An introduction of the experience in treating Ventricular premature beat with stasis heat

Xiao-Ming Jin,Qian Cui,Yu-Hui Ma,Jing Gao,Yuan Li*

1College of Chinese Medicine,Hebei University,Baoding,Hebei province,China.

Background

Ventricular premature beat(VP)known as VP contraction,is a ventricular activation produced by heterotopic pacemakerpoints below auriculo-ventricularbundle branch and a common kind of arrhythmia in clinic.It can be classified into two types of diseases.One is Accidental VP Beat,which can be seen in normal healthy people and has no organic disease of heart,it is asymptomatic and no some discomfort like slight palpitation can be happened as well.The other is Frequent VP Beat,which can be seen in heart disease(such as CAD,myocarditis and so on),it has serious symptom,and patients may suffer from palpitation or feel being thumped which is so grievous that patients may swoon.There is no specific medicine foritnow.Generally,western medicine isoften symptomatic treatment,but in later period patients are often overstrain and have the risk of sudden death.Traditional Chinese medicine includes the disease into the categories of"palpitations","severe palpitations"and“syncope”. Traditional Chinese medicine, a crystallization of wisdom in the fight against disease,has a well-established and standing history.And with two thousand year of experience,it has a unique superiority on VP treatment.

Li Yuan,an associate professor from Hebei University,study with famous doctors like Xiao Xiaohe.He has a deep study on the treatment of cardiovascular disease with traditional Chinese medicine.He puts forward the idea that is VP beat passive hyperemia must obey the thought which is”heat transformed from Yang”.What is more,with themodern pharmacology research of traditional Chinese medicine,he proposed the experience prescription named cool blood circulation and blood stasis drink,the curative effect of which is accurate for it has cured a great number of people.Now we will introduce his academic thought in combination with the previous understanding as follows.

Mechanism analysis

The symptoms of VP beat were first recorded in The Yellow Emperor’s Canon of Internal Medicine saying that“heart drum","heart suspended if hunger and thirst","heart eaves moving".The ancient doctors had different understanding of the pathogenesis of VP beat,which was mainly embodied in two aspects:deficiency syndrome and excess syndrome.As for deficiency syndrome,Sun Simiao proposed that Yang deficiency causes palpitations,Cheng Wuji thought that qi deficiency causes a disease,Zhang Jiebin thought that Yin deficiency,and the ancient doctors always took phlegm and retained fluid as a breakthrough point.Therefore,it is proposed in syndrome and treatmentcriteria saying that"the cause of palpitations is not more than two kinds,one is deficiency and the other is retained fluid".Modern doctors think the disease is intermingled deficiency and excess.In clinical,it is common to see qi deficiency,Yang deficiency,Yin deficiency,phlegm,retained fluid and so on.Chen keji et al.considered blood stasis is an important pathogenic factor of this disease.The thought provids a new idea for thetreatment of premature ventricular contractions,which has been accepted by many doctors[1-3].

VP beats are often caused by qi deficiency and the inability of promoting blood circulation.The qi of heart regulates the heart beat and the relaxation of blood vessels,and promotes the blood circulation in the vessels to make blood flow throughout the body.When the heart too weak to keep blood circulation normally,the blood flows slowly and the metabolites in the blood are hard to be removed from our body,which will lead to the tendency of blood stasis heat."Classic of Questioning"says that"qi is responsible for promoting,blood is responsible for nurturing body".Without the regular operation of the qi and blood,heart cannot maintain the heart force,the heart rhythm and the heart rate foundation,the qi and blood runs difficultly,and the heart function is out of control.Or some patients are the type of hyperactivity of fire due to yin,which can result in blood stasistransforming into heat.Premature beatsare abnormity heart beats,and it can be reflected by the pulse,so the pulse sign is the key of diagnosis of premature ventricular beat in Chinese medicine.Wei Zhizhen[4]believes that the pulse of the patients with basic rapid heart rate is thready and hasty,which means exuberant yang and excessive heat and indicate that the patient has heat-transmission based on blood stasis.The pulse of patients with slow basic heart rate are mostly thread and knotted,which is because of qi stagnation and blood stasis,and in a long term,the blood stasis may transform into heat.At this time,if the patient has hyperactivity of fire due to yin,heart fire hyperactivity,or exogenous wind-heat etc.,the situations mentioned above will accelerate different degrees of heat-transmission,then disturb the mind and cause VP beat.

