Practical Internal Medicine Integrating TCM and Western Medicine

Practical Internal Medicine Integrating TCM and Western Medicine For polycystic ovary syndrome, treatment with tonifying kidney and resolving phlegm was employed, achieving an efficacy rate of 82.7%. To further explore the underlying mechanisms, a complete set of ovarian function tests was conducted on 9 patients [61], revealing that the true cause of ovarian dysfunction in these 9 cases was a disruption in hypothalamic function. Subsequently, another 9 patients underwent dynamic hormone level tests, further confirming that the effects of tonifying kidney yang herbs were multifaceted, acting on multiple levels including the hypothalamus, pituitary gland, and ovaries, rather than acting in isolation. The Huashan Hospital of Shanghai First Medical College treated 100 patients with obstructive pyelonephritis caused by ureteral stones with warm-yang and water-removing therapies [7], achieving a cure rate of 71%. Meanwhile, animal models of renal hydronephrosis were used to demonstrate that warm-yang and water-removing herbs increased pressure within the renal pelvis and significantly enhanced peristaltic waves, whereas water-removing herbs alone did not produce such effects. Through animal models of renal hydronephrosis, CAMP levels were measured in both hydrated and contralateral renal tissues.

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Input: and norepinephrine (NA) content, then administered warm-kidney and diuretic herbs separately, it was found that the CAMP and NA levels in the hydronephrotic kidneys were significantly higher than those in the healthy kidneys, p < 0.001, proving that warm-kidney and diuretic therapies can influence the renal pelvis through catecholamines, enhancing the activity of the renal pelvis and ureter, thereby achieving a diuresis effect. This indicates that warm-kidney and yang-tonifying herbs not only improve the functions of the hypothalamus, pituitary gland, and target glands but also exert a significant regulatory effect on the autonomic nervous system. The Shanghai Institute of Endocrinology conducted observations on several diseases—such as diabetes, coronary heart disease, sick sinus syndrome, and hypertension—where kidney-yang deficiency is most commonly observed, and studied the patterns of sex hormone changes. It was observed that, in male patients with these conditions, the common pattern of sex hormone changes was an increase in E2 levels and a rise in the E2/T ratio, which showed a certain positive correlation with kidney-yang deficiency. Phillips had previously suggested that elevated E2/T ratios could be a risk factor for cardiovascular disease, but no effective treatment methods were found. After adopting a kidney-tonifying therapy, symptoms of kidney deficiency improved, sex hormone levels were corrected, and the specific symptoms associated with each disease also showed improvement: blood pressure decreased in patients with hypertension, blood sugar levels dropped in diabetic patients, angina pectoris in coronary heart disease lessened, and heart rate increased in patients with sick sinus syndrome. In recent years, further research has explored the relationship between sex hormone changes in female patients with diabetes, coronary heart disease, and hypertension and kidney deficiency. Salivary hormone measurements revealed that women of childbearing age with these conditions experienced varying degrees of ovarian function decline, manifested as reduced E2 levels and lower E2/T ratios—exactly opposite to what was observed in male patients. After adopting a kidney-tonifying approach similar to that used in male patients, the aforementioned conditions likewise improved. This suggests that kidney deficiency is a common manifestation of hormonal disorders in both men and women; at the same time, by focusing on the diagnostic characteristics of kidney deficiency, kidney-tonifying therapies can effectively address hormonal imbalances in both genders. This demonstrates that kidney-tonifying therapies possess a clear bidirectional regulatory effect in adjusting hormonal imbalances in both men and women. References [1] Shen Ziyun et al. An Exploration of the Kidney Essence in Traditional Chinese Medicine. Chinese Journal of Internal Medicine, 1976, 1:80 [2] Shen Ziyun et al. Comparative Observations on Thyroid Axis Function in Elderly Patients with Kidney Yang Deficiency and Healthy Individuals. Chinese Journal of Integrated Traditional and Western Medicine, 1982, 2:9 [3] Wang Wenjian et al. Preliminary Observations on the Function of the Hypothalamic-Pituitary-Gonadal Axis in Patients with Kidney Yang Deficiency and Elderly Men. Chinese Journal of Integrated Traditional and Western Medicine, 1982, 2:149 [4] Wang Wenjian. Clinical and Experimental Studies on the Effect of Kidney-Tonifying Therapy on the Hypothalamic-Pituitary-Gonadal Axis in Elderly Men. Chinese Journal of Traditional Chinese Medicine, 1996, 7:272 [5] Shen Ziyun et al. Research on the Prevention of Seasonal Asthma Attacks by Warm-Yang Tablets and Their Mechanisms. Chinese Journal of Integrated Traditional and Western Medicine, 1986, 6:11 [6] Yu Jin et al. Kidney-Tonifying and Phlegm-Dispersing Therapies for Regulating the Functions of the Hypothalamus, Pituitary Gland, and Ovaries in Polycystic Ovary Syndrome. Chinese Journal of Integrated Traditional and Western Medicine, 1986, 6:218 [7] Zhang Jianguo et al. Discussion on the Principles Behind the Warm-Yang and Diuretic Therapy for Ureteral Calculi and Hydronephrosis. Chinese Journal of Traditional Chinese Medicine, 1985, 6:390 [8] Kuang Anwang et al. Preliminary Observations on the Relationship Between TCM Diagnosis and Blood Plasma Hormone Levels in Male Type 2 Diabetes. Chinese Journal of Integrated Traditional and Western Medicine, 1983, 3:79 II. Research on the Spleen The spleen is the root of postnatal constitution, governing central qi and facilitating digestion and metabolism; it serves as the source of qi and blood formation, and like the kidneys, it plays a crucial role in human growth, development, health, and aging. The theory and study of the spleen are integral components of traditional Chinese medicine’s fundamental theories. In recent years, researchers have employed experimental methods to investigate the nature of the spleen and have achieved promising results. Overall, the “spleen” in traditional Chinese medicine carries three key meanings. (1) The Spleen Governs Digestion and Metabolism The concept of the spleen as a regulator of digestion in traditional Chinese medicine is closely related to modern medicine’s systems of digestion, absorption, gastrointestinal motility, and metabolism.

