Long-term palpitations, insomnia or angina pectoris are symptoms of lack of blood and restlessness. The heart is hidden in the gods, the main gods, should nourish the blood and calm the nerves, and the misuse of sedation, dilation, stents or blind surgery will inevitably lead to a situation of dependence on medicine.
One of the most authoritative clinical medical journals in the world——— the New England Journal of Medicine published a new study, pointing out that 1/5 of Americans undergoing coronary angiography (hereinafter referred to as coronary arthrography) examination are "optional"; Facts have also proved that nearly two-thirds of these people have indeed "no obvious abnormalities found". This is the latest global data on over-medicalization. Professor Hu Dayi, chairman of the Cardiovascular Disease Branch of the Chinese Medical Association and president of the Cardiovascular Physician Branch of the Chinese Medical Doctor Association, pointed out to the reporter of Life Times: "The same is true in the mainland, where more than half of the crown examination results are normal. I don't dare to say that these tests are unnecessary, but such a high negative result suggests that doctors should be more cautious when considering whether or not to have a crown surgery, because this test not only brings a huge cost to the patient, but also the risks inherent in the surgery. ”
Coronary stent is a necessary examination for heart disease patients before the placement of cardiac stents, and the consequences of its abuse are more serious than the consequences of indiscriminate cardiac stents becoming a common problem in the international medical community. In the United States, statistics show that nearly half of the people who should not have been put in a stent have been put in a stent. Hu Dayi believes that the same problem exists in China: a considerable number of patients with stents are "over-treated".
In the 80s of the last century, it was the time when cardiac interventional technology was just born in the West, and it was also the time when Hu Dayi was campaigning for it to be promoted everywhere in China. So far, on the domestic website, many patients can still see that Hu Dayi is one of the most powerful doctors who do heart stent surgery in China. However, now he has put down the scalpel for a long time. "This would have been a good technique to replace a large part of the heart bypass and significantly reduce the trauma of the patient. Hu Dayi said, but with the blind superstition and worship of this technology by many doctors, the phenomenon of excessive stent placement has intensified.
Dr. Judith Hodgman of New York University said that for non-emergencies, the study showed that "there is no need to rush invasive tests and procedures." It could even cause harm: To the doctor's surprise, study participants who received surgery were more likely to have a heart attack or die in the next year than those who received medication alone. Hochman co-led the study and gave the results at the American Heart Association meeting in Philadelphia on Saturday.
Dr. Glenn Levine, a cardiologist at Baylor College of Medicine, said: "This study clearly defies common sense over the past 30, 40 years" and may reduce testing and invasive treatments for such patients in the future. Role in research. Some doctors may still be skeptical of the study, he said, but the work is very well done, "and I think the results are very credible." ”
According to statistics, in 2008, more than 180,000 patients in China received interventional treatment for coronary heart disease. Yu Mengsun, vice president of the Chinese Society of Biomedical Engineering and academician of the Chinese Academy of Engineering, pointed out in an interview with the media that in fact, many patients with coronary heart disease can alleviate their condition by changing their lifestyle and behavioral habits, and the effect is very significant. Hu Dayi also gave reporters an example: his teacher is a well-known cardiologist, when he was 70 years old, angina pectoris, he did not go to the crown building, put a stent, but on the basis of maintaining a healthy lifestyle, insisted on oral statin and coronary heart disease drugs, now at the age of 87, can still easily climb to the second floor.
Even if surgery is required, heart bypass surgery has been developed for more than half a century, and the technology is very mature, but it is not selected by some doctors because of the large trauma, complexity, and low success rate. "Some doctors tell patients that coronary heart disease can be bypassed or intervened, and the bypass requires thoracotomy and does not intervene, which I think is very ridiculous. Hu Dayi once said. He told reporters that internationally, the ratio of stent and bypass surgery is 7:1 to 8:1, but in China, the ratio is as high as 12:1.
