| ObjectivesThe study and collection of Shanghanlun (Treatise on Febrile Disease) have been started since Wang Shuhe, Linyi, etc. in Jin and Song Dynasties collated it many times. It was Wang Shuhe who first studied Shanghanlun and Cheng Wuji in Jin Dynasty who became the first person to interpret Shanghanlun in his Zhujieshanghanlun (Treatise on Febrile Disease with Notes). Since the study on Shanghanlun focused on the six meridians, various doctrines about the essential of the theory of the six meridians have been established based on the studies of the doctors of all dynasties. But they could not do without explanation from the four aspects:location, nature, pattern and course of diseases. Before Ming and Qing Dynasties (before Opium War in 1840), there were theories of meridians, viscera, territories (Liujing DimianTheory by Keqin), levels,six areas, six territories, gasification,eight principles, and so on, which mostly elaborated in the view of traditional Chinese medicine. In modern times, doctors who advocated the integration of Chinese and Western medicine tried to expound combining with anatomy, physiology and pathophysiology.In recent years, some experts have attempted to establish a system of six meridians upon anatomical physiology of organs and tissues. Among them,Liu Shaowu’s theory of "Sanbuliubing" (Three areas and six diseases) has a clearer interpretation, which has become an influential school. Furthermore, there were advocates of the theory of Sanbuliujing (Three areas and six meridians) who still confined themselves to traditional stereotype of organs and channels, far away from the content related with the structure of tissues and organs. Some other experts pointed out the relation between five viscera and three embryonic layers,but afterwards, only the close relationship between three yin and three yang and three embryonic layers is mentioned instead of clear complete description of the content with regard to the connotation of five viscera and the structure of six meridians. Through analyses of the organs and tissues differentiated by three embryonic layers, our study expects to explore the nature and correlation of six meridians from the structure of body system. Through clinical practice, we hope we can verify the scientificity of our theory and effectively guide the clinical application.Methods1. Literature Search.Comprehensively sort out and dissect traditional and contemporary perspectives on the six meridians from doctors of all dynasties, especially Liu Shaowu’s Sanbuliubing theory and those put forward by other physicians about organs with three embryonic layers, three yin and three yang with three embryonic layers, differentiation of three embryonic layers with six meridians, etc..Although they all understand the six meridians on the basis of the structure, the analysis and conclusion are not in detail, concrete, systematic and profound, lacking empirical evidence and clinic practical application.2. Proposal of the relevant theory, "Sanpeiliujing" (three embryonic layers and six meridians).From the comparison and analysis of the structural characteristics of three embryonic layers and the features of visceral function of six meridians, the conceptions of "Peitailiujing" (embryos and six meridians) and the system of six meridians are formed. The system of six meridians is built upon the structure of three embryonic layers in terms of embryos and six meridians, which presents the correlation between them.The theory of "three embryonic layers and six meridians" refers to the correspondences between ectoderm and Taiyang Shaoyin meridians, entoderm and Yangming Taiyin meridians, as well as mesoderm and Shaoyang Jueyin meridians. The system of six meridians means respectively impeccable and relatively independent structure and function of organs and tissues differentiating from the embryos after maturation of the body. Similar to nine systems according to the structure and function in Western medicine, Chinese medicine has its own systems in line with different functional features, such as six meridians, five viscera and six bowels, channels and collaterals. Shanghanlun originally had no six-meridian theory, which developed into the system of syndrome-differentiation of six meridians in later generations. Because six meridians contain the functions of organs, channels and gasification, syndrome-differentiation of six meridians can be widely applied to various kinds of diseases in different clinical departments. Meanwhile it has become a paragon in later syndrome differentiations and those classical prescriptions summarized from it have been used effectively in the clinic to this day. The system of six meridians in our study has run through and generalized the theories of embryos and six meridians, viscera and bowels, as well as Western visceral system. It divides into six systems, i.e. Taiyang skin surface, Shaoyin heart and kidney, Jueyin liver and pericardium, Shaoyang gallbladder and Sanjiao (triple energizer), Taiyin spleen and lung, and Yangming stomach and intestine. The correlation between three embryos and six meridians shows that the system of six meridians is a systematic combination of the structure of embryos and six meridians.As a link between Chinese and Western medicine, embryos and six meridians can give effective guidance to clinical practice.3. Analyses of syndrome differentiation and treatment in Chinese medicine with relevant theories of "three