Kidney Deficiency Research Articles

Investigate the situation of knee osteoarthristic and evaluate the results of treatment in Ha Dong general hospital in 2021

Objective: To investigate the situation of knee osteoarthritis and evaluate the results of treatment of primary knee osteoarthritis at Ha Dong General Hospital in 2021.Subjects and methods: A retrospective descriptive study on 93 medical records with a diagnosis of knee osteoarthritis according to the standards of the American College of Rheumatology ACR 1991, VAS scale < 6 points, and Damp-Cold combined with Liver and Kidney deficiency according to TCM at Ha Dong General Hospital in 2021. Experimental group: Moxibustion-infrared lamp + Doc hoat ky sinh thang decoction + Electro- acupuncture for 20 days. Control group: Doc hoat ky sinh thang decoction + Electro-acupuncture for 20 days.Results: Physical workers and BMI ≥ 23 increase the risk of knee osteoarthritis. X-ray characteristics of the knee joint: mainly degeneration with 92.47% and inflammation with 60.81%. Features of knee joint ultrasound: Knee effusion accounted for 37.84%, Baker cyst accounted for 11.86%; 83.87% had osteophyte, 51.61% had endplate sclerosis and 39.78% had joint space narrowing. According to modern medicine: the number of patients with knee osteoarthritis and inflamed knee osteoarthritis has a similar incidence. According to traditional medicine: 81.72% were diagnosed with Damp-Cold combined with Liver and Kidney deficiency; 18.28% were Damp-Heat combined with Liver and Kidney deficiency, 9.68% were Damp-Cold standalone. The pain reduction efficiency according to VAS of the experimental group was 5.96 ± 1.09 points, higher than that of the control group which was 4.56 ± 0.77 points with statistical significance (p<0.05). In the experimental group, 30% of patients had no pain, 70% of patients had mild pain. In the control group, 10% of patients had moderate pain, 86.7% had mild pain and only 3.3% of patients had no pain. The difference between the two groups was statistically significant (p<0.05). The improvement effect of the experimental group was better than the control group, the difference was statistically significant (p < 0.05). During 20 days of treatment, there were no unwanted clinical effects.

Visual analysis of research on traditional Chinese medicine treatment of Alzheimer's disease in recent ten years

This study employed bibliometrics tools to review the studies of traditional Chinese medicine(TCM) treatment of Alzheimer's disease(AD) in recent ten years, aiming to explore the research status, hotspots, and future trends in this field at home and abroad. The relevant literature published from January 1, 2012 to August 15, 2022 was retrieved from Web of Science and CNKI. CiteSpace 6.1R2 and VOSviewer 1.6.15 were used for the visual analysis of authors, countries, institutions, keywords, journals, etc. A total of 2 254 Chinese articles and 545 English articles were included. The annual number of articles published showed a rising trend with fluctuations. The country with the largest number of relevant articles published and the largest centrality was China. SUN Guo-jie and WANG Qi were the authors publishing the most Chinese articles and English articles, respectively. Hubei University of Chinese Medicine and Beijing University of Chinese Medicine published the most articles in Chinese and English, respectively. Journal of Ethnopharmacology and Neuroscience Letters published the articles with the highest cited frequency and the highest centrality. According to the keywords, the research on TCM treatment of AD mainly focused on the mechanism of action and treatment methods. Metabolomics, intestinal flora, oxidative stress, tau hyperphosphorylation, β-amyloid(Aβ), inflammatory cytokines, and autophagy were the focuses of the research on mechanism of action. Acupuncture, clinical effect, kidney deficiency and phlegm stasis, and dredging governor vessel to revitalize mind were the hotspots of clinical research. This research field is still in the stage of exploration and development. Exchanges and cooperation among institutions should be encouraged to carry out more high-quality basic research on TCM treatment of AD, obtain high-level evidence, and clarify the pathogenesis and prescription mechanism.

