[Clinical Treatment
I. Discriminatory treatment
(A) Identifying the evidence
The development of viral myocarditis is always characterized by the pathological changes of the prevailing and declining of evil and yin and yang, and the manifestations of the symptoms are complex and varied. The symptoms are complex and varied, and are always a result of a deficiency of the root cause and the symptoms of the symptoms. The pathogenesis of the disease and the manifestations of the symptoms vary from individual to individual at different stages of the disease, therefore, evidence-based treatment is still the most common clinical method in Chinese medicine for treating this disease. Based on the principle of treating the symptoms of the disease when it is urgent and treating the root cause when it is slow, at the beginning of the disease, the focus should be on removing the evil to calm the righteousness. In the middle and late stages of the disease, the focus should be on helping the righteous to eliminate the evil. Hu Siyuan, Department of Paediatrics, The First Affiliated Hospital of Tianjin University of Chinese Medicine
(II) Treatment of symptoms
1. Evidence of external infection of evil and poison, invading the heart and veins
(1) Wind-heat invading the lung and heart
Clinical manifestations Fever with slight chilliness, sweating, redness and swelling of the throat, cough, myalgia, skin rash, followed by palpitations, shortness of breath, weakness and heart pain.
Analysis of the pathogenesis External wind-heat evil toxins invade the lung guard, hence the wind-heat superficial evidence; heat toxins invade the heart and damage Qi-Yin, hence the evidence of Qi-Yin deficiency of the heart.
Treatment Drain wind and clear heat, detoxify and protect the heart.
Application of prescriptions and medicines
Commonly used formula: Yin Qiao San (Wenzhi Zhuandian) plus and minus.
Yin Hua, Lian Qiao, Da Qing Ye, Wild Chrysanthemum, Guan Zong, Mint, Mustard, Edamame, Rutabaga, Bamboo Leaf, Mai Dong, Licorice.
Add and subtract: If heat congests the heart and blood, the symptoms include heart pain and knotted pulse, add Danshen, Red Peony, Bitter Ginseng and Huang Lian; if heat toxicity consumes qi and injures yin, add Prince’s Ginseng, Yu Zhu, Xuan Shen and Sheng Di; if wind-heat enters the lung, phlegm-heat obstructs and spreads internally to the heart, the symptoms include fever, cough and asthma, yellow phlegm, slippery pulse, palpitations, weakness, shortness of breath and heart pain, etc., add flavor to Ma Heng Gan Shi Tang to clear heat and promote the lung, resolve phlegm and asthma, and calm the mind. To calm the mind and tranquilize the spirit.
Commonly used Chinese medicines
Shuanghuanglian powder injection: 60mg/(Kg・d), add 150~250ml glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. Suitable for wind-heat and heat toxicity evidence.
Phlegm Heat Clear Injection: 5~20ml/d, add 150~250ml glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. Applicable to phlegm-heat evidence.
(2) Damp-heat invading the spleen and attacking the heart
Clinical manifestations Recurrent fever, sweating without relief, generalized pain, redness and swelling of the throat, nausea and vomiting, abdominal pain and diarrhoea, tiredness and fatigue, chest tightness and distension, palpitation and heartache, dizziness and shortness of breath, red tongue with greasy coating, moist pulse or intermittent.
Analysis of the pathogenesis External dampness and heat invade the spleen and stomach in the middle Jiao, hence the evidence of dampness and heat; dampness and heat invade the heart and deplete the heart qi, hence the evidence of deficiency of heart qi.
Treatment To resolve dampness and clear heat, detoxify the toxins and calm the heart.
Application of prescriptions and medicines
① Commonly used formula: Gan Lu Disinfectant Dan (Warming Heat Jing Wei) with addition and reduction.
Slippery Rock, Yin Chen, Scutellaria baicalensis, Huang Lian, Lian Qiao, Radix eucommiae, Peppermint, Soybean roll, Bitter Ginseng, Tiger Balm, Atractylodes cantonensis, Licorice.
