2012.4.17 Citicoline Sodium

Renal tubular acidosis (RTA) refers to the simultaneous impairment of HCO₃⁻ reabsorption and hydrogen ion secretion in the renal tubules, leading to a decrease in intratubular pH and subsequent acidosis. Main manifestations include: ① hyperchloremic acidosis; ② electrolyte disturbances: hypokalemia, hyponatremia, hypocalcemia; ③ polyuria, irritability, polydipsia—indistinguishable from diabetes insipidus; ④ bone demineralization; ⑤ Type I: distal RTA; Type II: proximal RTA; Type III: mixed RTA; Type IV: hyperkalemic RTA.

Renal tubular acidosis is classified as primary or secondary. Primary RTA occurs in infants and young children and is a genetic disorder; secondary RTA is associated with autoimmune diseases and poisoning, distinct from glomerulonephritis. In the late stages of nephrotic syndrome, patients with renal failure may exhibit similar pathological changes.

2012.4.17 Citicoline Sodium

Citicoline sodium, marketed as Thinklin, is a commonly used drug for treating cerebrovascular diseases, traumatic brain injury, toxic encephalopathy (carbon monoxide poisoning), and age-related neurodegenerative disorders. This medication has significant improvements in symptoms such as dizziness, headache, depression, memory loss, speech difficulties, spasms, gait instability, and fatigue. Its mechanisms of action are as follows:

① Promotes the biosynthesis of phospholipids in neuronal cell membranes, repairing membrane structure and improving membrane function. ② Antioxidant effect, reducing the toxicity of free fatty acids. ③ Regulates neurotransmitter levels, enhancing the ascending system of the brainstem reticular formation. ④ Increases cerebral blood flow, improving cerebral circulation. ⑤ Inhibits apoptosis and promotes neural remodeling.

2012.4.18 Antidepressant—Escitalopram Oxalate

Escitalopram oxalate is renowned for its rapid onset, high cure rate, and good safety profile in the treatment of depression. This drug has been available in China for ten years, and experts gathered in Sanya to discuss its efficacy, arriving at the aforementioned conclusions.

2012.4.20 Overview of Central Nervous System Diseases

I. Pyramidal System Disorders

The corticospinal tract, corticobulbar tract, and corticospinal tract form the pyramidal system, which is larger at the top and smaller at the bottom, also known as the coronal system. Various encephalitides, such as purulent meningitis, tuberculous meningitis, viral meningitis, epidemic encephalitis B, forest encephalitis, and various spinal cord diseases, all fall under this category. Pathological reflexes, such as Babinski sign, Gordon sign, Oppenheim sign, and Brudzinski sign, are also positive in these conditions.

II. Extrapyramidal System Disorders

Outside the pyramidal system, the central nervous system has two main conduction pathways that can affect the contraction and relaxation of skeletal muscles throughout the body.

1. Temporal lobe → striatum → substantia nigra and red nucleus → thalamus → anterior horn motor neurons of the spinal cord. The basal ganglia are scattered gray matter masses between the two cerebral hemispheres, consisting of the lentiform nucleus, caudate nucleus, amygdala, and claustrum. Among them, the lentiform nucleus and caudate nucleus together form the striatum. The diencephalon can be divided into five parts: dorsal thalamus, posterior thalamus, superior thalamus, inferior thalamus, and hypothalamus. The sagittal fissure between the two sides of the diencephalon is called the third ventricle. Its anterior part communicates with the lateral ventricles through the interventricular foramen, while the posterior part connects to the fourth ventricle via the cerebral aqueduct. The hypothalamus connects to the pituitary gland, and the dorsal thalamus connects to the pineal gland. The thalamus plays an important role, responsible for the endocrine system and the pyramidal nervous system throughout the body.

2. Temporal lobe → cerebellum → anterior horn motor neurons of the spinal cord. Extrapyramidal disorders include Parkinson's disease and hepatolenticular degeneration. The main symptoms are tremor, muscle rigidity, balance disturbance, and disorientation.

III. White Matter System Disorders

White matter system disorders are demyelinating lesions. White matter is located inside the brain tissue, adjacent to the gray matter of the cortex. White matter is responsible for the functions of the autonomic nervous system and, together with the thalamus, participates in the regulation of endocrine metabolism. Demyelinating lesions are white matter lesions, including white matter degeneration and white matter malnutrition. Demyelinating lesions occurring in the brain, thalamus, midbrain, etc., are called multiple sclerosis; those occurring in the spinal cord are called Guillain-Barré syndrome. Guillain-Barré syndrome in children under 15 is also classified as AFP.

