| According to the latest research data,it shows that the current number of heart failure patients worldwide up to 22.5 million,the number of new cases per year is about 2 million,5-year survival rate is equivalent to malignant tumors.Related statistics show that the total incidence of heart failure in China is about 2%,which has become a common disease nowadays.High mortality,rehospitalization rate and poor prognosis of heart failure result in a serious decline in the quality of life of the affected population.The most common underlying diseases of heart failure are hypertension,diabetes and coronary heart disease.As they have a common pathogenesis and risk factors,many patients suffer from these three diseases at the same time in clinical,the risk to complicate with heart failure will increase.The three diseases complicated with heart failure are more common.Because of its lots of basic diseases,complex and heavy condition,it is an incurable disease,and has a poor prognosis.Modern medicine on such heart failure treatment has quick,easy and other advantages.But the complex condition of heart failure patients,combining with chemical indications,adverse reactions,expensive price and other factors limit its clinical application,the clinical efficacy is poor.Chinese medicine on the treatment of chronic heart failure is experienced,and it works from multi-target,multi-link,multi-mechanism and multi-directional,making up for the shortcomings of Western medicine treatments and complementing each other to jointly improve the clinical efficacy.However,the etiology and pathogenesis,syndrome research of such heart failure-related traditional Chinese medicine is a serious lack at present,which has brought difficulties for our further study of dialectical treatment.This topic,first of all,reviews the progress of Chinese and Western medicine of chronic heart failure in recent years;then,discusses the pathogenesis of hypertension,diabetes and coronary heart disease complicated with chronic heart failure and the dilemma of modern medical treatment,and explains the theoretical connotation and clinical efficacy of warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema respectively from the perspective of Chinese and Western medicine;Finally,Heart failure No.1 prescription having the effect of warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema is commonly used by the tutor for the treatment of hypertension,diabetes,coronary heart disease complicated with chronic heart failure,which is also the focus of this topic.This topic aims to explore its clinical efficacy and safety for such heart failure patients in the real clinical practice,and then provides a safe and effective traditional Chinese medicine program for the clinical treatment on patients with heart failure.Part1:Theoretical researchIn the part of theoretical research,first of all,the topic discusses the pathogenesis of hypertension,diabetes and coronary heart disease complicated with chronic heart failure and the dilemma of modern medical treatment,then,related knowledge of etiology and pathogenesis,syndrome characteristics and clinical treatment of hypertension,diabetes and coronary heart disease complicated with chronic heart failure by using Chinese medicine is discussed.The etiology and pathogenesis of the disease is complicated,disease location is in the heart,and it has a closing relationship with lung,spleen and kidney.The nature of the disease belongs to asthenia in origin and asthenia in superficiality.Asthenia in origin is based on deficiency of vital energy and deficiency of yang,Deficiency of heart,kidney and yang is the fundamental and at the same time it has deficiency of spleen and yang.The main signs of Asthenia in superficiality is blood stasis,retained fluid and retained fluid;Yang-deficiency and water retention,static blood blocking collaterals is more common,the syndrome performance is mainly in palpitate,asthma,face and extremities edema,chilly sensation and the cold limbs;The condition is complex,heart failure is degree.The use of Western medicine alone is often difficult to obtain a satisfactory effect,plus traditional Chinese medicine treatment,will have a better recent and long-term efficacy.All those above are also the legislation basis of warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema method.At last,the part of theoretical research systematically explained the theoretical connotation of warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema,which includes:(1)Warming yang and benefiting qi treats its origin,promoting blood circulation for removing obstruction and inducing diuresis for removing edema treat its super face.Super face and origin are treated at the same time,mainly in origin.The theory traceability of heart failure with warming yang and benefiting qi is:'Huangdi Neijing' has many descriptions of the importance of yangqi on the human body.For pathogenesis fundamental of such heart failure,deficiency of vital energy and deficiency of yang,warming yang and benefiting qi should be used to treat the origin.All ancient Chinese medicine practitioners have attached great importance to treat heart failure with the method of warming yang,Zhenwu decoction,Fulingguizhibaishugancao decoction,Wuling powder,Sini decoction and others are commonly used for warming yang and inducing diuresis.The clinical efficacy is outstanding.As heart qi deficiency is the direct cause of heart failure,qi circulates,then the blood circulates;qi is deficiency,then the blood stagnates,most of the heart failure has syndrome of blood stasis.My tutor advocates that promoting blood circulation for removing blood stasis should be always used throughout the heart failure treatment.As the collaterals stasis is the center link of heart failure,vein relaxing drugs are always used for promoting blood circulation for removing blood stasis.The blood circulates,water circulates.It indirectly plays the effect of inducing dieresis.Vein relaxing drugs can be coordinated with the method of inducing dieresis.The two methods of promoting blood circulation for removing obstruction and inducing dieresis are used at the same time for the blood stasis and super face of water of the disease.