? Administration route and opportunity of traditional Chinese medicine

The route of administration is the way to introduce drugs into human body. The overall selection goal is to facilitate collaborative detoxification. Traditional administration methods of traditional Chinese medicine include oral administration and skin administration, as well as inhalation, sublingual administration, rectal administration, nasal administration and * * * administration. After 1930s, the routes of administration of traditional Chinese medicine increased from subcutaneous injection, intramuscular injection, acupoint injection and intravenous injection, and the order of absorption rate from low to high was: skin administration, mucosal surface administration, rectal administration, oral administration, sublingual administration, subcutaneous injection, intramuscular injection, inhalation administration and intravenous administration.

Oral administration: simple and safe, without the help of special instruments and medical personnel, the preparation of drugs is simpler than injection, and it has always been the main route of administration of traditional Chinese medicine. However, the absorption of oral drugs is slow and irregular, so comatose patients can't take it actively, and it is difficult for children to cooperate. Some drugs have * * * effects on the stomach, and their application is also limited.

Skin drug delivery: In addition to the treatment according to the focus, predecessors also advocated distinguishing between meridians and acupoints, painting, sticking, moxibustion and ironing. For example, foot rubbing can induce diseases and reduce fire, and can be used to treat aphtha, nosebleeds and headaches. Sudden fontanel, in order to treat children's cold and convulsion; Apply navel to dredge collaterals, treat constipation and edema, or warm and tonify deficiency and cold. Modern research holds that drugs for local skin diseases should be directly applied to the affected area, and drugs for visceral or systemic diseases should be administered through the skin and used behind the ear, navel and acupoints. The least sebum in human body is behind the ear, and the drug exudation rate is the fastest; The most sebum is the thigh, and the drug diffusion resistance is the biggest; Umbilical skin is directly connected with fascia and peritoneum. There are abdominal arteries and veins on both sides of the navel, and there is a rich capillary network, through which the anterior branch of the tenth intercostal nerve passes. The arterial wall of umbilical region also has a special structure, and the barrier function of umbilical region is the weakest and the sensitivity is high, so the drugs in umbilical region can easily penetrate the skin and enter the abdomen to achieve the therapeutic effect of diseases. The absorbed drugs rarely pass through the liver, which is better than oral administration to some extent.

Acupoint administration: Through the * * * effect of drugs on acupoints, it has a special therapeutic effect similar to acupuncture on visceral or systemic diseases.

Mucosal surface administration: covering a wide range, including digestive tract, respiratory tract and body cavity administration, such as administration from conjunctiva, nasal cavity, mouth, throat and urethra, especially nasal cavity administration, can not only treat local diseases of nasal cavity, but also treat diseases of sinus, throat, mouth, ear, eye and whole body. * * * Administration mainly produces a local effect, but when the mucosa is damaged, the drug is easily absorbed, faster and more effective. When using toxic drugs, we should prevent absorption poisoning.

Intrarectal administration: in ancient times, it was limited in application, mainly using honey, pig bile, sweet potato root and so on to guide stool. Modern applications have been expanded, such as reducing fever by rectal perfusion and treating acute renal failure, and the curative effect is better than oral administration.

Sublingual administration: Sublingual administration is a special form of mucosal surface administration. Because of the abundant sublingual blood vessels, drugs can be quickly absorbed by oral mucosa to play a role, and drugs can be prevented from being destroyed by liver and gastrointestinal digestive juice. Therefore, since Zhang Zhongjing's creation, it has been used in the Eastern Han Dynasty, but sublingual administration is only suitable for a few drugs that can be absorbed by oral mucosa.

Inhalation administration: mainly smoke inhalation, but also aromatic drugs can be decocted and smoked, or sachets and sachets can be worn, and aerosol is used in modern development. Such as Datura flower. By lighting tobacco and inhaling the gas of aromatic drugs, asthma can be prevented and sinus headaches or colds and nasal congestion can be treated.

