| Until today,there are three difficult issues pertaining to modern medicine handling virus infectious diseases:(1)there is no specific powerful remedy;(2)most of the antiviral drugs accompany with many side effects;(3)the efficacy of the developed vaccines and antiviral drugs expires after the viruses getting mutated.On the contrary,the Chinese materia medica(Chinese herbal medicine)has been in practice over two thousand years.It is evident from the past experience that Chinese materia medica will not suffer from the influence of the space and time.Based on the pattern identifications,the syndrome differentiations,and the treatments adopted by all the Chinese physicians,the diseases with the same pattern identification/syndrome differentiation can be treated by the same therapy. This guideline also holds good for the prophylaxis and treatment of virus infectious diseases;therefore,traditional Chinese medicine(TEN)is in the leading position pertaining to the treatment of virus infectious diseases.In the diagnosis and treatment of TCM,virus infectious diseases are classified into the category of "warm disease"(epidemic febrile diseases).The major difference between the Guilin classical edition of "Shang Han Za Bin Lun"(the Guilin classical edition of "Treatise on Cold Damage and Miscellaneous Diseases")written by the Eastern Han Dynasty physician Zhang Zhongjing and the circulating edition,"Shang Han Lun" ("Treatise on Cold Damage Diseases"),is that Volume 4 of the Guilin classical edition of "Shang Han Za Bin Lun" is completely devoted to the pattern/syndrome identifications and treatments of the warm diseases.Not only this volume answers the doubts such as why Zhang Zhongjing deliberated more upon cold damages and less on warm diseases,but also it much fits in with Zhongjing's original intention.The first formula of this volume is the Xiao-Chai-Hu-Tang(Sho-Saiko-To;SST)and its variants.From the related research and clinical cures,it is found that the treatment of virus infectious diseases with Chai Hu (Radix Bupleuri)formulae is remarkable.Therefore,in this thesis,we resort to the warm disease volume of the Guilin classical edition of "Shang Han Za Bin Lun" to proceed with the research pertaining to the theories,the mechanisms,and the applications of the treatment of virus infectious diseases with Chai Hu formulae,and investigate how TCM osculates and is in line with modern virology in order to develop the advantage of TCM over the treatment of virus infectious diseases.MethodsIn this thesis,we rest on the theories elaborated in the Guilin classical edition of "Shang Han Za Bin Lun".Accordingly,we first investigate its origin,issuing,and textual criticism in the first part of Chapter 1.We then study the relations between the warm diseases and virus infectious diseases based on the warm disease volume of the Guilin classical edition of "Shang Han Za Bin Lun" in the second part of the same chapter,in which we follow the seminal research to derive the theory of using Chai Hu formulae as the remedy for virus infectious diseases,and deduce the two corresponding mechanisms of pharmacodynamics:"expelling the pathogen" and "dispelling the syndrome due to the Latent Qi"(i.e.,the incubative pathogen).Next,we get acquainted with viruses,specifically the ones of influenza that frequently causes people getting sick,and the ones of avian flu which is currently drawing a great deal of attention in the world wide,by means of briefly introducing the molecular virology in the first part of Chapter 2.In the second part of Chapter 2,we first investigate the physiological and pathological viewpoints of TCM.We then study the transmission and transmutation path along the meridian vessels,and proceed with the related research pertaining to the virus infections and the corresponding pattern identifications,syndrome differentiations,and treatments used by TCM.Next,in Chapter 3, we start exploring the current research on applying Chai Hu formulae to treat virus infectious diseases.We then overview and summarize the results and conclusions revealed from those literatures that modern physicians make use of Chai Hu formulae to treat virus infectious diseases,in order to prove and validate that formulae usage mainly based upon thai Hu to handle virus infectious diseases is worth popularizing greatly.In Chapter 4,we propose the therapies with Chai Hu formulae in accordance with the transmission path of sensation of viruses to treat virus infectious diseases;we then practice these therapies in different phases in the actual clinical cures to test and verify their outstanding effectiveness. Further,in Chapter 5,we compare and discuss the common and different parts of the treatments of virus infectious diseases in fundamental theories and the corresponding therapies between Chai Hu formulae and the ones following the warm pathogen disease study during Ming and Qin Dynasties.We then can speculate that Chai Hu formulae based on the theory from the Guilin classical edition of"Shang Han Za Bin Lun" is corresponding to and in line with the anatomy and pathology of modern medicine.When comes to the integration of TCM and modern medicine,our speculations and deduction