August 1, 2013: A re-examination of atrial fibrillation

August 1, 2013: A re-examination of atrial fibrillation

Chronic atrial fibrillation is considered permanent atrial fibrillation, with the greatest danger being that blood clots form in the ventricles, creating emboli that can break loose and cause stroke or peripheral vascular embolism. To prevent this mechanism, current recommendations include long-term use of aspirin, clopidogrel, warfarin, dabigatran, apixaban, rivaroxaban, etc. In the 1980s, warfarin was established as the preferred drug for treating and preventing chronic atrial fibrillation and embolism. Although warfarin is the first-choice drug for chronic atrial fibrillation, its anticoagulant effect is influenced by many factors. Those taking warfarin should regularly check their coagulation time and prothrombin time, at least once a week. Therefore, some people compare taking warfarin to "walking on a tightrope." I often use "Ban Liao Xiang Cao," "Da Zao San Po Che," "Bu Shen Sheng," and "Zheng Lv Wu Yao" to treat chronic atrial fibrillation, and clinical results are very good. Traditional Chinese Medicine is highly effective in treating chronic atrial fibrillation, and some patients can even be cured. The aforementioned herbal formulas for this condition all show obvious efficacy; Da Jian Zhong Tang and Xiao Jian Zhong Tang can also treat this condition.

There is also acute atrial fibrillation, also called transient atrial fibrillation, which is commonly treated with Western medicines such as amiodarone, betaxolol, and propranolol.

August 1, 2013: Fluid resuscitation for sepsis

Sepsis is systemic inflammatory response syndrome (SIRS), characterized by decreased blood pressure (systolic pressure <90mmHg), serum lactate >4mmol/L, and confusion. In addition to antibiotics, extensive fluid replacement is recommended for treatment, but there are still disagreements about how to perform fluid resuscitation.

Viewpoint 1: Systemic vasodilation and slow blood flow lead to decreased arterial oxygen saturation (SaO2); according to Starling's curve, large volumes of fluid can increase cardiac output, thereby improving SaO2.

Viewpoint 2: Early massive volume expansion can reduce blood lactate and increase arterial oxygen saturation, but later it will increase cardiac load, affecting recovery of the heart and multiple organs, and increasing pulmonary edema and interstitial edema.

August 1, 2013: Six gynecological endocrine tests

1. Follicle-stimulating hormone (FSH) Follicular phase: 2.5–10.2mU/mL; ovulatory phase: 3.4–33.4mU/mL; luteal phase: 1.5–9.1mU/mL; pregnancy: 0–0.3mU/mL; menopause: 23–116.3mU/mL.

2. Luteinizing hormone (LH) Follicular phase: 1.9–12.5mU/mL; ovulatory phase: 8.7–12.5mU/mL; luteal phase: 0.5–16.9mU/mL; pregnancy: 0–1.5mU/mL; menopause: 15.9–54mU/mL.

3. Estradiol (E2) Follicular phase: 71.6–529.2pmol/L; ovulatory phase: 234.5–1309.1pmol/L; luteal phase: 204.8–786.1pmol/L; menopause: 0–118.2pmol/L.

4. Progesterone (P) Follicular phase: 0.15–1.4nmol/L; luteal phase: 3.34–25.56nmol/L; menopause: 0–0.73nmol/L; early pregnancy: 35.68–286.2nmol/L; mid-pregnancy: 81.25–284.29nmol/L; late pregnancy: 153.91–343.5nmol/L.

5. Testosterone (T) Follicular phase: <1.4nmol/L; ovulatory phase: <2.1nmol/L; luteal phase: <1.7nmol/L; menopause: <1.2nmol/L.

6. Prolactin (PRL) Non-pregnant: <1.14mmol/L; early pregnancy: <3.64mmol/L; mid-pregnancy: <7.28mmol/L; late pregnancy: <18.2mmol/L.

August 9, 2013: Gastrointestinal stromal tumor

Gastrointestinal stromal tumor originates from mesenchymal tissue cells, i.e., from the mesoderm, such as smooth muscle and mesothelial tissue. It can occur throughout the body, but gastrointestinal stromal tumors are the most common. These tumors are highly malignant and prone to metastasis; surgery is the first-line treatment, while chemotherapy has uncertain efficacy. Recently, some have suggested that imatinib (mesylate imatinib) has moderate efficacy, but the drug is too expensive and difficult to promote.

