| Summary of academic thoughts and clinical experience of Professor Zhang Binghou.Professor Zhang Binghou, MD, PhD supervisor, is one of the inheriting teachers of state traditional Chinese medicine inheritance work. Since fancy of traditional Chinese medicine, he assiduously studied the TCM, read and got familiar with all ancient Chinese medical classics and modern medical literatures. After 50 years’work in the clinic, he has laid a solid theoretical foundation of traditional Chinese medicine and accumulated rich clinical experience. Having inherited the essence of the TCM, he has created the new perspective of the TCM. He who has taken the theory of Zang-fu organs as his core syndrome differentiation and treatment system has gradually formed his unique mehthods of syndrome differentiation and treatment. His characteristic viewpoint on the treatment principle is the proposal that "nurturing the vital qi by catering to its property, strengthening the vital qi to ensure its natural property ". He writes out not complex but simple herb prescriptions for patients, excels in using similar functional herb prescriptions and often selects original effective herb prescriptions for them. His application of herbs is of orderly monarch, minister, assistant and guide. He is well in using herbs activating blood circulation and removing sputum, especially Chinese insect drugs and toxic herbs. In treatment he often uses peculiar herbs which would have significant effects.Academic origin:Retrieve ancient Chinese medicine classics, analyze famous TCM doctors academic thoughts which have had a greater impact on my instructor to explore academic origin of Professor Zhang Binghou.Classical medical books:1. Some native material ism ideas of Inner Canon of Yellow Emperor have a profound impact on the academic thought formation of Professor Zhang Binghou.①the whole concept-To differentiate the disease need to review the internal and external.②To seek the root cause before treatment.③To pay attention to envoy drugs, in addition, Basic Question Ju tong Lun chapter has a great impact on his understanding pain syndrome including its etiology, pathogenesis and treatment.2. Treatise on Exogenous Febrile Diseases Theory is the first TCM classic which transcribes the etiology, pathogenesis, therapy and prescription of pain syndrom, made the history of the Chinese insect drugs therapy and laid a theoretical foundation on Professor Zhang Binghou’s treating pain syndrome in Chinese insect drugs. In addition Professor Zhang Binghou treats headache according to the method of six meridians differentiation and uses guiding medicinals. His idea of using similar functional herb prescriptions orginates from the book Cold-induced Febrile Diseases.3. Danxi’s Experiential Therapy:Yang often excessive, yin often inadequate, which initiated nourish Yin and purge fire is the theory source of tonifying kidney of Pro. Zhang, especially nourshing kidney-yin. The ideas that to treat edema is to tonify middle energizer and treat involunta is to treat dampness and heat both orginate from Zhu Danxi’s medical theory.4. Jing Yue theory:Professor Zhang Binghou worships the theory of Zhang Jingyue and thinks that Zhang Jingyue develped the theory of yin often inadequate, put forward an argument that kidney-yin is inadequate and the deficency is more than excess in human body. While treatment Pro. Zhang focuses on the method of tonifying kidney, especially nourishing kidney essence. He likes to use large doses of medication Rehmannia and turtle version. The idea that lackage of nourshing results in pain of Zhang Jingyue is the theoritical foundation of the therapeutic method that the nourshing kills pain.5. The articles of Guide to Clinical Medical Records on the pain treatment, dredging collaterals and application of Chinese insect drugs have a great impact on his treating pain syndrome.6. "Yi Chun Teng Yi":Professor Zhang Binghou refers to differential guidelines of the book that five organs all can result in cough, develops the theory and expands the application range of Doctor Fei Boxiong’s herb presription Zishengqingyangtang which were used in treating headache and trigeminal neuralgia that induced by liver wind disturbance and hyperactivity of liver-yang.senior famous TCM doctors’academic thoughts:1. Liu Duzhou:①To differentiate syndrome around the main symptom.②To use similar functional herb prescriptions in treatment.③Application of aconite.