5. Promote Bowel Movement and Eliminate Accumulation

When blood stagnation persists for a long time, it can result in both masses and intensified pain in the upper abdomen. Even if stools are loose, methods to promote bowel movement and eliminate accumulation can still be employed. The author often adds 10 grams each of Rhubarb and Glauber's Salt to the liver-soothing, spleen-strengthening, and heat-clearing, blood-activating formulas, which often effectively relieve pain and disperse stasis.

III. Case Examples

[Case 1] Patient Wang ××, female, 48 years old, cadre. In August 1978, she suddenly experienced severe upper abdominal pain, described as knife-like, tossing and turning in bed, screaming in agony. Local health center administered atropine intramuscularly without effect, so she was rushed to the emergency room of Lanzhou Medical University First Hospital. Blood amylase measured 1,250 units, urine amylase 645 units, confirming acute pancreatitis. After more than a month of hospitalization and treatment including anti-inflammatory, antispasmodic, and supportive therapies, the pain subsided and she was discharged. Since then, she has frequently experienced vague distending pain in the left upper quadrant, radiating to the left chest, left shoulder, and lower back, with varying intensity and recurrence. She has gradually lost weight, her entire abdomen is distended, stools are loose, occurring 3–4 times daily, yet despite extensive treatment with both Chinese and Western medicines, there has been no significant improvement. Physical examination: Temperature 36.7°C, pulse 72 beats/min, blood pressure 16.0/10.7 kPa (120/80 mmHg). Face is pale, sclera shows no jaundice, upper abdomen is distended, soft to palpation, with mild tenderness in the left upper quadrant. Liver is palpable under the xiphoid process, measuring 1 cm, light in texture, Murphy's sign negative. Skin,五官, heart, and lungs are all normal. Laboratory tests: White blood cells 7,600/mm³, neutrophils 72%, lymphocytes 28%; blood amylase (Somogyi method) 32 units, urine amylase (Wina-Low method) 64 units; fat droplets in stool (+), blood sugar 125%, urine sugar (-), glucose tolerance curve elevated. Western medical diagnosis: Chronic pancreatitis. TCM differentiation: Pulse is wiry, fine, and rapid, tongue is pale, coating thin and yellowish-greasy, chest distension, poor appetite, loose stools, pale face, bitter taste in mouth, dry throat. This indicates liver qi stagnation and wood overcoming earth, requiring liver-soothing and spleen-strengthening treatment. Prescription: Bupleurum 10 g, White Peony 10 g, Citrus Aurantium 10 g, Licorice 6 g, Costus 6 g, Agarwood 6 g, White Atractylodes 10 g, Poria 12 g, Salvia 10 g, Agarwood 3 g, Cardamom 3 g, Coix Seed 15 g, Red Vine 30 g, Patrinia 20 g, Aconite 6 g, Dried Ginger 6 g, Yuan Hu 6 g, Sichuan Pepper 6 g, Water decoction taken once daily. After taking 20 doses, the patient’s general condition improved, chest distension eased, stools became formed, appetite increased, and tongue coating turned paler. The original formula was adjusted by removing Yuan Hu, Sichuan Pepper, Aconite, Dried Ginger, Coix Seed, Red Vine, and Patrinia, adding Codonopsis 10 g, Pinellia 6 g, Citrus Peel 6 g,焦三仙 each 6 g, Chicken Gizzard 6 g, and Leizhi Zi 10 g. After taking 10 doses, all symptoms were completely alleviated, and stool examination returned to normal.

