2. Effects of cytotoxic drugs on the cell cycle

2. Effects of cytotoxic drugs on the cell cycle ① Drugs affecting the M phase: Vinblastine (VCR), Vincristine (VLB), Vindesine (VDS), Colchicine (COL), VP-16. ② Drugs affecting the S phase: Cytarabine (Ara-C), 5-Fluorouracil (5-FU), 6-Mercaptopurine (6-MP), Methotrexate (MTX). ③ Drugs affecting the G1 phase: Hormones. ④ Drugs affecting the G2 phase: Antibiotics.

3. Formulation of chemotherapy regimens must consider the cell division cycle, classification of cancer cells, and degree of differentiation.

(1) Lung cancer: ① Small cell lung cancer (SCLC): EP regimen. ② Non-small cell lung cancer (NSCLC): AP, NP, GP, TP regimens. In general, cisplatin plays the main role.

(2) Gastric cancer: MFC regimen (Mitomycin + 5-FU + Ara-C), CF regimen (Cisplatin + 5-FU), CS regimen (Cisplatin + Taxotere). In typical gastric cancer chemotherapy regimens, 5-FU occupies the main position; in advanced gastric cancer, cisplatin (DDP) must be added.

(3) Colorectal cancer: FOLFOX regimen (Oxaliplatin + 5-FU + Calcium folinate), XELOX regimen (Oxaliplatin + Capecitabine).

(4) Esophageal cancer: TC regimen (Paclitaxel + Carboplatin), NP regimen (Vinorelbine + Cisplatin).

(5) Breast cancer: TC regimen (Docetaxel + Cyclophosphamide), AC regimen (Doxorubicin + Cyclophosphamide).

(6) Malignant lymphoma: ① Hodgkin lymphoma (HD): MOAP regimen (Mustard gas + Vinblastine + Adriamycin + Prednisone). ② Non-Hodgkin lymphoma (NHL): COAP regimen (Cyclophosphamide + Vinblastine + Adriamycin + Prednisone).

2010.8.31 Several Clinical Issues

1. Genital Herpes Genital herpes is a common disease in China, caused by the herpes simplex virus (HSV). Currently, two types of HSV have been identified: HSV-1 and HSV-2. In recent years, there have been breakthroughs in the treatment of this disease, such as the development of vaccines through HSV inactivation and genetic engineering.

2. Hemolytic Anemia ① Intracellular causes: Glucose-6-phosphate dehydrogenase deficiency, paroxysmal nocturnal hemoglobinuria, congenital familial spherocytic anemia. ② Extracellular causes: Infection, poisoning, immune response. Characteristics of this disease: Increased indirect bilirubin, increased reticulocytes, increased lactate dehydrogenase, decreased granulocyte-to-red-cell ratio, positive Coombs test.

3. Left Shift of White Blood Cells In bone marrow and peripheral blood, the ratio of band neutrophils to segmented neutrophils is 1:13. An increase in band neutrophils indicates a left shift, suggesting active bone marrow proliferation. A ratio greater than 0.06 indicates a mild left shift, greater than 0.1 a moderate left shift, and greater than 0.25 a severe left shift. The first two are seen in acute illnesses, such as infection and poisoning; the latter is seen in leukemia. An increase in segmented neutrophils indicates a right shift, suggesting restricted bone marrow proliferation, seen in aplastic anemia.

2010.12.20 Notes on Statins

Statins for lowering lipids are divided into hydrophilic and lipophilic types; the former has stronger organ penetration than the latter, but fewer side effects. The main side effects of these drugs include muscle fiber rupture and dissolution, as well as demyelination of the nervous system. The former manifests as muscle pain, while the latter as memory loss. Lipophilic statins include fluvastatin, simvastatin, and atorvastatin. Hydrophilic statins include pravastatin and rosuvastatin.

2010.12.21 Biological Treatment for Breast Cancer with Positive ER, PR, and HER-2

1. Tamoxifen (Toremifene) 10–20 mg, once or twice daily.

2. Toremifene (Shu Rui) 40–60 mg, once or twice daily.

3. Letrozole (Fu Rui) 2.5 mg, once daily; Anastrozole (Rui Ting) 1 mg, once daily.

The principle for using these drugs is to start them at the beginning of breast cancer surgery and radiochemotherapy, with a treatment course of at least 5 years.

Those with one positive result among ER, PR, or HER-2 can use them; those with HER-2 positive can also use them.

