3. Efficacy statistics

In the treatment group, there are 154 cases, with 51 recent cures, accounting for 33.31%; 42 cases show marked improvement, accounting for 27.27%; 43 cases are effective, accounting for 27.92%; and 18 cases are ineffective, accounting for 11.60%. The overall efficacy rate of the treatment group is 88.50%, while in the control group, there are 60 cases, with 6 recent cures, accounting for 10.00%; 4 cases show marked improvement, accounting for 6.66%; 32 cases are effective, accounting for 53.33%; and 18 cases are ineffective, accounting for 30.00%. The overall efficacy rate of the control group is 70.00%. The treatment group's rates of recent cure, marked improvement, and overall efficacy are all significantly higher than those of the control group, with statistical significance P<0.01, indicating a highly significant difference; however, the control group's effectiveness rate is higher than that of the treatment group, with statistical significance P<0.05, indicating a significant difference. The recovery of physical signs before and after treatment in the treatment and control groups is shown in Table 1, and the recovery of test indicators is shown in Table 2. Among the 51 cured patients in the treatment group, 2 took one course of medication, 11 took two courses, 20 took three courses, 12 took four courses, and 6 took five courses; among the 6 cured patients in the control group, 2 took four courses, 2 took five courses, and 2 took seven courses.

Four. Reflections

In terms of overall efficacy rate, recent cure rate, and marked improvement rate, the treatment group outperforms the control group. In the comparison of various physical signs and laboratory test indicators, the treatment group also outperforms the control group, which fully demonstrates the therapeutic significance of traditional Chinese medicine for liver cirrhosis with ascites. This formula uses Danzhi Xiaoyao San with added ingredients as the base formula, reflecting the traditional view of TCM regarding the pathogenesis of liver disease. TCM believes that "liver depression and spleen deficiency" is the basic pathogenesis of chronic liver disease, and Xiaoyao San's function of "soothing the liver and strengthening the spleen" aligns perfectly with this theory, making it an appropriate prescription for the condition. When depression persists for a long time, it can transform into heat; therefore, Dangpi and Shan Zhi are added to clear heat—both herbs clear虚热, with Dangpi also having the effect of promoting blood circulation, while Shan Zhi additionally helps to drain excess fire, complementing each other well, hence the name Danzhi Xiaoyao San. When liver depression lasts for a long time, it leads to qi stagnation and blood stasis; thus, Tu Bie Chong is added to activate blood circulation and remove stasis, while Bie Jia is added to soften hard masses and nourish yin. Huang Qi, Huang Jing, and Dan Shen are used in large quantities to tonify the body and strengthen the foundation, providing dual nourishment for qi and blood. The addition of

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Subtraction is a traditional experience in TCM for treating this disease, used to control its complications and prognosis.

(“Research on the Integration of Traditional Chinese and Western Medicine,” 1994.2)

A Collection of Clinical Treatments for Esophageal Cancer

Pei Zhengxue

Esophageal cancer is more prevalent in northern China, with an incidence second only to gastric cancer. The primary treatment method is surgery, supplemented by radiotherapy and chemotherapy; however, some patients lose the opportunity for surgery at initial diagnosis. Surgery for mid- and upper-esophageal cancer is particularly challenging and not suitable for all patients. In view of this, over the past several years I have been researching the use of traditional Chinese medicine in treating esophageal cancer, hoping to offer a glimmer of hope to patients who are ineligible or unsuitable for surgery.

In the autumn of the Jiazi year, a patient named Xu, male, 50 years old, presented with epigastric distension and dysphagia for over a month. Barium meal and gastroscopy confirmed adenocarcinoma of the middle esophagus. Given the patient’s financial difficulties, he requested to take traditional Chinese medicine for home-based recuperation. On examination: red tongue with thick, greasy yellow coating; weak pulse at the cun position; taut pulse at the guan position. The prescription was Liuwei Dihuang He Banxia Xiexin: Shengdi 12g, Shan Zhu Yu 10g, Shanyao 10g, Danpi 6g, Fuling 10g, Zehong 10g, Huanglian 6g, Huangqin 10g, Banxia 6g, Ganjiang 6g, Dangshen 15g, Danshen 10g, Muxiang 3g, Caokou 3g, Huangqi 30g, Zhinu Mei each 3g, Chuanshanjia 10g, Zaogjiaoci 6g. Decoct in water, obtain 800ml of decoction, divide into four doses to be taken over two days (200ml each time, after breakfast and dinner). In the spring of the Dingchou year, the patient came for follow-up, reporting that after taking more than 300 doses of the above formula, the effect was obvious. Currently, he has no symptoms at all; his complexion is rosy, his physique robust, with no difficulty swallowing or epigastric discomfort. Barium meal showed no positive findings, and gastroscopy revealed no abnormalities in the middle esophagus—only chronic superficial and atrophic gastritis. This case of recovery is truly miraculous. The patient even had the original prescription bound into a cardboard board, which, due to long-term use, has become worn and the writing on it is faint but still discernible. When asked how he managed to adhere to the medication for several years, he replied: “At first, after taking just over ten doses, I felt that food could pass through a bit better. Since there was no other option, I simply kept taking the medicine. After a year, my condition improved markedly, and I became more confident, so I’ve been able to keep going ever since.”

