Wen-Peng Chen, Jian-Qi Lu, Long-Yan Liu, Yan-Ze Xie, Hao Lin

1.Guangxi University of Chinese Medicine, Guangxi, Nanning, 530001, China

2.The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China

Keywords:

ABSTRACT

With the aging of the population and the acceleration of new urbanization, cardiovascular disease has gradually become one of the most important risk factors that threaten the health and life of urban and rural residents in China. Chronic heart failure (CHF) is caused by various factors. The abnormal changes of cardiac tissue structure and cardiovascular function caused by the action, a set of complex clinical syndromes leading to ventricular systolic and diastolic dysfunction, are the end-stage manifestations of patients with various cardiovascular diseases (CVDs) and The main cause of death [1]. It is estimated that there are about 4.5 million heart failure patients in China [2]. The incidence of CHF, mortality, hospitalization rate, and rehospitalization have increased significantly with increasing patient age. At present, long-term use of western medicine is symptomatic Cardiac rehabilitation treatments such as treatment and cardiac resynchronization therapy are the main consensus of the CHF treatment plan, but strict indications, contraindications and serious side effects, lower quality of life, and high rehospitalization rates are still facing modern medical cardiac rehabilitation. Challenge [3,4],There is an urgent need for a better Cardiac Rehabilitation (CR) model to further improve and improve the prognosis of patients with CHF. Traditional Chinese medicine cardiac rehabilitation methods have multiple channels, multiple targets, etc., and their curative effect is good and safety is good. The early prevention and treatment of cardiovascular disease and the later rehabilitation of heart disease have received more and more attention. This article describes the application and specific development methods of traditional Chinese medicine rehabilitation in chronic heart failure and cardiac rehabilitation, and discusses its current status, future development and research and prospects. .

1. Definition of cardiac rehabilitation

CR is a rehabilitation exercise for CHF patients who need cardiac rehabilitation [5] after medical evaluation on the basis of professional and standardized treatment, and conducts comprehensive instruction and education on their lifestyle, mental and psychological, so as to correct the cardiovascular risk of CHF patients. Factors, improve the cardiovascular function of patients, control the symptoms of CVDs, reduce the impact of CVDs on the body's physiology and psychology, improve the psychological and professional status of patients, improve the quality of life of patients, and enable CHF patients to better return to family and integrate into society [6].

2. Knowledge of chf rehabilitation in traditional medicine of the motherland

There is no name for chronic heart failure in traditional medicine in the motherland. It was first found in the Yellow Emperor's Canon, Han Zhang Zhongjing's Treatise on Febrile and Miscellaneous Diseases, Tang Sun Siyi's "Preparing for the Thousands of Gold and Prescriptions, Heart Gate", and Song Zhao's "Shengji" "Heart Gate" and other classic ancient books, such as "heart palsy, heart swelling, heart water" and other related descriptions. Traditional Chinese medicine classifies chf as "heart palpitations", "asthma", "phlegm" and "Edema" and other categories. In recent years, with the study of the "Chronology", some scholars have proposed the "college sythesis of yingwei tongluo tong, cross biochemical" [7], which is widely used in CHF Chinese medicine Research on the theory and clinical application of pathogenesis and prevention; In the "Consultation of Experts in Traditional Chinese Medicine Diagnosis and Treatment of Chronic Heart Failure" [8], chf is established as the evidence of deficiency, and the essence is deficiency of qi, yang and yin. It is blood stasis, water dampness and phlegm turbidity, the central qi deficiency is the pathological basis, blood stasis is the central pathological link, and phlegm turbidity and water dampness are the main pathological products. Features.

Numerous works on health and well-being have been written in the vast Chinese classics, but most of the medical classics in the motherland's understanding of health and well-being have been developed from the "yin-yang reconciliation" theory and the thought of "both form and spirit". Ancient books In the "Su Wen · Ancient Innocence" cloud: "It is the Taoist, the law is yin and yang, and the number of arts ... the hundred years old is gone", and puts forward "the harmony of yin and yang, the correspondence between heaven and man, the unity of form and spirit" is The basic principles of maintaining human health and longevity; Han Zhang Zhongjing wrote in "The Golden Scape": "If one can cultivate prudence ... that is, guide, vomit, acupuncture, cream, don't let Jiuqiao occlude", emphasized Rehabilitation method that combines both form and spirit, and which is dynamic and static. Cardiac rehabilitation of traditional medicine in the motherland is based on the theory of dialectical treatment. Through various methods such as "Chinese medicine, acupuncture, massage, exercise exercises, and five-tone photography", CHF patients Qi and blood are smooth, and yin and yang are reconciled, so that their internal organs are reconciled, thereby improving clinical symptoms and improving the quality of life of patients.