2010.12.22 Combination of Ma Gui Decoction and Kidney-Nourishing Formula for Treating Chronic Nephritis

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Input: In the winter of Gengyin, a patient named Wang with chronic nephritis had been ill for several years. Despite multiple hospitalizations and repeated treatments, his condition kept relapsing without any sign of cure. He came to the outpatient clinic seeking treatment from me. Over three visits, he received more than ten prescriptions each time, which provided some minor improvement but no significant effect. During the fourth consultation, the patient also had a severe cold, with fever, body aches, nasal congestion, runny nose, and headache; urine protein (+++), occult blood (++); BUN 12 mmol/L, Cr 136 μmol/L.

Prescription: Ephedra 10 g, Cinnamon twig 10 g, Apricot kernel 10 g, Licorice 6 g, Gypsum 30 g, Chuanxiong 6 g, Angelica root 6 g, Asarum 6 g, Notopterygium and Ledebouriella each 10 g, Saposhnikovia 12 g, Dandelion 15 g, Houttuynia 10 g, Angelica sinensis 10 g, Red peony root 10 g, Peach kernel 10 g, Safflower 6 g, Motherwort 20 g, Salvia miltiorrhiza 20 g, Honeysuckle 15 g, Forsythia 15 g, Isatis root 15 g, Fresh ginger 6 g, Jujube 4 pieces.

After taking seven doses of the prescription, the patient’s cold resolved, and his nephritis also greatly improved. His renal function significantly improved compared with before, with urine protein (-) and occult blood (±). Subsequently, he was instructed to continue taking the above formula, and after several years, the previously incurable chronic nephritis and renal failure showed an unprecedented remission.

December 23, 2010: Yangyin Qingfei Decoction for treating acne

In the winter of Gengyin, I treated an adult patient with facial acne, who had previously found success using formulas such as Shishan Sangbai and Tongqiao Huoxue. The patient mentioned that he had once taken Yangyin Qingfei Pills with great effect. Upon hearing this, I began to ponder: In my treatment of acne, my main principles have always been to clear heat, nourish yin, and detoxify—using Sanhuang for clearing heat, Zengye for nourishing yin, and Wuwei Xiaodu Yin for detoxification. The composition of Yangyin Qingfei seems to encompass all these methods!

December 24, 2010: Revision of the Guidelines for Diagnosis and Treatment of Hepatitis B

1. For individuals with HBV DNA ≥ 2 × 1000, antiviral therapy is required regardless of whether they have hepatitis or cirrhosis.

2. Antiviral therapy is necessary when ALT and AST levels rise to twice the upper limit of normal.

December 26, 2010: Traditional Chinese Medicine Treatment for Heel Pain

Eighty percent of heel pain patients suffer from Achilles tendonitis, which is an inflammatory injury affecting the ligaments and periosteum around the calcaneus.

Topical medication: Wu Zhu Yu 10 g, Schisandra 10 g. Grind into powder and place inside the shoe at the heel area.

Oral medication: Goji berries 10 g, Cinnamon 3 g, Rehmannia glutinosa 12 g, Papaya 20 g, Eucommia bark 10 g, Achyranthes bidentata 10 g, Angelica sinensis 10 g. Take one dose daily, decocted in water.

December 27, 2010: Malignant Lymphoma

1. The primary treatment for Hodgkin’s lymphoma is radiotherapy, as it is not sensitive to chemotherapy. The ten-year survival rate for this disease with radiotherapy ranges from 80% to 92%.

2. NK/T-cell lymphoma often first affects the nasopharynx; it can be treated with radiotherapy or chemotherapy.

3. Non-Hodgkin’s lymphoma may involve the spleen and brain.

December 28, 2010: Acute Respiratory Distress Syndrome (ARDS) is a common critical condition in respiratory diseases

ARDS is a major form of respiratory failure, clinically characterized by alveolar collapse due to inflammation, a significant reduction in lung volume, decreased systemic oxygen partial pressure, difficulty breathing, and subsequent multi-organ dysfunction syndrome (MODS).

For emergency treatment, Western medicine typically uses mechanical ventilation. However, mechanical ventilation can damage the respiratory tract, leading to secondary infections that further complicate recovery. Therefore, some advocate using low-tidal-volume continuous ventilation instead of mechanical ventilation.

December 30, 2010: A Case of Chronic Nephritis

A child in Jiuquan, Gansu Province, suffered from chronic nephritis that had remained untreated for many years and recently sought treatment from me. I used the formula “Three Herbs Eliminate Earth, Yellow, White, and Leucomallus Decoction” with good results.

Honeysuckle 12 g, Forsythia 12 g, Dandelion 15 g, Houttuynia 12 g, Tuckahoe 12 g, Imperata cylindrica 30 g, Rehmannia glutinosa 12 g, Kochia scoparia 10 g, Saposhnikovia 12 g, Smilax glabra 10 g, Red peony root 10 g, Peony bark 6 g, Licorice 6 g, Cicada slough 6 g, Astragalus 20 g, Polygonatum 20 g, White Flower Snake Tongue Herb 20 g, Leucomallus 30 g.

