主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R
30 September 2021, Volume 44 Issue 9 Previous Issue   
Voices of Guidance
Expert Opinion
Comment on the clinical value of traditional Chinese medicine in the maintenance treatment of tumor*
Chen Xinyi, Dong Qing, Tian Shaodan, Hou Li, Jia Mei, Li Xiao
2021, 44 (9):  777-783.  doi: 10.3969/j.issn.1006-2157.2021.09.002
Abstract ( 58 )   PDF (893KB) ( 35 )  
In view of the differences in the knowledge systems between Chinese and Western medicine and the concept of maintenance treatment of malignant tumors, this paper reviews the concept of maintenance treatment of malignant tumors, the characteristics of maintenance treatment in traditional Chinese medicine (TCM), and the existing problems and coping strategies of TCM maintenance treatment. Firstly, the definition, ways of thinking and treatment methods of TCM maintenance treatment are clarified. It is emphasized that the maintenance treatment in TCM should be guided by the core theory of “Tao conforms to the nature”, and the concepts of people-orientedness, commitment to the golden mean, adherence to internal energy, restoration and protection of the original qi, regulation of the emotions and correspondence between human beings and nature throughout the whole process of maintenance treatment. In addition, patients with malignant tumors should be placed in the best state of mind and body by adhering to the highest principle of “nourishing the heart”. Such concepts and theories should be applied with flexibility as pattern differentiation and treatment, holistic concept, balanced state, consolidating the basis and clearing the source, targeted meridian tropism and preventive treatment.It is proposed that the maintenance treatment of malignant tumors in TCM is a multi-dimensional system that integrates maintenance treatment of diseases, of tumor-related symptoms, and of tumor-related complications. The goal of the treatment should be control of patterns (symptoms) and improvement in the quality of life of patients as well as longer progression-free survival (FPS) and overall survival (OS), so that more patients with malignant tumors can benefit from maintenance treatment.
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Standards & Guidelines
Chinese Medicine Practice Guidelines for COVID-19 in Malaysia (3rd Trial Version)
Malaysian Chinese Medical Society of Epidemic Control and Prevention
2021, 44 (9):  784-788.  doi: 10.3969/j.issn.1006-2157.2021.09.003
Abstract ( 627 )   PDF (683KB) ( 557 )  
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Theoretical Studies
Interpretation of the “opening-closing-pivoting” functions of the six meridians*
Chen Ming
2021, 44 (9):  789-795.  doi: 10.3969/j.issn.1006-2157.2021.09.004
Abstract ( 97 )   PDF (899KB) ( 41 )  
The theory of the “opening, closing and pivoting” functions of thesix meridians, first proposed in the chapter of Separation and Combination of Yin and Yang in Suwen (Plain Conversation), was an important part of the theoretical system of Huangdi Neijing (Huangdi's Internal Classic). This theory originated from the change in the separation and combination of yin and yang in the four seasons. As the variations and the exiting and entering of qi in the three yin and three yang are reflected as the concrete manifestation of “opening-closing-pivoting”, the yin-yang alternation in the four seasons is achieved through the“opening-closing-pivoting” function. The yin-yang “opening-closing-pivoting” function in the human body is a high-level generalization of the function of qi transformation of the six meridians. The separation of yin and yang generates the opening, closing, and pivoting functions while the combination of yin and yang generates one yin and one yang. The separation and combination of yin and yang work both independently and closely, i.e. in separation, there are three functions and in combination, there is one.The “opening-closing-pivoting” function is based on the manifestation, root cause, and medial qi of the six meridians as the material basis, and reflected by the ascending, descending, exiting, and entering of qi movement as the functional state. The taiyang, also known as the old yang and giant yang, safeguards the healthy qi against pathogens with the qi movement of opening, which distributes the nutrient qi and defensive qi, and promotes the circulation of body fluid. The yangming, or the combination of two yang, boasts sufficient qi and blood with the qi movement of closing, which stores energy and yang and decomposes food. The shaoyang, the new yang,is full of vitality with the qi movement of pivoting, which pivots yin and yang, relates the interior and the exterior, connects the upper and the lower, and facilitates the qi movement of the spleen and stomach.The taiyin, the old yin which is mature and steady, is located on the surface of the yin with the qi movement of opening, which transports and transforms the nutrients, generates nutrient qi, and maintains the metabolism of the body. The jueyin, the extremity of two yin, enjoys exuberant yin with the qi movement of closing, which preserves yin, stores blood and soul, and induces the generation of yang. The shaoyin, the new yin which pertains to the heart and kidney, stores both water and fire with the qi movement of pivoting, which harmonizes water and fire and coordinates the heart and kidney. The theory of “opening-clos-ing-pivoting” of the three yin and three yang provides important reference for pattern differentiation and treatment in accordance with the theory of the six meridians.
