雷忠义主任医师治疗冠心病的学术思想和临床经验研究
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摘要
研究背景：中医学是几千年来中国人民和疾病作斗争的经验总结,其发展和进步与历代医家的贡献密切相关。各个时代优秀医家的学术思想、临床实践经验和技术专长,是促进中医理论不断完善发展和临床疗效不断提高的保证,是中医学保持长久生命力的关键。因此继承和挖掘名老中医的学术经验,是保持和加快中医发展的重要途径。
雷忠义主任医师从事中西医结合内科临床科研工作50余年,学验俱丰,医术精湛,医德高尚。主要致力于心血管疾病的中西医结合科研和临床研究,尤其对冠心病心绞痛(胸痹)的临床诊治有独到的见解和经验。在临床中坚持中医理论,强调辨证论治,先后创制了养心活血汤、加味瓜蒌薤白汤、丹曲饮、心悸宁方、心衰病方、百合知母地黄汤等多首行之有效的方剂。
冠心病心绞痛属中医胸痹心痛范畴,老师根据历代医家论述及临床经验认为：冠心病患者多为中老年人,脏气亏虚,气血阴阳不足,气虚运血无力,血行瘀阻；气机失调,气滞血瘀；寒邪侵袭,寒凝血瘀；痰浊内生,痰瘀互阻,热毒内聚,热壅血瘀。本病属本虚标实,虚实夹杂。本虚有气虚、气阴两虚、阴阳两虚,标实有血瘀、寒凝、痰浊、气滞、热毒。老师早在70年代就致力于活血化瘀研究,运用活血化瘀法治疗冠心病心绞痛效果显著。依据临床所见,提出把胸痹心痛的痰浊说与瘀血说溶为一体的痰瘀互结说,认为从痰瘀立论是治疗胸痹的基础。痰浊和瘀血常相兼为病,两者既是病理产物,又是致病因素,相互交结,在冠心病发生发展中起着非常重要的作用。近年来,随着中医理论的发展与临床实践,发现部分患者临床表现有：胸闷痛,有灼烧感,心烦,易怒,头晕,少寐,五心烦热,大便干结,舌红苔腻等症,多为久病不愈者,老师认为此为痰瘀互结日久,生热化毒,郁热毒邪内伏致营卫不和,气血亏虚,脏腑衰败,形成痰瘀互结与热毒互为因果的恶性循环,促进了冠心病的恶化,因而提出了痰瘀热毒互结的观点,与现代医学认为冠状动脉粥样硬化发生机制与炎症相关相吻合。认识和抓住此点,可能对防治本病发展与恶化有着极其重要的意义。
研究目的：1、系统总结雷忠义主任医师从医50余年来治疗冠心病心绞痛的学术思想和临床经验,便于更好地继承和发扬老中医宝贵经验,丰富中医学胸痹证治,提高临床诊治水平。2、通过对胸痹痰瘀毒互结证的临床研究,以期改善冠心病稳定型心绞痛患者的预后,提高中医对胸痹证治规律的认识,增加治疗胸痹的手段和经验,提高辨证论治的水平,最终提高中医药疗效以造福人民。
研究方法：第一部分：通过整理研究老师的论文、著作、医案、医话以及跟师临床实践,结合文献研究和理论分析,论述雷忠义主任医师对胸痹(冠心病心绞痛)的中医病因病机认识及其学术思想渊源。
第二部分：系统总结雷忠义主任医师治疗冠心病心绞痛的学术思想和临床经验。
第三部分：观察丹曲饮治疗痰瘀毒互结型冠心病稳定型心绞痛的有效性和安全性,进一步阐述雷忠义主任医师胸痹痰瘀毒互结病机的理论基础和活血化瘀、宣痹化痰、清热解毒法对冠心病稳定型心绞痛的临床疗效。临床观察60例冠心病稳定型心绞痛痰瘀毒互结型患者,随机分为治疗组和对照组各30例。病例选择标准参照《中药新药临床研究指导原则》确定。西医诊断标准参照国际心脏病学会《缺血性心脏病的命名及诊断标准》；中医辨证标准,参照《中药新药临床研究指导原则》及导师临床经验确定。治疗方法及用药：治疗组给予丹曲饮汤剂口服。每次200ml,每日2次。对照组给予舒心片汤剂口服,每次200ml,每日2次。疗程均4周。观察指标：(1)安全性指标：心率、呼吸、血压,血、尿常规,肝功、肾功能,不良事件。(2)疗效性指标：中医症候、心电图、血脂、血凝系列、同型半胱氨酸、超敏C反应蛋白。统计学方法：两组治疗前后进行自身比较和组间比较,计量资料采用“t”检验,计数资料采用“χ2”检验。
