A long night of contemplation brings peace of mind,

The spleen is the postnatal foundation, while the kidneys are the prenatal foundation; nothing else can truly serve as the foundation. Therefore, people refer to the method of strengthening the spleen and kidneys as “tonifying the body and strengthening the foundation.”

Thirty years ago, I published an article titled “Strengthening the Spleen and Kidneys and Immunity.” Through reviewing relevant domestic and international research, the article concluded that non-specific immunity relies heavily on strengthening the spleen, while specific immunity depends on strengthening the kidneys. The idea is that strengthening the spleen regulates non-specific immunity, while strengthening the kidneys regulates specific immunity. Of course, strengthening the spleen and kidneys complement each other and mutually reinforce one another. Thirty years of domestic and international research have shown that there are tens of thousands of bioactive factors in the human body. Most of these factors are divided into two phases with relatively opposite functions, which aligns with the yin-yang theory of traditional Chinese medicine. Harmonizing yin and yang is also a major principle of tonifying the body and strengthening the foundation, as stated in the “Yellow Emperor’s Inner Canon”: “When yin is balanced and yang is stable, spirit is healthy. When yin and yang are out of balance, vital energy disperses.”

Therefore, the grand strategy of tonifying the body and strengthening the foundation should include strengthening the spleen and kidneys, as well as harmonizing yin and yang. This perspective facilitates clinical adjustments and allows for flexible prescription formulations.

Common spleen-tonifying formulas I use clinically include Buzhong Yiqi Tang, Guipi Wan, Shengyang Yiwu Tang, Liujunzi Tang, Xiangsha Liujunzi Tang, Jianpi Wan, Shenling Baizhu San, Wenwei Tang, Houpu Wen Zhong Tang, and Zhenren Yangzang Tang; common kidney-tonifying formulas include Liu Wei Di Huang Wan, Zhibai Di Huang Wan, Maiwei Di Huang Wan, Gui Fu Ba Wei Wan, Zuogui Yin, Yougui Yin, etc.; common yin-yang harmonizing formulas include Xiao Chai Hu Tang, Xiaoyao San, Chai Hu Shu Gan San, Chai Hu Jia Longgu Muli Tang, and Zuo Jin Wan, etc.

A long night of contemplation brings peace of mind,

Success and failure are but fleeting clouds.

At seventy-five, one should speak no more of worldly affairs,

Let the flowing water and drifting clouds follow nature’s course.

December 8, 2013: National Master of Traditional Chinese Medicine selection is imminent

In old age, only reading brings joy,

Leaving behind all the cold and heat of the world.

Devoting oneself wholeheartedly to nurturing students,

With clear skies and colorful clouds stretching endlessly.

November 29, 2013: Pei Zhengxue’s personal statement

December 5, 2013: Advances in molecular pathology

In the 1960s, molecular biology entered the scientific stage, ushering in the study of RNA and DNA. Molecular biology is essentially the interpretation of biological laws through changes in molecular and atomic structures.

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Input: As the drawbacks of radiotherapy and chemotherapy in treating tumors have become increasingly apparent, molecular targeted therapy has emerged on the medical stage. So-called targeted therapy refers to the inhibition of vascular endothelial growth factor and epidermal growth factor. In recent years, many effective drugs for cancer have appeared in this field, such as gefitinib, sorafenib, imatinib, bevacizumab, trastuzumab, rituximab, and others. The introduction of these drugs has opened a new chapter in molecular pathology. The rapid advancement of tumor-targeted drug therapy must be guided by molecular pathological diagnostic results, so that individualized treatment can achieve ideal accuracy.

The targeted drug Herceptin (trastuzumab) for breast cancer is more effective and precise when used in patients with positive HER2 indicators. HER2 testing has now been extended to gastric cancer, applying to all patients with positive HER2 indicators. When trastuzumab is added during chemotherapy, the therapeutic effect is significantly better than conventional chemotherapy regimens.

