2013.2.6 Effective Prescription for Treating Behçet’s Disease

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can increase high-density lipoprotein levels; vitamin PP can lower low-density lipoprotein levels, with efficacy comparable to that of fenofibrate. For a long time, people have focused solely on cholesterol and triglycerides, neglecting the importance of raising high-density lipoproteins and lowering low-density lipoproteins. Recently, many scholars have made significant contributions in this area, demonstrating that increasing high-density lipoproteins and decreasing low-density lipoproteins are crucial for the treatment and prevention of atherosclerosis.

2013.2.6 Effective Prescription for Treating Behçet’s Disease

10g of Phellodendron amurense, 10g of Amomum villosum, 6g of Glycyrrhiza uralensis, 15g of Asparagus cochinchinensis, 12g of Rehmannia glutinosa, 15g of Pseudostellaria heterophylla, 10g of Scrophularia ningpoensis, 10g of Dendrobium nobile, and 10g of Nelumbo nucifera seed heart. Take one dose daily, decocted in water and taken orally.

Mnemonic: Phellodendron, Amomum, Glycyrrhiza, Asparagus, Scrophularia, Dendrobium, Nelumbo.

Note: This formula is primarily based on the “Zengye Tang”; Dendrobium and Nelumbo nucifera seed heart are added to nourish yin and generate fluids; Phellodendron clears heat and drains fire, while ginseng tonifies qi and supports the body—both serve as complementary treatments; Amomum prevents stomach irritation caused by other herbs, also serving as a complementary treatment; Glycyrrhiza harmonizes all the herbs, acting as a guiding agent. The essence of Behçet’s disease is fire, which easily harms yin, so the “Zengye Tang” nourishes yin to reduce fire. This fire is deficiency fire rather than excess fire, and can be treated simply by nourishing yin. However, the root cause of this disease lies in deficiency; besides yin deficiency, there is also qi deficiency, which is another important factor. This formula is the specialized prescription used by the renowned modern physician Pu Fuzhou to treat Behçet’s disease, and his distinguished disciple Professor Gao Huiyuan personally handed it down to me during a conference.

2013.2.24 Severe Adverse Reactions to Contrast Agents

Iopromide injection is a new non-ionic, low-osmolar contrast agent used for cardiovascular and cerebrovascular angiography as well as brain CT scans. In 2012, the State Food and Drug Administration (SFDA) received a total of 207 reports of adverse events related to iopromide, including 157 serious incidents. Notably, 94.27% of these incidents occurred within one hour after administration, and 9.74% of patients had undergone allergy testing prior to receiving iopromide. Dr. Chen, chief physician at Tianshui City Hospital, suffered a cerebral hemorrhage after receiving iopromide before a CT scan, resulting in severe hemiplegia.

2013.2.24 Women Do Not Need Long-term Calcium Supplementation

A Swedish study shows that long-term, high-dose calcium supplementation in women can increase the incidence of cardiovascular events. The study followed 61,433 women from 1989 to 1990 for an average of 19 years, arriving at this conclusion.

2013.3.4 A Case of Sudden Severe Myocardial Infarction

The February 2013 issue, No. 28, of the “Chinese Medical Forum” published a case of sudden severe myocardial infarction. The patient had all the risk factors for coronary heart disease (hypercoagulability, coronary vasospasm, and coronary inflammation). The patient’s elevated platelet count suggested the presence of a myeloproliferative tumor. Such proliferative tumors are most commonly seen in primary thrombocytosis, primary polycythemia vera, primary myelofibrosis, and chronic myelogenous leukemia. A common characteristic of these conditions is increased blood coagulation, which in turn leads to myocardial infarction. Antiplatelet aggregation is key to treating this condition, and dual antiplatelet therapy is currently the consensus among experts. Commonly used antiplatelet drugs include aspirin, clopidogrel, warfarin, dabigatran etexilate, apixaban, and rivaroxaban; for cases of extreme hypercoagulability, heparin and hydroxyurea may also be used.

2013.3.11 Niacin’s Lipid-Lowering Effect Once Again Undermined

For a long time, clinicians have observed two drawbacks when using statins: muscle pain and elevated transaminases. Consequently, they have sought alternative medications to mitigate these side effects. Research results released at the end of 2012 showed that sustained-release niacin has no clinical efficacy. An article published in the European Heart Journal on February 26, 2013, noted that adding sustained-release niacin or verapamil to a regimen of 40 mg simvastatin increases the risk of myopathy several times over, a phenomenon particularly evident in Chinese patients. Prostaglandin D2 receptor antagonists are used to alleviate niacin-induced facial flushing, but whether their lipid-lowering effect is truly zero remains to be further clinically observed.