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Discussion of “unblocking and supplementing extraordinary vessels and treating them separately” in tumor pattern differentiation and treatment based on the theory of innateness from Huangdi Neijing*
Cao Luchang, Zhu Guanghui, Li Jie
2021, 44 (9):  796-801.  doi: 10.3969/j.issn.1006-2157.2021.09.005
Abstract ( 71 )   PDF (858KB) ( 42 )  
The eight extraordinary vessels originate from the prenatal qi, and the original qi runs in them. The occurrence and development of tumors are regulated by genes and closely related to congenital basis. However, nowadays most physicians treat tumors from the perspectives of postnatal zang-fu organs while pattern differentiation and treatment from the perspective of congenital extraordinary vessels has not received due attention. Based on relevant records in Huangdi Neijing (Huangdi's Internal Classic), this paper discusses the direct and indirect relationships between tumorigenesis and congenital condition, and suggests the possible circulation of the congenital qi in the kidney-twelve meridians-extraordinary vessel pathway to elucidate the relationship between congenital extraordinary vessels and tumorigenesis and development. The treatment characterized by unblocking, supplementing and purging should be flexibly adjusted according to the deficiency and excess of the extraordinary vessels, the stage of tumor development, and the stage of treatment. In addition, the eight extraordinary vessels should be treated based on their different characteristics. It's hoped that the analysis of the etiology and pathogenesis in TCM differentiation and treatment of tumors and the treatment principles and methods will be enriched.
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Theoretical discussion on manifestation, root cause and medial qi*
Liu Yi, Lu Mingyuan
2021, 44 (9):  802-806.  doi: 10.3969/j.issn.1006-2157.2021.09.006
Abstract ( 58 )   PDF (564KB) ( 29 )  
Based on a review of relevant literature of manifestation, root cause and medial qi, this paper explains their theoretical connotation from the perspective of the literal meaning of the Chinese characters 标 (roughly manifestation), 本 (root cause) and 中 (medial) and the natural flow and distribution of qi in the nature. In the circulation and transformation of qi, wind, cold, summerheat, dampness, dryness and fire, i.e. the six qi, are the six external states of qi and can be regarded as the root cause.The hidden trend of transformation that regulates qi flow and distribution and coordinates and harmonizes the six qi is known as the medial qi. The three yin and three yang used to demarcate the six qi state are called manifestation.The essence of the theory of manifestation, root cause and medial qi is a theoretical model depicting natural changes such as the circulation of qi and the climatic changes in nature and a specific application of the philosophical idea of achieving the golden mean of Confucianism.
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Discussion of the regulatory effects of Guizhi Tang on the immune system from the perspective of harmonizing nutrient and defense*
Pang Fengtao, Tang Xiaopo, Xu Haodong, Cheng Zengyu, Li Kesong, Xia Congmin, Jiang Quan
2021, 44 (9):  807-811.  doi: 10.3969/j.issn.1006-2157.2021.09.007
Abstract ( 59 )   PDF (705KB) ( 54 )  
Objective To explore the regulatory effects of Guizhi Tang (Cinnamon Twig Decoction, GZT) on immune system. Methods In view of the relationship between the theory of nutrient and defense and that of the immune system, the regulatory effects of GZT on the immune system were analyzed. Results As one of the important achievements of traditional Chinese medicine, the nutrient-defense theory plays an important role very similar to the function of immune system in modern medicine in disease prevention and treatment. The combination of Guizhi (Cassia Twig, Ramulus Cinnamomi) and Baishao (White Peony Root, Radix Paeoniae Alba) in different proportions in GZT can treat immune diseases caused by such conditions as strong nutrient and weak defense. Conclusion GZT can regulate the immune function by harmonizing nutrient and defense, which has been confirmed by its pharmacological components, basic research and clinical research. Integrating traditional medicine with modern medicine, we could prove the theory of Chinese medicine with the basic research and clinical practice in modern medicine, and guide the development of modern medicine with the philosophy of Chinese medicine so as to achieve better clinical outcomes.
