Wen-Bin Zhang, Kai-Ming Chen , Zhen Wang, Yi-Tao Xue?

1.The First Clinical Medical College, Shandong University of Chinese Medicine, Shandong, 250000, China

2.Cardiovascular medicine department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, 250011, China

Keywords:

ABSTRACT

Chronic total occlusion (CTO) is the TIMI level 0 of the anterior blood flow of the occluding blood vessel segment, and the occlusion time is at least 3 months[1]. Coronary CTO lesions are the problems of cardiovascular intervention. On the one hand, interventional surgery has a high risk and high cost, which cannot be accepted by patients and their families. On the other hand, coronary artery bypass surgery is the preferred method of Western medicine treatment, but coronary artery bypass surgery is expensive And it is a thoracotomy operation, which is extremely invasive, and patients with coronary CTO lesions are mostly middle-aged and elderly people, so most patients choose conservative treatment with drugs. In recent years, traditional Chinese medicine has played an important role in various fields. For patients with coronary CTO lesions, Western medicine alone can not significantly relieve the symptoms of the patients, and the quality of life of the patients is low. Therefore, combined with traditional Chinese medicine treatment is the general trend. Cognition of etiology and pathogenesis, combined with the TCM treatment plan for coronary CTO lesions in recent years, discusses the diagnosis and treatment theory of TCM for coronary CTO lesions, provides reference for clinical treatment of coronary CTO lesions, improves the quality of life of patients, and reduces the suffering of patients.

1.Discussion on the etiology and pathogenesis of CTO lesions by traditional Chinese medicine

Coronary artery CTO lesions belong to the categories of "thoracic paralysis" and "true pain" of the motherland medicine. "Lingshu·Wuxie" points out that "evil is in the heart, but the heartache is sick"; "Suwen·Juelun" says: "True heartache,…, Dying on the day of death, dying on the day of death, mainly manifested as chest pain, and even chest pain through the back, and severe cases manifested as severe and persistent posterior sternal pain, accompanied by heart palpitations, edema, breathlessness and other symptoms, even is life-threatening.

1.1 Discussion on etiology

The occurrence of this disease is mostly related to the invasion of foreign cold pathogens into the human body, emotional and dietary disorders, and frailty of the elderly. Yang is blocking the heart; deficiency is qi deficiency, yin injury, yang decay, liver, spleen, kidney deficiency, and heart failure, most of the CTO lesions are formed first and then become virtual, and some are later Be honest.

1.1.1 Caused by illness

First of all, the cold master can not only suppress the yang qi, socalled scorching cold, but also make the meridians cramped, blood stasis, and cause the disease; "Su Wen · Tongjing theory" cloud "cold qi accumulated in the chest ... If you stay alone, the blood will weep, and the blood will be impassable. "The True Story of Medicine" says "If you have real pain, the big cold will break your heart." The invasion, cold evil stagnation of the heart network caused qi stagnation and paralysis of the chest and yang, and the occlusion of the blood vessels, resulting in this disease.

Secondly, eating disorder, just like eating fat and thick taste, or like the addiction of tobacco and alcohol, so that the spleen and stomach are damaged, unlucky, spleen and stomach like bad bathing and dampness, and moisture gathers into phlegm. In this area, the heart yang is blocked so that the heart yang can not be reached, the Qi is not smooth, the heart is blocked, and the disease is cumulative.

Finally, worry about hurting the spleen, spleen is not healthy, fluid is not distributed, and then gathers into phlegm; Yu anger hurts the liver, liver loss and discharge, liver stagnation and qi stagnation, even qi stagnation and fire, burning phlegm, regardless of qi Stagnation or phlegm obstruction can lead to poor blood flow, unfavorable veins, or phlegm and blood stasis, thoracic yang unlucky, cardiopulmonary obstruction, uncomfortable pain, emotional disease, long-term, and the disease . "The miscellaneous soldiers rhythm candle" cloud "In short, the seven emotions are heartache". The imbalance of seven emotions can cause qi and blood consumption reversal. It is most likely to cause heart, liver and kidney disease, heart failure, and liver and kidney yin deficiency can not be maintained. It will make the arthralgia impede and cause real pain.

