1. Good afternoon, everyone! Today we are here to share my experience in the treatment and study of “Cardiac neurosis with Chinese medical characteristics”. 2, cardiovascular disease is currently the number one killer of life and health of the middle-aged and elderly, and to the younger development, cardiovascular outpatient volume remains high. However, according to the research statistics, only about 40% of the patients really suffer from CHD, and about 30% of the non-CHD patients are misdiagnosed as CHD, among which, many patients with chest pain have no obvious abnormalities in their coronary angiography results. This is not only a psychological blow to the patient, but also increases the burden of treatment cost to the patient and society. 3. Therefore, the treatment of cardiac neurosis has attracted attention. Cardioneurosis, also known as cardiac neurosis, is a neurological disorder characterized by cardiac discomfort as the main clinical manifestation: cardiovascular symptoms and neurological disorders are seen together. 5, patients subjectively feel complex and diverse cardiovascular symptoms, including palpitations, precordial pain, shortness of breath, weakness, transient blood pressure, increased heart rate, and occasionally premature beats, accompanied by fatigue, dizziness, sweating, insomnia, dreaminess, anxiety and other symptoms; there is no clinical evidence of organic heart disease or other physical diseases affecting the heart that have a causal relationship with it. 6, most patients with psychological disorders, such as obvious anxiety, depression, hypochondriac or neurasthenia patients with cardiovascular symptoms and changes are closely related to psychological factors. 7, Young adults are more common, women are significantly more than men, 30-50 years old are more common, “palpitations”, “palpitations”, “palpitations”, “palpitation”, “heart pain “8, cardiac neurosis 9, belongs to the category of “palpitation, palpitation, sleeplessness, chest paralysis and vertigo” in Chinese medicine. 10, common in Chinese medicine “palpitations”, as seen in the understanding of palpitations, the earliest can be traced back to the “Nei Jing”, which did not put forward the term palpitations, but the cause has been recognized, the original deficiency plus emotional stimulation or feeling external evil, can lead to palpitations “Typhoid” and “Jin Kui Yao” in the first appeared in the palpitations of this name, the author repeatedly The author repeatedly mentions “heart palpitations” p “heart palpitations” p “palpitations in the heart” and “palpitations in the heart”, Zhang Zhongjing believes that the emotion and will The author repeatedly mentions “palpitations of the heart” and “palpitations of the heart” and “palpitations of the heart”. Cheng Wuji in the “Theory of Typhoid Fever and Palpitation” clearly pointed out that the causes of palpitations are not only qi deficiency and phlegm drink. In the Jin and Tang dynasties, medical practitioners recognized that palpitations were a disease of deficiency. Zhu Danxi believed that deficiency and phlegm were the main pathological mechanisms of palpitations. However, at this time, there was no clear division between palpitations and palpitation. In the Ming dynasty, “Medical Zhengzhuan – Palpitations, Palpitations, and Forgetfulness” proposed to divide palpitations into palpitations and palpitations. In the Qing Dynasty, Wang Qingren paid special attention to the role of blood stasis in the development of disease and proposed the theory that blood stasis could cause palpitation. 11. The main etiology can be caused by external sensation, emotion, poor diet, excessive exertion or other disease transmission or mismanagement. 12. The main pathogenic mechanisms can be seen in positive deficiency: Yang deficiency causes palpitation, Yin and blood deficiency; evil reality: fire and heat, water and phlegm drinks, blood stasis. First, in terms of etiology and pathogenesis, for example, Deng Tietao believes that the disease belongs to the root deficiency and the symptoms, the root deficiency is Qi deficiency and Yin deficiency, and the symptoms are phlegm and blood stasis; the basic pathogenesis: Qi deficiency, Yin deficiency, phlegm and blood stasis. 15. According to Li Yindong, the disease is characterized by Qi and Blood deficiency, i.e. original deficiency, with emotional factors leading to liver depression and Qi stagnation producing pathological products of Blood stasis. 