Re: [問卦] 中醫狂粉的小孩是不是很可憐？

※ 引述《lepputte (華英成秀)》之銘言：
: 2005年的review我幫你標黃的，
: 是要告訴你砷劑最早在用在治療癌症，是從中醫那邊繞進西醫的。
: 結果你質疑說那篇太舊......
: 你有注意到那個開頭的24篇參考文獻是
: Science, Blood, NEJM....
: 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

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 promyelocytic leukemia (APL) cell line NB4 to downregulate bcl-2 expression, aswell as to undergo apoptosis. Clinically efficacy has been shown in 14 of 15 patients with relapsed APL, where the use of intravenous As2O3 at a dose of 10mg/d for 4 to 9 weeks resulted in complete morphologic remission without associated bone marrow suppression. In these cases, partial differentiation of theAPL cells and downregulation of the fusion protein PML/RARα could also be shown, 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 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 “leucocythemia” 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 popularitywaxed again when Forkner and Scott, also at Boston City Hospital, described nine of 10 patients with chronic myeloid leukemia (CML) who responded to As2O3 treatment. These results were subsequently confirmed by other reports, so that As2O3 was considered next to irradiation as the most effective treatment of CML before the development of modern chemotherapy. Clinical improvement of the leukemia, including the control of fever, reduction of white cell count, amelioration 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, toxic side effects were observed in the majority of patients given long-term As2O3 , including skin pigmentation and keratosis, cirrhosis, polyneuritis, and gastrointestinal problems. In this department, As2O3 was used by hematologists in the 1950's for the treatment of a variety of leukemias. Figure 1 shows the typical course of a patient treated with As2O3 for CML in chronic phase. As As2O3 appeared to be effective for leukemias of different morphologic types, theaction 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 Norwegian 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。

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。

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, 33–65 (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.
3. Ho D, Lowenstein EJ. Fowler's Solution and the Evolution of the Use of Arsenic in Modern Medicine. Skinmed. 2016 Aug 1;14(4):287-289. PMID: 27784519.

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沒看過什麼西醫狂粉，中醫狂粉多很多

※ 編輯: DaiRiT (39.10.102.111 臺灣), 07/15/2021 18:01:21