Wangbi granule as a combination therapy to achieve clinical deep remission in rheumatoid arthritis: protocol for a multicenter, triple-blind, randomised, placebo-controlled trial

IntroductionRheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that may lead to bone erosion and disability. Although there are many biological therapies in RA treatment nowadays, such as etanercept and tofacitinib, there are still a considerable number of patients who cannot achieve clinical deep remission, which makes patients feel pain and stiffness of joints. As a traditional Chinese medicine preparation, Wangbi granule showed a synergistic role with methotrexate in the treatment of RA patients with “kidney deficiency and dampness” or “stasis blocking channels”. Therefore, it is a promising therapeutic strategy for the clinical deep remission of RA. In this study, Wangbi granule will be used as the test drug. The investigators conduct this study to evaluate the efficacy and safety of Wangbi granule in the treatment of patients who have not achieved deep remission despite the use of methotrexate and tofacitinib.Methods and analysisTwo parallel randomized, triple-blind, placebo-controlled trials will be conducted. In six study centers, 340 eligible RA patients will be recruited and randomly allocated to either the intervention group or the control group (in a 1:1 ratio). They will receive Wangbi granule or Wangbi placebo 12.0 g each time, three times a day for 12 weeks. The primary outcome is the disease activity score derivative for 28 joints (DAS28). Secondary outcomes are patient-reported outcomes, American College of Rheumatology 50% response criteria (ACR50), fatigue scale-14 (FS-14), visual analogue scale for pain (VAS), health assessment questionnaire disability index (HAQ-DI) and biomarkers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).Expected outcomesThe success of this study will provide strong evidence to confirm the efficacy and safety of Wangbi granule in the treatment of RA.Trial registration The trial has been registered in the ClinicalTrials Registry (NCT05540938, Date: 09/15/2022, https://clinicaltrials.gov/ct2/show/NCT05540938)

High-throughput Treg cell receptor sequencing reveals differential immune repertoires in rheumatoid arthritis with kidney deficiency.

Regulatory T (Treg) cells are important immune cells that are regulated by adaptive immunity in the composition of Treg-cell subsets and T-cell receptors (TCRs). Treg cells are related to most autoimmune diseases, such as rheumatoid arthritis (RA). In traditional Chinese medicine (TCM), RA is typically attributed to kidney deficiency (KD) associated with the immunosenescence that causes immune dysfunction and the impaired function of Treg cells. So far, however, no mechanism related to KD and immune repertoires has been identified in RA. Flow cytometry and high-throughput Treg-cell receptor sequencing were used to investigate the amount of different Treg-cell subsets and the diversity of TCRs between RA patients and healthy subjects, as well as between KD RA and non-KD RA patients. RT-qPCR was used to validate the high-throughput sequencing results. The data showed that the amount of naïve Treg cells in KD patients was less than in non-KD RA patients (P = 0.004) with no significant differences observed between other subsets. In the TCR of Treg cells, the length of complementarity determining region 3 (CDR3) was low and clonotypes increased in the KD group compared with the non-KD group. The diversity and abundance of Treg TCRs were low, as determined by the Hill number. In addition, several V(D)J combinations, such as T-cell receptor beta variable 7-2 (TRBV7-2), TRBV11-1, TRBV13, TRBV15, and TRBJ2-3, varied significantly between the two groups, indicating that KD causes Treg dysfunction. RT-qPCR shows that FOXP3 expression in peripheral blood Treg is lower in KD than in non-KD. The results demonstrate the close correlation between KD and immune repertoires in RA and provide a new evaluation method for RA in TCM.

Mitochondrial dysfunction in a rat model and the related risk of metabolic disorders.

To explore whether kidney deficiency (KYD) is prone to metabolic disorders may be linked to impaired mitochondrial function in thermogenesis and metabolic tissues. A rat model of KYD was used, which was established using Sprague Dawley rat dams with warm preference subjected to herbal treatment that can improve kidney . The human relevance was confirmed by reduced serum corticosterone levels, and increased preference for warm location. KYD Rats were underdeveloped. Adenosine-triphosphate (ATP) production was reduced in the brown fat, but increased in the muscle. However, oxidative phosphorylated complexes to generate ATP and mitochondrial biogenesis marker were reduced in both tissues. When the second insult of high-fat diet (HFD) was introduced, KYD rats gained less weight yet developed more severe lipid and glucose metabolic disorders. This may be driven by disregulated liver gluconeogenesis marker forkhead box protein O1 and lipid metabolic regulator cholesterol 7 alpha-hydroxylase. KYD rats exhibited reduced mito-chondrial function in the brown fat, but were partially compensated by skeletal muscle, associated with the phenotype of warm preference and metabolic disorder, which was further exacerbated by additional HFD consumption. Future studies can focus on treatment targetting mitochondria function to reverse this phenotype.

