Third: Principles of Heart Failure Treatment

Treatment aims to reduce both preload and postload through positive inotropic effects and negative chronotropic effects. Therefore, the goal of treating heart failure is to lower both preload and postload.

New Uses of Xindan – June 25, 1986

1. Treatment of Hyperthyroidism: This medication can quickly control hyperthyroidism symptoms, but it does not affect the thyroid gland enlargement, exophthalmos, or biochemical parameters such as serum T3, T4, or iodine uptake rates. Xindan is ideal for preoperative preparation of hyperthyroidism patients; typically, 20 mg twice daily, orally. If a crisis is detected during surgery, 10 mg can be administered intravenously, often successfully turning the situation around.
2. Treatment of Headaches: Headaches are often caused by episodic vasospasm. Xindan can inhibit small arterial spasms and suppress platelet aggregation around cerebral blood vessels. Currently, Xindan is considered one of the best medications for treating headaches, with 20 mg twice daily, orally.
3. Treatment of Schizophrenia: In recent years, the dopamine hypothesis has been proposed for the onset of this condition—cerebral cortex is particularly sensitive to dopamine. Xindan can inhibit dopamine’s effects, thereby helping to treat schizophrenia.
4. Treatment of Primary Tremor: Also known as tremor paralysis, or Parkinson’s disease, taking 120 mg of Xindan daily can lead to some degree of improvement.
5. Treatment of Portal Hypertension: Xindan can reduce heart rate and decrease hepatic venous wedge pressure. For patients with cirrhosis, the hepatic venous wedge pressure directly reflects portal pressure; therefore, Xindan’s reduction of venous wedge pressure is equivalent to a reduction in portal pressure. At the same time, since Xindan reduces cardiac output, visceral arterial blood flow also decreases accordingly, leading to a reduction in portal pressure. Lebrec first used 40–180 mg of Xindan twice daily for 1 month in 8 patients with portal hypertension and variceal bleeding, confirming that the reduction in cardiac index led to a decrease in visceral venous blood flow, thereby lowering portal pressure.
6. Anxiety Disorders: Patients with anxiety disorders often experience a range of psychological and physical symptoms, such as palpitations, tremors, and sweating. These symptoms are often triggered by increased sympathetic nervous system excitation; therefore, Xindan frequently provides satisfactory results.
7. It has also been used for infertility, renal failure caused by epidemic hemorrhagic fever, and neuralgia, and is said to have certain therapeutic effects.
8. The effects of digitalis on the heart – June 25, 1986

Small doses of digitalis can increase cardiac stress and conduction, but higher doses tend to have a reducing effect. Regardless of the dose, digitalis can slow conduction through the atrioventricular node. This leads to a prolonged P-R interval, and higher doses can cause cardiac conduction disturbances. Digitalis inhibits the cardiac conduction system, which includes both the vagal and non-vagal systems. At low doses, the vagal system dominates; at higher doses, the non-vagal system becomes more prominent. Digitalis can shorten the refractory periods of the atrium and ventricle and extend the refractory period of the atrioventricular node; it can also promote the autonomy of the atrium, ventricle, atrioventricular node, and bundle branches. Digitalis’ diuretic effect is primarily due to increased cardiac output, along with increased renal blood flow and glomerular filtration rate. In addition, digitalis can directly act on the distal renal tubules to promote sodium and water loss, while also having an anti-aldoosterone effect that aids in diuresis. 9. Monoclonal Antibodies in the Treatment of Malignant Blood Diseases – June 26, 1986

