血浊理论产生的历史背景和现实意义

Historical background and practical significance of the theory of blood turbidity

关键词:  血浊  血浊理论  疾病谱系  基础理论

Key words:  blood turbidity  the theory of blood turbidity  disease pedigree  basic theory

摘要:

空前的学术繁荣是血浊理论产生的肥沃土壤，疾病谱系的改变是血浊理论产生的客观需求。在长期的临床实践中，在总结前人经验的基础上，结合当今致病因素的变化，综合考虑了医学、现代科学和社会发展的现状，构建了血浊理论体系，以期为中医基础理论的发展贡献一份力量。

Abstract:

Unprecedented academic prosperity is the fertile soil generated by blood turbid theory. The change of disease pedigree is the objective demand of the theory of turbidity of blood. In long-term clinical practice,on the basis of summing up the experience of predecessors and considering the changes of pathogenic factors,we have synthetically considered the current situation of medical science,modern science and social development,and constructed the theory system of blood turbidity,so as to contribute to the development of basic theory of traditional Chinese medicine.
1 Emergence of blood turbidity theory is an objective trend in the historical development of Traditional Chinese medicine
Traditional Chinese medicine (TCM) has experienced thousands of years of development history. In the long process of development, successive generations of physicians have continuously absorbed the excellent achievements of the humanities and natural sciences at that time, developed and enriched the theoretical system of the motherland medicine. In the long-term clinical practice, the humanities and natural sciences were perfectly combined, and the medical thought system has formed with tenacious internal logic characteristics. Now Traditional Chinese medicine has become an independent medical science with distinctive national characteristics, and it stands proudly in various world medical systems.
Throughout the history of the development of Traditional Chinese medicine, it can be seen that the breakthrough development and leap of Traditional Chinese medicine theory must meet two basic conditions: one is the unprecedented prosperity of academics, which laid the foundation for the birth of new theories; the other one is the change of the disease spectrum, which determines the reform of the theoretical system and the innovation of treatment methods[1]. The formation, development and innovation of TCM theories have gone through five important stages. This historical process can be summarized as “one source, three prosperity, and two major developments”.
The theory of TCM originated from the Huangdi Neijing, which has a history of more than 2,000 years. The academic thoughts of the era when the Huangdi Neijing was written are unprecedentedly active. The core frame work of TCM basic theory was established by yin, yang and the five elements, the viscera meridian, qi, blood and body fluid, concept of viewing the situation as a whole, and the treatment based on syndrome differentiation. Until the Eastern Han Dynasty, in order to cope with the rampant typhoid fever, ZHANG Zhongjing read a wide range of books, collected various sources, and concentrated his life’s efforts to write the book Treatise on Febrile and Miscellaneous Diseases. On the basis of Suwen: relun, the principle of syndrome differentiation and treatment of “six meridian classification” for typhoid fever was creatively established, and the first breakthrough development of TCM theory was born from this. During the Jin and Yuan Dynasties, there were many talented people and famous books, and flourished theories. During this period, distinctive medical schools emerged, which greatly promoted the innovation and development of TCM theory. In the middle of the Ming and Qing dynasties, the epidemic of warm and fever epidemics and new infectious fevers continued to appear, the types of diseases were very different from typhoid fever, so new theories and treatment methods were needed. Therefore, on the basis of the academic thoughts of the ancestors, YE Tianshi and WU Jutong creatively put forward some new theories for exogenous fever, such as Weiqi Yingxue and sanjiao Syndrome differentiation, which is another innovative development of the theoretical system of TCM. In modern times, the prosperity of TCM has reached its peak.
