Clinical Essentials of Jiao Shude's Clinical Experience

Author: Jiao Shude
Editor: Yu Xinhua
Publisher:
Publish Date: 1998-01-01
Features:
Content Summary
This book is a collection of clinical experiences by Professor Jiao Shude. It is divided into four parts: "Medical Theory and Clinical Experience," "Summary of Medication Experience," "Practical Application of Formulas," and "Essentials of Syndrome Differentiation and Treatment." It reflects Professor Jiao's unique clinical insights, particularly his distinctive approach to treating nine types of bi syndrome. His prescription and medication application are skillful and innovative, directly guiding clinical practice and inspiring future generations. The book is rich in content, covering theory, method, formula, and medication, with a strong emphasis on clinical diagnosis and treatment. The case studies presented are all distinctive. It is suitable for clinical Chinese medicine practitioners and students and teachers of TCM colleges.
Excerpt:
Diagnosis and Prevention of Stroke
The "wind" in stroke refers to the sudden onset, rapid progression, and unpredictable changes of the disease, characterized by sudden collapse, loss of consciousness, of the mouth and eye, and hemiplegia, akin to the swift and violent nature of a storm or an arrow striking. This differs from the "wind" in cold-induced wind, which should not be equated.
Traditional Chinese Medicine's understanding of stroke is quite similar to Western medicine's ischemic cerebrovascular disease, hemorrhagic cerebrovascular disease, and minor strokes. The diagnostic and preventive methods discussed in this article can be applied to the treatment of these diseases and are highly effective.
Traditional Chinese Medicine has accumulated extensive theory and experience in preventing and treating stroke. For example, the Yellow Emperor's Inner Canon records conditions such as "striking and collapsing," "hemiplegia," "thin and collapsed," and "great collapse." The Master Zhang Jing discussed four syndromes of stroke. Later generations of physicians further elaborated on conditions like "sudden flare-up of heart fire," "damp phlegm generating heat," "internal wind movement," and "internal wind surging." They developed treatments such as "soothing the liver," "nourishing the kidneys," "transforming phlegm," "clearing the heart," "," "subduing wind," "promoting bowel movement," "activating blood circulation," and "opening the orifices."
In my long-term clinical practice, I have deeply studied and applied ancient and modern medical theories and methods to treat many stroke patients. Here, I share some of my personal insights for reference by fellow practitioners.
(1) Key Etiology and Pathogenesis
Although the etiology and pathogenesis of stroke are complex, they can be broadly summarized into five main factors: wind, fire, qi, blood, and phlegm.
(1) Wind
Before the Tang and Song dynasties, wind was primarily considered external, believed to invade the body due to internal deficiency. After the Tang and Song dynasties, the focus shifted to internal wind, believed to arise from internal wind activation. Personally, I find that when wind invades the collaterals, causing of the mouth and eye with no other symptoms, it is often due to weakened exterior defense and invasion by external wind, which is effectively treated with wind-dispelling and pathogen-extracting herbs. Internal wind is mainly due to liver wind movement, often caused by anger and depression injuring the liver, leading to sudden hyperactivity of liver yang and internal wind movement. The elderly may also develop it due to yin deficiency of the liver and kidneys, causing hyperactivity of liver yang.
(2) Fire
Liver fire often results from unfulfilled emotions, prolonged liver qi stagnation turning into fire, wind movement driven by fire, and chaotic qi and blood flow. Heart fire is usually caused by excessive mental strain, depleting heart blood and causing hyperactivity of heart fire; overexertion may injure the kidneys, leading to insufficient kidney yin to nourish the heart, causing sudden hyperactivity of heart fire; or "wood fire blazing the heart," resulting in excessive heart fire. Fire tends to ascend, and when it becomes violently excessive, it causes delirium.
(3) Qi
Qi stagnation is common in individuals with excessive qi, where unfulfilled emotions lead to qi stagnation turning into fire, and the combination of qi and fire causes qi stagnation and blood chaos, triggering stroke. Qi deficiency is often seen in the elderly (over 40) with declining qi, insufficient essence and blood, qi deficiency and blood stasis, obstructed collaterals, and wind movement due to blood stasis.
(4) Blood
Blood stasis can occur as described in the Plain Questions·On Generating Qi and Allowing Heaven to Pass Through: "Great anger causes the body's qi to cease, blood stasis accumulating above, leading to scorching collapse." Blood stasis is often caused by falls, straining, prolonged illness, childbirth, or surgery, resulting in blood stasis and obstructed blood vessels, leading to stroke. Blood deficiency may occur when blood fails to nourish the liver, causing wind disturbance.
(5) Phlegm
Phlegm is often due to spleen dysfunction, leading to damp accumulation and phlegm formation, which obstructs collaterals and clouds the clear orifices. Heat phlegm may arise from sudden hyperactivity of heart fire or qi stagnation turning into fire, scorching body fluids into phlegm, phlegm-heat transforming into wind, and clouding the clear orifices, causing stroke.
These five factors can mutually cause and exacerbate each other, transforming into root and manifestation under certain conditions, leading to sudden onset. In summary, the general pathogenesis is deficiency at the root and excess at the manifestation, with hyperactivity above and deficiency below.
(2) Common Syndromes and Treatment
1. Onset Phase
After onset, patients with unconsciousness and those without it require different differentiation and treatment.
(1) Unconsciousness
First, distinguish between closing syndrome and collapse syndrome.
① Closing Syndrome
Signs include clenched jaw, inability to open the mouth, clenched fists, constipation of both urine and stool, rigid limbs, no sweating, and unconsciousness. Accompanied by red face, body heat, rough breathing, mouth odor, restlessness, and agitation. Yellow greasy tongue, wiry or slippery rapid pulse indicates yang closing. Accompanied by pale face, dark lips, lying quietly without restlessness, limbs cold, and abundant phlegm. White greasy tongue, slow slippery pulse indicates yin closing. Treatment for closing syndrome involves resolving phlegm, opening depression, activating blood circulation, and subduing wind. For yang closing, add clearing heat; for yin closing, enhance phlegm resolution.