Study On TCM Syndrome And Medication Rules Of Chronic Coronary Syndrome Combined With Insomni

The relatively stable characteristic of chronic coronary syndrome is based on good management of the chronic disease.Insomnia,as a factor that affects cardiovascular events,is commonly found in patients with chronic coronary syndrome.The comorbidity of the two is a typical cardio-psychologic disease,and it is also where traditional Chinese medicine has advantage.Symptom-syndrome-formula is the unique thinking of traditional Chinese medicine in understanding diseases,and it is also the foundation of traditional Chinese medicine treatment.However,it is lack of relevant traditional Chinese medicine research on chronic coronary syndrome comorbid with insomnia.Therefore,this study attempts to explore this cardio-psychologic disease from the perspective of diagnosis,treatment.Objective1.To investigate and analyze the sleep quality and its risk factors of patients diagnosed with chronic coronary syndrome comorbid with insomnia disorder,and study the patterns of TCM syndromes,thus providing a basis for the prevention and TCM diagnosis and treatment of this disease.2.To explore the rules and ideas of traditional Chinese medicine prescriptions for treating Chest Impediment comorbid with Inability to Sleep,as in Xiongbi comorbid with Bumei,through the TCM inheritance assistance platform,and provide reference for clinical medication.MethodsStudy 1:Patients diagnosed with chronic coronary syndrome(CCS)comorbid with insomnia disorder(ID)who were treated at the cardiovascular outpatient and ward departments of Dongfang Hospital and the Third Affiliated Hospital of Beijing University of Chinese Medicine from March 2022 to December 2022 were included.The "Chronic Coronary Syndrome Comorbid with Insomnia Disorder Survey Questionnaire" was used to survey the included patients,collect general information,Canadian Cardiovascular Society Classification(CCSC),Pittsburgh Sleep Quality Index(PSQI),Patient Health Questionnaire-9(PHQ-9),Generalized Anxiety Disorder-7(GAD-7),and TCM syndrome information.Analyze the general conditions of patients diagnosed with CCS comorbid with ID,and explore the influencing factors related to sleep quality.TCM symptoms were subjected to factor analysis and cluster analysis,and combined with expert opinions to obtain the patterns of TCM syndromes in patients diagnosed with CCS comorbid with ID.Study 2:By using the TCM inheritance assistance platform,the medication rules of traditional Chinese medicine prescriptions for treating Chest Impediment comorbid with Inability to Sleep published were analyzed.The frequency of drugs included in the literature,the statistical analysis of the properties and channels of drugs,correlation analysis,complex system entropy clustering,and entropy hierarchical clustering analysis were conducted to explore commonly used drugs,drug pairs,core drug combinations,and possible new prescriptions for the clinical TCM treatment of Chest Impediment comorbid with Inability to Sleep.Results1.Clinical epidemiological research:Among the 220 patients diagnosed with CCS comorbid with ID,there were 117 males with a mean age of 64.05 ± 12.47 years and 103 females with a mean age of 72.61 ± 12.01 years;51.8%of patients had no exercise habits,while 39.5%and 35%of patients smoked and drank alcohol,respectively;Among the 86 diabetic patients,the blood glucose control rate was only 32.6%;Among the 220 patients,73 patients had undergone blood vessel reconstruction for more than one year,50 patients had stable coronary heart disease,46 patients had microvascular disease or coronary spasm,35 patients had undergone blood vessel reconstruction for less than one year and had stable symptoms,and there were the fewest number of patients with ischemic cardiomyopathy and hidden coronary heart disease,with 14 and 2 patients,respectively;101 of the 220 patients had a PSQI score of≤7,and 54.1%of patients had a PSQI score of>7;61.5%of patients used sedative-hypnotic drugs,and benzodiazepines accounted for the highest proportion among sedative-hypnotic drug users.The type of chronic coronary syndrome is not related to the degree of sleep quality;there is a weak correlation between the number of diseased coronary artery and sleep quality;there is a moderately strong correlation