Since the founding of the People’s Republic of China, with the strong support of the Party’s policies, TCM has made great progress. First of all, TCM education has been developed and spread rapidly, training a large number of outstanding TCM talents for the country. Under the encouragement of the Party, “Western medicine should learn Chinese medicine” has also become a fashion, contributing to the expansion of the TCM team, revealing the TCM advantages, and supplying the “Chinese prescriptions” for global health. Especially since the 40 years of reform and opening up, thanks to the rapid development of graduate education, a large number of senior TCM talents have come to the fore and the academic atmosphere has been unprecedentedly active. Secondly, the clinical development of TCM is booming. Basically, every county and city in the country has established TCM hospitals. A large number of clinical practices and good clinical effects have provided inexhaustible power and source for the development of TCM. Third, the advancement of modern technology has given the ancient Chinese medicine new vigor and vitality. New technologies and new methods use in the research of Chinese medicine helps us to analyze the essence and connotation of TCM from different perspective. During this period, researches on the essence of syndromes and meridians have made certain progress. Various new theories such as steady-state theory, black box theory and information control theory have emerged as the times require. The TCM research exhibition presents a situation where contention and flourishing of numerous schools of thoughts emerge. Multi-disciplinary, multi-polar, multi-level research and collisions are like surging rivers and new TCM theories are ready to emerge.
However, there are various shortcomings in TCM, such as simple and simple diagnosis and treatment methods, cumbersome Chinese medicine processing and formulations, relatively backward administration methods, lack of surgical methods. When it coexists with modern medicine, people subconsciously think that TCM is out of date and has not kept pace with the times. Gradually, the position of mainstream was replaced by western medicine, and TCM retreated to a subordinate position.
However, when we use a new concept to observe TCM, we find that TCM is advanced and it is at the intersection of novel medical concepts. So, we ask to ourselves, what is TCM? In 2010, President XI Jinping attended the licensing ceremony of the Confucius Institute of Traditional Chinese Medicine in Melbourne, Australia and said, “Traditional Chinese Medicine embodies profound philosophical wisdom, health preservation concepts and practical experience. It is a treasure of ancient Chinese science and also the key to unlocking the treasure house of Chinese civilization. In-depth research and scientific summary of Chinese medicine are of positive significance to enriching the world’s medical undertakings and advancing life science research.” It clearly points out that TCM covers both cultural and scientific characteristics. It can be said that TCM is a unique medical science system with national characteristics that perfectly combines the humanities and natural sciences in long-term clinical practice.
When we turned our attention to the West and re-observe modern medicine, it can be found that Western medical concepts have also produced differences through the spectroscope of different ethnic cultures. Western medical models are shifting from a single biomedical model to the Integrated medical model of “environment-society-psychology-physiological medicine”. Western medical thinking began to focus on the diagnosis of disease subtypes and individualized treatment of “syndrome” and treatment. Western medical verification methods began to turn to evidence-based medicine and the people-oriented systematic approach. These cutting-edge and most advanced thoughts and theories of modern medicine have such a beautiful coincidence with the inherent thoughts and theories of TCM.
Of course, coincidence and similarity alone cannot make TCM develop. TCM must develop itself according to its inherent development trajectory. That is to say, TCM must use Chinese excellent culture as the basis for development, and basic theories of TCM as the core of development. The change of disease spectrum is the direction of development, modern science and technology are used as the experimental basis for development, and clinical efficacy are used as the ultimate goal of development. The development of TCM clearly shows us that changes with the sky, the earth, people, and disease will inevitably lead to innovations in treatment methods and theories. Different luck brings to different results, the past cannot be compared with the present, the ancient prescriptions may not match the present disease, so the TCM need reform with the step of modern situation[1].
Nowadays, with the improvement of living standards, people’s diet, lifestyle and other aspects have undergone great changes. The pathogenic factors have changed from the six evils and pestilential qi in the past to environmental pollution, mental factors, and bad living habits which has been the main pathogenic factors. The disease spectrum has also change daccordingly that acute biological infectious diseases have been declined consistently, and the chronic non-communicable diseases have been increase drapidly. That is to say, diseases caused by organisms (viruses, bacteria, parasites, etc.) hosted in human being are greatly reduced. Whether it is vector-borne diseases, such as malaria, plague, filariasis, schistosomiasis, or non-vector-transmitted diseases, such as tuberculosis and measles (through the air), cholera and dysentery (through water), typhoid (through food), the incidence rate is declining rapidly. With the development of economy, these diseases have been basically controlled in most areas of the world [2]. In 1900, the main causes of death in the United States were pneumonia, influenza, tuberculosis, diarrhea, and enteritis, but these diseases are now relegated to a secondary position [3]. According to the 2002 Survey of Nutrition and Health Status of Chinese Residents [4] and the Report on Nutrition and Chronic Disease Status of Chinese Residents (2015)[5], the fatality rate of overnutrition diseases has been greater than that of malnutrition diseases. Changes in the spectrum of diseases require corresponding changes in medicine. As to this new problem, some theory of traditional Chinese medicine is also in danger and confusion. Many famous doctors are thinking about how TCM will develop and how the TCM theory will adapt to the new disease spectrum? Problem brings challenges, crisis brings opportunities, and new TCM syndrome differentiation system and treatment methods will surely be nurtured, shaped and born in this crisis.
