Polish up the golden sign of Chinese medicine (in-depth observation)
General Secretary Xi Jinping pointed out: “It is necessary to do a good job in the integrity, innovation, inheritance and development of traditional Chinese medicine, and establish a service system, service model, management model, and talent training model that meet the characteristics of traditional Chinese medicine, so that traditional Chinese medicine can flourish.”
Following the law of TCM development, sticking to TCM clinical thinking, and inheriting TCM characteristic techniques are the magic weapon for the revitalization and development of TCM.
A few days ago, the author visited a number of traditional Chinese medicine hospitals in Beijing to see how they explored the path to the development of traditional Chinese medicine.
Inheriting the concept of Chinese medicine in the clinic
As a treatment method, TCM maneuvers requires differentiation of syndromes, types, and positions.
The bone-setting technique is not passed on every move, but the concept of traditional Chinese medicine.
68-year-old grandmother He accidentally fell when she went downstairs, and her left foot couldn't move.
Her family lives in Tiantan Nanli Community, Dongcheng District, Beijing, and was taken to a nearby hospital by ambulance.
After the film examination, the doctor pointed to the film and said that there are comminuted fractures of the medial malleolus, lateral malleolus, and posterior malleolus, accompanied by dislocation of the talus, surgery is recommended.
Grandma He cried, worried that her paralyzed wife who was in bed would not be taken care of.
"I have a broken ankle and I don't want surgery. Can I treat it conservatively?" Grandma He has been in Beijing Fengsheng Traditional Chinese Medicine Orthopedics Specialty Hospital for many years. She dialed the number of Qi Yuefeng, the dean.
"Come on, we try our best to strive for conservative treatment." Qi Yuefeng fully agreed.
In clinical practice, although ankle fractures are more common, all three bones in the ankle and ankle of Grandma He are fractured, and joint dislocations occur. Conservative treatment is not small.
Grandma He lay flat on the hospital bed in pain, bending her knees and hips, her injured left foot sticking out of the end of the bed.
Qi Yuefeng led the trauma department director Li Ye to perform manual bone correction for Grandma He, holding the calf on the ankle with one hand and pressing down, holding the heel with the other hand, turning the ankle inwardly and inwardly, extending the ankle joint with the back, and pressing the palms tightly with both palms. Repeatedly buckle and squeeze both sides of the ankle to successfully reset the ankle.
After the ankle was reset, the doctor used a hard paper splint to fix the injured ankle in a varus position. Place the two hard paper splints on the inner and outer sides of Grandma He’s calf, and cut off one corner of the oblique smooth arc forward. Adapt to the shape of the ankle and the instep.
The splint is lined with a thick cotton pad of the corresponding size, which is fixed in the ankle joint varus and internal rotation position to maintain the ankle joint dorsal extension.
Compared with traditional wood plywood and plaster, hard paper plywood is lighter, more comfortable, firmer and more stable.
The cardboard is yellow-brown and is a straw cardboard pressed from straw. The thickness of a single layer is only 1 mm. It is still very thin after folding 4-6 layers, and it can be bent by spraying water on the surface.
Not only that, it can also be flexibly tailored according to the patient's limbs.
For the injured ankle, the doctor cut off the rounded corners at the bottom, cut out a small gap at the bend, and pressed cotton inside to make it fit the skin more closely under the bandage.
The traditional Chinese medicine method lays the bones without moving the knife, and recovers quickly. It took Grandma He less than 8 weeks to grow her bones.
Three months later, the left ankle joint anterior and lateral view showed that the fracture alignment was good, the fold line was blurred, and the ankle point did not widen.
She excitedly said to Qi Yuefeng, "Chinese medicine is a good way to set bones! Without surgery, I don't know how many crimes I have suffered."
The "Four Ankle Ankle Method" praised by Grandma He originated from the rich experience in bone setting. Although it has gone through more than 60 years, it has never even had a name.
"The first emphasis is on the technique, the muscles and bones, the combination of movement and static, and the supremacy of function." This is the academic philosophy of orthopedics treatment that Fengsheng has always adhered to.
How to make the inheritance of the characteristic orthopedics of traditional Chinese medicine not be out of shape?
