Representative work 1:
The doctor didn’t see the disease, but the patient interviewed Academician Zhong Nanshan.
Our reporter Jiang Yongbin Aring Zhang Jing Peixuan
During the three-day holiday in Tomb-Sweeping Day, 84-year-old Zhong Nanshan has been working in the office of Yuexiu Campus of Guangzhou Medical University.
Zhong Nanshan, an academician of China Academy of Engineering, was born in Nanjing in 1936. He graduated from Beijing Medical College (now peking university health science center) in 1960, and was one of the first batch of public students after the reform and opening up. 17 years ago, during the SARS period, Zhong Nanshan, 67, firmly adhered to this; Seventeen years later, the COVID-19 epidemic struck, and at the age of 84, he still stood at the forefront of the struggle like an iron warrior.
"The doctor is not seeing a disease, but a patient." On April 4th, when interviewed by a reporter, Zhong Nanshan expressed the kindness of doctors and the understanding of life of an 84-year-old man with a direct remark.
Go to: "I have a more urgent mood when I go to Wuhan."
Q: You rushed to Wuhan on January 18th. What did you learn after you arrived in Wuhan? What was your mood at that time?
Zhong Nanshan: On the afternoon of January 18th, when I was attending a meeting to discuss the deployment of Guangdong province to fight the epidemic, I was suddenly informed that I had to rush to Wuhan that evening to attend a high-level expert group in National Health Commission, and arranged for me to be the team leader, and we would discuss it the next day. At that time, I realized that this problem should be more serious, and I had a more urgent mood when I went to Wuhan.
I went to Wuhan with a series of questions, because once an acute infectious disease is transmitted from person to person, it will affect the whole society and the whole economy. I have been thinking in the car, how to look at this problem.
Before the meeting the next morning, many of my students working in Wuhan clinical frontline and experts sent from Beijing told me something. Combined with the investigation, I have a very positive conclusion.
On the morning of January 20th, I reported on behalf of the expert group that what we saw was rather serious. There must be two phenomena in it, one is human-to-human transmission, and the other is that medical personnel are infected. These are two very important signs, indicating that the disease will spread rapidly.
Facing a new infectious disease, we should first consider how to prevent it. For all public health incidents, we must first block them in the upstream, and we must prevent them from spreading out in large numbers. At that time, what I thought most about was how to solve the patient’s situation in the upstream, which was a key for us to minimize the spread of the first wave.
Fight: "Nothing is more important than avoiding more infections and reducing deaths."
Q: How to sum up the days of more than two months in the front line of prevention and control?
Zhong Nanshan: Under the leadership of the CPC Central Committee, our epidemic prevention and control strategy is very correct. Early implementation of upstream interception, cutting off the source of infection in Wuhan, and carrying out mass prevention and treatment throughout the country, and later rose to joint prevention and control. What is joint defense and joint control? My own understanding is "four early": early detection, early report, early isolation and early treatment, which is successful in China. While paying attention to medical treatment, we should also pay attention to summing up the laws, such as its clinical characteristics and which drugs may be effective, which have a good guiding role for the whole world.
After hard work, it is not easy to achieve important results in epidemic prevention and control in China. However, the epidemic situation abroad is accelerating, and the pressure of epidemic input in China continues to increase. By April 3, there had been more than 700 imported cases, and the number was increasing. Therefore, we should adjust and improve the epidemic prevention and control strategy in time, and focus on external defense input and internal defense rebound. All entry personnel must be tested, and as long as they are positive, they must be isolated.
Q: During this period, what is your greatest personal pressure?
Zhong Nanshan: Since I became a doctor, I think the biggest pressure is whether the patient was saved or died. The patient was saved and recovered, and everything was easy to say; If the patient is not saved, then my pressure is the greatest. Now the same is true for fighting the COVID-19 epidemic. What is more important for doctors to avoid more infections and reduce deaths?
Q: During the epidemic, you contacted the rescue team for consultation many times. What role did this special way play?
Zhong Nanshan: Remote video consultation has played an important role in fighting the epidemic. Through video connection, my team and medical staff from the Department of Critical Care Medicine and Radiology regularly connected to the intensive care units of hospitals in the epicentre of the epidemic, such as Shenzhen, Zhongshan and Dongguan, Guangdong, and Wuhan, Hubei, to discuss the treatment of severe and critically ill patients. This method played a unique role in extraordinary times and special conditions.
Progress: "historically, the prevention and control of the epidemic still depends on vaccines."
Q: In this race between science and virus, what progress has your team made in scientific treatment and drug verification in COVID-19?
Zhong Nanshan: We have carried out clinical trials of chloroquine and Lianhua Qingwen Capsule. From the results of current analysis, both of them have positive effects. Chloroquine can shorten the course of disease and reduce the viral load. Lianhua Qingwen capsule can obviously shorten the time of symptom relief.
Compared with SARS, COVID-19 has common features such as pulmonary fibrosis, and its outstanding feature is that there are a lot of mucus in small airways, which hinders airway patency and easily leads to secondary infection. We observed the treatment of some patients with hydrogen-oxygen mixture in the early stage, and found that hydrogen-oxygen mixture can obviously improve shortness of breath, which may be more suitable for patients with dyspnea.
Q: Apart from the means of treatment, the public is also generally concerned about the research and development of vaccines in COVID-19. Why is vaccines so concerned this time?
Zhong Nanshan: It is necessary to develop a vaccine. Covid-19 is much more infectious than SARS, and the infection coefficient can reach 3.5, that is to say, one person spreads three and a half, while SARS spreads two at most, so now some countries increase tens of thousands of confirmed cases every day. Historically, the prevention and control of the epidemic still depends on vaccines.
We know the typical examples, one is smallpox and the other is polio. Smallpox and polio are highly contagious, with a mortality rate of 20% to 30% and many sequelae. I remember when I was a child, many people around me had pockmarked faces, which was the sequela of smallpox. It’s out of sight now, thanks to the vaccine. In my opinion, the development of COVID-19 vaccine is very urgent, and we must press ahead.
