” [Clinical Treatment
I. Identification and treatment
hpv infection has a certain effect.
The development of viral myocarditis has always been the pathological changes of the prevailing and declining of evil and yin and yang, and the manifestations are complex and varied, and always belong to the evidence of deficiency of the origin and the symptoms. The root of the problem lies in the partial strength and weakness of the body’s qi, blood, yin and yang, while the symptoms are different from external evil and toxicity, internal blood stasis, phlegm and dampness. The pathogenesis and manifestations of the disease vary among individuals at different stages of the disease, therefore, evidence-based treatment is still the most common clinical approach in the treatment of this disease. According to the different conditions of the prevailing and declining evil, deficiency of yin and yang, qi and blood, and retention of stagnant blood, phlegm and dampness, clinical treatment methods such as draining wind, clearing heat, detoxifying toxins, removing dampness, benefiting qi, nourishing yin, tonifying blood, warming yang, rescuing reversal, fixing deficiency, activating stasis, resolving phlegm, promoting water circulation and regulating qi should be flexibly applied. Based on the principle of treating the symptoms of the disease urgently and treating the root of the disease slowly, at the beginning of the disease, the focus should be on eliminating the evil to stabilize the righteousness, and at the middle and late stages of the disease, the focus should be on supporting the righteousness to eliminate the evil. However, if the positive qi is severely weakened, the positive qi should be resuscitated at all times. Hu Siyuan, Department of Pediatrics, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine
(II) Treatment of symptoms
1. External evil and poison, invading the heart and pulse
(1) Wind-heat invading the lung and heart
Clinical manifestations Fever with slight cold, sweating, red throat, swelling and pain, cough, myalgia, skin rash, followed by palpitation, shortness of breath, weakness, heart pain, etc. The tongue is red, the fur is thin, and the pulse is floating or rapid, substituted or knotted.
Analysis of the pathogenesis External wind-heat evil toxins invade the lung guard, so see wind-heat surface evidence; heat toxins invade the heart body, damaging qi-yin, so see the evidence of qi-yin deficiency of the heart.
Treatment Dredge wind and clear heat, detoxify and protect the heart.
Application of prescriptions and medicines
①Commonly used formula: Yin Qiao San (Wenzhi Zhuandian) plus or minus.
Yin Hua, Lian Qiao, Da Qing Ye, Wild Chrysanthemum, Guan Zong, Mint, Mustard, Dou Shuo, Lu Gen, Bamboo Leaf, Mai Dong, Licorice.
Add and subtract: If heat congests the heart and blood, the symptoms include heart pain and pulse knotting, add Dan Shen, 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 congestion, internal transmission in the heart, the symptoms include fever, cough and asthma, yellow phlegm, slippery pulse, palpitation, weakness, shortness of breath and heart pain, etc., add flavor to Ma Heng Gan Shi Tang to clear heat and promote lung, resolve phlegm and asthma, and calm the mind. Calming the heart and tranquilizing the mind.
③Commonly used traditional Chinese medicine
Shuanghuanglian powder injection: 60mg/(Kg・d), add 150~250ml of glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. It is suitable for wind-heat and heat toxicity evidence.
Phlegm-heat clear injection: 5~20ml/d, add 150~250ml glucose injection intravenously, 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 Repeated fever, sweating without relief, generalized pain, redness and swelling of the throat, nausea and vomiting, abdominal pain and diarrhea, tiredness and fatigue, chest tightness and distension, palpitation and heartache, dizziness and shortness of breath, red tongue, greasy coating, moist pulse or intermittent.
Pathogenesis Analysis 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 consume the heart energy, hence the evidence of deficiency of heart energy.
Treatment: Eliminate dampness and heat, detoxify and calm the heart.
Application of prescriptions and medicines
① Commonly used formula: Ganlu Disinfectant Dan (Warming Heat Jingwei) with addition and reduction.
Slippery Rock, Yin Chen, Scutellaria, Huang Lian, Forsythia, Radix Angelicae Sinensis, Peppermint, Soybean Roll, Bitter Ginseng, Tiger Balm, Atractylodes, Licorice.
If the symptoms include fever, diarrhea, abdominal pain, palpitations, chest tightness, slippery pulse, or shortness of breath, we can use Ge Gen Scutellaria Tang with addition to clear heat and dampness, detoxify and penetrate evil, and calm the mind.
