Overview Of Treatment Of Vascular Dementia With Warming Yang Method

Vascular dementia (VaD) is a cerebrovascular disease that frequently occurs in middle-aged and elderly people, with learning and memory dysfunction as the main clinical manifestations, including ischemic cerebrovascular disease, hemorrhagic cerebrovascular disease, and dementia caused by acute or chronic hypoxic cerebrovascular disease. According to relevant data, the prevalence of VaD in China is 1.1% to 3.0%, seriously affecting the quality of life of patients. With the advent of the global aging era, the incidence rate of VaD is on the rise. On the one hand, preventing VaD can improve the quality of life of the elderly, reduce the burden on families and society, and on the other hand, it can achieve the "healthy aging" proposed by the World Health Organization. VaD belongs to the category of "dementia" in traditional Chinese medicine, and its occurrence is mainly related to factors such as phlegm, blood stasis, turbidity, toxicity, and deficiency. Clinical treatment is mostly based on the methods of enriching essence and intelligence, tonifying qi and blood, promoting blood circulation and resolving stasis, resolving phlegm, and opening the orifices. In recent years, with the rise of the Fuyang academic school in the academic field of traditional Chinese medicine, certain achievements have been achieved in the treatment of VaD using the warming yang method. The following is a summary.

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TCM treatment

VaD is located in the brain and rooted in the five internal organs. The disease is characterized by deficiency and excess in origin and is more common in elderly patients. Its deficiency is mainly due to the deficiency of yang and qi. Therefore, clinical prescription selection and medication should be based on warming yang legislation, supplemented by methods such as filling essence and marrow, tonifying qi and blood, promoting blood circulation and resolving stasis, and purging fire and expelling phlegm according to different syndromes, which can achieve satisfactory results. Rosa et al. [9] believe that modern people are mostly characterized by yang deficiency due to factors such as lifestyle, so VaD is mainly characterized by yang deficiency, providing new ideas and methods for the treatment and differentiation of symptoms and signs of VaD. Zhang Ruijie (10) believes that warming yang and resolving phlegm is the key to the treatment of VaD. He randomly divided 60 patients with VaD into two groups. The control group took nimodipine tablets, 40 mg each time, three times a day; The treatment group took Wenyang Huatan Decoction (dried ginger, Morinda Officinalis, osmanthus cassia "Branches, prepared Spinelli ternata, Acorus calamus, Poria cocos (15g each), processed aconite (decocted first) 12g, tangerine peel, prepared nan xing, ginseng 12g each, and roasted licorice 6g each), with a 2-month treatment period. After 6 months of treatment, ADL scores, MMSE scores, and the total effective rate of the two groups were compared."The results showed that after treatment, the ALD score in the treatment group decreased significantly compared with that before treatment and after treatment in the control group (P<0.05), while the MMSE score increased compared with that before treatment and after treatment in the control group (P<0.01). The total effective rate in the treatment group was significantly better than that in the control group (P<0.05), indicating that Wenyang Huatan Decoction can effectively improve the daily living ability of patients, improve their cognitive function, and improve their quality of life. Wang Qizhi et al. [11] believe that the formation of VaD is mainly related to the weakness of the lung function, which leads to insufficient intake of clear qi in the human body, resulting in passive gasification of the body, inability to replenish the brain due to qi deficiency, accumulation of turbid qi in the body, interaction of turbid qi and blood as blood stasis, and turbid qi ascending with blood in the brain and stagnation of the brain meridians. They also use the "Wenfei Jiangzhuo Tang Tang Tang Tang Tang Decoction", which was prepared by Professor Tang Nong of the Fuyang School and consists of prepared aconite (decocted first) 30g, ginseng 15g, roasted licorice, dried ginger, wine rhubarb Tian Sanqi (10g each) is used to treat patients with VaD, supporting the body's yang qi, and eliminating phlegm, dampness, and cold. Results: There were 16 cases with significant effect, 12 cases with effective effect, and 2 cases with ineffective effect. The clinical efficacy was 93.3%, indicating that Wenfei Jiangzhuo Decoction can achieve certain efficacy in the treatment of VaD. Tang Nong et al. [12] believe that the etiology and pathogenesis of VaD are mainly qi stagnation, phlegm turbidity, and blood stasis, and their formation is rooted in the deficiency of yang in the five zang organs. Based on this understanding, 44 patients with atherosclerotic VaD were treated with a self-developed Wuzang Wenyang Huayu Decoction (30g monkshood, 15g epimedium, ginger, morinda officinalis, cassia twig, Spinelli ternata, notoginseng, Acorus tatarinowii, ginseng, and 6g rhubarb), with a total effective rate of 86.36%. This treatment can significantly improve the patient's daily living behavior ability and neurological function defects.

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Integrated Traditional Chinese and Western Medicine Treatment

