Yan Dexin, a master of traditional Chinese medicine, has long been engaged in the study of cardiovascular and cerebrovascular diseases. He praised the theory of qi and blood academically, and regarded "qi is the long-term disease and blood is the embryo of all diseases" as the key link in the diagnosis and treatment of cardiovascular diseases. He advocated the theory that "there must be blood stasis for a long time, and there must be blood stasis for a strange disease", and put forward the main treatment principle of "promoting qi and blood, making it unobstructed and achieving peace", which established a balanced view for the diagnosis and treatment of cardiovascular diseases. The heart is "the day of yang", and the deficiency of heart qi or heart yang leads to the failure of yang qi in the chest and has no right to warm the yin and cold; Deficiency of heart and yang leads to malnutrition of five internal organs, spleen deficiency leads to damp phlegm and kidney temperature loss, which makes yin-cold evil such as water vapor and phlegm drink attack Yang position by deficiency, and the two cold are combined, resulting in pain, chest obstruction, heartache, cough, shortness of breath, dysuria and edema of face and limbs. In synopsis of the golden chamber, Yan Dexin praised the theory that "the husband's pulse should be obtained too slowly, and the yang is weak and the yin is painful, so it should be blamed for its extreme deficiency", and concluded that the pathogenesis of heart disease is deficiency with blood stasis, and both deficiency and excess can be seen. Most of them are based on the loss of heart, qi, blood, yin and yang, marked by heart pulse, and phlegm and blood stasis are combined into qi stagnation and blood stasis. The basic pathogenesis is "qi deficiency and blood stasis". Clinically, he is good at treating both qi and blood, and often takes nourishing the temperature, yang and promoting blood circulation as the treatment method. Now, the medication methods are arranged as follows.

Combination of reinforcing and reducing

The combination of attack and reinforcement is a treatment method of attacking evil and strengthening the body resistance at the same time, which is suitable for diseases and syndromes with excessive evil and insufficient positive energy. Yan Dexin believes that heart diseases are mostly based on the loss of Qi, blood, yin and yang in the heart, and qi stagnation, blood stasis, phlegm and blood stasis and yin stagnation are marked by the heart pulse. Therefore, if only warm tonic is used, the more stagnant the qi is, the more deficient the blood is; Only by promoting blood circulation and removing blood stasis, the more gas consumption, the more blood deficiency. In fact, this disease is virtual and cannot be supplemented, and blood stasis does not attack. Yan Dexin followed Wang Qingren's theory that "Qi can promote blood circulation, but no disease can be eliminated", and emphasized that qi and blood should be used for the purpose. He advocated that attack and reinforcement should be combined in the treatment of integral heart disease, and Taohong Siwu decoction should be used clinically. This recipe contains removing blood stasis and nourishing blood, and can supplement both, attack without cutting, and replenish without coagulation, and has the effect of "dispersing qi and blood, making it achieve its goal and guiding it to harmony"

Coronary heart disease develops into heart failure, with symptoms such as dyspnea and edema after waking up from sleep, which is very similar to the description in synopsis of the golden chamber that "a man with water in his heart is full of qi, unable to lie down, irritable and irritable, and his body is swollen and yin is abundant". Yan Dexin highly praised Su Wen's theory that "anger reaches the sky", holding that "if the sun and moon are out of position, they will lose their lives, so the sky will be bright", and stressing that "where there is sun, there will be vitality", he believed that warming yang is an important rule for treating cardiovascular diseases, especially for some critical cardiovascular diseases, and its application should not be ignored. First, the legislative drugs are used to warm yang, with aconite, dried ginger and licorice warming yang, astragalus, codonopsis pilosula and Atractylodes macrocephala benefiting qi, safflower and peach kernel promoting blood circulation, lepidium, Eupatorium adenophorum and Leonurus japonicus purging lung and promoting diuresis, which complement each other. It can be used for the syndrome that blood is unfavorable to water, and it has the effect of "getting rid of it when you are old".

