TCM Acupuncture and Massage

Chapter 43 Cardiovascular and Cerebrovascular System Diseases (1)
Palpitations
An overview of the disease

([-]) Relevant knowledge

In traditional Chinese medicine, palpitations refer to deficiency of qi and blood, yin and yang, or stagnation of phlegm, fluid and blood stasis, resulting in loss of nourishment for the heart and poor heart arteries, causing rapid beating of the heart, panic, restlessness, and involuntary involuntary as the main clinical manifestations.Palpitations are often accompanied by shortness of breath, chest tightness, or even dizziness, shortness of breath, and syncope; the pulse condition may be few or late, or irregular.Palpitation is a common disease of the heart. This disease is mostly based on deficiency syndrome, and also from deficiency to excess, mixed with deficiency and excess, including palpitations and convulsions.The onset of palpitations is mostly related to emotions, mostly paroxysmal, although the onset is rapid, the condition is mild.The palpitations are mostly caused by long-term illness and physical weakness and heart damage.

In modern medicine, palpitations belong to the category of arrhythmia in western medicine.The excitation source or excitation conduction in the heart is abnormal, causing the activity of the whole or part of the heart to become too fast, too slow or irregular, or the order of excitation of each part is disordered, causing the rate or rhythm of the heart to change, which is called Arrhythmia.

([-]) Etiology and pathogenesis

Traditional Chinese medicine believes that palpitations are mainly located in the heart. Due to lack of nourishment or restlessness of the mind, the mind is shaken and palpitations are disturbed. The onset is related to the dysfunction of the spleen, kidney, lung, and liver.The nature of heart palpitations mainly has two aspects: deficiency and excess.Deficiency refers to the deficiency of qi, blood, yin and yang, and the lack of nourishment of the mind.In fact, it means that phlegm and fire disturb the heart, drinking water irritates the heart, blood stasis blocks the collaterals, and Qi and blood flow poorly.The disease is deficiency in origin and excess in superficiality. Its origin is deficiency of qi and blood, deficiency of yin and yang, and its symptoms are qi stagnation, blood stasis, phlegm turbidity, and drinking water.Specifically related to the following factors:

1. Weak body, weak body, prolonged illness or overwork, or various blood loss, resulting in deficiency of qi, blood, yin and yang, resulting in loss of nourishment for the heart, resulting in palpitations.

2. Prolonged illness, deficiency of body, heat damage to yin, or excessive sexual intercourse can lead to loss of kidney yin, heart fire fluttering, disturbing the mind, and forming palpitations.

3. Improper diet, work and rest, overwork and fatigue can hurt the spleen, or sitting for a long time can hurt the qi, causing insufficient biochemical sources, resulting in insufficient heart blood, lack of nourishment for the heart, and palpitations.Or improper diet, addicted to the thick flavor of oatmeal, can produce phlegm and accumulate heat to transform fire, or injure the spleen and breed phlegm, and phlegm fire disturbs the heart and causes palpitations.

4. The seven emotions stimulate people who are usually guilty and timid. If they suddenly encounter panic, or can't let go of their feelings, extreme sorrow, worry and incomprehension, etc., the seven emotions will be disturbed, violating the mind, involuntary and palpitations.Or long-term worry and panic, excessive mental and emotional tension, heart-qi deficiency and timidity, dark blood consumption, unable to nourish the heart;Or great anger injures the liver, great fear injures the kidneys, anger leads to qi reversal, fear leads to timidity, yin deficiency in the lower part and fire in the upper part can also shake the mind and cause palpitations.If stagnant heat accumulates in the body and anger is added, it will become liver fire, which disturbs the heart; or if phlegm fire disturbs the mind, the mind will lose peace, and it will easily lead to palpitations.

5. Feeling of exogenous pathogenic wind, cold, and dampness mixed together, combined to form numbness.Arthralgia syndrome over time, exogenous evils re-felt, and inner homes are in the heart, the evils block the heart vessels, block the meridians, and block the circulation of heart blood; or wind, cold, dampness, heat and other exogenous evils invade the heart from the blood vessels, consuming heart energy or Heart Yin can also cause heart palpitations.

