The Study Of Professor LuoLuLi’ Academic Thoughts And Clinical Scientific Research On Dilated Cardiomyopathy

BackgroundThe clinical experience, academic specialty and thoughts of the old doctor of Traditional Chinese Medicine (TCM) are the essence for the area, which come with their practice and repeated tests for years. They represent the highest level of the practice of traditional Chinese medicine and are also effective ways to become famous traditional Chinese medicine experts. So it is significant to arrange them as well as make them pass on. Professor Luo Luyi is famous expert of TCM in China, he is very experienced in internal medicine of TCM, with unique academic thinkings and methods in cardiovascular diseases. It is valuable to sort and reseach his ideas.Objective:This research aims to summarize and sort professor Luo LuYi’s academic thoughts and clinical experience. New methods and ideas will be put forward based on developing the clinical scientific research which refers to his experiences.Methods:The academic ideas and clinical experiences were analyzed, extracted and summarized by methods of apprentice training from teacher, diagnosis, wards-round, discussion, communication and summarization. At the same time, we continually study the classical theory combining with the practice, using and understanding the teacher’s experience in clinical practice.A randomized and controlled research was carried out to observe and analyse Dilated cardiomyopathy (DCM),which our teacher was good at. The treatment method is in favor of strengthening Dilated cardiomyopathy and the randomized study forward-looking.100cases of Dilated cardiomyopathy were divided into the treatment group and the control group (50each).According to the treatment guidelines for Dilated cardiomyopathy and heart failure, the control group was administrated with the most appropriate drugs.:Cardiac drugs:Digoxin; Diuretics:Hydrochlorothiazide, spironolactone, furosemide; Vasodilators:isosorbide dinitrate; β-blockers:metoprolol; ACE inhibitor: Perindopril. Besides these western medicines in control group, strengthening heart soup was given according treatment in the treatment group (P.O. bid, for4weeks).Composition of strengthening heart soup is composed by astragalus, red ginseng, white atractylodes, baked licorice, angelica, poria, curculigo, epimedium, salvia, pseudo-ginseng, Fa Xia, polygala, semen, placenta, antler, gecko etc. Used for supplement breathe, strengthening vitality and resistance, profiting lung, spleen and kidney and blood circulation.Make the following test before and after the treatment in two groups. UCG (EF, FS), X-ray of frontal chest (cardiothoracic ratio), TCM symptoms integral (palpitations, shortness of breath, fatigue, edema, chest pain, fear of the cold and cold limbs, less urine, asthma), physical signs (heart rate, blood pressure, pulse, respiration, heart murmur, lung breath sounds and rhonchus etc.), tongue (quality, coating, state), pulse condition, six minutes walking distance test, and laboratory testing, such as inflammatory tumor necrosis factor (TNF), brain natriuretic peptide (BNP), hypersensitive c-reactive protein (hs-CRP). All the datas were analyzed by statistical method.Results:The academic ideas of Luo Luyi professor were generally summarized as follows:1. The main classic clinical guidelines are from’Yellow Emperor’s Medicine Classic’ and ’Treatise on Febrile Diseases’, such as using the typhoid six-channel to treat myocarditis;2. Clinical diagnosis of disease emphasized the combine of four diagnostic, especially inspection;3. Regulating spleen and kidney should be used in internal medical diseases.4. Deficiency of the kidney is the basic pathogenesis of coronary artery disease; 5. Treatment of cardio-cerebrovascular disease emphasizes the stasis theory of dispeling phlegm;6. Clinical medication should protect stomach and the spirit. He also is good at using toxic medicine such as aconite, asarum, centipede and scorpion can also be used for persistent ailment;7. He advocates the treatment principle of strengthening body resistance and eliminating evil, prevention and health care.Luo Luyi professor indicates the basic principle of heart disease therapies: strengthening body resistance and eliminating evil, adjust the Yin and Yang, adjust the blood and gas in viscera.Professor Luo Luyi points out that deficiency of the kidney is the basic pathogenesis (?)nary artery disease:heart related to kidney. A deficit of kidney Yang can not warm (?)art. Then the heart can not afford the blood circulation, so stasis emerges. On the (?) hand, kidney Yin deficiency can not nourish the heart, veins are insufficient (?)ation, sluggish blood circulation leads to a disease, then blood stasis is the pathology (?)duct.The treatment of coronary heart disease is nourishing kidney first. When nourishing the kidney, we need to pay attention to partial prosperous, partial failure, cold dampness, the mix of phlegm and blood stasis, then treat respectively with nourishing kidney, supply kidney Yin, warm kidney Yang, keep kidney essence and remove cold, eliminate phlegm, promoting blood circulation. The common pathogenesis of atherosclerosis (stroke) is spleen and kidney deficiency, phlegm stasis resistance pulse. Treatment should remove stasis phlegm. The pills were named as Tong Mai Di Xian Wan.Professor