Introduction to the experiential effective recipe

With years of clinical medication experience,Li Yuan created the special prescription on the basis of the characteristic of the disease which is mixture of asthenia and sthenia.The composition of prescription is:ChiShao(Paeoniae radix rubra)15g,MuDanPi(Moutan cortex)15g,HuangLian (Coptidisrhizoma)10g,DanShen(Salvia miltiorrhiza Bga) 30g,YuanHu (Corydalis rhizoma)10g,ChuanXiong(Chuanxiong rhizoma)10g,HuangQi(Astragaliradix)30g,GeGen (Puerariae lobatae radix)30g,CiWuJia(Acanthopanax senticosus)30g,ZhiHuangJin(Polygonati rhizoma)15g,SangJiSheng(Taxilli herba)15g,gansong(Nardostachys jatamansi)10g,and QingHao(Artemisiae annuae herba)10g.

The evidence for addition and subtraction:KuShen(Sophorae flavescentis radix)is added for patients with tachycardia;ChenPi(Citrus reticulate blanco),FoShou(Citri sarcodactylis fructus),XiangYuan(Citri fructus)and LaiFuZi(Raphani semen)are added for patients with dyspepsia; SuanZaoRen (Ziziphi spinosae semen),ShouWuTeng(Polygoni multiflori caulis)are added for patients with insomniac and vexation;YiMuCao(Leonuri herba),WuJiaPi(Acanthopanacis cortex),DongGuaPi(Benincasaeexocarpium)andXiaKuCao(Prunellae spica)are added for patients with retained fluid.

The features of the experiential effective recipe

Cool blood first and remove blood stasis later

The MuDanPi in the recipe is acrid,bitter and slightly cold.It can clarify heat and cool blood,promote blood circulation by removing blood stasis.It is a medicine but has two usages.ChiShao,bitter and cold,can clarify blood stasis and heat.Combined with HuangLian（which is bitter and slightly cold,belongs to heart channel,purges fire and coordinates intestines and stomach）,it can not only enhance the strength of heat clarifying,but also prevent diarrhea from the coldness of MuDanPi and ChiShao.Three drugs used together can hit the mark of the disease.DanShen,bitter and slightly cold,is the key to removeblood stasis.Chuanxiong andYuanHu harmonize qi and blood,disperse for acridity and warmth and flow rapidly.They can not only help DanShen promote blood circulation,but also prevent the stomach from being nourished with HuangJing.The combination of the three drugs eliminates the pathologic basis of blood heat.Because of the remove of blood stasis and heat,the disease will be in stable condition.

Replenish qi and yin,treating root cause of disease and tonifying deficiency

The HuangQi,sweet and warm,focus on replenishing qi and blood to promote blood circulation.CiWuJia,which belongs to heart,spleen and kidney channel,can not only replenish the heart and spleen,calm the mind,but also warm up the kidney and Yang.The nature of Parasitic loranthus is neutral,which can enrich the yang of the kidney to balance yinyang.ZhiHuangJing nourishes qi and Yin,and it is widely used to treat the coronary heart disease with arrhythmia in clinical.GanSong can enliven the spleen and strengthen the stomach,which can not only nourish the heart by the qi and blood as spleen governstransportation and transformation,butalso protect spleen and stomach from being harmed by vast cold drugs.QingHao clears deficient heat,and avoids heat transmission and fire invigoration for lack of kidney-yin.GeGen helping produce saliva and slack thirst is used for yin deficient with diabetes.All drugs are used together to improve the symptoms of the heart-qi deficiency and kidney deficiency,so as to achieve the objective of treating both principal and secondary aspect of disease.

Combinate with pharmacology through the ancient and modern time

Combining the study of modern pharmacology with the using of drugs effect in ancient time,this prescription has an unexpected effect,and all of its drugs have the effect of improving arrhythmia[5-7].Puerarin,for example,can reduce the arrhythmia caused by pituitrin[8].Berberine can prolong the hyperpolarization refractory period of atrial cells[9].Artemisinin can inhibit 1kr,1ks and 1kl,and hasadefiniteeffecton anti-arrhythmia[10].GanSong can inhibit Na+inflow and promote K+outflow of myocardial cells to prolong action potential[11].These studies are not only a powerful verification of the curative effect of this prescription,but also provide a new idea for clinical treatment for this disease.