IV. Cerebrovascular Diseases

These are cerebrovascular accidents, including cerebral hemorrhage, cerebral infarction, cerebral embolism, subarachnoid hemorrhage, cerebral arteriosclerosis, and cerebral atrophy. Cerebral atrophy is common in children, mainly resulting from perinatal brain injury, poisoning, hypoxia, infection, and other sequelae.

V. Motor Neuron Disease

Motor neuron disease refers to a group of conditions characterized by progressive damage to the motor nuclei in the thalamus and brainstem, as well as the motor neurons in the spinal cord, including amyotrophic lateral sclerosis, progressive bulbar palsy, primary lateral sclerosis, and progressive muscular atrophy.

2012.4.21 Traditional Chinese Medicine Treatment for Pulmonary Interstitial Fibrosis

Pulmonary interstitial fibrosis is a terminal complication of respiratory diseases. Chronic bronchitis, asthma, bronchiectasis, pulmonary tuberculosis, pneumoconiosis, lung cancer, postnasal drip, upper airway cough syndrome, and other conditions ultimately lead to emphysema, pulmonary interstitial fibrosis, pulmonary hypertension, cor pulmonale, and heart failure. Pulmonary interstitial fibrosis progresses in tandem with emphysema; wherever there is emphysema, there is fibrosis in the interstitium, and the condition advances more rapidly if accompanied by autoimmune diseases. The catalyst for this pathological process is infection—each infection accelerates the progression. The source of infection is upper respiratory tract infection. As stated in traditional Chinese medicine, "Warm pathogenic factors first attack the lungs," "The lungs belong to metal and are most easily overcome by fire," and "Wind-cold enters deeply and transforms into heat upon reaching the lungs," illustrating this principle. Western medicine offers numerous treatments for this condition, primarily centered on antibiotics, supplemented by β-receptor agonists, biologics, expectorants, and hormones, but the efficacy remains unsatisfactory.

With over fifty years of clinical experience, I treat this condition using Maxing Ganshi Tang as the core formula, combined with nourishing yin and clearing the lungs, Baihe Gujin, Xingsu San, Suzi Jiangqi, Sanzi Yangqin, Jinshui Liu Jun, Shengmai Er Chen, Dawei Yuantou Tang, Mengshi Guntan, Gansu Xiao A, Gansu Chen Nan, and Zhishou San, adjusted according to individual patterns. For relieving chest tightness and shortness of breath, commonly used herbs include purple quartz, agarwood, cinnamon, chicken gizzard, leech, trichosanthes fruit, allium tuberosum, pinellia ternata, citrus aurantium, platycodon grandiflorus, with generally good effects, but they must be used after thorough pattern differentiation.

2012.4.23 Purple Ginseng Compound for Treating Epilepsy

Purple Ginseng Compound: 10g gallnuts, 20g mountain corydalis, 5g purslane seeds, 10g euphorbia, 3g realgar, 2g cinnabar, 1g musk, 30g sophora. All ground into powder, 0.3g each time, twice daily.

Mnemonic: Five mountains follow big sulfur (realgar), musk and cinnabar are bitter.

This formula combines Purple Gold Pill with sophora, hence the name Purple Ginseng Tablet (Purple Ginseng Compound). The Purple Gold Pill formula originates from "Shoushi Baoyuan," though some say it comes from "Xian Nian Ji," and is primarily used for epilepsy, sores, ulcers, sore throat, parotid swelling, and high fever convulsions. The purslane seeds in the formula are actually thousand-gold seeds—the dried, mature seeds of the Euphorbiaceae plant purslane—which are toxic and should be shelled and de-oiled before use, typically 2g per dose, with diuretic, anti-swelling, softening, and detoxifying effects.

