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主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

Table of Content

    10 July 2017, Volume 40 Issue 7 Previous Issue    Next Issue
    Therapeutic principles on damp disease, phlegm-fluid retention, water-qi disease in Jinguiyaolue based on theory of preventive treatment of disease*
    ZHU Wenxiang, WANG Qingguo, WANG Xueqian, LI Chengwei, CHENG Fafeng, MA Chongyang, MU Jie, LI Changxiang, LIAN Yajun
    2017, 40 (7):  533-536.  doi: 10.3969/j.issn.1006-2157.2017.07.001
    Abstract ( 352 )   PDF (1230KB) ( 232 )   Save
    The theory of preventive treatment of disease in Jinguiyaolue (Synopsis of Prescriptions of the Golden Chamber) includes following 4 aspects: preventing disease at the first, stopping disease transmission, treating disease overall and deciding diagnosis and treatment plan before disease onset. There are 3 theoretical principles for this theory: disease preventive principle, overall therapeutic principle, and principle for selecting diagnosis and treatment steps. The therapeutic principles for damp disease, phlegm-fluid retention, water-qi disease in Jinguiyaolue is analyzed based on the theory for getting ZHANG Zhong-jing’s therapeutic thinking, expand understanding to original texts, and enrich the content of modern system of pattern differentiation and treatment.
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    On “patterns and symptoms” and “pattern differentiation and disease identification”*
    YIN Xiaoyu, CHEN Ming
    2017, 40 (7):  537-541.  doi: 10.3969/j.issn.1006-2157.2017.07.002
    Abstract ( 429 )   PDF (1216KB) ( 285 )   Save
    Three issues, relationship between TCM patterns and symptoms, methods for identifying TCM patterns in clinic, and necessity of integrating pattern differentiation with disease identification, are discussed in the paper. Then it comes to conclusions that pathogenesis differentiation depends on the tip and the root, priority is confirmed according to disease urgency, and furthermore, diagnosis by Western medicine is referenced. The purpose is to explain disease name identification, TCM pattern differentiation and pathogenesis seizing under the guide of TCM theory in modern TCM clinical practice. In the discussion of disease identification, the article emphasizes on how to regard the results of relevant examinations and diagnosis by Western medicine as a modern TCM practitioner. An opinion is presented that Western medicine is referenced flexibly based on TCM theory for reducing misdiagnosis and missed diagnosis, and clinical thinking is extended based on integrating TCM and Western medicine for improving clinical efficacy.
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    Referential indefiniteness of theory of “Shaoyang dominating bone”: an analysis on cause*
    SI Yuhao, MA Yong, XU Lili, GUO Yang, CAO Lumei
    2017, 40 (7):  542-545.  doi: 10.3969/j.issn.1006-2157.2017.07.003
    Abstract ( 412 )   PDF (1153KB) ( 322 )   Save
    The connotation of theory of “kidney dominating bone” is quite clear, but theory of “Shaoyang dominating bone” has an obscure meaning. The causes are analyzed as followings: insufficient explanation in Huangdineijing (Huangdi’s Internal Classic), controversial original texts, unclear clinical indications and no unified opinion on theoretical interpretation made by later physicians. The theory of “kidney dominating bone” stresses on growing of bone, refers to a single and clear meaning. However, the theory of “Shaoyang dominating bone” stresses on the using of bone, including liver blood, kidney essence, qi and blood, meridians and the coordination of bones and muscles, is a wide range of theoretical category which is difficult to be clarified. It is possible that the ancients intended to make an obscure meaning of the theory of “Shaoyang dominating bone”.
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    Local medical officials in Xin’an in the Ming and Qing Dynasties*
    WAN Simei, LIU Boshan, WANG Jian
    2017, 40 (7):  546-549.  doi: 10.3969/j.issn.1006-2157.2017.07.004
    Abstract ( 354 )   PDF (1207KB) ( 396 )   Save
    The study, based on Huizhou Chronicle, on official medical services in Huizhou and local medical officers in Xin’an in the Ming and Qing Dynasties finds out that the major affairs of Xin’an local medical officials were to rescue and cure poor and sick military and civilians, and dealt with plague in early Ming Dynasty. But official medical services and local medical officers have been gradually abolished since the Jiajing period of the Ming Dynasty, and stepped down gradually from the historical stage after the Qing Dynasty except of Wuyuan County. And then folk multiple forces have risen and become undertakers of social medical insurance in Huizhou.