(2)Warming heart and kidney is the main,taking into account the spleen.In the process of the occurrence and development of heart failure,heart,kidney and yang deficiency have always played a major role in its promotion,which is the nature of the disease.Kidney dominates the whole body's yangqi.Deficiency of kidney yang cannot cause splenic yang,which easily lead to spleen yang weak,eventually lead to all the deficiency of yang of the heart,spleen and kidney.The treatment should be mainly warming heart and kidney,taking into account warming spleen and benefiting qi.At last,from the view of modern medical point,a large number of studies show that the method of warming yang and benefiting qi,promoting blood circulation and inducing dieresis has following effects:it relieve the heart failure symptoms and improve the heart function;through the Influence on activation of sympathetic nervous system,it inhibit the activation of the renin-angiotensin-aldosterone system(RAAS),thereby inhibit ventricular remodeling and delay myocardial damage;it improve exercise tolerance and enhance life quality.The full text explains the theoretical connotation and clinical efficacy of warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema respectively from the perspective of Chinese and Western medicine.The method plays a role in treatment of heart failure from multi-target,multi-link,multi-mechanism and multi-directional.It is involved in multiple pathological processes of heart failure,side effects are small,and it has certain advantages compared to Western medicine.This medicine can not only improve the symptoms of patients,delay the progression of the disease,but also improve the quality of life of patients,it is worthy of clinical application.Part2:Clinical observation part1 ObjectiveThis part evaluates the clinical efficacy and safety of hypertension,diabetes and coronary heart disease complicated with chronic heart failure with heart failure No.1 prescription in the real clinical practice(syndrome of yang-deficiency and water retention,static blood blocking collaterals).2 MethodsHypertension,diabetes,coronary heart disease complicated with chronic heart failure patients,whose traditional Chinese medicine syndrome is yang-deficiency and water retention,static blood blocking collaterals,may be included in the study.The patients with hypertension,diabetes,coronary heart disease complicated with chronic heart failure in the Southern District of Guang'anmen Hospital outpatient and hospitalized from September 2014 to October 2016,are partly given Western medicine basic treatment and heart failure No.1 prescription with full consideration of the patients wishes(Chinese medicine decoction,100ml/time,2 times/day),which is the treatment group.The others divided into control group are given Western medicine basic treatment and Qili Qiangxin capsule(1.2g/time,3 times/day).In this period,taking the heart failure on the No.1 prescription of the case were all included in the treatment group.Taking Qiliqiang heart capsule cases,according to age ± 5 years old,the same sex,heart function classification,duration ± 2 years and other factors,the patients were matched with the treatment group to 1:1 to form a control group.In the two groups of patients,they are matched according to age,gender,cardiac function classification and course.Each of the 60 patients of the two groups which final match are included in the clinical study.The analysis takes 4 weeks data.Before and after the treatment,we record the patient symptoms,signs,medication,adverse reactions,and detection of safety and efficacy indicators.Safety indicators:blood,urine,liver and kidney function.Efficacy indicators:traditional Chinese medicine syndrome score,heart failure score,New York Heart Association(NYHA)cardiac function classification,left ventricular ejection fraction,BNP,quality of life evaluation.All data are analyzed by SAS9.3 software for data management and statistical analysis.3 ResultsThe final two groups of 60 patients are included in the analysis,including outpatients in 43 cases(35.83%),inpatients in 77 cases(64.17%).Gender,age,weight,height,duration of disease,grade of heart function is not statistically significant in the two groups(P>0.05),which has comparability between the groups.Cardiac function classification:after treatment for 4 weeks,the treatment group is obviously effective in 37 cases(61.67%),effective in 16 cases(26.67%),ineffective in 7 cases(11.67%),deterioration in 0 cases(0.00%);The control group is obviously effective in 20 cases(33.33%),effective in 24 cases(40.00%),ineffective in 16 cases(26.67%),deterioration in 0 cases(0.00%).The total effective rate is 88.33%in the treatment group and 73.33%in the control group.The total effective rate in the treatment group is higher than that in the control group,the difference between the two groups is statistically significant(P<0.05).In the comprehensive effect of traditional Chinese medicine syndrome,after treatment for 4 weeks,the treatment group is obviously effective in 38 cases(63.33%),effective in 17 cases(28.33%),ineffective in 5 cases(8.33%),deterioration in 0 cases(0.00%);The control group is obviously effective in 16 cases(26.67%),effective in 31 cases(51.67%),ineffective in 13 cases(21.67%),deterioration in 0 cases(0.00%).The total effective rate is 91.67%in the treatment group and 78.33%in the control group.The total effective rate in the treatment group is higher than that in the control group,the difference between the two groups is statistically significant(P<0.05).In the changes in symptoms and signs of Chinese medicine,the two groups are significantly improved after treatment(P<0.05).Among them,the treatment group's palpitations,asthma,facial edema,aversion to cold,less urine,pleural effusion ascites better than the control group,the difference between groups is statistically significant(P<0.05).In the heart failure syndrome integral effect,after treatment for 4 weeks,the treatment group is obviously effective in 36 cases(60.00%),effective in 14 cases(23.33%),ineffective in 10 cases(16.67%);The control group is obviously effective in 21 cases(35.00%),effective in 19 cases(31.67%),ineffective in 20 cases(33.33%).The total effective rate is 83.33%in the treatment group and 66.67%in the control group.The total effective rate in the treatment group is higher than that