| Objective:1. To collect and summarize academic thought and clinical experience on distinguishing and treating CHD (chest stuffiness and pains) of professor ZHOU Yi-xuan, the national famous veteran teran doctors of TCM; 2. To collect and summarize clinical experience and medicine law on treating CHD of professor ZHOU Yi-xuan; 3. According to the tutor’s empirical formula, to observe the efficacy of replenishing vital energy and nourishing heart, phlegm-resolving and collateral-unblocking therapy on the patients with CHD after primary percutaneous coronary intervention (PCI); 4. To investigate the effect of Xinyi Capsule on myocardial ischemia reperfusion injury and explore its mechanism of effect.Method:1. Through reviewing the related literatures and studying aside the tutor, we collate the tutor’s clinical case reports completely, summarize academic thoughts and clinical experience on distinguishing and treating CHD (chest stuffiness and pains) of professor ZHOU Yi-xuan; 2.140 CHD outpatients treated by professor ZHOU Yi-xuan were enrolled in our study, a total of 214 visits; the Database was established by data acquisition system and data processing system which were developed by information center in the first affiliated hospital of anhui medical university, standardizing medical terminology; the information obtained by four diagnostic methods was entered in data acquisition system, analyzed by SQL Sever tools; CHD syndrome principle and therapy were analyzed by using data mining methods, including frequency analysis method, association rules and the complex network technique, analyzing prescription formulating rule and core prescription.3.65 CHD hospitalized patients received PCI were divided into two groups, treatment group(32 cases), control group(33 cases). In control group, the patients received postoperative routine drug treatment, in treatment group, the patients received buxintongluotang besides postoperative routine drug treatment, the total course of 2 groups was 1 month. The clinical efficacy between the two groups were compared before and after treatment, including the curative effect of angina pectoris, electrocardiogram and TCM symptom. The blood was taken from the patient’s elbow in the two groups before PCI, one day after PCI, one month after PCI respectively, and then FIB, Hs-CRP,ET-1 and sP-sel was measured.4. 120 SD rats were divided into 6 groups in random, model group (with an equal volume distilled water), sham operation group (with an equal volume distilled water), Compound Danshen Pill group(Compound Danshen Pill 0.54 g/kg), Xinyi Capsule high dose group, medium dose group, low dose group (8.4 g/kg、4.2 g/kg、 2.1 g/kg),20 rats in each group. In medication groups,7 days after intragastric administration with drug by different dosages, a model of ischemia and reperfusion of the myocardium was established by ligating the left anterior descending coronary arteries for 30 min, followed by 120 min of reperfusion; in sham operation group, all rats underwent similar surgery but without coronary artery ligation. The content of CK-MB. MDA、SCD、TNF-a、NF-kB in serum was measured with ELISA; the expression level of Bc1-2、Bax mRNA was measured by RT-PCR; p-AKT level was measured by Western blot; the impairment of myocardium was observed through he coloratura.Result:1.Professor ZHOU Yi-xuan considers that the key factors of CHD are qi-blood disharmony, stasis-phlegm type, stagnation of heart collateral, and then obstruction leading to the pain. Based on related theories, he puts forward his own view that angina pectoris in CHD presents in heart and roots in kidney, one step further, he indicates that "stagnation of heart collateral and jerky collateral syndrome" is the major disease pathogenesis of chest stuffiness and pains in CHD patients after PCI. Based on the overall condition, professor ZHOU Yi-xuan advocates 6 principles for treating chest stuffiness and pains:tonifying qi and blood, activating blood and purging phlegm, dredging collaterals, tonifying heart and kidney, harmonizing stomach and spleen, regulating qi activity. On the technique of medication, professor ZHOU is skillful at compatibility, herb pairs, combination of drugs and syndromes, he creates empirical formula buxintongluotang, it is developed into new drug Xinyi capsule, which has obtained national invention patent. 