罗陆一学术思想和通脉地仙丸对冠心病心绞痛的临床研究
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摘要
老中医专家的学术经验是中医药学的巨大财富,继承老中医的临床经验、和学术思想才能使中医学薪火相传,不断发展。本人为第四批全国老中医师承工作罗陆一教授弟子,跟师学习,随诊左右,体会导师认识和治疗疾病理法方药的思维方法、临证遣方用药、加减化裁的特点和规律,研究总结导师的学术思想和临床经验,从而继承发扬传承中医。罗陆一教授为第四批全国老中医学术经验继承指导老师,广东省名中医,深圳市名医,临床四十余载,中医造诣深厚,临床经验丰富,擅治内科疑难杂病,尤其对冠心病、心肌炎、心律失常等疾病有着自己独到的学术见解和临床经验。
一、罗陆一教授学术思想和临床经验的整理与研究
罗陆一教授自幼学医,熟读经典,旁及百家,后师从国医大师李振华、赵清理、周仲英。由此形成了源于《内经》,法于《伤寒》,精于辨证,重视脾肾,崇尚养生的学术思想。总结罗陆一教授学术思想有：法于经典,采撷各家；精于辨证,重视脾肾；推崇望诊；痰瘀同治；善用虫类；重剂猛药,屡起沉疴；针药并施,擅长外治；崇尚养生,未病先治。
罗陆一教授临床善治心血管疾病,总结罗陆一教授的临床经验有：补肾活血化痰法治疗冠心病心绞痛；六经辨证治疗病毒性心肌炎；温阳散寒法治疗缓慢性心律失常；养心归草汤治疗快速性心律失常；清热活血法治疗深静脉血栓；固本强心汤治疗心肌病。
在跟师继承学习过程中,学习并总结导师的临床经验和学术思想,钻研中医经典理论,并创新运用导师的学术思想和临床经验于临床灾践。创新点：运用望诊理论治疗心脏神经症；宣畅气机法治疗冠心病；中药外治法治疗失眠。在临床中取得很好的疗效。
二、通脉地仙丸对冠心病心绞痛的临床研究
冠心病心绞痛相当于中医学“胸痹”、“胸痛”等范畴。在现代社会,冠心病心绞痛、脑动脉硬化、颈动脉硬化等动脉硬化性疾病发病率和致死率日益增高,已成为当今社会的常见疾病,故本病的中医病因病机和用药研究一直是当今中医学者研究的热点和焦点。老中医专家的学术经验是中医药学的巨大财富,研究根据罗陆一教授治疗冠心病心绞痛的临床经验。罗陆一教授总结各家对冠心病的中医病因病机,沿袭《金匮要略》的“阳微阴弦”胸痹病机,以本虚标实来归纳冠心病病机,认为其病位在心,其本在肾,肾虚为其重要的病机,痰瘀为标。临床采用补肾活血化痰法,以通脉地仙丸治疗冠心病患者进行临床疗效、血脂、凝血纤溶指标、颈动脉硬化斑块进行临床观察研究,以总结经验,探讨补肾活血化痰法治疗冠心病的临床疗效及作用机制,从而进一步继承发扬老中医的学术思想和经验。
研究目的：本研究通过观察补肾活血化痰法对冠状动脉粥样硬化性心脏病心绞痛患者治疗前后临床疗效的影响,对血脂、NO、凝血、纤维溶指标的影响,对心电图的疗效,以及对颈动脉多普勒超声检查结果的影响,包括颈动脉内中膜厚度(intima-media thickness, IMT)、颈动脉内斑块类型、数量,探讨补肾活血化痰法对冠心病的疗效、血脂、凝血、纤溶指标以及动脉粥样硬化斑块的干预作用以及中西医结合在治疗AS上的独特优势。
方法：选取冠心病合并颈动脉硬化患者150例。所有患者随机分为3组,分别为中药治疗组、西药治疗组和中西药结合治疗组,以上三组患者分别给予中药补肾活血化痰中药—通脉地仙丸、西药阿斯匹林合并阿托伐他汀钙以及中西药结合口服治疗,共给药24周。24周末观察治疗前后对三组患者的临床病情评分、临床、心电图疗效的影响；检测患者总胆固醇、甘油三酯、高、低密度脂蛋白、6-keto-PGF1α、TXB2、组织型纤溶酶原激活物(t-PA)、组织型纤溶酶原激活物抑制物(PAI)、NO,颈动脉多普勒超声检测颈动脉IMT及颈动脉内斑块的类型、数量,以上结果均进行治疗前后组内对比观察以及治疗后组间对比观察。数值用均数±标准差(X±S)表示,计量资料分析采用t检验及方差分析：组间比较采用独立样本t检验,组内治疗前后比较采用配对样本t检验,组间两两比较采用方差分析；计数资料分析采用卡方检验：率的比较采用卡方检验；等级资料比较采用Ridit分析。
结果：
(1)治疗前后组内比较,三组心绞痛疗效评分均明显降低(P<0.05或P<0.01)；中药组及中西结合组中医症状评分均明显降低(P<0.01),三组在心绞痛疗效、心电图疗效、中医症候疗效显效率及总有效率方面均有不同程度地改善。
(2)治疗前后组内比较,三组TC、TG、LDL-C值均显著降低,HDL-C值显著升高(P<0.05或P<0.01)；西药组优于中药组。中西结合组优于中药组和西药组。
(3)治疗前后组内比较,三组NO、6-keto-PGF1α、TXB2、t-PA、PAI均显著改善(P<0.05或P<0.01)；而中西结合组优于中药组和西药组(P<0.01)。
(4)治疗前后组内比较,三组颈动脉IMT厚度明显降低(P<0.05),颈动脉内斑块数量明显减少(P<0.01)。在降低动脉IMT厚度方面,中药组与西药组疗效相当(P>0.05),中西结合疗效明显优于中药组及西药组(P<0.01)。减少颈动脉内斑块数量方面,西药组优于中药组(P<0.01),中西结合疗效明显优于中药组及西药组(P<0.01)。