Scientific research: "Basic scientific research should escort clinical practice"
Q: You are a doctor and an academician who led the team to tackle key problems. What research did your team carry out in COVID-19 this time?
Zhong Nanshan: Clinical treatment must always be placed in an extremely important position to fight the epidemic, and basic scientific research should escort clinical practice. For example, after the outbreak, we quickly summarized the clinical characteristics of 1099 cases and published them in the New England Journal of Medicine. This is the first time to summarize the data of more than a thousand cases nationwide, and it is still the most cited paper in the world in this epidemic. Through research, it is found that half of the cases do not have fever when they are admitted to hospital, so it is not appropriate to take fever as the only symptom; In addition, some patients’ laboratory indicators are particularly high, and they will soon become severe. These basic scientific research has played a very good guiding role in global treatment, which is also a common concern when connecting with foreign counterparts.
Q: What basic scientific research achievements did we share when connecting with foreign experts?
Zhong Nanshan: During the video connection with our foreign counterparts, we mainly started from the concepts of "four mornings" and joint prevention and control, and shared the key points of critical cases management, new laboratory detection technology and new treatment methods. We have initially reached a cooperation consensus with Harvard University in the United States, and the two sides will cooperate extensively in epidemiological investigation, laboratory testing and clinical treatment in COVID-19.
Family style: "My father seldom talks, he says that there must be evidence in his speech."
Q: Many people want to know whether your becoming a doctor is related to your family environment.
Zhong Nanshan: I think it still matters. My father is a pediatrician. In the forties and fifties of last century, many neighbors often brought their children to my house to see a doctor at night. After taking the medicine, the children got better, the neighbors were very happy, and my father felt a sense of accomplishment. My mother is a senior nurse practitioner who graduated from Union Medical College. Later, she became the vice president of South China Cancer Hospital and now the affiliated cancer hospital of Sun Yat-sen University, and participated in the establishment of this hospital. At home, my parents talk about medicine, which has a great influence on me and cultivated my interest.
Q: What is the biggest influence of parents and family style on you?
Zhong Nanshan: I’m afraid the biggest influence on me is seeking truth from facts. My father seldom talks. He says he needs evidence to speak. In 1969, I went to the countryside to join a medical team to see some patients. Once I met a child with severe hematuria. Everyone said that this was a tuberculosis patient and needed treatment. I went home and talked about this situation for a long time. My father suddenly asked me, how do you know he is tuberculosis? I was stumped at once. Because hematuria is a very common symptom, it may be inflammation of the bladder, stones, and of course tuberculosis, but you have to have evidence to treat it.
I still remember his words. This makes me insist on telling the truth and seeking truth from facts no matter what I do in the future. You should believe what you practice, not just what you hear.
Q: What do your family think of your career?
Zhong Nanshan: Their support is silent and intangible. Because I seldom take weekends off, even at home, my wife says that your best rest is to sit quietly at home and read by yourself. My family doesn’t ask much of me. It’s not that I want the whole family to travel, but I owe it to my family in this respect. I have made some achievements in my work, and the support of my family is extremely important.
I am now in a state of "my mouth is full of food and my clothes are stretched out". As soon as I get home, I have food to eat and good life care. Because there are no worries in life, I can also guarantee to undertake heavier tasks.
Being a man: "How Steel was Tempered has a great influence on me, and patriotism has influenced a whole generation."
Q: You once said that your medical career only started at the age of 35. Why do you say that?
Zhong Nanshan: At that time, the children were still young, and my wife and I were separated for a long time, so it was very difficult to take care of the family and the elderly, so we moved back to Guangzhou at the first opportunity. Why is coming back a big turning point? Because I was engaged in basic research in Beijing Medical College before, I didn’t start from scratch until I returned to Guangzhou at the age of 35, and I was engaged in clinical work in the Fourth People’s Hospital of Guangzhou, now the First Affiliated Hospital of Guangzhou Medical University, which is unforgettable for me. At that time, I was almost "poor and white" in clinical knowledge, because I trained for the first National Games for one year when I was in college. I went back to Beijing Medical University and took a clinical class for half a year, and then stayed as a teacher. So I haven’t done clinical work before, which is a great challenge.
Q: You went to study at the University of Edinburgh in England in 1979, and just a few days ago, on April 2nd, you won the Edinburgh Outstanding Alumni Award. What impressed you during your study abroad?
Zhong Nanshan: I am the first batch of international students from public schools after the reform and opening up. I have to take the examination of the Ministry of Education, and I can’t go until I have passed it. At that time, I got 52.5 points in the English exam. As a result, I passed 45 points that year, so I went out.
At that time, all international students were very hard. It takes nine days to go to England by train. In order to save money, even toilet paper and washing powder are brought. We only have 6 pounds a month to live on, and it costs 12 pounds to get a haircut in England. We have to do everything on our own. When I arrived at the Royal Medical College in Edinburgh, the most difficult thing was the language barrier. I used to study Russian. After attending rounds every day, I went to the library to borrow tapes to listen and write, and asked if I didn’t understand them. It took me almost half a year to improve my English.
My tutor, Professor Franny, is very famous for studying chronic airway diseases. I have done some research work, and three of them have been done well, which has also been recognized by the whole department. Some research ideas in Britain are worth learning. We often do it directly after we have made some achievements. They want to verify it again and again, and never take the second step until we have taken the first step. Then you have to trust your own experiments, not necessarily the authority. I was deeply impressed by these two items, so I have always attached great importance to the training of the basic skills of the team, and I will improve it after training.
Q: I heard that my tutor tried his best to stay before returning to China. Why did you decide to return to China?
Zhong Nanshan: Later, I wanted to do research on asthma, so I went to London for further study and stayed for half a year. It is another professor in London who wants to keep me. He mainly thinks that my research on asthma is better. But I think the country is so difficult that it gives us the opportunity to study abroad, and I never thought about not coming back. After studying, I have to come back to improve the scientific level of our country. It was such a simple idea at that time.
