Systematic lupus erythematosus(SLE)

The systematic lupus erythematosus(SLE) is chronic inflammatory connective tissue disease with unknown origin which affects the joint, kidney, surface of serous membrane and blood vessel s wall. Mainly occurs in youth females, but may also occurs in children. The clinical manifestation: SLE occurs more in female, especially in puberty and fertile period; chronic onset of disease, the common symptoms includes:1) fever: irregular subfebrile temperature.2) skin damages: seen commonly on the face- butterfly shaped red patches; from the bridge of the nose to two cheek, resembles butterfly shape, the edge may be clear or not clear, bright red or the purple red, aggravates after the exposure to sun; skin rash is widespread, symmetrical, polymorphic; mucous membrane of mouth, throat, vagina and others have light degree of ulcer.3) athralgia (joint pain) wandering athralgia of large and small joints, myalgia (muscular pain) may appear.4) urinary system: continuous or remittance proteinuria, hematuria, cylinduria adng hypertension, edema and kidney insufficiency.5) cardiobascular system: pericarditis, myocarditis, endocarditis, arrhythmias, cardiac insufficiency and etc .6) respiratory system: pneumothorax, pneumonia, pulmonary artery inflammation and etc.7) digestive system: poor appetite, nausea, vomiting, abdominal pain, diarrhea, melena (blood in stool), ascites and etc.8) nervous system: encephalitis, meningitis, brain stroke, spinitis; may also have slight enlargement of lymph nodes and etc.Additional inspection:Anemia: 90%above patient has anemia, mainly normocytic anemia, normochromic anemia, or hemolytic anemia.White blood cell: The white blood cell reduces, is lower than4.5*10 9/ L (4500/mm2), decrease of neutrophils and lymphocyte, eosinophil increases, which accounts for 10% of total white blood cell. When there is continuous infetions, the white blood cell may elevate (leukocytosis).Platelet reduction: The partial patients have mild or the severe blood platelet reduction (thrombocytopenia).Elevation of ESR (erythrocyte sedimentation rate).Routine urine test: different degree proteinuria, hematuria, cylinduria or pyuria (pus in urine).Biochemistry analysis: elevation of transaminase, unusual turbidity. When the kidney function is not sufficient, BUN, NPN and blood potassium are elevated; most patients protein electricity shows elevation of r-globulin.50% of patients have hypoproteinemia (low level of protein in blood).Immunology analysis:Lupus cell (LEcell) average positive rate50% - 80%.The anti-nuclear antibody (ANA) is the antibody that is produced against a cell s nucleus. Approximately more than 90%of patients are positive. Among the anti-nuclear antibody, anti-DNA antibody specificity is stronger, but among them anti-dsDNA are more specific, approximately 60-70% SLE manifestation stage is positive, its its fluctuation is parallel with the condition of disease. The anti-Sm antibody is a high specificity symbol of SLE, approximately 25-30% patient are positive. This antibody generally only appears in SLE, therefore, it has high early diagnostic value.Complement: more than 70 of patients blood serum always has decrease of complement, C3 and C4 decrease, especially C3 decreases significantly.The lupus belt test(LBT) has high specificity. It can also diagnose SLE which do not affect the skin and may estimate the condition and prognosis of the disease.The treatment includes:1) eliminates the other suspicious causes of disease, e.g control of infection, avoid using the influential drugs (for example oral contraceptive, penicillin, streptomycin, sulfonamide and etc.), avoids exposure to sun and etc.2) immunosuppressors (1) corticosteroids, e.g prednisolone 10-20 milligram or dexamethasone 3 milligrams, 3 times orally daily; gradually decrease of dosage, if it is effective, to maintenance dose;(2) mercaptopurine 50milligrams, 3 times orally daily.3) uses shift factors and the L-imidazole, the latter 50 milligrams, 3 times daily, 3 days consecutively, then stop for 10 days for one treatment course.4) symptomatic therapy e.g aspirin for fever and pain; besides, also use drugs for antihypertension, diuresis, anti-cardiac insufficiency, anti-kidney insufficiency and etc.[Clinical treatment results] Treated 356 cases; 335 cases with significant effectiveness (clinical symptoms disappeared, related laboratory analysis normal), 20 cases effective (clinical symptoms reduced, related laboratory analysis comparatively restored), 1 case of invalid (clinical symptoms and laboratory analysis comparatively no significant changes).

Still disease

This is a rarely seen syndrome, mostly seen in children. Its characteristics: acute onset, continuous or remittance fever; repeatedly skin rash, wandering athralgia and enlargement of lymph nodes, hepatosplenomegaly, leukocytosis and shift to left, increase of ESR, negative in blood culture, antibiotic terapy is not effective, corticosteroids can suppress those symptoms. The modern medicine not yet completely explore this disease, most patients have the infection history, especially streptococcus and staphylococcus infection; but due to negative blood culture, some thought it might concern with the infectious abnormal allergical reaction. The diagnosis is based on clinical signs, this disease does not have specific diagnosis method, therefore, confirmation of diagnosis is done after elimination of other possibilities. This sickness must be distinguishes from septicaemia, rheumatic fever, lymphoma, systematic lupus erythematosus (SLE), dermatomyositis, rheumatic arthritis, juvenile rheumatism arthritis and so on. The modern medicine mainly uses the steroid anti- inflammation medicine and the non- steroid anti- inflammatory medicine in treatment; in recent years, some people even applied cytotoxic drugs in treatment, but the results are not satisfied. The traditional Chinese medicine (TCM) categorized this sickness as wen bing (warm illness), the main sign is fever with appearance of symptoms; emotional unstable, thirst and rashes appear during fever, redness of tongue, small pulse; the pathological energy is wandering around Qi (energy) base, or both energy formed two obvious wave . Secondly, some thought that this disease is supposed to classify as bi zheng (rheumatism) and li jie feng (strong wind in joint), so it combines the pathological changes in joint, wandering characteristic and edematous, thus evil cold as the main sign and divided into pain in cold and pain in moist. The pathogenesis is internal shutting of cold dampness invading muscle and bones, stagnant of jing mai (route) with isolation of Yang externally and Yin internally, resulting in transformation of heat and injuring the Yin and cause this disease. The clinical presentations are not constant, often locates at qi base in hot weather, then resulted in weakness of Qi and Yin after decrease of heat; therefore, one must eliminates evil and adjust of Yin and Yang in treatment. [Clinical treatment result] Treated 120 cases, average age of patients is 25 years-old, 116 cases of female patients. Fully recovered 117 cases, 3 cases became better. Average duration of fever reduced 13 days, skin rash diminished averagely 8 days.

Dermatomyositis

Dermatomyositis Dermatomyositis is a chronic inflammatory disorder of skin, subcutaneous fat as well as skeletal muscle. It is characterized by distinctive skin rash and edema which induce muscle weakness, it may accompanied by athralgia (pain in joint). The cause of dermatomyositis is unknown; recently it is said to be related to anti-immune disease, abnormal reaction towards viral infection and tumor and etc.Clinical manifestations: In early stage, the signs are general weakness, headache, athralgia, slight muscle weakness and others; main pathological changes is at the skin and muscle. Polymyositis is inflammatory myopathy without involving the skin. Mostly seen in middle-ages women.(1) skin symptoms: it begins by edematous rashes especially at the eyelids with purple discoloration, while the cheek may have diffuse chronic dusky patches. Besides, there is dilatation of capillaries, similar to SLE; body dehydration, skin dryness with scalling erythematous eruption and minor skin atrophy, capillaries dilatation and skin discoloration. The skin of posterior surface of fingers joint yields significant edematous rashes, pigmentation, sometimes would appear purple papules. Rashes around nails. 30% of patients has Reynaud phenomenon as early symptoms. 20% of juvenile dermamyositis has deposition of calcium in the muscles or under the skin.(2) muscular symptoms: in acute period, there is myositis (inflammaion of muscle), muscular weakness, swollen muscle, origin pain or compression pain. Generally, proximal muscle is first affected, appearance of movement disturbances such as raising hand and leg, squatting, swallowing, speaking and so on. There will be different symptoms according to different muscular damages. The chronic dermatomyositis has muscular atrophy or sclerosis and leads to complete loss of physical ability. Other complications are such as periodical pneumonitis, myocarditis, athritis, glomerulonephritis and widespread of vasculitis. According to several studies, about 5-40% of patients have the risk of cancer, often combined with lung tumor, digestive tract tumor, stomach tumor, lymphosarcoma and etc. Cancer can happens before, during or after dermatomyositis. Juvenile dermatomyositis seldoms accompanied by cancer.Laboratory analysis:1. Quantity of creatine in 24 hours urine is increased, may more than 1000 milligram (norm: 0-200 milligram).2. Blood serum enzymes: significant increase of ASAT (aspartate aminotransferase, previously known as GOT- glutamate oxaloacetate transaminase), LDH (lactate dehydrogenase), CPK (creatine-phosphate-kinase), CK (creatinine kinase), aldolase; CPK and aldolase often follow the pathological changes of muscle.3. Immunological analysis: increase of immunoglobulins, ESR (erythrocyte sedimentation rate), RA positive.4. Electromyography (EMG): myopathic and atrophic EMG. During low voltage, the oscillation amplitude reduces, the unit reduces, appears of multihomogeneous unit, unit s duration is reduced and etc. 5. Pathology: Skin: Epidermis basal cell undergoes liquefication, basal membrane s subcutaneous shows positive in PAS dye. The upper part of dermis has edema, sedimentation of amyloid protein, swelling of collagen fiber and vasodilatation. Muscle: (1) allergic reaction: mild case: The lines of muscle fiber vanish, coagulation of muscular fluid, transparent changes, proliferation of cells. Severe case: The breaking of muscle fiber, abnormal reaction of macrophages. (2)Inflammation: The infiltration of inflammatory germ cells, edematous muscular fibers, vasodilatation. In late period may appear sclerosis of muscular fibers, atrophy, substitute by connective tissue after its degeneration.Diagnosis:(1) muscular symptoms:1. acute, subacute or chronic process.2. sometimes accompanied by myalgia (pain in muscle).3. decrease ability of muscles of extremities (especially proxiaml muscle), face, neck, pharynx and larynx muscle and etc or muscular atrophy but it must be differentiated from other connective tissue disease which is along with myopathies.(2) skin symptoms: symmetrical distribution on face, chest, limbs (extensor surface), especially the joint, back and etc. 1. purplish-red edematous patches (particularly eyelid)2. blood capillary dilatation, pigmentation, atrophy.3. Raynaud symptom.4. joints pains.Treatment:The western medicine uses 1.cortical hormone 2.immunosuppresors 3.vitamins 4.muscular medicines 5.proteins assimilated medicines 6 .supportive therapy.Traditional Chinese medicine (TCM) treatment. Heat type: clear and nutritive to blood and disintoxicating; cold type: eliminate cold and invigorates blood; weak type: adjustment of yin and yang , invigorates qi (vital energy) and blood.[Clinical treatment result] Treated 513 cases, after 1 month of medicine introduction, 496 cases significantly effective, effective17 cases.