In 2006, as the fourth-generation successor of "Fengsheng Bone Surgery", Qi Yuefeng led the team to dismantle and refine the ankle joint osteosynthesis technique.
In order to solve the technical difficulties, they walked into the ray room wearing lead suits and exposed their hands to X-rays to reset the patient.
"When we saw the dynamic trajectory of bone movement, we suddenly realized." Qi Yuefeng said.
The research team summarized the four-step ankle-lifting method of "lifting, turning, back extension, buckling and squeezing". Observed more than 120 cases, proved its effectiveness with data, and conquered the most serious ankle fracture-three ankle fracture The problem of manual therapy.
"Fengsheng Bone Repair" has continuously won the praise of patients.
In 2019, the annual number of outpatient (emergency) visits in the hospital exceeded 700,000, and more than 80% of the patients were orthopedic patients.
Qi Yuefeng said that as a treatment method, the four-step normal ankle method requires differentiation of syndromes, types, and positions in clinical practice.
For different fracture types, some use one technique alone, some require three techniques of lifting, turning, and squeezing, and some require a combination of four techniques.
The traditional Chinese medicine bone setting method is not passed on one by one, but the concept of Chinese medicine.
The characteristics of Chinese medicine can not be lost
Following the law of development of Chinese medicine and maintaining its characteristics and advantages, Chinese medicine preparations can be continuously optimized and convenient for patients to use
"I just came here!" At the Dermatology Clinic of Beijing Traditional Chinese Medicine Hospital, Grandma Li, who was in her 80s, pointed to a black stick in the nurse's hand and smiled.
Grandma Li developed a piece of shingles on her thigh. After the blisters subsided, she was still very painful. Various methods were used to treat her, but the effect was not obvious. She rushed to the Chinese Medicine Hospital with a glimmer of hope.
The nurse took a small stick and roasted it on the alcohol lamp, and it melted into a viscous liquid in a short while, spreading the small piece on the gauze, finding the pain point, and applying the remaining heat to Grandma Li's leg.
After returning to the clinic a week later, Grandma Li's pain eased a lot, and she asked for more posts.
The "little stick" that made Grandma Li come here, is five or six centimeters long and has a thin fingertip. It is called black poisonous plaster, commonly known as plaster plucking stick.
It is a "baby" often used by dermatologists. It has a good effect on skin keratosis, hypertrophy, and pain caused by poor blood, damp and toxin accumulation.
Zhou Dongmei, director of the Department of Dermatology, Beijing Hospital of Traditional Chinese Medicine, introduced that the plaster stick was born out of the ancient black plaster, which is a special topical medicament of traditional Chinese medicine.
The plaster stick is exquisite in medicine, and contains more than 20 traditional Chinese medicines such as fresh impatiens, Tougucao, and Maqianzi.
Taking fresh impatiens as an example, it must be collected during the flowering period. It can inhibit fungi and promote penetration. It is an indispensable raw material for making plaster sticks.
"If black plaster is'engraving printing', plastering stick is'moving type printing'." Zhou Dongmei said, its inventor is Zhao Bingnan, founder of the Dermatology Department of Beijing Hospital of Traditional Chinese Medicine.
He reformed the traditional black ointment formulations, removed the plaster mount dressing, and directly made it into a stick shape, which can be spread with hot paste, can be burned and melted into drops, can be heated for dipping, and can be melted and added.
According to the characteristics and size of the skin lesions, the corresponding usage can be flexibly selected to control the temperature and coating area of the drug, which is practical and convenient.
The plaster stick is an in-hospital preparation, which can only be used in hospital treatment, and the patient is treated with medicine by the nurse.
The treatment cost is only 6 yuan per square centimeter, but higher treatment skills are required.
The compound Huanglian Ointment, which is also an in-hospital preparation, has flown into the homes of ordinary people because of its convenient treatment and carrying, and has become a "good heart" for many patients.
Aunt Bai from Shunyi, Beijing is Zhou Dongmei's old patient.
She suffers from severe palm and plantar pustulosis. There are large erythema on the palms and soles of her feet, keratinization and peeling, and pustules often appear, which are painful and itchy.
