Zhang Zanchen (1904- 1993), whose real name is Ji Xun, used the word "line" and was later called "Hu CuO". Jiangsu Wujin Rong Lakers. He practiced medicine on earth, learned a lot from home, and was taught by his father, Bo Xigong, and laid a foundation in medicine. Endosperm, surgery, gynecology, pediatrics and five senses, especially surgery and larynx. Create "Jindengshangen Decoction", "Yangyin Lihou Decoction", "Qianhu Yupingfeng Decoction" and various throat prescriptions for external use, such as "Laryngology Niuhuang Powder" and "Yin Bo Zhike Oral Liquid".

Chinese name: Zhang Zanchen

Nationality: China.

Birthplace: Ronghu, Wujin, Jiangsu

Date of birth: 1904

Date of death: 1993

Occupation: doctor

Masterpieces: A Brief History of China's Medicine in Past Dynasties and China's Diagnostic Outline.

The life of the character

Zhang Zanchen (1904 ~ 1993) was born in Wujin, Jiangsu. Zu Yu Ming and his father Bo Xi are good at this.

Surgery and laryngology. Zhang inherited his family studies in his early years and came to Shanghai with his father at the age of 65,438+06. He was admitted to Shanghai College of Traditional Chinese Medicine and then transferred to Shanghai University of Traditional Chinese Medicine, where he studied under famous teachers such as Xie, Cao and others. 15 (1926) hanged himself in Shanghai after graduation. Endosperm, surgery, gynecology, pediatrics and five senses, especially surgery and larynx. He once taught in China Medical College and New China Medical College, founded Medical Spring and Autumn Magazine with his classmates Yang Zhiyi and Marco, and served as editor-in-chief. Published 1 1 year. He also founded Shanghai College of Traditional Chinese Medicine and China Medical Research Institute. In the spring of the Republic of China 18, the Central Health Committee of the Ministry of Health of the National Government passed the abolition of the Chinese medicine case, and Zhang joined hands with the Chinese medicine community in Shanghai. On March 17, 2007, the National Congress of Traditional Chinese Medicine was held in Shanghai, and five people, including Xie, were recommended to go to Beijing to petition, and Zhang was appointed as the secretary of the delegation.

Zhang advocates carrying forward the traditional characteristics of traditional Chinese medicine, absorbing the advantages of modern medicine, applying the diagnostic methods of modern medicine in clinical treatment, summing up clinical experience, adopting modern knowledge and methods, and taking the essence of medicine. The sublingual collaterals diagnosis method was initiated, and various throat prescriptions such as Jindengshangen Decoction, Yangyin Lihou Decoction, Qianhu Yupingfeng Decoction, Laryngology Niuhuang Powder and Yin Bo Zhike Oral Liquid were created.

After liberation, he served as deputy director of Shanghai TCM Clinic, deputy director of TCM Department of Municipal Health Bureau, deputy director of Shanghai TCM Literature Research Institute, member of Medical Science Committee of Ministry of Health, member of TCM Professional Committee of State Science and Technology Commission, and director and professor of Otolaryngology Teaching and Research Group of Shanghai College of Traditional Chinese Medicine. He was elected as the vice chairman of Shanghai Society of Traditional Chinese Medicine, the representative of the fifth and seventh Shanghai Municipal People's Congress, and the member of the first, second, fourth and sixth Shanghai CPPCC. In his later years, he edited the masterpiece Integration of Chinese Medicine and Laryngology. He has written more than 0 monographs 10 and dozens of academic papers on medical treatment, health preservation, clinical summary, etc., such as A Brief History of China, Diagnostic Outline of China, Selected Clinical Experiences of Zhang Zanchen, and A New Mirror of Throat Disease.