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    Effect and mechanism of Buyang Huanwu Tang in prevention and treatment of idiopathic pulmonary fibrosis*
    YANG Kun, LI Yonghua, WANG Fei, DONG Yan
    2017, 40 (7):  550-557.  doi: 10.3969/j.issn.1006-2157.2017.07.005
    Abstract ( 369 )   PDF (3197KB) ( 198 )   Save
    Objective To investigate the pharmacodynamic mechanism of Buyang Huanwu Tang (Yang-Tonifying Five-Returning Decoction) in treatment of bleomycin-induced idiopathic pulmonary fibrosis (IPF) in rats. Methods Male SD rats (n=144) were randomly divided into blank group, bleomycin group, prednisone group (0.004 2 g/kg) and high-dose Buyang Huanwu Tang group (27.32 g/kg, high-dose group), mid-dose Buyang Huanwu Tang group (13.66 g/kg, mid-dose group) and low-dose Buyang Huanwu Tang group (6.83 g/kg, low-dose group, each n=24). The model of IPF was induced by one-time intratracheal injection of bleomycin in all groups except of blank group. All groups were given corresponding medicinal after modeling for 24 h, and 8 rats were chosen from each group on the 7th d, 14th d and 28th d respectively for collecting bronchoalveolar lavage fluid (BLAF) and lung tissue. The severity of pulmonary alveolitis was observed by using HE staining, and levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and high mobility group box 1 (HMGB1) in BLAF were detected by using enzyme-linked immunosorbent assay (ELISA). Results Compared with blank group, fibrosis focal increased in alveolar septa, lung parenchyma structure was damaged, and levels of TNF-α, IL-1β and HMGB1 increased in bleomycin group at different time points (P<0.05). Compared with bleomycin group, pulmonary alveolitis was relieved in varying degrees, and levels of TNF-α, IL-1β and HMGB1 decreased in high-dose group, mid-dose group and low-dose group. Conclusion Buyang Huanwu Tang can effectively reduce the levels of IL-1β, TNF-α and HMGB1 in BLAF, relieve alveolitis and inhibit pulmonary fibrosis in rats with bleomycin-induced IPF.
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    Influences of Banxia Xiexin Tang and guanosine on learning and memory in APPswe/PS1dE9 double transgenic mice*
    SHENG Ning, HE Yingkun, FENG Huili, DONG Yunfang, FAN Hui, DANG Huizi, REN Ying, YANG Jinduo, WANG Pengwen
    2017, 40 (7):  558-563.  doi: 10.3969/j.issn.1006-2157.2017.07.006
    Abstract ( 384 )   PDF (1193KB) ( 260 )   Save
    Objective To detect the influences of Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) and guanosine on learning and memory in APPswe/PS1dE9 double transgenic mice (6 months old) by applying step-down test and Morris water maze (MWM). Methods The mice were randomly divided into model group (given 0.5% CMC intragastrically), Western drug control group [WD group, given donepezil in 0.92 mg/(kg·d) intragastrically], Banxia Xiexin Tang group [BXT group, given Banxia Xiexin Tang in 650 mg/(kg·d) intragastrically], Chinese medicinal control group [CM group, given curcumin in 200 mg/(kg·d)] and guanosine group (given 0.5%CMC intragastrically, each n=15). The guanosine group was given intraperitoneal injection of guanosine [16 mg/(kg·d)], and other groups were given intraperitoneal injection of isopyknic normal saline (NS). The brood wide type C57BL/6J mice (n=15) were set into normal group and given 0.5%CMC intragastrically and isopyknic NS. All groups were given corresponding interventions when mice were 3 months old. The ethological detection was conducted by using step-down test and MWM in al groups after 3 m. Results The results of step-down test showed that latency was significantly shorter in model group than that in normal group (P<0.01), and was significantly longer in all medicinal intervention groups than that in model group (P<0.01). The results of MWM showed that escape latency was shortened, swimming distance showed decline trend with slight fluctuation in all groups along with days increasing. The results of MWM showed that in spatial probe test, the time of targeting quadrant was significantly shorter in model group than that in normal group (P<0.01), and was longer in WD group, CM group and BXT group than that in model group (P<0.05). Conclusion Banxia Xiexin Tang has an ameliorative effect on early learning and memory disorder, and guanosine can improve the ability of memory retaining in APPswe/PS1dE9 double transgenic mice.