结果：雷忠义主任医师学术思想：(1)重视中医理论,善用辨证论治；(2)遵循整体观念,注重脏腑相关；(3)衷中参西,辨病与辨证相结合；(4)注重经方研究,善用活用经方；(5)详审病因病机,临床灵活施治；(6)重视气血理论,倡导活血化瘀；(7)痰瘀互结立论,创制丹蒌方药；(8)延伸痰瘀认识,痰瘀化热化毒；(9)突出中医特色,强调未病先防；(10)胸痹心痛,重视补先后天。临床经验有：(1)方药研究：①对羊红膻的研究,打开了“从肾治心”的新思路；②对药和角药应用；③经方应用；④自拟方应用。(2)用药特点：寓通于补；平衡阴阳；气血双调；善用虫药；重视“风药”；病症结合。(3)临床常用治法：温阳益气法；益气养阴法；益气活血法；活血化瘀法；活血通络、化痰宣痹法；活血化痰、清热解毒法。(4)临床论治：冠心病心绞痛的临床施治；冠心病急性心肌梗死的临床施治；冠心病心律失常的临床施治；冠心病心力衰竭的临床施治；心脏神经官能症的临床施治。
临床研究结果：丹曲饮治疗冠心病稳定型心绞痛四周后,心绞痛疗效总有效率为86.67%,心电图有效率63.33%,优于对照组,但无统计学意义。硝酸甘油停减率、中医证候总有效率均为86.67%,较对照组改善明显,差异显著(P<0.05)；两组均能改善胸痛、胸闷、心悸等症状,而丹曲饮组能明显改善心烦、急躁、大便干结症状,两组比较差异显著(P<0.05)；瘀暗舌、黄厚腻苔明显改善。治疗后治疗组能显著延长APTT(P<0.05),降低Fib、TG、TC水平(P<0.05),同时能显著降低hs-CRP、HCY(P<0.01,P<0.05)。治疗前及治疗后两组患者的肝、肾功能和血、尿常规均无明显差异(P>0.05)。
结论：1、雷忠义主任医师认为胸痹为本虚标实证,痰瘀化热生毒是目前胸痹的重要病机。2、丹曲饮治疗痰瘀毒互结型冠心病心绞痛有确切疗效,具有抗凝和调脂、抗炎、稳定斑块等作用。而且能改善症状,防止心绞痛恶化。
本研究的创新点：1、提出痰瘀互结化热化毒观点,认为痰瘀毒互结证是胸痹的重要证型,活血化瘀、宣痹化痰、清热解毒法是该证型的重要治法,并创制了丹曲方剂。2、通过观察丹曲饮治疗冠心病稳定型心绞痛的疗效对比分析,从多指标综合研究中药治疗冠心病心绞痛、抗动脉粥样硬化的机理。
Research background:Traditional Chinese Medicine (TCM) is a summary of the Chinese people's experience in their struggle against diseases with a history of several thousand years, the advance and development of which is related closely with contributions made by the physicians of past dynasties. It was guaranteed by the academic ideas, clinical experience, and technical skills of ancient famous physicians to improve the TCM theory and clinic curative effect. And it was also the key to prolong TCM theory. The important way to keep and develop rapidly TCM is to inherit and explore the experience left by ancient famous physicians.