If this formula is supplemented with Alisma orientalis, Coix seed, Phellodendron amurense, Talc, and Aristolochia manshuriensis, it becomes “Smilax Removes Dampness Decoction + Three Herbs Eliminate Earth, Yellow, and White, plus Leucomallus Decoction,” which is even more effective in treating nephritis.

2011–2014 2011

January 10, 2011: Functional Uterine Bleeding in Adolescents

Ms. Wu, a 17-year-old female, experienced heavy menstrual bleeding that persisted throughout the day, seeking treatment from me.

At the time of examination, she reported mild abdominal discomfort and continued bleeding for over a day. My pulse diagnosis revealed a deep, fine pulse, with blood pressure at 90/60 mmHg.

I prescribed a formula to regulate qi and control blood: Codonopsis pilosula 10 g, Atractylodes macrocephala 10 g, Astragalus membranaceus 20 g, Poria cocos 10 g, Polygala tenuifolia 6 g, Stir-fried Ziziphus jujuba seeds 15 g, Agarwood 3 g, Longan meat 10 g, Angelica sinensis 10 g, Cinnamon twig 10 g, White peony root 10 g, Peach kernel 10 g, Cortex moutan 6 g, Rehmannia glutinosa 12 g, Donkey-hide gelatin 10 g, Mugwort 10 g, Raw Dragon Bone 15 g, Raw Oyster Shell 15 g, Cuttlefish bone 15 g. Take one dose daily, decocted in water.

After 14 doses, the bleeding stopped, and her menstruation returned to normal.

According to Zhang Jingyue’s “Blood Stasis Dissolving Decoction” (made with mountain fragrant flowers, green herbs, and black substances) and Zhang Xichun’s “Regulating Qi Soup” (with three types of Atractylodes, chicken, and Tian Shan vinegar), both are designed to treat pelvic venous stasis syndrome, masses, ovarian cysts, uterine fibroids, and other blood stasis conditions. Could they be used to stop bleeding? I believe that if the bleeding is caused by the aforementioned diseases, then they can be used; however, if the bleeding occurs without these underlying conditions, then they should definitely not be used!

January 11, 2011: Zhenwei Decoction

Zhang Xichun’s Zhenwei Decoction: Codonopsis pilosula, Atractylodes macrocephala, Astragalus membranaceus, Cornus officinalis, Longan meat, Raw Dragon Bone, Raw Oyster Shell, Anemarrhena asphodeloides, Fresh Ginger, Processed Frankincense, Processed Myrrh, Cuscuta chinensis.

Pei Zhengxue’s Zhenwei Decoction: Astragalus membranaceus, Angelica sinensis, Processed Frankincense, Processed Myrrh, Raw Dragon Bone, Raw Oyster Shell, Strychnos nux-vomica, Deer Antler Glue, Turtle Shell, Longan meat, Cornus officinalis.

Combining these two formulas yields even greater efficacy.

January 12, 2011: Zijin Ding for Treating Epilepsy

Galla chinensis 10 g, Rhizoma gastrodiae 20 g, Semen Euphorbiae 10 g, Euphorbia kansui 6 g, Realgar 2 g, Cinnabar 2 g, Sophora flavescens 20 g, Musk 1 g.

Grind all the ingredients into powder, sieve, compress into tablets, 0.3 g per tablet, take 3 times daily, 1–2 tablets each time.

Mnemonic: “Five mountains follow the big male, cinnabar is bitter yet fragrant.”

January 14, 2011: Tacrolimus

Tacrolimus is a potent immunosuppressant that binds to FKBP-12, inhibiting the release of interleukin-2 (IL-2), thereby preventing and/or treating rejection reactions. This drug is available in oral and injectable forms, with an oral dosage of 1 mg/kg/day, taken twice daily. Its anti-rejection effect is 100 times stronger than cyclosporine.

January 19, 2011: Coagulation Mechanism

Trauma stimulates platelets, causing them to release thromboplastin. Thromboplastin acts on prothrombin, converting it into thrombin. Thrombin then acts on fibrinogen, turning it into fibrin. As fibrin contracts, a blood clot forms. Twelve coagulation factors participate in this process, labeled with Roman numerals I, II, III...XIII, with factor VI actually being the activated fifth factor, so its designation has been canceled. Calcium ions and vitamin K are commonly known as coagulation factors. Hemophilia is the clinical manifestation of a deficiency in coagulation factor VIII.

