Collection And Study Of Medical Records Recorded By Lingnan (in The Southern Region Of Five Mountains) Physicians Before The Year Of 1949 And Analysis Of Clinical Application Of Rhizoma Zingiberis Recens, Ramulus Cinnamomi And Radix Aconiti Lateralis Prep

1 Objective and methodsAn over-all investigation of Lingnan (in the southern region of five mountains) traditional Chinese medicinal (TCM) literature before the year of 1949 was carried out in libraries located in Guangzhou, Beijing, Shanghai and Hong Kong. Methods for literature study, history study, comparison study, statistical analysis and traditional Chinese medicinal academic study were used comprehensively to study the medical records recorded by Lingnan physicians before 1949, thus to present the general situation of Lingnan physicians' medical records in different dynasties. The generality and individuality of main medical records or large-sample medical records were explored by the methods for medicinal history and literature study and clinical study, for example, the clinical application of Rhizoma Zingiberis Recens, Ramulus Cinnamomi and Radix Aconiti Lateralis Preparata in the records of different dynasties, thus to lay a foundation for the further research of disease spectrum, academic thoughts, and prescriptions and medication.2 Main content of the studyThis study consists of four parts: (1) Research situation of traditional Chinese medical records in China and those in Lingnan; (2) Collection and arrangement of Lingnan physicians' medical records; (3) General situation of Lingnan physicians' medical records; (4) Analysis of clinical application of Rhizoma Zingiberis Recens, Ramulus Cinnamomiand Radix Aconiti Lateralis Preparata in Ling-nan physicians' medical records.3 Results(1) the establishment of database of Lingnan physicians' medical records in different dynastiesThe results of over-all investigation showed that 50 bibliographies of medical records in different dynasties were found present, 20 were found disappeared, 9 kinds of magazines reported medical records, 16 kinds of local chronicles kept medical records。 After listing the bibliographies present and those disappeared, we screened 42 bibliographies, 9 kinds of magazines, 16 kinds of local chronicles which kept Lingnan physicians' medical records, and 173 Lingnan physicians who were contributed to medical records. We edited 1671 Lingnan physicians' medical records in different dynasties that are relatively completed and can be referred.(2) Presenting the general situation of Lingnan physicians' medical records in different dynastiesThe distribution of Lingnan physicians' medical records in different dynasties was described: bibliographies and physicians that had over 10 medical records were listed thus to study the clinical experience, diseases spectrum, medication and for the associated research of large-sample medical records: the native places of the physicians were listed for the study of related factors: Diseases spectrum in the records were listed to show the medical level of the physicians and for the collection of the records in the order of branches.Based on the dynasty clue and physicians clue, the characteristics of medical records were compared, as well as the introduction of main physicians and medical records examples, thus to presenting the general situation of present Lingnan physicians' medical records.Jing and Tang Dynasties: It is the germination of Lingnan physicians' medical records. No biography of medical records was found in Jing Dynasty, only the present biographyof Ge Hong who had been in Lingnan extracted Lingnan physicians' medical records. Also no medicinal record was found in Lingnan physicians' biography of Tang Dynasty.Song and Yuan Dynasties: Lingnan physicians' biographies of Song Dynasty increased, but no medicinal record was found. Only 3 records were kept in notebook and local chronicles. Valuable records appeared in Yuan Dynasty, native Lingnan physicians recorded 4 records. The 15 medical records of Shi Jihong contributed to the diagnosis and treatment of malignant malaria and the clinical application of Rhizoma Zingiberis Recens, Ramulus Cinnamomi and Radix Aconiti Lateralis Preparata.Ming Dynasty: Lingnan physicians' biography increased, with the characteristics of increase of medical records of native physicians from local chronicles and less accuracy of the contents. Meanwhile, San He Jin written by Zhang Jike, a biography of medical records, discussed diseases in Lingnan and showed a high academic level; Ming Yi Lei An kept 4 records of Yu Zirong, short but accurate.Qing Dynasty: Lingnan physicians' medical records went to the adult period. The quantity and quality of native Lingnan physicians' medical records much increased: 31 Lingnan physicians' biographies kept 35 Lingnan physicians and 515 medical records, 13 local chronicles kept 24 Lingnan physicians and 60 medical records, and in toal 31 Lingnan physicians' biographies and 13 local chronicles kept 59 Lingnan physicians and 575 medical records. Among them, 49 were native in Lingnan and 10 had been in Lingnan. Some physicians were specialized in treating some diseases: Luo Rulan, Li Peilan, Lin Qingquan, Lao Shoushen and Liang Daqiao were specialized in plague, diphtheria and cholera; Chen Botan, Yi Jusun and Li Piliu were specialized in febrile diseases; Xu Yanzuo and Jian Xizeng who had been in Lingnan were specialized in comparing the Lingnan diseases with diseases occurring in other provinces; Pan Lanping, the preventative