Q: You often say that you are "just a doctor". What do you think of the profession of doctor?
Zhong Nanshan: Medicine is a practical science. Many of my ideas and even inspirations, or some scientific research topics, come from clinical practice. I’m not used to finding topics from literature.
The doctor is not seeing a disease, but a patient. What we should always think of is, what problems can’t be solved in medicine, and how do you solve them? As I was in England 40 years ago, I began to study chronic obstructive pulmonary disease with my tutor. At that time, the diagnosis was clear, but the treatment was backward. Later, the technology improved a lot, but the treatment of patients still did not bring substantial changes.
I’ve been thinking, where is the key? Many chronic diseases, such as hypertension, will not develop into cerebral hemorrhage and cerebral infarction if you control it early. The same is true for diabetes. It is not necessary to wait until other symptoms appear before making a diagnosis. If the blood sugar reaches a certain level, it will be controlled, and some complications can be avoided. This is the progress of strategy.
Many respiratory doctors are reluctant to study chronic obstructive pulmonary disease because there is no good way to treat it. When the patient came, he had difficulty breathing. At this time, the lung lesions were irreversible. So at the beginning of 2000, I had this idea, why not intervene in the early stage of the disease?
In the diagnosis and treatment of chronic obstructive pulmonary disease (COPD) in the world, only the symptoms are intervened. Now our view has changed, because we have done some research and found that it is very effective to intervene when there are no symptoms or only mild symptoms at an earlier stage. We should continue to follow this road.
Q: We see that on your desk, in addition to computers and materials, there is also a small statue dedicated to playing basketball when you were young. You can still undertake very heavy tasks over 80 years old. Is it related to continuous exercise?
Zhong Nanshan: I like sports since I was a child. Later, I often participated in sports competitions in middle schools and universities. The advantages of competitive sports, on the one hand, mean that exercise is very beneficial to the body, on the other hand, it is also very helpful to cultivate the quality of will, and everything wants to strive for the upstream and pursue high efficiency. I used to run 400 meters, and it would be great to improve my performance for two or three seconds in one year of training. Why can’t you cherish every minute and hour in your normal work? So it is very enlightening for me to improve my learning efficiency. Another is cooperation, like running a relay race, which requires everyone to work together. Basketball teams have been organized in our institute since 1982. Every Saturday night, everyone gets together to play, and it has lasted for more than 30 years.
Health is the foundation, and health needs investment. I work twelve or thirteen hours a day now, and I have this ability to support me, which has a lot to do with physical exercise, and it has benefited me a lot in my life.
Q: Can you recall with us what books have a greater influence on yourself?
Zhong Nanshan: After work, I didn’t have time to read novels, but I read a lot in primary and secondary schools, such as How Steel was Tempered, which had a great influence on me at that time. Patriotism, the idea that I am for everyone and everyone is for me, has influenced a whole generation. As my father said, it is not in vain to leave something in this world in one’s life.
Future: "Health should be implemented in all policies of the whole medical and health work, which is the key."
Q: In the future, where should we focus on improving the public health system?
Zhong Nanshan: After SARS, China has made great efforts to monitor possible sudden infectious diseases in time. These years have also done a good job, including effectively dealing with influenza A (H1N1), MERS (Middle East Respiratory Syndrome), H5N1 and H7N9 avian influenza. But there is still room for improvement, because prevention should be placed in a higher position. The Central Committee of the Communist Party of China put forward the strategy of "healthy China", and "health" should be implemented in all policies of the whole medical and health work. From this perspective, we should pay more attention to the upstream and do a good job of prevention, which is the most crucial issue.
Generally speaking, the public health system needs to be strengthened in understanding, and the organizational structure needs to be improved. For sudden outbreaks, CDC should be given more power.
Just after 20 years of this century, there have been three coronavirus infection epidemics-SARS in 2003, MERS in 2012 and COVID-19 this time. This is a game between nature and human beings. It is very important to maintain a harmonious ecological relationship between man and nature, so that the natural ecological chain can operate better.
Q: A few years ago, you said that you had two wishes: to build the Guangzhou Respiratory Center and to launch your own anti-cancer drugs. Please introduce the latest progress of these two tasks.
Zhong Nanshan: With the support of Guangdong and Guangzhou, Guangzhou Respiratory Center is progressing smoothly. More and more pharmaceutical and medical device companies are cooperating with us, and they see that we are doing real work and have real achievements. It took us ten years to push forward, and now this platform is accelerating construction and is expected to be completed in the second half of next year.
This center has four functions, one is scientific research, the other is personnel training, the third is the diagnosis and treatment of difficult diseases, and the fourth is the prevention and control of acute infectious diseases. Now we are very confident to build it into the largest respiratory disease research center in the world.
A Chinese-American scientist and I spent 26 years developing an anticancer drug. This drug has certain universality, and it is not only used to treat a certain tumor, but also a variety of solid tumors, including lung cancer, gastric cancer, breast cancer, liver cancer, etc., and it is expected to be clinically approved this year. I encountered various difficulties in the process of drug research and development, but I never gave up. Because this medicine can benefit many people, I must stick to it.
In addition to these two wishes, I have another wish, that is, I hope to change the treatment strategy of chronic obstructive pulmonary disease all over the world. The disease is divided into one to four stages, and now the treatment focus is on three or four stages, and a lot of energy is spent on treating dyspnea and even respiratory failure, which is the best policy. If we focus on early prevention, we can get twice the result with half the effort. I especially hope that early diagnosis and early treatment of chronic obstructive pulmonary disease can form a national and even global treatment idea.
It was 10 am at the end of the interview. When the alarm sounded outside the window, Zhong Nanshan stood up, straight back, and stood in silence. "The medical staff in China have always been worthy of the title of’ angels in white’," he said. This national mourning activity is also recognition and respect for the medical staff who died of Covid-19 infection, and it is to affirm the contribution of these white soldiers from people’s hearts.