Immunotherapy is one of the treatments for malignant tumors. While passive immunization has proven effective in some cases, its efficacy is short-lived, and systemic reactions can be severe, often limited by the heterogeneity of antibody serums. Since the development of lymphocyte hybridization technology, highly concentrated, uniform antibodies—monoclonal antibodies (MOAb)—that specifically target certain antigens have been continuously obtained. Over the past few years, monoclonal antibody hybridoma lines against multiple tumor antigens have been established, and some monoclonal antibodies have already been trialed in clinical treatments, with promising results expected. Monoclonal antibodies are antibodies that share a chemical structure identical to a specific antigen determinant. For a long time, people have known that immune globulin mutations can lead to tumor development; for example, myeloma protein in multiple myeloma is a pure immunoglobulin, though its antibody activity remains unknown. However, these tumor cells can survive for extended periods in vitro culture. In 1975, researchers successfully fused mouse myeloma cells with spleen cells to create the first lymphocyte hybridoma producing MOAb, marking the beginning of the development of techniques for generating various monoclonal antibodies through lymphocyte hybridization. Lymphocyte hybridomas can produce monoclonal antibodies with specific targeting capabilities, which hold great clinical significance. The basic steps and principles of this technology are as follows: ① Select appropriate myeloma cell lines; ② Prepare a suspension of hepatocytes immunized with specific antigens; ③ Mix the two components and perform hybridization; ④ Cultivate the hybridoma cells in a selective culture medium suitable for their growth—HAT medium. 10. New Cancer Drug: Cisplatin – June 27, 1986

This drug, fully named cis-dichlorodiammineplatinum, is a platinum complex with magnetic field effects. It has therapeutic applications for ovarian cancer, head and neck squamous cell carcinoma, bladder cancer, prostate cancer, lymphoma, lung cancer, and other cancers—but it can also cause certain kidney damage. This drug has brought hope for cure or relief to many cancer patients and has opened new avenues for advancements in inorganic chemistry-based anticancer drugs. Kidney damage can be mitigated through combination chemotherapy, while side effects in the digestive tract are currently being studied. 11. Atypical Clinical Symptoms of Acute Leukemia – June 29, 1986

1. Clinical manifestations such as nephritis, tinnitus, and bilateral blindness are all caused by white blood cell infiltration.
2. Vomiting and electrolyte disturbances are the most common clinical symptoms of acute leukemia. Because serum lysozyme levels rise in acute patients, damage to renal tubules leads to renal insufficiency, exacerbating vomiting and electrolyte imbalances. Most patients experience nausea and vomiting after chemotherapy.
3. Aplastic-Anemia-Leukemia Syndrome: Both conditions involve stem cell abnormalities and can sometimes convert into each other.
4. Acute Leukemia and Pregnancy: Some believe that pregnancy can promote remission of leukemia, while others think that pregnancy can accelerate leukemia progression.
5. A Brief Overview of Hyperthyroidism – June 30, 1986

This condition can be treated with antithyroid drugs, beta-blockers, radioactive iodine, or surgical intervention. Each treatment method has its own advantages and disadvantages. Medication is convenient and safe, but the remission rate is low, and relapse is common. Radioactive iodine and surgery offer higher remission rates, but they can easily lead to hypothyroidism; therefore, careful selection of treatment plans is essential before treatment to achieve satisfactory results. Sulfur-containing drugs: Patients under 40 years old should first choose these medications, which work by inhibiting the synthesis of T3 and T4: ① reducing white blood cell infiltration in the thyroid; ② suppressing the production of thyroid autoantibodies; ③ lowering plasma levels of thyroid microsomal antibodies; ④ reducing plasma levels of thyroid-stimulating immunoglobulins. 13. Huo Xue Hua Yu Tang for Treatment of Atrophic Gastritis – June 30, 1986

Astragalus 20 g, Dang Gui 15 g, Chuan Xiong 15 g, Zhi Shi 15 g, Liang Jiang 10 g, Lu Xiang 10 g, Mu Yao 10 g, Zhi Gan Cao 10 g; add Yuan Hu 15 g for severe pain, Hou Pu 10 g and Qing Pi 10 g for severe abdominal distension, and Jiao San Xian for indigestion. The characteristic of this formula is that it combines a blood-tonifying soup with herbs like Chuan Xiong and Mu Yao, plus Liang Jiang and Zhi Shi. The mnemonic phrase is: “Wu Di Huang, Liang Ji, Zhi Cao, Xiang.” 14. Two Formulas Used by My Late Father, Pei Shen – July 1, 1986