August 15, 2013: A verified formula for lichen planus

Sheng Di Huang 12g, Mu Tong 6g, Gan Cao Shao 6g, Dan Zhu Ye 12g, Huang Lian 6g, Huang Qin 10g, Huang Bai 6g, Zhi Zi 10g, Dang Gui 10g, Chi Shao 10g, Dan Shen 10g, Tai Zi Shen 12g, Sha Shen 12g, Mai Dong 10g, Fu Ling 12g, Ze Xie 10g, Chong Lou 10g, Ku Shen 10g, Bai Xian Pi 10g, Di Fu Zi 10g.

August 15, 2013: A formula for rheumatoid arthritis

Qiang Huo 10g, Du Huo 10g, Sang Ji Sheng 15g, Wei Ling Xian 15g, Chuan Niu Xi 10g, Qing Feng Teng 15g, Hai Feng Teng 15g, Chuan Shan Jia 10g, Zao Jiao Ci 10g, Luo Shi Teng 10g, Xun Gu Feng 12g, Chuan Wu and Cao Wu each 10g, Dan Shen 20g, Dang Gui 10g, Mu Fang Ji 10g, Huang Qi 30g, Qin Jiao 10g. Take one dose daily, decocted in water.

This formula can lower erythrocyte sedimentation rate and also dispel wind and relieve pain.

August 18, 2013: A brief discussion on chronic kidney disease (CKD)

According to the latest statistics, China now has 140 million CKD patients. Although this figure is alarming, it is actually a realistic number. Diabetic nephropathy, chronic glomerulonephritis, autoimmune nephritis, hypertensive nephropathy, malnutrition-related nephropathy, and so on, all contribute to the CKD army. These patients will eventually progress to renal failure, dialysis, or transplantation, and national resources will undoubtedly be directed toward this area. The soaring incidence of breast disease has led to the prosperity of the breast department, while chronic kidney disease has led to the prosperity of the nephrology department. Behind the word "prosperity" lies both inflow and outflow of funds. In recent years, the breast and nephrology departments have been bustling with patients and busy with work, and hospitals at city and county levels have been actively recruiting staff and purchasing equipment.

August 26, 2013: An effective formula for diabetic nephropathy

In the mid-autumn of the year of Gui Si, patient Shen, with type 2 diabetes, diabetic nephropathy, renal failure, and hyperuricemia. I prescribed a compound formula combining kidney-tonifying herbs with A Fa Jian Mai.

Prescription: Dang Gui 10g, Chuan Xiong 10g, Chi and Bai Shao each 10g, Sheng Di Huang 12g, Tao Ren 10g, Hong Hua 6g, Yi Mu Cao 20g, Dan Shen 20g, Jin Yin Hua 15g, Lian Qiao 15g, Pu Gong Ying 15g, Ban Lan Gen 15g, Gui Zhi 10g, Fu Ling 12g, Dan Pi 6g, Shan Yu Rou 30g, Bai Zhu 10g, Ze Xie 10g, A Jiao 10g (melted), Xue Yu Tan 10g, Mai Dong 10g, Shan Zhi 10g, Bai Guo 15g. Decocted in water, take two doses every three days.

After taking 10 doses, the patient's blood urea nitrogen dropped from 9.81mmol/L to 8.18mmol/L, creatinine from 113μmol/L to 93μmol/L, and uric acid from 652μmol/L to 290μmol/L. Urinary protein changed from (+++) to (++), and occult blood in urine changed from (±) to (-).

August 30, 2013: Talking about Li Yin Jian

Li Yin Jian is a formula created by the famous Ming Dynasty physician Zhang Jingyue. Although the name suggests regulating yin, it actually nourishes yin and replenishes blood, cools blood and invigorates circulation—truly a sacred remedy for nourishing kidney yin and activating blood stasis. The liver and kidneys are where the body's essence and blood reside; any internal injury affects these vital substances, which is why "where evil gathers, qi must be deficient." Four Substances Soup, Clear Stomach Powder, and Dragon Gall Bladder Drainage Soup all contain ingredients from Li Yin Jian, demonstrating the importance of the body's essence and blood. Recently, I have consistently added Shu Di Huang and Dang Gui—two herbs, 20g each—to my formulas for treating rheumatoid arthritis, and the therapeutic effect has significantly improved. Checking various herbal texts, I found that these two herbs have the effect of dispelling wind and relieving pain, no wonder there is a folk saying that Shu Di Huang and Dang Gui alone can treat blood and pain.