Administration by injection: Traditional Chinese medicine was made into injection in the early 1940s, with a short history, but its application gradually increased. There are several methods, that is, subcutaneous injection, in which the liquid medicine is injected into the soft tissue between the dermis and the muscle, and the site is selected on the outer side of the upper arm, so the pain is more obvious; Intramuscular injection is to inject liquid medicine into muscle tissue, which is widely used; Acupoint injection is a special intramuscular injection, which produces special effects on specific acupoints through drugs; Intravenous injection is the direct injection of drugs into venous blood vessels without absorption. In order to make drugs slowly enter the blood stream and maintain the concentration of drugs in the blood for a long time, intravenous drip can be used.

Take medicine regularly

Timing drug use is an important content of TCM chronopharmacology research. It is required to distinguish zang-fu organs according to the four-season alternation, yin-yang change and rhythm change put forward by classic works such as Huangdi Neijing and Shennong Materia Medica Classic, to clarify the primary and secondary relationship between time and symptoms according to the development and change of illness, to master the principle of correlation and complementarity between time and symptoms, and to make the use of drugs synchronized and coordinated with human rhythm as far as possible. Referring to the experience of the ancients and their neighbors, as well as the textual research of related materials, there are roughly the following requirements:

According to the legislation of drug use according to the law of four seasons: that is, "the combination of human body is dominated by four seasons and five elements." In other words, there are four seasons in a year, and the legislation on drug scheduling should also be different. First of all, "heat does not cause heat, and cold does not cause cold." Generally, hot medicine is not needed in spring and summer, and cold medicine is not needed in autumn and winter. When necessary, anti-adjuvant drugs or cold and hot medicine should be used in combination. Secondly, we should follow the principle of "spring spits summer sweat, autumn falls and winter supplements" according to the rhythm of the four seasons' qi movement. Third, we should use the seasonal laws of the five internal organs to determine the treatment principles, such as soothing the liver and strengthening the spleen in spring, suppressing fire and consolidating gold in summer, nourishing the liver and qi in autumn, and nourishing the heart and qi with salt in winter, without cutting the sky and overstepping the limit; Fourth, to master the requirements of seasonal drugs and seasonal banned drugs, we should not only mix seasonal drugs according to different seasons to adapt to the climatic characteristics of the four seasons, but also understand some drugs that are forbidden to be mixed in different climates in the four seasons, such as "no white tiger in winter and no green dragon in summer". Even if you use the same prescription, you should add or subtract at any time.

Legislation of medication according to monthly rhythm: The monthly rhythm of human body can be divided into endogenous rhythm and exogenous rhythm. First of all, drugs should be treated in stages according to endogenous rhythm. For example, the menstrual cycle can be divided into four stages: menstrual period, late menstrual period, inter-menstrual period and premenstrual period. During menstruation, clearing the heart and removing blood stasis is the main method, tonifying the kidney and strengthening the body resistance in the later period, invigorating the spleen and eliminating dampness in the intermission period, and soothing the liver and regulating qi before menstruation. Secondly, according to the exogenous rhythm, that is, periodic change and monthly profit and loss to choose the party. For example, in the treatment of gynecological diseases, it was suggested: "Collaterals regulate menstruation, mainly warming up;" Looking at the moon and removing blood stasis, regulating qi and removing blood stasis are the methods; The safety of the lower chord is the most important; The new belt stops the downward movement, eliminates dampness, strengthens the spleen and tonifies the kidney. "

According to the circadian rhythm medication legislation: that is, the best time to take medicine in a day should be considered, which can be summarized as the following nine aspects:

Take the medicine before noon in the morning. Because "from Pingdan to Japan, the sun is in the sky, and the sun in the sun is also ... the weather is rising, and the popularity is also rising ... so it is better to live early than at night. In this regard, doctors in past dynasties have many practices. For example, the antimalarial prescriptions, such as Changshan Decoction and Qibao Decoction, contained in Dong Yi Bao Jian all emphasize the use of drugs before noon to stop vomiting, although their indications are different.

Drugs for relieving exterior syndrome and sweating should be taken before noon. Wang of Yuan Dynasty said in Hard to Know that when Chinese medicine perspires, the time should be before noon. Li's Treatise on Febrile Diseases, such as Mahuang Decoction, Guizhi Decoction, Jiuwei Notopterygium Decoction, Gegen Decoction, etc. It is recommended to sweat before noon, but not in the afternoon. This applies not only to antiperspirants, but also to drugs that show appearance and reveal evil. "The reason is that the use of exterior-relieving drugs or exterior-removing drugs at this time can conform to the rising and falling state of yang, which is conducive to the turning point of drug efficacy and the recovery of diseases.