1. Raw Oyster 30 g, Ze Xie 15 g, Hai Cao 10 g, Fu Ling 12 g, Zhu Ling 10 g, Cinnamon 3 g, Cang Zhu 6 g, Che Qian Zi 30 g, Bai Mao Gen 30 g, Di Ku Man 30 g, Chong Hu Lu 30 g, Sang Niu 10 g, Yin Chen 15 g, Dan Shen 30 g, Tao Ren 9 g, Zhi Ke 9 g, Xiang Fu 6 g, Da Zao 3 pieces, Yu Gong Wan 4.5 g; decocted in water and taken once daily. This formula is suitable for patients with decompensated cirrhosis accompanied by massive ascites.
2. Codonopsis 10 g, Atractylodes macrocephala 10 g, Fu Ling 12 g, Chen Pi 6 g, Chai Hu 10 g, Zhi Ke 10 g, Dang Gui 10 g, Bai Shao 15 g, Ze Xie 10 g, E Jue 6 g, Dan Shen 10 g, Yu Jin 6 g, Bo He 3 g, Xiang Gu 3 g, Da Zao 10 g; decocted in water and taken once daily. This formula is suitable for patients with decompensated cirrhosis, esophageal and gastric fundal varices accompanied by severe indigestion.
3. Hepatitis B Incidence – July 11, 1986

In a nationwide survey conducted in 1979, the HBV infection rate ranged from 31.1% to 61.6%, with HBsAg carriage rates between 3.8% and 16.8%, averaging 8.8%. The HBsAg positivity rate gradually increased after birth, exceeding 30.4% before the age of 10, then declining with age. HBV transmission pathways include: ① blood transfusions and blood products; ② horizontal transmission—commonly referred to as contact transmission, which occurs through general contact in the population, such as through water, hands, or flies. This type of transmission accounts for about 55% of all cases; fortunately, adults can clear 30% of this type of infection on their own. ③ Vertical transmission, especially mother-to-child transmission; the mother-to-child transmission rate for HBeAg-positive patients is 90%, and fathers carrying HBsAg can also transmit the virus in 20% of cases. Horizontal transmission of HBV does not result in clearance upon adulthood, unlike vertical transmission, where 85%–100% of cases become HBsAg carriers. Vertical transmission accounts for 40% of all cases, making it the primary mode of HBV transmission in China. 16. Formula for Regulating Anemia – July 12, 1986

Astragalus 20 g, Rehmannia glutinosa 30 g, Chuan Xiong 15 g, Polygonum cuspidatum 20 g, Licorice 10 g, Ligusticum chuanxiong 30 g, and 1 piece of Spica Prunella. For yin deficiency, add Cornus officinalis, Paeonia lactiflora, and Polygonum cuspidatum; for internal heat, add Gastrodia elata and Artemisia annua; for yang deficiency, add Coptis chinensis and Dioscorea opposita; for spleen and stomach qi deficiency, add the Four Gentlemen Decoction. The mnemonic for this formula is: “Wu Dang, Huang He, Cao, Ji Ma, You Tong.” (Chinese Journal of Integrated Traditional and Western Medicine, May 1985) Note: “Wu Dang” refers to the absence of Dang Gui in the Si Wu Tang formula; thus, the meaning of “Wu Di,” “Wu Xiong,” and “Wu Cao” becomes clear. 17. Fragrant Powder for Treating Pulmonary Edema – July 13, 1986

