最新刊期
      卷 45 ， 期 5 ， 2022

        Special Theme: TCM Oncology

      • Yufei YANG
        Vol. 45, Issue 5, Pages: 433-437(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.004
        摘要：In recent years, the Western medicine treatment of advanced digestive tract cancers has developed rapidly, but it still has shortcomings such as a short survival time, high toxicity, and poor quality of life. Traditional Chinese medicine emphasizes holistic concepts, syndrome differentiation, and treatment, as well as patient satisfaction and quality of life. It is unique in improving the life quality of patients, prolonging their survival time, and reducing the side effects of radiotherapy and chemotherapy. In recent years, this team has cooperated with the Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, the Cancer Hospital of the Chinese Academy of Medical Sciences, and the School of Statistics of Renmin University to conduct a series of explorations into the characteristics of advanced digestive tract cancers in traditional Chinese medicine and the path of diagnosis and treatment. The potential and advantages of traditional Chinese medicine for the treatment of tumors will guide clinical medication and clinical research and in integrating traditional Chinese and Western medicine for the diagnosis and treatment of advanced digestive tract tumors in a manner suitable for the Chinese people.  
        关键词：digestive tract cancers;traditional Chinese medicine dominant population;characteristics analysis;optimal dynamic intervention strategy   
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        发布时间：2022-06-02
      • Yue CHEN,Haijun JIANG,Yuying XU,Lei WANG,Jiawei ZHAI,Tong ZHANG,Yufei YANG
        Vol. 45, Issue 5, Pages: 438-445(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.005
        摘要：ObjectiveTo evaluate the efficacy and safety of the Jianpi Bushen Jiedu formula combined with apatinib and tegafur/gimeracil/oteracil (S-1) for patients with metastatic colorectal cancer (mCRC).MethodsA single-arm, open-label clinical study was conducted. The patients were treated with the Jianpi Bushen Jiedu formula combined with a low dose of apatinib (250 mg, once per day) and S-1 (20 mg, twice per day). The primary outcome was progression-free survival (PFS), and secondary outcomes included the objective remission rate (ORR), the disease control rate (DCR), overall survival (OS), and the MD Anderson Symptom Inventory for Traditional Chinese Medicine (MDASI-TCM) score.ResultsThe median PFS and median OS of the treatment of the Jianpi Bushen Jiedu formula combined with apatinib and S-1 were 4.80 months and 12.73 months, respectively. The ORR was 7.32% (3/41) while the DCR was 68.29% (28/41). The score of the MDASI-TCM did not fall. The common adverse events were hypertension, proteinuria, thrombocytopenia, and bleeding, with incidences of 51.22%, 41.46%, 26.83%, and 19.51%, respectively.ConclusionPatients with mCRC, especially after the failure of the second or above lines of treatment or without treatment with previous bevacizumab may potentially benefit from the treatment with the Jianpi Bushen Jiedu formula combined with low dose apatinib and S-1.  
        关键词：Jianpi Bushen Jiedu formula;apatinib;S-1;metastatic colorectal cancer   
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        发布时间：2022-06-02
      • Jiayang CHEN,Tingting LIU,Rui ZHOU,Jian LIU,Danhui YI,Li HOU,Yuying XU,Chaoxu WU,Li FENG
        Vol. 45, Issue 5, Pages: 446-451(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.006
        摘要：ObjectiveTo explore the prognostic factors that affect patients with advanced esophageal cancer treated with Traditional Chinese medicine (TCM).MethodsA total of 72 patients with stage IV esophageal cancer were selected for analysis, and the advantaged and disadvantaged groups of TCM treatment were defined according to survival time. The log-rank method was used for the univariate analysis, the rank-sum test was used for the correlation between the syndrome type and the prognostic grouping, and the Cox proportional risk model was used for multiple factors.ResultsThe median survival of the 72 patients with esophageal cancer was 17.9 months. The univariate analysis of the result showed that the presence of organ metastasis, the presence of lung metastasis, and the post-treatment symptom self-assessment and length of herbal medication were related to the prognosis of advanced esophageal cancer treated with TCM. The rank-sum test between the TCM syndrome elements, and survival prognosis grouping showed that the syndrome element of Qi stagnation may also affect prognosis. The result of the multifactorial analysis showed that the factor of the duration of the TCM administration was an independent factor that affects the prognosis of advanced esophageal cancer treated with TCM.ConclusionThe duration of TCM treatment affected the prognosis of patients with advanced esophageal cancer.  