Diarrhea drugs should be taken in the afternoon and evening. Some people have made textual research on the works such as "Standard of Syndrome Differentiation and Treatment", and found that a large number of newly recorded medical records all pointed out that when using the purgative method, it should be taken in the afternoon and evening according to the theory of "declining popularity". Article 198 of Treatise on Febrile Diseases says: "Yangming disease, if you want to solve it, you should start from God to E". Zhang's Shuidao Pills, Powder, Tongjing Powder, Pills and other pills are all marked as "pro-lying clothes". Because it is cloudy at noon, the qi begins to sink, and taking medicine at this time can conform to the downward trend of qi and achieve the purpose of taking medicine.

Yiqi Buyang medicine should be taken in the morning or early morning. In three books, Spleen and Stomach, Differentiation of Internal and External Injuries and Shi Lan's Secret Collection, Li Dongyuan formulated Buzhong Yiqi Decoction, Shenshu Tiaozhong Decoction and other prescriptions for invigorating qi and rising yang, all of which emphasized taking them in the morning or before noon, thinking that taking them at this time would have miraculous effects. Tianyi Luo, a disciple of Tianyi Luo, followed suit and further pointed out that invigorating qi and promoting yang should be taken before noon, which means that yang is easy to reach when the yang is strong.

Nourishing yin and nourishing blood should be taken at night. Drugs for nourishing yin and blood, including drugs for calming nerves and reducing fire and astringing yang, should be taken at night. According to records, the main effect of Liu Hejian's stopping pain powder is to nourish yin and reduce fire; Li Dongyuan Danggui Huang Liu Decoction for the treatment of night sweats due to yin deficiency: Wang Kentang used human milk to soak Phellodendron amurense to treat water shortage and fire inflammation; Tianwang Buxin Dan has the functions of benefiting blood, solidifying essence, calming the nerves and nourishing the heart; Maijian powder is suitable for yin deficiency with internal heat and bone steaming at night. The reason is that yin medicine is easy to play a role when yin is abundant.

Take dampness-removing medicine in the morning. For example, Ji Ming powder for treating edema and beriberi, and taking medicine at night; Gong Tingxian's "Sean Kuaipi Pill" can activate yang, promote water circulation and eliminate facial swelling. It is also recommended to take it with scallion, dried tangerine peel and mulberry bark when watching it for the fifth time.

Antipsychotics should be taken before going to bed. Xu, the first person who put forward this view, created cinnabar pills and mother-of-pearl pills, both of which indicated that they should be taken lying down. Later doctors followed this theory when using sedatives. Modern people have made clinical observation on this method, and it has also been confirmed that it is of practical significance to take sedatives at night.

Regular paroxysmal diseases should be taken before the onset. For example, malaria, class five cough, damp-heat syndrome and so on. , mainly used to cut off the evil path when the condition is not tense, so as to give full play to the efficacy.

Take medicine according to the objective indexes of modern research. The administration time can be adjusted according to the daily rhythm of hormone secretion or cyclic nucleotide metabolism. For example, for all kinds of kidney (spleen) yang deficiency syndrome with low adrenocortical function, when applying the prescription of warming kidney (spleen) yang, we can consider giving it once at the peak of adrenocortical hormone (6-8 am); For diseases with low levels of prolactin and thyroxine, when applying the prescription of promoting blood circulation and promoting lactation or supplementing qi and nourishing blood, we can consider giving it once at each peak; Can be used for treating tumors, coronary heart disease, asthma, psoriasis and other diseases. It has been clarified that cyclic nucleotide levels have directional changes and can be considered to be administered at their peak time (that is, when CAMP level increases from 15 to 18, CGMP level increases from 23 hours to 24 hours).

It can be predicted that according to the chronopharmacology theory of traditional Chinese medicine, timely medication can adapt to the seasonal changes, meet the timeliness of the human body's demand for yin and yang, and can induce the disordered human rhythm to return to normal with the help of the ascending and descending trend of human qi, prevent or reduce the adverse reactions of drugs, improve the curative effect of drugs, and increase the cure probability and ways of some difficult diseases.