| The method of Yiqi Huoxue(invigorating qi and activating blood circulation)is a combination of invigorating qi and activating blood circulation.The formation,development and establishment of the method are based on the gradual and profound understanding of the theory of qi and blood.Qi and blood are the foundation and the important material basis of human body.Qi is the commander of blood,and blood is the mother of qi.Qi and blood complement each other.At the same time,both of them suffer losses of eachother.The development of the cognition of qi and blood is accompanied by the Chinese nation’s history of fighting against diseases for thousands of years.The method of Yiqi Huoxue originated in the Qin and Han dynasties.From the understanding of the harmonization of qi and blood to the harmony of human body,to the gradual emergence of the etiology and pathogenesis theory of qi deficiency and blood stasis,the groundwork of the method of Yiqi Huoxue is firmly laied.It was not until the Ming and Qing Dynasties that qi deficiency and blood stasis,as the etiology and pathogenesis,clearly appeared in medical classics.The method of Yiqi Huoxue was gradually perfected and established with the creation of Wang Qingren’s Buyang Huanwu decocation(BYHWD).With regard to Qi and blood,if qi is sufficient,then blood lines.If qi is failing,then blood becomes stagnant.Yiqi can promote blood circulation.The deficiency of healthy qi may lead to in regular blood circulation and meridians stasis,And then qi deficiency and blood stasis syndrome comes up.Qi function s to warm,blood functions to moisten and nourish.Qi deficiency is Yang deficiency,which generates cold from the inner body,and then the body is easy to be attacked by evil.At the same time,the inability to promote blood nourishing around the body leads to the brain,s loss of nourishing,adverse meridians,action disorders,and insensitivity.Blood and meridians stasis,,skin color change,and general block pain occur.Doctors of all dynasties believed that the occurrence of cerebrovascular diseases was closely related to the qi and blood of the human body.The brain was the house of the Yuan God,the master of the god,and the brain had the functions of dominating life activities,spiritual activities,feeling and body movements.Sun Simiao has a saying,"The head is the head of human beings.It is noted by people’s qi.The qi and blood are smart,and all of them go up to the head.The three Yang channels and collaterals of the hands and feet converge in the head and face,and travel through the limbs and bones.As a result,qi and Blood disorders,brain degeneration,or exogenous evil spirits,result in paralysis,muscle atrophy,convulsions,and tremors."Huang Di Nei Jing"pointed out that"when blood flows from qi,it is a big jue",and pointed out that the changes of qi and Blood are the basis of the occurrence of syncope.qi deficiency caused by Qing Yang does not rise,Blood flow is not smooth,qi and Blood stasis,brain loss to support,resulting in deity loss.Liu Wansu believed that"the blood is stasis but can not honor the muscle",the Blood is stasis and difficult to nourish body,the stasis makes painful,then the human limb segment muscle is weak and disadvantageous."If there are a bit of stiff,qi and Blood circulation,muscles and muscles not twonic,slowly occurrence as before",that qi and Blood fluid,through the bones of limbs,then restore as before.About hemiplegia,Zhang Jingyue,Wang Qing Ren,all agree that limb immobility is"non-wind",that"this syndrome more see the stroke,the stroke more from the inner weakness,the internal injury accumulation and decadence,the original is not caused by exogenous cold",therefore qi and Blood disorders,qi deficiency and Blood stasis become the common etiology and pathogenesis of encephalopathy.The physical channels spasm,tremor,adverse action,consciousness obstacle,caused by the disorder of qi and blood,qi deficiency and blood stasis.To these symptoms,we can make the use of the rule of"rest should be remove,insufficient need to fill".We could call this rule,Yiqi Huoxue method,"nourished,Yin and Yang deficiency of vital energy".Enough qi can promote blood lines,the human body full of qi and Blood,patrons have to luck.In modern clinical practice,the method of Yiqi Huoxue is used widely and has definite curative effect.Some scholars have conducted laboratory research on its relevant prescriptions,and the results show that the method of i Yiqi Huoxue can repair and improve the pathological state of human body very well.In the early stage of cerebrovascular disease and in the convalescent stage,the application of BYHWD,the representative prescription of Yiqi Huoxue method,can not only improve