Study On The Distribution Of TCM Syndrome Elements And Medication Rule Of Heart Failure After Myocardial Infarction

ObjectiveTo discuss the distribution of TCM syndrome elements and the characteristics of disease and syndrome combination of heart failure after myocardial infarction,and the regularity of clinical medication.Method1.Clinical data analysis of heart failure after myocardial infarctionContinuously included from January 1,2017 to January 1,2021,a total of 183 patients with heart failure after myocardial infarction were outpatient by Professor Li Jun from the Department of Cardiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences.Use Excel to establish the initial database,import the Excel table into the ancient and modern medical record cloud platform(http://www.yiankb.com/)to establish a standardized medical record database,and then perform frequency statistics,association analysis,cluster analysis,complex network analysis and other data Visual analysis;finally,analyze and discuss the distribution and combination of syndrome elements of heart failure after myocardial infarction,and the medication frequency,four qi,five flavors,meridian,efficacy,core prescriptions and other medication rules of traditional Chinese medicine for treating heart failure after myocardial infarction.2.Literature research on Yang deficiency and blood stasis syndrome in heart failureThe method of combining computer retrieval and manual retrieval is used to retrieve the relevant literatures from the establishment of the database to the clinical research on the treatment of Yang-deficiency and blood-stasis heart failure with traditional Chinese medicine from the establishment of the database to 2020,use Excel 2010 to establish a database and combine with IBM SPSS Statistics 20.0 to carry out its medication rules Cluster analysis.Result1.Research on the distribution of TCM syndrome elements and medication rules of heart failure after myocardial infarction based on clinical cases?Among the 183 patients with heart failure after myocardial infarction,there are 120 males and 63 females,respectively.The prevalence of people aged 50-69 years is higher,accounting for 56.28%;the combined diseases are hypertension and high in descending order.Lipemia,after coronary stent placement,type 2 diabetes,ventricular premature beats,atrial fibrillation,hyperuricemia,120 cases of hypertension,prevalence rate of 65.57%,hyperlipidemia 68 cases,the prevalence rate was 37.16%.?Four diagnosis:183 cases of post-MI heart failure patients involved 64 kinds of clinical symptoms.The most frequent clinical symptoms were chest tightness(79 cases,43.17%),fatigue(78 cases,42.62%),and palpitation.(61 cases,33.33%),shortness of breath(60 cases,32.79%),poor sleep(60 cases,32.79%),chest pain(56 cases,30.60%),dry mouth(43 cases,23.50%),etc.Tongue and pulse are mostly pale and dark,with thin white fur,stringy or heavy pulse.?Distribution of syndromes:There are 22 kinds of syndromes in traditional Chinese medicine,among which there are 6 kinds of syndromes with frequency>10,followed by Yang deficiency and blood stasis syndrome(35 cases,19.13%),phlegm and blood stasis syndrome(23 cases,12.57%),Qi deficiency and blood Stasis syndrome(22 cases,12.02%),Qi and Yin deficiency syndrome(19 cases,10.38%),Yin and Yang deficiency syndrome(13 cases,7.10%),Phlegm-heat internal accumulation syndrome(13 cases,7.10%).?Distribution of syndrome elements:heart and lung are the main disease locations,accounting for 34.43%and 30.05%respectively;the disease is mainly blood stasis,yang deficiency,qi deficiency,phlegm,and yin deficiency,accounting for 49.73%and 36.07%respectively,33.88%,32.24%,26.78%.There are 22 types of combinations of TCM syndrome elements,among which there are 2 types of single syndrome elements,a total of 11 cases,which are Qi stagnation(6 cases,3.28%)and Yang hyperactivity(5 cases,2.73%);use two syndrome elements to simultaneously differentiate symptoms There are 10 types,a total of 148 cases,which are Yang deficiency+blood stasis(35 cases,19.13%),phlegm turbidity+blood stasis(23 cases,12.57%),Qi deficiency+blood stasis(22 cases,12.02%),Qi deficiency+Yin deficiency(19 cases,10.38%),Yin deficiency+Yang deficiency(13 cases,7.10%),phlegm+internal fire(13 cases,7.10%),Yang deficiency+internal dampness(7 cases,3.83%),Yin deficiency+internal fire(7 cases,3.83%),phlegm turbidity+internal fire(7 cases,3.83%),qi deficiency+phlegm turbidity(2 cases,1.09%);there are 4 types of syndromes that use three syndromes at the same time.There are 5 cases in total;there are 6 kinds of syndrome differentiation using four syndrome elements at the same time,a total of 19 cases.? Medication rule:(1)Frequency of single medicine:3188 times of single medicine,involving 139 medicines,among which the top 30 using frequency are Poria,Guizhi,Astragalus,Chuanxiong,Angelica,Scallion White,Licorice,Prince Edward Ginseng,Coptis,Pinellia,Dried Ginger,Trichosanthes,Red Peony,Salvia,Citrus Aurantium,Ophiopogon,White Peony,Safflower,Aconite,Schisandra,Atractylodes,Tangerine Peel,Dalbergia,Amomum,Turmeric,Habitat,Peach Seed,Asarum,raw keel,raw oyster.