Pingyao County, Pei Yi

Coronary atherosclerotic heart disease refers to the heart disease caused by myocardial ischemia and hypoxia due to coronary atherosclerosis, which is a common critical disease in clinic. In the past ten years, great progress has been made in the clinical and experimental research on the prevention and treatment of this disease by traditional Chinese medicine, which is summarized as follows:

Although there is no name of "coronary heart disease" in TCM literature, symptoms similar to this disease have long been recorded, such as coal shaft? Juebing said: "It really hurts, my hands and feet are blue to the joints, and my heart hurts badly." Zhang Zhongjing's synopsis of the golden chamber in the Eastern Han Dynasty said that the descriptions of "heartache penetrating the back, lumbago penetrating the heart" were quite similar to the clinical manifestations of the disease, belonging to the categories of "true heartache", "sudden heartache" and "chest obstruction" in traditional Chinese medicine.

1 etiology and pathogenesis

This disease mostly occurs in middle-aged and elderly people, and is related to physical weakness, emotional imbalance, invasion of cold pathogen, invasion of fire pathogen, improper diet, endogenous phlegm and other factors. Although the disease is located in the heart, it is damaged with the liver, spleen and kidney, resulting in pathological factors such as qi stagnation, blood stasis, phlegm turbidity, cold coagulation or fire evil. Its clinical symptoms are characterized by excess and deficiency, and excess and deficiency. As shown in figure 1, the schematic diagram is as follows:

"insufficient element body"

Deficiency of essence and qi (damage of viscera)

Yin deficiency, Yang Qi and blood.

F emotional disorder \ chest pain.

Invasion of cold pathogen

Standard reality

Bad diet

Phlegm is endogenous.

Figure 1 Etiology and pathogenesis of coronary heart disease

2 Clinical manifestations

The disease has a long course and is often induced by physical activity, emotional excitement or improper diet, with sudden pain (angina pectoris) or pulse symptoms such as chest tightness, palpitation, shortness of breath and pulse knot. In severe cases, "heartburn, backache, heartache" may occur, the limbs are bruised and swollen to the joints, the lips are clouded, the face is pale, the limbs are cold, sweating, thready pulse and other pulse symptoms (myocardial infarction, heart failure, arrhythmia), and even sudden death.

3 Diagnosis and differential diagnosis

3. 1 diagnosis point

1) medical history: the disease mostly occurs in middle-aged and elderly people over 40 years old, with more men than women and more mental workers. Hypertension, hyperlipidemia and smoking are important risk factors. The incidence of diabetes is also quite high.

2) Diagnostic basis and method network: Coronary heart disease can be diagnosed according to its clinical manifestations and laboratory examination data, whether there is myocardial ischemia and coronary atherosclerotic obstruction. Electrocardiogram and echocardiography are effective and noninvasive methods to diagnose the disease.

3) Clinical types: The disease can be generally divided into five clinical types. (1) Occult or asymptomatic coronary heart disease: asymptomatic myocardial ischemia and myocardial tissue morphological changes accompanied by ECG changes. (2) Strangulation pain: Paroxysmal retrosternal pain caused by short-term myocardial blood supply insufficiency. Most of the myocardium has no morphological changes. (3) Myocardial infarction: The symptoms are serious, which is caused by coronary artery obstruction and acute myocardial ischemia and necrosis. (4) Ischemic cardiomyopathy: Myocardial fibrosis caused by long-term myocardial ischemia, which used to be called myocardial fibrosis or myocardial sclerosis, is characterized by heart enlargement, heart failure and/or arrhythmia. (5) Sudden death: sudden severe cardiac arrest and death, mostly due to local electrophysiological disorder or pacing, leading to conduction dysfunction and serious arrhythmia. Among them, angina pectoris and myocardial infarction belong to "syncope and heartache", "true heartache" (Neijing) and "chest obstruction" (concise) in traditional Chinese medicine. It is believed that deficiency of heart-qi and weakness of heart-yang lead to qi stagnation and blood stasis, phlegm obstruction of collaterals, obstruction of heart pulse and influence of qi and blood circulation.

