4. Latest classification of cardiac function

4. Latest classification of cardiac function Level 1: Has heart disease but no discomfort. Level 2: No discomfort at rest, but palpitations and shortness of breath upon slight activity. Level 3: Mild palpitations at rest, with palpitations and shortness of breath during activity. This corresponds to heart failure stage II. Level 4: Palpitations and shortness of breath even at rest. This corresponds to heart failure stage III, with obvious signs of heart failure.

5. Latest staging of heart failure Stage A: Causes various heart diseases but no symptoms of heart failure. Stage B: Organic heart disease exists but no heart failure symptoms. Stage C: Organic heart disease present, with heart failure symptoms already appearing. Stage D: Heart failure symptoms are obvious and repeatedly unresponsive to treatment.

September 11, 2012: Gabapentin for Refractory Cough

Gabapentin is a commonly used medication for treating epilepsy and schizophrenia. Recently, in Australia, the United States, and other places, there have been reports of significant efficacy in using gabapentin to treat refractory cough. Why can sedatives relieve cough? Both codeine and poppy shell in traditional Chinese medicine demonstrate that sedatives have cough-suppressing effects. Zhang Xichun’s Shen Zhe Zhen Qi Tang uses raw dragon bone and raw oyster shell, while the “Taiping Huimin Heji Ju Fang”’s Er Chen Tang uses poria, both illustrating this point.

September 12, 2012: Diabetic Ketoacidosis (DKA)

DKA is a common complication of diabetes, occurring in both type 1 and type 2. Type 1 can occur without any apparent cause, while type 2 may develop when diabetes is poorly controlled (sudden discontinuation of hypoglycemic drugs, infection, overeating), accompanied by hyperglycemia, high urinary glucose, high ketones, acidosis, and electrolyte imbalance.

Clinical manifestations of DKA: ① Exacerbation of the “three more, one less” symptoms. ② Nausea, vomiting, abdominal pain, diarrhea. ③ Signs of dehydration, such as skin lacking elasticity, sunken eyes, and rapid heartbeat. ④ Deep, labored breathing with a ketone-like odor on the breath. ⑤ Coma.

Treatment of DKA: Massive fluid replacement—start quickly then slow down, prioritize saline before sugar, crystal before colloid—with a total fluid intake of 3,000–5,000 mL over 24 hours. Intravenous insulin infusion, potassium supplementation, and correction of electrolyte disturbances.

There is also diabetic hyperosmolar coma, which, except for lower blood ketones, shares all other symptoms with DKA. Its main triggers are infections. The key to treating DKA is fluid replacement, whereas the key to treating diabetic hyperosmolar coma is anti-infection, hypoglycemic fluid replacement, and correction of electrolyte disturbances.

September 17, 2012: Compound Danshen Dropping Pills Reduce Carotid Intima-Media Thickness

Carotid intima-media thickness (IMT) is a recognized indicator of major vascular disease. Professors at the Second Military Medical University of the People’s Liberation Army of China have confirmed through experimental research that Compound Danshen Dropping Pills can significantly inhibit carotid IMT and plaque formation, having observed 100 patients over a five-year period.

September 18, 2012: Menopausal Syndrome

Menopausal syndrome is most common around the time of menopause (ages 45–55), mainly manifesting as irritability, hot flashes in the five centers, excessive sweating, dizziness, insomnia, loss of willpower, laziness, and in some cases, increased blood pressure and chest tightness. Common treatments include Xuefu Zhuyu Tang, Danzhi Xiaoyao Wan, and Chaihu Jia Longgu Muli Tang.

October 25, 2012: Staging and Classification of Pancreatitis

1. Classification Acute pancreatitis can develop into chronic pancreatitis. The former is classified as type I; the latter as type II; if accompanied by intestinal obstruction, portal hypertension, ascites, pancreatic fistula, etc., it is classified as type III; if there is malabsorption, diarrhea, or diabetes, it is classified as type IV.

2. Staging

Stage I: Acute pancreatitis attack or transition to chronic pancreatitis manifests as abdominal pain.

Stage II: Whether type I or type II, i.e., whether acute or chronic, can lead to local complications such as pseudocysts, intestinal obstruction, portal hypertension, ascites, pancreatic fistula, etc.

Stage III: Occurrence of malabsorption, diarrhea, or diabetes.