④Syndrome differentiation and treatment on menalgia.2. Zhu Shenyu:To focus on spleen and stomach and study clinical experiences of treating spleen and stomach diseases. After studying the Qi-movement theory which is on ascending, descending, out and in, Zhang proposed the theory that Following its nature means tonifying and enhancing its nature means tonifying. He has a unique insight into Doctor Shi theory on double herbs.3. Song xiangyuan:To study the method of blood circulation, the way how to excel in using Xuefuzhuyutang and the treatment of gynecological diseases. Pro. Zhang fouses on dispersing liver qi but not breaking the stagnant qi. He likes using Xiaoyaosan and Shuangweiyin prescriptions which application range was expanded.4. To Learn how to apply Xiaoqinglongtang from Doctor Wang wending and academic thought of treatment in treating sputum. A Summary of Academic Thoughts and Clinic ExperienceThe academic thoughts of Professor Zhang Binghou are summarized as follows.1. In conformity to zang-fu syndrome differentiation theory, Professor Zhang strictly follows three fundamental principles in diagnosis:inspecting both the internal and the external, tracing the etiology by syndrome differentiation, and synthesizing the four diagnostic methods. He gives special attention to five key points in syndrome differentiation:①attain an explicit and comprehensive understanding of the syndrome, and lay more stress on inquiry;②conduct differentiation based on main syndromes;③differentiate the syndrome with an eye on the process of the disease;④several syndromes play a key role in differentiation;⑤in spite of the stress on syndrome differentiation, disease identification cannot be ignored either.2. In treatment, Professor Zhang advocates the ideas "nurturing the vital qi by catering to its property", and "strengthening the vital qi to ensure its natural property". These ideas have extensive application in his eight methods of treatment, especially in the reinforcing one. He applies different tonifying medicine to cater to the natural property of vital qi in different zang-fu organ and diseased part.3. Professor Zhang lays stress on tonifying the kidney and attaches particular importance to nourish the kidney yin. He holds that "to tonify yin, one must tonify the yin resided in yang; and to tonify yang, one must tonify the yang resided in yin". He puts forward eight methods of tonifying kidney and creates analogous prescription Digui Decoction (Digui Tang) to treat disease caused by kidney deficiency.4. Grasping the key points to simplify the complex, Professor Zhang has created many analogous prescriptions and divided them into basic and modified ones. Basic prescriptions are mostly approved or self-formulated prescriptions aimed to tackle the general aspect of a disease. Modified prescriptions, however, are those aimed to tackle the individual aspect of a disease based on the identification of its specific etiology and pathogenesis. Basic prescriptions fall into three categories:the one for a permanent cure, the one for syndrome alleviation, and the one for ushering the medicine qi into its designated channel.5. Though Professor Zhang has a good command of approved prescriptions and a large variety of Chinese medicine, he is no stickler. He follows the convention of Chinese medicine but is never bound by the specific composition. In treating a disease, he modifies the approved prescription based on a profound understanding of both the mechanism of the prescription and syndrome and disease differentiation of a specific case. 6. Professor Zhang is adept at using insect medicine to alleviate pain and has earned himself a reputation as "master of pain alleviation".①Based on the idea "channel blockage giving rise to pain", he stresses the importance of dredging channels and collaterals to alleviate pain.②He applies insects, ants and other medicine with toxic and anesthetic property. The paper summarizes the dosage, couplet, compatibility, and the method of application frequently used by Professor Zhang.The paper summarizes the details of Professor Zhang Binghou’s clinic practice, appended with representative case records.1. Chronic kidney disease:①Pathogenesis of the disease is identified as deficiency in origin and excess in superficiality. The disease shows syndromes of intermingled deficiency and excess with deficiency as the main cause.②Treatment of the disease is focused on nourishing the kidney yin. Eight methods of tonifying the kidney are adopted too.③Analogous prescription Digui Decoction is applied in concert with eight methods of tonifying the kidney to treat various kidney disease.2. Stomachache:Treatment of the disease is focused on invigorating the spleen, soothing the liver, regulating the qi flow, and invigorating blood circulation. The pattern of stomachache due to weakness of the spleen and stomach is treated by using Kaiwei Jinshi Decoction; the pattern due to deficiency-cold in spleen and stomach is treated by using Shenqi Jianzhong Decoction; the pattern due to liver-spleen disharmony is treated by using Shuangwei Potion; the pattern due to liver-stomach disharmony is treated by using Jiegan Decoction together with Jinlingzi Powder, an analogous prescription, to invigorate blood circulation and alleviate pain.3. Trigeminal neuralgia:The etiology and pathogenesis of the disease is identified basically as liver-kidney yin deficiency causing upward disturbance of liver-wind. The disease may also be attributed to weakness of the spleen and stomach. The up-rising yin fire complicated by wind-fire in liver channel flows hither and thither along the channels and collaterals, attacks upward, and obstructs