April 18, 2011: A Case of Renal Failure

In the spring of Xin Mao, Mr. Wang suffered from cervical spondylosis, with headaches and neck pain, accompanied by shooting pain and numbness in the back, shoulders, and arms. He had previously taken ibuprofen, fenbid, indomethacin, pyroxicam, diclofenac, and other medications without noticeable effect. I formulated a prescription for him, and after taking seven doses, all his pain disappeared, and the numbness in his arms vanished completely.

Prescription: Astragalus 20 g, Coix seed 20 g, Papaya 20 g, Natural Copper 20 g, Psoralea corylifolia 10 g, Drynaria fortunei 10 g, Chuanwu and Caowu each 15 g (decocted for 1.5 hours first), Dipsacus asper 10 g, Tuckahoe 10 g, Cinnamon twig 10 g, White peony root 10 g, Licorice 6 g, Fresh Ginger 6 g, Four Jujubes, Pueraria lobata 20 g, Angelica dahurica 6 g, Asarum 3 g, Notopterygium and Duhuo each 10 g, Ledebouriella 12 g, Fangfeng 12 g, Silkworm pupa 6 g, Scorpion 6 g, Centipede 1–2 pieces. Take one dose daily, decocted in water.

This formula consists of four parts: ① Coix seed breaks through the earth and Chuanwu; ② Cinnamon twig soup with Pueraria lobata (including the five-substance formula of Astragalus and Cinnamon twig); ③ Notopterygium removes dampness; ④ Three-insect soup.

April 18, 2011: A Case of Renal Failure

Mr. Chen suffers from chronic nephritis and renal failure. Urine protein (++), occult blood (++); urea nitrogen 11.2 mmol/L, creatinine 135 μmol/L.

Prescription: Rehmannia glutinosa 12 g, Cornus officinalis 10 g, Yam 10 g, Peony bark 10 g, Poria cocos 12 g, Alisma orientalis 10 g, Cinnamon twig 10 g, Prepared Aconite 6 g, Peach kernel 10 g, Safflower 6 g, Angelica sinensis 10 g, Chuanxiong 6 g, Red peony root 10 g, Motherwort 20 g, Salvia miltiorrhiza 20 g, Honeysuckle 20 g, Forsythia 20 g, Dandelion 20 g, Isatis root 20 g, Su stem 15 g, Cicada slough 6 g, Han Sanqi 3 g, Water leech 10 g. Take one dose daily, decocted in water.

After taking a total of 14 doses of this prescription, the patient’s spirits and appetite improved, urea nitrogen dropped to 5.9 mmol/L, creatinine fell to 90 μmol/L, urine protein became (+), and occult blood in urine disappeared completely.

The addition of certain ingredients to this formula was something I had used 30 years ago to treat Mr. Chen, the stationmaster of Qin’an Bus Station. Over the past 30 years, I have consistently used this formula as a standard treatment for chronic nephritis, helping countless patients recover, but I had never seen such remarkable results in treating renal failure before. This case demonstrates that formulas capable of eliminating urine protein and occult blood in urine are also effective in restoring kidney function.

April 18, 2011: Warning about Superbugs

Following methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii (hospital-acquired infections), in 2010 a new superbug—New Delhi metallo-beta-lactamase-1 (NDM-1)—swept across the globe. In December 2009, a hospital in New Delhi, India, first discovered NDM-1. The bacterium was found in the intestinal secretions of a patient with Klebsiella pneumonia. This bacterium is resistant to all beta-lactam antibiotics, resulting in a high mortality rate.

April 19, 2011: New Antidepressant Mirtazapine

Mirtazapine’s antidepressant effect is significantly stronger than that of its counterparts, chlorpromazine, and selective serotonin reuptake inhibitors (SSRIs). SSRIs work by inhibiting the reuptake of serotonin at presynaptic nerve terminals, thereby increasing the concentration of serotonin in the synaptic cleft and enhancing monoamine neurotransmission to achieve an antidepressant effect.

April 19, 2011: Key Updates to the NCCN Cancer Diagnosis and Treatment Guidelines

1. Non-small Cell Lung Cancer Before surgery, patients must undergo fiberoptic bronchoscopy, mediastinoscopy, bronchoscopic examination, positron emission tomography/computed tomography (PET/CT), and pulmonary function tests. These examinations are essential prerequisites for NSCLC surgery.

