How to treat heart failure with a combination of disease and evidence?

For cardiac insufficiency, TCM practitioners use Zhen Wu Tang and Ling Gui Zhu Gan Tang to warm the kidneys, transform qi and move the heart according to symptoms such as edema, floating face, cold and fear of cold, and palpitations under the heart. Water; according to the symptoms of suffocation in the chest, wheezing and unable to lie down, more use of Scape Dahurian Dates Diarrhea Lung Soup to diarrhea the lung and calm wheezing. Modern medicine believes that the physiopathology of cardiac insufficiency can be basically divided into three aspects: one is the decrease of cardiac systolic and diastolic functions; the second is the obstruction of blood circulation and retention of water and fluid metabolites; the third is the compensatory activation of the neuroendocrine system. Chinese medicine treatment of this disease also cannot disregard these aspects, Chinese medicine believes that cardiac systolic and diastolic hypokinesis mostly belongs to qi deficiency and yang deficiency. Qi and Yang deficiency not only lies in the heart, but also involves the spleen and kidney. There are also clinical cases of deficiency of yin and blood, which cannot nourish the heart veins and lead to cardiac decompensation. Zhen Wu Tang and Ling Gui Zhu Gan Tang are the treatment for Yang deficiency and water flooding, water overwhelming the heart, coughing and panting, and suffocation in the chest; Scape Drabble and Jujube Diarrhea of the Lung Tang is an expedient treatment for lung qi depression, panting and restlessness. Zhen Wu Tang and Ling Gui Zhu Gan Tang are pungent, warm and dissipative, and their prolonged use is likely to injure yin and deplete qi; if Draban Qian Da Zao Diarrhea Lung Soup is not used in conjunction with heart qi and zong qi medicines, it has the disadvantage of leaking profit and hurting the righteousness. In chronic cardiac insufficiency, because of its long duration, there are mostly yin loss and yang loss and yin loss, and in the process of pathological development, because the heart qi cannot master the blood vessels, there are pathological changes of stagnant blood stagnating the veins and stagnant blood unfavorably transforming water. Therefore, clinical Chinese medicine treatment should pay attention to the following aspects: ① Benefiting Qi and warming Yang, invigorating Blood and resolving blood stasis to facilitate water circulation: Benefiting Qi and warming Yang to warm the Blood and make it flow; invigorating Blood and resolving blood stasis to facilitate water, which can promote the excretion of stagnant metabolites. Benefit Qi with astragalus and ginseng to replenish heart Qi and vital energy, should not only use party ginseng. Party ginseng is good at tonifying the spleen qi and replenishing the lack of strength of heart qi and vital energy; warming the yang with branches to warm the blood vessels. If the blood vessels are not cold, the extremities are cold, or the kidney yang is deficient and the yin is cold, the Radix et Rhizoma is not used. The large pungent, hot, dry products, easy to hurt Yin and disperse Qi, long-term application of large amounts, in the long-term treatment of chronic cardiac insufficiency is more unfavorable. For chronic cardiac insufficiency water retention, should not use the method of water alone, with drugs such as poria, pig ling, carpenter, zedoary, two ugly, etc.. “The blood is not conducive to water”, chronic cardiac insufficiency patients water metabolism stagnation is mostly due to unfavorable blood vessels, so blood and water should be activated to promote blood circulation and eliminate blood stasis as the main, supplemented by water. To invigorate blood circulation and eliminate blood stasis, use Salvia miltiorrhiza, Zelenia, and Yimoucao. These three drugs modern pharmacological research shows that there is expansion of renal arteries, increase glomerular filtration rate, promote the role of water metabolism. The use of carpenter, red bean, poria, poria, Sichuan pepper, etc., light percolation of water without depleting yin; ② regulate the bowel: chronic cardiac insufficiency, especially with cardiac insufficiency, intestinal stasis, mucosal edema patients, the ambassador loose is more common. Clinically speaking, constipation or constipation is not constipated, but defecation difficulties