| Working at the Beijing Friendship Hospital, Professor Zhang is the Director Doctor, professor, and PhD's teacher of the infection and emergency department and PhD's teacher. She is also known as the teacher of Traditional Chinese Medicine doctor in the area of academic experience for the third and forth batch, vice director of the Chinese committee of integrated and western medicine in intensive and critical care, honorary director of the Beijing association of integrative medicine. She is the editing member of two well-known magazines:Chinese critical care medicine and Chinese journal of integrated traditional and western medicine in intensive and critical care. As a result, she enjoys the allowances from the State Council. She has been working in her area and also in treating multiple organ dysfunction syndromes (MODS) for 40 years and has rich experience in clinic. As one of Professor Zhang's student in the forth batch, I have gained a lot. In order to carry on her great medical experience, especially her experience on treatment for acute serious infection, I write this dissertation to try to sum up most of these to report her thoughts completely and offer some help to treat acute serious infection.In the thesis, professor Zhang's academic experience was concluded in three aspects.First, I reviewed the history of traditional Chinese treatment towards infection and the academic thought vein of professor Zhang's findings on this area to state professor Zhang's theoretical systems from early generations. It records how she studied and carried on the Endo-meridians and Treatise on Febrile Diseases. In her exploration and practice, professor Zhang summarized four main TCM syndromes:excessive heat syndrome, (heat with dampness, excessive heat damaging yin), blood stasis syndrome, Fu-qi obstruction and syncope. In the process, she grasped the ideas to treat intensive and critical infection with integrated traditional Chinese medicine and western medicine.Secondly, the thesis summarized Zhang's theory and clinical experience. It introduced four main syndromes of grave infection on the base of clinical research. Four types of grave infections are classified as the followings:(1) heat syndrome:which are divided to 3 cases.A. excess-heat syndrome:fever,red tongue with yellow fur,cool drink,surging and large pulse B. damp-heat syndrome:fever,red tongue,greasy and flavo coated tongue,doesn't feel like to drink,inseparable heatC. excessive heat and damaged yin:fever,red tongue,short of saliva,less or no coated tongue,feel like to drink.(2)FU QI being obstructed:abdominal distention,Hypoactive bowel sounds,no autonomous defecation or flatus.(3) blood stasis syndrome:fixing pain,patches,cchymosed,texture of tongue is dark and purple,blood disk ecreasing,blood clotting functional parameter of lab is abnormal.(4) syncope syndrome:low temperature at extremities,tiny nervure,the decrease of blood pressure.Based on the research, formulate and confirm the Chinese treatment using particles of FUFANGQINGRE,SHENMAOHUOXIE,TONGFU. Professor Zhang points out that we should analyze pathogen and healthy qi based on the principle of syndrome differentiation. Using the methods of strengthening healthy qi to eliminate pathogens gets through the whole treatment process. The thesis strengthens professor Zhang's features on treating acute infections. It concludes the method of heat-clearing and detoxifying, clearing heat and expelling damp, pouring down Fu qi and diarrhea, tonifying qi and yin, activating blood and dissolving stasis. At the same time, Zhang's combination of modern medicine with traditional medicine, treatment of tonif ication and purgation in combination are summarized. And the clinical experience of serious pneumonia,acute pancreatitis, severe sepsis and Multiple abscess were concluded. After three years study and conclusion, I understood definitely the thought of Zhang's treatment for serious infections which is the foundation of kinds of researches in the future. The method of syndrome differentiation became my basic solutions to the infectious diseases. The clinical research has been done in order to test Zhang's experience.Thirdly, acute pancreatitis has been study under the guidance of professor Zhang. The clinical research and experience has been concluded in order to conclude thoroughly professor Zhang's experience of pancreatitis. We choose the acute pancreatitis patients at the ward of emergency and infection department in Beijing Friendship hospital during the period from June,2010 to July,2011, with a prospective, random and parallel design. We selected the cases according to China Acute Pancreatitis Treatment Guideline (Draft) of the pancreatitis diagnosis standard and separated into the western medicine group(WMG) treated with mosapride citrate and integrated Chinese traditional and western medicine TONGFU group(ICWG) treated with TONGFU granules in accordance with random number table. Patients'condition, states of the tongue and conditions of the pulse with serum levels of amylase were compared with each other.The results showed that:1. Independent defecate time at the WMG is 3.67±0.485 days, and 2.90±0.359 days at ICWG. The recovery time of serum levels of amylase is 4.23±0.986 days, and 2.55±0.724 days at ICWG. The recovery time of diet at WMG is 7.03±0.686 days, and 6.10±0.502 days at ICWG. The disappearance time of abdominal pain at WMG is 3.23±.383 days, and 4.31±0.530 days, at ICWG. There is no significant difference between two groups. 2. Two patients among the 59 cases (3.4%) have unknown causes, and the others (96.6%) have relationship with diet. The main syndrome includes 38 patients with food retention under congealing cold (64.4%),16 with jumble and interweave of cold and heat (27.1%) and 5 with food retention under heat accumulation (8.5%). As for the syndrome differentiation, there are 42 patients with obstruction of Fu-qi (71.2%),19 with liver and gall heat stagnation (32.2%),5 with liver and gall qi stagnation (8.5%),2 with damp heat liver and gall (3.4%),4 with dampness encumbering the spleen (6.8%), 5 with asthenia of both qi and yin (8.5%),1 with yin asthenia syndrome (1.7%),5 with blood stasis syndrome (8.5%)We got next conclusions:1. The effects of integrated Chinese traditional and western medicine TONGFU method are reliable to treat acute pancreatitis. 