[Case 2] Xu ××, male, 40 years old. Nine years ago, he was diagnosed with acute cholecystitis complicated by gallstones at a certain hospital due to severe right flank pain. After surgical removal of the gallbladder, the pain subsided and he was discharged. One year ago, he again experienced severe upper abdominal pain, and was admitted to Lanzhou Medical University Second Hospital with a diagnosis of acute pancreatitis. According to reports, blood amylase reached 1,250 units at the time, and urine amylase also hit 560 units. After conservative treatment including anti-inflammation, antispasmodics, and supportive care, his condition improved and he was discharged. In the past six months, he has had persistent pain in the left upper quadrant, recurring and worsening, especially after heavy meals or fatty foods, with obvious aggravation. Pain radiates to the left chest, left waist, and lower abdomen, accompanied by severe abdominal distension. Stools alternate between dry and loose, and despite extensive treatment with both Western and Chinese medicines, there has been no improvement, so he came to our clinic for treatment. Physical examination: Temperature 36°C, pulse 80 beats/min, blood pressure 13.3/8.0 kPa (100/60 mmHg). Face is pale, sclera slightly yellow, upper abdomen is distended, palpation reveals a 10 cm × 3 cm horizontal mass with obvious tenderness. Liver, spleen, heart, and lungs are all normal. Laboratory tests: White blood cells 5,600/mm³, neutrophils 76%, lymphocytes 24%; blood amylase (Somogyi method) 16 units, urine amylase (Wina-Sw method) 32 units; fat droplets in stool (++), blood sugar 100 mg%, urine sugar (-). Western medical diagnosis: Chronic pancreatitis. TCM differentiation: Pulse is wiry, slippery, and rapid, tongue is red with thick yellow and greasy coating, persistent pain in the left hypochondrium, abdominal mass, jaundice, abdominal fullness, constipation—all indicative of liver qi stagnation transforming into fire, dampness and heat combining, and qi and blood becoming stagnant. Treatment principle is to soothe the liver and regulate qi, clear fire and remove dampness, and activate blood to disperse stasis. Prescription: Bupleurum 10 g, Citrus Aurantium 10 g, White Peony 15 g, Licorice 6 g, Costus 6 g, Agarwood 6 g, Yuan Hu 6 g, Sichuan Pepper 6 g, Pu Huang 6 g, Five Spirit Resin 6 g, Rhubarb 6 g, Glauber's Salt 10 g, San Leng 6 g, E Zhu 6 g, Patrinia 15 g, Red Vine 30 g, Water decoction taken once daily. After taking 5 doses, large amounts of black sauce-like material were passed in the stool, pain in the hypochondrium and abdominal fullness significantly eased, jaundice disappeared, and yellow coating turned thinner. The original formula was adjusted by removing Glauber's Salt, adding Coptis and Agarwood, and continuing to take 8 doses. After that, pain in the hypochondrium disappeared, abdomen slightly distended, stools regular, and stool examination showed no abnormalities. Tongue coating turned thin and slightly yellow, pulse remained deep and wiry, and the horizontal mass in the upper abdomen was no longer palpable. The original formula was adjusted by removing Yuan Hu, Sichuan Pepper, Pu Huang, Five Spirit Resin, Red Vine, Rhubarb, and Glauber's Salt, adding Codonopsis 10 g, White Atractylodes 10 g, Poria 12 g, Pinellia 6 g, Citrus Peel 6 g, and Cardamom 3 g to improve the outcome. After taking 10 doses, all symptoms were completely alleviated, and the patient returned to work in good health.

(From “Gansu Medicine” 1982, Supplement)

Case of Chronic Pancreatitis Complicated by Gallstones

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Pei Zhengxue

Patient, male, 26 years old, was admitted on August 26, 1963, due to severe upper abdominal pain lasting for one day. Prior to admission, about 15 minutes after lunch, he experienced a knife-like, persistent severe pain in the upper abdomen that radiated to the waist, back, left chest, and left shoulder, accompanied by nausea and vomiting. Multiple injections of atropine were ineffective. He had a previous history of right upper quadrant pain, and a cholecystography in 1960 diagnosed gallstones.

Physical examination: Temperature 38°C, blood pressure 10.7/8.0 kPa (80/60 mmHg), pale complexion, passive posture, distended upper abdomen, soft upon palpation with marked tenderness, predominantly on the left side of the upper abdomen, rebound tenderness, diminished bowel sounds, no flatus or stool passage for one day. Liver, spleen, and gallbladder were not palpable; Murphy's sign was negative. Skin, facial features, heart, and lungs were all normal. Laboratory tests: White blood cells 13,600/mm³, neutrophils 85%, acidophilic granulocytes 2%, basophils 1%, lymphocytes 11%, monocytes 1%; serum amylase 524 units (Somogyi method), urinary amylase (Wina-Low method) 256 units, blood glucose 120 mg%, blood calcium 8 mg%, urine sugar (-). Diagnosis: Acute pancreatitis. Western medical treatment was administered, including sedation, anti-inflammatory, antispasmodic, and fluid replacement therapies, but the dull upper abdominal pain persisted and radiated to the waist, worsening after meals and during hunger. More than two months after onset, the patient developed chronic diarrhea, 7–8 times per day, with foul-smelling, watery brown stools. Laboratory tests: Fatty droplets in stool (++), urinary amylase 64 units, blood amylase 226 units, blood glucose 125 mg%, urine sugar (-), elevated glucose tolerance test curve. Duodenal drainage showed bile type B containing a small amount of cholesterol crystals. Cholecystography revealed a 2 cm × 3 cm shadow of a radiolucent gallstone. Diagnosis: Chronic pancreatitis complicated by gallstones.