Note: The above formula is a combination of Liuwei Dihuang Tang, Banxia Xiexin Tang, Banxia Houpu Tang, and Tuoli Tounong San. Liuwei Dihuang Tang tonifies the body and strengthens the root; Banxia Houpu Tang clears heat and dries dampness while regulating qi and easing the middle burner; Tuoli Tounong San softens hard masses, activates blood circulation, reinforces the body, and disperses stasis. Together, these formulas achieve the effect of treating cancer. With long-term, uninterrupted use, they ultimately bring great success.

In the second month of the Gengchen year, a patient named Zhang, male, 56 years old, presented with dysphagia for over three months, accompanied by epigastric distension. Barium meal and gastroscopy confirmed squamous cell carcinoma of the upper esophagus, atrophic gastritis with intestinal metaplasia, and Helicobacter pylori positivity. He had previously undergone 20 sessions of Co-irradiation, totaling 6,000 millirems, which slightly improved his swallowing compared to before, but he could only consume milk and tea. His epigastric distension worsened, so he sought treatment from me. Tongue was red with thick, greasy yellow coating; pulse was deep and taut. In addition to the above symptoms, the patient also suffered from constipation and reddish, painful urination. The prescription was Dachengqi Tang combined with Sanyuang Xinxin Tang and Qipeng San with added ingredients: Dahuang 10g, Huanglian 3g, Huangqi 10g, Zhishi 10g, Houpu 10g, Mangxiao 10g, Fuling 10g, Yujin 6g, Danshen 10g, Danpi 10g, Muxiang 10g, Zhebei 10g, Sharen 6g, Chutoukang 20g, and Heye Di 10g. Decoct in water and take orally. After ten doses, the patient’s swallowing improved significantly—he could eat noodles, chew and swallow bread and biscuits—and bowel movements became regular, urine turned clear, and epigastric pain and distension markedly alleviated. The thick, greasy tongue coating also became thinner. The next step was to remove Mangxiao and add Shengdi 12g, Shan Zhu Yu 10g, Shanyao 10g, and Zexie 10g, then decoct again and take one dose daily. After another ten doses, symptoms improved further: epigastric pain disappeared, and the tongue was red with thin, slightly greasy yellow coating. The prescription then became a combination of Liuwei Dihuang Tang, Sanyuang Xinxin Tang, Danshen Yin, and Qige San: Dahuang 6g, Huanglian 3g, Huangqi 10g, Ganjiang 6g, Banxia 6g, Danshen 10g, Muxiang 6g, Sharen 6g, Shengdi 12g, Shan Zhu Yu 10g, Shanyao 10g, Danpi 10g, Fuling 10g, Zexie 10g, Yujin 6g, Zhebei 10g, Heye Di 10g, and Jingmi 20g. Decoct in water and take one dose daily, continuing long-term. In the third month of the Xinshi year, the patient came for follow-up, reporting that after taking over 90 doses of the above formula, all symptoms had completely disappeared. Local barium meal and gastroscopy examinations showed no lesions. He was instructed to grind the previous ten doses into powder, mix with honey to form pills weighing 6g each, and take three times daily after meals with warm boiled water, to maintain the therapeutic effect.

Note: This case of recovery is also a miracle. Both Sanyuang and Chengqi are symptomatic treatments, while Liuwei, Qige, and Danshen Yin address the root cause. By combining traditional Chinese medicine with radiotherapy, we achieved results that radiotherapy alone could not attain. This case is now considered cured, but given that only a little over a year has passed, continued observation of long-term efficacy is recommended.

Over my more than forty years of medical practice, I have treated hundreds of patients with esophageal cancer. Some received traditional Chinese medicine before or after surgery; others took it alongside chemotherapy or radiotherapy; and many who relied solely on traditional Chinese medicine were rural patients facing economic hardship. Although traditional Chinese medicine is based on syndrome differentiation and individualized adjustments, the prescriptions generally fall into categories such as Banxia Houpu Tang, Liuwei Dihuang Tang, Qige San, Sanyuang Xinxin Tang, Banxia Xiexin Tang, and Danshen Yin. For the vast majority of cases, traditional Chinese medicine has varying degrees of effectiveness, especially in prolonging survival for surgical patients and reducing toxic side effects for those undergoing chemo- or radiotherapy. The two cases mentioned above represent the best examples of the effectiveness of using traditional Chinese medicine in treatment, and I record them here to share with others.