6 g each of Chicken Gizzard, Agarwood; grind them into powder and take with boiled water. This formula is effective for treating coronary heart disease, hypertensive crises, acute pulmonary edema, renal insufficiency, and bronchopneumonia. Agarwood helps to descend qi and regulate qi; its effects include lowering blood pressure, calming the mind, relieving asthma, alleviating pain, and eliminating phlegm. It is effective for chest and abdominal qi stagnation, bloating, vomiting, hiccups, wheezing, and abdominal pain. Chicken Gizzard aids digestion and nourishes the kidneys, with warming and qi-nourishing properties. (Journal of Traditional Chinese Medicine, June 1985) 18. Atrophic Gastritis with Intestinal Metaplasia – July 14, 1986

5 portions each of Ume, Zhi Ke; 3 portions each of Xianhe Cao, Bai Fuan, Yu Jin, and Huo Xiao; 2 portions of Macha Qianzi; 1 portion of Gan Qi; grind them into powder and take 3 g twice daily. This formula was used to treat 20 patients, with 16 achieving complete recovery and 4 improving. The mnemonic is: “U Ma Jin, Gan Huo Xiao, Niu He Fei Fei Guo Cao.” (Chinese Journal of Traditional Chinese Medicine, December 1985) 19. Formula for Activating Blood and Removing Stasis for Atrophic Gastritis – July 19, 1986

Astragalus 20 g, Dang Gui 10 g, Chuan Xiong 6 g, Bai Shao 15 g, Liang Jiang 6 g, Zhi Ke 3 g each, Zhi Shi 10 g. This formula treats atrophic gastritis and is a specialized remedy for activating blood and removing stasis in this condition. The mnemonic is: “Wu Di Huang, Liang Xiang.” As mentioned earlier, “Wu Dang,” “Wu He,” and “Wu Cao” are used in this formula, which is a specialized remedy for treating anemia. Thus, the specialized remedies for treating anemia and those for treating atrophic gastritis share similarities, indicating a certain connection in terms of strengthening the body’s fundamental forces. 20. A Single Approach to Diabetes Treatment – July 20, 1986

Shen Shen Jiang Tang: Rehmannia glutinosa 12 g, Chinese Yam 30 g, Cornus officinalis 6 g, Paeonia lactiflora 6 g, Poria 12 g, Alisma 12 g, Cortex Moutan 6 g, Goji Berries 20 g, Achyranthes bidentata 10 g, Pollen 30 g; decocted in water and taken once daily. For qi deficiency, add Astragalus and Prince Ginseng 15 g each; for greasy coating on the tongue, add Cang Zhu. The characteristic of this formula is its heavy use of pollen, Chinese Yam, and Goji Berries. Its composition combines Six-Flavor Rehmannia Decoction with Zhi Bai, Qi Ju, and Ji Sheng, yet its approach does not deviate from conventional practices. (An Medical Journal, May 1986)

Allergic Purpura: Two Cases, July 25, 1986

1. For severe cases of allergic purpura, add Bai Mao Gen, Dan Pi, and Chan Yi to the formula, along with Chai Hu, Fang Feng, Dang Gui, Wu Mei, and Gan Cao; for particularly severe cases, increase the dosage of Zhi Jie, Xiao Ji, and Di Yu. If there is qi deficiency, add Huang Qi and Huang Jing; if there is excessive dampness, add Cang Zhu.

2. For those with cold aversion, add Sang Bai Pi and Fang Feng; for severe wind-cold symptoms, add Su Jing; for heart discomfort and thirst, add Lian Qiao and Sheng Shi Gao; for intense itching, add Jiang Zao; for constipation, add Sheng Da Huang. (San Miao Chan)

(From “Chinese Medicine Journal,” 1986.2)

Soft Pulse Spirit for Treating Cerebral Arteriosclerosis, July 27, 1986

Composition: 10g of Dang Shen, 12g of Shu Di, 10g of Gou Qi Zi, 20g of Niu Xi, 20g of Shou Wu, 6g of Chuan Xiong, 20g of Dan Shen, 10g of Dang Gui, and 10g of Chi Shao. The herbs are decocted in water and taken as one dose daily—a traditional remedy for treating cerebral arteriosclerosis.

