Professor Lin Dan’s Academic Thoughts And Experiences Summary And The Study Of Erhong Lipid-lowering Soup In The Treatment Of Non-alcoholic Fatty Liver Disease

ProfLIN Dan, one of Hainan Province Famed Doctors of TCM, advisor of TCM Lineage Class (State Administration of TCM PR China). Being engaged in teaching and clinical field, she works in the Department of traditional Chinese medicine of the Affiliated Hospital of Hainan Medical Universityfor more than 30 years. Apart from having profound theoretical knowledge, rich clinical experience, superb medical skills, she has noble medical ethics, being strict with her work but nice with other people. No doubt, she is a good example for people to follow.During the three years of learning from professor Lin Dan in clinical field, I not only benefited from the instruction of professor Lin which leaded to my academic achievement, but also I was influenced by her noble medical ethics, teaching morality and moral character. This paperwill describe the tutor’s scholarly ideas and experiences in three main parts.The first part of this paper summarizes the origin of her academic thoughts.1.Delving into traditional Chinese medicine classics, dabbling in the academic thoughts and ideas of many ancient doctors. Her academic views and the ideas of treating were originated in the traditional Chinese medicine classics such as 《the HuangdiNeijing》、《ShanghanLun》、《Synopsis of Golden Chamber》. She respects Zhang Zhongjing’s therapy with syndrome differentiation system, the same time, takes an interest inthe doctrines of Zhang Jingyue, Fu Qingzhu, Ye Tianshi, Wu Jutong, Wang Qingren and etc.2.Absorbing modern medical knowledge, innovating and developing. She is always ready to consult others modestly, exchange experiences, absorb modern medical knowledge, widely get the strengths from the modern times and contemporary famous doctors, fuse various theories. She is constantly innovating and developing in the clinical practice. In the end, her scholarly ideas and experiences were gradually formed.The second part of this paper summarizes Professor Lin Dan’s scholarly ideas and experiences.The main scholarly ideas of Professor Lin Dan were summarized through the study and clinical practice which from learning from Professor Lin Dan. Besides, I also got them from recording and arranging the medical records which she does in her regular work. Her main scholarly ideas is:1. Focusing on the holism concept, emphasizing on treatment basing on syndrome differentiation. 2. Advocating the combinationof traditional Chinese medicine and western medicine, comprehensive treatment and differentiation of disease. 3. Macroscopic and microcosmic syndrome differentiation, promotingthecombination of disease and syndrome; 4. Paying attention to protection the spleen and stomach and regulating functional activities of qi in the course of clinical treatment.5.The prescription of the drugs is not only simple, inexpensive and convenient, paying attention to preserving patients’health and aftercare of life.This study systematically summarized the 5 kinds of diseases, which is the most common diagnosis and treatment of Professor Lin Dan.This paper expounded in detail about her clinical experiences and thinking of dialectic in TCM practices, And also attached to the clinical cases1. The experiences in the diagnosis and treatment of chronic liver diseases. Chronic liver diseases are caused by deficiency of vital qi, Toxic pathogens invasion, stagnation of qi and blood-stasis obstruction.Its pathogenesis is complex, and often shown as deficient root with overdo superficial, mixture of asthenia and sthenia. Damp and heat accumulate knot, Hepatic Stagnation causing Splenic Deficiency, liver-kidney deficiency, qi stagnation and blood stasis are the common clinical syndromes of Chronic liver diseases. She considers thatthe treatmentof chronic liver diseases withClearing away Heat-Removing Damp and distant liver, stasis-and sputum-clearing is the most commonly-usedmethods. Meanwhile, warming cold-damp and tonic methods can be applied in the treatment of chronic liver diseases process flexibly. In the process of the treatment of chronic liver diseases she pays constantattention to protection of the spleen and stomach. She believes that it is reasonable to eliminate pathogens but not to damage the vital, provide yin-nourishment but not to keep the pathogens. She also emphasizes the combination of differentiation of syndrome and disease, and the application of Chinese drug pair.2. The experiences in the diagnosis and treatment ofgastralgia. Professor Lin Dan considers that the main pathogenesis of gastralgiaisgastric gas block, spleen and stomachqiactivity lifting disorders, stomach cannot manage downward transportation of food, stagnation leading to pain which is caused by exogenous pathogenic factors or Function of organs disorder. Qi-regulating principle is the most important principle of treatments of gastralgia, which should be mild tonic without retention of pathogenic factors, combining of frigotherapy and pyretotherapy, interdependence between drying and moistening, interdependence between ascending and descending. The same time, do not ignore the therapy of acid-inhibitory and correct the pain, apply themethod ofactivating blood circulation and dissipate blood stasis when the disease for a long time into the blood vessels. She