6. Drug overdose Overdose of drugs can damage the heart qi, and even damage the heart and body, causing palpitations.For example, the overdose or inappropriate use of antimony, digitalis, quinidine, epinephrine, atropine and other drugs in modern times can cause syndromes such as "pulse knot generation and palpitation".Modern medicine believes that before the heart beats, there is the generation and conduction of impulses.The pacing conduction system of the heart has self-discipline, among which the sinoatrial node has the strongest self-discipline and the fastest frequency. It is the pacemaker of heart beat under normal circumstances and controls the activity of the whole heart.The other part of the conduction system is the potential pacemaker of the heart. When the function of the sinoatrial node is inhibited, an impulse can occur and an escape rhythm can be established to replace the sinoatrial node.Any abnormality in the formation and conduction of cardiac impulses can disrupt the regularity of cardiac beating and form arrhythmias.Arrhythmia is any abnormality in the pace and conduction of the heart.A normal heartbeat originates from the sinoatrial node. Due to abnormal impulse generation and conduction in the heart, the whole heart or a part of it moves too fast, too slow or unplanned, or the degree of part of the activity is disturbed, resulting in arrhythmia. Also known as heart rhythm disorder.

([-]) Clinical manifestations

The basic characteristics of palpitations are conscious onset palpitations, violent heartbeats, involuntary, or transient, paroxysmal, or prolonged duration, or several episodes a day, or once a few days.Chest tightness, shortness of breath, mental fatigue, dizziness and shortness of breath are often seen together, and even inability to lie on the back, and even syncope.The pulse condition manifests as several or late, or sparse and rapid pulses, and the conjunctive pulse, alternate pulse, rapid pulse, and astringent pulse are particularly common.

([-]) Diagnosis

1. Conscious palpitation and restlessness, violent heartbeat, nervous expression, involuntary, rapid heartbeat, or slow, or heavy heartbeat, or sudden beating and stopping, showing paroxysmal or persistent.

2. Accompanied by chest tightness and discomfort, irritability, upset, less sleepiness, sweating, trembling, fatigue, dizziness, etc.Middle-aged and elderly people with frequent attacks may be accompanied by chest pain, even shortness of breath, cold sweating of the extremities, or syncope.

3. The attack is often induced by factors such as emotional stimulation, panic, tension, overwork, drinking, and satiety.

4. It can be seen that there are changes in pulse condition such as number, disease, rapidity, generation, sinking, and delay.

5. Examinations such as blood pressure measurement, chest X-ray and electrocardiogram are helpful for confirming the diagnosis.

([-]) Treatment

Before the exact diagnosis is known, it is generally not appropriate to make specific treatment for palpitations.In fact, not all palpitations need treatment; moreover, it is dangerous to use drugs to suppress the arrhythmia before the condition is known, because the anti-arrhythmic drugs may themselves cause the arrhythmia.After the diagnosis is confirmed, on the one hand, treatment should be carried out according to the primary disease, such as infectious disease, anemia, thyroid disease, etc.;

([-]) Prevention

1. Patients with palpitations should maintain optimism, emotional stability, adhere to treatment, and strengthen confidence.

2. For heart palpitations caused by timidity, phlegm fire disturbing the heart, yin deficiency fire, etc., panic stimulation, worry, anger, etc. should be avoided.Mild syndrome can engage in appropriate physical activities, to the extent that they do not feel tired and do not aggravate symptoms, and avoid strenuous activities.For severe palpitations such as drinking water and heart palpitations, blood stasis, etc., they should be instructed to rest in bed and maintain a certain rhythm of life.

3. Patients should eat moderately, eat nutritious and easy-to-digest foods, avoid hunger, fullness, tobacco and alcohol, strong tea, and should eat low-fat and low-salt diets. Those who are deficient should avoid spicy food, those with turbid phlegm and blood stasis should avoid overeating fat and sweet, and those who drink water to linger the heart should eat less salt.

4. The palpitations are lingering, and long-term treatment should be adhered to. After the effect is achieved, attention should also be paid to consolidating the curative effect. You can take ginseng and other qi-tonifying medicines!Improve the symptoms of heart-qi deficiency and enhance disease resistance.Actively treat chest obstruction and heartache, phlegm retention, lung distension, dyspnea and arthralgia, etc., which are of great significance to prevent palpitations.