Attachment: Recommendation Form for Participating Works of China News Prize.
Representative work 2:
Interview with Academician Wang Chen with Healthy Deep Breathing
Our reporter Nie Xinxin Chen Hao
On April 15th, the latest data from the National Health and Wellness Commission showed that there were fewer than 50 severe cases in mainland China. And more than two months ago, at the most serious juncture of the epidemic in COVID-19, there were more than 11,000 severe cases at most.
Academician Wang Chen, vice president of China Academy of Engineering, dean of Peking Union Medical College of China Academy of Medical Sciences, expert in respiratory and critical care medicine, and the first special inspector of the State Supervision Commission, is one of the experts who actively participate in the treatment of severe patients. On February 1st, Wang Chen led a team to Wuhan. A few days later, in the program broadcast by CCTV, the academician, who is elegant and determined, calm and rational in speech and clear in thinking, left a deep impression on people.
It is a key measure to turn around the battle of defending Wuhan by promptly admitting the diagnosed mild patients to Fangcang Hospital for centralized treatment and isolation. On April 2nd, the team of Academician Wang Chen published a paper in The Lancet, sharing the construction and management experience of China Fangcang Hospital with the world.
A few days ago, our reporter had an exclusive interview with Academician Wang Chen.
The treatment of severe and critically ill patients is the key work at present.
Q: What is the focus of your work and that of the team after the "unblocking" in Wuhan?
Wang Chen: The treatment of severe and critically ill patients has always been the focus of my team and me. The team of China-Japan Friendship Hospital treated all critically ill patients, including some medical staff who were infected on business. I will care about and understand the rescue work carried out by the team every day. This is a team of respiratory and critical care medicine, which is very neat in staffing, so it has undertaken a lot of work in treating severe and critical patients. As the situation of epidemic prevention and control continues to improve, we have transferred the critically ill patients who were admitted to different hospitals to the national medical team composed of Concord, Beijing, China-Japan Friendship and other hospitals for treatment. At the same time, during this time, I also undertook the consultation work in hospitals such as Jinyintan and Raytheon Mountain.
There are many other key tasks. As the vice president of China Academy of Engineering and the dean of Peking Union Medical College of China Academy of Medical Sciences, these two jobs need to be completed by remote means during my stay in Wuhan. China Academy of Engineering, as one of the highest-level think tanks in China, and China Academy of Medical Sciences, as an important medical research institution in China, have undertaken a series of systematic work in epidemic prevention and control.
Q: Compared with when you first arrived in Wuhan, how do we know about Covid-19 now?
Wang Chen: At present, we have some preliminary knowledge about Covid-19, which has played a certain guiding role in epidemic prevention and control. However, our understanding of Covid-19 is far from enough, and the law of its transmission is not very clear. We must carry out key scientific research quickly, so that we can better grasp the law of diseases and carry out prevention and control more actively and scientifically.
Viruses have no borders. Although each country has its own characteristics, China’s experience has its reference significance. At present, we have done a lot of academic exchanges with European and American countries, including health policy exchanges, such as the European Respiratory Society, the American College of Respiratory Physicians, the Karolinska Medical College in Sweden and so on. We hope that through a series of important international exchange activities, we can share China’s wisdom and China’s experience in fighting the epidemic with our counterparts in other countries, and promote international cooperation in fighting the epidemic.
We must treat drug research with a strict scientific attitude.
Q: At present, we are conducting an epidemiological survey of serum antibodies. Why is this a key task at present?
Wang Chen: The central government has made arrangements for the leading group to deal with the epidemic situation, demanding that the scope of nucleic acid testing and serum antibody testing should be expanded in key areas, the detection rate should be improved, epidemiological investigations should be done well, infected people should be found in time, and the situation of asymptomatic infected people should be grasped. At present, we have made a complete technical scheme and detailed work manual. Through the epidemiological study of nucleic acid and serum antibody, we can further understand the transmission characteristics, epidemiological characteristics and pathogenic rules of the virus, provide scientific basis for perfecting the prevention and control plan, and reduce its possible infection risk.
What kind of trend will COVID-19 be, what kind of mutation will happen to the virus, whether there is a long-term chronic virus-carrying state, and what kind of situation are asymptomatic infected people and "relapse" patients? These are all issues that we are concerned about at present. To answer these questions, there is a lot of scientific research to be done, but one of the key research is to carry out epidemiological investigation of nucleic acid and serum antibody on the basis of scientific design, focusing on Wuhan and Hubei, including other parts of the country. Only in this way can we know how many antibodies have been produced, how long this antibody can last, how its changing trend is, and how long the antibody can provide protection, etc. Scientific answers to the above questions will play a positive and important role in perfecting the prevention and control strategy.
Q: Everyone is very concerned about which drugs are helpful to the treatment. How is the research progress in this regard?
Wang Chen: At present, we have carried out strict experiments and observations on some drugs, and recently we are close to the stage of solving blindness and producing results in drug trials. We expect to give an objective evaluation based on the research data about whether some drugs are helpful to the treatment.
It must be clear here that we are not sure whether these drugs are effective until the rigorous research results come out, including Remdesivir and chloroquine, which are very promising in the medical field. For example, in vitro experiment is effective and animal experiment is effective, but whether it is effective for human body is completely two concepts in medicine. It is very important to treat it with a strict scientific attitude.
Great happiness in health is to be able to breathe calmly and smoothly.
Q: It’s not the first time that you have stood at the forefront of epidemic prevention. During the SARS epidemic in 2003 and the influenza A (H1N1) epidemic in 2009, you served as the head of the clinical expert group in Beijing and the whole country. What is your biggest feeling after many wars and epidemics?