(2)Nature and flavor return to meridian:The four qi is used most frequently with warm drugs,the top 5 are Wen>Ping>Mild Cold>Cold>Temperature,the frequency is 1109 times,577 times,521 times,323 times,186 times.For the five flavors,pungent drugs are used most frequently,followed by pungent>sweet>bitter>acid>slightly bitter.The frequency is 1345 times,1340 times,1028 times,279 times,and 263 times.In the return channel,the use of the lung channel drugs is the most frequent.The order of frequency>500 times is lung>spleen>heart>stomach>liver>kidney,and the frequency is 1488 times,1444 times,1191 times,1060 times,956 times,607 times.(3)Efficacy:The most frequent use of dampness and phlegm drugs,the top 10 in order are dampness and phlegm,diuresis and dampness,dispelling wind and pain,moistening the bowel,warming the meridians,dispelling blood stasis and relieving pain,clearing heat and detoxification,and clearing away heat Cooling blood,invigorating the spleen,and calming the heart;(4)Cluster analysis of traditional Chinese medicines:8 groups of drug combinations were obtained:?Poria-Cinnamomi-Atractylodes-Astragalus-Licorice;?Ligusticum chuanxiong-Red peony root;? Aconite-Dried ginger-Angelica-red Flower-peach kernel;? Danshen-Dalbergia odorifera-Amomum villosum;?Taizi ginseng-Ophiopogon japonicus-Schisandra-Shengdi-Raw keel-raw oyster;?White peony-Zhishi;?Bupleurum-Magnolia officinalis-Tangerine peel-Scrophulariaceae-fine Xin-turmeric;?Pinellia-Coptis-Gualou-Xiebai;(5)Complex network analysis of traditional Chinese medicine:core prescriptions available:Aconite,dried ginger,cassia twig,salvia,red peony,chuanxiong,angelica,poria,licorice,scallion white There are a total of 18 medicines including Trichosanthes,Fructus Pinelliae,Citrus aurantium,Radix Astragali,Ophiopogon japonicus,Atractylodes macrocephala and Coptidis.2.Literature study on the medication rule of traditional Chinese medicine in treating heart failure of Yang-deficiency and blood-stasis typeA total of 101 literatures were included,sharing 106 flavors of traditional Chinese medicines.The frequency of occurrence of the drugs was 1094.There were 28 core drugs.Among them,the drugs with a prescription application rate of more than 50%were Aconite,Poria,Danshen,and Astragalus.In the classification of drug efficacy,the frequency of warming yang drugs The most,followed by activating blood and removing blood stasis medicine and qi medicine.Cluster analysis obtained 7 drug pairs and 3 drug combinations.ConclusionClinical studies have shown:1.After myocardial infarction,patients with heart failure have chest tightness,fatigue,palpitation,shortness of breath,and poor sleep as their main clinical symptoms.Chest pain,dry mouth,dizziness,mouth pain,aggravation after exercise,chills and other symptoms appear more often.2.In terms of clinical syndrome differentiation and treatment,through clinical investigation and literature analysis,the syndrome differentiation characteristics of this disease can be summarized as follows:(1)Multiple internal organs with the same disease,mainly responsible for the heart and lung;(2)The main deficiency is mostly Yang deficiency and Qi deficiency,and the physical signs are mostly blood stasis and turbid phlegm.Among them,yang deficiency and blood stasis are important syndromes in the development of heart failure after myocardial infarction.(3)The common syndrome type of heart failure after myocardial infarction is Yang deficiency and blood stasis syndrome,followed by phlegm and blood stasis syndrome,Qi deficiency and blood stasis syndrome,and Qi and Yin deficiency.According to the distribution of syndromes,the main treatment methods are warming Yang and replenishing qi,promoting blood circulation and removing blood stasis,and emphasizing both diuresis and expectorant,and nourishing yin,moisturizing dryness,soothing liver and regulating qi.3.Core prescription:Aconite,dried ginger,cassia twig,salvia,red peony root,chuanxiong,angelica,tuckahoe,licorice,scallion white,fennel,pinellia,citrus aurantium,ginseng,astragalus,Ophiopogon,atractylodes,coptis 18 medicines.Literature studies have proved that traditional Chinese medicine treatment of heart failure of Yang deficiency and blood stasis type is mainly based on warming yang and promoting blood circulation,supplemented by drugs such as diuresis and nourishing yin.The core drugs for treatment are Aconite,Poria,Danshen,and Astragalus,which are useful for guiding the clinical treatment of heart failure.