罗陆一教授学术思想及临床治疗扩张型心肌病的研究
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摘要
背景
名老中医的临床经验、学术特长、学术思想是中医药专家经过多年的实践、反复检验证实有效的中医药智慧的结晶。它代表中医实践的最高水平,是学习中医成为有水平的名中医的有效途径,所以继承、整理名中医的经验具有重要的现实意义。罗陆一教授是全国名老中医,广东省名中医,他学验俱丰,在中医内科,特别是心血管内科疾病的治疗形成自己独特的学术思想和诊治方法,对他学术思想的整理、研究非常有价直。
(?)究目的：
(?)研究旨在全面总结、整理罗陆一教授的学术思想与临床经验,并在此经验基础(?)中医临床治疗扩张型心肌病的科学研究,旨在探索中药治疗该病新方法与新思
(?)方法：
采用中医师带徒的方法,包括跟师出诊和病房查房,相互探讨,沟通交流,不断(?)录总结学习的心得、体会,并进行归纳、分析、整理提炼出其学术思想与临床经验。同时自身不断的加强经典理论的学习,努力做到理论与实践相结合,在独立临床实践中运用、体会老师的经验。
采用随机对照的科研设计方法对老师擅长治疗的疾病扩张型心肌病进行科学研究,观察、统计、分析、得出科学结论。采用固本强心法治疗扩张型心肌病：采用随机对照前瞻的方法研究,将100例符合纳入标准的扩张型心肌病人分为治疗组和对照组各50例,对照组按照现代医学关于扩张型心肌病和心衰的治疗指南给与最合适的治疗药物,强心药：地高辛；利尿药：双氢克尿噻、安体舒通,速尿；扩血管药：消心痛；β-阻滞剂：美托洛尔；ACEI类：雅施达；治疗组在西药治疗基础上根据其证型加减辨证应用中药固本强心汤治疗,每天两次口服,各组疗程为4周。
固本强心汤基本方由黄芪、红参、白术、炙甘草、当归、茯苓、仙茅、仙灵脾、丹参、田七、法夏、远志、酸枣仁、紫河车、鹿角胶、蛤蚧等组成具有补气、培元、固本、益肺、健脾、补肾、活血作用。
分别检测记录两组治疗前后的心脏彩超心功能(EF、FS),胸部正位片(心胸比例),中医症状积分(心悸、气短、疲倦乏力、水肿、胸闷痛、畏寒肢冷、尿少、气喘),体征(心率、血压、脉搏、呼吸、心脏杂音、肺呼吸音罗音等),舌(舌质、舌苔、舌态),脉象,六分钟步行距离测试,并进行实验室检测如炎症因子肿瘤坏死因子(TNF)、脑钠肽(BNP)、超敏C反应蛋白(hs-CRP),对数据进行统计学的分析,
研究结果：
罗陆一教授的学术思想大致概括为如下：1.以《黄帝内经》、《伤寒论》为主要经典指导临床；2诊断疾病强调四诊合参,尤擅望诊；3内科疾病重视健脾、补肾4肾虚为冠心病的基本病机5心脑血管病治疗强调化痰、祛瘀、通络6临床用药注意保胃气、护阳气、善于运用有毒中药如附子、细辛、蜈蚣、全蝎等治疗顽症7提倡扶正祛邪的治疗原则,倡导治未病的理念,擅长食疗保健。
罗老师认为心脏病的基本治则治法：扶正祛邪,调整阴阳,调整脏腑气血。罗老认为冠心病的基本病机为肾虚：心肾相关,肾气亏虚不能温心阳,心阳不足,血运无力,留而为瘀；肾阴亏虚滋养心阴不足,脉道失润,血行滞涩而为病,瘀血为病理产物,冠心病的治疗以补肾为先,补肾时需要注意肾的阴阳偏盛,偏衰,寒湿,痰瘀夹杂分别予以补肾气,滋肾阴,温肾阳,养肾精以及散寒、化痰、活血之法.动脉硬化(中风)的常见病机为脾肾亏虚、痰瘀阻脉,治疗方法宜健脾补肾化痰祛瘀.制成丸药通脉地仙丸.