September 2, 2013: More on myelodysplastic syndrome (MDS)

Myelodysplastic syndrome (MDS) is divided into five types: ① Refractory anemia (RA): bone marrow shows active dysplasia, but all three cell lines decrease, with blast cells <1%. ② Refractory anemia with ringed sideroblasts (RARS): bone marrow shows active dysplasia, all three cell lines decrease, and there are ringed sideroblasts in the marrow. ③ Refractory cytopenia with multilineage dysplasia (RCMD): bone marrow has ≥10% cells with multilineage dysplasia, blast cells <5%, and peripheral blood monocytes <10^9^/L. ④ Refractory anemia with increased blasts-1 (RAEB-1): RA + blast cells <5%. ⑤ Refractory anemia with increased blasts-2 (RAEB-2): RA + blast cells >5%.

Clinical manifestations of MDS include anemia, bleeding, infection, and hepatosplenomegaly. The cause of this disease remains unknown, and it is insensitive to Western medicine's radiotherapy and chemotherapy, especially for patients over 50 who are even less responsive. Western medicine generally recommends hormones, immunosuppressants, interferons, and blood transfusions for treatment.

I treat this disease based on the "Lanzhou Formula," adding "Ma Tu Shui," while simultaneously taking Qing Kou capsules, Qing Kou No. 2, Sheng Xue granules, and Sheng Bao Dan. Qing Kou No. 2 contains red arsenic, whose main component is arsenic trioxide. I have used the "Lanzhou Formula" to treat over a hundred cases of MDS, and most have shown improvement.

September 5, 2013: Whole-body pain from lung cancer

Patient, female, 36 years old. Right upper lung cancer with cervical lymph node metastasis. Feeling heavy-hearted and generally fatigued and uncomfortable.

Prescription: Ren Shen Xu 15g, Tai Zi Shen 15g, Lu Dang Shen 15g, Bei Sha Shen 15g, Sheng Di Huang 12g, Shan Yu Rou 30g, Mai Dong 10g, Tian Dong 15g, Wu Wei Zi 3g, Gui Zhi 10g, Bai Shao 10g, Gan Cao 6g, Fu Xiao Mai 30g, Da Zao 4 pieces, Mu Li 15g, Sheng Jiang 6g, Chai Hu 10g, Ge Gen 20g, Huang Qin 10g, Gan Cao 6g, Chuan Xiong 6g, Bai Zhi 10g, Xi Xin 3g, Qiang Huo 10g, Du Huo 10g each, Fang Feng 12g, Jie Geng 20g.

After taking 14 doses of this formula, all of the patient's symptoms completely disappeared.

September 6, 2013: More on pancreatic cancer

The incidence of pancreatic cancer (PC) has been increasing year by year, with a five-year survival rate of less than 5%, and 60% of patients are already metastatic when diagnosed. Current treatments—surgery, radiation, and chemotherapy—are not very ideal. Some overseas researchers suggest combining gemcitabine with tegafur for chemotherapy, but domestic scholars believe that although the efficacy is not ideal, it can still be the first choice. Currently, it is widely believed that pancreatic cancer treatment should be comprehensive, not solely focused on killing cancer cells, but also on improving the internal environment of the pancreas and strengthening the body's immunity. According to Traditional Chinese Medicine theory, "where evil gathers, qi must be deficient" and "when righteous qi resides within, evil cannot invade." I treat pancreatic cancer based on the principles of soothing the liver and benefiting the gallbladder, clearing heat and draining fire, invigorating blood and removing stasis, and clearing the stomach and reversing reverse flow, forming a formula for bile and pancreas disorders. Clinically, this formula has shown improvements in most pancreatic cancer patients, enhancing their quality of life and prolonging their survival.

September 16, 2013: More on HBV

After HBV enters the host's body, it first binds to receptors on the surface of liver cells, then enters the nucleus to complete double-stranded DNA replication, forming a double-stranded circular supercoiled DNA structure (cccDNA). This cccDNA then serves as a template for transcribing two types of RNA: ① pgRNA: pre-genomic RNA, which serves as the template for subsequent reverse transcription. ② mRNA: messenger RNA, used to transcribe various viral proteins.

After the two types of RNA enter the cytoplasm, mRNA travels through the cytoplasm, with part binding to cell membrane receptors to form surface antigens, and another part binding to cytoplasmic particles to form e-antigens. pgRNA serves as the template for subsequent reverse transcription, converting weaker mRNA into mRNA. Some pgRNA then returns to the nucleus to form cccDNA, continuing to transcribe pgRNA and mRNA using the template.

