Academic Ideas Of Professor Cao Yushan And Research On His Clinical Experience Of Diagnosing And Treating Coronary Heart Disease

Coronary heart disease is a commonly and frequently encountered disease that severely harms people’s health world-wide at present. Although modern medicine makes great progress in treating coronary heart disease, prophylaxis and treatment of coronary heart disease is still the difficulty of medicine nowadays for the problems such as side effect and drug resistance of the patient taking medicine longtime. Traditional Chinese Medicine has unique advantage in prophylaxis and treatment of coronary heart disease and it is worth to be study and generalized in clinic.The paper is divided into three parts. Part one is about literature review of diagnosis and treatment of CHD with Traditional Chinese Medicine. It introduces minutely the cognition of name, etiology, pathogenesis and treatments of CHD of the Chinese Medicine scholars in all ages. It also introduces research progress on diagnosis and treatments of CHD of modern Chinese Medicine scholars.Part two introduces the academic ideas and clinical experiences of my teacher in diagnosing and treating CHD in detail. My teacher’s academic ideas can be generalized and summarized in the following eight aspects: diligently learning the Traditional Chinese Medicine classic, laying equal stress on Traditional Chinese Medicine and Western medicine; paying equal attention to differentiation of disease and syndrome; approving the theory that man is an integral part of nature, recuperating in whole under medical treatment; acknowledging the correlation of phlegm stagnation and blood stasis and simultaneously treating them; coordinating Qi and blood, especially attaching importance to supplement Qi; sincerely abiding by old maxim, inheriting and innovating; preventing before disease onset, early treating while feeling ill; specializing in using medicine pair and gaining outstanding curative effect. My teacher thinks that the name of coronary heart disease in Chinese medicine belongs to the domain of obstruction of qi in the chest and heartache. But the concept of obstruction of qi in the chest in Chinese Medicine includes respiratory and digestion system diseases except CHD. He considers the disease causes of CHD in Chinese Medicine are internal emotions damage, inappropriate diet, incongruous labor and rest, oldness and asthenia and exogenous evil invading. He especially emphasizes the function of phlegm and retained fluid and blood stasis. With regard to the pathogenesis of CHD, the teacher thinks that it is the syndrome of asthenia in root and sthenia in branch. Its primary lesion is deficiency of Qi and blood, especially deficiency of Qi. The pulse of heart loses nourishment of Qi and blood, so it pains. He particularly pays attention to the impact of deficiency of pectoral qi on attack of CHD. Its indication lesion is dysfunction of Qi transformation of San jiao. Phlegm and retained fluid and blood stasis block the heart pulse, so it pains. Asthenia and sthenia interplay. The teacher treats CHD sincerely according to the pathogenesis. He unblocks Phlegm and retained fluid and blood stasis and fills up Qi and blood at the same time. He also gives consideration to branch and root. He cures the root of CHD by adjusting and replenishing pectoral qi. The heart blood comes into being by replenishing pectoral qi. The heart pulse is unobstructed by adjusting pectoral qi. He cures the branch of CHD mainly by promoting San jiao circulation. He treats CHD according to the disease causes and remedies phlegm stagnation and blood stasis simultaneously in the course of disease from beginning to end.Part three discusses the clinical research on treating stable angina of CHD with his empirical prescription named Tong guan tang.Objective:By observing the clinical curative effects and safety in treating stable angina pectoris of CHD with Tong guan tang, its mechanism of treating stable angina pectoris of CHD will be discussed. It is aimed at providing a safe and effective method of treating CHD in clinic.Methods:60 patients suffering from angina pectoris of CHD coming from affiliated hospital of Gansu university of Traditional Chinese Medicine was collected, and was divided randomly into treatment group and control group. Every group had 30 patients. Diagnostic criteria of Chinese Medicine and western medicine of CHD consulted international and inland single standard and the tutor’s clinical experiences. Control group was given basic treatments of western medicine, in addition to these, treatment group took Tong guan tang half-hour after a meal, twice a day, and the course of treatment was four weeks. One of the observation targets was security index such as blood routine examination, routine urine test, hepatic and renal function tests and untoward effect. Another index was about curative effect for example the therapeutic effect of angina, improvement on symptoms and traditional Chinese medicine syndrome. Besides, it included some tests for instance electrocardiogram, four items of blood fat, cruor series, hemorheology, Plasma homocysteine and D-dimer. Software SPSS 19.0 was used for analyzing statistic data. All measurement data was showed with mean adding and subtracting standard deviation(x±s). T-test was used for comparison intra-group and among groups commonly. Ranked data used rank test. χ2-test was used for enumeration data. On the contrary, it was used for Fisher exact probability. While P<0.05, it has statistical significance.Results:After four weeks of treatments, (1) as far as the efficacy comparison on relieving angina of the two groups pre-therapy and post-treatment was concerned, prominent effective rate of the treatment group was 63.33%, effective rate was 23.33%, and total effective rate of the treatment group was 86.67%. While prominent effective rate of the control group was 60%, effective rate was 20%, total effective rate of the treatment group was 80%. The comparison on the two groups pre-therapy and post-treatment was done with fourfold table chi-square test and the result was χ2=0.48, P=0.49. According to the standard of α=0.05, there had no statistical significance. So it was thought that there was no distinction about the efficacy comparison on relieving angina of the two groups pre-therapy and post-treatment. (2)As far as the efficacy comparison on the Chinese Medicine symptoms was concerned, the symptoms such as chest distress, chest pain, palpitation, fatigue, spontaneous perspiration and pant of the treatment group after treatments were relieved obviously. And the symptom score declined. On