are beneficial to TCM and modern medicine in communicating to each other.Results1.The start of circulation of the Guilin classical edition of"Shang Han Za Bin Lun" is during the end of Qin dynasties and the beginning of the republics by Zhongjing's descendants.It gives rise to a rage of query and debating regarding its trueness.Although some physicians believe that it is an imitation by the posterity,they still acknowledge the effectiveness and usage of the formulae depicted inside the book and its significance to the research and development of the medical science.Some related research addressed that through this writing,the early interpretation and development of the warm disease study could be understood.This classic edition also overthrows the parlance that Zhongjing's school of thought excludes the diagnoses and treatments of warm diseases.As a whole,the trueness of the Guilin classical edition of "Shang Han Za Bin Lun" is a research issue belonged to the workers of cultural heritage.From the viewpoints of clinicians,we should not overlook and neglect its practicality and academic values,as long as the book elaborates accurately.Both the cold damages and warm diseases are the exogenous febrile diseases that will lead to the raise of body temperature;nevertheless;they are greatly different in the essence. Taking the fever as the example,cold damages makethe body temperature raised through the meridians;on the other hand,the fever procured by warm diseases is because that the syndromes due to Latent Qi induce the onset of warm diseases and makes the body temperature high.The fever induced by the Latent Qi is more serious than that of cold damages.In a narrow sense,the "cold evil" and "wind evil" that induce the cold damage are the physical "wind" and "cold";while the evil of the warm diseases is a kind of living creature with specific biological structure.Because the incubation period of bacteria is seldom longer than one season,the evil of the warm diseases should be viruses. Consequently,the "warm disease" is equivalent to the "virus infectious disease" and the "pestilence" means the "pandemic disease" such as the Spanish flu in 1918.In this thesis,we validate and confirm our speculations that using Chai Hu formulae to expel the pathogens and dispel the syndromes due to Latent Qi is a significant therapy for virus infectious diseases,majorly based upon the warm disease volume in Guilin classical edition of "Shang Han Za Bin Lun" and following many research literature regarding the treatments of virus infectious diseases with the integration of TCM and modern medicine.2.Virus is a kind of creature that has been existing from the ancient periods.Due to the development of modern molecular virology,we can understand it more and more. However,there are still a lot of bottlenecks in the prophylaxis and treatment due to its high variability.It takes a large amount of manpower and material resources for modern medicine to develop the antiviral drugs and vaccines;nevertheless,they usually accompany many side effects.Furthermore,when the viruses get adapted to those medicines,they will mutate and make the efficacy of those drugs and vaccines expired.This results in the catastrophe that the development of vaccines always falls behind the prevalence of the virus infectious diseases.On the contrary,Chinese materia medica has been over more than one thousand and eight hundred years,ever since the advent of Zhongjing's "Shang Han Za Bin Lun".The diagnoses and treatments of warm diseases with Chai Hu formulae still can be applied to the modern virus infectious diseases.There is no such efficacy expired problem due to the mutation of viruses.Meanwhile,under the principles of pattern identification/syndrome differentiation and treatment,there is no side effect,either.By means of understanding the modern virology,we can understand the transmission and transmutation path of viruses now,which let us render the administration of Chai Hu formulae with "flavor of medicinals" and "nature of medicinals" in accordance with the "location of disease" and the "nature of disease".For the virus infectious diseases which are the troublesome and headachy problems to modern medicine,it is much worth popularizing.3.It is manifested in modern research literature that a lot of the physicians have adopted the formulae containing Chai Hu to treat various kinds of virus infectious disease, and all of them can obtain good curative effects.These researches have proved the theory indirectly,that Chai Hu can be used to expel the pathogens.At the same time,from those results,it is good enough for us to speculate and infer that we don't have to differentiate the kind of virus when we utilize the Chai Hu formulae to expel the pathogens.This therapy can be applied to any virus infectious disease,provided that they exhibit the same pattern identification and syndrome differentiation.Nevertheless,there are two things to be noted. Firstly,the virus infectious diseases are equivalent to the warm diseases in TCM.In addition to the severe and acute induced heat,there are other syndromes such as the body fluid(the so called "Yin" in TCM)consumed by the induced pathogenic