Hyperlipidemia (hyperlipidemia) means that one or several lipids in the plasma are higher than normal due to abnormal fat metabolism or transport, but it has been recognized that serum total cholesterol (TC), triglycerides (TG) and low density Dyslipidemia, such as high levels of lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (LDL-C), is one of the important risk factors for myocardial infarction, stroke, and atherosclerotic diseases Therefore, it is believed that dyslipidemia can more accurately reflect the disorder of blood lipid metabolism. The author now briefly summarizes the differentiation and treatment of integrated western medicine as follows.
1. TCM understanding of dyslipidemia
It is generally believed that the disease is based on internal resistance of phlegm, blood stasis, solid evil, and spleen and kidney deficiency. If the content of lipids in the blood is higher than normal, many pathological changes such as thickening, stickiness, coagulation, aggregation and so on will be formed in the blood. The course of the disease will block the veins, and the block will cause chest pain, stroke, and limb incompetence. This pathological change is similar to the pathogenic features of phlegm evil and blood stasis in Chinese medicine. Due to the turbidity of phlegm and its sticky nature, it is multi-sick. It is easy to block the qi and blood, and the blood flow is unfavorable.
The formation of dyslipidemia is mostly related to the loss of spleen and renal hypothermia. The spleen governs transportation and transformation, and the subtle transportation, transportation, and excretion of water and grains are closely related to the function of the spleen. Just as "Suwen·Another Treatise on Meridians" said, "Drink into the stomach, overflow the essence, and lose the spleen. Sanjing, the upper returns to the lungs, regulates the waterway, lowers the bladder, the four distributions of water, and the five meridians are in parallel." If the temper is not healthy, the water and valleys will not be normalized, the body fluid will become phlegm, and the turbid phlegm will block the veins and cause many changes. The spleen is the foundation of acquired nature, and the kidney is the congenital foundation. The movement and transformation of spleen yang needs to rely on the warmth of kidney yang. If congenital deficiency, kidney yin and kidney yang are deficient, the kidney cannot dominate the body fluid energy, fire does not produce soil, spleen yang declines. It also causes body fluid to accumulate into wetness into phlegm. Therefore, the formation of dyslipidemia is often considered from the above two aspects.
2. Differentiation and treatment
2.1 Syndrome Differentiation and Treatment
In traditional Chinese medicine, there is no disease name directly corresponding to abnormal blood lipids, but the basic idea of clinical treatment is still based on syndrome differentiation and treatment, prescriptions and syndromes. There are syndromes and prescriptions, which comprehensively summarize the symptoms and signs of the patient’s tongue and pulse. Choose the prescription that fits best with it.
It has been clinically found that patients with abnormal dyslipidemia take Gualou Xiebai Banxia Decoction, Wendan Decoction, Xiaoxianxiong Decoction, Erchen Decoction, Pingwei San and other phlegm-reducing and turbidity-removing prescriptions are more common. This may be related to irregular diet and overeating. Injury to the spleen, resulting in turbid phlegm and endogenous food accumulation. If the symptoms are chest tightness, chest pain, white and greasy tongue coating, and tight pulse strings, most are the Gualouxiebaibanxia soup syndrome, which is more common in dyslipidemia combined with coronary heart disease; if symptoms are inexplicable, timid, easily frightened, dreamy, easily dizzy, palpitation, tongue coating Greasy is mostly due to Wendan Decoction syndrome. If you see the tip of the tongue is red, insomnia and upset, it is Huanglian Wendan Decoction syndrome. It is more common in patients with abnormal blood lipids and cerebral neurasthenia; if the symptoms are stomach pain, bloating, chest tightness, upset, Yellow and greasy tongue coating, slippery or slippery pulse before Guan, and even worse in the right pass, it is mostly small chest decoction syndrome, which is more common in dyslipidemia with diabetes, or chronic gastric disease; such as phlegm, body fat, dizziness, palpitation, tooth brushing, nausea, etc. It is mostly Erchen Decoction syndrome, and this prescription is mostly the basic prescription of phlegm-resolving prescriptions; if the symptoms are discomfort, stomach distention, white and thick tongue coating, weak Youguan pulse, and weak pressure, it is mostly Pingwei San prescription. The two are also more common in dyslipidemia combined with chronic gastric disease. In addition, prescriptions such as Erzhiwan and Chaishao Liujunzi Decoction are also commonly used.
2.2 Special prescriptions
2.2.1 Special prescription
Commonly used special prescriptions for the treatment of dyslipidemia, such as Fangfeng Tongsheng San, Fangji Huangqi Decoction, etc., have the following features.
Fangji Huangqi Decoction is derived from "The Synopsis of the Golden Chamber". The original text mainly treats feng shui, "the pulse is floating and the body is heavy, sweating bad wind". The key to its prescription is easy edema, especially the lower limbs. Sensitive to cold. Some people have given this prescription to patients with diabetes mellitus accompanied by visceral fat obesity and retinal or kidney disease for 6 consecutive months. The curative effect shows that visceral fat/subcutaneous fat (V/S), blood sugar, and cholesterol have a significant decreasing trend , Long-term (2 years) diabetic patients treated with this prescription have significantly reduced V/S and BMI, and have a tendency to decrease blood sugar and blood lipids. The results show that this prescription can improve obesity, especially reduce visceral fat, and improve HbA1c. For those who are difficult to use exercise therapy The patient is a better treatment drug . According to the characteristics of the prescriptions and symptoms and modern research, this prescription is more suitable for patients with dyslipidemia who are biased towards deficiency syndrome, have weaker physique, prone to sweating and edema.