3.2 The differential diagnosis of this disease should be differentiated from cardiac neurosis, intercostal neuralgia and other diseases. Chinese medicine believes that "true heartache" should be distinguished from "stomach disease": the pain of coronary heart disease often occurs in the left chest and chest, and every time it breaks out suddenly, the pain is severe or unbearable, such as spinal tingling or chest tightness. Pain can radiate to the left shoulder or the inside of the left arm, which is called "heartache through the back". What is the coal hub like? Juebing said in the article: "It really hurts. My hands and feet are all blue to the joints, and my heart hurts." Its location, symptoms and prognosis are obviously different from those of stomachache and should not be confused.

4 Prevention and control measures

4. 1 prevention

1) Modern medicine thinks it is possible. The root cause of coronary heart disease is atherosclerosis. The onset is hidden, and it can occur in the early stage, and it is difficult to recover in severe cases. Therefore, we must focus on prevention, starting from adolescence, preventing diseases early and reducing the incidence. Attention should be paid to the following points: (1) Prevention and treatment of three inducing factors-smoking, hypertension and hyperlipidemia. You should quit smoking and actively treat hypertension and hyperlipidemia. (2) Patients with risk factors (with multiple main risk factors at the same time) are particularly prone to coronary heart disease, especially those who need active prevention and treatment. (3) Prevention and treatment of other susceptible factors: ① diabetes; ② Cerebral thrombosis; 3 fat. (4) Pay attention to the combination of work and rest to avoid excessive tension. (5) manage diet.

[If! Support lists] 2) [Endif] As early as 2,000 years ago, Chinese medicine had the preventive medicine thought of "treating diseases before they occur", that is, "preventing diseases before they occur" and "preventing diseases from changing", and "healthy qi has its internal causes, and evil cannot be done". It is effective to advocate cautious life, avoid catching a cold, adjust diet, relax mood, save sex and exercise frequently. According to the characteristics of coronary heart disease, Chinese medicine believes that the following points should be paid attention to in prevention: (1) Pay attention to daily life and proper cold temperature: the changes of cold and hot weather, sunny and rainy weather also have obvious effects on the occurrence and development of coronary heart disease, such as "On the causes and symptoms of various diseases?" "Symptoms of Heart Disease" said: "Those who feel heartbroken, pathogenic wind and cold multiply in their hearts", and pointed out that the induction or occurrence of the disease is related to abnormal climate change. According to the investigation report of pathogenic factors made by relevant units, the incidence of coronary heart disease induced by climate change accounts for more than 1/2. Therefore, we should pay attention to our daily life, which is suitable for cold and humid places. Because "lung governs fur" and "lung governs qi", it is called "coronary heart disease lung".

2) pay attention to adjust the spirit and avoid mood swings. Chinese medicine has always attached importance to taking care of health, such as Su Wen? The ancient theory of innocence said: "Nothing is indifferent, and the true qi follows, and the spirit is hidden inside, and the disease is safe." Another example is the line problem? Treatise on Febrile Diseases says: "All diseases are born of qi", and Jin Shen 'ao once said: "Seven emotions lead to heartache". Therefore, it is very important to pay attention to psychological adjustment, avoid overreaction and maintain a happy mood, which is very important for preventing the disease. Because "the liver governs the drainage" and "the liver stores blood", it is called "the liver of coronary heart disease".

[If! Supporters] (2) [Endif] Pay attention to diet regulation and avoid binge drinking fat and sweet: Chinese medicine believes that eating fat and sweet without restraint is easy to produce dampness, produce phlegm, block meridians, stagnate viscera, affect qi and blood circulation and cause heartache. Because "spleen governs transport and transformation", it is called "spleen of coronary heart disease". So it is very important to pay attention to the regulation of diet at ordinary times. Irritating products, such as cigarettes and alcohol, will also affect the function of viscera, so smoking and alcohol should be banned.

