| ObjectiveTo systematically summarize and explore the academic ideas and experience of Professor Liu Dong-han differentiating and treating lung system diseases and introduce the clinical research of draining lung and supplementing heart formula treating chronic pulmonary heart disease. To provide academic experience of Chinese Medicine for the differentiation and treatment of lung system diseases, by inheriting and subliming Professor Liu’s academic ideas.MethodsBasing on records of the clinical experiences and teaching of professor Liu. combining the articles and books professor Liu published, and conferring to the academic ideas of other doctors, this study is constructed in the following five aspects:review of integrative medicine treating chronic pulmonary heart disease, professor Liu’s academic background, professor Liu’s academic viewpoint and features differentiating and treating lung system diseases and patterns, professor Liu’s clinical experience treating chronic pulmonary disease like chronic cough, bronchial asthma, chronic obstructive pulmonary disease, interstitial lung diseases and lung cancer, and clinical observation and exploration of the effects of draining lung and supplementing heart formula treating patients of chronic pulmonary heart disease.In part one, review of chronic pulmonary heart disease, the literatures were summarized and analyzed in the perspectives of mechanism and treatments of both western and Chinese medicine. In part two, professor Liu’s academic background was introduced. In part three, professor Liu’s academic viewpoint and features differentiating and treating lung system diseases and patterns were summarized and explored in the aspects of pathogenic factor, differentiation and treatment thoughts, treatment and prevention. In part four, professor Liu’s clinical experience treating chronic pulmonary disease like chronic cough, bronchial asthma, chronic obstructive pulmonary disease, interstitial lung diseases and lung cancer were summarized and explored. In part five, a randomized controlled trial was adopted to observe the effects of draining lung and supplementing heart formula treating patients of chronic pulmonary heart disease in the decompensation stage. The main parameters were Traditional Chinese Medicine syndrome integral, mMRC questionnaire, blood gas parameter, blood coagulation parameter, NT-proBNP, tei index of the right heart. The safety was also evaluated by the liver and kidney functions. Randomly divide 80 patients of chronic pulmonary heart disease into two groups,40 cases in each group. Regular standard treatments were given to patients of both groups. When there was an acute outbreak, the plan in the 7th Internal Medicine was adopted, the onset time, cause, outbreak situation and treatment duration should be recorded. Besides the regular standard treatments, patients in the treatment group were given decoction of draining lung and supplementing heart formula, one preparation a day,400 ml of decoction should be drank up warmly in three times. The treatment duration was 2 weeks. Before and after the treatments, changes of the parameters Traditional Chinese Medicine syndrome integral, mMRC questionnaire, blood gas parameter, blood coagulation parameter, NT-proBNP, right heart tei index were recorded in both groups for clinical effect analysis. The safety was also evaluated by the liver and kidney functions.ResultIn part two, professor Liu’s academic background was introduced in the following aspects.1 Family inheritance from his father since a child Professor Liu Dong-han’s father, Mr Liu Jing-quan, was characterized in the following aspects:(1) Deep understanding of the classics. Influenced by his father, taking Huangdi’s Internal Classic as the theoretic foundation and Treatise on Cold Damage Diseases as the clinical practice guide, Professor Liu Dong-han learned many medical theories and had a deep understanding of the four famous doctors’theories of Jin and Yuan dynasties and doctor Zhang Jie-bin. He emphasizes a lot in the theories of doctor Zhang Yuan-su and doctor Li Dong-yuan, which are currently guiding his clinical practices. (2) Integration of Chinese and Western medicine in the clinic. Deeply influenced by Tang Rong-chun and Zhang Xi-chun, Professor Liu Dong-han takes the western medicine diagnosis as the basis and Chinese medicine pattern differentiation and treatment as the principle. He determines the treating principle and prescription on the precondition of both Chinese medicine pattern differentiation and treatment and western medicine diseases differentiation and treatment, which gives promising clinical effects. (3) Flexible prescription. Despite of the variety of prescription modification. Professor Liu Dong-han sticks to the essence