Give consideration to both upper and lower levels

Giving consideration to both upper and lower levels refers to the method of ascending Qing Yang and descending turbid yin. Before and after the occurrence and development of heart disease, qi stagnation, blood stasis, phlegm stasis and yin stagnation are blocked in the heart artery, which leads to abnormal rise and fall of qi, further aggravating or inducing heart disease. On the basis of the prescription, Cimicifuga rhizome, Bupleurum root, Vitex negundo, Chuanxiong rhizome, etc. are added to make the qi of clearing yang rise; Peach kernel, safflower, angelica and cassia seed moisten the intestines to relieve constipation, and motherwort and poria cocos induce diuresis. According to the treatment of qi and blood, drugs can also reduce the hyperactivity of yang. Or commonly used drugs are compatible with Radix Puerariae, Rhizoma Acori Graminei and Semen Cassiae, wherein Radix Puerariae has effects in promoting hair growth, clearing yang, and relieving chest obstruction; Cassia seed is slightly cold, which can not only control the pungent dryness of monarch and minister drugs, but also clear away heat, cool blood and drain turbidity; Pueraria lobata and cassia seed can rise and fall, dredge the upper and lower qi and strengthen transportation, so there is no obstacle; Acorus gramineus can induce resuscitation and dredge collaterals, introduce various drugs into the blood, promote qi and blood circulation, calm the heart and improve intelligence. Or use Dalbergia odorifera with cassia seed to reduce turbidity and qi, so as to make qi move up and down in an orderly way, so as to achieve the goal of "clearing yang out of the upper orifices and turbid yin out of the lower orifices", nourish the heart, make it dense, release dampness and turbidity, dredge the lower orifices and reconcile the viscera. Or radix aconiti lateralis preparata. Aconitum carmichaeli is dry, which can help the heart yang to dredge the pulse. Rehmannia glutinosa is warm and has the effect of moistening the intestines and relaxing bowels. It is often used in clinic for patients with heart failure or atrial fibrillation with constipation due to deficiency of both yin and yang.

Simultaneous application of cold and heat

The combination of cold and heat is a method of applying cold medicine and hot medicine to one side at the same time, such as Banxia Xiexin Decoction, Wu Mei Pill and Dahuang Fuzi Decoction. In the long-term clinical practice, Yan Dexin combined cold and heat, giving full play to the role of heart disease, a complex disease. Yan Dexin believes that qi stagnation and blood stasis are the early pathogenesis of cardiovascular diseases, but the intersection of phlegm and blood stasis is the final pathological product of qi stagnation and blood stasis. In the process of disease, once phlegm and blood stasis are formed, it is difficult to linger and transform each other. Moreover, phlegm and blood stasis are endogenous to damp heat, so they can't persist, stagnate in collaterals, and damage Yang Qi, so that qi and blood can't be compressed and perfused, which leads to poor operation, mental dystrophy and heart disease. In clinical practice, Yan Dexin highly praised the "Synopsis of the Golden Chamber", so he took Radix Aconiti Lateralis and Ramulus Cinnamomi to drink warm water, and used Zhenwu Decoction and Gui Ling Pig Liver Decoction in clinic, and flexibly combined with Sanhuang (Scutellaria baicalensis, Coptidis Rhizoma and Cortex Phellodendri) to clear away damp-heat, eliminate phlegm and remove blood stasis, and clear away heat and tonify.

