| ObjectCoronary atherosclerotic heart disease, also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium, causing myocardial ischemia and anoxia. With the improvement of living standard and changes of living style, the morbidity of coronary atherosclerotic heart disease is increasing annually and the patient thereof become younger in average age. As a result, it is severely threatening the people's life and health. Coronary heart disease angina belongs to the field of chest obstruction and cardiodynia in traditional Chinese medicine. The TCM treats coronary atherosclerotic heart disease from the perspective of an organic whole, and it is with unique features and effective. My tutor, Professor Hua Mingzhen has engaged in TCM clinical work for more than five decades and she is very experienced in TCM internal research and work. She has also made great achievements in the differential treatment of chest obstruction. Inheriting and developing my tutor's academic thoughts and experience is an important part of my study. Meanwhile, it is also hoped new thought and methods will be proposed based on my tutor's achievements, offering a more creative and feasible method for treating clinical chest obstruction.Research Methods and Research Contents1. Theory OriginChest obstruction had different names in ancient China, namely cardiac pain, heart obstruction, pulse obstruction, sudden precordial pain, precordial pain, angina pectoris,etc., With the development of TCM, the different names tends to become unique and it has beenmade a consensus that it is called "chest stuffiness and pains" in TCM. Since warring state period, Qin Dynasty, Han Dynasty, Jin Dynasty, Sui Dynasty, Tang Dynasty, Song Dynasty, Jin Dynasty, Yuan Dynasty to Ming and Qing Dynasty, there were statements on chest obstruction from the perspective of its etiology and pathogenesis, clinic symptom, therapy and formula, differential diagnosis and disease prognosis. The aforementioned statements has made solid TCM theory foundation and accumulated affluent clinical experiences.2. Pro. Hua Mingzhen's Understanding on Chest Stuffiness and PainsPro. Hua Mingzhen holds that heart deficient is usually caused by insufficiency of natural endowment, exogenous pathogenic factors, drinking and eating disorder, visceral deficiency, sorrow, fear, depression and melancholy, as well as being influenced by other visceral organs. The disease occurs in heart, but it is closely related to the imbalance of liver, spleen and kidney functions. The treatment of the disease shall focus on the whole, combine TCM and western medicine as well as disease and symptom. To treat chest obstruction should not only focus on heart, but to regulate liver, strengthen spleen, reinforce kidney, activate blood, promote flow of qi, reduce phlegm and release excessive turbid as per its etiology and pathogenesis. Moreover, more attention shall be paid to the prevention and recuperation of the disease, mutual interaction of treatment and recuperation, combination between prevention and treatment.3. Pro. Hua Mingzhen's Academic Thoughts on Chest Obstruction Treatment3.1 Treatment Must Originate from Yin and YangYin and yang are terms of Chinese ancient philosophy, and they penetrate to every aspect of TCM theory system. Pro. Hua has incorporated yin and yang theory in diagnosis, differentiation and treatment. To cure the disease, she aims to adjust the uneven relation and resume the balance between yin and yang.3.2 Pay Attention to Differentiation of Five Zang, particularly to Liver, Spleen and KdneyTheory of viscera, a study to the physical function, pathological change and interrelations of viscera organs, is the core of basic theory of TCM. In the treatment of clinical chest obstruction, besides the heart, my tutor also paid much attention to the relation between heart and other viscera organs. She holds that heart is closely related to liver, spleen and kidney.3.3 Pay Attention to Qi and Blood Theory, Lay Emphasis on Adjusting Qi and BloodQi and blood are the basic substance of the body. My tutor holds that the etiology and pathogenesis of chest obstruction is caused by the disharmony between qi and blood, thus obstructing heart vessel. To treat disease from the root, the key point is to dredge qi and blood, making qi and blood in harmony and unblocked, as a result, the imbalanced yin and yang will be resumed.3.4 Pay Attention to Adjusting Qi and OrgansThe rising, falling, input and output of qi is the basic of human life as well as an important part to balance various physical functions. My tutor regulates qi-activity and corrects qi-activity abnormities by regulating liver, strengthening spleen, reinforcing kidney, releasing lungs, invigorating pulse-beat, nourishing blood, promoting salivation, reduceing phlegm. Thus the qi-activity will be in a harmonious condition, the qi and blood will circulate and the heart and pulse will be unobstructed.3.5 Pay Attention to PhlegmPro. Hua Mingzhen holds that phlegm is the key basis for chest obstruction, to