• The similar properties of formulas mainly manifest in the core treatment methods. The “Ling Shao Zhu Gan Decoction” represents the method of “Harmonizing Yin and Promoting Water Metabolism,” enriching the treatment of abnormal water metabolism diseases, which holds significant value.
• The differentiation of similar formulas is based on the changes in symptoms that arise from the main syndrome, leading to modifications of the primary formula. The formula is derived from the method, which is established according to the syndrome, with the pathogenesis being the core of differentiation. The treatment methods of similar formulas are alike, corresponding to similar pathogenesis, and the choice of herbs reflects the specific similarities and differences among similar formulas.
The concept of “similarity” is a representation of ancient Chinese logical thought, reflecting the evolution of understanding from lower to higher levels, and is an important way to promote cognitive movement. By observing and judging the “similarities and differences” of things, one can form categories, placing similar entities within an orderly taxonomic relationship. In-depth examination and abstraction of similar properties help to transcend appearances and discover essential laws, thereby establishing an orderly knowledge system. Although the concept of “similarity” is not explicitly stated in the “Shang Han Za Bing Lun” (Treatise on Cold Damage and Miscellaneous Diseases), it contains a rich concept of “similarity.” Japanese physician Yoshiyasu Tōdō conducted specific comparisons of herbs between similar formulas in the “Shang Han Lun,” such as the difference between Gui Zhi Decoction and Gui Zhi Jia Ge Gen Decoction, noting that Ge Gen (Pueraria) is the key herb, leading to the conclusion that “Ge Gen is indicated for neck and back stiffness,” thus identifying the herbal and symptomatic laws.
Renowned TCM expert Bai Changchuan, Chief Physician at Dalian Traditional Chinese Medicine Hospital, has deeply explored the concept of “similarity” in the “Shang Han Za Bing Lun,” proposing a “formula-syndrome differentiation system,” which differentiates based on the main formula, combined formulas, similar formulas, similar syndromes, herbal-syndrome relationships, and accompanying symptoms. The similar properties of formulas mainly manifest in the core treatment methods. For instance, the “Ling Shao Zhu Gan Decoction” represents the method of “Harmonizing Yin and Promoting Water Metabolism,” enriching the treatment of abnormal water metabolism diseases, which holds significant value. The author is fortunate to have studied under the master and now organizes Bai Changchuan’s insights on the “Ling Shao Zhu Gan Decoction” and analyzes it from the perspectives of similar formulas and herbal-syndrome differentiation, aiming to elucidate the principles contained within the Ling Shao Zhu Gan Decoction and its similarities and differences with similar formulas, hoping to provide references for the theoretical research and clinical application of Zhang Zhongjing’s formulas.
Origin and Explanation of the Formula Name
“Ling Shao Zhu Gan Decoction” is a modern term proposed by Professor Liu Duzhou, referring to “Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Decoction.” Zhang Zhongjing advocated for the harmony of Yin and Yang, where Gui Zhi (Cinnamon Twig) and Shao Yao (Peony) in Gui Zhi Decoction each have the functions of harmonizing Yang and nourishing Yin, respectively. Liu Duzhou studied the “Shang Han Lun” and discovered the mutual application of Gui and Shao. Thus, he posited that there should be a correspondence between “Ling Shao Zhu Gan Decoction” and “Ling Gui Zhu Gan Decoction,” indicating that “Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Decoction” is indeed “Ling Shao Zhu Gan Decoction.”
Since the proposal of “Ling Shao Zhu Gan Decoction” over 30 years ago, its dissemination has been limited, necessitating further explanation. The following text will analyze the necessity of using the original formula name “Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Decoction” based on the original text of the 28th section of the “Shang Han Lun” and the annotations by physicians.
The 28th section of the “Shang Han Lun” states: “If after taking Gui Zhi Decoction, there is still stiffness in the head and neck, fever, no sweating, fullness and slight pain in the heart area, and difficulty in urination, then Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Decoction is indicated.” Regarding this section, there has been both consensus and controversy among physicians throughout the ages. It is generally believed that this syndrome involves the pathogenesis of “water retention internally,” with much debate on whether to remove Gui or Shao in the formula. This article respects the Ming Dynasty’s interpretation, believing that the “no sweating” indicates a contraindication for Gui Zhi Decoction, and thus should adhere to the original text and “remove Gui.”
