2012.12.25 Polymyalgia Rheumatica PMR

2012.12.25 Polymyalgia Rheumatica (PMR)

This disease predominantly affects middle-aged and elderly individuals over 50, with main symptoms being widespread muscle pain, especially around joints; some patients also experience mild joint pain. ESR and C-reactive protein levels are elevated, and low-dose corticosteroids are effective. The incidence of PMR is approximately 58.4 per 100,000. Traditional Chinese medicine, such as Yiyang Chitu Jihé Ji (the formula composition is detailed in "Pei Zhengxue Medical Notes"), shows good efficacy against this condition.

2012.12.28 Leukemia with Elevated White Blood Cells

Anyone with a white blood cell count exceeding 100 × 10⁹/L falls into this category. Due to massive infiltration of white blood cells into vital organs such as the heart, brain, spleen, liver, and kidneys, their functions are compromised, making the condition extremely severe. Destruction of immature white blood cells releases nucleic acids, potassium, phosphorus, etc., leading to: ① increased uric acid, causing renal failure; ② increased blood phosphorus, decreasing blood calcium; ③ increased blood potassium, placing extra burden on the heart.

These three pathogenic mechanisms accelerate disease progression. When treating this condition, chemotherapy regimens should be administered gradually, avoiding large doses of chemotherapy drugs to prevent massive white blood cell necrosis and accumulation of degradation products in the liver, kidneys, and brain, which could lead to death.

2012.12.31 Several Clinical Issues

1. Blood transfusion increases the risk of myocardial infarction This issue has been debated for decades. Recent joint research conducted by the United States and Japan shows that blood transfusions increase the risk of death for patients with myocardial infarction, so blood transfusions are not recommended for these patients.

2. Amoxicillin ineffective for acute lower respiratory tract infections A research paper published in The Lancet on December 16, 2012, confirmed that compared with placebo, although the amoxicillin group had fewer new respiratory symptoms, they experienced more accompanying symptoms such as coughing.

3. Clinical application of quinolone drugs Quinolone drugs began to be used clinically 20 years ago, going through four generations. The first generation was pipemidic acid, the second was norfloxacin, the third included ofloxacin, levofloxacin, and ciprofloxacin, and the fourth was moxifloxacin. Moxifloxacin not only has strong bactericidal effects against Gram-negative bacilli and Gram-positive cocci, but also shows certain efficacy against Streptococcus pneumoniae, drug-resistant Staphylococcus aureus, beta-hemolytic streptococcus, Pseudomonas aeruginosa, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia, and Mycoplasma. This drug has high bioavailability, good oral absorption, and few side effects. Side effects include gastrointestinal reactions and prolonged QT interval. Moxifloxacin was introduced to the Chinese market relatively late.

4. Molecular diagnosis of tuberculosis In clinical practice, tuberculin skin test (PPD test), ESR, imaging examinations, and biological tests are commonly used, combined with clinical manifestations to confirm tuberculosis. Currently, TB-DNA molecular testing has been applied in clinical practice, with high accuracy, few false positives, and can be performed on sputum, blood, body fluids (ascites, pleural effusion, pericardial effusion, joint fluid), urine, and feces.

2013

2013.1.2 More on Renal Anemia

From October 30 to November 4, 2012, the American Society of Nephrology (ASN) held "Kidney Week," during which several scholars discussed the issue of anemia in patients with chronic kidney disease (CKD). Clinically, 80% of CKD patients and 100% of renal failure (RF) patients exhibit reduced hemoglobin levels. In China, renal failure patients generally receive erythropoietin treatment, with some also receiving iron supplements. Hemoglobin stability is an important indicator for assessing the severity of CKD and RF conditions.

