| Carotid atherosclerotic plaque(CAS)is a common disease that endangers human health.It has a high incidence and disease population in the world and in my country.The treatment of reversal of As plaque is a hot and difficult point of research at home and abroad.This study reviews the current research progress in the treatment of cervical As plaques in traditional Chinese and Western medicine,and puts forward the idea of "meridian Phlegm Node" theory for the treatment of As plaques,and carried out a randomized,double-blind,placebo-parallel controlled clinical trial test.It includes two parts:literature review and clinical research.1 Literature reviewThis research systematically summarizes the current clinical research progress on the reversal of CAS plaque in Chinese and Western medicine.In the research progress of Western medicine treatment of reversing CAS plaques,the latest epidemiological results are summarized,combined with the needs of clinical treatment practice,and the understanding of the pathological mechanism,lesion types and clinical manifestations of CAS plaques is summarized in detail.According to the treatment method of reversing CAS plaque,it is divided into statins,other drugs,diet intervention,and surgical treatment.The results of the corresponding clinical trials are summarized and analyzed.The clinical evaluation technology of CAS plaque is the basic work to ensure the accuracy and reliability of treatment and research results.This review introduces the application of ultrasound imaging technology,magnetic resonance imaging technology and other vascular imaging technologies in the clinical assessment of CAS plaques,and analyzes the advantages and disadvantages.In the research progress of TCM treatment of reversing CAS plaques,the etiology and pathogenesis of TCM,the treatment and treatment methods,and the research results of corresponding clinical trials were introduced,and the current shortcomings were analyzed and the possible future development directions were prospected.2 Clinical researchStudy 1:The instructor's experience in treating atherosclerotic plaques from the perspective of "meridian Phlegm Nodes"This study puts forward a new way of treating As plaque from the perspective of "meridian Phlegm Node".It is believed that "phlegm" runs through the pathological changes of As plaques,characterized by"phlegm nucleus" disease in the veins and knot in the liver meridian,and its core pathogenesis is the loss of phlegm and sputum nucleus in the artery.In the treatment,it is necessary to focus on the"phlegm core",with "resolving phlegm and dispelling congestion" as the main principle,taking tonifying Spleen,activating Qi,solving Phlegm,clearing Heat and detoxification into account.As plaque is treated according to dialectics,it can be divided into 6 stages:?The period of Phlegm Node formation(inner membranous thickening period):the pathogenesis is the stagnation of Phlegm on the wall of the artery,and Shunqiyunxue Decoction is given for treatment;?The stage of developed Phlegm Node(stable plaque stage):pathogenesis is phlegm and stasis,combined with blood stasis,and Neixiao Ruanmai Decoction is added or subtracted;?Phlegm Node hardening period(plaque calcification period):the pathogenesis is phlegm and stasis,For both stasis and heat,give Neijin Cahuahua San addition and subtraction;?Phlegm Node decay period(vulnerable plaque period):the pathogenesis is phlegm staying out of the way,the poison does not dissipate,the qi and blood decline,and the vulnerable plaque is formed.Tuoli Wenban Decoction is given;? Phlegm Node rupture period(plaque rupture period):the pathogenesis is the stagnation of blood stasis and poison,which turns into pus,and the plaque is ruptured,and Simiao Yongan Decoction is given and subtracted;? Phlegm Node recovery period(restenosis period):The pathogenesis is traumatic blood stasis,and Jiawei Restoration Decoction is mainly given,followed by Neixiao Ruanmai Decoction.The developed Phlegm Node has become a critical period for the development and intervention of As plaques.Neixiao Ruanmai Decoction is often used for treatment.Study 2:Neixiao Ruanmai Decoction in reversing the syndrome of phlegm and blood stasis in carotid atherosclerotic plaque-A randomized,double-blind,placebo parallel controlled studyObjective to evaluate the efficacy and safety of neixiaoruanmai Decoction in reversing carotid atherosclerotic plaque without reducing LDL-C.Methods a randomized,double-blind,placebo-controlled parallel method was used in 36 patients with carotid atherosclerotic plaques who did not take lipid-lowering drugs.The treatment group was given neixiaoruanmaitang granules,the control group was given placebo,the two groups were treated for 12 weeks.The crouse score,total plaque area,IMT,maximum plaque thickness and area,blood lipid,plaque reversion rate,TCM syndrome efficacy and safety of the two groups were observed before and after treatment.Results the crouse score(p<0.01),total plaque area(p<0.01),IMT(p<0.01),maximum plaque thickness(p<0.01)and area(p<0.05)of carotid plaque in the treatment group were significantly decreased compared with those in the control group before treatment.The plaque reversion rate in the treatment group was 61.11%,which was significantly higher than that in the control group(p<0.01).The effective rate of TCM syndrome in the treatment group was 94.44%,which was superior to 55.56%in the control group(p<0.05).There was no significant difference in blood lipid level between the two groups before and after treatment(p>0.05).There was no serious adverse event and no significant abnormal change of liver and kidney function before and after treatment(p>0.05).Conclusion with no decrease of LDL-C,neixiaoruanmai Decoction shows good efficacy and safety in reversing carotid atherosclerotic plaque and improving clinical symptoms. |
PDF Full Text Request