An Introduction Of The Experience in Treating Ventricular Premature Beat With Stasis Heat
Mar 15, 2022
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Highlights
Ventricular premature beat, the common arrhythmia disease in clinics, not only greatly decreases the quality of life but also has the danger of death. The teacher, Li Yuan, with decades of clinical experience, considered that the important pathogenesis of the VP beat, that is “heat transformed from Yang”, should not be ignored, which is on the influence of diverse factors and can be observed in different symptoms and different treatment states of the disease.
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Abstract
Ventricular premature beat, a kind of arrhythmia. is one of the common diseases which not only decreases the quality of life but also has the danger of death. The pathogenesis in Traditional Chinese Medicine is that the injury of the heart and kidney is the essence and the block of solid evil such as phlegm and blood stasis is the manifestation. The teacher, Li Yuan, has worked in a clinic for decades and considered that the important pathogenesis of the VP beat is "heat transformed from Yang", which cannot be ignored as it is on the influence of diverse factors and can be observed in different symptoms and different treatment states of the disease.
Keywords: Traditional Chinese Medicine, Ventricular premature Beat, Stagnated Heat, The introduction of experience
Xiao-Ming Jin, Qian Cui, Yu-Hui Ma, Jing Gao, Yuan Li
1 College of Chinese Medicine, Hebei University, Baoding, Hebei province, China.
Background
Ventricular premature beat(VP)known as VPcontraction, is a ventricular activation produced by heterotopic pacemaker points below auriculo-ventricular bundle branch and a common kind of arrhythmia in the clinic. It can be classified into two types of diseases. One is Accidental VP Beat, which can be seen in normal healthy people and has no organic disease of the heart, it is asymptomatic and no some discomfort like slight palpitation can happen as well. The other is Frequent VP Beat, which can be seen in heart disease(such as CAD, myocarditis, and so on), it has a serious symptom, and patients may suffer from palpitation or feel being thumped which is so grievous that patients may swoon. There is no specific medicine for it now. Generally, western medicine is often symptomatic treatment, but in later periods patients are often overstrained and have the risk of sudden death. Traditional Chinese medicine includes the disease into the categories of"palpitations", "severe palpitations" and "syncope".Traditional Chinese medicine, crystallization of wisdom in the fight against the disease has a well-established and standing history. And with two thousand years of experience, it has a unique superiority on VP treatment.
Li Yuan, an associate professor from Hebei University, studies with famous doctors like Xiao Xiaohe. He has a deep study on the treatment of cardiovascular disease with traditional Chinese medicine. He puts forward the idea that is VP beat passive hyperemia must obey the thought which is"heat transformed from Yang". What is more, with the modern pharmacology research of traditional Chinese medicine, he proposed the experience prescription named cool blood circulation and blood stasis drink, the curative effect of which is accurate for it has cured a great number of people. Now we will introduce his academic thought in combination with the previous understanding as follows.
Mechanism analysis
The symptoms of VP beat were first recorded in The Yellow Emperor's Canon ofIntemal Medicine saving that "heart drum", "heart suspended if hunger and thirst", "heart eaves moving", The ancient doctors had a different understanding of the pathogenesis of VP beat, which was mainly embodied in two aspects; deficiency syndrome and excess syndrome. As for deficiency syndrome, Sun Simiao proposed that Yang deficiency causes palpitations, Cheng Wuji thought that qi deficiency causes a disease, Zhang Jiebin thought that Yin deficiency and the ancient doctors always took phlegm and retained fluid as a breakthrough point. Therefore, it is proposed in syndrome and treatment criteria saying that "the cause of palpitations is not more than two kinds, one is deficiency and the other is retained fluid". Modern doctors think the disease is intermingled deficiency and excess. In clinical, it is common to see qi deficiency, Yang deficiency, Yin deficiency, phlegm, retained fluid, and so on. Chen keji et al. considered blood stasis is an important pathogenic factor of this disease. The thought provides a new idea for the treatment of premature ventricular contractions, which has been accepted by many doctors [1-3].