embryonic layers and six meridians".4. Observation of curative effect of Cassia Twig Decoction Modified treating ametropia based on the theory of "three embryonic layers and six meridians" aiming to prove the scientificity of the theory.Clinical research:Observation of curative effect of Cassia Twig Decoction Modified treating ametropia (or attended by strabismus, amblyopia)1. General dataAll the subjects are patients who accepted treatment in my own clinic (Wu Qiubao Western Internal Medicine) from Dec.2014 to Dec.2015. Nonage (< 18) and adult (≥18) groups are divided according to the age. Nonage,54 patients (male 32, female 22),3-17 years old (average 10),108 eyes in all, normal 6, ill 102, merely amblyopia 3, hyperopia and myopia 99 (or with astigmatism 44, or amblyopia 18, or strabismus 7).Adult,46 patients (male 25, female 21), 21-65 years old (average 38), ill eyes 92, merely amblyopia 1, hyperopia and myopia 91 (or with astigmatism 29,or amblyopia 3).2. Diagnostic criteria(1) In accordance with Newest Chinese and International Standards for Diagnosis and Treatment , in the normal adjustment, if farsightedness (or nearsightedness) is decreased, nearsightedness (or farsightedness) is normal, and skiascopy is nearsightedness (or farsightedness) ametropia, negative (or positive) spherical lens (or cylindrical lens) can be used to increase visual acuity of farsightedness (or nearsightedness).Mild myopia= 3.0D, moderate myopia ≤6.0D, and high myopia> 6.0D.(2) In the diagnostic criteria constituted by the National Children Amblyopia& Strabismus Prevention Group of Chinese Ophthalmological Society in 1996, those who has no organic pathologic changes around eyes and corrected visual acuity is under 0.8 are suffering from amblyopia. Mild amblyopia (including corrected visual acuity) 0.7～0.6, moderate amblyopia (including corrected visual acuity) 0.5～0.2, and severe amblyopia (including corrected visual acuity)≤0.1.3. Inclusion criteria(1) Obscure far or near eyesight, swelling uncomfortable eyes, and visual fatigue. Naked farsightedness< 1.0, nearsightedness> 1.0 or naked nearsightedness< 1.0, farsightedness> 1.0.(2) Through ophthalmic optometry examination of mydriasis with computer.(3) Over age of 4, conforming to diagnostic criteria.(4) Treatment on time, regular reexamination, over 4, informed consent.4. Exclusion criteria(1) In line with diagnostic and inclusion criteria.(2) Under the age of 4.(3) Disobey though in line with inclusion criteria.5. Treatment methodsYizhimingmu pill (Cassia Twig Decoction Modified), set prescription, concentrating agent (my own empirical prescription)Supplier of Cassia Twig Decoction:Taiwan ShengchangPharmaceutical Co.Ltd. Batch Number:CP2910080Supplier of concentrating agent:Guangdong Yifang PharmaceuticalFactory.Batch Number:Yizhiren 405460T:**………;***……Composition:Cassia Twig Decoction 9g (cassia twig, white paeony root,ginger, Chinese-date, honey-fried licorice root), Yizhiren 1.0g;**0.8g;***1.2g.Dosage and Administration 6.0g ·bid, take with warm water,7 days a courseof treatment,8 courses on the average(1-13 courses).6. Criterion for curative effectExamination with standard logarithmic visual acuity chart(1) According to Diagnosis and Curative Effect Determination (Standards)for Common Diseases, vision improved over 1.0 is recent cure, over level3 but not to 1.0 is excellent, improved to levels 1-2 is effective, belowlevel 1 or no improvement is ineffective (referring to InternationalStandard Visual Chart and InternationalStandard Logarithmic Visual Acuity Chart.1 line indicating 1level).(2) In the criterion for curative effect constituted by the National Children Amblyopia & Strabismus Prevention Group of Chinese Ophthalmological Society in 1996, basic recovery:naked eye or corrected visual acuity increased over 0.8, improvement:corrected visual acuity increased 2 lines or over, inefficacy:vision decreased, unchanged or increased only 1 line. Improvement and basic recovery belong to efficacy.7. Statistical MethodUsing statistical software SPSS21.0 for the data analysis.ResultsI. Curative effect of Cassia Twig Decoction treating ametropia (or attended by strabismus, amblyopia)1. Comparison of naked vision before and after treatment in nonage and adult groupsAfter treatment, naked vision in both groups has been obviously increased, which is statistically significant (P<0.05, P<0.01).Compare the two, naked vision of nonage group has improved much more than that of adult group, which also has statistic significance (P<0.05)2. Comparison of treatment curative effect in both groupsThere is difference of curative effect for farsightedness, mild, moderate and severe nearsightedness in each group and the difference is statistically significant (P<0.05, P<0.05). Better curative effect goes to farsightedness and mild nearsightedness. The condition is milder,the effect is better. The recovery rate of mild nearsightedness is respectively 74.5% and 48.6% in nonage group and adult group.The rates of recovery, excellence, efficacy and ineff icacy in nonage group respectively are 51.5%、34.3%、11.1%、3.0%, with the total effective rate 97.0% while those of the adult group are 30.8%、20.9%、41.8%、6.6%, with total 93.4%. More obvious curative effect is found in nonage group, which has statistic significance (P<0.01)3. Change of naked vision and eye distribution before and after treatment in the two groupsAfter treatment, greater change of eyeball constituent ratio has been