Lei Zhongyi, chief-physician, has been operating clinical research on combination of TCM and western medicine for over50years going with noble medical ethics and skilled medicine art, wealthy knowledge and rich experience in the medical field. He has devoted himself to the scientific and clinical research on cardiovascular diseases in combination of TCM and western medicine and with original view and experience on treatment for angina pectoris (chest discomfort). He insists on TCM theory guiding his clinical work and stresses differentiation in treatment. He developed many effective prescriptions, such as Yangxin Huoxue Decoction, Jiawei Gualou Xiebai Decoction, Danqu Decoction, Xinjining Decoction, Xinshuaibing Decoction, Baihe Zhimu Dihuang Decoction and so on.
Angina pectoris refers to obstruction of qi in the chest in TCM. Doctor Lei thinks that patients suffer from the coronary heart diseases are mainly middle-aged and old people because of the disorder of body function, like deficiency of qi, qi stagnation and blood stasis, disorder of movement, blood stasis due to congealing cold, phlegm generating in interior leading to the accumulation of heat and blood stasis. Angina pectoris is a problem of deficiency in fundamental aspect and excess in incidental aspect and crossing of deficiency and excess. Deficiency in fundamental aspect includes symptoms of deficiency of qi, deficiency in both qi and yin, deficiency of yin and yang, while excess in incidental aspect has symptoms of blood stasis, cold accumulation, phlegm turbid, qi stagnation and heat toxin. Doctor Lei started to work on the research of activating blood to resolve stasis early in the1970s, and achieved curative effects in the treatment of angina pectoris with this method. He put forward an idea of stagnation of phlegm and blood which combines the turbid phlegm theory and blood stasis theory together according to the clinic experience. He considered that the idea of disturbing of stagnation of phlegm and blood is the base to treat obstruction of qi in the chest. Both of turbid phlegm and blood stasis can cause diseases. They are not only pathologic results, but also factors causing problems which disturb each other. They played a very important role in improving the occurrence of coronary heart disease. In recent years, with the development and clinical practice of TCM, some patients were found to have symptoms marked by fullness and pain in the chest, burning feeling, upset, irritable, dizziness, restlessness, dysphoria feverish sensation in chest, palms and soles, dry feces, companied with red tongue with sticky coating, etc. Most of them were chronic sickness. Dr. Lei thinks that prolonged disturbing of phlegm and blood stasis will generate toxin caused by accumulation of heat, which lead to disharmony between nutrient and defense, deficiency of qi and blood, failure of zang-fu organs. The vicious circle improves the worsen of coronary heart disease. The idea of disturbing of phlegm and blood stasis coincides with the coronary atherosclerosis and inflammation in modern medicine. It is sure to have significance to prevent the development and worsening of the disease.
Purpose of research:1.Summarizing systematically Lei Zhongyi's academic ideas and over50years'experience on treatment for angina pectoris so as to inherit and develop the precious experience and improve the clinical treatment.2. Improving the prognosis of patients with stable angina pectoris by studying the disturbing of phlegm and blood stasis, deepening the knowledge of differentiation regulation for obstruction of qi in the chest in TCM, strengthening the methods and experience, improving the treatment level and effect to benefit people.
Research methods:Part I:Expounding the knowledge of TCM pathogenesis and academic thought for angina pectoris by studying and systematizing his papers, works, cases records and clinic practice.
Part Ⅱ:Summing up systematically the academic thought and clinical experience of Lei Zhongyi's for angina pectoris
Part III:Observing the efficacy and safety of Danqu Decoction for stable angina pectoris, Expounding Lei Zhongyi's theoretical basis against obstruction of qi in the chest caused by turbid phlegm, blood stasis and clinic effect for angina pectoris with method of activating blood to resolve stasis, removing obstruction and phlegm and clearing heat and removing toxin.60cases of stable angina pectoris due to turbid phlegm and blood stasis were randomly divided into treatment and control groups with30ones in each. The cases were selected according to the standard of Guiding Principles for the Clinical Research of TCM New Drugs while diagnosed referring to the Naming and Diagnosis Criteria of Ischemic Heart Disease in western and differentiation in TCM were made by Guiding Principles for the Clinical Research of TCM New Drugs and tutor's clinical experience. Treatment and dosage:patients in treatment group take Danqu Decoction orally twice a day and200ml each time, while those in control group take Heart-soothing Decoction orally twice a day and200ml each time. The course of both includes4weeks.