Hu Dayi believes that a large number of patients who do not need interventional treatment or cannot benefit from interventional treatment are being placed with stents. Huo Yong, head of the Medical Quality Control Center for Cardiovascular Diseases (Coronary Heart Disease Intervention) of the Ministry of Health and director of the Department of Cardiology of Peking University First Hospital, also pointed out that in the placement of cardiac stents, there is even a phenomenon of "simply comparing the number of surgeries" between hospitals. An unnamed doctor at Beijing Tiantan Hospital told reporters that he had heard that some doctors went to grassroots hospitals for surgery, and if they did not put stents, they would not be reimbursed for the travel expenses back.
Indiscriminate is the biggest over-the-top medical treatment. "Some over-treatments are disposable, but putting in a stent that shouldn't be put is one of the most serious over-treatments for life, and the mental stress, drug side effects, and inconvenience it brings to patients will not go away over time. Hu Dayi said. For example, some patients will feel uncomfortable in the heart after being placed in the stent, and they can only adapt to it after 1 year; Compared with bare stents, not only is the price higher, but it is also necessary to take clopidogrel for a year and take aspirin for life to fight blood clots, which will irritate the gastrointestinal tract and bring the risk of bleeding. He himself has met some "returning" patients, some of whom do not meet the indications for interventional treatment, but have been placed with one or more stents, and due to the failure to take medication on time after surgery, blood clots appear, leading to more serious myocardial infarction.
As for why there is an abuse of cardiac stents, some experts have analyzed that it is undeniable that some hospitals regard it as an economic growth point and a cash cow, and doctors also attach great importance to the benefits brought by stents. Hu Dayi believes that "this situation is a minority, but it is by no means an individual." A small bracket, with a diameter of 2-4 mm and a weight of less than 1/10,000 grams, requires 1-20,000 yuan for domestic production, and the price of imports must be doubled, and the interests behind it can be seen. Another reason is that doctors are overly obsessed with technology. Hu Dayi said: "Medicine is gradually moving away from the humanities and service objects, and the disciplines are becoming more and more detailed, and medical students quickly enter a specific field of operation, ignoring the comprehensive analysis of patients' conditions. ”
In the theory of Chinese medicine, heart disease is classified as "chest paralysis" and "heartache". Traditional Chinese medicine believes that qi deficiency and blood stasis are the essence of cardiovascular diseases, and blood congestion is the key factor leading to cardiovascular diseases. This view has long been recorded in ancient Chinese medicine books, for example, in the fifth century B.C., the Yellow Emperor's Neijing, there is a description of the symptoms of heart disease, calling it "heart disease" and "true heartache".
The heart is the official of the sovereign, the main bloodline, irrigating the valleys, moistening the internal organs, and nourishing the internal organs; The physiological dysfunction of the heart is often manifested as two types of pathogenic changes: abnormal blood vessels and altered mental status.
Abnormal blood veins: The heart does not dominate the blood vessels, which will lead to pathogenic changes such as dysfunction of the heart itself, head and face, limbs and internal organs. The heart itself is mainly disturbed, and the heart blood is not running smoothly, resulting in palpitations, or emptiness, shortness of breath and heartache. Tachycardia or bradycardia will cause changes in the beating frequency, rhythm, and intensity of the pulse, and there will be changes in the pulse such as number, delay, deficiency, solidity, slippery, astringent, urgent, knot, and generation.
On the head and face, when the blood and qi rush upward, it will manifest as red face, red eyes, red lips, red tongue, pain, ulceration, or vomiting of blood or blood. When blood and qi are not nourished, the complexion is pale and yellowish, and the lips and tongue are pale and pale. When the blood flow is not smooth, the color is dull and dark, the lips and tongue are blue, or the tongue has ecchymosis and petechiae.
In terms of the limbs, when the blood is full, it will manifest as irritability in the limbs and fever in the hands and feet. When the blood is cold and condensed, the limbs are cold, the hands and feet are cold and painful, and the claws and nails are purple and dark.
When the whole body is deprived of blood and qi supply, it will lead to various manifestations of low function and decline of the internal organs. Therefore, it is essential to maintain good health.