结论：
研究表明通脉地仙丸治疗冠心病心绞痛患者,可改善心绞痛症状,尤其在中医症候疗效方面有显著效果,并可降低患者TC、TG及LDL-C水平,升高HDL-C水平,降低颈动脉IMT值；减少颈动脉粥样硬化斑块数目。由此可见肾虚痰瘀互结是冠心病发生发展的重要中医病机之一。推断对机体内血脂、内皮功能以及凝血纤溶水平的调节可能是补肾活血化痰法抗AS的机制之一。
通脉地仙丸联合阿司匹林及阿托伐他汀钙中西结合治疗,对心绞痛疗效以及血脂、凝血、纤溶指标、颈动脉斑块情况改善更为明显。本研究为中西医结合治疗AS类疾病开辟了崭新的方向,提供了科学、客观、有力的理论依据。
The academic experience of the aged doctors of traditional Chinese medicine is the huge precious wealth of Chinese medicine, only successfully inheriting the clinical experience and the academic thoughts of the aged Chinese medicine doctors can enable the continuous development of the traditional Chinese medicine. As a disciple of Professor Luo Luyi, who is the forth generation instructor of aged Chinese medicine academic experience inheriting project. By follow-up learning and treatments assisting, I always pay attention to experience and understand Professor Luo's knowledge and the thinking method of recipe, and the main features and principles of clinical medicine usage and addition or subtraction of changes.
Professor Luo, as The forth generation instructor of aged Chinese medicine academic experience inheriting project, famous traditional Chinese medicine doctor of Guangdong province, famous doctor of Shenzhen city, has more than40years clinical experience. During this the40years time range, the huge profound attainments of traditional Chinese medicine, rich clinical experience, and expertise in medical difficulty miscellaneous disease, especially for coronary heart disease, viral myocarditis, arrhythmia and so on, were all be obtained by Professor Luo.
1. The research and arrangement of Professor Luo Luyi's academic thoughts and Clinical experience
Professor Luo Luyi started learning Chinese medicine since his childhood, therefore, he is very familiar with the classic medicine books and numerous famous doctors thinking. Then, he became the disciple of the great masters Li Zhenhua, Zhao Qingli and Zhou Zhongying. after that, according to the "Canon of Medicine" and" Treatise on Exogenous Febrile Disease", the academic thoughts of treatment based on syndrome differention were formed.