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    Review on quality of Lurong (cornu cervi Pantotrichum) based on osteoinductive differentiatione effect of bone mesenchymal stem cells*
    QU Leiming, LI Feng , GONG Wei, LIU Wei
    2017, 40 (7):  564-571.  doi: 10.3969/j.issn.1006-2157.2017.07.007
    Abstract ( 313 )   PDF (1205KB) ( 214 )   Save
    Objective To investigate the influences of medicated serum of Lurong (cornu cervi Pantotrichum) in various specifications on proliferation and osteogenic differentiation of bone mesenchymal stem cells (BMSCs), and conduct a cluster analysis on Lurong in 8 specifications. Methods SD rats (n=72) were randomly divided into 9 groups. The medical materials of Lurong in 8 specifications were screened according to the growth characteristics and processing methods of antlers. The medicated serum samples contained Lurong in various specifications were prepared respectively in rats, and BMSCs were cultured in these serum samples. The proliferation of BMSCs was detected by using methyl thiazolyl tetrazolium test (MTT), and secretion volume of alkaline phosphatase (ALP), bone morphogenetic protein-2 (BMP-2) and bone gla-protein (BGP) were detected by using enzyme-linked immunosorbent assay (ELISA). The test results were statistically analyzed by applying SPSS17.0 software and grey relational analysis respectively. Results The medicated serum of Lurong had an accelerative effect on proliferation of BMSCs, which was superior in Lurong wax-scale groups to that in inducing liquid group. The serum also improved the secretion of ALP, BGP and BMP-2 during the course of osteogenic differentiation of BMSCs. The ranking of Lurong in different qualities, according to the effects of tonifying the kidney and invigorating bone, showed that the results of quality reviews on samples of Lurong in 8 specifications conformed to the traditional quality partition of Lurong medical materials. Conclusion This method and model can be applied in quality review of medical materials of Lurong.
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    Influences of baldrinal on gastrointestinal sensitivity and expressions of 5-HIAA and relevant receptors of 5-HT in rats with irritable bowel syndrome*
    TAO Siyu, XIAO Congrui, WANG Jing, ZHANG Shujing, GAO Yushan, MU Fangyuan, WANG Yicheng, YAN Xingli
    2017, 40 (7):  572-577.  doi: 10.3969/j.issn.1006-2157.2017.07.008
    Abstract ( 345 )   PDF (1248KB) ( 244 )   Save
    Objective To investigate the effect of baldrinal on irritable bowel syndrome (IBS) induced by chronic-acute stress and its influences on the protein expressions of 5-hydroxyindoleacetic acid (5-HIAA) and relevant receptors of 5-hydroxytryptamine (5-HT) in rats. Methods SD rats were randomly divided into control group, model group, high-dose baldrinal group (0.6 mg/kg), mid-dose baldrinal group (0.3 mg/kg), low-dose baldrinal group (0.15 mg/kg) and pinaverium group (25 mg/kg). The rat model of IBS was established by using chronic-acute stress combined with independent feeding for observing the influence of baldrinal on the scores of abdominal withdraw reflection (AWR). The content of colonic 5-HIAA was detected by using high performance liquid chromatography (HPLC), and influences of baldrinal on protein expressions of colonic 5-HT1A, 5-HT3A and 5-HTR4 were detected by using Western blotting. Results The scores of AWR content of colonic 5-HIAA were decreased in high-dose baldrinal group, mid-dose baldrinal group and low-dose baldrinal group compared with model group (P<0.05). The protein expressions of colonic 5-HT1A, 5-HT3A and 5-HTR4 were regulated in high-dose baldrinal group, mid-dose baldrinal group and low-dose baldrinal group. Conclusion Baldrinal has significant inhibitory effect on gastrointestinal hyperfunction in rat model of IBS and reduce viscera sensitivity, which indicates that baldrinal can relieve IBS symptoms. The effective mechanism may be related to the regulation effect of baldrinal on 5-HIAA contents and protein expressions of relevant receptors of 5-HT.