(4) Pay attention to the combination of work and rest, and insist on proper physical exercise: in the theory of taking students with Chinese medicine, the idea of combining work and rest is advocated, that is, "don't do light work" and "don't overwork". At the same time, it is also emphasized not to "overwork the kidney". Both overwork and overwork have a serious impact on the disease. Because "kidney is a powerful official" and "kidney governs storing essence", it is called "kidney of coronary heart disease". Within the range of stable illness and physical strength, it is of great benefit to patients to insist on proper physical exercise, such as walking and playing Tai Ji Chuan.

4.2 Care of coronary heart disease should pay attention to:

[If! Support lists]1) [endif] Feel comfortable, build up confidence, reduce the ideological burden, and avoid being too nervous, which is conducive to the smooth flow of qi and blood and the coordination of viscera functions.

[If! Support lists] 2) [Endif] Pay attention to climate change, avoid cold and heat, keep cool and warm, and prevent colds.

[If! Support lists] 3) [Endif] Eat lightly, avoid overeating, eat less and eat more, and ban smoking and alcohol. After angina pectoris is relieved, you should not be too full. Chen Shiduo said, "But after the pain stops, you must starve for a day."

4) Ask the patient to keep calm, rest in time, and give quick-acting analgesic drugs immediately, so as not to aggravate the condition and prevent accidents. If you have severe angina pectoris, you should stay in bed strictly, take coronary artery dilating drugs immediately, and it is best to treat it on the spot, and then send it to the hospital after the situation is relatively stable. This can reduce the occurrence of myocardial infarction. 5) Rehabilitation exercise is gradually started during the recovery period of coronary heart disease.

4.3 First aid

[If! SupportLists] 1)[endif] Acute attack of angina pectoris: The patient suddenly feels chest tightness, chest tightness with pain behind the sternum or precordial area, which spreads from the left shoulder and left forearm to the little finger, ring finger or mandible, neck, pharynx and upper abdomen, and generally lasts 1 ~ 5 minutes. Emergency treatment is needed in this period, mainly to treat symptoms, quickly expand the crown, relieve pain and control the development of the disease.

[If! Support list] (1) [endif] Acupuncture: Take Neiguan, Shenmen, Laogong, Houxi and Zhongshan points, mainly for purging.

[If! Support list 】 (2)【endif 】 Broad-chested aerosol: It is composed of Chinese herbal medicine, asarum, Alpinia officinarum, sandalwood, borneol and ethanol (using difluoro dichloride as propellant). Its efficacy in relieving angina pectoris is similar to that of domestic nitroglycerin.

(3) sublingual administration: ① Muscone tablets 15-30 mg, administered sublingually. ② Quick-acting Jiuxin Pills 3~5 pills, including oral administration. ③ Guanxin Suhe Pill 1 pill, including oral administration. ④ Shexiang Baoxin Pill 1~2 Pill, including oral administration.

4.4 injection

① add compound Danshen injection 10~20 ml into 500ml 10% glucose and drip intravenously.

② 40~ 120mg ligustrazine was added to 500 mg 10% glucose for intravenous drip. ③ Ginseng injection (4~20 ml) with 50% or 10% glucose, intravenous injection or drip.

④ Shenmai injection (4~20 ml) with 50% or 10% glucose, intravenous injection or drip.

4.5 oxygen inhalation

If this stage cannot be controlled, it will develop further. Due to ischemia and hypoxia, myocardial infarction will be formed, angina pectoris will be more severe and unbearable, chest tightness and contraction will be squeezed, and there will be a sense of dying, accompanied by irritability, palpitation, palpitation, pale or blue face, cold sweat, chills in limbs, and accompanied by blood pressure drop, heart failure or arrhythmia, weak pulse and so on. At this stage, it is necessary to carry out the treatment of integrated traditional Chinese and western medicine, cooperate with the rescue, and closely observe the changes of the disease, otherwise it is very easy to die. In addition to the above measures, TCM can use Shen Du Decoction (including injection), Shengmai Powder (including injection), or Shenfu Decoction (including injection), Shenfu Long Mu Jiuni Decoction and Sini Decoction urgently. Moxibustion: Yongquan, Sanyinjiao, Neiguan, Zusanli and other points. After the condition is relieved, it can be treated according to the pulse condition.