        关键词：esophageal cancer;advanced esophageal cancer;traditional Chinese medicine;advantaged population;survival;prognostic factor analysis   
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        发布时间：2022-06-02
      • Xiaochen YANG,Yue CHEN,Tao SUN,Cunjie LIN,Jian LIU,Danhui YI
        Vol. 45, Issue 5, Pages: 452-458(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.007
        摘要：ObjectiveTo explore whether early treatment with integrated Chinese and western medicine can prolong the survival time of patients with advanced digestive tract malignant tumors using a new statistical analysis method and real-world data.MethodsBased on the left truncated data, the Copula model was used to construct a joint model of the time from stage IV diagnosis to treatment and the time to overall survival. The estimated value and significance of the Copula dependence parameter, η, were obtained to evaluate the dependence strength between the two event times of interest.ResultsThe numerical simulation showed that this method performed well when the left truncation rate was 20%. The estimated Copula dependence parameter, η^, in the real data analysis was 0.279 (P<0.05), indicating that there was a significant correlation between times to treatment and overall survival. Gender, the Eastern Cooperative Oncology Group score, targeted treatment, and metastatic site 1 were significant factors associated with overall survival.ConclusionThe new statistical method provided valuable insights and analytical tools for the effectiveness of integrated traditional Chinese and western medicine in treating patients with advanced digestive tract malignant tumors.  
        关键词：Copula;dependent left truncation;integrated traditional Chinese and western medicine;joint model;survival analysis   
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        发布时间：2022-06-02

        Theoretical Studies

      • Xuelin WANG,Peng WANG,Liang WANG,Shaodan LI,Minghui YANG
        Vol. 45, Issue 5, Pages: 459-464(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.008
        摘要：There are many controversies regarding Jue Yin disease in the Treatise on Febrile Diseases. The author found that it is reasonable to understand Jue Yin disease from two perspectives: a deficiency of bodily fluids, and the advance and retreat of Yin and Yang based on an understanding of Huangdi Neijing and modern scholars on Jue Yin disease, the meaning of the internal meridian, and the research result of modern medicine on Jue Yin disease. If Jue Yin disease is regarded as the state of Yin and Yang advancing and retreating based on deficiencies of bodily fluids, then article 326 and the Wumei pill can be regarded as the outline syndrome and main prescription of Jue Yin disease, respectively. The progression and withdrawal of Yin and Yang and the associated fluctuation of bodily fluids make Jue Yin disease dynamic and multiphasic. The essence of Jue Yin disease is determined by the characteristics of bodily fluids and the Yang Qi. Instead of focusing on the disease location or the combination of cold and heat, whether the Yang Qi advances or retreats and the coordination of the bodily fluid state should be focused on as the internal cause of the transfer of Jue Yin disease to Yin and Yang, or the occurrence of heat, cold and the self-healing syndrome. Although Yin and Yang are all-inclusive, the state of bodily fluids has many meanings; there is a significant deficiency of bodily fluids in Jue Yin disease. As such, by emphasizing the state of bodily fluids and the characteristics of Yin and Yang, Jue Yin disease can be better explained and gains a certain clinical significance.  
