Research On The Academic Thought And Clinical Experience Of Chief Physician Lei Zhongyi In Treating Coronary Heart Disease

Research background:Traditional Chinese Medicine (TCM) is a summary of the Chinese people’s experience in their struggle against diseases with a history of several thousand years, the advance and development of which is related closely with contributions made by the physicians of past dynasties. It was guaranteed by the academic ideas, clinical experience, and technical skills of ancient famous physicians to improve the TCM theory and clinic curative effect. And it was also the key to prolong TCM theory. The important way to keep and develop rapidly TCM is to inherit and explore the experience left by ancient famous physicians.Lei Zhongyi, chief-physician, has been operating clinical research on combination of TCM and western medicine for over50years going with noble medical ethics and skilled medicine art, wealthy knowledge and rich experience in the medical field. He has devoted himself to the scientific and clinical research on cardiovascular diseases in combination of TCM and western medicine and with original view and experience on treatment for angina pectoris (chest discomfort). He insists on TCM theory guiding his clinical work and stresses differentiation in treatment. He developed many effective prescriptions, such as Yangxin Huoxue Decoction, Jiawei Gualou Xiebai Decoction, Danqu Decoction, Xinjining Decoction, Xinshuaibing Decoction, Baihe Zhimu Dihuang Decoction and so on.Angina pectoris refers to obstruction of qi in the chest in TCM. Doctor Lei thinks that patients suffer from the coronary heart diseases are mainly middle-aged and old people because of the disorder of body function, like deficiency of qi, qi stagnation and blood stasis, disorder of movement, blood stasis due to congealing cold, phlegm generating in interior leading to the accumulation of heat and blood stasis. Angina pectoris is a problem of deficiency in fundamental aspect and excess in incidental aspect and crossing of deficiency and excess. Deficiency in fundamental aspect includes symptoms of deficiency of qi, deficiency in both qi and yin, deficiency of yin and yang, while excess in incidental aspect has symptoms of blood stasis, cold accumulation, phlegm turbid, qi stagnation and heat toxin. Doctor Lei started to work on the research of activating blood to resolve stasis early in the1970s, and achieved curative effects in the treatment of angina pectoris with this method. He put forward an idea of stagnation of phlegm and blood which combines the turbid phlegm theory and blood stasis theory together according to the clinic experience. He considered that the idea of disturbing of stagnation of phlegm and blood is the base to treat obstruction of qi in the chest. Both of turbid phlegm and blood stasis can cause diseases. They are not only pathologic results, but also factors causing problems which disturb each other. They played a very important role in improving the occurrence of coronary heart disease. In recent years, with the development and clinical practice of TCM, some patients were found to have symptoms marked by fullness and pain in the chest, burning feeling, upset, irritable, dizziness, restlessness, dysphoria feverish sensation in chest, palms and soles, dry feces, companied with red tongue with sticky coating, etc. Most of them were chronic sickness. Dr. Lei thinks that prolonged disturbing of phlegm and blood stasis will generate toxin caused by accumulation of heat, which lead to disharmony between nutrient and defense, deficiency of qi and blood, failure of zang-fu organs. The vicious circle improves the worsen of coronary heart disease. The idea of disturbing of phlegm and blood stasis coincides with the coronary atherosclerosis and inflammation in modern medicine. It is sure to have significance to prevent the development and worsening of the disease.Purpose of research:1.Summarizing systematically Lei Zhongyi’s academic ideas and over50years’experience on treatment for angina pectoris so as to inherit and develop the precious experience and improve the clinical treatment.2. Improving the prognosis of patients with stable angina pectoris by studying the disturbing of phlegm and blood stasis, deepening the knowledge of differentiation regulation for obstruction of qi in the chest in TCM, strengthening the methods and experience, improving the treatment level and effect to benefit people.Research methods:Part I:Expounding the knowledge of TCM pathogenesis and academic thought for angina pectoris by studying and systematizing his papers, works, cases records and clinic practice.Part Ⅱ:Summing up systematically the academic thought and clinical experience of Lei Zhongyi’s for angina pectorisPart III:Observing the efficacy and safety of Danqu Decoction for stable angina pectoris, Expounding Lei Zhongyi’s theoretical basis against obstruction of qi in the chest caused by turbid phlegm, blood stasis and clinic effect for angina pectoris with method of activating blood to resolve stasis, removing obstruction and phlegm and clearing heat and removing toxin.60cases of stable angina pectoris due to turbid phlegm and blood stasis were randomly divided into treatment and control groups with30ones in each. The cases were selected according to the standard of Guiding Principles for the Clinical Research of TCM New Drugs while diagnosed referring to the Naming and Diagnosis Criteria of Ischemic Heart Disease in western and differentiation in TCM were made by Guiding Principles for the Clinical Research of TCM New Drugs and tutor’s clinical experience. Treatment and dosage:patients in treatment group take Danqu Decoction orally twice a day and200ml each time, while those in control group take Heart-soothing Decoction orally twice a day and200ml each time. The course of both includes4weeks.Observing index:(1) Safety index:heart rate, respiration, blood pressure, routine blood, routine urine, routine feces, liver and kidney function, and harmful events.