16. Yan Dexin believes that “imbalance of qi and blood” is the root cause of palpitations, and blood stasis is the basic pathogenesis; Wang Shoufu believes that liver depression is the root cause of cardiac neurosis. 17. Zhou Duan proposed that palpitations are the evidence of deficiency and stagnation, with deficiency as the root and phlegm and water-drink as the symptoms; Xu Zhanmin believed that the pathogenesis of palpitations is deficiency and stagnation, with deficiency of qi and blood, yin and yang as the root and phlegm and blood-drink and stagnation as the symptoms. 18. Zhu Guangli believes that palpitations in young people are closely related to liver depression and emotional factors; Nie Chang’e believes that the disease is mixed with deficiency and reality, with deficiency of both heart and spleen as the origin and stagnation of qi, phlegm and blood stasis as the symptoms. 19. In terms of diagnosis and treatment, the disease is mainly characterized by the following basic evidence: liver depression and qi stagnation, heart deficiency and timidity, heart and spleen deficiency, heart and kidney disconnection, phlegm-heat internal disturbance, and blood stasis; “Diagnostic and Therapeutic Criteria for Chinese Medicine”: heart deficiency and timidity, heart and spleen deficiency, yin deficiency and fire, heart and blood stasis, water overflowing the heart, and heart yang. 20. The treatment is based on the heart, the deficiency of the heart and gallbladder Qi: sleeplessness, dreaminess and wakefulness, timidity and palpitations, easily startled by touch, accompanied by shortness of breath and spontaneous sweating, lassitude and fatigue, light tongue and thin pulse; the treatment is to benefit the Qi, calm the mind and fix the will; the prescription is to calm the mind and fix the will. 21, the former formula emphasizes calming the heart and tranquilizing the mind; the latter formula favors nourishing the blood and clearing heat to remove annoyance; together, it benefits the qi of the heart and gallbladder, clears the deficiency heat of the heart and gallbladder and settles the heart and tranquilizes the mind; if the palpitations are very high and the palpitations are restless, add raw dragon bone, raw oyster and vermilion. 22, heart yin deficiency: emotional restlessness, palpitations, forgetfulness, insomnia, dreaming, fever, night sweating, dryness of the mouth and throat, red tongue and less fluid, thin pulse; treatment: nourish yin and nourish blood, nourish the heart and tranquilize the mind; prescription: Tianwang tonic heart dan plus or minus; heart trouble and insomnia, dreaming and spermatorrhea, can be combined with Jiaotai pill (Huang Lian, cinnamon) traffic heart and kidney 23, heart and spleen deficiency: palpitations, shortness of breath, dizziness, insomnia and forgetfulness, the face is not florid, fatigue weakness, dullness and abdominal distension, pale tongue, thin white fur, weak pulse. Treatment: Tonify the heart and spleen, nourish blood and calm the mind. Remedy: Add and subtract Gui-Spleen Tang. If the deficiency of heart blood is more severe, add peony and aconite to nourish heart blood; if sleeplessness is more severe, add nightshade vine, helianthus bark and cypress seed to nourish the heart and calm the mind. 24, second, from the liver theory of treatment, the first type of evidence for liver depression and stagnation: depression, chest fullness, chest distension and pain, good breath or see foreign body sensation in the throat. In women, it is seen that the breasts are swollen and painful, dysmenorrhea, irregular menstruation, or even amenorrhea, with thin white tongue coating and string pulse. The changes in severity of the disease are closely related to the changes in emotion. 25. Treatment: De-stressing the liver and relieving depression, regulating qi and clearing the middle; formula: Chai Hu De-Liver San with addition and subtraction; addition and subtraction: for those with painful swelling in the ribs, add Yu Jin, Qing Pi, and Buddha’s Hand to de-stress the liver and regulate qi. 26, plus or minus: liver qi offending the stomach. If belching is frequent and the stomach is uncomfortable, add Radix et Rhizoma Polygonati, Ochre, and Radix Fructus Panax to harmonize the stomach and reduce rebelliousness. 