▲Zhu Liangchun, Master of Traditional Chinese Medicine (1917.8-2015.12)
Zhu Liangchun, the first master of traditional Chinese medicine, was the chief physician of Nantong Hospital of Traditional Chinese Medicine, and a tenured professor of Nanjing University of Chinese Medicine. The experience of treating Alzheimer's disease is introduced as follows for the benefit of colleagues.
Classification of Alzheimer's disease
Alzheimer's disease is clinically divided into three main types.
Mixed dementia: refers to both senile dementia and vascular dementia or other types of dementia.
Vascular dementia: refers to cerebrovascular disease with dementia as the main manifestation. In addition to atherosclerosis and hypertension, it is generally accompanied by recurrent cerebrovascular accidents, including multiple infarcts or small bleeding foci due to Alzheimer's classification.
Alzheimer's disease: diffuse cerebral cortex atrophy, vacuolar degeneration of nerve cell granules, neurofibrillary tangles and senile plaques in the brain in terms of pathological and histologic changes. It is a classification of brain degenerative diseases that predominate progressive dementia and is a common disease in dementia.
Awareness of Alzheimer's disease
The brain is the origin of the functions of the gods, and it is the substantive organ that produces the gods, also known as the "house of the gods". However, the normal function of the gods of the brain is closely related to the functions of the five organs of the body, especially the one depends on the strong heart function, because the "heart is the main blood vessel", the function of the heart is normal, the blood can be smooth, and the blood can fully nourish the brain; Second, it depends on sufficient kidney essence, only the sufficient kidney essence can metaplasia of the cerebral medulla, and the normal function of the heart and kidney makes the brain cells not cause too much apoptosis and brain atrophy. Of course, the quality of digestion and absorption function will affect the metaplasia of qi, blood and kidney essence, and the normal function of the lungs and liver will affect various mental symptoms such as hallucinations, fantasies, nocturnal swimming, and self-talk in the mirror, so Chinese medicine believes that the occurrence of senile dementia is closely related to the metamorphosis of the five organs, qi and blood, and the function of the cerebral marrow, especially whether the function of the heart and kidney is normal. Of course, we are talking about the heart and kidneys in traditional Chinese medicine, which are different from Western medicine in terms of concept.
Although modern medicine has reached the molecular level in the study of senile dementia, there is still no ideal way to delay the progression of the disease. At present, traditional Chinese medicine research believes that senile dementia is mainly related to liver and kidney deficiency, medullary sea deficiency, spleen and kidney deficiency, heart and liver fire, phlegm turbidity obstruction, qi stagnation and blood stasis.
When senile dementia patients have symptoms such as forgetfulness, indifferent expression, slow response, lazy speech, drowsiness, low voice, irritability, pale complexion, weakness or wetness or swelling and weakness, they belong to the type of heart qi deficiency, and the method of adjusting heart qi should be applied; When there are symptoms such as forgetfulness, slow movement, slow movement, operation error, loss of fluency, head tilt and back curvature, uncontrollable stool, and weak ulnar pulse, it belongs to the type of kidney essence deficiency, and the method of nourishing kidney qi should be applied.
Etiology, pathogenesis and treatment
Although the pathological process of dementia varies, the outcome is brain cell atrophy. "The brain is the sea of the kidney", and "the main bone of the kidney", the crux of the lesion is "kidney deficiency". According to the survey results of 235 cases of people over 20 years old by Yao Peifa et al., the percentage of kidney deficiency in both sexes has been certain since the age of 30, and the percentage of kidney deficiency in the group over 40 years old can reach more than 70%, and the percentage of kidney deficiency in the old age group increases with age. It was also found that 95% of ordinary people over 70 years old had kidney deficiency. Chen Qingsheng made a preliminary analysis of the five visceral functions of 94 healthy elderly people over 90 years old, and found that all subjects had different degrees of kidney deficiency, and the kidney deficiency rate accounted for 100%.