SLE (kidney form)

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Ninety percent of cases are in women, usually of child-bearing age, but children, men, and the elderly can be affected. The occurrence rate of SLE along with organs pathologies in overseas is 16-80%, while in China is 64-67%.ClassificationClinically, SLE is divided into 4 forms:(1) light degree of harmfulness(2) combination of renal diseases(3) progressing renal insufficiency(4) acute form In the traditional Chinese medicine studies, this disease belongs to the categories of Yin Yang du (Yin and Yang poisoning), xu lao (weakness) and shui zhong (edema), it is mainly caused by insufficiency regulation and hypofunction of internal organs system, damage of liver and kidneys, weakening of both Qi and Yin , zheng (healthy) cannot resist xie (disease), thus xie du (bad substances of the disease) will cause the opportunistic infections which leads to du heat burning, impair fluid metabolism, disturbances in balance between Qi and xue , weakening of internal organs and bruising of jin (one of the vessels pathway). Clinical treatment results There were 62 cases using traditional Chinese medicine therapy with 52 complete recovery cases and 9 non-complete recovery cases. Total effectiveness 100%.

Chronic glomerulonephritis

This syndrome is characterized by persistent proteinuria and/or hematuria and renal insufficiency that progresses slowly over years. This disease is a multietiological disease which has the possibility to progress to chronic nephritis with course of disease more than one year (gradually developing). It??s prone in adults and male than female. Among them, few cases develop from acute nephritis and mostly occur without symptoms and disease history. Clinically it??s classified into three types:
(1) normal form
(2) hypertensive form
(3) acute form
The causes of this disease is still unknown but is probably due to lower immune system that will leads to infection by different microbes, or the body immune system could not produce enough antibodies to eliminate cause of disease and leads to high immune complex(toxic to body) remain in body and chronic nephritis.
Renal biopsy typically reveals a variable combination of proliferative, membranous, and sclerotic changes, depending on the causative glomerulopathy. Arteriosclerosis, induced by secondary hypertension, is a common finding in the renal vasculature. Tubulointerstitial inflammation and scarring are frequent additional findings and portend a poor prognosis.
Modern therapy uses diuresis, decreases hypertension, decreases inflammatory symptoms and other symptomatic treatments. The usage of glucocorticoids and immunesuppressive agents are also often used. It is effective in some chronic glomerilonephritis but there are lots of side effects and in total the predicted results are comparatively poor.

Polycystic kidney

Polycystic kidney or cystic disease of kidney includes a group of single or multiple cysts which present in different parts of kidney. Usually, multiple cyst or polycystic is more often occurred, it may affect one or both of kidneys. This disease is more often seen in 35-45 years old people. The main symptoms are such as bloating of the abdomen, abdominal pain (increased in physical exertion, decreased in lying position), swelling of abdomen, hypertension, hematuria, anemia and small amount of patients may have erythrocytosis; 50% of patients may accompanied with cysts of liver, pancreas, lung, spleen, bone, prostate, ovary and thyroid; small amount of patients may even have tumor of the cerebral small veins. At the same time, most of the patients developed nephritis (inflammation of kidney) and nephrolithiasis (stones in kidney). The patients of the late stage will have chronic renal failure. If the patient is newborn or infant, it will accompanied with other mutations and usually die in the first month of life. The modern medicine still not know the cause of this disease clearly, probably it??s caused by the genetic factor; in adult this disease is shown fully (dominant) while in child this disease is hidden (recessive). The diagnose of this disease must be based on family history, middle-aged person will have abdominal and waist pain or twitching pain, along with hematuria or unknown etiology of renal failure but has non-significant anemia. The kidney is enlarged during inspection. The abdominal x-ray may reveals enlargement of kidney borders. The kidney phlebography may show the distension of renal pelvis and semilunar form of renal calices. The ultrasound examination may point out the presence of cysts with fluid and information about it??s size and localization. The modern medicine till now is lack of efficient treatment against this disease, it is mainly directed to treat by the symptomatic therapy (inflammation of urinary tract, stones, blockades), avoiding the injury of urinary tract during inspection. Recently, there were peoples reported that cyst puncture and sclerosis with ethanol are used to treat single cyst as a closed-therapy. While late stage patients with uraemia are suggested to do kidney transplantation. In Chinese medicine, this disease is belongs to zheng ji (accumulative of diseases), pi kuai (cysts), fu tong (abdominal pain), niao bai (proteinuria) and gan yang (liver s function improper) and so on. Ling Shu-the 47th chapter said that the kidney is very important and as the sensitive organ (easily injured) which reflected by waist pain. The congenital insufficiency of body system causes the lack of kidney Qi (energy) and then resulted in hypofunction of kidney and inner blockade by e xue (bad blood), gradually forming cysts; once the disease is prolonged, it will decrease kidney Qi, insufficiency of liver s Yang, partially stop of kidney s metabolism, oliguria, edema, headache and others, lastly it will leads to terminal stage and cause the death of the patient. Clinical treatment resultsThere were 15 cases that adopted the pure traditional Chinese medical therapy; all cases turned out better after taking of medicine for 3 months. Urine became normal; 9 abnormal cases before treatment, 5 cases became normal after treatment and 4 cases became better. Blood pressure: 9 abnormal cases before treatment, 4 cases became normal and 5 cases became better.

Henoch-Schonlein purpura

Henoch-Schonlein purpura, also referred to as anaphylactoid purpura, is a distinct systemic vasculitis syndrome that is characterized by palpable purpura (most commonly distributed over the buttocks and lower extremities), arthralgias, gastrointestinal signs and symptoms, and glomerulonephritis. It is a small vessel vasculitis.Henoch-Schonlein purpura is usually seen in children; most patients range in age from 4 to 7 years; however, the disease may also be seen in infants and adults. It is not a rare disease; in one series it accounted for between 5 and 24 admissions per year at a pediatric hospital. The male-to-female ratio is 1.5:1Causes(1)The presumptive pathogenic mechanism for Henoch-Schonlein purpura is immune-complex deposition. A number of inciting antigens have been suggested including upper respiratory tract infections, various drugs, foods, insect bites, and immunizations. IgA is the antibody class most often seen in the immune complexes and has been demonstrated in the renal biopsies of these patients(2)Genetics factor.(3)Respiratory infectious diseases(4)Food and drugs allergyClinical and labaratory manifestations(1) In pediatric patients, presenting symptoms related to the skin, gut, and joints are present in 50% of cases. (2) In adults, presenting symptoms related to the skin are seen in over 70% of patients, while initial complaints related to the gut or the joints are noted in fewer than 20% of cases. (3) The typical palpable purpura is seen in virtually all patients; most patients develop polyarthralgias in the absence of frank arthritis. Gastrointestinal involvement, which is seen in almost 70% of pediatric patients, is characterized by colicky abdominal pain usually associated with nausea, vomiting, diarrhea, or constipation and is frequently accompanied by the passage of blood and mucus per rectum; bowel intussusception may occur rarely. (4) The renal involvement is usually characterized by mild glomerulonephritis leading to proteinuria and microscopic hematuria, with red blood cell casts in the majority of patients; it usually resolves spontaneously without therapy. Rarely, a progressive glomerulonephritis will develop. Renal failure is the most common cause of death in the rare patient who dies of Henoch-Schonlein purpura.. (5) Myocardial involvement can occur in adults but is rare in children.(6) Routine laboratory studies generally show a mild leukocytosis, a normal platelet count, and occasionally eosinophilia. Serum complement components are normal, and IgA levels are elevated in about one-half of patients.Clinical treatment resultsThe prognosis of Henoch-Schonlein purpura is excellent. Most patients recover completely, and some do not require therapy. Treatment is similar for adults and children. When glucocorticoid therapy is required, prednisone in doses of 1 mg/kg per day and tapered according to clinical response has been shown to be useful in decreasing tissue edema, arthralgias, and abdominal discomfort; however, it has not proven beneficial in the treatment of skin or renal disease and does not appear to shorten the duration of active disease or lessen the chance of recurrence.By using pure Chinese medicine therapy (after non-effective western treatment-no response towards glucocorticoids), there are 157 cases. Among them, the longest course of disease is 5 years and the shortest is 6 months. From them, 147 cases are fully recovered (healthly); symptoms disappeared, proteinuria and hematuria are absent and their normal life routine is recovered. While the rest of 11 cases are effective with whole body symptoms disappeared, absent of proteinuria but hematuria is remained.Those who used purely Chinese medicine from the beginning have 30 cases, male 21, female 9; age range 8-15 years old. The course of disease took place within 6 months-21 cases, 6 months to 1 year-9 cases. They had decreasing in hematuria in average and resulthe in full recovery (purpura disappeared, normal urine analysis). Their effectiveness is 100%. Their average medicine intake is about 15 days.

Chronic renal failure (CRF)

Chronic renal disease (CRD) is a pathophysiologic process with multiple etiologies, resulting in the inexorable attrition of nephron number and function, and frequently leading to end-stage renal disease (ESRD) . In turn, ESRD represents a clinical state or condition in which there has been an irreversible loss of endogenous renal function, of a degree sufficient to render the patient permanently dependent upon renal replacement therapy (dialysis or transplantation) in order to avoid life-threatening uremia . Uremia is the clinical and laboratory syndrome, reflecting dysfunction of all organ systems as a result of untreated or undertreated acute or chronic renal failure. In the traditional Chinese medicine studies, this disease belongs to the categories of shui zhong (edema), yao tong (waist pain) , xu lao (weakness) and shen feng (dizziness, muscular spasm and etc) . The traditional Chinese doctors consider that congenital body weakness, overworking, imbalance of nutrition, repeated disease infections or cannot be cured after long time, all these will cause gradually weakening of kidney Qi , weakness and damage of internal organs, if the spleen is weak, it will impair the circulation and fluid metabolism causing lack of nutrition and growth of blood, then resulted in accumulation of poisonous (bad) moist at san jiao (an acupuncture point at the abdomen) , clear Qi cannot ascend and bad Qi cannot descend, the body cannot differentiate between clear and bad Qi , therefore, the bad moist and Qi are accumulated inside the body and cannot be excreted externally, thus resulted in heart and kidney failure and lastly-death. Clinical treatment result There were 98 cases using Chinese medicine; 55 cases of shown effectiveness, 33 cases turned out better, shown effectiveness 56.1%, total effectiveness 89.7%.

Acute renal failure (ARF)

Acute renal failure (ARF) is a syndrome characterized by rapid decline in glomerular filtration rate (hours to days), retention of nitrogenous waste products, and perturbation of extracellular fluid volume and electrolyte and acid-base homeostasis.
ARF is usually asymptomatic and is diagnosed when biochemical screening of hospitalized patients reveals a recent increase in plasma urea and creatinine concentrations.
Classification:
It may complicate a wide range of diseases, which for purposes of diagnosis and management are conveniently divided into three categories:
(1) diseases that cause renal hypoperfusion without compromising the integrity of renal parenchyma (prerenal ARF, prerenal azotemia) (~55%);
(2) diseases that directly involve renal parenchyma (intrinsic renal ARF, renal azotemia) (~40%); and
(3) diseases associated with urinary tract obstruction (postrenal ARF, postrenal azotemia) (~5%)
In the clinical differential diagnostic, the traditional Chinese doctors differentiate it mostly based on re zheng (heat symptoms) and shi zheng (true symptoms) ; generally it is due to excessive accumulation of heat, stoppage of heat, accumulation of heat and moist affecting heart and liver and caused the disturbances in the internal regulation and external dehydration and injured to the Qi Yin . The main treatment is to eliminate xie (heat) , often used treatment which can discharge heat and bad substances, clear heatiness and nourish blood, improve blood circulation, strengthen Yin and normalized Yang , nourish Qi and Yin and so on.