October 26, 2012: Overview of Dementia

Dementia is characterized by cognitive decline, commonly seen in Alzheimer’s disease (AD), but also in vascular dementia. Additionally, Parkinson’s disease, frontotemporal dementia, and Lewy body dementia can also present with dementia. Currently, the pathogenesis of this disease remains unclear, and there is no specific cure; commonly used medications are cholinesterase inhibitors, such as donepezil and rivastigmine, as well as galantamine.

October 30, 2012: Another Prescription for Chronic Renal Failure

Astragalus 30g, polygonatum 30g, tribulus terrestris 30g, imperata cylindrica 30g, sanleng 15g, ezhushi 15g, talc 10g, woodruff 6g, licorice tip 6g, su geng 20g, cicada slough 6g, motherwort 15g, rhubarb 15g.

Thirty years ago, I used this prescription to treat a renal failure patient named Wu, with remarkably quick results—the patient’s blood urea nitrogen dropped from 20 mmol/L to normal. Rhubarb in the formula has a purgative effect, acting like intestinal dialysis; astragalus and polygonatum strengthen the body and regulate immunity; sanleng and ezhushi promote blood circulation and remove stasis, following the principle “to treat wind, first treat blood; when blood flows, wind naturally dissipates”; tribulus terrestris and imperata cylindrica work together to dispel wind and promote diuresis; talc, woodruff, and licorice tip help facilitate urination; su geng, cicada slough, and motherwort also aid urination.

October 31, 2012: Fibroma

Fibroma is a benign tumor originating from fibrous tissue. Fibrous tissue was formerly known as connective tissue, including elastic fibers and collagen fibers. These two types of fibers exist in all organs of the human body, so fibromas can occur in any organ, but are most common in subcutaneous tissue, breasts, and mesentery. Fibromas can be divided into fibroadenomas, fibromyomas, and fibrosarcomas. The first two are benign, while the last is malignant. Recent domestic research has found that fibromas are particularly common in the mesentery, presenting as masses in the peritoneum.

November 1, 2012: Traditional Chinese Medicine Treatment for Cancer-Related Fever

My antipyretic formulas include Ma Xing Yi Gan, Gui Zhi Shaoyao Jia Sang Dan, and Cang Gong Su Tong Yi Niu Long. Now there is another formula—"White horse half crane grass green, gypsum two liang must be used raw" (white flower snake tongue grass, purslane, half branch lotus, crane grass, licorice, artemisia, indigo, raw gypsum). The first two are anti-inflammatory antipyretics, while the latter is an anti-cancer antipyretic.

November 5, 2012: Two Prescriptions for Liver Cancer Treatment

Prescription One: Curcuma, chicken gizzard membrane, citron, angelica, strychnos seed, raw coix seed, half branch lotus, salvia. Prescription Two: Sanleng, ezhushi, seaweed, kelp, pangolin, white flower snake tongue grass, half branch lotus, tiger stick, turtle shell, soft-shelled turtle shell, oyster shell, crane grass.

Both prescriptions contain ingredients that promote blood circulation and remove stasis, soften hard masses, and clear heat and detoxify, aligning closely with my approach to formulating "Liver Cancer No. 1" and "Liver Cancer No. 2." However, the overall drawback of these four prescriptions for liver cancer treatment is the lack of guiding herbs and symptomatic remedies. Prescription One could benefit from adding Xiao Chai Hu and formulas for gallbladder-pancreatic syndromes; Prescription Two could benefit from adding Tao Hong Si Wu, goji berries, two insects, two methyl compounds, and the mature stem of the loofah gourd.

November 6, 2012: Diagnosis and Treatment of Pulmonary Tuberculosis

Currently, the incidence of pulmonary tuberculosis has reached 300–500 cases per 100,000 people.

1. Diagnosis The posterior upper lobes account for 88%, the posterior basal segments of the lower lobes account for 5%, and the remaining areas account for 7%. Chest X-rays show nodules as dark, dot-like or patch-like shadows, with clear or unclear borders; round shadows smaller than 3 cm are considered tuberculous nodules.

2. Classification ① Primary pulmonary tuberculosis: Typical lesions are primary complex. ② Hematogenous disseminated pulmonary tuberculosis: Includes acute, subacute, and chronic hematogenous disseminated pulmonary tuberculosis. ③ Secondary pulmonary tuberculosis: Infiltrative pulmonary tuberculosis, infiltrative pulmonary tuberculosis, cavitary pulmonary tuberculosis, tuberculous nodules, caseous pneumonia, chronic fibro-cavitary pulmonary tuberculosis. ④ Tuberculous pleurisy, etc.