On November 2, 1963, traditional Chinese medicine treatment based on syndrome differentiation was initiated. Upon examination: pulse stringy and rapid, tongue white and greasy, persistent dull pain in the chest and epigastrium radiating to both flanks, dizziness and fatigue, shortness of breath and reluctance to speak. The syndrome was identified as liver-gallbladder stagnation, with wood overacting earth, requiring liver-soothing and gallbladder-promoting, spleen-strengthening and dampness-transforming, qi-moving and pain-relieving therapies. The prescribed formula is as follows:

Chaihu 18 g, Danggui 9 g, Hangshao 6 g, Baizhu 9 g, Fuling 9 g, Zhike 4.5 g, Yujin 4.5 g, Xiangfu 4.5 g, Qingpi 3 g, Foshou 6 g, Danshen 9 g, Tanxiang 3 g, Sharen 1 g, Jinlingzi 6 g, Jinqiancao 30 g, Gancao 6 g. Decocted in water and taken once daily. After two doses, the flank pain gradually subsided, the bitter taste in the mouth and dry throat eased, but there was still distension and pain in the chest and epigastrium radiating to the left shoulder, with relief upon pressing and warmth. Diarrhea decreased to 3–4 times per day, with yellow, watery stools. Tongue coating white and greasy, pulse stringy and fine, still indicating liver-stomach disharmony and deficiency of middle qi. Therefore, the next prescription was formulated to soothe the liver and harmonize the stomach, tonify the middle jiao and replenish qi:

Dangshen 10 g, Huangqi 12 g, Guishen 9 g, Shengma 3 g, Chaihu 6 g, Gancao 6 g, Yujin 6 g, Neijin 6 g, Huangqin 6 g, Zhike 6 g, Baizhu 9 g, Baishao 12 g, Jinqiancao 30 g. Decocted in water and taken once daily. A total of 73 doses were administered, and all symptoms significantly improved. On March 25, 1964, cholecystography revealed that the gallstone shadow had disappeared. Further examination showed a weak and thin pulse at the cun position, combined with lingering dull pain in the chest and epigastrium, loose stools—indicating deficiency of qi and blood, as well as liver stagnation and spleen deficiency. Subsequently, the treatment focused on strengthening the spleen and harmonizing the stomach, while also promoting qi movement and soothing the liver, emphasizing reinforcing the body’s vital energy and eliminating pathogenic factors.

(“Shaanxi Journal of Traditional Chinese Medicine,” 1981.2)

Report on 73 Cases of “Hair Loss” Treated with Traditional Chinese Medicine

Pei Zhengxue, Zhong Xu

“Hair loss” is a common condition. Apart from physiological hair loss, the most common diseases causing hair loss are early baldness and alopecia areata. Early baldness, commonly known as “high forehead” or “thinking head,” is more prevalent among young and middle-aged adults, with some patients also having seborrheic dermatitis; Western medicine refers to this as seborrheic alopecia. Alopecia areata, commonly known as “ghost-shaved head” or “oil wind,” is referred to as circular alopecia in Western medicine. From 1978 to 1984, the author treated 73 cases of “hair loss” using traditional Chinese medicine, achieving relatively satisfactory results.

I. Case Information

Among the 73 cases, 41 were male and 32 were female; 4 were under 10 years old, 15 were between 10 and 20, 23 were between 20 and 30, 18 were between 30 and 40, and 13 were between 40 and 50. Of these, 30 had early baldness and 43 had alopecia areata. Among them, 24 had concurrent neurasthenia, and 21 had gastrointestinal disorders. Fifteen cases had both neurasthenia and gastrointestinal disorders. The time from onset to initial diagnosis was within 3 months for 13 cases, 3–6 months for 24 cases, 6 months–1 year for 18 cases, 1–2 years for 14 cases, and more than 2 years for 4 cases.

II. Treatment Methods and Formulas

Regardless of whether it was early baldness or alopecia areata, all 73 cases were classified into three types based on the principles of traditional Chinese medicine syndrome differentiation.

(1) Spleen-Stomach Qi Deficiency (29 cases): Emaciation, pallor, poor appetite, fatigue, swollen and pale tongue, deep and fine pulse. Formula No. 1: Dangshen 10 g, Baizhu 10 g, Fuling 10 g, Gancao 6 g, Chenpi 6 g, Heshouwu 10 g, Huangzhi 20 g, Danggui 10 g, Muxiang 3 g, Caokou 3 g, Nüzhenzi 10 g, Hanliancao 10 g, Shengdi 12 g, Gouqizi 12 g. Decocted in water and taken once daily.

(2) Liver Stagnation and Kidney Deficiency (24 cases): Dizziness, lower back pain, leg weakness, bitter taste in the mouth, fullness and irritability in the flanks, red tongue, stringy pulse. Formula No. 2: Shengdi 10 g, Shanyu 6 g, Chuanxiong 6 g, Baishao 15 g, Danggui 10 g, Dangshen 10 g, Baizhu 10 g, Fuling 12 g, Gancao 6 g, Heshouwu 20 g, Nüzhenzi 10 g, Chaihu 10 g, Hanliancao 10 g. Decocted in water and taken once daily.