2. Breast Cancer ① For breast cancer patients with positive sentinel lymph node biopsy (SLNB), axillary lymph node dissection may not be necessary. Professor Carlson in the United States divided 856 patients into two groups: one undergoing axillary lymph node dissection and the other not. Comparing the two groups, there was no significant difference in disease-free survival or overall survival. ② New drugs for bone metastases: Pamidronate disodium, zoledronic acid, and denosumab all show good efficacy, with denosumab being the best. Recently, a new drug, eribulin, has been launched, which is a synthetic analog of natural marine sponge compounds and can be used for refractory cases of metastatic breast cancer. ③ ER, PR, and HER-2 testing should not be done just once, as these markers are constantly fluctuating, so dynamic monitoring is recommended.

3. Gastric Cancer ① PET/CT can detect lesions that conventional CT and MRI cannot, especially small peritoneal, lymph node, and bone metastases. However, PET/CT has a relatively low detection rate for small peritoneal metastases, with about 36% going undetected. ② Endoscopic mucosal resection is suitable for Tis or T1a stage. M1 stage is not operable. ③ For M0 stage patients, preoperative use of paclitaxel + capecitabine + cisplatin is recommended. ④ The effectiveness of capecitabine + oxaliplatin is no less than that of 5-FU + cisplatin, so it is also recommended. ⑤ First-line chemotherapy regimen for colon cancer—FOLFOX regimen approved for gastric cancer; FOLFRIL regimen (irinotecan + 5-FU + calcium folinate) also recommended.

4. Ovarian Cancer The incidence rate is about 1–2 per 100,000, ranking around tenth among malignant tumors. According to different origins, ovarian cancer can be divided into epithelial tumors, germ cell tumors, sex cord-stromal tumors, and metastatic tumors. Epithelial tumors account for about 70% of ovarian cancer, while germ cell tumors account for about 20%. Treatment options for ovarian cancer include surgery, radiotherapy, and chemotherapy. Commonly used chemotherapy drugs include CTX, DDP, TSPA, phenylalanine nitrogen mustard, and phenylalanine nitrogen mustard.

April 25, 2011: Introduction to Ewing’s Sarcoma (ES)

Ewing’s sarcoma originates in the bones, primarily affecting children and adolescents, accounting for 70–80% of cases. The tumors are most commonly found in long bones, and the gender ratio among patients is 3:1. Ewing’s sarcoma is a poorly differentiated cancer with a high degree of malignancy, often metastasizing to the lungs first. Treatment typically involves surgery, radiotherapy, and chemotherapy. Chemotherapy drugs include Melphalan, Cyclophosphamide, Doxorubicin, Adriamycin, and Actinomycin D.

April 26, 2011: Introduction to Bladder Cancer

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Bladder cancer accounts for approximately 6% to 10% of all malignant tumors, with an incidence rate of 0.5 to 1 per 100,000 people. The primary age of onset is between 50 and 70 years, and it is more common in males than females. Transitional cell carcinoma makes up 75% to 80% of bladder cancers. The main symptoms of bladder cancer are hematuria and bladder irritation symptoms. Surgical treatment is the first-line therapy for this disease, which can be performed via cystoscopy using techniques such as electroresection, laser resection, and radiofrequency ablation. Chemotherapy drugs include doxorubicin, cisplatin, and mitomycin.

2011.6.20 Reading Notes

Recently, I read "Honglu Dianxue" by Gong Juzhong, a physician from the Ming Dynasty. In the chapter "Discussion on the Da Zao Wan Formula," it is mentioned that this formula nourishes both qi and blood while balancing yin and yang, making it the premier prescription today for tonifying deficiency, accumulating vital energy, and alleviating weakness.

The composition of the Da Zao Wan Formula includes: placenta, asparagus root, rehmannia root, ginseng, ophiopogon root, schisandra berry, eucommia bark, achyranthes root, turtle shell, phellodendron bark, amomum seed, poria mushroom, astragalus root, and angelica root.

The "Fushou Jing Fang" also discusses the Da Zao Wan, stating: "A person with weak constitution and erectile dysfunction... after taking two doses, their appearance and health improved dramatically, and they even had several children. A woman nearing sixty, whose physical strength was declining day by day... after regularly taking this formula herself, she lived until ninety, remaining as strong as a young adult... Another person who had been unable to walk due to leg paralysis for half a year saw half of the condition disappear after taking one dose of this formula."

Mnemonic: Three Treasures—Placenta, Eucommia, Achyranthes, Turtle Shell; Angelica for Blood Nourishment, Amomum and Poria for Balance.

