Li Delin's Academic Thoughts And Clinical Experience And Sanjia Shenxiao Decoction In The Treatment Of Diabetic Nephropathy (stage III~IV) With Qi And Yin Deficiency

Summary of professor Li Delin's academic thoughts and clinic experienceProfessor Li Delin is one of the inheriting teachers of state traditional Chinese medicine inheritance work,as well as a chief physician,doctoral supervisor and postdoctoral supervisor.With great devotion about TCM,he assiduously studied TCM,read and got familiar with Chinese medical classics and learned widely from others' strong points.With 50 years'working in the clinical applications and teaching work,he has laid a solid theoretical foundation of TCM and accumulated rich clinical experience.With remarkable medical skills and noble medical ethics,he has not only thought highly of inheritance of TCM but also advocated to creat the new perspective of TCM.He gradually formed the acadmic thought'attaching great importance to spleen and kidney;strengthening vital qi to eliminate pathogenic factor;differentiation adjusting by the change of patient's condition;selecting Jing Fang not stick to disease;selecting Shi Fang according the nature of disease;searching disease location in the polymorphism of coldness and heat;skillfully using the outcomes of pharmacy research';advocated the innovation thought 'researching the theory and clinical applications of TCM by biological methods and interpreting the theory and clinical applications of TCM by biological language',Professor Li has made new exploration and contribution to realize modernization of TCM.Academic origin:Study and analyze the Chinese medical classics and senior famous TCM doctors' academic thoughts,which have had a greater impact on my instructor,and know his experience of learning medicine,to explore Professor Li Delin's academic origin.Classical books of TCM:1.Pathogetic factors and pathogenesis and syndrome differentiation theory of TCM on Inner Canon of Yellow Emperor have a guiding significance on the academic thought formation of professor Li Delin.?examination of pathogenesis;treating disease from the root—differentiation adjusting by the change of patient's condition;differentiating syndrome correctly;?the incoordination between Yin and Yang;the theory of coldness and heat—searching disease location in the polymorphism of coldness and heat;?discourse of diabetic mellitus in Inner Canon of Yellow Emperor has had a important guidance on professor Li Delin's cognition of the pathological factors and pathogenesis and treatment of this disease.2.The methods of treatment and syndrome differentiation and theory of cold-heat jumble in Treatise on Cold Pathogenic and Miscellaneous Diseases have had a profound impact on pro.Li Delin's formation of acadmic thoughts—differentiation adjusting by the change of patient's condition,selecting Shi Fang according the nature of disease,searching disease location in the polymorphism of coldness and heat.3.The instructions of gynecology and surgery in Golden Mirror of Medicine have had a greate impact on professor Li's clinical treatment experience.The syndrome differentiation theory of TCM and formula selection from Miscellaneous Diseas Instructions of Golden Mirror have a guiding significance on Pro.Li's treatment of miscellaneous diseas of internal medicine.In the treatment of gynecological diseases,Pro.Li attached great importance to regulating Qi and blood,dispersing stagnated liver-qi,invigorating spleen and supplementing qi,nourishing the blood and promoting blood circulation for regulating menstruation,and highly praising the prescriptions derived from Gynecology Instructions of Golden Mirror of Medicine.The treatment determination of dermatosis from Surgery Instructions of Golden Mirror of Medicine enlightened professor Li on treating skin disease.4.The theory of Wei-Qi-Ying-Xue treatment and syndrome differentiation in Treatise on Epidemic Febrile Diseases has had a important guidance on professor Li's clinical treatment experience of warm-heat disease.5.Lots of prescriptions created based on Qi-blood theory for eliminating extravasated blood in Correction on the Errors of Medical Works have had a important guidance on pro.Li's treatment on blood stasis syndrome.The theory 'brainwave and memory controlled by heart not brain' in this book enlightened pro.Li on treating emotional disease(depression)and senile cerebropathy(brain atrophy,Alzheimer's disease).6.The scholarship viewpoints of intergrating Chinese and Western Medicine and methods of experiment research in Intergrating Chinese and Western Medicine have had a profound impact on pro.Li's formation of acadmic thoughts 'attaching great importance to development and innovation,advocating skillfully using the outcomes of pharmacy research'.Shiquan Yuzhen decoction mainly treating 'consumptive disease' in this book enlightened pro.Li on treating chronic primary glomerular disease.Experience of learning medicinePro.Li Delin's experience