(3) Dual Deficiency of Qi and Yin (20 cases): Prolonged illness without improvement, dull complexion, fatigue, dry mouth, restlessness, red tongue with pale coating, deep and fine pulse. Formula No. 3: Poguozi 100 g, Heshouwu 100 g, Danggui 70 g, Chishao 70 g, Shengdi and Shushu each 70 g, Hanliancao 70 g, Dangshen 70 g, Maidong 70 g, Wuweizi 70 g, Danshen 100 g, Bai Supi 70 g, Mugua 70 g, Nüzhenzi 70 g, Qianghuo 70 g. All ingredients ground into powder, sifted, mixed with honey to form pills, 9 g each, take 1 pill twice daily, morning and evening, dissolved in hot water.

Note: ① Twenty doses of decoction constitute one course of treatment; three months of pill treatment constitute one course. ② All cases used 60 g of Platycladus orientalis leaves and 3 g of ginger boiled in water for hair washing, one dose washed twice, once daily.

III. Efficacy Criteria and Treatment Outcomes

Efficacy is categorized into three levels: cured, effective, and ineffective. Cured: New hair grows normally; Effective: New hair grows, but not satisfactorily; Ineffective: No new hair growth.

Treatment outcomes: 24 cases were cured, including 18 cases of alopecia areata and 6 cases of early baldness; 14 males and 10 females; 4 cases under 10, 16 cases between 10 and 30, and 4 cases over 30. Forty cases were effective, and 9 were ineffective, including 8 cases of early baldness and 1 case of alopecia areata; 5 males and 4 females; 7 cases over 40 and 2 cases under 40. Among the cured cases, 15 were of the spleen-stomach qi deficiency type, 8 were of the liver-stagnation and kidney-deficiency type, and 1 was of the dual qi-yin deficiency type. Among the cured cases, 3 took one course of treatment, 6 took two courses, 11 took three courses, and 4 took four courses.

IV. Case Examples

[Case 1] Li ××, male, 21 years old, from Hebei Province, worker, first visited in early September 1983. He had suffered from hair loss for 4 years, starting with hair loss at both frontal angles, gradually spreading to the top of the head. Two years ago, only a few sparse hairs remained at the occipital region, with most of the scalp completely bald. The scalp had an oily sheen, with occasional itching and occasional shedding of a few flakes of dandruff. He had a history of duodenal ulcer and still experienced stomach pain recently. Physical examination: Moderate nutrition, good development, no abnormalities in heart and lungs. Abdomen flat, liver and spleen not palpable. Most of the hair had fallen out, leaving only a smooth, oily scalp with few wrinkles. Western diagnosis: Seborrheic alopecia. Traditional Chinese medicine diagnosis: Deep and fine pulse, white and slightly greasy tongue, feeling of fatigue and poor appetite, discomfort in the epigastrium. Syndrome: Spleen-stomach deficiency, lack of middle qi, imbalance in the source of nourishing blood, manifesting as early baldness. Treatment: Strengthen the spleen and harmonize the stomach, nourish the blood. Prescribed formula No. 1 decoction, one dose daily, along with 60 g of Platycladus orientalis leaves boiled in water for hair washing, once daily. After 20 doses, fine hairs began to grow all over the head; after another 20 doses, the fine hairs turned black and thicker. Three months later, the patient’s entire head was covered with black hair, indistinguishable from normal people.

[Case 2] Xu ×, female, 16 years old, from Gansu Province, middle school student, first visited in early March 1978. She had suffered from hair loss for one year, starting with complete hair loss at the occipital and crown regions. Physical examination: Fair nutrition, good development, no abnormalities in heart and lungs, abdomen flat, liver and spleen palpable. Forehead and crown completely bare, scalp smooth with no wrinkles. Western diagnosis: Alopecia areata. Traditional Chinese medicine diagnosis: Stringy and fine pulse, slightly weak at the cun position, red tongue with thin white coating. She reported occasional bitterness in the mouth and fullness in the flanks, dizziness and lower back pain, dark-colored menstrual flow and abdominal pain. Syndrome: Liver-stagnation and kidney-deficiency, deficiency of nourishing blood, leading to hair loss. Treatment: Soothe the liver and nourish the kidneys, tonify qi and nourish blood. Prescribed formula No. 2 decoction, one dose daily, along with one course of formula No. 3 pills, two pills daily, divided into two doses dissolved in hot water. After three months, she reported that after taking 20 doses of the decoction and finishing one course of pills, the previously bald areas had grown black hair, indistinguishable from normal people, and follow-up for three years showed no recurrence.