Since Gui Zhi is removed, why does the formula name still include “Gui Zhi Decoction”? Xu Lingtai explains: “This formula, although it removes Gui Zhi, still does not depart from the essence of Gui Zhi.” Gui Zhi Decoction has the functions of releasing the exterior and nourishing the Ying (Nutritive Qi), where Gui Zhi releases the exterior and Shao Yao nourishes the Ying. Analyzing this, the reason for naming it “remove Gui” has two aspects: first, it emphasizes that the syndrome may be confused with that of Gui Zhi Decoction, fearing the misuse of Gui Zhi, hence the explicit instruction to “remove Gui.” Fever and muscle stiffness are common points between the two. The 28th section mentions “still stiffness in the head and neck, fever,” which is also present in Gui Zhi Decoction and Gui Zhi Jia Ge Gen Decoction, where “stiffness in the neck” is a primary manifestation.
In the “Zheng Zhi Zhun Sheng,” it is recorded, “This is not a Gui Zhi syndrome, but belongs to water retention,” indicating that the stiffness in the neck is related to water retention. Second, it aims to harmonize the Ying. The removal of Gui Zhi from Gui Zhi Decoction does not diminish its ability to harmonize the Ying. This syndrome, after sweating and purging, presents with “no sweating, difficulty in urination,” indicating insufficient body fluids. After removing Gui Zhi, ginger and jujube nourish the spleen and stomach, protecting the source of body fluids, while Shao Yao and Gan Cao (Licorice) harmonize and generate fluids.
It can be seen that this syndrome is a variant of Gui Zhi Decoction, and the name “remove Gui” emphasizes the differentiation from Gui Zhi syndrome. The efficacy of this formula lies in Shao Yao rather than Gui Zhi, and the name “Ling Shao Zhu Gan Decoction” corresponds with “Ling Gui Zhu Gan Decoction,” highlighting the efficacy of promoting water metabolism, which aligns more closely with the pathogenesis of internal water retention.
Pathogenesis of the Formula and Syndrome
“Water retention internally” is the widely recognized pathogenesis of the “Ling Shao Zhu Gan Decoction” syndrome, but the reasons for water retention remain a topic of debate, with four main interpretations: ① Bladder Qi transformation dysfunction. Ke Qin believes that this syndrome involves “water and Qi condensing in the heart area,” yet the root of the disease lies in the heart area while the pathogenesis is in the bladder, leading to dysfunction of bladder Qi transformation, difficulty in urination, and internal water retention. ② Yang stagnation leading to water retention. Wang Fei from Beijing University of Chinese Medicine and others believe this syndrome is due to unresolved exterior syndrome, causing blockage of the pores, thus preventing fluids from being released, leading to water retention on the exterior (“Exploring the Pathogenesis of Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Decoction from the Perspective of Transmission Law,” “Global Traditional Chinese Medicine,” 2018, Issue 5). ③ Spleen failure in transportation. Chen Xiuyuan explains that “this is due to evil invading the spleen, causing it to lose its transport function, leading to the bladder being unable to transform and release fluids, and the San Jiao not functioning to drain fluids.” ④ Insufficient body fluids leading to water retention. Both Fang Youzhi and Xu Dachun point out that “this syndrome is due to the loss of body fluids leading to water retention,” but they do not further explain how insufficient body fluids lead to water retention.
This formula belongs to a variant of Tai Yang disease, and the process of disease change is complex, with the formation of water retention not being due to a single cause. The above viewpoints are partial explanations for the causes of “water retention internally.” Bai Changchuan synthesizes the strengths of various schools, systematically explaining the pathogenesis of this formula as: insufficient body fluids, damage to spleen Yin, failure in transportation, and internal water retention. This syndrome presents with no sweating after sweating and purging, indicating damage to body fluids. The “Su Wen: Reverse Regulation” states, “Water flows along the body fluids,” indicating that insufficient body fluids can lead to water retention, similar to insufficient rainfall, where even if the riverbed is clear, the flow of water is still sluggish. The spleen is the hub for the transformation of body fluids, dispersing them to the lungs above and the bladder below. Sweating and purging damage body fluids, leading to damage to spleen Yin and failure in transportation, resulting in water retention. When water is retained in the neck and shoulder muscles, it leads to “still stiffness in the head and neck, fever,” and when retained in the heart area, it presents as “fullness and slight pain in the heart area,” and when retained in the bladder, it results in “difficulty in urination.”
