The Study On How To Apply The Principle Of 'Truncation And Inverse Draft' To Treatment To Chronic Severe Hepatitis B

The study on how to apply the principle of'truncation andinverse draft'to treatment to chronic severe hepatitis BProfessor Qian Ying,the hepatic specialist of TCM,had recently treatedchronic severe hepatitis B by the principle of'truncation and inverse draft',which was the comprehensive use of'cut-off'and'pull a boat upstream'.It wasthe theoretical innovation of TCM in treating the disease.This thesis studied the Professor's thoughts and the syndrome of thedisease based on the theory of'toxin injuring hepatic body',so as to discusshow to apply the principle to treatment to the disease.More,the thesis reportedthe therapeutic effect evaluation of the principle on the disease.Part one:To study the academic thoughts of Professor Qian Yingabout treating chronic severe hepatitis B by the principle of'truncation and inverse draft'Objective:Research the academic thoughts of Professor Qian Ying abouthow to treat chronic severe hepatitis B by the principle of'truncation andinverse draft'.Method:To study the academic thoughts of Professor Qian Ying on how totreat chronic severe hepatitis B by the principle of'truncation and inverse draft'by analyzing his academic view,clinical reasoning and analysis,application ofprinciple,clinical cases,inheritance and innovation,and relative literature and searching the theoretical origin of the principle.Results and conclusion:The principle is the comprehensive use of'cut-off'and'pull a boat upstream'.Professor Qian Ying thought that it wasimportant to be flexible in the use of the principle in the various stage of thedisease.We should catch hold of the special laws of the evolution ofpothogenesis,the transmission of Zang-Fu organs,inter-transformation betweenasthenia and sthenia in the occurrence and development of the disease,and weshould integrate with syndrome differentiation and disease diagnose and managethe theory of traditional Chinese medicine.1 Aiming at the severe and acute characteristics of the disease,quick cut-offis the primary principle.There are three main treatment measures,such as:①Clearing away heat and virus is the key to cut off(to clear awaypathogeny-viruses).Whereas,we should not rigidly adhere to the measure.Weneed to differentiate syndrome and treat based on the characteristics of the virusexopathogens.②Purging Fu organs is the turn to cut-off.(to purge theintestine and prevent from the secondary hit).③Cooling the blood andremoving blood stasis is the point of cut-off.(to set-back disease progress andprevent from transmission to Yin-Xue).2 Aiming at the pathogenesis of asthenia,the measures of"pull a boatupstream"are strengthening healthy Qi and eliminating pathogens.We shouldstrengthen healthy Qi by strengthening liver as soon as early,which is,replenishing Yin of liver and kidney,strengthening Qi of liver and spleen and warming Yang of spleen and kidney,etc.Basing on the theory of"liver of yinnature with yang functioning",we should supply liver-Yin nature and strengthenliver-Yang function,regulate the nature and function,balance between Yin andYang.Such as:1 Strengthening liver-Yang function and supplying liver Yin.2Using more raw rehmannia to replenish liver-Yin.3 Regulating liver Qi andsafeguarding liver body.3 For the transmission of Zang-Fu organs mainly referring to spleen andkidney,the measures the principle are that:1 To strengthen the root byregulating liver and spleen.For Qi of liver and spleen lost a lot,large dose ofmedicine was necessary to manage severe disease using large dose of rawastragali(100～120g).At the same while we need to strengthen,invigorate andregulate spleen.2 To manage liver and kidney and replenish water to nourishwood.For liver and kidney sharing the same origin,liver disorder involvedkidney.Liver-Yin deficiency and kidney yin deficiency were accompanied,andthe same liver Qi and kidney Qi,liver-Yang and kidney yang.we must treat bothliver and kidney.4 Treating basing on stage:Aiming at the progress of healthy Qi andpathogen in stages of the disease,the principle should apply flexibly.In theprogression stage we should apply mostly the method of'removal viruses andblood stasis to cut off the tendency of disease',so as to treat the disease and savethe patient.And the method of purgation should not be used too long.While thedisease progressed steadily or in the convalescent stage,strengthening healthy Qi is the main therapeutic principle for recovery including regulating the natureand function,regulating liver and spleen and'replenishing water to nourishwood',etc.If viruses and blood stasis,and healthy Qi asthenia were all severe,we should pay equal attention to purgation and tonification.Part two:To study chronic severe hepatitis B with its syndrome basedon the theory of'toxin injuring hepatic body'and the thoughts of'truncation and inverse draft'Objetcive:To study the syndrome of the disease based on the theory of'toxin injuring hepatic body',to explore the rule of the syndrome,to analyzerationality