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VP beats are often caused by qi deficiency and the inability of promoting blood circulation. The qi of the heart regulates the heartbeat and the relaxation of blood vessels and promotes the blood circulation in the vessels to make blood flow throughout the body. When the heart is too weak to keep blood circulation normally, the blood flows slowly and the metabolites in the blood are hard to be removed from our body, which will lead to the tendency of blood stasis heat." Classic of Questioning" says that "qi is responsible for promoting, blood is responsible for nurturing body". Without the regular operation of the qi and blood, the heart cannot maintain the heart force, the heart rhythm, and the heart rate foundation, the gi, and blood run difficultly, and the heart function is out of control. Or some patients are the type of hyperactivity of fire due to vin, which can result in blood stasis transforming into heat. Premature beats are abnormal heartbeats, and they can be reflected by the pulse, so the pulse sign is the key to the diagnosis of the premature ventricular beat in Chinese medicine. Wei Zhizhen [4 believes that the pulse of the patients with basic rapid heart rate is thready and hasty, which means exuberant yang and excessive heat and indicates that the patient has heat-transmission based on blood stasis. The pulse of patients with slow basic heart rate are mostly thread and knotted, which is because of qi stagnation and blood stasis, and in a long term, the blood stasis may transform into heat. At this time, if the patient has hyperactivity of fire due to yin, heart fire hyperactivity, or exogenous wind-heat, etc., the situations mentioned above will accelerate different degrees of heat-transmission then disturb the mind and cause VP beat.
Introduction to the experiential effective recipe With years of clinical medication experience, Li Yuan created the special prescription on the basis of the characteristic of the disease which is a mixture of asthenia and sthenia. The composition of prescription is; ChiShao (Paeoniae radix rubra)15g, MuDanPi(Moutan cortex)15g, Huang Lian (Coptidis rhizoma) 10g, DanShen (Salvia miltiorrhiza Bga) 30g, YuanHu (Corvdalis rhizoma)10g, ChuanXiong(Chuamxiong rhizoma)10g, HuangQi(Astragali radix)30g, GeGen (Puerariae lobate radix) 30g, CiWuJia(Acanthopanax senticosus)30g, ZhiHuangJin(Polygonati rhizoma)15g, SangJiSheng (Taxilli herba)15g, ginseng(Nardostachys jatamansi)10g, and QingHao (Artemisia annual herba)10g.
The evidence for addition and subtraction: Ku Shen (Sophorae flavescent radix) is added for patients with tachycardia; ChenPi(Citrus reticulate Blanco ). Fuzhou (Citri sarcodacrylis Fructus), XiangYuan(Citri Fructus), and LaiFuZi(Raphanmi semen) are added for patients with dyspepsia; SuanZaoRen (Ziziphi spinosad semen), ShouWuTeng(Polyomi multiflora caulis) are added for patients with insomniac and vexation; YiMuCao (Leonuri herba), WuJiaPi(Acanthopanacis cortex), DongGuaPi (Benincasa exocarpium), and XiaKuCao (Prunella spica) are added for patients with retained fluid.
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The features of the experiential effective recipe
Cool blood first and remove blood stasis later
The MuDanPi in the recipe is acrid, bitter, and slightly cold. It can clarify heat and cool blood, promote blood circulation by removing blood stasis. It is medicine but has two usages. ChiShao, bitter and cold, can clarify blood stasis and heat. Combined with HuangLian( which is bitter and slightly cold, belongs to the heart channel, purges fire, and coordinates intestines and stomach), it can not only enhance the strength of heat clarifying but also prevent diarrhea from the coldness of MuDanPi and ChiShao. Three drugs used together can hit the mark of the disease. DanShen, bitter and slightly cold, is the key to removing blood stasis. Chuanxiong and YuanHu harmonize qi and blood, disperse for acridity and warmth and flow rapidly. They can not only help DanShen promote blood circulation, but also prevent the stomach from being nourished with Huanging. The combination of the three drugs eliminates the pathologic basis of blood heat. Because of the removal of blood stasis and heat, the disease will be in stable condition.
