| Objective:Tutor Zhang Wu has rich clinical experience on the prevention and control of Liver disease. Through collecting and sorting teacher’s academic experiences on treating chronic hepatitis, and the clinical research about shuganshipi decoction in the type of liver depression and spleen deficiency, in order to sublimate and inherite teacher’s academic thoughts, providing some references for the clinical treatment,and further research on chronic hepatitis.Methods:This study base on the records of learning with my teather’s clinical guidance, combining with the teacher published papers, writting the feelings and experiences,teaching notes and clinical experiences. This thesis is divided into three parts. Part one is the literature review, the second part is teacher Zhang’s academic origin,his idea of etiology and pathogenesis about chronic hepatitis and his clinical experiences. The third part is teacher Zhang’s experimental research on clinical application of shuganshipi decoction in chronic hepatitis (the type of liver depression and spleen deficiency).In the first part of the literature review, TCM literature part respectively from the understanding of the ancient physicianst, the modern famous doctors and the contemporary doctors to review and summarize. Modern medical research part from aspects of the pathogenesis, diagnosis and treatment to discuss. In the second part, discusse the teacher’s academic origins, summarizes his academic thoughts and clinical experiences.on the treatment of chronic hepatitis.In the third part of the clinical study, using randomized controlled clinical research method, select the 72 cases included in the standard, which were divided into the treatment group and the control group randomly.37 cases in the treatment group,35 in the control group.Analysis the two groups cases from age, gender, marriage, illness weight, duration, laboratory indexes and TCM symptom classification etc, determining the comparable. Among them, gaving the foundation treatment of western medicine to the control group(increased transaminase to oral glucurolactone,viral replication treated with oral entecavir). On the basis of the control group, the treatment group is serving with shuganshipi decoction. Before and after treatment, evaluate the clinical efficacy about the two groups on the TCM clinical syndrome integral, liver function index,abdominal ultrasound and HBV-DNA, etc.Result:1.Through the study of the teacher’s academic origin and academic experiences about chronic hepatitis,informing that teacher Zhang has been practicing medicine for more than 40 years, and he’s been focused on liver disease since the 1980s. He is good at theory and practice. He has earned great medical skill and has high medical theory. His academic thought originates from classic pieces like Neijing, Jinguiyaolue, Piweilun as well as traditional chinese medicine theories from various schools. He is learning from the best, carrying their essence, inheritting and innovating,then forming a new system of himself.2.And after years of clinical experience, teacher Zhang thinks that chronic hepatitis is caused by weakened body resistance, evil influence, poor emotion, eating without temperance, false diagnoses and so on. Its pathogenesis is mainly empty, gloomy, wet, heat, stasis and cruel. When zhengqi is weak, xieqi tends to sneak up on people, and the disease could spread to liver, spleen and kidney, causing stagnation of liver qi and therefore leads to hepatitis. Wet and heat resistance is both the cause and the result of it, blood stasis endogenous is one of the symptoms, yidu retardarced may cause other diseases. This is also one of the late stage hepatitis symptoms.3.Teacher Zhang’s academic thoughts about chronic hepatitis treatment can be descripted into four points: ① Finding the cause. The symptoms of hepatitis patients are different and complicated, so it’s very important to seek for its origin, find the causes of the problem and tackle each one with an importance order, and choosing treatment based on different symptoms. ② Strengthening body resistance to elimina, tonification and purgation in combination. Clinical practice proved that single cause is rare, combination of virtualness and reality is usually seen, especially when it comes to the last stage of ascites due to cirrhosis. Patients will show both virtual and real symptoms. Therefore teacher Zhang does both strengthening body resistance to elimina, tonificaion and purgation.③ Reference sizhen at the same time, combination of Chinese and western medicine. It’s crucial to practice all sizhen to get syndrome data, telling reality from fake and providing the right treatment. Also, due to the advantages of chinese and western medicine, it’s best to combine them together in discrimination and disease diagnosing, and have a better understanding both microcosmically and macroscopically.