It can be seen that the elderly have kidney deficiency. If the kidneys are deficient, the gasification is passive, and the inability to warm, excite, and vibrate the visceral qi, "the brain is gradually empty", so that the viscera and limbs lose their nourishment, resulting in the unfavorable gasification of the three cokes, the abnormal rise and fall of the qi machine, the loss of blood flow, the astringency of the veins, and the blood stasis. Therefore, the main cause of Alzheimer's disease is the gradual decline of kidney qi in old age. Kidney deficiency is due to the deficiency of the sea, the dysfunction of the viscera, the stagnation of qi and blood stasis in the brain, or the phlegm and stasis in the brain, and the brain is lost, resulting in intellectual activity disorders, mental and mental disturbances, and dementia.
The kidney in TCM is a summary of the neurological, endocrine, immune, biochemical and metabolic physiology of the hypothalamic-pituitary-target gland. Kidney deficiency is a disorder of the comprehensive regulation of the internal environment of the body, mainly nervous and endocrine disorders. These disorders both lead to the appearance of aging and are the source of blood stasis. Kidney deficiency can promote the occurrence and development of blood stasis, which in turn aggravates the condition of kidney deficiency, and the two affect each other and are cause and effect of each other. Therefore, the etiology and pathogenesis of Alzheimer's disease is based on kidney deficiency, blood stasis as the standard, and the deficiency and reality are mixed. Therefore, the method of benefiting the kidney and removing stasis is the main rule for the treatment of Alzheimer's disease, and it is quite convenient to treat this disease.
Examples of medical cases
Zhang Moumou, male, was 66 years old at the time. Initial diagnosis on May 4, 1993: history of hypertension, frequent dizziness, numbness in the limbs, significant memory loss in recent years, dizziness, emotional instability, easy to be impatient and impulsive, sometimes doubtful, depressed, poor speech, weakness in limbs, backache, unpleasant walking, and frequent insomnia. High blood lipids and blood pressure. CT examination showed cerebral atrophy and focal infarction. He was diagnosed with "cerebrovascular dementia". The moss is thin and greasy, the tongue is lined with purple, the tip of the tongue is red, and the veins are thin and weak.
Diagnosis: (kidney deficiency and liver prosperity, phlegm stasis obstruction type) dementia (called cerebrovascular dementia in Western medicine).
Treatment: benefit the liver and kidneys, dissolve phlegm and stasis, and wisdom the brain.
Prescription: 10g of wolfberry, 10g of chrysanthemum, 10g of gastrodia, 15g of Dilong, 15g of raw and cooked ground, 15g of salvia, 10g of red and white peony, 10g of peach kernel and safflower, 20g of jujube and cypress kernel, 8g of gallbladder star, 15g of fairy spleen, 8g of Zhiyuanzhi, 20g of mulberry parasitism, 20g of raw oysters, 4g of licorice, 10 sticks, 1 decoction per day.
On May 15, 1993, the second diagnosis showed that the dizziness, numbness and insomnia were all slightly reduced after the medicine, the conscious speech and walking were smoother than before, the mood was stable, the memory was slightly enhanced, and he felt very happy, and he was able to actively cooperate with physical exercise. Moss is thin and the veins are fine. The former law continues to advance. Add 10g of puzzle kernels on top, followed by 10 servings.
On May 24, 1993, the third diagnosis: all the signs were improving, so he made 10 times the above dose into pills, 6g per dose, 3 times a day, and continued to take it to consolidate it.
Follow-up after half a year: everything is normal.
Note: This case is a mild case of "cerebrovascular dementia", so the effect is rapid, such as severe cases need to be patient and adhere to medication, and moderate exercise, such as tai chi, walking, etc., speech counseling, improve the living environment, make it feel comfortable, eliminate loneliness and doubts, appropriately increase the high-protein, low-fat diet, and eat more vegetables and fruits, which is conducive to recovery.
Kidney deficiency and blood stasis syndrome is the pathological basis of geriatric diseases, so the method of benefiting the kidney and removing blood stasis is the main treatment rule of this disease. Because kidney tonic drugs work by regulating the "brain-medullary axis", it can improve and restore brain function. According to Gong Bin's experiment, Chinese medicine can significantly delay the aging of brain tissue by adjusting the content of neurotransmitters, the number of neurotransmitter receptors, the content of gonadotypes and sex hormones, and the content of monoamine oxidase (MAO) and superoxide dismutase (SOD). Liang Xiaochun et al. have proved that Kidney Supplement can not only enhance the activity of free radical scavengers such as SOD, but also reduce the level of lipid peroxide metabolism, so as to reduce the damage of free radical accumulation to cells and tissues.
