Professor Feng Xinghua’s Academic Thoughts About Impediment Syndrome And Clinical Alresearch On The Treatment Of Migraine With Treating Liver

By practicing with Professor Feng Xinghua, taking notes, collecting proved cases, retrieving and reading relevant literatures and books, talking and discussing with teacher, writing learning experience, I summed up Professor Feng Xinghua’s thought about impediment syndrome and explored its origin and development. Moreover, based on these thoughts and my practice, I designed a clinical trial to explore the clinical effects of "treatment from liver".1Origin and development of Professor Feng Xinghua’s thought about impediment syndromeProfessor Feng Xinghua’s thought about impediment syndrome had profound theoretical foundation and special origin.Many of these thoughts came from Huang Di’s Canon of Medicine, such as holistic view, preventive treatment of disease theory, treatment based on syndrome differentiation theory. Professor Feng thinks that heat evil, dryness evil, improper diet, emotional problems, overstrain can lead to impediment syndrome as same as wind, cold, dampness evil.Synopsis of Golden Chamber presented many kinds of impediment syndrome and explained their mechanisms. It emphasized the connection of differentiation of disease and differentiation of pattern. What’s more, it advocated treating the same disease with different methods and treating different disease with the same method. All of these had a profound influence on Professor Feng’s thoughts.Theory of Spleen and Stomach considered that spleen and stomach was the root of yuan qi, the junction of upward and downward. Professor Feng attaches great importance to spleen and stomach and often uses the method of invigorating spleen and supplementing qi.Required Readings for Medical Profession put forward the rules of treating impediment syndrome:to treat migratory arthralgia, mainly dispersing the wind plus some drugs to enrich the blood; to treat arthralgia aggravated by cold, mainly dispersing the cold plus some drugs to warm the yang; to treat damp arthralgia, mainly eliminating dampness plus some drugs to strengthen the spleen and qi. All of the above had been integrated into Professor Feng’s thoughs.A guide to clinical practice with medical record and Treatise on Differentiation and Treatment of Epidemic Febrile Diseases were the origin of clearing the heat and eliminating the dampness in Professor Feng’s thoughs.Yilin Gaicuo paid much attention to the relation between impediment syndrome and blood stasis.It recorded many prescriptions such as Shen-Tong-Zhu-Yu Decoction, Xue-Fu-Zhu-Yu Decoction and Tong-Qiao-Zhu-Yu Decoction. Some of them were often used by Professor Feng in his clinical practice.In addition, academic thoughts of Professor Lu Zhizheng, Professor Jiao Shude, Professor Zhu Liangchun, Professor Xie Haizhou, and Professor Wang Weilan had a positive impact on Professor Feng Xinghua’s thought.2Professor Feng Xinghua’s academic thoughts of treating impediment syndrome2.1Professor Feng’s ideas to etiology and pathology of impediment syndromeProfessor Feng’s new understanding to the etiology and pathogenesis of impediment syndrome:it is not only caused by feeling external evils such as wind, cold, wetness and heat, but also caused by the internal impairment of emotion, improper diet, or other diseases. Besides, he specially proposed "Bi disease treated from the liver".2.2Professor Feng’s general therapeutic methods of treating impediment syndromeAccording to the TCM theory and his own experience, treatment based on syndrome differentiation and holism are the two basic rules. The therapeutic methods which professor Feng often uses include eliminating pathogens, protecting the health qi, treating according the time, smoothing the emotion, taking care of the constitution.2.3Professor Feng’s specialty of treating impediment syndrome2.3.1Pay much attention to dampness-heat patternExcept wind, cold, dampness evil, heat and dry evil are important pathogens of impediment syndrome. Professor Feng thinks heat-dampness took a key point in disease’s development.2.3.2Treating impediment syndrome from liverProfessor Feng thinks that impediment syndrome was not only caused by exopathogens, but also by disorders of emotion and stagnation of liver