June 10, 2009: Consensus on Diagnosis and Treatment of Primary Hepatocellular Carcinoma HCC

American physicist Holter invented the dynamic electrocardiogram, later named Holter by subsequent generations. This technology has two major advantages: “long-term” and “dynamic,” greatly improving the understanding of arrhythmias. However, the dynamic electrocardiogram is powerless against intermittent arrhythmias. Therefore, implantable dynamic electrocardiograms emerged. In 1997, the first-generation implantable Holter was approved by the U.S. FDA for clinical use. The implantation method involves making a 1.5cm incision in the rectangular area formed by the left sternal border, the mid-clavicular line, the first rib, and the fourth rib, then burying the device under the skin for about 1.5 years.

June 10, 2009: Consensus on Diagnosis and Treatment of Primary Hepatocellular Carcinoma (HCC)

1. Small HCCs are treated by surgical resection, large ones by interventional therapy, which can be combined with biological therapies such as INF-α, thymosin α1, IL-2, etc.

2. Targeted therapy drugs are used, such as sorafenib and sunitinib.

3. Systemic chemotherapy regimens, previously including 5-FU, mitomycin, cisplatin, and doxorubicin. Currently, commonly used drugs in clinical practice include oxaliplatin, capecitabine, irinotecan, and gemcitabine.

June 16, 2009: Can Aspirin Be Used for Primary Prevention?

The “Chinese Guidelines for Primary Prevention of Cardiovascular Diseases” consider taking aspirin when healthy to be an important measure for primary prevention of cardiovascular diseases. However, the International Antithrombotic Trial (ATT) Collaborative Group, after evidence-based medical analysis, concluded that only patients who have already experienced a cardiovascular emergency should take aspirin to reduce the recurrence of cardiovascular events; therefore, aspirin should not be used as a first-line preventive drug, but rather as a second-line preventive drug.

June 17, 2009: Long Breastfeeding Period Can Prevent Cardiovascular Events in Women

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A study by American scholars indicates that prolonged breastfeeding is associated with a reduced incidence of postmenopausal hypertension, diabetes, hyperlipidemia, and cardiovascular diseases in women. The paper was published in the 5th issue of the International Journal of Obstetrics and Gynecology in 2009.

2009.6.18 Chronic Kidney Disease

Chronic kidney disease (CKD) is a major threat to human health. According to statistics, by 2010, the number of patients worldwide requiring dialysis (end-stage renal disease, ESRD) had reached 2 million.

The most extensive association is between CKD and diabetes, with approximately 30% of diabetic patients also having CKD. How to prevent the progression of CKD to ESRD is currently a major concern in the medical community.

2009.6.19 Common Gynecological Tumors

1. Cervical Cancer The most common, accounting for 72.4%–92.1% of gynecological malignancies. Among these, squamous cell carcinoma accounts for 95%, adenocarcinoma for 2.5%, and mixed carcinoma (squamous + adenocarcinoma) for 2.5%. Surgery and radiotherapy can both be used as first-line treatments for this disease. Chemotherapy can also be used, but only as an adjuvant therapy.

2. Uterine Cancer Accounts for about 10% of gynecological malignancies. Surgical resection is the preferred treatment for this disease.

3. Ovarian Cancer ① Epithelial ovarian cancer: Serous adenocarcinoma accounts for 40%–50%, mucinous adenocarcinoma for 10%, endometrioid adenocarcinoma for about 5%, and clear cell adenocarcinoma for 5%. ② Germ cell tumors: Teratoma (10%), dysgerminoma, yolk sac tumor (children). ③ Metastatic cancer (Krukenberg tumor). ④ Sex cord-stromal tumors.

4. Gestational Trophoblastic Neoplasia Complete hydatidiform mole, partial hydatidiform mole, choriocarcinoma.

2009.7.6 Estrogen Receptor Antagonists

Estrogen receptor antagonists can be used in ER- and PR-positive patients. For patients with high estrogen levels, breast cancer is prone to recurrence; using these antagonists can delay or prevent breast cancer recurrence.

Common estrogen receptor antagonists include: ① Tamoxifen (Toremifene) 10–20 mg, twice daily, can be used long-term. ② Toremifene (Shu Rui) 40–60 mg, once daily, can be used long-term. ③ Letrozole (Fu Rui) 25 mg, once daily, can be used long-term. ④ Anastrozole (Rui Ting) 1 mg, three times daily.