2011.7.7 Antiplatelet Therapy for Acute Coronary Syndrome (ACS)

Currently, antiplatelet therapy for ACS is particularly emphasized. The essence of this therapy is to inhibit platelet aggregation. In addition to aspirin, warfarin, and clopidogrel, platelet membrane glycoprotein IIb/IIIa receptor antagonists (GPI) are now recommended. The main GPIs currently used in clinical practice are eptifibatide and tirofiban.

2011.7.7 Diabetic Nephropathy

Diabetic nephropathy is the most severe complication of type 2 diabetes. While there are corresponding treatments for cerebrovascular and cardiovascular sclerosis, there is still no effective cure for this condition. Currently, the focus is on early diagnosis and prevention. For healthy individuals, urinary microalbumin should be less than 20 μg/min; if it exceeds 20 μg/min or 24-hour urinary microalbumin exceeds 30 mg, diabetic nephropathy (DN) should be considered.

2011.7.7 Diagnosis of Diabetes

① Fasting blood glucose ≥ 7.0 mmol/L. ② 2-hour postprandial blood glucose ≥ 11.1 mmol/L. ③ OGTT (oral glucose tolerance test) 2-hour blood glucose ≥ 11.1 mmol/L.

Meeting any one of these three criteria is sufficient for diagnosing diabetes.

2011.7.8 Syringomyelia

The cause of this disease remains unclear, with lesions most commonly found in the cervical and sacral segments of the spinal cord. MRI scans in the sagittal plane reveal long, strip-like cavities filled with cerebrospinal fluid, and patients may exhibit dissociative sensory disturbances in the hemi-vestibular and vestibular regions. Dissociative sensory disturbance refers to the separation of superficial sensations (pain and temperature) from deep sensations, meaning superficial sensations are lost while deep sensations remain intact.

2011.7.11 Ependymoma

This is one type of intracranial tumor and belongs to the category of glial tumors. Ranked by incidence, glial tumors are: astrocytoma > ependymoma > medulloblastoma > oligodendroglioma. Ependymomas commonly occur in the fourth ventricle and the central canal of the spinal cord.

2011.7.13 Staging of Diabetic Nephropathy

Stage I: Increased glomerular filtration rate (GFR) and enlarged kidney volume. Stage II: Urinary microalbumin < 20 μg/min, 24-hour urinary microalbumin < 30 mg, but slight increases may be observed after exercise. Stage III: GFR begins to decline and approaches normal levels; at the end of Stage II, microalbumin often tests positive. Stage IV: Urinary microalbumin > 200 μg/min, 24-hour urinary microalbumin > 0.5 g. Stage V: Uremic stage.

2011.9.19 Mediastinal Tumors

Mediastinal tumors can be classified according to their location into anterior mediastinal tumors, middle mediastinal tumors, and posterior mediastinal tumors.

① Neurogenic tumors: Commonly found in the posterior mediastinum, with an incidence of 27.1%. ② Teratomas: Commonly found in the anterior and middle mediastinum, with an incidence of 26.4%. ③ Thymomas: Commonly found in the anterior mediastinum, with an incidence of 20.7%. ④ Retrosternal thyroid goiter: Commonly found in the anterior mediastinum, with an incidence of 5%–6%.

Most anterior mediastinal tumors are thymomas, which can be further classified pathologically into epithelial, lymphocytic, mixed, and spindle cell types. Thymomas are relatively low-grade malignancies, grow slowly, initially present no symptoms, and later may cause chest tightness, shortness of breath, cough, hoarseness, and in advanced stages, lymph node metastasis, superior vena cava syndrome, and pleural effusion.

Treatment for this condition mainly involves surgery and radiochemotherapy, with traditional Chinese medicine also being an option.

2011.9.19 Neck Discomfort Extending to Head, Face, and Chest

A male patient with neck discomfort extending to the head, face, and chest was initially treated for subacute thyroiditis without success. He was then treated with the following prescription:

Angelica root 10 g, red peony root 10 g, chuanxiong rhizome 6 g, rehmannia root 12 g, peach kernel 10 g, safflower 6 g, bupleurum root 10 g, citrus peel 10 g, platycodon root 20 g, licorice root 6 g, achyranthes root 10 g, perilla leaf 10 g, pinellia tuber 6 g, tangerine peel 6 g, poria mushroom 12 g, magnolia bark 6 g, rhubarb 6 g, cicada slough 6 g, silkworm pupa 6 g, turmeric 6 g. One dose daily, decocted in water and taken orally.