Polycystic ovarian syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a syndrome caused by disturbances in feedback mechanism of hormonal regulation. The clinical manifestations are anovulatory menstrual abnormalities (including amenorrhea, oligomenorrhea or uterine functional bleeding), infertility, hirsutism, obesity and so on. The signs are such as pelvic cavity inspection with external pathological changes, single-phase of body basal temperature, the consistent quantity and degree of maturity of shedded vagina cells, and persistent (no phases changes) condition of uterine cervix grading by ultrasound (1nsler law). There is bilateral enlargement of the ovaries demonstrated radiographically. In the ultrasound or laparascopy examination, there is cortical stromal hyperplasia(stromal hyperthecosis) with numerous of subcortical cystic follicles underneath; in histological examination of ovary, there is no luteal body (corpora lutea) but presents of subcapsular follicles, atrophy of granular layer, hyperplasia of follicular layer and cortical stroma; clinically, it must be accompanied with ratio of luteinizing hormone(LH) to follicle stimulating hormone(FSH) by more than 3, ratio of estrone (E1) to estradiol (E2) more than 1 for diagnostic purpose. Generally, some people thought that excessive secretion of androgens (from adrenal or ovary) will later converted into estrogens and direct the hypothalamus and pituitary to secrete excessive of LH, causing dysbalance in LH:FSH ratio, makes the ovary to secrete more androgens and therefore affects the maturity of follicles and resulted in anovulation. Some also thought that this disease is related to the impairment of hormonal regulation of the central nervous system or the adrenal glands. There are some patients with elevated level of dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone (17OH-progesterone) and 17-hydroxysteroid. In the treatment aspect, the usage of clomiphene,combination of Chinese and western medicine, gonadotrophic hormones and so on have increased the ovulatory rate up to 70-80%. While the wedge resection of ovary is seldom used due to the possibility of adhesion. Some patients has elevated prolactin level in blood, it can be reduces after introduction of bromocriptine or traditional chinese medicine (TCM). The prognosis of this disease is often satisfied after treatment, while without treatment or prolonged anovulatory patients must be aware of increased risk of endometrial cancer. The TCM has various understanding about menstrual irregularities and infertility of PCOS, but the main point is still the insufficiency of kidney Qi (energy). The TCM theory said that,kidney Qi is high in 7 years-old female, so teeth and hair grow better; later menstrual is in progress, opening of ren mai ( a point in acupunture), high energy in tai chong mai (a point in acupunture), occurence of menstruation and then fertile to have child." And " chong ren (2 points) is from bao gong (uterus), and connected to liver and kidney", "kidney stores Jing (one of vital element), jing produces marrow, brain as the sea of marrow"(this phrase means having sufficient kidney Jing will affect brain, thus having flexible movements and good hearing and vision functions), "the kidney also acts according to thinking or will, positive mind yields good condition", " fear(emotions) will affect the kidney". Thus, the kidney is not only related to pituitary gland and ovary, but also closely conneted to other parts of the body including the development of the brain, it is also influences by thinking, emotions, environment and other factors. Therefore, internal and external factors both can affect the menstrual regulation through kidneys. At the same time, according to TCM-- "liver and kidney are of the same source"; so, in some cases of menstrual irregularities, it may due accumulation of heat in the liver other than kidney s qi insufficiency. The PCOS is characterized by obesity and enlargement of ovaries, it confirms to weaknesses of kidney and appearance of phlegm in TCM due to weak kidneys cannot regulate fluid and accumulated to become phlegm. In cases of oligomenorrhea or amenorrhea, there is bruise (disturbances) in jing mai (a point in acupunture) in addition to kidney insufficiency. As a conclusion for now, generally this disease is belongs to weakness of kidney with liver dullness, phlegm and bruises. Clinical treatment resultThere were 285 cases adopted TCM, ovulation occured within 3 months and 272 cases got pregnant within 3 years.

Fallopian tube blockage

Fallopian tube (oviduct) blockage is mainly due to inflammatory processes. In acute phase of inflammation, the wall of oviducts become thicken and when no treatment is introduced in time, fluid or pus will accumulate in oviduct. If treatment is not sufficient, it will then progress to chronic inflammatory syndrome, adhesion of mucosal membrane and resulted in oviduct blockage. It may also due to insignificant symptoms during acute inflammatory phase which is discovered later in chronic phase and causes oviduct blockage. Nevertheless, mild degree of mucosal adhesion in its cavity or partly blockade is very common. Clinical symptoms include lower abdominal cramps, abdominal pain or irregular menstrual, but there are some patients that complained only about infertility and do not have any subjective symptoms; metrosalphingography (radiography of uterus and fallopian tube) with iodolipol solution can accurately reveals part and degree of blockage (complete or partial), if one shows long and slender oviduct with beads shape or hardened form as tubercles, then, the treatment would be more difficult. In judgment of the radiography, it is important to notice the location and size of uterus, shape of cervix cavity, whether there is irregular border, any filling defects, shadows interrupting blood vessels and widening of cervix or yields appearance of folds and etc. The Chinese medicine thought that the chronic salpingitis (inflammation of oviduct) causes the blockage, mainly due to inattentive lifestyle or habits during menstrual period (e.g. cooling of body during menstruation and so on), which causes invasion of uterus by evil substances, resulting in imbalance of the vital energy and blood; old blood then accumulates in uterus, therefore new blood cannot be generated. Clinically, there is often a mixture of actual and other symptoms that is caused by bruises blockage. As the sayings in "Secret journal of Shi" (Shi shi mi lu): "If there are any disturbances in Qi, then the reproductive Qi cannot pass through due to external blockage." Therefore, the primary aim of clinical treatment is to dissolve bruises, and different treatment according to the pathogenesis.Clinical treatment resultThere were 260 cases adopted traditional Chinese medicine (TCM); 240 cases recovered completely and 20 cases with shown effectiveness.

Uterine leiomyoma (fibroids)

Uterine leiomyoma or fibroid is a type of myometrium tumor cause by immature proliferation of smooth muscle cells. It grows from the muscular layer of uterus (myometrium). When the leiomyoma is surrounded by muscular layer, it is called intramural leiomyoma; if the fibroid grows towards the serous layer, bulging to the uterine surface, it is called subserosal leiomyoma; when the fibroid progresses towards endometrial cavity, beneath the endometrium, it is called submucosal leiomyoma. Most of leiomyomas may be asymptomatic, they are only discovered during physical examination, but the submucosal leiomyoma or large intramural leiomyoma can cause excessive menstruation or continuous menstrual dripping; the large leiomyoma can also cause increased of vaginal discharge(leucorrhea) or compression of neighbouring organs; leiomyoma that causes endometrium neoplastic changes(with menstrual abnormalities, lower abdominal pain, inflammatory reaction, angiogenesis, leukocytosis, fever, vomitting and etc) or the submucosal leiomyoma that twisted the peduncles, may resulted in severe abdominal pain. Besides, 1/3 of patients may impaired fertility. Generally, the main pathogenic factor is long-term large dosage of estrogen stimulation, especially when there is only estrogen but no progesterone. But the leiomyomas may also related to other unknown factors.Usually, the leiomyomas are not difficult to diagnose according to its clinical signs e.g uterus enlargement, menorrhagia and so on. If it cannot be assured with clinical examination, it can be confirmed with examination of cervix and cervical biopsy, B-sonography. But one must becareful to distinguish from uterus leiomyosarcoma(cancer), endometrial position changes, ovarian tumor and etc. The modern medicine usually uses surgical and non-surgical treatment according to patients age, fertility condition and clinical symptoms. The non-surgical method consists of uterine curettage and androgen hormones therapy; they are used against tiny leiomyoma with menorrhagia. If the leiomyoma is large with significant symptoms and the conservative treatment is not effective, the surgical method is used e.g extirpation submucosal leiomyoma through vagina of infero median laparatomy and partial or whole cervicectomy. In the traditional chinese medicine (TCM), leiomyoma is categorized as zheng jia (lump in abdomen). It is mainly caused by decrease of flowing Qi (energy), bruise, accumulation of moist heat and phlegm. While some said that it is due to functional regulation disturbances of liver, spleen and kidney, in addition of presence of cold Qi in zi men (a point in acupunture in cervix), bruised blood accumulate and changed into heat which then mixed with internal moist, and lastly it became leiomyoma after certain time. The principles of treatment are correction and adjustment of Qi and blood, relieving of heat and moist congestion, eliminating of bruise and phlegm, and symptomatic therapy. When there is rupture of leiomyoma, one may also uses the so-called han liu , deng yuan , fu jiu method (a method to stop bleeding and regulate Qi, blood and functions of spleen, kidney and liver according to patients clinical signs). Clinical treatment result There were 166 cases adopted TCM; 125 cases recovered clinically (symptoms disappeared, leiomyoma resolved, uterus returned into normal size), 29 cases shown curative effect (symtoms disappeared basically, shrinkage of leiomyoma), 12 cases turned out better (improvement of symptoms but no significant shrinkage of leiomyoma).

Ovarian cyst

Ovarian cyst generally means a type of ovarian tumor, it can happened in all ages, but mostly seen in 20-50 years old. Usually, the malignant tumor or cancer of the ovary seldom shows any illness in their course of disease, therefore, early prognosis is difficult; 70% diagnosed are already in the late stage, very little patients can get early treatment in time, the survival rate often lingers at 20-30%, it is one of the most dangerous female cancer; ovary is a small organ but it is a good location for various types of tumor, the ovarian cyst has different features and morphology--single or combined type, unilateral or bilateral, cystic or dense type, benign or malignant, and not less ovarian tumors can produce female or male hormones (androgens). The ovarian cyst has no significant clinical signs in the early stage, normally, patients discovered it by other gynecological diseases. As the tumor grows, the patient will feel it and the symptoms vary due to the characteristic, size, development, mutation and secondary changes. Main signs: 1. Early signs-- lower abdominal discomfort without feeling of lumps at the particular area. The patient might feel swelling and falling in the lower abdominal or the pelvis cavity due to tumor movement that affects its peduncle and the pelvis funnel ligament, which is caused by the tumor s mass, peristaltic movement of the intestine and changes of the body posture. 2. Increase of the abdominal circumference and lumps in the abdomen; the patient will sense that their clothes or belt becomes tight, then only get to know increasing of the abdomen s size, or accidentally feel of lumps while pressing it in the morning which accompany by abdominal distension. 3. Abdominal pain: If the tumor has no complications, there will be less pain. Therefore, if the patient feels pain in the abdomen, especially sudden occurence, it is mainly due to twisting of the tumor s peduncle, rupture of tumor, hemorrhage or infections. Besides, the malignant tumor always causes abdominal pain and leg pain; the pain often makes the patient to receive treatment as an acute disease. 4. Menstrual disorder: Usually, the ovarian cyst or even bilateral ovarian cyst will not irregulates menstrual cycle if there is no disturbances in the ovaries tissue. Some of the uterine hemorrhages do not cause by hormonal factor, it may cause by pelvic vessels changes due to tumor s malignancy which resulted in hyperemia of the endometrium; or cause by the malignancy spreading (metastases) to the endometrium. The menstrual disorder cause by hormonal tumor often accompanied by other hormonal disturbances. 5. Compression syndrome: The large ovarian tumor can compress diaphragm and cause difficulties in respiratory and heart palpitation, ovarian tumor that causes ascites can also induce the same symptom; but some of the respiratory disturbances is due to either unilateral or bilateral hydrothorax; it is often followed by ascites and forms the so-called Meigs syndrome. The large benign cyst may occupied whole abdominal cavity, causing increasement of intra-abdominal pressure and impairs the venous flow of the lower extremities and may resulted in edema of abdominal wall and lower extremities; while the malignant one will compress the venous flow of the pelvic canity and resulted in edema in one of the lower extremities. The compression of organs in abdominal and pelvic cavity normally causes difficulties in urination such as retention of urine and stool disturbances, e.g constipation and etc.There are 4 conditions to diagnose as ovarian cyst: (1) Is it an ovarin tumor? (2) What type of ovarian tumor? (3) Any other complications? (4) What type of growth?[Clinical treatment result] There were 230 cases adopted the traditional chinese medicine (TCM); 225 cases recovered completely, 5 cases turned out better. Effectiveness 100%.