considers that the method of Intergrating Chinese and Western Medicine should be applied in gastralgia, and usually combined with the physiological and pathophysiological features of the spleen and stomach disease to prescribe drugs with the changes of diseases and syndromes, whichwere based on syndrome differentiation.3. The experiences in the diagnosis and treatment ofcoughing. On diagnostic, she pays attention to the differentiation of disease, exogenous and internal injuries, the characteristics of Sputum and cough, accompanied symptoms. On therapeutic, She considers that the eliminate pathogenic method is the first therapy of the caugh caused by exopathogens, different methods are flexible used in removing phlegm, alsopay attention to the ascending and descending of qi activity, Do not forget spleen and kidney in searching for the primary cause of disease in treatment. And the paper also lists and analyzes the most common Chinese drug pairs of cough.4. The experiences in the diagnosis and treatment of depression. Qi stagnation is caused by emotional disorder, then disorder of qi and blood, Yin and Yang, maladjustment of viscera functionare its basic pathogenesis. On therapeutic, she considers that psychotherapy is the most importanttherapy. Soothing livertorelieve stagnation method is the first therapy of depression. A number of zang-fuvisceras and Qi-blood need to be treated together. Attaching great importance to improvepatients’sleep and appetite, usually from liver-qi stagnation, hepatic stagnation causing phlematic retention, lack of spirit preservation, deficiency of heart and spleen, fire excess from yin deficiency, liver-qi stagnation and blood stasisand so on syndromes to treat depression.5. The experiences in the diagnosis and treatment ofpolycystic ovarian syndrome(PCOS). The basic pathogenesis of PCOSincludes that deficiency of kidney. Spleen is the root, liver-qi stagnationis the important reason of this disease, Phlegm dampness and blood stasis are the most commonsthenia syndromes of the branch. Reinforcing kidney and spleen is the most fundamental treatment. Sthenia syndromes of the branch, such asQi stagnation, blood stasis, Phlegm dampnessand Damp-heat are treated using treatment of syndrome differentiation. She also attaches great importance to menstrual cycle therapy.Part 3 is the experimental study on the ef f i cacy and its re I evant mechan i sm of Professor Lin Dan’s empirical prescription, Erhong lipid-lowering soup, in the treatment of rat non-alcoholic fatty liver disease. ObjectiveTo develop a rat model ofnon-alcoholic fatty liver disease (NAFLD) through high-fat diet feeding, observe the effect of Professor Lin Dan’s empirical prescription, Erhong lipid-lowering soup, on general condition, liver function, blood lipid, liver fat, blood glucose, insulin resistance, leptin, oxidative stress, lipid peroxidation damage and liver histopathology in the rat model of NAFLD, and discuss the efficacy and its relevant mechanism of Erhong lipid-lowering soup in the treatment of rat non-alcoholic fatty liver disease. MethodsA total of 48 clean-grade male SD rats (140-160g) were selected and raised in a clean-grade animal experimental room. After 1 week of adaptive feeding, these rats were randomly assigned to two groups, the normal group that contained 10 rats and the high-fat group which contained 38 rats. The normal group was fed with common diet, while the high-fat group was fed with high-fat diet (84% common diet,1% cholesterol,5% yolk powder and 10% lard). After 12 weeks of modeling,2 rats from both the normal group and the high-fat group were randomly selected for HE staining of liver tissue at the end of the 12nd week, to ensure a successful modeling. The remaining rats in the high-fat group were randomly divided into 3 groups:high-fat model control group (model group, n=12), high-fat group with pioglitazone intervention (western medicine group, n=12), and high-fat group with Erhong lipid-lowering soup intervention (Chinese medicine group, n=12). These groups were still fed with high-fat diet and simultaneously administered with different medicines by gavage every morning. The western medicine group was given 3mg/kg. dpioglitazone suspension by gavage, and the Chinese medicine group was given 10ml/kg. d Erhong lipid-lowering soup apozem by gavage, where 1.54g/ml crude drugs were contained. The other rats in the normal group acted as the normal control group (normal group, n=8) and were fed with common diet as always. The normal group and the model group were also given an equal amount of distilled water by gavage. After 4 weeks of continuous gavage, blood samples were collected after 12 hours of fasting following the last feeding. The levels of alanine aminotransferase (ALT), aspartate transaminase (AST), total cholesterol (TC), triglyceride (TG), fasting blood-glucose (FBG) and fasting insulin (FINS) in serum were determined with fully automatic biochemical analyzer. Insulin resistance index was calculated with the formula (HOMA-IR)=FINSxFBG/22.5. The level of leptin in serum was determined through radio-immunoassay. Liver tissue was collected for HE staining and its alteration in pathomorphism was observed under a light microscope. Additionally,0.5g of liver tissue was cut, weighed and prepared as homogenate with ultrasonic homogenizer for detecting the level of free fatty acid (FFA), TG, superoxide