channels and collaterals in the head. As channel blockage gives rise to pain, treatment of the disease is focused on nourishing the liver and kidney, calming the endogenous wind, dredging the collateral, and eliminating the phlegm. Zisheng Qingyang Decoction is adopted as the main prescription and insect medicine is applied supplementarily to penetrate the bone to expel wind and dredge the channel to alleviate pain. Apart from that, insect medicine also serves the function of ushering medicine qi to its designated channel.4. Insomnia:Differentiate firstly whethezair it is deficiency or excess pattern and then identify the Zang-fu syndrome. The disease is mostly located in the heart but is closely related to the kidney, liver and spleen. Self-formulated analogous prescription, Erren Anmei Decoction is applied to treat insomnia and the therapy has been proved quite effective.5. Arrhythmias:Arrhythmias falls into four patterns:①The pattern due to dual qi-yin deficiency and malnourishment of heart channel is treated by using Zhi Gancao Decoction;②the pattern due to qi deficiency and blood stasis, and heart channel obstruction is treated by using prescription coronary six formulated by Professor Zhang;③the pattern due to devitalization of heart yang and fluid adversion attacking the heart is treated by using modified Linggui Zhugan Decoction;④the pattern due to internal attack of phlegm-heat and malnourishment of the heart spirit is treated by using modified Huanglian Wendan Decoction.6. Cough:Professor Zhang Bing-hou holds that "five zang and six fu may all give rise to cough". This paper sums up clinical manifestations of cough related to five zang organs and their relevant therapy respectively. Prescriptions frequently used by Professor Zhang are modified Xiao Qinglong Decoction for cough caused by wind-cold, modified Maxing Shigan Decoction for cough caused by heat, Qingzao Jiufei Decoction for cough caused by lung dryness, and Baihe Gujin Decoction for cough caused by lung and kidney yin deficiency.7. Fever due to internal damage:Heat by internal injury is mainly generated by fire, which is induced by excess of qi. Heat by internal injury falls into nine types, which are heat due to yin deficiency, heat due to yang deficiency, heat due to qi deficiency, stagnated heat due to food retention, stagnated heat due to phlegm and retained fluid, stagnated heat due to water and dampness, stagnated heat due to liver depression, stagnated heat due to static blood, and stagnated heat due to spleen qi. Qingshu Yiqi Decoction is used to treat heat due to qi deficiency, modified Sanshi Decoction is used to treat heat due to dampness, and modified Qinjiao Biejia Decoction is used to treat heat due to yin deficiency.8. Dysmenorrhea:The etiology and pathogenesis of gynecopathy is identified as disorder of qi and blood, dysfunction of zang-fu organs, and injuries of conception and thoroughfare vessels. The principle of treatment is regulating qi-blood flow, harmonizing the spleen and stomach, soothing the liver qi, and tonifying kidney essence. Syndrome differentiation of dysmenorrhea by means of inquiry is focused mainly on the cycle, color, quantity, and substance of menstruation.9. Chronic cholecystitis:Dampness heat in liver gallbladder is the pattern most frequently seen clinically. Self-formulated decoction, Qinggan Lidan Decoction is applied to treat chronic cholecystitis, cholelithiasis, and chronic hepatitis caused by dampness heat in liver gallbladder.10. Skin rash:Analogous prescription, Wupi Wuteng Yin, is applied to treat various skin rash as it is believed that "the skin of plant can benefit the skin of human, while the plant rattan dredges the channel of human"Study on the experience of Pro. Zhang in using insect drugsBackground:Insect drugs are part of medicinal animals. Because of its unique biological activity, it is extremely admired by ancient physicians. Pro. Zhang is good at treating pain disease and chronic kidney disease. One of his most unique clinical experiences is the treatment of pain disease using insect drugs, which is worth further studying. Through exploring the database, the paper summarizes Pro. Zhang’s academic thoughts of focusing on unblocking meridians and collaterals with insect drugs. Chronic kidney disease is featured by prolonged course and difficulty in treatment. This paper makes clinical study on it according to the TCM theory of "intruding into meridians and producing hematoma after long time of disease" and by combining insect drugs and Pro. Zhang’s experience in treating chronic nephritis.PartⅠLiterature Review:It reviews the history of insect drug development and summarizes the effect of insect drug, its pharmacological actions, such as immunoregulation, anticoagulation, inhibition and killing of microorganism, analgesia, etc. as well as various common diseases, frequently-occurring diseases, difficult miscellaneous diseases, severe and lingering illness in which insect drugs are widely used in clinical treatment.Part II Clinical Study on Treatment of Pain disease Using Insect