Efficacy: Harmonizing Yin and Promoting Water Metabolism
Based on the above pathogenesis, Bai Changchuan believes that the efficacy of Ling Shao Zhu Gan Decoction can be summarized as “Harmonizing Yin and Promoting Water Metabolism.” “Harmonizing” encompasses multiple meanings such as harmony, adjustment, moderation, and unification. “Harmonizing Yin and Promoting Water Metabolism” refers to the method of replenishing Yin fluids, adjusting the relationship between Yin and Yang, and promoting the harmonious union of Yin and Yang through peaceful and harmonious means, thereby facilitating the smooth flow of body fluids.
Ling Shao Zhu Gan Decoction is a typical example of “Harmonizing Yin and Promoting Water Metabolism,” corresponding to the “Warming Yang and Transforming Water” method of Ling Gui Zhu Gan Decoction. Ling Gui Gan Cao Decoction can be viewed as Gui Zhi Gan Cao Decoction with the addition of Ling and Zhu, while Ling Shao Zhu Gan Decoction can be seen as Shao Yao Gan Cao Decoction with the addition of Ling and Zhu. Promoting water metabolism is a common point between the two, with the key being that both have the commonly used combination for treating water retention—Fu Ling (Poria) and Bai Zhu (White Atractylodes). The combination of Gui Zhi and Shao Yao in Gui Zhi Decoction reflects the opposition and unity of Yin and Yang. Gui Zhi Gan Cao Decoction and Shao Yao Gan Cao Decoction both derive from Gui Zhi Decoction. The former, with its acrid and sweet properties, transforms Yang, combining with Ling and Zhu to form Ling Gui Zhu Gan Decoction, which embodies the method of “Warming Yang and Transforming Water,” later seen in Ling Zhu class formulas; the latter, with its sour and sweet properties, harmonizes Yin and preserves body fluids, combining with Ling and Zhu to form Ling Shao Zhu Gan Decoction, which embodies the method of “Harmonizing Yin and Promoting Water Metabolism,” and is subsequently applied in Ling Shao class formulas. Among these, Shao Yao is the key to harmonizing Yin and promoting water metabolism, which will be discussed in detail in the subsequent herbal-syndrome differentiation.
Differentiation of Similar Formulas and Herbal-Syndrome Differentiation
The differentiation of similar formulas is based on changes in symptoms that arise from the main syndrome, leading to modifications of the primary formula. The formula is derived from the method, which is established according to the syndrome, with the pathogenesis being the core of differentiation. The treatment methods of similar formulas are alike, corresponding to similar pathogenesis. Modern physicians recognize pathogenesis from different angles, such as pathological factors, location, and nature of the disease.
Water retention internally is a pathogenesis at the level of pathological factors, while there are also distinctions in location and properties. Dampness accumulates as water, and water retained becomes drink, which condenses into phlegm; phlegm, drink, and dampness are all forms of water Qi, with diverse symptoms. Generally speaking, the water Qi that is insufficient in Yang is pathological, treated with the “Ling Gui” class formulas that warm Yang and transform water, and specific formulas are selected based on the degree and location, such as using “Ling Gui Jiang Gan Decoction” for water retention in the stomach, or “Ling Gui Jujube Gan Decoction” for water retention in the lower jiao that ascends and causes a sensation of impending suffocation. Similarly, the similar formulas of “Ling Shao Zhu Gan Decoction” follow the treatment principle of “Harmonizing Yin and Promoting Water Metabolism” as the framework, with specific similar formulas as the focus, understanding the method from the formula, recognizing the pathogenesis from the method, and integrating symptoms with pathogenesis, refining the pathogenesis, and combining the framework and specifics, achieving a simplification of complexity, thus providing a prescription thought system for the treatment of “insufficient Yin fluids and water Qi as a problem”—formula-method-syndrome-pathogenesis, enhancing the accuracy of differentiation and formula selection.