Wang Chen: First of all, we must fully realize that from specific epidemic prevention and response to new infectious diseases, especially respiratory infectious diseases, to the overall development of the country, health is one of the public utilities that the country needs to attach great importance to, which is related to people’s health and life safety, and to national security and social stability. After this epidemic, we have to make a profound summary.
Health care is still an important factor related to economic and social development. The people’s demand for health has great potential. It is very important to realize the strategic goal of healthy China by taking the medical and health industry as a major industry to promote economic and social development while developing the national health cause.
Q: You have worked in Beijing Chaoyang Hospital, Beijing Hospital, China-Japan Friendship Hospital, etc. In your opinion, how to better play the key role of hospitals in strengthening the construction of public health system?
Wang Chen: We must strengthen the construction of public health system and promote the integration of medical treatment and prevention. From the beginning of SARS, to the H1N1 flu, and then to the COVID-19 epidemic, it has proved this point. We must really promote the integration of medical care and prevention systems, rather than let them go further and further. From an international point of view, the prevention team is also dominated by medical institutions and medical personnel. If the hospital is only responsible for diagnosis and treatment, and the preventive function is separated from the hospital, this practice is to keep the hospital, the mainstream preventive force, out of it.
Prevention and cure are complementary and inseparable. For example, tertiary prevention, primary prevention is the so-called prevention of disease, prevention of diseases, such as eating less salt to prevent hypertension, smoking less to prevent lung cancer, and so on; Secondary prevention is mainly to prevent minor diseases and serious diseases; Tertiary prevention is to prevent patients from functional disability, pain and death caused by serious illness. Among them, secondary and tertiary prevention are all carried out in clinic, and medical staff can also play a key role in primary prevention. For example, there is a phenomenon that many people usually don’t listen to the propaganda of tobacco control, but when the doctor tells him to quit smoking, he is very interested. Therefore, only when the clinical system is highly integrated and consistent with the prevention system can the fundamental problem of prevention be solved. After the epidemic, we must strengthen the integration of prevention and treatment.
Q: As an expert in respiratory and critical care medicine, what new knowledge do you have about the development of respiratory science after this epidemic?
Wang Chen: After this epidemic, we fully realized the importance of developing the respiratory discipline. Looking back on all the major public health incidents, both SARS and COVID-19 were transmitted through the respiratory tract, and the problems were mainly in the lungs. The respiratory discipline undertook the most important task of diagnosis and treatment.
In the future, I hope to pay more attention to and attach importance to the development of respiratory science. The modern discipline development pattern of respiratory discipline is respiratory and critical care medicine. From the perspective of infectious diseases, the most terrible, most significant and subversive public health events are respiratory infectious diseases; From the point of view of common diseases, respiratory diseases are the largest systemic diseases from children to the elderly. In pediatrics, 70% are respiratory diseases, and 80% of elderly patients die of respiratory infection and respiratory failure. According to the disease burden, respiratory diseases, including chronic obstructive pulmonary disease, asthma, pneumonia, lung cancer, tuberculosis, pneumoconiosis, pulmonary embolism and cor pulmonale, are the biggest disease burden.
The greatest happiness of life in health is to be able to breathe calmly and smoothly. We may not think it is precious at ordinary times, but in fact, the most uncomfortable symptom of all is holding your breath, that is, difficulty breathing, which is related to the feeling of dying. Respiratory discipline is related to the national economy and people’s livelihood, social stability and national security, and it is a major discipline that must be developed well.
The success of medical education should be brilliant in its prospects and strict in its process.
Q: You have been studying medicine for 40 years. How can you become a good doctor?
Wang Chen: First of all, kindness. I think this is the first accomplishment of doctors. When a kind person becomes a doctor, he will naturally embody the spirit of humanity in the process of treating patients. In order to treat patients better, he must improve his medical skills, that is, he must have scientific literacy, and he must devote himself to the work of studying, researching and developing medicine. Only with kindness can you really be a good doctor in the hospital, which is the place where you can see the most floating beings and life. This is what the so-called doctor’s benevolence says.
The second is scientific cognition and research ability. As a medical worker, if you want to be optimistic about the disease, you must rely on the accumulated medical experience. This accumulation is not a simple accumulation of sporadic cases, but a result of thinking and summing up. This process is actually the embryonic form of scientific research. Medicine is a complex subject to study life and prevent and treat diseases, which requires every medical worker to reveal the mystery of life through scientific research and promote the continuous progress of medicine. By participating in scientific research, medical personnel can become the masters and users of the most advanced scientific and technological methods, and patients can become the beneficiaries of the doctor profession.
Then there is humanistic accomplishment. Learn to communicate well with patients and society. We should pay attention to caring for patients psychologically and spiritually.
As the president of Peking Union Medical College, I should not only teach in the epidemic, but also pay attention to protecting students from infection. At the same time, through this epidemic, it is necessary to cultivate students’ feelings about home and country, and to stimulate and strengthen their sense of mission. These are all things that schools need to do to train good doctors.
Q: How do you think China’s medical education should be adjusted and improved after this fight against the epidemic?
Wang Chen: This epidemic shows that the medical education system in our country is still relatively weak. On the one hand, we can see the noble professionalism of medical staff, on the other hand, we should also see the shortcomings of doctors and nurses with higher standards. If the society can set up a better mechanism to attract more outstanding talents to engage in doctors and nurses in the future, it will bring great health and well-being to the people.
Whether in urban or rural areas, developed or poor areas, people’s lives are the first, and efforts should be made to improve the quality of local medical staff. We must devote more social resources to attract outstanding talents to study medicine and strengthen the training of medical personnel, so that we can really serve people’s health well.
In recent years, we have run many medical colleges and attracted a large number of students to apply for medical majors. The number has increased, but the quality needs to be improved. Therefore, we must try our best to improve the attractiveness of medical colleges and universities, strictly control the quality of education in medical colleges and universities, and truly improve the career prospects of doctors and nurses in terms of economic treatment and social status.
Q: You have emphasized on many occasions that medicine is the most lovely profession, occupation, industry and career. What should a successful medical education be like?
