中医药治疗艾滋病的现状
http://www.51daifu.com日期:2009-01-16 10:54 来源:医生在线
中医药治疗艾滋病的现状
如果说,两年前“中医药治疗艾滋病项目”开始实施时,主要作为“关怀项目”,针对不能接受抗病毒西药治疗的患者,那么,两年后,对以河南中医学院李发枝教授为首的专家组成员而言,心中则更多有着“中医服务人类健康”的使命感。
自2004年10月项目开始至今,一项持续两年、涉及1792例病人的临床疗效评估显示:相对西医药,中医药在缓解症状体征、提高生活质量、延缓发病时间、延长生命等方面,具有明显优势。中医药能使艾滋病患者感觉像正常人一样的工作和生活。
水黄村的故事
河南省尉氏县水黄村,是该省30余个艾滋病高发村之一。
快过年了,村民叶狗明说,准备卖掉家里的几头猪,好好置办些东西。看他神采奕奕的样子,谁也不会想到,两年前处于艾滋病发病期的他,因为皮炎等机会性感染,眉毛胡子都掉光了,而且浑身乏力,更别说下地干农活了。
10多年前,叶狗明和村里人四处卖血,感染了艾滋病毒。直到2000年,经常无故生病,又听到乡亲们流传的一些说法,才意识到问题的严重性。随后,他被检查确认,接受抗病毒治疗,没想到全身过敏反应强烈。正在绝望之际,2004年10月中医药治疗艾滋病项目在村里实施,他试着参加。中医药的“神奇”,给他带来了现在的“幸福生活”。
从医30余年的村医刘广岭说,全村2500多人,上世纪90年代不少村民因卖血感染,数年后陆续发病和死亡,2002年死17人,2003年死19人。此后,接受抗病毒西药治疗,死亡率下降,但八成病人胃肠道副反应厉害,其他则因过敏等原因不适应抗病毒治疗。“头发、眉毛掉的,皮肤烂的,拉肚子止不住的……好多家田里都荒了,不少小孩子没人管了,我这卫生所有时一天接几十个病人,很惨啊!”
转折发生在2004年10月,中医药项目实施。很快,情况发生了变化,100多个病人中,有副反应的明显缓解,皮炎、腹泻、发热的好了,乏力者有劲了。走在街上,病人和正常人看不出两样。
“鸡尾酒疗法”的困境
作为全国最严重的艾滋病疫情省份之一,河南省疫情主要开始于90年代中期。
当时,有偿献血风在较贫困的豫东南一带盛行,造成艾滋病的经血传播,涉及18个省辖市,局部村庄呈高度密集的“灶性”分布。发病人群以30岁到50岁之间的青壮年为主,占83%。由于有偿献血已10余年,现进入发病、死亡高峰期,病人逐年增多。
进入21世纪,该省实施西医药抗病毒治疗(高效抗逆转录病毒,又称鸡尾酒疗法)和抗机会感染的医疗救治。然而,随之而来的挑战日益突显:
一是“成本高”。从采购、配送到监督服药到口,免费治疗对国家则意味着大量人力、物力、财力的消耗。
二是“机会感染难控制”。农村条件差,免疫力较低的患者机会性感染层出不穷,西药的对抗治疗只能“头痛医头,脚痛医脚”,基层卫生机构因此天天人满为患,压力巨大。 三是“耐药性”。鸡尾酒疗法每3至5年服用者会产生不同程度的耐药性,须重新调整药物方案。每次调整,则给下一步的治疗带来更大难度。
四是“存在不适应人群”。如肝肾功能不全、过敏体质等人群,无法接受抗病毒治疗,面对的只有“绝望”。
很快,从中央到地方,从医学专家到基层医生,一种让中医药参与艾滋病治疗的呼声渐起,并迅速为决策层采纳。2003年,国家中医药管理局会同卫生部、财政部启动“中医中药治疗艾滋病试点项目”,选择河南、河北、安徽、湖北、广东等5省,涉及2500余例患者。其中,仅河南占到七成以上,达1792例,所具有的大样本优势,也使该省的试点项目最具疗效评估的价值。
2004年8月,按照三部委的统一部署,经过周密的准备,备受瞩目的河南省中医药治疗艾滋病项目在5市9县区展开。
中医“摸着石头过河”
河南中医药“试水”治疗艾滋病,还要上溯至2002年7月。
由于新蔡县疫情严重,在治疗措施难以跟进的情况下,希望转向中医药。当时,李发枝等专家赶赴疫区时,心情复杂,对中医药能不能治这种“新病”心里没底。几天内接触60余例病人,归纳、分析、反复讨论,然后开出处方,制成中药制剂,选择200例病人服用。1月后反馈来的信息令人振奋,病人原先的并发症状大为缓解。尽管这次尝试没有持续下去,但专家们对中医药的疗效有了“底”。
2004年8月国家项目启动,以李发枝为首的专家组提前进驻尉氏县的3个高发村,对300多例进行先期治疗探索。20余个河南中医界各学科领域的顶级专家,几乎天天泡在村里,以2002年经验为基础,讨论病机病理,辨证施治,观察处方疗效,一次不行二次、三次……“先当学生,后当老师”,一个可以在全省推广的初步治疗方案慢慢“出笼”。两个月后,项目全面推开。
随后,对试点地区的一线医生进行了广泛的业务培训,一个以县中医院为依托,省、县、乡、村四级参与的项目实施体系开始运行……
面上治疗的问题基本解决。然而,随着病程的自然延进,重症患者增多,尤其伴发的严重腹泻,此前的方案又显不足。2005年7月,专家组赶赴重症病人最多的上蔡县中医院,几番临床,3个月后,制成“泻痢康胶囊”,有效控制率达90%。
“天天像在打仗。”河南省中医药管理局局长夏祖昌说,开始时经费不多,补助也低,条件艰苦,“他们靠的是中医悬壶济世的使命感”。
2005年,《河南省艾滋病常见病症辨证治疗要点》完成并在项目县推广。河南的经验被全国其他省市试点地区借鉴。
中西医“疗效”之别
分属两种不同医学体系的中医和西医,在艾滋病治疗疗效评价问题上再次“交手”。
对于西医,病毒载量和免疫功能(CD4淋巴细胞数量)是公认的疗效指标。病毒载量下降越快,CD4细胞上升越快,疗效越好。
如果以此为标准,中医药的劣势是明显的。河南1000多例病人两年的临床显示,单纯用中医药对增加CD4细胞、降低病毒载量不明显,仅能减缓CD4细胞的下降幅度,稳定病毒载量,显示可以延长病人生存期。
但在现实中,中医药在病人带毒生存方面,显著提高了生活质量,尤其针对艾滋病并发症的疗效之快捷和稳定“独具优势”。
艾滋病患者由于免疫缺陷,常伴有发热、胸痛、腹泻、咳喘、乏力、自汗等症状和淋巴结肿大、口腔溃疡、疱疹等体征,很难治愈,而且治疗起来也非常棘手。西医只是对症治疗,往往“按下葫芦起了瓢”,病人备受折磨。
http://www.51daifu.com date :2009-01-16 10:54 Source: doctors online
Chinese medicine treatment of AIDS, the status quo
If we say that two years ago, "Chinese medicine treatment of AIDS Project" launched mainly as a "Care Project", in view of Western medicine can not accept the anti-viral treatment of patients, then after two years of Henan College of Traditional Chinese Medicine, headed by Professor Li Fazhi experts Group members, the mind is more a "Chinese medicine services to human health," sense of mission.