Observing index:(1) Safety index:heart rate, respiration, blood pressure, routine blood, routine urine, routine feces, liver and kidney function, and harmful events.(2)effective index:TCM syndromes, ECG, blood lipid, blood coagulation, homocysteine, High-sensitivity C-reactive protein. Statistic methods:comparing each group itself and between them before and after the treatment. The measurement data takes'/'tests and count date takes 'χ2' tests.
Results:His academic thought contains ten points:(1) Paying more attention to TCM theory and being good at in using of differentiation;(2)Following the general principle of TCM and laying stress on relation of zang-fu organs;(3) Basing on TCM referring to western medicine and combining the diagnosis with differentiation;(4) Studying and improving classical prescriptions;(5)Thinking etiology and pathogenesis in free use;(6)Proposing the principle of activating blood to resolve stasis in treatment and qi-blood theory;(7)Putting forward the theory of disturbing of phlegm and blood stasis and developed the prescription of Dan Lou;(8)Deepening the knowledge of phlegm and blood stasis and suggesting that phlegm stagnation will generate heat and toxin;(9)Strengthening TCM characteristics and prevention of disease;(10) Considering that reinforcing both of spleen and kidney for coronary angina pectoris.
Clinical experience are about four aspects:(1)Research on prescription:①Study on Yang Hong Shan showed a new way suggesting that kidney should be considered when treating heart problems;②Using the prescription only with two or three herbs;③Classical prescription;④Prescriptions made by himself.(2)Administration characteristics:general notifying, keeping balance of yin and yang, regulating both qi and blood, insect drugs are often used, pay special attention to herbs with function of expelling wind, symptoms and signs are both considered in diagnosing.(3)Clinical treatment method:warming yang and benefiting qi, replenishing qi and nourishing yin, replenishing qi and activating blood, activating blood to resolve stasis, promoting blood circulation to remove meridian obstruction, removing phlegm to eliminate obstruction, activating blood circulation to eliminate phlegm,clearing heat and removing toxin.(4)Clinical principles:treatments for angina pectoris, acute myocardial infraction of coronary heart disease, cardiac arrhythmias of coronary heart disease, heart failure of coronary heart disease and cardiovascular neurosis.
The clinical results:After four-week's treatment for angina pectoris with Danqu Decoction, the result showed that the total effective rate is86.67%, ECG effective rate is63.33%, which is better than the result of controlled group, but with no statistical significance. The ceasing and reducing rate of nitroglycerin and effective rate of general syndromes are86.67%. The result is improved clearly in the controlled group, and the differences between the two shows (p<0.05). The symptom of chest pain, oppressed feeling in chest, and palpitation were improved in both groups, while symptom of upset, irritable and dry feces in the group treated with Dan Qu Decoction were improved clearly. The difference between the two groups were obviously (p<0.05). Dark ecchymotic tongue with yellowish and greasy tongue coating (trial group) are obviously improved. The APTT, TT (p<0.05) in treatment group can be distinctively prolonged, and Fib and TG, TC, LDL-C (p<0.05) can be reduced, meanwhile, the hs-CRP, HCY can be lowered notably after treatment. There isn't any significant change (p>0.05) in liver and kidney functions in both groups, neither is in routine blood, routine urine, routine feces before and after treatment.
Conclusion:1. He thinks that obstruction of qi in the chest is a problem of deficiency in fundamental aspect and excess in incidental aspect and phlegm and blood stasis is the important mechanism causing it.2.Dan Qu Decoction has certain effect in treating coronary angina caused by disturb of phlegm, blood stasis which with the function of anticoagulation, lipid-lowering, anti-inflammation, and speckle-stablizing, etc. What's more, it can improve symptoms to pro vent angina pectoris going worse.
The innovative points in the research:1.The idea of disturbing of phlegm and blood stasis which is the main type of obstruction of qi in the chest. The important treatment principles include activating blood and resolve stasis, eliminiating phlegm and obstruction and clearing heat and removing toxin and Dan Qu Decoction was formulated.2. Studying the mechanism of angina pectoris with Chinese herbs and anti-atherosclerosis according to multi-indexes by comprehensively analyzing the effection of Dan Qu Decoction for stable angina pectoris of coronary heart disease.