Wang Chen: The success of education depends on two major elements, namely, "brilliant prospects and strict processes". Medicine is one of the greatest industries in human society, because it is connected with human health and life. Therefore, it is necessary to attract the best talents to receive the best medical education. This is the value orientation that modern civilized society should have.
After the epidemic, I also hope that the whole society will not forget this point: our health and life must be maintained by the best medical staff. Therefore, we must do a good job in medical education and take care of the career development of doctors and nurses. In terms of medical education and career prospects, only by truly brilliant prospects and strict processes can we truly cultivate medical talents who can care for people’s health and life with high quality and high level.
Discipline inspection and supervision, like medicine, should be carried out at the same time.
Q: You are a doctor and a special inspector of the State Supervision Commission. What suggestions do you have for discipline inspection and supervision?
Wang Chen: As the first special inspector of the State Supervision Commission, from my own experience and thinking, there are indeed some serious problems of formalism and bureaucracy in reality, some of which are manifested as inaction, and some regard the power that should serve the country and the people as the power of individuals or departments, and even become a means of self-interest. In the communication with other special inspectors, everyone has a prominent view that the discipline inspection and supervision organs should not only effectively supervise and investigate violations of law and discipline, but also strengthen the supervision of cadres’ laziness and inaction.
In addition, how to take responsibility for those who are willing to take responsibility is also a problem that needs to be studied at present. Like medicine, we should pay attention to "strengthening the body resistance" while "eliminating evil spirits", and these two aspects must be carried out at the same time. In this way, discipline inspection and supervision will better safeguard and embody social fairness and justice, and help to form a more effective modern social governance system.
Representative work 3:
Interview with Academician Tong Xiaolin before he was cured by medical treatment.
Our reporter Wang Shaowei Chai Yaxin
More than 2,000 years ago, Huangdi Neijing put forward: "Medical treatment before illness, Chinese treatment for craving, and lower treatment for illness." In an interview with this reporter, Tong Xiaolin, an academician of China Academy of Sciences and chief researcher of Chinese Academy of Traditional Chinese Medicine, who just returned to Beijing from Wuhan for treatment, said that the idea of "preventing diseases" in traditional Chinese medicine runs through the whole process of prevention, treatment and rehabilitation in COVID-19.
Since he entered Changchun College of Traditional Chinese Medicine (now Changchun University of Traditional Chinese Medicine) in 1978, Tong Xiaolin has been dealing with Chinese medicine for 42 years. As the leader of the medical treatment expert group in state administration of traditional chinese medicine, Wuhan’s anti-epidemic experience has made Tong Xiaolin have a deeper understanding of the terms doctor, traditional Chinese medicine and doctor of traditional Chinese medicine. "To be a doctor, you must protect people with medical spirit, medical ethics, medical ethics and medical skills."
Prevention before illness, prevention after illness, and prevention after illness
Q: You have mentioned many times that you hope more people will understand the idea of "preventing diseases" in TCM. How is the Chinese medicine "preventing disease" reflected in this epidemic?
Tong Xiaolin: TCM’s "prevention of disease" is embodied in three aspects, which runs through the whole process of prevention, treatment and rehabilitation in COVID-19. The first is "prevention before illness". This is aimed at a large number of suspected patients who are isolated at home and people who have symptoms such as fever and fatigue, and provides them with general treatment, which has played a role in eliminating symptoms and preventing the onset.
The second is "prevention of disease". Let light patients take traditional Chinese medicine at the first time to prevent them from turning into severe cases, and when patients reach severe cases, use traditional Chinese medicine with western medicine to treat them, thus reducing death. We carried out research in Wuhan Hospital of Integrated Traditional Chinese and Western Medicine, and found that the mortality rate of severe and critically ill patients in the decoction group of traditional Chinese medicine decreased by more than 80%, which proved that traditional Chinese medicine had the effect of "preventing diseases from changing".
The third is "defense after defense." Traditional Chinese medicine has advantages in promoting rehabilitation. In particular, non-drug therapies, such as moxibustion and cupping, as well as Wuqinxi and Baduanjin, can effectively prevent the recurrence of old diseases or other diseases. The project of the recovery period of the Ministry of Science and Technology that we undertake has just been carried out, and a lot of data have yet to be counted, but the initial effect has already appeared.
Q: How can the idea of "preventing disease" be applied to the specific diagnosis and treatment plan?
Tong Xiaolin: First of all, according to the nature and characteristics of the disease, I worked with front-line experts to formulate and revise the national TCM diagnosis and treatment plan, providing guidance for the front line and suggestions for the national judgment. Now, the diagnosis and treatment plan has been updated from the third edition to the seventh edition. On the basis of extensively absorbing the experience from all over the country, a series of highly targeted and effective clinical treatment methods including "three drugs and three parties" have been innovatively summarized, which has greatly improved the curative effect of treating COVID-19 with integrated traditional Chinese and western medicine. The second is to promote the prevention and control of traditional Chinese medicine in the community, draw up the general prescription of traditional Chinese medicine, and create the "Wuchang model" of "general prescription+community+internet" to stop the spread of the epidemic at the source. The third is to promote the treatment of integrated traditional Chinese and western medicine in designated hospitals. The statistical analysis of the treatment results of 1476 inpatients in Wuhan Hospital of Integrated Traditional Chinese and Western Medicine shows that the risk of death in the decoction group of traditional Chinese medicine decreased by 87.7%. The fourth is to arrange the intervention in recovery period in advance, guide Hubei Provincial Hospital of Traditional Chinese Medicine to set up the first rehabilitation clinic in China and take the lead in setting up the national rehabilitation clinic cooperation network.
The key is to find out the nature of the disease. In Huangdi Neijing, it is said, "Look at the color and pulse, don’t be yin and yang first." I went to Wuhan on New Year’s Eve, and it was raining lightly, which was very wet and cold. After dinner, I walked in the yard for more than an hour. There is no heating in Wuhan citizens’ homes, so I also turned off all the air conditioners and opened the windows that night to understand what the onset environment of this disease is and how Chinese medicine should treat it.