2009.7.16 Several New Anti-Cancer Drugs

1. Tarceva (Erlotinib) 150 mg, once daily, taken on an empty stomach.

2. Iressa (Gefitinib) 250 mg, once daily, taken on an empty stomach.

3. Gemcitabine (Gai Nuo) 25–30 mg/m², once weekly, administered intravenously.

2009.7.30 Several Effective Traditional Chinese Medicine Formulas

1. Compound Qiju Decoction Rehmannia root 12 g, Cornus fruit 10 g, Chinese yam 10 g, Moutan bark 6 g, Poria 12 g, Alisma 10 g, Goji berries 10 g, Chrysanthemum flowers 10 g, Codonopsis 10 g, Atractylodes 10 g, Astragalus 20 g, Polygala 6 g, Stir-fried Ziziphus seed 15 g, Agarwood 3 g, Longan meat 10 g, Kudzu root 15 g, Vitex 10 g, Ginkgo nuts 20 g, Phellodendron 6 g, Cimicifuga 3 g. Take one dose daily, decocted in water.

This formula is a combination of Qiju, Guipi, and Congming formulas. In the year of Yichou, I used this formula to treat three cases of anxiety in Zhaojiahe (Ganquan Town, Maiji District, Tianshui City), and all were effective.

2. Compound Shaoyao-Gancao Decoction White peony root 20 g, licorice 6 g, Qingfeng vine 15 g, Haifeng vine 15 g, Jixueteng 15 g, Papaya 20 g, Coix seed 20 g, Achyranthes 15 g, Weilingxian 10 g, Angelica 10 g, Peach kernel 10 g, Safflower 6 g, Rehmannia root 12 g, Red peony root 10 g, Chuanxiong 6 g, Chuanwu and Caowu each 10 g, Asarum 3 g, Strychnos seed 1 piece (fried). Take one dose daily, decocted in water.

This formula is effective for treating joint diseases.

2009.7.31 Prescription for Cervical Spondylosis

This condition often presents with headache, dizziness, shoulder heaviness, and numbness in the hands; however, a small number of patients experience head heat, neck heat, tinnitus, ear ringing, irritability, and depression, leading to frequent misdiagnoses!

I reviewed 10 well-known traditional Chinese medicine prescriptions for treating cervical spondylosis nationwide, and here are some examples:

① Four Substances, Kudzu root, Astragalus, Weilingxian, Citrus aurantium, Scorpion.

② Coix seed, Papaya, Natural copper, Psoralea, Caowu, Chuanwu, Tuber insect.

③ Kudzu root, Cinnamon twig, White peony, Licorice, Chuanxiong, White angelica, Asarum, Qianghuo, Duhuo, Fangfeng.

④ Red peony root 10 g, Chuanxiong 10 g, Safflower 6 g, Agarwood 10 g, Salvia miltiorrhiza 20 g, Panax notoginseng 3 g, Leech 10 g, White angelica 6 g, Earthworm 12 g, Asarum 10 g, Qianghuo and Duhuo each 15 g, Fangfeng 12 g.

2009.8.7 Gout Prescription

Herba Lysimachiae 15 g, Hedyotis diffusa 20 g, Bombyx batryticatus 15 g, Rhizoma gastrodiae 10 g, Weilingxian 10 g, Smilax glabra 10 g, Stephania tetrandra 6 g, Liu jinu 15 g, Talc 20 g, Atractylodes lancea 16 g, Phellodendron 10 g, Processed frankincense and myrrh each 10 g. Decocted in water.

Mnemonic: Stretch mountain, smudge stone, make milk and myrrh; two wonders leave Weilingxian and insects.

2009.8.13 Primary Biliary Cholangitis (PBC)

This disease was formerly known as cholestatic cirrhosis, with diagnosis based on jaundice, portal hypertension-related cirrhosis, elevated alkaline phosphatase (ALP), and positive serum anti-mitochondrial antibody (AMA). It was previously widely considered an autoimmune liver disease. Recently, it has been suggested that most cases are overlapping syndromes of PBC and AIH.

2009.8.14 Primary Sclerosing Cholangitis (PSC)

Diagnosis of primary sclerosing cholangitis (PSC) often relies on magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). PSC often coexists with irritable bowel syndrome (IBS); if IBS is not detected, it suggests that PSC has just begun. Patients with long-term cholecystitis should have their intrahepatic bile ducts and colon examined for inflammation—positive findings indicate PSC, while negative results suggest IBS.

