青蒿素获诺奖将激励中医药研究

果德安

（中国科学院上海药物研究所，上海 201203）

2015年，诺贝尔生理学或医学奖的半数都颁给了中国科学家屠呦呦，以肯定其在抗疟药物青蒿素方面的开创性工作。屠呦呦创造性地从一味治疗发热的传统中药青蒿中提取了抗疟药青蒿素。这无疑极大地鼓励了中医药研究者们。正如屠呦呦在其获奖感言中所讲的，青蒿素是中医药贡献给世界的一份礼物。屠呦呦的获奖无疑会引起人们对中医药及欧洲、非洲、印度、美洲等在内的其他传统医学更大的研究兴趣。尽管诺贝尔奖评委会不承认这一奖项是颁发给中医药的，而是颁发给从中药中衍生出来的一种新型药物的，但这一奖项也足以让中医药科学家们欢欣鼓舞、激动不已。笔者认为，争论青蒿素属于中药还是西药毫无意义。任何来自于中医药的贡献或者新发现，只要有利于人类的健康，就应该得到认可和尊重。任何有关发展了的或者现代化的中医药已不属于中医药的观点都会极大地阻碍中医药的现代化及其与现代医学结合的进程，甚至加深中医药与现代医学之间的鸿沟。借助现代生物医学的新进展和新方法把中医药发展成为循证医学才是中医药的未来之路。

在过去的20年，中医药经历了快速发展期，取得了丰硕的成果。例如，中医药研究的论文数量呈几何速度增长，中药产业繁荣发展，中药新药研发成果丰硕等等。然而，中医药在未来仍面临着巨大的挑战。中药在安全性、有效性、质量可控性以及作用机理研究方面现代科学证据的缺乏需得到足够重视并提供解决方案。中医药基于经验的属性应该向基于证据和基于科学的方向转化。以下是笔者对未来现代中医药发展的几点建议：1. 基于中医药的创新药物研发。中医药仍是一个尚未充分挖掘和开发的宝库。中药资源调查表明，中药的种类超过了12000种，其中大多数是草药。除了青蒿素及其衍生物，还有一大批单一化学实体的药物已得到开发并成功投入市场，包括三氧化二砷，人参皂苷Rg3, 联苯双酯，β-榄香烯，靛玉红等。可以预见，应用现代药物研发技术和方法，这个巨大的中药资源宝库将会释放出巨大潜能，创制出更多的创新药物。2.中医药整体质量控制研究。现有的质量控制方法多半基于单一或少数几个指标成分的分析方法，沿用了化学药物的质控模式，但这种质控模式并不能真正控制中药产品的质量。应建立系统的整体质量控制方法全面控制中药原药、饮片和成药的质量，尤其是中药复方产品的质量。3.中药炮制研究。中药材被制成汤剂或中药产品前都应经过不同程度的炮制。传统炮制方法多基于经验或者传统知识。在未来，用于提高药效或降低毒性的中药炮制应得到全面研究并阐明炮制机理。4.中医药疗效及安全性研究。在中医药发展过程中，应更加重视基于中医药理论和现代医学理论的中药药效及安全性的整合评估。我们应该通过国际合作发展新的适合中医药复杂体系特点的评价方法，并构建国际认可的评价标准。其它方面的中药现代研究如药代动力学、道地性、药效物质以及构建大数据库等也应得到加强。笔者坚信，随着现代生物医学科技的快速发展，中医药必将为全人类的健康做出前所未有的贡献，并最终发展成为一个循证医学体系。

Nobel Prize forArtemisinin Inspires Modern TeM Research

De-An Guo

Instituteof Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China, E-mail:daguo@simm.ac.cn

Half ofthe 2015 Nobel Prize in Physiology or Medicine was awarded to Chinese scientistYouyou Tu in recognition of her pioneering work on the antimalarial artemisinin, extracted from Artemisia annua, a traditional Chinese herbal remedy usedto treat fever. This is clearly a great encouragement for scientists who engagetraditional medicine research. As Youyou Tu stated in her Nobel Prize awardinglecture, artemisinin is a gift from traditional Chinese medicine (TCM) to theworld, this definitely will generate great interest in not only TCM but alsoother traditional medicine systems from other parts of the world, includingEurope, Africa, India, Americas, etc. Though the Nobel Prize selectioncommittee did not confess that the prize is to award traditional Chinese medicine,rather a new drug discovery inspired from TCM, this is indeed the exciting andencouraging event for Chinese TCM scientists. In my opinion, it is meaninglessto dispute if artemisinin is still belonging to TCM or western medicine. Any contributionor new discovery derived from TCM to benefit for the human health should berecognized and respected. TCM needs to be developed and modernized. Anystandpoint that developed or modernized TCM does not belong to TCM maydrastically hinder the TCM modernization and integration with modern medicineprocess, or even deepen the gap between TCM and modern medicine. Evidence-basedmedicine is the future of TCM by means of modern biomedicine advances and novelapproaches.

In thepast 20 years, TCM has undergone rapid development period evidenced by a numberof achievements including the geometric growth of TCM research papers, boomingTCM industry, TCM new drug research and development, etc. However, TCM is stillfacing grand challenges in the future development. Shortage of modern scientificevidence for safety, effectiveness, quality and mode of action should beemphasized and dealt with solutions. TCM experienced-based feature should beturned into evidence-based and science-based one. Following several aspects aresuggested for the future modern TCM research: a) TCM-based new drug discovery.TCM is still a non-fully explored treasure house for new drug discovery anddevelopment. According to TCM resource survey, there are over 12000 TCMspecies, among which majority are herbs. Apart from artemisinin and itsderivatives, a number of single chemical entity drugs have been developed andsuccessfully marketed, such as arsenic trioxide, ginsenoside Rg3, bifendate, β-elemene,indirubin, etc. It is anticipated that more new drugs could be discovered fromthis vast TCM resource with modern drug discovery technology and methodology. b)Research on the holistic TCM quality control. The current quality controlapproach is more focused on a single marker or a few marker determinations,which follows the western drug quality control model and hence, could notreally monitor the quality of TCM products. Systemic and comprehensive qualitycontrol method should be developed for the TCM crude drugs, prepared slices andfinished products, especially for those multiple-ingredient herbal products. c)Research on TCM processing. All TCM crude drugs should be processed indifferent extent before they can be used either for decoction or for herbalproduction. TCM processing method is mainly based on the traditional knowledge orexperience. Mechanism of processing either for the purpose of enhancingefficacy or eliminating toxicity should be thoroughly investigated andclarified. d) TCM efficacy and safety research. During the development of TCM,greater attention needs to be paid to the integrated evaluation of the effectivenessand safety based on TCM theory and modern scientific research. New evaluationmethodology fit for TCM complex feature should be developed with international collaborations.Globally recognized evaluation criteria should be constructed. Other TCMresearch focuses include pharmacokinetics, geo-authenticity, active principlesand giant data library. It is firmly believed that TCM will contribute morethan ever to the human health along with the rapid advances of biomedicinescience and eventually developed into an evidence-based medicine system.

Cited as: Guo DA.Nobel Prize for Artemisinin InspiresModern TCM Research. World J Tradit Chin Med 2015; 1(4): 1.