of learning medicine can be generalized to 'three-stage' and'seven-from'.'three stages' were:stage at school,stage at clinic and promotion stage.'Seven-from' meaned learning medicine from books,practice,chinese and western fusion,medical cases,scientific research,teaching and current events.These experiences have laid a solid basis for his academic thoughts later,and created a important influence.Senior famous TCM doctors' academic thoughts1.Gao Zhongshan:Affected by pro.Gao,Pro.Li paid attention to using the formulas in Treatise on Cold Pathogenic and Miscellaneous Diseases and Treatise on Epidemic Febrile Diseases,learning and using the theory and knowledge of western medicine.He skillfully used the outcomes of pharmacy research;actively conducted scientific research laboratory and developed new drugs.2.Ma Ji:By treating both the outward symptoms and root cause,the treatment of kidney diseases mainly obeyed the principle for strengthening healthy qi to eliminate pathogens.Based on 'Yiqi Yangyin,Huoxue Huayu' therapy,he coordinated other therapies according accompanied symptoms and signs to treating DM.3.Zhang Qi:In the treatment of kidney diseases he paid more attention to entirety.Spleen-kidney is especially importent.In the differentiation of difficult and baffling diseases he paid more attention to changes of Qi and blood.4.Yu Yingke:In the treatment of gynecological diseases,he attached great importance to regulating Qi and blood.He was good at using insect drugs and choosed prescriptions mainly from Gynecology Instructions of Golden Mirror of Medicine.5.Bai Junfu:Based on zang-fu,jing-luo,qi-xue syndrome differentiation,the characteristics of choosing prescriptions and using drugs flexibly have had a important impact on pro.Li's formation of acadmic thoughts 'differentiation adjusting by the change of patient's condition,selecting Jing Fang not stick to disease,selecting Shi Fang according the nature of disease'.Summary of Pro.Li Delin's academic thoughts1.Attaching great importance to spleen and kidney;strengthening vital qi to eliminate pathogenic factor:Pro.Li attached great importance to adjusting and mending the function of spleen and kidney and strengthening vital qi to eliminate pathogenic factor.2.Differentiation adjusting by the change of patient's condition;Correct syndrome differentiation:Correct syndrome differentiation based on the change of patient's condition was emphasized.Only by this way,can therapy and prescription be correctly made and have a good curative effect.3.Selecting Jing Fang not stick to disease;Selecting Shi Fang according the nature of disease:Selecting Jing Fang or Shi Fang based on correct syndrome differentiation was emphasized.4.Searching disease location in the polymorphism of coldness and heat:Syndrome of intermingled heat and cold extensively exists and it has various forms.The disease location of cold ang heat should be differentiated first and then correctly set up therapies and dispatch prescriptions.5.Skillfully using the outcomes of pharmacy research:Attaching great importance to applying outcomes of modern pharmacy research.Attaching great importance to syndrome differentiation as well as disease differentiation.Summary of pro,Li Delin's clinic experience(appended with representative case records)1.Lung diseases:Treatment of acute lung diseases mainly adopted six-channel syndrome-differentiation,Wei-Qi-Ying-Xue syndrome-differentiation and sanjiao syndrome-differentiation.Treatment of chronic lung diseases mainly adopted zang-fu syndrome differentiation.The therapies include dispersing,clearing,descending,purging,moistening,supplementing,astricting and dissipating.The therapy 'Jianpi Bufei,Tongfu Xiangji' was often used.Influenza falls into four patterns to treat,including syndrome of pathogenic evils consisting in defense tier,syndrome of exuberance of lung heat,syndrome of gastrointestinal disorders,syndrome of pathogenic evils consisting in nutrient-blood.Abscess formation stage of lung abscess and rupture stage of lung abscess were often seen-in lung abscess and the treatments of these tow stages were crucial.'Qingre Jiedu,Sufei Huatan 'therapy was adopted and modified Qianjin Weijing decoction was used to treat abscess formation stage of lung abscess.2.Spleen-stomach diseases:Pro.Li established the theory of polymorphism of coldness and heat in the development and changes of diseases to treat spleen-stomach diseases 'Hanre Bingyong,Xinkai Ku-jiang'therapy was adopted and modified Banxia Xiexin decoction was used to treat CAG.'Buzhong Shengyang with Qingre Huashi 'therapy was adopted and Changyannin capsul created on the basis of modified Shengyang Yiwei decoction was used to treat UC.3.Kidney diseases:Pro.Li treated kidney diseases by the therapy of tonification and purgation in combination.'Yiqi Yangyin,Huoxue Lishi' therapy was adopted and Shiquan Yuzhen capsul created on the basis of modified Shiquan Yuzhen decoction was used to treat chronic primary