Re: [問卦] 中醫狂粉的小孩是不是很可憐？

※ 引述《DaiRiT (QSOFA)》之銘言：
: ※ 引述《lepputte (華英成秀)》之銘言：
: : 如果你嫌它舊，keyword都有了，其實你應該也有能力查新的，
: : 叫我一個中醫不停地上pubmed查英文期刊給你
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
: : 我真心覺得累。
^^^^^^^^^^^^
: 專門回一篇砒霜/三氧化二砷的歷史跟你說明
: 因為你寫的太奇怪，中醫理論沒有癌症或白血病的概念，怎麼可能會有用砒霜治療癌症/: 白血病的開端
科學的方法是這樣說的
科學方法涉及到很多步驟，首先，需要觀察大自然並且對於自然現象提出有意義的問題，然後再想出假說來解釋自然現象，之後設計實驗來檢驗這些假說，核對從這些假說所給出的預言是否正確無誤。為了要防範在做實驗時發生錯誤或誤解，這些步驟必須具有可重複性。一個假說在被學術界廣泛接受之前，必須先通過科學方法的嚴格驗證，以有條有理的方式來將理論結果與實驗數據互相比較。只有當理論結果和實驗數據互相吻合時，這假說才能被學術界接受。

科學的討論是這樣幹的
1.列出你看到的文獻，好好的閱讀
2.提出你的假說來解釋當下的現象
3.然後繼續查文獻(如果你沒辦法做實驗)或設計實驗(如果你有能力)來驗證你的假說
4.保持中立的態度，思考別人(實驗/所查文獻)與你衝突的地方
5.與別人溝通，解決中間的歧異
6.如果無法否定對方的實驗/文獻，讓兩種說法並存。

你....唉~~ 你知道為什麼我有時候只能默默的靜靜的看你裝逼嗎?
不是說你講的完全都錯，其實你講的有些東西我也蠻認同的，中醫確實該進步改變

因為你已經先有預設立場
(因為你寫的太奇怪，中醫理論沒有癌症或白血病的概念，
怎麼可能會有用砒霜治療癌症/白血病的開端)

然後完全看不到你自己看不到的東西，

別人看到了，提醒你，你仍舊照你自己的想法依然故我

於是我只好悲情的再點一下你。

我只是要讓你有點醒悟，其實我本意不是要跟你吵架，

請原諒這次，我只好打醒你。

回去看一下我給你的2005年review，我給你看的文章

In traditional Chinese medicine, the arsenic trioxide (As2O3) form of
arsenicals has been used thousands of years in the treatment of a great
variety of illnesses, including cancers, and in Western medicine it has
been used in the last decades to treat chronic myeloid leukemia and
was known as Fowler’s solution. However, due to toxic side effects of

Thousands of years 也不一定是千年都拿來治癌症，但你好歹去念一下中醫文獻

因為你想一下吧，中醫文獻又不會翻譯成英文給外國人看，你是不是該科學一點，

先廣泛蒐羅證據，再來提你的想法呢？

好吧，大家都忙，沒時間這樣幹。

不然就去看一下當初拿砷劑治療APL的那個中國醫師到底是怎麼想，怎麼啟發的。

(假如你很喜歡唸英文，不喜中文尤其是中醫的中文)
那不然至少去讀一下我給你的文章，OK？

Fowler's solution需要你再去查嗎? 我給你的文章不就有了嗎?

long-term intake of high doses of oral arsenic and with the advent of
modern radiotherapy and chemotherapy, treatment for CML with arsenic
However, due to toxic side effects of long-term intake of high doses of oral
arsenic and with the advent of modern radiotherapy and chemotherapy,
treatment for CML with arsenic was given up in Western medicine.
對，2005年的last decades, 就有了，也拿來治癌症了，但你看到這句了沒?

因為長期服用的高毒性以及現代放療化療的進步，所以西醫放棄砷用來治療CML.

A recent renaissance of arsenic trioxide (ATO) came about,
following the discovery in China of its therapeutic effect in acute
promyelocytic leukemia (APL) which revived the interest in this ancient drug.最後是在中國醫師治療APL重新興起使用ATO治療....