of accurate pattern differentiation. (4) Emphasizing in the spleen-stomach. Professor Liu Dong-han emphasizes in the acquired foundation spleen-stomach, especially when he is treating internal trauma diseases. (5) Emphasizing in traditional culture. Professor Liu Dong-han emphasizes traditional cultures like daoism, confucianism and buddhism.2 Deriving from the classics and conferring to various theories Professor Liu Dong-han considers Huangdi’s Internal Classic, Treatise on Cold Damage Diseases and Treatise on spleen and stomach as the origin of Chinese Medicine theory, thinks highly of the importance of Chinese medicine classics, and he also confers to many other theories to guide clinical practices.3 Rooted in the traditional cultures Chinese medicine is rooted from the traditional Chinese cultures, the cores of which are confucianism, buddhism and daoism. Golden mean of confucianism led to the’harmony’treating principle of Chinese medicine. Benevolence moral concepts of confucianism and mercy tenet of buddhism deeply influenced the benevolence medical moral concepts. Many of the basic Chinese medicine treating principles, like tranquilized mind, treating disease before its onset, treating disease on the root, reaching the balance, adjusting yin and yang, conforming to the season and time, are closely related to daoism. Rooted in the traditional cultures, Professor Liu Dong-han says,’Medicine is a combination of yin-yang differentiation of daoism, golden mean and harmony of confucianism and great mercy and kindness of buddhism. It’s impossible to be a great doctor with absence of any of the three.’4 Keeping pace with the time, taking Chinese and western medicine equally in the clinic Influenced by his father Mr Liu Jing-quan, Professor Liu Dong-han advocates ’integration of Chinese and Western medicine’. He thinks that both Chinese and western medicine have their own characteristics and superiorities, and we should take Chinese and western medicine equally in the clinic for complementary advantage.In part 3, professor Liu’s academic viewpoint and features differentiating and treating lung system diseases and patterns were summarized and explored in the following aspects.1 Taking’turbidity and toxin invading the lung’as the pathogenic factor. Basing on the reality of tobacco spreading in the current society and frequent fog and haze, Professor Liu Dong-han classifies the pathogenic factors as’turbidity and toxin’. He thinks that ’turbidity and toxin invading the lung’is the main pathogenic factor causing the occurrence and development of the lung system diseases and patterns. Turbidity is of yin property and toxin is of yang property, yet they are closely related and always mixed in the same disease. On the treatment aspect, it’s important to identify the main pathogen before the treatment. For patients of mainly toxin invasion,’clearing heat and removing toxin’method should be used and’draining dampness and eliminating turbid’as the complementary method, and vice versa.2 Differentiation and treatment thoughts emphasizing the combination of diseases and patterns. In Chinese medicine, there are’disease differentiation and treatment’and’pattern differentiation and treatment’ In western medicine, there are’disease differentiation and treatment’and’symptomatic treatment’. Professor Liu Dong-han thinks that the’disease differentiation’of western medicine is better than Chinese medicine, while the’pattern differentiation and treatment’ of Chinese medicine is better than’symptomatic treatment’of western medicine. Therefore, the combination of’disease differentiation’of western medicine and’pattern differentiation’of Chinese medicine will avoid misdiagnosis and mistreatment, and improves the clinical therapeutic effects.3 Adjusting spleen and stomach while differentiating and treating lung diseases. Professor Liu Dong-han approves that the concept of’stomach’in Chinese Medicine field covers the stomach, large intestine and small intestine. As the lung connects with the spleen and stomach through the channels, they support each other physiologically and influence each other pathologically. In the clinics, Professor Liu Dong-han attaches importance to spleen and stomach adjustment while treating lung diseases. Here are some examples:(1) purificating the lung to relieve cough by harmonizing and descending stomach qi; (2) drying dampness and resolving phlegm to cut off the root of cough and dyspnea; (3) invigorating spleen to supplement lung, namely banking up earth to generate metal:(4) nourishing yin and benefiting stomach for promoting fluid production to moisten lung; (5) avoiding bitter and cold medicines to prevent damage to the spleen and stomach.4 Referring to’collateral disease theory’for chronic lung diseases. The