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    Water-soluble organic acids in 5 fruit medicinal with sour taste from rosaceae family*
    CAO Fu, KUANG Zuopin, XIE Xiaomei, WU Beili, ZHANG Ling
    2017, 40 (7):  578-584.  doi: 10.3969/j.issn.1006-2157.2017.07.009
    Abstract ( 401 )   PDF (2648KB) ( 336 )   Save
    Objective To probe the similarities and differences in water-soluble organic acids among 5 fruit medicinals with sour taste from rosaceae family [Shanzha (Crataegi Fructus), Mugua (Chaenomelis Fructus), Wumei (Mume Fructus), Jinyingzi (Rosae Laevigatae Fructus) and Fupenzi (Rubi Fructus)] through detecting their pH value and organic acid content. Methods The pH value and content of total titratable organic acids in 5 fruit medicinals were determined by using direct potentiometric method and potentiometric titration. The content of water-soluble organic acids including quinic acid, malic acid, shikimic acid, citric acid, fumaric acid, protocatechuic acid and chlorogenic acid were determined by using high performance liquid chromatography (HPLC) and three-wavelength switching method. Results The pH value of 5 fruit medicinals was in an ascending order as follows: Wumei (2.64)<Shanzha (3.19)<Mugua (3.28)<Fupenzi (4.33)<Jinyingzi (5.06). The content of total titratable organic acids was in a descending order as follows: Wumei (16.2%)>Shanzha (8.39%)>Mugua (7.19%)>Jinyingzi (3.97%)>Fupenzi (3.58%). Mugua and Wumei contained nearly all of detected 7 organic acids, and chlorogenic acid was not detected from Jinyingzi and chlorogenic acid and quinic acid were not detected from Fupenzi. The organic acids with higher content in 5 fruit medicinals were, respectively, citric acid (1.09% in Wumei, 0.290% in Shanzha and 0.272% in Fupenzi), shikimic acid (0.753% in Mugua) and quinic acid (0.277% in Jinyingzi). The results of data analysis indicated that pH value and content of total titratable organic acid showed a good negative correlation (Pearson correlation coefficient was -0.73, P<0.01). The content changes of total titratable organic acids and citric acid showed nearly equal in 5 fruit medicinal. The comparison in content of each organic acid showed that the changes of spectrums of monomeric organic acid were different among 5 fruit medicinal. Conclusion This experiment conducts a fairly comprehensive analysis on water-soluble organic acids in 5 fruit medicinal, provides thinking and accumulates experimental data for the systematical characterization and quantification of important content in Chinese medicinal with sour taste. Meanwhile the experiment provides the evidence for Pharmacopoeia of People’s Republic of China that citric acid can be taken as the quality marker for Wumei and Shanzha.
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    Medication rules of formulas containing Longgu (Os Draconis, Bone Fossil of Big Mammals) by national TCM master-YAN Zhenghua based on data mining*
    WU Jiarui, GUO Weixian, LIU Xinkui, LIN Mengjuan, WANG Kaihuan, ZHANG Xiaomeng, YANG Bing, ZHANG Bing
    2017, 40 (7):  585-592.  doi: 10.3969/j.issn.1006-2157.2017.07.010
    Abstract ( 383 )   PDF (3217KB) ( 267 )   Save
    Objective To discuss the medication rules of formulas containing Longgu (Os Draconis, Bone Fossil of Big Mammals) by national TCM master-YAN Zhenghua. Methods On the base of collecting the formulas containing Longgu used by YAN Zhenghua and a database was established based on Traditional Chinese Medicine Inheritance Support System (TCMISS). Apriori algorithm and other data mining methods were built in the data analysis module in TCMISS, and then the module was used for analyzing frequency of single medicinal, frequency of medicinal combinations, association rules and core medicinal combinations. Results The formulas containing Longgu were commonly used for treating insomnia, vertigo and stomachache. The medicinal with high frequency included Muli (Concha Ostreae, Oyster Shell), fried Suanzaoren (Semen Ziziphi Spinosae, Spine Date Seed), Shouwuteng (Caulis Polygoni Multiflori, fleeceflower stem), Danshen (Radix Salviae Miltiorrhizae, Salvia Root) and Chishao (Radix Paeoniae Rubra, Red Peony Root). The medicinal combinations with high frequency included Muli+Longgu, Muli+fried Suanzaoren, and Longu+fried Suanzaoren. The association rules with support degree≥35% and confidence coefficient≥0.98 included Longgu→Muli, Fuling (Poria, Indian Bread, Poria), Longgu→Muli, Muli, Fuling→Longgu, and Longgu, fried Suanzaoren→Muli. Conclusion The medicinal, used by YAN Zhenghua, mostly have the effects of tranquilizing mind and activating blood, and his formula constructing laws are clear and precise.