He came to Shanghai at a very young age to learn from others' strengths. First studied at Shanghai College of Traditional Chinese Medicine, and then transferred to Shanghai College of Traditional Chinese Medicine. Because he is diligent and studious, he has made many innovations and won the admiration of contemporary famous doctors Xie, Cao and Bao Zhisheng. After graduation, he is proficient in various subjects such as veins, women and children, and is deeply loved by patients. At the invitation of China Medical College, he served as a professor of diagnostics and materia medica, edited the magazine Medical Spring and Autumn, and wrote books such as Diagnostic Outline of China and Brief History of Medicine in China. In particular, in 1929, the Central Health Conference of the old National Government tried to pass the "Abolition of TCM Cases". After hearing the news, Zhang was saddened, that is, he ran around and called for help, and joined hands with people in the field of Chinese medicine, and finally won. This shows his enthusiasm for maintaining the cause of Chinese medicine. After liberation, in response to the call of the people's government, Zhang took the lead in participating in the work of the national medical team. He has served as the deputy director of the Fifth Outpatient Department of Shanghai (formerly the Chinese Medicine Outpatient Department), the deputy director of the Chinese Medicine Department of Shanghai Health Bureau, the deputy director of the Shanghai Chinese Medicine Literature Research Institute, and the consultant of Shuguang Hospital of Shanghai College of Traditional Chinese Medicine. He is the author of Compendium of Materia Medica, Diagnosis and Treatment of Surgery in Traditional Chinese Medicine, Selected Clinical Experiences of Zhang Zanchen, and has published many academic papers in relevant journals. From 1960, Zhang witnessed that the otolaryngology department of traditional Chinese medicine did not receive due attention, and there was no successor and it was on the verge of extinction. He resolutely decided to focus on the clinical and scientific research work of otolaryngology of traditional Chinese medicine. He also served as the director of the teaching and research group of otolaryngology of Shanghai College of Traditional Chinese Medicine, presided over the training courses for otolaryngologists in China and Shanghai, and made certain contributions to the inheritance and development of otolaryngology of traditional Chinese medicine in all aspects of personnel training and academic research.

Academic viewpoint

Zhang Zhixue is serious and rigorous. He not only attaches importance to the theoretical understanding summarized by predecessors according to clinical practice, but also constantly improves and develops on the basis of his own experience in prescription medication. With regard to the ancient literature of traditional Chinese medicine, he spoke highly of You's The Secretary of the Laryngology (You Cheng), The Finger and Palm of the Laryngology (Zhang Zongliang), The Collection of Laryngeal Diseases (Joo Sang wook) and Paris Jade Keys (Zheng), which are considered as relatively important reference documents of the Laryngology. Regarding the popular laryngology, he thinks The Complete Works of Diphtheria (written by Li Lun), General Theory of Diphtheria Treatment (written by Zhang Mengxun) and White Rot Essentials of Laryngology (written by Xu Zhu) are excellent works for diphtheria treatment. Chen Geng's Epidemic Grass, Nong's Brief Discussion on Epidemic Throat and Cao Xinyi's Correct Throat are valuable reference books for the treatment of laryngeal tuberculosis. While emphasizing the inheritance of TCM laryngology, Zhang did not confine himself to predecessors' theories, but also put forward his own academic opinions according to the clinical treatment effect, which not only played a certain role in the development of TCM laryngology, but also inspired future scholars.

First, focus on the whole, focusing on the lungs and stomach.

It is believed that throat diseases are local and part of the whole person, but once the patient occurs in the throat, it will inevitably affect the whole body. In treatment, we should take corresponding treatment measures according to specific diseases and overall changes. If we only see the manifestations of local symptoms and ignore the changes of the whole body, it is difficult to achieve the ideal effect in treatment. However, Zhang also believes that because throat diseases mostly occur locally, no matter what the cause or disease, local lesions can not be ignored when diagnosing diseases. The treatment of local diseases should focus on lung and stomach meridians. Because "the throat governs the weather and the pharynx governs the local gas", which are the main thoroughfare of breathing and the pass of diet respectively, and are closely related to the lung and stomach meridians. Therefore, all throat diseases are patients with heat toxicity, and "Jindengshangen Decoction" (Sophora Tonkinensis 4.5-9g, Platycodon grandiflorum 3-4.5g, Fructus Arctii 4.5-9g, Rhizoma Belamcandae 3-4.5g, and Radix Glycyrrhizae 1.5-3g) was created by clearing lung and stomach heat toxicity. Self-made decoction for nourishing yin and relieving sore throat (Radix Adenophorae 10~20g, Lily 10 ~ 20g, Radix Paeoniae Alba 9g, Trichosanthes root 9g, Rhizoma Belamcandae 5g, dried stems 4.5g, and raw licorice root 2.5g) is used as the main treatment. The above two aspects have made great achievements in clinical application, which fully confirmed the correctness of Zhang's theory.