[Case 3] Ning ××, male, 38 years old, from Gansu Province, first visited in early April 1983. Half a month ago, due to marital discord at home, he felt very depressed and discovered a bald patch the size of a fingernail at the occipital region one day, which gradually expanded. Within half a month, his scalp and eyebrows were completely bald, with a shiny scalp and mild itching. Physical examination: Pale complexion, poor nutrition, no abnormalities in heart and lungs, abdomen flat, liver and spleen not palpable. Western clinic diagnosis: Alopecia areata. Traditional Chinese medicine diagnosis: Deep and fine pulse, red tongue with pale coating, showing signs of fatigue, dry mouth, and deficiency of nourishing blood, leading to hair loss. Treatment: Tonify qi and nourish yin, greatly replenish nutrition. Prescribed formula No. 3 pills, two pills daily, divided into two doses dissolved in hot water; additionally, one dose of formula No. 1 decoction, one dose daily; simultaneously, 60 g of Platycladus orientalis leaves and 3 g of ginger boiled in water for hair washing, once daily, divided into two washes. On December 1983, the patient’s entire head was covered with black hair, eyebrows included, indistinguishable from normal people, claiming to have endured 45 doses of decoction and two courses of pills, along with two months of hair-washing treatments. In April 1985, a follow-up letter indicated no recurrence.

V. Reflections

“The hair is the surplus of blood” indicates that “blood” is the foundation for hair growth and development. Once “blood” is deficient or “blood” is depleted, the foundation for hair growth weakens, leading to “hair loss.” The generation of “blood” is the result of “the middle jiao receiving qi and extracting essence, transforming into red.” The middle jiao refers to the spleen and stomach, so spleen-stomach qi deficiency is often an important cause of hair loss. Among the 73 cases in this group, 39 were affected by spleen-stomach qi deficiency, and 21 had obvious gastrointestinal disorders, which can serve as a reference. The liver stores blood, and blood flows freely to all four extremities, nourishing hair growth; all depends on the liver’s smooth flow and unobstructed circulation. Once liver qi stagnates or blood vessels become blocked, hair growth will be affected. Therefore, when treating “hair loss,” in addition to regulating the spleen and stomach, it is also necessary to focus on smoothing the liver’s flow. The liver and kidneys share a common origin; over time, kidney qi may become deficient. The kidneys are the fundamental basis for balancing yin and yang in the human body, and to some extent, they encompass the integrated functions of endocrine and autonomic nervous systems in modern medicine. Whether it’s early baldness or alopecia areata, although the exact causes remain unclear, most believe that they are closely related to endocrine and autonomic nervous system dysfunction. Therefore, when treating “hair loss,” it is essential to pay attention to the manifestation of “liver stagnation and kidney deficiency.” Among the 73 cases, 24 fell into this category, and patients with this syndrome often experience emotional depression and irritability, similar to what Western medicine calls neurasthenia. Patients with long-term, intractable hair loss often show signs of dual qi-yin deficiency, and their treatment outcomes are generally poor. Among the 10 patients, only 1 was cured, indicating that qi and blood are the sources of nourishing blood, and when both qi and blood are deficient, the source of nourishment dwindles, making hair growth difficult. Among the 9 ineffective cases, 7 were over 40, suggesting that the older the patient, the more difficult it is to regulate qi and blood and internal organs compared to younger patients, which is consistent with general physiological changes.

(“Journal of Traditional Chinese Medicine,” 1987.7)

Self-Formulated Shenqi Sanhuang Decoction for Treating Idiopathic

Thrombocytopenic Purpura

Pei Zhengxue, Peng Xiang, Zhong Xu

Since 1980, we have been using a self-formulated Shenqi Sanhuang decoction to treat idiopathic thrombocytopenic purpura, achieving satisfactory results. Here, we report 24 cases confirmed by bone marrow examination for reference by colleagues.

I. Case Overview

All 24 cases had platelet counts below 100,000/mm³, prolonged bleeding time, and bone marrow findings consistent with the diagnosis of this disease. Among them, 9 were male and 15 were female. Ages ranged from under 20 years (14 cases), 20–30 years (8 cases), to over 30 years (2 cases). Four cases were initially diagnosed within six months of onset, 16 within one year, and 4 after one year.

All 24 cases exhibited varying degrees of purpura and bleeding symptoms. Among them, 23 had pale faces, 23 felt fatigued, 22 had dizziness, 20 had palpitations, 16 had poor appetite, 14 had spontaneous sweating, 12 had lower back pain, 10 felt cold, 9 had tinnitus, 9 had fever (body temperature above 37.5°C), 16 had thick white tongue coating, 5 had red tongue with yellow and greasy coating. Ten had bruising on the tongue, 3 had red tongue with little coating. Ten had deep and fine pulses, 6 had fine and rapid pulses, and 12 had weak cun pulses. Eight had enlarged livers, 14 had enlarged spleens, 2 had platelet counts between 60,000–100,000/mm³, 8 between 40,000–60,000/mm³, 8 between 20,000–40,000/mm³, and 6 below 20,000/mm³. Blood clot contraction time was measured in 19 cases, with 17 showing prolonged clotting.