If the symptoms include fever, head heavy as a wrap, muscle pain, nausea and vomiting, dullness and weakness, abdominal distension and diarrhoea, palpitation and shortness of breath, greasy tongue coating, moist and slow pulse or knotted generation, add or subtract Huo Xiang Zheng Qi San or Lei’s Xuan Shu Xuan Xuan Damp method to clear the surface and resolve dampness; if the symptoms are due to damp-heat invasion, both the surface and the interior are real, disturbing the mind, with fever, diarrhoea and abdominal pain, palpitation and chest tightness, slippery pulse If the symptoms include fever, diarrhoea, abdominal pain, palpitation, chest tightness, slippery pulse or shortness of breath, we can use Ge Gen Scutellaria Tang with addition to clear the heat and dampness, detoxify and penetrate the evil and calm the mind.
③Commonly used traditional Chinese medicines
Qingkailing Injection: 5~20ml/d, add 150~250ml glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. Applicable to damp-heat evidence.
(3) Reference for clinical evidence
According to Hu Si-yuan, the evidence of external infection of evil toxins and invasion of the heart and veins is commonly seen at the beginning of the acute phase of viral myocarditis, when clinical symptoms of respiratory or gastrointestinal viral infection are predominant. In this case, if an ECG is routinely performed, premature beats, ST-T changes, atrioventricular block or bradycardia can be detected. Early detection and care of the heart, while focusing on the primary cause, can help to stop the progression of myocardial disease. Myocarditis has a long course and can manifest itself in the recovery, prolonged, chronic and even post-acute periods. In addition, some seasonal diseases such as measles, mumps and chicken pox can easily involve the heart and lead to myocarditis, so clinical treatment should also focus on treating the original disease, while taking early care of the heart energy and heart yin.
2. Internal trapping of evil toxins, Yang Qi failure
(1) Weakness of heart yang
Clinical manifestations Sudden onset of pale or greyish complexion, restlessness, chest tightness and shortness of breath, blue lips, cold extremities, enlarged heart, masses under the right hypochondrium, swelling of the lower limbs, scanty urination, blue tongue or petechiae, weak pulse.
Analysis of the pathogenesis of the disease: internal trapping of the evil toxin, lack of support for the right qi, damage to the heart yang, hence the evidence of deficiency of the heart yang.
Treatment Warming and tonifying the Heart-Yang, inducing diuresis and removing stasis.
Application of prescriptions and medicines
①Commonly used formula: Ginseng and Radix Pseudostellariae (Women’s Recipe) with added flavour.
Ginseng, Radix et Rhizoma, Semen Scopariae, Radix Angelicae Sinensis, Radix Salviae Sinensis, Radix et Rhizoma Saffron.
②Addition and subtraction: Combination of Chinese and Western medicine is used when necessary.
③Commonly used Chinese medicines
Ginseng and Fructus injection: administered intravenously at 10-20ml/d with 150-250ml of glucose injection. It is suitable for the evidence of deficiency of heart yang and external loss of yang energy.
(2) Violent loss of Yang energy
Clinical manifestations Sudden onset of pale or blue-gray face, cold extremities, profuse sweating, restlessness, or even coma, shortness of breath, little or no urination, blue and purple lips and nails, florid skin, decreased blood pressure, and a weak pulse that wants to die.
Analysis of the pathogenesis of the disease: internal trapping of evil toxins, lack of support for the righteousness, violent loss of yang energy and deficiency of heart yang.
Treatment Benefit Qi, astringent Yin, and return Yang to consolidate detachment.
Application of prescriptions and medicines
①Commonly used formula: Ginseng, Radix et Rhizoma Longmu, Rescue the Rebellion Soup (experimental formula).
Ginseng, Radix et Rhizoma, Dragon Bone, Oyster, White Peony and Licorice.