2013.1.3 Further Discussion on Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia. As age increases, the number of patients with atrial fibrillation gradually rises. Among people over 40, approximately one in four has experienced atrial fibrillation. Currently, there are about 8 million atrial fibrillation patients in China, with an incidence rate of about 500 per 100,000. Atrial fibrillation is a major cause of ischemic stroke. Ischemic stroke includes cerebral embolism and cerebral infarction. An important preventive measure against ischemic stroke is antiplatelet aggregation, with drugs such as aspirin, clopidogrel, warfarin, dabigatran etexilate, apixaban, and rivaroxaban having this effect. Some scholars suggest that dual antiplatelet therapy is better than single antiplatelet therapy, i.e., combining aspirin and clopidogrel. Others argue that using warfarin alone is more effective than the aforementioned dual therapy. Still others believe that dabigatran is more effective than warfarin. Regarding the prevention of atrial fibrillation, experts recommend stabilizing blood pressure, blood lipids, blood sugar, blood viscosity, and uric acid levels.

2013.1.4 Portal Vein Thrombosis

The incidence of portal vein thrombosis in the general population is 1.1%, in patients with cirrhosis it ranges from 10% to 25%, and in liver transplant patients from 2.1% to 26%. This indicates that portal vein thrombosis is not exclusive to cirrhosis or liver transplantation; ordinary people can also develop portal vein thrombosis.

2013.1.5 Further Discussion on Antiviral Treatment for Hepatitis B Cirrhosis

Antiviral treatment for hepatitis B can reverse liver fibrosis in cirrhotic patients. Professor Zhang Wenhong from Huashan Hospital affiliated with Fudan University in Shanghai reported that long-term (ten-year) use of lamivudine can induce histological changes in 75% of patients.

The 2012 Journal of Viral Hepatitis published: combining antiviral lamivudine with adefovir dipivoxil results in a high viral response rate, with zero resistance after five years.

2013.1.7 Clear Causes of Chronic Cough in Chinese People

The Guangzhou Institute of Respiratory Diseases, in collaboration with medical centers in North China, East China, South China, West China, and Northeast China—a total of nine centers—spent one year studying the causes of chronic cough, enrolling 704 patients. Among them, 640 cases (90.9%) had clearly identified causes, including cough variant asthma (32.6%), upper airway cough syndrome (18.6%), eosinophilic bronchitis (17.2%), and allergic cough (12.2%).

2013.1.9 Oral Compound Huangdai Tablets for M3 Treatment

Huangdai tablets are a compound preparation made of realgar, indigo, and red arsenic, containing trioxide of arsenic. Academician Chen Saijuan and her research team at the Shanghai Institute of Hematology used this formulation to treat acute promyelocytic leukemia (APL). The experimental group received Huangdai tablets (RIF) at 60 mg/(kg·d); the control group received intravenous infusion of trioxide of arsenic (ATO) at 0.15 mg/(kg·d). Both groups also jointly used all-trans retinoic acid (ATRA) at 25 mg/(m²·d) without time restrictions. After achieving complete remission (CR), both groups underwent three courses of anthracycline-based chemotherapy combined with cytarabine (Ava-C), followed by either compound Huangdai tablets (RIF) or trioxide of arsenic (ATO) combined with all-trans retinoic acid for two years. The trial results showed that the RIF group achieved a CR rate of 99.1%, while the ATO group achieved a CR rate of 91.1%. In summary, treatment for M3 now has clear efficacy, representing a breakthrough in cancer treatment.

2013.1.13 Microalbuminuria and Microglobulinuria

Normal microalbuminuria levels: ① 1–2 mg; ② 10–20 mg (two methods). Diabetic patients should regularly check this indicator, as diabetic nephropathy is the most serious complication of diabetes.

Microglobulinuria, also known as β-microglobulin, is almost absent in healthy individuals' urine; if present, it should be below 0–0.5 mg/L. Exceeding this level suggests autoimmune kidney disease, chronic glomerulonephritis, or nephrotic syndrome, among others.

2013.1.14 Primary Gastrointestinal Non-Hodgkin Lymphoma (PGI-NHL)

PGI-NHL is the most common primary non-Hodgkin lymphoma occurring outside lymph nodes, with its incidence increasing in recent years. Common sites of occurrence include the stomach, small intestine, colon, and rectum. The most frequent pathological type is diffuse large B-cell lymphoma, often found in gastric mucosa-associated lymphoid tissue (MALT) and intestinal follicular lymphoid tissue (follicular lymphoma). Clinical manifestations of this disease lack specificity, with nausea, vomiting, abdominal pain, and intestinal obstruction being common symptoms. Abdominal pain is the most prominent clinical manifestation. Given that the lesion is an isolated focus in the mucosa, it has little impact on digestion and absorption, resulting in a relatively low incidence of anemia.