2009.10.19 Treatment Experience with Gliomas

I have treated two brain glioma patients with good results. One was a 20-year-old male patient, and the other was a 14-year-old female patient. The former took medication after surgery, while the latter took medication without undergoing surgery. After surgery, the low-density plaque in the former completely disappeared; after treatment, the low-density plaque in the latter almost completely disappeared, and both showed complete improvement in mental state. Specific prescriptions are as follows:

Tortoise shell 15 g, Soft-shelled turtle shell 15 g, Oyster shell 15 g, Ligustrum lucidum fruit 12 g, Eclipta prostrata 12 g, Rehmannia root 12 g, Cooked Rehmannia root 12 g, Safflower 6 g, White peony root 15 g, Achyranthes 15 g, Psoralea 10 g, Salvia miltiorrhiza 20 g, Sophora flavescens 20 g, Cinnabar 2 g, Ephedra 10 g, Sanleng 10 g, Ezhushi 10 g, Seaweed 10 g, Kelp 10 g, Acorus calamus 6 g, Locust flower 15 g, Snake tongue grass 15 g, Half branch lotus 15 g, Cornus fruit 10 g, Chinese yam 10 g, Moutan bark 6 g, Poria 12 g, Alisma 10 g, Cinnamon twig 10 g, Attached slice 6 g, Leech 10 g (taken in divided doses), Panax notoginseng 3 g (taken in divided doses), Ophiopogon 10 g. Decocted in water, one dose every two days.

At the same time, take Ancient Sage No. 2 and Wind-Dispelling No. 2.

2009.10.21 Treatment Experience with Aplastic Anemia

Angelica 10 g, Chuanxiong 6 g, Jixueteng 15 g, Salvia miltiorrhiza 20 g, Safflower 6 g, Rehmannia root 12 g, He Shou Wu 15 g, Eclipta prostrata 20 g, Rhubarb 10 g, Cornus fruit 30 g, Longan meat 10 g, Dodder 10 g, Ligustrum lucidum fruit 10 g, Goji berries 10 g, Strychnos seed 1 piece (fried), Cistanche deserticola 10 g, Ginseng roots 15 g, Prince ginseng 15 g, Codonopsis 15 g, Northern sand ginseng 15 g, Ephedra 10 g, Deer antler 10 g, Soap alum 2 g. Decocted in water, one dose every two days.

I use the above formula with adjustments and have cured many cases of aplastic anemia.

2009.11.3 Treatment Experience with Invasive Fungal Infections

Massachusetts General Hospital in the United States points out: Candida infection is the main form of invasive fungal infection in immunocompromised patients, and if not treated promptly, the consequences can be severe. Fluconazole and echinocandin drugs can be used as initial treatment. Amphotericin B liposome can be used as a supplement for those who do not respond to the aforementioned two drugs.

Caspofungin is a representative echinocandin drug and currently the only one available on the market. Caspofungin's trade name is Cancidas, which is only available for intravenous infusion at 50 mg per dose, slowly infused into saline solution over 2 hours; the first dose is 70 mg, with a 14-day course.

2009.11.16 Treatment Experience with Psoriasis

I treated a psoriasis patient surnamed Chen in the outpatient clinic. Initially, I prescribed Ke Yin No. 1: Radix Sophorae Tonkinensis 10 g, Paris polyphylla 10 g, Cortex Dictamni 10 g, Bai Mao Gen 20 g, Tribulus terrestris 30 g, Smilax glabra 15 g, Lonicera japonica 20 g, Rehmannia root 12 g, Isatis indigotica 20 g, Weilingxian 10 g, Rheum palmatum 10 g, Forsythia suspensa 20 g, Indigo naturalis 3 g, Cannabis sativa 15 g.

After taking more than a hundred doses, there was significant effect, but the condition fluctuated. Later, I added Smilax glabra 20 g, Honeysuckle 15 g, Dandelion 15 g, Plantago 15 g, Fructus Cnidii 10 g, Fangfeng 12 g, Rhizoma Dioscorea 15 g, Red peony root 10 g, Moutan bark 6 g, Licorice 6 g, Cicada slough 6 g. After taking these additional herbs, the patient experienced unprecedented effectiveness.

2009.11.18 Upper Airway Cough Syndrome

Mr. Li suffered from chronic pharyngitis and cough, with no effect from any medication. Initially, I treated him with Yangyin Qingfei Tang combined with Zhousou San, but the effect was only moderate. Later, I added Poppy shell 10 g, and the effect improved. Subsequently, I added Ephedra 10 g, Apricot kernel 10 g, Licorice 6 g, Poppy shell 20 g, Oyster shell 15 g, Earthworm 15 g, Citrus peel 6 g, Bile gallbladder 6 g, and found great effect.

Mnemonic: Sweet poppy, oyster, earthworm, and citric acid—there’s plenty of apricot and almond.

In addition, I used Indigo naturalis 20 g, Cordyceps sinensis 20 g, Calcined alum 20 g, Zhejiang fritillary bulb 20 g, and a pair of gecko. All were ground into powder, put into capsules, 0.5 g per capsule, taken three times a day, two capsules each time.

