “poison” meaning; avoid blind use and excessive use, pay attention to individual differences, always pay attention to the toxic side effects of drugs, really play its maximum therapeutic effect, do not make the toxic effect, that is, far from the meaning of drug harm. In the book “The Use of Medicine is Like the Use of Soldiers” written by Xu Da-chun in the Qing Dynasty, he used analogy to illustrate the use of medicine to attack diseases by setting up soldiers to remove violence, the way of using soldiers is analogous to the method of using medicine, and the use of soldier is compared to the use of medicine in a slow and urgent manner, arguing from the similarity of purpose, method and conditions that “the use of medicine is like the use of soldiers”. However, drugs have two sides that cure and cause disease, as a medical practitioner, we must promote their strengths and avoid their weaknesses. The “poison” of the drug is the cure, far from the harm of drugs do not cause disease! That is, to do just the right thing, “in the disease that stop. The original meaning of poison is poisonous grass, “Shuowen Jiezi”: “poison, thick also. The grass that harms people.” In ancient times, it was widely extended to mean poison, scourge, harm, suffering, etc. The Nei Jing says: “Medicine is also poison”. The “poison” here refers to the bias of the drug, the principle of the cure: that is, to correct the bias of the disease with the bias of the drug; not to “poisoning” also (drug harm). Drugs are designed to cure diseases, and taking drugs is a last resort. However, “medicine is three parts poison”, improper or long-term use of drugs will have many adverse reactions (i.e. drug harm), in addition to the general side effects, sometimes also cause serious toxic reactions, and even the possibility of inducing malignant tumors. For example, long-term use of drugs containing finasteride may cause liver and bladder cancer, and the risk of carcinogenesis is significantly increased if drugs containing paracetamol are taken for a long time [1]. “All drugs are toxic, only the dose determines that certain drugs are non-toxic.” [Paracelsus (1493-1541), a Renaissance Swiss pharmacologist and alchemist] such as cephalosporin (1st generation) nephropathy (cefradine causing acute sarcoid hematuria, acute interstitial nephritis, etc.), aminoglycoside nephropathy, NSAID and contrast nephropathy, CsA nephropathy, analgesic nephropathy, AA nephropathy [2], ACEI nephropathy [ 3], etc. “Yesterday the doctor cured my disease, today he took my life.” “Every time you give to someone, you are taking a risk.” The Zhoulić»Tianguan Tsukazai says: “The physician is in charge of the government of medicine and gathers poisons for the medical service.” The “Confucianism” refers to drug-induced diseases as “drug evil”, which stagnates the kidneys, depletes the qi and injures the essence, damages the kidney ligaments, and leads to abnormal kidney function. Zhang Jinyue said: “Poison is Chinese medicine. Medicine, that is, grass, wood, insects, fish, animals and so on, to be able to cure disease, are called poison. The increase in medically-derived diseases (the harm of medicine): liver and kidney damage, cardiac events, various adverse reactions, etc., should attract the great attention of the majority of medical workers. Therefore, the rational use of drugs, improve clinical efficacy, reduce toxic side effects, is the top priority in front of every medical workers. The Shennong Ben Cao Jing says: “The lower products are toxic and should not be taken for a long time”; Li Shizhen’s “Compendium of Materia Medica” classifies toxic Chinese medicines into four levels: major, toxic, minor and slightly toxic, of which 381 kinds of toxic Chinese medicines are introduced in a special section. The causes of drug harm include: confusion of varieties, misuse of poison, excessive dosage, improper preparation, improper dosage form, improper management, inaccurate identification, individual differences and excessive treatment brought by medical marketization. Clinical application of Chinese and Western medicines must be strictly in accordance with the drug instructions, strict drug dosage and treatment course, pay attention to individual differences, observe the reaction after the use of drugs at any time, encounter abnormalities, timely discontinuation of drugs and make the corresponding treatment. In the application of Chinese herbal medicines, the following aspects should be achieved in order to “use the poison of medicine, far from the harm of medicine”. 1 Reasonable application of Chinese herbal medicine combination to improve drug efficacy and reduce toxic side effects. 1.1 The combination of the two systems (killing each other, fearing each other): such as ginger with half summer, coriander with dates, etc. 1.2 Contrary to each other: for example, “Radix et Rhizoma Pseudostellariae with Rhubarb, Radix et Rhizoma Phellodendron, Radix Phellodendron with Rhubarb, etc., one cold, one hot, one yin, one yang, yin and yang, so that there is a function without bias” (Compendium of Materia Medica). 