1.1.2 Disease caused by deficiency

CTO lesions are more common in the middle-aged and elderly people, "the kidney qi declines after half a year", the deficiency of essence and blood, and the deficiency of kidney yang, can not encourage the visceral yang to travel outside, which can cause insufficient heart qi or heart yang, blood vessels lose temperature Yun, the arteries are impeded, which leads to this disease; the deficiency of kidney and yin is the deficiency of the viscera of the five organs, and it can not support it, so that the water does not sculpt the tree, and it cannot help the heart, so the heart and liver are busy and the heart and Yin are damaged. Heart yin can't support the heart and cause it to develop; on the other hand, heart yin deficiency can't support the heart, causing heart burns and burning, draws kidney water, and can further damage the kidney yin, repeated meridian circulation, and become sick for a long time; heart and kidney yang Deficiency, yang deficiency is unlucky, yin and cold, phlegmdrinking deficiency occupy the yang position, blocking the heart. Any of these can form a standard evidence on the basis of this deficiency, leading to the invasion of real evil, chest yang loss, heart block, and the disease.

In summary, coronary CTO lesions are more common in middleaged and older people. Patients cannot take care of righteousness on weekdays, and they invade the human body with external evils. Pathological products such as blood stasis are mainly formed by the accumulation of lesions.

1.2 Pathogenesis

The pathogenesis of CTO pathology is cardiopulmonary obstruction, and its development trend is changed from specimens and specimens, from light to dramatic. The light ones are mostly the yang in the chest that cannot be declared outside, and the evil of external cold is multiplied inside, blocking the heart, Clinical manifestations of chest tightness and shortness of breath; severe cases induce the interaction of pathological products due to phlegm and blood stasis, Qi and Qi obstruction, chest suffocation, clinical manifestations can not lie down, even heartache, etc. It is different from the emergency, the slow-sending author, who has a slow onset, and occasionally has chest tightness and shortness of breath, accumulates over months, and then suffers from heartache, with a feeling of near-death, frequent attacks, and even pain in the traction of the chest and back, and the chest cannot support it Anxious author, there is no uncomfortable feeling on weekdays, maybe it hasn't been sent for a long time, or it is suddenly caused by heartache, external disorder, emotional injury and other inducements, and even suffocation caused a seizure.

The pathogenesis of CTO lesions can be caused by deficiency, phlegm occupies the chest, and the heart and yang paralysis can not be blocked. If the disease lasts for a long time, the heart yang is consumed, the heart qi is insufficient, and the yin and yang are damaged; For a long time, the cold evil hurts the heart and yang, resulting in the deficiency of the heart, qi and yang; pathological products such as phlegm and blood stasis take advantage of the body's weakness, leading to the onset of evil, phlegm blocking the veins, blood stasis and stagnation. Go, the new blood is not born ", phlegm and blood stasis for a long time will consume the heart and qi, and heart qi paralysis will cause the heart and yang to be weak; the above are all caused by the deficiency; also due to the deficiency, the human body has insufficient heart qi and the deficiency of Qi In the pulse channel, weak agitation, qi deficiency and blood stasis; heart and kidney yin deficiency, yin deficiency heat and water deficit fire Yan, evaporating body fluid is phlegm; heart yang deficiency, yang deficiency internal cold, cold phlegm condensation, all of the above are Because of fictitiousness.

2.TCM treatment ideas for CTO lesions

According to the etiology and pathogenesis, treatment should be based on tonic, combined with tonic, and its "tong" method should include aroma warming method, Xuanbi Tongyang method, Huoxue Tongluo method [2]. On the clinical card, blood nourishing and blood activating drugs can be added, such as Coprinus chinensis, Rhizoma Chuanxiong, Angelica, Rehmannia glutinosa, etc., so that the blood can be promoted without hurting the body. The "tonic" method includes tonic qi, using traditional Chinese medicines such as astragalus, floating wheat, codonopsis, etc .; tonic heart blood uses purple river caraway, angelica, etc .; Fat; nourish kidney and yin to nourish heart and yin, choose to add ink lotus, jade bamboo, licorice, Ophiopogon, etc. It has been clinically proven that combination of tonic and tonic is an important treatment principle for the treatment of coronary CTO lesions. Combination of tonic and tonic, or alternate application, coronary CTO lesions are caused by long-term coronary vascular lesions in patients. It hurts right qi, but the evil qi still exists in the body. It is necessary to ventilate the evil qi in the body, but also care for the original and reduce the suffering of the patient.