In desperation, she came to Beijing Hospital of Traditional Chinese Medicine to look for a miraculous little ointment.
After meticulous treatment, Aunt Bai took traditional Chinese medicine internally and huanglian ointment for external use. The curative effect continued to appear. The erythema shrank and faded, and the pustules gradually decreased until they basically subsided. She even dared to show her hands that could not be taken out for many years.
Huanglian ointment is 20 grams per box and applied directly to the affected area. It has become Aunt Bai’s “life necessities” and she has to take it with her wherever she goes.
She sighed to Zhou Dongmei: "I have never felt so good, and life has returned to normal!"
The research and development of in-hospital preparations is as difficult as new drugs.
In the 1950s and 1960s, Zhao Bingnan gathered decades of clinical experience and found that Liangxue Huoxue Decoction was effective in treating psoriasis of blood-heat syndrome.
In the 1990s, the dermatology team verified its effectiveness through a large number of clinical trials.
"At that time, thousands of bags were sent out every day." Zhang Cang, deputy director of the hospital's dermatology department, recalled.
At the beginning of 2000, the team further adjusted the formula and successfully developed a capsule for cooling blood and promoting blood circulation, which has the same effect and is more convenient to take.
Sixty or seventy kinds of Chinese medicine preparations that have been used so far are neatly placed in a medicine cabinet in the dermatology office of the hospital.
"No matter how the dosage form changes, the characteristics of traditional Chinese medicine cannot be lost. Following the law of development of traditional Chinese medicine, inheriting the essence, keeping integrity and innovation, and maintaining its characteristics and advantages, can traditional Chinese medicine preparations be continuously optimized and convenient for patients to use." Zhou Dongmei said.
Chinese medicine thinking is the essence
Traditional Chinese medicine pays more attention to disease, and more attention to people.
Start with symptoms, combine symptoms, treat according to syndrome differentiation, and take a targeted approach to relieve the suffering of patients
"My heart is not big anymore!" 26-year-old Shandong guy Wang Xiaolei said excitedly.
He gave the latest cardiac ultrasound report to Li Jun, director of the Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences. The report showed: "The left ventricle has an anteroposterior diameter of 34/53 mm, a transverse diameter of 30/46 mm, and a long diameter of 64/78 mm. The inner diameter of each atrioventricular cavity is within a normal range. There is no obvious abnormality in the structure of the heart, and the systolic function is normal."
Wang Xiaolei suffers from dilated cardiomyopathy, commonly known as "big heart".
After catching a cold, he showed symptoms of chest tightness and often suffocated at night.
The local hospital diagnosed: viral myocarditis, hypofunction of the heart, and enlarged heart.
The doctor prescribed the medicine. He didn't relieve his symptoms after taking it for 20 days. He felt breathless after a short period of activity, and it was difficult to walk.
Ultrasound examination results showed that the systolic function of the heart decreased, and the cardiac ejection fraction was 38%.
Wang Xiaolei was carried into Li Jun's clinic by his father.
Li Jun asked him about the pulse, the pulse was heavy and stringy, the tongue coating was thin and yellow and greasy, and the syndrome was characterized by deficiency of both qi and yin and phlegm-heat accumulation. He prescribed prescriptions for replenishing qi and nourishing yin, clearing heat and resolving phlegm.
After taking 14 medicines, Wang Xiaolei felt that his chest was no longer tight, he was not suffocated, and his fatigue was alleviated.
With persistent efforts, Wang Xiaolei adjusted the prescription twice and continued to take the medicine for half a year, and his heart returned to normal.
Clinically, this major heart disease is still a difficult problem to be solved.
Cardiovascular disease is the number one killer affecting human health.
There are many helpless patients like Wang Xiaolei: patients with angina pectoris after coronary heart disease implanted with stents, patients who cannot put stents and cannot bypass the bridge, patients with severe heart failure after myocardial infarction... Faced with helpless patients, Li Jun relieved them with decoction. The patient's "heart disease".
"Patient needs are the driving force for the advancement of Chinese medicine." Li Jun said.