dismutase (SOD) and malondialdehyde (MDA).Results1. Changes in weight, wet liver weight and liver index of each groupThe model group had significantly higher weight, wet liver weight and liver index than the normal group, showing a significant difference (P<0.05). However, the western medicine group and the Chinese medicine group had significantly lower weight, wet liver weight and liver index than the model group, showing a significant difference (P<0.05).2. Pathological changes in the liverAs a result ofobservationwithnakedeyes, the liver of the model group was swollen and soft, with a tense liver capsule and a round blunt edge. It was yellow-red alternating with gray-red and friable, with oily surface and sections. As a result of observation with a light microscope, obvious hepatocyte fatty degeneration was observed in the liver. The cells in hepaticlobule, especially in the central area of hepaticlobule, were filled with fat vacuoles. In addition, there was also inflammatory cell infiltration. The hepatocytes became swollen and round, containing loose cytoplasm and big fat droplets. Cell nucleus was pushed to one side of the cell with various degrees of edema and degeneration. These indicated a successful modeling. Distinctly relieved fatty degeneration and inflammation was found in the western medicine group and the Chinese medicine group compared with the model group, showing a significant difference (P<0.05).3. Testing results of serum markers(1) Blood lipid:Compared with the levels of TC and TG in the normal group, they increased significantly in the model group (P< 0.01). In contrast, the levels of TC and TG in the western medicine group and the Chinese medicine group were significantly reduced compared wi th that in the model group (P<0.05). Moreover, the Chinese medicine group apparently had a better efficacy in lowering TC level than the western medicine group (P<0.05).(2) Liver function:The levels of ALT and AST in the model group increased significantly compared with that in the normal group (P< 0.01). In contrast, the levels of ALT and AST in the western medicine group and the Chinese medicine group were significantly reducedcompared with that in the model group (P<0.05). Moreover, the Chinese medicine group had a distinctly better efficacy in lowering ALT level than the western medicine group (P<0.05).(3) Fasting blood-glucose:Blood-glucose level in the model group was higher than that in the normal group, showing a significant difference (P<0.01); However, blood-glucose levels in the western medicine group and the Chinese medicine group were lower than that in the model group, showing a significant difference (P<0.05).(4) Insulin:The model group had significantly higher insulin level than the normal group, showing a significant difference (P<0.05); However, the western medicine group and the Chinese medicine group had significantly lower insulin level than the model group, showing a significant difference (P<0.05).(5) Insulin resistance (IR) index:Compared with the IR index in the normal group, it increased significantly in the model group (P< 0.01); However, the IR index in the western medicine group and the Chinese medicine group were significantly reduced compared with that in the model group (P<0.01).(6) Leptin:Leptin level in the model group increased significantly compared with that in the normal group (P< 0.01); In contrast, leptin levels in the western medicine group and the Chinese medicine group were significantly reduced compared with that in the model group (P<0.05).4. Testing results of FFA, TG, MDA and SOD in the liver tissueThe levels of FFA, TG and MDA in the model group increased significantly (P< 0.01), while SOD level decreased significantly (P< 0.01), compared with that in the normal group. In contrast, the levels of FFA, TG and MDA in the western medicine group and the Chinese medicine group decreased significantly (P< 0.05), while SOD level increased significantly (P< 0.05), compared with that in the model group. Additionally, the Chinese medicine group had a distinctly better efficacy in lowering the level of FFA and TG than the western medicine group (P<0.05).Conclusions1. Erhong lipid-lowering soup is capable of losing weight and wet liver weight of rats with NAFLD, improving hepatomegaly and its histopathology. It has an effect of losing weight, and achievestherapeutic effect through losing weight and relieving visceral obesity.2. Erhong lipid-lowering soup is capable of reducing serum transaminase level in rats with NAFLD, improving liver function and protecting hepatocytes from damage.3. Erhong lipid-lowering soup is capable of reducing blood lipid, inhibiting accumulationofliverlipids and regulating lipid metabolism in rats with NAFLD.4. Erhong lipid-lowering soup is capable of reducing the expression of serum leptin, contributing to improve leptin resistance and relieving liver fatty degeneration in rats with NAFLD.5. Erhong lipid-lowering soup is capable of reducing blood glucose and serum insulin, improving IR and stopping the progression of NAFLD effectively in rats with NAFLD.6. Erhong lipid-lowering soup is capable of enhancing the activity of serum SOD, lowering MDA level, improving anti-oxidative ability, reducing oxidative stress injury and protecting lipids from peroxidation, and thus prevents inflammation and necrosis as well as fibrosis progress in rats with NAFLD.