Treating qi and blood together

Treating both qi and blood is a therapeutic method of regulating qi or invigorating qi and promoting blood circulation. Qi is the handsome of blood, and blood is the mother of qi. Su Wen's theory of regulating classics points out: "disharmony between qi and blood leads to changes in all diseases." Zhu Danxi also said: "Qi and blood are in harmony, and all diseases are not born. There is depression, a hundred diseases. " The heart governs the blood vessels, and blood can run in the veins and circulate throughout the body, relying on the promotion of heart and gas. Qi deficiency and qi stagnation lead to blood stasis, which are mutually causal and can lead to the occurrence and development of cardiovascular diseases. Yan Dexin proposed that the best way to eliminate blood stasis is to "consolidate the source and clear the source", which means consolidating the source and clearing the source. The representatives of supplementing qi and promoting blood circulation are ginseng and hematoxylin. Ginseng is slightly bitter and has the functions of invigorating qi, calming nerves, consolidating body fluid and quenching thirst. Sumu is sweet and salty, and has the effects of promoting blood circulation, removing blood stasis, reducing swelling and relieving pain. Compatibility of the two drugs can invigorate qi and promote blood circulation. Ginseng can replenish sappan wood without stagnation, and ginseng with sappan wood has stronger blood circulation. It has obvious curative effect on palpitation caused by qi deficiency and blood stasis. Regulating qi and promoting blood circulation with Fructus Aurantii and Radix Curcumae, Fructus Aurantii can remove qi and Radix Curcumae can remove blood. The combination of the two drugs has the functions of promoting qi circulation, relieving depression and relieving joint pain. Or use Acorus gramineus with Pollen Typhae, use Acorus gramineus to soothe the liver and remove turbidity, and use Pollen Typhae to promote blood circulation and qi circulation. The two herbs have fragrant smell, have the functions of promoting qi and blood circulation, resolving phlegm and removing blood stasis, and are generally painless. It is mostly used for patients with palpitation and chest pain.

Open and close.

Opening and closing refers to the simultaneous use of astringent drugs, one opening, one closing and one dispersing, and the two are complementary to each other, so that the two drugs can play a better role. Ascension and health promote metabolism of the body and maintain normal life activities. The circulation of blood in the pulse depends on the beating of the heart, the promotion of qi and the patency of the pulse. Heart, pulse, qi and blood are the four elements to maintain normal blood circulation, and their central functions are mainly reflected in the state of qi and blood. Soft, smooth and smooth pulse is the basis and premise for qi and blood to exercise their physiological functions. Blood vessels are the functional carriers for the normal operation of qi, blood and body fluids. If the blood vessels are unobstructed, the lifting movement will be coordinated and balanced. Therefore, Yan Dexin believes that the treatment of cardiovascular diseases needs to pay more attention to the unity of opposites between the rise and fall of Qi, and often add products in the method of warming yang, benefiting qi and promoting blood circulation to relieve depression and promote blood circulation. Acorus gramineus, Pollen Typhae and Radix Paeoniae Alba are commonly used in clinic. "Materia Medica from the New" said: "Acorus gramineus, warm, fragrant, happy, beneficial to nine orifices, clear eyes and ears." "Materia Medica Justice" said: "Pollen Typhae specializes in treating blood, which can treat aroma and qi, so it can guide blood stasis and treat qi stagnation and blood stasis." Or use Semen Ziziphi Spinosae with Rhizoma Chuanxiong, Semen Ziziphi Spinosae to nourish liver and blood, calm the heart and soothe the nerves, and Rhizoma Chuanxiong to calm qi and blood, soothe the liver and regulate qi. Two kinds of drugs are matched, one is sour and the other is pungent, which complement each other. With the cooperation of the drugs for collecting and dispersing, the drugs for collecting and dispersing can be combined with each other and properly opened and closed, thus promoting blood circulation, removing blood stasis and harmonizing qi.