September 20, 2013: Persistent inflammation-immunosuppression-catabolic syndrome (PICS)

Early on, inflammatory factors such as interleukin-1 (IL-1) and tumor necrosis factor (TNF-α) were discovered, and later it was found that these inflammatory factors could activate NF-KB, leading to the production of multiple inflammatory factors in the body and resulting in multi-organ failure, causing the condition to deteriorate rapidly in a short period of time. Dr. Roger C. Bone proposed the concept of systemic inflammatory response syndrome (SIRS), arguing that after inflammation occurs, immune function is suppressed, and the body develops compensatory anti-inflammatory response syndrome (CARS), characterized by increased anti-inflammatory factors in the circulation (IL-1, IL-6, IL-10). Some believe that SIRS comes first, followed by CARS, and that the former causes the latter; others argue that although the former causes the latter, the two happen almost simultaneously.

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Macrophages and dendritic cells in the immune system are key cells for clearing antigens. SIRS can inactivate these cells, while CARS activates relevant bioactive factors to counter SIRS. Regardless of the outcome, this process consumes a large amount of energy throughout the body, which must be replenished by the breakdown of fat and protein, leading to emaciation, anemia, and cachexia; some refer to this syndrome as PICS.

PICS includes: ① CRP > 150 mg/L, retinol-binding protein (RBP) < 10 mg/L. ② Lymphocyte count < 0.80 × 10^9^/L. ③ Serum protein concentration < 30 g/L, creatinine elevation index < 80%.

These three indicators respectively represent the level of inflammation, immune status, and degree of organ failure.

October 9, 2013: Case report of myelodysplastic syndrome—refractory anemia with excess blasts (MDS-RAEB)

Patient, female, 90 years old. Diagnosed with MDS-RAEB, had undergone three rounds of chemotherapy without improvement, with occasional fever, epistaxis, and skin petechiae. Complete blood count: WBC 1.6 × 10^9^/L, PLT 32 × 10^9^/L, Hb 56 g/L. After taking "Lanzhou Formula + Matu Shui," Shengxue Granules, Xiaofeng No. 2, Qingkou No. 2, and Shengbao Dan for two weeks, follow-up blood test showed: WBC 3.6 × 10^9^/L, PLT 32 × 10^9^/L, Hb 82 × 10^9^/L. Subsequently, due to shortages of Qingkou No. 2 and Shengbao Dan, continuous medication was interrupted, resulting in disease relapse, with WBC, PLT, Hb, and RBC all dropping back to previous levels. After resuming Qingkou No. 2 and Shengbao Dan, the condition improved again, with all three cell lines rising once more. This case demonstrates the efficacy of Qingkou No. 2 and also highlights the effectiveness of Shengbao Dan.

October 12, 2013: Case report of chronic glomerulonephritis

Ms. Wang, female, 32 years old. Has suffered from chronic glomerulonephritis for eight years, with urinary protein (+++), occult blood (+++), and blood pressure at 160/100 mmHg. Despite extensive treatment, no significant improvement was observed, so she sought consultation with me.

Prescription: Danggui 10 g, Chuanxiong 10 g, Chishao 10 g, Shengdihuang 12 g, Taoren 10 g, Honghua 6 g, Yimucao 20 g, Danshen 20 g, Sugeng 15 g, Jinyinhua 15 g, Lianqiao 15 g, Pugongying 15 g, Baijiangcao 15 g, Banlangen 15 g, Dahuang 10 g, Huashi 12 g, Mutong 10 g, Gancao 10 g, Huangqi 20 g, Huangjing 20 g, Baimaogen 20 g, Baiziliti 20 g, Sanleng 10 g, Ezhushi 10 g. Decoction to be taken twice every three days.

After taking the above formula for 15 doses, the patient's urinary protein and occult blood both turned negative, so she continued with the following prescription.

Prescription: Dangshen 10 g, Huangqi 20 g, Gancao 6 g, Rougui 3 g, Danggui 10 g, Chishao 10 g, Chuanxiong 10 g, Shengdihuang 12 g, Xuan Shen 10 g, Maidong 10 g, Shanyurou 30 g, Shanyao 10 g, Mudanpi 6 g, Fuling 10 g, Zexie 10 g, Sugeng 20 g, Yimucao 15 g, Huashi 15 g, Mutong 6 g, Huangjing 20 g, Baimaogen 20 g, Baiziliti 20 g, Sanleng 10 g, Ezhushi 10 g. Decoction to be taken twice every three days.

The mnemonic for the first formula is: "Compound kidney-tonifying, Dahuang three-three-three." The mnemonic for the second formula is: "Protect four, enhance six, Dahuang three-three-three."

October 17, 2013: Pelvic congestion syndrome