In the clinical work of TCM, when faced with today’s diseases, we deeply realize that the TCM syndrome differentiation and treatment system is insufficient and there are certain shortcomings. How to keep pace with the times, to harmonize our syndrome differentiation and treatment with the changes in the current disease spectrum, how to inherit and innovate, and to develop Chinese medicine based on the theory of TCM is the top priority for the majority of TCM workers at present, and it is also an urgent task and must be the starting point and end of our thinking. Therefore, in the long-term clinical practice, on the basis of summing up the previous experience, combined with the changes of current pathogenic factors, we have constructed the blood turbidity theory system and proposed the corresponding syndrome differentiation and treatment methods, hoping to adapt to the new disease spectrum changes, and can be beneficial to the development of TCM.
2 The generation of blood turbidity theory is the consensus of the majority of contemporary clinicians
In fact, the turbidity theory is based on the long-term clinical practice experience of the majority of clinicians and the theoretical research results of the majority of basic workers. It can be said that the turbidity theory is the summary, understanding and condensing of the development consensus of modern TCM theory and practice.
Professor WANG Yongyan’s team paid more attention to “poison” and “stasis” in the early collateral disease theory. During the past ten years, the team has turned its attention to the research of “turbidity” and “turbid disease”. It is believed that “blood turbidity” is a state in which the texture of blood is too sticky caused by the excessive accumulation of turbidity and turbidity in the veins. When the turbid yin and turbid qi gather to be excessive, it will cause the occurrence of diseases, which is calledturbid diseasescaused by turbid evil[6]. The endogenous turbid evil is the initial cause of abnormal changes in the blood itself and circulation. When the body has shown observable pathological manifestations, it indicates that the accumulation of turbid evil in the blood which has become more and more serious. That is to say, multiple components in the blood have gradually increase dincluding various trace elements, carbohydrates, protein, fat, but there may be no obvious symptoms in the human body. Through clinical laboratory tests, some elements can be quantified such as hyperglycemia, hyperlipidemia. With the time passing, turbid evil accumulates and forms, which is sticky and leads the accumulation of metabolites, causing increased pressure on the blood vessel wall. At this time, high blood pressure and high uric acid will occur. If we can effectively control the turbidity that pervades the veins, the disease can be prevented, otherwise, the turbidity will gradually damage vein and the result inthe organ dysfunction [7]. Phlegm, blood stasis, and poison are three pathological products that have repeatedly appeared in ancient and modern literatures that cause organic damage, and they are also important pathogenic factors in the pathogenesis of Chinese medicine. It is believed that turbidity is the prodromal stage of phlegm, blood stasis, and toxin. The interior turbidity hinders the infusion of body fluid, which can accumulate dampness and become phlegm. Sticky blood resulting in blood stasis, long-time illness will aggravate the cohesion among phlegm, blood stasis, and turbidity even make it poison,and eventually lead to various diseases.
Professor JIANG Liangduo[8] put forward the “theory of detoxification, to regulate the health maintenance” in the 1990s. From the perspective of poison, he proposed that the channels for health maintenance and treatment of diseases are to effectively discharge substances that accumulate in the body and cause harm to human health. Poisons are substances that exist in the body in an abnormal state which either destroy the normal physiological functions of the body, or produce certain adverse effects on the body’s internal organs, which effect can be temporary or permanent. Poisons come from two aspects, one is the external environment, that is, environmental toxicity. All substances that are harmful to health that come from outside the body belong to external poisons, such as the six exogenous evils proposed by TCM, pathogenic microorganisms such as viruses and bacteria in modern medicine, and air pollution from the environment, chemical pollution, physical pollution. The second, endogenous toxin is the substances that are produced by the body itself but do not have any beneficial effects on the body and may even endanger the health. The sources are mainly from three channels as follow: metabolic production caused by growth and development, excessive nutrients accumulated in the body which can lead to diseases such as lipotoxicity, glycotoxin, secretions existing where it shouldn’t be which causes body damaged, for example, reflux esophagitis, is caused by the reflux of gastric acid from the stomach to the esophagus. We think that poison is the first killer of human health, and detoxification is the primary measure for disease prevention and health care.