of physicians for Lingnan warm disease, showed experienced prescription and medication for warm disease.The republic period: The republic period showed the largest amount of Lingnan physicians, biographies and medical records, which is great prosperity period for Lingnan physicians' medical records. This is the result of the development of Lingnan medicine. Moreover, the establishment of different kinds of periodicals in Guangdong province promoted the communication of Lingnan medicine, which contributed to the social advancement and cultural progress in Guangdong province. There were four biographies of medical records for reference during this period. Moreover, there were 4 biographies of Lingnan physicians' medical records, 9 kinds of periodicals, 3 local chronicles, 103 physicians and 999 medical records. The medication characteristics of in Lingnan physicians' medical records of the republic period were as follows: Chen Yingqi and Chen Yuzhou were specialized in application of prescriptions from Shanghan Lun; Cai Dongrong and He Kuiyuan were specialized in application of medicinal herbs with the clearing and cooling actions; Lu jueyu was good at applying western and traditional Chinese medicine; Chen Zhiping was good at acupuncture therapy. The contents and the styles of medical records in this period were various and the academic levels were higher than the previous periods.(3) Analysis of clinical application of Rhizoma Zingiberis Recens, RamulusCinnamomiand Radix Aconiti Lateralis Preparata in different dynastiesBased on the analysis of 1671 medical records, clinical application of Rhizoma Zingiberis Recens (RZR), Ramulus Cinnamomi(RC) and Radix Aconiti Lateralis Preparata (RALP) was investigated in Lingnan physicians' medical records of different periods.The evidence for Lingnan physicians applying RZR, RC and RALP in Lingnan region was firstly extracted. And then the characteristics of Lingnan climates, the influence of Lingnan residents'dietary on their constitution and some disputed TCM theories were investigated and discussed. It is indicated that there exist theoretical evidence and clinical experience for the application of RZR, RC and RALP in Lingnan regions. Under certain proper condition and based on syndrome differentiation and treatment, these three drugs had good effect for the treatment of acute and critical disease. The following supplied some data for the application of RZR, RC and RALP in Lingnan regions.Jing, Tang, Song and Yuan Dynasties: There collected 25 medical records, in which there were 8 involving application of RZR, RC and RALP in combination or alone, and there were 17 not involving the application. In the 8 medical records, there were 3 involving the combined application of RZR and RC, 2 involving application of RZR alone, 3 involving application of RALP alone o It is indicated that there was no application of the three drugs together, or RC with other drug together. There were several medical records involving the combined application of RZR and RALP. For the use of RALP, there was differentiated use of Chuanwu, Wutou and Tianxiong in Jing, Tang, Song and Yuan Dynasties, but less mentioned by the physicians in the later period. The physicians used the above three drugs were Shi Jihong and Yang Jilao, they used them for miasma, wind-phlegm syncope and deficiency-cold vomiting and diarrhea. The common-used prescriptions were 4 including Sanjian Decoction. It is said that long-term use of RZR and RALP prolonged life span, and RZR cured throat abscess.Ming Dynasty: There collected 72 medical records, in which there were 7 involving application of RZR, RC and RALP in combination or alone, and there were 65 not involving the application. In the 7 medical records, there were 1 involving the combined application of RZR and RALP, 1 involving, the combined application of RZR and RC, 3 involving application of RZR alone, 1 involving application of RC alone o It is indicated that there were few records recorded the combined application of the three or two. The combination with Fructus Evodiae occurred. The physician used the above three drugs was Yu Zirong, he used them for 3 kinds of diseases including miasma. The common-used prescriptions were Shengjiang Fuzi Decoction and Wuzhuyu Decoction. It is said that use of RALP and Radix Angelicae Sinensis in granule cured headache.Qing Dynasty: There collected 575 medical records, in which there were 230 involving application of RZR, RC and RALP in combination or alone, and there were 345 not involving the application. In the 230 medical records, there were 15 involving the combined use of three, 71 1 involving the combined application of RZR and RALP, 36 involving the combined application of RZR and RC, 23 involving the combined application of RALP and RC, 46 involving application of RZR alone, 10 involving application of RALP alone and 29 involving application of RC alone o Raw RALP was used un-prepared in 17 medical records. Fresh common ginger rhizome was used in 50 records, prepared ginger rhizome in 8 and dry ginger rhizome in 49. It is indicated that there were many physicians used the three drugs in clinics and they usually had one or two effective cases. The applied principle is using the proper drug for the certain syndrome. The application of drug pairs of RZR & RC, RZR & RALP, RALP & TC increased, in particular the use of RC. The number of indicative diseases also increased. The physician used the above three drugs were 12 including Li Piliu, they used the drugs for 38 