Medical herbal therapy preparations

Medical herbal therapy preparations refer to regular preparations that use traditional herbal medicinal resources as raw materials, follow modern pharmaceutical technology, and obtain national drug approval qualifications through the approval of the national drug regulatory department. They are used for clinical prevention and treatment of diseases. They are neither a "miracle drug" that can cure all diseases, nor a "magic drug" that can cure all diseases. The worthless "placebo" currently has clear clinical benefits in the fields of dermatology, respiratory medicine, chronic disease conditioning and other fields. At the same time, there are also practical controversies about the difficulty of quality control of compound ingredients and insufficient evidence-based evidence for some categories. Clinical use must strictly follow the indications and medication specifications.

Two years ago, when I was stationed at the Traditional Chinese Medicine Department of a certain county in the west, I came across two cases that left a particularly deep impression on me, which clearly highlighted the advantages and existing pitfalls of this type of preparation. The first one is a 62-year-old chronic bronchitis patient who coughs for two to three months every autumn and winter. He used to use theophylline drugs and always felt nervous and his hands were shaking. Later, he was prescribed the approved medical herbal aerosol preparation with a modified version of Maxing Shigan Decoction. After using it for a week, the frequency of coughing was reduced by half, and the side effects of panic did not appear. The old man came to open two boxes in advance every winter to prepare. The other is a 28-year-old girl. She bought a so-called "medical herbal acne cream" in an online live broadcast room. After using it for more than half a month, her face was swollen like a steamed bun. When she came to the doctor, she checked and found that the product did not have the national drug approval at all. It was just an ordinary cosmetic with a large amount of glucocorticoids secretly added. The so-called "herbal" was purely a marketing gimmick.

Many people's misunderstandings about medical herbal preparations are actually caused by these mixed products. The industry's attitude toward such preparations has always been divided, and there is no unified approach at all.

Friends who engage in evidence-based pharmacy always complain to me, saying that many compound herbal preparations still have no clear quantitative standards for active ingredients, and it is difficult to ensure the consistency of ingredients between each batch, let alone complete adverse reaction monitoring data. The Guanmutong incident in the early years is a lesson. People used it on a large scale without knowing the ingredients, and finally cheated many people. This is indeed not a nitpick. When I was compiling clinical data a few years ago, I also found that many herbal preparations that have been on the market for more than ten years have no large-sample multi-center randomized double-blind controlled trial data. There are a lot of "adverse reactions are not yet clear" in the instructions. This is the core reason why many Western medicine colleagues dare not prescribe them casually.

But when I turned to an old pharmacist who has been working in traditional Chinese medicine preparations for a lifetime, they also had something to say: "We have used classic prescriptions for thousands of years. Originally, multiple ingredients work together. If you take the standard of a single chemical drug and require that the effect of each ingredient be isolated and verified, it does not conform to the logic of herbal compound formulas. Just like if you drink millet porridge to nourish your stomach, you can't ask for separate clinical trials on the effects of each polysaccharide and amino acid, right?" ”Last year, I followed their team to conduct a clinical observation of a topical herbal burn preparation. It was found that the healing speed of superficial second-degree burns was indeed faster than that of silver sulfadiazine alone, and the probability of scarring was also lower. It cannot be said that the improvement of hundreds of follow-up patients was due to psychological effects, right?

Nowadays, more people in the industry are taking a middle-of-the-road approach, neither sticking to traditional experience and rejecting quality control, nor beating them to death with a single standard. For example, the fingerprint quality control technology for herbal preparations currently promoted by many companies does not require each ingredient to be purified and sequenced separately, but it can ensure that the "fingerprint" of each batch of ingredients is consistent, which not only retains the synergy of the compound, but also solves the problem of large batch differences. Compound Danshen Dropping Pills and Kanglaite Injection, which are commonly used in clinical practice, have passed FDA Phase II clinical trials or have clear large-scale evidence-based evidence, and their effects and safety can stand the test.

To be honest, it is really simple for ordinary people to distinguish between regular medical herbal preparations and messy marketing products. They just need to look at whether there is a Z mark on the package. If not, don’t believe it no matter how hyped it is. Especially the "ancestral secret recipe" and "pure herbal without side effects" that are passed down in the circle of friends are most likely to be illegal products with Western medicine ingredients added. Last month, I met a parent who used a so-called "herbal antipyretic patch" on his child. As a result, his child developed a large rash due to skin allergies. That antipyretic patch is not even qualified as a medical device and is just an ordinary daily necessities.

In fact, this field is still maturing, and controversy is a good thing. Whether it is a skeptic who insists on quality control issues or a supporter who speaks based on clinical experience, the ultimate goal is to allow patients to use safer and more effective drugs. After all, for doctors and patients, the origin of the medicine is not important. If it can solve problems and does not hurt people, it is a good thing.