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    Treatment of advanced gastric cancer with Xinjia Liangfu Granules combined with chemotherapy*
    WANG Jing, GUO Shanshan, HOU Li, CHEN Xinyi, TIAN Shaodan
    2017, 40 (7):  593-598.  doi: 10.3969/j.issn.1006-2157.2017.07.011
    Abstract ( 331 )   PDF (1177KB) ( 243 )   Save
    Objective To observe the clinical efficacy of Xinjia Liangfu (Modified Galangal and Cyperus) Granules on advanced gastric cancer. Methods The patients with stage III/IV gastric cancer (n=42) were randomly divided into control group and treatment group by applying prospective randomized controlled multi-center clinical trial method. The treatment group was treated with standard chemotherapy regimens combined with Xinjia Liangfu Granules, and control group, with only chemotherapy regimens. During the therapeutic course, 2 groups were given the best supportive care and observed for 4 cycles of chemotherapy. The scores of symptoms and signs, Karnofsky performance status (KPS), pain numerical rating scale, tumor size and indexes of blood and urine routine tests, liver and renal functions and electrocardiogram were recorded on the day of grouping and at the end of each cycle of chemotherapy. Results There were 21 cases in treatment group, 20 in control group and 1 case was missed. The trial results showed that the relief of symptoms and signs was significant superior in treatment group to that in control group (P<0.005). The symptoms of stomach pain, abdominal distension and pain, fearing of cold, cold limbs and loss of appetite were relieved in treatment group (P<0.05). The improvement of total physical condition were superior in treatment group to that in control group (P<0.05). The treatment group had higher clinical remission rate compared with control group but the difference had no statistical significance (P>0.05). Xinjia Liangfu Granules had a higher safety in clinical administration. Conclusion Xinjia Liangfu Granules has the effects of relieving symptoms, improving quality of life and reducing toxic and side effects of chemotherapy, and it is safe and effective in clinic.
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    Reliability and validity of Scale for TCM Pattern Element Differentiation of Depression*
    YU Miao, LI Qiyu, GUO Rongjuan, HAN Aiqing, WANG Jialin, XING Jia, CHEN Jianxin, LU Ming
    2017, 40 (7):  599-602.  doi: 10.3969/j.issn.1006-2157.2017.07.012
    Abstract ( 392 )   PDF (1214KB) ( 281 )   Save
    Objective To review the reliability and validity of the Scale for TCM Pattern Element Differentiation of Depression. Methods The reliability was detected by using test-retest reliability, split-half reliability and internal consistency reliability, and validity was evaluated by using criterion related validity and construct validity in 232 patients with depression. Results The correlation coefficient of test-retest reliability of each pattern element was between 0.612 and 0.977, Cronbach’s α coefficient of the total scale was 0.892, split-half reliability was 0.849, and Kappa coefficient was between 0.689 and 0.892. The results of factor analysis showed that 8 common factors were roughly consistent with anticipated results, and accumulating contribution rate was 53.43%. Conclusion The Scale for TCM Pattern Element Differentiation of Depression has higher reliability and validity.