glomerular disease.'Supplementing Qi and kidney with expelling residual evils 'therapy was adopted and Yishenkang prescription was created to treat chronical pyelonehritis.'Tongluo Huoxue,Quyu Shengxin,Xieshi Jiedu' therapy was adopted and Dahuang Zhechong pill was used to treat refractory nephropathy syndrome.4.Depression syndrome f'alls into six patterns:?The pattern due to hepatic depression is treated by modified Chaihu Shugan powder;?the pattern due to blood stagnation is treated by modified Tongqiao Huoxue decoction coordinated by Sini powder;?the pattern due to stagnated gallbladder qi with disturbing phlegm is treated by modified Wendan decoction;?the pattern due to melancholy frustrating is treated by modified Ganmai Dazao decoction;?the pattern due to heart-spleen deficiency is treated by modified Guipi decoction;?the pattern due to kidney deficiency and liver depression is treated by modified Liuwei Dihuang decoction coordinated by Chaihu Shugan decoction.5.Blockage syndrome:In the treatment of blockage syndrome,the depth of disease location was analyzed first.Secondly,the nature of disease should be identified,including recent illness or enduring illness,deficiency or excess,physical differences and the nature of pathogenic evils.Wind-coldness-damp blockage syndrome and heat blockage syndrome should be identified.The self-made prescription Erlong Juanbi decoction was used to treat wind-coldness-damp blockage syndrome.Modified Danggui Niantong decoction was used to treat wind-damp-heat blockage syndrome.Modified Mufangji decoction was used to treat Zhengqi deficiency accompanied by damp-heat blockage syndrome.Modified Duhuo Jisheng decoction was used to treat lingering blockage syndrome accompanied by kidney-deficiency.6.Epilepsy syndrome:Vitality movement of heart and brain disuse is root cause of epilepsy syndrome and pathogetic factors of wind fire phlegm and blood stasis are outward symptoms of epilepsy syndrome.Blood stasis and phlegm are particularly important.The therapies of'Huoxue Huayu Tongqiao,Huatan Huotan Tongqiao,Shugan Rougan Xifeng,Qinggan Zhengan Xifeng,Yiqi Buxue Tongluo' were adopted and the prescriptions of Tongqiao Huoxue decoction,Huangqi Guizhi Wuwu decoction,Buyang Huanwu decoction,Mengshi Guntan pill and Wendan decoction were often used to treat this disease.7.Dementia falls into five patterns:?The pattern due to insufficiency of marrow-sea is treated by modified Liuwei Dihuang decoction;?the pattern due to Qi deficiency and blood stasis is treated by modified Huangqi Guizhi Wuwu decoction coordinated by Buyang Huanwu decoction;?the pattern due to hyperactivity of heart-liver fire is treated by modified Longdan Xiegan pill coordinated by Niuhuang Qingxin pill(Ju Fang);?the pattern due to turbid phlegm blocking the clear orifices is treated by modified Ditan decoction coordinated by Wendan decoction;?the pattern due to static blood blocking orifices is treated by modified Tongqiao Huoxue decoction.8.Vessel impediment(Raynaud disease):The germination of this disease is related to blood deficiency and catching a cold and blockage of channel.'Huoxue Buxue,Wenjing Sanhan 'therapy was adopted and modified Danggui Sini decoction was used to treat this disease.9.Thyroid disease falls into four patterns:?The pattern due to Qi depression and phlegm obstruction is treated by modified Sihai Shuyu decoction;?the pattern due to phlegm and blood stasis is treated by modified Haizao Yuhu decoction;?the pattern due to hyperactivity of liver-stomach fire is treated by modified Zhizi Qinggan decoction coordinated by Zaoyao powder;?the pattern due to heart-liver Yin deficiency is treated by modified Tianwang Buxin pill.10.Diabetic mellitus and it's complication:The basic pathogenesis of DM can be summarized.That is 'five internal organs' deficiency,stifling internal heat,injuring Jin and consuming Qi,adhesive blood and body fluid'.The pathogenesis of diabetes mellitus complicated with coronary heart disease is 'five internal organs' deficiency,stifling internal heat,injuring Jin and consuming Qi,adhesive blood and body fluid and blood-stagnation andphlegm-coagulation'.According to 'Yiqi Yangyin,Huoxue Huatan' therapy,self-made prescription Qixuan Yixin decoction was used to treat this disease.The pathogenesis of DPN is'five internal organs' deficiency,stifling internal heat,injuring Jin and consuming Qi,adhesive blood and body fluid and blood stasis obstructing the collaterals'.According to 'Yiqi Yangyin,Huoxue Tongluo assisted by Zaoshi Qutan Huazhuo'therapy,self-made prescription Qixuan Tongluo decoction was used to treat it.Study on Professor Li Delin's Medication Experience in Treating Diabetic Mellitus Based on Cluster AnalysisBackground:As a lifelong progress disease,the work of prevention and control of DM faces serious challenges.Pro.Li Delin has concentrated on studies of TCM treatment of diabetic mellitus and it's complication for many years.He accumulated rich clinical experience and created