Research Of Professor Zhou Zhongying’s Clinical Experience And Thinking Methodon Treating Coronary Heart Disease And Associated Diseases

Objective:To inherit clinical diagnosis and treatment experience and academic thoughts of the professor Zhou Zhongying’s syndrome differentiation in treating coronary heart disease and it combined with hypertension,diabetes,hyperlipidemia,and to analyze similarities and differences in pathogenesis syndrome factor,therapeutic principle and method and making formula and medication for studying professor Zhou Zhongying’s thinking method of syndrome differentiation,based on which,combined clinical experience with learning experience by following the teacher,aiming at completing the TCM syndrome differentiation system,in order to guide clinical practice and improve clinical curative effect.Methods:A total of 615 outpatients of coronary heart disease,317 outpatients of coronary heart disease combined with hypertension,58 outpatients of coronary heart disease combined with diabetes,and 103 outpatients of coronary heart disease combined with hyperlipidemia treated by Professor Zhou Zhongying from February 1983 to December 2014 were collected.Data mining was adopted to dig the pathogenesis and prescriptions in medical cases,and the data mining results was analyzed in combination with detailed text reading relevant works and medical cases to extract the core pathogenesis and basic prescriptions.Meanwhile,clinical thinking methods of professor Zhou Zhongying were analyzed and studied to explore clinical TCM thinking methods commonly used by him and dig creative thinking methods.Results1.Clinical experience(1)Coronary heart diseaseGeneral condition:Among the 615 cases,the number of males was higher than that of females,with 367(59.67%)males and 248(40.33%)females.The core pathogenesis:Qi and Yin deficiency(15.61%),Deficiency of liver and kidney(9.27%),phlegm and blood stasis resistance(6.77%)and poor circulation of heart-nutriment(1 8.21%).The core prescription drugs:radix pseudostellariae(45.20%),radix ophiopogonis(48.62%),salviae miltiorrhiza(74.15%),rhizoma chuanxiong(52.36%),rhizoma pinellinae praeparata(34.80%),trichosanthes kirilowii maxim(26.18%),allium macrostemon(23.41%),hawthorn(17.89%)and radix puerariae(24.55%);when incline to syndrome of Qi and Yin deficiency,adding radix codonopsis(26.34%),rhizome of rehmannia(20.49%),astragalus(26.18%)or anemarrhena(21.14%);when incline to syndrome of dysfunction of spleen and stomach,adding fructus amomi(29.43%),semen aesculi(27.97%)or roasted licorice(25.04%);when incline to syndrome of blood stasis,adding carthamus tinctorius(18.86%)and so on(2)Coronary heart disease with hypertensionGeneral condition:Among the 317 cases,the number of males was higher than that of females,with 182(57.41%)males and 135(42.59%)females.The core pathogenesis:Qi and Yin deficiency(11.99%),kidney deficiency and liver-yang hyperactivity(11.36%),phlegm and blood stasis resistance(3.79%)and poor circulation of heart-nutriment(19.87%).The core prescription drugs:radix pseudostellariae(48.90%),radix ophiopogonis(56.47%),salviae miltiorrhiza(77.29%),rhizoma chuanxiong(58.04%),rhizoma pinellinae praeparata(32.81%),caulis spatholobi(32.12%),allium macrostemon(23.41%),rhizoma wenyujin concisum(29.97%),pueraria lobata(30.91%),gastrodia elata(31.23%),tribulus terrestris(25.55%),parasitic loranthus(26.81%)and hawthorn(25.24%);when incline to syndrome of liver wind agitation,adding Keel(16.09%)or oyster(17.03%)(3)Coronary heart disease with diabetesGeneral condition:Among the 317 cases,the number of females was higher than that of males,with 26(44.83%)males and 32(55.17%)femalesThe core pathogenesis:Qi and Yin deficiency(13.79%),Deficiency of liver and kidney(13.79%),phlegm and blood stasis resistance(8.62%),poor circulation of heart-nutriment(12.07%)and heat blocking collaterals and blood stasis(12.07%)The core prescription drugs:radix pseudostellariae(53.45%),radix ophiopogonis(48.28%),salviae miltiorrhiza(62.07%),rhizoma chuanxiong(44.83%).rhizoma wenyujin concisum(46.55%),herba taxilli(44.83%),ramuli euonymi(34.48%),hawthorn(17.89%),coptis chinensis(39.66%),rhizome of rehmannia(44.83%),dendrobium(18.97%)and rhizoma anemarrhenae(43.10%);when incline to syndrome of dampness-heat in liver and gallbladder,adding rhizoma alismatis(17.67%)and so on.