③Commonly used traditional Chinese medicine
Qingkailing injection: 5~20ml/d, add 150~250ml of glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. Applicable to damp-heat evidence.
(3) Clinical evidence reference
According to Hu Siyuan, the evidence of external evil toxicity 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. At this time, if the ECG can be routinely examined, premature beats, ST-T changes, atrioventricular block or bradycardia can be detected. Early detection and care of the heart while focusing on treatment of the primary disease is expected to stop the progression of myocardial disease. Myocarditis has a long course and can manifest itself as this group of symptoms during the recovery period, extended period, chronic period, and even post-acute period. In addition, some seasonal diseases such as measles, mumps, chicken pox, etc., are also very likely to involve the heart and myocarditis occurs, clinical treatment should also focus on the original disease, while early care of the heart qi heart yin.
2. the evil poison is trapped, Yang Qi decay off the evidence
(1) Deficiency of heart yang
Clinical manifestations Sudden onset of pale or grayish face, irritability, chest tightness and shortness of breath, blue lips, cold extremities, enlarged heart, mass under the right hypochondrium, swelling of the lower extremities, little urination, blue tongue or petechiae, and weak pulse.
Analysis of the pathogenesis: The internal trapping of evil toxins and the lack of support of positive qi damage the heart yang, hence the evidence of deficiency of heart yang.
Treatment Warming the heart yang, promoting water circulation and removing stasis.
Application of prescriptions and medicines
①Commonly used formula: Ginseng and Radix Pseudostellariae (Women’s Good Recipe) with added flavor.
Ginseng, Radix et Rhizoma, Semen Scopariae, Radix Angelicae Sinensis, Radix Salviae Sinensis, Radix et Rhizoma Safflower.
②Addition and subtraction: Combination of Chinese and Western medicine is used when necessary.
③Commonly used traditional Chinese medicine
Ginseng and Radix Injection: 10~20ml/d, add 150~250ml glucose injection in intravenous drip. Applicable to the evidence of deficiency of heart yang and external loss of yang qi.
(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 urine, 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 positive qi, violent loss of yang qi 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, Licorice.
②Add and subtract: if the lips and nails are blue, add peach kernel and safflower: if yin exhaustion is the main cause, add flavor to Shengwen San to benefit qi and save yin; if yang failure and cold condensation, blood does not nourish the brain, qi and blood disorder, see convulsions, coma, hand and foot rebellious cold, sluggish pulse, add and subtract Ginseng and Annexed Soup with Ephedra and Fructus Sinensis Soup to warm yang and dispel cold, benefit qi and nourish blood.
③ Commonly used Chinese medicine: concentric Yang deficiency failure.
Acupuncture therapy
①Selected acupuncture points Main acupuncture point: Su mash, Neiguan. Supporting points: Shaochong, Shaozhe, Zhongchong, Yongquan.
Method Moderate to strong stimulation or strong stimulation, leave the needles in place, twist continuously or intermittently, and leave the needles 3 hours after the blood pressure has stabilized.
Functions Raise blood pressure. Suitable for resuscitating cardiogenic shock.
②Selected points: Renzhong, Shixuan, Neiguan, Fenglong.
Method: Strong stimulation, with needle retention.
Functions To open and close and fix the abscess. Indicated for resuscitation treatment of viral myocarditis with evil trapped in the pericardium and internal closure and external detachment.
(3) Clinical evidence reference
According to Hu Siyuan, the evidence of internal trapping of evil toxins and heart yang failure 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, violently damaging heart yin and heart yang, so that yin and yang cannot maintain each other, especially heart yang failure is urgent. Therefore, the treatment should focus on saving heart yang, while not forgetting to balance yin and yang. For those who are suffering from deficiency of heart yang, we can also add Wanqing, Fructus wujia bark, Fuxu grass and Bellflower to help strengthen the heart; for those who are suffering from deficiency of heart yang, the disease is very urgent, and if necessary, we can use integrated therapy of Chinese and Western medicine.
3. Evil toxins stay in the heart and damage the heart veins
(1) Heat and toxins do not go away, injuring Yin and consuming Qi
Clinical manifestations Low fever that does not subside or recurrent fever, red and swollen throat, cough, dry mouth, heartburn, 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, smooth or fine pulse.
