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Discussion and treatment of late onset hypogonadism in male based on " tian gui out of time sequence"

Hui WU ; Gang NING ; Bonan LI ; Ajian PENG ; Haoyu WANG ; Ruobing SHI ; Xing ZHOU

Journal of Beijing University of Traditional Chinese Medicine.2024;47(11):1501-1505. doi:10. 3969 / j. issn. 1006-2157. 2024. 11. 004

The unique advantages of traditional Chinese medicine (TCM) in treating late onset hypogonadism in male have gradually emerged with the continuous deepening of the understanding and research on late onset hypogonadism in male. Time sequence is a general summary of the natural growth and operational laws. Tian gui and testosterone have their normal time sequences, and they may be associated with each other. A man′s tian gui follows the regular time sequence from " inception" to " exhaustion" throughout " eight" under normal physiological conditions. " Tian gui out of time sequence" includes the loss of tian gui exuberance (dysfunction of viscera dominated by the liver) and exhaustion in the time sequence (pathological deficiency of viscera dominated by the kidney), resulting in " tian gui exhaustion" in advance of " eight eight". Tian gui and testosterone are key concepts in Chinese and Western medicine for understanding late onset hypogonadism in male. The theory of " tian gui out of time sequence" may be closely related to the core pathogenesis of this condition, particularly in cases of liver depression and kidney deficiency. This study suggests that restoring the normal time sequence of tian gui while treating the liver and kidney simultaneously through time-sharing treatment should be effective. The use of Xiongcan Yishen Formula has shown promising therapeutic result, offering new insights and references for treating late onset hypogonadism in male using TCM.

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Construction of a system for differentiation and treatment of psychiatric symptoms based on the five spiritual zang viscera theory

Hongxiao JIA

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1629-1636. doi:10.3969/j.issn.1006-2157.2024.12.001

To date, there are four critical challenges currently present in traditional Chinese medicine psychiatry: inconsistency in guiding theory, limitations in disease nomenclature, inapplicability of the syndrome differentiation and treatment model of internal medicine somatic symptoms to psychiatry, and need for improved clinical treatment efficacy. This study follows the guiding principle of syndrome differentiation and treatment that focuses on "identifying core prescriptions based on core symptoms and pathogenesis", by using psychiatric symptoms from Western psychiatry as the core symptoms for differentiation and treatment, and by applying the refined five spiritual zang viscera theory to qualitatively and locationally assess psychiatric symptoms, this approach establishes the core pathogenesis and corresponding treatment methods for common psychiatric disorders. Specifically, the core pathogenesis of schizophrenia is identified as "kidney deficiency with liver hyperactivity", treated by tonifying kidney and tranquilizing liver; for depression, the core pathogenesis is "yang qi stagnation", treated by ascending yang and relieving stagnation; for bipolar affective disorder, the core pathogenesis is "excess metal with latent fire", treated by nourishing yin and regulating yang; for anxiety disorder, the core pathogenesis is "kidney deficiency with hyperactivity of the will", treated by tonifying kidney and calming anxiety; for tic disorder, the core pathogenesis is "kidney deficiency with liver wind", treated by tonifying kidney and suppressing hyperactive liver for calming endogenous wind; for attention deficit hyperactivity disorder, the core pathogenesis is "kidney will deficiency with heart spirit imbalance", treated by nourishing kidney and enhancing will for storing the spirit; and for autism, the core pathogenesis is "kidney deficiency with weak spirit", treated by nourishing kidney and strengthening heart for benefiting spirit. Based on clinical evidence and the identified core pathogenesis, core herbal prescriptions for treating common psychiatric disorders are established, thereby constructing a syndrome differentiation and treatment system for psychiatric symptoms based on the five spiritual zang viscera theory.