(“Journal of Traditional Chinese Medicine,” 2002.7)

Treatment with “Newly Revised Taoren Chengqi Tang”

Experiences in Treating Fulminant Dysentery

Pei Zhengxue

Fulminant dysentery currently has several effective treatment methods, such as high-dose atropine therapy, hormone therapy, and hibernation therapy. These therapies have reduced the mortality rate of the disease, but the results are still far from ideal. Over the past three years, under the guidance of Western medicine’s fluid replacement and chloramphenicol injections, I have tried using “Newly Revised Taoren Chengqi Tang” to treat 26 cases of fulminant dysentery, with satisfactory results.

I. Case Overview

The diagnosis of all 26 cases was based on the diagnostic criteria for fulminant dysentery formulated at the August 1964 Huangshan Infectious Diseases Conference of the Chinese Medical Association.

Among the 26 cases, 12 were male and 14 female; 6 were under one year old, 4 were between one and three years old, 8 were between three and six years old, 6 were between six and twelve years old, and 2 were over twelve years old. The time from onset to initiation of treatment was within three hours for 4 cases, within twelve hours for 12 cases, within twenty-four hours for 4 cases, and over twenty-four hours for 6 cases.

II. Composition and Usage of the Formula

The composition of “Newly Revised Taoren Chengqi Tang” is as follows: Dahuang 5 qian, Mangxiao 5 qian, Taoren 3 qian, Guizhi 3 qian, Gancao 2 qian, Huanglingli 1 qian, Huanglian 2 qian, Muxiang 1 qian, Maichiji 1 liang. Add 1,000 ml of water to the herbs, decoct until 300 ml remains, and administer to adults in three nasal feedings (once consciousness returns, oral administration is possible); for children, reduce the dosage according to age.

All 26 cases received Western medicine’s fluid replacement and intramuscular chloramphenicol injections in conjunction with the traditional Chinese medicine treatment, with only one case having undergone atropine therapy and hibernation therapy. After these therapies proved ineffective, the traditional Chinese medicine took effect; there was also one case that did not use antibiotics at all but still recovered through traditional Chinese medicine alone.

III. Observation of Efficacy

Out of the 26 cases, 22 were cured, 2 died, and 2 voluntarily requested transfer to another hospital due to unsatisfactory results. Patients over three years of age responded better, while those under three years of age responded worse. Patients who sought treatment within twelve hours of onset fared better, whereas those who came later had poorer outcomes.

IV. Case Presentation

[Case 1] Chen ×, 21 years old, male, a middle school student. On February 16, 1969, at 2 p.m., he was admitted to the hospital after two hours of high fever, abdominal pain, coma, and convulsions. Earlier that morning, around 7 a.m., he woke up and washed his face, feeling abdominal pain and nausea, and self-administered a small bottle of Shidi Water without relief. He then developed high fever and chills, immediately lying down. Two hours later, his consciousness gradually faded, accompanied by intermittent convulsions. The patient had always been in good health. Physical examination: body temperature 40.1°C, pulse 12 beats per minute, respiration 21 breaths per minute, blood pressure 14.7/10.7 kPa (110/80 mmHg). The patient was comatose, with occasional convulsions, and no jaundice, ecchymosis, rash, or petechiae on the skin or mucous membranes. No significant lymphadenopathy was observed, both pupils were slightly dilated, and light reflex and accommodation reflex were both sluggish. Pharynx was red, tonsils were grade I enlarged, neck was stiff, heart was “–”, both lungs had snoring sounds, abdomen was slightly distended, lower abdomen had slight tenderness, liver and spleen were “–”, bowel sounds were weakened, shifting dullness was present, knee-jerk reflex was slightly hyperactive. Pathological reflexes were not elicited. Complete blood count: red blood cells 4.6 million/mm³, hemoglobin 89%, white blood cells 12,300/mm³, neutrophils 80%, lymphocytes 18%, monocytes 1%; urine analysis (catheterization): yellow color, acidic, sugar “–”, protein “–”, only a small number of epithelial cells; stool analysis (rectal swab): mucus “+++”, pus cells “+++”, red blood cells “+”, roundworm eggs 0–3/low power; cerebrospinal fluid: clear, transparent, Pandy’s test “–”, cells “–”. Diagnosis: toxic bacillary dysentery (fulminant type). Upon admission, standard resuscitation procedures for fulminant dysentery were followed: immediate intramuscular injection of 50 mg each of Dormicum and Phenobarbital for sub-hibernation therapy. Additionally, 30 ml of 0.5% Furacilin suspension was administered via enema, 200 ml of 20% mannitol was infused intravenously, 200 mg of hydrocortisone and 1,000 mg of vitamin C were given, along with penicillin 400,000 units every six hours, streptomycin 0.5 g intramuscularly every eight hours, and chloramphenicol 0.5 g intramuscularly every eight hours. After these treatments, the patient’s convulsions eased somewhat, but his coma deepened. Around midnight, Cheon’s breathing pattern appeared, and the pupils were unequal in size. Atropine 1 mg was immediately injected intravenously via saline drip, once every five minutes, for a total of more than ten injections. However, respiratory failure did not improve significantly, so the family was notified of “critical condition,” atropine therapy was discontinued, and traditional Chinese medicine “Newly Revised Taoren Chengqi Tang” was used instead (nasal feeding), administered in three doses via gastric tube. After three hours of nasal feeding, about 500 ml of gelatinous material was expelled from the anus, breathing gradually stabilized, pulse became stronger than before, yet the patient remained in a deep coma. While continuing the aforementioned fluid therapy and antibiotic treatment, another dose of “Newly Revised Taoren Chengqi Tang” was administered via nasal feeding. During the medication period, the patient’s consciousness gradually cleared, breathing returned to normal, and subsequently, the dosage of Dahuang and Mangxiao was reduced to 3 qian each, with Danggui 4 qian, Baishao 3 qian, and Shangyou Gui 8 fen added. One dose was taken daily for three consecutive days, and the patient fully recovered.