Since October 2004 the project since the start of an on-going two years, 1792 cases of patients involved in clinical efficacy assessment shows: the relative Western medicine, Chinese medicine to alleviate symptoms and improve quality of life, delay the onset time, prolong life, etc., with obvious advantage. AIDS patients with Chinese medicine can feel the same as the normal work and life.
Huangcun water story
Water Huangcun Weishi County, Henan Province, is the province more than 30 high incidence of AIDS, one of the village.
快过年, the villagers said the dog leaves, ready to sell the house a few pigs, something good acquisition. To look at his eyes look, no one would have thought that two years ago in view of his AIDS, because of opportunistic infections such as dermatitis, eyebrows, mustache and goatee are drop, and all weak, let alone a farm work Shimoji.
More than 10 years ago, leaves the dog out and around the village to sell blood, infected with HIV. Until 2000, often without cause illness, also heard some folks have been saying, did not realize the seriousness of the problem. Subsequently, he was checking confirmed receiving antiretroviral treatment, the body did not expect a strong allergic reaction. Are desperate, the 2004 mid-medicine treatment of AIDS in 10 projects implemented in the village, he tried to attend. Traditional Chinese Medicine "magic", brought him a present, "a happy life."
Medical more than 30 years of village doctors刘广岭said that the village more than 2500, the last century 90's, many villagers sold their blood infection, one after another after several years of morbidity and mortality, 17 people died in 2002, 19 people died in 2003. Since then, the acceptance of western medicine, anti-viral treatment, mortality has declined, but the patient八成severe gastrointestinal side effects, and other allergies due to reasons such as not meet anti-virus treatment. "Hair, eyebrows out, broken skin, diarrhea止不住... ... a lot of fields are the shortage of homes, many children没人管, and my health all the time then a few dozen patients a day, sorry ah! "
Turning point occurred in October 2004, Chinese medicine project implementation. Soon, the situation has changed, and more than 100 patients, the apparent ease side effects, dermatitis, diarrhea, fever Well, weak from the strong. Walking down the street, patients and normal people do not see the same.
"Cocktail therapy" the plight of
As the country's worst AIDS epidemic one of the provinces, the major epidemic in Henan Province began in the mid-90s.
At that time, paid blood donors in poorer winds southeast of Henan along the prevalence of AIDS caused by blood transmission, involving 18 provincial cities, local villages showed a high concentration of "focal" distribution. Incidence of the crowd of 30-year-old to 50-year-old young adults between the mainly accounted for 83%. As a result of paid blood donors have been more than 10 years, is now in the incidence, mortality peak period, the patient is increasing year by year.