Analysis of the pathogenesis Heat and toxins stay in the heart, so see the evidence of heat and toxins; Qi and Yin have been injured, so see 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 soup (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 Licorice.
(2) Add and subtract: for low fever, add Yin Chai Hu and Di Bark; for cough, add Radix Platycodon grandiflorus, Semen Scopariae, Qian Hu and Loa; for cardiothoracic pain, add Gua Pou, Dan Shen, Yu Jin and Chuan Xiong; for obvious weakness and palpitations, add Sheng Sheng Wu San; for pulse generation, add Bitter Ginseng and Chuan Lian.
(2) Dampness and toxicity 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, light red tongue, white greasy coating, moist and slow pulse or knotted generation.
Analysis of the disease mechanism Dampness and toxicity remain, so we still see the evidence of damp-heat injury to the spleen; injury to Yang and depletion of Qi, then we see the symptoms of Yang deficiency.
Treatment Clear heat and dry dampness, benefit Qi and warm Yang.
Application of prescriptions and medicines
①Commonly used formula: Ginseng and Astragalus Pill (Ulcer Doctor’s Guide) with flavour.
Bitter ginseng, Chuan Lian, Cang Zhu, Hou Pu, Huang Qi, Gui Zhi, Fu Ling, Gan Cao, Dan Shen, Yu Jin.
②Add and subtract: cold extremities, add Radix et Rhizoma Polygonati, Ginger; sluggish pulse, add Roasted Ephedra, Hosanna; dullness, add Jiao Sanxian, Jiao Hammer; loose stools, add Poria, Zedoary; sweating, add Dragon Bone, Faustus; fever, add Edamame, soybean roll, fresh lotus leaf.
(3) Clinical evidence reference
According to Hu Siyuan, the evidence of evil toxins staying and damaged heart veins is commonly seen in the acute phase of myocarditis, and the majority of clinical cases manifest this evidence at the beginning of consultation, with the evidence of heat toxins not being exhausted and injury to yin and depletion of qi being the most common. The clinical diagnosis can be determined with reference to the following two conditions: one is the presence of fever, red throat, swelling and pain, cough and other obvious evidence of retention of heat and toxicity, and the other is the slight evidence of incomplete heat and toxicity such as red throat within 2 to 3 months of the disease. The treatment should focus on eliminating the evil, and the removal of the evil will make the righteousness safe.
4. Qi, blood, yin and yang are in favor of decay
(1) deficiency of both qi and yin
Clinical manifestations Obvious weakness, dizziness and sweating, palpitations, dry mouth and tongue, light or red tongue, little coating, thin and weak pulse.
Analysis of the pathogenesis Qi and Yin are deficient and the heart is deprived of nourishment and is not nourished, hence the evidence.
Treatment Benefit Qi and nourish Yin.
Application of prescriptions and medicines
①Commonly used formula: Shengwen Wan San (Prepared for Emergency Thousand Gold Essentials) with added flavor.
Radix et Rhizoma Ginseng, Radix et Rhizoma Macrocephalae, Fructus Schisandrae, Rhizoma Polygonatum, Radix et Rhizoma Polygonatum, Radix Salviae Miltiorrhizae, Radix et Rhizoma Glycyrrhiza.
Add floating wheat; 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 intravenously, once a day, 7~10 days as a course of treatment. Applicable to Qi and Yin deficiency evidence.
Yu Dan Rong Xin Wan: 1.5g/pill. Take orally. Children:2-4 pills each time, three times a day. Indicated for viral myocarditis with deficiency of Qi and Yin and evidence of stagnation of heart veins.
(2) Qi-Yang deficiency
Clinical manifestations Pale face, cold extremities, palpitations, shortness of breath, weakness and spontaneous sweating, pale tongue, thin white fur, sluggish and feeble pulse or knotted generation.
Pathogenesis Qi-Yang deficiency, weakness of agitation and loss of nourishment of the limbs, hence the evidence.
Treatment To benefit Qi and warm Yang.
Application of prescriptions and medicines
① Commonly used formula: Ginseng and Astragalus Beneficial Qi Tang (Rhinoceros Candle on the Origin of Miscellaneous Diseases) combined with Ma Huang, Radix et Rhizoma Fine Sinensis Tang (Treatise on Typhoid Fever) plus or minus.