account of the disposal data coming from Chinese Medicine symptoms was ranked data, the difference value of Chinese Medicine symptoms of the two groups pre-therapy and post-treatment was done with independent sample rank sum test and the result was P<0.05. It had statistical significance on difference value of Chinese Medicine symptom score of the two groups pre-therapy and post-treatment. And the mean value of difference value of Chinese Medicine symptoms of the treatment group was greater than the control group. So the curative effect of improvement on Chinese Medicine symptoms of the treatment group was superior to the control group. (3)As far as the efficacy comparison on Traditional Chinese Medicine syndrome of the two groups pre-therapy and post-treatment was concerned, prominent effective rate of the treatment group was 43.33%, effective rate was 40%, total effective rate of the treatment group was 83.33%, while prominent effective rate of the control group was 26.67%, effective rate was 33.33%, total effective rate of the control group was 60%. The comparison on the two groups pre-therapy and post-treatment was done with fourfold table chi-square test and the result was χ2=4.02, P=0.04. According to the standard of α=0.05, there had statistical significance.(4)As far as the efficacy comparison on improvement of electrocardiogram of the two groups pre-therapy and post-treatment was concerned, prominent effective rate of the treatment group was 46.67%, effective rate was 26.67%, and total effective rate of the treatment group was 73.33%. While prominent effective rate of the control group was 26.67%, effective rate was 26.67%, and total effective rate of the control group was 53.33%. The comparison on curative effect of improvement on electrocardiogram of the two groups pre-therapy and post-treatment was done with fourfold table chi-square test and the result was χ2=2.58, P=0.11. According to the standard of a=0.05, there had no statistical significance. So the curative effect of improvement on electrocardiogram of the two groups had no difference. (5) As far as the rate of reduction or withdrawal of isosorbide dinitrate of the two groups pre-therapy and post-treatment was concerned,12 patients of the treatment group stop taking isosorbide dinitrate,14 patients cut the usage amount and the rate of reduction or withdrawal of isosorbide dinitrate was 86.67%. While 7 patients of the control group stop taking isosorbide dinitrate,11 patients cut the usage amount and the rate of reduction or withdrawal of isosorbide dinitrate was 60%. The comparison on the rate of reduction or withdrawal of isosorbide dinitrate of the two groups pre-therapy and post-treatment was done with fourfold table chi-square test and the result was χ2=5.46, P=0.02. According to the standard of α=0.05, there had statistical significance of the two group. And the treatment group exceeded the control group. (6)As far as the curative effect of blood lipid metabolism of the two groups pre-therapy and post-treatment was concerned, TG、TC and LDL-C of the two groups after treatment were evidently decreased compared to prior treatment, and HDL-C was obviously increased. The difference value of blood lipid metabolism of the two groups pre-therapy and post-treatment was done with independent sample t-test and the result was P<0.05. It showed that there was statistical significance. Because the absolute value of difference value of blood lipid metabolism of the treatment group pre-therapy and post-treatment was also greater than the control group, the curative effect of the treatment group was superior to the control group. (7) As far as the comparison of cruor index variation of the two groups pre-therapy and post-treatment was concerned, APTT and TT of the treatment group lengthened evidently, and the level of Fib decreased obviously after treatment. Difference value of cruor index of the two groups pre-therapy and post-treatment was done with independent sample t-test and the result was P<0.05, so there was statistical significance. Because the absolute value of difference value of cruor index of the treatment group pre-therapy and post-treatment was also greater than the control group, the curative effect of the treatment group was superior to the control group. (8)As far as the variation of hemorheology index of the two groups pre-therapy and post-treatment was concerned, the targets of the treatment group such as whole blood viscosity 1, whole blood viscosity 5, whole blood viscosity 30, whole blood viscosity 200, plasma viscosity and red cell assembling index were all decreased obviously after treatment. Difference value of the change of hemorheology index of the two groups pre-therapy and post-treatment was done with independent sample t-test and the result was P<0.05, so there was statistical significance. Because the absolute value of difference value of the variation about hemorheology index of the treatment group pre-therapy and post-treatment was also higher than the control group, the curative effect of the treatment group was superior to the control group. (9) As far as the comparison of the variation of homocysteine and D-dimer of the two groups pre-therapy and post-treatment was concerned, HCY and D-D of the treatment group were all reduced evidently after treatment. Difference value of the level of HCY and D-D of the two groups pre-therapy and post-treatment was done with independent sample t-test and the result was P<0.05. So there was statistical significance. Because the mean value of difference value of HCY and D-D of the treatment group pre-therapy and post-treatment was also greater than the control group, the curative effect of the treatment group was superior to the control group.Conclusion:It shows that the basic treatment of western medicine and Tong guan tang can evidently alleviate the symptoms of angina attack of the patients with coronary heart disease such as chest distress, chest pain, palpitation, pant, fatigue and spontaneous perspiration etc. It can reduce the usage amount of Nitroglycerin, and improve electrocardiogram and lipid metabolism disorders. It can improve the cruor and hemorheology index of the patients. It also can reduce the level of plasma homocysteine and D-dimer of the patients with coronary heart disease. Blood routine examination, routine urine test, hepatic and renal function tests pre-therapy and post-treatment have no change. And there is no untoward effect. It shows that Tong guan tang is effective in treating the type syndrome of deficiency of Qi and blood, phlegm and blood stagnation of coronary heart disease and it is safe and reliable in clinic.