some extent blood stasis is derived from phlegm. The phlegm begets blood stasis. In the treatment of chest obstruction, curing "phlegm" goes through the whole process of treatment. In some phases of treating chest obstruction, laying more emphasis on treating phlegm other than blood stasis will get a more curative effect. Laying more emphasis on resolving phlegm or curing phlegm and blood stasis at the same time is an effective experience in the treatment of chest obstruction.3.6 Pay Attention to Disease PreventionMy tutor not only treat the occurred disease, but also pay more attention to prevention. She advocates regulating mental states, doing more exercises and holding a regular life to nourish qi and blood and strengthen the vital energy. In the treatment, she advocates early diagnosis and treatment to prevent the deterioration of the disease.4. Summary of Pro. Hua Mingzhen's Clinical Experience4.1 Following Concept of Holism, Lay Emphasis on Interconnection of Zang-fu VisceraPro. Hua emphasizes that the treatment of chest obstruction shall not only focus on heart treatment. The treatment shall be done as per the five viscera generation and restriction and zang-fu theory under the discipline of holism according to natural environment, climate change, individual physical condition.4.2 Lay Emphasis on Yang EnergyThe heart is pushed by yang energy, which maintains the life of human beings and keeps life on. In chest obstruction treatment, my tutor always lays emphasis on maintaining the patients' yang energy. She usually use monkshood, cassia twig and allium macrostemon to warm and activate yang. Thus the yang energy will be affluent and spread in the body, dispelling the cold-pathogen and phlegm and retained fluid in the body. The recovery of heart-yang will warm heart and pulse.4.3 Strengthening Spleen and Eliminating Dampness, Treating Disease from SpleenSpleen governs movement and transformation. If the spleen is well-functioned in transforming dampness, the water liquid will not accumulated abnormally in the body. If the transforming function is weakened, the water liquid will be accumulated in the body, causing such pathological products as dampness, water and phlegm, which are the "yin evil". Accordingly, in the treatment such medicines as tuckahoe, atractylodes, prepared pinellia tuber and dried orange peel are usually used to strengthen spleen and regulate qi-flowing for eliminating phlegm. If the spleen is strengthened and the phlegm eliminated, the yin evil will be dispelled and the qi and pulse will be unblocked.4.4 Relief liver for smooth Qi, Treating Disease from LiverPro. Hua points out that the masculine and tender features of the liver are mainly reflected by its discharging function. The occurrence of chest obstruction is also often reflected in the liver's function of discharging. Blood is the base of liver, which will promote the energy of qi. If the liver's discharging function is normal, the qi in the body will be unblocked, as well as the transformation of blood and body fluid. If the liver's discharging function is abnormal, the qi will be blocked, and the blood and blood vessel will be clogged. If the liver is not well-functioned, it will also influence the spleen, which will cause turbid phlegm. In the treatment of chest obstruction, Pro. Hua always observes and unchoke the patients'liver energy. She prefers such herbs as Chinese thorowax root, radix curcumae, rhizoma typhonii, fructus aurantii to regulate liver energy to soothe mood, tender qi and blood and strengthen spleen function. Thus the heart and blood will be robust.4.5 Reinforcing Kidney and Strengthening Resistance, Treating Disease from KidneyKidney is the congenital foundation and root of the vigour. Kidney yin and kidney yang is the basis of the yin and yang of the body, it is also the motive power of human activities. Heart yin and heart yang originate from kidney yin and kidney yang. In the treatment, my tutor often considers to nourish kidney, and applies barbary wolfberry fruit, pulp of cornus, polygonatum,rehmannia glutinosa in the prescription to nourish kidney yin and raise energy. Fructus psoraleae, epimedium, rhizoma curculiginis and cistanche will warm kidney yang and regulate the kidney function, making the treatment more effective.4.6 Make Flexible Prescription and Internal and External Treatment at the Same Time; Rescue the Emergent, Endangered and Severe Patients by Providing Different Prescriptions.Pro. Hua Mingzhen make flexible use of the doses, and puts equal importance to desperate and light remedies. As per actual practices she created new prescriptions, combing soup and paste, offering internal and external treatments at the same time. In curing the emergent, endangered and severe patients, Pro. Hua adopts different treating methods such as CTM injection or drip injection, offering medicine under tongue, through nasal feeding, rectum feeding, inhalation feeding and oral taking to save the lives of the severe patients.4.7 Contribute to Peace of Mind