Professor Luo Luyi's academic thinking can be summarized as follows, comparing with the classic methods, learning from others, differentiation of symptoms and signs, spleen and kidney, recommending to inspection, treating sputum and blood stasis simultaneously, using insects and strong recipe, ills repeated, acupuncture and medicines, good external governance, health maintenance, and treatment before diseases.
Professor Luo Luyi is good at governance of cardiovascular disease clinically, Professor Luo Luyi's clinical experience can be summarized as follows, Therapy of Tonifying the Kidney and Activating Blood and Dissipating Phlegm on Angina pectoris of coronary heart disease, synfome differentiation of six channels theory on viral myocarditis, warming Yang on chronic arrhythmia, Yang Xin grass soup on Tachyarrhythmia, clearing heat and Activating Blood on venous thrombosis, Strengths of cardiac soup on myocarditis.
During the process of learning from Professor Luo, Ilearnt and summarized his clinical experience and academic thoughts, researched the classic theory of chinese medicine, and creatively applied them in clinical practice. The creation areas are showing as follow:inspection theory on Cardiac neurosis, regulating qi-flowing method on Coronary Heart Disease, and external treatment on insomnia, and all of them obtained very good treatment result in clinical practice.
2. Clinical Study of Tongmaidixian pills on Angina pectoris of Coronary Heart Disease
Angina pectoris of coronary heart disease can be the obstruction of chest in chinese medicine. In modern society, the Morbidity and mortality of the arteriosclerosis diseases like Angina pectoris of coronary heart disease has been increasing and become a common disease in today's society, therefore, the disease's cause, pathogenesis, and treatment research are always the studying focuses of today's Chinese medicine researchers.
The academic experience of the aged doctors of traditional chinese medicine is the huge precious wealth of chinese medicine. This research is based on Professor Luo's clinical treatment experience of Angina pectoris of coronary heart disease. Professor Luo Luyi summarizes each of the cause and pathogenesis of coronary heart disease, following the "Golden Chamber" and "yin yang micro strings," the obstruction of chest, locate the mind is the disease area and the present is in the kidney, and the kidney is important for its pathogenesis, phlegm and blood stasis as symptom.
In this study, the tonifying the kidney and activating blood and dissipating phlegm methodology is used to treate coronary heart disease, and the changes of clinical efficacy, blood lipids, coagulation and fibrinolysis indicators in carotid atherosclerotic plaque will be summed up to generate clinical experience and discuss the treatment of kidney and blood phlegm and clinical efficacy of coronary heart disease mechanism, further more to carry and broadly apply the aged Chinese medicine doctors'academic thoughts and experiences.
Objectives
In this study, by observing the Tongmaidixian pills's affection on the Coronary atherosclerotic heart disease with carotid atherosclerosis in patients with clinical efficacy before and after treatment, affection on Lipids, coagulation and Fibrinolysis, affection on the results of carotid Doppler ultrasound, Including carotid intima-media thickness, carotid plaque type, quantity, kidney and blood phlegm of the efficacy of coronary heart disease, blood lipids, coagulation, fibrinolysis and atherosclerotic plaque, and the intervention of Chinese and Western medicine combined with the unique advantage in the treatment.
Methodology
To select150patients with Combined CHD and cases of carotid atherosclerosis, divide them into3groups randomly, and the three groups can be chinese medicine group, Western medicine group, Chinese medicine combined western medicine group, the three groups of patients were given medicine kidney blood phlegm medicine-Tongmaidixian pills, aspirin and combined medicine atorvastatin calcium and oral treatment with Chinese combined western medicine, give them medicine in24weeks.
At the end of the24th week, compare the treatment for three groups of patients with clinical disease score,the impact of clinical efficacy; test patients for total cholesterol, triglycerides, high and low density lipoprotein,6-keto-PGFiα, TXB2, tissue-type plasminogen activator material (t-PA), tissue-type plasminogen activator inhibitor (PAI), NO, carotid artery Doppler ultrasound carotid IMT and carotid artery plaque type, quantity, these results were carried out by comparing before and after treatment group comparative study.