between CCSC and sleep quality;there is a weak correlation between the course of chronic coronary syndrome and the course of insomnia;age,number of diseased coronary artery,and anxiety status are risk factors for decreased sleep quality in patients with chronic coronary syndrome and insomnia.2.Traditional Chinese Medicine Syndrome Study:In this study,a total of 112 traditional Chinese medicine symptoms were collected,and the high-frequency TCM symptoms in 220 patients diagnosed with CCS comorbid with ID including difficult to fall asleep,tongue ecchymosis,chest tightness and pain,palpitations,dry throat,restlessness,yellow tongue coating,dizziness,red tongue,wiry pulse,chest stabbing pain,abdominal distension,and shallow sleep with easy waking.Cluster analysis resulted in four TCM syndromes:liver depression with blazing fire and phlegm-heat stagnating gallbladder,qi deficiency with dampness and spleen-kidney deficiency,heart and liver yin deficiency with excessive fire,and qi stagnation with blood stasis.Factor analysis combined with cluster analysis resulted in four TCM syndromes:heart-kidney yang deficiency with water stasis and blood stasis,yin deficiency with internal heat,liver depression with excessive fire,and gallbladder heat with phlegm disturbance.2.Study on Medication Rules:This study included 236 prescriptions with a total of 233 traditional Chinese medicine ingredients,in which sweet,bitter,and pungent flavors were used more frequently,and the main meridians targeted were heart,liver,spleen,and lung.The highfrequency medication for treating Chest Impediment comorbid with Inability to Sleep was determined by adjusting the correlation:Salvia miltiorrhiza,Ligusticum chuanxiong,sour jujube seed,licorice,and astragalus.Eight core drug pairs were obtained from the correlation analysis:Allium sativum→Psidium guajava,Yujin→Danshen,Red peony→ Danshen,Chuanxiong,Sour date palm→Danshen,Huangqi→Danshen,Psidium guajava→ Danshen,Chuanxiong→Danshen,Chaihu→Danshen.The association analysis generated 35 pairs of drugs that were roughly the same as those in Xiaochaihu Decoction,Suanzaoren Decoction,and Gualouxiebaibanxia Decoction.Using the new prescription analysis function,36 pairs of core drugs were identified,and their effects were roughly categorized as resolving phlegm,calming the mind,promoting blood circulation and opening collaterals,clearing heat and promoting diuresis,regulating qi and resolving food stagnation,nourishing qi and blood,and nourishing yin and clearing heat.After recombining and trimming the 36 pairs of drugs,18 new prescriptions were obtained.Conclusion1.In this study,male patients diagnosed with CCS comorbid with ID accounted for the majority,and the onset age was earlier than females.Healthy lifestyles need advocating.The blood glucose control rate of diabetic patients was low,and clinical education needs to be strengthened.Benzodiazepines were still the main hypnotic drugs used,and it is expected to choose hypnotic drugs that can benefit patients more under the premise of strict mastery of contraindications and indications.2.In our study of CCS comorbid with ID,patients with coronary revascularization>1 year were the main group,and it is expected that such patients will form a good concept of chronic disease management to control its risks.Age,number of diseased coronary artery and anxiety status were risk factors for decreased sleep quality in patients diagnosed with CCS comorbid with ID.3.This study combined the results of cluster analysis,factor analysis and cluster analysis with expert opinions to finally determine the possible TCM patterns of CCS comorbid with ID as Qi stagnation and blood stasis pattern,heart and liver Yin deficiency with fire flourishing pattern,liver depression and fire excess combined with phlegm-heat obstructing the gallbladder pattern,and heart and kidney Yang deficiency combined with stasis and water retention pattern.4.The effects of TCM medication for treating Chest Impediment comorbid with Inability to Sleep are mainly regulating qi,nourishing qi,promoting blood circulation,nourishing yin and clearing heat.Salvia miltiorrhiza is most frequently used in this disease and has wide therapeutic effects.Xiaochaihu Decoction,Suanzaoren Decoction,and Gualouxiebaibanxia Decoction are the common formulas for this disease.