Research on microecological medicine as a clinical medicine discipline Scientists had begun to study human microecology before the end of the 19th century, but progress was slow in the following half century and had little impact on the development of medicine. In the 1940s, the outbreak of World War II accelerated the large-scale production and global application of antibiotics, but the widespread use of antibiotics, while saving a large number of lives, also destroyed the human microecology. At the same time, the huge impact of modern urbanized lifestyles and dietary structures has exacerbated the damage to the human microecology. Research since the 1990s has gradually shown that diseases ranging from infection, inflammation, malnutrition to tumors are all closely related to the human microecology, which adds a new dimension to the understanding of medicine and life sciences. A series of breakthrough technologies have been born by targeting the human microecology for the diagnosis and treatment of diseases, especially in the key advances in microbiome sequencing technology, multi-omics integrated mining technology, and fecal microbiota transplantation methodology development, which are changing clinical practice. However, the number of people actually benefited by the emerging microecological technology is far from the number of people who should benefit in theory. If these microecological technologies are only used, promoted and developed in the current form, the entire field will face bottleneck constraints. Technological thinking, technology-related utilitarian behavior, and some narrow behaviors driven by commercial activities will generate high costs and cause medical inequality. The excessive use of technology will lead to technical ethics and technical morality issues, which may in turn create traps for the development of the field. Solving these bottleneck problems and avoiding these possible traps is inseparable from a scientific framework that is higher than the existence of technology. The answer is to develop the discipline of microecological medicine. This article aims to propose and explore the discipline concept and dimension of microecological medicine, hoping to build a new clinical medicine discipline based on the essence of medicine, and develop its theory, medical technology and medical education. I. The significance of microecology and its technology to the development of medicine (I) Microecological destruction faced by humans In the past 100 years, the global use of drugs such as antibiotics, the popularity of Western diets, the great changes in lifestyles, the development of industrialization, etc., have continuously destroyed the environmental microecology and human microecology. With the development of microbiome sequencing technology and multi-omics integrated mining technology, the complex interactions between microorganisms and hosts have gradually been recognized. The "Integrated Human Microbiome Project" has been implemented in the United States in the past decade. Similar large scientific projects have also been run in Europe, China and other regions and countries under different names or forms, but their research purposes and research contents are similar. When humans have realized that the role of microecology in human health requires a cognitive breakthrough, they have at least touched upon the following scientific issues related to human health: how microorganisms coexist with each other, how microecology affects human health, how various drugs (including chemical drugs, biological agents, Chinese herbal medicines, etc.) and diet affect human microecology, and how to use human microecology to treat individual diseases and promote human health. (II) Medical issues facing microecological technology Humans have realized the harmfulness of human microecological destruction and the importance of microecological reconstruction. However, there is still a prominent contradiction between the advanced nature of microecological technology and its wide clinical application. To resolve these contradictions, we first need to recognize the limitations of traditional clinical medicine and then define a new discipline framework. 1. Microecological reconstruction is a transformative medical technology From the perspective of the efficacy of using microorganisms to treat diseases, probiotics and fecal microbiota transplantation are at two "extremes". Fecal microbiota transplantation proves the importance of microecology to human disease and health from an extreme perspective. Between the two "end points" of probiotics and fecal microbiota transplantation, the technology of using microorganisms to achieve microecological reconstruction mainly includes three levels: probiotics, selective microbiota transplantation, and washed microbiota transplantation. The term "fecal microbiota transplantation" was officially defined in 2011. In its ten-year history to 2022, the total number of fecal microbiota transplantation-related papers included in PubMed has exceeded 5,000. A 2022 study analyzing global fecal microbiota transplantation clinical reports found that fecal microbiota transplantation has treated 85 diseases in the past decade, involving the immune system, blood system, nervous system, respiratory system, urinary system, reproductive system and other fields. These rapidly increasing clinical evidences will inevitably break through the boundaries of classic digestive system diseases and are more convincing than analyzing the correlation between microbiomes and diseases, highlighting the transformative status of technologies based on targeting human microecology. These diseases or their subcategories that are related to microecological imbalance and can be treated through microecological reconstruction can be collectively referred to as microecological imbalance-related diseases (or microbial imbalance-related diseases). 