Professor ZHANG Minghe[9] emphasized the importance of heat poison in diseases, and believed that in the development of most autoimmune diseases, foreign antigens including various pollution and microorganisms in nature can be regarded as six evils in TCM. When the body’s self-repair and detoxification functions cannot bear the invasion of foreign antigens, viscera dysfunction occurs, and vitalqi cannot resist pathogenic qi. Then due to the activation of the immune system, the antigen and antibody specifically combine to form an antigen-antibody complex considered as endogenous poison which is formed by the combination of heat and poison in vivo and six evil in vitro. Phagocytes engulf the macromolecular antigen-antibody complexes and small-molecule antigen-antibody complexes in kidneys, then exclude them out of the body that progress is equivalent to the body’s detoxification. Molecular immune complexes that cannot be swallowed by phagocytes and cannot be excreted through the kidneys can be considered as that evil qi accumulation become poison. The accumulation of antigen-antibody complexes in blood vessels is equivalent to the evil qi obstructs in meridian in TCM. Immune active cells recognize antigens, respond and release a large number of cytokines, which is equivalent to the process of evil qi blocking in the body and turning into fire and poison. Vasculitis exudation and the formation of angiogranuloma lead to bone and joint damage and even harm to the viscera, which is similar to the process of combination among phlegm, dampness, heat and poison. Although there are some differences among metabolic rheumatism, rheumatoid arthritis, joint ankylosis, systemic lupus erythematosus and autoimmune rheumatism in pathogenesis, it is believed that some pathological manifestations are similar, all they are caused by the evil qi blocking in the body, leading phlegm and blood stasis, formation of heat and poison, eventually damage to bones and viscera. In short, the process of heat poison-induced paralysis in TCM runs through all types of rheumatism, so the treatment should be focused on clearing heat and detoxification.
Professor TONG Xiaolin[10]approved the blood turbidity theory. He believed that blood turbidity is a new concept in TCM pathology. Blood turbidity is the pathogenesis summary involving cardiovascular diseases, diabetes, hyperlipidemia and other diseases related to blood circulation dysfunction. The proposal of blood turbidity built a bridge between Chinese medicine and Western medicine, that modern laboratory indicators can be used by Chinese medicine to realize the modernization of TCM.At the same time, it also makes up for the shortcomings in the overall treatment and early prevention in Western medicine. It also explains the importance of the theory of blood turbidity in the prevention and treatment of “spleen constriction”. The name of “spleen constriction” comes from Huangdi Neijing, which is similar to the formation and development process of metabolic syndrome, and can evolve into hypertension, diabetes, and hyperlipidemia. Diseases with blood circulation disorders are belong to “blood turbidity”. Therefore, the theory of “blood turbidity” can guide to prevent the further development of “spleen obliteration”, and has great significance for the treatment of metabolic diseases, also can achieve the purpose of TCM to treat the disease before it occurs. It is not difficult to see that all the concepts are related with blood turbidity including blood stasis-poison, heat-poison, poison, turbidity, spleen constriction. Therefore, the theory of blood turbidity is a combination of the overly abstract concepts in many ancient documents and modern clinical practice, then make it concrete and clarified, which has clear and operable clinical significance [2]. It is the consensus of the majority of clinicians.
3 The generation of blood turbidity theory is a demand for changes in disease spectrum
The change of disease spectrum is the driving force of the development of clinical medicine. The change of disease spectrum determines the enrichment and transformation of the TCM theoretical system, and the development and innovation of TCM treatment methods. The generation of blood turbidity theory is its typical manifestation.