罗陆一教授的学术渊源：罗老师古文功底深厚,善于自学,博览群书,理、法、方、药知识全面。他读的主要书目,医理方面书籍：主要学习《易经》《黄帝内经》；理、方、药俱备的书籍：《伤寒论》《金匮要略》；方药：《神农本草经》《本草纲目》等为对其有影响的主要书籍。
对罗陆一教授有影响的医家主要有：张仲景(理、法、方、药),张景岳(擅长补肾、温补派),朱丹溪(痰瘀理论、六郁理论),李杲(脾胃理论),当代医家：国医大师如李振华(重视脾胃学术思想),赵清理(伤寒论学术思想)和周仲瑛(望诊思想)。
罗老师善于望诊,心病望诊经验包括望神,望色,望下级,通过望神即可以推测心之盛衰,心的生理病理状况。心主全身的血脉,由于血脉循行周身,人的血气是否充盈,可以在望诊面色时看出来。下极望诊属于局部望诊,是面部望诊的一部分,临床上广泛应用于心病诊疗及预后推测。
月经的产生以肾---天癸----冲任---胞宫轴为基础。运用中医望诊人中,判断妇科疾病之阴阳、寒热、虚实,辨证施治,治疗以健脾气、温肾阳、调冲任为法。
临床研究结果表明：
1.中西医结合治疗组在改善患者临床症状方面由于西药组：两组治疗后的中医症状积分比较采用独立样本t检验,两组治疗后在心悸,气短,疲倦乏力,面浮肢肿,胸闷痛,畏寒肢冷,气喘等积分具有明显差异(P值均为0.0001),
P<0.01,说明与对照组相比,治疗组在改善中医症状积分方面效果更加明显。
2两组临床总疗效的比较,治疗组达到89.36%,对照组达到70%.两组治疗前后心功能疗效比较采用卡方检验,经比较中西医结合组的总有效率高于单纯西医治疗组,X2=6.74,半P<0.01,具有显著性差异。
3治疗前后炎性因子TNF检测结果比较两组治疗后的TNF的比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合降低炎性因子TNF的效果更加显著
4治疗前后BNP检测结果比较两组治疗后的BNP的比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合组降低BNP的效果更加显著
5治疗前后超声心动图变化比较两组治疗后的超声心动图变化比较采用独立样本的t检验(P值分别为0.0001,0.003,0.0001和0.0001),**P<0.01具有显著性差异,表明与西药组相比,中西医结合组减低LVESd和LVEDd,升高LVEF和FS效果更加显著,即明显改善患者的心脏的收缩和舒张功能,使扩大的心脏有所减小.
6治疗前后胸部X片(心胸比例)变化比较两组治疗后的心胸比例比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合组减小心胸比例的效果更加显著
7治疗前后两组六分钟步行距离的比较两组治疗后的六分钟步行距离比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合组可以显著提高患者的运动耐力,间接反映心功能的改善。
结论：
1本研究对罗陆一教授的学术思想和临床经验进行了全面系统地总结和整理。罗陆一教授的诸多经验临床实用,有效,是非常珍贵的中医经验.
2经临床科学研究表明,运用培元固本强心法治疗扩张型心肌病具有显著的疗效加用中药辨证治疗可以明显改善患者临床症状；加用中药辨证治疗对缩小扩大的心脏,具有一定的意义；加用中药辨证治疗对于改善心功能,和患者的耐力和生活质量具有显著价值；加用中药辨证治疗可以减少西药的应用,减轻西药的副作用；加用中药辨证治疗心脏病的治疗可能与其减轻心脏病发展过程中所产生的炎症因子有关,值得临床进一步研究。
Background
The clinical experience, academic specialty and thoughts of the old doctor of Traditional Chinese Medicine (TCM) are the essence for the area, which come with their practice and repeated tests for years. They represent the highest level of the practice of traditional Chinese medicine and are also effective ways to become famous traditional Chinese medicine experts. So it is significant to arrange them as well as make them pass on. Professor Luo Luyi is famous expert of TCM in China, he is very experienced in internal medicine of TCM, with unique academic thinkings and methods in cardiovascular diseases. It is valuable to sort and reseach his ideas.
Objective:
This research aims to summarize and sort professor Luo LuYi's academic thoughts and clinical experience. New methods and ideas will be put forward based on developing the clinical scientific research which refers to his experiences.