II. Composition and Administration of the Prescription

Composition: Dangshen 10 g, Huangqi 20 g, Baizhu 10 g, Gancao 6 g, Tudahuang 10 g, Huangqin 10 g, Huanglian 3 g, Zhiliumo each 3 g, Bailizhi 60 g.

Adjustments: For severe bleeding, add Xianhecao 10 g; for internal heat due to yang deficiency, add Shengdi 10 g and Yuzhu 6 g; for fever, thirst, and spontaneous sweating, add Shengshi 30 g; for lower back pain and tinnitus, add Shanyu 6 g; for palpitations and dizziness, add Yuanzhi 6 g and Xingren 15 g; for spontaneous sweating and feeling cold, add Poguozi 10 g; for those with weak cun pulses, add Tusi Zi 10 g; for enlarged liver and spleen, add Biejia and Muli each 15 g.

III. Treatment Outcomes

After medication, all cases showed varying degrees of improvement in subjective symptoms and purpura (including bleeding symptoms), with an effectiveness rate of 100%. Among them, 20 cases saw platelet counts rise above 50,000/mm³ (including 8 cases above 100,000/mm³), with only one case failing to increase platelet count. Among the cases whose conditions improved, 12 underwent bone marrow examinations, with 4 showing completely normal bone marrow findings, 6 showing significant improvement, and 2 remaining roughly the same as before treatment. Among the 20 cases with platelet counts rising above 50,000/mm³, 8 took fewer than 20 doses, 8 took 20–40 doses, 3 took 40–60 doses, and 5 took more than 60 doses.

IV. Typical Cases

[Case 1] Peng ××, female, 27 years old, cook, first visited on September 8, 1983. One year ago, she began experiencing nosebleeds that recurred frequently, with scattered petechiae all over the body, varying in size, and some areas forming patchy purpura. Menstrual flow was heavy, color was pale, and her face became increasingly pale, accompanied by fatigue, dizziness, palpitations, lower back pain, tinnitus, fear of cold, and spontaneous sweating. She had previously undergone a bone marrow aspiration at a local hospital, which diagnosed idiopathic thrombocytopenic purpura. Patient’s body temperature was 36.7°C, blood pressure 12.0/8.0 kPa (90/60 mmHg). Face was pale, with scattered petechiae on the neck, front chest, and limbs that did not fade upon pressure. Heart border percussion was not enlarged, with a grade II systolic murmur audible at the apex, lungs (-), liver not palpable, spleen palpable 1.5 cm below the ribs. Platelets were 27,000/mm³, red blood cells 3.6 million/mm³, hemoglobin 10 g%, white blood cells 5,600/mm³, neutrophils 72%, lymphocytes 28%. Bleeding time was 8 minutes, and blood clots contracted poorly over 24 hours. Bone marrow examination showed normal megakaryocyte morphology with increased numbers, but markedly reduced megakaryocytes involved in platelet formation. Diagnosis: Idiopathic thrombocytopenic purpura. Traditional Chinese medicine diagnosis: Patient’s tongue was swollen and pale, with tooth marks, slightly yellow and greasy coating, and pulse was deep and fine, especially weak at the cun position. Combined with symptoms of pale face, fatigue, dizziness, palpitations, lower back pain, tinnitus, and fear of cold, this indicated spleen-kidney qi deficiency, with qi unable to control blood, and long-term qi deficiency leading to dampness stagnation, blood stasis, and even fire. Treatment: Strengthen the spleen and kidneys, tonify qi and collect blood, while also clearing heat and drying dampness, harmonizing blood and resolving stasis. Prescribed formula: Shenqi Sanhuang decoction with added ingredients: Dangshen 10 g, Huangqi 20 g, Baizhu 6 g, Tudahuang 10 g, Huanglian 3 g, Huangqin 10 g, Zhiliumo each 3 g, Bailizhi 20 g, Yuanniu 10 g, Shanyu 10 g, Poguozi 10 g, Tusi Zi 10 g. Decocted in water and taken once daily. After 10 doses, the patient’s overall purpura and bleeding symptoms significantly improved. Dizziness, fatigue, spontaneous sweating, lower back pain, tinnitus, fear of cold, and palpitations also improved. Later, Poguozi and Tusi Zi were removed, and the dosage was adjusted to one dose daily. After 21 doses, all symptoms had completely subsided, platelet count rose to 120,000/mm³, bleeding time and blood clot contraction returned to normal. Bone marrow examination also returned to normal. Red blood cells reached 4.8 million/mm³, hemoglobin 14 g%.