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The theory of turbidity-toxin induced by spleen deficiency*
Sun Jianhui, Yang Qian, Zhang Wan, Wang Zhikun, Liu Yang, Wang Bin, Liu Qiquan
2021, 44 (9):  812-817.  doi: 10.3969/j.issn.1006-2157.2021.09.008
Abstract ( 44 )   PDF (777KB) ( 25 )  
The turbidity-toxin theory is an innovative theory put forward by Professor Li Diangui, a master of traditional Chinese medicine. At present, the research of turbidity-toxin theory mainly focuses on the pathogenic characteristics of turbidity-toxin and the pathological changes caused by turbidity-toxin. However, there is no systematic understanding of the condition and endogenous nature of the formation of turbidity-toxin. Based on the theory of the zang-fu organs and the physiological function and pathological changes of spleen, and in view of the hotspots of immune function and human micro-ecology in modern research, this paper discusses the origin of turbidity-toxin from the perspective of dynamic pathogenesis evolution from spleen deficiency to intestinal flora imbalance or immune dysfunction and to turbidity-toxin, clarifies the conditions for the formation and pathogenicity of turbidity-toxin, and summarizes the pathogenic characteristics of spleen deficiency induced turbidity-toxin, improving the understanding of the pathogenesis of turbidity-toxin. The theory of turbidity-toxin induced by spleen deficiency complements and develops the turbidity-toxin theory, providing new ideas for further study of the latter.
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TCM Constitutions
Reflection on the application of TCM constitution in the prevention and treatment of malignant tumor against the background of comprehensive healthcare*
Qin Jingbo, Li Zhuqing, Meng Xianghe, Cui Jiarui, Wang Ji
2021, 44 (9):  818-823.  doi: 10.3969/j.issn.1006-2157.2021.09.009
Abstract ( 33 )   PDF (722KB) ( 27 )  
Malignant tumor is a complex and diverse disease.Affected by genetic factors,environmental pollution, bad lifestyle and other factors, the incidence rate of malignant tumors has been increasing in recent years, which poses a serious threat to people's life and health.Constitution-disease correlation theory believes that constitution is the “soil”for the development of disease. Compared with people with thebalanced constitution,those with the biased constitution have a much higher risk of suffering from malignant tumor.In the context of China's national policy of comprehensive healthcare,based on the constitution-disease correlation theory, and in view of the prevention and treatment of chronic disease, we divide the development of malignant tumor into four phases:disease-free phase, pre-disease phase, disease phase and post-disease phase. The diagnosis and treatment model of constitution-disease-pattern differentiation should be applied with flexibility to the prevention and treatment of malignant tumor in the four phases. It is not only helpful for starting malignant tumor prevention and control as early as possible, but also conducive to establishing a multidisciplinary collaborative model for malignant tumor diagnosis and treatment and health management, which may reduce the incidence and mortality of malignant tumor, thus promoting the development of the national endeavor of comprehensive healthcare.