        关键词：Treatise on Febrile Diseases;Jue Yin disease;fluid   
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        发布时间：2022-06-02
      • Jie HONG,Cuili LIN,Xingwei XU,Minghan HUANG,Xiao KE,Chunbo YANG
        Vol. 45, Issue 5, Pages: 465-470(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.009
        摘要：In the Legacy of Huangdi Neijing Suwen, the spleen is likened to the "Official in Charge of Admonition and Arbitration" , and its mechanism of action is closely related to the physiological characteristics of the spleen. The spleen’s function is based on its "concealment of the mind and mastery of thought" , and this provides ideological guidance for the spleen’s "remonstration" . Furthermore, the spleen’s "central position to instill the four sides" creates convenient conditions for the rapid arrival of "remonstration" , and its "main transport and transformation" provides an important source of energy for the "Zhi Zhou" ; it further ensures the orderly development of the "remonstration" function. The "spleen is the guard" is the concrete embodiment of "remonstration" by the spleen that plays the role of guarding the body and resisting external evil. Western medicine believes that this theory has something in common with the immune function of the body. This paper summarizes the interpretation of the spleen as the "Official in Charge of Admonition and Arbitration" by medical scholars through the ages, relying on the ideas of "comparing images with similarities" and "preventing diseases" based on the philosophy of traditional Chinese medicine that considers the physiological characteristics of the spleen related to Chinese medicine and the interpretation of its theoretical connotation by modern medicine. This paper provides a reference for the clinical management of spleen and stomach diseases, neurological diseases, and immune disorders in Chinese medicine.  
        关键词：spleen;Official in Charge of Admonition and Arbitration;physiological characteristics;immunity   
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        发布时间：2022-06-02
      • Xinyu XU,Zhikang YING,Pengfei GUAN,Yun CUI,Zecheng SHEN,Junzhuang ZHENG,Jun WU
        Vol. 45, Issue 5, Pages: 471-477(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.010
        摘要：This paper analyzes the relationship between male semen diseases and the spleen and stomach, and establishes a basic framework for treating semen diseases from the spleen and stomach. However, the spleen and stomach are important organs for transporting the essence and nourishing the zang-fu organs. Hence, an abnormal spleen and stomach inevitably affects the functions of other zang-fu organs, thus jointly affecting the semen chamber. Accordingly, the theory that "middle deficiency causes seminal changes" and the differentiation and treatment of male semen diseases are further discussed to clarify the pathogenesis of medium deficiency, establish specific treatment method , and expand the theoretical connotation. First, the spleen occupies the center of the hospital with four other organs. The production of the heart, lung, liver, and kidney is related to the spleen and stomach, and this determines the important role of the middle deficiency during the process of causing semen diseases. Second, there are numerous causes of semen changes, and both the spleen and stomach directly affect the semen chamber, which also contains four organs that involve the following: spleen deficiency affects the kidney, resultsing in loss of essence and qi; spleen deficiency affects the liver, resultsing in loss of blood and stagnation of qi; spleen deficiency affects the lung, resultsing unable derisive and descending; spleen deficiency affects the heart, resultsing in loss of blood and god disorderly; spleen deficiency causes phlegm, dampness and blood stasis conjointly and can trigger semen chamber abnormal and semen changes. In addition to the pure spleen-strengthening method , the differentiation and treatment of semen diseases should be treated using the simultaneous treatment of kidney and spleen to restore nature and nurture mutual funding; the simultaneous treatment of liver and spleen to restore the transformation of essence and blood; the simultaneous treatment of lung and spleen to restore the derisive and descending of Qi; the simultaneous treatment of heart and spleen to restore mental regulation; and the simultaneous treatment of removing real evils to restore Qi circulation and blood. Finally, the theory of the "middle deficiency causes seminal changes" in guiding the treatment of diseases in semen has reduced the disease treatment difficulty and expanded the advantage of syndrome differentiation thinking; however, there is still a need to actively filtrate and expand advantageous diseases, demonstrate the effect of spleen-strengthening herbs on the sperm molecular level, and study the relationship between the middle deficiency and reproduction by allowing for the alteration of intestinal flora as a mediator to make the theory of the "middle deficiency causes seminal changes" content richer.  