(4)Coronary heart disease with hyperlipidemiaGeneral condition:Among the 103 cases,the number of males was higher than that of females,with 65(63.11%)males and 38(36.89%)females.The core pathogenesis:Qi and Yin deficiency(14.56%),Deficiency of liver and kidney(10.68%),phlegm and blood stasis resistance(8.74%),poor circulation of heart-nutriment(20.39%)and Heart-Yang deficiency(11.65%)The core prescription drugs:radix pseudostellariae(31.07%),radix ophiopogonis(48.62%),salviae miltiorrhiza(64.08%),rhizoma chuanxiong(56.31%),astragalus membranaceus(51.46%),pueraria lobata(42.72%),caulis spatholobi(42.72%),prepared rhizoma pinellinae praeparata(24.27%),rhizoma wenyujin concisum(41.75%),ramulus cinnamomi(33.01%),herba epimedii(31.07%),commonly using rhizoma pinelliae preparata(24.72%)to resolve phlegm.2.Thinking methods of professor Zhou ZhongyingReference to modern medical to explain TCM pathogenesis and make TCM syndrome differentiation which was an sublimation and innovation of traditional Chinese medicine dialectical thinking methods,that is one of the prominent features clinical thinking methods of professor Zhou Zhongying,such as:some cases showed a history of coronary heart disease(CHD)and changed ST segment,but no obvious symptoms of blood stasis,professor Zhou Zhongying suggested that patients with this kind of medical history and changes of ST segmen can be classified into the syndrome of blood stasis,in further thinking,"combining modern detection index with TCM etiology and pathogenesis" was taken as the basic way of TCM clinical thinking methods by professor Zhou Zhongying.The most common thinking methods are summarized as follows:(1)The compound application of thinking methods of traditional Chinese medicine,such as:holistic thinking,dialectical thinking and balance philosophy,paying equal attention to prevention and treatment,integration of body and spirit,concept of perpetual motion and time-phase thinking,etc.(2)The creative thinking of integration of Chinese and western:the eidetic reduction of TCM etiology and pathogenesis,and the transformation of modern detection indicators to TCM etiology and pathogenesis.Conclusions1.Clinical experience(1)Coronary heart diseasePathogenesis characteristics:"Qi deficiency is more severe than Yin deficiency","bloodstasis is more severe than phlegm dampness","stagnant heat is more severe than phlegm heat",the pathogenesis is more inclined to injury Yang and cause accumulation of blood stasis and phlegm,with nature of less hot and more cold.Basic syndromes:Qi and Yin deficiency,phlegm and turbidity resistance,deficiency of liver and kidney and poor circulation of heart-nutriment.Basic treatment methods:benefiting qi and nourishing Yin,tonifying liver and kidney,eliminating phlegm and removing blood stasis,smoothing chest and clearing qi and eliminating obstruction.Basic prescriptions:It is characterized by compound prescriptions,and radix pseudostellariae,radix ophiopogonis,salviae miltiorrhiza,rhizoma chuanxiong,rhizoma pinellinae praeparata,trichosanthes kirilowii maxim,allium macrostemon,hawthorn and radix puerariae were the most commonly used drugs.(2)Coronary heart disease with hypertensionPathogenesis characteristics:"Simultaneous deficiency of Qi and Yin","Simultaneous stagnation of blood stasis and phlegm-dampness",and "Simultaneous accumulation of phlegm heat and stagnant heat",compared with pure coronary heart disease,it is characterized by kidney deficiency and liver-yang hyperactivity,occurrence of deficiency wind in the interior,upper excess and lower deficiency,with nature of heat easily transformed from yang,more heat and less cold.Basic syndromes:Qi and Yin deficiency,phlegm and blood stasis resistance,kidney deficiency and liver-yang hyperactivity,occurrence of endogenous wind and poor circulation of heart-nutriment.Basic treatment methods:Compared with pure coronary heart disease,methods of calming liver wind,nourishing the liver and clearing liver-fire were adopted more often.Basic prescriptions:Radix pseudostellariae,radix ophiopogonis,salviae miltiorrhiza,rhizoma chuanxiong,rhizoma pinellinae praeparata,caulis spatholobi,allium macrostemon,rhizoma wenyujin concisum,pueraria lobata,gastrodia elata,tribulus terrestris,parasitic loranthus and hawthorn were the most commonly used drugs.Compared with pure coronary heart disease,drugs with the function of nourishing kidney yin,calming liver wind,nourishing the liver and clearing liver-fire were often used.