Radix Codonopsis pilosulae, Osmanthus pilosulae, Epimedium pilosulae, Radix Astragali, Glycyrrhiza glabra.
②Add and subtract: with blood stagnation and qi stagnation, add Danshen, Chuanxiong, Radix Angelicae Sinensis, Citrus aurantium, and Fragrant Rhizoma; with internal obstruction of phlegm and dampness, add Semen, Guadua, Fu Ling, Chen Pi, and Yu Jin.
③Commonly used traditional Chinese medicine
Astragalus injection 5~20ml/d, add 100~250ml of glucose injection into intravenous drip, once a day, 7~10 days as a course of treatment. Applicable to heart qi deficiency evidence.
Huangqi Granules 4g/bag. 4g each time, taken orally twice a day.
(3) Evidence of deficiency of both qi and blood
Clinical manifestations Pale or withered face, palpitation and palpitation, weakness, dizziness, shortness of breath with spontaneous sweating, pale tongue, thin coating, thin or knotted pulse, generation.
Analysis of the pathogenesis Qi and Blood deficiency, heart loss of nourishment, no above glory, so see this evidence.
Treatment Benefit Qi and nourish Blood, restore the pulse and calm the heart.
Application of prescriptions and medicines
①Commonly used formula: Roasted licorice soup (Treatise on Typhoid) with addition and reduction.
Roasted licorice, Radix Rehmanniae, Medlar, Agaricus, Radix Angelicae Sinensis, Radix et Rhizoma Ginseng, Radix prunus ginseng, Radix et Rhizoma Cinnamomi.
(2) Add and subtract: for concurrent blood stasis, add Danshen and Safflower: for concurrent Yang deficiency, add Epimedium and reuse Cinnamomum; for concurrent food stagnation, add Jiao Sanxian, Citrus aurantium and Jiuxiangwu; for concurrent spleen deficiency, add Radix Codonopsis, Atractylodes and Astragalus.
(4) Evidence of loss of both yin and yang
Analysis of the disease mechanism The kidney contains true yin and true yang. If the disease is prolonged and affects the kidney, yin loss and yang, or yang loss and yin, both yin and yang can be lost and the symptoms can be seen.
Treatment: Nourish the kidney and help 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 Tang (Classical Evidence Treatment).
Ginseng, Wu Wei Zi, Mai Dong, Shu Di, Radix Angelicae Sinensis, and Deer Antler.
For those with Yang deficiency, 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, Pericarpium Citri Reticulatae.
Add and subtract: for those with internal obstruction of blood stasis, enlarged heart, right hypochondriac mass, purple tongue, sluggish pulse, add Dan Shen, Red Peony, Red Flower, Radix Panax notoginseng, Citrus aurantium, Chuanxiong, etc.; for those with internal stagnation of water drink, swollen face and limbs, wheezing and coughing, add Fang Qi, Atractylodes Macrocephala, Scapularia scabra, Zedoaria, Poria, Poria, Plantago ovata, etc.
③Commonly used traditional Chinese medicine
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) Clinical evidence reference
According to Hu Siyuan, the evidence of bias of qi and blood, yin and yang, is mostly seen in the recovery period of myocarditis, extended period or chronic period. Since the disease is always a deficiency and mixed with deficiency, therefore, the above series of symptoms are actually deficient and dominated by deficiency. In terms of treatment, the focus should be on remedying the deficiency and correcting it, while not forgetting to eliminate the real and treat the symptoms. The most common cause of myocarditis is myocardial injury or arrhythmias (such as premature beats), so the treatment should be to benefit qi and nourish yin (blood). The treatment should focus on both yin and yang, and according to the yin and yang of the decline of the focus, because this evidence is serious, once the heart failure or serious life-threatening arrhythmias, can be rescued using a combination of Chinese and Western medicine.
5. Stasis, blood, phlegm and turbidity paralysis of the heart arteries
(1) Stasis of the heart arteries
Clinical manifestations Dark face, blue lips, tingling pain in the heart, palpitations and palpitations, weakness and night sweating, suffocation in the chest, enlarged 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, remove blood stasis, nourish blood and open the veins.