2013.3.13 Three Effective Prescriptions

In the spring of the Gui-Si year, I treated three patients at the Huicui Hall outpatient clinic with remarkable results, which I now record.

Case 1

Patient Wang, a child with idiopathic thrombocytopenic purpura and attention deficit hyperactivity disorder.

Prescription: Honeysuckle, Forsythia, Dandelion, Patrinia scabiosaefolia, Smilax glabra, Dictamnus dasycarpus, Tribulus terrestris, Imperata cylindrica, Rehmannia glutinosa, Kochia scoparia, Saposhnikovia divaricata, Dioscorea nipponica, Paeonia lactiflora, Glycyrrhiza uralensis, Cicada slough, Floating wheat, and Jujube.

After taking seven doses of the above formula, the purpura disappeared, and the ADHD symptoms were also cured. Attention deficit hyperactivity disorder is considered a wind syndrome in traditional Chinese medicine, while purpura falls under the category of allergic reactions in Western medicine. Since both conditions share similar pathogenic mechanisms, this formula unexpectedly proved effective in treating ADHD as well.

Case 2

Female patient with diabetes, fasting blood glucose of 14 mmol/L, postprandial blood glucose of 1814 mmol/L, numbness in the limbs, especially the lower extremities. Diagnosed with diabetic peripheral neuropathy.

Prescription: Angelica sinensis 10g, Ligusticum chuanxiong 6g, Paeonia lactiflora 10g, Rehmannia glutinosa 12g, Poria cocos 10g, Citrus reticulata peel 6g, Dioscorea opposita 10g, Cinnamomum cassia 10g, Aconitum carmichaelii 6g, Cornus officinalis 10g, Paeonia suffruticosa 6g, Alisma plantago-aquatica 10g, Polygala tenuifolia 6g, Dragon’s Blood 3g (taken by mouth), Lycopus lucidus 10g, Fructus cnidii 15g, Cuscuta chinensis 10g, Black soybeans 30g, Mulberry branches 30g, Herba artemisiae selengensis 15g, Clematis armandii 10g, Bungarus multicinctus 10g, Centipede 1 piece, and Scorpion 6 pieces. Ten doses, decocted in water and taken orally.

Simultaneously, metformin and glimepiride were administered to control blood sugar.

After ten doses of the above formula, the patient’s fasting blood glucose dropped to 5.1 mmol/L, and postprandial blood glucose to 9.2 mmol/L, but there was no obvious improvement in peripheral nerve symptoms. This indicates that the formula is effective against diabetes but ineffective against the accompanying peripheral neuropathy. Originally, this formula was specifically designed to treat diabetic peripheral neuropathy. Although the patient took ten doses and saw improvements in diabetes, the peripheral neuropathy remained unchanged. Upon reflection, I realized that the formula’s effectiveness against diabetes comes first, while its efficacy against comorbid conditions may follow. Therefore, I advised the patient to continue taking the formula for another ten doses. However, the patient never returned for follow-up.

Case 3

Female patient with chronic glomerulonephritis, proteinuria (++), occult blood in urine (+++), and unresponsive to multiple medications.

Prescription: Angelica sinensis 10g, Ligusticum chuanxiong 10g, Paeonia lactiflora 10g, Rehmannia glutinosa 12g, Peach kernel 10g, Carthamus tinctorius 6g, Leonurus cardiaca 15g, Salvia miltiorrhiza 15g, Honeysuckle 15g, Forsythia 15g, Dandelion 15g, Patrinia scabiosaefolia 15g, Isatis indigotica 15g, Verbena officinalis 20g, Vitex negundo 10g, Aristolochia fangchi 15g, Coix lachryma-jobi 15g, Achyranthes bidentata 15g, Liu Jiniu 15g, Xu Changqing 15g. One dose daily, decocted in water and taken orally.

After ten doses of the formula, the patient’s proteinuria disappeared, and occult blood in urine decreased to ++. This demonstrates the formula’s effectiveness in treating proteinuria associated with chronic glomerulonephritis.

