Stage IV: Lesions have reached the bladder and rectum.

Stage III: Lesions extend beyond the lower one-third of the vagina and have reached the pelvic sacral lymph nodes, but have not yet reached the bladder or rectum.

Stage IV: Lesions have reached the bladder and rectum.

4. Cervical smear examination Level 1——inflammation; Level 2——severe inflammation; Level 3——metaplasia; Level 4——metaplasia plus atypical hyperplasia; Level 5——cervical cancer cells.

5. Metastasis

(1) Direct spread: Soft tissues surrounding the cervix, such as the vagina, bladder, and rectum.

(2) Lymphatic metastasis

First station: Cervical lymph nodes.

Second station: Obturator lymph nodes, internal and external iliac lymph nodes.

Third station: Sacral lymph nodes, abdominal aortic lymph nodes.

(3) Hematogenous metastasis: Liver, bones, lungs, and brain.

6. Symptoms ① Bleeding. ② Pain: Early stages involve general pain; in mid-to-late stages, very severe pain may occur (due to nerve infiltration). ③ Invasion of the bladder anteriorly and the rectum posteriorly can cause intense irritation.

7. Treatment Surgery is the preferred option. For Stage I and II, surgery combined with radiotherapy yields the best results, with a five-year survival rate exceeding 97%. For Stage III and IV, radiotherapy should be the mainstay. Radiotherapy includes 25 sessions of external beam radiation at 5 Gy each, and 5–6 sessions of brachytherapy at 2.5 Gy each, with chemotherapy used only as an adjunct.

8. Traditional Chinese Medicine Treatment According to the “Jin Gui Yao Lue·Women’s Pregnancy Diseases Pulse Diagnosis and Treatment”: “If a woman has a pre-existing mass, and her menstruation has not yet resumed for three months, yet she continues to experience excessive vaginal bleeding, and the fetus is located above the umbilicus, this indicates a longstanding mass-related condition. If the fetus moves at six months of pregnancy, it means the previous three months of menstruation were normal, and the fetus is healthy. If bleeding occurs after three months of cessation, it indicates a pathological condition. Therefore, if the bleeding does not stop, it is because the underlying mass has not been removed; we should address the mass, with Guizhi Fuling Wan as the primary remedy.” Guizhi Fuling Wan is the basic formula, and additional herbs such as Trichosanthes kirilowii, Prunella vulgaris, Five Spirit Resin, Paeonia lactiflora, Aconitum carmichaelii, Aconitum kusnezoffii, Rhizoma cyperi, Curcuma zedoaria, seaweed, kelp, Panax notoginseng, and leeches can be added to this formula. For cases of bleeding, Yi Huang Tang with five types of charcoal (charcoal from palm fiber, peppermint, thistle, peony bark, and hedgehog) can be used; for cases of pain, Huangqi Guizhi Wuwu Tang with compound formulations of Cyperus and Artemisia, as well as compound formulations of mulberry branches, can be employed.

2013.4.11 Post-renal Uremia Formula

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Angelica sinensis 10g, Ligusticum chuanxiong 6g, Paeonia lactiflora 10g, Prunus persica seed 10g, Carthamus tinctorius 6g, Leonurus cardiaca 15g, Salvia miltiorrhiza 20g, Lonicera japonica 20g, Forsythia suspensa 20g, Taraxacum mongolicum 20g, Isatis indigotica 20g, Rheum palmatum 10g, Perilla frutescens 10g, Cicada slough 6g, Talc 15g, Aristolochia debilis 6g, Glycyrrhiza 6g, Astragalus membranaceus 20g, Polygonatum odoratum 20g, Tribulus terrestris 30g, Imperata cylindrica 30g, Sparganium stoloniferum 10g, Curcuma zedoaria 10g.

Additionally, four supplementary prescriptions may be added, as follows: Lonicera japonica 15g, Hedyotis diffusa 15g, Rheum palmatum 6g, Aconitum carmichaelii 6g, Leonurus cardiaca 15g, Plantago asiatica 10g, Salvia miltiorrhiza 20g, Astragalus membranaceus 20g, Cornus officinalis 10g, Lycium barbarum 10g, Morus alba 10g, Hirudo 10g (to be taken in divided doses).

April 15, 2013, Minutes of Consultation at Lan Medical First Hospital

Patient, male, with chronic glomerulonephritis for 4 years. Previously treated with hormones, cyclosporine, methotrexate, etc., but repeatedly relapsed without cure. Requested consultation. The patient presents with sallow complexion and mild edema, complaining of fatigue, leg weakness, and lumbago. Pulse is deep, fine, and wiry, with weak pulse at the cun position. Diagnosis: Kidney Yang deficiency and blood stasis in the Liver Meridian. Treatment principle: tonify the kidney, activate blood circulation, clear heat, and promote diuresis.