Early the next morning, after watching the pulse and tongue pictures of a large number of patients in Wuhan Jinyintan Hospital, I had a basic judgment: COVID-19 was suffering from a cold-dampness epidemic.
Q: Chinese medicine emphasizes syndrome differentiation and treatment. How to apply it flexibly according to the actual situation?
Tong Xiaolin: Different strategies are adopted in different situations. There are many patients and few Chinese medicine practitioners, so it is unrealistic to feel the pulse one by one. The Yellow Emperor’s Internal Classic says, "When the five epidemics arrive, they are all susceptible to each other, regardless of the size, and the symptoms are similar." When a plague is prevalent on a large scale, it has its regular characteristics. Grasping the main rules and treating the prescription with drugs can get twice the result with half the effort. Therefore, on the basis of the main prescription, we have drawn up four modified prescriptions for symptoms such as fever, cough and asthma, anorexia, shortness of breath and fatigue, and used drugs as individually as possible. "Flood irrigation" plus "precise drip irrigation", treating the same disease together with syndrome differentiation, and tongzhi prescription is a flexible embodiment of syndrome differentiation and treatment.
After making the basic judgment that COVID-19 is suffering from the epidemic of cold and dampness, I combined with the symptoms of cough, fever, loss of appetite, fatigue, diarrhea and so on, and finally determined that the main disease sites of this disease are the lungs and spleen, established the treatment principles of dispersing lung qi and removing dampness, detoxicating and dredging collaterals, and formulated a general treatment prescription-Cold and Damp Epidemic Prescription (Wuhan No.1 Anti-epidemic Prescription) composed of more than 20 kinds of Chinese medicines such as betel nut and stewed grass fruit, which was widely used.
The emergency response ability of traditional Chinese medicine in major public health events has been greatly improved.
Q: You participated in the prevention and treatment of epidemic hemorrhagic fever in 1970s and 1980s and SARS in 2003. Can you tell us about the role of Chinese medicine in it?
Tong Xiaolin: In the 1970s and 1980s, epidemic hemorrhagic fever broke out in northern Jiangsu. I spent three years as a doctor from 1985 to 1988, basically fighting hemorrhagic fever. At that time, there were many patients with epidemic hemorrhagic fever, and the initial mortality rate was also high, exceeding 10%. I followed my tutor, Mr. Zhou Zhongying, to treat hemorrhagic fever according to "epidemic febrile disease" and treated a large number of severe patients such as high fever and acute renal failure. Later, the mortality rate dropped to more than 1%, and I accumulated a lot of experience in diagnosis and treatment of severe and critical diseases.
During the fight against SARS in 2003, I was in the China-Japan Friendship Hospital. China-Japan Friendship Hospital is a temporary SARS hospital designated by the State Council. I served as the head of the hospital’s treatment of traditional Chinese medicine and integrated traditional Chinese and western medicine, and treated 248 SARS patients. I also sent him out of the hospital for the last SARS patient. In addition to treating more than 200 patients with integrated traditional Chinese and western medicine, we also treated 11 patients with pure Chinese medicine. Based on the plague theory of traditional Chinese medicine, we have created a differential treatment scheme of "SARS- lung toxic epidemic in four stages and eight directions", and at the same time we do not use glucocorticoid, antiviral drugs, immunomodulators and antibiotics. Facts have proved that the curative effect of traditional Chinese medicine is very ideal, symptoms such as fever and cough and asthma have been significantly improved, and the course of disease has been shortened, and 11 patients have been successfully treated. We wrote a case report, which was included in the report of WHO’s Clinical Trial of Treating Severe Acute Respiratory Syndrome with Integrated Traditional Chinese and Western Medicine.
Q: Why can Chinese medicine play a greater role than before in the fight against the COVID-19 epidemic?
Tong Xiaolin: Personally, with the previous two anti-epidemic experiences, I feel more confident this time. In this epidemic, I am not only an assault soldier, but also the leader of the expert group of traditional Chinese medicine. I need to think about the problem from a macro level and grasp the direction of diagnosis and treatment as a whole, which is different from the previous two times.
Compared with the previous two times, the emergency response ability of Chinese medicine in major public health events has been greatly improved, and Chinese medicine intervened earlier, and for the first time, the whole system took over the ward, and for the first time, Chinese and Western medicine made joint rounds and rounds in the whole process, and deeply intervened in the treatment of severe and critically ill patients for the first time. This first benefited from our country’s principles and policies of paying equal attention to Chinese and Western medicine and combining Chinese and Western medicine, which played a decisive role. Chinese medicine is involved in the first time, and patients are given Chinese medicine in the first time-this is a model that can be used for reference in dealing with new and sudden major infectious diseases in the future.
To be a doctor, you must protect people with medical spirit, medical ethics, medical ethics and medical skills.
Q: Your mother is also a doctor. Did you choose to be a doctor because of your mother?
Tong Xiaolin: My mother used to be a war doctor, who braved bullets to treat the wounded on the battlefield to resist US aggression and aid Korea. Off the battlefield, in the weather of MINUS 20-30 degrees in winter in Northeast China, whenever I hear a call for home visits, my mother will also carry the medicine box on her back against the cold for the first time. Although she was born in western medicine, she taught herself acupuncture and experienced the feeling of needles over and over again in her own body in order to cure diseases and save lives better. My mother’s words and deeds influenced me imperceptibly, so my ambition to study medicine was set long ago. When I was in the third grade of primary school, I wrote "Be a Bethune-style doctor" in an essay.
In 1978, I went to Changchun College of Traditional Chinese Medicine. At that time, my whole family was very happy. Studying medicine was not only my ideal, but also my parents’ expectation.
Q: What kind of influence did your TCM tutors, Mr. Zhou Zhongying and Mr. Li Jiren, have on you?