Methods:
The academic ideas and clinical experiences were analyzed, extracted and summarized by methods of apprentice training from teacher, diagnosis, wards-round, discussion, communication and summarization. At the same time, we continually study the classical theory combining with the practice, using and understanding the teacher's experience in clinical practice.
A randomized and controlled research was carried out to observe and analyse Dilated cardiomyopathy (DCM),which our teacher was good at. The treatment method is in favor of strengthening Dilated cardiomyopathy and the randomized study forward-looking.100cases of Dilated cardiomyopathy were divided into the treatment group and the control group (50each).According to the treatment guidelines for Dilated cardiomyopathy and heart failure, the control group was administrated with the most appropriate drugs.:Cardiac drugs:Digoxin; Diuretics:Hydrochlorothiazide, spironolactone, furosemide; Vasodilators:isosorbide dinitrate; β-blockers:metoprolol; ACE inhibitor: Perindopril. Besides these western medicines in control group, strengthening heart soup was given according treatment in the treatment group (P.O. bid, for4weeks).
Composition of strengthening heart soup is composed by astragalus, red ginseng, white atractylodes, baked licorice, angelica, poria, curculigo, epimedium, salvia, pseudo-ginseng, Fa Xia, polygala, semen, placenta, antler, gecko etc. Used for supplement breathe, strengthening vitality and resistance, profiting lung, spleen and kidney and blood circulation.
Make the following test before and after the treatment in two groups. UCG (EF, FS), X-ray of frontal chest (cardiothoracic ratio), TCM symptoms integral (palpitations, shortness of breath, fatigue, edema, chest pain, fear of the cold and cold limbs, less urine, asthma), physical signs (heart rate, blood pressure, pulse, respiration, heart murmur, lung breath sounds and rhonchus etc.), tongue (quality, coating, state), pulse condition, six minutes walking distance test, and laboratory testing, such as inflammatory tumor necrosis factor (TNF), brain natriuretic peptide (BNP), hypersensitive c-reactive protein (hs-CRP). All the datas were analyzed by statistical method.
Results:
The academic ideas of Luo Luyi professor were generally summarized as follows:
1. The main classic clinical guidelines are from'Yellow Emperor's Medicine Classic' and 'Treatise on Febrile Diseases', such as using the typhoid six-channel to treat myocarditis;
2. Clinical diagnosis of disease emphasized the combine of four diagnostic, especially inspection;
3. Regulating spleen and kidney should be used in internal medical diseases.
4. Deficiency of the kidney is the basic pathogenesis of coronary artery disease;
5. Treatment of cardio-cerebrovascular disease emphasizes the stasis theory of dispeling phlegm;
6. Clinical medication should protect stomach and the spirit. He also is good at using toxic medicine such as aconite, asarum, centipede and scorpion can also be used for persistent ailment;
7. He advocates the treatment principle of strengthening body resistance and eliminating evil, prevention and health care.
Luo Luyi professor indicates the basic principle of heart disease therapies: strengthening body resistance and eliminating evil, adjust the Yin and Yang, adjust the blood and gas in viscera.
Professor Luo Luyi points out that deficiency of the kidney is the basic pathogenesis (?)nary artery disease:heart related to kidney. A deficit of kidney Yang can not warm (?)art. Then the heart can not afford the blood circulation, so stasis emerges. On the (?) hand, kidney Yin deficiency can not nourish the heart, veins are insufficient (?)ation, sluggish blood circulation leads to a disease, then blood stasis is the pathology (?)duct.
The treatment of coronary heart disease is nourishing kidney first. When nourishing the kidney, we need to pay attention to partial prosperous, partial failure, cold dampness, the mix of phlegm and blood stasis, then treat respectively with nourishing kidney, supply kidney Yin, warm kidney Yang, keep kidney essence and remove cold, eliminate phlegm, promoting blood circulation. The common pathogenesis of atherosclerosis (stroke) is spleen and kidney deficiency, phlegm stasis resistance pulse. Treatment should remove stasis phlegm. The pills were named as Tong Mai Di Xian Wan.
