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Clinical study of Xu heart,such as academic thought and clinical experience and Yiqi Huoxue,Xiefei Diuresis treatment,congestive heart failure

Author: PengWei
Tutor: XuXinRu
School: Beijing University of Traditional Chinese Medicine
Course: Integrative clinical cardiovascular and cerebrovascular
Keywords: Xu heart academic origins academic thought clinical experience of chronic congestive heart failure Yiqihuoxue Xiefei Lee Water Act
CLC: R259
Type: Master's thesis
Year: 2011
Downloads: 35
Quote: 0
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Abstract


Professor Xu Xinru is a state-renowned doctor of traditional Chinese medicine, who is among the first practitioners of western medicine learning traditional Chinese medicine (TCM) in the country. She is a clinical expert on cardiovascular and cerebrovascular diseases. As the student from the forth batch of master-disciple teachings of national famous professors on traditional Chinese medicine, the author summarized both the academic thoughts and clinical experiences of Professor Xu, and studied Yiqihuoxue Therapy (reinforcing qi and promoting blood circulation) and Xiefeilishui therapy (purging lung and alleviating water retention) on the treatment of chronic congestive heart failure (CHF) in clinic. This article has four parts.Part one is a general statement of this academic origin. Professor Xu was born in the family engaging in traditional Chinese medicine. Her grandfather Jiang Zimei was a famous doctor in both Jiangsu and Zhejiang province. Professor Xu has learned from teacher Fei Boxiong in Menghe and now still kept the prescriptions from predecessors. She graduated from Shanghai Tongji Medical College and was among the first practitioners of Western medicine learning traditional Chinese medicine. Professor Xu learned from famous doctors Wang Hushi, Guan Youbo, Xu Gongyan etc. while working in Beijing TCM Hospital. She laid a solid foundation of traditional Chinese medicine, and brought the modern scientific methods and progress into the researches of traditional Chinese medicine with her own advantage of integrated medicine, worked very hard, and has hecome an expert on the cardiovascular diseases of integrated medicine.The author analyzed the treatment thoughts and viewpoints of modern famous TCM doctors, summarized the progress of modern TCM on the treatment of cardiovascular diseases and its pathogenesis of qi deficiency and blood stasis with the basic treatment principle of Yiqihuoxue Therapy. Through the summary of academic thoughts of Professor Xu, the author not only studied Yangyinyiqi Therapy (nourishing yin and qi) and Xingqihuoxue Therapy (promoting circulation of qi and blood) on pectoral stuffiness pain, Yiqihuoxue Therapy and Xiefeilishui Therapy on heart failure, but also analyzed the composing prescription of Sanshentongmai Heji and Xinshuai Heji. The clinical experiences of Professor Xu in the treatment of cardiovascular and cerebrovascular diseases was analyzed, which mainly focuses on pectoral stuffiness pain, heart failure, palpitation, vertigo, and insomnia, relating to six kinds of diseases of angina pectoris, CHF, arrhythmia, insomnia, high blood pressure, and cerebral infarction in modern medicine. In addition, the characteristics of differentiation on other diseases beyond cardiovascular and cerebrovascular diseases were also summarized and mainly related to cervical spondylosis and vegetative nerve functional disturbance.Part two:The main academic thoughts of professor Xu in treating cardiac disease were summarized. Combined with the modern medicine to the cardiac disease, professor Xu believes that there are two aspects in the incidents of organic heart disease.They are myocardial blood supply and ejection function. Through the summery of professor Xu’s basic methods which were YangYinYiQi and XingQiHuoXue in treating XiongBi and YiQiHuoXue and XieFeiLiShui in treating heart failure,in this paragraph we analized her main academic thoughts in treating cardiac disease. The mixture SanShenTongMai and XinShuai which was invented by professor Xu were analized too.Part three:The experiences of professor Xu in treating cardiovascular and cerebrovascular diseases.The clinical experiences in treating other cardiovascular and cerebrovascular diseases were systematically described.Professor Xu’s unique experiences in treating palpitations, dizziness and the insomnia disease were discussed and which involved