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Staged treatment of post-stroke depression based on "deficiency of heart qi leading to sadness"

Yilong SUN ; Yanbo SONG ; Fangbiao XU ; Yijun WU ; Yuhe HU ; Yongkang SUN ; Huan YU ; Yina WANG ; Xinzhi WANG

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1646-1654. doi:10.3969/j.issn.1006-2157.2024.12.003

Post-stroke depression is a common complication after a stroke. Based on the theory of ＂deficiency of heart qi leading to sadness＂recorded in Huangdi Neijing, our team proposes that deficiency of heart qi is the basic pathogenesis of post-stroke depression, with sadness being its main manifestation. Therefore, we advocate treating post-stroke depression from the perspective of the heart, and clinically, it can be divided into four stages: heart-liver stage, heart-lung stage, heart-spleen stage, and heart-kidney stage. Treating post-stroke depression with the principle of regulating qi and nourishing the heart, patients in the heart-liver and heart-lung stages are mainly middle-aged and young adults, with a pathological nature of qi stagnation and mild deficiency of heart qi, and therefore, the method of promoting the flow of meridians and regulating qi should be adopted. In contrast, patients in the heart-spleen and heart-kidney stages are mainly middle-aged and elderly, with a pathological nature of qi deficiency and severe deficiency of heart qi, and therefore, nourishment and tonification should be prioritized. In response to the above four stages, our team has achieved good clinical efficacy by administering Xiaoyao Powder, Baihe Dihuang Decoction, Ganmai Dazao Decoction and Jingui Shenqi Pill respectively. This study discusses the approach to treating post-stroke depression from the perspective of a "deficiency of heart qi leading to sadness" by examining three aspects: the theoretical basis of Chinese and Western medicine to treat post-stroke depression from the heart, the basic pathogenesis and staging of post-stroke depression, and the treatment principle of regulating qi and nourishing the heart. The study also briefly analyzes the clinical experience of the medications used for this condition to provide a reference for the treatment of post-stroke depression.

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Discussion on the viewpoint integration in Huangdi Neijing

Shuangqing ZHAI

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1655-1660. doi:10.3969/j.issn.1006-2157.2024.12.004

To clarify the reasons for the phenomenon of producing different viewpoints in the theory of Huangdi Neijing and how to understand and apply these different viewpoints correctly. This study explores the founding basis of the characteristics of "viewpoint integration" in the theory system of Huangdi Neijing and explains the theoretical significance and clinical value of "viewpoint integration" from the perspective of the core concept of Huangdi Neijing. In conclusion, when grasping the characteristics of "viewpoint integration" in Huangdi Neijing, thinking about, recognizing, analyzing, and solving problems is the main line and the core. Understanding different points of view should be extensive and in-depth. Do not use one viewpoint to understand all viewpoints, do not use one viewpoint to explain another viewpoint, and do not mechanically mix two viewpoints. At the same time, it is necessary to clarify the construction process of different viewpoints and to learn to grasp these viewpoints from different angles. Studying the characteristics of "viewpoint integration" in Huangdi Neijing can not only better understand the theoretical content of Huangdi Neijing, but can also help open up ideas for the diagnosis and treatment of diseases, develop and innovate the theory of traditional Chinese medicine, and improve clinical efficacy.

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Exploration on the pathological mechanism of central fatigue from the correlation between liver stagnation and spleen deficiency and mitophagy

Yifei ZHANG ; Qingqian YU ; Qinghuan SHI ; Bijuan LAN ; Zehan ZHANG ; Feng LI

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1661-1667. doi:10.3969/j.issn.1006-2157.2024.12.005

Central fatigue refers to the central nervous system disease caused by excessive mental pressure or excessive physical activity, which shows a series of fatigue symptoms. The pathological mechanism of central fatigue remains unclear, and the mitochondrial quality control pathway represented by mitophagy is closely related to the occurrence and development of central fatigue. Traditional Chinese medicine considers liver stagnation and spleen deficiency as the key pathogenesis of central fatigue. This paper suggests that oxidative stress may be an important basis for the occurrence of central fatigue, energy metabolism disorders are specific manifestations of liver′s failure of conveyance and dispersion and spleen′s failure of healthy transportation, and the abnormal accumulation of reactive oxygen can be regarded as pathological products of central fatigue. Therefore, based on oxidative stress and energy metabolism, the pathologic mechanism of liver′s failure of conveyance and dispersion and spleen′s failure of healthy transportation in central fatigue from the perspective of mitophagy has a rich theoretical connotation, and provides a theoretical reference for the clinical treatment of central fatigue.

