The Clinical Research On Differentiation Standard For Toxin-stasis Syndrome Of ACS In Chinese Medicine

ACS is the severe and critical disease in CAD.Although modern medicine has made substantial progress in recent years, its high mortality and disability rates are still a big problem in clinical practice.In order to improve the therapeutic and preventive effects on ACS with TCM, we followed the toxin-stasis theory through analyzing the traditional medical literature and combining modern pathophysiologic mechanisms of ACS, to conduct a prospective clinical research to explore the diagnostic standard of the toxin-stasis syndrome and the effects on UA treated by Chinese medicine for activating blood circulation and detoxicating.This study is divided into two parts: review and clinical study.1.Review: This part includes 2 reviwes,the research progress between traditional Chinese medicine toxin-stasis pathogenesis and atherosclerotic vulnerable plaque, and the diagnosis and treatment progress in ACS.2. Clinical research: Including the following two parts.Part 1: The Clinical Research on the Differentiation Standard for Toxin-stasis Syndrome of ACS in Chinese Medicine.Objective: To provide the objective and scientific evidence for differentiation Standard of toxin-stasis syndrome of ACS in Chinese medicine.Method: This research continued from March of 2008 to March of 2009.According to the requirement of large sample, multicenter, prospective clinical epidemiology, we investigated 165 patients with ACS treated by PCI and conventional medicine. The content of CRF included registering date, past medical history, diagnosis, the grade of patient's condition, the result of coronary angiography and laboratory examination, the symptoms, the physical sign and the pattern of TCM, the score of primary symptoms,BBS and angina. And then we imported these data into database.There were several statistical methods used in the analysis, including Frequencies, Logistic regression, Principal components analysis and correlation. We summarized objectively the differentiation Standard for toxin-stasis syndrome of ACS in Chinese medicine.Result: Integrating clinical practice, we filtered the syndrome factors and risk factors of the toxin-stasis syndrome of ACS, the syndrome factors including the blood stasis, phlegm with pyretic syndrome, Qi deficience, Yin deficience, Qi stagnatin. And blood stasis, phlegm with pyretic syndrome, Qi deficience, Yin deficience were positive correlation to the toxin-stasis syndrome, Qi stagnatin was negative correlation to the toxin-stasis syndrome. The risk factors including the high level of LDL-C, diabetes mellitus, stroke, smoking and previous myocardial infarction. In these risk factors, the high level of LDL-C was the most strong than others.Applying principal components analysis, we found the primary symptoms. Then according to the combination of syndrome factors, we classified two sort of syndrome factors,the one was deficience syndrome,the other was excess syndrome.And the primary symptoms were divided on the basis of the classification of syndrome factors, Finally, we gained the result of differentiation Standard of the TCM toxin-stasis syndrome of ACS. The one is toxin-stasis with deficiency syndrome, the symptoms including chest pain, chest distress, lassitude, short breath, palpatation, spontaneous perspiration, tongue pale and dark, thready pulse. The other is toxin-stasis with excess syndrome, the symptoms including chest pain, chest distress, bitter taste in the mouth, thirst and polydipsia, constipation, tongue red and dark, fur yellow and wax, slippery pulse.Conclusion: According to the results of mathematical statistics combining with theory of TCM, it is found that the differentiation standard of the TCM toxin-stasis syndrome of ACS has its regularity , and is worth extending and studying further.Part 2: Clinical Randomized Controlled Study on UA Intervened by Chinese Medicine for Activating Blood Circulation and Detoxicating.Objective: To evaluate the effects on UA treated by Chinese medicine for activating blood circulation and detoxicating.Method: By designing a prospective randomized controlled research program, we observed 61 patients diagnosed by UA and treated by PCI and conventional medicine. 31 patients were divided into the treatment group of activating blood circulation and detoxicating, 30 patients were divided into the control group of activating blood circulation. the treatment group was treated by Xiongshao capsule and Huanglian capsule, the control group was treated by Xiongshao capsule alone. The period of taking medicine is two weeks, then we observed the result of laboratory examination, the symptoms, the physical sign and the pattern of TCM, the score of primary symptoms,BBS and angina, and compared the effects between pre-treatment and post-treatment.Result: Based on the conventional treatment, the treatment group could lower the level of hsCRP, there was significant difference compared to that of control group. Comparing with the control group, the treatment group seemed to show superiority in lowering the score of UA. Analysis to the effect on the pattern of syndrome indicated that phlegm with pyretic syndrome combined blood stasis syndrome was most obvious pattern treated by Chinese medicine for activating blood circulation and detoxicating.Conclusion: The treatment of activating blood circulation and detoxicating could decrease the level of hsCRP and relieve the symptoms of UA, there was some significance to treat UA with the Chinese Medicine for activating blood circulation and detoxicating.