An Analysis of the Clinical Medication Rules of Traditional Chinese Medicine for Polycystic Ovary Syndrome Based on Data Mining.

The aim of the present study is to investigate the rules and characteristics of the clinical administration of traditional Chinese medicine (TCM) in the treatment of polycystic ovary syndrome (PCOS) using data mining methods. Medical cases of well-known contemporary TCM doctors treating PCOS were collected from the China National Knowledge Infrastructure, Chinese Biomedical Literature Service System, Wanfang, Chinese Scientific Journals Database, and PubMed; the data were then characterized, and a standardized database of medical cases was built. This database was used to (1) count the frequency of syndrome types and the herbs used in medical cases by data mining methods and (2) analyze drug association rules and systematic clustering methods. A total of 330 papers were included, involving 382 patients and a total of 1,427 consultations. The most common syndrome type was kidney deficiency; sputum stasis was the core pathological product and causative factor. A total of 364 herbs were used. Among them, 22 herbs were used >300 times, including Danggui (Angelicae Sinensis Radix), Tusizi (Semen Cuscutae), Fuling (Poria), Xiangfu (Nutgrass Galingale Rhizome), and Baizhu (Atractylodis Macrocephalae Rhizoma). Additionally, 22 binomial associations were obtained from the analysis of association rules; five clustering formulae were obtained via the analysis of high-frequency drug clusters; and 27 core combinations were obtained by k-means clustering of formula. In the treatment of PCOS, TCM is primarily employed as a combination approach involving tonifying the kidneys, strengthening the spleen, eliminating damp and dissolving phlegm, activating blood circulation, and resolving blood stasis. The core prescription is primarily a compound intervention based on the Cangfu Daotan pill, Liuwei Dihuang pill, and Taohong Siwu decoction.

Research Progress of Traditional Chinese Medicine Therapy on PCOS

Polycystic ovary syndrome is a common reproductive endocrine metabolic disease in adolescents and women of childbearing age, with 55% being severe and leading to infertility. Currently, the pathogenesis of this disease is not clear. Traditional Chinese medicine attributes this condition to dysfunction of the kidneys, liver, and spleen. This disease has multiple types of syndromes, mainly divided into kidney deficiency and blood stasis, spleen deficiency and phlegm dampness, liver depression and spleen deficiency and qi stagnation and blood stasis, and phlegm and blood stasis intermingling. The clinical manifestations of each syndrome type are different. In recent years, traditional Chinese medicine has achieved satisfactory results in treating this disease. Targeted treatment for the disease not only regulates endocrine and metabolic disorders in the body, but also has high drug safety. This article summarizes and analyzes clinical research on the treatment of polycystic ovary syndrome (PCOS) in traditional Chinese medicine by consulting ancient literature and modern medical journals. By using the literature review method, it summarized and analyzed the traditional Chinese medicine etiology, drug action mechanism, and positive effects of traditional Chinese medicine treatment for polycystic ovary syndrome.This provides a scientific theoretical basis for the prevention and treatment of PCOS in traditional Chinese medicine.

论“肝肾亏虚”型股骨头坏死的病因病机分析及相关治疗

论“肝肾亏虚”型股骨头坏死的病因病机分析及相关治疗

The treatment of depression after stroke based on the theory of "five essence"

With the increasing number of people suffering from stroke, the important complication of poststroke depression (Post stroke depression, PSD) is also getting more and more attention. Liver loss and liver qi stagnation are the key pathogenesis of post-stroke depression, and deficiency of heart, liver, spleen and kidney is the main pathological basis of depression after stroke. "Five essence place" theory points out that "essence qi and liver worry", heart, liver, spleen, kidney four viscera essence qi deficiency, deficiency phase, "and in the liver worry", there will be low mood, interest decline, slow thinking and other symptoms of depression after stroke, clinical can be treated from the liver.