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Analysis on application of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines in FU Qingzhu Nüke

Linlin GUO ; Yanfeng LIU ; Qiaosheng REN ; Jingjing LI ; Chaoyue HUO ; Zhichao HUANG

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1668-1674. doi:10.3969/j.issn.1006-2157.2024.12.006

There are a total of 16 couplet medicines of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma in the book FU Qingzhu Nüke, covering a wide range of diseases such as leukorrheal diseases, menopathy, pregnancy, and puerperal diseases, and there is a fine sense of the dosage, processing, and proportion of the couplet medicines. Through analyzing the cases of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines and the characteristics of dosage, processing, and proportion, we conclude that Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines are mainly as followed: smoothing liver and strengthening spleen in treating leukorrheal diseases to remove dampness and stop leucorrhoea; regulating liver and tonifying spleen in menopathy to regulate menstruation and relieve pain; nourishing blood and benefiting qi in pregnancy to lower adverse qi and tranquilize fetus to prevent miscarriage; regulating and tonifying qi and blood in puerperal diseases to eliminate pathogenic factors and promote lactation; suppressing hyperactive liver for descending adverse qi, and relieving spasm and pain in cases of miscarriage due to rage. In terms of dosage, Paeoniae Radix Alba is mainly used for three to five qian, and Glycyrrhizae Radix et Rhizoma is primarily used for one qian, and the dosage of the two medicinals is adjusted according to the degree of primary and secondary liver stagnation and spleen deficiency. In terms of processing, wine Paeoniae Radix Alba and raw Glycyrrhizae Radix et Rhizoma are primarily used. Stir-frying with wine can help Paeoniae Radix Alba nourish blood and promote blood circulation, tonifying without stagnation, and it is used in most of the diseases caused by liver qi stagnation or qi and blood deficiency. Glycyrrhizae Radix et Rhizoma used in raw is tonifying without causing stagnation, and it can also have the effect of purging fire. In terms of proportion, the ratio of Paeoniae Radix Alba to Glycyrrhizae Radix et Rhizoma is 5∶1 for liver stagnation restraining spleen, 3∶1 for qi and blood deficiency, and 1∶1 for obvious fire-heat. This paper analyses the application of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines in FU Qingzhu Nüke, aiming to deeply study and inherit the academic thought of FU Qingzhu, and to provide new ideas and method for the precise application of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines in clinical practice and researches.

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Discussion on LI Dongyuan′s "deficiency of spleen and stomach qi" theory

Xiang LI ; Jianjun GU

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1675-1680. doi:10.3969/j.issn.1006-2157.2024.12.007

LI Dongyuan, the founder of the tonification school, attaches great importance to the role of the spleen and stomach in the ascending and descending movement of qi in the human body. Based on years of clinical experience, LI Dongyuan proposed that regulating the spleen and stomach is fundamental to treating liver, heart, lung, and kidney diseases. This theory is a concentrated expression of his clinical approach. This provision is derived from the chapter 9 and has rich connotations. This article draws on the theory of five movements and six qi, as well as the theory of yin fire, to explain the deeper connotations of this provision. According to Dongyuan′s theories, "Should be to but not to, this is insufficient", "Unimpeded by my restrained delusions", "Born by me is insufficient because of me", and "Restrain my arrogance unimpeded", correspond to the pathogenesis of the spleen and stomach disease of the heart, kidney, lung, and liver. Simultaneously, this article also discusses the rules and treatment method of the other four zang-organ diseases in the case of spleen and stomach deficiency, providing novel insights for treating multi-zang organ diseases with spleen and stomach deficiency as the core.

