Mnemonic: Cinnabar, Divine Turtle, Five Stones, Six.

Mnemonic: Cinnabar, Divine Turtle, Five Stones, Six.

Formula 2: Magnetite 30g, Acorus Tatarinowii 6g, Polygala 6g, Chrysanthemum 15g, Red Peony 10g, Gardenia 10g, Scutellaria 10g, Forsythia 15g, Mint 3g, Bitter Tea 30g.

Mnemonic: Peony, Chrysanthemum, Polygala, Double Stone, Cool Heart Four, Bitter Tea.

Deafness and tinnitus are common clinical conditions, and both traditional Chinese and Western medicine often lack effective treatments for them. Before treating these conditions, I often found that formulas like Deafness Left-Ci Pill, Dangbai Gui Compound, and Erxian Decoction were somewhat effective, but truly remarkable results were rare. The above formula is newly developed by me, and clinical trials have shown it to be quite effective.

October 27, 2008: Compound Huoluo Lingdan for Rheumatic Heart Disease

Earthworm 6g, Earth Dragon 15g, Typha Pollen 6g, Five Spirit Resin 6g, Deer Antler Glue 10g (melted), Mulberry Branch 30g, Angelica 10g, Salvia 30g, Processed Frankincense 3g, Processed Myrrh 3g, Red Peony 10g, Safflower 6g, Agarwood 10g, Trichosanthes Fruit 10g, Allium 10g, Pinellia 6g.

Mnemonic: Earth, Land, Smile, Deer, Mulberry, Crown Two, Trichosanthes, Allium Soup.

This formula is particularly effective in treating rheumatic heart disease, mitral valve double damage, and patients with heart failure.

October 27, 2008: Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors

Drugs in this system include: ① Angiotensin-Converting Enzyme Inhibitors (ACEI, prils). ② Angiotensin II Receptor Blockers (ARB, sartans). RAAS inhibitors are currently recognized as effective drugs that can provide end-organ protection against hypertension. It has been proven that only regimens containing RAAS inhibitors can reduce the risk of hypertension-related damage to the heart, brain, and kidneys.

October 31, 2008: Pyramidal System and Extrapyramidal System

The pyramidal tract is the basic pathway connecting the cerebral cortex with the lower central nervous system. Any lesion affecting the connection between the cortex and this pathway is called a pyramidal system lesion or pyramidal tract lesion, at which point patients exhibit positive pathological reflexes (Babinski sign, Gordon sign, Oppenheim sign, Chaddock sign, Hoffmann sign, ankle clonus test), disappearance of superficial reflexes, and hyperreflexia of deep reflexes. Apart from the pyramidal tract, other central nervous system lesions, such as Parkinson's disease and Wilson's disease, do not involve the pyramidal system, manifesting as muscle rigidity, tremor, bradykinesia, and postural abnormalities—these four characteristics are known as extrapyramidal symptoms. Metoclopramide, sedatives, and analgesics can all induce extrapyramidal reactions.

November 3, 2008: The Concept of Personalized Treatment

The personalized treatment proposed in modern times is essentially the same as the syndrome differentiation and treatment in traditional Chinese medicine. Zhang Zhongjing’s view of syndrome differentiation and treatment emphasizes a patient-centered approach rather than a disease-centered one. Academician Sun Yan firmly believes this, citing an example: gefitinib, used to treat non-small cell lung cancer (NSCLC), is ineffective for Western populations but effective for Eastern populations. Moreover, among Easterners, the drug is effective for women, non-smokers, and adenocarcinoma patients under 65, but ineffective for others. Additionally, imatinib was originally a specialized drug for treating chronic myeloid leukemia, but later it was discovered to be effective for gastrointestinal stromal tumors as well. Academician Sun believes that there are many points of convergence between traditional Chinese culture and Western philosophical thought in the field of medical science.

November 11, 2008: Three Types of Antihypertensive Drugs

1. Isosorbide Mononitrate, a derivative of sorbitol, intended to dilate blood vessels and lower blood pressure, 40mg each time, once daily.