Luo LuYi’s academic origin:he has profound skills of ancient prose, is good at self-study, extensively read, comprehensive knowledge in principle,method and drug prescription. His main bibliography which have influences includes:Principle:’The Book of YIJING’,The medical classic of the Yellow Emperor’; Method:’Treatise on Febrile Diseases’,’Synopsis of Golden Chamber’; Prescription’Shen Nong’s herbal classic’,’Compendium of Materia Medica’ Luo Luyi professor was influenced by the following physicians:Zhang Zhongjing (principle,method. and drug prescription); Zhang Jingyue (good at nourishing the kidney); Zhu Danxi (phlegm and blood theory, six stasis theory); Li Gao (Spleen and Stomache theory); Li Zhenhua (emphasis on academic ideas of Spleen and Stomache); Zhao Qingli (treatise on febrile diseases); Zhou Zhongying (inspection).Luo Luyi professor is good at inspection diagnosis which includes mental state, the color and the Xiaji. The rise and fall (the physiological and pathological conditions) can be speculated by inspection diagnosis. Heart leads the blood circulation of the whole body. Because blood runs on human body, blood flowing can be speculated in the inspection. The Xiaji inspection belongs to local inspection, is part of the facial inspection, widely used in clinical cardiac diagnosis and treatment and prognosis speculation.Menstruation generates on the basis of kidney-TianGui-ChongRen-BaoGongZhou. Philtrum inspection diagnosis is applied to determine gynecological diseases (Yin and Yang, cold and hot, diagnosis and treatment based on an overall analysis of the illness and the patient’s condition). disease can be treated with strengthening the spleen, warming the kidney Yang and regulating Chong-Ren.The results of clinical trials show:1. On the point that combination therapy group improving clinical symptoms:the independent sample t-test was used to compare the TCM symptoms of these two groups. After treatment, there is obvious difference in the heart palpitations, shortness of breath, fatigue, surface floating limb swelling, chest pain, chills, asthma and other points (P values are to0.0001) between these two groups. FromP<0.01, we can see for the treatment group, the improvement of traditional Chinese medicine in symptom score was more obvious when comparing with the control group.2. Clinical comparison of the total effect of the two groups:the treatment group reached89.36%while the control group reached70%. Chi-square test was used to compare the efficacy of cardiac function before and after treatment. After comparison, the total effective of Chinese and Western medicine group is higher than Western medicine alone, X2=6.74,*P<0.01, it states that significant difference were existed.3. We used independent samples t-test to analyze the inflammatory cytokines TNF of two groups after treatment. From P=0.0001,P<0.01, we can see significant differences were existed, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce inflammatory cytokines TNF.4. Independent samples t-test was used to analyze the BNP of two groups after treatment. From P=0.0001.P<0.01, we can see significant differences were existed, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce BNP.5. Independent samples t-test was used to analyze the echocardiography change of two groups after treatment (P were0.0001,0.0003,0.0001,and0.0001). FromP<0.01, we can see significant differences were existed, illustrating in comparison with western medicine,(?)rative medicine group can reduce LVESd and LVEDd and has more significant effect (?)ncreasing LVEF and FS. That means it can significantly improve the patient’s systolic (?)iastolic function, so the expansion of the heart decreased.6. We also used independent samples t-test to analyze the cardiothoracic ratio of two (?)s after treatment. From P=0.0001,P<0.01, we can included there were obvious (?)rence, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce cardiothoracic ratio.7. Independent samples t-test was used to analyze the six-minute walk distance of two groups after treatment. From P=0.0001,P<0.01, we can included there were obvious difference, indicating that in comparison with the group with western medicine, integrative medicine group can significantly improve the patient’s exercise tolerance, indirectly reflecting the improvement in cardiac function.Conclusion1. In this study, academic thinking and clinical experience of Luo Luyi professor were summarized and organized in a comprehensive way. Luo Luyi professor’s many clinical experiences are practical and effective. His clinical experiences are practical, effective and valuable.2. The clinical research shows that the application of Pei Yuan Gu Ben Qiang Xin method is quite effective for on expansionary cardiomyopathy. And adding TCM differential treatment can significantly improve the clinical symptoms; plusing TCM differential treatment has a significant effect on reducing expansion of the heart, which has certain meaning; adding TCM differential treatment can significantly improve the cardiac function, patient endurance and quality of life; plusing TCM differential treatment can aslo reduce the side effects of western medicine; adding TCM differential treatment may have a relationship with inflammatory cytokines which produced in the process of reducing the heart disease, and it is worthy of further study.