27, qi depression and fire: palpitations, impatience and irritability, chest fullness, bitter and dry mouth, or headache, red eyes, tinnitus, or noisy and swallowing acid, constipation, red tongue, yellow fur, string pulse; treatment: dredge the liver and relieve depression, clear the liver and diarrhea fire; prescription: Danjian Yiyao San plus or minus. 28, plus or minus: the heat is very strong, bitter mouth, constipated stool, can add gentian grass, rhubarb diarrhea heat and internal organs; pain in the ribs, bitter mouth, noisy swallowing acid, belching, vomiting, can add Huanglian, Wu Zhuyu to clear the liver fire, lower the rebellion and stop vomiting. 29, liver fire on inflammation and see headache, red eyes, tinnitus, add chrysanthemum, hooked vine to clear heat and calm the liver; heat and injury to the yin, and see red tongue with less coating, thin pulse, the original formula can be removed angelica, atractylodes, ginger, add raw earth, maitake, yam nourish yin and strengthen the spleen. 30, the dolphin disease: the patient feels that there is a gas from the abdomen up to the heart or more up to the chest, even rushing to the throat, such as the dolphin of the rushing, seizures want to die, not as normal, palpitations (tachycardia), shortness of breath, heartburn, limb tremors, with the dolphin soup; treatment: regulating the liver to relieve depression, lowering the rebellion and calm the rushing; prescription: dolphin soup (Li Genpi 20 g, Ge Gen 3 0 g, Chuan Shao 1 5 g, Bai Shao 20 g, Angelica 15 g, Panaxia 15 g, Scutellaria 10 g, roasted licorice. Scutellaria baicalensis 10 g, roasted licorice 10 g) 31, plus or minus: rebellious Qi rushing upward interferes with the heart and mind, resulting in dry mouth, irritability, restlessness, wandering insomnia, and other evidence. Add 20g of Hepatitis Bark, 20g of Nightshade; for chest tightness, breath-holding, shortness of breath, irritability, “pulling Qi”, etc., add 15g of Jiguangshell. 32. Treatment from the kidney, non-interaction of the heart and kidney: palpitations and palpitations, light annoyance, insomnia and dreaminess, dizziness, tinnitus, difficulty concentrating, soreness of the waist and legs, dryness of the throat and mouth, seminal emission in men, menstrual disorders in women, tongue Red tongue with little coating, sunken and thin pulse. Common in menopausal women. Treatment: Nourishing Yin and lowering fire, and promoting traffic between the heart and kidney. 33, prescription: Tai Wan combined with Tian Wang Tonic Heart Dan plus reduction. (Xuan Shen 15g, Bei Sha Shen 15g, Zhen Zhen Zi 15g, Mai Dong 15g, Shu Di 15g, Fructus Fructus 12, Dan Shen 30g, Huang Lian 10g, Huang Bai 10g, Bai Shao 15g, Zhu Ru 15g, Radix Platycodon 10g, Cinnamomum 3g, Phellodendron 30g, Sour Jujube 30g) 34, plus and minus: if palpitations are very high, add magnet, dragon tooth; if the hands and feet are hot and bothered, add turtle nail, gardenia, red peony, white peony; if the waist is sore and the legs are weak, add Du Zhong, and the legs are weak. For weakness of the legs, add Dulcimer, Niubizi; for poor sleep and dreaminess, add Nightshade Vine and Hedychium bark. 35. Kidney Yin and Yang deficiency: palpitations and palpitations, restlessness, insomnia and dreaminess, sudden cold and heat or dry mouth, cold extremities, sweating, red tongue with little coating, sunken and thin pulse. Treatment: Nourishing Yin and lowering fire, warming the heart and promoting Yang. 36, Formula: Erxian Tang plus Blood Mansions and Blood Stasis; addition and subtraction: for severe heat, 6g of Cynomorium, Cynomorium and Bacopa monniera, 12g of Zhi Mu and Huang Bai; for severe cold, 10g of Cynomorium, Cynomorium and Bacopa monniera; for excessive sweating, add Fucus Wheat, Calcined Long Mu, Ephedra Root and Wu Bei Zi. 37, Kidney Yin deficiency: palpitations and palpitations, light annoyance and restlessness, insomnia, dizziness, tinnitus, soreness and weakness of the waist and legs, dry throat and mouth, heat in the hands and feet, red tongue with little coating, sunken and thin pulse. Treatment: Nourishing Yin and lowering fire, clearing the heart and eliminating irritation; formula: Tianwang Tonic Heart Dan plus Blood Mansion and Blood Stasis Soup. 38. Treatment from the spleen, Qi deficiency and phlegm obstruction: white face, body fat and phlegm, body sleepiness, palpitation, palpitation, painful heart and chest congestion. Treatment: Benefit Qi, strengthen the spleen, broaden the chest, regulate Qi and dispel phlegm; formula: Si Jun Zi Tang with Gua Gua Bai Han Xia Tang. 39.Addition and subtraction: for more severe qi knots, add heliotrope, cinnamon branch and thick park; for heavy spleen deficiency, add astragalus and cinnamon. 