The treatment of VaD with Wenyang Prescription combined with Western medicine can often play their respective advantages and achieve complementary effects, thereby improving clinical effectiveness. Lv Lifeng et al. [13] divided elderly patients with VaD (yang deficiency type) into two groups. The control group was given basic treatment and orally administered butylphthalide capsules. The research group was given Wenpi Tongluo Kaiqiao Decoction (30g astragalus root, 10g each of Yizhiren, Sanqi, Shichangpu, Polygonum multiflorum, Gynostemma pentaphyllum, Prepared aconite, Eucommia ulmoides, 6g cinnamon, 15g cistanche deserticola) on the basis of the control group. After three consecutive courses of treatment, the simplified mental state examination scales MMSE, HDS, and MoCA were used BI scores were used to evaluate patients' cognitive function and activities of daily living, compare various clinical observation indicators, and record the occurrence of adverse reactions. The results showed that the clinical symptoms in the study group were significantly improved compared to the previous one, and were superior to the control group (P<0.05). The incidence of adverse reactions in the study group was lower than that in the control group. This indicates that this prescription combined with butylphthalide can effectively improve the cognitive function and daily living ability of elderly patients with VaD (yang deficiency type). Zhuang He et al. [14] studied the improvement of cognitive function and daily living ability of VaD patients with integrated traditional Chinese and Western medicine. They divided VaD patients into two groups. The control group was treated with Liuwei Dihuang Decoction alone (30g bovine spinal cord, 20g tortoiseshell, 12g Poria cocos, and ginseng each, 12g yam, rhizoma polygonal, and Acorus tatarinowii each, 6g alisma orientalis, 9g peony bark, 10g gastrodia elata, Fructus oxyphylli, and cistanche deserticola ma, 5g aconite, and 3g cassia twig each), The combination group was given buflomedil orally on the basis of the control group for 2 months. MMSE and BI scores were used in the first and second months of treatment, respectively. The results showed that the MMSE and BI scores of the treatment group at two-time nodes were higher than those of the control group (P. Huang Xunfu et al. [15] treated the disease with integrated traditional Chinese and Western medicine, while the control group was treated with conventional western medicine. The observation group was treated with modified Dihuang Yinzi Decoction on this basis. The course of treatment was 3 months, and the scores of ADL and HDS were compared.

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The results showed that the total effective rate of behavioral ability in the observation group after treatment was significantly higher than that in the control group(P＜0.05). After treatment, the ADL score in the observation group was higher than that before treatment and in the control group(P＜0.05), and the HDS score was significantly lower than that before treatment and in the control group(P＜0.05). Therefore, it is believed that integrated traditional Chinese and Western medicine treatment can significantly improve the cognitive ability and daily living ability of Va patients, which is worthy of clinical promotion.

Mechanism of action

1) A prescription for warming yang.

In recent years, basic research has found that Sini Decoction, Shenfu Injection, Dipsacus, Epimedium, Cistanche deserticola, and other yang warming formulas have significant neuroprotective effects. The neuroprotective effect of Cistanche deserticola has been confirmed, and its protective mechanism is closely related to improving the ability to scavenge oxygen free radicals, enhancing GSH-Px activity, reducing NOS synthesis, and enhancing antioxidant capacity. Some studies have confirmed that Cistanche deserticola has a protective effect on hippocampal neurons injured by cerebral ischemia, and its mechanism is closely related to scavenging oxygen free radicals, anti-neuronal apoptosis, and stabilizing intracellular calcium ions. Zhu Dan et al. [17] obtained through a Morris water maze behavioral test that intraperitoneal injection of 4 ml/(kg · d) Cistanche deserticola can increase the number of times VaD rats cross the platform and improve their learning and memory abilities.

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2) Chinese herbal medicine for warming yang.

Chinese herbs such as Dipsacus, Epimedium, and Cistanche deserticola and their extracts have a certain protective effect on neurons. Some studies have confirmed that the mechanism of vascular damage caused by VaD is mainly related to the production of a large amount of oxygen-free radicals after cerebral ischemia and hypoxia, thereby damaging nerve cells in the brain, while the Bcl-2 gene has the effect of inhibiting cell apoptosis. Hong Ru et al. [18] found in discussing the protective effects of Dipsacus extract on learning and memory abilities and hippocampal neurons in VaD rats that Dipsacus extract can increase the expression of the Bcl-2 gene, enhance the ability to scavenge oxygen free radicals, improve the body's antioxidant ability, and anti-apoptosis ability. It has a certain protective effect on neurons in cerebral ischemia and hypoxia rats, thereby improving the learning and memory abilities of VaD rats. Xu Ruixia et al. [19] confirmed in their experimental study on the protective effect of Cistanche deserticola on learning and memory in rats that its neuroprotective effect is related to its ability to increase SOD activity, increase the expression of ChAT and AChE, reduce MDA content, and inhibit the production of lipid peroxides in neurons. Yang Bo et al. [20] studied the efficacy of total glycosides of Cistanche deserticola in the treatment of VaD patients with mild to moderate cognitive impairment. The results showed that total glycosides of Cistanche deserticola can significantly improve cognitive function, reduce the degree of dementia, and improve the ability of daily living in VaD patients, which is related to factors such as the effective elimination of various reactive oxygen free radicals by total glycosides of cistanche.

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Summary

In summary, traditional Chinese medicine has made certain progress in the prevention and treatment of VaD. The academic school of Fuyang takes "yang deficiency" as the key point of syndrome differentiation, and uses the warming yang method to treat VaD, which has achieved certain efficacy and enriched the understanding of VaD. The warming yang method will bring new ideas and broad prospects to the treatment of VaD. In the future, more standardized and scientifically designed clinical research should be carried out, and the research results should be applied to clinical practice so that traditional Chinese medicine treatment can play a greater role in the treatment of VaD patients.

reference

[1] Weng Yinghong, Huang Jianhong. Definition and diagnostic progress of vascular dementia ［ J ］. Guangdong Medical Journal, 2010, 31 (14): 1881-1882

[2] Zhao Qingshan. Applying the theory of one Qi circulation to explore the mechanism of treating vascular dementia from the lung ［ J ］. Journal of Guiyang College of Traditional Chinese Medicine, 2013, 35 (6): 51-53

[3] Jia Menghui, He Xiaohui, Tian Jianying. Treatment of Alzheimer's Disease from Yang Deficiency [J]. New Chinese Medicine, 2005, 37 (7): 80-81

[4] Lu Chonghan. Lectures on Fuyang. Beijing: China Traditional Chinese Medicine Press, 2006:47176189

[5] Xing Bin, Huang Li. Zhu Weiju: A Review of Five Medical Books. Beijing: China Traditional Chinese Medicine Press, 2008:169