2.2.2 Special disease medicine
2.2.3 Kidney-tonifying drugs
Clinical exploration found that for middle-aged and elderly patients with dyslipidemia, the treatment effect of removing phlegm and turbidity, promoting blood circulation and removing blood stasis is often not very satisfactory, and the combined use of kidney-tonifying prescriptions can often synergize.There are two considerations in the use of kidney-tonifying drugs: one is the physiological kidney deficiency. The Neijing points out that "women...five-seven, the Yangming pulse declines, the face begins to focus, and the hair begins to fall; Sixty-seven, the three Yang pulse declines on the face, The beginning of the Jiao, the beginning of the beginning of the white; Qiqi, Ren pulse deficiency, Taichong pulse decline, Tiangui exhaustion, the tunnel is unreasonable, so the shape is bad and the childless", "Husband...Fifty-eight, the kidney qi is weak, and the teeth are weak. Sixty-eight, yang qi declines at the top, face burnt, hair sideburns white; seventy-eight, liver qi failure, tendons can not move; eighty-eight, Tiangui exhaustion, less refined, kidney failure, body shape is extremely, then the teeth are lost. Those who dominate the water, are stored by the essence of the five Tibetans and six fu-organs, so the five Tibetans are prosperous and can diarrhea. Today the five Tibetans are all declining, the bones and muscles are broken, the sky is exhausted, so the hair is white, the body is heavy, the walking is not correct, and there is no child ear "It can be seen that, regardless of men and women, after middle age, kidney deficiency is a physiological process in the human body. The second is pathological kidney deficiency. "The kidneys dominate the sting, the foundation of sealing, and the essence is also". Overwork, serious illness and chronic illness often damage the kidney essence and kidney qi. This is the internal injuries and miscellaneous diseases, the poor must reach the kidneys. Patients with dyslipidemia are more common in middle-aged and elderly people, indicating that such patients have a tendency of physiological kidney deficiency. At the same time, the disease is mostly associated with coronary heart disease, hypertension, diabetes and other chronic diseases, indicating that such patients also have pathological kidney deficiency factor. Therefore, we believe that adding kidney-tonifying drugs to patients with dyslipidemia is often the finishing touch in the prescription.
Kidney deficiency can be further divided into deficiency of kidney essence, deficiency of kidney qi, deficiency of kidney yin and deficiency of kidney yang, and the four are related to each other. Deficiency of kidney essence can transform into deficiency of kidney qi and deficiency of kidney yang, or into deficiency of kidney yin and deficiency of kidney yang. . We have realized that no matter what type of kidney deficiency it is, replenishing essence and replenishing the kidney is the most basic treatment rule, because of the four types of kidney essence deficiency is the mildest disease, tonifying the kidney essence can achieve the indirect effect of nourishing kidney yin and kidney yang. Eucommia, Cistanche, Morinda officinalis, Cornus, Lycium barbarum, etc. are all commonly used kidney medicines, but among them, Cistanche is sweet and salty, moisturizing and liquid, warm but not dry, it can nourish the kidney and improve the essence, moisturize the intestines and relax the bowel. The essence and nourishment of the kidney tend to be more stable than other medicines, while the wolfberry has a sweet and sweet taste, and the cornus has a sour and slightly warm taste. If the medicine is used too large or for a long time, it is easy to warm the fire and cause the patient to have dry mouth, mouth sores, upset and other discomforts. Therefore, the clinical treatment should be based on the degree of depletion and the nature and flavor of kidney-tonifying drugs.
3. Points for attention in the treatment of lipid-lowering treatment
Clinical observations have found that long-term use of western medicine for lipid-lowering treatment often shows symptoms and signs such as decreased physical strength, involuntary muscle spasm, sinking legs, waist and knee weakness, or even pain. This may be related to long-term use of lipid-lowering drugs or inappropriate combination The use of lipid-lowering drugs causes dissolution of normal muscle fiber tissue.
In this regard, we believe that this phenomenon can be considered from the following three aspects: First, modern pharmacological studies have found that when HMG-CoA reductase inhibitors are combined with clofibrate treatment, one should be alert to severe toxic side effects such as rhabdomyolysis. This shows that improper use of lipid-lowering western medicine may have a strong effect of degrading muscle fibers; secondly, lipid-lowering Chinese medicine also has a similar effect of degrading muscle fibers. Taking Shenqu as an example, Chen Ziming’s "Women's Complete Recipe" records that it has " The effect of "resolving stillbirth" is based on the ability of Divine Comedy to transform stillbirth. We speculate that the drug has the effect of degrading muscle fibers. Third, Meng Xu’s "Diet Therapy Materia Medica" records that Divine Comedy can "break the crux", and "Medicinal Materia Medica" also contains its ability to "transform". Supplementary food, stagnation of the crux”, the author once saw an old Chinese doctor in Wenyang Huayin Qiangxin Recipe with 60 grams of Shenqu to treat heart failure complicated by hepatomegaly and lower five fingers with elevated alanine aminotransferase, the patient took the medicine Hepatomegaly receded after six doses, and the author also used high-dose Shenqu (from 40 grams) to treat patients with hyperlipidemia and fatty liver.
From the perspective of TCM syndrome differentiation, the above-mentioned discomfort after the medicine is obviously manifested by kidney deficiency and qi deficiency, which suggests that we should also use kidney and qi drugs to prevent and improve related adverse reactions in clinical practice.