40.Treatment from the lung, Qi deficiency and blood stasis: chest tightness and palpitation, coughing and shortness of breath, dizziness and fatigue, sweating and weakness, pale tongue with white fur, or pale purple lips and tongue, sunken and weak pulse or knotted generation. Treatment: Tonify lung qi, activate blood circulation and resolve blood stasis. Formula: Bao Yuan Tang with addition and subtraction; in case of excessive sweating, add floating wheat, dragon bone and oyster. 41. Other treatments. 42.Acupuncture and moxibustion treatment, using body acupuncture, intradermal acupuncture, auricular acupoint pressure, moxibustion and acupuncture point injection, etc. The selected meridians are mostly the foot sun meridian, hand shao yin meridian, hand sympathetic yin meridian, and the selected acupuncture points are mainly the five Yu points and the corresponding collection points, Nei Guan and Shen Men. 43. Use auricular acupuncture plus body acupuncture; after pressing Wang Bu Liuxing Zi onto the acupuncture point, press or twist it about 100 times, and preferably feel redness and heat in the ear after the treatment. The Shenmen, Neiguan, and Gongsun points are treated with 1.5-inch milli needles. The Shenmen point is pierced straight for 0.3 to 0.5 inch, and the needle is twisted for 2 to 3 minutes after obtaining Qi. The Gongsun point is stabbed obliquely, with the needle point upward, and twisted after obtaining qi, so that the needle sensation is transmitted to the chest. 45, retaining the needle for 20-30 min, during which the needle is performed once or twice a day, 10 times a day for a course of treatment, separated by 2 d between courses, for 3 consecutive courses of treatment. 46.General acupuncture. The acupuncture points of Baihui and Shenting were used for scalp acupuncture, and the acupuncture points of Neiguan, Feosanli, Taichong and Sanyinjiao were combined with electroacupuncture for 6 times a week, with 1 day off on Sunday, and 4 weeks for 1 course of treatment. 47. Moxibustion of the back point. Take the side lying position or supine position, moxibustion at the dorsal acupuncture point from the section of the sympathetic yin yu to the diaphragm yu (both sides) within the range of acupuncture points, so that the local flushing, the patient feels the warmth of Qi to the chest, that is, the heart area; each time 30 min, once a day, 10d for a course of treatment, intermittent 7d, a total of two months of treatment. 48. Tui na massage. The techniques used are: kneading, rolling, pressing, rubbing, neck and chest resetting, etc. 49.Auricular point pressure bean therapy. Shenmen, sympathetic, subcortical, endocrine, heart Yu; liver Yu for liver stagnation and fire; liver Yu and kidney Yu for yin deficiency and fire; spleen Yu and lung Yu for heart and spleen deficiency; bile Yu and spleen Yu for heart deficiency and timidity; stomach Yu, bile Yu and Sanjiao Yu for gastrointestinal dampness and heat. 50.After putting on Wang Bu Liu Xing Zi, give the patient a stimulation intensity that makes him feel sore, swollen, numb, burning and tolerable. The pressure is applied 3~5 times a day for 1-2 min per point, and the pressure bean is changed every 3 days for a course of 4 weeks. 51. Bloodletting therapy. Internal disturbance of fire-heat, manifested by restlessness, sores on the mouth and tongue, painful swelling of the extremities, and irritability, directly causing the evil of fire-heat to be diarrhea with the blood, and is suitable for a variety of heat symptoms. 52, Precautions. The amount of blood should not be too deep and the incision should not be too large, and the general amount of blood should be about 5 drops, which should be done once every 1 or 2 days. If this therapy is only applied for symptomatic first aid, after the condition is relieved, a comprehensive examination should be conducted and treatment should be carried out again; bloodletting therapy should not be abused. 