: 於是我就查了一下，查到一些史料，其中一篇是在American society of hematology美國史料...嗯...1997年的叫史料

2005年的review叫舊資料

: 血液科期刊一位讀者給編輯的回信
: Delicious Poison: Arsenic Trioxide for the Treatment of Leukemia
: Y.L. Kwong, D. Todd
: Blood (1997) 89 (9): 3487.
: To the Editor:
: Lately, arsenic trioxide (As2O3 ) has been described in the treatment of acute: myeloid leukemia. Experiments in vitro showed that As2O3 induced the acute pr: omyelocytic leukemia (APL) cell line NB4 to downregulate bcl-2 expression, as: well as to undergo apoptosis. Clinically efficacy has been shown in 14 of 15 p: atients with relapsed APL, where the use of intravenous As2O3 at a dose of 10: mg/d for 4 to 9 weeks resulted in complete morphologic remission without assoc: iated bone marrow suppression. In these cases, partial differentiation of the: APL cells and downregulation of the fusion protein PML/RARα could also be sho: wn, which might account for the pharmacologic action of the drug.
: Arsenic has been known to be poisonous for centuries. Medicinal use of arsenic: began in the 15th century. In the 18th century, Dr Thomas Fowler developed a: solution preparation of As2O3 in potassium bicarbonate (1% wt/vol), known gene: rally as Fowler's solution, which was used empirically for the treatment of a感謝補充啊， 先不提我給你2005年review你K我說給你舊資料，
結果你給我1997... 你知道我都快暈倒了嗎?
好吧~~反正你就是這樣，我其實也知道。

你先看一下它用多濃，(你要不要去查看看，ATO 如果是口服治療APL 吃多少？)

所以毒性太強，沒辦法用了，放棄了，看到了嗎?

: variety of infectious and malignant diseases. The effect of Fowler's solution: on the reduction of white cells in two normal people and one patient with “l: eucocythemia” studied at Boston City Hospital, MA was first described in 1878: .
: This lead to the use of As2O3 for the treatment of leukemia, until the advent: of radiotherapy caused a decline in its clinical application. Its popularity不唸我給你的

這你自己查的文章，可以好好念嗎?

: waxed again when Forkner and Scott, also at Boston City Hospital, described ni: ne of 10 patients with chronic myeloid leukemia (CML) who responded to As2O3 t: reatment. These results were subsequently confirmed by other reports, so that: As2O3 was considered next to irradiation as the most effective treatment of CM: L before the development of modern chemotherapy. Clinical improvement of the l: eukemia, including the control of fever, reduction of white cell count, amelio: ration of anemia and decrease in the size of spleen, could often be achieved.: Sometimes, a remission might be maintained for a long period. As expected, tox: ic side effects were observed in the majority of patients given long-term As2O: 3 , including skin pigmentation and keratosis, cirrhosis, polyneuritis, and ga: strointestinal problems. In this department, As2O3 was used by hematologists i: n the 1950's for the treatment of a variety of leukemias. Figure 1 shows the t: ypical course of a patient treated with As2O3 for CML in chronic phase. As As2: O3 appeared to be effective for leukemias of different morphologic types, thea: ction was probably related to an intrinsic toxicity of arsenic to marrow cells: .
: 後面還有一個個案討論跟藥物幾轉討論，總之三氧化二砷在西方從15世紀就有了，到了18: 世紀，Dr Thomas Fowler用三氧化二砷跟碳酸氫鉀溶液調配出Fowler’s solution，這個: 福肋溶液會經驗性拿來治療感染疾病跟惡性疾病，後來在波士頓醫院有醫師報導關於三氧: 化二砷在白血病(還包括CML)的效果。
: 中途查了APL的發展史，是在1957年：APL was first described in 1957 by the Norweg: ian hematologist Leif Hillestad[1]
: 然後我就去查這個福肋溶液跟「砷治療」，有關歷史上的治療，寫說拿來治療瘧疾、梅毒: 和非洲錐蟲，裡面也有寫到中國研究三氧化二砷在APL的治療，最後是美國進行RCT被FDA: 認證為APL治療之一[2,3]
: 總結：砒霜/三氧化二砷拿來治療血癌是西方有、兩百年以前就開始有的，拿砒霜/三氧化: 二砷治療白血病不是中國開始的，中醫也沒有血球、白血病概念，而且是西醫先有AML分你再想想我跟你講的，

至少去查一下APL那個醫師是怎麼啟發，重新使用砷劑的

然後他看到甚麼文獻.... 那個文獻是甚麼時代的。

理論上這應該是我要查給你，但是....我讀了好多英文，可以拜託你念一下中文文獻嗎?