4.6 Treatment of angina pectoris in remission stage:

[If! SupportLists] 1)[endif] Differentiate diseases and treat diseases:

The method of adding and subtracting with symptoms was adopted. Symptoms of patients: chest tightness, tingling in precordial area, and fixed pain, which may lead to ecchymosis or ecchymosis on shoulder and back, or cyanosis and poor sublingual collaterals. This is chest obstruction, and the syndrome belongs to heart pulse stasis. Treatment: promoting blood circulation and removing blood stasis, regulating qi and relieving pain. Prescription: Danshen Yinhe Guanxin II prescription: Danshen 25g, Sandalwood 10g, Amomum villosum 12 g, Pink 12 g, Carthamus tinctorius 10g, Paeonia lactiflora 15g, white calyx 10g.

Addition and subtraction: Radix Bupleuri, Radix Paeoniae Alba, Fructus Citri Sarcodactylis and Fructus Hordei Germinatus are added for liver depression; Qi stagnation plus xiangfu and fructus aurantii; Adding Pericarpium Citri Tangerinae, Rhizoma Pinelliae Preparata and Poria for phlegm dampness; Qi deficiency plus Codonopsis pilosula and Huangmiao; Ginseng and Ophiopogon japonicus are added for patients with yin deficiency; Radix Angelicae Sinensis and Radix Rehmanniae Preparata are added for blood deficiency; Yang deficiency plus Radix Aconiti Lateralis Preparata and Cortex Cinnamomi; Spleen deficiency plus Atractylodis Rhizoma, Poria, and Rhizoma Dioscoreae; Semen Cuscutae and Fructus Lycii are added for patients with kidney yin deficiency; Morinda officinalis, Rhizoma Curculiginis, Herba Epimedii, etc.

[If! Support list ]2)[endif] Syndrome Differentiation and Treatment: (

1) Heart pulse stasis (same as above in syndrome, treatment and prescription, omitted).

[If! (3) Obstruction of chest due to obstruction of yang. Symptoms: chest pain, backache, chills, chest tightness, shortness of breath, pale purple tongue, thin white fur and tight pulse. Treatment: dredging yang and relieving arthralgia, promoting blood circulation and removing blood stasis. Prescription: Guaweipeng Liquor Decoction and Danshen Drink: Guaweiren 15 g, Bai Peng 12 g, Danshen 20g, Sandalwood 10g, Amomum villosum 12g and Yujin 15g.

[If! Supporters] (4)[endif] Phlegm and turbidity block collaterals. Symptoms: chest tightness, heartburn, obesity, excessive phlegm, anorexia, white or greasy fur, and slippery pulse. Treatment: dredging yang and relieving arthralgia, eliminating phlegm and turbidity, promoting blood circulation and removing blood stasis. Prescription: Guaweilian Baibanxia Decoction and Danshen Decoction: Guaweilin 15 g, Bai Peng 12g, Rhizoma Pinelliae Preparata 15 g, Pericarpium Citri Tangerinae 10 g, Poria cocos 30g, Salvia miltiorrhiza 20g, Sandalwood 10g, and Fructus Amomi (below).

⑷ Chest pain caused by phlegm heat. Symptoms: chest tightness, chest pain, cough, yellow and thick phlegm, yellow and greasy fur and slippery pulse. Treatment: clearing heat and resolving phlegm, mainly arthralgia and dredging collaterals, supplemented by promoting blood circulation and removing blood stasis. Prescription: Xiaozhi Tangxiong and Danshen Decoction. Fructus Trichosanthis15g, Rhizoma Pinelliae Preparata15g, Rhizoma Coptidis 6g, Fructus Aurantii10g, Radix Salviae Miltiorrhizae 20g, Lignum Santali Albi10g, Fructus Amomi Rotundus12g and Radix Curcumae/kloc-0.