2.1 Application of Xuanbi Tongyang Method

The Xuanbi Tongyang method such as "Treatment of Chest Pain, Heartache, Shortness of Breath, and Pulse Syndrome" cloud "Chest Pain ... Those who are completely back, the main person of Gualou Xiebai Banxia Decoction", the treatment idea follows the pathogenesis of "Yang Wei Yin Xian", It is believed that chest yang is weak and yin cold condensation is the root cause of the disease. Xuanbi Tongyang is the key to the treatment of the disease. Guagua Xiebai Banxia Decoction [3, 4, 5, 6, 7], Zhishi Xiebai Guizhi Decoction [ 8, 9, 10] and other decoctions to disperse cold and yang. Gualou [11], sputum bleeds, sputum collected by the scorching evil qi, stagnation of yin evil in the chest, and the yang stagnation in the chest, so that the yang qi in the chest can be promulgated. If the heart and yang are recovered, the evils of phlegm and turbidity will be eliminated, and Zhishi decomposes qi and dissipates. The combination of phlegm and stagnation combined with warm medicine can disperse the cold evils in the chest, broad chest and Qi depression, and the combination of Zhishi and Wentong medicine to treat the chest. Bi is used by medical doctors of all dynasties, and various medicines are used together to play the functions of Tongyang Xuanbi, Xiezhuo Huatan. Among them, Professor Yuan Zhaokai[5]focused on proposing the method of supplementing and communicating two as the major treatment method for this disease. CTO lesions are caused by long-term coronary vascular lesions.

2.2 Application of Huoxuetongluo method

Huoxue Tongluo method is a common method for modern clinical treatment of CTO lesions, such as Sanshen Danyin[12], Xuefu Zhuyu Decoction [13, 14, 15], etc. However, it is necessary to follow the overall concept and syndrome differentiation, and those who cannot be blood stasis are blind The blood circulation and blood stasis of the human body are very easy to damage the body's yang, so clinical treatment should pay attention to the use of blood circulation and blood stasis products for nourishing yin and benefiting qi, activating qi and breaking phlegm, and combining medicines with syndrome differentiation. The treatment idea is consistent. Xuefu Zhuyu Decoction is a classic decoction of cardiology, aiming at the longterm coronary artery CTO lesions, it will stay stasis for a long time, and Xuefu Zhuyu Decoction can take care of Yiqi Xingqi, nourishing Yin and nourishing blood, and is suitable for blood stasis constitution [14], can further reduce other diseases caused by blood stasis. At the same time, blood stasis is closely related to mental, mental and sensory disorders. Patients with coronary CTO lesions have long-term chest pain, chest tightness, breathlessness, poor mental state, "strange disease and blood stasis". "Lin Gai Mistake", the original article mentions that "when lying on the chest and lying on the chest, you can sleep soundly, but you can't sleep with a layer of cloth pressure." The best agent for CTO lesions needs to be used flexibly in clinic.

Promoting blood circulation and removing blood stasis medicine should mainly use the important of blood circulation in addition to promoting blood circulation, such as Achyranthes bidentata, Salvia miltiorrhiza, Radix Codonopsis, Angelica, Puhuang, Rubia, Chuanxiong and so on. Blood-breaking products such as frankincense, myrrh, trigonum, zedoary, peach kernel, leech, etc., although it can promote blood circulation and relieve pain, but it is very easy to hurt the body's righteousness. It should be used with caution. At the same time, we must pay attention to whether there is bleeding tendency or signs, and patients with CTO lesions themselves take antiplatelet drugs. Therefore, traditional Chinese medicine should be treated according to syndrome differentiation and reasonable use.