Therapeutic ideas

Early intervention for preventing aggravation

In clinical,some middle-young aged people are suffering from accidental VP beat.The western medicine believes that accidental VP beat has no organic disease and no harmful impact on health,so it is called benign VP beat.If patients have no symptoms,we don’t need to bother it.If palpitation occurs,antiarrhythmics can be used for a short-term treatment[12].The patients mostly suffered from irregular sleep schedule or some bad habits like smoking and drinking,which make people dissipate a lot of heart qi,so they will have some symptoms like laziness,shortness of breath and chest stuffiness with pale tongue,glossy coating and weak left inch pulse.What’s more,a few patients are even accompanied with kidney deficiency.If no intervention is adopted,it might turn into Frequent VP Beat.Therefore,patients are often treated with drugs which can nourish the qi of heart such as HuangQi,ZhiGanCao(Glycyrrhizae radix et rhizoma),RenShen(Ginseng),et al.

Cooling blood,dissolving stasis and symptomatic treatment in acute condition

Teacher Li thinks that heat and fire can fry blood,which make blood too sticky to move on.It cannot be unblocked by single drug for activating blood circulation to dissipate blood stasis.Only by cooling blood and dissolving stasis can we stabilize the condition quickly.In the acute stage of the disease,the selection of drugs should give priority to be cold and cool.Excessive use of warming drugs is likely to aggravate the fire and delays the disease.The choice of the drug for clearing heat and cooling blood should give priority to MuDanPi and ChiShao,and we can add HuangLian to enhance the strength of clearing heat.Among the drugs of promoting blood circulation and dissolving stasis,DanShen and ChuanXiong have the best power that can quickly dredge blood veins and make blood smooth.

Tonifying kidney and strengthening Jing,strengthening healthy qi and eliminating pathogens

The aged,as a common group suffering from the disease,alwayshave organicheartdisease with significant symptoms.Because the function of every viscera has declined,it is not common to see an elderly patient with a single syndrome in the clinical,they are always accompanied with deficiency of the yin-yang of kidney.Kidney is the origin of Yin and Yang,and there is mutual use between the yin-yang of kidney and the viscera.Plain Questions says that when the women are forty-nine years old and the men are fifty-six years old,their “tiangui”is exhausted.That is to say the kidney essence of the old is exhausted,kidney yang is too weak to promote kidney yin to help heart yin restrict the fire in heart.So,when the fire of heart is strong and the blood will be fried becoming invisiblephlegm which can causeheat.Therefore,most elderly patients have some symptoms of kidney yin and yang deficiency,such as lumbar and knee weakness,dizziness,tinnitus or long urine,lower limb edema.The treatment on the blood cooling and activating just can stabilize the condition but cannot cure disease at all, so it is necessary to tonify kidney to help the Yin-Yang of the whole body.What’s more the blood cold medicine is often bitter and cold,which is afraid that the medicine can get the healthy qi injured,so we should clear the heat,cool the blood,dissolve stasis,tonify qi and nourish Jing together that is treating both principal and secondary aspect of disease.

Focus on daily life and prevent relapse

Patients should keep good daily routines and living habits,and avoid excessive tiredness.Their diet should be light and quit smoking and alcohol to avoid heart dissipation.And they should keep a good mood as well.Zhu Guangli thinks that there is a close relationship between premature ventricular contraction and liver depression in young people[13].The heart controls mental activities,the unhealthy emotion must impact the function of the myocardium.In addition,In addition,elderly patients often suffer from deficiency of vital energy,so the prevention of colds should be strengthened,whatever anemofrigid cold or anemopyretic cold can come into deeper and transform into heat,which can make the disease get worse,so It is advisable to treat exogenous cold first.

Typical examples

Sun Mou,a 70-year-old man,visited the doctor on September 15,2017.Chief complaint:had been flustered uninterruptedly for more than 2 years and aggravated for 4 days.History of present illness:Coronary heart disease for 5 years,in 2013,he suffered panic and discomfort due to cold after running,since then the symptom uninterrupted attacked which mostly caused by cold or cold.The 24h dynamic electrocardiogram showed that sinus rhythm(50-121 beats/min,average heart rate 65 beats/min)was completely blocked by right bundle branch,and premature ventricular beats were 5458 beats/24h.There was no significant improvement in Oral bisoprolol.Some visible symptoms as below:chest tightness and shortness of breath,insomnia and head distension,soreness and weakness of waist and knees,dry pharynx,well urine and stool.Tongue dark red moss yellow greasy,intermittent,hasty but weak pulse.Dialectic:deficiency of heart and kidney,blood stasis transforming into heat,with phlegm and drink,all of them can be treated with improving qi and Yin,cooling blood and dissolving stasis.Prescription: liangXueTongYu decoction added in XiaKuCao 10g and TianHuaFen(Trichosanthis radix)20g,the total course of treatment is 7 days,decoction is taken once a day with water.