②Addition and subtraction: if the lips and nails are blue, add peach kernel and safflower: if yin is the main cause, add Shengwen San to benefit qi and save yin; if yang is weak and cold, blood does not nourish the brain, qi and blood are disordered, the symptoms include convulsions, coma, coldness in the hands and feet, and sluggish pulse, add and subtract Ginseng and Concentrate Soup with Mahuang and Pine Soup to warm yang and dispel cold, benefit qi and nourish blood.
③ Commonly used Chinese medicine: concentric Yang deficiency.
Acupuncture and moxibustion therapy
①Selected acupoints Main acupoints: Su Mash, Neiguan. Companion points: Shaochong, Shaozhe, Zhongchong, Yongquan.
Method Medium to strong stimulation or strong stimulation, leave the needles in place, twist continuously or intermittently and leave the needles after 3 hours when the blood pressure is stable.
Functions To raise blood pressure. Suitable for resuscitating cardiogenic shock.
②Selected points: Renzhong, Shixuan, Neiguan and Fenglong.
Method: Strong stimulation, retaining the needles.
Functions To open and close the needle. Indicated for the resuscitation of viral myocarditis in which the evil is trapped in the pericardium and the internal is closed and the external is detached.
(3) Reference for clinical evidence
According to Hu Siyuan, the evidence of internal trapping of evil toxins and failure of heart yang is also seen in the initial stage of the acute phase of viral myocarditis, which is complicated by acute congestive heart failure, cardiogenic shock and As syndrome, and is an acute and critical illness that can easily lead to death. According to Chinese medicine, it is caused by the internal trapping of evil toxins that violently damage the heart’s yin and heart’s yang, making the yin and yang unable to maintain each other, especially when the heart’s yang fails. Therefore, treatment should focus on saving heart yang, while not forgetting to balance yin and yang. For those who are suffering from a deficiency of heart yang, the clinical treatment may include the addition of Wanqing, Fructus wujia bark, Fuxing grass and Bellflower to help strengthen the heart.
3. Evidence of damage to the heart chakra due to retention of evil toxins
(1) Heat and toxins do not go away, injuring Yin and depleting Qi
Clinical manifestations Low fever that does not subside or recurrent fever, red and swollen throat, cough, dry mouth, irritability of the heart, heat in the hands and feet, weakness, palpitations, shortness of breath, dizziness, excessive sweating, red or light red tongue, little moss or yellow moss in the middle, slippery or fine pulse.
Analysis of the pathogenesis Heat and toxins remain, hence the evidence of heat and toxins; Qi and Yin have been injured, hence the evidence of Qi and Yin deficiency of the heart.
Treatment Clear the heart and detoxify the toxin, nourish Yin and benefit Qi.
Application of prescriptions and medicines
①Commonly used formula: Clearing the heart and detoxifying the toxin (experimental formula).
Wild chrysanthemum, Big green leaf, Radix et Rhizoma, Radix et Rhizoma Ginseng, Radix Rehmanniae Praeparata, Radix Paeoniae Alba, Salviae Miltiorrhizae, Chuan Lian, Yu Zhu, Radix et Rhizoma Glycyrrhizae.
(2) Add and subtract: for low-grade fever, add Yin Chai Hu and Di Bone Bark; for cough, add Radix Platycodon grandiflorus, Semen Scopariae, Qian Hu and Loa; for pain in the heart and chest, add Psidium guajava, Dan Shen, Yu Jin and Chuan Xiong; for marked weakness and palpitations, add Sheng Sheng Wu San; for knotted pulse generation, add Bitter Ginseng and reuse Chuan Lian.
(2) Dampness and toxins stay in the body, injuring Yang and depleting Qi
Clinical manifestations Fever rising and falling, palpitation, chest tightness, tiredness, fatigue, cool sweating, pale complexion, dullness and loose stools, pale red tongue, white greasy coating, moist and slow pulse or knotted generation.
Analysis of the pathogenesis of the disease
Treatment To clear heat and dry dampness, benefit Qi and warm Yang.