With a mean value±standard deviation (X±S), said measurement data were analyzed by t test and variance analysis:comparison between groups using independent samples t-test, before and after treatment group compared with paired sample t test, pairwise comparison between groups using analysis of variance; count data were analyzed by chi-square test:chi-square was used to compare the rate of inspection; Ridit analysis was used to compare ranked data.
Result
(1) the before and after treatment comparison inside the group, three groups of angina scores were significantly lower (P<0.05or P<0.01), combined with Western medicine group medicine group and symptom scores were significantly lower (P<0.01), while no significant medication group improvement (P>0.05); three groups in angina pectoris, ECG, significant efficiency and efficacy of traditional Chinese medicine symptom total efficiency got improved in varying degrees.
(2) the before and after treatment comparison inside group, three groups of TC, TG, LDL-C values were significantly lower, HDL-C values were significantly higher (P<0.05or P<0.01); western group was better than medicine group. Combination group was superior to traditional Chinese medicine and Western medicine group and the group.
(3) the before and after treatment comparison inside the group, three groups of NO,6-keto-PGF1α, TXB2, t-PA, PAI were significantly improved (P<0.05or P<0.01); the combination group than the Chinese and Western medicine group and WM group (P<0.01)
(4) the before and after treatment comparison inside the group, the three groups significantly reduced the thickness of carotid IMT (P<0.05), the number of carotid plaque was significantly reduced (P<0.01). To reduce artery IMT thickness, traditional Chinese medicine and western medicine group as effective as group (P>0.05), with significantly better than Western medicine group and WM group (P<0.01). Reduce the number of carotid artery plaque, the western medicine group was superior (P<0.01), with significantly better than Western medicine group and WM group (P<0.01).
Conclusion
The study result shows that the Tongmaidixian pills patients on angina pectoris, angina symptoms can be improved, especially in the efficacy of traditional Chinese medicine symptoms have a significant effect, and reduces patient TC, TG and LDL-C levels, increased HDL-C levels, lower carotid IMT values; reduce carotid atherosclerotic plaque number. Due to these factors, the kidney phlegm and blood stasis is an important cause of coronary heart disease one of TCM. Inference of body lipids, endothelial function, and regulation of coagulation and f ibrinolysi s may be one of the anti-AS mechanisms of kidney blood phlegm.
The Tongmaidixian pills in combination with aspirin and atorvastatin calcium as combined with Chinese and Western treatment of angina pectoris will improve the situation of blood fat, blood lipids, coagulation, fibrinolysis, carotid plaque more obviously.