Mental Alteration: The state of the mind, which is the core of our mental activity, has a direct impact on our thinking, emotions, and behavior. When our minds are not nourished, our mental state can become very unstable. This usually manifests as restlessness, confusion, inability to concentrate, and even malaise and memory loss. These symptoms not only affect our work efficiency, but also cause disruption to our daily lives.
The situation becomes more serious when the mind is disturbed by external factors. Minor disturbances can lead to upset, insomnia, and dreaminess. Severe disturbances can lead to restlessness and even extreme behaviors such as mania, slurred speech, hitting and destroying people's property, etc. These symptoms not only cause harm to the individual but also cause distress and panic to those around them.
What's more, when the mind loses its mastery, our mental state becomes very unstable. Mild cases may be drowsy, drowsy and hazy, while severe cases may be confused, suddenly fall to the ground, gibberish or even delusional. These symptoms not only affect an individual's quality of life but can also pose a threat to those around them.
The causes of heart disease are varied, among which the six external senses, especially the evil of cold and heat, are the most likely to invade the heart. Internal injuries, such as sadness, joy, and worry, can also lead to heart disease. Other factors such as insufficient endowment, overwork, unhealthy diet, chronic illness, mistreatment and mistreatment, and the retention of pathological products can cause various cardiac lesions.
From the perspective of traditional Chinese medicine, the lesions of the heart are mostly based on the virtual and the real. There is already a mention of "heart deficiency" in the "Yellow Emperor's Neijing", such as "Su Wen: Wuzang Sheng" pointed out: "Thinking and sad". The "Pulse Meridian" most clearly puts forward the pathogenesis of "heart truth" and "heart deficiency", such as the "Pulse Before and After the Pulse of the Ordinary People Welcoming the Divine Gate": "The heart is solid, the left hand and inch mouth people greet the person who has the previous pulse and the yin is solid, and the hand is also the Yin meridian." Sick and bitter, unfavorable stool, full abdomen, heavy limbs, body heat, bitter stomach distention, heart deficiency, left hand and mouth people face the front pulse yin deficiency, hand syncope yin meridian also. Sickness, palpitations, fear, heartache, unspeakable, cold heart, trance. ”
Since then, "A Thousand Golden Prescriptions" has the saying of "the heart is really hot" and "the heart is weak and cold". "Shengji General Record", "Jisheng Fang", "Danxi Hand Mirror", "Jingyue Quanshu" and other medical books all have detailed discussions on the pathogenesis of "heart truth" and "heart deficiency". This is because heart deficiency is mainly due to the lack of basic substances such as qi, blood, and fluid in the heart, which is prone to show the pathogenesis of loss of heart qi, heart yang, heart blood, and heart yin, while heart deficiency is mostly caused by the feeling of evil qi or pathological products.
"The Soul of the Evil Guest" points out: "Those who are evil in the heart are all in the envelope of the heart. "Warm Jingwei Ye Xiangyan External Warmth Chapter" also said: "The heart is the master of the body, and it is not subject to evil, and if it is evil, God will go and die." Whoever speaks evil in his heart will be surrounded by his heart. This means that when external evil invades the heart, it is mostly caused by the pericardial pericardium, while internal injuries and weakness and functional decline are attributed to the heart.
Although there is some controversy about whether to attribute heart disease to the pericardium and deficiency to the heart, one thing is certain: it is of great significance to study heart disease from the virtual and real classification.
"The Yellow Emperor's Neijing" has long been discussed on the pathogenesis of the heart, as stated in the "Su Wen Tibetan Qi Law Treatise": "People with heart disease have pain in the chest, full of flank branches, pain under the flank, pain between the back and shoulders, and pain in the arms. Among them, the concepts of "heart and heart" and "heart and heat" were proposed, but the word "heart and heart" was not officially proposed. However, the Chinese classics such as the Chinese Tibetan Sutra, the Treatise on the Origin and Syndrome of Diseases, and the Qianjin Yao Fang are basically the same as the Neijing, and they all recognize the existence of the pathogenesis of the heart. It was not until the "General Record of Shengji" that the word "heart" was officially proposed, as pointed out in the book "Heart Gate": "Those who close the front inch of the left hand and the mouth and pulse are solid, and the heart is also true." Later generations of physicians such as "Jingyue Quanshu, Chuan Zhonglu, Void and Reality" also said: "Those who are honest in their hearts are more angry and cry more." All these further confirm the objective existence of the heart pathogenesis.