2. The study indicated that acute pancreatitis subordinate to TCM internal conditions---abdominal pain due to retention of food. It consists of three types of syndromes:food retention under congealing cold, jumble and interweave of cold and heat, food retention under heat accumulation. Obstruction of Fu-qi is the main clinical manifestation and crucial reason. The pathogenesis changed on the basis of food, qi, damp, blood stasis, cold and heat stasis or only cold and only heat which cause the following condition: stagnating the qi activity of spleen-rising and stomach descending in middle energizer, obstruction of Fu-qi which result in malfunction of liver controlling dispersion and dysfunctional large intestine governing the conveyance and transformation of waste. In further, the pathogenesis results in damaging the five-organs, impairment of yin, syndrome of qi-yin deficiency, blood stasis, yang declination, and coma, etc.3. As for the comparison of three types of acute pancreatitis subordinate to TCM internal conditions, which include food retention under congealing cold, jumble and interweave of cold and heat, food retention under heat accumulation, TONGFU granules is more useful in the type of jumble and interweave of cold and heat. It indicated that differentiation of symptoms and medication to the syndromes have important role in the process of treatment. We suggested that doctors should take individual treatment according to the principal of "six hollow organs building on obstruction-removing therapy" and "relieving the secondary symptoms first in treating acute disease and relieving the primary symptoms in treating chronic disease". The principal mainly is built on the base of promoting digestion, removing food retention and pouring down the setting. In the process, we can take the methods such as warm purgation, cold purgation and combination of heat and cold. Considering the change of the vital-qi and pathogenic factors, doctors may supplement the treatment with soothing liver-gallbladder, tonifying spleen, clearing heat and resolving dampness, tonifying qi and yin, activating blood circulation, recuperating vital i ty. Objective:As the fourth generation inheritor of nation's elder traditional Chinese medicine experts'experience, I found Ms. Zhang was good at using TONGFU granules method in curing serious infection diseases. She uses the TONGFU granules to treat serious infection complication with the stomach and intestine function exhaustion and had received great effectives, especially in treating acute pancreatitis. She strongly suggests that we should use the TONGFU treatment as soon as possible to improve the illness quickly. As a result, I take the cases of acute pancreatitis Ms. Zhang treated as examples, in order to further conclude her methods of treating acute pancreatitis at a higher level. And I conclude her diagnostic experience to carry on the elder traditional Chinese medicine expert's experience well. At the same time, because of the continuously changes of pathogenic factor caused by the society and environment change, as well as the rapid study progress of pancreatitis, Prof. Zhang points out that we should improve our diagnostic and treatment ability according to the current facts. This research hopes to do some work for further study of pancreatitis based on the clinical observation when studying with Ms. Zhang. We will discuss the etiology, pathogenesis and syndrome differentiation of pancreatitis in order to make progress on the treatment.Methods:We choose the acute pancreatitis patients at the ward of emergency and infection department in Beijing Friendship hospital during the period from June,2010 to July,2011, with a prospective, random and parallel design. We selected the cases according to China Acute Pancreatitis Treatment Guideline (Draft) of the pancreatitis diagnosis standard and separated into the western medicine group(WMG) treated with mosapride citrate and integrated Chinese traditional and western medicine TONGFU group (ICWG) treated with TONGFU granules in accordance with random number table. Patients'condition, states of the tongue and conditions of the pulse with serum levels of amylase were compared with each other.Result:1. Independent defecate time at the WMG is 3.67±0.485 days, and 2.90±0.359 days at ICWG. The recovery time of serum levels of amylase is 4.23±0.986 days, and 2.55±0.724 days at ICWG. The recovery time of diet at WMG is 7.03±0.686 days, and 6.10±0.502 days at ICWG. The disappearance time of abdominal pain at WMG is 3.23±0.383 days, and 4.31±0.530 days, at ICWG. There is no significant difference between two groups.2. Two patients among the 59 cases (3.4%) have unknown causes, and the others (96.6%) have relationship with diet. The main syndrome includes 38 patients with food retention under congealing cold (64.4%),16 with jumble and interweave of cold and heat (27.1%) and 5 with food retention under heat accumulation (8.5%). As for the syndrome differentiation, there are 42 patients with obstruction of Fu-qi (71.2%),19 with liver and gall heat stagnation(32.2%), 5 with liver and gall qi stagnation (8.5%),2 with damp heat liver and gall (3.4%),4 with dampness encumbering the spleen (6.8%),5 with asthenia of both qi and yin (8.5%),1 with yin asthenia syndrome (1.1%),5 with blood stasis syndrome (8.5%).Conclusion:1. The effects of integrated Chinese traditional and western medicine TONGFU method are reliable to treat acute pancreatitis.2. The study indicated that acute pancreatitis subordinate to TCM internal conditions-abdominal pain due to retention of food. It consists of three types of syndromes:food retention under congealing cold, jumble and interweave of cold and heat, food retention under heat accumulation. Obstruction of Fu-qi is the main clinical manifestation and crucial reason. The pathogenesis changed on the basis of food, qi, damp, blood stasis, cold and heat stasis or only cold and only heat which cause the following condition:stagnating the qi activity of spleen-rising and stomach descending in middle energizer, obstruction of Fu-qi which result in malfunction of liver controlling dispersion and dysfunctional large intestine governing the conveyance and transformation of waste. In further, the pathogenesis results in damaging the five-organs, impairment of yin, syndrome of qi-yin deficiency, blood stasis, yang declination, and coma, etc.3. As for the comparison of three types of acute pancreatitis subordinate to TCM internal conditions, which include food retention under congealing cold, jumble and interweave of cold and heat, food retention under heat accumulation, TONGFU granules is more useful in the type of jumble and interweave of cold and heat.It indicated that differentiation of symptoms and medication to the syndromes have important role in the process of treatment. |
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