Diagnosis of this disease still relies mainly on gastroscopic biopsy, and treatment continues to focus on surgery, radiotherapy, and chemotherapy.

2013.1.15 Pediatric Acquired Pneumonia (CAP)

Most pediatric CAP cases are viral infections. For children over six months who have received the "complete vaccination series," blood culture is unnecessary, and treatment can proceed as for viral pneumonia.

Babies are vulnerable to infectious diseases from birth to six months, with the most common being: ① Hib infection (Haemophilus influenzae type B): This bacterium can cause bacterial meningitis, pneumonia, pericarditis, sepsis, cellulitis, suppurative arthritis, osteomyelitis, etc., with pneumonia and meningitis being the most frequent. ② Poliomyelitis: Also known as infantile paralysis. ③ Whooping cough. ④ Diphtheria. ⑤ Tetanus. Vaccines for these five diseases are combined into a pentavalent vaccine, providing protection against all five diseases with a single shot.

2013.1.16 Tracheal Intubation and Tracheostomy

Tracheal intubation is an emergency measure used to rescue patients with respiratory failure and establish an artificial airway. Intubation can be performed orally or nasally, with a guidewire inside the tube and an inflatable cuff outside. The former ensures smooth passage of the tube, while the latter ensures tight contact between the tube and the mucosa to prevent fluid leakage. Intubation facilitates removal of foreign objects from the trachea and can also be connected to ventilators or respirators to form an artificial airway and enable passive breathing.

Tracheostomy is used in life-threatening situations such as laryngeal spasm, upper airway obstruction, asphyxia, and respiratory distress.

2013.1.17 Emergency Rescue: The Heart Matters Most

Rescuing critically ill patients is a major concern in the medical community. Critical illness triggers a chain reaction across all body systems, requiring physicians to maintain a holistic and comprehensive view. However, within this overall process, cardiac dysfunction is the most critical factor—hence the saying, "Emergency rescue: the heart matters most." The heart is the driving pump that supplies blood throughout the body, and the proper functioning of any organ depends on adequate blood supply from the heart. Acute poisoning, severe infection, and major trauma can all lead to severe cardiac failure, directly impacting systemic blood supply. Insufficient blood supply, in turn, disrupts immune function, quickly triggering a cascade effect and multi-organ dysfunction syndrome. Damage to multiple organs further exacerbates cardiac damage, leading to inadequate myocardial perfusion, metabolic disorders, and cellular apoptosis.

In this sequence of pathophysiological events, ischemia and hypoxia are at the core of pathological transformation. In hypoxic organs, tissues, and body fluids, various cell adhesion molecules and inflammatory mediators accumulate in large quantities, causing mitochondrial dysfunction and ultimately leading to myocardial necrosis. Mitochondrial dysfunction stems from an increase in free radicals. Nitric oxide (NO) is the primary free radical, and the aforementioned cell adhesion molecules and inflammatory mediators also fall under the category of free radicals to some extent. Cardiac dysfunction first affects the body's microcirculation; when microcirculatory disturbances reach a certain level, disseminated intravascular coagulation (DIC) occurs, signaling a critical situation. Cardiopulmonary resuscitation (CPR) can help the heart resume beating and improve perfusion to major vessels like the heart, brain, and kidneys, but microvascular problems persist, resulting in a low success rate for resuscitation. Since the discovery of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in heart and brain fluids, people have realized that cardiac function, like brain function, is regulated by mysterious neuroendocrine mechanisms. As stated in the "Yellow Emperor's Classic of Internal Medicine": "The heart is the sovereign organ, where divine spirit resides."