[Case 2] Wang ××, female, 1.5 years old. She had a fever for half a day and convulsions for one hour before being admitted. The patient began running a fever that morning and was crying restlessly, but her family didn’t pay much attention. An hour ago, she suddenly started having continuous convulsions, alarming her family, who then rushed her to the hospital. Physical examination: body temperature 35.6°C, pulse unclear, breathing intermittent, consciousness clouded, face cyanotic, jaw clenched, foaming at the mouth, intermittent convulsions, heart sounds faint and irregular, breathing sometimes present, sometimes absent, no dry or wet rales. Abdomen was distended, bowel sounds were “–” for both liver and spleen, and pathological reflexes were not elicited. Urgent stool analysis (rectal swab) showed mucus “+++” and pus cells “+++.” Diagnosis: toxic dysentery (fulminant type). Immediate infusion of 500 ml of 10% glucose solution and 500 ml of 5% glucose-saline solution, plus 1 g of vitamin C via scalp vein drip, intramuscular injection of 3 mg of Lobelin, and then administration of one dose of “Newly Revised Taoren Chengqi Tang” via nasal feeding. Prescription: Dahuang 3 qian, Mangxiao 3 qian, Taoren 2 qian, Guizhi 2 qian, Gancao 1 qian, Huanglian 1.5 qian, Muxiang 1 qian, Huangling 2 qian, Maichiji 1 liang, add 1,000 ml of water and decoct until 200 ml remains, divided into three doses to be administered within two hours. After finishing the medication, the child’s convulsions stopped, and a large amount of gelatinous material was discharged from the anus. Breathing stabilized, and the next day, another dose of “Newly Revised Taoren Chengqi Tang” was administered in three doses. The following morning, the child was in good spirits, eating slightly better, and the original formula was adjusted by removing Dahuang and Mangxiao, adding Qinpi, Baishao, Danggui, and ShanZha. After taking one dose, the child was discharged cured.

