The use of modern test indicators in TCM clinical practice?

  Rapid, digital, networked and standardized is the trend of modernization of laboratory medicine. Each test indicator is the result of the development of modern society. Although Chinese and Western medicine belong to two different medical systems, their purposes are the same? The same, complementary to each other. Western medicine uses test indicators to identify diseases, and modern Chinese medicine does the same. Objective indicators recorded by various modern techniques are the main content and means of microscopic research, and are also one of the main symbols of modern TCM clinical research.  1. Test indicators promote the innovation of TCM theories TCM theories are subject to continuous development. The innovation of the theory of TCM disease mechanism and treatment is especially important for the development of TCM clinical and the improvement of therapeutic efficacy. Modern medical research on disease pathological mechanisms and the development of relevant test indicators can inspire us to conduct innovative discussions on the theory of TCM disease mechanisms and treatment rules, which in turn can guide the innovation of TCM treatment methods and promote the improvement of clinical efficacy.  Atherosclerosis (AS) is a chronic disease with complex pathological mechanisms, and its pathogenesis has been studied for nearly a century. After the development of the lipid infiltration theory, thrombosis theory and damage response theory, the inflammatory hypothesis of atherosclerosis proposed by Ross in 1999 has gradually become the mainstream theory of current research, which believes that the inflammatory response runs through the whole process of atherosclerosis, especially the central link of plaque instability to rupture [1]. In related studies, inflammatory indicators such as C-reactive protein (CRP) and tumor necrosis factor alpha (TNFα) have received high attention, and in January 2003 the American Heart Association and the Centers for Disease Control recommended hs-CRP as a secondary clinical test for cardiovascular disease (level of evidence B) [2]. In addition there are pathological factors in the blood such as LDL, glucose, homocysteine and pathogenic microbial stimuli, which act on the intima to cause structural and functional changes in the vascular endothelium, followed by lipid deposition, platelet activation aggregation and thrombosis, inducing the production of a large number of inflammatory factors and promoting inflammatory cell activation, resulting in a chronic reparative inflammatory response in the intima; and inflammation is in turn an inducer of AS a major cause of plaque instability and plaque rupture. Plaque rupture, which stimulates thrombosis and blockage of the arterial lumen, can lead to the occurrence of serious clinical cardiovascular and cerebrovascular events such as acute coronary syndrome (ACS) [3].  Based on the above understanding, from the basic theory of TCM, combined with new advances in modern medicine, the abnormally elevated inflammatory indexes are closely related to the theory of pathogenesis of toxic evil in TCM, and the cardiovascular center led by academician Chen Keji has clearly proposed for the first time the etiology of cardiovascular thrombotic diseases “stasis and toxicity” and “stasis and toxicity cause changes “It is believed that blood stasis is the central link in the development of coronary artery disease and the basic pathological state of stable patients. If stasis turns into heat for a long time, breeding toxic evil, or from transformation into poison, it can lead to internal accumulation of stasis and poison, if it is prolonged for a long time and mismanaged, the positive and negative evil will grow, once the external cause is triggered and the accumulated poison suddenly develops, it will erode the muscle and injure the flesh, and then the poison and stasis will wrestle with the knot, paralyze the heart arteries, leading to sudden changes in the condition and the emergence of unstable angina pectoris, acute myocardial infarction, sudden cardiac death and other acute and critical diseases, which is the main etiology of acute cardiovascular events in stable coronary heart disease and The key pathological mechanism of the transition. It provides new ideas for the early identification and prevention of acute cardiovascular events. In this study, inflammatory indicators such as hs-CRP and TNF-α played a key role and could not be replaced by other indicators.  2, test indicators help modern Chinese medicine to recognize diseases Modern test indicators have reached the scope of Chinese medicine itself to recognize diseases. Many clinicians have started to use physical and chemical indices as an important basis for diagnosis and treatment in TCM, and try to combine the data from modern scientific tests into TCM treatment, combining the test indices with traditional diagnosis in TCM, gradually forming two systems of morphological diagnosis and microscopic diagnosis in TCM, which has largely enriched the content of the four diagnoses in TCM and promoted the development of TCM.  