heat and become dry,and that of invading the blood aspect(i.e.,invading the deepest stratum of the body involved in the severest stage of an acute febrile disease),also called "warm disease induced by Latent Qi".Consequently,in addition to introducing the specific Chai Hu formulae according to the intrusion positions of the virus to expel the pathogen,the induced pathogenic heat,dryness,and stasis must also be manipulated at the same time,namely, dispelling the syndrome due to Latent Qi.With the approach of introducing the specific Chai Hu formulae to expel the pathogen and with that of dispelling the syndrome due to Latent Qi,the whole therapy is complete.Secondly,Zhongjing's Chai Hu formulae differ from each other,according to the transmission and transmutation paths of the virus.There are different treatments with different strata and hierarchy.By knowing well the "location of disease" and the "nature of the disease",and then rendering the treatments with the corresponding "flavor of medicinals" and "nature of medicinals",accordingly,the effects of the treatment will be more conspicuous and remarkable.4.To treat the virus infectious diseases under the two pharmacodynamic mechanisms, i.e.,"expelling the pathogen" and "dispelling the syndrome due to Latent Qi",we must first understand thoroughly the body substance and constitution of the patients and the transmission and transmutation paths of the virus.Next,we should firmly determine the locations and nature of the diseases.After that,we adopt the Chai Hu formulae with the corresponding flavor and nature of medicinals to handle the virus infectious diseases, accordingly.Taking flu as an example,the flu viruses invade the pharynx and the throat first.Next,they transmit and transmute along the Shao Yang(Lesser Yang)Meridian. Finally,they go deep into the Zang-Fu(viscera and bowels)to induce the body pathological changes.Therefore,the process of the treatment should be divided into different phases, each using respective Chai Hu formulae.Often,such procedure can obtain significant curative effects in clinical treatments.5.Both the origins of theory of the warm diseases depicted in the Guilin classical edition of "Shang Han Za Bin Lun" and that of illustrated in the schools of thought of the warm diseases during Ming and Qin Dynasties come from the "Huangdi Neijing"(the "Huangdi's Internal Classic")and the "Nan Jing"(the "Classic of Difficult Issues"). Nevertheless,due to the lack of the diagnosis and the treatment of warm diseases in the circulating edition of "Shang Han Lun",the results of the clinical treatment of warm diseases are not easily seen.Consequently,under the frameworks and the structures of the "Nan Jing" and the "Shang Han Lun",the schools of thought of the warm diseases during Ming and Qin Dynasties evolved gradually.Both the warm diseases depicted in the Guilin classical edition of "Shang Han Za Bin Lun" and the schools of thought of the warm diseases during Ming and Qin Dynasties point out the differences between the occurrences of the warm diseases and the cold damages.This is the reason why Zhang Zhongjing composed the warm diseases in an independent volume.However,no specific literature explicitly depicts the evil factors(pathogens)invading from the mouth and the nose,until the one written by Wu YouKe(a.k.a.Wu Youxing)at the end of Ming Dynasty.Aiming at the characteristics of warm diseases such as the heavier fever,easily consuming the body fluid and then turning body into dryness,and that of invading the blood aspect,etc.,both of the theories follow the principles of "reducing heat","increasing body fluid',,and "making up the deficiency" to treat the virus infectious diseases.The major difference between the two doctrines is that with respect to the transmission and transmutation path,the speculations of transmission and transmutation illustrated in the Guilin classical edition of "Shang Han Za Bin Lun" match with TCM theories in anatomy and physiology,more.The depicted clinical symptoms,inspecting,and testing in the Guilin classical edition of "Shang Han Za Bin Lun" are able to correspond with the theories of modern medicine in anatomy and pathology.This is beneficial to the communications between TCM and modern medicine for the treatments with integration of TCM and modern medicine.On the other hand,the representatives of the schools of thought of the warm diseases during Ming and Qin Dynasties are the "Defense,Qi,Nutrient and Blood Pattern Identification/Syndrome Differentiation" proposed by Ye Tianshi(a.k.a. Ye Gui)and the "Triple Energizer Pattern Identification/Syndrome Differentiation" proclaimed by Wu Ju Tong(a.k.a.Wu Tang).However,both advocates are not easy to be integrated and matched with the modern medicine in anatomy and pathology.Hence,there is no common language between these advocates and the modern medicine.Consequently, it is difficult to achieve the common consensus and the integration with the modern medicine for treatments of the virus infectious diseases.The various kinds of Chai Hu formulae proposed in this thesis obey the principles of the two pharmacodynamic mechanisms,i.e.,"expelling the pathogen" and "dispelling the syndrome