Professor Luo LuYi's academic origin:he has profound skills of ancient prose, is good at self-study, extensively read, comprehensive knowledge in principle,method and drug prescription. His main bibliography which have influences includes:Principle:'The Book of YIJING',The medical classic of the Yellow Emperor'; Method:'Treatise on Febrile Diseases','Synopsis of Golden Chamber'; Prescription'Shen Nong's herbal classic','Compendium of Materia Medica'
Luo Luyi professor was influenced by the following physicians:Zhang Zhongjing (principle,method. and drug prescription); Zhang Jingyue (good at nourishing the kidney); Zhu Danxi (phlegm and blood theory, six stasis theory); Li Gao (Spleen and Stomache theory); Li Zhenhua (emphasis on academic ideas of Spleen and Stomache); Zhao Qingli (treatise on febrile diseases); Zhou Zhongying (inspection).
Luo Luyi professor is good at inspection diagnosis which includes mental state, the color and the Xiaji. The rise and fall (the physiological and pathological conditions) can be speculated by inspection diagnosis. Heart leads the blood circulation of the whole body. Because blood runs on human body, blood flowing can be speculated in the inspection. The Xiaji inspection belongs to local inspection, is part of the facial inspection, widely used in clinical cardiac diagnosis and treatment and prognosis speculation.
Menstruation generates on the basis of kidney-TianGui-ChongRen-BaoGongZhou. Philtrum inspection diagnosis is applied to determine gynecological diseases (Yin and Yang, cold and hot, diagnosis and treatment based on an overall analysis of the illness and the patient's condition). disease can be treated with strengthening the spleen, warming the kidney Yang and regulating Chong-Ren.
The results of clinical trials show:
1. On the point that combination therapy group improving clinical symptoms:the independent sample t-test was used to compare the TCM symptoms of these two groups. After treatment, there is obvious difference in the heart palpitations, shortness of breath, fatigue, surface floating limb swelling, chest pain, chills, asthma and other points (P values are to0.0001) between these two groups. From
P<0.01, we can see for the treatment group, the improvement of traditional Chinese medicine in symptom score was more obvious when comparing with the control group.
2. Clinical comparison of the total effect of the two groups:the treatment group reached89.36%while the control group reached70%. Chi-square test was used to compare the efficacy of cardiac function before and after treatment. After comparison, the total effective of Chinese and Western medicine group is higher than Western medicine alone, X2=6.74,*P<0.01, it states that significant difference were existed.
3. We used independent samples t-test to analyze the inflammatory cytokines TNF of two groups after treatment. From P=0.0001,
P<0.01, we can see significant differences were existed, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce inflammatory cytokines TNF.
4. Independent samples t-test was used to analyze the BNP of two groups after treatment. From P=0.0001.
P<0.01, we can see significant differences were existed, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce BNP.
5. Independent samples t-test was used to analyze the echocardiography change of two groups after treatment (P were0.0001,0.0003,0.0001,and0.0001). From
P<0.01, we can see significant differences were existed, illustrating in comparison with western medicine,(?)rative medicine group can reduce LVESd and LVEDd and has more significant effect (?)ncreasing LVEF and FS. That means it can significantly improve the patient's systolic (?)iastolic function, so the expansion of the heart decreased.
6. We also used independent samples t-test to analyze the cardiothoracic ratio of two (?)s after treatment. From P=0.0001,
P<0.01, we can included there were obvious (?)rence, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce cardiothoracic ratio.
7. Independent samples t-test was used to analyze the six-minute walk distance of two groups after treatment. From P=0.0001,
P<0.01, we can included there were obvious difference, indicating that in comparison with the group with western medicine, integrative medicine group can significantly improve the patient's exercise tolerance, indirectly reflecting the improvement in cardiac function.
Conclusion
1. In this study, academic thinking and clinical experience of Luo Luyi professor were summarized and organized in a comprehensive way. Luo Luyi professor's many clinical experiences are practical and effective. His clinical experiences are practical, effective and valuable.
2. The clinical research shows that the application of Pei Yuan Gu Ben Qiang Xin method is quite effective for on expansionary cardiomyopathy. And adding TCM differential treatment can significantly improve the clinical symptoms; plusing TCM differential treatment has a significant effect on reducing expansion of the heart, which has certain meaning; adding TCM differential treatment can significantly improve the cardiac function, patient endurance and quality of life; plusing TCM differential treatment can aslo reduce the side effects of western medicine; adding TCM differential treatment may have a relationship with inflammatory cytokines which produced in the process of reducing the heart disease, and it is worthy of further study.