Application of prescriptions and medicines
① Commonly used formula: Ginseng and Astragalus Pill (The Complete Book of Ulcers) with added flavour.
Bitter ginseng, Chuan Lian, Cang Zhu, Hou Pu, Huang Qi, Gui Zhi, Fu Ling, Gan Cao, Dan Shen, Yu Jin.
(2) Add and subtract: for cold extremities, add Radix et Rhizoma Pseudostellariae and Radix Ginger; for sluggish pulse, add Roasted Ephedra and Hesperidin; for dullness, add Jiao Sanxian and Jiao Hamlet; for scanty stools, add Poria and Zedoary; for sweating, add Dragon Bone and Faustus; for fever, add Edamame, Soybean Roll and Fresh Lotus Leaf.
(3) Reference for clinical evidence
According to Hu Siyuan, the evidence of evil toxins staying and damaged heart veins is commonly seen in the acute phase of myocarditis. The majority of clinical cases manifest this evidence at the beginning of the consultation, with the evidence of heat and toxins not being exhausted and injuring yin and depleting qi being the most common. The clinical diagnosis can be determined with reference to the following two conditions: firstly, there are obvious signs of retention of heat toxins such as fever, red and swollen throat and cough, and secondly, there are minor signs of incomplete heat toxins such as red throat within 2 to 3 months of the disease. The treatment should focus on eliminating the evil, and when the evil is gone, the righteous will be safe.
4. Evidence of the bias of Qi, Blood, Yin and Yang
(1) Deficiency of both qi and yin
Clinical manifestations Obvious weakness, dizziness and sweating, palpitations, dry mouth and tongue, pale or red tongue with little fur, thin and weak pulse.
Analysis of the pathogenesis Qi and Yin are deficient and the heart is deprived of nourishment and cannot be nourished.
Treatment To benefit Qi and nourish Yin.
Application of prescriptions and medicines
①Commonly used formula: Sheng Wei San (Prepared for Emergency Thousand Gold Essentials) with added flavour.
Radix et Rhizoma Ginseng, Radix et Rhizoma Macrocephalae, Fructus Schisandrae, Rhizoma Polygonati, Radix et Rhizoma Huangjing, Radix Rehmanniae, Radix Salviae Miltiorrhizae, Radix et Rhizoma Glycyrrhiza.
Add and subtract: for Qi deficiency, add Radix Astragali and Atractylodes Macrocephala; for Yin deficiency, add Radix et Rhizoma Ginseng and Lily; for heat toxicity retention, add Dan Pi, Radix Paeoniae Alba and Wild Chrysanthemum; for stasis of the heart veins, add Rhizoma Chuanxiong, Radix Angelicae Sinensis, Radix Angelicae Sinensis and Rhizoma Ginger. Add Faustus; for heart trouble, add Huang Lian and Gardenia.
③Commonly used Chinese patent medicines
Ginseng and wheat injection: 10~20ml/d, add 150~250ml glucose injection in intravenous drip, once a day, 7~10 days as a course of treatment. Applicable to Qi and Yin deficiency.
Shengve Injection: 10~20ml/d, add 150~250ml glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. It is suitable for the evidence of deficiency of both Qi and Yin.
Yu Dan Rong Xin Wan: 1.5g/pill. Take orally. Children:2-4 pills each time, three times daily. Indicated for viral myocarditis with deficiency of Qi and Yin and stagnation of heart veins.
(2) Qi-Yang deficiency
Clinical manifestations Pale face, cold extremities, palpitation, shortness of breath, weakness and spontaneous sweating, pale tongue, thin white fur, sluggish and feeble pulse or knotted generation.
Pathogenesis Insufficient qi-yang, weak agitation and loss of nourishment of the limbs.
Treatment To benefit Qi and warm Yang.
Application of prescriptions and medicines
Commonly used formula: Ginseng and Astragalus Beneficial Qi Tang (Rhinoceros Candle on the Origin of Miscellaneous Diseases) combined with Ma Huang and Phyllanthus Fine Pine Tang (Treatise on Typhoid Fever) plus or minus.