of the principle based on the syndrome;to explore the scheme of thesyndrome and treatment to the disease based on the principle.It was beneficialto the clinic.Method:To study the distribution rules of manifestations of 260 cases.Toanalyze syndrome factors of'the pathogen of toxin'.To establish the schemebased on the principle,the rules and the factors.Result and conclusion:1 The rules:The basic syndrome types of the cases were blood stagnationof liver and spleen,superabundance of Yin toxin,superabundance of Yangtoxin,Ying deficiency of liver and kidney,Qi deficiency of liver,spleen andkidney,Yang deficiency of liver,spleen and kidney.The basic types reflectedcharacteristics of pathogenesis of'toxin injuring hepatic body,Qi-Yin deficiency of spleen and kidney,or Yin-Yang deficiency of spleen and kidney'.It wascompletely meet to the principle.2.The factors:It has two features of syndrome types,such assuperabundance of Yin toxin and Yang toxin.It was Yin-Yang syndrome whenthere were features of superabundance of both Yin toxin and Yang toxin.Amongthe 260 cases,110 cases were with superabundance of Yin toxin,46 cases withsuperabundance of Yang toxin,104 cases with Yin-Yang syndrome.Commonsymptoms of superabundance of Yin toxin and Yang toxin included that:symptoms which were yellow body,eyes and urine,dim complexion,fatigueand lassitude,poor appetite,abdominal distension,debility of sexuality,drymouth,tongue symptoms which were dark red or purple color of tongue,ecchymosis in tongue body,yellow thick or greasy coat,thickening or varicosehypoglossal vein,pulse symptoms which were slip,string,sinking,bedew,etc.Itwas interesting to distinguish superabundance of Yang toxin for red color oftongue,yellow greasy coat,slippery or pulse rapid pulse etc,and the same assuperabundance of Yin toxin for swollen limbs,waist and knee fatigue,darkcomplexion,liver palms,dilute or loose stool,pale red tongue and curdy coat,etc.We collected image data about the color inspection of 141 cases among the260 cases.The patients' complexion,lips,palm and tongue including tonguetexture,tongue coating and hypoglossal vein were photoed under the conditionsof indoors,close focus and flash with Olympus 2.0 digital cameras.RGB(three elemental colors,R refers to the red color,G refers to the green color,B refersto the blue color)values were measured by the expert system of tongueinspection of TCM.①Compared in the three groups,the RGB values ofcomplexion,lips,palm and tongue texture of the cases with superabundance ofYang toxin＞those of the cases with Yin-Yang syndrome＞those of the caseswith superabundance of Yin toxin.Compared between the cases with Yin-Yangsyndrome and the cases with superabundance of Yin toxin,the R values ofcomplexion,the RGB values of lips and the RG values of tongue texture weresignificantly different(P＜0.05).Compared between the cases with thesuperabundance of Yang toxin and the cases with the superabundance of Yintoxin,there was significant difference in the R values of complexion,the RGBvalues of lips and the R values of tongue texture(P＜0.05).The RGB values oftongue coat of the cases with superabundance of Yin toxin were higher thanthose of the cases with Yin-Yang syndrome,and there was significant differencebetween then in the GB values(P＜0.05).The RGB values of hypoglossal vein ofthe cases with superabundance of Yang toxin were highest among the threegroups.②The RGB values of tongue texture of the syndrome type of bloodstagnation of liver and spleen were higher than those of the others.There wassignificant difference between the two groups(P＜0.05).The B values of lipsbetween the two groups were significantly different(P＜0.05).From above it canbe said that there was relationship between the toxin including Yin toxin andYang toxin and the RGB values of complexion,lips,palm,tongue manifestation. There was relationship between the RGB values of lips,tongue texture and thesyndrome type of blood stagnation of liver and spleen.So the change of RGBvalues can be a reference target for the syndrome differentiation of chronicsevere hepatitis B.3 The scheme:To establish the scheme,which was based on the syndromedifferentiation based Yin toxin and Yang toxin,and whose guiding ideology wasthe thoughts.Therapeutic principle:It was easy to injury Yin and Yang of the cases withYin-Yang Syndrome,so it was important to remove stagnation and cut off thetrend of disease.We can take the methods of clearing away virus and removingstasis,reducing turbid matter by purging Fu organs,clearing away damp-heat,harmonizing liver,spleen and kidney.The cases with superabundance of Yangtoxin were easier to injure Qi and Yin,so it was more important to cut off thetrend of disease.We should take the methods such as clearing away heat andvirus,cooling blood and removing blood stasis,purging Fu organs,supplementing Qi and nourishing Yin.And for the same reason,the cases withsuperabundance of Yin toxin were easier to injure Yang,so this principle couldonly be an assistant,and the more important is the principle of'pull a boatupstream',such as