2. The subdivision of medical specialties is contrary to the integrity of the microecology Existing literature evidence and technological progress are not enough to influence doctors who are distributed in many traditional disciplines to make treatment decisions. This is not because the safety issues of the technology have not been resolved, nor is it because the so-called technology has not been standardized, but because it has subverted the original knowledge structure of doctors, and solutions need to be found from the framework of medical discipline education. The current clinical medicine discipline is mainly based on the characteristics of organs, treatment technologies, etc., and is constantly subdivided into new subspecialties. The boundaries of new subdivided specialties are artificially defined, and their own camps are formed in clinical practice. The problems brought to clinical practice by clinical medicine from "whole" to "segmentation" have become increasingly prominent. For example, the new coronavirus infection has spread all over the world, causing or aggravating multi-system diseases in the human body, and causing a large number of people to develop into critical and severe diseases. These patients are distributed in large numbers in the wards of various traditional specialties in hospitals, and the comprehensive abilities of doctors in various specialties are uneven. The integrity of medicine has been artificially dispersed, gradually moving away from the core medical value of "people-oriented", which is contrary to the integrity of the interaction between the microecology and the host. At present, medical experts who carry out microecological diagnosis and treatment technology are mainly distributed in the discipline of gastroenterology, and a few are in the disciplines of endocrinology and metabolic diseases, surgery, oncology, etc. This also leads to large differences in technical backgrounds between different medical teams, and large differences in the accessibility of endoscopy, intervention and other technologies. 3. The practice of microecological technology lags behind Fecal microbiota transplantation, which has a medical history of 2,000 years, has been expected to enter the mainstream of medicine in recent years, but from the past ten years, it is far from achieving this goal. Medical scientific research places special emphasis on innovation. Fecal microbiota transplantation has developed two directions: washing microbiota transplantation and spore group treatment, but the pace of change in medical practice is very slow. From the emergence of the new technology of fecal microbiota transplantation to entering the guidelines, and then to changing medical practice on a large scale, according to the current clinical medicine discipline framework, it may be difficult to achieve a huge quantitative change in the degree of popularization in another ten years. Even though the basic theories and basic skills of microecological technology have become the training content of medical students' in-school education and post-graduate education, how to train these medical professionals, how to screen people who should be treated but have different underlying diseases, and how to carry out disease prevention based on microecology are all key issues that need to be solved. In other words, as a transformative medical technology, if microecological technology is far away from the public service for a long time, then it is only the work of niche medical technology and research population, and only benefits a niche patient group. Therefore, the problem of lagging behind in the practice of microecological technology should be solved as soon as possible. 4. Clinical medicine needs new discipline classification Currently, new clinical departments that go beyond the boundaries of traditional clinical specialties have emerged in a few hospitals at home and abroad: a professional team focuses on treating diseases, including intestinal bacterial infections, Crohn's disease, ulcerative colitis, severe malnutrition, complex intestinal fistulas, constipation, radiation damage, immune checkpoint inhibitor-related enteritis, graft-versus-host disease after hematopoietic stem cell transplantation, IgA nephropathy, refractory urinary tract infections, Parkinson's disease, childhood autism, Tourette syndrome, depression, rheumatoid arthritis, allergic rhinitis, allergic dermatitis, etc. The clinical medicine team that the author belongs to has gradually formed a new discipline collective that goes beyond traditional gastroenterology from the diagnosis and treatment of digestive tract diseases in the process of many years of development, and involves the entire life cycle from newborns to adults. The existence of these forms is determined by clinical efficacy and conforms to the diagnosis and treatment needs of the majority of patients. It should be emphasized that the effective cure or control of these diseases is mainly a comprehensive treatment based on washing flora transplantation, and the use rate of antibacterial drugs is very low in the entire population. However, in the existing classification system of clinical medicine disciplines, there is no discipline setting that can be used to cover the medical problems faced by the development of microecological technology, such as curriculum setting, graduate student enrollment, specialized talent training, and discipline setting affiliation. To solve these medical development problems faced by clinical practice, it is urgent to sort and classify them at the disciplinary level and create a new clinical medicine discipline. This new discipline should follow the nature of human microecology and disease and should have the ability to integrate different disciplines in the process of clinical medicine practice. (III) Academic scope of microecology and