一、罗陆一教授学术思想和临床经验的整理与研究
罗陆一教授自幼学医,熟读经典,旁及百家,后师从国医大师李振华、赵清理、周仲英。由此形成了源于《内经》,法于《伤寒》,精于辨证,重视脾肾,崇尚养生的学术思想。总结罗陆一教授学术思想有：法于经典,采撷各家；精于辨证,重视脾肾；推崇望诊；痰瘀同治；善用虫类；重剂猛药,屡起沉疴；针药并施,擅长外治；崇尚养生,未病先治。
罗陆一教授临床善治心血管疾病,总结罗陆一教授的临床经验有：补肾活血化痰法治疗冠心病心绞痛；六经辨证治疗病毒性心肌炎；温阳散寒法治疗缓慢性心律失常；养心归草汤治疗快速性心律失常；清热活血法治疗深静脉血栓；固本强心汤治疗心肌病。
在跟师继承学习过程中,学习并总结导师的临床经验和学术思想,钻研中医经典理论,并创新运用导师的学术思想和临床经验于临床灾践。创新点：运用望诊理论治疗心脏神经症；宣畅气机法治疗冠心病；中药外治法治疗失眠。在临床中取得很好的疗效。
二、通脉地仙丸对冠心病心绞痛的临床研究
冠心病心绞痛相当于中医学“胸痹”、“胸痛”等范畴。在现代社会,冠心病心绞痛、脑动脉硬化、颈动脉硬化等动脉硬化性疾病发病率和致死率日益增高,已成为当今社会的常见疾病,故本病的中医病因病机和用药研究一直是当今中医学者研究的热点和焦点。老中医专家的学术经验是中医药学的巨大财富,研究根据罗陆一教授治疗冠心病心绞痛的临床经验。罗陆一教授总结各家对冠心病的中医病因病机,沿袭《金匮要略》的“阳微阴弦”胸痹病机,以本虚标实来归纳冠心病病机,认为其病位在心,其本在肾,肾虚为其重要的病机,痰瘀为标。临床采用补肾活血化痰法,以通脉地仙丸治疗冠心病患者进行临床疗效、血脂、凝血纤溶指标、颈动脉硬化斑块进行临床观察研究,以总结经验,探讨补肾活血化痰法治疗冠心病的临床疗效及作用机制,从而进一步继承发扬老中医的学术思想和经验。
研究目的：本研究通过观察补肾活血化痰法对冠状动脉粥样硬化性心脏病心绞痛患者治疗前后临床疗效的影响,对血脂、NO、凝血、纤维溶指标的影响,对心电图的疗效,以及对颈动脉多普勒超声检查结果的影响,包括颈动脉内中膜厚度(intima-media thickness, IMT)、颈动脉内斑块类型、数量,探讨补肾活血化痰法对冠心病的疗效、血脂、凝血、纤溶指标以及动脉粥样硬化斑块的干预作用以及中西医结合在治疗AS上的独特优势。
方法：选取冠心病合并颈动脉硬化患者150例。所有患者随机分为3组,分别为中药治疗组、西药治疗组和中西药结合治疗组,以上三组患者分别给予中药补肾活血化痰中药—通脉地仙丸、西药阿斯匹林合并阿托伐他汀钙以及中西药结合口服治疗,共给药24周。24周末观察治疗前后对三组患者的临床病情评分、临床、心电图疗效的影响；检测患者总胆固醇、甘油三酯、高、低密度脂蛋白、6-keto-PGF1α、TXB2、组织型纤溶酶原激活物(t-PA)、组织型纤溶酶原激活物抑制物(PAI)、NO,颈动脉多普勒超声检测颈动脉IMT及颈动脉内斑块的类型、数量,以上结果均进行治疗前后组内对比观察以及治疗后组间对比观察。数值用均数±标准差(X±S)表示,计量资料分析采用t检验及方差分析：组间比较采用独立样本t检验,组内治疗前后比较采用配对样本t检验,组间两两比较采用方差分析；计数资料分析采用卡方检验：率的比较采用卡方检验；等级资料比较采用Ridit分析。
结果：
(1)治疗前后组内比较,三组心绞痛疗效评分均明显降低(P<0.05或P<0.01)；中药组及中西结合组中医症状评分均明显降低(P<0.01),三组在心绞痛疗效、心电图疗效、中医症候疗效显效率及总有效率方面均有不同程度地改善。
(2)治疗前后组内比较,三组TC、TG、LDL-C值均显著降低,HDL-C值显著升高(P<0.05或P<0.01)；西药组优于中药组。中西结合组优于中药组和西药组。
(3)治疗前后组内比较,三组NO、6-keto-PGF1α、TXB2、t-PA、PAI均显著改善(P<0.05或P<0.01)；而中西结合组优于中药组和西药组(P<0.01)。
(4)治疗前后组内比较,三组颈动脉IMT厚度明显降低(P<0.05),颈动脉内斑块数量明显减少(P<0.01)。在降低动脉IMT厚度方面,中药组与西药组疗效相当(P>0.05),中西结合疗效明显优于中药组及西药组(P<0.01)。减少颈动脉内斑块数量方面,西药组优于中药组(P<0.01),中西结合疗效明显优于中药组及西药组(P<0.01)。
结论：
研究表明通脉地仙丸治疗冠心病心绞痛患者,可改善心绞痛症状,尤其在中医症候疗效方面有显著效果,并可降低患者TC、TG及LDL-C水平,升高HDL-C水平,降低颈动脉IMT值；减少颈动脉粥样硬化斑块数目。由此可见肾虚痰瘀互结是冠心病发生发展的重要中医病机之一。推断对机体内血脂、内皮功能以及凝血纤溶水平的调节可能是补肾活血化痰法抗AS的机制之一。
通脉地仙丸联合阿司匹林及阿托伐他汀钙中西结合治疗,对心绞痛疗效以及血脂、凝血、纤溶指标、颈动脉斑块情况改善更为明显。本研究为中西医结合治疗AS类疾病开辟了崭新的方向,提供了科学、客观、有力的理论依据。
The academic experience of the aged doctors of traditional Chinese medicine is the huge precious wealth of Chinese medicine, only successfully inheriting the clinical experience and the academic thoughts of the aged Chinese medicine doctors can enable the continuous development of the traditional Chinese medicine. As a disciple of Professor Luo Luyi, who is the forth generation instructor of aged Chinese medicine academic experience inheriting project. By follow-up learning and treatments assisting, I always pay attention to experience and understand Professor Luo's knowledge and the thinking method of recipe, and the main features and principles of clinical medicine usage and addition or subtraction of changes.