1.3 Matching: Combine two drugs with similar efficacy to achieve interaction and improve the therapeutic effect. For example, Chuan Wu with Cao Wu, Radix et Rhizoma Polygonati with Cinnamon, etc. 1.4 make a pairing: the performance and efficacy of the two drugs have some commonality of use, one drug as the main, one drug as a complement, the complementary drugs can enhance the efficacy of the main drug. 2 strict drug use contraindications, to avoid drug toxicity. 2.1 contraindications: weakness of the spleen and stomach, forbidden Gansui class steep down and water medicine, so as to avoid steep drainage injury Yin, injury Yang. 2.2 physical contraindications: “Suwen – five permanent political theory” said: “can be toxic to thick medicine, not win the poison to thin medicine.” Toxic Chinese medicines should be prohibited for the elderly and infants or used with caution after a reasonable combination. 2.3 Contraindications: For example, 10 of the 19 drugs in the list of “18 antibiotics and 19 dreads” are toxic drugs, so they should be used with special caution. 2.4 Pregnancy contraindication: large poisonous and toxic Chinese medicines are all contraindicated in pregnancy; small poisonous medicines should be used with caution, such as spotted cypress, croton and blood-activating and gas-breaking medicines should be used with caution; strychnine should not be used. 3 strict drug dosage, in the disease and not cause disease. 3.1 Toxic size to determine the dosage: such as the size of small large principle. “Ben Jing”: “If the use of poisonous drugs to treat disease, starting with a grain of corn, the disease to stop; not to go to double; not to go to ten, to take the degree.” The Suwen – the five permanent politics of the great said: “big poison cure, ten to its six; regular poison cure, ten to its seven; small poison cure, ten to its eight; no poison cure, ten to its nine; grain, meat, fruit and vegetables, food nourishment exhausted, not to make too much, hurt its right.” 3.2 Combination dosage to determine the dosage: the amount of the main drug is heavier than the auxiliary drugs, into the soup is heavier than the pill, the amount of single flavor is heavier than the amount of compound. 3.3 physical age to determine the dosage: the body is strong, toxic-resistant, drug-resistant, the dosage can be large; infants and children when prohibited or cautious use. 3.4 Disease severity to determine the dosage: light disease, light medicine, heavy disease, heavy medicine, overcome the enemy. 3.5 the same drug, the dosage is different, the efficacy is also different: for example, Chai Hu: 6g or less, has the function of lifting Yang Qi, 7-15g, it can de-stress the liver, 25g or more can clear heat and detoxification; peppermint with 3g, to de-stress the liver wood; with up to 15g, it disperses wind-heat, clear the head and eyes. Betel nut with 6~15g can eliminate stagnation, move Qi and promote water retention, while with 60~120g, it can kill ginger worms and tapeworms. Atractylodes macrocephala 10~20g, can strengthen the spleen and stop diarrhea, and 30~60g, can benefit Qi and relax the bowels. Weilingxian 10~20g, which favors dispelling wind-dampness and clearing meridians; 30~50g, which has a better effect of bile and decomposing uric acid. Similarly, in the clinical application of Chinese herbal medicines, there are numerous cases, which are very different from the use of Western medicines strictly according to the kilogram weight, and it is worth to summarize carefully. 4 Pay attention to the decoction method to reduce drug toxicity. 4.1 Toxic drugs should be decocted first: such as Chuanwu and other aconite should be decocted first, to the tip of the tongue to test the liquid is not numb. 4.2 Dosage method: most drugs should be taken after meals, with an interval of 1h between meals; but there are also taken before meals, such as ten jujube soup serving method, served on a flat day. Three equal parts of the three flavors for the end, each serving 0.5 ~ 1g, once a day, with 10 jujube decoction to send down, early in the morning after the downward profit, cereal porridge self-nourishment. For the treatment of acute diseases, the drugs are taken at any time; for anthelmintics, tapping drugs and other drugs for gastrointestinal diseases, it is advisable to take them before meals; for tranquilizers, it is advisable to take them 0.5~1h before bedtime, etc. As long as we consciously pay attention to the above principles of medication in the clinic, to achieve accurate identification, there are rules to follow, will be able to cure the patient’s pain in a timely manner, and will not bring unnecessary drug toxic side effects, that is, “the use of drugs of poison, far from the harm of drugs”, the real benefit to patients, there is no greater good!