Печень 3

The treatment of viral and toxic hepatitis in Chinese medicine. Oksana Nachataia.

Good day to all! The treatment of HCV infection, as well as toxic and alcoholic hepatitis is very complicated topic. We can say that this is a separate direction in medicine. It is interesting to note that quite literally in my eyes over the last 10-12 years in the relationship between Chinese and Western medicine in this area, there have been quite large changes. A physician who practices TCM now should keep his finger on the pulse, keeping track of current advances in the treatment of hepatitis. On the other hand, the ancient knowledge of TCM does not lose relevance, finding confirmation of its truth in modern studies. The highest analytics approaches the maximum generality. And it cannot but rejoice. During the practice at Tianjin University, I was fortunate enough to study the “middle jiao” treatment system using prescriptions. It is a logically harmonious, systematized principle of selecting Chinese ingredients and their stable combinations for simultaneous targeting of each syndrome, primarily for the liver and spleen in their Chinese sense. This clear algorithm allows you to assign personalized treatment to virtually every patient. As a result, multicomponent recipes are obtained, consisting of individual small stable combinations of ingredients, like a house of “bricks”. In some ways, the principle of their construction echoes with Tibetan medicine, but the basis of this system is the physiology and pathophysiology of BMT in terms of the interaction of organs in the “middle jiao”. Even taken separately, the physiology of TCM is of great interest, since it illuminates the life of the organism from a different angle. But this is by the way. As you know, the physiological connections between the organs of the “middle jiao” (for example, the controlling connections of the “wu xing,” the processes of “raising and lowering”, the distribution of qi, the deposition of blood, etc.) constitute a background, which is then affected by the pathogenic factor that causes hepatitis. According to the views of TCM, there are several factors, such as viruses, alcohol, various hepatotoxic substances. By their nature in Chinese medicine, they all belong to the pathogens “heat and poison,” as they cause a set of concrete specific syndromes in the liver. The main purpose of treating hepatitis of any etiology in TCM is the preservation of the liver – both its structure and function. Usually the basic set of ingredients in the prescription is the same for all situations, since for any hepatitis there is always a certain set of syndromes, both from the liver and spleen, from the blood and so on. Further to this “basic” recipe the ingredients with an emphasis on the main pathogenic factor are added . For example, with hepatitis C, these are plants with more pronounced antiviral properties. In case of toxic hepatitis there are the ingredients that remove toxins from the body. That is, the most important thing is to stop structural changes in liver tissue, the disintegration of hepatocytes, stop the inflammatory process and create a cirrhosis prevention. Not setting the main goal of eliminating the viral agent (with the help of herbs it is extremely difficult to do this), TCM recipes are good at the task of normalizing biochemical parameters, restoring normal liver size, improving well-being. That is, the patient in the process of treatment becomes a virus-carrying condition. For this, there is a certain system for prescribing recipes, taking into account seasonal biorhythms, gender, patient’s age, leading syndrome and other features.

Just 15 years ago, this system was truly a rescue for patients suffering from a persistent viral infection. But then Western medicine made a real breakthrough, learned how to deal with viruses by directly influencing it.(https://www.ncbi.nlm.nih.gov/pubmed/29377464; https://www.mdlinx.com/…/sofosbuvir-vel…/2018/03/29/7508571/) From year to year the drugs became more and more perfect, and now effective and safe drugs are being used, which in most cases solve the problem of eliminating the virus. And, it would seem, the methods of TCM recede into the background. But it is not so. It turns out that by the present moment two medical systems each solve their own task. In the case of viral hepatitis, in particular, hepatitis C, the main goal of TCM is to preserve and improve the liver before antiviral medicines begin treatment, normalize biochemistry, and remove intoxication. The same thing after the treatment – restore the liver tissue, if necessary. In difficult cases, when there is simultaneous infection with two strains of the virus, or there are severe kidney problems, there are contraindications to western treatment, TCM recipes, in my opinion, can be used as “insurance” and additional help for the patient. For cases of toxic and alcoholic hepatitis, as is known, Chinese medicine remains, as before, a pretty good choice to prevent or permanently delay the onset of cirrhosis. Moreover, according to statistics, the number of patients with toxic liver damage does not decrease. Toxic medicines, environmental factors, unhealthy diet contribute to this. (https://onlinelibrary.wiley.com/doi/abs/10.1111/liv.13662) This topic remains relevant. I am glad that more and more TCM recommendations on the way of life for patients with liver diseases find their confirmation in modern studies. This concerns, for example, a diet based on cereals and vegetables, as well as a complete rejection of alcohol – the traditional approaches of TCM in the treatment of hepatitis.(https://www.reuters.com/…/even-light-drinking-may-make-fatt…) Much attention in modern medicine has been given to daily biorhythms, their effect on health. Whereas in Chinese medicine, “the liver is responsible for cycles, for order in the body,” and the first one suffers from sleep and wakefulness, time zones, and the like. Of course, medicine does not stand still, various medical systems enrich each other due to the possibilities of information exchange. Therefore, I wish every success to all specialists and health care practitioners! Many thanks!