warming Yang to reducing turbid matter,removing stasis inblood and collaterals,reducing turbid matter by purging Fu organs,warmingkidney and spleen.Prescription:1 Basic prescription:phyllanthusnirud linn 30g,trichosanthes fruit 30g,lysimachia 30g,rhizome 6g,dried rehmannia root 20g,astragalus root30g,loranthus mulberry mistletoe 30g,red stage root 20g,notoginseng 6g,prepared aconite branch-root 15g(decocted in advance for 30 minutes).2 Enemaprescription I:rhubarb 30g,magnolia bark 30g,immature bitter orange 30g,dried rehmannia root 30g,dandelion herb 30g.3 Enema prescription II:preparedaconite ranch-root 30g,dried ginger 15g,poria 30g,prepared licorice 30g,cinnamon twig 15g.The cases with Yin-Yang syndrome had the basic prescription one potionone day,which was decocted to 300ml and taken for two times.In the same time,they had the enema I every other day which dosage was 150ml in singular day,the same as the enema II in even day.The cases with superabundance of Yang toxin had the basic prescriptionwhich was added some other kind of herb to increase the function on clearingaway virus,nourishing Yin,cooling blood and removing blood stasis,whichwere dried rehmannia root(15g),red peony root(15g)and purple gromwellroot(10g).They also had the enema I every day.The cases with superabundance of Yin toxin had the basic prescriptionwhich was added some other kind of herb to increase the function on warmingyang to reduce turbid matter,which were prepared aconite branch-root(10g),cinnamon twig(15g),dried ginger(10g).They also had the enemaⅡevery day. Part three:The therapeutic effect evaluation of the principle of'truncationand inverse draft' on chronic severe hepatitis BObjective:To evaluate initially therapeutic effect on the disease accordingto the principle.Method:About 110 patients were selected and received the treatment ofTCM and western medicine or the treatment of only western medicine,toevaluate initially the effect by the comparison of effective rate,frequency ofcomplication,case fatality rate and the main chemical indexes.Results and conclusion:There were total 111 patients who got treatment,among which 55 cases were in the treatment group and 56 cases in the controlgroup.1 The effect on syndrome:After one week's treatment,the integral ofsyndrome in the treatment group dropped remarkably,and the difference was allsignificant compared before treatment with after treatment(P＜0.01).After twoweek's treatment,the integral of syndrome in the control group droppedremarkably,and the difference was significant compared before treatment withafter treatment(P＜0.05).After one week's treatment,the mean integral dropped by 1.82+3.88 in thetreatment group,and-0.02+4.18 in the control group,and the difference wasremarkably significant(P＜0.05).After eight week's treatment,the mean integraldropped by 8.29+7.53 in the treatment group,and 4.41+9.64 in the control group,and the difference was remarkably significant(P＜0.05) 2 The effect on liver function:①Total bilirubin(TBIL):After two weeks'treatment TBIL of the two groups decreased remarkably.And the difference inthe treatment group was all significant compared TBIL before treatment withafter two weeks' treatment(P＜0.05),four weeks' treatment(P＜0.01)and eightweeks' treatment(P＜0.05).②Blood clotting function:in the treatment groupPTA was significant increased after treatment.And the difference between oneweek's therapy(43.6%)and pretherapy(35.0%)was significant(P＜0.01).But there is no significant difference in the control group.After one week'streatment PTA in the treatment group(43.6%)was higher remarkably than in thecontrol group(33.4%),and the difference was remarkably significant(P＜0.01).3 The effect on complications:①Hepatorenal syndrome:After therapythe incidence rate in the treatment group was remarkably lower than in thecontrol group.Four weeks' later the incidence rate in the treatment group(1 case,1.8%)was remarkably lower than in the control group(8 cases,14.3%)and thedifference was significant(P＜0.05).②Abdominal cavity infection:In the twogroups the rate of abdominal cavity infection both decreased after treatment.Inthe treatment group after eight weeks' therapy the rate(16 cases,29.1%)waslower than pre-therapy(25 cases,45.5%)and the difference was significant(P＜0.05).③The incidence rates of complications were no remarkablydifference after therapy compared with pre-therapy like hepatic encephalopathy,alimentary tract hemorrhage and electrolyte disturbances,etc in the two groups.4 The compositive effect:The effective rate(37cases,67.27%)in the treatment group was higher than in the control group(30 cases,53.57%),and thedifference between them was not significant(P＞0.05)..The case fatality rate(5cases,9.09%)in the treatment group was lower than in the control group(13cases,23.21%),and the difference between them was significant(P＜0.05).The effect in the treatment group was better than in the control group,especially in recoverying syndrome,liver function(such as TBIL,blood clottingfunction),and complications,etc.Which proved the rationality of the principle.