Similarities Among Similar Formulas
The choice of herbs reflects the specific similarities and differences among similar formulas. The similarities among the similar formulas of Ling Shao Zhu Gan Decoction lie in the use of Fu Ling, Bai Zhu, and Shao Yao, which together embody the principle of harmonizing Yin and promoting water metabolism.
Fu Ling is sweet and bland, strengthens the spleen, promotes water metabolism, and drains dampness. Research has shown that Fu Ling is the most frequently used herb in the treatment of water Qi diseases in the “Jin Kui Yao Lue” (Essential Prescriptions of the Golden Chamber), aside from Gan Cao. The “Shen Nong Ben Cao Jing” states that it “promotes urination.” Zhang Zhongjing utilized Fu Ling’s diuretic properties in many formulas, often used to treat Tai Yang water retention, Yang deficiency with water retention, stomach deficiency with water retention, and Yin injury with water retention.
Bai Zhu eliminates water Qi and tonifies the Qi of the spleen. ① Eliminating water Qi. Phlegm, drink, water, and dampness are different names but share the same quality, all arising from abnormal water metabolism. The “Shen Nong Ben Cao Jing” records that Bai Zhu “is indicated for wind, cold, and dampness obstruction,” while the “Ri Hua Zi Ben Cao” states it “dissolves phlegm and promotes water Qi,” and the “Lei Gong Pao Zhi Yao Xing Jie” states it “eliminates dampness and promotes the water pathway.” Zhang Zhongjing also noted that Bai Zhu can eliminate water Qi. After removing Gui Zhi from the formula, it states, “This is due to Fu Zi and Bai Zhu, which both enter the skin and expel water Qi”; the Zhi Zhu Decoction is also indicated for “water retention syndrome.” ② Tonifying the Qi and Yin of the spleen. The spleen is the hub for water metabolism, and whether its Qi is deficient or its Yin is deficient can lead to abnormal water metabolism. The “Ben Cao Wen Da” records that “raw Bai Zhu contains sweet and moist oils that can nourish spleen Yin, while its warm nature can reach the Yang of the spleen”; the “Ben Cao Bei Yao” states that Bai Zhu “can tonify blood when combined with blood tonics, and tonify Qi when combined with Qi tonics.” The Gui Zhi Fu Zi Qu Bai Zhu Decoction is used for wind-dampness with exterior Yang deficiency, constipation, and spontaneous urination; in this formula, Bai Zhu both tonifies spleen Yin and moistens dryness, while also combining with Fu Zi to warm Yang and expel water Qi.
Shao Yao is the key distinguishing herb of the Ling Shao formula from the Ling Zhu formula, emphasizing the focus on nourishing Yin Qi and regulating blood. ① Nourishing Yin Qi and promoting urination. Sweating and promoting urination are the two main methods for treating water Qi. However, promoting urination can inherently harm Yin. The “Shen Nong Ben Cao Jing” states that Shao Yao “promotes urination,” while Li Dongyuan believes that “Shao Yao can stop various dampness and nourish body fluids, allowing urination to occur naturally,” and Xu Lingtai refers to Shao Yao Gan Cao Decoction as a “pure Yin formula” that can “nourish Yin Qi.” Thus, Shao Yao nourishes body fluids and assists urination, promoting water metabolism without harming Yin, making it suitable for conditions of water Qi due to Yin injury. ② Regulating Ying and nourishing blood. Wei represents Yang, while Ying represents Yin. Shao Yao regulates Ying and nourishes blood, similar to Gui Zhi Decoction. The new Gui Zhi Decoction explains, “The liver governs Ying blood, circulating through the meridians and the entire body; sweating releases the warm Qi from the Ying, leading to dryness and blood stagnation, causing body pain and a slow pulse… Shao Yao clears the dryness of the wood.” Zhang Xichun states that Shao Yao “nourishes blood and activates blood circulation.” Shao Yao enters the blood division to nourish blood and activate circulation; body fluids and blood share the same source. ③ Alleviating pain. The “Shen Nong Ben Cao Jing” states that Shao Yao “is indicated for abdominal pain due to evil Qi” and “stops pain.” “Pain” is a common symptom treated by Ling Shao class formulas, whether in the muscles, joints, or in the heart and abdomen.