3. Chinese medicine treatment

Basic medicine treatment is the core of chf cardiac rehabilitation. Traditional Chinese medicine rehabilitation treatment is based on the theory of syndrome differentiation and compound medication, to recuperate qi, nourish yin, or warming Yang to recuperate, and at the same time, follow the card as appropriate to promote blood circulation, remove blood stasis, Huatan Lishui is guided by the principle of treating the symptoms and protecting the basics. At present, the traditional Chinese medicine rehabilitation treatment of chf is mainly based on classic ancient prescriptions and various doctors' own prescriptions. Contemporary doctors based on their clinical experience, take into account differences, and form their own focus. The method of dialectical diagnosis and treatment has many good effects. A large number of clinical studies have shown that the classical ancient prescriptions and the prescriptions of various doctors can significantly improve the left ventricular ejection fraction (lvef), plasma bnp content, inflammatory factor indicators, clinical symptoms, and improve Chf patient quality of life.

3.1 Classical Ancient Recipes

There are four main types of classic ancient recipes used to treat chf, including tonics and qis (baoyuan decoction), yinyangyang (zhenwu decoction, lingguizhugan decoction, shenfu decoction), and qi to nourish yin (zhigancao decoction, Shengmaiyin) and blood circulation and blood stasis (Xuefu Zhuyu Decoction) supplement each other.The benefits of Qi include warming Yang, nourishing yin, activating blood, and removing blood stasis.

3.1.1 Baoyuan Decoction

Zhang Guofang et al. [9] found that Baoyuan Decoction can increase the rate of early cardiac diastolic filling (E) and E / late diastolic cardiac filling (A), and reduce deceleration time (DT) to improve left Diastolic function of the ventricle. In addition, Zhou Aimin [10] and so on randomly divided 70 patients with CHF into a control group (standardized drug treatment) and a treatment group (baoyuan decoction) each with 35 cases. After 1 course of treatment, the clinical efficacy and The efficacy of TCM syndromes has been significantly improved, and the total effective rate in the treatment group is significantly higher than that in the control group (P <0.05) .The plasma N-terminal forebrain natriuretic peptide (NT-pro BNP) levels and inflammatory factors in the physical and chemical indicators have been significantly reduced. And it was lower than the control group (P <0.05) .The above research shows that Baoyuan Decoction has significant effects on improving cardiac diastolic function and hemodynamics, reducing physical and chemical indicators and inflammatory factors.

3.1.2 Zhenwu Decoction, Lingguizhugan Decoction, Shenfu Decoction

Zhang Fenhong, etc. [11] Randomly divided 120 elderly patients with hypertension and CHF into a control group of 60 cases (Western medicine treatment) and an experimental group of 60 cases (Western medicine treatment + flavored Zhenwu Decoction), 3 months later, before and after treatment, the levels of left ventricular endsystolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), LVEF and BNP, endothelin-1 and CRP levels were significantly improved, and " The CHF patients in Jiawei Zhenwu Decoction group showed more improvement and better than the control group. Sui Shihua et al [12] used Lingguizhugan Decoction combined with trimetazidine to treat 78 patients with CHF with ischemic cardiomyopathy. The course of treatment was 14 days. Results analysis It was found that compared with other conventional control groups that only used western medicine (trimetazidine), the research group (Lingguizhugan Decoction + Trimetazidine) could significantly improve the total effective rate of treatment and LVEF (P <0.05), and significantly To improve the levels of LVEDD, LVESD, NT-proBNP, reduce the length of hospital stay and the rate of rehospitalization (all P <0.05). Another study found that Lingguizhugan Decoction can reduce serum IL-6, IL-18, TNFα, elevated T lymphocytes (CD3 + T cells, CD4 + T cells, CD4 + T cells / CD8 + T cells, CD8 + T cells)Inhibition of inflammatory response in CHF patients, improvement of cellular immunity to improve cardiac function in patients with CHF, thereby improving clinical efficacy [13]. Yu Mei et al [14] conducted randomized clinical research on 92 patients with CHF who are deficient in heart-yang type. Decoction can effectively improve the patient's heart function by regulating blood pressure and heart rate, reducing physical and chemical indicators such as BNP, C-reactive protein, and TNF-a. From the above research, it can be concluded that Zhenwu decoction can improve the heart-yang deficiency CHF patients. Physical and chemical indicators, inhibition of inflammatory response, improvement of cardiac function and quality of life of patients.