Mnemonic: Green grass, calcined alum, and a pair of geckos.

2009.11.24 New Drug Nicorandil for Treating Coronary Heart Disease

Angina pectoris can be divided into exertional and spasm-type; the former occurs after labor (physical work), while the latter occurs when there is no exertion. Traditional medications such as nitroglycerin and calcium channel blockers (CCB) are effective for both types of angina; beta-blockers are ineffective for spasm-type angina; ACE inhibitors, ARBs, aspirin, and statins have no symptom-relieving effect for either type, but they do improve prognosis. Recently introduced Nicorandil, marketed as Xigemai, not only relieves symptoms of both exertional and spasm-type angina, but also improves prognosis.

2009.11.28 Pure Red Aplastic Anemia

Pure red cell aplasia is rare clinically, but has become more common in recent years. This condition is usually accompanied by thymoma; after surgical removal of the thymoma, recovery or stabilization is expected. Treatment mainly involves hormones, with examination focusing on poor red cell regeneration and absence of reticulocytes.

2009.11.29 Plasma Cell Mastitis

Plasma cell mastitis refers to mastitis primarily characterized by plasma cell infiltration, also known as chronic mastitis, mainly manifested as chronic dilation of the mammary ducts. This condition tends to recur after surgery, with necrosis, nodules, and sinus tracts; anti-inflammatory treatment is usually ineffective, while traditional Chinese medicine is effective.

2009.11.30 Multiple Myeloma (MM)

Multiple myeloma refers to a reduction in all three blood cell lines caused by excessive proliferation of plasma cells in the bone marrow, clinically manifested as bone pain, osteolysis, reduction in all three blood cell lines, increased monoclonal immunoglobulin, increased Bence Jones protein, hypercalcemia, hyperuricemia, and kidney dysfunction. Chemotherapy is not very effective for treating this disease. Whether plasma cell myeloma should be distinguished from this disease remains a topic of ongoing discussion.

2009.12.15 Inhalation Spray for Treating Bronchial Asthma

There are various forms of inhalers, but the medications used are generally limited to four types: ① Ipratropium bromide: relieves spasms and dissolves phlegm. ② Salbutamol: a beta-adrenergic agonist. ③ Budesonide: a corticosteroid with few side effects. ④ Antibiotics.

2009.12.16 Course of the Vena Cava

The vena cava is divided into the inferior vena cava and the superior vena cava.

Inferior vena cava: Located between the 4th and 5th lumbar vertebrae, formed by the confluence of the left and right common iliac veins, runs along the right side of the abdominal aorta, parallels the abdominal aorta up to the medial aspect of the hepatic portal, then diagonally through the vena cava groove upward, passing through the diaphragmatic vena cava hole into the thoracic cavity, finally entering the right atrium.

Superior vena cava: Located behind the right 1st costal junction, formed by the confluence of the left and right brachiocephalic vein, runs along the right side of the ascending aorta, descending to the lower edge of the right 3rd costal joint before injecting into the right atrium.

2009.12.28 Major Clinical Events Announced by the American Society of Clinical Oncology (ASCO)

1. Breast cancer treated with capecitabine monotherapy is less effective than standard chemotherapy (cyclophosphamide + 5-FU, cyclophosphamide + doxorubicin).

2. Gastric cancer patients who are HER-2 positive have a higher mortality rate. Trastuzumab can reduce the risk of death by 26% and increase the objective response rate from 34% to 47%.

3. NSCLC patients treated with gefitinib, if EGFR positive, experience a significant prolongation of progression-free survival (PFS).

2010

2010.1.4 Sentinel Lymph Node Biopsy (SLNB)

Performing sentinel lymph node biopsy (SLNB) lays the foundation for accurate staging of axillary lymph nodes. A positive sentinel lymph node (SLN) provides a basis for deciding how to proceed with axillary lymph node dissection.

2010.1.6 Cancer Incidence in China

According to the number of cancer cases, ranked from highest to lowest: lung cancer > gastric cancer > liver cancer > esophageal cancer > colorectal cancer > breast cancer > cervical cancer > nasopharyngeal cancer > bladder cancer > ovarian cancer.

2010.1.13 Discussion on Malignant Tumors

Malignant tumors are currently the greatest threat to human health. Although the exact causes are not fully understood, immune disorders, gene mutations, and genetic factors are the fundamental reasons for abnormal cell division.

1. Cell division cycle (G1, S, G2, M, G0) G1 phase lasts 2–3 days, S phase 1–2 days, G2 phase 2–3 hours, M phase 1–2 hours, G0 phase lasts from several hours to several decades.