In this case, wolfberry, rehmannia root, white peony, mulberry parasitic, fairy spleen, Yizhiren, etc. all have kidney tonic effects, and others such as ginseng, mountain firewood meat, Polygonum multiflori, yam, dodder seed, etc., can also be used. Drugs that promote blood circulation and eliminate blood stasis can improve blood circulation, prevent thrombosis, regulate cell metabolism and immune function, promote tissue repair and anti-inflammatory. Specifically, it can reduce blood viscosity, improve blood composition and microcirculation, increase blood flow to tissues and organs throughout the body, especially increase blood flow and nutrition in brain tissue, thereby improving and delaying brain aging and improving its function.
▲Hitoshi Kashiwashi
In this case, the Dilong, Salvia, Red Peony, Peach Kernel, and Safflower in the prescription all have good effects on blood circulation and blood stasis. other gallbladder breath weathering stasis; Yuanzhi tonifies the heart and kidneys, calms the mind, and dissolves phlegm stagnation; Chrysanthemum clears the liver and eyes, relieves headache and dizziness; Longmu Town takes the liver and yang, calms the heart and calms the nerves; Jujube and cypress are good at sleeping, and these drugs can help improve symptoms and help recover from dementia. Gastrodia is long in the wind and spasmodics, good at treating headache and dizziness, "Shennong's Materia Medica" said that it "long-term service is good for qi, long yin fat and healthy", Tang Zhenquan's "Treatise on Medicinal Properties" said that it can treat "paralysis does not follow, more trance, good at frightening and losing will", "Kaibao Materia Medica" also pointed out that it "benefits the waist and knees, strengthens the muscles, and benefits the mind for a long time", which is a good medicine for both the symptoms and the root cause of Alzheimer's disease.
Clinical measures also need to be adapted to the symptoms, and patients with qi deficiency can reuse astragalus and codonopsis; those who are deficient in yin add dendrobium, wheat winter, and turtle plate; manic wind movers plus antelope horn powder, spirit magnet; Those who are hot add rhubarb and coptis; Those with spleen deficiency and stupidity add atractylodes, yams, wood, etc., with the profit and loss of symptoms, and start to have good results. In the early 70s of the last century, Zhu Liangchun formulated the "Brain Strengthening", which was originally designed for the sequelae of concussion, because it has the function of strengthening the brain and kidneys, invigorating qi and removing stasis, and later transferred to treat Alzheimer's disease, which also has good results.
Prescription used: 15g of red ginseng, 20g of ground turtle worm, angelica, and wolfberry; 15g of strychnine and Chuanxiong, 12g of Dilong, frankincense, myrrh, and burning; 24g each of Zihe car and chicken gold; 9g of blood exhaustion and licorice. Shangyan very fine, take 4.5g every morning and evening, take it with boiling water, and can be taken continuously for 2~3 months. Among them, strychnine, also known as the turtle, is highly poisonous, and whether it is prepared properly or not has a great impact on the curative effect. Generally, it is soaked in water to remove hair, dried in the sun, and fried in sesame oil, but if the frying time is too short, it will be white, and it is easy to cause vomiting and other poisoning reactions after taking it; If the frying time is too long, it will turn black and charcoal, resulting in failure. Therefore, in the processing, one can be cut with a knife, so that the inside is purple-red, which is the most suitable. ■
Zheng reiterates:
Since each person's constitution and condition are different, the prescription and dosage in this case are only applicable to the patient's condition at that time. Without TCM syndrome differentiation diagnosis and treatment, the prescription and dosage in this case must not be copied. If necessary, readers should go to a regular hospital for diagnosis and treatment to avoid delaying their condition.
[Source: China Journal of Traditional Chinese Medicine, the content is compiled from: The fifth edition of "China Journal of Traditional Chinese Medicine" on March 22, 2021, this article is excerpted from Zhu Liangchun's speech at the first conference of the International Association of Chinese Medicine and Cerebrospinary Cord in 1996]