Although Zhang attaches great importance to the treatment of lung and stomach, he attaches great importance to the principle of "seeking the cause based on syndrome differentiation and treating the cause" in traditional Chinese medicine. For example, some throat diseases belong to "stagnation of liver fire", which should be treated by clearing liver fire and purging fire. If they belong to "inflammation of heart fire", they should be treated by drugs to clear heart fire and purging fire. There were 36 syndromes and 72 syndromes of throat diseases in the past. Zhang believes that "the syndrome of throat, though complicated, is mostly fire". His assertion is mainly based on the fact that throat syndrome is mostly red. Because there are different shades of throat redness, the fire should also be divided into excess and deficiency. Zhang believes that: "most people with sore throat are filled with heat and toxin;" Those with dark red color and no drama are mostly symptoms of yin deficiency and fire. " Where the throat is red, the person with a red finger is a "small canthus"; The appearance of filiform red veins is called "Ge Wenyao". He also believes that the "Ge Kiln Pattern" is thick and bright red, which is related to virtual fire and real fire. Those with fine lines and dark red belong to deficiency fire. "Small canthus" is born in the front and bottom wall of pharynx, with nodules and high red color, and the fire is strong; Thin and red, the virtual fire gets angry; If its shape is large, squint is transparent like a crystal bubble, and most of it is wet. Where the throat is red, people with intense heat toxicity and sore throat often have phlegm and saliva stagnation, and symptoms of phlegm heat appear. In treatment, the method of clearing heat and resolving phlegm is mostly used, but Zhang thinks that it is mostly caused by burning and inflammation of large intestine. In the treatment, we should seize the opportunity and use the method of attacking the interior and dredging the internal organs. Because if defecation can be promoted in time, it can often achieve the effect of getting sick at the top, causing fever at the bottom and bringing the root of the disease at the top; Otherwise, if you hesitate, the evil fire will not drain, and the sore throat will eventually disappear. In the specific application of purgation, Zhang adopted different methods for different diseases. Generally speaking, there are four methods: (1) purgation, which is mainly used for symptoms of excessive fever and dry stool; (2) The purgation and phlegm-resolving method is mainly used for the symptoms of lung and stomach fire, phlegm-heat overflow and dry stool; (3) Clearing the lower energizer and calming the liver is mainly used for the symptoms of stagnation of liver fire and unclear viscera; (4) The method of nourishing yin and dredging fu organs is mainly used for symptoms such as yin deficiency and excessive fire, sore throat and intestinal dryness. It can be seen that Zhang's purgation method has a direct or indirect relationship with purging fire and releasing heat. Zhang Can, in particular, is flexible and changeable, so he can be handy and effective.

Second, purging against disadvantages and protecting righteousness.