Xiao Lin: The medical ethics and academic spirit of several gentlemen have a great influence on me. They are my guides. I still remember that shortly after I entered the university, I went to the library to borrow books and met an old gentleman. He recited 28 meridians verbatim in front of me, and then recited 14 meridians and 8 strange meridians from beginning to end. I was shocked at that time. This old gentleman is my first teacher in the future-Mr. Chen Yufeng. Chen Lao’s theoretical foundation of Chinese medicine is solid, and his explanation is simple, and my foundation of Chinese medicine has been laid down since then.
After that, I studied Huangdi Neijing with Mr. Li Jiren in Southern Anhui Medical College. Li Lao was the first master of traditional Chinese medicine. He taught me that the basic theory should be closely combined with clinic, and also made me realize that dosage is the key to affect the curative effect of traditional Chinese medicine. Mr Zhou Zhongying is an expert in treating acute and critical diseases, and I am his first doctoral student. He inspired me in the pathogenesis theory and provided me with a direction to study the prescription strategy of "state target causality"
Q: From 1991 to 1994, you were a visiting professor at Kumamoto University in Japan. The Japanese side wanted to keep you at a high salary, but you decided to return to China. How was it considered at that time?
Tong Xiaolin: The reason for returning to China is very simple. I am a Chinese medicine practitioner trained by the state. The unit needs it and the country needs it. Of course, I will come back.
After returning to China, I took over the post of director of the Department of Stroke and Miscellaneous Diseases in the China-Japan Friendship Hospital. The first thing I did after taking office was to propose the establishment of the Department of Diabetes in Chinese Medicine, which was regarded as the "first initiative" in China. At that time, the field of integrated traditional Chinese and western medicine recognized that Chinese medicine could only assist in reducing blood sugar, and I firmly believed that Chinese medicine should have its own doorway to treat diabetes. Aiming at the blank of TCM theory and practice in the early and middle stages of diabetes, we put forward a series of therapies and prescriptions with "relieving depression and clearing heat" as the core, and finally obtained high-level evidence-based evidence of independent hypoglycemic effect of Chinese herbal compound, which broke the query that "Chinese herbal medicine cannot independently hypoglycemic".
Q: You once said that "as long as you are a doctor for one day, you must be careful for the patients". What do you think of the profession of doctors?
Tong Xiaolin: Doctors cure diseases and save lives. I have been working hard to complete every diagnosis and treatment with a demanding attitude and grow into a doctor with quick thinking, profound knowledge, responsibility and achievements in the process of continuous improvement. All medical staff will have this sense of responsibility and mission. Patients need you, no matter how dangerous the environment is, they must be ahead. This is the responsibility of doctors.
I am proud of being a doctor of traditional Chinese medicine, which also means a heavy responsibility. The patient entrusts his life to you, so you have to pay 100% attention and medical skill, and at the same time try your best to be careful for the patient. The characteristic advantage of traditional Chinese medicine is "simple and inexpensive". If you can’t prescribe it without a big prescription, why not spend the least money to cure the disease? To be a doctor, you must protect the whole life with medical spirit, medical ethics, medical ethics and medical skills.
We should learn from, solve and stand on our own feet.
Q: You have been dealing with Chinese medicine for 42 years. Do you have any special experience in studying and studying Chinese medicine?
Tong Xiaolin: Learning Chinese medicine means hard work. Others spend an hour, and I spend an hour and a half or even two hours. I remember when I was in graduate school, I often studied outside in the middle of the night. There are many mosquitoes in the mountainous areas of southern Anhui in summer, so I wear a pair of rain boots to prevent biting.
I think the key to the research of TCM is to deal with the relationship between "keeping the right" and "innovation". "Keeping the right" should have correct ideas, correct thinking and correct culture, while "innovation" should have original ideas on the basis of predecessors, have doubts and even set foot in areas that have not been studied by predecessors. Every step of scientific breakthrough is "no man’s land". The real innovation is not to follow other people’s standards, but to explore and formulate standards.
The collision of different viewpoints is more conducive to the development of traditional Chinese medicine, and I encourage students in this way. It is better to believe in books than to have no books. We should learn from them, solve problems through them, and stand on our own feet through them. We should melt the study and thinking of Chinese medicine into our lives, constantly metabolize it, and get rid of the old and absorb the new.
Q: Why do you propose to promote rehabilitation clinics and community rehabilitation stations in COVID-19 during the recovery period? Why is a healthy community important?
Tong Xiaolin: We have counted more than 600 patients, and found that there are 14 main symptoms in convalescent patients, such as cough, chest tightness, shortness of breath, fatigue, insomnia, etc. These symptoms will greatly affect the quality of life and health of rehabilitation patients, so from mid-February, I began to lay out and promote the establishment of community rehabilitation stations and hospital rehabilitation clinics. This is like a buffer zone, which can help reduce the resistance of discharged patients in COVID-19 to return to normal life.
A healthy community is an important part of a healthy China. The Wuchang model, which is characterized by the prevention and control of community Chinese medicine, came into being under the special situation of epidemic situation, but it has a good enlightenment to the construction of the whole public health system in the future.
Q: What are your thoughts and suggestions on the future development of integrated traditional Chinese and western medicine and Chinese medicine?
Tong Xiaolin: In the 21st century, modern medicine faces six challenges: senile diseases, chronic diseases, metabolic diseases, cardiogenic diseases, drug-induced diseases and sudden plagues. If overcoming the needs of infection, trauma and first aid creates an opportunity for the development of modern medicine, the six major medical challenges in the 21st century are the opportunities given to Chinese medicine by the times. Mutual borrowing, complementarity and mutual development are the basic process of the integration of Chinese and western medicine in the future, and self-confidence, self-reliance and self-improvement are the essential qualities that Chinese medicine practitioners must have. Facing difficulties and following the trend, the ancient Chinese traditional medicine will surely show its talents in the new era.
Liu Ye