Professor Luo, as The forth generation instructor of aged Chinese medicine academic experience inheriting project, famous traditional Chinese medicine doctor of Guangdong province, famous doctor of Shenzhen city, has more than40years clinical experience. During this the40years time range, the huge profound attainments of traditional Chinese medicine, rich clinical experience, and expertise in medical difficulty miscellaneous disease, especially for coronary heart disease, viral myocarditis, arrhythmia and so on, were all be obtained by Professor Luo.
1. The research and arrangement of Professor Luo Luyi's academic thoughts and Clinical experience
Professor Luo Luyi started learning Chinese medicine since his childhood, therefore, he is very familiar with the classic medicine books and numerous famous doctors thinking. Then, he became the disciple of the great masters Li Zhenhua, Zhao Qingli and Zhou Zhongying. after that, according to the "Canon of Medicine" and" Treatise on Exogenous Febrile Disease", the academic thoughts of treatment based on syndrome differention were formed.
Professor Luo Luyi's academic thinking can be summarized as follows, comparing with the classic methods, learning from others, differentiation of symptoms and signs, spleen and kidney, recommending to inspection, treating sputum and blood stasis simultaneously, using insects and strong recipe, ills repeated, acupuncture and medicines, good external governance, health maintenance, and treatment before diseases.
Professor Luo Luyi is good at governance of cardiovascular disease clinically, Professor Luo Luyi's clinical experience can be summarized as follows, Therapy of Tonifying the Kidney and Activating Blood and Dissipating Phlegm on Angina pectoris of coronary heart disease, synfome differentiation of six channels theory on viral myocarditis, warming Yang on chronic arrhythmia, Yang Xin grass soup on Tachyarrhythmia, clearing heat and Activating Blood on venous thrombosis, Strengths of cardiac soup on myocarditis.
During the process of learning from Professor Luo, Ilearnt and summarized his clinical experience and academic thoughts, researched the classic theory of chinese medicine, and creatively applied them in clinical practice. The creation areas are showing as follow:inspection theory on Cardiac neurosis, regulating qi-flowing method on Coronary Heart Disease, and external treatment on insomnia, and all of them obtained very good treatment result in clinical practice.
2. Clinical Study of Tongmaidixian pills on Angina pectoris of Coronary Heart Disease
Angina pectoris of coronary heart disease can be the obstruction of chest in chinese medicine. In modern society, the Morbidity and mortality of the arteriosclerosis diseases like Angina pectoris of coronary heart disease has been increasing and become a common disease in today's society, therefore, the disease's cause, pathogenesis, and treatment research are always the studying focuses of today's Chinese medicine researchers.
The academic experience of the aged doctors of traditional chinese medicine is the huge precious wealth of chinese medicine. This research is based on Professor Luo's clinical treatment experience of Angina pectoris of coronary heart disease. Professor Luo Luyi summarizes each of the cause and pathogenesis of coronary heart disease, following the "Golden Chamber" and "yin yang micro strings," the obstruction of chest, locate the mind is the disease area and the present is in the kidney, and the kidney is important for its pathogenesis, phlegm and blood stasis as symptom.
In this study, the tonifying the kidney and activating blood and dissipating phlegm methodology is used to treate coronary heart disease, and the changes of clinical efficacy, blood lipids, coagulation and fibrinolysis indicators in carotid atherosclerotic plaque will be summed up to generate clinical experience and discuss the treatment of kidney and blood phlegm and clinical efficacy of coronary heart disease mechanism, further more to carry and broadly apply the aged Chinese medicine doctors'academic thoughts and experiences.