3.1.3 Zhigancao Decoction and Shengmaiyin

Maomeijiao [15] and other randomized clinical trials using "Zhigancao Decoction" to treat patients with CHF patients with Qi and Yin deficiency showed that "Zhigancao Decoction" could obviously improve Qi and Yin deficiency types. TCM syndrome scores, cardiac function (NYHA) classification, Minnesota quality of life scale, Lee score, six-minute step distance (6MWT), and BNP levels in patients with CHF. The improvement of various cardiac function scores was better than that of the control group ( Western medicine group) (P <0.05). Zhao Xinhua [16] and other randomized controlled trials of 120 elderly patients with CHF complicated with sinus bradycardia showed that Zhigancao Decoction combined with trimetazidine can significantly improve patients' cardiac diastole Function, reducing plasma levels of NT-proBNP and H-FABP, improving patients' cardiac diastolic function, increasing heart rate, blood pressure, etc. He Peigen et al. [17] used Yiqi Yangyin Huoxue Huayu method to treat 95 cases (qi and yin deficiency both Blood stasis syndrome) CHF patients, the results found that Zhigancao Decoction combined with Xuefu Zhuyu Decoction combined with Western medicine can significantly improve (qi and yin deficiency and blood stasis syndrome) TCM symptom scores and heart function indicators (LVDD, LVEF, SV) , FS) and various evaluation indicators (BNP, hs-cTn, galectin-3, sST2, hs-CRP), improve the efficacy of cardiac function, and improve the quality of life of patients. Clinical research conducted by Rong Gexuan et al. [18] showed that Shengmaiyin combined with enalapril maleate can improve cardiac function and reduce serum H- The levels of FABP, sICAM-1, Cys-C, sRAGE, and NT-proBNP indicate that CHF patients treated with Shengmai Yin combined with enalapril maleate can effectively reduce myocardial damage and inhibit the process of myocardial fibrosis. All patients with CHF patients with Qi-Yin Deficiency Syndrome were treated with Yiqi Yangyin Formulas.After treatment, the cardiac function score indexes and blood physical and chemical indexes of CHF patients were greatly improved, and the effect was more significant compared with conventional treatment.

3.1.4 Xuefu Zhuyu Decoction

Mu Haiping et al. [19] randomly divided 134 patients with CHF with qi deficiency and blood stasis syndrome into a control group (conventional western medicine group) and an observation group (xuefuzhuyu soup + danshen drink + conventional western medicine treatment). In 62 cases, after Ridit analysis, the cardiac function efficacy and NYHA cardiac function classification in the observation group were better than those in the control group (P <0.05), the LVEF value was higher than that in the control group (P <0.05), and Lee's heart failure The scores, TCM Qi deficiency and blood stasis syndrome scores and MLHFQ scores were significantly lower than those in the control group, and other physical and chemical indicators: serum MMP-9, TGF-β1, NT-proBNP and peptin levels were lower than those in the control group, and the results showed that the routine Based on western medicine treatment, adding Danshen Yin Hexuefu Zhuyu Decoction can improve the cardiopulmonary capacity and tolerance of CHF patients, reduce the symptoms and extent of CHF, and can inhibit ventricular remodeling, promote cardiac rehabilitation, and delay the disease. Development. A meta-analysis conducted by Lin Weiji [20] and so on included 11 RCTs. The meta-analysis results of a total of 999 patients with CHF showed that Xuefu Zhuyu Decoction combined with conventional Western medicine treatment can significantly improve the total effective rate of treatment [RR = 1.25,95% CI (1.18,1.32)], significantly increase ejection fraction [MD = 10.51,95% CI (9.08,11.94)] and effectivePlus stroke output [MD = 13.59, 95% CI (10.48, 16.70)]. The above research shows that the method of promoting blood circulation and removing blood stasis has always been a major rule for the treatment of cardiovascular system diseases. In terms of improving the patient's cardiac rehabilitation, it improves the patient's cardiopulmonary function and delays the course of CHF patients.