Taking blood stasis as an example, previous studies have confirmed the value of blood viscosity, microcirculatory disorders, thromboxane and prostacyclin indicators [5]. Recent studies have also confirmed the presence of platelet activation in patients with blood stasis in various diseases. Platelet activation is one of the receptor-mediated responses of resting platelets to various stimuli and is manifested by significant changes in platelet membrane glycoproteins, which are abundantly expressed on the platelet membrane and become specific molecular markers of platelet activation. Platelet membrane glycoproteins play a key role in platelet adhesion, aggregation and release responses. The study of blood stasis evidence has now advanced to the cellular and molecular levels, and platelet activation molecules have been measured in patients with blood stasis evidence from a variety of diseases, with α-granule membrane protein 140 (GMP-140, CD62P) and lysosomal membrane protein (LIMP,CD63) predominating. The results of a comparative study between the same diseases, such as type 2 diabetes, hypertension, coronary heart disease, psoriasis and lung cancer, showed that both the plasma GMP-140 content and the expression of platelet CD62P and CD63 were significantly higher in patients with blood stasis evidence than in patients without blood stasis evidence, and there was no significant difference between different diseases, suggesting that the measurement of activated platelet membrane glycoprotein can be used as one of the microscopic This suggests that activated platelet membrane glycoprotein measurement can be used as one of the microscopic indicators of blood stasis [6].  Since the hypothesis of “endothelial damage reaction” was proposed, the study of vascular endothelial function has become a hot topic in the field of blood stasis. Currently, studies on blood stasis and vascular endothelial function have focused on the increase or decrease of active factors secreted by endothelial cells in patients with blood stasis in order to reveal the pathophysiological basis for the occurrence of blood stasis. It was found that vasoactive substances such as nitric oxide (NO), endothelin (ET), angiotensin II (Ang II), soluble intercellular adhesion molecule (slCAM-1) and soluble vascular cell adhesion molecule (sVCAM-1) produced by vascular endothelial cells were significantly higher in patients with blood stasis, compared with those without blood stasis [7]. It is suggested that the abnormal secretion function of vascular endothelial cells may be one of the pathological bases for the development of blood stasis evidence.  Inflammatory reaction is another hot spot in the current research of blood stasis evidence, and inflammation in modern medicine refers to the process of tissue cells undergoing different degrees of morphological and structural damage, congestion, swelling, exudation, degeneration, vascular destruction necrosis or proliferation embolism, local ischemia, hypoxia accompanied by metabolic function changes, circulatory disorders, and blood flow variability. In recent years, numerous experimental studies have found that many of the above processes are closely related to blood stasis evidence. Inflammatory factors such as C-reactive protein, serum interleukin-6, tumor necrosis factor, and adhesion molecules have been shown to be significantly elevated in patients with blood stasis evidence in both clinical and experimental studies [8], suggesting that the inflammatory response reveals the essence of blood stasis evidence from one side.  This shows that test indicators play an important role in promoting the study of the essence of blood stasis evidence.  3, test indicators guide the treatment and medication of Chinese medicine “treating the untreated” is an important treatment concept of Chinese medicine. It contains three meanings: first, to prevent the occurrence of diseases, second, to treat early and prevent changes, and third, to grasp the direction of disease development to prevent transmission. The key premise of treating the disease is to be able to identify people at risk before the onset of the disease, to detect the signs of deterioration when the disease is mild or superficial, and to anticipate the trajectory of its development when the disease is still relatively simple. In this way, we can take timely and targeted preventive interventions in TCM. Traditional Chinese medicine is based on symptoms and signs as the basis for diagnosis, but the best time for treatment is already missed when symptoms appear in most diseases, and most of these diseases have undergone changes in physiological indicators before the appearance of symptoms and signs. Laboratory medicine can detect the changes of these objective indicators and appropriately identify the people or patients who need preventive interventions, which provides a bigger stage for Chinese medicine to play its role and make it effective as early as possible.  