WU PI SAN

“Wu Pi San” and “Wu Pi Yin”. Oksana Nachataia.

Good afternoon, dear colleagues! If you had a minute of free time, and you wanted to clarify for yourself some vague questions related to TCM recipes, then here is one of them. At the recipe seminars, we try to focus on the differential diagnosis of prescriptions (by the way, very soon a workshop on TCM recipes is scheduled). As you can see, in the classics there are several such pairs of recipes with almost the same name, often very similar in mechanism of action. And in practice it is sometimes important to know accurate information on their purpose. One such pair is Wu Pi San and Wu Pi Yin. What are their differences and similarities?

As is known, the recipe for Wu pi san was invented in ancient times. We can find a description of this recipe from the famous classic Hua Tuo in the treatise Zhong Zang Jing, 220 (“Precious Classics”). The recipe consists of five ingredients. Sheng jiang pi – 9, sang bai pi – 9, chen pi – 6-9, da fu pi – 6-9, fu ling pi – 9.

The name Wu Pi San literally translates as “powder of five skins”. And the essence of the recipe lies in the presentation of the TCM about tropism and the similarity of everything in nature, that is, “the skin has the tropism to the skin.” Referring to the group that removes dampness and dispels swelling, this recipe expels water that has accumulated under the skin. Edema occurs against the background of a weak spleen, when its function as a “water source” is impaired. There are many recipes for the expulsion of edema. The indications for using Wu Pi San are water retention and skin pastos, when the relief lines of the body and limbs are smoothed, the contours of the figure loses its shape like wax. Even against the background of thinness, the whole body flabbiness is observed. The face is usually pale, pasty, slightly yellowish. These symptoms are accompanied by severe weakness, fatigue, exhaustion. At the same time we can see general edema, fluid retention in the body. Many other symptoms of deficiency of the spleen are present. The condition of emptiness is rather heavy. For example, such a syndrome often appears after chemotherapy at the treatment of tumors; in case of toxicosis of pregnant women, when the spleen was initially very weak; after severe mental fatigue.

The main ingredient (jun yao) is fu ling pi, as it removes swelling, removes dampness and strengthens the spleen. Fu ling has the ability to remove water from top to bottom, “wipe out” dampness, while carefully preserving qi. Sang bai pi has tropism to the lungs, removes both phlegm and dampness. According the theory of TCM the lungs are the “son” of the spleen. Therefore, normalizing the lungs, sang bai pi indirectly improves the exchange of water in the body, contributing to its excretion. Da fu pi, in addition to diuretic properties, still has the property of “loosening the chest.” That is, da fu pi removes the rigidity of the chest, which appears due to the accumulation of water. Chen pi moves qi in the middle Jiao, helps normalize spleen function, removes phlegm, removes swelling. Sheng jiang pi, sharp and warm in nature, removes water through diaphoretic action, “opens” the lungs, soothes the stomach, relieves nausea. The whole recipe is very soft, safe and has a narrow specificity in its action. In mild cases, it can be used in case of pasty face, swelling around the eyes against the background of various exhaustion, especially mental fatigue. In practice, this recipe is often used as part of the general medical course, as a separate unit in the general scheme. For example, if the body is affected by external dampness and wind (which happens quite often), add fang feng and qiang huo. Wu pi san goes well with recipes that bring out dampness from internal cavities when it is necessary, as well as with means that gently strengthen the spleen and move qi.

The recipe Wu Pi Yin is very similar in its action.

Di gu pi – 9, wu jia pi – 9, da fu pi – 9, fu ling pi – 9, sheng jiang pi – 9 (+ sang bai pi-3, chen pi – 3).