Analysis of the Prescription Regularities of Proprietary Chinese Medicines for Insomnia Based on Data mining

Objective: To analyze the medication characteristics and regularities of proprietary Chinese medicines for the treatment of insomnia, and to provide new ideas for the clinical treatment of this disease and the research and development of proprietary Chinese medicines. Methods: The prescriptions of proprietary Chinese medicines for the treatment of insomnia were collected from“yaoZH” database, and then Excel 2016, and SPSS Modeler18.0 was employed for frequency statistics, correlation analysis and Apriori association rule. Analysis graphs were drawn using Cytoscape to summarize the patterns of medication use Results: A total of 152 prescriptions were finally screened, involving 336 Chinese herbal medicines, with a cumulative frequency of 1433. The top 5 drugs with the highest cumulative frequency were Danggui (3.07%), Fuling (2.86%), Wuweizi (2.86%), Shudihuang (2.58%) and Huangqi (2.37%). The first place of each order of the drug-drug association rule was Danggui→ Zhiyuanzhi, Chaosuanzaoren+ Danggui→ Fuling; the first place of each order of the drug-symptom association rule was Fuling → Insomnia, Fuling + Danggui → Insomnia. In addition, 152 Chinese patent medicines could treat a total of 66 TCM syndromes, and the top 5 syndromes with the highest treatment frequency were Qi and Blood Deficiency Syndrome (16.5%), Liver and Kidney Deficiency Syndrome (10.9%), Heart and Spleen Deficiency Syndrome (5.21%), Qi and Yin Deficiency Syndrome (4.73%), and Liver Yang Hyperactivity Syndrome (4.26%). Conclusion: The treatment of insomnia with proprietary Chinese medicines is focused on nourishing deficiency, and is particularly good at treating insomnia caused by deficiency of Qi and Blood, deficiency of Liver and Kidney or deficiency of Heart and Spleen, and its main treatment symptoms, apart from insomnia, are most often accompanied by palpitations, fatigue, dizziness and memory loss, which can provide a basis for the clinical treatment of insomnia and the development of proprietary Chinese medicines.

Differentiation and Treatment of Chronic Renal Failure Based on the Theory of "Peace and Balance"

Chronic renal failure is slow, the course of disease is long, and it is difficult to heal. At present, modern medicine is faced with many difficulties in treatment, and it is difficult to break through. The Chinese medicine treats the symptoms according to the whole concept and has obtained good curative effect. Although the pathogenesis of the disease is complicated, in the whole process of onset, deficiency in origin and excess in superficiality is still the most critical. It is often caused by deficiency of spleen and kidney, disorder of liver ascending and lung descending, combined with phlegm-dampness and stasis toxin, and the disturbance of internal and external wind. Consequently. It is necessary to treat multiple viscera at the same time, and treat both manifestation and root cause of disease. The theory of "Peace and Balance" fully interprets the overall concept of Chinese medicine, we advocate "aim for peace" and Incorporate "balance" throughout the entire treatment,to reach the balance of yin and yang. Therefore, this article will discuss the treatment based on syndrome differentiation of Chronic renal failure by the theory of "Peace and Balance".

Therapeutic Effect of Guilu Congnao Granules Combined with Acupuncture on Syndrome of Deficiency of Liver and Kidney with Mental Retardation

Therapeutic Effect of Guilu Congnao Granules Combined with Acupuncture on Syndrome of Deficiency of Liver and Kidney with Mental Retardation

A Case of Burning Mouth Syndrome in a Depressed Patient with Kidney Deficiency Responding to Goshajinkigan

A Case of Burning Mouth Syndrome in a Depressed Patient with Kidney Deficiency Responding to Goshajinkigan

Polycystic Ovary Syndrome-Related Infertility Based on the Theory of “Liver and Kidney Homology”

Polycystic ovary syndrome (PCOS) is an endocrine disorder caused by hypothalamic-pituitary-ovarian (HPO) axis dysfunction. In the field of gynecology and reproduction, PCOS has emerged as both a research hot spot and a challenging area of study. According to Chinese medicine, this disease is related to kidney deficiency, phlegm and dampness obstruction, blood stasis and interconnection, Chong pulse impassability, the lack of Ren pulse, and the loss of uterine nourishment, all of which affect the normal development and maturation of eggs as well as the duration at which menstrual blood stores. In this paper, based on the theoretical basis of “liver collects blood, regulates the flow of qi, and is the master of drainage,” we explore the rationality of the treatment of this disease from the perspective of “liver and kidney have the same origin” and the development of PCOS-related infertility in relation to dysfunctional internal organs. We also explore the feasibility of treatment from the perspective of “liver and kidney homology,” expand the ideas for treatment, as well as develop and innovate the application of organ identification in PCOS in relation to infertility.

