[Abstract] OBJECTIVE: To investigate the therapeutic effect and clinical significance of Feng’s manipulation in the treatment of spinal-derived coronary heart disease. METHODS: Retrospective analysis of 180 patients with coronary artery disease of spinal origin treated with Feng’s manipulation and simple herbal hot compresses, 86 men and 94 women, aged 18-82 years, mean age 43.7 years, duration of disease 1d-40 years, mean 20.6 months; 180 patients were followed up for 4 months to 3 years, mean 12.7 months; 90 cases were treated with Feng’s manipulation (group A) 1-2 times a week; 90 cases were treated with simple herbal hot compresses (group B). Group A) 1-2 times per week; 90 cases were treated with external application of Chinese herbal medicine alone (Group B), with hot compresses twice a day (at an interval of 6h or more each time) for 20 minutes each time for 1 month. The symptoms and signs (including chest tightness, precordial pain, palpitations, neck and back pain, spinal pressure pain, and painful nodules) were observed and compared between the two groups after treatment. RESULTS: After 1 month of treatment, comparing the symptoms and signs in group A and group B, chest tightness χ2=8.9322, p =0.0028<0.05, precordial pain χ2=20.6527, p <0.0001, palpitation χ2=24.2804,p<0.0001, neck and back pain χ2=23.5917, p <0.0001,
spinal pressure pain χ2=12.2062, p
=0.0005<0.01,painful nodules χ2=4.0261, P =0.044<0.05, the difference was statistically significant. Conclusion: Disorders of the posterior thoracic spine joints can lead to the appearance of symptoms of coronary heart disease, and the efficacy of manipulative treatment is certain. Guo Wei, Department of Integrative Orthopedic Treatment, Air Force General Hospital
[Keywords]
Feng’s technique; posterior thoracic spine joint disorder; coronary artery disease
Cervical spondylosis and posterior thoracic spine joint disorder is a common and high incidence disease, and its accompanying symptoms of coronary heart disease such as back pain, chest tightness, panic and shortness of breath are becoming more and more common, and some people put forward the concept of pseudo-coronary heart disease or spinal origin-like coronary heart disease [1]. The current treatment options for posterior thoracic spine disorders are well defined. However, traditional conservative treatment options are not ideal for spinal origin-like coronary artery disease. We conducted clinical observation and research on the treatment of spinal origin-like coronary heart disease using Feng’s manipulation [1], and initially figured out that Feng’s manipulation is effective in the treatment of spinal origin-like coronary heart disease caused by spinal subluxation with a simple method, which is reported as follows.
1 Data and methods
1.1 General data From January 2005 to June 2008, a total of 180 patients, 86 males and 94 females, aged 18-82 years, average 43.7 years, with a duration of 1d-40 years, average 20.6 months, were admitted with spinal origin coronary artery disease; 180 patients were followed up for 4 months to 3 years, average 12.7 months. The general data of the two groups are shown in Table 1. The differences in gender, age and duration of disease between the two groups were statistically not significant (P > 0.05) and were comparable.
Table 1 General information of patients in two groups
Tab.1 the common
information of two groups patient
Group
Number of cases
Sex(case)*
Age
Duration of disease#
Male
Female
(X±S, years)
(X±S, months)
Group A
90
42
48
42.5±8.2
20.7±6.3
Group B
90
44
46
44.6±6.5
21.1±5.5
Note:*t=0.0891, P =0.7654>0.05, △t=0.0961, P =0.7791>0.05, #t=0.0773, P =0.6324>0.05 when comparing with the two groups.
Note: There is no difference between compare with the two
groups patient, *t=0.0891, P
=0.7654>0.05, △t=0.0961, P =0.7791>0.05, #t=0.0773, P =0.6324>0.05.
1.2 Case inclusion criteria [2]: ① history of trauma or long-term history of poor posture; ② pain or stuffy discomfort in the shoulder and back, thoracic region, and some limitation of automatic or passive movement of the shoulder and back; ③ palpation by Feng’s palpation method [1], all of them could have pressure pain, percussion pain and paravertebral pressure pain in the spine corresponding cervical and thoracic vertebrae spinous processes, pressure pain in the paravertebral soft tissues, and palpable painful nodules or striae; ④ X-ray plain radiographs showed painful nodules or striae. ④ Radiographs showed no significant abnormalities in the thoracic spine and other organic diseases were excluded. Patients meeting all the above conditions were included in the study.