(2)effective index:TCM syndromes, ECG, blood lipid, blood coagulation, homocysteine, High-sensitivity C-reactive protein. Statistic methods:comparing each group itself and between them before and after the treatment. The measurement data takes’/’tests and count date takes ’χ2’ tests.Results:His academic thought contains ten points:(1) Paying more attention to TCM theory and being good at in using of differentiation;(2)Following the general principle of TCM and laying stress on relation of zang-fu organs;(3) Basing on TCM referring to western medicine and combining the diagnosis with differentiation;(4) Studying and improving classical prescriptions;(5)Thinking etiology and pathogenesis in free use;(6)Proposing the principle of activating blood to resolve stasis in treatment and qi-blood theory;(7)Putting forward the theory of disturbing of phlegm and blood stasis and developed the prescription of Dan Lou;(8)Deepening the knowledge of phlegm and blood stasis and suggesting that phlegm stagnation will generate heat and toxin;(9)Strengthening TCM characteristics and prevention of disease;(10) Considering that reinforcing both of spleen and kidney for coronary angina pectoris.Clinical experience are about four aspects:(1)Research on prescription:①Study on Yang Hong Shan showed a new way suggesting that kidney should be considered when treating heart problems;②Using the prescription only with two or three herbs;③Classical prescription;④Prescriptions made by himself.(2)Administration characteristics:general notifying, keeping balance of yin and yang, regulating both qi and blood, insect drugs are often used, pay special attention to herbs with function of expelling wind, symptoms and signs are both considered in diagnosing.(3)Clinical treatment method:warming yang and benefiting qi, replenishing qi and nourishing yin, replenishing qi and activating blood, activating blood to resolve stasis, promoting blood circulation to remove meridian obstruction, removing phlegm to eliminate obstruction, activating blood circulation to eliminate phlegm,clearing heat and removing toxin.(4)Clinical principles:treatments for angina pectoris, acute myocardial infraction of coronary heart disease, cardiac arrhythmias of coronary heart disease, heart failure of coronary heart disease and cardiovascular neurosis.The clinical results:After four-week’s treatment for angina pectoris with Danqu Decoction, the result showed that the total effective rate is86.67%, ECG effective rate is63.33%, which is better than the result of controlled group, but with no statistical significance. The ceasing and reducing rate of nitroglycerin and effective rate of general syndromes are86.67%. The result is improved clearly in the controlled group, and the differences between the two shows (p<0.05). The symptom of chest pain, oppressed feeling in chest, and palpitation were improved in both groups, while symptom of upset, irritable and dry feces in the group treated with Dan Qu Decoction were improved clearly. The difference between the two groups were obviously (p<0.05). Dark ecchymotic tongue with yellowish and greasy tongue coating (trial group) are obviously improved. The APTT, TT (p<0.05) in treatment group can be distinctively prolonged, and Fib and TG, TC, LDL-C (p<0.05) can be reduced, meanwhile, the hs-CRP, HCY can be lowered notably after treatment. There isn’t any significant change (p>0.05) in liver and kidney functions in both groups, neither is in routine blood, routine urine, routine feces before and after treatment.Conclusion:1. He thinks that obstruction of qi in the chest is a problem of deficiency in fundamental aspect and excess in incidental aspect and phlegm and blood stasis is the important mechanism causing it.2.Dan Qu Decoction has certain effect in treating coronary angina caused by disturb of phlegm, blood stasis which with the function of anticoagulation, lipid-lowering, anti-inflammation, and speckle-stablizing, etc. What’s more, it can improve symptoms to pro vent angina pectoris going worse.The innovative points in the research:1.The idea of disturbing of phlegm and blood stasis which is the main type of obstruction of qi in the chest. The important treatment principles include activating blood and resolve stasis, eliminiating phlegm and obstruction and clearing heat and removing toxin and Dan Qu Decoction was formulated.2. Studying the mechanism of angina pectoris with Chinese herbs and anti-atherosclerosis according to multi-indexes by comprehensively analyzing the effection of Dan Qu Decoction for stable angina pectoris of coronary heart disease.