[Case 2] Hua ×, female, 5 years old, first visited on February 17, 1984. Six months ago, after a cold, she developed nasal bleeding and widespread purpura all over the body. A local hospital diagnosed her with “primary thrombocytopenic purpura,” and she had previously been treated with hormones and other Western medicines, resulting in a temporary increase in platelet count, but the widespread purpura and nasal bleeding continued to recur. The patient became increasingly thin and pale, accompanied by fatigue, thirst, spontaneous sweating, poor appetite, dry stools, and palpitations, with rectal bleeding during defecation. Body temperature was 38.9°C, blood pressure 10.7/6.7 kPa (80/50 mmHg), face was pale, with bleeding spots of various sizes on the front chest, back, and limbs that did not fade upon pressure, heart border percussion was not enlarged, no murmurs heard in any valve area, lungs (-), liver palpable 2 cm below the xiphoid process, soft texture, no tenderness, spleen not palpable. Platelets were 17,000/mm³, red blood cells 4.6 million/mm³,

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mm^3^、hemoglobin 12 g%, white blood cells 5600/mm^3^, neutrophils 78%, lymphocytes 21%, acidophilic granulocytes 1%, bleeding time 6 minutes, poor clot retraction within 24 hours, bone marrow smear shows megakaryocyte morphology and quantity are still normal, but platelet-forming megakaryocytes are reduced. TCM syndrome differentiation: the patient's tongue body is red with scattered ecchymoses, coating is slightly yellow and thick and greasy. Pulse is deep, slippery, and rapid, with both cun pulses being deep and fine. Considering symptoms such as emaciation, pallor, fatigue, spontaneous sweating, loss of appetite, thirst, palpitations, fever, dry stools, the disease is attributed to dual deficiency of qi and blood, with qi failing to control the blood. Qi deficiency leads to yang deficiency and dampness, while blood deficiency results in blood stasis and transformation into heat. Deficiency is the root cause, and damp-heat is the manifestation. Treatment should address both root and manifestation; the formula used is Shen Miao San Huang Tang with modifications: Codonopsis pilosula 10 g, Scutellaria baicalensis 20 g, Atractylodes macrocephala 10 g, Glycyrrhiza 6 g, Smilax glabra 19 g, Scutellaria baicalensis 10 g, Coptis chinensis 3 g, processed Paeonia lactiflora each 3 g, Tribulus terrestris 60 g, Gypsum fibrosum 30 g, Agrimonia pilosa 15 g, decocted in water and taken once daily. After 5 doses, the patient's fever subsided, thirst stopped, spontaneous sweating and fatigue lessened, and purpura all over the body and epistaxis significantly improved. The original formula was then adjusted by removing Gypsum fibrosum and Agrimonia pilosa, and another 22 doses were taken, after which all symptoms disappeared and the patient returned to normal. Platelet count reached 91,000/mm^3^, red blood cell count 4.8 million/mm^3^, hemoglobin 14.5 g%, white blood cell count 6,200/mm^3^, neutrophils 71%, lymphocytes 28%, monocytes 1%. Bleeding time and 24-hour clot retraction both normalized. Bone marrow smear showed platelet-forming megakaryocytes close to normal levels.

V. Discussion

Statistical analysis of the syndromes in this group indicates that, apart from purpura and bleeding symptoms, signs of middle-jiao deficiency such as emaciation, fatigue, loss of appetite, dizziness, spontaneous sweating, pale tongue with thin coating, and fine pulse are the main manifestations of this disease. Therefore, the purpura and bleeding fall under the TCM category of "qi failing to control the blood." According to the "Ling Shu·Jue Qi Chapter," "The middle jiao receives qi, extracts essence, and transforms it into red blood—this is called blood." This demonstrates that middle jiao qi is an important factor in blood production, and since platelets are one of the formed elements of blood, their generation is closely related to the strength or weakness of middle jiao qi (spleen and stomach). Thus, in the Shen Qi San Huang Tang formula, ingredients that tonify middle jiao qi such as Codonopsis pilosula, Atractylodes macrocephala, Astragalus membranaceus, and Glycyrrhiza uralensis were selected. Qi is the commander of blood; prolonged qi deficiency leads to blood deficiency and blood stasis. Qi deficiency can cause fever, blood deficiency can cause fever, and blood stasis can also transform into fire and cause fever. Consequently, patients often present with symptoms of rising heat and excessive fire, such as fatigue and spontaneous sweating accompanied by fever, palpitations and dizziness with irritability and heat, or a yellow tongue and constipation with high fever. Tang Rongchuan said, "The heart is the sovereign fire, generating blood; blood is the soul of fire, and fire is the spirit of blood. When fire rises, blood rises; when fire falls, blood falls. Knowing that blood is born from fire, and that fire resides in the heart, we understand that draining the heart means draining fire, and draining fire means stopping bleeding." (Blood Evidence Treatise, Volume 7) Following this principle, the formula includes Rhubarb, Scutellaria baicalensis, and Coptis chinensis, embodying the idea of "draining the heart, draining fire, and stopping bleeding." Tribulus terrestris in the formula dispels wind to counteract wind-driven fire, preventing wind and fire from exacerbating each other; processed Paeonia lactiflora resolves blood stasis to eliminate the source of stasis-related fire. Middle jiao qi deficiency often leads to yang deficiency and dampness stagnation; many patients in this group have a greasy tongue and slippery pulse. In addition to draining fire and stopping bleeding, the three yellows also have the effect of drying dampness. The Shen Qi San Huang Tang treatment for idiopathic thrombocytopenic purpura achieved a 100% effective rate in this group, indicating that the composition of this formula aligns with the pathogenesis of idiopathic thrombocytopenic purpura. The combination of disease and formula has thus established a corresponding system of theory, method, prescription, and medication. Based on the formula, the TCM pathogenesis of idiopathic thrombocytopenic purpura lies within the categories of "qi failing to control the blood," "blood heat running amok," "blood deficiency and blood stasis," and "yang deficiency and excessive dampness," which warrant further exploration. Some patients in this group also presented with lower back pain and tinnitus, suggesting that, in addition to middle jiao deficiency as the root cause, long-term illness can also damage the kidneys, since the kidneys govern bone marrow production and are closely linked to platelet formation. Therefore, in the modification process, ingredients that tonify the kidneys such as Cornus officinalis, Cuscuta chinensis, and Psoralea corylifolia were added.