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Discussion on the pathogenesis and treatment of non-alcoholic fatty liver disease in postmenopausal women based on the theory of "deficient qi and stagnation"

Mingyao XU ; Wenyuan SU ; Jing WU ; Jiawen HE ; Haowei ZHANG ; Jinjuan LI ; Jia YUE ; Yan ZHANG

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1745-1752. doi:10.3969/j.issn.1006-2157.2024.12.014

Non-alcoholic fatty liver disease is a common chronic liver disease in clinical practice. In recent years, with increasing social attention to the health of women and the elderly, the prevention and treatment of non-alcoholic fatty liver disease after menopause has increasingly become a research hotspot in metabolic diseases. This study explores the pathogenesis and treatment method of non-alcoholic fatty liver disease in postmenopausal women based on the theory of "deficient qi and stagnation" and combined with the physiological and pathological characteristics of postmenopausal women and the Western medicine understanding of non-alcoholic fatty liver disease. We believe that the pathogenesis of non-alcoholic fatty liver disease in postmenopausal women is rooted in the "deficient qi" caused by depletion of liver and kidney essence and blood. The imbalance between the physical and functional aspects of the liver due to this "deficient qi" is the primary factor, while the "stagnation" of phlegm and blood stasis is the manifestation. Furthermore, the "deficient qi" and "stagnation" reinforce each other, with the deficiency leading to stagnation and stagnation exacerbating the deficiency, thus accelerating the progression of the disease. The treatment approach should be one that combines nourishing deficiency and resolving stagnation, addressing both root cause and maifestations. Given the female characteristic of "the liver as the innate organ" and the post-menopausal physiological state of "gradual decline of kidney essence", it is important to focus on nourishing the liver and kidneys, nurturing the liver′s physical body while maintaining its function, and also promoting the circulation of qi, resolving phlegm, and invigorating blood circulation to remove blood stasis. This approach aims to reduce the accumulation of lipids in the liver, offering a new perspective and approach for the treatment of non-alcoholic fatty liver disease in post-menopausal women with traditional Chinese medicine.

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Analysis on the differentiation and treatment of premature ovarian insufficiency from "qi" based on granulosa cell autophagy

Guanghui LI ; Xiaoling FENG

Journal of Beijing University of Traditional Chinese Medicine.2024;47(12):1753-1758. doi:10.3969/j.issn.1006-2157.2024.12.015

Premature ovarian insufficiency belongs to the category of early menstrual cessation, blood depletion, and infertility in traditional Chinese medicine, which not only affects women′s fertility and forces them into a premature perimenopausal period, but also increases the risk of long-term complications such as osteoporosis, cognitive impairment, and cardiovascular diseases. Autophagy has a dual regulatory effect on follicular development and atresia, closely related to the onset of premature ovarian insufficiency. In women, blood is the basis and qi is the use. This article argues from the perspective of "qi", positing that the pathogenesis of premature ovarian insufficiency is fundamentally due to the deficiency of qi in the zang-fu organs leading to inadequate nourishment of the uterus, while the obstruction of the uterine vessels by qi depression in the zang-fu organs as manifestation. It also takes the correlation between autophagy and qi in the onset of premature ovarian insufficiency as the starting point, proposing a therapeutic principle centered on replenishing qi as the foundation and activating qi as the key. The internal and external treatment of traditional Chinese medicine can correct the abnormal autophagy of granulosa cells through "regulating qi", thus improving the ovarian microenvironment, protecting the ovarian function, and finally preventing and treating premature ovarian insufficiency.

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The mechanism of modified Xiangsha Liujunzi Decoction in regulating apoA-Ⅰ and improving endoplasmic reticulum stress in hyperlipidemic mice

Qi ZHANG ; Guoyuan SUI ; Nan SONG ; Jie WANG ; Yu LIU ; Haoran CAI ; Lianqun JIA

Journal of Beijing University of Traditional Chinese Medicine.2024;47(9):1236-1246. doi:10.3969/j.issn.1006-2157.2024.09.008