After seven doses, the patient reported significant improvement, calling this formula a divine remedy!

2011.10.20 Eight Types of Lesions Caused by Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) typically includes ulcerative colitis and Crohn's disease. Patients with this condition may develop eight types of lesions: ① colitis. ② oral inflammation. ③ cholecystitis. ④ fatty liver. ⑤ osteoporosis. ⑥ arthritis. ⑦ lower extremity thrombophlebitis. ⑧ suppurative skin lesions.

2011.10.20 ICS/LABA Treatment for Bronchial Asthma

The first-line medication for treating bronchial asthma is glucocorticoids. Long-acting β2-adrenergic agonists (LABA) generally only dilate bronchial smooth muscle, expand the airways, and improve airway hyperresponsiveness, but they lack anti-inflammatory effects. Inhaled glucocorticoids (ICS) are currently the most effective anti-inflammatory drugs for treating asthma. Combining inhaled glucocorticoids with long-acting β2-adrenergic agonists constitutes the internationally recognized ICS/LABA therapy.

2011.11.9 Falx Cerebri and Tentorium Cerebelli

The falx cerebri is a fold of the meninges between the two cerebral hemispheres, shaped like a sickle, containing the superior and inferior sagittal sinuses.

The tentorium cerebelli is a meningeal structure covering the surface of the cerebellum, with its anterior margin free and surrounding the midbrain, and its sides extending to attach to the petrous part of the temporal bone. Above the tentorium cerebelli lies the cerebrum, while below it are the cerebellum and brainstem. This membrane divides the brain tissue into supratentorial and infratentorial parts, with its primary function being to prevent the cerebrum from descending under gravity and compressing the cerebellum.

2011.11.10 Advances in Lung Cancer Surgery

In 1933, Washington University School of Medicine in St. Louis, USA, performed the first total pneumonectomy. In 1948, Massachusetts General Hospital in the United States performed the first lobectomy. In 1993, Americans performed the world's first thoracoscopic lobectomy. More recently, some have proposed sublobar resection techniques. In summary, the larger the surgical incision, the greater the trauma to the patient; the smaller the incision, the less trauma. From total pneumonectomy to lobectomy, then to minimally invasive lobectomy, and finally to minimally invasive sublobar resection—this represents progress in surgical techniques.

2011.11.12 Recent Increase in Cancer Cases

According to statistics from recent years, several common cancers—such as lung cancer, gastric cancer, liver cancer, esophageal cancer, bladder cancer, and malignant lymphoma—have higher incidence rates among men than women. Specifically, for lung cancer, gastric cancer, and liver cancer, the incidence among men is about twice that of women. Among women, only thyroid cancer has an incidence rate more than twice that of men; of course, cervical cancer, uterine cancer, and ovarian cancer are virtually absent in men. Overall, however, the gender gap in cancer incidence is becoming increasingly small!

2011.11.14 New Drug for Diabetes—Saxagliptin

Saxagliptin’s brand name is Onglyza. This drug is a DPP-4 inhibitor. DPP-4 stands for dipeptidyl peptidase. When carbohydrates enter the gastrointestinal tract, they first activate two incretin hormones—glucagon-like peptide (GLP) and glucose-dependent insulinotropic polypeptide (GIP)—which stimulate insulin release, thereby lowering blood sugar. Once blood sugar drops, GLP and GIP are degraded. Since GLP and GIP are both dipeptidases, inhibiting this enzyme prevents blood sugar from rising again!

2011.11.22 There Are Three Types of Cutaneous T-Cell Lymphoma

Primary cutaneous CD30+ T-cell lymphoproliferative disorder (CD30+ LPD) is a CD30-positive T-cell lymphoid proliferative disease, also known as cutaneous T-cell lymphoma, accounting for 30% of primary cutaneous T-cell lymphomas (CTCL). It includes lymphomatous papulosis (LYP), primary cutaneous anaplastic large cell lymphoma (PCALCL), and borderline lesions.

2011.11.25 Acute Superior Mesenteric Artery Ischemia (ASMA)

ASMA is a common disease, more prevalent in men than women. Because the superior mesenteric artery is a medium-sized artery with numerous branches and curves, it is prone to atherosclerosis. As a result, the intestinal tract suffers from ischemia, inflammation, necrosis, obstruction, and pain. This condition is often misdiagnosed and must be differentiated from acute pancreatitis, acute cholecystitis, and intestinal obstruction.

Diagnosis: Abdominal X-ray, Doppler ultrasound, digital subtraction angiography (DSA).