Endometriosis

The endometriosis is characterized by detection of endometrial stoma and glands beyond uterus with pathological changes and symptoms. When endometrium exists in myometrium, it is called internal endometriosis or adenomyoma; while when endometrium is displaced to any region externally from the uterus wall (including cervix and serous layer), they are called external endometriosis. If the endometrium is displaced to the ovary, clinically, it is known as chocolate cyst (endometriotic cyst). There are 3 main clinical signs of endometriosis other than symptoms of pathological area: (1) continuous and progressive menstrual pain mainly at lower abdomen or lumbar region. When pathological process invades vagina or rectovaginal septum, it can induces pain during sexual intercourse and intense during menses. (2) menstrual irregularities or menorrhagia. (3) 50% of patients with infertility. This is a polyetiological disease, the main reason for its occurence may due to regurgitation or implantation theory of fallopian tube; other important factor is metaplasia of coelomic epithelium (metaplastic theory); there is bigger possibility of benign transformation if the endometriosis occurs outside pf pelvic cavity; while endometriosis in abdominal wall is usually due to iatrogenic factor e.g Casaeran section. The diagnosis of endometriosis is done according to history and clinical signs. Basically, the clinical diagnosis can be established if the young woman has continuous or progressive menstrual pain, or menstrual irregularities with infertility, obvious and painful small nodules on uterosacral ligaments or rectouterine excavation (Douglas cul-de-sac) during gynecological examination. But, the confirmation is received by endoscopy or dissection of pathological area and performing tissue biopsy. The treatment of this disease depends on the degree of severity, area of pathological changes, age, fertility demand and other factors; those young women that require fertility uses hormonal therapy or conservative surgical method while those old patients which do not require fertility uses radical surgical intervention -- complete cervicectomy with resection of other female organs. The traditional chinese medicine (TCM) studies categorized endometriosis as zheng jia (lump in abdomen) and tong jing (menstrual pain). The main pathological changes is bruise, the main pathological secretion is bruise blood clot of menstrual blood which stays in nodules and turns into lump. Therefore, the TCM treatment principle will be invigorating the blood, eliminating of bruise and nodules. Some said that the weak kidney is the main internal pathological reason (sex hormonal disturbances), so treatment is done by invigorating kidney as well as the blood and eliminating bruise. Usually, bruise is formed due to stagnant and accumulation of Qi (energy) as a result of weak spleen, liver and kidney; it may also cause by external factor such as cold, moist, heat accumulation or stagnant or struggling among them. Qi stagnant causes bruise, clinically resemble by menstrual pain. When there is decreased of liver s regulation, weak spleen and kidney with struggle between moist and heat, these will resulted in menstrual irregularities and infertility.Clinical treatment resultThere were 256 cases adopted TCM; 210 cases completely recovered (all symptoms disappeared), 25 cases shown effectiveness (basically symptoms disappeared, diminishing of pathological area, pressing pain disappeared, or pregnancy in infertile patients), 21 cases turned out better (improved and stabilized of symptoms). Total efficiency 100%.

Tympanic membrane penetration

The tympanic membrane is a gate of the middle ear which separates the external and middle ear and responsibles to protect cavity of the middle ear. Once it is penetrated due to otitis media (inflammation of middle ear) or external injury, it can resulted in two main complications: protective function is impaired causing external microbes infections, drainage of dirts, invasion of foreign substances where all these cause suppurative infection; penetration of tympanic membrane diminishes the vibration surface area and causes decreased of hearing function. The causative factors are otitis media, external injury and etc.[Clinical treatment result] There were 1560 cases adopted traditional chinese medicine (TCM), among them were 1023 cases of otitis media patients; 1550 cases recoverd completely and 10 cases turned out better.

False cyst of the auricle

The false cyst of the auricle or also known as perichondritis (fluid type), is a aseptic inflammatory response of the cartilage membrane; the cause of disease is unclear, it may associated with slight external injury repeatedly such as compression, touches and others that related to machinery stimulation. The purulent perichondritis is characterized by acute suppurative inflammatory syndrome of auricle s cartilage and its membrane, it is often caused by external injury, surgical operation, frostbite, burn and hemorrhagic edema with infection of auricle. This condition must be treated attentively because it may induce necrosis of the cartilage and resulted in auricle abnormalities. The main signs are regional swelling of auricle, elasticity, redness absent, no significant pain, the puncture may extract yellow fluid. The patients are seen more in males, generally 30- 40 years-old and usually occurs at one side of ear (unilaterally).Clinical manifestations:1. Mostly seen in adult males, usually unilaterally. 2. Presence of hemispheroid swelling at posterior of auricle, distinctive borders, normal colour of skin with hard or fluctuation feeling and no pain. 3. The puncture may extract yellow or the bloody liquid; after puncture, it will soon recurs.Diagnosis basis:1. Mostly seen in adult males, usually unilaterally of auricle with swelling. 2. The cyst occurs at the posterior of auricle, presence of hemispheroid swelling, distinctive borders, normal colour of skin with hard or fluctuation feeling. 3. The puncture may extract yellow or the bloody liquid; after puncture, it will soon recurs.Treatment principles:1. Repeat the puncture of fluid under aseptic condition, pressurizes bandages or small incision for drainage with pressurizes bandages.2. The physical therapy, laser therapy.Medicine usage principles:The usage of antibiotics and supplementary medicines against regional swelling painess therapy or fluid puncture therapy, the prevention of infection.Clinical treatment resultsThere were 150 cases adopted the traditional chinese medicine (TCM), all recovered completely.

Sudden deafness (tinnitus)

The sudden deafness is characterized by sudden decrease of hearing function and would reach its climax about 1-2 days until complete hearing loss. It happens in one side (unilateral) mostly, is a type of (sense) nervous deafness which is caused by systemic or local factor. Minority cases is accompanied by dizziness.[Clinical signs]1.Hearing loss: significant decrease of hearing function (unilateral mostly), most of the patients is accompanied by murmurs in the ears (tinnitus), some may have dullness, swelling and blockade sensation in the ear.2. Causative factor: most patients have no significant pathological cause, many occurs during sleep, sense of murmurs in the ear and of deaf after wake up. Some patients has obvious general weakness, emotional overstimulated, anxiety and history of flu; all these are related to the pathological factors in certain degree.3. Dizziness: some patients may have hearing loss along with dizziness simultaneously, may accompanied by nausea and vomitting; in many cases, there is decrease of dizziness about 1-2 weeks of disease while murmurs in the ears and hearing loss do not improve; it is more difficult to recover for those patients that accompanied by dizziness. [Diagnosis]1.Significant decrease of hearing function, usually unilaterally, along with dizziness, examination by electrical response audiometry will yield sensible deafness.2. Differential diagnostic: it is easy to diagnose pure sudden deafness according to its symptoms- sudden attack, significant decreased of hearing function, mostly unilateral, therefore, it is not confused with other deafness; but if it is accompanied by dizziness, it may have many possibilities, at this time, it is necessary to send the patient to hospital to be diagnosed in time because other instruments are needed to distinguish the reason of deafness.[Treatment]If the patients has no significant decrease of hearing functions and their symptoms are not severe, they can treat it at home after doctor s inspection; but if vice versa and along with dizziness, then one need to be hospitalized.1. Western medicine treatment: mostly uses intravenous medication combined with intramuscular injection therapy, may also use infusion of vasodilator and glucose solution with vitamin B1, B2 intramuscular injections. Or assist by acupunture medical treatment such as rhizome of Ligusticum, salvia miltiorrhiza compound injection, Chinese angelica infusion and so on.2.Traditional chinese medicine (TCM): TCM thought that this disease is due to stagnant of Qi and formation of bruise, the route of ear is blocked by bruise and resulted in impairment ascending of clear Yang Qi (Yang energy) to er qiao (part of ear), thus decreasing of normal physiological function of the ear-- appearance of murmurs in ears, deafness and so on. Treatment method: invigorates the blood, eliminating bruise and route clearing. [Clinical treatment result] There were 980 cases adopted TCM; 790 cases recovered completely (increased of hearing capacity to normal or nearly normal, disappearance of ear murmurs), 110 cases shown effectiveness (hearing capacity more than 30dB or were in clear hearing zone) and 80 cases turned out better (hearing capacity increased about 15-30 dB).

Chronic inflammation of middle ear

Chronic inflammation of middle ear is also known as chronic suppurative otitis media.The middle ear is connected to the nasopharynx via the eustachian tube. When this tube is blocked, fluid collects in the middle-ear and mastoid cavities, providing a culture medium for any bacteria present. Otitis media, like upper respiratory tract infections, is most common in fall, winter, and spring. In chronic suppurative otitis media, patients have painless hearing loss and intermittent purulent ear drainage. On examination, there is a central perforation in the tympanic membrane and purulent drainage from the middle ear. If a cholesteatoma is present, the perforation is peripheral. For therapeutic purposes, patients are divided into two groups: those with and without cholesteatoma. In western medicine, those in the former group are cured with surgical excision of the cholesteatoma. Those without cholesteatoma require repeated courses of topical antibiotic drops for relapse of "active" (draining) disease, and true cures are rare. The role of systemic antibiotics is unclear. In one study, a course of intravenous antibiotics produced long-term success in 78% of children without cholesteatoma who had persistent otorrhea despite topical and oral antibiotic therapy.ComplicationsExtracranial complications include hearing loss, labyrinthitis and resulting vertigo, and facial-nerve palsy. Additional complications from mastoiditis develop when infection tracks under the periosteum of the temporal bone to cause a subperiosteal abscess or breaks through the mastoid tip to cause a neck abscess deep to the sternocleidomastoid muscle (Bezold s abscess). Intracranial complications include epidural abscess, dural venous thrombophlebitis (usually sigmoid sinus), meningitis, and brain abscess. In the traditional Chinese medicine studies, it considers that chronic suppurative otitis media as damage of kidney Yuan (vital Qi), wet and laziness of the spleen which is due to affection of the middle ear. Treatment: nourish kidney and spleen, eliminate wet and pus. This disease belongs to the category of nong er (purulent ear). The causes of the disease include:1. external factor such as Feng (wind), Re (heat) and xie du (??evil?? substances), or due to entrance of contaminated water during a bath, resulting in accumulation of bad substances and wet , then, it will cause the increasing of heat steam in liver, gall bladder and later, in the middle ear that resulted in death of tissues (necrosis), formation of pus and penetration of tympanic membrane; 2. or after recovering from warm disease with lowered immunity along with non-complete clearance of evil substances remains, resulted in affection of the middle ear.If there are weakness of spleen and kidneys or imbalance of functions adjustment, prolonged accumulation of xie du in middle ear accompanied with disturbances in homeostasis (internal regulation of functions) or ascending of xu huo (false heat) which causes the its inflammation, all these can develop into chronic form of disease.Clinical treatment resultsThere were 3790 cases adopted the traditional Chinese medical therapy, all cases recovered completely (healing of tympanic membrane penetration). There was no reoccurs of the disease during the follow-up visit in one year.