2.3 Application of aromatic warm medicine

As mentioned earlier, Hanxie Necrosis is one of the important pathogenesis of its onset. Clinically, it adopts traditional Chinese medicine such as Guixin, dried ginger, Evodia, musk, woody and so on. The key to treatment is to get rid of internal cold and lead evil spirits out. Aromatic Wentong drugs contain volatile oil. Modern research shows that it can relieve coronary spasm, increase coronary blood flow, reduce myocardial oxygen consumption, protect vascular endothelial cells, improve myocardial blood supply, inhibit inflammatory factors, and at the same time, hemorrhage and myocardial contraction Both have effects [16]. CTO lesions caused by cold pathogens have an acute onset, and Chinese medicines such as Suxiao Jiuxin Pills [17, 18] and Shexiang Baoxin Pills [19] can be used to temporarily relieve clinical symptoms. The Chuanxiong and Borneol of the fast-acting Jiuxin Pill have the power of spicy, so as to achieve the purpose of promoting blood circulation and collaterals, which further confirms that the treatment method of traditional Chinese medicine is closely related; Shexiang Baoxin Pill ischemic caused by coronary CTO lesions Sexual cardiomyopathy is supported by evidence-based medicine [20], in which musk is a fragrant product that walks through the meridians, removes evil spirits, and warms the heart to cure the disease. For the first-aid effect of aromatic Wentong medicine, Zhao Zhihong [21] stated that aromatic medicine can be used to administer Qi and widen the chest to relieve pain. It is used for cold stagnation and qi stagnation, and induced heart palsy , Damage the spleen and stomach, so it should be used clinically depending on the onset.

Therefore, the treatment of traditional Chinese medicine should follow the principle of "treatment is urgent if it is urgent, treatment is the root if it is slow", and the medicine should be adjusted according to the change of the disease and the transformation of the truth and reality, and the treatment should be based on the disease. There is an ancient "Tai Ping Sheng Hui Fang" in the "Treatment of Sudden Heart Pain" article, which collects and treats a large number of prescriptions, including aromatic, spicy and warm-toned products, and products of nourishing qi, nourishing yin, nourishing blood and warming yang For mutual use, both specimens are considered. In fact, diarrhea, need to clear the Qi machine, promote blood circulation to remove blood stasis, Xin Wen Tong Yang, phlegm phlegm, especially for the treatment of Huoxue Tongmai; For deficiency, nourish the temperature and yang, nourish the yin and nourish the kidney, correct the partial decay of the viscera, and pay special attention to nourishing the heart and qi. Once the harbinger of the syndrome is found, the product of Yiqi Gutu must be used as soon as possible.

3. Discussion

3.1 Advantages of TCM diagnosis and treatment

This article describes the etiology and pathogenesis of coronary CTO lesions from the theory of traditional Chinese medicine, establishes the treatment principle of "combination of tonification and tonicity", and clarifies the advantages of treatment from the perspectives of Xuanbi Tongyang, Huoxue Tongluo, and aroma Wentong. ; Among them, the use of aromatic Wentong drugs conforms to the principle of "emergent treatment of the symptoms", and the use of Xuanbi Tongyang and Huoxue Tongluo drugs can relieve patients' symptoms for a long time, which is in line with the principle of "slowness and cure the root cause".

Western medicine is the first choice for heart bypass surgery, which is expensive, and most of the patients are elderly. Some patients have "disease caused by deficiency", and thoracotomy surgery further damages the body's righteousness. Postoperative patients are very easy to consume a lot of energy. The Qi machine broke up, and critical syndromes such as forgetfulness appeared. Therefore, more patients choose conservative treatment. The use of traditional Chinese medicine can greatly reduce the suffering of patients, relieve symptoms, and improve the quality of life of patients.

The diagnosis and treatment of traditional Chinese medicine is not limited to the treatment of coronary artery disease. Some patients can cause the disease due to emotional stimulation and other stimuli. Traditional Chinese medicine can adjust emotions, cut off the cause from the source, and reduce the incentives for patients to develop. Limitations of treatment.

3.2 Limitations of TCM diagnosis and treatment

For the complete occlusion of coronary arteries, the diagnosis and treatment of traditional Chinese medicine is still a chronic and longterm process, the effect may be slow, and the continuous taking of Chinese herbal medicine decoction still has certain irritation to the gastrointestinal tract of patients. There is still a need to further improve the accuracy of medication, shorten the time taken by patients, and adjust the medication reasonably.

The effective diagnosis and treatment of traditional Chinese medicine cannot treat Western medicine as useless. Although coronary artery bypass surgery has many shortcomings, it is still the most obvious effective method to improve the symptoms of patients. However, there are still limitations in the treatment after surgery. The combination of Chinese and Western medicine will give full play to its greatest advantages.