2013.3.14 Response to Hepatitis C Virus (HCV)

A U.S. study has demonstrated a close correlation between HCV and the development of hypertension, diabetes, and atherosclerosis. (See the March 7, 2013 edition of the “Chinese Medical Forum”)

2013.3.22 Clinical Experience in Treating Renal Failure

In the third month of the Gui-Si year, patient Chen, a 60-year-old woman with chronic nephritis and renal insufficiency. Proteinuria (++), BUN 28.9 mmol/L, Cr 504 μmol/L, edema, and blood pressure of 150/100 mmHg. Diagnosed with chronic glomerulonephritis and chronic renal failure.

Prescription: Rheum palmatum 10g, Perilla frutescens 10g, Cicada slough 6g, Leonurus cardiaca 15g, Talc 15g, Akebia quinata 6g, Glycyrrhiza uralensis 6g, Astragalus membranaceus 20g, Polygonatum odoratum 20g, Imperata cylindrica 20g, Tribulus terrestris 10g, Curcuma zedoaria 10g, Aconitum carmichaelii 6g, Honeysuckle 15g, White flower snake tongue grass 15g, Plantago asiatica 10g, Salvia miltiorrhiza 30g, Cornus officinalis 10g, Goji berries 10g, Mulberries 10g, Leeches 10g (taken by mouth). Five doses, decocted in water and taken every three days, two doses per day.

After taking the medication, the patient’s renal function returned to normal, proteinuria disappeared, and her spirits and appetite improved significantly.

2013.3.22 Another Prescription for Renal Failure

Pericarpium citri aurantii 10g, Gardenia jasminoides 10g, Coix lachryma-jobi 20g, Hemiphragma humile 20g, Epimedium 20g, Styrax japonicus 20g, Liu Jiniu 10g, Xu Changqing 10g. One dose daily, decocted in water and taken orally.

All of the above herbs have the effects of promoting diuresis and reducing swelling, clearing heat and detoxifying, dispelling wind and dampness, and invigorating blood circulation to remove blood stasis. The formation of nephritis is due to allergic reactions, proliferation, fluid accumulation, and inflammation. Allergy corresponds to wind, proliferation to blood stasis, inflammation to heat toxicity, and fluid accumulation requires diuresis.

2013.3.22 Talking about Urea and Creatinine

Foods high in protein, such as meat, eggs, and dairy products, are processed by the liver. Besides providing energy to various organs, their final metabolic products are nitrogen-containing substances. These nitrogen-containing substances are called non-protein nitrogen (NPN), with urea nitrogen being the main component, which is excreted by the kidneys.

Muscle tissue in the human body undergoes routine consumption during normal functioning, producing metabolic byproducts such as creatinine. These byproducts are entirely eliminated by the kidneys. When kidney function is impaired, these metabolic substances cannot be excreted, leading to their accumulation in the blood. When the concentration of these substances in the blood reaches a certain level, it can be diagnosed as renal failure.

2013.3.24 A Prescription for Treating Gastric Spasms

Cyperus rotundus 6g, Angelica sinensis 10g, Leonurus cardiaca 10g, Rhizoma cyperi 10g, Curcuma zedoaria 10g, Wu Yao 6g, Evodia rutaecarpa 6g, Typha angustifolia 6g, Cinnamomum cassia 3g, Citrus aurantium 10g, Atractylodes macrocephala 10g, Salvia miltiorrhiza 10g, Xiangfu 3g, Cardamom 3g, Frankincense 3g, Myrrh 3g.

This formula is highly effective in treating gastric spasms.

2013.3.28 Reflections on Luo’s Three Surgeries

Luo, a 58-year-old man. Three years ago, he was misdiagnosed with esophageal cancer due to a hiatal hernia and underwent an “esophageal cancer resection” at the Second Hospital of Lanzhou University. However, not only did the surgery fail to bring any relief, but his swallowing difficulties actually worsened, prompting him to travel to Beijing for a cardia resection and gastrointestinal anastomosis. Even this surgery did not solve the problem; after the operation, he still had difficulty eating, severe chest distension, and constipation.

A doctor suggested that relieving constipation and alleviating chest distension could be achieved by administering “Tiao Wei Cheng Qi Tang” combined with “Ma Zi Ren Wan.” After taking five doses of the medication, the patient still felt no significant improvement and even experienced more severe chest distension, so he came to Lanzhou to seek my consultation.

