Arrhythmia: It is a disturbance of the normal site of origin, frequency, rhythm and conduction system of the heart, and is one of the most common cardiovascular anomalies. It can be caused by myocardial injury due to various cardiovascular diseases, ischemia, hypoxia, or due to drugs, electrolyte disorders (hypokalemia, hyperkalemia or hypercalcemia), anesthesia, mental and emotional abnormalities, genetics and other factors. The etiology of some arrhythmias is unclear, and it is now found that social and psychological factors, stress, and insomnia also play a considerable role in the development of arrhythmias.
Since the use of 24-hour ambulatory electrocardiography and prolonged cardiac monitors in clinical practice, physicians have found that most people have arrhythmias of varying degrees of severity. For example, one researcher applied 7-day continuous ambulatory ECG to screen the general population for arrhythmias and found that 70-75% of the subjects had recorded premature ventricular beats. If the 7-day recorded atrial premature, short-onset atrial tachycardia and atrial fibrillation were statistically processed, the incidence of 7-day arrhythmias would be even higher, even reaching 80-90%, suggesting that the actual incidence of arrhythmias is much higher than what we used to The actual incidence of arrhythmias is much higher than what we used to think.
The North American Arrhythmia Suppression Trial (CAST), a landmark evidence-based trial in the field of cardiac arrhythmias, came of age in the early 1980s, and its findings completely overturned physicians’ beliefs about the treatment of arrhythmias. Since then, physicians have taken a more cautious and conservative approach to the treatment of arrhythmias.
What were the results of the CAST trial?
The purpose and original intent of the trial was that antiarrhythmic drugs would be effective in controlling ventricular arrhythmias in patients with acute myocardial infarction, but the results of the trial showed that the incidence of ventricular arrhythmias was significantly reduced in the treatment group, but the death rate was higher in the treatment group and significantly higher than in the placebo group. Instead, they exacerbate the condition. Subsequently, Morganroth proposed the new concept that antiarrhythmic drugs can cause arrhythmias, which led to a global debate on the pros and cons of arrhythmia treatment and led to the realization that most antiarrhythmic drugs have varying degrees of negative inotropic and cardiotoxic effects, so that before choosing a drug, one must weigh the pros and cons and objectively evaluate the drug efficacy to risk ratio.
Since arrhythmias are so common and there are concerns about the side effects of western drugs, should arrhythmias be treated or not?
The need for arrhythmia treatment depends on the degree of harm and priority of the arrhythmia, which is evaluated through four main aspects.
1, the heart rate is fast or slow: under normal circumstances, the heart rate at rest is 60-80 beats/min. In normal heart function, the heart rate in the range of 40-160 beats/min can maintain the basic needs of human metabolism, but a heart rate below 50 beats/min or above 160 beats/min for a certain period of time will lead to damage to heart function and myocardial ischemia.
2, duration: arrhythmia on the human body with the duration of the cumulative effect of harm, such as sustained tachycardia, can cause cardiac diastolic insufficiency, arrhythmogenic cardiomyopathy, myocardial ischemia, heart failure, and even death.
3, atrioventricular separation: as the name suggests, the atria and ventricles have lost their unity and coordination, the atria and ventricles move separately, without the normal synchronization pattern, resulting in dysfunction of the ventricular pump, or even decline.
4, whether accompanied by heart disease: arrhythmia with underlying heart disease, arrhythmia has the potential to be dangerous, and conversely, arrhythmia can aggravate the original heart disease, the two can be independent of each other, but also affect each other, or a vicious circle occurs, as if adding insult to injury.
So how does Chinese medicine view arrhythmia?
Cardiac arrhythmia belongs to the category of “palpitation”, “palpitation” and “syncope” in Chinese medicine. Cardiac arrhythmia is located in the heart, but it can affect other organs, mainly involving the liver, spleen and kidney, and can also affect the heart due to diseases of other organs, and the onset of the disease is often related to physical weakness, emotional stimulation, invasion of external evil, diet disorders and other factors.
1, external invasion of evil toxins, internal shedding in the heart, depletion of oxygen and injury to yin, loss of nourishment of the heart veins and resulting in cardiac arrhythmia.