Key phrase: “Wu Shen, Qi, Shou, Niu, Dan.” (From “Chinese Medicine Magazine,” 1986.3)

New Anti-Cancer Drug: Oleic Acid Multiphase Liposomes, July 28, 1986

This drug was jointly developed by the Shenyang Pharmaceutical College and the Central Hospital of Changning District, Shanghai, and is known as Oleic Acid Multiphase Liposomes (139) Suspension. Each vial contains 10ml, and it can be administered intravenously in saline solution.

Insights into the Treatment of Heart Failure, July 28, 1986

When treating heart failure, the amount of digitalis should be calculated based on its half-life. There are two formulas for calculating the daily excretion rate of digoxin: ① Excretion Rate (%): [14 + Endogenous Creatinine Clearance × 100%]{.underline}; ② Excretion Rate (%): (11.6 + [20]{.underline} ) × 100%. Under normal renal function, the calculated values are approximately 31%–33%, or about one-third. Therefore, the approximate daily excretion rate of digoxin is roughly one-third. Since the excretion rate is one-third, the formula for calculating the body’s digitalis reserve is: Daily Body Reserves = (Yesterday’s Body Reserves + Daily Dosage) × 2/3. According to this formula, a dose of 0.25 mg, taken once daily via oral administration, would result in a total body reserve of 1 mg after three days.

Atrial Premature Beats, July 30, 1986

1. When an ectopic atrial P wave appears prematurely, its morphology differs from that of a normal P wave. Sometimes, the atrial P wave appears earlier and overlaps with the preceding T wave, requiring identification through changes in the T wave pattern. 2. The P-R interval may sometimes exceed 0.20 seconds. 3. In some cases, the premature QRS complex appears as an rSR pattern on V1 lead, and an atrial P wave can often be identified before the QRS complex. Although the P-R interval is longer than 0.12 seconds, the compensatory pause is often incomplete—this allows for differentiation from ventricular premature beats. (A complete compensatory pause refers to the sum of the short pause before the premature beat and the long pause after the beat being equal to twice the normal pause.) If the P wave appears even earlier, located within the absolute refractory period of the atrioventricular node, no corresponding QRS complex will appear; this is referred to as a blocked atrial P wave. However, if the premature beat occurs during the relative refractory period, the resulting QRS complex shows differences in the ventricular rhythm. It is crucial to clearly understand one concept—the interbeat interval. An interbeat interval refers to the distance between a premature beat and the underlying sinus rhythm. If the interbeat intervals of each premature beat are equal, it indicates that the premature beat originates from a single source. If the interbeat intervals differ, however, the premature beat is likely to originate from multiple sources.

Dosages and Administration of Several Medications, July 2, 1987

1. Nitrogen mustard (HN2): This medication inhibits nucleic acid metabolism and suppresses cancer cell division. Administer 10 mg dissolved in 250 ml of saline solution via intravenous infusion once daily, with 4–6 doses constituting a course of treatment.

2. Adenosine triphosphate (ATP) is a coenzyme that releases energy when it is broken down into adenosine diphosphate (ADP) in the body. The typical dosage is 20 mg, administered via intramuscular injection or slow intravenous infusion, 1–2 times daily.

3. Methimazole, 5–10 mg, taken three times daily; generally, effects begin after 10–15 days of use, though prolonged use is not recommended.

4. Furosemide and hydrochlorothiazide, also known as loop diuretics, have different structures but share similar mechanisms of action. They primarily act on the distal convoluted tubules, providing potent diuresis. Overuse can lead to hyponatremia, hypochloremia, hypokalemia, and alkalosis; in severe cases, it may cause decreased blood volume, hearing loss, gastrointestinal reactions, skin rashes, thrombocytopenia, neutropenia, hyperglycemia, and hyperuricemia. These medications are contraindicated in patients with refractory heart failure, acute pulmonary edema, hepatic encephalopathy, and electrolyte imbalances. When used, potassium chloride supplementation is often necessary. Common dosages include 20–40 mg of furosemide orally, 1–2 times daily; diuresis begins 30 minutes after oral administration, peaks at 2 hours, and lasts for 6–8 hours. Intravenous administration leads to diuresis within minutes, reaching peak levels after 1 hour, with continued diuresis for 6–10 hours.