④ The importance of spleen care. Liver and spleen are physically codependent and pathologically influencing each other. Treating spleen when it comes to hepatitis is a long-time tradition, teacher Zhang also stressed the influence of one ill organ has on other ones, especially spleen and stomach and that we should all pay attention to regulating the spleen. Teacher Zhang has his own unique understanding of spleen regulation, and came up with the "three rules of spleen regulation’’, which is explained in detail in my thesis.4.1 summarized teacher Zhang’s clinical experiences of treating chronic hepatitis in five aspects:①Different treatment for different stages. Teacher Zhang thinks that there is different pathogenesis in different stages for chronic hepatitis,so we should have different treatment. On early stage the causes are usually wet and heat alongside with liver depression. Therefore treatment usually includes clearing heat and dispeling wet, soothing liver-qi stagnation. On middle stage the disease starts spreading from liver and spleen to kidney, causing organ deficient and liver-kidney yin deficiency, weak yin implicating yang, and eventually spleen-kidney yang deficiency.Treatment on this stage is nourishing liver and kidney or tonifying the spleen and kidney. On late stage pathogenesis gets even more complex, organs get weak, qi and blood stasis, and the treatment is strengthening the body resistance to elimina, tonification and purgation in combination. ②The key of treating liver illness is tong. Teacher Zhang thinks that no matter the stage, invasion of pathogenic and empty and full of organ damage is always there, therefore treating liver illness should follow tong. Tong is not tapping branch but all differentiating syndrome for etiology and evil existing. Relieving, sweating and urine pass is tong, tonic vital qi, regulating qi and relieving stagnation and activating blood circulation are all ways to be tong. ③ Giving prescription based on symptom. Teacher Zhang does not only follow this rule but also base on the main symptom to write prescription. My thesis talked about his method via clinical common diseases such as jaundice and flank pain etc.④ Eight ways to promote blood circulation to remove meridian obstruction.Teacher Zhang thinks that during chronic hepatitis development, blood stasis, mild or serious, is always seen. After many years of clinical practice, he came up with eight ways to promote blood circulationto remove meridian obstruction.They are qingrejieduhuayu, yiqifuzhenghuayu, zibuyinxuehuayu, jianpilixuhuayu, wenbupishenhuayu, gongzhushuiyinhuayu and ruanjiansanjiehuayu. ⑤ Precise medication and pay attention to cultivate.Teacher Zhang always gives perfect prescription, likes to use couplet medicines and insect drugs for enhancement. He is well-informed about property of a medicine and the difference of unripe and ripe clinical medicine, so he can make the most out of medicine given to patients and make remarkable progress. Also, due to the delicacy of liver diseases, when gived the wrong medicine or the wrong dose, it gets more difficult to cure. Teacher Zhang pays a great deal of attention to contradiction in drug-using, diet, mood and daily schedule, and considers that they are indispensable part of the treatment.5.Teacher Zhang thinks that the liver stagnation and spleen deficiency is a common syndrome in the course of chronic hepatitis. After many years of clinical practice,he put forward the method of shuganshipi,then developed the shuganshipi decoction.In the course of clinical research,due to various reasons,35patients finished the experiment in the treatment group and 32 in the control group. In this experiment, the syndrome of traditional chinese medicine in the treatment group was improved (P<0.01 or P<0.05), the control group made a few improvement (P<0.01 or P<0.05)). When compared, the treatment group showed superiority with an effect rate of 88.6% (the control group 59.4%). The difference has significant meaning. Liver function and HBV-DNA were better after treatment in both groups. Abdominal ultrasound results indicated the treatment group with P<0.01, showing great improvement and statistics meaning. But the control group has the result of P>0.05 with no obvious improvement after treatment, the difference has no statistics meaning. Comparing the two groups and it can be seen:the treatment group had a more obvious improvement.Conclusion:Teacher Zhang’s academic origin respect the classic,inherit the masters and then get a further innovation;He summed up the cause of chronic hepatitis into weakened body resistance,evil influence, poor emotion, eating without temperance, false diagnoses and so on;It’s pathogenesis is mainly empty, gloomy, wet, heat, stasis and cruel：In practice,teacher Zhang advocats that we should finding the cause,strengthening body resistance to elimina, tonification and purgation in combination, reference sizhen at the same time, combination of chinese and western medicine,care the importance of spleen; In the treatment process,teacher Zhang gaving different treatment on different stages.Dexterous in the application of "tong".Giving prescription based on symptom.Being good at promote blood circulation to remove meridian obstruction.Precise medication and pay attention to cultivate.According to the etiology and pathogenesis of chronic hepatitis,teacher Zhang put forward the method of shuganshipi,then developed the shuganshipi decoction.Clinical studies confirm that the decoction is superior to the western medicine control group in relieving clinical symptoms, improving liver function,reducing virus replication and improving abdominal ultrasound.The decoction is safe and effective.Shuganshipi decoction is an effective prescription in the treatment of chronic hepatitis(the type of liver depression and spleen deficiency). |
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