        关键词：semen diseases;semen chamber;the spleen and stomach;middle Qi;four organ;middle deficiency causes seminal changes;differentiation and treatment thinking   
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      • Yu JIANG,Leitao SUN,Minhe SHEN,Xin GAO,Lulin YU,Shanming RUAN
        Vol. 45, Issue 5, Pages: 478-482(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.011
        摘要：Tumorigenesis result from the formation of a continuous accumulation of cellular dysplasia and impaired immune recognition and clearance functions. In modern times, traditional Chinese medicine (TCM) scholars have proposed the concept of a "cancer toxin" as an important factor in the TCM theory to recognize the occurrence and development of malignant tumors. Currently, the Yin and Yang attributes of a cancer toxin are still controversial. Patients with cancer have diminished body defenses and somatic and mental weakness. The risk of metastasis is difficult to prevent, presenting the pathological features of a weak fire and virtual inclusion of Yang. By utilizing an analysis of the "vigorous fire" theory in Huangdi Neijing, we explore the properties of cancer toxins and believe that there are similarities between cancer toxins and vigorous fire; the malignant proliferation characteristics of tumor cells are close to the Yin Yang differentiation principle. Furthermore, the excessive use of Yang Qi turns into fire, recruits Yin around restricted tumors, forms tangible entities, consumes primordial Qi continuously, and leads to the final death. The dynamic process of cancer toxins and Yuan Qi competition in the body that constitute the multistage disease mechanism transformation—such as tumor initiation, growth, and metastasis, and the identification of the essential features of cancer toxins—provides clinical ideas for the Yin and Yang therapeutic principle.  
        关键词：malignant tumor;Huangdi Neijing;cancer toxin;vigorous fire   
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        发布时间：2022-06-02

        Chinese Medicinal Pharmacology

      • Chaoran GE,Xin WANG,Gansheng ZHONG,Jia HE,Min HUO,Na LI,Feng CHEN,Linlin XIU,Haiyan LIU,Shaohong CHEN,Xue YU
        Vol. 45, Issue 5, Pages: 483-491(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.012
        摘要：ObjectiveTo study the effect of a seaweed and licorice anti-drug combination on thyroid function and the expression of the mammalian target of rapamycin (mTOR) in rats with goiter. This is done to provide an experimental basis for the application of an anti-drug combination of sargassum and glycyrrhiza.MethodsA total of 84 male Wistar rats were selected and randomly divided into a blank group, a model group, a euthyrox group (20.00 μg/kg), a Haizao Yuhu decoction group (10.08 g/kg), a Haizao Yuhu decoction without sargassum group (9.00 g/kg), a Haizao Yuhu decoction without glycyrrhiza group (9.18 g/kg), and a Haizao Yuhu decoction without sargassum and glycyrrhiza group (8.10 g/kg). Except for the blank group, the others were given propylthiouracil to replicate the goiter pathological model and the corresponding drug solution. The serum levels of triiodothyronine (T3), tetraiodothyronine (T4), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) in rats were determined using a radioimmunoassay, and the expression of the Ki67 protein was detected using immunohistochemistry. The p-mTOR and mTOR proteins were detected using a western blot assay.ResultsCompared with the model group, the serum levels of T3, T4, FT3, and FT4 in the euthyrox group were higher, and the TSH level was lower (P < 0.01). Serum levels of T3, T4, FT3, and FT4 were increased in the Haizao Yuhu decoction group, the Haizao Yuhu decoction without the sargassum group, the Haizao Yuhu decoction without glycyrrhiza group, and the Haizao Yuhu decoction without sargassum and glycyrrhiza group (P < 0.05, P < 0.01), The TSH level was decreased (P < 0.05, P < 0.01). Compared with the model group, the positive expression rate of the Ki67 protein in the thyroid tissue of rats in the Haizao Yuhu decoction group and the Haizao Yuhu decoction without sargassum group was lower (P < 0.01). The positive expression rate of the Ki67 protein in the thyroid tissues of the rats in the Haizao Yuhu decoction without glycyrrhiza group and the Haizao Yuhu decoction without sargassum and glycyrrhiza group was decreased (P < 0.05). Compared with the model group, the p-mTOR protein expression level in the euthyrox group, the Haizao Yuhu decoction without sargassum group, and the Haizao Yuhu decoction without glycyrrhiza group was decreased (P < 0.05). In addition, that in the Haizao Yuhu decoction group was decreased (P < 0.01). Furthermore, there was no significant difference in the expression level of the mTOR protein, but p-mTOR/mTOR decreased in the Haizao Yuhu decoction without sargassum group and the Haizao Yuhu decoction without glycyrrhiza group (P < 0.05).ConclusionThe Haizao Yuhu decoction had a significant thyroid hormone effect on the level of thyroid enlargement in rats and may inhibit cell proliferation by inhibiting the activation of the mTOR signaling pathway. Hence, it had the effect of correcting goiter.  