Application of prescriptions and medicines
①Commonly used formula: Blood Mansions and Stasis Removal Soup (《Medical Forest Reform》) with addition and reduction.
Radix Angelicae Sinensis, Radix Rehmanniae, Radix Panax Ginseng, Fructus Crataegus, Radix Paeoniae Alba, Rhizoma Ligustici Chuanxiong, Radix et Rhizoma Ginseng, Citrus Aurantium.
Add and subtract: for heat congestion and blood stagnation, add Dampi, Wild Chrysanthemum, Big Green Leaf, Chuan Lian, Guanzhong, and Shengan; for Qi deficiency and blood stagnation, add Astragalus, Radix Codonopsis (or Ginseng or Prince’s Ginseng); for Yin deficiency and blood astringency, add Medlar, Yuan Shen; for Yang deficiency and blood clotting, add Radix et Rhizoma, Cinnamomum, Lupinus, Epimedium; for Qi stagnation and blood stasis, add Radix Aromaticus, Yu Jin, and Wu Yao. If the pulse is knotted, add bitter ginseng, Chuan Lian, Gan Song, Chang Shan, Qiang Wu, etc.; if the pulse is thin and astringent, add Aconite, Jujube, etc.; if the chest is stuffy, add Gua Gua, Han Xia; if the heart is painful, add Yuan Hu, Boswellia, Myrrh; if the liver is large, add Qing Pi, Nei Xiang, Wu Jia Pi.
③Commonly used Chinese patent medicines
Compound Salvia injection: 5~20ml/d, add 100~250ml glucose injection intravenously, 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, little food 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 cause phlegm to grow internally, and phlegm blocks qi stagnation, hence the symptoms.
Treatment To resolve phlegm and regulate qi, broaden the chest and open the yang (nimble the heart).
Application of prescriptions and medicines
①Commonly used formula: Er Chen Tang (Da Ping Huimin He Yang Bureau Formula) combined with Gua Gua Bai Bai Han Xia Tang (Jin Kui Yao) plus or minus.
Guadua, Allium, Semen, Chenpi, Poria, Citrus aurantium, Yujin, Licorice.
②Addition and reduction: for phlegm-heat paralysis obstruction, add and reduce Huang Lian Wen Biao Tang instead; for phlegm-qi stagnation obstruction, add and reduce Si Qi Tang instead; for Yang deficiency and water flooding, add and reduce 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, add Sha Ren, Huo Xiang and Jiao Sanxian: for vertigo, add Ze Xie.
(3) Clinical evidence reference
According to Hu Siyuan, the evidence of blood stasis and phlegm paralysis of the heart can be seen in all clinical stages of myocarditis, and is often seen in conjunction with the evidence of deficiency, which is the main evidence of deficiency. Even when there is no obvious evidence of deficiency, attention should be paid to protecting the right qi so as not to injure the right qi by activating stasis and dispelling phlegm. In addition, between blood stasis, phlegm and dampness, and between the two and qi stagnation and heat toxicity also often appear, which should also be taken into account clinically. In general, this evidence, especially the evidence of stasis blocking the heart, is commonly seen in people with a long course of myocarditis, but it should be noted that this evidence is not only seen in people with a long course 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. The sequelae of myocarditis are often clinically manifested as more stable electrocardiogram abnormalities, such as premature beats, various conduction blocks, etc., but also as heart enlargement or ventricular hypertrophy. This is in line with the academic view of Chinese medicine that “long-standing diseases enter the liao”. The results of 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 eliminate the foci left in the heart muscle and promote the healing of the disease.
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 Plaque Essentials”: “coughing against leaning breath, short of breath can not lie down, its shape as God, called the branch drink”. “Stroke vomiting, subcardiac gangrene, compartment with water, dizziness and palpitations, small half summer plus get and other soup main”. As the drink stops under the heart, so the heart under the plankton, the heart is uncomfortable, vomiting but not thirsty. Water qi upward obscures the clear yang, so the eyes are dizzy, and water qi overtakes the heart, so the heart palpitates. As the surface and the interior are attacked by drinking evil, the Ying and Wei are not conducive to the flow of water and drink overflowing, spreading throughout the body, so its shape is like swelling. Drink stops in the stomach, then the stomach can not overflow essence, so the whole body loses nourishment, tiredness and weakness, treatment with small half summer plus Poria soup.