or Inner Tranquility, Lay Emphasis on Daily Life NursingMy tutor holds that chest obstruction is a lifestyle disease, that is to say it is caused by unhealthy lifestyle or habits. In the diagnosis, she usually inquire the patients'living habits, eating and drinking habits, bad habits, occupation and mind condition. Besides asking the patients to take medicines, she also ask them to regulate diet and daily life, do moderate exercises, give up unhealthy habits, foster hobbies and interests and ease negative emotion. The regulation of patients'living habit will help a lot to cure the disease.5.The Clinical Research of Coronary Heart Disease (Stable Angina Pectoris) Treatment by Trichosanthes, Pinellia and Tuckahoe Soup5.1 Diagnostic Criteria5.1.1 Diagnostic Criteria of Western Medicine. The coronary heart disease or old myocardial infarction confirmed by coronary angiogram or coronary artery CT, with reference to Diagnosis and Treatment Guide for Chronic Stable Angina regulated by Chinese Society of Cardiovascular Diseases of Chinese Medical Association and editorial board of Chinese Journal of Cardiology in 2007 as well as the diagnosis criteria of coronary heart disease regulated in Internal Medicine, the stable and effort angina is chosen as the observation object.5.1.2 Differentiation Criteria of TCM. With reference to Clinical Guideline of New Drugs for Traditional Chinese Medicine regulated by State Drug Administration in 2002, and Chinese Internal Medicine, the programmed teaching material for national traditional Chinese medicine colleges, as well as tutor's clinical experience.5.2 Choose of Clinical Case There are totally 70 cases matching the condition, all of them are from the clinic and ward of Department of Cardiology, Jinan TCM from Dec,2013 to Mar.2015. The cases are divided into test group (35 cases) and control group (35 cases) by random number table method. As per statistical analysis, there is no significant difference between the two groups in gender, age, course of disease, TCM symptom score, TCM symptom disease classification, tongue body and tongue coating, angina pectoris grade, angina symptom classification, complication composition and the quantities received PCI(P>0.05).5.3 Treatment MethodThe two groups are both treated based on the routine treatment of western medicine. According to the patients'conditions choose the medicines such as platelet aggregation inhibitor, nitrate preparations, calcium ion antagonist, beta-adrenoceptor antagonist and statins drugs. On the basis of regular western medicines, the test group took trichosanthes, pinellia and tuckahoe soup (Ingredients include Trichosanthes 10g, allium macrostemon 10g, pinellia 10g, tuckahoe 10g, radix curcumae 10g, notoginseng powder 3g, immature bitter orange 10g, mangnolia officinalis 10g, dangshen 15g, red paeony root 15g, dried tangerine peel12g, cardamom 10g, liquorice 6g)as a basic oral prescription, and the dose will be added or reduced as per the patients'disease condition. The medicine is processed into full ingredients formula granule by Beijing Kangrentang Pharmaceutical co., ltd. Every time the medicine is fully dissolved with 200ml 100? water, and it is taken after shaking when the water is not too hot. The medicine will be taken two times everyday. When the angina occurs, the patient will be given 0.5mg nitroglycerin placing under the patients'tongue. For the patients who suffers from high blood pressure, diabetes and other diseases, continue to use the western medicine for the disease. The patients' medicines previously taken was stopped seven days before the trial.5.4 Observation ContentsMake the following observations to the patients before the treatment and four weeks after the treatment, including the clinic symptom improvement before and after the treatment, curative effect of angina, cardiograph change, the use of nitroglycerin, coagulation index change, blood fat change, the data change of hypersensitive c-reactive protein (hs-crp) and homocysteine (HCY), as well as security observation to blood, urinalysis and stool routine, liver function test and kidney function test.Research Result1.The comprehensive curative effect of the two groups. The effective rate of the test group is 88.57%, the effective rate of the control group is 65.71%. The difference between the two groups is of statistics significance (P<0.05).2.The comparison of TCM symptom improvement between the two groups. After treatment, the symptom score of the two groups was improved. According to statistical analysis, the difference between the two groups is of statistics significance (P<0.05). There is significant difference or dramatic difference (P<0.05 or P<0.01) on the comparison of symptom score after treatment between the two groups. There are more changes for the test group on chest pain, chest distress, palpitation, physical tiredness, weakness, abdominal distention, anorexia and vomiting than that of control group. According to statistical analysis, there is significant difference or dramatic