Deficiency is essentially qi deficiency, blood deficiency, yin deficiency and yang deficiency; It is phlegm, blood stasis, qi stagnation and cold coagulation. "Su Wen Miao Lenz" says: "The evil guest is in the collateral of shaoyin, which makes people feel heartbroken and full of chest and hypochondrium." Su Wen Sting Fever said: "People with heart fever are unhappy at first, but after a few days of fever, they die of heartache, boredom, vomiting, headache, redness and no sweat." In Han Dynasty, Zhang Zhongjing believed that the basic pathogenesis of chest obstruction and heartache was "Yang Yin Wei Xian". In the Song Dynasty, the General Record of the Holy Records first proposed that the basic pathogenesis of chest obstruction and heartache was "deficiency in essence but excess in substance". Physicians in later generations are also divided into "emptiness" and "reality".
For example, Yu's Medical Law in the Qing Dynasty pointed out that the treatment of thoracic obstruction can be summarized as "mild, insufficient upper energizer can lead to yang;" What's more, it will drive its center of gravity down and rebel. " In the Qing Dynasty, Wang Qingren put forward that chest pain is related to blood stasis in Lin Yi's Correction, saying: "Chest pain is in the front, and Jin Mu powder can be used to treat it;" My back hurts, too, but it can be cured with Gualou Scallion Decoction ... I suddenly have chest pain, and I shouldn't use this prescription (here refers to Xuefu Zhuyu Decoction) to stop the disease. " Coronary heart disease and angina pectoris in western medicine can be treated according to syndrome differentiation.
Professor Yan Zhenghua is good at treating thoracic obstruction with Gualou Congbai series soup. The recipe of Fructus Trichosanthis and Bulbus Allii Macrostemi white wine comes from Zhang Zhongjing's synopsis of the Golden Chamber in Han Dynasty. The original record: "Chest pain, wheezing, coughing and vomiting, chest and back pain, shortness of breath, deep and late pulse, close the number, lick the onion and white wine soup to treat it." Original ingredients: Fructus Trichosanthis 1 tablet (mashed), half a liter of Allium macrostemon, and 7 liters of white wine. Trichosanthes kirilowii in the prescription tastes bitter, cold and slippery, with excessive phlegm and no worries about the chest and diaphragm; Bulbus Allii Macrostemon is pungent and warm in nature, which can relieve joint pain by activating yang and dispersing stagnation; Liquor can promote yang, help drug potential, block arthralgia, promote chest yang, and solve various diseases.
This prescription is Zhang Zhongjing's basic prescription for treating chest obstruction and heartache. If there is too much phlegm and saliva, Pinellia ternata is added to form the decoction of Fructus Trichosanthis and Bulbus Allii Cepae and Pinellia ternata. If the chest yang is weak, phlegm is blocked in the middle, and qi is blocked in the chest, and there are chest tightness, wheezing and cough, Fructus Aurantii Immaturus, Cortex Magnolia Officinalis and Ramulus Cinnamomi are added to form Fructus Aurantii Immaturus Bulbus Allii Macrostemon Guizhi Decoction.
Modern research shows that Gualou Congbai decoction can dilate coronary artery, increase coronary blood flow, slow down heart rate, improve animal's hypoxia tolerance and inhibit platelet aggregation. In the treatment of chest obstruction and heartache, the pharmacological effects of Fructus Trichosanthis and Bulbus Allii Macrostemi are different, and the combination of the two drugs mainly shows the effect of Fructus Trichosanthis; However, the two drugs have a certain synergistic effect in inhibiting platelet aggregation and improving the hypoxia tolerance of animals.
Professor Yan Zhenghua used it to think about Allium macrostemon Bunge, warming yang to dissipate stagnation, promoting blood circulation to eliminate phlegm and worry-free diaphragm. The combination of the two drugs has the effects of warming yang, transforming qi, promoting blood circulation, resolving phlegm and dredging collaterals. If you are bored and full, you can use dried tangerine peel, bitter orange and other products to promote qi and nourish your stomach. If the pain is like acupuncture, the tongue is dark with ecchymosis and the sublingual is blue, some drugs for promoting blood circulation and removing blood stasis, such as safflower, salvia miltiorrhiza and Dalbergia odorifera, can be added as appropriate; For fullness and chest distress caused by phlegm blocking heart collaterals, it can be combined with Yujin, Acorus Gramineus and Pinellia ternata. If you feel pain modestly, on the basis of promoting blood circulation, resolving phlegm and dredging collaterals, you should add drugs such as Radix Astragali, Radix Glycyrrhizae and Ramulus Cinnamomi.