Drugs by Pro. Zhang.Purpose:In this study, by using the structured databases to analyze the series data, collect and summarize academic experience of Pro. Zhang, systematically and comprehensively study his own experience in using insect drugs to cure pain disease, and sublimate his academic ideals.Method:Start ing with typical medical cases of Professor Zhang’s treatment for pain disease, applying the database to summarize and analyze the frequency of "drugs" and "symptoms and signs" and other TCM elements, reveal the characteristics and dialectical thinking of Pro. Zhang on insect drugs medication.Results:The database of Professor Zhang Binghou’s typical medical cases totally include 208 cases of pain disease in the top 10 diseases are Bi syndrome, headache, epigastric pain, back pain, face pain, chest pain, dysmenorrhea, abdominal pain, hypochondriac pain, sore throat, among which Bi syndrome and headache are most common. The split process involves a total of 42 syndromes and the total frequency of 498 times. It showed that the most common syndromes is blood stasis, deficiency of liver and kidney-yin, deficiency of kidney-yin, Bi syndrome by the evil of wind cold dampness, qi stagnation and blood stasis, hyperactivity of liver-yang and flaming up of excessive heat of liver. The differentiation of Zang-Fu is mainly located on the liver due to the cause of various pains belonging to the liver. Pathogenesis of pain disease often exists in stasis, evil wind (including the wind inside and outside), pathogenic cold, dampness, qi deficiency, qi stagnation, blood deficiency and yin-deficiency. Database shows the used Chinese patent or self-made prescriptions are 32 recipes and the total frequency of 231 times. The most common prescriptions are pain Sanliang San decoction, the Zisheng Qingyang decoction, peony and licorice decoction, Chuan Xiong Chatiao power decoction, Xuefu Zhuyu decoction, reinforce kidney by turtle decoction (self-made side) and so on. 314 drugs were used in the database, the total frequency of drug is 3318 times, in which most frequently used drugs are licorice, peony root, astragalus, angelica, Scorpio, Chuanxiong, Rehmannia, centipedes, blood surface, pangolins, habitat, earthworm, etc. Pain disease database uses 16 kinds of Chinese use insect drugs and the total frequency of 518 times, accounting for 15% of all drugs. Drugs commonly used include insect scorpion, centipede, pangolins, earthworm, turtle shell, leech, nosed pit viper, stiff silkworm, trogopterus dung, cicada, turtle, gecko, honeycomb, Eupolyphaga, late silkworm excrement and mole crickets. Most taste "salty and pungent". The main herb characteristic is "mild". Many herbs belong to the liver, their effectiveness are prominently displayed at relieving the pain and pass qi through meridian and collaterals, subduing hyperactivity of liver-yang to cease endogenous wind, activating blood circulation, and replenishing deficiency of liver and kidney vital energy, expelling the evil wind & dampness.51 typical cases of patients who have Bi syndrome have been collected into the database of pain disease of Pro. Zhang. Among them there are 38 cases of damp Bi syndrome, wherein,30 cases are meridians block, which can be treated by nourishing blood to expel wind; dredge collaterals to relieve pain, and pain Sanliang San decoction with modification is used; 8 cases are unceasingly long-term rheumatology and inner liver and spleen, which can be treated by reinforcing liver and kidney and dredging collaterals to relieve pain, and Duhuojisheng decoction with modification is used. 13 cases of rheumatism pyretic arthralgia are also divided in to two types.6 cases of them are directly affected by pathogenic heat and can be treated by clearing heat, dredging collaterals and clearing wind and dampness, and white tiger decoction added with cassia twig is used; 7 cases of them are long-term arthritis changing into rheumatism pyretic arthralgia and are treated by warming the meridians and clearing stagnated heat, and cassia twig and peony zhimu decoction with modification is used. The most frequently used drugs are:licorice, angelica, raw radix astragalis, leech, chuan xiong, dragon’s blood, Caulis Spatholobi, peony root, scorpio, pangolins, cassia twig, long-noded pit viper, radix rehmanniae praeparata, centipede, roasted ephedra, stiff silkworm, lumbricus and tortoise plastron, and eight kinds of these drugs are insects. Pro. Zhang is good at using insect drugs to treat Bi syndrome and he also prefers to use astragalus and attaches importance to use guiding drug.43 cases of patients who have headache are collected into database of pain diseases. Among them, there are 10 cases of liver yang headache, 9 cases of liver wind headache,4 cases of liver fire headache,3 cases of headache due to kidney insufficiency, 5 cases of qi deficiency, 4 cases of blood stasis headache, 2 cases of rheumatism headache,2 cases of headache due to deficiency of blood, 2 cases of headache due to deficiency of Yin and 2 cases of headache due to pathogenic wind-heat. The