名老中医的临床经验、学术特长、学术思想是中医药专家经过多年的实践、反复检验证实有效的中医药智慧的结晶。它代表中医实践的最高水平,是学习中医成为有水平的名中医的有效途径,所以继承、整理名中医的经验具有重要的现实意义。罗陆一教授是全国名老中医,广东省名中医,他学验俱丰,在中医内科,特别是心血管内科疾病的治疗形成自己独特的学术思想和诊治方法,对他学术思想的整理、研究非常有价直。
(?)究目的：
(?)研究旨在全面总结、整理罗陆一教授的学术思想与临床经验,并在此经验基础(?)中医临床治疗扩张型心肌病的科学研究,旨在探索中药治疗该病新方法与新思
(?)方法：
采用中医师带徒的方法,包括跟师出诊和病房查房,相互探讨,沟通交流,不断(?)录总结学习的心得、体会,并进行归纳、分析、整理提炼出其学术思想与临床经验。同时自身不断的加强经典理论的学习,努力做到理论与实践相结合,在独立临床实践中运用、体会老师的经验。
采用随机对照的科研设计方法对老师擅长治疗的疾病扩张型心肌病进行科学研究,观察、统计、分析、得出科学结论。采用固本强心法治疗扩张型心肌病：采用随机对照前瞻的方法研究,将100例符合纳入标准的扩张型心肌病人分为治疗组和对照组各50例,对照组按照现代医学关于扩张型心肌病和心衰的治疗指南给与最合适的治疗药物,强心药：地高辛；利尿药：双氢克尿噻、安体舒通,速尿；扩血管药：消心痛；β-阻滞剂：美托洛尔；ACEI类：雅施达；治疗组在西药治疗基础上根据其证型加减辨证应用中药固本强心汤治疗,每天两次口服,各组疗程为4周。
固本强心汤基本方由黄芪、红参、白术、炙甘草、当归、茯苓、仙茅、仙灵脾、丹参、田七、法夏、远志、酸枣仁、紫河车、鹿角胶、蛤蚧等组成具有补气、培元、固本、益肺、健脾、补肾、活血作用。
分别检测记录两组治疗前后的心脏彩超心功能(EF、FS),胸部正位片(心胸比例),中医症状积分(心悸、气短、疲倦乏力、水肿、胸闷痛、畏寒肢冷、尿少、气喘),体征(心率、血压、脉搏、呼吸、心脏杂音、肺呼吸音罗音等),舌(舌质、舌苔、舌态),脉象,六分钟步行距离测试,并进行实验室检测如炎症因子肿瘤坏死因子(TNF)、脑钠肽(BNP)、超敏C反应蛋白(hs-CRP),对数据进行统计学的分析,
研究结果：
罗陆一教授的学术思想大致概括为如下：1.以《黄帝内经》、《伤寒论》为主要经典指导临床；2诊断疾病强调四诊合参,尤擅望诊；3内科疾病重视健脾、补肾4肾虚为冠心病的基本病机5心脑血管病治疗强调化痰、祛瘀、通络6临床用药注意保胃气、护阳气、善于运用有毒中药如附子、细辛、蜈蚣、全蝎等治疗顽症7提倡扶正祛邪的治疗原则,倡导治未病的理念,擅长食疗保健。
罗老师认为心脏病的基本治则治法：扶正祛邪,调整阴阳,调整脏腑气血。罗老认为冠心病的基本病机为肾虚：心肾相关,肾气亏虚不能温心阳,心阳不足,血运无力,留而为瘀；肾阴亏虚滋养心阴不足,脉道失润,血行滞涩而为病,瘀血为病理产物,冠心病的治疗以补肾为先,补肾时需要注意肾的阴阳偏盛,偏衰,寒湿,痰瘀夹杂分别予以补肾气,滋肾阴,温肾阳,养肾精以及散寒、化痰、活血之法.动脉硬化(中风)的常见病机为脾肾亏虚、痰瘀阻脉,治疗方法宜健脾补肾化痰祛瘀.制成丸药通脉地仙丸.