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Study on the detection rate of depression among adolescents during COVID-19 epidemic in five provinces of China and its correlation with qi stagnation*
Zhang Xiaofeng, Cao Yujia, Chen Jianghe, Du Yun, Wang Jing, Wen Xiaoyu, Qu Miao
2021, 44 (9):  824-829.  doi: 10.3969/j.issn.1006-2157.2021.09.010
Abstract ( 30 )   PDF (735KB) ( 27 )  
Objective To investigate the incidence of depression in adolescents under the influence of COVID-19 epidemic, and to explore the relationship between qi-stagnation constitution and depression. Methods In this study, 11,548 junior high school students were selected from Shandong, Liaoning, Shaanxi, Fujian and Henan provinces by means of total population sampling from March 20 to March 31,2020 after online classes. The subjects were surveyed with questionnaires developed by the present research team, Patient Health Questiornaire-9 (PHQ-9) scale and qi-stagnation scale, their risks of COVID-19 infection were investigated and all the Results were analyzed statistically. Results 1.Of the 11,548 adolescents, 1,694 (14.67%) suffered depression. 2. Risk factors for adolescent depression included female (OR=1.507,95%CI: 1.344~1.690), graduation (OR=1.352,95%CI: 1.193~1.532),COVID-19 infection risk (OR=1.552,95%CI: 1.132~2.128), and qi-stagnation constitution (OR=3.571,95%CI: 3.170~4.024), and protective factors included good relationship between parents (OR=0.859, 95%CI: 0.753~0.980), and good parent-child relationship (OR=0.246,95%CI: 0.216~0.281). Adolescents with qi-stagnation constitution were exposed to a 3.6 times higher risk of depression than those without qi stagnation. Conclusion In the context of COVID-19 epidemic, the detection rate of depression in adolescents was not significantly higher than that in the non-epidemic period.Instead, the influence of qi-stagnation constitution on the occurrence of depression was greater, even higher than that of the risk of COVID-19 infection.
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Dose-response relationship between sleep duration and qi-deficiency constitution of middle-aged and elderly adults-based on restricted cubic spline model*
Zhang Hui, Zhu Yanbo, Zhang Qian, Lyu Xiaoying, Ooh Chye Tan , Liu Han, Zheng Kun
2021, 44 (9):  830-836.  doi: 10.3969/j.issn.1006-2157.2021.09.011
Abstract ( 26 )   PDF (1053KB) ( 18 )  
Objective To explore the dose-response relationship between sleep duration and qi-deficiency constitution in the middle-aged and elderly adults. Methods From 2 established databases (with 2 170 cases and 1 814 cases respectively), 1 021 samples age 45 and above and with complete questionnaire information were selected for analysis. The scores of the qi-deficiency constitution subscale of the Constitution in Chinese Medicine Questionnaire (CCMQ) with 60 parameters were used to assess the degree of qi-deficiency constitution, and sleep duration was collected through the question “How long do you sleep on average everyday?” in the self-designed background questionnaire. Multiple linear regression analysis and restricted cubic spline model were used to establish the multiple linear regression model to evaluate the relationship between sleep duration and qi-deficiency constitution. Results Among the 1 021 middle-aged and elderly subjects, the average sleep duration was (7.01±1.01) h/d, and the average score of qi-deficiency constitution was (28.50±16.00). Multiple linear regression showed that there was no relationship with statistical significance between sleep duration and qi-deficiency constitution (linear test:β=-0.950,t=-0.060,P=0.071).After adjustment of the confounding factors, the multiple linear regression model fitted with restricted cubic spline model showed that there is a U-shaped relationship between sleep duration and qi-deficiency constitution (non-linear test:P<0.01). The sleep duration at the lowest score of qi-deficiency constitution was about 7~7.5 h/d, and sleep duration shorter than 7h/d and longer than 7.5 h/d was a factor that increases the scores of qi-deficiency constitution. Conclusion Sleep duration had an U-shaped association with qi-deficiency constitution. Therefore, it is recommended that middle-aged and elderly adults ensure 7~7.5 hours of sleep a day and develop a regular and healthy sleep style, which may help reduce their qi-deficiency level.