The majority of chronic hepatitis B virus infections in China are due to vertical transmission from mother to child or infection in early childhood, and the basic pathogenesis pattern is immune tolerance period → immune clearance period → immune stability period → immune clearance period again. Most of the patients in the immune tolerance and immune stability phases have no obvious symptoms and signs, and their liver functions are normal, but the tests show positive hepatitis B E antigen and high replication of HBV-DNA, and the pathology suggests that the inflammation and fibrosis are not severe. It has been found that TCM interventions based on the abnormalities of the test indexes, right before the onset of hepatitis B in the immune tolerance and immune stabilization phases, can reduce the chances of patients developing decompensated liver disease, prolong their survival and improve the quality of survival [9].  Hyperlipidemia is the name of a modern medical condition. Hyperlipidemia is formed whenever the dysfunction of internal organs due to various reasons causes abnormalities in the body’s lipid metabolism, resulting in higher than normal plasma cholesterol, triglycerides, and low-density lipoprotein components. The damage of hyperlipidemia to the body is insidious, gradual, progressive and systemic, and its direct damage is to accelerate systemic atherosclerosis, which is also a risk factor for stroke, coronary heart disease, myocardial infarction and sudden cardiogenic death. However, most of the early hyperlipidemia has no clinical symptoms, and there is often no evidence to identify the situation, and the treatment can only be guided by the abnormalities of test indicators. Currently, the clinical use of mulberry, cassia, poria, zedoary, atractylodes, salvia, raw hawthorn, and lotus leaf is mostly added to reduce lipids [10].  In the early stage of chronic kidney disease, due to the improvement of detection rate and early treatment of the primary disease, most patients do not have typical symptoms such as obvious edema, lumbago, and weakness. In this stage, although there are no typical symptoms, the pathogenesis is single. Studies have shown that targeted early intervention treatment with blood activation and treatment of blood stasis can achieve good results according to the abnormal changes of test indexes [11].  This shows that the test indexes are of great help to the development of TCM clinical practice and to improve the targeting of TCM medicine.  4, test indicators to evaluate the clinical treatment effect of Chinese medicine Evaluation of clinical treatment effect can be divided into three levels. The first level is the diagnosis by virtue of subjective consciousness, which also includes the patient’s self-perception. This is the original method of clinical efficacy evaluation, and traditional Chinese medicine practitioners are mainly limited to such a level when evaluating diseases due to the limitations of diagnostic conditions. The second level is the physical signs, which mainly include the clinical diagnosis seen by the doctor. The changes in signs are more objective and repeatable than subjective diagnosis. The third level is the modern physical and chemical indicators, that is, the physical, chemical, biochemical phenomena reflected by the physical and chemical indicators, which are more objective and repeatable.  For example, in patients with viral hepatitis and liver fibrosis caused by hepatitis B, C and excessive alcohol consumption, liver function will recover significantly after a certain period of TCM treatment, and the changes in liver serum enzyme profile, protein metabolism and liver fibrosis indexes at this time are objective evidence of the obvious efficacy of TCM. For example, Western medicine treats autoimmune disease SLE with hormones and immunosuppressants, but the prognosis is not good. Chinese medicine believes that the disease mechanism is mainly liver and kidney yin deficiency, with heat toxicity and blood stasis as the symptoms, so the treatment principle is to nourish liver and kidney yin, clear heat and detoxify and activate blood stasis, which often has good efficacy, and the detection of blood sedimentation, complement C3 and antinuclear antibody is a convincing evaluation basis and objective index [12]. In the treatment of metabolic syndrome, after a certain period of TCM treatment, the patients’ blood glucose and lipid levels decreased significantly, which objectively reflects the effect of TCM clinical treatment.  In summary, test indicators often provide important biochemical, immunological, hematological and other physiological and pathological objective diagnostic bases, and even play a decisive role in the diagnosis of some infectious diseases. The proper and rational application of test indicators can help the innovation of the theory of TCM disease mechanism and treatment rules, and play a key role in the microscopic diagnosis of TCM, the evaluation of clinical efficacy of TCM, and the exploration of mechanisms, and can also be an important reference for the clinical selection of drugs, the selection of measures for “treating the untreated disease” and the prognosis of patients. Therefore, only when traditional Chinese medicine treatment methods and modern laboratory medicine are well integrated, it will be more beneficial to the diagnosis and treatment of the disease.