For lung cancer, the targeted therapy drugs gefitinib and erlotinib can only exert their efficacy in patients with epidermal growth factor receptor gene mutation types. However, the technical detection of EGFR-TKI application belongs to molecular pathology; currently, developed regions abroad have already implemented it, while Beijing, Tianjin, Guangzhou, and Shanghai in China have also begun to carry out this technology. Less-developed regions in China are gradually improving their equipment and increasing this technology.

The above two examples are merely illustrations of the clinical application of molecular pathology. Molecular pathology is rapidly occupying the position in diagnostics. Using the characteristics of changes in molecular structure to diagnose diseases is what we call molecular pathology.

December 9, 2013: A Lesson in Treating Iron Deficiency Anemia

Patient, female, iron deficiency anemia, hemoglobin 78 g/L, fatigue, pallor, palpitations, and shortness of breath for 3 months; condition worsened, so she came for consultation. First, she was given Guipi Sanzi Tang, which had slight effect; later, red peony root, chuanxiong, safflower, agarwood, and salvia were added to the formula, and her hemoglobin increased markedly.

Prescription: Ginseng roots 15 g, prince ginseng 15 g, codonopsis 15 g, northern sand ginseng 15 g, rehmannia 12 g, cornelian cherry 10 g, atractylodes 10 g, astragalus 20 g, angelica 10 g, longan meat 10 g, poria 12 g, polygala 6 g, sour jujube seed 15 g, agastache 6 g, red peony root 10 g, chuanxiong 10 g, safflower 6 g, agarwood 10 g, salvia 20 g, dodder seed 15 g, ligustrum fruit 15 g, goji berry 15 g, cinnamon twig 10 g, turtle shell 15 g, psoralia 10 g, alum 3 g, chicken blood vine 15 g. One dose daily, decocted in water and taken orally.

After taking 10 doses, the patient's hemoglobin rose to 120 g/L, and all symptoms subsided.

Guan II is a superior herb for promoting blood circulation and removing blood stasis. Tang Rongchuan said: "If old blood is not removed, new blood cannot be generated." Therefore, promoting blood circulation and removing blood stasis is the correct treatment for anemia!

December 11, 2013: New Insights into Old Drugs

Amiodarone is an old antiarrhythmic drug, and its wide-ranging and diverse physiological effects have made it a commonly used and enduring antiarrhythmic medication. Arrhythmia is a common cause of death in cardiovascular diseases. Although methods such as cardioversion, implantable defibrillators, and radiofrequency ablation are effective, due to the drug's harmlessness and non-invasiveness, it remains widely used. This drug is a derivative of iodinated benzofuran, originally used for coronary heart disease. In the 1970s, it was discovered to have antiarrhythmic effects and began to be used for arrhythmias; however, because severe toxic side effects could occur at higher doses, it was once discouraged for a period of time. In the 1990s, after the CAST trial questioned the efficacy of new clinical drugs flucainide and moricizine, amiodarone once again gained attention in the medical community. Recently, the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC) have all included the use of amiodarone in their published guidelines.

December 16, 2013: Rare Pathogen Infections Recently Seen

Infections caused by Staphylococcus aureus, Streptococcus, Streptococcus pneumoniae, Escherichia coli, and Pseudomonas aeruginosa are well known; there are also MRSA, MDR-AB, VRE, ESBL-E, CRE, and other resistant bacteria. In addition to the aforementioned pathogens, there are also: ① Burkholderia pseudomallei, which causes liver abscesses. ② Brucella, which causes lumbar spine infections. ③ Histoplasma capsulatum, which causes lung infections. ④ Cryptococcus neoformans, which causes rare fungal meningitis.

December 16, 2013: Progressive Muscular Dystrophy

This disease is also known as dystrophinopathy, including Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). Currently, there is no specific cure for this disease. Hormones are the only drugs that can extend the survival time of affected children.