core ideology of’collateral disease theory’is’prolonged diseases involving collaterals and blood’. Professor Liu Dong-han thinks that, lung being delicate zang-organ of abundant blood collaterals, common lung system diseases, such as chronic obstructive pulmonary disease, bronchial asthma, interstitial pneumonia, lung cancer, are prone to be prolonged and recurrent, which always involves collaterals and blood. The use of’dredging collateral’ method treating chronic lung system diseases showed promising effects. Here are some specific methods: (1) benefiting and moving qi to dredge collateral; (2) activating blood and resolving stasis to dredge collateral; (3) resolving phlegm and removing dampness to dredge collateral; (4) nourishing yin and clearing lung to dredge collateral; (5) avoiding bitter and cold medicines to prevent damage to the spleen and stomach. Some of the worm herbs are also chosen to soften hardness and dissipate mass, dispel wind and dredge collateral.5 Prolonged lung diseases involve the heart. In the idea of professor Liu, prolonged lung diseases would involve the heart, and the relationship between the lung and heart is also the relationship between qi and blood, hence the lung should be treated together with the heart and qi together with blood.6Taking the idea of’treating disease before its onset’ as a guide of clinical practice. Professor Liu Dong-han thinks that, the Chinese medicine concept of’treating disease before its onset’is the idea of’prevention’:prevention of the occurrence before ward, prevention of the aggravation afterward, and prevention of the relapse in the stable state. The usage of the idea of’treating disease before its onset’as a guide through the whole course of lung system disease plays a significant role in preventing the occurrence, development and aggravation of the diseases.In part four, professor Liu’s clinical experience treating chronic pulmonary diseases were summarized and explored mainly about the following disease.1 chronic cough. The most common causes of chronic cough are Upper Airway Cough Syndrome (UACS). Cough Variant Asthma (CVA). gastroesophageal reflux couqh (GERC) and post Infectious Cough (PIC). (1) Cough Variant Asthma. The cause and mechanism of the disease is zang-fu deficiency and wind invading lung. CVA should be treated differently in different stage:in the acute stage, basing on the wind pathogen, dispelling wind and relieving spasm and coughing method should be used; in the recovery stage, supplementing lung, and invigorating spleen and kidney method should be used. (2) gastroesophageal reflux cough. The cause and mechanism of the disease is prolonged stomach disease, earth stagnation and wood depression, liver-stomach disharmony, disorder of qi movement and lung qi ascending counterflow. It should be treated with the methods of soothing liver and harmonizing stomach, descending adverse qi and inhibiting gastric acid, purifying lung and relieving cough. (3) Upper Airway Cough Syndrome. When the location of the disease is in the nose, the cause and mechanism of the disease is ’wind invading nose, nose obstruction and lung qi failing in ventilating and purification’ It should be treated with the methods of dispersing wind, dissipating pathogens and relieving stuffy orifices, resolving phlegm, ventilating lung and relieving cough. When the location of the disease is in the throat, the cause and mechanism of the disease is wind and dryness harassing pharynx (throat), lung qi failing in purification and moistening. It should be treated with the methods of dispersing wind, nourishing yin and moistening dryness, resolving phlegm, ventilating lung and relieving cough. (4) Post Infectious Cough (PIC). The cause and mechanism of the disease is ’wind invading lung, residual pathogen and lung qi failing in ventilating and purification. It should be treated with the methods of dispersing wind pathogen, ventilating lung and relieving cough.2 bronchial asthma. The cause and mechanism of the disease is deficiency of healthy qi, retained phlegm latent in the lung, dysfunction of the lung, spleen and kidney, and cold eliciting latent phlegm. During the occurrence, the main mechanism is excess pathogen and it should be treated with dispelling pathogen methods. During the recovery stage, the main mechanism is deficient healthy qi and it should be treated with supplementing healthy qi methods.3 chronic obstructive pulmonary disease. The key mechanism of the disease is ’lung deficiency and phlegm and blood stasis. The location of the disease is in the lung, and involves spleen, kidney, and heart in later stage. The pathogenic factors are turbid phlegm, blood stasis and water. The nature of the disease is excess pathogen and deficient healthy qi. During