3. Staging: Infiltration progression stage, dissolution dissemination stage, absorption improvement stage, hardening calcification stage.

4. Tuberculin skin test 0.5 cm (-), 0.5–1 cm (+), 1–2 cm (++), over 2 cm (+++), with necrosis (++++) . Weak positives may include some false positives; hematogenous disseminated pulmonary tuberculosis and tuberculous pleurisy may show false negatives, while small cell lung cancer may show false positives.

5. Treatment Isoniazid (INH, H), rifampicin (RFP, R), pyrazinamide (PZA, Z), ethambutol (EMQ, E). Using all four drugs together for two months is called the intensive phase, with two of them continuing for another four months as the consolidation phase.

November 7, 2012: Pathogenic Bacteria and Host Response

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Hippocrates said more than 2,000 years ago that infection is decay. In 1877, Robert Koch first discovered Bacillus anthracis, proving that this strain can cause anthrax, a disease characterized by systemic inflammatory responses. In 1904, William argued that patients with anthrax seemed to die from the body's reaction to the bacteria rather than from the bacteria itself, thus raising awareness of the importance of host response. In 1977, Eiseman named the sequential failure of multiple organs caused by different primary diseases as "multiple organ failure." In 1992, ACCP/SCCM formally proposed the concept of multiple organ dysfunction syndrome (MODS), bringing public attention to this issue. Professor Zeng Xianjiu, a surgical expert at Peking Union Medical College, encountered in clinical practice cases where local surgery could trigger dysfunction in distant organs, even leading to systemic reactive changes in various organs. Therefore, he advised his student, Professor Chen Dechang, to observe and reflect on this phenomenon during future surgeries.

2012.11.8 Traditional Chinese Medicine Treatment for Esophageal Cancer

The traditional Chinese medicine treatment for esophageal cancer initially involved Liuwei Xiapu Yuan, followed by Tuoli Tounong San, then Qige San, Xuanfu Daizhe Sanjin Xiang, Zhuhou Dangji Duancaocao Qiang. Three pairs—Dadanshen, Houzao Cao Zuojin, Sijitang, Banxia Houpu Tang, and others—are all applicable to this condition.

2012.11.17 Lotus Seed Heart-Clearing Decoction

Lotus Seed Heart-Clearing Decoction is a renowned formula from the "Taiping Huimin Heji Ju Fang." Its composition includes: Bupleurum 10g, Scutellaria 10g, Codonopsis 10g, Poria 12g, Licorice 6g, Nelumbo nucifera seeds 20g, Plantago 10g, Astragalus 20g, Ophiopogon 10g. This formula is indicated for tidal fever, irritability, and red-hot urination. It can be used in conjunction with Xuefu Zhuyu Tang to treat female neurosis, or with Daochi San to treat painful and difficult urination.

2012.11.20 Hormone Replacement Therapy (HRT) and Artificial Menstrual Cycle in Gynecology

The establishment of an artificial menstrual cycle primarily involves the use of estrogen and progesterone. Estrogen commonly used is estradiol, while progesterone typically employed is progesterone. The purpose of HRT is to improve women's menopausal conditions and restore normal sexual function. For establishing an artificial menstrual cycle, commercially available tibolone can meet clinical needs.

2012.11.24 Ventilator-Associated Pneumonia (VAP)

VAP refers to pneumonia that occurs when patients have an artificial airway established (tracheal intubation or tracheostomy) and are receiving mechanical ventilation. In the United States, approximately 250,000 cases occur annually, resulting in economic losses of $2.5 billion and 35,000 deaths. The incidence of VAP in developing countries is five times that of the United States, and in low- and middle-income countries it is three times higher than in high-income countries. Causes of VAP include translocation of endogenous flora, respiratory tract contamination, and decreased local immunity. Preventive measures include: ① maintaining airway pressure no lower than 25 cmH₂O, ideally between 20–30 cmH₂O; ② elevating the head of the bed by 30–45°; ③ suctioning subglottic secretions; ④ avoiding repeated intubation; ⑤ maintaining oral hygiene; ⑥ using oral intubation; ⑦ early extubation; ⑧ daily assessment; ⑨ early non-invasive ventilation; ⑩ reducing equipment contamination.