Prescription: Angelica sinensis, Ligusticum chuanxiong, Paeonia lactiflora, Prunus persica seed, Carthamus tinctorius, Leonurus cardiaca, Salvia miltiorrhiza, Lonicera japonica, Forsythia suspensa, Taraxacum mongolicum, Isatis indigotica, Rehmannia glutinosa, Cornus officinalis, Areca catechu, Gardenia jasminoides, Scutellaria baicalensis, Hemiphragma humile, Daphne genkwa, Spatholobus suberectus, Vitex negundo, Verbena officinalis, Vitex rotundifolia, Cynanchum auriculatum, Coix lacryma-jobi, Achyranthes bidentata, Solanum nigrum, Earthworm. Decoct in water and take two doses every three days.

After taking seven doses over ten days, the patient’s wife reported that urinary protein had decreased from (+++) to (+), occult blood in urine changed from (+++) to (-), and the patient’s spirits improved with a significant increase in appetite.

April 19, 2013: Several Practical Tips

① Acute treatment of esophageal cancer with Semen Sinapis. ② Treatment of erectile dysfunction with Allium tuberosum seeds. ③ Use of Boehmeria nivea root for fetal preservation. ④ Treatment of hepatosplenomegaly with Scarabaeus. ⑤ Treatment of chronic glomerulonephritis with Solanum nigrum.

April 20, 2013: Formula for Reducing Swelling

Gastrodia elata 15g, Prunella vulgaris 15g, Myrrha 6g, Fritillaria thunbergii 6g, Scrophularia ningpoensis 10g, Sparganium stoloniferum 6g, Curcuma zedoaria 6g, Laminaria japonica 15g, Undaria pinnatifida 15g, Panax notoginseng 3g, Hirudo 10g. One dose daily, decocted in water and taken orally.

This formula can treat all types of swelling and is particularly effective when used in combination with other formulas.

April 21, 2013: Two Formulas

1. Alternative hemostatic formula Bletilla striata 10g, Eclipta prostrata 20g, Callicarpa cathayana 20g, Agrimonia pilosa 20g. These four herbs are highly effective in stopping bleeding.

Mnemonic: “Pearl, Lotus, Bletilla, Agrimonia.”

2. Chai Ge Jie Ji Tang Bupleurum chinense 10g, Pueraria lobata 12g, Scutellaria baicalensis 10g, Platycodon grandiflorus 20g, Paeonia lactiflora 15g, Glycyrrhiza 6g, Ligusticum chuanxiong 6g, Angelica dahurica 6g, Asarum sieboldii 3g.

April 22, 2013: Case Study on Facial Erythema

In the spring of Guisi year, a patient named Wang presented with persistent facial redness, swelling, and itching, accompanied by localized desquamation and crusting. Diagnosed as discoid lupus erythematosus and demodicosis. Previous treatments with Cang Gong Heji, Bai Feng Heji, and Bai Chan Heji were ineffective, so the treatment was switched to Fangfeng Tongsheng San combined with four anti-itch herbs.

Schizonepeta tenuifolia 10g, Ledebouria socialis 12g, Talc 10g, Ephedra sinica 10g, Angelica dahurica 10g, Platycodon grandiflorus 20g, Angelica sinensis 10g, Ligusticum chuanxiong 6g, Paeonia lactiflora 10g, Atractylodes lancea 10g, Magnolia officinalis 10g, Citrus reticulata 6g, Pinellia ternata 6g, Poria cocos 12g, Gardenia jasminoides 10g, Rheum palmatum 10g, Glauber's salt 10g (to be taken in divided doses), Forsythia suspensa 15g, Scutellaria baicalensis 10g, Glycyrrhiza 6g, Mentha haplocalyx 6g, Boa constrictor 6g, Cicada slough 6g, Dictamnus dasycarpus 10g, Kochia scoparia 10g. One dose daily, decocted in water and taken orally.

The patient took seven doses and experienced significant improvement.

April 22, 2013: Traditional Chinese Medicine Formulas for Oral Diseases

Traditionally, when treating oral diseases, I often add Rehmannia glutinosa, Angelica sinensis, Ophiopogon japonicus, Schisandra chinensis, Bupleurum chinense, Cortex Moutan, Scutellaria baicalensis, Anemarrhena asphodeloides, Phellodendron amurense to the Xiehuang San formula (raw gypsum, Gardenia jasminoides, Coptis chinensis, Scutellaria baicalensis, Agastache rugosa, Ledebouria socialis). Recently, my experience suggests adding Yuniu Jian to nourish yin and clear lung heat. Adding Fritillaria thunbergii, Platycodon grandiflorus, or even bee hive products to the above formulas further enhances their efficacy.