microecological technology The human microbiome is considered to be an organ, or an intrinsic feature of the human development environment, or is included in the overall ecology of the human body as a superorganism. These understandings have been the focus of scientific debate. From the microbial level, Professor Deng Zixin proposed that microbiota should be expressed as microbial community, which can be expressed as "bacterial community" in a narrow sense; from the perspective of the overall integration of superorganisms, when used to express microbial communities and their ecological niches or ecological environments, microbiota should be understood as microecology. Although microbiome has multiple meanings, it essentially provides molecular research coverage for ecology in the genomic era. Similar "-ome" nouns include virome, genome, transcriptome, proteome, etc. Ecology can be divided into macroecology and microecology. The latter is often called microecology, which studies the mechanisms and laws of the interaction between microorganisms and their hosts (including plants, animals and humans) and belongs to the category of ecology. In the past two decades, microecological research has developed rapidly. In countries where English is the native language, the biomedical field mainly uses microbiota or microbiome to describe microecological research. There are many microecological technologies, including all technologies used to study microorganisms and microbial communities, such as microbial isolation, cultivation, sequencing, data mining, pharmaceuticals, treatment and other technologies. They are widely used in microbiology, immunology, zoology, environmental science, pharmacy, clinical medicine and other disciplines. The application of microecology and its technology in clinical medicine belongs to the category of direct use in clinical medical practice, research, education and training. 2. The Origin, Definition and Development of Microecological Medicine (I) Conditions for the Formation of a New Clinical Medical Discipline The research and understanding of microecology around the world have gradually formed the following four favorable conditions to support the birth of a new clinical medical discipline. 1. A series of specific concepts Concepts such as metagenome, virome, phage group, and metabolome have been widely used in life science research, supporting the formation and development of the concept of microecology. Professor Li Lanjuan and others suggested and obtained approval to rename the national unified medical textbook "Medical Microbiology" to "Medical Microbiology and Microecology", laying a conceptual foundation for supporting the use of microecological technology in clinical medicine. 2. A conceptual relationship network serving the clinic Multiple concepts have been formed and form a relationship network with each other, so that the needs of prevention, diagnosis and treatment based on microecology can be understood and a specific logical structure can be formed, such as the development from the human microbiome project to the integrated human microbiome project, as well as the flora-gut-brain axis, flora-gut-liver axis, flora-gut-lung axis, flora-neural plexus, etc. 3. Clinical verification concept The knowledge and concept statements based on microecology can be verified by clinical practice, such as fecal microbiota transplantation, which has lasted for thousands of years, the great changes in the spectrum of human diseases in recent decades, health problems in the post-antibiotic era, and diseases related to microecological imbalance. A large amount of clinical experience can be verified through technology and long-term practice, and ultimately reflected in the relationship network on which the concept system relies, which profoundly affects the decision-making of disease prevention, diagnosis and treatment. 4. Specific technology promotes the development of clinical medicine Specific technologies have been developed for explanation, teaching and clinical application to promote the progress of clinical medicine, such as washing flora transplantation, repeated flora transplantation through endoscopic intestinal catheterization, spore group pharmaceutical technology, phage group or phage combination treatment technology, specific dietary fiber treatment, etc. (II) Definition of microecological medicine After a long period of gestation and development, a series of specific concepts have formed a conceptual relationship network serving the clinic, clinically verifying the value of the microecological concept, and specific microecological technology promoting the development of medicine, which ultimately leads to the emergence of a new clinical medical discipline. Therefore, the author proposes "microecological medicine" as a new discipline concept at this appropriate time. The definition of microecological medicine is to study the basic theories and diagnosis and treatment techniques of the interaction between microbial communities and the human body, to diagnose, treat and prevent diseases, and to carry out clinical medical education. It is a branch of clinical medicine. (III) The difference between microecological medicine and medical microecology Microecological medicine is different from medical microecology. Microecological medicine belongs to the category of clinical medicine, and its core task is effective diagnosis and treatment. Medical microecology belongs to the category of basic medicine, and its core task is rational medicine. Since the starting point of the definition of microecological medicine is Chinese, different words can be used to express this meaning when translating microecological medicine into other languages. For example, microecological medicine can be translated into English as microbi-otamedicine. (IV) The development direction of microecological medicine Microecological medicine is a brand-new clinical medicine discipline, involving healthy people, patient populations, multiple disciplines, and multiple technologies. The development of the discipline mainly involves the implementation methods of discipline setting, the purpose of discipline construction, and the direction and tasks of discipline development. 