arrhythmia, atrial fibrillation, hypertension, cerebral arteriosclerosis, insomnia and other types of diseases in modern medicine.And also summarized the differentiations in treating cardiovascular and cerebrovascular diseases of professor Xu which involved cervical disease and autonomic dysfunction.Part four is the core of this article.There is a disscussion on Yiqihuoxue Therapy and Xiefeilishui Therapy in the treatment of CHF, proposed by professor Xu.Through the accumulated experiences in several decades and the theory of Xinzhuxuemai (heart governs the blood), Feichaobaimai (all blood vessels converges in lung) and Feizhuzhijie (lung regulates visceral activities), professor Xu believes that Qixuxueyushuiting (qi deficiency, blood stasis and water retention) is the core cause and pathogenesis in CHF. Tanyinzufei (phlegm and excessive fluid obstructing in the lung) is the chief pathomechanism and should be treated as soon as possible. So she proposes the important thoughts of Yiqihuoxue and Xiefeilishui in the treatment of CHF with the modified prescription of the combination of Tinglidazaoxiefei Tang and Fangjihuangqi Tang from Synopsis of Prescriptions from the Golden Chamber..Methods:All the patients of CHF from both outpatients or inpatients treated by professor Xu or the author from June 2010 to June 2011 were enrolled and randomized into two groups, the treatment group and the control group, with 30 patients in each group. NYHA, TCM symptom scores, the symptomatic efficacy, EF and safety indicators were analyzed before and after the treatment.Results:After the treatment the total effective rate of the improvement of heart function was 83.3% which was significantly higher compared with that in the control group, and that of the symptom scores was 86.7%, while EF was obviously improved, which was significantly higher compared with that in the control group, There were significant statistical differences. Deterioration of heart function and adverse reactions weren’t observed.Conclusions:The results showed that this therapy in the treatment of heart failure was safe and effective, especially for the syndrome Xinfeiqixu (qi deficiency of heart and lung). The efficacy of the syndromes of Qiyinliangxu (deficiency of qi and yin) and Qixuxueyu was better than that of Yangxushuifan (hydroretention with asthenic yang). It is noteworthy that the improvement of the heart function of Qiyinliangxu Syndrome was better than that of Qixuxueyu Syndrome after the treatmen, but which was contrary to the symptom scores.Achievements:We found that patients of heart failure at the attack stage are manifested with Shuiyinneiting Syndrome and Fangyinzufei Syndrome except for the patients with Yinjieyangtuo Syndrome (yin-exhaustion depleting yang), among which severe patients are differentiated with Yangxushuifan Syndrome, while it is very rare as to the deficiency syndrome without pathogens. Thus, it is concluded that Tanyinfufei is the chief syndrome in CHF, is consistent with the pathogenesis of heart failure leading to fluid retention in western medicine, and also accords with the theory of No Sputum without Asthma in TCM. So Yiqihuoxue and Xiefeilishui are the basic treatment methods in CHF.The common causes of heart failure include cardiomyopathy, valvular heart disease, hypertensive heart damage, coronary atherosclerotic heart disease (CHD) and cor pulmonale. We believe that if we summarize, analyze, and confirm the appropriate therapy, and develop in-depth observation and summary, professor Xu’s experiences will be inherited and be promoted into application. This part is the core of the whole article. The clinical research of Yiqihuoxue Therapy and Xiefeilishui Therapy proposed by professor Xu Xinru in the treatment of chronic congestive heart failure (CHF) was studied.It is known that the deficiency of heart qi is the basic cause of CHF through the review of the modern Chinese medicine. The deficiency of heart qi may lead to yin deficiency or yang deficiency, and yin deficiency is the early syndrome of CHF while yang deficiency is the pathological basis in the crisis. Qixuxueyu runs through the whole process of CHF. Tanyinshuiting (phlegm and water retention) is the main pathological product, and Shuiyujiaozu (statsis of water and blood stagnation) is one of the important pathogenesis which can lead to worse conditions, causing the separation of yin and yang that is incurable. There are various viewpoints from different schools in treating CHF such as Wenyangbuqi (warming yang and reinforcing qi), Huoxuehuayu (promoting blood circulation and removing blood stasis), Lishuixiaozhong (inducing diuresis to alleviate edema) and Bushenyangxin (reinforcing kidney and nourishing heart).Through the accumulated experiences in several decades and the theory of Xinzhuxuemai (heart governs the blood), Feichaobaimai (all blood vessels converges in lung) and Feizhuzhijie (lung regulates visceral activities), professor Xu believes that Qixuxueyushuiting (qi deficiency, blood stasis and water retention) is the core cause and pathogenesis in CHF. Tanyinzufei (phlegm and excessive fluid obstructing in the lung) is the chief pathomechanism and should be treated as soon as possible. So she proposes the important thoughts of Yiqihuoxue and Xiefeilishui in the treatment of CHF with the modified prescription of the combination of Tinglidazaoxiefei Tang and Farigjihuangqi Tang from Synopsis of Prescriptions from the Golden Chamber.We carried out relevant researches with the purpose on the understanding of CHF by professor Xu.Methods:All the patients of CHF from both outpatients or inpatients treated by professor Xu or the author from June 2010 to June 2011 were enrolled and randomized into two groups, the treatment group and the control group, with 30 patients in each group. Chinese Medicine Clinical Research Guideline and Guideline of Diagnosis and Treatment of Chronic Heart Failure made by Cardiovascular Branch of Chinese Medical Association were applied as the standard of diagnosis, while NYHA was used as the evaluation index of heart function. Patients were treated with the combination of TCM according to the syndrome differentiation with a self-control. NYHA, TCM symptom scores, the symptomatic efficacy, EF and safety indicators were analyzed before and after the treatment.Results:After the treatment the total effective rate of the improvement of heart function was 83.3%, which was significantly higher compared with that in the control group, and that of the symptom scores was 86.7%, while EF was obviously improved which was significantly higher compared with that in the control group. There were significant statistical differences. Deterioration of heart function and adverse reactions weren’t observed.Conclusions:The results showed that this therapy in the treatment of heart failure was safe and effective, especially for the syndrome Xinfeiqixu (qi deficiency of heart and lung). The efficacy of the syndromes of Qiyinliangxu (deficiency of qi and yin) and Qixuxueyu was better than that of Yangxushuifan (hydroretention with asthenic yang). It is noteworthy that the improvement of the heart function of Qiyinliangxu Syndrome was better than that of Qixuxueyu Syndrome after the treatmen, but which was contrary to the symptom scores.Achievements:We found that patients of heart failure at the attack stage are manifested with Shuiyinneiting Syndrome and Fangyinzufei Syndrome except for the patients with Yinjieyangtuo Syndrome (yin-exhaustion depleting yang), among which severe patients are differentiated with Yangxushuifan Syndrome, while it is very rare as to the deficiency syndrome without pathogens. Thus, it is concluded that Tanyinfufei is the chief syndrome in CHF, is consistent with the pathogenesis of heart failure leading to fluid retention in western medicine, and also accords with the theory of No Sputum without Asthma in TCM. So Yiqihuoxue and Xiefeilishui are the basic treatment methods in CHF. The research showed that many patients were sensitive to digitalis and prone to poisoning manifested with bradycardia and premature ventricular beats, whose symptoms were relieved after treatment. Excessive heat of the stagnation of qi in the patients are treated with Radix Paeoniae Rubra instead of Radix Salviae Miltiorrhizae, or with Cortex Moutan Radicis, Cortex Lycii Radicis, Gardenia jasminoides Ellis, Fructus Forsythiae Suspensae, etc. Herbs of warming yang and reinforcing the root won’t be applied until the improvement of excessive heat of the stagnation of qi, which has been proven in clinic.The common causes of heart failure include cardiomyopathy, valvular heart disease, hypertensive heart damage, coronary atherosclerotic heart disease (CHD) and cor pulmonale. We believe that if we summarize, analyze, and confirm the appropriate therapy, and develop in-depth observation and summary, professor Xu’s experiences will be inherited and be promoted into application.

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