April 22, 2013: Insights on Pancreatic Cancer Treatment

Pancreatic cancer is extremely malignant and widely regarded as the “king of cancers,” posing a severe threat to human life and health. On March 17, 2013, the Chinese Society of Clinical Oncology (CSCO) held a “Pancreatic Cancer Surgical Advisory Conference” in Shanghai, inviting 20 renowned pancreatic clinical surgeons from across the country. Academician Sun Yan served as the chairperson of the conference. After extensive discussion, it was unanimously agreed that tegafur, an oral fluoropyrimidine agent, is an optional drug for pancreatic cancer treatment.

April 25, 2013: A Discussion on Blood Transfusion

In the early 20th century, many wounded soldiers were saved through blood transfusion. By the late 20th century, component transfusion had become widespread, marking a major advancement in blood transfusion technology. This eliminated infectious diseases caused by blood transfusion. There are two main types of component transfusion: ① packed red blood cell suspension: this is the standard form of blood transfusion and the basis of component transfusion, with red blood cells accounting for 70% and plasma for 30%. Its viscosity is higher than whole blood, so saline must be added appropriately during infusion to ensure smooth flow. Like whole blood, this suspension contains platelets, white blood cell breakdown products, and metabolic byproducts. ② washed red blood cell suspension: this consists solely of red blood cells, with no platelets, white blood cells, antibodies, or complement. It is often used for patients with hemoglobin levels below 60 g/L and results in fewer transfusion reactions.

May 7, 2013: The Wonderful Uses of Fangfeng Tongsheng San

In the spring of Guisi year, a man had a face as red as a jujube, covered with scattered white scales, swelling, and mild itching. The patient claimed he had been ill for more than two years, with no effect from any medication. Upon examination, his six pulses were wiry, large, and rapid. I prescribed Fangfeng Tongsheng San to dispel wind and dampness and activate blood circulation.

Prescription: Schizonepeta tenuifolia 10g, Ledebouria socialis 12g, Talc 10g, Ephedra sinica 10g, Angelica dahurica 10g, Platycodon grandiflorus 20g, Angelica sinensis 10g, Ligusticum chuanxiong 6g, Paeonia lactiflora 10g, Atractylodes lancea 10g, Magnolia officinalis 10g, Citrus reticulata 6g, Pinellia ternata 6g, Poria cocos 12g, Gardenia jasminoides 10g, Rheum palmatum 10g, Glauber's salt 10g (to be taken in divided doses), Forsythia suspensa 15g, Scutellaria baicalensis 10g, Glycyrrhiza 6g, Mentha haplocalyx 6g. One dose daily, decocted in water and taken orally.

After taking ten doses of this formula, the patient’s facial skin lesions were almost completely healed.

May 8, 2013: Two Effective Case Studies

Case One

In the spring of Guisi year, a patient named Zhang caught a cold, with nasal congestion, runny nose, sneezing, mild headache, and chills with fever. I treated him with Ma Huang Gui Zhi Tang combined with Xanthium sibiricum and Magnolia denudata. After taking three doses, there was no improvement. Then I tried combining Ma Huang Gui Zhi Tang with Jing Fang Bai Du San, adding Yu Ping Feng San and Gui Zhi Tang, which proved highly effective.

Case Two

In the spring of Guisi year, a patient named Qiu was in a sub-health state and claimed to have depression for several days, seeking treatment. Upon examination, his pulse was wiry, large, and strong, especially on the right cun position. This was due to a prolonged cold, with residual pathogenic factors lingering, leading to disharmony between heart and kidney, liver stagnation, and mental agitation.

Prescription: Bupleurum chinense 10g, Scutellaria baicalensis 10g, Pinellia ternata 6g, Codonopsis pilosula 10g, Glycyrrhiza 6g, Ginger 6g, Four Dates 4 pieces, Raw Dragon Bone 15g, Raw Oyster Shell 15g, Uncaria rhynchophylla 20g, Hematite 15g, Poria cocos 12g, Gui Zhi 10g, Atractylodes macrocephala 10g, Paeonia lactiflora 15g, Rehmannia glutinosa 12g, Scutellaria baicalensis 10g, Ophiopogon japonicus 10g, Platycodon grandiflorus 20g, Fritillaria thunbergii 10g.