雷忠义主任医师从事中西医结合内科临床科研工作50余年,学验俱丰,医术精湛,医德高尚。主要致力于心血管疾病的中西医结合科研和临床研究,尤其对冠心病心绞痛(胸痹)的临床诊治有独到的见解和经验。在临床中坚持中医理论,强调辨证论治,先后创制了养心活血汤、加味瓜蒌薤白汤、丹曲饮、心悸宁方、心衰病方、百合知母地黄汤等多首行之有效的方剂。
冠心病心绞痛属中医胸痹心痛范畴,老师根据历代医家论述及临床经验认为：冠心病患者多为中老年人,脏气亏虚,气血阴阳不足,气虚运血无力,血行瘀阻；气机失调,气滞血瘀；寒邪侵袭,寒凝血瘀；痰浊内生,痰瘀互阻,热毒内聚,热壅血瘀。本病属本虚标实,虚实夹杂。本虚有气虚、气阴两虚、阴阳两虚,标实有血瘀、寒凝、痰浊、气滞、热毒。老师早在70年代就致力于活血化瘀研究,运用活血化瘀法治疗冠心病心绞痛效果显著。依据临床所见,提出把胸痹心痛的痰浊说与瘀血说溶为一体的痰瘀互结说,认为从痰瘀立论是治疗胸痹的基础。痰浊和瘀血常相兼为病,两者既是病理产物,又是致病因素,相互交结,在冠心病发生发展中起着非常重要的作用。近年来,随着中医理论的发展与临床实践,发现部分患者临床表现有：胸闷痛,有灼烧感,心烦,易怒,头晕,少寐,五心烦热,大便干结,舌红苔腻等症,多为久病不愈者,老师认为此为痰瘀互结日久,生热化毒,郁热毒邪内伏致营卫不和,气血亏虚,脏腑衰败,形成痰瘀互结与热毒互为因果的恶性循环,促进了冠心病的恶化,因而提出了痰瘀热毒互结的观点,与现代医学认为冠状动脉粥样硬化发生机制与炎症相关相吻合。认识和抓住此点,可能对防治本病发展与恶化有着极其重要的意义。
研究目的：1、系统总结雷忠义主任医师从医50余年来治疗冠心病心绞痛的学术思想和临床经验,便于更好地继承和发扬老中医宝贵经验,丰富中医学胸痹证治,提高临床诊治水平。2、通过对胸痹痰瘀毒互结证的临床研究,以期改善冠心病稳定型心绞痛患者的预后,提高中医对胸痹证治规律的认识,增加治疗胸痹的手段和经验,提高辨证论治的水平,最终提高中医药疗效以造福人民。
研究方法：第一部分：通过整理研究老师的论文、著作、医案、医话以及跟师临床实践,结合文献研究和理论分析,论述雷忠义主任医师对胸痹(冠心病心绞痛)的中医病因病机认识及其学术思想渊源。
第二部分：系统总结雷忠义主任医师治疗冠心病心绞痛的学术思想和临床经验。
第三部分：观察丹曲饮治疗痰瘀毒互结型冠心病稳定型心绞痛的有效性和安全性,进一步阐述雷忠义主任医师胸痹痰瘀毒互结病机的理论基础和活血化瘀、宣痹化痰、清热解毒法对冠心病稳定型心绞痛的临床疗效。临床观察60例冠心病稳定型心绞痛痰瘀毒互结型患者,随机分为治疗组和对照组各30例。病例选择标准参照《中药新药临床研究指导原则》确定。西医诊断标准参照国际心脏病学会《缺血性心脏病的命名及诊断标准》；中医辨证标准,参照《中药新药临床研究指导原则》及导师临床经验确定。治疗方法及用药：治疗组给予丹曲饮汤剂口服。每次200ml,每日2次。对照组给予舒心片汤剂口服,每次200ml,每日2次。疗程均4周。观察指标：(1)安全性指标：心率、呼吸、血压,血、尿常规,肝功、肾功能,不良事件。(2)疗效性指标：中医症候、心电图、血脂、血凝系列、同型半胱氨酸、超敏C反应蛋白。统计学方法：两组治疗前后进行自身比较和组间比较,计量资料采用“t”检验,计数资料采用“χ2”检验。
结果：雷忠义主任医师学术思想：(1)重视中医理论,善用辨证论治；(2)遵循整体观念,注重脏腑相关；(3)衷中参西,辨病与辨证相结合；(4)注重经方研究,善用活用经方；(5)详审病因病机,临床灵活施治；(6)重视气血理论,倡导活血化瘀；(7)痰瘀互结立论,创制丹蒌方药；(8)延伸痰瘀认识,痰瘀化热化毒；(9)突出中医特色,强调未病先防；(10)胸痹心痛,重视补先后天。临床经验有：(1)方药研究：①对羊红膻的研究,打开了“从肾治心”的新思路；②对药和角药应用；③经方应用；④自拟方应用。(2)用药特点：寓通于补；平衡阴阳；气血双调；善用虫药；重视“风药”；病症结合。(3)临床常用治法：温阳益气法；益气养阴法；益气活血法；活血化瘀法；活血通络、化痰宣痹法；活血化痰、清热解毒法。(4)临床论治：冠心病心绞痛的临床施治；冠心病急性心肌梗死的临床施治；冠心病心律失常的临床施治；冠心病心力衰竭的临床施治；心脏神经官能症的临床施治。