the acute severe stage, it should be treated with dispelling pathogen methods. During the stable stage, it should be treated with supplementing healthy qi methods.4 interstitial lung diseases. In different stages, the mechanism and nature of the disease varies. In the early stage, the toxin pathogen invades the lung, and the nature of the disease is mainly excess pathogen. In the middle stage, phlegm and blood stasis combine together, and the nature of the disease is deficiency-excess in complexity. In the late stage, and the mechanism of the disease is deficiency of qi and yin, zang-fu deficiency and stasis in the collaterals. It should be treated differently in different stage: in the early stage, clearing heat and removing toxin and dispersing lung qi method should be used. In the middle stage, resolving phlegm and activating blood method should be used combined with replenishing qi and nourishing yin. In the late stage, reinforcing healthy qi and supplementing deficiency method should be used, combined with dredging collaterals.5 lung cancer. The mechanism of the disease is zang-fu deficiency, combined phlegm and blood stasis, and internal generation of cancer toxin. The basic treatment principle is reinforcing healthy qi and eliminating pathogen. It should be treated differently in different stage:in the early stage, the healthy qi is still strong, eliminating pathogen method should be mainly used. In the middle stage, the mechanism is deficiency-excess in complexity, and both supplementing and eliminating methods should be used. In the late stage, the healthy qi and original qi are becoming weak, reinforcing healthy qi method should be used. Expelling-toxin and anti-cancer herbs can be added on the basis of reinforcing lung, invigorating spleen and supplementing kidney.In part five, a clinical research was adopted to observe the effects of draining lung and supplementing heart formula treating patients of chronic pulmonary heart disease. And the result showed that:1.The overall integral of the treatment group after the treatment showed statistically improvement than the control group (P<0.05).2. There was no statistical differences of the blood gas parameters (pH、PO2、PCO2、SO 2) between the groups after the treatment (P>0.05).3. Comparison of the blood coagulation parameter and D-Dimer after the treatment between the groups showed that, the blood coagulation parameters were statistically prolonged and D-Dimer decreased (P<0.05).4. Comparison of the NT-proBNP after the treatment between the groups showed that, the NT-proBNP decreasement in the treatment group was statistically greater than the control group (P<0.05).5. There was no statistical difference of right heart tei index between the groups after the treatment (P>0.05).6. Comparison of the mMRC after the treatment between the groups showed that, the mMRC improvement in the treatment group was statistically greater than the control group (P<0.05).7. There was no statistical difference of the liver and kidney functions between the groups before and after the treatment (P>0.05).ConclusionBy summarizing and exploring professor Liu’s academic ideas and experience in differentiating and treating lung system diseases and observing clinical effects of draining lung and supplementing heart formula treating chronic pulmonary heart disease, here are the conclusions.Professor Liu has got family inheritance from his father since a child, derived from the classics and conferring to various theories, rooted in the traditional cultures, and kept pace with the time, taking Chinese and western medicine equally in the clinic.Basing on the reality of tobacco spreading in the current society and frequent fog and haze, professor Liu classifies the pathogenic factors as’turbidity and toxin’, which provides a practical guide for the prevention and treatment of lung diseases.Professor Liu’s differentiation and treatment thoughts emphasize the combination of diseases and patterns, adjusting spleen and stomach while differentiating and treating lung diseases, referring to’collateral disease theory’for chronic lung diseases, taking the idea of’treating disease before its onset’as a guide of clinical practice and pointed out that prolonged lung diseases involve the heart.The decoction of draining lung and supplementing heart formula wan invented based on the mechanism and treatment of chronic pulmonary heart disease. And the study proved that the formula is able to improve the cardiac and pulmonary functions, reduce thrombus risk, relieve patients’symptoms, improve patients’quality of life, and there was no obvious side effect or adverse reactions, which offers a new method treating patients of chronic pulmonary heart disease. |
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