The Study On Experience Of Professor Wang Jie's Treatment On Atrial Fibrillation

Background and ObjectiveAtrial fibrillation(AF)is a common arrhythmia disease.According to a study in 2011 by USA,patients with atrial fibrillation were 2.5 million.And Europe datas in 2012 showed that its prevalence was 1%to 2%,people with age above 80 years had higher rate(5%to 15%).While China's relevant survey was less at present,investigation in 2004 showed that the total prevalence of AF was 0.77%,and about 7.5%in old populations above 80 years.Thus,as the number of old population went up,AF incidence was gradually increasing.What's more,it was an important risk factor of stroke,thromboembolism,and congestive heart failure,and even severely reduced the quality of life and increased hospitalization rates,and was thereby closely related to cardiovascular mortality and all-cause mortality.Therefore,AF has become an important social hygiene issue.However,current treatments including drug,catheter ablation,surgery and other methods can not effectively avoid their own side effects and recurrence of AF,especially for the elderly who have poor physical tolerance and many other diseases.So it's necessary and urgent to explore safe and effective treatments.Traditional Chinese medicine(TCM)is our traditional medicine,and it has comprehensive understanding of diseases with manifestation of palpitation.Before the modern medicine develops so fast,it has been the main medical methods to help patients overcome diseases and thus save countless lives.Moreover,with the rapid development and modernization of TCM,many monomers or active ingredients,and some patent Chinese medicines have been demonstrated to be efficient.Potential action mechanisms have also been discovered and confirmed by experimental and clinical studies.However,the compound preparations have complex and variable drugs and compositions,making themslves difficult to be studied.Therefore,it's advisable and well-founded to explore new method of AF management from TCM.But unfortunately current treatment of AF has not yet achieved satisfactory results.More emphasis should be thereby put on the ancient source of TCM theory,and combination with current clinical practices.Professor Wang has engaged in clinical practice for 31 years.He pays much attention to the theoretical studies of TCM and is good at integrating the ancient theory and prescriptions with modern technology.He is particularly expert in the management of AF.Therefore,this study summarized and analyzed Professor Wang's prescriptions of AF outpatients through "Chinese medicine transmission support platform(v2.5)"(platform)which contains some complex statistical methods like association and entropy clustering analysis,with the purpose of finding out the rules of those prescriptions and the pathogenesis of AF.Then ancient literatures about palpitation were sorted out to explore the source and characteristics of Professor Wang's theory of treating AF and further provide some potential guidances and references for AF management.Methods1 Clinical researchWe collected 39 AF outpatients who all had complete medical history,definite diagnosis and received Professor Wang's TCM treatmment.The number of prescriptions were 244.All cases were collected during 2015.6-2016.12.AF diagnosis and classification criteria,symptom severity assessment and rhythm control evaluation criteria referred to the relevant industry standards.In addition,appropriate inclusion and exclusion criteria were provided.We then followed up all those outpatients for half year to evaluate their changes of symptom,heart rate and rhythm control before and after treatment.Moreover,the recovery rate of sinus rhythm with only 1 prescription was counted.We standardized the symptoms,signs,TCM syndromes,treatment methods,and names of Chinese herbal medicines in all medical records.Two different persons who major in TCM coped with these datas,and then they exchanged and checked each other's results in order to ensure the accuracy and reliability of all datas.Then the symptoms,signs and syndromes of 244 individual cases and medications and prescriptions were analyzed by means of the platform.Moreover,the components and doses of prescriptions that major in regulating ying and wei,heart and kidney were further analyzed.Therefore,from the results of medications and prescriptions analysis,we summarized professor Wang's understanding of the etiology and pathogenesis of AF and further explored his characteristics of AF treatment.2 Source and characteristics of experienceSince palpitation as a traditional Chinese disease didn't have a standardized name in ancient times.We first searched all its ancient names in CNKI and Wanfang databases.Many different names were found in several classical books such as "The Inner Canon of Huangdi" and "Treatise on Febrile and Miscellaneous Diseases".Then we chose and entered "palpitations","startled",and "heartbeat" as the key names into the "Chinese Medical Code"(an ancient Chinese medicine electronic literature system which contains 1156 books).What's more,we further searched "xin che"?"xin xia gu"?"xin dong"?"xin dan dan da dong"?"dan dan" and "ti ti" in the book of "The Inner Canon of Huangdi".Finally,we combined the results of literature and clinical research to explore the source and characteristics of Professor Wang's theory of treating AF.Results1 Clinical researchEfficacy evaluations:all 39 outpatients but 3 ones who were short of half year were followed up.The ventricular rates of 36 patients were all controlled at 85 beats/min or below.According to the 2014 American Atrial Fibrillation Guidance,the target rate was 81%.And those patients' EHRA scores were significantly reduced.As with the rhythm control,13(36%)patients received significant effect,all of them were paroxysmal