1. Discipline Setting and Purpose The development of clinical medicine should be demand-oriented. Microecological medicine is suitable for independent setting in university teaching hospitals with conditions. It is a secondary discipline under clinical medicine. It encourages multidisciplinary talents with interests, feelings and professional skills to form new discipline teams, carry out leading research, discipline framework practice, professional education and teaching, guideline formulation, establishment of national technical standards, compound talent training, and popularization of science for microecological medicine. Therefore, one of the important purposes of microecological medicine is to cultivate professional and research-oriented medical talents for the prevention, diagnosis and treatment of human microecological related diseases. The initial professional talents of microecological medicine mainly came from clinical medicine disciplines such as gastroenterology, endocrinology and metabolic diseases, surgery, and oncology. The cross-disciplinary education carried out in the medical education stage of universities around the world is being actively promoted. At present, it is mainly carried out in countries with a high level of medical education development. The educational process of microecological medicine will become a cross-disciplinaryAn important starting point for integrated education. Therefore, compared with traditional clinical disciplines, professionals in the field of microecological medicine need a broader vision, master more skills, and be better at dealing with complex and critical diseases. Microecological medicine professional education will inject vitality into the design of medical curriculum systems and innovation of teaching methods, and deepen the connotation of teaching reform to adapt to the development of integrated medical models. 2. Discipline direction and tasks The subordinate disciplines of microecological medicine include basic microecological technology, clinical microecological treatment technology, and microecological medical technology management. Among them, the main task of basic microecological technology is to carry out microecological laboratory technical services, research and education around clinical needs, such as donor recruitment, flora preparation, component analysis, technical quality control, safety evaluation, microecological diagnosis, engineering technology, and pathological and physiological mechanisms of diseases related to microecological imbalance. The main task of clinical microecological treatment technology is to directly carry out microecological treatment services, research and education for patients, such as the level of decision-making on intestinal flora transplantation, endoscopic intervention for the purpose of microecological diagnosis and treatment, and microbiome component treatment. The main task of microecological medicine technology management is to carry out services, research and education on microecological diagnosis and treatment technology, health care policies, talent training, cost performance, etc. ‘ Three, the dimensions of microecological medicine (I) The interdisciplinary nature of microecological medicine The specific research and clinical practice of microecological medicine include research on microecological diagnosis technology, washing flora transplantation, selective flora transplantation, phage therapy, microecological diagnosis and treatment intervention technology, human intestinal flora storage, systemic multi-system disease diagnosis and treatment basis, life cycle nutrition, antimicrobial drug application decision, microecology-immunity, microecology-tumor, health care policy, microecological medicine education, etc. Bioinformatics experts hope to transform the gene sequencing data of microbiome into medical reports through big data mining technology, and use this to understand microecological behavior. Although these data reports do not have outstanding clinical guidance value at this stage, this interdisciplinary field has shown strong charm. Because of its outstanding interdisciplinary nature, microecological medicine will continue to lead the development of medicine for a long time in the future. Microecological medicine is a new form of medicine in the new round of scientific and technological revolution and industrial transformation (or called "new medicine"), and it is a proactive adaptation of higher medical education to the transformation of human society's talent needs from industrial civilization to information civilization. (II) Classification and positioning of microecological medicine To understand the classification and operation mechanism of microecological medicine within the framework of clinical medicine, we can refer to the development history of transfusion medicine. The core technology of microecological treatment is fecal microbiota transplantation. The material sources of fecal microbiota transplantation and blood transfusion are the intestines and blood vessels of healthy donors, respectively. Both remove harmful components in the laboratory, and finally use the separated and washed components to treat diseases. Blood transfusion has undergone a long and tortuous exploration, based on the invention of disinfection methods, the development of infusion methods, the application of anticoagulants, the discovery of blood types, the establishment of blood banks, the development of component transfusion, etc., and later gradually developed