1. When the spleen fails to function properly, digestive issues such as indigestion and loss of appetite may arise. Some researchers have used salivary amylase activity as an indicator to observe that in patients with spleen deficiency, salivary amylase activity significantly decreases under effective stimulation (acidic stimuli), whereas in healthy individuals, salivary amylase activity tends to increase. Some studies have also found that the basal acid output (BAO) and peak acid output (PAO) in patients with gastric discomfort due to spleen deficiency are significantly lower than those in healthy individuals¹. Researchers have measured the gastric protease activity in patients with chronic gastritis who exhibited spleen deficiency, finding that it was comparable to that of healthy individuals³. The Beijing Institute of Traditional Chinese Medicine measured urinary amylase activity in patients with spleen deficiency, discovering that it was notably lower than in healthy individuals, suggesting that the pancreatic secretion of pancreatic amylase in patients with spleen deficiency was impaired⁴. Some researchers conducted pancreatic function tests on patients with spleen deficiency, revealing reduced pancreatic protease secretion⁵. From these experimental studies, it becomes clear that when the spleen is deficient and its digestive functions are disrupted, the secretion of salivary amylase, the basal and peak acid output, urinary amylase activity, pancreatic amylase secretion, and protease function all fall below normal levels². This indicates that the spleen’s dysfunction—particularly the reduction in various digestive secretions—is one of the core underlying causes of these issues.

2. The Spleen and Absorption In addition to the reduced secretion of digestive enzymes, the spleen’s dysfunction also involves changes in gastrointestinal absorption. Some domestic institutions have used xylitol excretion rates as an indicator to study the intestinal absorption status of patients with spleen deficiency. The Beijing Institute of Traditional Chinese Medicine found that the xylitol excretion rates in children suffering from rickets or those prone to respiratory infections were lower than normal levels. However, after treating with a spleen-tonifying regimen, as the spleen deficiency symptoms improved, the xylitol excretion rates returned to normal levels⁴. Some researchers repeated the above experiments on adult patients with spleen deficiency, and the results were consistent⁶. Researchers performed pathological observations on gastric tissue removed from patients with spleen deficiency, discovering that the regeneration of gastric mucosal epithelial cells was enhanced, while the process of differentiation into mature cells was hindered⁷. Pathological examinations of duodenal biopsy samples from patients with chronic gastritis and peptic ulcers who exhibited spleen deficiency revealed that the villi were flattened, many areas of damage were present, and small villi were sparse or even absent⁸.

3. The Spleen and Gastrointestinal Motility The dysfunction of the spleen also manifests in changes to gastrointestinal motility. Patients with spleen deficiency often experience symptoms such as belching, acid reflux, abdominal distension, and loose stools. Traditional Chinese medicine views these symptoms as signs of improper ascending and descending movement of the spleen and stomach—meaning that the spleen’s ascending and descending functions are compromised. Some researchers used X-ray barium meal imaging to find that most patients with spleen deficiency exhibited reduced gastrointestinal peristalsis and prolonged gastrointestinal emptying times⁹. Others used surface gastric electrical waves as an indicator to observe that the amplitude of gastric electrical waves in patients with spleen deficiency was lower, a difference that was particularly evident both during fasting and after meals¹⁰. After adopting a spleen-tonifying and qi-enhancing therapy, this condition quickly improved¹¹. Some researchers used isotopic tracing techniques to observe gastrointestinal emptying function, discovering that the emptying speed of the digestive tract in patients with spleen deficiency was significantly slower compared to patients without spleen deficiency and healthy individuals. However, after taking spleen-tonifying and qi-enhancing medications, improvements were observed¹².