1.3 Treatment methods
1.3.1 Group A was treated with Feng’s manipulation [1]: the patient sat on a square stool with the feet separated at shoulder width. After the operator sits on the patient, the patient’s spine is deviated to the right, and the deviated spine is first checked by thumb palpation. For example, if there is a misalignment of the cervical vertebral joints, the left elbow lightly surrounds the lower jaw and lightly lifts upward while rotating 20-30 degrees, the right thumb is placed to the right of the distorted spinous process, and the distorted spinous process is plucked upward in an oblique direction, and then slowly turned back to a neutral position. If there is a disorder in the posterior thoracic joint, the right hand reaches forward from the patient’s right axilla and presses the palm of the hand against the posterior part of the neck, with the thumb down and the remaining four fingers supporting the neck (the patient lowers the head slightly) while asking the patient to put both feet on the ground and sit with the hips squarely without moving. The assistant stands facing the patient, clamps both legs on the patient’s left thigh, presses both hands on the root of the left thigh, and maintains the patient in a sitting position. The left thumb of the manipulator clasps the spinous process on the right side, then the right hand pulls the patient’s neck so that the body bends forward 40°-60°, continues to the right side (as much as possible greater than 45°), in the maximum lateral bending position the right upper limb of the manipulator makes the patient’s torso rotate backward medially, at the same time the left thumb pushes the spinous process upward to the left and immediately detects a slight misalignment of the vertebral body under the finger, often accompanied by a “ka ” sound. The affected vertebral spinous process is skewed to the left, supporting the patient’s limbs and traction in the opposite direction, the same method. Manipulation treatment 1-2 times a week, a total of 4-8 times. Note that the application of this technique must be gentle, accurate, discretionary force, and strive to stabilize, accurate, light, dexterity, do not rough. Otherwise, it can aggravate the injury and cause adverse consequences.
1.3.2 Group B adopts traditional Chinese medicine chasing hydra chasing fruits or protection of Miyuki station hollow all box ùΨ [1]: stretching grass 30g, winter melon skin 30g, penetrating bone grass 30g, papaya 15g, pepper 9g, Wujia Pi 15g, safflower 9g). Take 1 sachet of the new medicine first wet and wring it out, then steam it for 30 min. for the second time, heat it for 8-10 min. After steaming, take out the package and put it on warm, then put the package directly on the neck and waist, paying attention to prevent burns. Apply hot compress twice a day (at intervals of 6h or more) for 20 min each time.
Each pack can be used 6-8 times repeatedly, and placed in a cool place after use, the course of treatment is 1 month.
1.4 Observation items and methods: ① Observe whether patients have symptoms of coronary heart disease before and after treatment, including chest tightness, breath-holding, pain in the precordial region and palpitations. ②Signs and symptoms of cervical spondylosis and thoracic spondylosis before and after treatment, including the presence of neck back pain, spinous process pressure, paravertebral soft tissue pressure, painful nodules or striae, and the presence of spinous process deviation determined by single thumb palpation [1], were examined by two senior attending physicians separately and the symptoms and signs were recorded.
1.5 The SPSS13.0 statistical software was used to perform the χ2 test for the possession ratio of both the presence and disappearance of symptoms and signs in patients before and after treatment.
2 Results The changes of coronary heart disease and cervical spine symptoms and signs in the two groups before and after treatment are shown in Table 2
Table 2 the accompanying symptom and sign existence before and after treatment in the two groups (cases)
Tab2 the accompanying symptom and signed before and after treatment of two groups patient (case)
Symptoms and signs
Group A
Group B
Before treatment
After treatment
Improvement rate
Before treatment
After treatment
Improvement rate
Chest tightness
59
10
83.05%*
65
27
58.46%*
Anterior heart pain
90
22
75.56%**
90
52
42.22%**
Heart palpitations
74
6
91.89% △
68
30
55.88% △
Neck and back pain
76
8
89.47% △△
71
33
53.52%△△△
Spine pressure pain
88
22
75.00%#
78
40
48.72%#
Painful nodules
43
10
76.74%##
41
18
56.10%##