Replenish qi and yin, treating the root cause of disease and tonifying deficiency
The HuangQi, sweet and warm, focus on replenishing qi and blood to promote blood circulation. CiWuia, which belongs to the heart, spleen, and kidney channel, can not only replenish the heart and spleen, calm the mind, but also warm up the kidney and Yang. The nature of Parasitic Loranthus is neutral, which can enrich the vang of the kidney to balance vintage. ZhiHuangJing nourishes qi and Yin, and it is widely used to treat coronary heart disease with arrhythmia in clinical. GanSong can enliven the spleen and strengthen the stomach, which can not only nourish the heart by the qi and blood as the spleen governs transportation and transformation, but also protect the spleen and stomach from being harmed by vast cold drugs. Qinghao clears deficient heat and avoids heat transmission and fire invigoration for lack of kidney-yin. Gegen helping produce saliva and slack thirst is used for yin deficient with diabetes. All drugs are used together to improve the symptoms of heart-qi deficiency and kidney deficiency, so as to achieve the objective of treating both principal and secondary aspects of the disease.
Combinate with pharmacology through the ancient and modern time
Combining the study of modern pharmacology with the use of drugs effect in ancient times, this prescription has an unexpected effect, and all of its drugs have the effect of improving arrhythmia [5-7]. Puerarin, for example, can reduce the arrhythmia caused by pituitrin [8]. Berberine can prolong the hyperpolarization refractory period of atrial cells [9]. Artemisinin can inhibit 1kr, Iks, and lkl, and has a definite effect on anti-arrhythmia [10]. GanSong can inhibit Na+ inflow and promote K outflow of myocardial cells to prolong action potential [11]. These studies are not only a powerful verification of the curative effect of this prescription, but also provide a new idea for clinical treatment for this disease.
Therapeutic ideas
Early intervention for preventing aggravation
In clinical, some middle-young aged people are suffering from accidental VP beat. Western medicine believes that accidental VP beat has no organic disease and no harmful impact on health, so it is called benign VP beat. If patients have no symptoms, we don't need to bother them. If palpitation occurs, antiarrhythmics can be used for a short-term treatment [12]. The patients mostly suffered from irregular sleep schedules or some bad habits like smoking and drinking, which make people dissipate a lot of heart qi, so they will have some symptoms like laziness, shortness of breath, and chest stuffiness with pale tongue, glossy coating, and weak left inch pulse. What's more, a few patients are even accompanied by kidney deficiency. If no intervention is adopted, it might tum into Frequent VP Beat. Therefore, patients are often treated with drugs that can nourish the qi of the heart such as HuangQi, ZhiGanCao(Ghcyrhizae radix et rhizoma), RenShen (Ginseng), et al.
Cooling blood, dissolving stasis, and symptomatic treatment in acute condition
Teacher Li thinks that heat and fire can fry blood, which makes the blood too sticky to move on. It cannot be unlocked by a single drug for activating blood circulation to dissipate blood stasis. Only by cooling blood and dissolving stasis can we stabilize the condition quickly. In the acute stage of the disease, the selection of drugs should give priority to being cold and cool. Excessive use of warming drugs is likely to aggravate the fire and delay the disease. The choice of the drug for clearing heat and cooling blood should give priority to MuDanPi and ChiShao, and we can add HuangLian to enhance the strength of clearing heat. Among the drugs promoting blood circulation and dissolving stasis, DanShen and ChuanXiong have the best power that can quickly dredge blood veins and make blood smooth.
Tonifying kidney and strengthening Jing, strengthening healthy qi, and eliminating pathogens
The aged, as a common group suffering from the disease, always have organic heart disease with significant symptoms. Because the function of every viscera has declined, it is not common to see an elderly patient with a single syndrome in the clinical, they are always accompanied by deficiency of the yin-yang of the kidney. The kidney is the origin of Yin and Yang, and there is mutual use between the vin-yang of the kidney and the viscera. Plain Questions says that when the women are forty-nine years old and the men are fifty-six years old, their"Niangua" is exhausted. That is to say, the kidney essence of the old is exhausted, kidney yang is too weak to promote kidney yin to help heart yin restrict the fire in the heart. So, when the fire of the heart is strong and the blood will be fried becoming invisible phlegm which can cause heat. Therefore, most elderly patients have some symptoms of kidney yin and yang deficiency, such as lumbar and knee weakness, dizziness, tinnitus or long urine, lower limb edema. The treatment on the blood cooling and activating just can stabilize the condition but cannot cure the disease at all, so it is necessary to tonify the kidney to help the Yin-Yang of the whole body. What's more, the blood cold medicine is often bitter and cold, which is afraid that the medicine can get the healthy qi injured, so we should clear the heat, cool the blood, dissolve stasis, tonify qi, and nourish Jing together that is treating both principal and secondary aspect of the disease.