2012.4.24 Carcinoid Tumor

Carcinoid tumors are a group of low-grade, long-term malignancies that can metastasize. Neuroendocrine tumors are often representative of carcinoid tumors. Ninety percent of carcinoid tumors are located in the digestive tract, while ten percent are in the lungs, adrenal glands, and thyroid. Among the former, the incidence ranks as follows: gastric body, esophagus, large intestine, appendix, pancreas, bile duct, and spleen. Some believe that the cells of these tumors originate from a subtype of pheochromocytoma. Pheochromocytomas secrete catecholamines, adrenaline, noradrenaline, and dopamine. Carcinoid tumors secrete serotonin, histamine, and acetylcholine. Carcinoid tumors in the digestive tract usually present with gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, and diarrhea. Treatment options include surgery and chemotherapy; traditional Chinese medicine can also be effective when applied according to individual patterns.

2012.4.26 Hashimoto's Thyroiditis

In 1912, Hashimoto first published a paper confirming the existence of chronic lymphocytic thyroiditis. The diagnostic criteria for this condition are positive thyroid globulin antibodies (TGAb), positive thyroid peroxidase antibodies (TPOAb), fluctuating levels of T3 (triiodothyronine) and T4 (thyroxine), and variable TSH levels. Later, chronic lymphocytic thyroiditis was named Hashimoto's thyroiditis. In subacute thyroiditis, hyperthyroidism accounts for 70% and hypothyroidism for 30%; in Hashimoto's thyroiditis, hyperthyroidism accounts for 30% and hypothyroidism for 70%. There is also Graves' disease (hyperthyroidism, exophthalmos, TGAb and TPOAb both positive), previously known as Basedow's disease, which should be distinguished from Hashimoto's thyroiditis.

2012.4.27 Two Issues in Radical Mastectomy for Breast Cancer

1. In 2011, the "St. Gallen International Expert Consensus on Initial Treatment of Early-Stage Breast Cancer" recognized radiotherapy as the standard therapy following surgical removal of ductal carcinoma in situ (DCIS). This consensus stipulated that DCIS patients must undergo additional radiotherapy after radical surgery, and that it should be considered routine treatment.

2. In March 2012, the National Comprehensive Cancer Network (NCCN) of the United States released the "Clinical Practice Guidelines for Breast Cancer." These guidelines recommend that axillary lymph node-positive breast cancer patients undergo sentinel lymph node biopsy (SLNB) as the first choice. Patients with negative SLNB results do not need axillary lymph node dissection.

2012.4.27 Pathological Classification of Breast Cancer

1. Non-invasive cancers: ductal carcinoma in situ, lobular carcinoma in situ.
2. Invasive cancers ① Non-specific invasive breast cancer: invasive ductal carcinoma, invasive lobular carcinoma. ② Specific types: simple tubular carcinoma, invasive cribriform carcinoma, medullary carcinoma, mucinous carcinoma.

2012.5.9 Brief Discussion on Thyroid Cancer

Thyroid cancer is abbreviated as "thyroid cancer." Since the Soviet nuclear leak incident in the 1980s, the incidence of this disease has increased significantly, currently reaching 3.5 per 100,000 people, second only to nasopharyngeal cancer and ranking 12th among global cancer incidences. Pathological classification of thyroid cancer: ① Papillary carcinoma accounts for 90%. ② Follicular carcinoma accounts for 5%. ③ Medullary carcinoma accounts for 4%. ④ Other (including undifferentiated carcinoma, poorly differentiated carcinoma, squamous cell carcinoma, etc.) account for about 1%.

Among thyroid cancers (papillary, follicular, medullary), 99% are moderately to highly differentiated, thus having low malignancy and a long disease course. Papillary and follicular carcinomas both belong to adenocarcinomas; although their malignancy is not high, lymph node metastasis is very common and often seen early on. Many thyroid cancer patients already have obvious cervical and mediastinal lymph node enlargement before the primary tumor is detected. Some thyroid cancer patients are misdiagnosed as malignant lymphoma, while others are misdiagnosed as lymph node tuberculosis. Mediastinal lymph node enlargement can cause compression symptoms, such as Horner's syndrome, hoarseness, frequent coughing, and difficulty swallowing.

Medullary thyroid cancer, strictly speaking, should not be called cancer. If C-cell hyperplasia is found below the thyroid gland, this hyperplasia is usually referred to as medullary cell cancer. These cells typically secrete a hormone called calcitonin. Medullary cancer usually has two characteristics: elevated calcitonin levels and elevated carcinoembryonic antigen (CEA) levels. Therefore, medullary thyroid cancer should be classified as a gastrointestinal carcinoid tumor. Like adrenal pheochromocytoma, it belongs to the neuroendocrine tumor family, commonly referred to as carcinoid tumors.