Effects of Hydrosalpinx on Endometrial Receptivity and Uterine Microbiome: An Interesting Case of Double Uterus with Unilateral Hydrosalpinx

Endometrial receptivity array (ERA)—an objective tool used in assisted reproductive technology—is used for personalized embryo transfer in in vitro fertilization. Hydrosalpinx affects implantation through various mechanisms. However, its effects on ERA are not well established. In this case report, we present the diagnosis and treatment of a 34-year-old nulligravida woman with infertility for two years, obesity, double uterus with unilateral hydrosalpinx and right kidney deficiency. Based on ERA results, endometrial microbiome metagenomic analysis (EMMA), analysis of infectious chronic endometritis (ALICE), and CD138 immunostaining, the patient was treated with hormonal replacement cycle and amoxicillin/clavulanic acid. After one week of amoxicillin/clavulanic acid administration, the vitirified-warmed 4AA blastocyst was transferred to the left uterus—which was absent of hydrosalpinx and easily accessible to transfer and pregnancy was achieved. To the best of our knowledge, this case study is the first one in which we found that there were no differences between the left and right uterus in ERA, EMMA, ALICE, and CD138 immunostainings. Hence, we suggest that hydrosalpinx does not necessarily cause endometrial changes in all cases. Further research to evaluate the effects of hydrosalpinx on implantation with ERA and EMMA/ALICE is warranted.

Development and Validation of a UPLC-MS/MS Method for the Quantification of Components in the Ancient Classical Chinese Medicine Formula of Guyinjian

Guyinjian (GYJ) is an ancient classic formula of traditional Chinese medicine used for the treatment of liver and kidney yin deficiency; it was derived from the book "Jing Yue Quan Shu" in the Ming Dynasty. Modern clinical observation experiments have shown that GYJ has a definite therapeutic effect on the treatment of gynecological diseases such as kidney deficiency type oligomenorrhea, climacteric syndrome, intermenstrual bleeding, pubertal metrorrhagia, etc. However, the lack of GYJ quality control studies has greatly limited the development of its wider clinical application. In this study, a validated UPLC-MS/MS method was developed successfully for the first time and used to quantify fourteen compounds in GYJ samples with good specificity, linearity (r = 0.9960-0.9999), precision (RSD% ≤ 3.18%), stability (RSD% ≤ 2.22%) and accuracy (recovery test within 88.64-107.43%, RSD% at 2.82-6.22%). Simultaneously, the determination results of 15 batches of GYJ samples were analyzed by multivariate statistical methods, and it was found that the compounds have a greater influence on batch-to-batch stability, mainly Rehmannioside D, Loganin, Morroniside, Ginsenoside Re, and 3',6-Disinapoylsucrose. The proposed new method has the advantages of high sensitivity, high selectivity, and rapid analysis, which provides a reference for the GYJ quality control study.

Efficacy of stimulating Mingmen (GV4) and Guanyuan (CV4) on kidney deficiency in rat model: laser irradiation traditional moxibustion.

To investigate the effect of 10.6-μm laser moxibustion (LM) and traditional moxibustion (TM) on kidney deficiency (KYD) model rats. Forty rats were randomly divided into normal, model, 10.6-μm LM, and TM groups. KYD was induced through intramuscular hydrocortisone injections. Hydrocortisone injections decreased the body weight, activity, and temperature and induced changes in the organ coefficients. Compared with the model group, TM and LM treatment prevented body weight loss and improved organ coefficients after treatment ( < 0.05), while the body weight remained lower compared to the normal group ( < 0.01). Additionally, LM and TM significantly increased the levels of urine 17-hydroxycorticosteroid (17-OHCS) compared with the model group ( < 0.01). The LM and TM groups showed a greater distance travelled across the central area, time spent in the central area, and 5-min total distance than the model group in the open field test ( < 0.01). The model group had the lowest anal or surface temperature ( < 0.05); there were no differences among the other three groups ( > 0.05). TM treatment increased the temperature of Mingmen (GV4) and Guanyuan (CV4) compared to the model group ( < 0.05, < 0.01). LM treatment increased Mingmen (GV4) temperature ( < 0.05), while there were no obvious differences in Guanyuan (CV4) temperature compared with the normal group before and after treatment ( > 0.05). There was a positive correlation between Mingmen (GV4)/Guanyuan (CV4) temperature and 17-OHCS levels. LM and TM treatment can improve KYD symptoms, and acupoint temperature changes may be an objective indicator of KYD.