临床研究结果：丹曲饮治疗冠心病稳定型心绞痛四周后,心绞痛疗效总有效率为86.67%,心电图有效率63.33%,优于对照组,但无统计学意义。硝酸甘油停减率、中医证候总有效率均为86.67%,较对照组改善明显,差异显著(P<0.05)；两组均能改善胸痛、胸闷、心悸等症状,而丹曲饮组能明显改善心烦、急躁、大便干结症状,两组比较差异显著(P<0.05)；瘀暗舌、黄厚腻苔明显改善。治疗后治疗组能显著延长APTT(P<0.05),降低Fib、TG、TC水平(P<0.05),同时能显著降低hs-CRP、HCY(P<0.01,P<0.05)。治疗前及治疗后两组患者的肝、肾功能和血、尿常规均无明显差异(P>0.05)。
结论：1、雷忠义主任医师认为胸痹为本虚标实证,痰瘀化热生毒是目前胸痹的重要病机。2、丹曲饮治疗痰瘀毒互结型冠心病心绞痛有确切疗效,具有抗凝和调脂、抗炎、稳定斑块等作用。而且能改善症状,防止心绞痛恶化。
本研究的创新点：1、提出痰瘀互结化热化毒观点,认为痰瘀毒互结证是胸痹的重要证型,活血化瘀、宣痹化痰、清热解毒法是该证型的重要治法,并创制了丹曲方剂。2、通过观察丹曲饮治疗冠心病稳定型心绞痛的疗效对比分析,从多指标综合研究中药治疗冠心病心绞痛、抗动脉粥样硬化的机理。
Research background:Traditional Chinese Medicine (TCM) is a summary of the Chinese people's experience in their struggle against diseases with a history of several thousand years, the advance and development of which is related closely with contributions made by the physicians of past dynasties. It was guaranteed by the academic ideas, clinical experience, and technical skills of ancient famous physicians to improve the TCM theory and clinic curative effect. And it was also the key to prolong TCM theory. The important way to keep and develop rapidly TCM is to inherit and explore the experience left by ancient famous physicians.
Lei Zhongyi, chief-physician, has been operating clinical research on combination of TCM and western medicine for over50years going with noble medical ethics and skilled medicine art, wealthy knowledge and rich experience in the medical field. He has devoted himself to the scientific and clinical research on cardiovascular diseases in combination of TCM and western medicine and with original view and experience on treatment for angina pectoris (chest discomfort). He insists on TCM theory guiding his clinical work and stresses differentiation in treatment. He developed many effective prescriptions, such as Yangxin Huoxue Decoction, Jiawei Gualou Xiebai Decoction, Danqu Decoction, Xinjining Decoction, Xinshuaibing Decoction, Baihe Zhimu Dihuang Decoction and so on.