Typing therapy
On this basis, Professor Yan Zhenghua also emphasized the syndrome differentiation and treatment of thoracic obstruction.
Blood stasis syndrome
Blood stasis syndrome is characterized by tingling in chest and hypochondrium, local pain, especially at night, heartburn, backache, or pain to shoulder and back, accompanied by chest tightness, prolonged recovery, dark red or purple tongue, ecchymosis, cyanosis under the tongue, thin moss and astringent pulse. Treatment is to promote blood circulation to remove blood stasis and relieve pain. The representative prescription is Xuefu Zhuyu Decoction. Commonly used drugs: Ligusticum Chuanxiong, Peach Blossom, Carthamus tinctorius, Radix Paeoniae Rubra, Radix Bupleuri, Radix Platycodi, Fructus Aurantii, Radix Angelicae Sinensis, Radix Rehmanniae, Lignum Dalbergiae Odoriferae, Radix Curcumae, etc.
stagnation syndrome of Qi
Qi stagnation syndrome is characterized by chest tightness, dull pain, pain with no definite location, shortness of breath, which is easily induced or aggravated when emotional exhaustion occurs, abdominal distension, belching or suffocating, thin or greasy fur, and thready pulse. Soothing liver and regulating qi. The commonly used prescription is Chaihu Shugan Powder. Commonly used drugs: Bupleurum, Fructus Aurantii, Radix Paeoniae Rubra, Rhizoma Cyperi, Caulis Perillae, Pericarpium Citri Tangerinae, Rhizoma Chuanxiong, etc.
Syndrome of phlegm-dampness blocking collaterals
Syndrome of phlegm-dampness blocking collaterals is characterized by chest tightness and pain, excessive phlegm, shortness of breath, heavy limbs, obesity, easy attack in rainy days, mental fatigue, anorexia, loose stool, cough and spitting, fat tongue, teeth marks on the edge, greasy fur and slippery pulse. Eliminating phlegm and treating arthralgia. The commonly used prescription is Gualou Scallion Pinellia Decoction combined with Ditan Decoction. Commonly used drugs: Fructus Trichosanthis, Bulbus Allii Macrostemon, Rhizoma Pinelliae, Arisaema cum bile, Caulis Bambusae, Ginseng Radix, Poria, Glycyrrhrizae Radix, Rhizoma Acori Graminei, Pericarpium Citri Tangerinae, Fructus Aurantii Immaturus, etc.
Syndrome of cold blocking heart pulse
Cold blocking the heart pulse syndrome is characterized by sudden heartburn, heartburn penetrating the back, often caused or aggravated by sudden cold, accompanied by chills, even tepid hands and feet, cold sweat, chest tightness, shortness of breath, palpitation, pale face, thin white fur and tight pulse. Xin Wen San Han, Tong Chest Yang. Common prescriptions are Fructus Aurantii Immaturus Garlic Guizhi Decoction and Danggui Sini Decoction. Commonly used drugs: Ramulus Cinnamomi, Bulbus Allii Macrostemon, Fructus Trichosanthis, Radix Angelicae Sinensis, Radix Paeoniae, Radix Glycyrrhizae, Fructus Aurantii Immaturus, Cortex Magnolia Officinalis, Fructus Jujubae, etc.
Syndrome of deficiency of both qi and yin
Deficiency of both qi and yin is characterized by chest distress and pain, intermittent rest, palpitation and shortness of breath, severe pain when moving, fatigue and fatigue, low voice, easy sweating, red tongue, teeth marks on fat side of tongue, thin and white fur, weak and slow pulse or knotted pulse. Treat with qi and yin. The commonly used prescription is Shengmai Powder combined with Ginseng Yang Rong Decoction. Commonly used drugs: Ginseng, Radix Astragali, Radix Glycyrrhizae Preparata, Radix Ophiopogonis, Rhizoma Polygonati Odorati, Radix Angelicae Sinensis, Radix Salviae Miltiorrhizae, Fructus Schisandrae Chinensis, etc.