The patient took eight doses of this formula and reported great improvement, saying, “A half-year-long illness was cured in one go.” The key to the effectiveness of this formula lies in resolving exterior symptoms in Shaoyang and Taiyang. After catching a cold, the patient did not receive thorough treatment and continued working while ill, allowing pathogenic factors to linger in the body and causing autonomic nervous system dysfunction, resulting in depressive-like symptoms. This formula mainly uses Bupleurum plus Dragon Bone and Oyster Shell Soup to calm the liver and soothe the spirit, standing out uniquely; it also adds Paeonia lactiflora to form Gui Zhi Tang; and includes a Yin-nourishing and Lung-clearing Soup to treat the throat. By resolving both Shaoyang and Taiyang pathogenic factors and eliminating warm toxins, the disease is cured.

May 27, 2013: Thyroid Nodules

1. Both nodular goiter and endemic goiter are caused by iodine deficiency. The former may be accompanied by cystic changes, known as thyroid cysts. Cysts can further develop into adenomas, called thyroid cystadenomas. Thyroid cystadenomas are benign tumors and do not require surgery unless they are too large or located behind the sternum, compressing mediastinal organs, in which case surgery may be considered. Endemic goiter is diffuse enlargement of the thyroid gland and is not suitable for surgical treatment.

2. Fibrous tumors caused by subacute thyroiditis and Hashimoto’s thyroiditis can develop into thyroid adenomas or fibroadenomas. The rate of malignant transformation in fibroadenomas is higher than in cystadenomas, but both can become cancerous.

3. Among the pathological classifications of thyroid cancer, papillary carcinoma accounts for 90%, follicular carcinoma for 5%, medullary carcinoma for 4%, and undifferentiated carcinoma for 1%. Except for undifferentiated carcinoma, these types are generally insensitive to radiotherapy and chemotherapy, so surgical treatment is the first choice. The most distinctive feature of thyroid cancer is distant metastasis.

May 29, 2013: Mechanical Ventilation and Tracheotomy

Tracheal intubation, i.e., mechanical ventilation, is an emergency measure taken when breathing stops or severe respiratory failure occurs, with continuous decline in oxygen partial pressure and imminent danger to life. After tracheal intubation, artificial airway pressure is applied to induce spontaneous breathing. To maintain unobstructed breathing, tracheotomy may be performed, but performing tracheotomy in advance does not reduce mortality; if spontaneous breathing does not occur within 10 days, intubation becomes meaningless.

May 29, 2013: Endometrial Thickness

Normal endometrial thickness fluctuates between 5–10 mm. If it exceeds 10 mm, it is considered endometrial thickening. For patients with uterine bleeding, if the endometrium is less than 10 mm and the boundary is clear, functional uterine bleeding, uterine fibroids, or uterine polyps should be considered; if the boundary is unclear, endometrial hyperplasia can be diagnosed; if endometrial hyperplasia exceeds 10 mm, cancer should be suspected.

June 6, 2013: Further Discussion on Invasive Fungal Infections

In recent years, with the widespread use of broad-spectrum antibiotics, hormones, immunosuppressants, and anti-tumor drugs, the incidence of invasive fungal infections has increased significantly. Invasive fungi can coexist with various pathogenic infections to form mixed infections. Among invasive fungi, Candida accounts for 90%, and Aspergillus for 10%. Candida includes white Candida and non-white Candida (tropical Candida, smooth Candida, Kruse Candida). Aspergillus belongs to the non-Candida group (yeast-like).

June 6, 2013: Overview of Gastrointestinal-Pancreatic Neuroendocrine Tumors (GEP-NETs)

Gastrointestinal-Pancreatic Neuroendocrine Tumors (GEP-NETs) are digestive tract tumors that have grown rapidly in recent years. Neuroendocrine tumors (NETs) include pheochromocytoma when they occur in the adrenal glands, medullary tumor when they occur in the bones, inflammatory pseudotumor when they occur in the lungs, and those occurring in the gastrointestinal tract fall into this category. Most of these tumors start as benign, but can develop into malignancies. GEP-NETs occurring in the colon account for 17%; those occurring in the small intestine account for 13%; those occurring in the stomach account for 6%; those occurring in the duodenum, appendix, and cecum each account for 3–4%; those occurring in the pancreas account for 0.7%; and those occurring in the liver account for 0.8%.

All of the above NETs are characterized by elevated endocrine hormones, such as: ① pheochromocytoma, with elevated catecholamines. ② medullary tumor, with elevated calcitonin. ③ gastrinoma, with elevated gastrin. ④ insulinoma, with elevated insulin. ⑤ vasoactive intestinal peptide tumor, with elevated vasoactive intestinal peptide. ⑥ glucagonoma, with elevated glucagon. ⑦ somatostatinoma, with elevated somatostatin. ⑧ non-functional islet cell tumor, with no secretion.