the pathological damage of the central nervous system,but also be superior to the treatment of simple western medicine in the recovery of motor function,cognition,efficiency and neurological function of the disabled limbs.Therefore,the theoretical source of the method of Yiqi Huoxue was analyzed,and the clinical randomized trials of the method of Yiqi Huoxue on brain diseases in the past 20 years were systematically evaluated and meta-analyzed,so as to provide the theoretical support of TCM literature and evidence of evidence-based medicine for the clinical application of the principle of Yiqi Huoxue in modern medicine.Part Ⅰ The origin and application of the Yiqi Huoxue based on ancient Chinese medical literature.Objectives:Comprehensive search on the ancient ancient Chinese medical literature about the theory of qi and blood,and therapeutic method,prescription medication,which were related to"Yiqi Huoxue",to in-depth research and analysis into the literature,system elaborated the ancient historical periods in"Yiqi Huoxue"and its corresponding theoretical analysis,clinical application,and discuss on the whole Yiqi Huoxue method.Questing the development of"Yiqi Huoxue",explore its historical origin,the development derivation.This paper summarizes the academic theory and clinical experience of traditional Chinese medicine scientists in the past dynasties in the application of the method of Yiqi Huoxue in clinic to provide theoretical basis for the clinical application of the principle of Yiqi Huoxue in modern Chinese medicine.Methods:This study used the method of combining traditional Chinese medicine literature retrieval with modern literature retrieval technology from the Qin and Han dynasties to the late Qing Dynasty,to retrieve the contents of the theory analysis of Qi and blood,Qi deficiency and blood stasis,blood stasis,therapeutic method,medication ideas and so on which related to Qi and blood circulation in ancient Chinese medicine classics.When sorting out the origins,the development process of the thought of"Yiqi Huoxue"circulation is longitudinal reflected in the chronological order,and the author and the works are lateral discussed.The academic thoughts of Qi and Blood in each period are abstracted and sorted out,and the development of the method of"Yiqi Huoxue"circulation is summarized.Result:The development of the method of"Yiqi Huoxue"has gone through five stages:be,foundation laying,enrichment,development and perfection.The whole text can be divided into Qin and Han Dynasties,Jin,Sui and Tang Dynasties,Song Dynasties,Jin and Yuan Dynasties,Ming and Qing Dynasties.1 The stage of beginning(Qin and Han Dynasties).This stage fully explained the theory of Qi and blood,that the two can not be missing one,the function of complementary,Qi and blood for the human body,Enough Qi and flowing blood make human peace and harmony.Qi forming and blood flow are crucial in the whole body.Among them,the concept of blood stasis was first put forward in "Treatise on Febrile and Miscellaneous Diseases",and corresponding principles of promoting blood circulation to remove blood stasis,attack and tonic as well as treatment can be seen in the dialectical treatment of gynecological diseases.2 The foundation laying stage(Jin,Sui and Tang Dynasties).The theoretical understanding of Qi and blood is gradually profound.Therapeutic method needs to investigate Qi and blood,search for the source of various diseases,clarify the etiology and pathogenesis,and demonstrate the blood stasis.Qi deficiency is often considered in surgery,gynecology and obstetrics.With the publication of the Tang Dynasty’s herbaceous books,medicines with beneficial effects of Qi and blood circulation were summarized and applied continuously,which laid a theoretical foundation for the analysis of the etiology and pathogenesis of Qi deficiency and blood stasis corresponding to the source of Qi and blood circulation in later generations,and the construction of medication thought.3 The stage of enrichment(Song Dynasties).Academic thought at this stage enriched the theory of Qi and Blood,expounded the importance of qi and blood to the mental state of human body from the physiological and pathological aspects,emphasized the importance of qi,and discussed the occurrence of blood stasis from the internal,external,internal and other aspects,and held that"deficiency"was the etiology and mechanism of blood stasis.The rule of Yiqi Huoxue in this stage has been enriched,invigorating qi from tonifying primordial Qi,replenishing defence qi,to invigorating spleen qi.4 The stages of development(Jin and Yuan Dynasties).With the emergence of medical schools,the method of Yiqi Huoxue has been