The 21st century, the province's implementation of the West Pharmaceutical antiviral therapy (highly active anti-retroviral, also known as cocktail therapy) and anti-opportunistic infections of medical treatment. However, the challenges attendant increasingly highlighted:
First, "the high cost." From the procurement, distribution to the supervision of medication to the mouth, free treatment for the country would mean a great deal of manpower, material and financial resources consumption.
The second is the "opportunistic infections refractory." The rural poor, people with lowered immunity, an endless stream of patients with opportunistic infections, western medicine can only be against the treatment of a "stop-gap", the grass-roots health organizations overcrowding every day, therefore, tremendous pressure. The third is the "resistance." Cocktail every 3-5 years users will have varying degrees of resistance, re-adjusting the drug program. Each of the adjustments, then the next step to bring about greater difficulty of treatment.
The fourth is "not suited crowd there." Such as liver and kidney dysfunction, allergy, such as population, not receiving antiretroviral treatment, in the face of the only "desperate."
Very quickly, from central to local, from the medical experts to the grass-roots doctors, a kind of Chinese medicine to participate in AIDS treatment since becoming the voice and quickly adopted as the decision-making level. In 2003, the State Administration of Traditional Chinese Medicine in the Ministry of Health, the Ministry of Finance to start, "Chinese medicine treatment of AIDS pilot project", select the Henan, Hebei, Anhui, Hubei, Guangdong and other 5 provinces, involving 2,500 patients. Among them, only Henan七成accounted for more than 1792 cases of Tatsu, have the advantage of large sample, but also the province's pilot project to assess the value of the most effect.
In August 2004, in accordance with the unified arrangement of the three ministries, after careful preparation, high-profile Chinese medicine treatment of AIDS in Henan Province project in 5 counties and districts of the city of 9 to start.
Chinese medicine, "feeling the stones across the river"
Henan Traditional Chinese Medicine "test the water" to treat AIDS, but also dates back to July 2002.
County epidemic as a result of serious measures in the treatment of difficult to follow up the case, I hope towards Chinese medicine. At that time, Li-chi and other experts rushed to the affected areas, the feelings of the complexity of the Chinese medicine can rule this "new disease"心里没底. Contact a few days more than 60 patients, draw conclusions, analysis, repeated discussions, and then giving into Chinese medicine, 200 cases of patients to choose. In January after the feedback of information to an exciting, patients had significantly alleviate the symptoms of complicated. Although this did not try to continue, but experts on the efficacy of Chinese medicine has been "at the end."
August 2004 national project start to Li Chi-led group of experts stationed in Weishi County in advance of the three high incidence of the village, more than 300 cases of pre-treatment to explore. Henan more than 20 different disciplines of Chinese medicine practitioners in the field of the top experts in almost every day the bubble in the village to experience in 2002 to discuss the pathogenesis, pathology, diagnosis and giving of treatment efficacy observation prescription, one will not do the second, three times ... ... "first when students, later, when the teacher, "a promotion in the province of initial treatment program slowly," came out. " Two months later, pushing the full-scale project.
Subsequently, the pilot of the first-line doctors in the region a wide range of business training, a county-based Chinese medicine hospital, provincial, county, township and village levels to participate in the project implementation system to start running ... ...
Surface treatment of the problem basically solved. However, with the course of the natural extension into an increase in critically ill patients, especially associated with severe diarrhea, after the program has increasingly inadequate. In July 2005, the group rushed to the critically ill patients Shangcai largest Chinese medicine hospital, a series of clinical, three months later, made "泻痢Capsule" effective control rate was 90%.
"Like every day in the war." Henan Traditional Chinese Medicine Authority祖昌Xia said that the beginning of low levels of funding, grants are also low, difficult conditions, "they relied on traditional Chinese medicine悬壶济世sense of mission."
In 2005, the "common symptoms of AIDS in Henan Province points Differential Treatment" completed and the project to promote the county. Henan has been the experience of other provinces and cities nationwide from pilot areas.
Chinese and Western medicine, "efficacy" of other
Belong to two different medical system of Chinese medicine and Western medicine in AIDS treatment evaluation of the issue once again "against."
For medical practitioners, viral load and immune function (CD4 lymphocyte number) is recognized as indicators of efficacy. The faster decline in viral load, CD4 cell increase in the faster the better curative effect.
If we take this as the standard of Chinese medicine's shortcomings are obvious. Henan two years more than 1000 cases of patients with clinical shown that simply using Chinese medicine to increase CD4 cells, reduce the viral load was not obvious, can only slow down the decrease in CD4 cells, the stability of viral load, showed that patients can extend survival time.
But in reality, Chinese medicine in patients infected survival significantly improved the quality of life, especially the effect of AIDS complications of fast and stable "unique advantages."
AIDS as a result of immune deficiency, often accompanied by fever, chest pain, diarrhea, cough, fatigue, spontaneous and symptoms such as swollen lymph nodes, oral ulcers, herpes and other signs, it is difficult to cure, but also very difficult to treat. Western medicine is only symptomatic treatment, often "press played a gourd dipper," a patient has been tortured.