Professor Wang Zhentao’s sharing of typical cases in the diagnosis and treatment of heart failure (373)

General:ZhaoXX, female, 22 years old, student, from Jinchang, Gansu. No history of drug allergy was found. 2018year07month10day.

Complaint: span>Intermittent palpitations and shortness of breath for 3 years.

History of present illness: 3 years ago without obvious trigger Palpitations, shortness of breath, lasting 2-3 minutes. Irregular seizures, echocardiography showed large left ventricle, ECG: inferior wall leadsQS type, orally Drug treatment, now intermittent shortness of breath, fatigue, sleep well, and two stools are normal. He was in good health and denied other medical history. Physical examination: HR: 64times/score, regularity, BP: 94mmHg/60mmHg, red tongue, thin white fur, thin pulse. Auxiliary examination: echocardiography: left ventricular end-diastolic diameter57mm, LVEF 45%, enlarged heart, left , Right ventricular systolic function was slightly reduced.

Traditional Chinese Medicine Diagnosis:Heart Failure

< span>Syndromes:Qi deficiency and blood stasis

Treatment:Replenishing Qi and Activating Blood

Prescriptions for Initial Diagnosis :

2018 Year08Month21DaySecond diagnosis: The condition is stable, the spirit is better than before, the sleep is good, and the stool is adjusted. Pale red tongue, thin white fur, thin pulse.

Processing:7month< /span>10Sunfang Astragalus is changed to 60g, and tea root is changed to 60g span>, Five-clawed dragon changed to 60g, Anemarrhena changed to 30g, Cimicifuga changed 30g, Platycodon grandiflorum, Bupleurum modified 24g, Garlic15g span>, wine dogwood meat30g. Traditional Chinese medicine30paid, one dose per day, decoct in water.

2018year09Month18DayThree Clinics:The condition is stable, and the spirit is better than before. Pale red tongue, thin white fur, thin pulse.

Processing:8month< /span>21Sunfang Astragalus is changed to 75g, remove Alisma, Campanulaceae is changed to 30g, Bupleurum to 30g, add Scutellaria 15g. Traditional Chinese medicine30paid, one dose per day, decoct in water.

2018year10month23day< /span>Four diagnostics:Stable condition after taking the medicine, conscious abdominal distension, loose stool, < span>2-3/ times, urinating. Red tongue, thin white fur, thin pulse. Echocardiography: left ventricular end-diastolic diameter 52mm, LVEF 43%, left ventricular slightly larger, left ventricular contraction Functionality is reduced.

Processing:09.18The Japanese prescription changed to Astragalus 90g, Atractylodes30g, remove Ophiopogon japonicus, add Myrobalan30g, Cimicifuga changed to 40g, Wuzuo Dragon instead of 75g. Chinese medicine30pay, one dose per day, decoct in water.

Notes:Master Wang’s summary in long-term clinical practice Syndrome elements, related symptoms and signs of dilated cardiomyopathy, combined with historical literature research results and expert knowledge, summarize its clinical characteristics, it is believed that the disease is mainly characterized by qi deficiency and blood stasis in the early stage, and late heart and kidney yang deficiency and qi deficiency, warm Xu Neglect of duty leads to dysfunction of various organs. The treatment is guided by nourishing qi, focusing on the rise and fall of zong qi and the mutual influence and connection between the heart and lungs in qi machine and blood operation. During the treatment, the main purpose is to replenish the heart qi, smooth the lung qi, and strengthen the spleen. Starting from the theory of “Qi deficiency to extreme qi depression” in traditional Chinese medicine, Master Wang combined the method of raising yang and lifting depression on the basis of traditional nourishing qi and activating blood. class of disease. In this recipe, Astragalus tonifies qi and raises yang, diureses water and relieves swelling, and can replenish qi and blood, and replenish the heart and veins: Codonopsis pilosula tonifies qi and invigorates the middle, invigorates the lungs and produces body fluid; Poria is good for invigorating the spleen and invigorating the spleen. Dry dampness, invigorate qi and promote water, the two medicines are matched, keep the middle and pass, one transport and one infiltration, the water and dampness have a way to work; Salvia miltiorrhiza promotes blood circulation and removes blood stasis, removes vexation and calms the mind; Removing blood stasis; Huixin grass calms the mind and calms the mind; Five-clawed dragon nourishes qi and invigorates the spleen; Cohosh, Bupleurum, Platycodon, Zhimu and Astragalus are Shengxian Tang, Astragalus tonifies Qi and lifts Qi, and is beneficial to the cooling and moisturizing of Zhimu , Bupleurum is the medicine of Shaoyang, Cimicifuga is the medicine of Yangming, and those who lead the trapping of the atmosphere rise from the left and right, and the platycodon grandiflorum carries the power of various medicines up to the chest; licorice harmonizes all medicines. The patient suffers from palpitations, shortness of breath, fatigue, and low blood pressure. Therefore, the dosage of Shengyiqi Shengshen and other drugs is continuously increased during the follow-up, in order to achieve the best therapeutic effect.