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    Influence of Jiedu Huoxue Fang on perioperative myocardial injury in patients undergone percutaneous coronary intervention*
    WANG Xindong, QI Xiaoxia, HUANG Dan, ZHANG Sujie, GAO Xin, ZHANG Yiyan
    2017, 40 (7):  603-606.  doi: 10.3969/j.issn.1006-2157.2017.07.013
    Abstract ( 274 )   PDF (1166KB) ( 216 )   Save
    Objective To observe the influence of Jiedu Huoxue Fang (Detoxification and Blood-Activating Granules) on perioperative myocardial injury in patients undergone percutaneous coronary intervention (PCI). Methods The patients with angina pectoris received PCI (n=160) were randomly divided into Jiedu Huoxue Fang group (n=84) and control group (n=76). The Jiedu Huoxue Fang group was given routine treatment and Jiedu Huoxue Fang (1 dose/d) 7 d before PCI. The control group was treated with basic drugs. The levels of serum creatine kinase-M B isoenzyme (CK-MB) and cardiac troponin I (cTn I) were detected before and 12 h and 24 h after PCI. Results The levels of serum cTn I and CK-MB were significantly lower in Jiedu Huoxue Fang group than those in control group 12 h after PCI (P=0.003 8, P=0.027 6) and 24 h after PCI (P=0.001 2, P=0.002 7). The constituent ratio of patients with cTn I and CK-MB increasing by 3 times more than normal value was significantly lower in Jiedu Huoxue Fang group than that in control group (P=0.008 2,P=0.007 6). Conclusion Jiedu Huoxue Fang administrated before PCI has a certain preventive effect on perioperative myocardial damage.
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    Distribution characteristics of TCM patterns and pattern factors in patients with coronary heart disease-induced chronic heart failure complicated by hypertension*
    LUO Liangtao, GUO Shuzhen, ZHANG Peng, ZHAO Huihui, WANG Juan, WANG Wei
    2017, 40 (7):  607-612.  doi: 10.3969/j.issn.1006-2157.2017.07.014
    Abstract ( 391 )   PDF (1176KB) ( 223 )   Save
    Objective To compare the influences of hypertension on TCM pattern factors and pattern combinations in patients with coronary heart disease-induced chronic heart failure (CHD-CHF), and provide some reference for pattern differentiation and classification of CHD-CHF. Methods The patients with CHD-CHF (n=252) were chosen from 14 cooperation clinical units through multi-center cross-section study, and then all patients were divided, according to whether they are complicated by hypertension or not, into CHD-CHF+hypertension group and CHD-CHF group. The distribution rules of sex, age, types of heart failure, cardiac grades, pattern factors related to disease nature, pattern factors related to disease locations and pattern combinations were compared between 2 groups for conducting statistical analysis and rules investigation. Results The comparisons in sex, age and heart function had no difference between 2 groups. The pattern factors related to disease nature with the highest occurrence frequency were qi deficiency, blood deficiency and yin deficiency in 2 groups, but occurrence frequency of qi deficiency was lower in CHD-CHF+hypertension group than that in CHD-CHF group (P<0.01). The pattern factors related to disease locations were heart and meanwhile involved spleen, lung, kidney and liver, and there was no significant difference between 2 groups (P>0.05). The pattern combinations were almost multi-factor combinations in 2 groups, and 2-factor combination was more in CHD-CHF+hypertension group than that in CHD-CHF group (P<0.05). The most common pattern types were pattern of qi deficiency and blood stasis, and pattern of dual deficiency of qi and yin with blood stasis in CHD-CHF+hypertension group. Conclusion The percentage of qi deficiency reduces in pattern factors related to disease nature, 2-factor combination is more in pattern combinations, and pattern of qi deficiency and blood stasis and pattern of dual deficiency of qi and yin with blood stasis are the most common pattern types in patients with CHD-CHF complicated by hypertension.
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    Aggrieved qi: What does needling supplement and draining*
    JIANG Shan, ZHAO Jingsheng
    2017, 40 (7):  613-620.  doi: 10.3969/j.issn.1006-2157.2017.07.015
    Abstract ( 344 )   PDF (1155KB) ( 285 )   Save
    The needling methods of supplementation and draining derived from Huangdineijing (Huangdi’s Internal Classic) and have been developed greatly in the later, which is reflected in unified compiled textbook-Acupuncture-Moxibustion and some texts related to terminological standardization. However, supplementation-draining needling methods are excessively complicated and their original intention is hindered to be inherited and applied. On the base of analyzing modern definition and sorts of supplementation-draining needling methods, the necessity of solving the problem has been raised. After study on the content of supplementation-draining needling methods in Huangdineijing, the authors propose that the original intention is a plain embody of homeopathic thinking. The reason of mysterious development of the methods is clarified as misunderstanding to the concept of qi. It is believed that, in interpretation of ancient medical texts, the ancient thoughts and language features should be paid special attention to. Idea expositions and experience records should be identified for avoiding mistakes in comprehension and application.
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