V. Discussion

Traditional Chinese medicine treats dysentery by regulating qi, promoting blood circulation, detoxifying, purging, and dispersing exterior pathogens. In clinical practice, these principles are applied flexibly based on syndrome differentiation and individualized treatment. Generally, the results for ordinary dysentery are quite satisfactory. However, fulminant dysentery is different: it strikes suddenly and aggressively, and once it breaks out, it spreads rapidly. What makes it even more unique is that, at the onset, symptoms like coma, convulsions, respiratory failure, and circulatory failure often dominate, while gastrointestinal symptoms such as abdominal pain may not be obvious. This easily leads to misdiagnosis and fatal consequences. Chairman Mao said: “When we look at things, we must see their essence and regard their phenomena merely as guides to enter the door. Once inside, we must grasp the essence—that is the reliable scientific method of analysis.” Based on this teaching, we should view fulminant dysentery as follows: although coma, convulsions, and respiratory-circulatory failure are major causes of death, from the perspective of pathogenesis, they are merely the phenomena of the disease (belonging to the “symptom”). The root cause of these phenomena is the massive accumulation of dysentery bacilli and their toxins in the intestinal lumen, which continuously absorb into the bloodstream, causing toxic reactions and edema in the brain’s capillaries. This is the essence of the disease’s lethality (belonging to the “root”). I have tried using general dysentery remedies, such as Gegen Huanglian Huangqin Tang, Xianglian Wan, and Baitouweng Tang, to treat fulminant dysentery, but the results were poor—this was because I overlooked the special nature of fulminant dysentery. I have also tried using Gouteng, Jiangchong, and Zixue Dan to treat fulminant dysentery, but the results were still unsatisfactory—this was because I focused only on the phenomena and ignored the root cause. Zhang Zhongjing proposed: “If diarrhea is accompanied by delirium, it indicates the presence of hardened feces.” He was the first to link intestinal disorders with cerebral symptoms. Zhu Danxi attached great importance to this point and began using nitrate and rhubarb to treat dysentery, saying: “In the first one or two days of dysentery, the principle is to promote bowel movement; absolutely do not use astringents. If the condition is severe, use Weichengqi, Dachengqi, or San Yi Chengqi Tang to purge the bowels.” Large doses of nitrate and rhubarb cleanse the intestinal lumen, quickly expelling bacteria and their toxins from the body, thereby reducing systemic capillary toxicity. At the same time, the purgative effect of nitrate and rhubarb relieves brain edema, alleviating cerebral symptoms. Therefore, for fulminant dysentery, the use of this “purging” measure is indeed urgent—a “cutting off the fuel supply” approach that effectively resolves the main contradiction among the various contradictions of the disease. However, while emphasizing “purging,” we must also pay attention to using methods such as clearing heat and detoxifying, resolving stasis, regulating qi, and dispersing exterior pathogens, so that the prescription balances addressing the main contradiction with the secondary ones. Clearing heat and detoxifying can eliminate or reduce the pathogenic effects of bacteria and toxins; resolving stasis improves blood circulation in the lesion, promoting healing. Regulating qi adjusts intestinal peristalsis, and when combined with resolving stasis, it produces antispasmodic and analgesic effects, helping the intestines return to normal function. Dispersing exterior pathogens is a symptomatic treatment for the early stages of dysentery. We must deeply study the rich traditions of traditional Chinese medicine in this area—for example, Zhang Zhongjing’s Gegen Qinlian Tang integrates dispersing exterior pathogens with clearing heat and detoxifying, and Zhang also said: “For heat-induced diarrhea with heavy stools, Baitouweng Tang is the main remedy.” This has been highly valued by later generations of physicians. Dai Sigong excelled at using Muxiang to regulate qi when treating dysentery, proposing: “Dysentery was historically called ‘stagnant diarrhea,’ caused by qi stagnation leading to accumulation, which over time turns into hard clumps. The treatment should prioritize smoothing the qi...” Wang Kentang believed: “If there is abnormal downward flow, with purple-black areas and severe pain, it indicates dead blood. Use Taoren to resolve stasis.” During the Song Dynasty, Yu Gang advocated using Baidu San combined with Chen Cangmi to treat dysentery, which was precisely targeted at the disease. Based on my focus on nitrate and rhubarb for purging, I chose Qinlian for clearing heat and detoxifying, Taoren for resolving stasis and promoting blood circulation, Muxiang for regulating qi, Guizhi for dispersing exterior pathogens, and opened up blood circulation to improve peripheral circulation. I also heavily used Maichiji to enhance the effect of clearing heat and detoxifying. Thus, “Newly Revised Taoren Chengqi Tang” was formed. This formula is similar to Zhongjing’s “Taoren Chengqi Tang,” but Zhongjing’s version was specifically designed for bladder blood stasis. Zhongjing said: “If solar disease is not resolved, heat accumulates in the bladder, causing the person to become狂, and blood flows downward, curing the illness. Those whose external symptoms are not resolved cannot be treated yet; first, the external symptoms must be addressed. Once the external symptoms are resolved, if there is still acute lower abdominal pain, then it can be treated with Taoren Chengqi Tang.” Some commentators on the “Shanghan Lun” have objected to the idea of “heat accumulating in the bladder.” Qian Huang pointed out: “Some commentators believe that blood accumulates in the bladder, especially in the classics.” They think this is because “heat resides in the lower jiao, pressing on the blood, causing it to overflow into the large intestine.” As for using Taoren Chengqi Tang to treat dysentery, Wu Kun believed: “This formula is mainly for severe cases at the beginning of the disease. If the initial stage is missed and astringents are used instead, evil heat will accumulate internally, blood will not flow, and the patient will suffer from abdominal pain and risk dying. In such cases, this formula should be used urgently.” Yoshiyuki Higashidō, on the other hand, believed that this formula is mainly for “patients with acute lower abdominal pain due to dysentery.” All of the above considerations provide us with some reference points for using “Newly Revised Taoren Chengqi Tang” to treat fulminant dysentery.

VI. Summary

①Although the treatment of 26 cases of fulminant dysentery with “Newly Revised Taoren Chengqi Tang” was conducted in conjunction with Western medicine’s fluid replacement and chloramphenicol injections, its cure rate is higher than that of antibiotic-only treatment and close to the currently well-regarded atropine therapy. Therefore, the effectiveness of “Newly Revised Taoren Chengqi Tang” in treating fulminant dysentery can be affirmed.

②Case 1 in the text achieved therapeutic effect after the ineffectiveness of atropine therapy and hibernation therapy, demonstrating that this formula has unique advantages over atropine and hibernation therapy in treating fulminant dysentery. Case 2 in the text achieved therapeutic effect using only this formula (without antibiotics), indicating that this formula alone can also cure fulminant dysentery, providing a new avenue for future research on its efficacy.