2. Shoubishan (indapamide), a sulfonamide diuretic, 2.5mg each time, once daily.

3. Xibilin (flunarizine), a calcium channel blocker, 20mg each time, once daily.

The aforementioned isosorbide mononitrate is also known as “Xinxintong,” and sustained-release tablets have recently become available. This drug can relieve coronary artery spasm as well as systemic vascular spasm, and it is particularly effective in relieving bronchial spasm. In November 2008, I used this drug to treat a patient with severe pulmonary infection, but the patient experienced serious adverse drug reactions. These reactions included generalized burning sensation, headache, joint pain, palpitations, and shortness of breath. Remember this!

November 20, 2008: Cardiorenal Syndrome

Cardiorenal syndrome refers to a complex condition in which multiple organs throughout the body are successively affected due to simultaneous dysfunction of cardiac and renal functions. The root cause is that the heart and kidneys cannot compensate for the damage to other related organs. For patients with chronic heart failure, if renal dysfunction occurs, the mortality rate increases significantly. The worse the renal function, the higher the mortality rate.

November 13, 2008: Five-Minute Impressive Speech

On November 13, 2008, the China Medical Forum Newspaper invited medical experts from various disciplines in China to share their unique experiences.

1. Hou Xiaohua Gastroesophageal reflux disease, functional dyspepsia, irritable bowel syndrome, and functional constipation can all lead to changes in gastrointestinal motility. Barrett’s esophagus is more common in elderly men, with more hyperplasia and less metaplasia. Functional constipation is more common in women, and the more deliveries a woman has, the more likely she is to experience constipation.

2. Hu Fulián Helicobacter pylori, after leaving the gastrointestinal tract, can induce atherosclerosis, leading to acute coronary heart disease, pancreatic cancer, and other diseases.

3. Xu Guoming Acute severe pancreatitis cannot be simply resolved; internal medicine treatment is still necessary.

4. Qian Jiaming Research on gastrointestinal hormones has permeated all academic groups. The gastrointestinal-endocrine system is related to various gastrointestinal diseases and is currently a difficult point in treating stomach ailments, especially functional gastrointestinal disorders.

5. Tang Chengwei Interventional procedures such as shunt surgery, devascularization, and splenic artery embolization for portal hypertension are currently under discussion.

6. Hu Pinjin Discussions have been held regarding the safety of using the immunosuppressant azathioprine. Azathioprine is a derivative of 6-mercaptopurine and is one of the anticancer chemotherapy drugs. Immunossuppressants can be used to treat autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus; in recent years, they have also been used to prevent rejection in organ transplantation.

December 15, 2008: Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia, accounting for about one-third of all patients with arrhythmias. It is divided into paroxysmal, persistent, and permanent types. Clinical manifestations include chest tightness, palpitations, shortness of breath, and shock.

Treatment for atrial fibrillation: ① Amiodarone 100mg, three times daily, oral administration, side effects include dry mouth, tongue numbness, dizziness, headache, and conduction block. ② Propafenone (Rytmonorm) 150mg, three times daily, oral administration, side effects include headache, dizziness, hand numbness, conduction block, and shock.

December 25, 2008: Several New Preparations

1. Ambono (irbesartan hydrochlorothiazide), each tablet contains 150mg of irbesartan and 12.5mg of hydrochlorothiazide, three times daily, oral administration.

2. Ambovi (irbesartan), 150mg each time, once daily, oral administration.

3. Plavix (clopidogrel), 75mg each time, once daily, oral administration.

Year 2009

January 15, 2009: Two Types of Insecticides

1. Leiwan The dried sclerotium of the fungus Leiwan in the family Tricholomataceae, with insecticidal effects, slightly toxic, enters the large intestine and stomach meridians. Leiwan is 0.5–0.8cm in diameter, do not boil, grind into powder and take with water, 3–6g each time.

2. Wuyi Made from the processed seeds of the elm tree in the family Ulmaceae, with effects of killing three kinds of parasites and removing dead flesh, entering the spleen and stomach meridians. Wuyi can be taken internally as a decoction or made into pills and powders, 3–6g each time.