5. Theophylline: Its primary effects include dilating glomerular arteries and increasing renal blood flow by enhancing myocardial contractility, thereby promoting diuresis. Additionally, it can inhibit renal tubular reabsorption to a certain extent. This medication promotes diuresis, strengthens the heart, and dilates the bronchi—but its diuretic effect is relatively modest. Common dosages are 0.1 g orally, tid; for intramuscular or intravenous injections, 0.25–0.5 g can be dissolved in 5% glucose solution for intravenous drip, while intramuscular injections may cause localized pain.

6. Dopamine: A catecholamine that acts on specific dopamine receptors, causing dilation of the kidneys, mesenteric vessels, coronary vessels, and cerebral blood vessels—and especially enhancing myocardial contractility, thereby increasing coronary blood flow. However, high doses can activate adrenal receptors, leading to vasoconstriction and reduced coronary blood flow. Because individual tolerance to this medication varies greatly, clinical intravenous infusions typically start with small doses—beginning with 0.5–1 µg per kg of body weight per minute. For an average person weighing 50 kg, the infusion rate should be 50 µg per minute. Each vial of dopamine contains 20 mg, and doses should be gradually increased starting from 20 mg, slowly infused over 500 ml of 5% glucose solution.

7. Adrenergic Receptor Blockers, July 4, 1987

8. Alpha-receptor blockers: Phenylpropanolamine and Tolazoline can cause vasodilation and pupil constriction. While Phenylpropanolamine is used for both diagnostic and therapeutic purposes in pheochromocytoma, it has also been increasingly employed in the treatment of cardiogenic shock, pulmonary edema, and arrhythmias caused by digitalis overdose. Due to its significant side effects and limited antihypertensive efficacy, this medication is rarely used for treating hypertension.

9. Beta-receptor blockers: These drugs are effective and important treatments for hypertension. Currently, the most commonly used medications include Bisoprolol (Bisoprolol, Bisoprolol Sustained-Release, Bisoprolol Extended-Release), and Thiothiazide, which is a potent formulation with an effect six to eight times stronger than Bisoprolol. The daily dosage of Thiothiazide is equivalent to that of Bisoprolol. The antihypertensive effects of Beta-blockers may be related to slowed heart rate and reduced cardiac output. Recent research has shown that patients with high renin levels and normal renin levels respond well to Beta-blockers, whereas those with low renin levels tend to respond less favorably. Consequently, researchers speculate that their antihypertensive effects may be linked to reduced renin activity. Beta-blockers have fewer side effects, typically including bradycardia, bronchospasm, skin rashes, and nausea. The antihypertensive effects of Bisoprolol usually require higher doses to achieve results, but it is generally best to start with lower doses.

10. Vasodilators

(1) Hydralazine: The oral dosage is the same as Bisoprolol, with gradual increases over time. However, excessive doses can trigger rheumatoid arthritis and lupus-like conditions; therefore, people often combine it with Rauwolfia preparations and thiazides, supplemented with appropriate magnesium and calcium ions, forming what are known as combined antihypertensive tablets. (2) Sodium nitroprusside: This medication directly relaxes small arteries, reducing postcardiac load while simultaneously relaxing small veins, thereby lowering preload. It is a powerful vasodilator used for treating hypertensive crises, hypertensive encephalopathy, as well as myocardial infarction and left ventricular failure caused by various factors. Sodium nitroprusside does not accelerate heart rate, provides rapid blood pressure reduction, and its effects are brief—40 mg each time (one time the dose of Bisoprolol). Administered in 500 ml of 5% glucose solution at a rate of 40–60 drops per minute, blood pressure can drop within seconds after administration, and the effect disappears 15 minutes after discontinuation. The metabolite of sodium nitroprusside, thiocyanate, when elevated in the bloodstream, can cause fatigue, nausea, muscle tremors, and psychiatric symptoms. 8. Revisiting Angina Pectoris, July 5, 1987