This recipe was included in “Tai Ping Hui Min He Ji Ju Fang” (“Recipes for the benefit of the civilian population”), the first state recipe guide in China (and probably all over the world), created in 1107 by Chen Shi Leng . This recipe is also mentioned in the “Ma Ke Huo Ren Quan Shu” edition (“Saving the lives of children with a rash”), dated 1748 and posted by Xie Yu Qiong. A distinctive feature is the addition of two ingredients – Di gu pi and Wu jia pi. Thise are also the skins. Both ingredients have a diuretic effect, so the main vector of the recipe does not change. But wu jia pi strengthens bones and ligaments against the background of a weak kidney and liver, and di gu pi has the property of treating fever “xu re” during prolonged exhaustion, hormonal imbalance, deficiency of yin, blood, normal fluids. Doses of sang bai pi and chen pi in this recipe are significantly reduced, or these ingredients are completely excluded from the recipe. Thus, the recipe Wu pi yin is also used for subcutaneous edema on the background of a weak spleen, but when there is still pain in the body, swelling is more in the joints, weakness of the ligaments and muscles. This recipe is more suitable for patients who have not only exhausted the spleen, but also have a lack of kidney and liver blood, especially against the background of hormonal disorders, after prolonged debilitating diseases, with a strong weather dependence with a tendency to retain fluids in the skin. The recipe Wu pi yin can be taken for a long time or several courses, since Wu jia pi has the property to strengthen the ligaments and bones, strengthen the heart muscle. By nature, it is warm, but in the recipe there is di gu pi, which prevents the occurrence of empty heat (“xu re”) and compensates for the warm properties of wu jia pi. I would be glad if this information will be useful for you!

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Oksana Nachataia. About treatise “Shang Han Lun” and its relevance in our days.

Dear colleagues! Today is the last day of March. I look out the window and see the real January snow, there are dense clouds in the sky – somehow atypically for the middle of spring. I read about the height of epidemic of flu in St. Petersburg with a significant excess of the epidemic threshold, I read about the flu in European countries. Friends write me about the abnormal cold in Spain and Portugal. And these thoughts pushed me to write a few words about the famous Chinese treatise TCM “Shang Han Lun” and its relevance in our days. It is known, that like any living organism, a person is part of the biosphere and continuously in contact with the environment. Of course, the progress and achievements of medicine increasingly protect a person from the harsh climate and severe infections, making life more and more long and comfortable. But the problem of morbidity due to variousclimate influences is still on the agenda in the most acute way. It’s no secret that this is one of the top topics for both scientific research and practical medicine. To address these issues, it is obviously necessary to have a deep understanding of the mechanisms of interaction between person and nature, and in this matter additional sources of information can be very useful. A real storehouse of knowledge in this area is considered to be one of the most studied treatise of TCM “Shang Han Lun”.

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СТЕАТОЗ

Oksana Nachataia. Non-alcoholic fatty liver disease from the point of view of Traditional Chinese Medicine.

Dear colleagues! Again I would like to return to the discussion of liver diseases from the perspective of Chinese medicine. And for what reason. On the one hand, statistics show that the number of such patients, in particular those suffering from steatosis, is steadily growing.  It’s growing in different countries, with different levels of economic and social well-being, different habits in nutrition and lifestyle. I think that Chinese medicine contains a great resource, at least to systematize the causes of this disease – and this is a big step in the direction of choice of treatment. Many of you practice TCM in this disease and, perhaps, this topic will be interesting for discussion. At least, I increasingly meet such patients in my practice and often observe a stubborn steatohepatitis, which requires more attention. On the other hand, it seems to me that the understanding of the need to adapt the fundamental knowledge of TCM to modern conditions is simply in the air. Many experts come to the conclusion that the work at the junction of not only two medical systems, but also at the junction of several scientific disciplines, just gives that fresh view of the problem, a non-standard solution that brings the necessary result. That is, the perception of TCM as a guide to action, but not a dogmatic form, is becoming increasingly relevant. If earlier Chinese medicine was studied in the classical inviolability of its works, and the direction of the study was directed deep into the past (which is still not lost its relevance), today more and more the correspondences are opened between TCM and modern discoveries of physiology and medicine. Especially it’s actually in the light of the spread of modern “diseases of civilization”, which previously simply did not exist. At times it remains only to be surprised how accurately and precisely the statements of contemporary thinkers and scientists correlate with the ancient postulates of TCM. And liver disease is not an exception. So, for example, the Austrian physiologist Ludwig von Bertalanfy, the creator of the “General Theory of Systems,” described the fundamental distinctive character of physical (non-living) systems and living organisms. In his definition, as is known, “living systems constantly exchange matter with environment to get the necessary energy to resist entropy (to support the inner order) and save the stability in the environment.” Agree that this definition generates the association with the theory of TCM, where the main role to maintain the order in the body belongs specifically to the liver: “the liver smoothly distributes qi over the body,” which is due to, in particular, the coordinated work of the autonomic nervous system.

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Тиреотоксикоз

Oksana Nachataia. Thyrotoxicosis. A universal prescription for excess syndromes.