(C) effective formula selection
The Chinese herb Astragalus has the efficacy of benefiting the qi and nourishing the yuan, raising the yang and fixing the surface, supporting the righteousness 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 the effect of anti-viral, regulating the immune function of the body, enhancing the function of adrenal cortex, anti-hypoxia, anti-radiation and raising the white blood cells, and has obvious regulating effect on non-specific immunity, humoral immunity and cellular immunity, and has obvious stimulating and inducing effect on interferon. Astragalus injection is refined from active ingredients extracted from Astragalus membranaceus, which 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 cardiomyocytes and improving cardiac function. At present, various kinds of Astragalus preparations are widely used in the treatment of pediatric myocarditis, all of which have achieved better efficacy.
Yudan Rongxin Wan is a new class III Chinese medicine developed according to Professor Chen Baoyi’s experience prescription. In the formula, yu zhu is sweet and flat to nourish yin, wu wei zi is sour and warm to astringent yin, licorice is sweet and flat to benefit qi. The two drugs have the function of activating blood circulation and resolving blood stasis. The bitter cold of Da Qing Ye and Bitter Ginseng enters the heart and clears heat and detoxification to remove residual heat and evil toxins. The whole formula works together to benefit Qi and nourish Yin, invigorate blood circulation and remove blood stasis, and clear heat and detoxification. Pediatric viral myocarditis mostly develops after viral infection, as the evil toxin depletes the qi and blood of the heart veins, and the children mostly show symptoms of deficiency of both qi and yin with different degrees of residual heat or stasis of the heart veins.
(IV) Experience of famous doctors
1. Liu Buchen’s experience
According to Liu Buchen, the prevention and treatment of viral myocarditis in children must pay due attention to the treatment of primary diseases, 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 easy to digest and rich in vitamins and proteins to enhance resistance to disease and promote rapid recovery of body function. In terms of treatment, Chinese medicine believes that there are only two ways to “dispel evil” and “stabilize righteousness”, which should be determined according to the specific condition. The expected effect can be received.
2. Chen Baoyi’s experience
According to Chen Baoyi, the evil of heat and toxicity is the main cause of myocarditis. The blood and the heat toxin are intertwined, causing the blood to become congested and not dispersed, resulting in fever, sore throat, cough, diarrhea, heartburn, dry mouth and inability to drink, rash, palpitation, weakness, heart pain, etc. The tongue is red and vivid, and the pulse is smooth or fine.
The heart of the heat toxin, depletion of qi and blood yin and yang is a key part of the transformation process of myocarditis. The heart is not nourished by the deficiency of yin and blood, and the drum is weak when the yang is deficient, which can lead to poor blood flow and stasis of the heart; in turn, stasis of the heart can impede the normal operation of the blood and affect the disease to heal. Therefore, blood circulation, remove blood stasis to produce new for this stage of the important treatment.
In the course of myocarditis, the stagnation of the heart arteries may not be restored for a long time, and the flow of Qi may be obstructed and stagnated, thus producing phlegm. 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. Since myocarditis is always a deficiency of the heart and a deficiency of the symptoms, this method is usually applied when the deficiency of the heart (deficiency of Qi, blood, yin and Yang) has normalized, or when the deficiency is less severe, but the symptoms of the heart (Qi stagnation, phlegm blockage, blood stasis) are the main ones.
3. Song Jomin’s experience
According to Song Jomin, pediatric viral myocarditis is an injury to yin before yang, and the loss of yin and yang qi and blood after a long period of illness will definitely lead to stasis of heart veins, which will eventually lead to complex changes of yin loss and yang, yang loss and yin. Injury to yin and depletion of qi, partial yin and yang, should be different; heart vein stasis, phlegm and internal stagnation, performance varies, so the treatment should be different. The actual evidence should be treated with evidence, but also flexible, in order to improve the effectiveness.
In the early stages of viral myocarditis, most of the heat and toxicity are internal invasion, residual heat consumes yin, first injures yin and then yang, the evidence is yin deficiency residual heat type, treatment should be to nourish yin and benefit qi, and clear residual heat. If the disease is prolonged, most of the Qi and Blood, from Yin and Yang, resulting in deficiency of Qi, Blood, Yin