罗陆一教授的学术渊源：罗老师古文功底深厚,善于自学,博览群书,理、法、方、药知识全面。他读的主要书目,医理方面书籍：主要学习《易经》《黄帝内经》；理、方、药俱备的书籍：《伤寒论》《金匮要略》；方药：《神农本草经》《本草纲目》等为对其有影响的主要书籍。
对罗陆一教授有影响的医家主要有：张仲景(理、法、方、药),张景岳(擅长补肾、温补派),朱丹溪(痰瘀理论、六郁理论),李杲(脾胃理论),当代医家：国医大师如李振华(重视脾胃学术思想),赵清理(伤寒论学术思想)和周仲瑛(望诊思想)。
罗老师善于望诊,心病望诊经验包括望神,望色,望下级,通过望神即可以推测心之盛衰,心的生理病理状况。心主全身的血脉,由于血脉循行周身,人的血气是否充盈,可以在望诊面色时看出来。下极望诊属于局部望诊,是面部望诊的一部分,临床上广泛应用于心病诊疗及预后推测。
月经的产生以肾---天癸----冲任---胞宫轴为基础。运用中医望诊人中,判断妇科疾病之阴阳、寒热、虚实,辨证施治,治疗以健脾气、温肾阳、调冲任为法。
临床研究结果表明：
1.中西医结合治疗组在改善患者临床症状方面由于西药组：两组治疗后的中医症状积分比较采用独立样本t检验,两组治疗后在心悸,气短,疲倦乏力,面浮肢肿,胸闷痛,畏寒肢冷,气喘等积分具有明显差异(P值均为0.0001),
P<0.01,说明与对照组相比,治疗组在改善中医症状积分方面效果更加明显。
2两组临床总疗效的比较,治疗组达到89.36%,对照组达到70%.两组治疗前后心功能疗效比较采用卡方检验,经比较中西医结合组的总有效率高于单纯西医治疗组,X2=6.74,半P<0.01,具有显著性差异。
3治疗前后炎性因子TNF检测结果比较两组治疗后的TNF的比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合降低炎性因子TNF的效果更加显著
4治疗前后BNP检测结果比较两组治疗后的BNP的比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合组降低BNP的效果更加显著
5治疗前后超声心动图变化比较两组治疗后的超声心动图变化比较采用独立样本的t检验(P值分别为0.0001,0.003,0.0001和0.0001),**P<0.01具有显著性差异,表明与西药组相比,中西医结合组减低LVESd和LVEDd,升高LVEF和FS效果更加显著,即明显改善患者的心脏的收缩和舒张功能,使扩大的心脏有所减小.
6治疗前后胸部X片(心胸比例)变化比较两组治疗后的心胸比例比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合组减小心胸比例的效果更加显著
7治疗前后两组六分钟步行距离的比较两组治疗后的六分钟步行距离比较采用独立样本的t检验,P=0.0001,
P<0.01具有显著性差异,表明与西药组相比,中西医结合组可以显著提高患者的运动耐力,间接反映心功能的改善。
结论：
1本研究对罗陆一教授的学术思想和临床经验进行了全面系统地总结和整理。罗陆一教授的诸多经验临床实用,有效,是非常珍贵的中医经验.
2经临床科学研究表明,运用培元固本强心法治疗扩张型心肌病具有显著的疗效加用中药辨证治疗可以明显改善患者临床症状；加用中药辨证治疗对缩小扩大的心脏,具有一定的意义；加用中药辨证治疗对于改善心功能,和患者的耐力和生活质量具有显著价值；加用中药辨证治疗可以减少西药的应用,减轻西药的副作用；加用中药辨证治疗心脏病的治疗可能与其减轻心脏病发展过程中所产生的炎症因子有关,值得临床进一步研究。
Background
The clinical experience, academic specialty and thoughts of the old doctor of Traditional Chinese Medicine (TCM) are the essence for the area, which come with their practice and repeated tests for years. They represent the highest level of the practice of traditional Chinese medicine and are also effective ways to become famous traditional Chinese medicine experts. So it is significant to arrange them as well as make them pass on. Professor Luo Luyi is famous expert of TCM in China, he is very experienced in internal medicine of TCM, with unique academic thinkings and methods in cardiovascular diseases. It is valuable to sort and reseach his ideas.
Objective:
This research aims to summarize and sort professor Luo LuYi's academic thoughts and clinical experience. New methods and ideas will be put forward based on developing the clinical scientific research which refers to his experiences.