The pain of angina pectoris is located in the left anterior chest, radiating to the left shoulder and left arm. Attacks often occur during exercise, after eating, or after exposure to cold. Occasionally, attacks may occur even at rest. After taking nitroglycerin orally, symptoms can subside within a few minutes. If the sensation of tightness in the precordial region persists without any other identifiable cause, it is diagnosed as angina pectoris. The duration of an angina attack typically ranges from a few seconds to 20 minutes. Longer episodes may not necessarily be angina pectoris.

Treatment: The analgesic effects of nitroglycerin have been proven reliable through 200 years of practice. Its mechanism of action is not to dilate coronary arteries, but rather to reduce preload on the heart—by expanding systemic arteries and veins, it can also decrease afterload on the heart. Dinitro-nitroglycerin, marketed as Xiaoxin Tong, is a medium-effect nitrate; trinitro-nitroglycerin is a fast-acting nitrate; and tetranitro-nitroglycerin (also known as pentosan ester), is a long-acting nitrate. When angina attacks occur, it is advisable to take either trinitro-nitroglycerin or Xiaoxin Tong, with dosages of 0.5 mg and 10 mg respectively. Pentosan ester should not be swallowed; instead, it is absorbed in the gastrointestinal tract. Take 20 mg orally, tid. Additionally, amyl nitrite can be inhaled via nebulization—take 0.12–0.18 ml in a handkerchief, as this medication can cause severe hypotension and even shock, and is now rarely used. Beta-blockers like Bisoprolol typically slow heart rate and reduce cardiac contractility, thereby alleviating angina attacks. Combining Bisoprolol with Xiaoxin Tong can double the therapeutic effect, as the former helps eliminate the side effects of the latter.

Common Medication Dosages, July 6, 1987

Gastrointestinal Restorant 10 mg, po, tid; Ethoxybenzene 10 mg, po, tid; Probenecid 15 mg, po, tid; Atropine 0.3 mg, po, tid; Gastrointestinal Nerve 1 mg, po, tid; Anwei Ling 5 mg, po, tid; Sheng Wei Keton 100 mg, po, tid; Litu Ling 0.1 g, po, tid; Methylcysteine 200 mg, po, tid; Vitamin K3 8 mg, iv, st; Indomethacin 25 mg, po, tid; Oxibutynin 50 mg, po, tid; Vitamin C 80 mg, iv, st; Huluxin Tablets 0.1 mg, tid, po; High U甲素 Injection 4 mg, iv, st 9. Yigan San and Gou Teng San, July 10, 1987

Yigan San: Dang Gui, Chuan Xiong, Cang Zhu, Fu Ling, Gou Ding, Chai Hu, and Gan Cao—this formula is a primary treatment for depression and mental confusion, and can also be used to treat menopausal syndrome.

Gou Teng San: Gou Teng, Sheng Shi Gao, Mai Dong, Fang Feng, Ju Hua, Dang Shen, and Ban Xia, this formula treats depression, mental depression, and hypertension, with remarkable antihypertensive effects.

Among these two formulas, Gou Teng serves as the main ingredient; Gou Teng contains an alkaloid that can inhibit serotonin (5-HT) receptors. Serotonin is distributed in the smooth muscles of the esophagus and blood vessels, where it plays a role in diarrhea and vascular constriction. Serotonin is also abundant in the central nervous system, making it closely associated with irritability. Recently, Japanese scholar Yamaguchi noted that Gou Teng’s antidepressant effects include: ① good results for elderly women in menopause; ② effective for those experiencing numbness in their head; ③ this medication shares the same mechanism of action as the vasodilator Bisoprolol. Research on Gou Teng and Radix Fallopiae suggests they are known as “blood-pressure-lowering pills”—Gou Teng dilates blood vessels, while Radix Fallopiae relieves bloating and relaxes smooth muscles, thus creating a synergistic effect that aids in lowering blood pressure.