4. The Spleen and Metabolism The dysfunction of the spleen also involves disruptions in the metabolism of nutrients. Some researchers found that in patients with atrophic gastritis and superficial gastritis, serum isocitrate dehydrogenase activity was lower than in healthy individuals (p < 0.01). After treatment with Xiangsha Liu Junzi Tang, enzyme activity increased; although there was a statistically significant difference before and after treatment, the enzyme activity still did not reach normal levels¹². These patients also exhibited lower lactate dehydrogenase activity in their serum, and enzyme activity increased significantly after treatment with Xiangsha Liu Junzi Tang¹². Some researchers observed that the number of subcellular mitochondria per unit area of gastric mucosa in patients with gastric pain and spleen deficiency was markedly reduced. At the same time, the subcellular mitochondria in patients with spleen deficiency were swollen, their membranes were damaged, and their cristae were fractured¹³. Mitochondria are cellular organelles responsible for the biological oxidation of nutrients, containing enzymes necessary for oxidative processes. Studying the morphology and function of mitochondrial structures in patients with spleen deficiency is highly meaningful for exploring the essence of the spleen. (2) The Spleen Governs Central Qi Central qi is the “root of postnatal constitution,” an essential component of the body’s “right qi.” Traditional Chinese medicine emphasizes that “when evil gathers, qi inevitably becomes deficient,” and “when right qi resides within, evil cannot invade.” Thus, right qi and central qi, to some extent, encompass immune functions. Traditional Chinese medicine also holds that “a strong spleen resists evil.” Some researchers divided inpatients into two groups—those with spleen deficiency and those without—and used peripheral blood lymphocyte counts, PHA skin tests, total E rosette formation cell ratios, and active E rosette formation ratios as indicators. They found that the cellular immune function in patients with spleen deficiency tended to be significantly impaired, with the degree of impairment positively correlated with the severity of anemia and low protein levels in patients with spleen deficiency¹⁴. Patients with chronic bronchitis, peptic ulcers, chronic non-specific colitis, and chronic hepatitis also exhibited similar conditions¹⁵. Some researchers used square capillary electrophoresis to observe lymphocyte electrophoresis in patients with spleen deficiency, discovering that the lymphocyte electrophoresis rate was significantly lower. A decline in lymphocyte electrophoresis capacity indicated a decrease in lymphocyte electrophoresis vitality, which may be one of the reasons why patients with spleen deficiency exhibit weakened immunity¹⁶. Some researchers also studied the levels of SigA in the saliva of patients with peptic ulcers and chronic colitis, finding that the levels were higher in patients with spleen deficiency, especially in those with dampness accompanying spleen deficiency. As clinical conditions improved, the levels decreased accordingly. Traditional Chinese medicine believes that the onset of a condition is often related to an individual’s physical constitution; HLA is an important genetic marker of the human body, closely linked to the body’s immune response and susceptibility to disease. Some researchers conducted preliminary studies on the association between spleen deficiency and HLA, finding that spleen deficiency was significantly associated with HLA-B2, while chronic gastritis, chronic nephritis, and peptic ulcers—used as comparison subjects—did not show such a relationship¹⁸. This suggests that there is a clear connection between the essence of spleen deficiency and immune genetic factors.

Integrated Traditional and Western Medicine Practical Internal Medicine ( ) Liver and Gallbladder, and the interaction between Liver and Gallbladder—both are considered to be “Spleen Earth Overpowering Wood,” with the former often manifesting as liver region pain. The latter, however, presents with abdominal distension, intestinal rumbling, diarrhea, nausea, vomiting, and other symptoms. Some researchers note that the latter case is more common in women, while the former is more prevalent in men. In Western medicine, the situation is different:

For example, in the early stages of the disease, the patient may feel fatigued. In the later stages, the patient experiences abdominal distension, constipation, and even diarrhea, along with symptoms such as dry throat, irritability, and frequent anger. The patient may also feel a sense of fullness in the abdomen, accompanied by a feeling of heaviness in the chest and a tendency toward emotional instability. The latter case is more likely to be caused by a disorder of the autonomic nervous system in the intestines, while the former is more often attributed to sympathetic nervous system overactivity. IT Mouth V Ten Love HTWITT River 1 / Mouth White Eight White