Pneumonia

The term pneumonia usually refers to a syndrome caused by acute infection involving the lung parenchyma or interstitium usually due to bacteria and characterized by consolidation,both clinical and radiological,of a part of one or both lungs.The causative organisms can also be virus,parasites,mycobacteria and fungi.When noninfectious agents like chemicals and radiation cause pneumonia,the term pneumonia is used.
Classification:
1. Community-acquired pneumonia (CAP).
2. Hospital acquired (nosocomial) pneumonia.
3. Aspiration pneumonia.
4. Pneumonia in the immunocompromised bost including AIDS.
5. Recurrent pneumonia.
Causes:
`1. Bacteria -- Streptococcus pneumoniae,Mycoplasma pneumonia, Chlamydia pneumoniae,H. influenzae, Branhamella catarrhalis. Also M. tuberculosis,anaerobes,Gram negative pathogens and Staph. Aureus.
2. Primary atypical -- (a) Viral -- Psittacosis-ornithosis group, respiratory syncitial virus, measles and influenza, cytomegalovirus,adenviruses, varicella,herpes zoster,lymphocytic choriomeningitis.(b) Rickettsial -- Coxiella burneti (Q fever). (c) Mycoplasmal -- mycoplasma pneumoniae,Stevens-Johnson syndrome.
3. Protozoal -- Entamoeba histolytica.
4. Yeast and fungi -- Actinomycosis,aspergillosis,nocardiosis,histoplasmosis.
5.Chemical pneumonia -- (a) Aspiration of vomit.(b) Dysphagic pneumonia -- pharyngeal diverticulum, achalasia cardia, hiatus hernia or oesophageal stricture.(c) Lipoid pneumonia -- Kerosene,paraffin,petroleum.(d) Toxic gases and smokes.
6.Radiation pneumonia.

Symptoms:Onset often sudden although sometimes it follows a minor respiratory infection of a few days duration.
1. General symptoms of infection -- Malaise,fever,chills and rigors,vomiting; in the elderly confusion and disorientation.
2. Pulmonary symptoms -- Dyspnoea,cough,and sputum which is often blood-stained or rusty and difficult to expectorate.
3. Pleural symptoms -- Pain aggravated by cough, deep breath or movement,usually localised to site of inflammation.

Pleural effusion

Symptoms:

Onset -- (a) Acute with attack of pleuritic pain or pyrexia of unknown origin, later with pain. (b) Subacute. (c)Insidious -- with ill-defined health followed by dyspnoea.

1. pain -- in early stage due to dry pleurisy replaced by dull ache.

2. Dyspnoea -- depends on rate of collection of fluid.

3. Cough usually dry.

4. Loss of weight.

5. Symptoms of toxemia -- Malaise, fever, anorexia.

Chronic bronchitis

Chronic bronchitis is a clinical disorder characterised by productive cough due to excessive mucus secretion in the bronchial tree not caused by local broncho-pulmonary disease, on most of the days for at least 3 months of the year for at least two consecutive years. Chronic simple bronchitis is characterized by mucoid sputum production, chronic mucopurulent bronchitis by persistent or recurrent purulent sputum production in absence of bronchiectasis and chronic asthmatic bronchitis in patients who experience severe dyspnoea and wheezing during acute respiratory infections or following inhaled irritants.
Causes:
1. Infection -- (a) Result of acute bronchitis. (b) Infective focus in upper respiratory tract, the nasal sinuses or tonsils. (c)Infective focus in lungs, e.g. bronchiectasis, fibrosis, or tuberculosis.
2. Smoking -- particularly of cigarettes.
3. Air pollution -- due to industrial fumes and dust.
4. General illness -- which favour infections, e.g. obesity, alcoholism, and chronic renal disease.
Symptoms:
1. Cough -- constant or paroxysmal, worse in winter or on exposure to cold winds or sudden change of temperature.
2. Expectoration -- Variable, may be little, thin and mucoid or thick or frothy, mucoid and sticky. May become mucopurulent during attacks of acute bronchitis in winter.
3. Dyspnoea -- In advanced cases, breathing becomes quick and wheezing present even at rest.
4. Fever -- Absent except in acute exacerbation.
5. Haemoptysis -- Usually in the from of streaks of blood.

The modern medicine in treatment against this disease is directed towards antibacterial, diminishing sputum and cough, dilatation of respiratory airways and so on during acute stage. While during the delayed period, they use the vaccination therapy. Clinically, in traditional Chinese medical studies, this disease belongs to the category of ke sou (cough) and tan yin (excessive of sputum). Our motherland medicine considers that lungs manage the ventilation of gases and respiratory system; if the lungs are exposed to diseases, they will result in stoppage of ventilation of gases and it shall yield cough. The spleen is responsible for the homeostasis of fluid, absorption of nutrients, increased of metabolism; if the spleen is not functioning properly, the lungs will loss nourishment, so dampness will be accumulated in the lungs, causing the imbalance of gases and resulted in whitish and sticky sputum. If coldness of the lungs gradually turns to heat or the lungs structures are affected directly be heat, it will cause fever, trembling, greenish-yellowish sticky sputum; all these symptoms belong to the heat signs . If the gases in the lungs move abnormally and cannot descend to the normal condition, it will then cause dyspnea in lying position.

Bronchial asthma

Bronchial asthma is a syndrome characterised by increased responsiveness of trachea and bronchi to various stimuli and manifested by acute, recurrent or chronic attscks of widespread bronchial-bronchiolar narrowing, variable in severity and usually of brief duration. It is believed that airway reacitivity is the major feature of asthma and this is induced by inflammation and that inflammation is the basic abnormality present in asthma.

Classification:

1. Extrinsic asthma -- applies to those who produce excessive lgE in response to allergens (atopic).

2. Intrinsic asthma -- refers to those cases in whom excessive lgE production cannot be demonstrated (non-atopic).

Inducers and triggers of asthma

Inducers of asthma -- After birth, several factors interact to result in the clinical manifestations of asthma. Factors called inducers actually switch on the asthma following which symptoms may be present for weeks, months or years. These factors are:

1. Viruses -- Childhood virus infections are important inducers of asthma. 5-50% of children wheeze following respiratory syncitial virus (RSV) bronchiolitis. Also parainfluenza and influenza virus infections. Bacteria that can induce wheezing are pertussis and mycoplasma.

2. Cigarette smoke -- It is known that if parents smoke during the first two years of their child s life, the child is likely to develop asthma.

3. Allergens -- The influence of both genetic and environmental factors is important and asthma is a complex response to a variety of stimuli, making it difficult to identify specific factors. (a) Aero-allergens (inhalants) -- Exposure to aero-allergens such as house dust, mite allergens, tree pollens, feathers, paint, smoke, animal dander, moulds. (b) Ingestants -- Milk, eggs, nuts, chocolates, fish, shell-fish, strawberries, etc.

Triggers of asthma -- cause an attack of asthma which usually lasts only for minutes or hours. They trigger symptoms once the tendency is already there: a)Exercise especially running. (b) Laughing, coughing. (c)Emotional factors ranging from pleasurable excitement in children to stress or worry in adults. (d) Change of weather such as sudden changes in temperature, fog, wind. (e) Drugs -- Beta-blockers such as propranolol or alpha-blockers e.g. phenxybenzamine.

Asthmatic attack:

(1) Premonitory symptoms "asthmatic aura" -- Sometimes sneezing, flatulence and drowsiness, or restlessness and irritability. Dry irritant cough may precede or accompany attacks of wheezy breathlessness.

(2) Paroxysm -- Usually sudden in middle of night. Sense of oppression in chest going into respiratory distress. Patient sits up and leans forward fighting for breath, or runs to window to relieve sense of suffocation. Anxiety, cyanosis, perspiration and cold extremities. Wheezing may be heard at a distance. On auscultation -- inspiration short and high pitched, expiration prolonged, plenty of rhonchi. Rales may be heard at the bases towards the end of an attack. However, in very severe airways obstruction airflow may be so reduced that the chest is almost silent. Tachycardia especially in children.

(3) Termination -- Spontaneously or as a result of therapy. As bronchial spasm gets less, patient is able to cough a little and may bring out viscid muco-fibrin.

(4) Duration of attack -- Varies from few minutes to several hours. Sometimes paroxysms are continuous -- status asthma .


In traditional Chinese medical studies, clinically, this disease belongs to the category of xiao (wheezing) and chuan (dyspnea- difficultness in breathing). Our motherland medicine consider that weakness of sleen and its Qi (energy) insufficiency, causing hypofunction and decreased of nutrition absorption, reversely, it will yield phlegm thus the phlegm will cause lung and Qi blockade which resulted in lots of phlegm and dyspnea , struggle between phlegm and Qi, wheezing sound in throat and insufficiency of kidney Yang that will cause abnormal sweating; the lungs regulates Qi, accumulation of irregular solid Qi, decreased movements of diaphragm, as a result, it yields dyspnea in lying position and even in sitting position. The lungs regulate or host Qi while the kidneys as the root of Qi, therefore, kidney weakness will cause the Qi cannot conclude at the kidney, so one will has expiration more than inspiration and breathing difficulties; Qi as the main element of blood, if Qi is enough it is able to regulate blood but in contrary if Qi is weak it will cause stagnant of blood, lack of Yang Qi causing bruise immediately, cyanosis of lip and fingernails, dilatation of neck veins (jugular veins); improper Qi affect the normal blood, lose of positive Qi, internal injury of essence of blood, therefore there are possibility to cause respiratory acidosis, regenerative failure and insufficiency of Yang Qi.

Pneumothorax

Pneumothorax means air in the pleural space, making an air containing pleural cavity. Air may enter the pleural cavity through the chest wall, mediastinum, or disphragm, or from a puncture of the visceral pleura convering the lung. The term spontaneous pneumothorax refers to cases which are not due to trauma.

Causes:

1. Spontaneous

1) Primary -- Due to rupture of apical subpleural bleb (Benign spontaneous pneumothorax). Most common in young men.

2) Secondary -- Rupture of subpleural TB focus (active lesion or local emphysematous area from old scarring). Emphysematous bullae. Congenital cysts and bullae. Honeycomb lung.Oesophageal brupture.

Infections (other than TB) -- Bacterial pneumonia, lung abscess, pneumocystis carinii pneumonia, whooping cough ,bronchiectasis.

Diffuse fibrosing pulmonary disease: Sarcoidosis, Pneumoconiosis, Interstitial fibrosis.

Asthma -- Chronic bronchitis and emphysema.

Cystic fibrosis.

Neoplasms -- Bronchial or pleural.

Secondary to spontaneous mediastinal emphysema.

Pulmonary infarction.

2. Traumatic

Iatrogenic or accidental -- Chest aspiration, transbronchial biopsy, needle aspiration lung biopsy, intercostal never block, subclavian cannulation, positive pressure ventilation, transthoracic liver biopsy, surgical procedures at base of neck, chest compression injury (including external cardiac massage).

Non-iatrogenic -- Penetrating chest wounds, Crush injury.

Symptoms: Vary depending on -- (a) amount of air in the pleral sac, (b) rapidity of its accumulation, (c) condition of the lungs.

1. Insidious onset -- Vague discomfort in chest, later shortness of breath on exertion. In tuberculous spontaneous pneumothorax the onset is not always sudden as the condition commonly occurs in patients suffering from advanced pulmonary T. B. which has already cut down their normal activities. Patient may complain of more breathlessness or may have chest pain, or the pneumothorax may be latent and detected by routine chest examination.

2. Sudden onset -- Feeling of something snapping in the chest, severe pain, shock, increasing shortness of breath. Blood streaked sputum, cyanosis, restlessness and collapse.