Differences Among Similar Formulas
The pathogenesis of the Ling Shao Zhu Gan Decoction is due to sweating damaging body fluids, leading to insufficient spleen Yin and failure in transportation. The use of Shao Yao can still tonify spleen Yin. The “Feng Shi Jin Nang Mi Lu” explains Shao Yao as “inheriting the Yin of heaven and earth… its flavor is thick and its essence is thin, representing Yin, and it guides the meridians of the hands and feet.” It explicitly states that “Bai Shao nourishes spleen Yin.” For example, the Ma Zi Ren Wan formula belongs to the syndrome of “stomach strong and spleen weak,” where excessive heat in the stomach leads to spleen Yin deficiency, using Shao Yao to calm spleen Yin. The “fullness in the heart area” is treated with fresh ginger to descend the water Qi. The “Yao Xing Lun” states that fresh ginger “is indicated for phlegm and water fullness, and descends Qi.” Fresh ginger and jujube are commonly used combinations by Zhang Zhongjing to tonify the spleen and stomach, harmonizing Ying and Wei. The “Ben Cao Si Bian Lu” explains: “Fresh ginger is acrid and yellow, entering the Wei; jujube is sweet and red, entering the Ying. Its ability to enter the Ying is due to the sweet containing acrid, and the sweet is often used to guard, while fresh ginger is often used to promote. When used together, they harmonize Ying and Wei.” The combination of these two herbs, with sweetness and acridity, is the main agent for harmonizing Ying and Wei. Jujube combined with Shao Yao can also regulate Ying and promote water metabolism. Honey-fried Gan Cao is sweet and gentle, tonifying the middle and harmonizing various herbs, while combining with Shao Yao’s sour and sweet properties to nourish Yin and harmonize Bai Zhu’s sweet and warming Qi.
The Dang Gui Shao Yao San is formed by removing Gan Cao, ginger, and jujube from Ling Shao Zhu Gan Decoction, adding Dang Gui, Chuan Xiong, and Ze Xie, focusing on activating blood and promoting water metabolism. “Abdominal pain” is the main symptom, which is due to blood gathering in the uterus during pregnancy, resulting from insufficient liver blood and causing stagnation due to deficiency. Although it does not explicitly state water Qi syndrome, the relationship between body fluids and blood is evident, where blood deficiency and body fluid deficiency lead to water retention, exemplifying the principle that “blood not flowing leads to water retention.” Dang Gui and Chuan Xiong enter the blood division to nourish blood and activate circulation to alleviate pain and promote water metabolism; during pregnancy, there is often heat, thus fresh ginger is removed, and Ze Xie, which is salty and cold, is added to promote water and drain heat; internal heat and dampness do not favor sweetness, hence honey-fried Gan Cao and jujube are removed.
Zhen Wu Decoction consists of Ling, Shao, and Zhu, with the addition of Fu Zi and fresh ginger. The main pathogenesis is kidney Yang deficiency, leading to cold water overflow. In the differentiation of the six meridians, Zhen Wu Decoction belongs to the Shao Yin disease, with the main principle being “the pulse is weak and thin, desiring sleep.” It can be seen that Shao Yin disease is a syndrome of deficiency and cold, where sweating and purging can easily lead to damage to body fluids. Zhen Wu Decoction has the functions of inducing sweating and promoting diuresis, indicating that there is still a deficiency of body fluids. The Fu Zi in the formula treats true cold in the viscera, invigorating Yang Qi. Shao Yao has three functions: first, it nourishes Yin and harmonizes Ying to promote body fluids; second, it alleviates pain; third, it counteracts the dryness and heat of Fu Zi. The combination of Ling and Zhu harmonizes Yin and promotes water metabolism. Fresh ginger assists Fu Zi in warming Yang and dispersing cold water.