Objectives
In this study, by observing the Tongmaidixian pills's affection on the Coronary atherosclerotic heart disease with carotid atherosclerosis in patients with clinical efficacy before and after treatment, affection on Lipids, coagulation and Fibrinolysis, affection on the results of carotid Doppler ultrasound, Including carotid intima-media thickness, carotid plaque type, quantity, kidney and blood phlegm of the efficacy of coronary heart disease, blood lipids, coagulation, fibrinolysis and atherosclerotic plaque, and the intervention of Chinese and Western medicine combined with the unique advantage in the treatment.
Methodology
To select150patients with Combined CHD and cases of carotid atherosclerosis, divide them into3groups randomly, and the three groups can be chinese medicine group, Western medicine group, Chinese medicine combined western medicine group, the three groups of patients were given medicine kidney blood phlegm medicine-Tongmaidixian pills, aspirin and combined medicine atorvastatin calcium and oral treatment with Chinese combined western medicine, give them medicine in24weeks.
At the end of the24th week, compare the treatment for three groups of patients with clinical disease score,the impact of clinical efficacy; test patients for total cholesterol, triglycerides, high and low density lipoprotein,6-keto-PGFiα, TXB2, tissue-type plasminogen activator material (t-PA), tissue-type plasminogen activator inhibitor (PAI), NO, carotid artery Doppler ultrasound carotid IMT and carotid artery plaque type, quantity, these results were carried out by comparing before and after treatment group comparative study.
With a mean value±standard deviation (X±S), said measurement data were analyzed by t test and variance analysis:comparison between groups using independent samples t-test, before and after treatment group compared with paired sample t test, pairwise comparison between groups using analysis of variance; count data were analyzed by chi-square test:chi-square was used to compare the rate of inspection; Ridit analysis was used to compare ranked data.
Result
(1) the before and after treatment comparison inside the group, three groups of angina scores were significantly lower (P<0.05or P<0.01), combined with Western medicine group medicine group and symptom scores were significantly lower (P<0.01), while no significant medication group improvement (P>0.05); three groups in angina pectoris, ECG, significant efficiency and efficacy of traditional Chinese medicine symptom total efficiency got improved in varying degrees.
(2) the before and after treatment comparison inside group, three groups of TC, TG, LDL-C values were significantly lower, HDL-C values were significantly higher (P<0.05or P<0.01); western group was better than medicine group. Combination group was superior to traditional Chinese medicine and Western medicine group and the group.
(3) the before and after treatment comparison inside the group, three groups of NO,6-keto-PGF1α, TXB2, t-PA, PAI were significantly improved (P<0.05or P<0.01); the combination group than the Chinese and Western medicine group and WM group (P<0.01)
(4) the before and after treatment comparison inside the group, the three groups significantly reduced the thickness of carotid IMT (P<0.05), the number of carotid plaque was significantly reduced (P<0.01). To reduce artery IMT thickness, traditional Chinese medicine and western medicine group as effective as group (P>0.05), with significantly better than Western medicine group and WM group (P<0.01). Reduce the number of carotid artery plaque, the western medicine group was superior (P<0.01), with significantly better than Western medicine group and WM group (P<0.01).
Conclusion
The study result shows that the Tongmaidixian pills patients on angina pectoris, angina symptoms can be improved, especially in the efficacy of traditional Chinese medicine symptoms have a significant effect, and reduces patient TC, TG and LDL-C levels, increased HDL-C levels, lower carotid IMT values; reduce carotid atherosclerotic plaque number. Due to these factors, the kidney phlegm and blood stasis is an important cause of coronary heart disease one of TCM. Inference of body lipids, endothelial function, and regulation of coagulation and f ibrinolysi s may be one of the anti-AS mechanisms of kidney blood phlegm.
The Tongmaidixian pills in combination with aspirin and atorvastatin calcium as combined with Chinese and Western treatment of angina pectoris will improve the situation of blood fat, blood lipids, coagulation, fibrinolysis, carotid plaque more obviously.
引文
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