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Chinese Medicinal Pharmacology
Regulatory effects of regulating liver and lung by means of the HPA axis on Th1/Th2 of asthmatic rats with psychological stress*
Li Chang'an, Cui Hongsheng, Gong Xuefeng, Xin Fang
2021, 44 (9):  837-845.  doi: 10.3969/j.issn.1006-2157.2021.09.012
Abstract ( 43 )   PDF (1268KB) ( 33 )  
Objective The changes in serum, lavage fluid and lung tissue were observed in model rats treated with Xiaochuan Ning (Asthma-relieving) Granule to explore the regulatory effects of regulating liver and lung by means of the HPA axis on Th1/Th2 of asthmatic rats with psychological stress.Methods SD rats were randomly divided into the normal group, asthma with psychological stress (APS) group, Pulmicort Respules (PR) group and Xiaochuan Ning Granule (XCNG) group, with 8 rats in each group. The APS group was sensitized with ovalbumin (OVA) and luminum hydroxide adjuvant and stimulated with atomized OVA for 14 days, and restrained simultaneously for 28 consecutive days.The WM group was given atomized Pulmicert Respules 363.11μG/kg 2 hours before the daily stimulation from the 15th day of the experiment for 14 consecutive days in addition to the same intervention given to the APS group. The XCNG group was treated with Xiaochuan Ning Granule 2.18 g/kg by gavage 2 hours before the daily stimulation from the 15th day of the experiment for 14 consecutive days in addition to the same intervention given to the APS group. The normal group was sensitized and stimulated with saline, but was not restrained. Changes in the concentrations of relevant indicators, positive cell expressions and protein expressions in the serum, bronchoalveolar lavage fluid (BALF) and lung tissue were detected with flow cytometry, ELISA, immunohistochemistry and Western blotting to investigate the regulatory effects of regulating liver and lung on the function of hypothalamic pituitary adrenal axis (HPA) and immune inflammation in psychologically stressed asthmatic rats. Results Compared with The APS group, the peripheral blood eosinophil counts were significantly reduced (P<0.01) and the infiltration of inflammatory cells in lung tissue was significantly reduced of the rats in the XCNG group. The levels of CRH, ACTH and CORT in the serum and BALF of the rats in the XCNG group were significantly lower than those in the APS group (P<0.01), while the GR positive expressions were significantly higher than that in the APS group (P<0.01) though the content was only slightly higher without statistical significance (P>0.05). On the other hand, the levels of IL-4 and IL-17 in serum, BALF and bronchial lung tissue were significantly decreased (P<0.01), and the expression of IFN-γ positive cells in lung tissue was significantly decreased (P<0.01) but the content was only slightly decreased without statistical significance (P>0.05).Conclusion Regulating liver and lung may be able to treat asthma with psychological stress by regulating the HPA axis.
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Study on the mechanism of the regulatory effects of Guanxinkang and its composite formulas on hyperlipidemia based on PERK-eIF2α signaling pathway*
Ma Guiping, Yu Zhongyang, Sun Le, Qing Lijin, Huang Yusheng, Zhang Yiyi, Hong Chuangxiong
2021, 44 (9):  846-853.  doi: 10.3969/j.issn.1006-2157.2021.09.013
Abstract ( 35 )   PDF (1544KB) ( 24 )  
Objective To explore the regulatory effects of Guanxinkang (a patent Chinese medicine based on the Trichosanthes, Chinese Chive and Pinellia Decoction) and its composite formulas on liver cholesterol reverse transport and its mechanism.Methods 60 LDLR-/- mice, half male and half female, were induced by high-fat diet for 12 weeks to establish the hyperlipidemia model. After verifying the model, three composite formulas were obtained from the complete formula of Guangxinfang according to the commonly encountered clinical patterns of hyperlipidemia, i.e. Yiqi Huatan (qi-reinforcing and phlegm-resolving, YQHT)formula, Huatan Huoxue (phlegm-resolving and blood-activating, HTHX) formula, and Yiqi Huoxue (qi-reinforcing and blood-activating, YQHX) formula. The 60 mice were randomly divided into the model group, Guanxinkang (GXK) group, Yiqi Huatan (YQHT) group, Huatan Huoxue (HTHX) group, Yiqi Huoxue (YQHX) group, and simvastatin group, 10 mice in each group, and another 10 C57BL/6J mice with the same genetic background formed the normal group.Guanxinkang, its composite formulas and simvastatin were given to the corresponding groups respectively. Peripheral blood and liver of the mice were collected 12 weeks later. Biochemical method was used to detect the blood lipid content of mice in different groups, HE staining to observe liver pathological changes,real-time PCR to detect liver PERK, eIF2α, SREBP-2, ABCA1 