3. If hydropneumothorax -- Splash of fluid in the chest when he jumps may be the first intimation to the patient.

Pleurisy

Pleurisy is an inflammation of parietal pleura of the lung.
Causes:
1. Infection -- Tuberculosis, pneumonia, bronchiectasis, lung abscess, infection with Coxsackie B virus (epidemic pleurodynia or Bornholm disease).
2. Infarction of lung.
3. Bronchogenic carcinoma.
4. Injury to chest wall or disease of ribs.
5. Rheumatoid arthritis.
6. Systemic lupus erythematosus.
7. Uremia.
8. Asbestos pleural disease.
9. Familial Mediterranean fever.
All pleural disorders with inflammatory exudation may start as fibrinous dry pleurisy.
Symptoms:
1. Pain in the side, sharp, stabbing or tearing, worse on coughing, deep respiration and pressure from outside. When the diaphragmatic pleura is affected the pain may be referred to the tip of the shoulder, or to upper abdomen from pleurisy affecting the lower lobes.
2. Rapid shallow breathing with unproductive cough.
3. Chilly sensations at onset and moderately intermittent fever.

Lung abcess (Suppurative pneumonia)

Lung abcess is a circumscribed suppurative inflammation of lung caused by pyogenic organisms leading to cavitation and necrosis.
Causes:
1. Aspiration abscess -- Aspiration of infected material -- (a) From upper respiratory tract -- Oral or pharyngeal sepsis,oesophageal obstruction,tracheo-oesophageal fistula,drowning. (b) Vomit. (c) Bronchiectasis. (d)Iatrogenic following use of intermittent positive pressure breathing therapy and nebulisers.
2. Specific abscesses -- (a) Lobar pneumonia particularly Klebsiella,Staphylococcal pneumonia. (b)Tuberculosis. (c) Fungal infection, e.g. actionmycosis.
3. Bronchial obstruction or stenosis -- Benign tumours,or inspissated bronchial mucus or foreign body, mucovscidosis.
4. Metastatic lung abscess -- Suppurative thromboembolism involving lung parenchyma??pulmonary embolism from pelvic thrombophlebitis or right sided endocarditis,or during septicemia and pyemia.
5. Malignancy -- Necrosis within a large solitary nodular malignant neoplasm.
6. Infected cysts -- Congenital or acquired.
7. Extension from neighbouring organs -- Diaphragm e.g. amoebic infection,vertebral column.
Symptoms -- Groups:
1. Mild general toxaemia -- with slight fever. No symptoms referrable to respiratory tract.
2. Sudden onset -- with high fever,pleuritic chest pain, cough and later copious expectoration.
3. Symptoms of subacute or chronic respiratory disease -- cough, foetid breath, expectoration and general toxaemia. Hemoptysis may occur, or pain due to associated pleurisy.
In traditional Chinese medical studies, this disease is belongs to the category of fei yong (pus in lung), struggle between evil (abnormality) and good (body system), declination of positive Qi will resulted in sudden high fever, then protective Qi is not enough, besides, it will has excretion of fluid as sweat and improper Qi penetrate into lungs causing afraidness of cold. The attack of re du (bad substances of heat), causing accumulation of bad heat thus resulted in suffering of fluid balance or the heat will caused injury to the lung pathway (pathway in acupuncture studies), internal accumulation of heat will turn into pus and leads to disorders of shu ji (lungs function) which later causes cough, cough with mucus or with mucosal phlegm or with purulent phlegm or with bloody phlegm and hemoptysis (coughing with blood). The spleen regulates the gas and blood system, weakness of spleen will cause imbalance of fluid homeostasis and decreased in nutrition absorption which later will resulted in lowered of mental capacity, body weakness, loss of appetite and decreased in taste perception.

Bronchiectasis

Bronchiectasis is a destructive lung disease characterised by chronic dilatation of the bronchi associated with persistent though variable inflammatory process in the lungs. These changes may involve any area but are predominantly found in the lung bases and can be divided into localized and diffuse forms.
Causes:
1. Host defence defects:
(a) Immune defects:Immunoglobulin deficiency (lgG2 and lgG4), complement deficiency, phagocyte defects.
(b) Chronic granulomatous disease.
(c) Chediak-Higashi syndrome.
(d) Leucocyte adherence deficiency.
(e) Hyperimmune states: Allergic bronchopulmonary aspergillosis, post-lung transplantation.
(f) Mucociliary clearance defects: Immotile cilia, Kartegener??s syndrome (situs inversus, sinusitis and bronchiectasis);Chandra-Khetarpal syndrome; Young??s syndrome, cystic fibrosis.
2. Localised bronchial obstruction: Inhalation of foreign body, benign tumor, external compression (e.g. nodes of primary tuberculosis).
3. Following infections: T.B., measles pneumonia, whooping cough, adenoviruses, mycoplasma pneumonia, pneumococcal pneumonia, AIDS.
4. Lung inflammation: Gastric aspiration, toxic gas inhalation (e.g. ammonia), 4 heroin, inflammatory bowel disease, rheumatoid arthritis, systemic vasculitis.
5. Others: Diffuse pulmonary fibrosis, absence of bronchial cartilage, yellow nail syndrome, primary lymphoedema, treated lymphoreticular malignancy, a-antitrypsin deficiency (rare).
Symptoms??Clinical types:
1. Bronchitic??Attacks of recurrent bronchitis, more common in winter. Clubbing of fingers diagnostic.
2. Haemorrhagic (bronchiectasis sicca)??Recurrent haemoptysis with good health in between, or attacks of bronchitis.
3. Suppurative-- Chronic cough, copious purulent expectoration, general toxemia, clubbing of fingers varying from slight parrot beak curvature of finger nails to bulbous drum stick enlargement (pulmonary osteoarthropathy), dyspnoea and perhaps haemoptysis, weakness, loss of appetite, digestive disturbances, loss of weight, mild anaemia. The paranasal sinuses are frequently infected. Retardation of growth may occur in children.
4. With relatively rapid onset??Symptoms developing with comparative suddenness, as a sequel to partial bronchial obstruction by a foreign body or after anaesthesia. In early stages paroxysmal cough with occasional offensive sputum which may be provoked by change of position. Later large amounts of foetid sputum.
In traditional Chinese medical studies, clinically, it belongs to the category of ke sou (cough), tan chui (stimulate production of sputum/phlegm) and ke xue (coughing out of blood or hemoptysis). Our motherland medical studies consider that the lungs are fragile organs which cannot endure excessive temperature changes; if the lungs are affected by excessive of heat, it will cause disturbances in blood circulation, disorganization of lung tissues and blood, thus easily causing pus (purulent) and the non-smoothness of gases ventilation, disturbances in inspiration and expiration, hence resulted in cough, repeated hemoptysis, spitting big volume of purulent phlegm with fishiness smell; excessive of heat, imbalance between evil (abnormality) and good (body system), thus forcing discharge of fluid and resulted in warm sweat; insufficiency of Yang Qi (Yang energy or gas), accumulation of phlegm in shang jiao (an acupuncture point in lung), thus causing dullness in the chest, dyspnea or chest pain, cyanosis; the spleen regulates the gas and blood system, weakness of spleen will cause imbalance of fluid homeostasis that will resulted in loss of appetite, decreased of mental capacity, body weakness and deformation of finger and toe nails.

Acute bronchitis

Acute bronchitis is an acute infection of mucous membrane of trachea and bronchi produced by viruses, bacteria or external irritants.
Causes:Precipitating causes -- (1) Infection -- Either bacterial or viral, or descending infection from nasal sinuses or throat. (2) Complicating other diseases -- e.g. measles, whooping cough. (3) Physical and chemical irritants -- Inhaled dust, steam, gases like SO2, ether. (4) Allergic bronchitis -- following inhalation of pollens or organic dusts.
Symptoms:1. Toxemic -- Malaise, fever, palpitation, sweating, etc,2. Irritative -- Cough with expectoration, at first scanty viscid sputum, later more copious and mucopurulent;substernal pain or raw sensation under the sternum.3. Obstructive -- Choked up felling, paroxysms of dyspnea particularly following spells of coughing relieved with expectoration. In Chinese clinical results, acute bronchitis belongs to ke sou (cough) category. The traditional Chinese medicine considers, wind and heat affect lungs and they lost the clearance ability, thus produced sputum (phlegm) and resulted in cough with sputum or cough without sputum which is left inside the lungs, headache, cold and fever and so on. The lungs (respiratory system) start from the nose, throat as the door of respiratory, heat accumulated in lungs, lungs Qi (energy) pathway not smooth, therefore caused snuffle, sneeze and pain in throat, raucity of voice; heat in lungs pathway, thus injured of the pathway and caused improper circulation, therefore one can sees blood in sputum; decreased lungs function, implicate on spleen and stomach and caused Qi to move in opposite direction and resulted in nausea and vomiting; sputum affected the diaphragm, Qi cannot circulate properly and thus causing pain in lungs and abdomen during cough.

Erythremia (Vaquez disease)

Erythremia or chronic erythromyelosis is characterized with abnormal increasing of red blood cells-a type of chronic hyperplasia of bone marrow which we called zhen hong (true red). Those middle and old aged males are often more prone to this disease. The clinical signs are peculiar plethoric redness of skin and mucosa, especially neck, cheek, lip, ear, nose and the most at distal part of limbs, hyperemic of eye conjunctiva, resembles the face of a drunken person. The other symptoms are such as headache, heaviness in the head, noise in ears, weakness and numbness of limbs; severe patients may even have impaired vision, narrowing of vision field, double vision, skin itching, about 1/3 even develop thromboses causing thrombosis of peripheral, brain and coronary arteries, often caused duodenal ulcers, rheumatoid arthritis and etc.
The etiology of this disease is still unknown clearly, considering the increasing of red blood cells is due to erythrocytosis (increased production of red blood cells or erythrocytes) and is not due to prolongation of life span of red blood cells. The researches shown that the increasing of red blood cells is related to the abnormality of hemopoeitic stem cells.
The diagnose is mainly based on clinical symptoms and blood analysis. The blood volume may increases to 120-240ml/kg (in norm 65-90ml/kg), hematocrit >50%, slow erythrocyte sedimentation rate, hemoglobin maybe more than 18-24g/dm, often accompanied by increasing of white blood cells, erythrocyte network normal or increased, neutrophils and alkaline phosphotase increased. The regenerative activity of bone marrow is obviously marked hyperactive and the ratio between neutrophils and young erythrocytes is decreased. Besides, there are positive result of iron dye and decreased iron storage in bone marrow.
The modern medical treatment mainly uses phlebotomy, new cytostatics (marcofan and myelosan) and radioactive phosphorus (32P) and etc.
In Chinese medicine studies, this disease belongs to stoppage of warm liver blood concretely, excessive of Qi (energy) and gradually increasing warmth of blood, with main signs such as liver Yang (stronger of liver function), liver Huo (hot, accumulation of heat), stoppage of Qi (energy) and increased of blood viscosity. During the treatment, it must be directed to clear the excessive Qi and cooling down the blood, clearance of stoppage, improves the blood circulation, clear Huo and Du (poison), helps to let out liver Huo, adjust liver Yang and etc.