2, mental stimulation, seven emotions and disharmony, Qi stagnation and blood stasis, stagnation of the heart veins and abnormal conduction.
3, heart Qi deficiency or heart Yang is not invigorated, the pulsation is weak, blood does not campanulate, pulse Qi can not be properly articulated and lead to arrhythmia.
4, deficiency of both qi and blood, imbalance of yin and yang, inability to regulate each other, resulting in irregular pulse rhythm.
From the above, it is clear that TCM considers arrhythmia as a complex symptom, which requires evidence-based treatment and holistic regulation, which integrates many pathological factors and brings into play the body’s own homeostatic regulatory mechanism, using the regulatory efficacy of TCM with multiple sites, targets and channels to trigger and mobilize the body’s own repair and self-healing ability to achieve the integration and coordination of the cardiovascular system with other systems and restore the heart rhythm disorder.
Chinese medicine has a long history of treating cardiac arrhythmias. As early as the Han Dynasty, Zhang Zhongjing proposed in “The Essentials of the Golden Horoscope” that “pulse knotting and palpitations” and “roasted licorice soup is the main remedy”. It is still the representative formula for palpitations. This formula has been used for thousands of years and is still effective today. In the “Danxi Xinfa” of the Yuan Dynasty, Zhu Danxi summarized the four substances and Zhu Sha An Shen Tang, and in the “Medical Lin Zaiwu” of the Qing Dynasty, Wang Qingren proposed the Blood Mansions and Stasis Expulsion Tang, all of which are still in use today and are classical and effective formulas with guiding significance.
There are countless cases of arrhythmias treated by modern TCM, and the treatment methods are also rich and diverse. The Heart Stabilizing Granules based on the classic formula of Roasted Licorice Soup and the Ginseng and Pine Heart Capsules based on the theory of complex disease have achieved significant efficacy in both animal experiments and clinical observations, and have been confirmed by scientific research to have a regulatory effect on the ion channels of cardiomyocytes, which is a strong indication of the effectiveness of TCM, and It has been confirmed by a multicenter, randomized, double-blind, large-scale evidence-based medical trial to be effective and safe in the treatment of various cardiac arrhythmias.
What are the arrhythmias that are suitable for TCM treatment? They are described as follows.
1, sinus tachycardia: especially caused by easy tension, anxiety and insomnia.
2, all kinds of premature beats: mainly functional premature beats, including frequent diphasic, ventricular, atrial and junctional premature beats.
3. Episodic and short-onset supraventricular tachycardia: including atrial tachycardia, atrial flutter, atrial fibrillation, and short-onset supraventricular tachycardia; episodic refers to episodes of several months or years, and short-onset refers to paroxysmal episodes, which last for several minutes or hours and can be relieved by themselves.
4, general sinus bradycardia: refers to heart rate <60 beats/min, no syncope, haze and other phenomena occur.
5.A variety of arrhythmias occurring during menopause; menopause can cause endocrine disorders in women due to changes in estrogen levels, resulting in atrial premature, ventricular premature, tachycardia and other arrhythmias.
6, arrhythmias with palpitations, panic, sweating and other phytonadic disorders.
What is the significance of arrhythmia treatment?
The causes of arrhythmia are complex, and the same arrhythmia occurs in different people with different clinical manifestations and causes different hazards, for example, the same paroxysmal atrial fibrillation, some people can have thromboembolism and heart enlargement and other complications after a few episodes, while some people have no complications for life; the same tachycardia, some people can have heart enlargement and arrhythmogenic cardiomyopathy after a few years, leading to It is found that myocardial ischemia has a cumulative damage effect, and transient ischemia will increase the total ischemic load: similarly, frequent arrhythmias also have a cumulative damage effect, which may be functional in the early stage, but will develop into organic changes from quantitative to qualitative changes in the long term. Therefore, if arrhythmias are found, they should not be taken lightly and should be checked regularly. For functional premature beats, comprehensive adjustment can effectively reduce the occurrence of arrhythmias by making full use of the advantages of Chinese medicine, which is non-toxic and has no side effects and can be taken for a long time.