Objective To explore the mechanism of modified Xiangsha Liujunzi Decoction in regulating apolipoproteinA-Ⅰ (apoA-Ⅰ),improving endoplasmic reticulum stress,regulating glucose and lipid metabolism,and preventing and treating dyslipidemia in mice. Methods Wild-type (WT) C57BL/6J mice were randomly divided into the WT,WT+high-fat diet(HFD),and WT+HFD+Xiangsha Liujunzi Decoction(XSLJZ) groups according to the random number table method. ApoA-Ⅰ-/-mice were randomly divided into the apoA-Ⅰ-/-,apoA-Ⅰ-/-+HFD,and apoA-Ⅰ-/-+HFD+XSLJZ groups (n=10) according to the random number table method. D12492 was used for HFD feeding to establish a hyperlipidemic mouse model. Modified XSLJZ (23.66g/kg) was administered daily by gavage from the ninth week. Serum and liver tissue were collected for testing after 4 weeks. An automatic biochemical analyzer was used to detect blood lipid levels;an enzyme-linked immunosorbent assay was used to detect serum fasting blood glucose (FBG) and insulin (INS) levels,and the INS resistance index (HOMA-IR) was calculated. Hematoxylin and eosin staining was used to observe the pathological changes in the liver. Oil red O staining was used to observe the lipid deposition in the liver. TG levels in liver tissue were detected using the microplate method. Real-time PCR was used to detect apoA-Ⅰ,glucose-regulated proteins (GRP78),sterol regulatory element binding protein-1c (SREBP-1c),acetyl CoA carboxylase 1 (ACC1),and fatty acid synthase (FASN) mRNA expression levels in liver tissue. The WES fully automated protein expression analysis system was used to detect apoA-Ⅰ,GRP78,inositol-requiring enzyme 1 (IRE1),p-IRE1,c-Jun N-terminal kinase (JNK),p-JNK,insulin receptor substrate (IRS1),p-IRS1,protein kinase B (Akt),p-Akt,SREBP-1c,ACC1,and FASN protein expression levels in liver tissue. Results Compared to the WT group,the WT+HFD group showed a significant increase in serum lipids,FBG,INS levels,and the HOMA-IR index (P<0.05). The orange-red lipid droplets in liver tissue increased,fat vacuoles were apparent,and TG levels were significantly increased. ApoA-Ⅰ mRNA and protein expression levels were significantly reduced,whereas GRP78,SREBP-1c,ACC1,and FASN mRNA expression levels were increased,GRP78,SREBP-1c,ACC1,and FASN protein levels and the IRE1,JNK,IRS1,and Akt phosphorylation degree were increased (P<0.05). The serum TG,HDL-C,LDL-C,FBG,and INS levels and the HOMA-IR index in the WT+HFD group were significantly reduced after administering modified XSLJZ (P<0.05). The orange-red lipid droplets in liver tissue were significantly reduced,fat vacuolization was alleviated,and TG levels were significantly reduced,ApoA-Ⅰ mRNA and protein expression levels were significantly increased,whereas GRP78,SREBP-1c,ACC1,and FASN mRNA expression levels were reduced,GRP78,SREBP-1c,ACC1,and FASN protein expression levels and the IRE1,JNK,IRS1,and Akt phosphorylation degree were reduced (P<0.05). Compared to the WT+HFD group,the TG,LDL-C,and FBG levels and HOMA-IR index in the serum of the apoA-Ⅰ-/-+HFD group were significantly increased,whereas the HDL-C levels were significantly decreased (P<0.05). Diffuse orange-red lipid droplets in liver tissue and a significant increase in fat vacuoles were observed. Furthermore,TG levels were significantly increased,SREBP-1c,ACC1,FASN mRNA,SREBP-1c,and ACC1 protein expression levels and IRE1,JNK,IRS1,and Akt phosphorylation levels were significantly increased (P<0.05). Compared to the WT+HFD+XSLJZ group,the apoA-Ⅰ-/-+HFD+XSLJZ group showed a significant increase in serum TG,LDL-C,FBG,and INS levels,and the HOMA-IR index,whereas HDL-C levels decreased significantly (P<0.05). The deposition of orange-red lipid droplets in liver tissue improved,and TG levels significantly decreased,GRP78,SREBP-1c,ACC1,and FASN mRNA expression levels,GRP78,SREBP-1c,and ACC1 protein levels,and IRE1,JNK,IRS1,and Akt phosphorylation levels increased (P<0.05). Conclusion Modified XSLJZ improves liver glucose and lipid metabolism disorder by regulating apoA-Ⅰ to alleviate endoplasmic reticulum stress.

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