2.The data mining results indicates that the frequency of TCM syndrome of CHD in sequence from high to low is:deficiency of both qi and yin with blood stasis(67 times), qi deficiency and blood stasis(54 times), heart-spleen deficiency(33 times), qi deficiency and blood stasis and phlegm (28 times), qi-yin asthenia(28 times), phlegm stagnation(23 times), heart blood stasis(17 times), heart-kidney yang deficiency (14 times), fluid retention stagnating in the interior(10 times), heart kidney-yin deficiency(5 times), qi-stagnancy and blood stasis(1 time); the frequency of TCM syndrome factors in sequence from high to low is:qi asthenia(210 times), blood stasis(167 times), yin deficiency(100 times), phlegm(51 times), yang deficiency(14 times), retention of fluid in the body(10 times), qi stagnation(1 time); the frequency of medication in sequence from high to low is buxintongluo soup(141 times), shengmai san(67 times), shenling baizhu san(30 times), suanzaoren tang(16 times), powder of Four Drugs containing Poria(12 times), zhenwu tang(11 times); and these chinese drugs are commonly used to treat CHD, such as salviae miltiorrhizae, Radix Astragali preparata, dogwood, chuanxiong, sealwort, dangshen, angelica sinensis, leech, red paeony root, white peony root, finger citron, Pericarpium Trichosanthis, Radix Ophiopogonis, Gonglao leaf, Semen Ziziphi spinosae, Acorns tatarinowii Schott and so on; common drugs combination:①white peony root and red paeony root,②chuanxiong and salviae miltiorrhizae, ③schisandra chinensis and Radix Ophiopogonis, ④sealwort and Radix Astragali preparata, ⑤red paeony root and angelica sinensis,⑥white peony root and angelica sinensis, ⑦sealwort and salviae miltiorrhizae, ⑧angelica sinensis and Radix Astragali preparata,⑨sealwort and dogwood, ⑩Radix Astragali preparata and salviae miltiorrhizae.etc. the major drugs in key prescription of treating CHD include salviae miltiorrhizae, Radix Astragali preparata, dogwood, chuanxiong, sealwort, dangshen, angelica sinensis, leech, red paeony root, white peony root, and finger citron.3.The results of clinical observation indicated that the curative effect of angina pectoris and TCM symptom in buxintongluotang group were better than those in control group(P<0.05), the effect of ECG didn’t have significant difference in the two groups(P>0.05). One day after PCI, hs-CRP、ET-1、sP-sel in the two groups rised significantly, compared with those before operation(P<0.05 or P<0.01), FIB in the two groups had no significant difference(P>0.05). One month after PCI, FIB、hs-CRP、ET-1、sP-sel in treatment group lowered significantly(P<0.05 or P<0.01), hs-CRP in control group lowered significantly(P<0.05 or P<0.01), compared with those one day after operation. One month after PCI, FIB、hs-CRP、 ET-1、sP-sel in treatment group had a more significant decrease than those in control group(P<0.05 or P<0.01).4.Animal test suggested that in Xinyi Capsule high dose group, medium dose group and low dose group, the level of serum CK-MB、MDA、TNaF-a、NF-kB after MIRI decreased significantly, the level of SOD rised significantly(P<0.01), the expression of p-AKT and Bcl-2 mRNA increased significantly (P<0.01), the expression of Bax mRNA significantly decreased (P<0.01), compared with those in model group (P<0.01). HE staining displayed that it alleviated myocardial injury significantly in Xinyi Capsule high dose group, medium dose group and low dose group, compared with that in model group.Conclusion:1. Professor ZHOU Yi-xuan, the national famous veteran teran doctors of TCM, he has developed unique academic thinking on the field of prevention and cure CHD(chest stuffiness and pains), which is valuable to improve the level of clinical diagnosis and treatment.2.The medicine law obtained by analysis of data-mining software is completely consistent with clinical experience of professor ZHOU, which demonstrates the data got from software analysis has taken on new value. Data mining analysis offers a new way to combine the heritage of TCM and modern scientific methods, which is worthy of further promotion and application.3.Replenishing vital energy and nourishing heart, phlegm-resolving and collateral-unblocking therapy could significantly improve clinical efficacy of the patients with CHD after PCI, its mechanism is correlated with suppression of inflammatory reaction, preserving the function of vessel endothelium, inhibiting platelet activation, activating fibrinolytic system, promoting fibrinolysis.4. Xinyi Capsule has protective effect on myocardial ischemia reperfusion injury in rats, its mechanism may be relevant to the effect of scavenging oxygen free radicals, abating myocardial damage, restraining inflammation reaction, increasing the expression of Bcl-2 mRNA, decreasing the expression of Bax mRNA and inhibiting cell apoptosis by activating myocardial tissue signal protein p-AKT signaling pathways,... |
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