Treatment of thyroid cancer still mainly relies on surgery. Radiation and chemotherapy are ineffective against papillary and follicular carcinomas, and also ineffective against medullary carcinoma. Traditional Chinese medicine shows excellent efficacy in treating thyroid cancer.

2012.5.10 Two Postoperative Formulas for Colon Cancer

The incidence of colon cancer is increasing year by year, and surgery remains the primary treatment, supplemented by chemotherapy and traditional Chinese medicine. The preferred chemotherapy regimen is FOLFOX, consisting of oxaliplatin + 5-FU + calcium folinate. After surgery, many patients experience bloating, abdominal pain, and difficulty with bowel movements, with severe cases even developing intestinal obstruction. To address these symptoms, the following two formulas can be chosen.

Formula One:

10g angelica sinensis, 10g white peony root, 6g atractylodes, 6g magnolia bark, 6g tangerine peel, 6g licorice, 10g citrus aurantium, 10g patchouli, 6g coptis, 10g scutellaria, 20g raw coix seed, 20g astragalus, 12g windproof herb, 10g areca nut.

Formula Two:

20g raw coix seed, 20g herba houttuyniae, 20g winter melon seed, 10g atractylodes, 15g white snake tongue grass, 10g privet berry, 15g black nightshade, 15g locust flower, 15g mountain corydalis, 20g salvia miltiorrhiza, 10g leech, 10g curcuma, 12g windproof herb.

2012.6.1 Traditional Chinese Medicine Treatment for Emphysema

The main symptoms of emphysema are shortness of breath, chest tightness, and difficulty breathing, which Zhang Xichun referred to as "the collapse of great qi." Treatment begins with Shengyang Juxian Tang (containing rhizoma cimicifugae, astragalus, bupleurum, and platycodon grandiflorus); followed by Shenzhuo Zhenqi Tang (containing ginseng, oyster shell, dragon bone, and oyster meat). These two formulas are indicated for chest tightness, shortness of breath, and difficulty breathing.

2012.6.3 Another Formula for Hyperthyroidism Treatment

10g celosia seeds, 10g gastrodia elata, 15g white peony root, 20g magnetite, 10g chicken gizzard, 6g chuanxiong, 12g raw rehmannia, 15g ophiopogon, 10g goji berries, 30g astragalus, 20g polygonatum, 20g chicken blood vine, 10g dodder, 6g amomum, 15g northern sand ginseng. Take one dose daily, decocted in water.

Mnemonic: Blue sky, white stone, gold; Chuan, earth, wheat, astragalus, yellow; Chicken, rabbit, yellow, sand, sand—another formula for hyperthyroidism.

2012.6.5 Milestone in Heart Failure Treatment

Cardiac resynchronization therapy (CRT, i.e., biventricular pacing) is the optimal method for patients with severe heart failure. Although CRT implementation started relatively late in China, its effectiveness in improving heart failure is good, leading to rapid development. In 2011, the total number of CRT implants in China reached 1,022, an increase of 18.8% compared to 2010. In 2011, 84.5% of hospitals implanted fewer than 10 CRTs, most of which were completed by visiting experts. Currently, the CRT implantation rate is 120 per million people in Europe, 300 per million in the United States, and 2 per million in China, indicating that China is still lagging behind in this area.

2012.6.8 Prevention of Ischemic Stroke

Ischemic stroke refers to cerebral infarction or cerebral hemorrhage caused by insufficient cerebral blood supply due to hypertension, cerebral arteriosclerosis, and cerebral vascular stenosis. Current consensus holds that aspirin alone as secondary antiplatelet prevention is the preferred option, but some suggest that dual antiplatelet prevention is more effective than single antiplatelet prevention. Dual antiplatelet prevention means adding clopidogrel or warfarin in addition to aspirin. Recently, new antiplatelet drugs such as dabigatran etexilate, apixaban, and rivaroxaban have also become available for optional use.

2012.6.9 Further Discussion on Type 2 Diabetes (T2DM)

Insulin resistance and early-phase secretory deficiency are the primary pathophysiological basis of T2DM, with the latter being the decisive factor in the onset of T2DM, having a more pronounced impact on postprandial blood glucose than fasting blood glucose or glycated hemoglobin (HbA1c). Controlling postprandial blood glucose is an important measure to reduce arteriosclerosis and cardiovascular events.