Radix Codonopsis pilosulae, Cinnamomum cassiae, Epimedium asiaticae, Radix et Rhizoma asiaticae, Radix et Rhizoma asiaticae, Glycyrrhiza glabra.
(ii) Add and subtract: for concurrent blood stasis and qi stagnation, add Danshen, Chuanxiong, Radix Angelicae Sinensis, Citrus aurantium, and Fragrant Herb; for concurrent internal obstruction of phlegm and dampness, add Radix Panax, Psidium guajava, Poria, Chen Pi, and Yu Jin.
③Commonly used traditional Chinese medicines
Astragalus injection 5-20ml/d, add 100-250ml of glucose injection into intravenous drip, once a day, 7-10 days for a course of treatment. Applicable to the evidence of deficiency of heart qi.
Huang Qi Granules 4g/bag. 4g each time, 2 times daily, taken orally.
(3) Evidence of deficiency of both Qi and Blood
Clinical manifestations Pale or withered face, palpitations and palpitations, weakness, dizziness, spontaneous sweating and shortness of breath, pale tongue, thin coating, thin or knotted pulse, generation.
Analysis of the pathogenesis Qi and Blood deficiency, the heart is deprived of nourishment and has no upper glory, hence the symptoms.
Treatment To benefit Qi and nourish Blood, restore the pulse and calm the heart.
Application of prescriptions and medicines
①Commonly used formula: Roasted licorice and sweet grass soup (Treatise on Typhoid Fever), plus and minus.
Roasted licorice, Radix Rehmanniae, Mai Dong, Aconite, Radix Angelicae Sinensis, Radix et Rhizoma Ginseng, Radix prunus ginseng and Radix et Rhizoma Cinnamomi.
(2) Add and subtract: for concurrent blood stasis, add Dan Shen and Hong Hua: for concurrent Yang deficiency, add Epimedium and reuse Gui Zhi; for concurrent food stagnation, add Jiao San Xian, Citrus aurantium and Jiuxiang Worm; for concurrent spleen deficiency, add Radix Codonopsis, Atractylodes and Huang Qi.
(4) Evidence of loss of both yin and yang
Analysis of the pathogenesis of the disease: The kidney is a source of true yin and true yang. If the disease is prolonged and affects the kidney, the loss of yin and yang, or the loss of yang and yin, may lead to the loss of both yin and yang and result in this symptom.
Treatment Nourish the kidneys and Yang, harmonize Blood and nourish the heart.
Application of prescriptions and medicines
①Commonly used formula: for those with deficiency of Yin and Blood, use Sheng Wei Wei Tonic Essence Soup (Classical Treatments).
Ginseng, Wu Wei Zi, Mai Dong, Shu Di, Radix Angelicae Sinensis and Deer Antler.
For those with a predilection for weakened yang energy, use Ginseng and Astragalus Beneficial Qi Tang (Rhinoceros Candle on the Origin of Miscellaneous Diseases).
Ginseng, Astragalus, Radix et Rhizoma, Atractylodes Macrocephala, Radix et Rhizoma Glycyrrhizae, Fructus Schisandrae, Radix et Rhizoma Macrocephala and Pericarpium Citri Reticulatae.
Add and subtract: for those with internal obstruction of blood stasis, enlarged heart, mass under the right hypochondrium, purple tongue and sluggish pulse, add Dan Shen, Red Peony, Red Flower, Radix Panax notoginseng, Citrus aurantium, Chuan Xiong, etc.; for those with internal stagnation of water and drink, swelling of the face and limbs, shortness of breath and cough, add Fang Qi, Atractylodes macrocephala, Scapularia scabra, Ze Xie, Pig Ling, Poria, Plantago ovata, etc.
Commonly used Chinese medicines
Jisheng Kidney Qi Pill: Take orally. Small honey pill 9g at a time, large honey pill 1 pill at a time, 2~3 times a day. Reduce as appropriate for children.