而且我很傷心，我查給你的英文，你都不好好念。讓我覺得

我本真心向明月，奈何明月照溝渠

: 型和APL研究成果。説拿砒霜治療血癌是由中醫導入有點牽強。
好吧，講到這裡你覺得我說的話，有問題?
如果你很堅持你看到的文獻，Fowler先，OK我接受，

畢竟中醫文獻沒有先發journal所以先者為王。

那我修正成
拿砒霜治療血癌由 中國醫師(也不要寫中醫，免得你說自己貼金) 復興可以嗎?

: 話說我也是有查到資料寫說中醫用砒霜治療肺結核、梅毒等等，但是中醫理論無法診斷肺: 結核和梅毒啊，這存在邏輯上的bug。
Fowler's solution也有被拿去治療梅毒.... 砷劑治療梅毒這可是中西方都有。

: Reference:
: 1. Thomas, X. Acute Promyelocytic Leukemia: A History over 60 Years—From the: Most Malignant to the most Curable Form of Acute Leukemia. Oncol Ther 7, 33–6: 5 (2019). https://doi.org/10.1007/s40487-018-0091-5
: 2. Antman KH. Introduction: the history of arsenic trioxide in cancer therapy.: Oncologist. 2001;6 Suppl 2:1-2. doi: 10.1634/theoncologist.6-suppl_2-1. PMID:: 11331433.
這篇，也是你查的，
我列一下abstract

Arsenic is a natural substance that has been used medicinally for over 2,400
years. In the 19th century, it was the mainstay of the materia medica. A
solution of potassium arsenite (Fowler's solution) was used for a variety of
Fowler's solution 又出現了

systemic illnesses from the 18th until the 20th century. This multipurpose
solution was also primary therapy for the treatment of chronic myelogenous
leukemia until replaced by radiation and cytotoxic chemotherapy. The past 100所以又再一次地說治療CML被化療和放療取代了

years have seen a precipitous decline in arsenic use and, by the mid-1990s,
the only recognized indication was the treatment of trypanosomiasis. Much of
後來砷劑唯一被認可的適應症是治療熱帶疾病trypanosomiasis

this decline was due to concerns about the toxicity and potential
carcinogenicity of chronic arsenic administration. The rebirth of arsenic
therapy occurred in the 1970s when physicians in China began using arsenic
trioxide as part of a treatment for acute promyelocytic leukemia (APL). Theiraccumulated experience showed that a stable solution of arsenic trioxide
given by intravenous infusion was remarkably safe and effective both in
patients with newly diagnosed APL leukemia and in those with refractory and
relapsed APL. The mechanisms of action of arsenic derivatives in this disease 1970年中國醫師復興
一開始是口服，我其實前面文章有簡單跟你提一下

但這裡復興開始改成靜脈注射，

我想你會說靜脈注射不是中醫的，中國醫師也不是中醫....
我也不要一直強調中醫好了，這樣你可能會稍微理性一點。
ATO又開始繞回口服，我之前查給你的就是這種的randomized trial

我可是一直都邏輯一致嗎? 現在的醫學是中西不分，互相啟發滲透。
所以才需要好好討論，看能不能彼此啟發。

不過，要討論前，先不要預設立場，先讀一下別人給你的文章，
不然也自己好好讀一下自己查的文章。

我也不是要給你打臉，

我只是要點一下你的態度，理性一點，科學一點，多聽聽別人在說甚麼。

學習一下怎麼跟別人溝通，ㄟ，應該是學習怎麼跟你"瞧不起的人"溝通。

愚者千慮，還必有一得

不要太過強勢聽不進去別人講的，急診是需要當下決斷沒錯，但不要變成職業病

我去run過急診，知道我自己不適合，但很敬佩別人做到我沒做到的。

一直覺得急診醫師很帥氣，影集看不少。

我想你在自己崗位上應該很優秀的，畢竟你認真回文。

一個認真努力的人到哪裡都是受人尊重的

and other malignancies are many and include induction of apoptosis, partial
cytodifferentiation, inhibition of proliferation, and inhibition of
angiogenesis. Molecular studies and ongoing clinical trials suggest that, as
a chemotherapeutic agent, arsenic trioxide shows great promise in the
treatment of malignant disease.

不要覺得丟臉，智者千慮，總會一失。

沒人能保證自己永遠正確，所以，討論的意義也在這裡。

看到自己沒看到，想到自己沒想到的，然後讓討論的雙方都成長。

不要受你情緒影響，不要急著反駁，

你再想想，我想告訴你的。

這樣也不枉費我，花了這麼多時間，跟你討論。

我希望你是能溝通的人，

因為不能溝通的，

我真的只能默默，

給予祝福。

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