greatly developed in this period.Qi and blood affect each other,qi promote blood flow,deficiency of qi and blood stasis,blood stasis impeding the movement of qi,and stagnation of qi and blood can easily lead to accumulation of qi and blood.During this period,Yiqi Huoxue is used for surgery,gynecology department.Yiqi refers to the Qi of the healthy,defence,qi of spleen and stomach.Herb of Yiqi were commonly used in Huangqi,Renshen,Baizhu,etc.,and the herb of Huoxue were commonly used Danggui,Shengdi,Chuanxiong,Chishao,Ganqi,Taoren,Honghua.5 The perfection stage(Ming and Qing Dynasties).At this stage,the role of Qi was highlighted in Qi and blood circulation.Qi deficiency and blood stasis began to appear clearly in the medical works as the principle of the etiology and pathogenesis at this period.The corresponding drugs were used to invigorate the Qi and flow the blood were added to invigorate the blood circulation.It was not until the representative prescription of Yiqi Huoxue came out that the principle of invigorating Qi and promoting blood circulation was formally established,with large doses of Qi tonifying drugs as the king’s medicine and Taohong Siwu as the combination.Commonly used in clinical departments.Conclusion:By sorting out the historical evolution of the method of Yiqi Huoxue,it is found that the method of Yiqi Huoxue is constantly sublimated along with the in-depth understanding of qi and blood by ancient doctors.At the beginning of formation,the physiological relationship between Qi and blood was not only recognized,but the pathological relationship between Qi and blood was also needed to be explored,and the method of invigorating Qi and activating blood began to germinate.With the gradual deepening of the understanding of the theory of Qi and blood,we began to discuss Qi as the main part of the relationship between the two,and realized that the change of Qi mechanism can indeed affect the change of blood flow.In the formation of blood stasis process,Qi deficiency play a important role,that is,Qi deficiency and blood stasis as the etiology and pathogenesis began to be included in the study,which laid a theoretical foundation for the formation of the method of replenishing Qi and activating blood.In tomifying qi and constantly filling,the road to maturity,Yiqi greatly abundant,with understanding of tonifying primordial Qi,replenishing defence qi and invigorating spleen qi.Then,medicine ideas have appeared in the Renshen,Huangqi,Baizhu and Buzhong YIqi,but still depended on disease to add and subtract,not form a fixed prescription.It was not until Wang Qingren,the master of the Qing Dynasty,established the method of Yiqi Huoxue until he created the famous recipe Buyanghuanwu Decoction.120g of Huangqi is the king in the formula.To promote qi and restore blood flow,and to achieve qi can generate blood.Danggui,Shengdi,Chuanxiong,Chishao,Ganqi,Taoren,Honghua to invigorate the circulation of blood.At the same time,the method of Yiqi Huoxue officially appeared.Part 2 Meta-analysis of the classical Buyang Huanwu decocation in the treatment of EncephalopathyObjective:To systematically evaluate the clinical efficacy of Buyanghuanwu Decoction in the treatment of encephalopathy(stroke,multiple sclerosis,epilepsy,dementia,headache,dizziness,etc.),and to provide evidence-based medicine for the clinical application of the method of Yiqi Huoxue and Buyanghuanwu Decoction.Method:In this study,two independent researchers searched Chinese and English databases,such as CNKI,Wanfang,VIP,Pub Med,Embase,and Cochrane Library,according to PRISMA international standards and inclusion and exclusion criteria,and collected clinical randomized controlled trials of Buyang Huanwu decocation(BYHWD)on encephalopathy(stroke,multiple sclerosis,epilepsy,dementia,headache,dizziness,etc.)from June,1999 to June,2020.Literature screening was conducted in strict accordance with inclusion and exclusion criteria.The Cochrane Collaboration bias risk assessment tool and GRADE system recommended GRADE method were used to evaluate the literature quality.Review Manager5.0 software was used to merge the data,and the evaluation indexes were RR and MD.Result:A total of 21 studies involving 1,946 patients were included.1 effective rate.Compare the effective rate of BYHWD+conventional western medicine with conventional western medicine in treating encephalopathy was[RR=1.19(95%CI[1.14,1.24]),I~2=21%,P<0.00001].Compare the effective rate of BYHWD alone with conventional western medicine in treating encephalopathy was[RR=2.38(95%CI[1.59,3.55]),I~2=0,P<0.05].The results showed that BYHWD+conventional western medicine or BYHWD alone was more effective than western medicine