Methods:
The academic ideas and clinical experiences were analyzed, extracted and summarized by methods of apprentice training from teacher, diagnosis, wards-round, discussion, communication and summarization. At the same time, we continually study the classical theory combining with the practice, using and understanding the teacher's experience in clinical practice.
A randomized and controlled research was carried out to observe and analyse Dilated cardiomyopathy (DCM),which our teacher was good at. The treatment method is in favor of strengthening Dilated cardiomyopathy and the randomized study forward-looking.100cases of Dilated cardiomyopathy were divided into the treatment group and the control group (50each).According to the treatment guidelines for Dilated cardiomyopathy and heart failure, the control group was administrated with the most appropriate drugs.:Cardiac drugs:Digoxin; Diuretics:Hydrochlorothiazide, spironolactone, furosemide; Vasodilators:isosorbide dinitrate; β-blockers:metoprolol; ACE inhibitor: Perindopril. Besides these western medicines in control group, strengthening heart soup was given according treatment in the treatment group (P.O. bid, for4weeks).
Composition of strengthening heart soup is composed by astragalus, red ginseng, white atractylodes, baked licorice, angelica, poria, curculigo, epimedium, salvia, pseudo-ginseng, Fa Xia, polygala, semen, placenta, antler, gecko etc. Used for supplement breathe, strengthening vitality and resistance, profiting lung, spleen and kidney and blood circulation.
Make the following test before and after the treatment in two groups. UCG (EF, FS), X-ray of frontal chest (cardiothoracic ratio), TCM symptoms integral (palpitations, shortness of breath, fatigue, edema, chest pain, fear of the cold and cold limbs, less urine, asthma), physical signs (heart rate, blood pressure, pulse, respiration, heart murmur, lung breath sounds and rhonchus etc.), tongue (quality, coating, state), pulse condition, six minutes walking distance test, and laboratory testing, such as inflammatory tumor necrosis factor (TNF), brain natriuretic peptide (BNP), hypersensitive c-reactive protein (hs-CRP). All the datas were analyzed by statistical method.
Results:
The academic ideas of Luo Luyi professor were generally summarized as follows:
1. The main classic clinical guidelines are from'Yellow Emperor's Medicine Classic' and 'Treatise on Febrile Diseases', such as using the typhoid six-channel to treat myocarditis;
2. Clinical diagnosis of disease emphasized the combine of four diagnostic, especially inspection;
3. Regulating spleen and kidney should be used in internal medical diseases.
4. Deficiency of the kidney is the basic pathogenesis of coronary artery disease;
5. Treatment of cardio-cerebrovascular disease emphasizes the stasis theory of dispeling phlegm;
6. Clinical medication should protect stomach and the spirit. He also is good at using toxic medicine such as aconite, asarum, centipede and scorpion can also be used for persistent ailment;
7. He advocates the treatment principle of strengthening body resistance and eliminating evil, prevention and health care.
Luo Luyi professor indicates the basic principle of heart disease therapies: strengthening body resistance and eliminating evil, adjust the Yin and Yang, adjust the blood and gas in viscera.
Professor Luo Luyi points out that deficiency of the kidney is the basic pathogenesis (?)nary artery disease:heart related to kidney. A deficit of kidney Yang can not warm (?)art. Then the heart can not afford the blood circulation, so stasis emerges. On the (?) hand, kidney Yin deficiency can not nourish the heart, veins are insufficient (?)ation, sluggish blood circulation leads to a disease, then blood stasis is the pathology (?)duct.
The treatment of coronary heart disease is nourishing kidney first. When nourishing the kidney, we need to pay attention to partial prosperous, partial failure, cold dampness, the mix of phlegm and blood stasis, then treat respectively with nourishing kidney, supply kidney Yin, warm kidney Yang, keep kidney essence and remove cold, eliminate phlegm, promoting blood circulation. The common pathogenesis of atherosclerosis (stroke) is spleen and kidney deficiency, phlegm stasis resistance pulse. Treatment should remove stasis phlegm. The pills were named as Tong Mai Di Xian Wan.