December 17, 2013: Talking About Fat Emulsions

Nutritional support is an indispensable and important measure in the treatment of critically ill patients; only reasonable nutritional supplementation can maintain the function of healthy organs and effectively prevent further collapse of the body's immune, metabolic, and endocrine functions. Fat emulsions, albumin, and glucose are the three pillars of parenteral nutrition. The latter two are relatively easy to administer and widely used, with few side effects. Clinicians should master the general principles of fat emulsion application; otherwise, not only will the therapeutic effect be greatly reduced, but adverse reactions are also likely to occur.

Advantages of fat emulsions: ① High energy density. ② Isotonic. ③ Not excreted in urine. ④ Non-irritating to veins. ⑤ Contains essential fatty acids. Disadvantages: May introduce pyrogens and trigger infections.

Types of fatty acids: ① Long-chain fatty acids (containing LCT): Soybean oil and safflower oil, which are most commonly used, have been clinically applied for 50 years. However, they have a fatal flaw: traditional soybean oil sources contain too much linoleic acid and lack antioxidants, making it difficult to clear large amounts of free radicals under high-metabolic conditions such as burns or high fever, leading to an increase in inflammatory factors. ② Medium-chain fat emulsions: Medium-chain fatty acids mostly come from edible oils. Medium-chain triglycerides (MCT) are 100 times more water-soluble than long-chain triglycerides (LCT), indicating that MCT is a water-soluble fatty acid, while LCT is a fat-soluble fatty acid. The former oxidizes more safely and completely, but people using this type of fatty acid have less essential fatty acids in their bodies than those using LCT, so clinicians often adopt a combined approach of medium and long chains. ③ Olive oil fat emulsions: Clinically used olive oil fatty acids are usually a mixture of 80% olive oil fatty acids and 20% soybean oil fatty acids. From a metabolic perspective, this formulation greatly reduces the content of polyunsaturated fatty acids, thereby lowering factors affecting redox reactions. ④ Fish oil fat emulsions: This type of fatty acid is broadly similar to the aforementioned olive oil fat emulsions, particularly suitable for ICU patients, helping to reduce hospital stay.

In summary, fat emulsions can be divided into long-chain and medium-chain types. The former contains various unsaturated fatty acids, with a relatively high content of linoleic acid, which has a negative impact on redox reactions, while the latter consists mainly of water-soluble fatty acids.

December 20, 2013: Drug Selection for Parkinson's Disease

Pramipexole 0.125 mg, three times daily; increase to 0.25 mg, three times daily in the second week; increase to 0.5 mg, three times daily in the third week. If further dosage increases are needed, they should be made weekly, adding 0.75 mg each week, with a maximum daily dose of 4.5 mg. The above treatment method is the latest Pramipexole regimen currently available and is most suitable for Parkinson's patients.

Previously, levodopa was commonly used to treat Parkinson's disease. The levodopa currently in use is carbidopa-levodopa, starting at 125 mg twice daily in the first week. Thereafter, increase by 125 mg daily every week. Generally, the daily dose should not exceed 1 g, divided into 3–4 doses. Levodopa/carbidopa 250 mg, three times daily. Levodopa/carbidopa can be combined with Pramipexole, with dosages gradually increased.

December 25, 2013: Oral Arsenic Preparations vs. Intravenous Arsenic Infusions

Professor Huang Xiaojun from Peking University People's Hospital published the results of a randomized, multi-center Phase III non-inferiority clinical trial in the Journal of Clinical Oncology. The study compared the efficacy and safety of oral compound Huangdai tablets containing tetrasulfur tetraarsenic (RIF) and intravenous arsenic trioxide (ATO) during induction and maintenance therapy for newly diagnosed acute promyelocytic leukemia patients. The results showed that the 2-year disease-free survival rates (DFS) were 98.1% and 95.5%, respectively, with a difference of 2.6%; the 3-year complete remission rates (CR) were 99.1% and 97.2%, showing a significant difference; the 3-year overall survival rates were 99.1% and 96.6%, also showing a significant difference. The conclusion is that the two treatments are equally effective, i.e., scientifically termed "non-inferior."