self-made prescription to treat DM with significant curative effect.This research based on recent three years' clinical medical cases of Pro.Li treating this disease and applying the methods of frequency and cluster analysis to analyzing his regularity of prescription.Purpose:To analyze Pro.Li Delin's thoughts of therapy and regularity of prescription in treating diabetic mellitus(DM)by data mining and summarize his experience in treating this disease.Method:Collecting typical medical cases of Pro.Li's treatment for DM,applying the database to analyzing the frequency and cluster of herbs and summarize Li Delin's experience in treating DM.Result:The prescribing information on 80 patients(436 visits)which visiting rate>3 times in specialist clinic of Li Delin was selected.There were 29 herbs with a frequency higher than 10%.The top 5 herbs were Huangqi(Astragalus membranaceus,??),Huanglian(Coptis chinensis,??),Danshen(Radix Salviae Miltiorrhizae,??),Gegen(Radix Puerariae,??)and Lingzhi(Ganoderma lucidum,??).The deficiency-supplementing herbs,heat-clearing herbs,relieving exterior syndrome herbs,as well as astringent herbs were commonly used.The herbs with plain nature(31.03%),sweet flavor(79.31%)and entry into lung channel(48.28%)were most frequently used.The clinical significance was clear when 29 herbs were clustered into 10 categories according to their nature.Conclusion:Though exploring the database,it is concluded that Pro.Li think that the main syndrome of DM is 'Qi-Yin deficiency with dryness-heat and blood-stasis',so he often uses herbs with plain or cold nature and sweet or bitter flavor to treat DM according to 'Yiqi Yangyin Qingre,assisted by Huoxue Huayu' therapy.He pays attention to using both tonifying method and clearing method.Self-made prescription Qihuang Xiaoke decoction is core prescription he uses most commonly.Clinical observation of the experience prescription Sanjia Shenxiao decoction treating diabetic kidney disease of stage ??? which syndrome differentiation is deficiency of Qi and Yin mingled with blood stasis and turbid pathogens.Part I Literature Review(consists of two parts):The first one reviews modern medicine research progress in diabetic kidney disease in recent ten years,including its pathogenic,diagnosis in early stage,treatment of western medicine.The second one reviews the progress of Chinese medicine treating diabetic kidney disease in recent ten years,including the Chinese medicine name of the disease,pathogetic factors and pathogenesis,syndrome differentiation and treatment and problem and expectation.Part II Clinical Study:Clinical observation of the experience prescription Sanjia Shenxiao decoction treating diabetic kidney disease of stage ??? which syndrome differentiation is deficiency of Qi and Yin mingled with blood stasis and turbid pathogens.Purpose:Observe the curative effect and safety of the experience prescription Sanjia Shenxiao decoction treating diabetic kidney disease of stage III-IV which syndrome differentiation is deficiency of Qi and Yin mingled with blood stasis and turbid pathogens.Method:Divide the 80 patients into control group and treatment group at random.Control group:treatment of lotensin based on the basic treatment.Treatment group:treatment of the experience prescription Sanjia Shenxiao decoction based on the basic treatment.Treat the tow groups for 8 weeks respectively.Observe the changes of traditional Chinese symptom score,24h proteinuria,indexes of kidney function,blood glucose,HbAlC,blood lipid,hemorheology and safety indexes.Result:1.The treatment group total effective rate was 85%and the control group total effective rate was 70%,which statistics difference was significant(P<0.05);2.After treatment,CHOL and TG of treatment group had a significant decrease.There is statistics meaning for the comparison between two groups after treatment(P<0.05);3.After treatment,blood viscosity of treatment group declined obviously.There is statistics meaning for the comparison between two groups after treatment(P<0.05);4.After treatment,the 24h proteinuria of both two groups all drop compared with that before treatment and there is statistics significance(P<0.05);5.After treatment,the value of serum creatinine and serum urea nitrogen in treatment group descended and glomerular filtration rate increased obviously at the same time.There is no significant changes of above indexes in control group(P>0.05);6.After treatment,the average symptom score of treatment group descended obviously(P<0.05).There is no significant decline of above indexe in control group(P>0.05);7.There is no any toxic effects and side effects in this clinical observation.Conclusion:Pro.Li Delin's experience prescription can obviously improve the symptoms of diabetic kidney disease of stage ?-? patients which syndrome differentiation is deficiency of Qi and Yin mingled with blood stasis and turbid pathogens,lessen the 24h proteinuria and improve the kidney function.It's safety is very good.