Focus on daily life and prevent relapse
Patients should keep good daily routines and living habits, and avoid excessive tiredness. Their diet should be light and quit smoking and alcohol to avoid heat dissipation. And they should keep a good mood as well. Zhu Guangli thinks that there is a close relationship between premature ventricular contraction and liver depression in young people [13]. The heart controls mental activities, the unhealthy emotion must impact the function of the myocardium. Addition, In addition, elderly patients often suffer from a deficiency of vital energy, so the prevention of colds should be strengthened, whatever an emo frigid cold or antipyretic cold can come into deeper and transform into heat, which can make the disease get worse, so It is advisable to treat exogenous cold first.
Typical examples
Sun Mou, a 70-year-old man, visited the doctor on September 15, 2017. Chief complaint: had been flustered uninterruptedly for more than 2 years and aggravated for 4 days. History of present illness: Coronary heart disease for 5 years, in 2013, he suffered panic and discomfort due to cold after running, since then the symptom uninterrupted attacked which mostly caused by cold or cold. The 24h dynamic electrocardiogram showed that sinus rhythm(50-121 beats /min, average heart rate 65 beats /min) was completely blocked by the right bundle branch, and premature ventricular beats were 5458 beats /24h. There was no significant improvement in Oral bisoprolol. Some visible symptoms as below: chest tightness and shortness of breath, insomnia and head distension, soreness and weakness of waist and knees, dry pharynx, well urine, and stool. Tongue dark red moss yellow greasy, intermittent, hasty but weak pulse.
Dialectic: deficiency of heart and kidney, blood stasis transforming into heat, with phlegm and drink, all of them can be treated with improving qi and Yin, cooling blood, and dissolving stasis.
Prescription: liangXueTongYu decoction added in XiaKuCao 10g and TianHuaFen(Trichosamthis radix)20g, the total course of treatment is 7 days, the decoction is taken once a day with water.
On September 23, 2017, the patient returned to the clinic and reported that his symptoms of palpitation were reduced after taking the drug, but sometimes they still broke out. The shortness of breath and his pharynx were improved. His pulse didn't change much. The prescription added ZhenZhuMu(Margaritifera concha)30g, YuanZhi (Polygalae radix)9g, and removed TianHuaFen, seven pairs of medicine, and water frying. After taking the drug, the patient felt that the flustered feeling was gone and his insomnia symptoms were improved, The results of the dynamic electrocardiogram showed that the sinus rhythm(46-135 times /min, and the average heart rate was 80 times /min) was incomplete and the right bundle branch blocked, and the VP beats were 2 times /24d, and the patient continued taking 14 pairs of medicine. Until now, the symptoms don't recur.
Conclusion
The incidence of premature ventricular contractions in China has been increasing in recent years, and the group of people suffering from premature ventricular contractions is becoming younger, which is closely related to pressure comes from society and life. As for this disease, the prevention treatment of disease must be taken, and the optimistic life attitude and healthy living habits are effective ways to prevent the disease. In view of the mixture of deficiency and excess, the treatment should be distinguished between primary and secondary. In the acute phase, the treatments like clearing heat, cooling blood, and dissolving stasis are mainly used, while in the remission phase, the treatments like nourishing qi and yin are mainly used, and we can't put the cart before the horse. Traditional Chinese medicine (TCM) is extensive and profound, with a long history. It has been used for over 2,000 years to treat palpitations, and the curative effect is remarkable. Meanwhile, the modern pharmacological effect of TCM cannot be ignored. We should attach equal importance to inheritance and innovation. Only in this way can the cause of traditional Chinese medicine achieve considerable development.
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