        关键词：Haizao Yuhu Decoction;antagonistic medicinal combination;goiter;thyroid hormone;cell proliferation;Ki67 protein;mTOR signaling pathway;rats   
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        发布时间：2022-06-02
      • Simin CHEN,Xiuyan WU,Guiying PENG,Tianfang WANG,Peipei ZHANG,Xianjiao LI,Yan LIU,Dongyu GE,Ruijuan DONG
        Vol. 45, Issue 5, Pages: 492-499(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.013
        摘要：ObjectiveTo study the regulatory effect of the Shaoyao Gancao decoction on the structure of the intestinal flora in mice with bronchial asthma.MethodsA total of 50 SPF BALB/c female mice were randomly divided into a normal group, a model group, a dexamethasone acetate group, a Shaoyao Gancao decoction 1∶1 group, and a Shaoyao Gancao decoction 2∶1 group. The intestinal flora disorder model was established by sensitization and atomization of the ovalbumin. From the 15th day of the experiment, 30 min was intragastrically administered continuously for 14 days before atomization. The normal group and model group were given the same amount of distilled water, and the mice in the dexamethasone acetate group (0.676 mg/kg), the Shaoyao Gancao decoction 1∶1 group (6.01 g/kg), and the Shaoyao Gancao decoction 2∶1 group (6.01 g/kg) were given corresponding drugs by gastric perfusion. On the 29th day of the experiment, colon tissue and fecal samples from each group were collected, and the general state and pathological changes in the mice’s colon tissue were observed and analyzed. Six mice in each group were randomly selected for 16S rRNA sequencing to analyze changes in the intestinal microflora diversity and species richness.ResultsThe general state and typical symptoms of asthma in the mice of the dexamethasone acetate group, the Shaoyao Gancao decoction 1∶1 group, and the Shaoyao Gancao decoction 2∶1 group were significantly improved. A histopathological examination showed that the colon in the normal group was clear and intact, and there were a large number of inflammatory cells and enlarged lymph nodes in the colonic mucosa and submucosa of the model group. Congestion and edema were significantly improved in the dexamethasone acetate group. Inflammatory cell infiltration was still seen in the Shaoyao Gancao decoction 1∶1 group. The structure of the Shaoyao Gancao decoction in the 2∶1 group was more complete, and inflammatory cells were occasionally scattered in the mucosa and submucosa. The 16S rRNA sequencing result showed that compared with the normal group, in the Chao1 of the model group, the PD was decreased (P<0.01), and the observed species was decreased (P<0.05) compared with the model group. However, the PD was increased (P<0.01) in the dexamethasone acetate group and the Shaoyao Gancao decoction 2∶1 group. The Chao1 and observed species were increased (P<0.05), and the levels of intestinal flora bacteria showed that the abundance of lachnospiraceae was increased (P<0.05) in the model group compared with the normal group. The abundance of Rothia increased (P<0.01), and the abundance of Bacteroides decreased (P<0.05) in the model group compared with the normal group. The abundance of Lachnospiraceae decreased (P<0.05) in the 1∶1 group of the Shaoyao Gancao decoction compared with the model group, and the abundance of Bacteroides Prevotella, Lactobacillus, and Rothia increased (P<0.05) in the 1∶1 group of the Shaoyao Gancao decoction compared with the dexamethasone acetate group (P<0.01). Compared with Shaoyao Gancao decoction 1∶1 group, the abundance of Rothia spp decreased in the 2∶1 group of the Shaoyao Gancao decoction (P<0.01), and the abundance of Lactobacillus spp decreased.ConclusionThe Shaoyao Gancao decoction improved the typical symptoms and colon pathology of asthmatic mice, and its mechanism may be related to restoring the diversity and richness of intestinal flora and regulating the structure of intestinal flora.  