In 1985, Academician Wang Zhenyi first successfully used all-trans retinoic acid (ATRA) to treat acute promyelocytic leukemia (APL). More than 80% of patients achieved remission, but most relapsed shortly thereafter. In the 1990s, some domestic researchers successfully treated leukemia with arsenic (As2O3), especially for APL. Their research suggested that arsenic preparations can both induce cell differentiation and promote apoptosis. Later, it was reported that combining ATRA with arsenic could increase the 5-year survival rate of APL patients by 90%, with no long-term toxic side effects observed.

December 26, 2013: Headaches Can Indicate Cerebrovascular Accidents

Among cerebrovascular accidents, 90% of cases involve cerebral hemorrhage accompanied by headache, 98% involve subarachnoid hemorrhage accompanied by headache, and 20%–40% involve cerebral infarction accompanied by headache. In short, if a sudden headache is accompanied by sensory or motor abnormalities on one side of the body, cerebrovascular accident should be considered. Even if there are no such abnormalities, this disease should still be ruled out.

December 30, 2013: Discussing Modern Large-Volume Infusions

Modern surgical procedures are becoming increasingly sophisticated, delicate, and complex, with emergency care centered around ICU wards. In terms of volume expansion and correction of electrolyte disturbances, large-volume infusions have opened up new horizons. Currently, large-volume infusions include colloidal and crystalloid solutions. The former includes hydroxyethyl starch, plasma, albumin, and fat emulsions, while the latter consists of hypertonic or isotonic glucose solutions and normal saline. The former is primarily used for volume expansion and nutrition, while the latter is used for drug delivery and correction of electrolyte disturbances. The calculation method for fluid replacement is as follows: for the first 10 kg of body weight, administer 1000 mL; for the next 10 kg, administer 500 mL; for any remaining weight, administer 200 mL per 10 kg. For example, a patient weighing 50 kg would receive a total of 1000 mL + 500 mL + 600 mL = 2100 mL. The initial portion of this total should be split evenly between colloids and crystalloids, i.e., 1000 mL of hydroxyethyl starch and 1000 mL of crystalloid solution. As nutritional status improves and peripheral circulation gets better, the amount of colloid should be reduced first, followed by a gradual reduction in crystalloid.

December 31, 2013: Reducing Microvascular Permeability Is the Core Issue in Correcting Hypoproteinemia

Hydroxyethyl starch is a large-molecule artificial colloid that does not easily seep out of capillaries, providing a physical sealing effect; at the same time, it also has biological activity, inhibiting the release of inflammatory factors, thus improving capillary permeability. Therefore, hydroxyethyl starch is currently a relatively ideal drug for treating hypoproteinemia. Plugging leaks, expanding volume, and improving microcirculation are the best treatment concepts for perioperative crises, and since hydroxyethyl starch excels in all three areas, it should be prioritized.

2014

January 1, 2014: New Year Reflections

Qingping Le: New Year Thoughts

As the New Year arrives,

the whole country celebrates together,

rural areas abolish taxes and express gratitude to the Party,

humanity enjoys abundant harvests.

Liaoning Ocean Patrol Expedition,

Chang'e flies to the moon,

peacekeeping missions in two seas are not halted,

the entire nation rejoices.

January 2, 2014: Discussion on the "2014 U.S. Adult Hypertension Treatment Guidelines (JNC8)"

On December 28, 2013, the Journal of the American Medical Association (JAMA) published online the "2014 U.S. Adult Hypertension Treatment Guidelines (JNC8)." The distinctive feature of these guidelines is that, unlike all previous guidelines, they are not overly specific, but clearly address three key issues: ① When should antihypertensive treatment begin? ② To what extent should blood pressure be lowered for optimal results? ③ How should treatment medications be selected? Answers to these three questions must be based on randomized controlled trials (RCTs). Regarding medications: ① The important role of ARB drugs is affirmed. ② The cornerstone status of thiazide diuretics is confirmed. ③ The advantages of combination formulations are solidified.

January 6, 2014: Endometriosis