Note: Improvement rate of signs and symptoms after treatment, Group A compared with Group B, *χ2=8.9322,p=0.0028<0.05, **χ2=20.6527, p<0.0001, △χ2=24.2804, p <0.0001, △Δχ2=23.5917, p <0.0001, # =0.0005<0.01, ##χ2=4.0261, P =0.044<0.05, the difference was statistically significant. Note: Improvement rate of symptom and signed is a significant difference between the two groups patient after treatment, *χ2=8.9322,p=0.0028<0.05, **χ2=20.6527,p<0.0001, △χ2=24.2804,p<0.0001, △△χ2=23.5917,p<0.0001,# χ2=12.2062,p=0.0005<0.01, ##χ2=4.0261,p=0.044<0.05. After 1 month of treatment, comparing the improvement rate of symptoms and signs between group A and group B after treatment, chest tightness χ2=8.9322, p =0.0028<0.05, precordial pain χ2=20.6527, p <0.0001, palpitations χ2=24.2804,p<0.0001, neck and back pain χ2=23.5917, spinal pressure pain χ2=12.2062, p =0.0005<0.01, painful nodules χ2=4.0261, P =0.044<0.05, the differences were statistically significant, and the improvement rate of the manipulation group was significantly better than that of the herbal tengxiang group. 3 Discussion 3.1 Clinical manifestations of spinal origin-like coronary artery disease: typical onset as sudden onset of pain, mostly occurring after prolonged ambulation, high pillow sleep and waking up, sudden head twisting or turning, with pain sites mostly in the back of the upper or middle sternum, also spreading to most of the precordial area, often radiating to the back of the shoulder and upper limbs, with the left side being more common. The nature of the pain is mostly a feeling of pressure or suffocation, often accompanied by chest tightness, tightness of breath, discomfort in the back of the neck, soreness and swelling. 3.2 The pathogenesis is: the sympathetic nerve of the heart starts from the upper thoracic ganglion, passes through the thoracic 1-5 nerves and gray-white traffic branches to the supracardiac, central and infracardiac nerves issued from the three sympathetic trunks of the supracardiac, central and infracardiac ganglia to the plexus around the aortic arch, and then the sympathetic fibers from the plexus to the sinoatrial node, atrioventricular node and the trunks of the left and right coronary arteries. The parasympathetic nerve of the heart starts from the dorsal nucleus of the vagus nerve of the medulla oblongata, passes through the vagus nerve and its cardiac branches (also the superior, central and inferior heart) to the cardiac plexus, and then divides into fibers to the heart, in short, the gray and white traffic branches of the sympathetic nerve can merge into cardiac branches, and some can coincide with the branches of the vagus nerve to the heart and the aortic arch, forming the cardiac plexus innervating the heart. Therefore, when the thoracic spine disorder affects the sympathetic nerve or its fibers, it can lead to coronary artery supply disorder or heart conduction system disorder and symptoms of coronary heart disease. [3] At the same time, stimulation of sympathetic nerves can increase the release of 5HT from the terminals of sympathetic nerve fibers in coronary artery walls with atherosclerosis or endothelial damage, leading to vasoconstriction and myocardial ischemia. [4] 3.3 Differential diagnosis of posterior thoracic spine disorder and coronary artery disease [5]: coronary artery disease has typical symptoms such as angina pectoris after exercise, and the electrocardiogram has S-T segment decrease and other manifestations, unlike coronary artery disease-like coronary artery disease, which mostly occurs after working with the head down for too long or suddenly shaking the head, all of which can have pressure pain, percussion pain and paravertebral pressure pain at the spine's corresponding vertebral spine, distorted spine, pressure pain and palpable pain in the paravertebral soft tissue The nodules or striae are not abnormal on electrocardiogram. 3.4 The therapeutic effect of Feng's manipulation on spinal origin-like coronary artery disease: We believe that by correcting the displacement of cervical and thoracic vertebrae, correcting joint disorders, relieving spasm of cervical and back muscles, eliminating sterile inflammation, and achieving the balance of spinal mechanics, thus relieving the stimulation of nerve roots, spinal cord, and sympathetic nerves, which can improve the symptoms and receive good results. In summary, we believe that when a patient has repeated symptoms of coronary heart disease without electrocardiographic evidence and is given the diagnosis of "neurosis", the use of Feng's technique for the treatment of spinal coronary heart disease caused by cervicothoracic vertebral subluxation is effective, simple and worth promoting. [Ref] [1] Feng Tianyou. Clinical study on the combined treatment of soft tissue injury with Chinese and Western medicine. Beijing: China Science and Technology Press, 2002. 174-177. [2] Yan Juntao. Beijing: China Science and Technology Press. Beijing: China Chinese Medicine Publishing House, 2003, 138. [3] Tian Ke, Lian Zhuo, Zhao Dawei. Clinical analysis of 36 cases of cervical heart syndrome. TCM Orthopedics,2006,18(2):45 46 [4] Chen Baoli, Li Wuyin, Ma Yue. Clinical analysis of 9 cases of misdiagnosis of cervical spondylosis-like coronary heart syndrome. Journal of Zhengzhou University (Medical Edition),2004, 39(3),543. [5] Li JJ, Ye XY, Zhao BL, et al. Clinical study on the mechanism of spinal origin coronary heart disease and its treatment by manipulation. Chinese Orthopaedic Injury,2007,20(Suppl.):20.