Heart disease is mainly caused by the presence of external evils or pathological products. External evils are mainly fire, heat and cold, which are easy to cause excessive heart fire and cold condensation of the heart veins, while pathological products can be phlegm turbidity, water stagnation, and obstruction of the heart and mind. In addition, phlegm and fire can also disturb the mind, and qi stagnation and blood stasis can block the heart pulse. However, these factors are only one of the factors that cause the heart to be solid, and there must also be an exuberance of the heart qi and heart yang in order to compete with the evil qi and produce a solid pathogenesis change with hyperactivity and excess function. Therefore, the understanding of the pathogenesis of the heart needs to comprehensively consider various factors such as phlegm, fire, cold, qi, and stasis, as well as the role of heart qi and heart yang.
1) Hyperactivity: Heart Qi is the main driving force and prerequisite for promoting the normal operation of blood, and it is also an important material basis to ensure the normal development of people's spiritual, thinking and consciousness activities. If the heart qi is in harmony, if it is violated by evil qi or disturbed by pathological products, it will be overly excited, but it will be harmful, causing abnormal heart pulse or mental function. "Lingshu: Lustful Dreams" says: "If the heart is vigorous, the dream is good at laughing, and the fear is afraid." "It was the first to propose the pathogenesis of hypercardia. "The Origin of Diseases: Heart Syndrome" says: "The heart is dirty, and in the Lord, the heart is full of energy, and there is more than enough for God, then the pain in the sick chest, the flank is full, the flank is painful, the armpit pain in the arms, the pain in the arms, and the laughter is endless, which is the truth of the heart." The various clinical manifestations caused by the pathogenesis of hypercardiac qi are elaborated in detail. The pathogenesis of hypercardiac qi can be divided into three aspects: stagnation of heart qi, phlegm obstruction of heart qi, and cold condensation of heart qi.
(1) Qi stagnation and heart qi: The heart qi is constantly circulating, and it cannot be stagnant for a moment. Injuries caused by the seven emotions and poor qi can make the heart and qi stagnant, causing qi stagnation and other pathologies such as heart pulse or qi closure of the mind.
Qi stagnation of the heart: emotional depression, or long-term and long-lasting mental stimulation, disturbing the mood, poor mood, and causing stagnation of heart qi. For example, "Cause and Pulse Treatment: Heart Paralysis" cloud: "The cause of heart paralysis is anxiety and fatigue, and the heart is injured." "The heart qi cannot promote the blood flow, the blood flow is stagnant, and the heart and pulse are blocked, and if it is not passed, it will be painful. It is manifested as chest suffocation and pain, traction of the shoulders and back, sometimes stopping, and good rest. This kind of heartache is mainly distention, which is closely related to changes in mental and emotional factors. As the "Lingshu Oral Question" says: "If you are worried, your heart is anxious, and if you are anxious, your airway will be about it, and if you are about it, you will be unfavorable, so you will stretch it out." "The Source of Miscellaneous Diseases: The Source of Heart Disease" even more clearly pointed out: "The cause of the seven emotions is heartache." ...... In addition to the joy of the qi can be dispersed, the rest is enough to make the heart stagnant, and it is painful. ”
Breath-shutting mind: strong mental stimulation, anger and fright, or grief-stricken, over-emotional, suppressing heart qi, mild cases can be seen chest congestion, chest congestion, chest tightness, shortness of breath and other symptoms. This is due to the fact that the heart is dominated by the mind and the emotions are excessive, and the heart qi is suppressed, which in turn affects the lung qi unfavorably, and the heart and lung qi are blocked at the same time, and the qi stops in the chest, and the upward reversal is formed. The heavy ones are chaotic in qi and blood, blinded by their minds, their minds are not conscious, and they suddenly faint and are delirious. "Jing Yue Quanshu, Miscellaneous Evidence, Mo and Convulsion" cloud: "Those who are solid and convulsive, their shape is angry, their pulse is heavy and slippery, and their chest is full, and this qi is also reversed." This is the evidence of qi convulsion caused by the stagnation of qi and organs, and it is closely related to the stagnation of mental qi. The chest and diaphragm are full of breath, which is caused by qi depression hurting the liver and damaging the heart, stagnation of liver and heart qi, loss of lung stagnation, and reversal of lung qi; It shows that the heart is strongly stimulated, and the heart qi is suddenly blocked and reversed, and then the mind is out of control, resulting in fainting.