January 16, 2009: Anti-Thyroid Drugs

1. Methimazole, 0.1–0.2g each time, three times daily, oral administration, side effects include urticaria, nausea, vomiting, and dizziness.

2. Propylthiouracil, 0.1–0.2g each time, three times daily, oral administration, side effects are the same as the above drug, slightly milder.

3. Methimazole (Tapazole), 5–10mg each time, three times daily, oral administration, its effect is ten times stronger than the above drugs, side effects are the same as the above drugs, extremely mild.

February 11, 2009: Overview of Stem Cell Transplantation Therapy

In the 1960s, hematopoietic stem cell transplantation began to be applied clinically. This therapy is usually divided into autologous transplantation and allogeneic gene transplantation. According to the source of stem cells, it is further divided into bone marrow transplantation and hematopoietic stem cell transplantation. Currently, the most common method is allogeneic hematopoietic stem cell transplantation. Autologous stem cell transplantation does not require a donor, and objectively can extend the survival period of patients with granulocytic leukemia, thus having promotional significance. At present, the method of stem cell transplantation is to first use high-dose radiotherapy and chemotherapy to eliminate tumor cells in the body, then transplant autologous or allogeneic hematopoietic stem cells. This method was first applied to leukemia and malignant tumors, and in recent years has made certain progress in applications for autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and multiple sclerosis (MS). Recurrence after transplantation is the biggest drawback of this method; to prevent recurrence, it is usually necessary to use some immunosuppressants, such as hormones, mycophenolate mofetil, tacrolimus, etc.

Progenitor cells have functions similar to stem cells, but differ in that their direction of differentiation has already been determined, unlike stem cells which have infinite directions of differentiation. The human body has a strong repair ability. In emergencies, stem cells are stimulated by activating factors from different sources and differentiate in various specific directions, thereby repairing their own injuries—for example, the formation of pseudo-gallbladder or pseudo-bladder in clinical practice falls into this category.

February 12, 2009: Further Discussion on Autoimmune Hepatitis

Autoimmune hepatitis (AIH) is a primary disease that occurs in the liver. Clinically, it is characterized by high serum transaminase levels, high gamma-globulin levels, positive autoantibodies, and interface hepatitis in liver tissue. Acute patients generally respond well to glucocorticoids.

AIH can be classified into three types based on serum immunology: Type I AIH is the most common, with relevant antibodies being ANA and/or SMA; Type II AIH is characterized by positive anti-LKM-1; Type III AIH is characterized by positive serum anti-SLA/LP. Some scholars also believe that Type III should be classified as Type I. There is no significant difference in the causes of each type or in their response to glucocorticoids, so classification has little guiding significance for clinical practice. Among them, 80%–85% of patients belong to Type I.

The International Autoimmune Hepatitis Group (IAIHG) formulated descriptive diagnostic criteria and a diagnostic scoring system for AIH in 1993, and revised them twice in 1999 and 2008.

March 4, 2009: Tongqiao Huoxue Tang and Xuefu Zhuyu Tang

These two formulas are famous prescriptions by Wang Qingren. The mnemonic for the former is: Peach, Red, Four Substances, Ginger, Jujube, Onion, Tongqiao Huoxue, Musk True. The mnemonic for the latter is: Peach, Red, Four Substances, Xuefu Famous, Chai, Zhi, Ju, Niu, Twenty Symptoms. The former mainly treats rhinitis, purpura, and deafness; the latter treats headache, dizziness, chest pain, and chest tightness, etc.

March 31, 2009: Evans Syndrome

This disease is idiopathic thrombocytopenic purpura combined with hemolytic anemia, first proposed by Canadian internist Evans, hence the name. Glucocorticoids and immunosuppressants are the preferred treatments for this disease, which can alleviate symptoms but cannot cure it completely.

April 1, 2009: Chemotherapy Regimens for Advanced Gastric Cancer

1. Cisplatin + Taxotere Cisplatin 60mg/m^2^, intravenous infusion, administered on day 1. Taxotere 40–60mg, oral administration, twice daily, administered from day 1 to day 14. Repeat every 21 days.