qi. In addition, deficiency of liver blood, which caused by massive loss of blood and insufficient production of blood or chronic disease, can lead to impediment syndrome. So, both stagnation of liver qi and deficiency of liver blood can result in impediment syndrome.2.4Professor Feng’s experience of treating impediment syndrome2.4.1Professor Feng’s experience of treating rheumatoid arthritisCauses of rheumatoid arthritis include two pails, which are feeling external evils and weakened body resistance.Pathogenic qi obstructed in the joints is the basic reason of swollen. Exopathogens’ blocking, phlegm coagulation, blood stasis, qi damage are the pathogenesis. Dispelling the evil qi is the basic treating method. In addition, strengthen the health qi can do well to dispelling evil.Common syndromes and prescriptions:Heat-dampness obstructing syndrome:To clear the heat, disinhibit the dampness, and free the collateral vessels; Modified Simiao Wan and Xuanbi Decoction, excessive heat needs modified white tiger decoction;Cold-dampness obstructing syndrome:To disperse the cold, dispel the dampness, dispel phlegm and tree the collateral vessels; Modified decoction of Wutou Decoction and Fangji Huangqi Decoction;Turbid phlegm and blood stasis syndrome:To activate blood, dispel phlegm to free the collateral vessels; Modified Shentong Zhuyu decoction;Kidney yang deficiency syndrome:To warm the kidney yang, and eliminate the evil; Modified Bushen Zhiwang Decoction;Liver and kidney deficiency syndrome:To nourish yin, clear heat, and free the collateral vessels; Modified Zhibai Dihuang Decoction;Deficiency of qi and blood:To tonify qi and blood, eliminate the evil; Modified Bazhen Decoction.2.4.2Professor Feng’s experience of treating ankylosing spondylitis(AS)Professor Feng thinks that the cause of ankylosing spondylitis had many aspects. A lack of innate endowment, kidney deficiency, exogenous pathogens (wind, cold and dampness), irregular diet, above all of these could promote AS. Especially, kidney qi deficiency is the fundamental pathogenesis.Also, Professor Feng believes that:At the acute phase of the disease, the common pattern of heat-dampness obstructing was mainly caused by heat form excessive yang or heat from chronic stagnation.so, the primary treatment was to clear the heat and disinhibit the dampness, then tonify the kidney.Professor Feng thinks that "blood stasis" runs through all stages of this disease.To treat cold-dampness obstructing syndrome, Professor Feng often use Modified decoction of Wutou Decoction and Shenzhao Decoction; to treat heat-dampness obstructing syndrome,he often use his own prescription of Qingre Qiangji Decoction; Bushen. Qiangji Decoction is used to treat deficiency of kidney qi; Modified Shentong Zhuyu decoction is used to treat blood stasis.2.4.3Professor Feng’s experience of treating Behcet’s syndromeProfessor Feng thinks that Behcet’s syndrome is caused by dampness, heat, toxin evil, and binding of dampness-heat, toxin evil in blood, and this could be continuous.Syndrome of dampness-heat in spleen and stomach:The dampness-heat evil hits the body; then the spleen qi is blocked; then damp turbidity emerges and could transform to heat because of long-time brewing and binding; at last, the heat could transform to fire, toxin, and result in worse state. Professor Feng often uses modified Qinlian Pingwei Decoction plus white tiger decoction to clear heat and resolve toxin and to dry dampness and transform turbidity.Syndrome of liver depression and qi stagnation, spleen deficiency with exuberant dampness:this syndrome is often caused by emotional frustration, testiness. These factors could result in stagnation of liver qi, and the stagnation could transform to fire or cause spleen deficiency; then damp turbidity emerges because of spleen deficiency. Damp turbidity failing to transform could give birth to heat. Professor Feng often uses modified Danzhi Xiaoyao powder to course the liver and resolve depression, to clear heat and eliminate vexation, to fortify the spleen and disinhibit dampness.Syndrome of heat-toxin invasion to blood, and qi-blood stagnate:long-time brewing and binding of dampness-heat in the body results in qi-blood stagnation, macular and papule eruption. Professor Feng often uses modified Simiao Yongan Decoction