Mucous Edema Formula, July 11, 1987

My father used Er Xian Tang and Yue Bi Tang to treat this condition, and each treatment was highly effective. Er Xian Tang is a primary formula for strengthening yang; Yue Bi Tang is an excellent diuretic. The former addresses the root cause, while the latter addresses the symptoms—combining both, it is truly a superior formula.

Chai Hu Jia Long Gu Mu Li Tang, July 11, 1987

Japanese researcher Ito Chu-shin studied this formula alongside Dan Zhi Xiao Yang Tang and found that the former inhibited serotonin receptors, while the latter did not. This confirmed the antidepressant effects of the former; if the latter were to provide antidepressant benefits, then Gou Teng should be added.

Dang Gui Si Yi San with Wu Zhu Yu Tang, July 14, 1987

This formula was developed by Japanese physician Takashi Takayama to treat occlusive vasculitis.

Dang Gui Si Yi Tang: Dang Gui, Gui Zhi, Bai Shao, Gan Cao, Mu Tong, Xi Xin, Dan Shen, Sheng Jiang, and Da Zao. According to the Shanghan Lun: “When the hands and feet are cold and the pulse is weak and nearly absent, Dang Gui Si Yi Tang is indicated. If the patient has long-term deficiency within the body, Dang Gui Si Yi Tang should be combined with Wu Zhu Yu Tang.” This formula is used to treat occlusive vasculitis; after the pain subsides, Gui Zhi Fu Ling Wan can be continued. Numerous documents indicate that this condition is often caused by blood stasis, and later, Da Huang Ma Dou Pi Tang with Fu Pi can be used to support recovery.

1987–1997 (Central Region)

Japanese Anzhong San for Treating Ulcerative Diseases, September 27, 1987

Composition: 4 g of Rou Gui, 3 g of Yuan Hu, 3 g of Mu Li, 1.5 g of Xiao Hui Xiang, 6 g of Sha Ren, 0.5 g of Liang Jiang, and 6 g of Gan Cao—ground together, sifted, and taken in divided doses twice daily, morning and evening. It is best to mix with white liquor or vinegar for enhanced efficacy.

Key phrase: “Rou Gui, Liang Jiang, Sha Ren, Yuan Hu, Mu Li, Gan Cao follow.”

Effects: Promotes bile secretion, reduces stomach acid, and combats ulcers.

Note: All spices such as Rou Gui, Sha Ren, Xiao Hui Xiang, and Liang Jiang have bile-promoting properties. If they do not promote bile secretion, then what makes them so effective in cooking meat?

Several Clinical Formulas, September 30, 1987

Ya Wang Shan Baishi Mu Lan, Chi Dan Tao Hong Bai Gou Chuan (Prostatitis). Wu Ma Jin Gan Huo Nuo, Bai He Fei Fei Guo Cao (Atrophic Gastritis). Can Shen Si Wu Shou Nu Dan (Arteriosclerosis). Huang He Teng Ma Si Wu Sheng, Yin Xu Shan Yu Dan Pi Jing, Nei Re Yin Hu Qing Hao Zai, Pi Xu Si Jun Liu Jian (Aplastic Anemia). Liu Wei Yi Huang Gou, Si Wu Er Huang Gou (Hypertension). Shi Dong Feng Ju Er Chen Can, Deng Ya Zeng You Ke Bei (Hypertension). Rou Gui Liang Jiang Sha Ren, Yuan Hu Mu Li Gan Cao Sui (Ulcer Disease).

Dang Gui Si Lian Wu Zhu Yu, this formula is particularly effective for treating vasculitis.

Discussion on the Integration of Chinese and Western Medicine: Exploring Legal Aspects, September 31, 1987