2. Cisplatin + 5-Fluorouracil Cisplatin 75–100mg/m^2^, intravenous infusion, administered on day 1. 5-Fluorouracil (5-FU) 750–1000mg/(m^2·d), intravenous infusion, continuous for 24 hours, administered from day 1 to day 4. Repeat every 28 days.

May 19, 2009: Latest Information on Hepatitis B

1. Treatment Goals for Chronic Hepatitis B The goal of treating chronic hepatitis B is to continuously suppress HBV replication, prevent cirrhosis, liver failure, and hepatocellular carcinoma, improve patients’ quality of life, and prolong survival. If HBV is persistently suppressed, the activity of inflammatory factors in liver tissue will decrease, making this goal achievable. However, since CCCDNA exists in the nuclei of infected liver cells, HBV cannot be completely eliminated.

2. Treatment Endpoint for Hepatitis B The so-called treatment endpoint refers to when medication can be stopped. Currently, anti-HBV drugs can be broadly divided into two categories: interferons and nucleoside analogs. The former includes regular interferon and polyethylene glycol interferon, while the latter includes lamivudine, adefovir, entecavir, telbivudine, tenofovir. Guidelines in various countries and the journal “Process” have different statements regarding the timing of stopping these two types of drugs. Interferon treatment courses are relatively fixed: 24 weeks for a short course, 48 weeks for a long course, and can be extended to 2 years if necessary. Nucleoside analogs have stable efficacy and are safer, but the treatment course is longer and harder to stop. The standard for stopping medication mainly applies to nucleoside analogs. The guidelines issued by the American Association for the Study of Liver Diseases (AASLD) state that patients who are e-antigen positive can stop medication once they turn negative, and 50%–90% of patients can maintain a sustained response. Patients who are e-antigen negative also often relapse, and there is currently no clear conclusion regarding nucleoside treatment for these patients. The ideal endpoint for hepatitis B treatment is the persistent disappearance of HBsAg and the formation of anti-HBs.

May 22, 2009: Liver Changes Seen on MRI

MRI is less specific than CT when examining the liver; analysis should be based on three characteristics: ① low signal of blood, water, and gas. ② size and location of liver fissures. ③ direction of blood vessels and bile ducts (whether they are disordered).

Liver cirrhosis: enlarged liver fissures, undulating anterior margin, enlarged liver.

Liver cysts: low T1 signal, high T2 signal.

Liver vascular disease: due to slow blood flow, low T1 signal, high T2 signal.

Liver cancer: equal T1 signal, uneven T2 signal. Morphological changes, displacement of liver fissures, disordered direction of blood vessels, and disordered direction of bile ducts.

June 2, 2009: Alzheimer’s Disease

Alzheimer’s disease is a neurological disorder first discovered in 1906 by German psychiatrist Alzheimer. The main manifestation is gradual progression to dementia as memory is lost. In 2005, American scholars confirmed that the insulin signaling in the brain tissue of patients with this disease is significantly lower than normal, so some people suggest calling it type 3 diabetes.

June 3, 2009: Vascular Dementia

Vascular dementia, also known as vascular depression, is caused by insufficient blood supply to the brain due to cerebral arteriosclerosis, coupled with increased secretion of neurotransmitters such as serotonin and norepinephrine. Patients initially exhibit depressive mood and cognitive decline, followed by impairments in memory, emotion, and behavior. Most of the medications used to treat it are serotonin receptor inhibitors.

June 4, 2009: Treatment Guidelines for Adult Heart Failure and Arrhythmia

The preferred drugs for treating adult heart failure and arrhythmia are ACEIs, followed by ARBs. In short, any drug in the renin-angiotensin system (RAS) is preferred, and beta-blockers can also be used, especially suitable for heart failure patients with rapid arrhythmias. Whether CCBs have the effect of correcting heart failure remains inconclusive.

Regarding arrhythmias, in addition to recommending RAS and beta-blockers, amiodarone is also recommended. This drug is a potassium channel blocker and also has calcium channel blocking effects, making it an ideal drug for arrhythmias.

June 5, 2009: Dynamic Electrocardiogram