(“New Traditional Chinese Medicine,” 1973.4)

Casual Talk on Cirrhosis

Pei Zhengxue

Various forms of liver damage can ultimately lead to cirrhosis. Among them, hepatitis caused by hepatitis viruses A, B, C, D, and E, if left untreated or improperly treated, all have the potential to develop into cirrhosis. Hepatitis B, C, and D are more prone to cirrhosis than other types of hepatitis. In addition to cirrhosis caused by hepatitis, malnutrition-related liver changes, chronic alcohol and drug poisoning, and parasitic infections can also lead to cirrhosis. Furthermore, certain diseases such as Wilson’s disease, systemic lupus erythematosus, and long-term heart failure can also result in cirrhosis, but this type of cirrhosis is symptomatic, also known as secondary cirrhosis. The pathological basis of cirrhosis is fibrotic degeneration of liver tissue, which compresses the portal venous system and biliary system within the liver. Increased portal pressure leads to varices in the esophageal and gastric veins, splenomegaly, ascites, and lower limb edema; increased pressure in the biliary system causes hepatomegaly and jaundice. When the former is predominant, it is called portal cirrhosis; when the latter is predominant, it is called cholestatic cirrhosis. There are various theories regarding the formation of cholestatic cirrhosis—whether cholestasis precedes hepatic fibrosis or vice versa—and immune system defects are characteristic of this type of cirrhosis. Many questions remain to be further studied. Clinically, cirrhosis is primarily diagnosed based on splenomegaly, elevated serum globulin levels, relative reduction in albumin levels, and eventually an imbalance or reversal in the albumin-to-globulin ratio.

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Based on findings such as portal hypertension, esophageal varices, increased portal vein diameter, and ascites; in contrast, cholestatic cirrhosis is characterized by

On the basis of the aforementioned clinical manifestations, jaundice becomes more pronounced, and some patients may exhibit accelerated erythrocyte sedimentation rate and changes in peptide antibodies.

The primary Western medical approach to treating cirrhosis focuses on hepatoprotection. When complications such as ascites, upper gastrointestinal bleeding, or hepatic encephalopathy occur, symptomatic treatments are diverse and can provide satisfactory short-term outcomes; however, long-term efficacy remains unsatisfactory. Therefore, Western medicine considers cirrhosis with ascites to be an incurable condition.