[If! Supporters] (5)[endif] Heart qi (Yang) is insufficient. Symptoms: chest tightness, shortness of breath, fatigue, spontaneous sweating, palpitation, and dull pain in the precordial area (heart qi deficiency); Even the limbs are cold, and the cold is aggravated (heart yang deficiency). The tongue is light and fat, the coating is thin and white, and the pulse is thin or knotted. Treatment: (deficiency of heart-qi) tonify heart-qi; (Heart yang deficiency) Warming yang and relieving arthralgia are supplemented by promoting blood circulation and removing blood stasis. Prescription: (deficiency of heart-qi) Baoyuan decoction; Guizhi Gancao Decoction (heart-yang deficiency). 25g of Radix Codonopsis, 30g of Radix Astragali, 0g of Ramulus Cinnamomi10g, 5g of Radix Glycyrrhizae, 0g of Semen Cucurbitae15g, 20g of Radix Salviae Miltiorrhizae, 20g of Radix Angelicae Sinensis12g, 6g of Radix Polygalae and 20g of Poria.

[If! (6)[endif] Deficiency of both qi and yin. Symptoms: chest tightness, shortness of breath, palpitation, dull pain in precordial region, fatigue, spontaneous sweating, night sweats, upset, insomnia, dry mouth and throat, less red tongue coating and thready pulse. Treatment: Yiqi Yangyin, Huayu Tongmai. Prescription: Shengmai Powder and Lily Dihuang Decoction. Radix Pseudostellariae (or Radix Panacis Quinquefolii) 30 g, Radix Ophiopogonis 20 g, Fructus Schisandrae 6 g, Lily 30g, Radix Rehmanniae 20 g, Poria 15 g, Radix Polygalae 5 g, Radix Salviae Miltiorrhizae 20 g, 15 go?

[If! SupportLists]7)[endif] Yin deficiency of heart and kidney. Symptoms: precordial pain, chest tightness, dizziness, forgetfulness, soreness of waist and legs, dry mouth, frequent urination, less red tongue coating and thready pulse. Treatment: nourishing yin and kidney, nourishing heart and dredging collaterals, promoting blood circulation and removing blood stasis. Prescription: Zuo Yin Gui, Wu Ziyan Liquor, Shou Yan Wu Shou Dan. 20 g of Radix Rehmanniae, 20 g of Rhizoma Dioscoreae 15 g, 20 g of Poria 10 g, 20 g of Fructus Lycii, 6 g of Semen Cuscutae 15 g, 6g of Fructus Schisandrae, 20 g of Rubus 15g, 20g of Radix Polygoni Multiflori Preparata, 20g of Herba Taxilli, 20g of Radix Salviae Miltiorrhizae and 20g of pumpkin seeds/kloc-.

(8) Yang deficiency of heart and kidney. Symptoms: heartburn, palpitation, aversion to cold, severe pain, chest tightness, shortness of breath, mental fatigue, chills and spontaneous sweating, cold limbs, weak waist and knees, pale and fat tongue, thin and white fur, and slow pulse. Treatment: Warming and tonifying kidney-yang, benefiting heart and dredging collaterals, and Zuo Wei promoting blood circulation and removing blood stasis. Prescription: You Yin Gui is modified. 25g of Radix Rehmanniae Preparata, 20g of Chinese yam, 0g of Poria cocos15g, 20g of Lycium barbarum, 0g of jujube peel12g, 0g of angelica sinensis12g, 0g of dodder15g, and 0g of Eucommia ulmoides Oliv. Morinda officinalis12g, Curculigo curculiginis12g.

abstract

Coronary heart disease is a kind of heart disease caused by coronary atherosclerosis, which leads to myocardial hypoxia and ischemia. Its clinical manifestations are arrhythmia, angina pectoris, chest tightness and myocardial infarction. This paper expounds the cognition, disease name, pathogenesis, clinical manifestations, diagnosis and differential diagnosis of coronary atherosclerotic heart disease in traditional Chinese medicine. Measures such as prevention, first aid, treatment and nursing were discussed. Traditional Chinese medicine believes that coronary heart disease belongs to the deficiency of essence, which is cold coagulation, phlegm turbidity, blood stasis and qi stagnation, while the deficiency of essence is yin and yang and qi and blood deficiency. In view of the prevention and treatment of coronary heart disease by traditional Chinese medicine, this paper also introduces the author's experience in treating heartache with Danshen Yin for reference.

202165438+6 February