With the time passing by, both the social environment and the natural environment have undergone great changes, leading the causes of human diseases have also undergone significant changes. The causes of human diseases mainly included mental factors, bad living habits, and environmental pollution.
First of all, with the advance of the information society, nervous life pace, strong life pressure and fierce competition increase emotional stimulation. As time passes, the qi movement blocks and damage to brain, causing nerve disorder, then depression become blood stasis, combined with turbidity, eventually become blood turbidity.
Second, the great abundance of material life brings about the improvement of living standards, frequent social interactions, leading to the changes in lifestyles. Various bad living habits such as smoking, drinking, abnormal daily life, overeating cause blood turbidity. Third, as the earth continues to warm, the ozone layer is destroyed, sunspots are active frequently, the climate changes have never been so drastic as today. The physiological functions of the human body are also affected by environmental factors, and the pathological changes appear correspondingly. Nowadays, environmental pollution has become a new pathogenic factor. Harmful substances pollute the atmosphere, water quality, soil, various organisms and food, and the accumulation to a certain extent enough to cause various harms. In addition, environmental pollution has also produced many pollutants that are not originally or contained in a small amount in nature, such as various pesticides, toxic metals, chemical substances. Most of these pollutants are toxic, invade the human body from the outside, contaminate the blood, and cause the emergence of various modern diseases, which has become new and important pathogenic factors[11].
Changes in pathogenic factors have led to major changes in the disease spectrum. The composition of modern diseases has changed from single-factor diseases such as infection and malnutrition to chronic non-communicable diseases whose main spectrum is the body’s own metabolism and regulatory disorders, such as tumors, cardiovascular and cerebrovascular diseases, diabetes, senile diseases, and autoimmune diseases. This kind of diseases closely are related to life, mentality, and environmental factors, called “modern lifestyle diseases” or “modern diseases”, and have become major diseases that endanger human life and affect human health. These diseases are often caused by multiple factors acting on the human body for a long time, and are mutual cause and effect which easily lead to the body’s multi-system metabolism and regulation disorders. Once the pathological state is formed, basically life-long rehabilitation and treatment are required [12]. Blood turbidity is the common pathological basis causing these diseases, and blood turbidity includes mental factors, bad living habits, environmental pollution and other pathogenic factors, which contaminate the blood, make the blood turbid even obstruct the blood circulation.
With the changes of diseases spectrum, challenges and opportunities coexist in TCM. Although TCM has historically played a important role in the prevention and treatment of diseases and health care, and has made indelible contributions to the prosperity of the Chinese nation, the traditional syndrome differentiation and treatment system, formed diagnosis and treatment thoughts cannot meet the meet the needs of disease treatment under the changes of modern disease spectrum. Therefore, how to break through the limitations of the times, seize the opportunity of the re-development of TCM, and construct a system of syndrome differentiation and treatment based on new etiology doctrines to develop new diagnosis and treatment methods and improve clinical efficacy has become the direction of the times [13] .
The changes in the spectrum of diseases ask us bring up novel request. Based on the traditional TCM theory, combined with contemporary clinical practice, we have to find new theories and new methods to serve clinic and improve the curative effect. As an important part of the theoretical system of cerebral blood syndrome differentiation and treatment, the theory of blood turbidity came into being under this background and opened up new ideas for the diagnosis and treatment of modern diseases.
4 The emergence of the theory of blood turbidity is the inevitable trend development of the basic TCM theory
The TCM basic theory is closely related to the TCM clinical practice, and they are complementary, with mutual support and co-development. The basic theory originates from clinical practice and is used to guide clinical practice, which is and is the summary of TCM clinic, and can promote the improvement of diagnosis and treatment. There is a progressive development model of practice, summary, re-practice, and re-summarization. Strictly speaking, there can be no separation and clear disciplinary boundary. The blood turbidity theory is based on the development of modern clinical practice and conforms to the inherent laws of TCM.