3.2 Self-prepared prescription

Yan Xiaorui et al. [21] used a Qi-qiangxin decoction prepared by Professor Yuan Mingzhong (composed of Codonopsis, Astragalus, Ophiopogon, Danshen, Poria, etc.) in a clinical study to treat 60 cases of chronic heart failure For patients with pandemic syndrome of Yang Deficiency, randomized clinical research results show that "Yiqi Qiangxin Decoction" can significantly improve cardiac function classification, Lee's heart failure score, LVEF, 6MWT, TCM syndrome score and other related indicators in CHF patients. The effective rate was higher than that of the control group (conventional western medicine) (P <0.05). Zhao Zhenxia et al. Observed the selfprepared formula of Wenyang Qiangxin Decoction [22] (composed of aconite, salvia, angelica, chuanxiong, etc.) combined with western medicine in treating heart and kidney yang deficiency In patients with CHF, the results show that Wenyang Qiangxin Decoction can reduce plasma viscosity and improve heart function and kidney deficiency symptoms in patients with CHF. Wen Zhihao et al. [23,24] observed that Professor Jianjian Lu made the Qiangxin Decoction (by Huangqi, Dangshen, (Effects of cinnamon sticks, cooked aconites, cypresses, etc.) combined with western medicine on the quality of life and exercise tolerance of 150 patients with CHF. It was found that taking Qiangxin Decoction on western medicine treatment can improve the quality of life and exercise tolerance of CHF patients. The self-made party combines each of the classic famous partiesBased on many years of clinical experience of doctors, it has a better effect in promoting the rehabilitation of patients with CHF, and the improvement of the situation is also convergent.

In summary, it can be seen that the current Chinese medicine treatment research in chf rehabilitation is mainly based on classic ancient prescriptions and self-made prescriptions of various medical practitioners.The conclusions of their clinical studies have also become consistent. Traditional Chinese medicine prescriptions have improved heart function and improved patient exercise. The role of tolerance, promotion of patient rehabilitation and improvement of quality of life is definite, and the effect is significant.

3.3 Chinese patent medicine

The proprietary Chinese medicines currently used to treat CHF are mainly divided into traditional Chinese medicine injection preparations (Shenmai Injection, Shenfu Injection, Xinmailong Injection, etc.) and oral preparations of traditional Chinese medicine (Qiqiangqiangxin Capsule, Xinbao Pill, Qishenyiqi Dropping Pill, Tongxinluo Capsule, Shexiang Baoxin Pill, Yangxin's Tablets, etc.). Most of its active ingredients are made from traditional Chinese medicine extracts or made with traditional Chinese medicine. A large number of clinical research results show that traditional Chinese medicine preparations are the same It can significantly improve the cardiac function of patients and improve exercise tolerance. At present, the clinical research of traditional Chinese medicine is especially researched on oral preparations of traditional Chinese medicine, such as Qizhiqiangxin Capsule, Qishen Yiqi Dropping Pill, and Yangxin's Tablets. Its contraindications, allergic reactions, and process purification have led to limited clinical applications.

3.3.1 Traditional Chinese medicine injection preparations

Traditional Chinese medicine injection preparations often have better treatment and preventive effects on hospitalized patients. There are many clinical research results showing that Shenmai injection combined with western medicine conventional treatment methods can reduce IL-1β in serum of patients with CHF. IL-6, Hcy, IL-17 levels, reduce plasma BNP levels, regulate ET, NO and other vascular factor content, and can improve cardiac ultrasound safety indicators [25,26]. A randomized, double-blind, multi-center comfort Controlled Controlled Trials [27] 160 cases of CHF patients with acute stage were treated with Shenfu injection, the treatment lasted 7 ± 1 days, and the follow-up was 28 ± 3 days after treatment. The results showed that the experimental group (Shenfu injection) NYHA functional classification and Chinese medicine The syndrome scores (78.38% and 89.19%) were significantly higher than those of the placebo (glucose injection) group (61.43% and 60.00%, P <0.05), and the amplitude increase time of the experimental group was significantly longer than that of the placebo group (113.00m vs. 82.99m). , P <0.0 5), there is no significant difference between the incidence of adverse events and other safety indicators (P> 0.05), and Shenfu injection combined with conventional treatment can improve cardiac function and clinical symptoms in patients with acute phase of CHF. In a randomized, double-blind, placebo-controlled clinical study, Xue J et al. [28] used "heart"Longlong Injection" was used to treat 100 patients with BNP≥≥200ng / mL and LVEF≤≤45% CHF. The results showed that "Xinmailong Injection" could effectively improve NYHA functional classification, LVEF and BNP, reduce symptoms, improve cardiovascular function, and improve Patient's exercise tolerance.