Righteousness is the foundation of human beings. Zhang attached great importance to this, especially emphasizing the maintenance of healthy qi during the treatment. Although he advocated the use of drugs for clearing away heat and toxic materials, purging fire and relieving sore throat, he also pointed out that both spleen and stomach should be taken into account. Even if the spleen and stomach function is normal, Zhang believes that the use of bitter cold and heat-releasing products must stop the disease and should not be taken in excess; If the spleen and stomach are weak, don't simply use bitter cold, lest the pathogenic heat is not carved out of the root, the middle jiao has been damaged first, the stomach qi has been defeated, and the acquired disorder hinders recovery. Regarding the application of purgation method, Zhang believes that although purgation method can clear away heat and purge fire, it has a rapid effect, but if it is not used properly, if the wrong medicine is used, the disease will be light and the yin fluid will be damaged; It is due to the obstruction of the throat due to yin deficiency, so we should pay special attention to it, that is, excess heat is bound to Yangming, which is easy to turn dryness into yin and cannot be ignored. The survival of vaginal fluid is very important for the prognosis of the disease. The so-called "leaving a little body fluid, there is a little life", although it is the motto for treating febrile diseases, it should also be regarded as an important principle for treating throat diseases. In addition, for patients with yin deficiency, laryngitis and weakness of spleen and stomach, Zhang not only avoids using products that are pungent and dry and hurt body fluids, but also has to "replenish qi but not yang, strengthen the spleen and not warm and dry". Most of the drugs he chose were sweet and cold, moistening dryness, sour and sweet, nourishing the stomach and promoting fluid production, so as to slow down the symptoms and cure the effect, and its original intention was also to protect righteousness.

Therapeutic experience

Treatment experience of laryngitis

Mr. Zanchen believes that the main cause of laryngitis is damp-heat, phlegm-dampness stagnation due to the loss of spleen defense, long-term stagnation of heat and internal consumption of body fluids; The liver meridian is drained, the meridians are blocked, the wood is depressed and invades the soil, the virtual fire and the real fire are combined, and the throat is fumigated until the mucosa is ulcerated, and the carrion falls off and folds like shrimp skin. Mr. Zanchen advocated dampness and heat clearing, benefiting yin and relieving sore throat in syndrome differentiation treatment. The main ingredients are Radix Paeoniae Rubra, Radix Paeoniae Alba, Scutellariae Radix, Alismatis Rhizoma, Radix Scrophulariae, Rhizoma Belamcandae, Radix Platycodi and Cortex Moutan. Among them, Paeonia lactiflora and Cortex Moutan should be used together to cool blood and disperse blood stasis, which can not only clear blood and divide excess heat, but also treat fever due to yin deficiency. Alisma orientalis and Scutellaria baicalensis Georgi are designed to clear away heat and relieve summer heat, aiming at the main contradiction of damp heat. Paeonia lactiflora has the function of calming the liver and astringing yin, and also has the function of relieving pain. When used with Paeonia lactiflora, it is scattered and collected, bringing out the best in each other. Radix Scrophulariae purges fire, detoxifies and relieves sore throat, nourishes yin and promotes fluid production, and removes floating deficiency fire; Shoot dry, clear away heat, relieve sore throat and resolve phlegm; Platycodon grandiflorum eliminates phlegm and discharges pus, spreads lung and relieves sore throat, and plays a role in inducing menstruation. For those with wet spleen and stomach, in addition to Radix Scrophulariae, Coicis Semen, Rhizoma Dioscoreae, fried atractylodes and Radix Astragali preparata are added as appropriate; Fructus Gardeniae, Rhizoma Anemarrhenae, Radix Angelicae Sinensis and Fructus Arctii can be added when stomach fire is excessive.

Differentiation and treatment of laryngeal obstruction due to yin deficiency

Sore throat has long been recorded in Neijing: "One yin and one yang knot is called laryngitis." The main clinical symptoms are pharyngeal swelling and pain, dysphagia and dysphagia, which are generally divided into acute and chronic. Most acute cases are wind-heat laryngitis, phlegm-fire laryngitis and so on. Chronic patients are mostly "yin deficiency and throat obstruction" caused by excessive internal heat. In treatment, the former is mainly for dispelling wind and clearing heat, resolving phlegm and purging fire, which is easy to cure, while the latter is mainly for nourishing yin and relieving sore throat, with lingering symptoms, which is particularly common in clinic. Sore throat due to yin deficiency usually appears for a long time, and the symptoms are mild and severe, so it needs to be treated according to the specific symptoms. The etiology, syndrome differentiation and treatment of this disease are as follows:

cause of a disease

There are two main causes of this disease: first, acute laryngeal syndrome can not be treated, resulting from long-term delay; Second, due to pathological changes in other parts of the body, yin deficiency is caused. Long-term treatment leads to yin deficiency, which leads to excessive fire and laryngitis, and they are interdependent. From the inducement, it is often due to talking (or singing), inhaling dust, working at high temperature, long-term insomnia, eating spicy products and so on. And most of them are induced by many languages, so this disease is often related to occupation, work nature and living habits.

