| Objective:The author was very lucky to become a academic thoughts heir of the fifth national famous doctor of old Chinese medicine experts, and inherited the national famous old TCM professor Dingshui Meng, and honored to become a student of professor Fusheng Zhou who worked in guangzhou university of Chinese medicine. With the careful guidance of professor Zhou. I has learned mainly from the academic origins of professor Meng Dingshui, and put coronary heart disease as main research direction.I began to learn from the professor Meng’s inherited traceabilited, academic thoughts of treating coronary heart disease (CHD). In order to comprehensively and systemly pack up professor Meng’s about the etiology and pathogenesis of coronary heart disease " five viscera correlation dialectical view", and the pathogenesis theory of coronary heart disease (CHD) "no deficiency no disease", "no stasis no disease", and the treatment theory of "supplement Qi and lift Yang for activating blood circuration ", and the academic thoughts characteristics and clinical experience of professor Meng’s differentiation treatment of coronary heart disease and drug characteristics. Affected by the academic thought of professor Meng, in recent years, the author was mainly engaged in research and discussion in the theory of coronary heart disease of "supplement Qi and lift Yang for activating blood circuration",and apply it into the clinical practice for the treatment of coronary heart disease (CHD). And respectively from the document arrangement, clinical curative effect evaluation and mechanism of coronary heart disease to study, in order to further enrich and develop TCM etiolotgy and the pathogenesis of coronary heart disease and the theory connotation of syndrome differentiation and treatment.Coronary atherosclerotic heart disease simple called as coronary heart disease (CHD), refering to coronary atherosclerosis (AS) and coronary vascular stenosis or occlusion, leading to myocardial ischemia and hypoxia caused by heart disease. Coronary heart disease (CHD) is a kind of caused by the combination of genetic factors and environmental factors of complex diseases, has now become the primary cause of death and disability worldwide . About the pathogenesis of coronary heart disease (CHD), domestic and foreign scholars think that is mainly related to vascular endothelial dysfunction, platelet activation, inflammation, plate fracture, thrombosis and the lipid metabolism disorders. The therapeutic method of coronary heart disease in modern medicine is mainly drug therapy and revascularization (including PCI and CABG), although great progress has been made, but there are also many unsoivable problems in the methods of interventional treatment at present, such as the problem of restenosis after interventional, and multivessel coronary microvascular lesions diffuse lesions that can’t implant stents, and there are many patients cannot achieve full reascularization and affect the prognosis of patients. Chinese medicine treatment of coronary heart disease mainly for many parts, multiple targets and dual regulation, etc,and the clinical curative effect is distinct, has incomparable advantage of modern medicine, at present has been aroused widespread concern and attention in the medicine communitity.This research is on the basis of the previous clinical research work, by using random, blind, placebo controlled study method, in order to prove that "supplement Qi and lift Yang for activating blood circuration" of Added Dange-zhitong Decoction to treat coronary heart disease stable angina is absolutely efficacy and safety. After the successful copying animal models by artificial made, we observed this drug for treating in the acute myocardial infarction of Qi deficiency blood stasis rats model, the influence of plasma ET and NO and the edge area of acute myocardial infarction, ischemic myocardial microvascular newborn influence, from a deeper research of Chinese medicine by the mechanism of the treatment of coronary heart disease, for "supplement Qi and lift Yang for activating blood circuration" of Dange-zhitong Decoction in treating of coronary heart disease (CHD) combined with Chinese traditional medicine modern pathophysiological mechanism provides reliable theoretical basis. At the same time also to further the study of traditional Chinese medicine (TCM) for " supplement Qi and lift Yang for activating blood circuration" and solution experimental evidence for the treatment of coronary heart disease to provide more powerful.Methods:This research was divided into two parts,the clinical research and experimental research1. Clinical reseach methods:64 cases of the coronary heart disease stable angina patients of qi deficiency blood stasis which meet the inclusion criteria, were randomly divided into the treatment group and control group (1:1), which 32 cases in each group, the patients in the treatment group were treated by Added Dange-zhitong Decoction,while the control group were treated by placebo.By using randomized, blinded, placebo-controlled clinical studies, we mainly from the clinical symptoms of angina and TCM syndrome score, Seattle Angina Questionnaire scale, the frequency and duration of angina attacks, nitroglycerin dose to patients, serum lipid levels, serum Hs-CRP, and hemorheology indices of the inpatients, evaluated the clinical curative effect of Added Dange-zhitong Decoction, and observed thr therapy for 4 weeks, followed up for 6 months.2. Experimental reseach:We haved copied the acute myocardial infarction model rats by ligation of the left anterior descending coronary artery, and the rats treated with Added Dange-zhitong decoction. We established the model and the control group. The plasma NO and ET level in the rats was observed in each group. By H. E dyeing, the pathological changes in ischemic myocardium was observed in the opitical microscope. By using immunohistochemistry, the endothelial cells(microvascular number) and the microvascular density in ischemic myocardium were observed.Results:1. Clinical reseach:To compared with the control group after treatment, there was significant difference in the clinical efficacy of angina between which in the two groups (P<0.05). The TCM symptom score in the trearment group were significantly decreased than that of the control group. To compared with control group, the frequency and duration of angina attacks, the nitroglycerin dose in the treatment group were significantly reduced (P<0.05).And there was significant difference in the lipid of levels, Serum Hs-CRP and hemorheological index in the patients after treated between which in the two groups (P<0.05).2. Experimental research:To compared with the model group, the plasma NO levels of the rats in each group was significantly higher than that of the model group. The angiogenesis is not obvious in the sham group. There was a small amount of angiogenesis in the model group, and There were many angiogenesis in the Qishen-yiqi pills group and the Added Dange-zhitong decoction group. To compared with the sham group,The endothelial cells(microvascular number) and the microvascular density in ischemic myocardium were significantly increased in the model group, Qishen-yiqi pills group and Added Dange-zhitong decoction group (P<0.05). To compared with the model group, The endothelial cells (microvascular number) and the microvascular density in ischemic myocardium were significantly increased in the Qishen-yiqi pills group and the Added Dange-zhitong decoction group (P<0.05). To compared with the Qishen-yiqi pills group, there was no significantly differance (P>0.05).Conclusion:1. Clinical research:The clinical efficacy in patients with coronary heart disease can be improved by treating with Added Dange-zhitong decoction(P<0.05). And the TCM symptom score can be significantly reduced, the frequency and duration of angina pectoris can be significantly decreased, the nitroglycerin dose can be significantly lowered. The lipid of LDL-C levels, serum Hs-CRP and blood hemorheological index can be significantly cut down.2.Experimental research:The plasma NO levels can be increased and the plasma ET levels can be reduced significantly in the model rats by treating with Added Dange-zhitong decoction. And the myocardial ischemia neovascularization in acute myocardial infarct periphery can be promoted, and the endothelial cells (microvascular number) and the microvascular density in ischemic myocardium were significantly increased. There was a good protective effect to acute mycardial ischemic by treating with Added Dange-zhitong decoction. |