kinds of diseases including edema. The common-used prescriptions were 12 including Gancao Fuzi Decoction.The republic period: There collected 999 medical records, in which there were 342 involving application of RZR, RC and RALP in combination or alone, and there were 657 not involving the application. In the 342 medical records, there were 60 involving the combined use of three, 94 involving the combined application of RZR and RALP, 35 involving the combined application of RZR and RC, 9 involving the combined application of RALP and RC, 93 involving application of RZR alone, 20 involving application of RALP alone and 31 involving application of RC alone. It is indicated that there were many physicians used the three drugs in clinics, and the flesh ginger rhizome was used in more medical records. Meanwhile, the set prescription was less used while the self-prepared prescriptions were used frequently. The combination with Fructus Evodiae was used in more medical records to increase the yang-warrning action. More medical records were issued in the periodicals: some physicians were good at using RZR while not using RC & RALP, for example Jiang Jishi; some used RALP More often than RZR, for example Pan Zhanglun; some used ginger juice. Physicians using RZR or RC alone was not for warming yang, mostly for dispersing evils. The physician used the above three drugs were 26 including Lu Jueyu and Chen Yingqi, they used the drugs for 39 kinds of diseases including damp-type beriberi and Shaoyin cold transformation syndrome. The common-used prescriptions were 28 including Fuzi Jingmi Decoction. It is said that Fuzi Lizhong Decoction with the heat property should be taken in cold decoction, large-dose prescription cured obstruction syndrome and prepared Tianxiong cured diabetes.Summary: There collected 1671 Lingnan physicians' medical records, in which there were 587 involving application of RZR, RC and RALP in combination or alone, and there were 1085 not involving the application. In the 587 medical records, there were 75 involving the combined use of three, 169 involving the combined application of RZR and RALP, 72 involving the combined application of RZR and RC, 32 involving the combined application of RALP and RC, 144 involving application of RZR alone, 61 involving application of RC alone and 34 involving application of RALP alone~ There collected 41 physicians, 42 entitys, 33 classical prescriptions. It is indicated that the records involving application of the three were one third of those not involving, the percentage of combined use of RZR & RALP was higher than that of combined use of RALP & RC.Analysis of some examples from main physicians: Chen Yingqi, a Lingnan physician lived between the end of Ming dynasty and the beginning of Qing Dynasty, left the largest medical records in different periods, and was good at application of RZR, RC and RALP. His experience embodied the principle of Lingnan physicians' medication, and their application of classic prescription and warm-heat drugs.IN Chen's 226 medical records, there were 140 involving application of RZR, RC and RALP in combination or alone, and there were 86 not involving the application which was one third of the former. In the 140 medical records, there were 32 involving the combined use of three, 77 involving the combined application of RZR and RALP, 3 involving the combined application of RZR and RC, 1 involving the combined application of RALP and RC, 14 involving application of RZR alone, 9 involving application of RC alone and 4 involving application of RALP alone, 11 involving the mis-application or overuse of the three drugs by the previous physicians。Chen's medical records showed the characteristics of standardization, repeatability, he used the combination usually in the classic prescription, for example in 13 prescriptions with the leading of Baitong Decoction, Sini with Guizhi added Decoction. Chen Yingqi kept the same basic medication principle as Zhang Zhongjing. For the use of Tongmai Sini Decoction, the indications should be feeble pulse and with the desire of sleeping, and the patients usually had the symptoms of dumbness, stiff body, stiff neck; Baitong Decoction not only was indicated for Taiyang disease invading Shaoyin Meridian, also for Junyin cold transformation syndrome and meridians concurrent diseases. The critical diseases induced by misapplication and overuse of RZR, RC and RALP were also discussed, usually used by Xijiao Dihuang Decoction, Qingzao Jiufei Decotion, Huanglian Ejiao Decoction and Shen Ling Shao Cao and Ejiao Decoction. He also brought forward that Shaoyin cold transformation syndrome turning into heat transformation syndrome after treatment with the three drugs was a good sign for prognosis. For heat transformation syndrome was easy to be cured and cold transformation syndrome was difficult to be treated.Conclusion: Although the amount of Lingnan physicians' medical records in different periods was not big enouth, the records are valuable for research and can give clinical evidence and some experience. The analysis of clinical application of RZR, RC and RALP is just a beginning, the future further research will supply more evidence for prescription according to the syndrome, dosage of medication, indications and contraindications, disease spectrum and treating the same disease with different therapies in the Lingnan medical records, as well as the medication characteristics, academic thought and academic origins of Lingnan physicians in the different period.