Angina pectoris refers to obstruction of qi in the chest in TCM. Doctor Lei thinks that patients suffer from the coronary heart diseases are mainly middle-aged and old people because of the disorder of body function, like deficiency of qi, qi stagnation and blood stasis, disorder of movement, blood stasis due to congealing cold, phlegm generating in interior leading to the accumulation of heat and blood stasis. Angina pectoris is a problem of deficiency in fundamental aspect and excess in incidental aspect and crossing of deficiency and excess. Deficiency in fundamental aspect includes symptoms of deficiency of qi, deficiency in both qi and yin, deficiency of yin and yang, while excess in incidental aspect has symptoms of blood stasis, cold accumulation, phlegm turbid, qi stagnation and heat toxin. Doctor Lei started to work on the research of activating blood to resolve stasis early in the1970s, and achieved curative effects in the treatment of angina pectoris with this method. He put forward an idea of stagnation of phlegm and blood which combines the turbid phlegm theory and blood stasis theory together according to the clinic experience. He considered that the idea of disturbing of stagnation of phlegm and blood is the base to treat obstruction of qi in the chest. Both of turbid phlegm and blood stasis can cause diseases. They are not only pathologic results, but also factors causing problems which disturb each other. They played a very important role in improving the occurrence of coronary heart disease. In recent years, with the development and clinical practice of TCM, some patients were found to have symptoms marked by fullness and pain in the chest, burning feeling, upset, irritable, dizziness, restlessness, dysphoria feverish sensation in chest, palms and soles, dry feces, companied with red tongue with sticky coating, etc. Most of them were chronic sickness. Dr. Lei thinks that prolonged disturbing of phlegm and blood stasis will generate toxin caused by accumulation of heat, which lead to disharmony between nutrient and defense, deficiency of qi and blood, failure of zang-fu organs. The vicious circle improves the worsen of coronary heart disease. The idea of disturbing of phlegm and blood stasis coincides with the coronary atherosclerosis and inflammation in modern medicine. It is sure to have significance to prevent the development and worsening of the disease.
Purpose of research:1.Summarizing systematically Lei Zhongyi's academic ideas and over50years'experience on treatment for angina pectoris so as to inherit and develop the precious experience and improve the clinical treatment.2. Improving the prognosis of patients with stable angina pectoris by studying the disturbing of phlegm and blood stasis, deepening the knowledge of differentiation regulation for obstruction of qi in the chest in TCM, strengthening the methods and experience, improving the treatment level and effect to benefit people.
Research methods:Part I:Expounding the knowledge of TCM pathogenesis and academic thought for angina pectoris by studying and systematizing his papers, works, cases records and clinic practice.
Part Ⅱ:Summing up systematically the academic thought and clinical experience of Lei Zhongyi's for angina pectoris
Part III:Observing the efficacy and safety of Danqu Decoction for stable angina pectoris, Expounding Lei Zhongyi's theoretical basis against obstruction of qi in the chest caused by turbid phlegm, blood stasis and clinic effect for angina pectoris with method of activating blood to resolve stasis, removing obstruction and phlegm and clearing heat and removing toxin.60cases of stable angina pectoris due to turbid phlegm and blood stasis were randomly divided into treatment and control groups with30ones in each. The cases were selected according to the standard of Guiding Principles for the Clinical Research of TCM New Drugs while diagnosed referring to the Naming and Diagnosis Criteria of Ischemic Heart Disease in western and differentiation in TCM were made by Guiding Principles for the Clinical Research of TCM New Drugs and tutor's clinical experience. Treatment and dosage:patients in treatment group take Danqu Decoction orally twice a day and200ml each time, while those in control group take Heart-soothing Decoction orally twice a day and200ml each time. The course of both includes4weeks.