alone in the routine treatment of encephalopathy.2 NIHSS score.Compare the NIHSS score of BYHWD+conventional western medicine with conventional western medicine in the treatment of stroke was[MD=-2.38(95%CI[-3.32,-1.44]),P<0.00001,I~2=81%],indicating that the addition of BYHWD on the basis of conventional western medicine in the treatment of stroke can significantly reduce the NIHSS score of nerve injury and improve the neurological function of patients.Compare the NIHSS score of BYHWD with conventional western medicine in the recovery period of stroke,[MD=-0.35(95%CI[-2.45,-1.75]),P>0.05],indicated that there was no difference in NIHSS score between BYHWD alone and conventional western medicine in the treatment of the recovery period of stroke.3 ADL score.The ADL score of by HWD alone compared with conventional western medicine in the treatment of dementia[MD=6.4(95%CI[5.23,7.57]),P<0.00001,I~2=0].ADL score of stroke treated by BYHWD+conventional therapy compared with conventional western medicine[MD=16.27(95%CI[13.73,18.80]),I~2=0].The results showed that the loading treatment of BYHWD could significantly improve the daily living ability of stroke patients compared with western medicine alone.4.Quality of evidence rating:BYHWD alone or in combination with conventional western medicine is superior to conventional western medicine in terms of effective rate,NIHSS and ADL scores in the treatment of stroke,multiple sclerosis and dementia.The GRADE of evidence in the included literature was moderate.Conclusion:In the treatment of apoplexy,multiple sclerosis and dementia,BYHWD alone or in combination with conventional western medicine is superior to conventional western medicine in terms of efficiency,NIHSS and ADL score.It is superior to conventional western medicine in the recovery of limb movement limitation,neurological function deficit and daily living function.SummaryThe method of Yiqi Huoxue is a treatment principle guided by the theory of TCM.It is widely used in clinical practice,especially in the prevention and treatment of encephalopathy.The method of Yiqi Huoxue originated in the Qin and Han dynasties,and the theory of qi and blood and the concept of stasis of blood were deeply rooted in people’s mind.The foundation was laid in Jin,Sui and Tang Dynasties,when the etiology and pathogenesis of qi deficiency and blood stasis were gradually clarified,and the medicine of qi and blood circulation began to be developed.The qi and blood theory of the law of Yiqi Huoxue were enriched in the Song Dynasty,and the etiology and pathogenesis of blood stasis were discussed in detail.During the Jin and Yuan Dynasties,the etiology and pathogenesis of blood stasis were clear,and the thought of herb use gradually took shape.It was improved in the Ming and Qing Dynasties,when the etiology and pathogenesis of qi deficiency and blood stagnation were clear,and BYHWD,the representative prescription for Yiqi Huoxue,began to be used clinically.The efficacy,NIHSS and ADL score of BYHWD,the representative prescription of Yiqi Huoxue,combined with conventional western medicine,were better than that of conventional western medicine alone in acute stage of encephalopathy.BYHWD was superior to conventional western medicine in terms of efficiency,NIHSS and ADL score when used alone in the convalescence period of encephalopathy.BYHWD alone or combined with conventional western medicine in the treatment of encephalopathy has better efficacy than conventional western medicine in the recovery of limb movement limitation,neurological function deficit and daily living function.Shortcomings and prospects:In the process of this study,there were still some shortcomings.The summary and sorting were not comprehensive enough,and there were the not adequate relevant ancient books.In the Meta-analysis of the treatment of encephalopathy by BYHWD,there was a lack of high-quality RCTs and the overall literature quality grade was not good enough,which resulted in certain bias in the research results.At the same time,this study did not systematically focus on the laboratory research progress of the method of invigorating qi and promoting blood circulation,and failed to provided theoretical support for the method of Yiqi Huoxue in molecular biology.In view of the application value of the method of Yiqi Huoxue,it is necessary to further study its relevant effective components and formulae by using more biological and immunological methods in the future,and to elaborate the cells and molecules that play a role,so as to continue to provide microscopic and specific theoretical support for the clinical application of the method. |
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