After the founding of the People’s Republic of China, medical workers continued to innovate. On the one hand, they explored and sorted out the medical achievements of the past generations. On the other hand, they applied modern scientific methods to the research of TCM basic theories and achieved fruitful results. The development of TCM theory presents a trend of enrichment, diversification and modernization, which is prominently manifested in:(1) The research adopts the principles, techniques and methods of modern philosophy, philosophy of science, and modern science in all aspects. For example, the multidisciplinary research of Chinese medicine that emerged in the early 1980s. (2) Research has been developed in all fields of TCM, such as physiology, pathology, syndromes, diagnosis, treatment, pharmacology, meridian. (3) Research has been formed a variety of modern TCM theories from macro to micro, correspond with the empirical characteristics of modern scientific theories. (4) The above theories have been quite mature and a large number of modern TCM theories have been published. Such as: The basis of modern traditional Chinese medicine physiology(JI Zhongpu), Traditional Chinese medicine Immunity (LIU Zhengcai), Traditional Chinese medicine pathology research (KUANG Tiaoyuan), Traditional Chinese medicine constitution theory (WANG Qi), Modern research on traditional Chinese medicine theory (Shen Ziyin) , Research on tongue diagnosis (CHEN Zelin), Research on application of TCM spleen and stomach theory (WEI Beihai), Pharmacology, toxicology and clinics of traditional Chinese medicine (LI Guangxun). Undoubtedly, theseworks are the most important progress in the modernization of TCM.
However, the fruitful results of modern TCM theoretical research have not caused the transformation of TCM from natural philosophy and empirical science to theoretical science. This is because the framework of TCM has not changed, and its knowledge system is still centered on experience, which is a discipline representative. The development momentum of TCM is still the summary of experience, and the production of new syndrome differentiation schemes and new drugs still rely on the accumulation of personal experience of clinicians.
In the development of modern Chinese medicine, in the relationship between theory and experience, theoretical development has lost its subjectivity and has become a subsidiary of experience. The specific manifestations include 2 aspects: first, the starting point and goal of theoretical development only depend on the interpretation of experience; second, the empirical knowledge system is used as the criterion for choosing or rejecting the theoretical knowledge system, and the latter is considered to confirm the essence of the former relationship. Therefore, the development of TCM is still a slow experience accumulation, rather than a theoretical science reform and advanced development.
We believe that under the background of modern science, research on the basic theories of TCM still needs to pay attention to the traditional research methods of TCM, that we should base on the clinical experience, combine the changes of the disease spectrum, following TCM theories and inherent laws, use TCM methods to study TCM and promote TCM academic development and theoretical innovation. Therefore, the development of modern TCM theory should establish its subjectivity, which means:1) the starting point of development should originate from the need of theoretical or logical deficiency instead of experience limitation; 2) the goal of development should lie in a deeper and broader grasp of the internal and essential laws of medical-related things, and propose bold predictions beyond the scope of experience, resulting in applications beyond the scope of experience technology. Therefore, the research subject should not be limited to “the mechanism research of XX syndrome (such as medicine, treatment, meridian)”, but should focus on “human physiology (such as pathology, pharmacology, genetics) research”. In terms of theoretical knowledge system versus empirical knowledge system, the emphasis should be on “seeking differences”, and exert the former’s ability to distinguish and transform the latter[14].
Based on the above understanding, we proceeded from the overall concept, comprehensively considered the status of medical, modern science and social development, followed the principle of syndrome differentiation and treatment, and proposed a theoretical system of cerebral blood syndrome differentiation that has practical significance for disease prevention and treatment, and it has been widely used in clinical practice, and has achieved good effects.
The theory of blood turbidity is an important part of the theoretical system of cerebral blood differentiation. Its theoretical framework and clinical application began in the 1990s, and it was formally proposed in the book Cerebral blood differentiation in the early 21st century, and later explained in the related literature. It is believed that blood turbidity refers to that blood is affected by various factors and loses its purity or its circulation rule, which affects its physiological functions, disturbs the qi movement of the viscera, causing the pathological phenomenon.
The theory of blood turbidity is mainly aimed at the most common diseases, but there are still many types of syndromes that have not been written into the textbooks, such as “modern diseases”, “rich diseases”, and “pollution diseases”. The syndrome differentiation and treatment methods such as syndrome differentiation of six channels theory, syndrome differentiation of eight principles, and syndrome differentiation of zang-fu viscera can be benefit and complement the theory of blood turbidity.