due to Latent Qi",and follow the criterion of prescribing the formulae of different disease locations and nature according to the corresponding virus invading and transmuting paths.Therefore,the treatment procedures are clear and complete,and the clinical curative effects are prominent.Because Chai Hu formulae do not aim to treat single or any specific virus,they not only can be used to treat the general kinds of influenza,but also hold good for the prophylaxis and treatment of the worldwide epidemics that may be procured by H5N1 viruses.Furthermore,because the speculations of transmission and transmutation path can correspond with the theories of modern medicine in anatomy and pathology,it will be beneficial to the communications between TCM and the modern medicine and will have more opportunities to develop the advantages of TCM over the treatments with the integration of TCM and the modern medicine for the virus infectious diseases.ConclusionsThe virus infectious disease is a tough question to the modern medicine;TCM,on the other hand,has greater advantages over this issue.To deal with the ever-changing viruses, simply follow the criteria and guidelines of the pattern identification/syndrome differentiation and treatment of TCM to prescribe the formulae with "flavor of medicinals" and "nature of medicinals" according to the corresponding "location of disease" and "nature of disease";we then could obtain the conspicuous and remarkable curative effects without paying any attention to how the viruses mutate,not to mention the catastrophe that the development of vaccines always falls behind the prevalence of the virus infectious diseases.In general,Chinese materia medica has no poisonous side effect.Taking "Chai Hu formula" as an example,it has been over more than one thousand and eight hundred years, ever since the advent of Zhongjing's "Shang Han Za Bin Lun" and the clinical utilization rate and curative effects of Chai Hu formulae are still high and remarkable.Chai Hu formulae do not have any issue of drug resistance and do not aim at treating any particular virus.For various ever-changing virus infectious diseases,Chai Hu formulae can greatly simplify the developments of the drugs and vaccines.Over the prophylaxis and treatment of virus infectious diseases,it is worth developing and popularizing the Chai Hu formulae.In addition,facing the tougher and tougher virus infectious diseases,the treatments with the integration of TCM and the modern medicine is an inevitable trend.The declarations and definitions of the virus transmission and transmutation path must be clear and acceptable to the both sides;then it could be beneficial to the communications between each other,and achieve the common consensus of the treatment with the integration of TCM and the modern medicine.In this thesis,we rest on the doctrines illustrated in the Guilin classical edition of "Shang Han Za Bin Lun" and propose that under the treating principles of the two pharmacodynamic mechanisms,i.e.,"expelling the pathogen" and "dispelling the syndrome due to Latent Qi",we must firmly determine the locations and nature of virus infectious diseases and then adopt the Chai Hu formulae with the corresponding flavor and nature of medicinals to handle them according to their transmission and transmutation paths. We then proceed with the investigations and research of the clinical applications.We have shown that not only the theory and formulae are highly feasible,but also the speculations of transmission and transmutation path can correspond with the theories of modern medicine in anatomy and pathology.This will be beneficial to the communications between TCM and the modern medicine,and will be helpful to the treatments with the integration of TCM and modern medicine for the virus infectious diseases.At last,the work in this thesis is still pretty rough and could elaborate the theory of the warm diseases depicted in the "Shang Han Za Bin Lun" quite a little.We wish that what we done in this thesis accounts for a modest spur to induce others to come forward with valuable contributions.So that,more and more physicians could get acquainted with the diagnoses and treatments of the warm disease advocated by Zhongjing,and then they can devote themselves to elaborating the theory and the clinical practice.On one hand,this could elucidate and clarify the theory more;on the other hand,by understanding more upon the correspondences between the "location of disease",the "nature of disease" and the "flavor of medicinals","nature of disease",not only we can apply this practice to treat various virus infectious diseases at the outpatient services,but also we can apply the work to other clinical diseases.Furthermore,this work can also get the instant treatment effect for the acute and emergent diseases,and can alleviate the ailment and illness of the patients and rescue the imminent fatal danger in a short instant,as well.This should be the Zhongjing's original intention and expectation to compose the "Shang Han Za Bin Lun". This is also the responsibility that we,the TCM physicians,should take over and then enhance the glory.
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