most commonly used prescriptions are Zisheng Qingyang Decoction and Chatiao powder Decoction. The most frequently used drugs are:licorice, scorpion, centipede, peony root, radix rehmanniae, concha haliotidis, radix rehmanniae preparata, uncaria, Chuanxiong, raw radix astragalis, gastrodia elata, radix ophiopogon japonicus, chrysanthemum, cassia obtusifolia, bamboo shavings, pinellia ternata, fructus viticis, Chinese angelica, stiff silkworm, long-noded pit viper, etc. Pro. Zhang originality uses Chuan Xiong Chatiao decoction in treating various types of headaches including headaches caused by external infection and internal damage.Conclusion:Through exploring the database, it is concluded that Pro. Zhang attaches importance to the meridians activation method when treating the pain syndrome, especially his academic thought of unblocking meridians and collaterals with insect drugs. He prefers taking the simple prescription for patients instead of the complex, and is skilled in using similar functional prescriptions. He also thought that various pains can be attributed to liver, and talked about the academic features of pain syndrome from liver. At the same time, Pro. Zhang concluded and analyzed the prescriptions and drugs commonly used for curing pain disease.PartⅢClinical Observation of Applying Insect Drugs to Cure Chronic Nephritic Proteinuria Purpose:Observe the curative effect and safety of taking insect drugs to match up the prescription of Pro. Zhang in curing chronic glomerulonephritis proteinuria.Method:Divide the 64 patients to control group and treatment group at random. Control group:dialectical treatment by using the experience prescription of flavored kidney tonifying and dampness decoction of Pro. Zhang. Treatment group: based on the above treatment, add turtle shell 15-30g, periostracum cicada 15-20g, stiff silkworm 6-20g, leech 3-6g, scorpio 3-6g, lumbricus 15-30g and pangolin 6g. Treat the two groups for 8 weeks respectively. Observe the change of safety indexes such as two groups of traditional Chinese symptom score,24h proteinuria and liver and kidney function.Result:After treatment, the symptom scores of two groups all drop compared with that before treatment, but there is statistics difference. However, there is no statistics meaning for the comparison between two groups after treatment. After treatment, the 24h proteinuria of both two groups all drop compared with that before treatment and there is statistics significance; the drop of proteinuria of treatment group after treatment is more obvious, and there is statistics significance compared with the difference of control group. During treatment, the vital signs of two groups of patients are stable; reexamination shows that the regular functions of blood, urine and defecate and functions of liver and kidney are stable; compared with the conditions before treatment, the electrocardiogram and abdominal ultrasound have no obvious dynamic change.Conclusion:The experience prescription of Pro. Zhang can obviously improve the symptoms of chronic nephritis patients, and matching up with insect drugs can more effectively lessen the proteinuria. This method is quite good.Propose new opinions:1. Through summarizing the academic thoughts of Pro. Zhang applying insect drugs meridians to unblock meridians in treating pain disease, obvious curative effect can be obtained by applying the insect drugs in new fields and dynamically integrating it with the experience of Mr. Zhang in treating chronic nephritis and chronic nephritic proteinuria.2. Pointed out the difference between the treatment of promoting blood circulation and dredge collaterals, expanded the application of Chinese insect drugs and used them in treating CKD, Stroke, CHD, Type 2 DM and other common disease.3. Taking method of insect drugs:make it into powder capsules as much as possible. The main reasons are as follows:①Most insect drugs are animal albumen, so long-term boiling may reduce its bioactivity and affect the curative effect.② Save medicinal materials and avoid wasting resources.③All insect drugs have fishy smell, using it by encapsulating can lessen the peculiar smell, offer convenience for patients to take and relieve the fear of patients.4. Propose the pathogenesis of chronic nephritis proteinuria. This disease is jointly caused by insufficient congenital endowment (the root) and acquired impairment to spleen and kidney, dampness-heat and stasis of blood, etc.5. reating CGN with Treatment by Regulating Kidney:I think kidney collaterals injury lied in the early stage of CGN. Early intervention with the corresponding treatment before clinical symptoms appearing can block the progress of the disease, prevent the patients from ESRD.6. Application of Chinese insect drugs in treating CGN:Chinese insect drugs can reduce the proteinuria effectively and be applied in treating CKD. As we used them, we should pay attention to combining the treatment with the disease differentiation at different stages and the drug security. |
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