Thalassemia

Thalassemia are genetic disorders of Hb synthesis in which there is reduced production of one or more chains of Hb. This results in a relative excess production of either a chains or b chains, which without their partner chains are unstable and precipitate in the red cell or their precursors. The inclusion bodies producd by this process increase the rigidity of the red cell and result in its destruction, either in the marrow or the circulation or both. Hence the anaemia of thalassemia results from ineffective erythropoiesis due to intramedullary red cell destruction and a shortened red cell survival caused by haemolysis. The b thalassemias are more often encountered. Their clinical symptoms are different, as for the b thalassemias severe patients will have severe anemia, jaundice, hepatosplenomegaly, disturbances in growth, mental retardation; typical cases shown the flat nose, increased width between eyebrow, protruded facial bones; regenerative and volume of compensatory cells of bone marrow are increased, shrinkage of size of erythrocytes, low colour index, accompanied with sickle cells syndromes; it is associated with inheritance and ontogeny.
The etiology of this disease is not clearly known, the b thalassemias are autosomal codominant traits.
The main diagnose of this disease in based on anemia and jaundice, lab analysis reveals microcytic hypochromic anemia with sickle cells syndromes, increased capillary network of erytrocytes (gelatinous network of fibrous polymers that stiffen the erythrocytes membrane), increase viscosity and cause dehydration due to potassium leakage and calcium influx.
The modern medicine treatments against this disease are transfusion of blood in severe anemic patients and even apply the spleenectomy (removal of spleen).
In chinese medicine, this disease belongs to xu lao (tiredness) and wang dan (jaundice). The patient will experience anemia since young, Qi (energy) is excessive accumulated thus causing imbalance of blood system, moreover the body system will start to become weaker and resulting in Yang cannot generate Yin and one will lack of Jing (essence) of blood; consequently the inner organs cannot adjust with one another and will cause slightly wetness of the blood Jing , then, causing excessive of bile which is shown on the skin as weakness and jaundice; if Yin Yang of blood Qi is not adequate and at the same time is infected by other diseases, therefore will resulted jin xu (symptoms of Qi), shi (symptoms of damp and jaundice) combination of symptoms.

Iron-deficiency anemias

Iron-deficiency anemias
Causes:
1. Increased physiological requirement
(a) Growth spurts??Children between ages of 6 months and 2 years, and from 11 to 16 years due to spurts of growth during these periods. (b) Pregnancy.
2. Pathological blood loss
(a) Reproductive system
Menorrhagia
(b) GI tract
Bleeding Atrophic gastritis
Oesophagitis
Oesophageal Inflammatory bowel
Varices disease
Hiatus hernia Haemorrhoids
Peptic ulcer
Malabsorption Coeliac disease
Hemorrhagic
Telangiectasia (rare)
(c) Dietary
Vegans
Elderly
(d) Hookworm infection
Clinical features:
A. Manifestation of underlying conditions -- e.g., pain of peptic ulcer, epigastric lump in carcinoma stomach.
B. Due to anemia -- Insidious onset of easy fatiguability, weakness, headache, bodyache, inability to concentrate, giddiness. With sever anaemia palpitation, exertional dyspnoea, anginal pain and congestive cardiac failure. Heamic murmur may be heard.
C. Due to iron-deficiency anemia
1. Tongue -- Smooth and pale (bald tongue). Sometimes angular stomatitis.
2. Dysphagia -- from formation of mucosal webs at junction of pharynx and oesophagus (believed to be due to reduction in iron containing enzymes in epithelium and GI tract).The combination of splenomegaly, koilonychia and dysphagia is known as Pulmmer-Vinson or Kelly-Paterson syndrome.
3. Atrophic gastritis -- associated with achlorhydria.
4. Nail changes -- Nails may be thin and fragile. Platynychia and koilonychia. More frequent in adults.
5. Hepatosplenomegaly -- usually mild degree may occur, regresses with correction of iron deficiency.
6. Pica -- Perversion of appetite in from of geophagy or pagophagia (excessive eating of rice).
7. Miscellaneous -- (a) Oedema of feet due to CCF, impaired renal function or hypoproteinemia. (b) Amenorrhoea in females, sometimes menorrhagia. (c) Increased intracranial tension and papilloedema rare. (d) In children -- Long-standing anaemia prominence and face resembling that in Cooley??s anaemia . Also reduced attention span and poor learning. (e) Possibly impairment of T cell function and neutrophil killing thus promoting infection.
In traditional Chinese medicine studies, this disease belongs to the categories of xue xu (weakness of blood), xu huang (false jaundice) and huang zhong (yellow coloured swelling); it is closely connected with the spleen and kidneys. The spleen and stomach as the root of the body system, regulate the fluid metabolism and support the heart and blood system; weakness of spleen will cause weakness of Qi and blood, so the blood firstly cannot supply to the head and then body which later caused headache, giddiness, weakness and murmurs in the ears; if the blood cannot support the heart, it will then cause palpitation and dypsnea. The spleen is closely related to the kidneys, if there is insufficient of kidneys Yang, the life is weakening and the spleen will not grow; in contrary, if there is hypofunction of the spleen, it will also further causes the kidney injury, insufficient of Yang of kidneys and spleen whick resulted in inadequate of blood and Qi to the entire body, thus appeared cracks of nails, wrinkles, dry and atrophy of skin, dry and loss of hair. Therefore, in treatment, one must care for the spleen, kidney and support the Qi and blood.

Megaloblastic anemia

Megaloblastic anemia is characterized by abnormal giant red blood cells regeneration that causes low quantity of erythrocytes.
Causes:
I. Vitamin B12 deficiency
1. Inadequate intake -- (a) Strict vegetarians (vegans). (b) Poor quality diet.
2. Malabsorption (a) Gastric -- Pernicious anaemia, congenital intrinsic factor deficiency, gastrectomy. (b)Intestinal -- Intestinal stagnant loop syndrome (e.g. jejunal diverticulosis, anatomical blind-loop, ileo-colic fistula), chronic tropical sprue, ileal resection and Crohn??s disease, selective malabsorption with proteinuria, fish tape-worm.
II. Folic and deficiency
1. Inadequate intake -- (a) Pool quality diet poverty, old age, alcoholism, goat??s milk. Kwashiorkor.
2. Malabsorption -- Gluten-induced enteropathy, dermatitis herpetiformis, tropical sprue, congenital folate malabsorption.
3. Increased cell turnover -- (a) Pregnancy and lactation. (b) Prematurity. (c) Chronic haemolytic anaemia. (d) Malignant disease. (e) Chronic inflammation (tuberculosis, rheumatoid arthritis).
4. Drugs -- Anticonvulsants, salazopyrin, trimethoprim. Alcohol.
5. Renal loss -- CCF, dialysis.
6. Metabolic -- Homocystinuria.
Clinical features
1. Due to anaemia -- Shortness of breath, dyspnoea, pallor and in older subjects angina or cardiac failure.
2. Gastrointestinal -- Diarrhoea, loss of appetite and weight. Sore tongue due to glossitis and angular cheilosis. Mild jaundice (from intramedullary breakdown of haemoglobin and shortened red cell life span) may give the patient a lemon yellow tint.
3. Neurological
(a) Vitamin B12 neuropathy -- due to symmetrical damage to peripheral ns. and posterior and lateral columns of sp. cord, the legs being more affected than arms. Psychiatric abnormalities and visual disturbances may occur (from folate deficiency).
(b) Neural tube defects -- Folic acid supplements during pregnancy have been show to reduce incidence of spina bifida, encephalocele and anencephaly in the fetus.
4. Gonadal dysfunction -- Deficiency of either B12 or folic acid may cause sterility, which is reversible with appropriate vitamin supplements.
5. Epithelial cell changes -- Glossitis and other epithelial surfaces may show cytological abnormalities.
6. CVS disease -- Raised serum homocysteine concentrations have been associated with arterial obstruction and venous thrombosis.
In traditional Chinese medicine studies, this disease belongs to the category of xu lao (weakness), it means the weakness of spleen and kidneys, insufficiency of blood essence. The formation of blood, its source came from the fluid metabolism, formation of blood also depends on blood essence, essence can form blood, therefore, the formation of blood is closely related to the kidney. The kidneys store the essence, regulate bones and growth of marrow which is connected with the brain system and serve as the root (basis) of our body system; if the kidneys are weak, there will be insufficiency of blood essence and marrow, thus lack of formation of blood. Therefore, the main aim of treatment is to strengthen the kidneys, then increases marrow and care for the spleen as well.

Hemolytic Anemias

Hemolytic anemia is a reduction, in the number of circulating red cells from their premature destruction.
Causes:
I. Genetically-determined disorders of red cells:
A. Enzyme deficiencies -- which result in abnormal energy metabolism:
1. Glucose 6-phosphate-dehydrogenase.
2. Pyruvate kinase deficiency.
3. Triosephosphate isomerase deficiency.
B. Haemoglobinopathies
1. Structural haemoglobin variants.
2. Thalassemia syndromes.
C. Disorders of the red cell membrane:
1. Hereditary spherocytosis.
2. Elliptocytosis.
3. Stomatocytosis.
4. Acanthocytosis in a-b-lipo-proteinemia.
II. Acquired disorders of red cells:
A. Associated with red cell antibodies
1. Isoantibodies -- Haemolytic disease of the newborn, transfusion reactions.
2. Autoimmune haemolytic anaemia -- Warm antibody type, drug-induced, cryopathic haemolytic syndrome.
B. Not associated with antibody formation
1. Acquired membrane defects -- paroxysmal nocturnal haemoglobinuria (PNH), liver disease, uremia, vitamin E deficiency.
2. Trauma -- microangiopathic haemolytic anemia, cardiac haemolysis, march haemoglobinuria.
3. Physical agents -- e.g. severe burns.
4. Chemical agents -- snake venom, drugs.
5. Infections -- parasitic, bacterial, disseminated intravascular coagulation.
6. Multifactorial -- Anaemia of chronic disorders, hypersplenism, malignancy including lymphomas, collagen vascular disorders.

The symptoms of this disease is depends on the course of the disease either acute or chronic. As for the acute patients, the symptoms appear spontaneously such as trembling, high fever, weakness, nausea, vomiting, abdominal pain, ache in waist, back and extremities and so on. The severe patients may even develop coma and shock, heart function insufficiency and acute renal failure. The other symptoms are severe anemia and jaundice accompanied with hemoglobinpathies and hematuria. While for the chronic patients, the course of disease starts gradually, along with weakness, headache, palpitation after physical activity and etc- similar as anemic symptoms. They have light or moderate degree of anemia, jaundice and hepatosplenomegalia (enlargement of liver and spleen). The prolonged chronic hemolytic anemia may arose cholelithiasis (formation of bile stones) and hepatic failure.
In traditional Chinese medicine studies, this disease belongs to the category of wang dan (jaundice) and xu lao (weakness). The hypofunction of spleen and stomach will cause the decreased function of Qi and blood regeneration, the weakness of Qi and blood is difficult to recover, so one will have weakness, headache, palpitation after physical activity and etc- similar as anemic symptoms; in severe cases, the patients will have weakness of kidneys Yang, when the Yang is weak, it cannot generate Yin and cause impairment of regeneration of blood s Yin. If the spleen is weak, it will cause retention of moist and fluid they accumulate and turn into heat, then the suffocation of moist and heat causing substances in the stomach to move in opposite direction, thus lead to high fever, nausea, vomiting and trembling. The interaction of moist and heat cause overflow of bile which later leads to jaundice. If the jaundice is prolonged, the moist and bad substances are accumulated which then caused the friction between Qi and blood, therefore there is enlargement of liver and spleen. Firstly, one must clear the heat and discharge the moist in their treatment, next are increase Qi, strengthen the spleen and kidneys.