treatment according to syndrome differentiation

There are five basic symptoms of sore throat, namely swelling, dryness, phlegm and blood stasis, chest tightness, blocked throat (or infarction) and hoarseness, among which swelling, redness and dryness are the main symptoms of blocked throat. These symptoms vary in severity, so after inquiring about the medical history in detail, we must distinguish the symptoms from these aspects and consider the treatment law.

1, dry throat and sore throat

The pharynx of laryngitis patients is often dark red (that is, dark red), and fresh exposure to wind-heat or gastrointestinal heat can also be seen as bright red swelling. Whether its color is dark red or bright red, it always belongs to fire. However, hidden red is a virtual fire, and bright red is a real fire, which cannot be treated equally. Anyone with swollen throat due to yin deficiency and excessive fire should be treated with the method of benefiting yin and clearing fire, such as Radix Scrophulariae, Radix Ophiopogonis, Radix Rehmanniae, Radix Paeoniae Alba, Trichosanthis Radix, Dendrobium, etc. If defecation is difficult at the same time, Fructus Mori and processed Radix Polygoni Multiflori can be added. Bright red throat is often just a stage in the process of laryngitis. In line with the principle of "treating the symptoms but not the root cause", drugs such as Diaojindeng, Sophora Tonkinensis, Cortex Moutan and Radix Paeoniae Rubra can be used first; Herba Menthae, Periostracum Cicadae, and Fructus Arctii can be added for sudden wind-heat attack; In case of bright red, Scutellariae Radix, Rhizoma Anemarrhenae, Rhizoma Coptidis, etc. Constipation plus mirabilite is similar to the treatment of acute laryngitis. Once the bright red fades and the acute symptoms pass, the method of nourishing yin and clearing fire is still used. While observing the red throat, we should also pay attention to the color of the throat, the pit lines of the upper jaw and the small corners of the eyes. Generally speaking, thick lines and bright red colors often have virtual fire and real fire; Thin lines and deep colors are undoubtedly virtual fires. The small corner of the eye is fine red and closely covers the palate and pharynx, which belongs to the inflammation of deficiency fire; Small corners of the eyes are big, squinting like crystal bubbles, which is mutual resistance of phlegm and dampness. In addition, after long-term laryngitis, nodules often appear on the pharyngeal wall and sublingual collaterals. Nodules are large and small, and the color is red and light. Red and swollen people are full of fire, and light and thick people are wet; It is true that the shape is tall and convex, and it is flat and empty. The sublingual collaterals are purple and exposed to blood stasis and heat.