Dear colleagues! I continue the analysis of the experience of Professor Tianjin University Wei Yu Qi. (1939-2014). It is interesting that such elder and very experienced practitioners are always perceived in China as a certain truth in the last resort. That is, of course, not quite the last one, as these people are not immune from mistakes. But very close to that. Such people are few, they are known all over the region, it is always difficult to get the meeting with them due the big queue, although they often work in ordinary people’s clinics. This is such a feature of China. If you ask, what specialization does this “patriarch” have, that you often listen the word “general”, that is, in general, a specialist in the human body. Their experience is often precious in some matters. And now I would like to say a few words on yours judgment regarding the treatment of thyrotoxicosis. As is known, thyrotoxicosis is a common disease in modern practice. And this is exactly the case in which Chinese medicine can show its strengths. A well-known variant of the integrative approach, namely, the “decomposition” of western nosology into TCM syndromes, certainly applies to thyrotoxicosis. But the pathogenesis of this disease has its own peculiarities, which make it possible to partially alleviate the task of the doctor, especially at the initial stages of this disease. Professor Wei successfully used these features in his practice, objectifying the results by laboratory research. As is known, the main criterion – an increase in thyroid function, can exist within several nosological forms of Western Medicine. And always, according to Chinese medicine, in the initial stages of the disease, there are three main components of pathogenesis, namely, the syndromes of qi stagnation, stagnation of phlegm and liver and heart fire syndrome. Each of them can be expressed in different degrees, but, nevertheless, they all are present. If the stasis of blood is added to these three syndromes,

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МАО ЧЖАО ЦАО

Hepatoprotective plants in Chinese medicine. Oksana Nachataia.

Dear colleagues! Looking through the articles on plant research, I noticed an interesting trend, namely the active study of medicinal plants from the perspective of evidence-based medicine. Working in the field of TCM, I reason from these positions and see a certain paradox. A lot of works are devoted to the study of plants separately, in isolation from the context of the theory of Chinese medicine and their direct indications. On the other hand, many specialists practicing TCM, on the contrary, are far from the methodology of modern research, as this is often not part of their professional interests. Therefore, here, apparently, we need a bridge, the work in tandem, to cover both spheres entirely.

Each TCM ingredient, that is, raw material from a plant, is clearly inscribed in the context of the theory, falls into different classifications according to its nature, mechanism of action, tropism, taste and so on. And any doctor who studies Chinese medicine knows this. The doctrine of recipes determines the rules of plant combination when the ingredients act in synergy, strengthening each other’s action, in antagonism, limiting too much strong action of each other, or bringing the whole recipe to a specific organ at the expense of tropism to the meridians. Thus, the combination of plants in the recipe and the effect of this aggregate in the body is more than a formal sum of actions for each one.

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Рисунок356

TWO PARADIGMS INTERACT. TCM AND WESTERN MEDICINE.

Dear colleagues! Somehow, more and more the approach of a turning historical moment is felt, when “the quantity is about to become quality.” I mean the process of official mutual recognition of two medical systems, which began in the 50s of last century. This process entailed an avalanche-like growth of interest, accumulation of experience, comprehension, explanation and joint practical application of classical Western medicine and TCM. Globalization and the exchange of information online have accelerated and intensified this movement.

The invaluable experience of the past years allowed to see interesting conclusions in terms of comparing the two systems of thinking and integration possibilities. Indeed, despite the real storehouse of knowledge that Chinese medicine possesses (like, incidentally, other ancient naturopathic medical systems), the main difficulty is precisely the formation of a “second thinking system” for a Western doctor, building a unified system of notions and concepts that makes it possible to most effectively combine the methods of both medicine.

TCM and Western Medicine are two paradigms, two different ways of thinking, therefore it is rather difficult to fit one of them into the conceptual framework of the other. For example, the question in relation to the pathogenic source of the disease is completely different. This is seen as one of the important differences between the “western” and “eastern” approaches in general to various natural phenomena.

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Рисунок56

THE FOUR-LEVEL EDUCATION PROGRAM OF TCM FOR DOCTORS OF WESTERN MEDICINE.

The doctor of Western medicine, for the first time starting to study the second medical system (in particular, TCM), often faces two of the most serious obstacles. The first is an absolutely unfamiliar system of thinking in terms of physiology, human pathology, the format of diagnoses and approaches to treatment. The second difficulty lies in the huge amount of information that is contained, in particular, in Chinese medicine, which requires years of painstaking study with natural losses of time, money and energy. Naturally, TCM is a self-sufficient medical system that has always been called upon to solve all the problems with the patient’s health with the using of only its own methods. But this pattern cannot be transferred to the present moment, because, thanks to the huge achievement of Western medicine, there is a natural redistribution of the share of methods of both medical systems depending on the strengths and weaknesses of TCM and Western medicine in different branches of medicine and in each individual clinical case. Joint work of specialists from both China and other countries made it possible to draw up training programs that would be adapted to the system of views of the Western doctor, to introduce conceptual “bridges” between TCM syndromes and the corresponding physiological manifestations of the human body in the modern sense. Working in close cooperation with the Tianjin University of TCM and EIC WFCMS, where a huge amount of work has been done in the last 20 years, we use a program that can be divided into four main levels.

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