(5) Reference for clinical evidence
According to Hu Siyuan, the evidence of partial strength and weakness of qi, blood, yin and yang is mostly seen in the recovery period, extended period or chronic period of myocarditis. As this disease is always a combination of deficiency and deficiency, the above-mentioned series of symptoms are in fact deficient in nature and dominated by deficiency. In terms of treatment, the focus should be on tonifying the deficiency and correcting it, while not forgetting to eliminate the real and treat the symptoms. In terms of specific symptoms, Qi-Yin (Blood) deficiency is the most common clinical condition, and is often manifested in myocarditis when there is myocardial injury or arrhythmia (e.g. premature beats), so treatment should focus on benefiting Qi and nourishing Yin (Blood). The treatment should focus on both yin and yang, with some emphasis on yin and yang according to their deviations.
5. Stasis of Blood, Phlegm and Paralysis of the Heart Vessel
(1) Stasis of the Heart Vessel
Clinical manifestations Dark face, blue lips, tingling in the heart, palpitations and palpitations, weakness and night sweating, suffocation in the chest, enlargement of the heart, vague blue tongue or petechiae, thin coating, astringent or thin pulse or knotted and rapid pulse.
Analysis of the pathogenesis: Deficiency of the heart’s qi, blood, yin and yang can lead to stagnation of blood flow and all the symptoms.
Treatment To invigorate blood circulation, resolve blood stasis and nourish the blood to clear the veins.
Application of prescriptions and medicines
①Commonly used formula: Blood Mansions and Stasis Removal Soup (《醫林改错》) with addition and reduction.
Radix Angelicae Sinensis, Radix Rehmanniae Sinensis, Radix Panax Ginseng, Fructus Crataegus, Radix Paeoniae Alba, Rhizoma Ligustici Chuanxiong, Radix et Rhizoma Gastrodiae, Citrus Aurantium.
For heat congestion and blood stagnation, add Dampi, Wild Chrysanthemum, Dacryophyllum, Chuanlian, Guanzhong and Shenggan; for Qi deficiency and blood stagnation, add Astragalus and Radix Codonopsis (or Ginseng or Prince’s Ginseng); for Yin deficiency and blood astringency, add Mai Dong and Yuan Shen; for Yang deficiency and blood clotting, add Radix et Rhizoma, Gui Zhi, Deer Antler and Epimedium; for Qi stagnation and blood stagnation, add Radix Aromaticus, Yu Jin and Wu Yao. If the pulse is knotted, add bitter ginseng, Chuan Lian, Gan Song, Chang Shan and Qiang Wu as appropriate; if the pulse is thin and astringent, add Aconite and Jujube as appropriate; if the chest is stuffy, add Gua Gua and Han Xia; if the heart is painful, add Yuan Hu, Boswellia and Myrrh; if the liver is large, add Qing Pi, Nei Xiang and Wu Jia Pi.
③Commonly used Chinese patent medicines
Compound Salvia injection: 5~20ml/d, add 100~250ml glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. Applicable to blood stasis evidence
Blood stasis granules: 5g per sachet, take with warm water, 1 sachet once, 3 times a day. Reduce as appropriate for children. Indicated for evidence of blood stasis.
(2) Phlegm paralysis and obstruction
Clinical manifestations Chest tightness and breath or long breath, palpitation and shortness of breath, dizziness, poor appetite and dullness, chest pain, fat tongue, white and greasy coating, moist and smooth pulse or knotted generation.
Analysis of the pathogenesis: Deficiency of the heart’s qi, blood, yin and yang can lead to internal production of phlegm and stagnation of phlegm and qi, hence the symptoms.
Treatment To resolve phlegm and regulate qi, broaden the chest and clear yang (tranquilize the heart).
Application of prescriptions and medicines
① Commonly used formula: Er Chen Tang (Da Ping Huimin Hodong Bureau Formula) combined with Gua Gua Bai Allium and Pan Xia Tang (Jin Kui Yao) plus and minus.