He has been engaged in vascular clinics of Chinese medicine for nearly 30 years. He has successively studied under Yu Qihuang scholar Wang Jie, Chinese medicine masters Xue Boshou, Liu Zhiming, Sun Guangrong, and capital Chinese medicine master Feng Xinghua. He has been continuously exploring methods of treating cardiovascular diseases and furthering the advantages of Chinese medicine. Highlight, so that more patients will be free from pain.
"Fuyang Huoxue is a common treatment method for heart disease." Li Jun has a lot of experience in Fuyang Huoxue Method. "If you want to support Yang, you need to promote blood; if you want to promote blood, you need to support Yang; Fuyang helps promote blood circulation. It is beneficial to support the Yang." When the Yang Qi is insufficient, it can cause blood stasis if the blood cannot be promoted. When the blood is stasis, the Yang Qi can not work, so it can be used to promote blood circulation and remove blood stasis. Traditional Chinese medicine with the effect of promoting yang helps to enhance the effect of promoting blood circulation and removing blood stasis.
Clinical studies have shown that Fuyang Huoxue method improves heart function, improves quality of life, and reduces the incidence of adverse events.
The Chinese medicine Fuyang Huoxue method helped 62-year-old Uncle Wang to tide over the difficulties.
Three months ago, he had just had a heart stent operation, but his chest tightness and chest pain were not relieved, he could not catch his breath after being unable to walk 100 meters, and he also developed symptoms such as insomnia and heart palpitations.
The operation was done and the medicine was taken on time. The doctor said that the recovery was good. Why did you feel worse than before?
Uncle Wang was a little drummed in his heart, and was hospitalized again for a coronary angiogram. The doctor said that the blood flow was smooth and there was no problem with the blood vessels.
The helpless Uncle Wang came to Guang'anmen Hospital.
Li Jun understood the condition in detail, looked at the coating of the tongue, and took the pulse. He believed that the large blood vessels were unblocked after the stent was implanted, and the chest tightness and pain were related to the microvessels of the heart.
According to the tongue pulse and symptoms, the syndrome is "deficiency of yang qi, phlegm and blood stasis blocking the collaterals".
Li Jun prescribed a Chinese medicine prescription for warming Yang and nourishing Qi, promoting blood circulation and resolving turbidity.
After 20 days of treatment, Uncle Wang's symptoms gradually improved and he could walk easily for more than half an hour.
"Traditional Chinese medicine thinking is the quintessence. To treat cardiovascular diseases, Chinese medicine pays more attention to the disease, and pays more attention to the people. Starting from the symptoms, combining the symptoms and treating the symptoms according to the syndrome, it is targeted to relieve the pain for the patients." Li Jun said.
Innovation and development are opportunities
With the help of modern technology, Chinese medicine techniques are more stable, more standardized, safer, and easier to promote, giving full play to the unique advantages and functions of orthopedics and traumatology in disease prevention and treatment.
"I'll try."
"One or two, turn! Okay, this is a good one."
In the multimedia classroom on the 18th floor of the Scientific Research Building of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, a group of doctors gathered around a "boy" in a suit and shoes to discuss and exchange in full swing.
This "boy" is 1.8 meters tall and weighs 70 kilograms. It is a cervical vertebra rotation and lifting technique assessment robot developed by Zhu Liguo's team.
Zhu Liguo is the chief researcher of the Chinese Academy of Chinese Medical Sciences, the chairman of the Orthopedics Branch of the Chinese Society of Chinese Medicine, and the inventor of the cervical spine lifting technique.
The "boy" is not ordinary. Doctors treat it as a "teacher", which can realize man-machine dialogue, quantitative assessment, and intelligently remind the operator of errors.
The cervical spine lifting technique is derived from the traditional rotation technique, commonly known as "pull the neck".
The relationship between TCM techniques and robots began at a medical malpractice appraisal meeting more than 20 years ago.
At that time, an old professor posed two questions to Zhu Liguo, the youngest TCM expert present: Is the operation procedure of the technique standardized?
How about security?
The old professor's doubts deeply touched Zhu Liguo.
He led the team to apply for the project and used data to verify the curative effect of TCM techniques, and rectify the name of TCM orthopedics.