(3)Coronary heart disease with diabetesPathogenesis characteristics:"Simultaneous deficiency of Qi and Yin","phlegm dampness is more severe than blood stasis","phlegm heat is more severe than stagnant heat",compared with pure coronary heart disease,it is characterized by Yin deficiency-stagnant heat-dampness heat,deficiency of spleen and stomach.Basic syndromes:Qi and Yin deficiency,phlegm and blood stasis resistance,deficiency of liver and kidney,poor circulation of heart-nutriment and heat blocking collaterals and blood stasis.Qi and Yin deficiency syndrome is more obvious,so "Three kinds of heat syndrome(including dryness-heat,stasis-heat,damp-heat)" was common in CHD combined with diabetes.Basic treatment methods:Compared with pure coronary heart disease,nourishing Yin and moistening dryness,clear heat and transform dampness and cool blood to eliminate stasis were adopted more often.Basic prescriptions:adix pseudostellariae,radix ophiopogonis,salviae miltiorrhiza,rhizoma chuanxiong,rhizoma wenyujin concisum,herba taxilli,ramuli euonymi,hawthorn,coptis chinensis,rhizome of rehmannia,dendrobium and rhizoma anemarrhenae were the most commonly used drugs.Compared with pure coronary heart disease,drugs with the function of reinforcing Qi and nourishing Yin,clearing heat and dampness and nourishing Yin and moistening dryness were usually used.(4)Coronary heart disease with hyperlipidemiaPathogenesis characteristics:"Qi deficiency is more severe than Yin deficiency","Simultaneous stagnation of blood stasis and phlegm-dampness","phlegm heat is more severe than stagnant heat",compared with pure coronary heart disease,it is characterized by more serious deficiency Qi and blood stasis,and qi deficiency,disharmony of nutritive qi and defensive Qi,deficiency of of liver-yin and kidney-yin mixed up with phlegm and blood stasis,and deficiency of the foundation of acquired constitution were the clinical features.Basic syndromes:Qi and Yin deficiency,deficiency of liver and kidney,phlegm and blood stasis resistance and poor circulation of heart-nutriment.Compared with pure coronary heart disease,syndrome of disharmony of nutritive qi and defensive qi,qi deficiency and blood stasis and Heart-Yang deficiency were more commonly seen.Basic treatment methods:Compared with pure coronary heart disease,methods including invigorating the spleen,harmonizing nutritive qi and defensive qi and enriching qi and promoting blood circulation to remove meridian obstruction were more commonly used.Basic prescriptions:radix pseudostellariae,radix ophiopogonis,salviae miltiorrhiza,rhizoma chuanxiong,astragalus membranaceus,pueraria lobata,caulis spatholobi,prepared rhizoma pinellinae praeparata,rhizoma wenyujin concisum,ramulus cinnamomi and herba epimedii were the most commonly used drugs.Compared with pure coronary heart disease,drugs with the function of benefiting qi and activating yang,strengthening the spleen and stomach were usually used.2.Clinical Thinking methods(1)The thinking methods of traditional Chinese medicine:it was characterized by the composite application of multiple thinking methods based on "syndrome differentiation of pathogenesis".(2)The creative thinking of integration of Chinese and western:Combination of the non-logical thinking of traditional Chinese medicine with the logical thinking of western medicine has formed two kinds of thinking methods,including "the eidetic reduction of TCM etiology and pathogenesis",and "the transformation of modern detection indicators to TCM etiology and pathogenesis".