gene expressions, and Western Blotting to detect liver phosphorylation PERK, phosphorylation eIF2α, ABCA1 and SREBP-2 protein expressions. Results Guanxinkang and its composite formulas can regulate blood lipids to different extents. The liver tissues of the mice in the GXK group and the YQHT group were relatively complete. In the liver of the mice in the HTHX group and YQHX group, a large number of lipid droplet vacuoles were seen, accompanied by obvious loose cells with network-like changes. Compared with the model group, the liver PERK, eIF2α, SREBP-2 gene and protein expressions of mice in the GXK group were significantly reduced, and the ABCA1 protein was significantly increased(P<0.05), but there was no such statistically significant difference in the three groups taking the composite formulas (P>0.05). Conclusion Guanxinkang can effectively regulate blood lipids and maintain liver cholesterol homeostasis. Guanxinkang's regulation of blood lipids and its“stabilizing” effects on liver cholesterol may be related to the activation of ABCA1 and inhibition of PERK-eIF2α-SREBP-2 signaling pathway, which reduces the synthesis and uptake of cholesterol and promotes the transport and metabolism of cholesterol. In addition, the herbal ingredients of Guanxinkang that invigorate qi and activate blood, including Huangqi (Astragalus Root, Radix Astragali), Yimucao (Motherwort Herb, Herba Leonuri), and Danshen (Danshen Root, Radix et Rhizoma Salviae Miltiorrhizae) inhibited the PERK-eIF2α-SREBP-2 signaling pathway more significantly.
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Clinical Studies
Analysis of blood stasis pattern from “blood-vessel correlation”*
Xu Tian, Ma Chongyang, Xu Wenxiu, Liao Xuejing, Ji Jing, Wang Xueqian, Cheng Fafeng, Wang Qingguo
2021, 44 (9):  854-859.  doi: 10.3969/j.issn.1006-2157.2021.09.014
Abstract ( 56 )   PDF (786KB) ( 38 )  
The“blood-vessel correlation” theory refers to the functional system constituted by the blood and vessel to maintain and regulate normal life activities of the human body, covering multiple relations between blood and vessel. Among many vascular diseases, blood stasis can best reflect the pathological changes in the interaction between blood and vessel. There are two main factors in the formation of blood stasis pattern: the change in the morphology and quality of blood and the abnormal circulation in the blood vessel. The fact that formulas and medicinal herbs for activating blood and removing blood stasis are effective for blood stasis pattern indicates that blood stasis and obstruction in vessels are the core pathogenesis of blood stasis pattern. In addition, the theory of “blood-vessel correlation” can explain the phenomenon of “the same pattern with different manifestations” of the blood stasis pattern in different diseases. Research into the overall characteristics, development rules and biological mechanisms of blood stasis pattern in the complex system should be guided by the principle of “combination of disease and pattern” and take into account the specificity of diseases. Therefore, it is of great value for better understanding the connotation of blood stasis pattern to clarify the theoretical system of “blood-vessel correlation”, taking typical diseases as the starting point and exploring the interaction between the two from the dual perspectives of blood and vessels.
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Discussion on the mechanism of treating “psychocardiological disease” from the perspective of spleen based on mitochondrial energy metabolism disorder*
Du Min, Tao Liyu, Feng Xiaoteng, Shen Hong, Liu Ping
2021, 44 (9):  860-864.  doi: 10.3969/j.issn.1006-2157.2021.09.015
Abstract ( 47 )   PDF (672KB) ( 33 )  
“Psychocardiological disease” is a common and frequently-occurring disease in the department of cardiology with dysfunction of spleen in transportation as the important pathogenesis. In recent years, a large number of studies have found that mitochondrial energy metabolism disorders are related to the occurrence of psychocardiological disease. The characteristics of the function of “spleen” and mitochondria are similar to a large extent. The essence of spleen deficiency is mitochondrial dysfunction. In clinical practice, invigorating the spleen and replenishing qi, and activating the spleen and draining dampness can significantly improve the symptoms of psychocardiological disease and alleviate mental disorders while improving mitochondrial function. This paper will explore the mechanism of treating psychocardiological disease from the perspective of spleen based on energy metabolism disorder of mitochondria so as to provide reference for the clinical treatment of the psychocardiological disease.
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