        关键词：Shaoyao Gancao decoction;bronchial asthma;intestinal flora;16S rRNA sequencing;mice   
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        发布时间：2022-06-02

        TCM Constitution

      • Hanlin WANG,Yu CHEN,Xinfeng GUO,Fuqin KANG,Jiaxin CHEN,Zhaoyue CHEN,Shunying ZHAO,Lihong YIN,Ji WANG,Yingshuai LI,Jincao LUO,Haiying CUI,Kangli LI,Changcai XIE
        Vol. 45, Issue 5, Pages: 500-506(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.003
        摘要：ObjectiveThe aim of this study was to investigate the correlations between body composition and traditional Chinese medicine (TCM) constitution in normal-weight, overweight, and obese outpatients in Department of Acupuncture for Endocrine-related Obesity.MethodsThe "YiJianZhong Weight Management" We Chat app was used to record patients’ weight, TCM constitution (only five types of TCM constitutions were included: balanced constitution, phlegm-dampness constitution, damp-heat constitution, yang-deficiency constitution, and qi-stagnation constitution), and other information. In addition, a body composition analyzer was used to collect the information including the percentage of body fat, body mass index (BMI), basal metabolic rate, and visceral fat index. Finally, the body constitution data of patients with different TCM constitutions were summarized and analyzed.ResultsA total of 308 patients were included in the analysis, including 100 cases of normal-weight patients and 208 cases of obese or overweight patients. The proportions of TCM constitutions in the normal-weight patients were ranked from most to least as follows: balanced constitution > yang-deficiency constitution > damp-heat constitution > qi-stagnation constitution > phlegm-dampness constitution, while the proportions of TCM constitutions in obese and overweight patients were ranked in the same order as follows: balanced constitution > phlegm-dampness constitution > damp-heat constitution > yang-deficiency constitution > qi-stagnation constitution. There was no significant difference in the composition ratio of the different TCM constitutions between normal-weight patients and overweight, obese patients. The BMIs of all the patients were negatively correlated with the qi-stagnation constitution scores. The BMI decreased by 0.152 kg/m2 when the qi-stagnation constitution score increased by one point. The age and qi-stagnation constitution scores had a positive interaction with the BMI. For every 1-year increase in the average age of patients, the effect of the qi-stagnation constitution scores on the BMI changed from -0.152 kg/m2 to -0.147 kg/m2.ConclusionIn terms of the TCM constitution, a balanced constitution accounted for the highest proportion in normal-weight patients, overweight, and obese patients, while phlegm-dampness and damp-heat constitution accounted for a higher proportion in overweight and obese patients, except for the balanced constitution. In addition, in terms of the relationship between the TCM constitution and body composition, due to the negative correlation between the BMI and the qi-stagnation constitution score, overweight or obese patients with a qi-stagnation constitution should pay more attention to the influence of body composition indicators other than BMI on the development of disease.  
        关键词：body composition analysis;traditional Chinese medicine constitution;obesity;retrospective review   
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        Clinical Studies

      • Zhilin LIU,Liqing SHI,Jianling MA,Jiashan LI,Ying WANG,Kun JI,Huan SONG,Kai YANG
        Vol. 45, Issue 5, Pages: 507-512(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.001
        摘要：Chronic cough is a common chronic respiratory disease in which cough is the only or main symptom. This cough typically lasts for more than eight weeks without significant abnormalities on the X-ray image. However, some chronic coughs may be diagnosed as chronic refractory cough (CRC) in two conditions: cough without definite causes after thorough examinations; symptoms without improving after conventional treatment. With the rapid advancement of science and society, CRC has received increased attention from clinicians, presenting the respiratory system research community with new challenges and opportunities. CRC has no specific name in the Chinese medicine system, but it can be named "Wan Ke" based on its "long duration" . In the history of Chinese medicine, the treatment of "Wan Ke" has been scattered throughout the clinical theory and practice of Chinese medicine, but a systematic theory is still lacking. In this article, we use "multidimensionality" as an entry point to understand the pathogenesis of CRC in terms of its cause, nature, location, and syndrome, and to summarize the ideas of its syndrome differentiation and treatment variation. We believe that CRC is a disease of mixed deficiency and reality, with a mixture of cold and heat. The disease is located in the lungs, and its pathogenesis is closely related to the internal organs, with " lung and spleen related" being significant. The wind-evil hidden lung is the basic and central pathogenesis of CRC. In terms of treatment, the primary approach is Qufeng Xuanfei, combined with the identification of the symptoms and focusing on the lung and spleen. This is combined with syndrome differentiation to clear heat and dampness, invigorate the spleen, warm the lungs, dissolve drinks, and remove dampness and phlegm. In addition, we should also pay attention to the treatment of sparing the liver and regulating wood by changing the medication and dosage as the syndrome changes.  