are also not uncommon. Constipation, the internal Qi is not pass, one affects the lift of lung gas, water metabolism is more unfavorable; two constipation, can aggravate the intestinal blood circulation disorders; three can affect the excretion of toxic metabolites. Chronic cardiac insufficiency patients, should pay attention to the smooth stool. The method of regulating the stool, one can be used almond, guajou kernel, peach kernel and other quality run down the lungs and regulate intestinal products; two available sweet and warm quality runny medicine such as angelica, meat from the rhizome, gas deficiency and constipation with astragalus with sweet and warm laxative; three can be applied to rhubarb to regulate the internal organs. Traditionally, it is believed that rhubarb is bitter, cold, laxative and laxative, easy to deplete the vital energy, and is prohibited for those with chronic illness and deficiency. For chronic cardiac insufficiency with constipation, it can be used to open the internal organs to lower lung Qi, promote the excretion of toxic metabolites, invigorate blood circulation, promote blood circulation in the intestines. Especially for those with cardiac insufficiency combined with infection and constipation in pulmonary heart disease, rhubarb can be used appropriately to obtain better curative effect. It can be used clinically at about 10g, or about 5g for those with obvious physical deficiency. Decoction with other drugs can weaken its laxative nature and enhance its function of activating blood circulation, resolving blood stasis and dispelling toxins; ③ Nourishing yin and astringent heart qi: if yin is not deficient, yang can be guarded internally and not dispersed externally in order to inject blood vessels to run. Nourishing yin with acid astringent, commonly used maitong, Wu Wei Zi, one can make the yang energy within the guard, warming the heart veins; two can prevent warming yang qi drugs pungent warm hurt yin dispersed gas. Heart qi and heart yang are used to stimulate the blood vessels and run with them. Unlike the spleen yang (qi) which is used to warm the middle and guard the middle, the kidney yang is used to conceal and seal the essence. Supplementing heart yang and heart qi with nourishing yin and acid astringency helps to make heart qi and heart yang run normally in the blood vessels. For those who have deficiency of both heart qi and yin, Shengwen San is often used, and the heart qi benefiting medicine Ginseng is combined with the yin nourishing and acid astringent medicine Mai Dong and Wu Wei Zi. For those who do not have obvious yin deficiency, they should also be supplemented with maitong and wu wei zi on the basis of qi to return the heart qi to the Ying blood. Yang deficiency, the clinical often warm, through the, because of fear of nourishing Yin Gan cold curb its Yang Qi or acid astringent affect Yang temperature, and abandoned. The heart qi, heart yang is different from the Wei qi, Wei yang, go to the muscle surface, warm the flesh, fat couples, the nature of the sudden and slippery, nowhere to go, heart qi, heart yang only contained in the Ying blood, go in the blood vessels, in order to warm the blood vessels to run. Therefore, in the warmth of Yang, through Yang, should also help to nourish Yin acid convergence, in order to play Yin and Yang each other, the wonderful. The author treats chronic cardiac insufficiency, according to the heart qi is easy to dissipate, the heart is the master of blood vessels and the heart and other viscera connection, commonly used formula as follows: ginseng, maitong, Wu Wei Zi, Dan Shen, motherwort, Che Qian Zi, Ze Lan, adzuki beans, Xian Ling Spleen, Ba Ji Tian. For heart yang deficiency and unfavorable blood vessels, add cinnamon branch; for constipation, add rhubarb; for generalized swelling, add mulberry leaf and stone reed. For reference; ④ As chronic cardiac insufficiency is difficult to heal for a long time, there are often pathological changes of Yang loss and Yin, even if there are no obvious clinical symptoms of Yang deficiency or Qi deficiency, there are potential pathological mechanisms of Yang (Qi) loss and Yin. On the basis of tonifying Yang (Qi), slightly supplemented with Yin nourishing herbs, such as maitong and shengdi, can make Yang (Qi) guarded internally, so as to penetrate the blood vessels and transport blood.