On September 23,2017,the patient returned to the clinic and reported that his symptoms of palpitation were reduced after taking the drug,but sometimes they still broke out.The shortness of breath and his pharynx were improved.His pulse didn't change much.The prescription added ZhenZhuMu(Margaritifera concha)30g,YuanZhi(Polygalae radix)9g and removed TianHuaFen,seven pairs of the medicine,and water frying.After taking the drug,the patient felt that the flustered feeling was gone and his insomnia symptoms were improved.The results of the dynamic electrocardiogram showed that the sinus rhythm(46-135 times/min,and the average heart rate was 80 times/min)was incomplete and the right bundle branch blocked,and the VP beats were 2 times/24d,and the patient continued taking 14 pairs of medicine.Until now,the symptoms don’t recur.

Conclusion

The incidence of premature ventricular contractions in China has been increasing in recent years,and the group of people suffering from premature ventricular contractions is becoming younger,which is closely related to pressure comes from society and life.As for this disease,the prevention treatment of disease must be taken,and the optimistic life attitude and healthy living habits are effective way to prevent the disease.In view of the mixture of deficiency and excess,the treatment should be distinguished between primary and secondary.In the acute phase,the treatments like clearing heat,cooling blood and dissolving stasis are mainly used,while in the remission phase,the treatmentslike nourishing qi and yin are mainly used,and we can’t put the cart before the horse.Traditional Chinese medicine(TCM)is extensive and profound,with a long history.It has been used for over 2,000 years to treat palpitations,and the curative effect is remarkable.Meanwhile,the modern pharmacological effect of TCM cannot be ignored.We should attach equal importance to inheritance and innovation.Only in this way can the cause of traditional Chinese medicine achieve considerable development

1.Chen KJ.Development track of inheritance and innovation of modern huoxue huayu school.Chin J integ tradi Chin western med,2015.35:1413-1414.

2.Chen KJ.Development Is A High-Level Inheritance for China Time-honored Brand Products.Chin J Integ Med,2014.20:803-804.

3.Chen KJ.Blood Stasis Syndrome and Its Treatment with Activating Blood Circulation to Remove Blood Stasis Therapy.Chin J Integ Med,2012.18:891-896.

4.Dai M,Zhang DW,Zhou XS,et al.Clinical experience of weiyizhen's treatmentof rapid arrhythmia.Beijing Chin med,2011.30:343-345.

5.Julie,Wang TY,Cui Y,et al.Research progress of the target of Chinese traditional medicine for the regulation of heart rhythm and anti-arrhythmia.Chin Her Med,2016.47:165-174.

6.Wei HM,Wu HJ.Clinical and basic research progress of traditional Chinese medicine against arrhythmia.J integ Chin western Med Cardiovascu Cerebrovascu Dis,2015.13:152-158.

7.Xin L,Hou WL,Wang L.Clinical research overview of the mechanism of action of traditional Chinese medicine against arrhythmia.Chin J Gerontol,2011.31:4297-4290.

8.Ding LB,Yan F,Chu Y.Observation on the therapeutic effect of gegen hujue decoction on premature ventricular beats.Shanghai J Tradi Chin Med,2015.49:49-50.

9.Zuo R,Cao XB,Zhang WS.Progress in studies on the pharmacological effects of berberine.Global Chin Med,2014.7:568-572.

10.Giu XL,Du ZM,Wang TQ,et al.Pharmacological effects of artemisinin against arrhythmia.Heilongjiang med,2001.4:271-272.

11.LiBL.Treatmentof20 casesofpremature ventricular contractions with radix astragali plus tang.YunnanJ tradi Chin Med,2007.4:28-30.

12.Huang YH,Chen ZF,Ye SY,et al.Therapeutic effect of shensong yangxin capsule on chronic cardiac insufficiency combined with premature ventricular beats.Guangdong med,2017.S1:274-275.

13.Liu Z,Zhu GL.Treating young people's palpitations by relieving depression.Zhejiang J Tradil Chin Med,2011.46:248-249.