The symptoms of dry throat and pain are slightly relieved after drinking water, even if you drink more, you can't improve it, especially in the afternoon and evening. This is because the body fluid is insufficient, so it is often used to produce body fluid. Although this kind of medicine is indispensable, it needs to be taken with the bright red or hidden red of the upper pharynx to clear heat, purge fire and benefit yin; It is necessary to further study the reasons. The formation of body fluid and the reasons that affect the consumption of body fluid are related to the function of viscera. Body fluid comes from Shui Gu, Shui Gu enters the stomach, turns into subtle, passes through the spleen, goes up to the lungs and irrigates the whole body; Kidney is the essence of five internal organs stored by human life activities. In this way, the normal activities of physiological functions of zang-fu organs are maintained by continuous storage, continuous supply and circulation. If the spleen, stomach, lungs and kidneys are sick or dysfunctional, it will affect the profit and loss of body fluids. Heart and liver are full of fire, and body fluids can be eliminated. Therefore, in the treatment of throat obstruction, dry throat and pain, besides general drugs for nourishing yin and promoting fluid production, symptomatic treatment should be taken. If you see the symptoms of unhealthy spleen and stomach, such as eating fast, full stomach or loose stool after eating, you should use fried atractylodes, yam, ginseng, poria cocos, Qu Yun, lentil coat, lotus seeds and Euryale ferox. Please please the spleen and stomach and make it return to normal, so that body fluid can be absorbed and the throat can be removed. People with yin deficiency and spleen and stomach weakness should use sweet and cold medicine, not greasy and bitter products, so as not to hinder the stomach. If the voice is weak and the lung qi is insufficient, Radix Pseudostellariae, Lily and Polygonatum odoratum can be added to benefit the lung qi; If the back is sore, nocturnal emission, endless urination or even little enuresis, Rhizoma Cibotii preparata, Cornus officinalis meat, Fructus Alpinae Oxyphyllae and Semen Cuscutae should be used to tonify the kidney and consolidate the foundation; If you feel dizzy, your eyes are full of red silk, white peony root, cowpea coat, tribulus terrestris, gastrodia elata and so on. Used for softening liver and benefiting yin; For cases of guilty conscience such as palpitation, spontaneous sweating and restless night sleep, it can be combined with Schisandra chinensis, floating wheat, Glehnia littoralis and Ophiopogon japonicus to nourish the heart. In short, the treatment of dry throat should not only use drugs that benefit yin and promote body fluid, but also suit the right medicine. Only by tracing the source and treating both the symptoms and root causes can the biochemical transport of body fluids return to normal and the symptoms of dry throat be fundamentally improved.

2. Phlegm is sticky

Spleen is the source of phlegm and lung is the reservoir of phlegm, so much phlegm is often attributed to spleen-yang deficiency and bad temper. But as far as laryngitis is concerned, it's not entirely true. Phlegm with throat syndrome is always due to heat stagnation in the lungs; At the same time, we should also observe the redness of the pharynx to judge the severity of stagnation or deficiency. When using expectorants, warm and dry drugs must be used with caution. Such as fritillary bulb, elephant fritillary bulb, almond, skullcap, clam powder, orange white collateral, clam powder and so on. Can be used as a common product; If it is sudden wind-heat, sore throat and excessive phlegm and saliva, use cicada slough, stiff silkworm and burdock to dispel wind, clear heat and remove blood stasis; If the tongue coating is sticky and the throat is not very dry, Erchen Decoction should be used as appropriate (but the dosage of Xianbanxia is only 6g). Of course, cases of spleen yang deficiency should also take into account spleen yang, and cannot be generalized.

Medical experience

Moth, also known as throat moth, is named because its throat (tonsil) is swollen and shaped like nipple or silkworm moth. Zhang believes that it is mainly caused by inflammation of lung and stomach fire, so it is clinically treated with Jindengshangen Decoction and has achieved remarkable results. Because of a case of cold and fever, it was diagnosed as wind-heat again. Schizonepeta, mint, honeysuckle and forsythia were used together to soothe the liver and dispel wind-heat and clear heat from the exterior to the interior. Case 2 appeared dizziness and red eyes, so it was diagnosed as hyperactivity of liver fire. Gentiana macrophylla, Chrysanthemum, Scutellaria baicalensis Georgi and Gardenia were added to clear away liver fire. Although the disease is the same, the symptoms are different, so the drugs can be changed with the symptoms and can be used. In addition, Zhang also believes that moths are easy to treat when they start in the pharynx, but it is more difficult to treat if they extend to the pharynx. The disease must be treated as soon as possible, otherwise it will not be resolved for a long time, not only the swelling of laryngeal nucleus can not be completely subsided, but also it is easy to recur after every exogenous or fatigue. For those who turn into moths, we must make careful diagnosis and take corresponding treatment measures. If there is no suppuration, focus on clearing it to promote its regression; If the pus has festered, the pus discharge service will be exhausted; Purulent secretions have been cleared, so we should clear away heat and relieve sore throat again to avoid future troubles.