from medical technology to transfusion medicine. In 2016, the Standardization Administration of China approved the second amendment to the national standard GB/T13745-2009 "Discipline Classification and Code", which officially included transfusion medicine as an independent secondary discipline into clinical medicine for the first time. Transfusion medicine consists of six third-level disciplines, including basic transfusion science, blood donation service, transfusion technology, clinical transfusion science, transfusion management and other transfusion medicine disciplines. In the field of transfusion medicine, transfusion technology is managed by the state as a special medical technology. At the same time, this field also develops drugs such as albumin, immunoglobulin for injection, and coagulation factors. In 2022, the GB/T41910-2022 "Quality Control of Washing Fecal Microbiota and Classification of Fecal Microbiota Samples" issued by the Standardization Administration of China is the first national technical standard in the field of fecal microbiota transplantation, which lays a technical foundation for the development of microecological medicine. IV. Development Path of Microecological Medicine Technology is not equal to science, and the development of microbiome technology is not equal to the development of microecological medicine. Researchers need to have more concerns about the development of technology. Microecological diagnosis and treatment technology, like other technologies, is prone to technological alienation, that is, the distortion, deviation, and disorder that occur during the development of technology, which in turn will become a negative force affecting the progress of medicine. On the one hand, the development of technology faces complex liberalized market competition. Because of the profit-seeking nature of technology and the interest protection stance, the best technology may not have the opportunity to derive the best products and serve the most people. For example, the illegal application of microecological diagnosis and treatment technology will lead to the destructive development of technology, and illegal profiteering will lead to government policy suppression. On the other hand, the process of technology development from hot spots to widespread application may be due to insufficient relevant theoretical research, insufficient iterative technology development, lagging policy management, etc., lack of disciplinary background to support and buffer, resulting in the original clinically important technology from one extreme to another, which is contrary to the clinical demand for technology. The inherent nature of microecological medicine determines its extensive interdisciplinary characteristics. The development of microecological disciplines is a strategic investment in the development of new technologies that emerge in an endless stream and form a technological ecology. Because of the nature of exploration, more doctors and basic scientists join the field of microecological medicine, which will contribute rich and colorful inventions and discoveries to the discipline and promote the development of technology and medicine. Therefore, paying attention to the sustainable development of microecological medicine as a clinical medical discipline is far more powerful than paying attention to the microecological diagnosis and treatment technology itself to influence the government to provide more support, activate social funds to invest in this field in a diversified manner, form a huge basic population, multi-level knowledge creation and multi-faceted media communication, and thus form a more stable discipline ecology. The path to developing microecological medicine is the process of forming a sustainable discipline ecology, which can be inspired by the essence of the integrity of human microecology. That is, the integrated medicine development path proposed by Academician Fan Daiming is inseparable from the contribution and continuous support of education, academic organizations, and professional journals to the development of microecological medicine. my country already has special issues in the field of microecology such as "Chinese Journal of Microecology", "Medicine in Microecology", "iMeta", and " mLife", and comprehensive medical journals such as "Chinese Medical Journal" have long established clinical microecological columns, which are all driving forces for the sustainable development of microecological medicine. The establishment of academic groups such as microecological medical societies, associations, and cooperative groups at all levels, types, and sizes is also extremely important for promoting the development of microecological medicine. The development process of modern medicine is a continuous process of solving the "what", "why" and "how" of medicine. Microecological medicine is the application of the theories and technologies of microecology and medicine to the diagnosis, treatment and prevention of diseases, and is recognized and developed with a holistic and integrated mindset. The exploration of microecological medicine involves scientific issues about the relationship between human microecology and diseases, and it also requires continuous technical creation and technology, and more importantly, the relationship between these technologies. This article initially explores the possibility of microecological medicine as a new clinical medical discipline, hoping that it can follow the essence of medicine in the process of development, continuously improve its upper and lower position relationship structure, and continuously develop its theory, technology and education. The country and universities are building microecological medicine from the strategic height of discipline layout, which is expected to lay a solid foundation for leading the development of modern medicine.