found in both groups. That is, less eyeball in low vision, more in high vision (P<0.01, P<0.01). In normal vision, the increasing rate of eyeball in nonage group is much higher than that in adult group (P<0.01). The curative effect is better in nonage group than in adult group. This is the same as the results in 1 and 2 above.4. Comparison of curative effect of ametropia attended by amblyopia in both groupsThe curative effect of amblyopia in nonage group is better than that in adult group. The discrepancy is statistically significant (P<0.05)The recovery rate of nonage group is 71.4%, and the total rate is 60%, which indicates there is higher curative rate for nonage.5. Curative effect treating ametropia attended by strabismus in nonage groupIn 7 cases of strabismus,3 recovered and 4 improved so much. Chinese medicine has a very good effect to treat strabismus.The results show that Cassia Twig Decoction Modified is very effective for treating ametropia(or attended by strabismus, amblyopia).II. The correlation between "three embryonic layers and six meridians" as well as analyses of six meridians diseases and their prescription-syndrome can make syndrome differentiation and treatment build upon the tissues and structure of the body. In this way syndrome differentiation may have certain pathology and disease location. Meanwhile for the diseases diagnosed by Western medicine, prescription and medicine can be exactly determined through the application of six-meridian syndrome differentiation together with prescription-syndrome. And organic dialectical unity will be achieved in disease differentiation (location, pathology and nature of disease), syndrome differentiation (disease location of six meridians and nature of cold, heat, deficient and excess diseases), and prescription treatment (prescription-syndrome and pathogenesis). This demonstrates a new idea of disease differentiation and syndrome differentiation in clinical treatment, and good curative effect has been acquired following the analysis and guidance of this idea in clinical practice.Ⅲ. We used the theory of "three embryonic layers and six meridians" to analyze the nature of "treating the same disease with different methods" and "treating different diseases with the same method", which are two concepts in Chinese syndrome differentiation and treatment. Different diseases are, namely, different anatomical structures. But due to the same attributes of the six meridians, they can be treated similarly.For example, tonsillitis and cystitis have different anatomical disease location, but both belong to embryo Taiyin, so the treatment method can be the same. As for "treating the same disease with different methods", although the disease is located anatomically the same, the congenital six meridians and the system of them are different, the treatment is therefore different. For example, the anatomical location of cystourethritis pertains to two different systems, i. e., embryo Taiyin and Taiyang bladder, thus the method should be different. In a word, "the disease" is in the anatomical location, but "the treatment" is dependent on the system of six meridians.This reveals the real meaning of "disease" and "treatment"ConclusionⅠ. Through the analysis of tissues and organs differentiated by three embryonic layers, the study reveals the correlation between the nature of six meridians and their syndrome differentiation system from the angle of bodily structure, namely, proposing the theory of "three embryonic layers and six meridians". It is of scientificity to apply the theory of "three embryonic layers and six meridians" clinically from the curative effect of ametropia cases treated with Cassia Twig Decoction for Taiyang diseases together with some medicine for Jueyin channel.Ⅱ. Through the concrete analysis of clinic cases with the theory of "three embryonic layers and six meridians", the study reveals that the nature of "treating the same disease with different methods" and "treating different diseases with the same method" is identifying the disease location and treating from the relevant channels. In this way, we can easily find methods in Chinese medicine for some diseases diagnosed in Western medicine. This can be a good example of integrated Chinese and Western medicine. We can also use the theory to analyze and guide the treatment of difficult and complicated diseases and expect to get good effect.From the above discussion and clinical application study,the theory of "three embryonic layers and six meridians" can be thought to have some creativity and clinical signality.1. It proves that visceral channels in the system of six meridians have structural basis of relevant physical substances.2. "three embryonic layers and six meridians" can be a link to connect bodily tissues and organs with visceral channels.3. It points to a clear disease location of the body structure in Chinese syndrome differentiation and treatment and tends to directly combine Chinese medicine with Western medicine in curing diseases.4. It broadens the horizon and scope of treating the same disease differently and treating different diseases similarly, and of treating difficult and complicated diseases. It also develops the clinical application of classical prescriptions.5. It enriches the content of six meridians and their syndrome-differentiation system, promoting combination of Chinese and Western medicine. |
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