3 Cerebral Artery Sclerosis

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The series of sweating formulas—Tang, Maxing Shigan Tang, Yuebi Tang, and Yuebi Jia Shu Tang—are used to treat renal edema, which is known as the "lifting the pot to uncover the lid" method. The lungs and kidneys share a common origin, with the metal element nourishing the water element; if lung qi is not dispersed, kidney qi will not descend. This is analogous to the vent tube on an infusion set, serving the same purpose. By using Ma Huang Tang and Yuebi Tang to disperse lung qi and induce sweating to release the exterior, we are essentially "opening the ghost gate and cleansing the palace," thereby treating edema.

Renal artery sclerosis can rapidly progress to renal failure. Chronic nephritis takes a longer time to develop into renal failure, whereas renal artery sclerosis quickly leads to elevated blood urea nitrogen, serum creatinine, decreased carbon dioxide binding capacity, and reduced creatinine clearance. At this stage, Western medicine often has few effective treatments, with dialysis being the only option. Unfortunately, there is no turning back once one starts dialysis. Over my fifty years of medical practice, I have never seen a patient with renal failure who, after undergoing dialysis, no longer requires it and survives. Almost all patients eventually die from complications such as infections. In contrast, Traditional Chinese Medicine does offer some approaches in this regard, although the efficacy may not be ideal. Nonetheless, it can significantly extend survival time and improve quality of life. Many patients in outpatient clinics and wards have achieved such outcomes. Of course, we adopt an integrated approach combining TCM and Western medicine, using TCM alongside the following Western medical measures: ① large doses of albumin; ② high-dose furosemide; ③ benazepril; ④ antibiotics for infection control, etc., which further enhances the therapeutic effect.

(3) Cerebral Artery Sclerosis The brain comprises the cerebrum, cerebellum, thalamus, and brainstem (midbrain, pons, medulla oblongata). The cerebrum consists of two cerebral hemispheres, below which lies the thalamus, followed by the brainstem. On top of the brainstem sits the cerebellum, resembling a snail shell. Let us now examine the distribution of blood vessels. From the aortic arch, the brachiocephalic trunk branches off to the right, which then divides into the right common carotid artery and the right subclavian artery; from the left side of the aortic arch, the left common carotid artery and the left subclavian artery branch off. The bilateral common carotid arteries further divide into the external and internal carotid arteries, while the bilateral internal carotid arteries enter the cranial cavity through the carotid foramina at the base of the skull. Their main trunks directly continue as the middle cerebral artery, with branches forming the anterior cerebral artery. The bilateral subclavian arteries also give rise to the vertebral arteries, whose small branches nourish the spinal cord. The main trunks of the vertebral arteries pass through the foramen magnum and merge into the basilar artery, which then branches into the cerebellum. Meanwhile, the main trunks of the vertebral arteries continue upward, reaching the upper border of the pons where they split into two posterior cerebral arteries—the siphon section. This is the vascular flow of the brain, and we need to understand it clearly. The areas most prone to arterial sclerosis are the siphon section and the middle cerebral artery, as both have numerous bifurcations and sharp turns, making them susceptible to cerebral artery sclerosis. These are the regions seen on brain CT and MRI as the basal ganglia and the internal capsule, where infarcts and hemorrhages frequently occur. Another area prone to arteriosclerosis is the vertebrobasilar region, which is also susceptible to infarcts and hemorrhages. The underlying pathology is always arteriosclerosis—just like a plastic bag that becomes brittle and prone to rupture over time. Similarly, blood vessels age and become more fragile. Previously, cerebral infarction was called cerebral thrombosis; since the advent of CT and MRI, it is referred to as cerebral infarction. Small infarct foci or incomplete blockages of blood vessels are termed lacunar infarcts. Left-sided cerebral infarction affects language function, while right-sided infarction causes ataxia. Cerebellar lesions lead to severe ataxia, and lesions in the cerebral parenchyma can result in varying degrees of paralysis on the opposite side. On CT scans, infarcts appear as low-density areas, while new hemorrhages appear as high-density areas—simply put, infarct foci look black, whereas hemorrhage foci look white. On MRI, however, it’s the signal that matters: on T1-weighted images, hemorrhages appear as low signals, while on T2-weighted images, they appear as high signals. This is because air, blood, water, and bone all show low signals on T1-weighted images, but water becomes a high signal on T2-weighted images. Infarct foci, on the other hand, don’t change much between T1 and T2. These are fundamental skills for any healthcare professional. As a physician, one cannot simply rely on others’ reports—or worse, depend entirely on them. We must learn to interpret the images ourselves, so that theory and practice can be combined, experience can be continuously summarized, and progress can be made. Finally, let’s talk about the treatment of cerebral artery sclerosis. Western medicine is largely powerless against this condition. Of course, for patients with severe cerebral hemorrhage, Western medicine can perform surgery—drilling a hole in the skull to drain the hematoma, reduce intracranial pressure, and save lives. However, for cerebral infarction—what is commonly referred to as chronic stroke—only drugs such as breviscapine, evening primrose oil, puerarin, and streptokinase can be administered, and the efficacy is not very optimistic. In contrast, Traditional Chinese Medicine offers quite remarkable results in treating the latter. This naturally brings to mind two renowned figures: first, Wang Qingren, who invented the famous Buyang Huanwu Tang; and second, Liu Hejian, whose Dihuang Yinzi is an excellent prescription for treating cerebral infarction and hemiplegia. Of course, these can be combined with large doses of blood-activating and stasis-resolving herbs, such as Wang Qingren’s Xuefu Zhuyu Tang and Chen Keji’s Guanxin No. 2.