3.3.2 Oral preparations of proprietary Chinese medicines

In recent years, oral preparations of proprietary Chinese medicines have continued to increase in both clinical research and basic research applications.Compared with traditional Chinese medicine injections, they are safer and more controllable, so they are more popular in clinical practice. Favored. Some studies have found that Qizhi Qiangxin Capsules combined with rehabilitation therapy can significantly increase LVEF, reduce angiotensin Ⅱ and BNP levels in patients with CHF, and inhibit ventricular remodeling, improve cardiac function, improve patient quality of life, and reduce patient's Admission rate [29,30]. Xinbao pills combined with metoprolol succinate sustained-release tablets for patients with CHF can not only improve the heart function of patients, but also promote the repair of myocardial cells and increase exercise tolerance [31] .Zou Jing et al [32] It has been found through research that Qishenyiqi Drop Pills combined with furosemide tablets have significant effects on improving cardiac function indicators and reducing serum factor BNP, troponin I (cTnI), and hs-CRP levels. Ji Jie et al [33] adopted Tongxinluo capsule combined with sodium creatine phosphate was used to treat 142 patients with CHF. The study found that Tongxinluo capsule combined with sodium creatine phosphate can improve cardiac function, inhibit left ventricular remodeling, positively regulate myocardial microcirculation, and reduce myocardial damage. Can get betterRehabilitation effect. Xu Surong et al. [34] also reached similar conclusions in a randomized clinical study of 108 patients with CHF using "Shexiang Baoxin Pills", and "Shexiang Baoxin Pills" had no obvious adverse reactions during the intervention. In addition Clinical studies have shown that Yangxin's tablets combined with western medicine can improve exercise tolerance in patients with CHF [35,36].

Many studies mentioned above show that Chinese patent medicine can significantly improve the cardiac function, improve circulation, promote cardiac rehabilitation and increase exercise tolerance in patients with CHF. The results of various studies have also shown that they are basically similar. Traditional Chinese medicine is more convenient in clinical application than traditional Chinese medicine decoctions. Patients have a higher degree of acceptance, but their flexibility is not as good as traditional Chinese medicine decoctions, both of which have their own characteristics.The use of traditional Chinese medicine to treat patients with chf under the principle of dialectical treatment can promote patient recovery and improve the symptoms of chf heart failure.

4. Exercise methods

Exercise exercises are the core content of cardiac rehabilitation for patients with CHF. Among the five prescriptions for cardiac rehabilitation, comprehensive rehabilitation with exercise as the core has gradually become the focus of cardiac rehabilitation. The traditional exercises of the motherland include Tai Chi, Qigong, and Baduanjin. Wait.

Hao Y et al. [37] conducted a randomized controlled clinical study on 1,084 patients with CHF, and showed that lower limb muscle function electrical stimulation + Tai Chi exercise can significantly reduce the peak oxygen consumption of CHF patients, improve cardiopulmonary function and quality of life, and improve exercise tolerance. Chen DM, etc. [38] 80 patients with CHF were randomly divided into the intervention group (n = 39, Baduanjin exercise) and the control group (n = 41, routine nursing). Questionnaires were used to assess fatigue after 4 weeks, 8 weeks, and 12 weeks. The results showed that the fatigue (F = 5.08, p = 0.009) and quality of life (F = 9.11, p = 0.001) in the 12th week group after the intervention of Baduanjin exercise were significantly improved. The control group started from the beginning By the 12th week, the fatigue was significantly worsened (F = 3.46, p = 0.033), and there was no significant change in the quality of life (F = 0.70, p = 0.518). Compared with the control group, the intervention group had exercise at 4 weeks, 8 weeks, and 12 weeks. The fatigue status and quality of life in the Zhou group were significantly improved. Zheng Liang et al [39] randomly divided 28 CHF patients with cardiac function grades Ⅱ to Ⅲ into the Health Qigong Liuzijue group, the walking group, and the control group. After receiving basic treatment, NT-pro BNP levels, MLHF-Q scores LVEF, and 6MWT were significantly improved in the three groups after 3 months (all P <0.05).Compared with the control group, the Liuzijue group has obvious advantages in the 6MWT and MLHF-Q scores (both P <0.05), and finally found that the Health Qigong Liuzijue can significantly improve the cardiopulmonary endurance and quality of life of patients with CHF. Physicochemical indicators such as BNP have no significant effect.

