Zhijian LIN has his expertise in clinical Chinese Pharmacy and passion in ADR research on Chinese Materia Medica. He has well experience in rational use of Chinese Materia Medica after years of research and teaching in Beijing University of Chinese Medicine. He teaches Chinese Pharmacy and applied integrative teaching methods for simulating real world clinical practice to advance students’ problem solving skills. And he also has a strong interest in basic pharmacological research on hyperuricemia and metabolic disorders with Chinese Materia Medica.
Chinese medicine is one of the great medical systems in the world, which performs treatment based upon principle of ZHENG Classification and Treatment (Bian Zheng Lun Zhi, 辨證論治in Chinese). And ZHENG (TCM syndrome) classification could be identified as clinical special phenotypes by symptoms and signs of patients. In ancient times, practitioners of Traditional Chinese Medicine (TCM) performed two roles as clinical physicians and clinical pharmacists. And TCM practitioners provided an effective approach for personalized diagnosis and treatment in clinic. In other words, clinical Chinese pharmacists have been practicing personalized drug therapy for thousands of years. Modern education of Chinese medicine began in the 1950s. According to the modern education system, physicians and pharmacists of Chinese medicine are two different groups of health-care professionals. The fundamental role of Chinese pharmacists is to distribute drugs prescribed to patients, to produce drugs in the manufacturing companies, and to research and develop new drugs in laboratories. As is known to all, a medication may demonstrate effectiveness in clinic, yet it may be less effective to some particular patients, or even results in adverse drug reaction /adverse drug event (ADR/ADE) and failure to reach desired treatment goals. Clinical Chinese pharmacists have now moved from laboratory to the patients’ bedsides to provide pharmaceutical care. They are positioned to play an active role in pharmaceutical care to improve personalized medications, such as consulting with physicians on individual patient’s needs, discussing the therapy based on the principle of ZHENG Classification and Treatment, performing therapeutic drug monitoring(TDM), ADR/ADE supervision, medication prescription assessment, providing recommendations of alternative treatments as necessary, and educating patients and families about drug rational use.
Zhang Xiaomeng, a Ph.D student in Clinical Pharmacy of Beijing University of Chinese Medicine, has her expertise in Pharmacovigilance and rational use of Traditional Chinese Medicine. She is committed to the assess the relationship of benefit-risk of the application of toxic herbs and herbal injections by using a variety of research methods. Until now, as first author, she has published 3 SCI papers and 4 papers in core periodicals.
The application of Aconitum herbs has a long history and wide range of indications, but in clinical, due to its inherent toxic ingredients, Aconitum herbs often lead to safety issues, whose application arouse public controversy. For the Aconitum herbs that has clear benefits and risks, how clinicians use? Therefore, based on retrieving more than 70 representative classical Traditional Chinese Medicine (TCM) works, such as Shennong's Herbal, Compendium of Materia Medica, Treatise on Febrile Diseases, and so on, we would systematically comb the benefit and risk cognition of Aconitum herbs by using the method of text mining, including the information of Aconitum’s origin, toxicity, medication risk and pharmacovigilance, which can provide traditional reference for clinical benefit-risk assessment, and reduce medication risk. In the classical TCM works, the cognization of toxicity of Aconitum herbs are almost accordance from ancient to present. Radix aconitum carmichaeli (Chuanwu) and Radix aconitum kusnezoffii (Caowu) have strong toxicity, while Radix aconitum carmichaeli (Fuzi) has toxicity. The medication risk of Aconitum herbs is not only relative with its own property, but also affected by processing, pattern, compatibility, dosage, patient physique, and so on. How these factors influence the benefit-risk relationship of Aconitum application are presented in Figure 1. From the representative classical medical formularies, we retrieved 7357 prescriptions (8.62%) that containing Aconitum herbs, whose medication ratio was relatively high. Ancient clinicians can effectively reduce the medication risk and ensure the efficacy of Aconitum herbs by alerting the risk factors in the medication course. At the same time, the classical works also recorded a lot of methods to detoxicate Aconitum toxicity, which major are cold, sweet drugs or foods. All in a word, although Aconitum herbs are with toxicity, the risk of toxicity-effect of Aconitum clinical used can be controlled if alerting various application factors.