Upon reflection, I realized that esophageal surgery raises the stomach upward, positioning the cardia above the diaphragm; removing the cardia causes the remaining stomach to rise again, placing it above the diaphragm; and performing a gastrointestinal anastomosis further elevates the remaining stomach. The entire digestive system’s position changes dramatically, as do its peristalsis and emptying functions, along with its secretory functions. Although laxatives can relieve some pressure in the chest and diaphragm, the fundamental reason for the problem lies in the drastic changes in the digestive system’s position, peristalsis, emptying function, and endocrine function, which cannot be solved by simply using laxatives. The previous approach of aggressively using laxatives was putting the cart before the horse—doing more harm than good. Instead, I plan to use “Liu Wei Di Huang Tang” with added ingredients to strengthen the body’s vital energy and gradually restore balance, naturally facilitating bowel movements.

Prescription: Rehmannia glutinosa, Cornus officinalis, Dioscorea opposita, Paeonia lactiflora, Poria cocos, Alisma plantago-aquatica, Prunella vulgaris, Psoralea corylifolia, Polygala tenuifolia, Astragalus membranaceus, Angelica sinensis, Frankincense, Myrrh, Soapberry thorns, Curcuma longa, Salvia miltiorrhiza, Fritillaria thunbergii, Amomum villosum, Dry lotus leaves, Galangal, Scrophularia ningpoensis, Paeonia suffruticosa, Oyster shell.

After taking ten doses of the above formula, the patient’s chest distension noticeably eased compared to before.

2013.3.29 Common Tumors in Children

Wilms’ tumor, neuroblastoma, and teratoma are common in children under three years old; the first two are malignant, while the latter is partially malignant. All three are characterized by the appearance of large masses, often occurring in the pelvic region (iliac and sacral areas) and retroperitoneum. In addition, optic nerve fibroma and optic nerve glioma can also occur in children, though only some of these are malignant.

2013.3.30 Selection of Autoimmune Antibodies

1. Chronic thyroiditis: Thyroid globulin antibody (TGAb) and thyroid peroxidase antibody (TPO-Ab).

2. Atrophic gastritis: Anti-gastric parietal cell antibody (PCA).

3. Toxic goiter: Thyroid-stimulating hormone receptor antibody (TRAb).

4. Ulcerative colitis: Anti-neutrophil cytoplasmic antibody (pANCA).

5. Primary biliary cirrhosis: Anti-mitochondrial antibody M2 (AMA-M2).

6. Myasthenia gravis: Acetylcholine receptor (AChR).

7. Autoimmune hemolytic anemia: Anti-red blood cell antibody.

8. Idiopathic thrombocytopenic purpura: Anti-platelet antibody.

9. Rheumatoid arthritis: Rheumatoid factor (RF).

10. Sjögren’s syndrome: Anti-SSA antibody and anti-SSB antibody.

11. Systemic lupus erythematosus: Anti-nuclear antibody (ANA) and anti-smooth muscle antibody (SMA).

12. Systemic sclerosis: Anti-Scl-70 antibody.

13. Mixed connective tissue disease: Anti-U1RNP antibody.

14. Systemic vasculitis: Anti-neutrophil cytoplasmic antibody (ANCA) and anti-neutrophil cytoplasmic antibody.

2013.3.31 Anti-tumor angiogenesis therapy: A new approach to treating malignant tumors

Vascular endothelial growth factor (VEGF) is a key factor in tumor formation. In recent years, VEGF antagonists have emerged, forming a new therapeutic approach for malignant tumors together with epidermal growth factor (EGFR).

2013.4.9 Cervical Cancer

Cervical cancer is a common malignancy among women, with an incidence of approximately 20 per 100,000, ranking third after breast cancer and colon cancer.

1. Epidemiology It is more prevalent among people with frequent sexual activity, early marriage, multiple births, regular use of contraceptives, smoking, and poor hygiene. It occurs more frequently in mountainous areas than in plains, and in rural areas than in cities. There are also regional differences, such as high incidence in Tonggu County, Jiangxi Province, Wufeng County, Hubei Province, and Lueyang County, Shaanxi Province.

2. Pathological classification Squamous cell carcinoma accounts for 95%, while adenocarcinoma accounts for 5%. Recently, there has been a trend toward an increase in adenocarcinoma. The cervical mucosa consists of glandular and squamous tissues, with the boundary between the two shifting up and down according to the menstrual cycle. When estrogen levels rise, the boundary moves downward; when estrogen levels fall, the boundary moves upward. If the boundary between glandular and squamous tissues continuously shifts downward, it is called metaplasia, which over time can develop into atypical hyperplasia.

3. Staging

Stage I: Lesions are confined to the cervix and have not extended beyond it.

Stage II: Lesions extend beyond the cervix but have not reached the lower one-third of the vagina.