Fu Zi Decoction consists of Ling, Shao, and Zhu, with the addition of Fu Zi and Ren Shen. The pathogenesis of this formula is kidney Yang deficiency and internal cold dampness. The “Jiang Xue Yuan Gu Fang Xuan Zhu” refers to it as “a Shao Yin formula for solidifying the foundation and resisting evil.” The use of fresh Fu Zi is doubled, directly entering the Shao Yin and affecting the bones, assisting Yang and dispelling cold, eliminating dampness and alleviating pain; Fu Zi combined with Ren Shen forms the later known Shen Fu Decoction, which has the function of tonifying Qi and raising Yang. Although the “mouth is harmonious” and body fluids are not harmed, the deficiency of original Yang can easily affect the generation and movement of body fluids, and since Fu Zi is drying, it requires the assistance of Shao Yao to preserve body fluids. Ling, Shao, and Zhu are used together to harmonize Yin and promote water metabolism. The only difference between Fu Zi Decoction and Zhen Wu Decoction is the addition of Ren Shen and fresh ginger; the former uses Ren Shen to assist Fu Zi in warming and tonifying true Yang, treating cold dampness due to Yang deficiency, while the latter uses fresh ginger to release the exterior and dispel water, enhancing the power of treating water retention.
Ma Huang Sheng Ma Decoction is quite controversial among the formulas in the “Shang Han Lun.” Bai Changchuan believes its pathogenesis involves internal stagnation of Yang Qi, insufficient body fluids, and water retention, with heat above and cold below. It is composed of the modified versions of Yue Bi Decoction (removing ginger and jujube), Ling Gui Zhu Gan Decoction (removing ginger and jujube), Gan Jiang Ling Zhu Decoction, Ma Huang Decoction (removing apricot kernel), Gui Zhi Decoction (removing ginger and jujube), Bai Hu Decoction (removing polished rice), and Huang Qin Decoction (removing jujube), adding Sheng Ma, Tian Dong, and Wei Rui (Yu Zhu). Among these, the first four formulas are all for treating water Qi, leading to the inference that it involves water retention internally. From the weak and thin pulse after purging, with cold extremities and persistent diarrhea, it can be inferred that the evil Qi has entered the interior, leading to insufficient body fluids, which may be due to water Qi formation.
Huang Yuanyu also believes that this disease, after purging, presents with cold dampness in the middle jiao, which is related to diarrhea and water Qi. Cao Yingfu also believes that Bai Zhu, Gan Jiang, Shao Yao, Gui Zhi, Fu Ling, and Gan Cao can resolve the cold dampness of water. Therefore, Bai Changchuan believes that the use of Ling Shao Zhu Gan Decoction harmonizes Yin and promotes water metabolism, while Yue Bi Decoction generates excessive water Qi, Ling Gui Zhu Gan Decoction warms Yang and promotes water metabolism, and Gan Jiang Ling Zhu Decoction drains dampness while warming cold; Zhi Mu, Wei Rui, and Tian Dong nourish Yin and generate body fluids; Dang Gui nourishes blood; Ma Huang and Sheng Ma disperse stagnant Yang to expel evil; Huang Qin Decoction clears heat above and stops diarrhea. The entire formula uses a variety of herbs in small amounts, encompassing methods for releasing the exterior, clearing heat, promoting water metabolism, warming the middle, and nourishing Yin.
The pathogenesis of Ling Shao Zhu Gan Decoction is characterized by insufficient body fluids, damage to spleen Yin, failure in transportation, and internal water retention, with the formula reflecting the characteristics of “Harmonizing Yin and Promoting Water Metabolism,” which runs through its similar formulas. The application of Ling Shao class formulas is extensive; whenever there is Yin deficiency and water retention, whether in the exterior or interior, upper or lower, cold or heat, Qi or blood, they can be used. Dang Gui Shao Yao San treats blood deficiency and blood stasis, harmonizing Yin and promoting water metabolism for blood-water diseases. Zhen Wu Decoction promotes Yang and warms Yang, facilitating water metabolism without harming Yin, treating Yang deficiency with water overflow and insufficient body fluids. Fu Zi Decoction warms Yang and dispels dampness, warming without drying, used for Shao Yin cold dampness, especially for joint pain. Ma Huang Sheng Ma Decoction integrates methods for releasing the exterior, clearing heat, promoting water metabolism, warming the middle, and nourishing Yin, warming without drying and cooling without being cold, suitable for conditions of heat above and cold below, with insufficient body fluids and water retention. The application of Ling Shao Zhu Gan Decoction and its similar formulas should also be combined with herbal-syndrome differentiation to maximize the efficacy of classical formulas.
(Source: China Traditional Chinese Medicine News; Authors: Zhang Lili, Liaoning University of Traditional Chinese Medicine; Hu Xuyang, Dalian Medical University; Pang Min, Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine)
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