2013.1.28 Another Formula for Glomerulonephritis

Liu Jinu 10g, Xu Changqing 10g, verbena 15g, Wang Buliu Xing 15g, Qingfeng Teng 15g, coix seed 15g, achyranthes 15g, earthworm 15g. One dose daily, decocted in water and taken orally.

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This formula is my innovative prescription. Liu Jiniu can both promote lactation and regulate menstruation, invigorate blood circulation to remove blood stasis while promoting diuresis; Xu Changqing dispels wind and dampness, clears heat and detoxifies, and promotes diuresis to reduce swelling. In my clinical experience treating kidney diseases, all four of these effects are present in the herbs used, making them suitable for clinical trials. What are these four effects? Invigorating blood circulation to remove blood stasis, promoting diuresis to reduce swelling, dispelling wind and dampness, and clearing heat and detoxifying.

2013.1.29 Dunhuang Manuscripts

In 1900, a large number of sutras and documents were discovered in a stone cellar buried under sand at the Mogao Caves in Dunhuang. The caretaker of the cellar, Taoist Wang Yuanlu, immediately reported this to the Qing government’s Jiuquan Prefectural Commissioner, but the report was ignored. Taoist Wang could only guard the site himself and, within his capabilities, clear away the sand to protect the ancient artifacts. In 1907, the British explorer Stein, and in 1908, the French scholar Pelliot, successively obtained thousands of the finest and most valuable sutras and silk manuscripts from Taoist Wang at extremely low prices through deception and trickery. In particular, Pelliot, a renowned Chinese expert in France who spoke fluent Chinese, directly negotiated with Wang Yuanlu and was thus allowed to enter the cave to select and steal over 6,000 precious cultural relics. Subsequently, scholars from Japan, Russia, the United States, and other countries also rushed to plunder Dunhuang’s treasures, nearly destroying China’s cultural heritage there. Today, Dunhuang’s treasures are scattered across major museums worldwide, such as the British Museum, the Louvre, and museums in Russia, Japan, and the United States. Later generations have collectively referred to this vast body of literature as the “Dunhuang Manuscripts” for ease of research. The study of the Dunhuang Manuscripts, Dunhuang’s ancient artifacts, and the sculptures on the cave walls is known as “Dunhuang Studies.” The term “Dunhuang Studies” was proposed by the famous Chinese scholar Chen Yinke in 1942 and quickly gained support from scholars in the field.

Among the medical texts found in the Dunhuang Manuscripts, those related to traditional Chinese medicine are later called “Dunhuang Medicine.” This field encompasses classic TCM texts such as the “Huangdi Neijing,” “Shanghan Zabing Lun,” “Zhou Hou Bei Ji Fang,” and “Bencao Jing Jizhu,” some of which are previously unknown rubbings. The book “Fuxing Jue: Tangye Jingfa” is one of the works of “Dunhuang Medicine,” but this copy was originally kept by a physician surnamed Zhang in Hebei Province and later donated to Wang Jirui and Ma Jixing at the China Academy of Traditional Chinese Medicine. Ma Jixing subsequently annotated the text and published it in the 1980s. It is believed that the grandfather of the Zhang family once did business in Gansu and visited Jiuquan, where he had contact with Taoist Wang Yuanlu, suggesting that this text may have been passed down through such connections.

Li Yingcun and Liang Yonglin from Gansu University of Traditional Chinese Medicine conducted research on “Fuxing Jue: Tangye Jingfa” and wrote academic papers, thereby bringing this long-forgotten ancient medical text to public attention.

2013.2.2 Metabolic Disorders in Chronic Renal Failure

In chronic renal failure, kidney tissue is damaged, leading to reduced erythropoietin production and subsequent anemia. Due to impaired renal excretory function, levels of metabolic end-products such as creatinine, creatine, urea, and uric acid rise, along with elevated blood phosphorus. Given the relationship between calcium and phosphorus metabolism, blood calcium levels consequently decrease. Treatment involves intravenous infusion of 10% calcium gluconate to increase blood calcium and reduce blood phosphorus. Consuming nuts and meat, however, has the opposite effect.

2013.2.2 Lipid-lowering drugs and vitamin PP (niacin)