Traditional Chinese Medicine has a long history of treating cirrhosis, with numerous prescriptions. As early as the late Eastern Han Dynasty, the "Jin Gui Yao Lue" proposed the principle that "when liver disease is observed, one should recognize its transmission to the spleen," indicating that patients with cirrhosis first experience gastrointestinal involvement, leading to abdominal distension, loss of appetite, loose stools, and upper gastrointestinal bleeding. Modern research has demonstrated that in cases of portal hypertension associated with cirrhosis, the submucosal blood vessels throughout the gastrointestinal tract become congested, with varying degrees of venous dilation, mucosal edema, and exudation. In severe cases, there may be reactive increases in gastric acid secretion, and some patients may develop erosion, ulcers, and bleeding of the gastrointestinal mucosa. Thus, the understanding of TCM is entirely consistent with modern medicine; the difference lies in the fact that TCM recognized this earlier than Western medicine—by over 1,000 years. Based on this understanding, the main therapeutic strategy in TCM for cirrhosis is to soothe the liver and harmonize the stomach. Soothing the liver integrates modern medical concepts such as hepatoprotection, bile promotion, and prevention of fibrosis into a comprehensive treatment regimen, with representative formulas including Xiaoyao San, Chaihu Shugan San, Si Ni San, and Si Wu Tang. Harmonizing the stomach combines regulation of gastrointestinal motility, relief of smooth muscle spasms, prevention of mucosal erosion and ulcers, suppression of gastric acid, and enhancement of appetite into a single comprehensive approach, with representative formulas such as Si Jun Zi Tang, Xiang Sha Liu Jun Zi Tang, Ban Xia Xie Xin Tang, Gui Pi Tang, and Bu Zhong Yi Qi Tang. In these formulas, raw dragon bone and oyster shell are added to enhance acid suppression and promote wound healing; salvia miltiorrhiza, astragalus, angelica sinensis, white peony, polygonum multiflorum, and polygonatum sibiricum are added to strengthen hepatoprotection; salvia miltiorrhiza, agarwood, cardamom, yuanhu, chuanlianzi, and processed myrrh are added to relieve spasm and alleviate pain; zhishi, houpu, rhubarb, dried ginger, fuzi, sanleng, ezhushi, cinnamon, qingpi, and turmeric are added to eliminate distension and relieve pain. For patients with bleeding, xuanfuhua, raw ochre, panax notoginseng, rhubarb, coptis, and scutellaria are added; for those with persistent black stools, zaoxin tu, Lizhong Tang, and Fuzi Lizhong Tang are added. Among these herbs, salvia miltiorrhiza, astragalus, and polygonatum sibiricum are typically used in larger doses, usually between 20–40 grams. Ascites and edema in patients with cirrhosis are inevitable late-stage symptoms; once ascites develops, infectious complications often follow. Therefore, formulas should include large belly skin, gourd skin, plantago seeds, honeysuckle, forsythia, dandelion, baijiang jiang, snake tongue grass, and ban zhi lian. In some cases of cirrhosis, certain liver tissues remain in a stage of chronic active hepatitis, and the effects of hepatitis viruses continue. Thus, formulas should also include qinjiao, banlangen, and daqingye. Patients with cirrhosis may develop liver necrosis due to improper treatment, excessive fatigue, recurrent colds, or emotional stress—this is known as subacute or chronic severe hepatitis. Its clinical features include rapidly worsening jaundice, relatively low transaminase levels (a phenomenon called "jaundice-enzyme dissociation"), reduced liver dullness border, and dramatic increase in ascites; severe cases often accompany hepatic encephalopathy. At this stage, the patient's condition is critical, and hospitalization for Western medical rescue is generally recommended. However, complementary traditional Chinese medicine treatment is also very important. TCM's bowel-clearing therapy often yields remarkable results. The author frequently uses Dachaihu Tang administered via nasal feeding to accelerate recovery and improve prognosis. The formula consists of: 10 grams of bupleurum, 10 grams of zhishi, 15 grams of white peony, 10 grams of rhubarb, 10 grams of houpu, 10 grams of scutellaria, 3 grams of cinnamon, 3 grams of coptis, 6 grams of licorice, and 10 grams of mirabilite (dissolved in water). The decoction is prepared twice, yielding a total of 400 ml, which is divided into three doses administered via nasal feeding at three-hour intervals. While administering this formula, Western medical treatment continues concurrently, including sodium arginine, sodium glutamate, acetylglutamine, hepatoprotective agents, glucagon, antibiotics, large-volume intravenous fluids, and electrolyte correction as appropriate. Two points must be particularly emphasized: (1) Throughout the entire resuscitation process, protect the kidneys to prevent renal dysfunction and the development of hepatorenal syndrome; (2) Protect the gastrointestinal tract to prevent gastrointestinal bleeding. For the former, avoid using antibiotics that affect kidney function, such as streptomycin and gentamicin, and promptly correct electrolyte imbalances like hyperkalemia, hypokalemia, hyponatremia, and hypocalcemia. For the latter, avoid medications that damage the gastrointestinal mucosa. Routine intravenous administration of metoclopramide and oral ranitidine should be discontinued; after the patient regains consciousness, the aforementioned TCM nasal feeding should be immediately replaced with modified versions of Xiao Chaihu Tang combined with Xiang Sha Liu Jun Zi Tang, Lizhong Tang, and other formulas designed to nourish stomach qi. Regarding gastrointestinal bleeding in advanced cirrhosis, it represents another challenging issue in treating this disease. Major bleeds often result from rupture of esophageal or gastric fundal veins, while minor bleeds may arise from general mucosal seepage or erosion throughout the digestive system. The former presents with massive hematemesis and melena, whereas the latter shows positive fecal occult blood. Western medicine has several effective methods for treating major upper gastrointestinal bleeding, such as the use of posterior pituitary extract and octreotide, both of which demonstrate significant efficacy; coupled with timely blood transfusions, they can often alleviate some upper gastrointestinal bleeding. The use of triple-lumen double-balloon tubes can also benefit some patients, but based on the author's experience, prolonged placement of these tubes often leads to patient asphyxia and irritability, exacerbating bleeding, and removal of the tube can cause rebleeding due to adhesion and traction. Traditional Chinese medicine achieves the best results in treating upper gastrointestinal bleeding through combinations of San Huang Xie Xin Tang, Xuan Fu Dai Zhe Tang, and Mi Hong Dan, with the following formulation: 10 grams of rhubarb, 10 grams of coptis, 10 grams of scutellaria, 10 grams of xuanfuhua, 10 grams of raw ochre, 6 grams of banxia, 6 grams of licorice, 6 grams of ginger, 4 jujubes, 3 grams of cinnamon, and 60 grams of zaoxin tu (first boiled for 10 minutes to extract the medicinal ingredients). The decoction is prepared to yield 300 ml (total of first and second decoctions), divided into three doses taken at three-hour intervals, one dose per day. For treating black stools, the preferred formula is Huang Tu Tang from the "Jin Gui Yao Lue," composed of: 20 grams of astragalus, 6 grams of coptis, 6 grams of huangbai, 10 grams of baizhu, 6 grams of fupian, 10 grams of ejiao (melted), 6 grams of dried ginger, and 60 grams of zaoxin huangtu (first boiled for 5 minutes to extract the medicinal ingredients).

(“Journal of Lanzhou Medical College,” February 2002)

Diagnosis and Differential Diagnosis of Arteriosclerosis

Pei Zhengxue

Arteriosclerosis is a non-inflammatory, degenerative, proliferative lesion of arterial vessels, often leading to thickening and hardening of the arterial wall, narrowing of the lumen, and loss of elasticity throughout the vessel wall, thereby causing a series of pathological changes in various related organs of the human body.