Observing index:(1) Safety index:heart rate, respiration, blood pressure, routine blood, routine urine, routine feces, liver and kidney function, and harmful events.(2)effective index:TCM syndromes, ECG, blood lipid, blood coagulation, homocysteine, High-sensitivity C-reactive protein. Statistic methods:comparing each group itself and between them before and after the treatment. The measurement data takes'/'tests and count date takes 'χ2' tests.
Results:His academic thought contains ten points:(1) Paying more attention to TCM theory and being good at in using of differentiation;(2)Following the general principle of TCM and laying stress on relation of zang-fu organs;(3) Basing on TCM referring to western medicine and combining the diagnosis with differentiation;(4) Studying and improving classical prescriptions;(5)Thinking etiology and pathogenesis in free use;(6)Proposing the principle of activating blood to resolve stasis in treatment and qi-blood theory;(7)Putting forward the theory of disturbing of phlegm and blood stasis and developed the prescription of Dan Lou;(8)Deepening the knowledge of phlegm and blood stasis and suggesting that phlegm stagnation will generate heat and toxin;(9)Strengthening TCM characteristics and prevention of disease;(10) Considering that reinforcing both of spleen and kidney for coronary angina pectoris.
Clinical experience are about four aspects:(1)Research on prescription:①Study on Yang Hong Shan showed a new way suggesting that kidney should be considered when treating heart problems;②Using the prescription only with two or three herbs;③Classical prescription;④Prescriptions made by himself.(2)Administration characteristics:general notifying, keeping balance of yin and yang, regulating both qi and blood, insect drugs are often used, pay special attention to herbs with function of expelling wind, symptoms and signs are both considered in diagnosing.(3)Clinical treatment method:warming yang and benefiting qi, replenishing qi and nourishing yin, replenishing qi and activating blood, activating blood to resolve stasis, promoting blood circulation to remove meridian obstruction, removing phlegm to eliminate obstruction, activating blood circulation to eliminate phlegm,clearing heat and removing toxin.(4)Clinical principles:treatments for angina pectoris, acute myocardial infraction of coronary heart disease, cardiac arrhythmias of coronary heart disease, heart failure of coronary heart disease and cardiovascular neurosis.
The clinical results:After four-week's treatment for angina pectoris with Danqu Decoction, the result showed that the total effective rate is86.67%, ECG effective rate is63.33%, which is better than the result of controlled group, but with no statistical significance. The ceasing and reducing rate of nitroglycerin and effective rate of general syndromes are86.67%. The result is improved clearly in the controlled group, and the differences between the two shows (p<0.05). The symptom of chest pain, oppressed feeling in chest, and palpitation were improved in both groups, while symptom of upset, irritable and dry feces in the group treated with Dan Qu Decoction were improved clearly. The difference between the two groups were obviously (p<0.05). Dark ecchymotic tongue with yellowish and greasy tongue coating (trial group) are obviously improved. The APTT, TT (p<0.05) in treatment group can be distinctively prolonged, and Fib and TG, TC, LDL-C (p<0.05) can be reduced, meanwhile, the hs-CRP, HCY can be lowered notably after treatment. There isn't any significant change (p>0.05) in liver and kidney functions in both groups, neither is in routine blood, routine urine, routine feces before and after treatment.
Conclusion:1. He thinks that obstruction of qi in the chest is a problem of deficiency in fundamental aspect and excess in incidental aspect and phlegm and blood stasis is the important mechanism causing it.2.Dan Qu Decoction has certain effect in treating coronary angina caused by disturb of phlegm, blood stasis which with the function of anticoagulation, lipid-lowering, anti-inflammation, and speckle-stablizing, etc. What's more, it can improve symptoms to pro vent angina pectoris going worse.
The innovative points in the research:1.The idea of disturbing of phlegm and blood stasis which is the main type of obstruction of qi in the chest. The important treatment principles include activating blood and resolve stasis, eliminiating phlegm and obstruction and clearing heat and removing toxin and Dan Qu Decoction was formulated.2. Studying the mechanism of angina pectoris with Chinese herbs and anti-atherosclerosis according to multi-indexes by comprehensively analyzing the effection of Dan Qu Decoction for stable angina pectoris of coronary heart disease.
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