The above research shows that the traditional exercise techniques of the motherland can effectively improve the cardiopulmonary function and exercise tolerance of patients with CHF patients.In addition, it can also relieve anxiety and depression, and improve the quality of life of patients.

5. Other therapies

Among the five prescriptions for cardiac rehabilitation, although exercise and drugs are the core and key to comprehensive rehabilitation treatment, they are also important for the emotional regulation of patients with CHF, and they cannot be underestimated in the control of risk factors and early prevention and rehabilitation. A large number of clinical research results show that in addition to traditional Chinese medicine and traditional Chinese medicine prescriptions in the treasure trove of Chinese medicine, there are also special therapies such as acupuncture therapy, massage massage, acupoint injection, five elements music, etc. The negative emotions caused thereby improve the quality of life of patients. The characteristics of traditional Chinese medicine external treatments have a wide range of indications, significant curative effects, easy operation, non-toxic side effects, and economic safety. These characteristics have played an important role in long-term clinical treatment and practice. .

Cheng Leiqun et al. [40] used acupuncture dual therapy (acupuncture + acupoint injection of astragalus injection) can improve cardiac function and inhibit inflammatory response in patients with CHF. Gao Wei [41] used "yangxinhuoxuezheng" combined with western medicine In the treatment of patients with CHD-CHF, the results showed a significant decrease in BNP measurement (P <0.05). Du Hongyao et al. [42] combined with western medicine treatment ("Shugan Liqi Jieyu Anshen Recipe + Acupuncture, Acupoint Massage + Auricular Point Pressing + "Chinese Medicine Emotional Nursing") For CHF patients, comprehensive Chinese medicine therapy can alleviate the symptoms of CHF patients, at the same time improve the patient's depression, improve the quality of life, and the advantages of long-term treatment are obvious. Gao Jing et al [43] treated five patients with CHF anxiety Randomized clinical studies found that the five elements music therapy combined with conventional western medicine treatment can significantly reduce the scores of the Pittsburgh Sleep Quality Index Scale and Flinders Day Fatigue Scale, indicating that the five elements music therapy can improve sleep quality and reduce daytime fatigue in patients with CHF anxiety. The degree of clinical efficacy is significant.

6. Summary

In summary, a large number of clinical research results have further confirmed that traditional Chinese medicine has a significant effect on cardiac rehabilitation in patients with CHF. Traditional Chinese medicine cardiac rehabilitation has gradually been widely recognized by clinicians and patients. It is combined with conventional anti-heart failure under the guidance of the principles of syndrome differentiation and treatment of traditional Chinese medicine. Western medicine for chronic heart failure can not only improve the patient's heart function, but also improve the patient's quality of work and life, reduce the rate of admission, readmission and mortality, etc. However, looking at the current clinical research quality of traditional Chinese medicine rehabilitation treatment of CHF, there is a lack of standardization and objectivity. The problem of low diagnostic and dialectical standards and the small number of clinical samples has always existed. Most clinical research is still performed on the basis of conventional western medicine treatment. There is no double-blind, random and blank control. I believe that with the development of the Chinese medicine industry and the heart of traditional Chinese medicine The formulation of the consensus of rehabilitation experts will provide more large samples and high-quality clinical research in the future to provide evidencebased medical evidence for the development of a standardized and systematic Chinese medicine cardiac rehabilitation model, which will benefit more patients with cardiovascular disease and promote the motherland. Inheritance and innovation of traditional medicine.