At the beginning of the research, Zhu Liguo's team was in trouble.
How to pull, where to pull, and how much to pull?
In the past, there was no clear standard, so the operation was difficult to repeat, the risk was high, and even improper operation could lead to medical accidents.
"Old Chinese doctors rely on the doctor's personal feelings to operate. It is difficult for beginners to repeat." Zhu Liguo said.
The team turned to analyze the rotation technique and found that the key lies in the timing of the force.
Zhu Liguo dismantled the force mode and standardized the rotation technique into the rotation lift technique.
From "revolving" to "revolving lift", although there is only one word difference, traditional Chinese medicine techniques have been iteratively upgraded. Doctors no longer sing "one-man shows" and evolved into a "two-person transfer" of doctor-patient cooperation: doctors guide patients to "rotate". The patient rotates the cervical spine to the maximum angle, and the doctor performs a longitudinal "lift".
Compared with traditional methods, what are the advantages of twisting and lifting?
Zhu Liguo led the team to independently develop a manual operation mechanics measuring instrument, and carried out a mechanical quantitative study on cervical spine manipulation.
When the traction force is greater than 44.76 kg, it can cause cervical spine soft tissue injury.
The twisting lifting method is used to lift vertically upwards, and the maximum force is between 19 kg and 36 kg, which is not easy to cause cervical spine injury.
According to statistics, the effective rate of rotating and lifting manipulation in the treatment of cervical spondylotic radiculopathy was 91.51%, and no adverse events occurred.
How to promote the cervical spinal lifting technique has become a difficult problem for Zhu Liguo.
It is difficult for beginners to grasp the main points just by relying on past oral teaching.
In the emergency room, Zhu Liguo saw a group of students learning cardiopulmonary resuscitation and pressing the simulated robot.
An idea flashed in Zhu Liguo's mind: Why can't we develop an assessment robot with a twisting and lifting technique?
Since then, Zhu Liguo has initiated the development of a training and assessment system for the twisting and lifting technique, opening a new paradigm of "human-machine integration" in technique teaching.
The system has trained more than 6,000 trainees and has been introduced to 7 Chinese medicine universities including Guangzhou and Hunan as a technique teaching tool.
Based on the new inheritance model, the technique is being exchanged internationally in 21 countries and regions.
Cervical spondylosis is a degenerative disease, prone to repeated attacks.
Aunt Liu, 64, had unbearable pain in her neck, unable to turn, and her arms were painful and numb.
After several twisting and lifting techniques, she felt visibly better, but after doing some tired work or catching a cold, her neck pain "returned".
Zhu Liguo's team developed a comprehensive therapy consisting of neck pain granules, lifting manipulation, and cervical rehabilitation exercises.
Aunt Liu became a beneficiary of the therapy and finally got rid of her neck pain.
"Traditional Chinese medicine techniques need to be promoted with the help of modern technology, so that Chinese medicine techniques are more stable, more standardized, safer, and easier to promote, and give full play to the unique advantages and functions of orthopedics and traumatology in disease prevention and treatment, and contribute to the construction of a healthy China." Zhu Liguo said.
Innovate in inheritance and inherit in innovation (Reporter's notes)
Clinically, Chinese medicine demonstrates its unique curative effect and advantages in diagnosis and treatment.
The characteristic methods of Chinese medicine are not so much "techniques" as "mental methods". They must be taught by old Chinese doctors orally, and apprentices can understand them carefully.
In order to inherit the essence, we must work hard in comprehension to ensure that inheritance does not fall into the past and innovation does not depart from the ancestry.
At the same time, traditional Chinese medicine must use modern technology to innovate through inheritance and inherit through innovation.
Clinical efficacy is the vitality of Chinese medicine.
Without clinical efficacy and the trust of the people, Chinese medicine cannot build self-confidence.
Using TCM thinking to analyze the cause, find the pathogenesis, and constantly solve clinical problems is the foundation of TCM.
Only by establishing a service system, service model, management model, and talent training model that conform to the characteristics of Chinese medicine, and polishing the golden sign of Chinese medicine, can Chinese medicine flourish.