53.Western medicine treatment, the patient’s heart rate is fast (heart rate greater than 100 times M minutes), can be given a small dose of beta-blockers to slow down the heart rate. 54, with severe sleep disorders, short-term application of sedative drugs such as Valium tablets; menopausal women can be given glutathione to adjust the function of the vegetative nerves; depressed or anxious people, taking Dextran, Olanzapine. 55, third is the dietary treatment, heart blood deficiency: blood nourishing and tranquilizing, avoid spicy and aromatic; weak heart: warm yang and benefit qi, avoid cold and nourishing; yin deficiency and fire: nourish yin and tranquilize, avoid aromatic and dry; phlegm and fire disturbance: clear heat and resolve phlegm, avoid frying and smoking, nourishing and fatty; gas stagnation and blood stasis: remove blood stasis and promote circulation, move qi, avoid cold and sour. 56. Duck pear (remove core), white radish 1000g each, ginger, angelica, condensed milk 200g each, honey 250g; add 70 ml of water to angelica, decoct for 50 min; chop pear, radish and ginger to get juice; mix with angelica liquid, decoct into paste, add condensed milk and honey, heat to boiling, cool and prepare for use; take 2-3 spoonfuls each time, take with boiling water, 2-3 times/day. 57. Boil 3 chicken hearts, dry 1 chicken bitter gall bladder and grind the noodles. 1 time/day, take 3 times in a row. 50 g of lamb, 30 g of yam, 30 g of brown sugar, 30 ml of yellow wine, decocted in water, divided into 1-2 doses, 1 time/day. Grind lotus seeds with heart into powder, mix with lotus root powder of the same weight and cook porridge, take for several weeks; use mung beans 20 g, tomatoes 2, take tomatoes in soup with mung beans, 2-3 times/day, take before meals. 58, cinnamon: cinnamon meat can be used to make tea, or cooked cinnamon porridge, especially suitable for heart blood type palpitations. Sour date seeds: 6-10 g of sour date seeds, 12 g of gorgonian, 6 g of longan, boiled in soup and taken before bedtime. Suitable for deficiency of heart blood. If there is no gravy or longan flesh, you can also use 15 g of sour date palm alone, pounded and cooked with round-grained rice for congee consumption. 59, lily: choose new lily 50-60 g, or dried lily 30 g, decoction of water and add appropriate amount of rock sugar to eat. Suitable for heart Qi deficiency type or Yin deficiency fire type; Ginseng: Ginseng 3 g, sliced, make tea every day. It is suitable for people with weak heart energy and palpitations due to deficiency of heart function after childbirth. 60, water chestnut: 60-120 grams of water chestnut, 50-100 grams of jellyfish can be used daily to make soup and drink in 2 times. It is suitable for palpitations caused by phlegm and fire; cypress kernel: 10-15 grams of cypress kernel can be used, slightly pounded, and boiled with japonica rice soup to make porridge. Suitable for palpitations of the heart blood deficiency type. 61. Allium: small garlic, also known as wild garlic. Use 10 g of dried Allium sativum and 10 g of melon seeds to make a decoction and drink 2-3 times a day. Suitable for palpitations of Qi stagnation and blood stasis; Hawthorn: 10-15 grams of wild hawthorn can be used, decoction of water for tea every day. This method is suitable for palpitations of Qi stagnation and blood stasis; American ginseng: 3-5 g of American ginseng slices alone, brewed tea and drink it regularly. Suitable for palpitations with deficiency of heart energy or yin deficiency and fire. 62, lotus seeds: first grind the dried lotus seeds, take 50 g of lotus seeds powder, 30 g of cinnamon meat and 50-100 g of round-grained rice every night to make a thin porridge, then add the right amount of rock sugar, and take 1 small bowl before bed. Or take 50 g of dried lotus seeds, 30 g of cinnamon meat and a little rock sugar together. Suitable for palpitations of heart blood deficiency; lotus seed heart: 1.5 g of dried lotus seed heart daily, brewed with boiling water and drink as tea. It is suitable for palpitations of Yin deficiency type and Phlegm fire type. 63, psychotherapy, exclude organic diseases, do a good job of psychological guidance, appropriate to participate in various activities to relieve the mood and pleasure. 64, the key to maintaining peace of mind is to play the role of the human spirit on the command of the body; active use of consciousness, improve the spirit of their own words and actions, emotions and other self-regulation and control; to achieve the harmonization of qi and blood, yin and Yang secret.