        关键词：chronic refractory cough;multidimensional pathogenesis;syndrome differentiation and treatment variation   
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      • Xiuli JI
        Vol. 45, Issue 5, Pages: 513-518(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.002
        摘要：In view of the confusion about the concepts of "phlegm" and "Yin" in the clinical practice and literature reports of contemporary Chinese medicine, this paper proposes that it is vital to clarify the concepts of "phlegm" and "Yin" for better prevention and treatment of diseases related to "phlegm" and "Yin" . Huangdi Neijing was the first to record the name of the disease related to "Yin disease" . Zhang Zhongjing’s detailed records of the disease related to "Yin" and the prescriptions for the treatment of "Yin" greatly developed and enriched the theory of "Yin disease" in traditional Chinese medicine, which had an important influence on later generations. Subsequently, the concept of "phlegm" gradually came into being. In the Song Dynasty, the concept of "phlegm" was gradually perfected. In the Yuan, Ming, and Qing Dynasties, doctors gradually generalized the concept of "phlegm" and gradually formed a relatively complete theory of phlegm disease. Contemporary Chinese medicine scholars have explored, analyzed, and preliminarily summarized the concept and essence of "Yin" and "phlegm" from the perspective of modern medicine and began to pay attention to "Yin" . By organizing and analyzing the differences in the concepts and treatment of "phlegm" and "Yin" above, and combining them with the author’s long-term clinical practice, it is proposed that the essence and connotation of "Yin" should be further explored. This would further expound on the important value and clinical significance of treating chronic respiratory diseases from "Yin evil" . In addition, the research ideas of preventing and treating chronic respiratory diseases are proposed based on "Yin evil" .  
        关键词：Yin;phlegm;Yin disease;chronic respiratory diseases;research ideas   
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      • Yuanyi GUO,Yuan LI,Ping LI,Xinning YAO,Xuhang LIN,Peirong HOU,Jiabao LIU,Xia DING
        Vol. 45, Issue 5, Pages: 519-525(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.014
        摘要：ObjectiveTo analyze the characteristics of the tongue image in the process of chronic gastritis shifting to gastric carcinoma and provide evidence and support for the study of the relationship between TCM tongue characteristic differentiation and the pathogenesis of chronic gastritis shifting to gastric carcinoma.MethodsThe tongue image data of 3 637 patients with chronic gastritis and 100 patients with primary gastric cancer were collected using a multi-center clinical epidemiological investigation. The tongue image data of patients with chronic non-atrophic gastritis, chronic atrophic gastritis, chronic gastritis with dysplasia, and primary gastric cancer during the process of the malignant transformation of chronic gastritis were analyzed using descriptive statistics, and the tongue image distribution was discussed using cluster analysis.ResultsThe cluster analysis showed that the characteristics of the tongue image could be divided into eight tongue image types that respectively represented the syndrome of qi stagnation of the liver and stomach, heat stagnation of the liver and stomach, dampness and heat of the spleen and stomach, dampness and dampness of the spleen and stomach, weakness of the spleen and stomach, and deficiency of stomach Yin and obstruction of stomach collateral stasis. The distribution of tongue image types differed in different stages of the malignant transformation of chronic gastritis. The overall distribution showed a change rule from excess to deficiency and then from deficiency to excess.ConclusionThe characteristics of the tongue image reflect the pathogenesis of chronic gastritis during the process of malignant transformation and can reflect the evolution law of the different stages of the syndrome to a certain extent. This is of great significance for TCM syndrome differentiation and the pathogenesis of chronic gastritis.  