Anemia

Anemia is a state in which the hemoglobin concentration falls below the accepted normal range depending on age and sex.
Classification:
1. According to cause
1. Blood loss -- Acute or chronic posthaemorrhagic anaemia.
2. Impaired red cell formation
(1) Genetic disorders of haemoglobin synthesis -- Thalassemia syndromes.
(2) Acquired deficiency of substances essential for haemopoiesis -- (a)Iron deficiency anaemia. (b)Megaloblastic anaemia due to deficiency of vitamin B12 or folic acid. (c)Protein malnutrition.
(3) Disturbances of erythropoiesis not due to deficiency states or genetic causes -- (a) Secondary anaemia -- due to infection and/or inflammatory disorders; renal or hepatic failure;metastatic malignant diease. (b) Aplastic anaemia. (c) Drug-induced disorders of erythropoiesis.(d) Infiltrative disorders of bone marrow ?Cacute and chronic leukaemia, malignant lymphoma, multiple myeloma, metastatic carcinoma, myelosclerosis, (e) Refractory sideroblastic anaemia. (f) Endocrine deficiencies -- Myxoedema, panhypoptuitarism.
ii. According to size of red cells and their haemoglobin content (Morphological)
1. Normocytic -- Average cell volume (MCV) within normal range mostly normal average cell haemoglobin concentration (MCHC).
2. Hypochromic microcytic -- MCV reduced, MCHC reduced.
3. Normochromic microcytic -- MCV redeced, but MCHC normal.
4. Macrocytic -- MCV increased. Mostly normochromic.
iii. Haemolytic anaemia -- Inherited or acquir
1. Intrinsic (erythrocytic), defects.
2. Extrinsic (extraerythrocytic). Mechanisma.
Investigation of a cause of anemia
1. History
(1) Age and sex -- Prematurity in infants. Females during reproductive period of life. G6PD deficiency confined to males.Sideroblastic anaemia mostly in males.
(2) Rate of onset -- Rapid onset over days, or one or two weeks suggests acute bleeding, acute leukaemia or haemolysis.
(3) Drug ingestion -- Especially aspirin and NSAIDs.
(4) Occupation -- Exposure to toxic chemical at work.
(5) Diet -- History suggesting dietary deficiency.
(6) Family history of anaemia or jaundice commom in congenital heamolytic anaemia. Occasionally family history in pernicious anaemia.
(7) Bleeding -- Blood loss commomest cause of anaemia -- haematemesis, melena, bleeding piles, menorrhagia, haematuria, haemoptysis.
(8) Gastrointestinal system -- Symptoms suggestive of peptic ulcer, cirrhosis, neoplasm, hiatus hernia. Diarrhoea often intermittent and glossitis common in megalobloblastic anaemias.
(9) Reproductive system -- Menorrhagia. Number such as nocturnal polyuria.
(10) Urinary system -- Symptoms of renal insufficiency isuch as nocturnal polyuria.
(11) Nervous system -- Paraesthesia in hands and feet in deficiency anaemias.
(12) Bleeding tendency as suggested by easy bruising or skin petechiae, prolonged bleeding after trivial injuries, or bleeding from more than one site.
(13) Skeletal system -- Bone pains may occur in anamias due to marrow infiltration or replacement as in multiple myeloma, leukaemia, malignant lymphomas and myelosclerosis.
2. Physical examination
(1) Skin -- Colour of skin, petechiae and ecchymoses. In pernicious anaemia the skin may have a lemon yellow tint, and in acute leukaemia an ashen tint. In myxoedema coarse and dry. Petechiae in anaemia suggest diagnosis of aplastic anaemia or leukaemia.
(2) Nails -- Brittleness and longitudinal ridging common in chronic iron deficiency anaemia, occasionally koilonychia.
(3) Conjunctivae -- show pallor due to anaemia. Icterus rare, when present suggests haemolytic anaemia or hepatic disease. Mild icterus may be seen in pernicious anaemia.
(4) Mouth -- (i) Mucous membrane -- Petechiae on palate, cheeks, or tongue in aplastic anaemia and leukaemia. (ii) Cums --Hypertrophy in leukaemia especially monocytic. (iii) Tongue glossitis, or smooth tongue common in megaloblastic anaemia, occasionally in iron deficiency anaemia. (iv) Pharynx -- Ulceration of throat may occur in acute leukaemia , and acute aplastic anemia. (v) Angular cheilitis suggests iron deficiency.
(5) Bones -- Bone tenderness especially sternal tenderness may occur in anaemias secondary to marrow infiltration, e.g., in acute leukaemia, also in metastatic bone carcinomia, muelosclerosis and malignant lymphomas.
(6) Breasts -- for evidence of carcinoma.

In the traditional Chinese medical studies, this disease belongs to the category of xu lao (weakness), wang xue (lost function of blood cells) and xue zheng (blood diseases symptoms). The pathogenesis of this disease is related to congenital under development and imbalance of vital supply after birth. The kidneys host the bones, regeneration of marrow is the root of blood formation; while the spleen gather blood, regulates their circulation and serves as the source of blood formation. If the spleen is weak and cannot circulate the blood properly, it will decrease the ability to form blood and leads to anaemia; if the kidney is weak, it cannot help the spleen to circulate blood, the improper marrow will cause obstruction of blood regeneration function and leads to blood deficit; the heart hosts cardiovascular system, lost function of blood cells will lead to inadequate nutrients to those blood cells; Qi act as the chief of blood, the weakness of Qi will decrease its absorption into the blood thus impaired the blood system. Therefore, anaemia is connected with the heart, spleen and kidneys.
Clinical treatment results Treated 958 cases, among them 723 cases used the western medicine but not effective, they used our remedy after cessation of western medicine and the total effectiveness is 89%. The most effective rate is in cases of decreased of white blood cells- up to 95%, while in decreased of platelets 78% and anaemia 87%. The symptoms such as headache and dizziness became better after the medical therapy.

Pemphigus

Pemphigus is a severe skin disease. Its characteristics include superficial vesicles and bullae that rupture easily; it is a blistering disorder resulting from loss of integrity of normal intercellular attachments (acantholysis) within the epidermis and mucosal epithelium. Pemphigus is an autoimmune disease. Etiology and pathogenesis The cause of this disease is still not clearly known; at present time, it is classified as an autoimmune disorder because patient??s serum yields antibodies to intercellular cement substance in stratum spinosum of epidermis of skin and mucose membrane (also known as pemphigus autoantibody) in indirect immunofluorescence examination. The main thing here is IgG, serum s pemphigus autoantibody titer is proportional to the severity of disease. The area of autopemphigus antibody reacts is the affected area where loss of intercellular attachments (acantholysed area). This autoantibdy interferes with the normal function of desmoglein 3 which responsibles for desmosome adhesion. Clinical manifestations The majority of individuals who develop pemphigus are in the fourth to sixth decades of life, and men and women are affected equally. There are four clinical and pathologic variants: pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceus and pemphigus erythematosus. (1) Pemphigus vulgaris: primary lesions are superficial vesicles and bullae that rupture easily, leaving shallow erosions covered with dried serum and crust. The fluid from the ruptured bullae is clear in the beginning, later with blood and it gives unpleasant smell. The superficial layer is easily slough-off under external force or slightly pressure on a large bulla will cause fluid in the bulla to spread radially ?C this is known as positive Nikolsky sign. The pathognesis of this situation is the loosening and separation of stratum spinosum of epidermis and leads to lacking of intercellular attachment. It causes slight itching, leaves behind pigmentation after treatment, no scar. About 80% patients may involve the oral cavity, external genitalia and eye conjunctiva, oral membrane erosions are easily bleeding regions with significant burning pain which normally is an early symptom of this disease before skin involvement appears. It can affect any region of the body, especially back, axilla and groin. Bullae appear at whole body, the affected region has erosions and more prone to secondary infections, fever, whole body weakness and etc. (2) Pemphigus vegetans: usually affects scalp, axilla, chest, back and others. It starts with loose bullae, positive Nikolsky sign, then rupture and become erosions and presents with large, moist, verrucous (wartlike), vegetating plaques studded with pustules which superficially dirty, scarring and has bad smell. It often involves oral cavity, nasal cavity, labia minora, anal area and other membranes area. Bullae are easily rupture and become erosions. ymptoms for own-revealing are not significant, sometimes along with high fever and other general symptoms. The course of disease always changes, sometimes light and sometimes severe, it often continuous for many years. Pemphigus vegetans can be divided into two forms: 1. Severe (Neumann) form which quite similar to pemphigus vulgaris. 2.Light (Hallopeau) form: no significant blisters, only small pustules and vegetative plaques at flexural surfaces. Clinically, it is difficult to distinguish from pyoderma vegetans; if uses direct immunofluorescence examination, one can see IgG deposition between cells of epidermis. (3) Pemphigus foliaceus: bullae are so superficial that only zones of erythema and crusting, site of previous blister rupture with fatty scarring, are usually present on physical examination. It also has regional skin slough-off and fishy bad smell. Sometimes, the affected area presents erythema swelling and leaf-shaped scar which are similar to ----------. Positive Nikolsky sign. Skin damage usually presents at scalp, facial, chest and back region. The membrane of oral cavity is less affected. The degree of itching and general symptoms vary all the time. (4) Pemphigus erythematosus: Is also known as Sener-usher syndrome and pemphigus seborrhoicus, is a less severe form of pemphigus foliaceus. Symptoms: erythema, small bullae, Nikolsky positive with repeated scalling, scarring process; usually affects scalp, cheeks, chest and back region. It selectively involves the malar area of the face in a lupus erythematosus-like fashion. The scalp, chest and back region often have fatty scarring and picture of dermatitis seborrheica. It usually less often spreads to the whole body, good prognosis, does not involve membranes, whole body symptoms are light. This disease can progress into pemphigus foliaceus. Diagnosis 1. Loose skin with big bullae, appear scarring or erosions. 2. Membranes especially of oral cavity is an early symptom of pemphigus. 3. Postitve Nikolsky sign. 4. Histological analysis of bulla reveals Tzanck cells. 5. Immunofluorescence examination. a. Direct method: epidermal cells of affected area have deposition of IgG and C3. Besides, about 25-30% of patients showed deposition of IgA and IgM. At the unaffected area, about 60% has IgG and C3 deposition. b. Indirect method: in patients serum, about 100% cases has pemphigus autoantibody. The autoantibody and level of disease is proportionate. Pemphigus erythematosus has the above mentioned features with additional positive antinuclear antibody, bridges between epidermis and dermis have deposition of IgG and C3 which is quite similar as lupus erythematosus. 6. Pathogenesis: stratum spinosum of epidermis has acantholysis type of bullae, one can see disconnection of bridges under micoscpe and leads to lost of intercellular attachment. This is also the basic pathogenesis of Nikolsky sign.Tzanck cells present in bullae. Formation of chorionic villi at the base of bullae, slight infiltration at the dermis layer. Pemphigus vegetans has the above mentioned features, and additional with hypertrophic of epidermis which gives a false picture of epitheloid tumor; in epidermis, there is presence of small pustules that contain lots of eosinophils. Acantholysis of pemphigus folioceus and pemphigus erythematosus happens at superficial layer of epidermis (stratum corneum or stratum granulosum). Western treatment: 1.Corticosteroids 2.Immunosuppression drugs. TCM treatment: a. Poison heat form: clearing of heat, neutralizes poison, cooling the blood. b. Heart fire, spleen moist form: clearing of heart and eliminating fire. c.Injured of Qi & Yin form: benefits Qi and support Yin, clearing of poison remnants. [Gufang treatment results] There were 560 cases adopted TCM therapy with 542 cases of completely recovery and 18 cases of shown effectiveness.