I. Overview

Arteriosclerosis is most commonly seen in middle-aged and elderly individuals, with a higher incidence among males. In recent years, it has also been found to occur in a certain number of adolescents. Urban residents, those with better living conditions, obese individuals, mental workers, and people who rarely engage in physical activity are more prone to this disease. Additionally, patients with hypertension, diabetes, and chronic nephritis are also susceptible. This disease has a higher incidence in European and American countries, while previously reported rates in China were much lower; however, in recent years, the incidence has been rising, possibly due to increased consultation rates and improved living standards. Although the exact pathogenesis of this disease has not yet been fully elucidated, most opinions agree that lipid metabolism disorders and elevated blood lipids are the fundamental causes. “Blood lipids” include insoluble cholesterol, triglycerides, phospholipids, free fatty acids, etc.; additionally, there are water-soluble lipoproteins, namely β-lipoproteins, which are products formed when cholesterol and triglycerides combine with protein particles. Through this combination, cholesterol and triglycerides can pass through the vascular endothelium, while excess deposits on the vessel wall, eventually leading to arteriosclerosis. Elevated blood lipids can be caused by excessive intake of fatty foods or by intrinsic lipid metabolism disorders. Furthermore, arteriosclerosis is most likely to occur at arterial bifurcations and bends, indicating that changes in hemodynamics are also a major contributing factor to atherosclerosis. Long-term vasospasm leading to tissue hypoxia, malnutrition, and altered permeability are also factors that contribute to lipid deposition in the arterial intima. This clarifies that in cases of hypertension, there is both the impact of blood flow on the arterial wall and the effect of small artery spasms on permeability, making hypertension the most common comorbidity with arteriosclerosis.

II. Clinical Manifestations and Diagnosis of Arteriosclerosis

After arteriosclerosis develops, the tissues supplied by the affected arteries, due to thickening of the arterial wall and narrowing of the lumen, initially exhibit varying degrees of ischemic changes. However, larger arteries, such as the aorta, have such wide lumens that even slight narrowing does not significantly affect blood flow; thus, arteriosclerosis in these arteries is usually asymptomatic. Smaller arteries, because the organ systems they serve are relatively limited in scope and the blood demand of the respective tissues is not high, can still meet basic supply and nutritional needs through collateral circulation, so clinical symptoms are also unlikely to appear. Only medium-sized arteries, such as the coronary arteries, cerebral arteries, renal arteries, mesenteric arteries, and lower limb arteries, when affected by arteriosclerosis, can produce more obvious clinical manifestations. Coronary atherosclerosis leads to angina pectoris, myocardial infarction, and myocardial sclerosis. Cerebral arteriosclerosis causes cerebral thrombosis, cerebral ischemia, cerebral hemorrhage, and brain atrophy. Renal arteriosclerosis results in refractory hypertension and renal insufficiency. Lower limb arteriosclerosis causes intermittent claudication and lower limb necrosis. Mesenteric arteriosclerosis leads to abdominal pain and hematochezia. Clinically, coronary arteriosclerosis often presents with chest tightness, chest pain, palpitations, shortness of breath, and occasional radiating pain to the back; cerebral arteriosclerosis causes headaches, dizziness, insomnia, excessive dreaming, spontaneous sweating, forgetfulness, feeling cold outside but hot inside, restlessness, and irritability. Some patients with cerebral arteriosclerosis may experience vertigo similar to Meniere’s disease, others may develop tremors and convulsions akin to Parkinson’s disease, and still others may exhibit psychiatric-like disturbances in consciousness. Renal arteriosclerosis, in addition to all the clinical manifestations of hypertension, also includes symptoms of chronic nephritis, such as proteinuria and edema, with severe cases developing uremia and azotemia.

Based on the above, the clinical manifestations of arteriosclerosis form an extremely broad and complex syndromes involving all systems of the human body.

In addition to the aforementioned clinical manifestations, elevated blood lipids serve as a meaningful diagnostic criterion for this disease, with particular significance attributed to the elevation of B-type lipoproteins. Fundus examination can assess the degree of arteriosclerosis, especially in cerebral arteries. In recent years, angiography has been used in various regions to examine vascular stenotic lesions, providing some auxiliary value. Doppler ultrasound helps diagnose peripheral arterial stenosis. In differential diagnosis, it is important to distinguish arteriosclerosis from inflammatory vascular stenosis, such as polyarteritis nodosa and thromboangiitis obliterans, as well as congenital arterial stenosis, such as aortic stenosis and renal artery stenosis. Moreover, ischemia in related organs caused by this disease should also be differentiated from other conditions.

III. Differentiation and Treatment of Arteriosclerosis

Due to the wide range of symptoms and extensive involvement of organs and tissues, TCM differentiation and treatment takes many forms, with differing viewpoints among practitioners. Based on personal clinical experience, the following classifications are presented: