Luo Weixian1, Yang Zefeng1, Ma Jiwei2
1. The First People's Hospital of Zhengzhou, Zhengzhou Henan China 450004;
2. The First Affiliated Hospital of Henan University of Chinese Medicine,
Zhengzhou Henan China 450000
ABSTRACT:Stratification theory in traditional Chinese medicine (TCM), belonging to traditional Chinese thinking, has been used not only in level of man and nature relationship, in level of physiological and etiological level and pathogenesis, but also in level of syndrome differentiation, treatment strategy, and drug prescription, etc. Therefore, it is necessary to further recognize the level of medical treatment of a specific disease to improve the efficiency of TCM clinical practices and the work of TCM inheritance. The early state of diabetic nephropathy pathogenesis is mainly the dysfunction of Qi, Blood and body Fluid, so the main clinical strategy in treatment of it is to regulate patients Qi, the function of Triple Energizer and to regulate the waterways in the body. In compensatory stage of the disease, the functions of the Zang and Fu of human body has been injured, hence the focus should be the relationship between Kidney and the other Zang and Fu systems to prevent injury transmission. In the final stage of the disease, the further depletion of Yang and Yin has hurt to the congenital and acquired essence. In this deepest pathological damage state, the priority would be to restore Yang and Yin for resuscitation or nourishing Yuan Yin and Yuan Yang. The basic pathological process and treatment principles fully embody the concept of TCM stratification theory.
KEYWORDS:TCM stratification theory; diabetic nephropathy; treatment based on syndrome differentiation
Chinese medicine's stratification theory has been applied in many aspects of TCM clinical practices, which include the life view of Yuanshen monism, to the correspondence between man and nature as a whole, the physiology and pathology of description as "internal conditions must be shown in the outside", the pathological evolution process from the outside to the inside and again to the outside of the body, TCM's herb's character, taste and channel tropism, and prescription priorities. Therefore, further cognition of the theory is necessary to improve the accuracy and efficacy of TCM clinical practices and TCM inheritance through education [1].
1 Analysis of the relationship between TCM stratification theory and clinical practices
The stratification theory of traditional Chinese medicine is based on Chinese traditional philosophy, with method of analogy to the image of things as well as deduction and induction interpretation is made about human life phenomenon, about physiology and pathology, about treatment and prognosis of diseases. The theoretical system of TCM is structured with stratification method including theories in levels of medical principle, method, recipe and medicine under the guidance of Holism concept. In ancient China, Yuanshen monism is the basic idea in understanding the general program of the material world. Under the guidance of Yuanshen monism, Theory of Yin Yang and Theory of Five Elements further explain the material world [2]. Traditional Chinese doctors consider human's Essence, Qi and Spirit as the most important three indicators of health. Based on that, human's constitution is discussed and then the Yin and Yang properties of the susceptible diseases and the existing diseases of human are analyzed according to time, place and patient conditions and treated with supplying method in dealing with deficiency syndrome or reducing method in dealing with excess syndrome. For instance, deficiency syndrome falls into four categories, namely Yin, Yang, Qi and blood deficiency, and herbs characters may be described as being hot, warm, cool, and cold. Yin and Yang together runs human's general program of health including physiology and pathology. At the same time, Five Elements Theory further illustrate the properties and management of human body more specifically, in which the Wood, Fire and Gold are of Yang property, while Soil and Water are of Yin Property. Therefore, huaman's Five Zang of Liver, Heart, Lung are Yin Zang, and Spleen and Kidney are Yin Zang. In terms of treatment, much attention should be paid to the propergy of the Zang. For example, Yin diseases usually happen to Yang Zang and the method of nourishing Yin and decreasing internal heat are frequently used in treatment. On the other hand, Yang diseases usually happen to Yin Zang and the method of tonifying Yang and eliminating internal coldness are frequently used in clinical practices.
Human's Five Zang is very important for body function, among which Heart is working as the center part and any physiological activities of all other Zang are under the command of Heart since Heart is the leader of others. At the anatomical level, stratification thinking or theory still works, with the Five Zang cooperate with the Six Fu in human’s body management. Besides, Meridian Theory, being an important supplement to the traditional Chinese Medicine Anatomy, it explains human hierarchical structure both inside and outside very clearly. With the terms of meridians, under-skin collaterals, the more superficial collaterals, human body’s structure and function are discussed more detailed in TCM.
Syndrome differentiation of diseases is also based on the stratification theory of TCM. It is said that best doctors treat disease when it happen in sweat pore, better doctors treat when in the skin, good doctors treat when in tendons, general doctors treat when in Six Fu, and bad doctor treat when in Five Zang. The above sayings mean that traditional Chinese doctors can take care of people’s health usually when a disease just begin or before that if people go to see them in time. In TCM clinical diagnosis and treatment, in the hierarchical concept, the Five Zang is centered with meridians going through the body everywhere. Human Qi, Blood and body Fluidis are the material basis of all physiological activities. The normal functioning of Qi, Blood and body Fluidis bring about the normal performance of body. Moreover, Yin functions in shape forming, while Yang functions in Qi forming, which means Yin and Yang can be separated in human since shape and Qi can not be separated. In other words, in exogenous disease or traumatic disease, Qi plays a role of defense. Therefore, best doctors usually prevent diseases or treat diseases in the earist stage, otherwise, the disease would hurt human more seriously.
2 Practical application of stratification theory of TCM
The development of the disease is a dynamic process. Therefore, it is necessary to take a dynamic view in dealing with the disease progression and in deciding the treatment. The understanding of a disease should be based on the principle of syndrome differentiation and distinguish of the disease. It is an immutable law that disease development from the shallow level of human body to the deep and from the outside to the inside. Therefore, knowing clearly about the level of disease can help in syndrome differentiation and the treatment [3]. A stratification thinking of Yin and Yang, Qi and Blood will lead to best curative effect [4].
It is also said in TCM that selecting and applying of drugs is like commanding military forces. With the exact information of the pathogenesis and the location of a disease, the drug prescribed would be appropriate [5].
Clinical practice is a process to recognize human body, a process to the understand diseases and to explore the law of human health. Modern medicine has understood the disease process in a more subtle level, so it is believed that with modern means of science and technology, more diseases would be treated effectively. Stratification thinking of TCM would help to explore the law of human body and human diseases.
3 The necessity of education on stratification theory for inheritance of TCM
Some people have difficulties in understanding of the Theory of Yin and Yang and the Theory of Five Elements. Stratification theory can be helpful in understanding of them. It is suggested that in education of TCM, the traditional Chinese medicine is to be explained, which makes the Chinese traditional Chinese medicine more quickly into the learning process. It is also necessary to teach the stratification thinking in order to simplify the traditional Chinese medicine theory and to promote the inheritance of TCM in education.
4 The practical effect of the stratification theory in TCM in treatment of renal disease
Kidney, by maintaining a stable inner environment for human, plays an important role in the following aspects: the excretion of metabolic waste; keep the balance between water, electrolyte and acid-base to ensure the constant normal fluid volume, osmotic pressure and ion concentration; (3) renin secretion, erythropoietin (EPO) element, vitamin D, prostaglandins and bradykinin and other hormone regulation of kidney function and body fluid regulation. And the basic clinical manifestations of kidney disease are proteinuria, hematuria, edema, acute nephritis syndrome, acute renal injury, with renal failure and abnormal urine symptoms in the final stage [6]. Modern medicine emphasizes the objective indexesin evidence-based medicine system, in which diagnosis is made according to clinical laboratory examination. However, the diagnosis of traditional Chinese medicine is based on clinical symptoms and syndromes with analogy method.Many diseases’ names in Chinese medicine have obvious marks of symptoms and syndromes. For example, a kidney disease was named as "edema" or "Uroschesis" in TCM. The following part is to discuss the method in understanding this kidney disease from the perspective of stratification theory in traditional Chinese medicine.
First, let’s look at what the main symptoms of kidney disease are, by taking diabetic nephropathy as an example. The process of the the disease is a series of gradual systematic changes of human body in TCM. The syndrome in the early stage is Blood, body Fluid, Yin and Yang abnormity, while in middle stage of the disease. Several organ injury would take place in this way or other. In final stage, Yin and Yang get damaged further and further, till the exhaustion of Yin and Yang of the patients.
In the early stage of diabetic nephropathy, mild abnormalities of asymptomatic proteinuria, urinary albumin, creatinine and urea nitrogen are manifested. In view of TCM pathogenesis, it is mainly the dysfunction of Qi, Blood and body Fluid without obvious function injury of the Zang and Fu damage. Fatigue, cold clear urine or turbid, anorexia, mild lower extremity edema, with or without tongue and pulse symptoms appear in compensation period. There is damage to the functions of the Zang and Fu, with systemic edema even bulging appear and cloudy urine or hematuria, anorexia, diarrhea, palpitations, dyspnea, etc. In the final stage of the disease, the deepest pathological damage would take place. Therefore, in treatment it is necessary to fully understand the key pathogenesis and the pathological damage level. In the early stage of the disease, it is important to adjust Qi and Blood and regulate of Triple Energizer and waterway. In compensatory stage, we should focus on kidney and related Zang-Fu’s conditioning to coordinate the relationship between Zang and Fu in order to prevent and prevent transmission. Finally, it is correct to revive Yang as well as nourishing Yuan Yin and Yuanyang. The renal damage of diabetic nephropathy are usually the main strategy. is a variety of pathological factors, especially transforming growth factor, platelet derived growth factor, basic fibroblast growth factor 1, vascular endothelial growth factor, growth hormone, and insulin-like growth factor [7]. With variety of pathogenic factors work together in the whole process of the pathogenesis, the clinical treatment can related to a single factor or to a variety of factors. TCM diagnosis and treatment advantage is that the disease is divided into different stages, with each stage having its own unique disease character. With stratification theory, combined methods in different levels are applied.
Chinese medicine, being a life science based on the practice in microcosmic dialectical thinking under the guidance of the whole concept. Chinese medicine treatment pay attention to syndrome differentiation in treatment, with stratification thinking, profound understanding of the disease, higher the accuracy of the syndrome, and better efficacy achieved [8]. In other words, through observing, smelling, asking and pulse-taking, changes of human’s internal body, Qi, Blood and body Fluids conditions can be worked out and the imbalance of Yin and Yang would be found and restored to impair the function of internal organs of the body.
Kidney deficiency syndrome is usually fatigue, while the pathological and physiological conditions would be gradually improved, such as in the micro blood stasis syndrome, the indexes of renal glomerular sclerosis, diffuse thickening of glomerular basement membrane, tubulointerstitial fibrosis, blood hypercoagulability, long-term microscopic hematuria, etc. can be recognized earlier as kidney blood stasis syndrome with TCM than that with modern medicine, thus promoting blood circulation and removing blood stasis earlier in health care. In clinical diagnosis and treatment of kidney disease dialectical thinking should be used on the application of modern medicine and traditional Chinese medicine. It is believed that with traditional Chinese medicine and modern medicine combined in diagnosis and treatment of kidney disease, the efficacy would be promoted significantly [9].
In conclusion, in treatment of renal anemia and edema, in addition to the treatment of kidney organ itself, it should be taken into account that Spleen, Liver, Lung and other Zang-Fu all work together and the stratification theory can be the guideline in the process [10].
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Foundation item: National Natural Science Foundation of China (number:81273950)
Received 12 July 2017;accepted 22 August 2017
Correspondence: Ma Jiwei, PhD;E-mail:jiwei193074@126.com
Editor:Qin Lin