in the control group,the difference between the two groups is statistically significant(P<0.05).The improvement of dyspnea in the treatment group is better than that in the control group,the difference is statistically significant(P<0.05).In the improvement of life quality score,the average improvement rate is 51.35 ±14.54 in the treatment group,40.67 ± 11.22 in the control group.The quality of life of the two groups is significantly improved(P<0.05).The improvement of the treatment group is better than the control group,the difference between the two groups is statistically significant(P<0.05).In the improvement of LVEF,the average increasement is 0.11±0.06 in the treatment group,0.12±0.05 in the control group.LVEF of the two groups is significantly improved(P<0.05).The difference between the two groups is not statistically significant(P>0.05).In the improvement of BNP,the average decreasement is 1168.35±632.62 in the treatment group,832.42±362.14 in the control group.BNP of the two groups is significantly improved(P<0.05).The improvement of the treatment group is better than the control group,the difference between the two groups is statistically significant(P<0.05).Two groups of systolic blood pressure,diastolic blood pressure,blood glucose treatment are significantly improved(P>0.05).The difference between the two groups is not statistically significant(P>0.05).The length of hospital stay is that the shortest 7 days,the longest 14 days in the treatment group,the average is 9.47±1.77 days;the control group is that the shortest 9 days,the longest 20 days,an average of 13.03±2.66 days.The number of the treatment group is less than the control group,the difference is statistically significant(P<0.001).In terms of safety,the incidence of adverse events in the control group is 8.33%,and the proportion of adverse events in the treatment group is 3.33%.There is not statistically significant between the two groups(P>0.05).In the two groups of patients after treatment,blood,urine,liver function,renal function and other laboratory safety indicators are not obvious abnormalities.4 ConclusionsEtiology and pathogenesis of hypertension,diabetes,and coronary heart disease complicated with chronic heart failure are asthenia in origin and asthenia in superficiality,yang-deficiency and water retention,static blood blocking collaterals are more common.Warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema is the key treatment of such heart failure patients.The heart failure No.1 prescription with a warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema effect can effectively improve the cardiac function of patients with hypertension,diabetes,coronary heart disease complicated with chronic heart failure,syndrome of yang-deficiency and water retention and static blood blocking collaterals.It can also significantly improve the clinical symptoms and quality of life;reduce the level of BNP,increase left ventricular ejection fraction(LVEF)level and have a good safety.This relationship is not only the prescription has the function of cardiac,diuretic,vasodilator,but also it inhibit the neuroendocrine system over-activation,and thus improve the myocardial remodeling.The prescription not only reflects the combination of Western medicine treatment characteristics,but also shows the compound treatment advantages of Chinese medicine in multi-link,multi-channel and multi-target.We suggest that the treatment of hypertension,diabetes,coronary heart disease complicated with chronic heart failure with heart failure No.1 prescription is effective,thus it is worth further study.Through this study,we can provide a theoretical and scientific basis for the clinical medication use for the patients with hypertension,diabetes and coronary heart disease complicated with chronic heart failure;hope to provide new ideas and research targets for the treatment of heart failure with traditional Chinese medicine.Thereby the treatment of heart failure with the traditional Chinese medicine can be reached to a new height.Innovation of this studyAt present,there is little research on traditional Chinese medicine on hypertension,diabetes and coronary heart disease complicated with chronic heart failure.In this study,we will evaluate the clinical efficacy and safety of heart failure No.1 prescription in patients with heart failure.So as to verify the scientific basis for the method of warming yang and benefiting qi,promoting blood circulation for removing obstruction and inducing diuresis for removing edema and provide scientific evidence for the clinical treatment of chronic heart failure.The composition characteristics of heart failure No.1 prescription include:on the basis of drugs with the conventional warming yang and inducing dieresis,plus nourishing yin drugs,yin is always with yang,which can significantly improve clinical efficacy;In view of the pathogenesis of static blood blocking collaterals,according to the Chinese medicine theory of Luo disease,plus Guizhi warming,and salvia and peach promoting blood circulation,It can enhance the effect of blood circulation.In this study,we use observational efficacy and comparative study design methods and divide the patients with hypertension,diabetes,coronary heart disease complicated with chronic heart failure outpatient and hospitalized into treatment group and control group in foll consideration of the patients' wishes,and take the appropriate treatment measures.According to the age of the patients,gender,cardiac function classification,the course of the final match into the group,as much as possible to maintain the balance between the baseline groups can be more realistic to reflect the clinical reality,the results have a better scientific and promotional.This study is an innovative application of comparative study of observational efficacy.According to the age,gender,cardiac function classification,the disease course,we match the patients into the final group,as much as possible to maintain the baseline balance between the groups and be more realistic to reflect the clinical reality;the results of the research have a better scientific and promotional effect.This topic is an innovative application of the comparative and observational efficacy study. |
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