Professor Luo LuYi's academic origin:he has profound skills of ancient prose, is good at self-study, extensively read, comprehensive knowledge in principle,method and drug prescription. His main bibliography which have influences includes:Principle:'The Book of YIJING',The medical classic of the Yellow Emperor'; Method:'Treatise on Febrile Diseases','Synopsis of Golden Chamber'; Prescription'Shen Nong's herbal classic','Compendium of Materia Medica'
Luo Luyi professor was influenced by the following physicians:Zhang Zhongjing (principle,method. and drug prescription); Zhang Jingyue (good at nourishing the kidney); Zhu Danxi (phlegm and blood theory, six stasis theory); Li Gao (Spleen and Stomache theory); Li Zhenhua (emphasis on academic ideas of Spleen and Stomache); Zhao Qingli (treatise on febrile diseases); Zhou Zhongying (inspection).
Luo Luyi professor is good at inspection diagnosis which includes mental state, the color and the Xiaji. The rise and fall (the physiological and pathological conditions) can be speculated by inspection diagnosis. Heart leads the blood circulation of the whole body. Because blood runs on human body, blood flowing can be speculated in the inspection. The Xiaji inspection belongs to local inspection, is part of the facial inspection, widely used in clinical cardiac diagnosis and treatment and prognosis speculation.
Menstruation generates on the basis of kidney-TianGui-ChongRen-BaoGongZhou. Philtrum inspection diagnosis is applied to determine gynecological diseases (Yin and Yang, cold and hot, diagnosis and treatment based on an overall analysis of the illness and the patient's condition). disease can be treated with strengthening the spleen, warming the kidney Yang and regulating Chong-Ren.
The results of clinical trials show:
1. On the point that combination therapy group improving clinical symptoms:the independent sample t-test was used to compare the TCM symptoms of these two groups. After treatment, there is obvious difference in the heart palpitations, shortness of breath, fatigue, surface floating limb swelling, chest pain, chills, asthma and other points (P values are to0.0001) between these two groups. From
P<0.01, we can see for the treatment group, the improvement of traditional Chinese medicine in symptom score was more obvious when comparing with the control group.
2. Clinical comparison of the total effect of the two groups:the treatment group reached89.36%while the control group reached70%. Chi-square test was used to compare the efficacy of cardiac function before and after treatment. After comparison, the total effective of Chinese and Western medicine group is higher than Western medicine alone, X2=6.74,*P<0.01, it states that significant difference were existed.
3. We used independent samples t-test to analyze the inflammatory cytokines TNF of two groups after treatment. From P=0.0001,
P<0.01, we can see significant differences were existed, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce inflammatory cytokines TNF.
4. Independent samples t-test was used to analyze the BNP of two groups after treatment. From P=0.0001.
P<0.01, we can see significant differences were existed, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce BNP.
5. Independent samples t-test was used to analyze the echocardiography change of two groups after treatment (P were0.0001,0.0003,0.0001,and0.0001). From
P<0.01, we can see significant differences were existed, illustrating in comparison with western medicine,(?)rative medicine group can reduce LVESd and LVEDd and has more significant effect (?)ncreasing LVEF and FS. That means it can significantly improve the patient's systolic (?)iastolic function, so the expansion of the heart decreased.
6. We also used independent samples t-test to analyze the cardiothoracic ratio of two (?)s after treatment. From P=0.0001,
P<0.01, we can included there were obvious (?)rence, indicating that in comparison with the group with western medicine, integrative medicine has more significant effect to reduce cardiothoracic ratio.
7. Independent samples t-test was used to analyze the six-minute walk distance of two groups after treatment. From P=0.0001,
P<0.01, we can included there were obvious difference, indicating that in comparison with the group with western medicine, integrative medicine group can significantly improve the patient's exercise tolerance, indirectly reflecting the improvement in cardiac function.
Conclusion
1. In this study, academic thinking and clinical experience of Luo Luyi professor were summarized and organized in a comprehensive way. Luo Luyi professor's many clinical experiences are practical and effective. His clinical experiences are practical, effective and valuable.
2. The clinical research shows that the application of Pei Yuan Gu Ben Qiang Xin method is quite effective for on expansionary cardiomyopathy. And adding TCM differential treatment can significantly improve the clinical symptoms; plusing TCM differential treatment has a significant effect on reducing expansion of the heart, which has certain meaning; adding TCM differential treatment can significantly improve the cardiac function, patient endurance and quality of life; plusing TCM differential treatment can aslo reduce the side effects of western medicine; adding TCM differential treatment may have a relationship with inflammatory cytokines which produced in the process of reducing the heart disease, and it is worthy of further study.
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