Lifting combination

The combination of ascending and descending is the combination of settling medicine and ascending and floating medicine, which makes the whole body move harmoniously, calls the movement, communicates yin and yang, and harmonizes qi and blood. Heart disease can be manifested in different ways according to the severity of the disease, from chest fullness and compression, chest pain and even heartache. If the chest is stuffy, it will be stuffy behind the heart, which is the syndrome of "chest obstruction, heart fullness and qi stagnation in the chest" in synopsis of golden chamber. The pathogenesis is mostly yang deficiency and qi stagnation, and the treatment must take into account the rise and fall of qi. Clinically, Fructus Aurantii Decoction is often used to treat cardiovascular diseases. Soup of Fructus Aurantii comes from Liang Fang, Su Shen, and the taste of Fructus Aurantii is bitter. Platycodon grandiflorum is used for lung gold and is often used as a boat medicine because of its pungent taste. When the two drugs are combined, they are bitter in bitterness. When one liter is lowered, the clear gas will rise, and the turbid gas will naturally drop, and the gas will benefit. Palpitation caused by phlegm-dampness or stagnation of liver qi can be used to regulate qi. The center of the five elements belongs to fire and the kidney belongs to water. Fire and water are the signs of yin and yang, and the ups and downs reflect the movements of yin and yang, so the ups and downs are based on the heart and kidney. The intersection of heart and kidney is the image of combining fire and water. The true qi in the kidney rises, and the heart fire does not cause inflammation, but the heart fire drops to warm the true water in the kidney. Therefore, clinical treatment is often accompanied by Jiaotai pills, one liter and one drop, one yin and one yang. If the mind is restless due to intense fire, lily and lotus plumule are often combined on this basis to clear the heart and soothe the nerves.

Typical medical record

Patient, male, 68 years old. Angina pectoris and myocardial infarction are hospitalized repeatedly, and the attack of angina pectoris can reach 10 times every night. The condition is unstable, please consult Chinese medicine. Initial diagnosis: chest tightness and heartache, with severe pain, palpitation and shortness of breath, once a day 10 times, heavy and thin pulse and thin purple tongue coating. The age is recent, both qi and yin fail, the heart qi is insufficient, the blood stasis blocks the heart pulse, and the yang is weak and the yin is abundant at night, so it mostly occurs in the middle of the night. It is appropriate to use the experience prescription Yixin Decoction to replenish qi and remove blood stasis. Prescription: Radix Codonopsis 15g, Radix Astragali 15g, Radix Puerariae 9g, Rhizoma Chuanxiong 9g, Radix Salviae Miltiorrhizae 15g, Radix Paeoniae Rubra 9g, Fructus Crataegi 30g, Rhizoma Acori Graminei 4.5g, Lignum Dalbergiae Odoriferae 3g, Semen Cassiae 30g, Radix Notoginseng 1.5g (respectively) and Sanguis Draxonis powder/kloc. 7 doses, decocted in water.

The second diagnosis: after taking the medicine, the chest tightness subsided, the pain was slow, the pulse was heavy and thin, and the tongue coating was purple and thin. Qi deficiency and blood stasis, keep the original prescription and take it again 14 dose. Ginseng powder 1.5g twice a day. After 5 years of follow-up, no one was hospitalized for heart disease except fatigue or cold.

According to the patient's age, the deficiency of both qi and yin, angina pectoris and myocardial infarction repeatedly attack to damage the heart qi and block the heart pulse. Blindly tonic, chest tightness and heartache are difficult to get rid of; Blindly removing blood stasis, healthy qi is more harmful, so we must grasp the discretion of reinforcing and reducing. Because of chest tightness and heartache, the focus of initial diagnosis is to remove blood stasis. Yixin Decoction, Radix Codonopsis, Radix Astragali, Rhizoma Chuanxiong, and Radix Salviae Miltiorrhizae are used for invigorating qi and removing blood stasis; Radix Puerariae, Rhizoma Acori Graminei, Lignum Dalbergiae Odoriferae, and Semen Cassiae are used for clearing away heat and turbidity; Radix Notoginseng and Sanguis Draxonis powder are effective for removing blood stasis, so there is no danger of injury. For the second diagnosis, ginseng powder should be used to replenish qi and remove blood stasis, and taken regularly, without any harm.

Note: Please follow the doctor's advice for specific treatment and medication!