January 21, 2011: Traditional Chinese Medicine Treatment for Tinnitus

Most cases of tinnitus are neurogenic, but hardening of cerebral arteries can also cause it, as can plaques in the carotid arteries and infarcts in the brainstem. When encountering this condition, I have previously used Tinnitus Pills, Bai Gui Compound, Liu Wei, Zuo Ci Pills, and Zhu Sha Shen Gui Five Stones Six, some of which were effective while others were not. Recently, I discovered a formula that is quite effective: Astragalus, Northern Ginseng, Bupleurum, Plantago, Turtle Shell, Softshell Turtle Shell, Raw Dragon Bone, Raw Oyster Shell, Magnetite, Pearl Oyster Shell, Raw Rehmannia, Cornus officinalis, Yam, Cortex moutan, Poria, Alisma. The hallmark of this formula is its heavy use of “five stones”—Turtle Shell, Softshell Turtle Shell, Raw Dragon Bone, Raw Oyster Shell, Magnetite, Pearl Oyster Shell, and others. Previously, I had never realized the significance of these stone-based medicines in treating tinnitus, but now I understand their potential and plan to try them out.

January 23, 2011: Treatment for Testicular Swelling and Pain

Testicular swelling and pain are usually due to inflammation. Epididymitis and orchitis are both purulent infections. There are also cases of epididymal tuberculosis and testicular cancer, which initially may not be painful but later become so (due to infection or infiltration). There is a formula that can treat the former: Angelica sinensis, Chuanxiong, Angelica dahurica, Asarum, Notopterygium, Ledebouriella, Saposhnikovia, Corydalis, Melia azedarach, Processed Frankincense, Processed Myrrh, Peach kernel, Safflower, Seaweed, Kelp, Soapberry thorns, Pangolin scales. This formula combines the Four Substances of Peach and Red, the Activating Spirit of Circulation, and the Selection of Oddities into one pot, while also carrying the connotation of the Immortal Life Drink. Based on my clinical experience, this formula can be modified to treat soft tissue injuries and infections in any part of the body, and I’ve devised a mnemonic to make it easier to remember.

Mnemonic: “Buddha’s Hand Peach and Red Combine with the Activating Spirit, the Selection of Oddities’ Golden Bell Rings Within, Still Have the Immortal Life Drink for Infections, Cinnamon Twig and Poria Treat Testicular Passage.”

February 9, 2011: Formula for Sudden Deafness

Magnetite, Acorus calamus, Yam, White peony root, Drynaria fortunei, Rheum palmatum, Chuanxiong, Pueraria lobata, Licorice, Stir-fried Ziziphus jujuba seeds.

Mnemonic: “Stone Mountain Buries Spiritual Bones, Great River Roots Grow Jujubes.”

This formula centers on Magnetite, Acorus calamus, Rheum palmatum, and Pueraria lobata.

February 9, 2011: Liver Cancer Pain Relief Decoction

Angelica sinensis 10 g, Chuanxiong 10 g, Red peony root 10 g, Rehmannia glutinosa 12 g, Peach kernel 10 g, Safflower 6 g, Goji berries 10 g, Chrysanthemum 10 g, Oyster shell 15 g, Turtle Shell 15 g, Ground Beetle 15 g, Scorpion 6 g.

This formula is specifically designed to treat liver pain caused by liver cancer.

February 25, 2011: Rare Adverse Effects of Chemotherapy

① Arrhythmia. ② Pneumothorax. ③ Cholecystitis, pancreatitis, appendicitis. ④ Mesenteric inflammation. ⑤ Hemolysis. ⑥ Exfoliative dermatitis.

March 15, 2011: First-Line Formula for Soft Tissue Tumors

Lithospermum 30 g, Gentian 15 g, Prunella vulgaris 15 g, Seaweed 10 g, Trichosanthes kirilowii 10 g, Peach kernel 10 g, Bupleurum 10 g, Salvia miltiorrhiza 20 g, Scrophularia ningpoensis 20 g, Cornus officinalis 10 g, Rhizoma gastrodiae 15 g.

Mnemonic: “Purple Dragon Summer Sea Cucumber, Mountains Mountains Mountains, Melon Peach Bupleurum.”

March 15, 2011: Formula for Arm Pain

White Mustard Seed 15 g, One Strychnos nux-vomica (fried), Myrrh 10 g, Cinnamon 3 g, Agarwood 6 g.

This formula is called the White Mustard Seed Compound and can be used in conjunction with the Zhimi Poria Pill. The highlight of its prescription is the inclusion of Strychnos nux-vomica.

March 15, 2011: Wind-Dispelling and Dampness-Removing Decoction