Gua Gua, Allium, Semen, Chen Pi, Poria, Citrus Aurantium, Yu Jin, Licorice.
②Addition and reduction: for phlegm-heat paralysis and obstruction, add and reduce with Huang Lian Wen Bile Tang instead; for phlegm-qi stagnation and obstruction, add and reduce with Si Qi Tang instead; for Yang deficiency and water flooding, add and reduce with Zhen Wu Tang instead. For Blood stasis, add Dan Shen and Chuan Xiong; for Qi deficiency, add Radix Codonopsis, Astragali and Atractylodes; for Yin deficiency, add Mai Dong, Yuan Shen and Zhe Bei; for food deficiency and fruit deficiency, add Sha Ren, Huo Xiang and Jiao San Xian: for dizziness, add Ze Xie.
(3) Reference for clinical evidence
According to Hu Siyuan, the evidence of stasis, blood, phlegm and paralysis of the heart can be seen in all clinical stages of myocarditis, and is often seen together with the evidence of deficiency. The treatment is based on activating blood stasis and dispelling phlegm, but depending on the severity of the deficiency of qi, blood, yin and yang, additional supplements should be added to help correct the deficiency. Even when there is no obvious evidence of deficiency, care should be taken to protect the righteousness so as not to injure the righteousness by invigorating stasis or dispelling phlegm. In addition, stasis of blood, phlegm and dampness, as well as qi stagnation and heat toxicity, are often found in conjunction with each other and should be taken into account in clinical practice. In general, this evidence, especially the evidence of stasis blocking the heart chakra, is commonly seen in people with a long history of myocarditis, but it should be noted that this evidence is not only seen in people with a long history of disease. In recent years, clinical practice has confirmed that the treatment of all stages of viral myocarditis with the method of activating blood circulation and resolving blood stasis has achieved good clinical results, usually in combination with the method of clearing heat and detoxifying toxins in the acute stage, and in combination with the method of regulating qi, blood, yin and yang in the recovery, extension and chronic stages. The sequelae of myocarditis are often clinically manifested as more stable electrocardiographic abnormalities, such as premature beats, various conduction blocks, etc. There are also patients with enlarged hearts or ventricular hypertrophy, most of whom have no obvious conscious symptoms and are often clinically undocumented. This is in line with the academic view of Chinese medicine that “long-standing diseases enter the liao”. Many studies have shown that herbs such as Salvia miltiorrhiza and Yimoucao can improve the microcirculation of the heart and promote the regeneration of myocardial cells, which can help to eliminate residual myocardial lesions and promote healing.
According to Liu Jingqi, the main symptoms of viral myocarditis are palpitations, nausea, shortness of breath, general weakness, and in some cases, swelling of the lower limbs. According to the Golden Tablet: “Coughing and rebellion leaning on the breath, short of breath and unable to lie down, its shape is like a god, it is called branch drinking”. “For those who vomit during stroke, who have a heart puffiness, water in the compartments, and who have vertigo and palpitations, Xiao Han Xia plus Get, etc. is the mainstay of the soup”. As the drink stops under the heart, the heart is swollen and the heart is uncomfortable, vomiting without thirst. Water qi upwardly obscures the clear yang, hence dizziness of the eyes; water qi overwhelming the heart leads to palpitations. As both the surface and the interior are attacked by the evil of drink, the Ying and Wei are not favoured and water and drink overflow and spread throughout the body, hence the swelling. If the drink stops in the stomach, the stomach cannot overflow with essence, so the whole body loses nourishment and is tired and weak.