to nourish yin and clear heat, to resolve toxin and transform macules, to activate and nourish the blood.2.4.4Professor Feng’s experience of treating Sjogren syndrome Professor Feng thinks that Sjogren syndrome is often caused by yin deficiency, dryness, toxin and stasis. Yin deficiency is the basis; whereas dryness, toxin and stasis are the developed results. Clinically, treatment should follow the rules of individualization and differentiation. Professor Feng often nourishes yin, moistens dryness, resolves toxin and transform stasis.Syndrom of lung and stomach Yin deficiency:Professor Feng woud like to nourish lung and stomach yin, clear heat and he prefers the Xuanmai Ganjie Decoction and Erzhi Wan.Syndrome of Liver and kidney yin deficiency:Professor Feng’s treatment are clearing the liver and brightening the eyes, enriching water to moistening wood. The preferred prescriptions are modified Xiao Chaihu Decoction and Erzhi Wan.Syndrome of qi and yin deficiency:Professor Feng often fortifies qi, blood, spleen and kidney. The preferred prescriptions are modified Si Junzi Decoction and Zuogui Wan.2.4.5Professor Feng’s experience of treating osteoarthritisProfessor Feng thinks that osteoarthritis is a sign of liver-kidney deficiency and aging, whereas invasion of wind, cold, dampness and trauma are the incentives of osteoarthritis. For treating the root, he supplements the liver and kidney, strengthens sinew and bone, and supplements qi and the blood; for treating the tip, he dispels wind, cold, and dampness, activates blood, frees the collaterals, and relieves the pain. Supplementing the liver and kidney is the fundamental treatment.Professor Feng stresses that the kidney deficiency can cause blood stasis, and kidney deficiency with blood stasis syndrome is often seen, clinically. Fortifying kidney and resolving stasis are effective. Knee osteoarthritis with secondary acute synovitis and joint, effusion often manifests as joint swelling, thermal pain. For the emergency, we need to treat the tip, so we should clear the heat and drain dampness firstly, and supplements the liver and kidney secondly.Professor Feng often uses Jianbu Decoction to supplement the liver and kidney, to strengthen sinew and bone strong gluten bones, to activate blood and resolve stasis. If there is synovitis with a heat-dampness obstructing syndrome, he often uses modified Simiao Wan to clear the heat and drain dampness.2.5Common used methods professor Feng’s treatment in impediment syndromeCommon used methods includes dispelling wind, cold, and dampness, clearing heat, transforming phlegm, activating the blood, regulating qi, tonifying qi, nourishing blood, nourishing yin, and warming yang.3Inheritance and development of "treating impediment syndrome from liver"Use prospective, nonrandomized queue over the same period, single blind (evaluators blind) research methods, to explore the clinical effect JIEYU ZHITONG TANG (depression-relieving and pain-stopping decoction) in treating migraine.Research object:60migraine patients who were in accordance with the inclusion criteria came from encephalopathy outpatient of Guang’anmen Hospital and neurological department outpatient of Xuanwu Hospital during March2010to September2011. The patients were divided into two groups:treatment group formed by patients of Guang’anmen Hospital and control group formed by patients of Xuanwu Hospital.Treatment:The patients in treatment group were treated by modified JIEYU ZHITONG TANG. The patients in control group were given Zolmitriptan plus Cymbalta. In acute attack, Zolmitriptan (2.5mg) was given. In paracmasis, Cymbalta (30-60mg) was given.1time per day,2months as a course.Observation indexes:Headache-Visual Analogue Scale (VAS), Migraine Disability Assessment Questionnaire (MIDAS), Migraine-Specific Quality of Life Questionnaire (MSQ), and the TCM symptoms points.Results:Contrast before and after treatment, the improvements of evaluation indexes such as the degree of headache, seizure frequency, and quality of life in treatment group all had statistical significance. The improvements of evaluation indexes in treatment group were obviously superior to the control group.Conclusions:JIEYU ZHITONG TANG used to treat migraine can improve patients’symptoms and had obtained satisfying clinical effects.