syndrome of yang deficiency of heart and kidney
Syndrome of yang deficiency of heart and kidney is characterized by palpitation and pain, chest tightness, shortness of breath, spontaneous sweating, severe pain when moving, mental fatigue and chills, no temperature or edema in limbs, pale and fat tongue, white or greasy fur at the edge of tooth marks, and deep, thin and late pulse. Treatment from warming yang, tonifying kidney and benefiting heart. The commonly used prescription is Shenfu decoction combined with Gui You decoction. Commonly used drugs: Ginseng, Radix Aconiti Lateralis Preparata, Ramulus Cinnamomi, Radix Rehmanniae Preparata, Cornus officinalis, Herba Epimedii, Fructus Psoraleae, Radix Glycyrrhizae Preparata, etc.
Examples of medical records
Ge Mou, male, 58 years old. First visit: 65438+February 6, 2009. 1 year complaining of chest tightness and pain.
Current medical history: chest tightness, pain, breath holding 1 year. He was admitted to the hospital half a month ago due to palpitation and dizziness, and was discharged after treatment. Chest tightness, pain, fatigue, sweating, neck discomfort, bitter taste, drowsiness, two stools, red and dark tongue, thin and greasy fur and slippery pulse. Electrocardiogram and blood lipid are normal.
Syndrome differentiation: spleen deficiency, phlegm and blood stasis blocking collaterals.
Treatment: invigorating spleen and qi, promoting blood circulation and resolving phlegm.
Prescription: Radix Astragali 15g, Fructus Trichosanthis 15g, Bulbus Allii Macrostemonae 10g, Radix Codonopsis 12g, Fructus Schisandrae Chinensis 5g, Radix Salviae Miltiorrhizae 30g, Flos Carthami 10g, Lignum Dalbergiae Odoriferae 5g, Poria 30g and Radix Puerariae 30g. 7 doses, decocted in water.
Secondary diagnosis: June 5438+February 2, 20091. The patient complained of relief of chest tightness. Symptoms include palpitation, fatigue, dry mouth and throat, no desire to drink, dark red tongue, thin body fluid, and slippery pulse.
Prescription: 25g of Radix Astragali, 5g of Fructus Trichosanthis10g, 10g of Bulbus Allii Macrostemonae10g, 0g of Radix Codonopsis12g, 5g of Fructus Schisandrae, 30g of Radix Salviae Miltiorrhizae, 0g of Flos Carthami10g, 5g of Dalbergia Odoriferae, 30g of Poria and 30g of Radix Puerariae. 7 doses, decocted in water. After taking 7 doses, all the symptoms were relieved.
Note: This patient's fatigue and hyperhidrosis is due to qi deficiency, weak circulation of qi, easy to cause phlegm, blood coagulation and blood stasis, which is a syndrome of deficiency in essence and excess in substance. Treatment should be based on invigorating spleen and qi, consolidating the foundation and strengthening the yuan, and promoting blood circulation and resolving phlegm. The prescription takes Radix Astragali, Radix Codonopsis, and Poria as raw materials, benefiting qi and strengthening spleen, consolidating exterior and stopping sweating; Trichosanthes kirilowii, Bulbus Allii Macrostemon, resolving phlegm and resolving hard mass, promoting qi circulation and widening chest are important drugs for treating chest tightness and suffocation. Safflower, salvia miltiorrhiza, Dalbergia odorifera, promoting qi circulation and removing blood stasis are commonly used in cardiovascular and cerebrovascular diseases; Schisandra chinensis converges and stops sweating, so as to enhance the power of Astragalus membranaceus to strengthen exterior surface and stop sweating; Pueraria lobata can relax muscles, directly dilate blood vessels, reduce peripheral resistance and relieve neck discomfort. The combination of multiple drugs, treating both the symptoms and the root causes, and combining syndrome with treatment have achieved good results. On the second diagnosis, the chest tightness was relieved, the mouth was dry and the throat was dry, and the coating was thin and there was little body fluid, which was a body fluid injury. Its former Gaza ginseng and Ophiopogon japonicus nourish yin and moisten dryness; In addition, notoginseng was added to promote blood circulation and relieve pain, and improve blood stasis. After taking 7 doses, all the symptoms were relieved.
The content was compiled from the fifth edition of China journal of traditional chinese medicine (2020165438+1October 13) and extracted from The Complete Works of Traditional Chinese Medicine Thought and Clinical Medication in Yan Zhenghua.