(2) Phlegm obstructs heart qi: phlegm turbidity is a pathological product formed by fluid imbalance in the body. Phlegm turbidity stops internally, blocking the heart qi, which can not only paralyze the heart pulse, but also close the mind.
Phlegm obstructs the heart pulse: People who are obese or have phlegm and dampness in the body, due to the evil of phlegm turbidity, are sticky and difficult to walk, increase the resistance of heart qi, and can make heart qi sluggish and stagnant. The qi is not smooth, the heart blood flow is delayed, and the heart pulse is gradually blocked. It can be seen that the heart and chest are suffocated and painful, palpitations and shortness of breath, the body is sleepy, and the tongue coating is thick and greasy. "Cause and Pulse Treatment: Chest Paralysis" points out: "The cause of chest paralysis is poor diet, hunger and satiety injury, phlegm coagulation and blood stagnation, and medium focus and turbidity, and the symptoms of closed food and stuffiness are the cause." "Jin Kui Yaolu: Chest Paralysis Heartache and Shortness of Breath Disease" said: "Those who are not allowed to lie down with chest paralysis and have heartache through their backs are the main ones of the white and half summer soup." "Jin Kui Yao Brief Heart Dictionary" commented on Shi Yun: "Chest paralysis cannot lie down, because the lung qi goes up but does not go down; Therefore, there is phlegm to drink to help, so the chest paralysis medicine is added to Banxia to chase phlegm to drink. "The pathogenesis of heart and pulse obstruction caused by phlegm turbidity and congestion of heart and lung qi is explained in detail.
Traditional Chinese medicine believes that qi deficiency and blood stasis are the root cause of cardiovascular diseases. The occurrence of diseases often affects the normal circulation of qi and blood, resulting in an imbalance of qi and blood, and the internal organs are not adequately nourished. On this basis, the viscera gradually weakens, and the essence and energy are gradually depleted, which eventually leads to the decline of the function of the viscera and the dying of life. With the increase of age, the body's righteous qi is continuously depleted, and qi deficiency leads to weak blood flow and aggravates the blockage of blood stasis. This situation has formed a complex situation, that is, "the mixture of virtual and real", "qi deficiency and blood stasis", which further exacerbates the development of cardiovascular diseases. For the treatment of cardiovascular diseases, TCM emphasizes the regulation of qi and blood, blood circulation and blood stasis. By adjusting the balance of qi and blood, the function of the viscera is enhanced to restore the body's health.
Blood congestion is a factor that leads to cardiovascular disease, and if it is simply removed, it will hurt the positive qi and make the righteous qi more weak; If it is simply supplemented, it will become more and more sluggish for some geriatric diseases, and the more it is replenished, the more it will become more and more deficient. The most appropriate way is to consolidate the root and clear the source, that is, to invigorate qi and invigorate blood. Because qi travels, blood travels, and qi is beneficial to stasis.
Traditional Chinese medicine (TCM) delves into the causes of qi deficiency and blood stasis and believes that it stems from two aspects. On the one hand, qi deficiency causes blood to not function properly, resulting in blood congestion, and on the other hand, the obstruction of blood congestion impairs qi and blood and prevents the production of new blood, resulting in qi deficiency. In terms of treatment, in addition to replenishing qi and blood, we should also skillfully use drugs that can dissolve blood congestion. However, it should be noted that many anti-stasis drugs will deplete the righteous qi, so for patients with blood stasis, even if they do not have symptoms of qi deficiency, we should also appropriately add qi-replenishing drugs at the same time as removing blood stasis to maintain the balance of the body.