difference (P<0.05 or P<0.01) between the two groups.3.The comparison of angina curative effect between the two groups after treatment. The overall effective rate of the test group is 91.43%, the overall effective rate of the control group is 85.71%. The difference between the two groups is of no statistics significance (P>0.05).4.The comparison of cardiograph curative effect between the two groups after treatment. The overall effective rate of the test group is 77.14%, the overall effective rate of the control group is 71.43%. The difference between the two groups is of no statistics significance (P>0.05).5.The comparison of the use of nitroglycerin between the two groups after treatment. The stopping rate of nitroglycerin of test group is 88.57%, the control group is 71.43%. The difference between the two groups is of statistics significance (P<0.05).6.The comparison of the coagulation index between the two groups after treatment. For the test group, the activated partial thromboplastin time of active partial is obviously extended, and there is an dramatic difference (P<0.01) before and after the treatment. After treatment, the thrombin time of test group is obviously extended, and there is a dramatic difference (P<0.05) before and after the treatment. After treatment, the content of fibrinogen of the test group falls down dramatically and there is an dramatic difference (P<0.01) before and after the treatment. After treatment, the thrombin time is obviously extended, and there is a dramatic difference (P<0.05) before and after the treatment. After treatment, the FIB content of control group falls down, and there is an dramatic difference (P<0.05) before and after the treatment. As per the comparison between the two groups after treatment, the FIB content of test group declines more dramatically than the control group, and there is a dramatic difference (P<0.01) between the two groups.7. The comparison of the blood fat index between the two groups after treatment. After treatment, the triglyceride, total cholesterol and low density lipoprotein cholesterin of the test group decreased, and the high density lipoprotein cholesterin thereof increased, there is a significant or dramatic difference before and after the treatment (P<0.05 or P<0.01). For the control group, after treatment the TC, LDL-C decreased, there is a significant difference before the treatment (P<0.05). As per the comparison between the two groups after treatment, the TC,LDL-C of test group decreased obviously and there is a dramatic difference between the two groups(P<0.01).8.The comparison of the hypersensitive c-reactive protein (hs-crp) and homocysteine (HCY) between the two groups after treatment. For the test group, the hs-CRP,HCY decrease obviously after the treatment, and there is a dramatic difference before and after the treatment. For the control group, even though the hs-CRP,HCY decrease after the treatment, there is no statistical significance (P>0.05). As per the comparison between the two groups after treatment, the hs-CRP,HCY of test group decrease obviously and there is a dramatic difference between the two groups(P<0.01).9.The observation of security index. There are 35 cases for the test group and control group respectively, and blood, urinalysis and stool routine, liver function test and kidney function test were made before and after treatment for all the cases, there is no significant change.ConclusionThis study is based on the theory of "weak spleen causing phlegm, stagnation of qi causing phlegm retention", combining TCM theory and clinical observation, the thesis has discussed the causing of turbid phlegm and its relation with coronary heart disease (chest obstruction), verifying the effectiveness and security of trichosanthes, pinellia and tuckahoe soup stimulated by Pro. Hua to cure coronary heart disease (chest obstruction) of phlegm blocking heart vessel syndrome.To cure coronary heart disease (chest obstruction) of phlegm blocking heart vessel syndrome with trichosanthes, pinellia and tuckahoe soup will relieve the patients'clinical TCM symptoms and reduce their physical pains, promoting their living quality. The test group has achieved better effectiveness than the control group who only relies on western medicines in clinical therapeutic effect, stopping rate of nitroglycerin coagulation indicator, blood fat, fibrinogen, hs-CRP,HCY and other coronary heart disease related dangerous factors, and it is safely applied in clinic.Clinic research and modern pharmacology prove that the trichosanthes, pinellia and tuckahoe soup will cure coronary heart disease (chest obstruction) of phlegm blocking heart vessel syndrome by reducing blood fat, causing anticoagulation and antithrombus, increasing coronary flow, improving heart function, creating antioxidant, controlling inflammation and adjusting immune systems. It is a safe and effective dose for coronary heart disease and worthwhile for further study and expansion. |
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