(III) Selection of effective remedies
The Chinese herb Astragalus has the effects of benefiting the qi and nourishing the vital energy, raising the yang and consolidating the surface, supporting the righteous and dispelling the evil, nourishing the heart and opening the veins. In recent years, a large number of experimental studies at home and abroad have proved that Astragalus has anti-viral, regulating the immune function of the body, enhancing adrenal cortical function, anti-hypoxia, anti-radiation and raising white blood cells, with obvious regulating effects on non-specific immunity, humoral immunity and cellular immunity. Astragalus injection is refined from the active ingredients of Astragalus membranaceus and has significant effects on enhancing myocardial contractility, improving myocardial diastolic function, inhibiting calcium ion inward flow, scavenging oxygen free radicals, improving myocardial tolerance to hypoxia, protecting myocardial cells and improving cardiac function. At present, various types of Astragalus preparations are widely used in the treatment of paediatric myocarditis, all of which have achieved better results.
Yudan Rongxin Wan is a new Class III Chinese medicine developed according to Professor Chen Baoyi’s experience prescription. In this formula, yu zhu is sweet and calm to nourish yin, wu wei zi is sour and warm to astringent yin, glycyrrhiza is sweet and calm to benefit qi, “sweet and warm to benefit qi, sour and sweet to transform yin”, combined together, it has the function of benefiting qi and nourishing yin. The two herbs have the function of invigorating the blood and resolving stasis. Da Qing Ye and Bitter Ginseng enter the heart with bitter cold, clearing heat and detoxifying toxins to remove residual heat and evil toxins. The whole formula works together to benefit Qi and nourish Yin, invigorate blood circulation and resolve blood stasis, and clear heat and detoxification. Most paediatric viral myocarditis develops after viral infection and is caused by the depletion of Qi and blood in the heart veins by evil toxins.
(IV) Experiences of famous doctors
1. Liu Buchen’s experience
According to Liu Bichen, the prevention and treatment of viral myocarditis in children must pay due attention to the treatment of primary causes, such as upper respiratory tract infections and viral infections of the digestive tract, which can greatly reduce or prevent the occurrence of viral myocarditis. If viral myocarditis has developed, in addition to active medication, patients should rest in bed and eat foods that are easily digestible and rich in vitamins and proteins in order to enhance resistance to disease and promote rapid recovery of body functions. In terms of treatment, TCM believes that there are only two ways to “dispel evil” and “stabilize righteousness”, which should be determined according to the specific condition. The desired effect will be achieved.
2. Chen Baoyi’s experience
According to Chen Baoyi, the evil of heat and toxicity is the main cause of myocarditis. The result is fever, sore throat, cough, diarrhoea, heartburn, dry mouth and inability to drink, rash, palpitations, weakness and heartache, with red and vivid tongue and smooth or fine pulse.
The heat toxin enters the heart and depletes the qi, blood, yin and yang, which is a key part of the transformation process of myocarditis. The heart is not nourished by a deficiency of yin and blood, and the heart is weak in yang, which can lead to poor blood flow and stagnation of the heart; in turn, stagnation of the heart can impede the normal flow of qi and blood and affect the healing of the disease. Therefore, invigorating the blood and opening the blood vessels, eliminating stasis and creating new blood is an important treatment at this stage.
In the course of myocarditis, the stagnation of the Heart Vessel for a long time may lead to obstruction of the flow of Qi and stagnation of Phlegm, which may further aggravate the stagnation of the Heart Vessel. The purpose of regulating qi and resolving phlegm is to move the stasis more effectively, so as to clear the heart vessels, dissipate the stasis and promote recovery. As myocarditis is always an evidence of deficiency of the heart, this method is usually applied when the original deficiency (deficiency of the heart’s qi, blood, yin and yang) has normalised, or when the condition is mild and the deficiency is not too severe, but the main cause of the disease is the underlying deficiency (qi stagnation, phlegm blockage, blood stasis).
3. Song Jo Min’s experience
According to Song Jo Min, paediatric viral myocarditis is a case of injury to Yin followed by injury to Yang. After prolonged illness, the loss of Qi and blood in Yin and Yang will lead to stagnation of the heart veins, which will eventually lead to Yin damage and Yang, and Yang damage and Yin complex changes. Injury to the yin and deplet