        关键词：chronic gastritis;information-carcinoma transformation;tongue;clustering analysis   
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      • Yuanyuan LI,Yongfa WANG,Ping ZHANG,Yanfei SHAO,Hualin ZENG,Shuying LIN,Shijie QIAO,Bizhen GAO
        Vol. 45, Issue 5, Pages: 526-533(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.015
        摘要：ObjectiveTo investigate the effect of the interaction between single nucleotide polymorphisms of the EXT2 gene and the KCNJ11 gene and blood glucose on the susceptibility to metabolic syndrome with Yin deficiency syndrome.MethodsMultiple single nucleotide polymorphism (SNP) typing techniques were used to detect SNPs in metabolic syndrome patients with Yin deficiency or non-yin deficiency syndrome and healthy people. The SHEsis software was used to analyze the genes of three groups of participants. A generalized multifactor dimensionality reduction combined with a logistic regression model was used to detect the effect of the interaction between the SNPs and blood glucose on the metabolic syndrome with Yin deficiency syndrome.ResultsIndividuals with the KCNJ11 gene rs5215-C allelic polymorphism (CT + CC) had a risk of metabolic syndrome with Yin deficiency syndrome being 0.947 times higher than those with TT (P > 0.05). Individuals with the EXT2 gene rs11037909-C allelic polymorphism (CT + CC) had a risk of metabolic syndrome being 1.839 times higher than those with TT (P <0.05). The model composed of the rs11037909 locus of the EXT2 gene and blood glucose was the best model related to the risk of metabolic syndrome with Yin deficiency syndrome (P=0.001). Individuals with the CT/CC genotype but without hyperglycemia had a 4.216 times higher risk of metabolic syndrome with Yin deficiency syndrome compared with those with the TT genotype but without hyperglycemia (P <0.05). Individuals with hyperglycemia and the TT genotype had a 3.737 times higher risk of metabolic syndrome with Yin deficiency syndrome compared with those with the same genotype but without hyperglycemia. (P <0.05).ConclusionCarrying the rs5215-C allele of the KCNJ11 gene did not increase the susceptibility to metabolic syndrome Yin deficiency syndrome. The rs11037909-C allele of the EXT2 gene was a risk factor for metabolic syndrome. The interaction between rs11037909 of the EXT2 gene and blood glucose will increase the susceptibility to metabolic syndrome with Yin deficiency syndrome. Both the rs11037909-C allele and hyperglycemia were risk factors for metabolic syndrome with Yin deficiency syndrome. After two risk factors interacted, the risk of developing metabolic syndrome with Yin deficiency syndrome was higher than those without risk factors.  
        关键词：metabolic syndrome;Yin deficiency syndrome;gene;single nucleotide polymorphisms;generalized multifactor dimensionality reduction;interaction   
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        Literature Study

      • Ruofan ZHENG,Dongfang YANG,Mingming YANG
        Vol. 45, Issue 5, Pages: 534-538(2022) DOI: 10.3969/j.issn.1006-2157.2022.05.016
        摘要：WANG Kentang, a medical scholar during the late Ming dynasty, systematically inherited the Ministerial Fire Theory in the Danxi School and explained the mechanism of some complex diseases using it. The current theory of traditional Chinese medicine teaching materials has difficulty explaining why Yin deficiency can cause edema. However, WANG Kentang successfully proposed a unique explanation from the perspective that the kidney meridian is affected by evil Qi, and ministerial fire explodes and induces water. Generally, the public believes that epilepsy is caused by inherent phlegm closing and blocking the Qi of organs in the body, while WANG Kentang proposed a new mechanism. A weak kidney cannot nourish the liver, and the Qi in the liver rises and induces phlegm, that is, some of the phlegm is attributed to Qi in the liver. In terms of treatment, WANG Kentang identified the method of nourishing yin to relieve fire for treating hyperactivity of the ministerial fire, and he corrected this with the administration of some herbs. For instance, he opposed the treatment of Laozhai (severe cases) due to Yin deficiency with the Zhibo Siwu decoction because taking in Zhimu and Huangbo for a long time would hurt Yin and help fire, and thus reduce the Qi of the body without rising. However, the heat of Chuanxiong and Angelica sinensis would increase the trend of Yin deficiency and the disorder of the ministerial fire. In addition, though his original views on the efficacy of cinnamon and monkshood in the Bawei pill also have high reference significance, his understanding of the tortoiseshell in the Dabuyin pill is wrong.  
        关键词：WANG Kentang;Danxi school;ministerial fire;Zhibo Siwu decoction;oedema;epilepsy   
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