Association between Oral Chinese Herbal Medicine and Recurrence and Metastasis in Patients with Stages II and III Colorectal Cancer: A Cohort Study in China

To evaluate the associations between long-term oral Chinese herbal medicines (CHMs) and recurrence and metastasis (R&M) in patients with stage II and III colorectal cancer (CRC). Furthermore, we aimed to determine the correlation between different syndrome patterns and prognosis and summarized the regularities among CHMs prescriptions, providing reference for clinical practice. An ambispective cohort study was conducted. All CRC patients who sought evaluation and treatment at Xiyuan Hospital and Beijing Cancer Hospital from August 2014 to August 2016 were included. In this study, "whether patients voluntarily take CHMs" was taken as the exposure factor, and the exposure degree was "the duration of CHM use." Stratification was performed according to the duration of TCM use to determine the relationship with R&M of CRC. The primary outcome was disease-free survival. Patients who had R&M of CRC after taking CHMs for ≥6 months were defined as "worst patients." R software was used for statistical analysis. The Kaplan-Meier method and Cox regression analysis were used to determine the prognosis. IBM SPSS was used to model a priori association rules; drug use rules were analyzed on this basis. A total of 186 patients with stage II and III CRC after radical resection were enrolled. All patients reached the study endpoint by August 2021. The difference in disease-free survival between the two groups was most significant when the cutoff value for CHMs was 18 months (P = 0.0012). Multivariate analysis showed that 18 CHMs were independent protective factors for R&M of CRC (P = 0.001, HR = 0.20, 95% CI = 0.08-0.53). The ratio of Pi (spleen) and Shen (kidney) deficiency in the worst cases was higher than patients without R&M (P = 0.018). Sijunzi and Liuwei Dihuang decoctions were the most frequently used prescriptions in the anti-R&M phase. CHMs complying with the "Jianpi Bushen" principle may attenuate the risk of R&M in patients with stage II and III CRC. Pi (spleen) and Shen (kidney) deficiency in patients receiving TCM intervention for the first time within 6 months of radical resection may be associated with a higher CRC R&M rate. Further research is warranted to validate these findings and elucidate underlying biological mechanisms.

Diterpenoid glucosides with anti-inflammatory activity from Rubi Fructus

For centuries, dried unripe fruits of Rubus chingii Hu (Chinese name “Fu-pen-zi”) have been widely used in traditional Chinese medicine for the treatment of various diseases, commonly associated with kidney deficiency. Rubi Fructus is an edible berry suitable for consumption either directly or in the form of juice and jam. The phytochemical investigation focused on the bioactive non-nutrient ingredient from the fruit of R. chingii, especially diterpenoid compounds. Seven diterpenoid glucosides, including three new (1–3) and four known (4–7) compounds, were obtained from the fruits of R. chingii. The structures along with the absolute configurations of the new compounds were determined by extensive NMR spectroscopic analysis. Compounds 1, 2, 4, 5, and 7 showed anti-inflammatory activity against LPS-induced NO production in RAW 264.7 macrophages. Further, the preliminary structure–activity relationships of these active compounds have been scientifically evaluated and discussed in this study.

Professor SHENG Can-ruo's experience of acupuncture for chronic pelvic pain of sequelae of pelvic inflammatory diseases

Professor SHENG Can-ruo proposes that the pathogenesis of chronic pelvic pain of sequelae of pelvic inflammatory diseases is "kidney deficiency and cold coagulation, obstruction of the governor vessel and the belt vessel". For the treatment, attention is paid to warming yang and tonifying kidney, dredging and regulating the governor vessel and the belt vessel; the acupoints of Sanyinjiao (SP 6), Fuliu (KI 7), Taixi (KI 3) etc. are selected. With the method of treating yang for yin disorder and mao-acupuncture, professor SHENG emphasizes the importance of syndrome differentiation-based treatment. The main point of treatment is to balance yin-yang and to maintain both sides of the symptoms and root causes.