2012.11.26 Dual Antiplatelet Therapy

Antiplatelet therapy is a crucial treatment following PTCA, as most patients with acute coronary syndrome (ACS) have varying sizes of blood clots within their vessels prior to intervention, which can easily detach and form thrombi once the procedure begins. Therefore, both pre- and post-procedural administration of antiplatelet agents such as aspirin, clopidogrel, warfarin, dabigatran etexilate, apixaban, and rivaroxaban is recommended. This type of therapy is particularly important for PCI. Currently, dual antiplatelet therapy is advocated, involving either doubling the dose of clopidogrel or combining two anticoagulant drugs mentioned above.

2012.12.5 Overview of Hepatocellular Carcinoma Treatment

According to the 2012 EASL/EORTC Clinical Practice Guidelines on the Management of Hepatocellular Carcinoma: ① histopathological diagnosis; ② CT and MRI imaging; ③ angiography; ④ fluorodeoxyglucose positron emission tomography (FDG-PET). These four examinations are recommended diagnostic methods for hepatocellular carcinoma (HCC). The first two are suitable for diagnosing all types of HCC, while the latter two are not recommended for early diagnosis. Patients with liver cancer complicated by decompensated cirrhosis, as well as those with severe liver damage, are not suitable for biopsy.

Treatment for this disease: ① surgery is the first choice, and the Milan criteria remain the "gold standard" for surgical indications. ② Patients who cannot undergo surgery may opt for radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI). RFA is suitable for tumors less than 5 cm in diameter, while PEI is suitable for tumors less than 2 cm in diameter. ③ For patients who are ineligible for surgery, RFA, or PEI, liver transplantation is the only treatment option.

Treatment for metastatic liver cancer: palliative care, transcatheter arterial chemoembolization (TACE), and systemic chemoradiotherapy are all viable options (this view differs from the old perspective). If none of the above treatments are effective, sorafenib (Nexavar) is recommended, which may prolong disease-free survival (DFS) and overall survival (OS).

2012.12.8 Non-Small Cell Lung Cancer GP Regimen

This is currently the most commonly used chemotherapy regimen for lung cancer: ① 250 mL saline + 1.2 g gemcitabine, intravenous drip, on days 1 and 8; ② 250 mL saline + 40 mg cisplatin, intravenous drip, on days 1–3; ③ 20% mannitol, intravenous drip; ④ 250 mL 5% glucose injection + 20 mg metoclopramide + 0.2 g vitamin B₆ + 5 mg dexamethasone, intravenous drip; ⑤ one vial of antiemetic injection before chemotherapy.

2012.12.9 A Revisit to Hemolytic Anemia

The incidence of hemolytic anemia is increasing, and Western medicine still lacks a reliable cure.

Currently, the disease manifests in the following types: ① hereditary spherocytosis; ② glucose-6-phosphate dehydrogenase deficiency; ③ paroxysmal nocturnal hemoglobinuria; ④ β-lipoprotein deficiency.

Causes of the disease include physical, chemical, and biological stimuli, as well as splenic hyperfunction, infections, and autoimmune diseases.

Diagnosis of the disease: increased indirect bilirubin, lactate dehydrogenase, reticulocytes, serum iron, and iron-containing granular cells in bone marrow.

Traditional Chinese medicine prescriptions: ① mugwort, artemisia, sophora flower, motherwort; ② saltpeter, black alum, turmeric, salvia; ③ indigo, black alum, lespedeza.

2012.12.10 A Formula for Chronic Myeloid Leukemia (CML)

Plum, oyster, phellodendron, papaya, leech, indigo, green peel, tangerine peel, sparganium, curcuma, turmeric, citron, codonopsis, ophiopogon, schisandra, and other herbs. One dose daily, decocted in water and taken orally.

This formula is effective in treating CML. CML is one of the most common hematological diseases in clinical practice, with commonly used medications including busulfan, hydroxyurea, and allopurinol. Recently, targeted therapy drug imatinib mesylate has emerged, but its efficacy still requires further verification.

2012.12.16 Another Formula for Chronic Renal Failure

Shiwei 10g, fenugreek 10g, guanzhong 10g, horsetail 10g, butterfly bush 6g, fish mint 15g, turmeric 6g, cistanche 10g, morinda 10g, gardenia 10g, rehmannia 12g, angelica 10g, bupleurum 10g, epimedium 10g, polygonum multiflorum 10g, mulberry 10g, astragalus 20g, deer antler 10g, cinnamon twig 10g, processed aconite 10g, deer horn glue 10g. One dose daily, decocted in water and taken orally.