AF;19(53%)patients received positive effect,including 3 persistent AF patients and 16 paroxysmal AF patients;4(11%)patients received no effect,containing 2 permanent AF patients and 2 paroxysmal AF patients.The rate of restoring sinus rhythm after 1 prescription was 80%among 45 episodes of AF.Symptoms,signs and syndrome distribution:According to the frequency statistics,the most common clinical symptoms and signs of AF(the top 10):palpitation,fatigue,insomnia,lumbago,light red tongue,white tongue moss,fine and wiry pulse,less tongue moss,sweat and red tongue.Through association analysis of those symptoms,we found they were closely related,especially palpitation and fatigue.In addition,the main syndromes were ying wei disorder,heart and kidney dysfunction,qi and yin deficiency,and qi deficiency with water metabolism disorder.Most of those syndromes were existing at the same time.Moreover,by means of association analysis,we found the most common prescription for AF was gui zhi jia long gu mu li tang,and other main drugs were Cornus officinalis Sieb,Achyranthes bidentata Bl,fried Ziziphus jujaba Mill,Astragalus memeranaceus Bge and Codonopsis pilosula Nannf.Based on entropy clustering analysis,we discovered common combinations of two drugs:Poria cocos Wolf,Platycla dusorientalis Franco;Sophora flavescens Ait,Polygonatum sibiricum Red;Ophiopogon japonicus,Equus asinus L;Sophora flavescens,Achyranthes bidentata Bl.Core combinations:Cornus officinalis Sieb,Morinda officinalis How,raw Atractylodes macrocephala Koidz;Salvia miltiorrhiza Bge,Paeonia lactiflora Pall,Dalbergia odorifera T,Carthamus tinctorius L;Uncaria rhyunchophylla Jacks,Lonicera japonica Thund,Curcuma wenyujin Y.H,Leonurus heterophyllus Sweet.Furthermore,223 prescriptions were for regulating ying wei and 107 for heart and kidney.Through association and entropy clustering analysis,we knew the key prescription for regulating ying wei was gui zhi jia long gu mu li tang.The component of professor Wang's prescription was the same to Zhang zhong jing's,but the drug dose ratio slightly changed.While the main prescription for regulating heart and kidney was jiao tai wan.The core combination were Cornus officinalis Sieb,Vinegar Chinemys reevesii shell,Morinda officinalis How and Cornus officinalis Sieb,Morinda officinalis How,Lycium barbarum L.Then based on the entropy clustering analysis,we discovered a new prescription for regulating heart and kidney:Cornus officinalis Sieb,Morinda officinalis How,Lycium barbarum L,Amber powder and Panax notoginseng.2 Source and characteristics of experienceAF belonged to palpitation in ancient times.48 books and 483 prescriptions were found in "Chinese Medical Code".The causes of palpitation were found to be complex,including emotional disorders,dietary problems,exogenous factors,physical fatigue and other diseases.Palpitation caused by other diseases was only one symptom,which couldn't be taken as the disease of palpitation.Furthermore,functional disorders of many organs involved in the pathogenesis of palpitation,containing heart,kidney,gallbladder,spleen and stomach,liver and lung.The main syndromes were yang qi deficiency,yin and blood deficiency,qi and yin(blood)deficiency,heart deficiency with other pathogenic factors,heat syndrome of the heart,the syndromes caused by water metabolism disorders,the syndrome of blood stasis,jing qi deficiency of kidney,yang qi deficiency of kidney,yin deficiency of kidney,heart and kidney dysfunction,spleen and stomach deficiency,heart and spleen dysfunction,qi deficiency of heart and gallbladder,blood deficiency of liver,qi and yin deficiency of heart and lung,the deficiency of multiple organs and so on.483 prescriptions aimed at adjusting organs'functions to treat AF,among which 296 targeted heart,53 kidney,21 gallbladder,29 spleen and stomach,28 liver,8 lung and 45 for multiple organs' deficiency.In addition,there were acupuncture,emotional therapy and 3 dietary prescriptions.From the above literatures,we knew that palpitation occurred in the heart,but was related to many other organic dysfunction including kidney,gallbladder,spleen,stomach,liver and lung.Kidney dysfunction ranks the first place,and spleen comes at the second one.Prescriptions in ancient books were of great numbers and complexity.By sorting and summarizing them,we found that the key point of AF management was regulating the yin and yang of heart and coordination of different organs.Based on the ancient theory,Professor Wang regulated ying wei and the function of heart and kidney as the main treatment methods of AF.ConclusionProfessor Wang took gui zhi jia long gu mu li tang and jiao tai wan as the main prescriptions,the former one of which combined the composition of gui zhi jia long gu mu li tang and the doses of xiao jian zhong tang.While the later one imitated the composition of jiao tai wan and further created and formed a new prescription.What's more,Professor Wang attached much importance to adjust the function of spleen and stomach.Functional copiousness and coordination of the two organs can be in return helpful to the regulation of ying and wei,heart and kidney,thus contributing to the management of AF.In addition,ying wei disorder,heart and kidney dysfunction,qi and yin deficiency and qi deficiency with water metabolism disorder were the most common syndromes of AF,Professor Wang then treated them with gui zhi jia long gu mu li tang,jiao tai wan,sheng mai san,wu ling san or si ling san accordingly and respectively.It showed that Professor Wang not only focused on integration of disease and syndromes,but also emphasized combination and parallelism of prescriptions and syndromes when treating AF.Therefore,Professor Wang put high value on ancient theory and emphasized the current condition.He was good at classical prescriptions and created new ones when treating AF.