(The Journal of Integrated Chinese and Western Medicine Research, 1986.1)

Advances in Hepatitis B Research

Pei Zhengxue

Since the discovery of the hepatitis B virus in the 1960s, the incidence and prevalence of hepatitis B have attracted widespread attention worldwide. Starting in the 1970s, Chinese scholars conducted extensive epidemiological surveys and research domestically, confirming that hepatitis B is also a very serious epidemic in China. Based on different figures reported from various regions, the current prevalence of hepatitis B in China is estimated to be between 5% and 25%. Therefore, a deeper understanding of the latest advances in hepatitis B research is essential for every medical professional.

I. Naming of the Hepatitis B Virus

In 1963, American scholar Blumberg and others discovered the "Australian antigen." In 1968, Japanese scholar Okochi and others confirmed the relationship between the "Australian antigen" and blood transfusions as well as hepatitis. Subsequently, many scholars proved that the "Australian antigen" is not a nonspecific product released during liver cell destruction, but rather a pathogenic factor with viral properties. In 1970, the Fourth International Conference on Liver Diseases passed a resolution naming the "Australian antigen" the "Hepatitis Associated Antigen" (HAA). In September 1972, at a United Nations conference on viral hepatitis, the name "Associated Antigen" was abolished and replaced with "Hepatitis B Antigen" (HBAg). In 1973, the U.S. National Academy of Sciences' conference on viral hepatitis separately proposed names such as Hepatitis B Surface Antigen (HBsAg), Hepatitis B Core Antigen (HBeAg), etc. The Hepatitis B Antigen is also known as the Hepatitis B Virus, abbreviated as HBV. Many scholars have proven that HBsAg is only found in the cytoplasm of liver cells; in fact, it is the outer shell protein of the Hepatitis B Virus, hence the name Hepatitis B Surface Antigen. Additionally, the Hepatitis B Core Antigen exists in the nucleus of liver cells. In 1977, the United Nations Expert Committee on Viral Hepatitis officially announced the names and writing methods for Hepatitis B antigens and antibodies: HBsAg stands for Surface Antigen, HBcAg for Core Antigen, HBeAg for e Antigen; Anti-HBs for Surface Antibody, Anti-HBc for Core Antibody, Anti-HBe for e Antibody.

II. Pathological Characteristics of the Hepatitis B Virus

In 1970, Zai En and others observed the serum of hepatitis B patients under an electron microscope and found that almost all samples contained small spherical particles about 22 nanometers in diameter, along with larger spherical particles approximately 42 nanometers in diameter. Later, through the research of many scholars, it was proven that the small particles are excess viral envelopes, which are precisely the Australian antigen discovered by American scholar Blumberg years ago and later named Hepatitis B Surface Antigen; the large particles, however, are complete Hepatitis B viruses. At that time, since people had not yet recognized the pathogenic nature of these particles, they were called Zai En particles. Subsequently, it was discovered that the Core Antigen exists in the nucleus of liver cells, while the Surface Antigen exists in the cytoplasm. In the mid-1970s, Hirshman proposed a hypothesis about the replication of the Hepatitis B Virus: he believed that after the virus invades the cytoplasm of liver cells, it loses its outer shell, at which point the circular DNA of the viral particle expands, especially after entering the nucleus, where the host's DNA also participates in the replication process to form the core. The host DNA infiltrated into the viral core quickly turns into circular DNA and produces DNA polymerase, thereby forming the Core Antigen. Meanwhile, the outer shell protein synthesized in the endoplasmic reticulum of the liver cell cytoplasm (i.e., the Surface Antigen) can combine with the Core Antigen to form a complete pathogenic particle, which then leaves the cell.