5. Early detection of aura symptoms of card change and preparation for first aid.

[-]. Point massage

([-]) Acupuncture therapy

1. Take acupuncture points
Main points: Shenmen, Neiguan, Sanyinjiao, Xinyu, Zusanli.Acupoints: fast heart rate plus intermittence; slow heart rate plus Suili; irregular heart rate (premature beats) plus Quze, Chize, and Daling; chest tightness plus Tanzhong; phlegm and chest nebula plus Fenglong. 2. Locate Shenmen-[-] wrist, on the transverse wrist crease, in the radial depression of the flexor carpi ulnaris tendon.

Neiguan-the palm side of the forearm, 2 cun above the transverse wrist crease, between the palmar longus tendon and the flexor carpi radialis tendon.

Sanyinjiao-3 cun above the tip of the medial malleolus, on the posterior border of the medial surface of the tibia.

On the back of Xinshu, below the spinous process of the fifth thoracic vertebra, 5 cun laterally.

Zusanli, 3 inches below the nose of a calf, and a transverse finger beside the front edge of the tibia.

Between the palm side of one forearm, on the line connecting Quchi and Daling, 3 cun above the transverse crease of the wrist, between the palmaris longus tendon and the flexor carpi radialis tendon.

Su Liao has a face, right in the middle of the tip of the nose.In the elbow crease of Quze, the ulnar border of the biceps tendon.In the transverse cubital crease of Chize, in the depression on the radial side of the biceps tendon.At the midpoint of the palmar crease of Daling [-] wrist, between the palmar longus tendon and the flexor carpi radialis tendon.

Tanzhong one chest, on the front midline, level with the 4th intercostal space, the midpoint of the line connecting the two nipples.

On the anterolateral side of Fenglong’s calf, 8 cun above the tip of the lateral malleolus, and two transverse fingers (middle finger) beside the front edge of the tibia.

([-]) Self-massage
1. Pinch the Qimen acupoint (5 inches above the horizontal wrist crease, between the two tendons) pinch and press the Qimen acupoint on the opposite side with the thumb peak for 2 minutes, so that the local area will feel sore and swollen.Knead and press Neiguan for 2 minutes.

2. Knead Tanzhong Use the index, middle, and ring fingers of the right hand, and put the three fingers together, rub Tanzhong for 3 minutes.

3. Rub the left chest. Use your right hand to rub the precordial area on the left chest for 3 minutes, so that it is advisable to feel the heat in the precordial area.Take advantage of the situation and use the middle finger to rub the Zhongfu point (2 inches outside the breast, level with the first intercostal space) and Rugen point (directly below the nipple, level with the fifth intercostal space) 18 times each.

4. Take the Jiquan point with the thumb and index finger, and pinch the Jiquan point under the opposite armpit (raise the arm to open the armpit, in the middle of the armpit) 3 times, so that the numbness radiates to the fingers.Then take Jianjing on the opposite side (the highest point of the shoulder, the midpoint of the line between Dazhui point and the acromion) 3 times.

5. Massage the Zusanli and rub the Zusanli on both sides with your thumb for 2 minutes.

6. Press Neiguan acupoint Press the contralateral Neiguan acupoint with your thumb for 3 minutes to make it feel a strong soreness, numbness and swelling.

7. Beat the front chest with hollow fists, and beat the front area (left chest) 18 punches, the strength should be tolerable.

8. Press Tanzhong Place the palm of your right hand on Tanzhong, overlap your left palm on the back of your right hand, press and relax alternately 18 times. 9. Deep breathing method First inhale deeply, hold your breath as much as possible, and then take a deep breath.

Coronary heart disease

An overview of the disease

([-]) Relevant knowledge

Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease.Refers to a heart disease in which severe atherosclerosis or spasm occurs in the coronary artery, the blood vessel that supplies nutrients to the heart, narrowing or blocking the coronary artery, and thrombosis causes occlusion of the lumen, leading to myocardial ischemia, hypoxia or infarction. called ischemic heart disease.Coronary heart disease is the most common type of organ lesions caused by atherosclerosis, and it is also a common disease that endangers the health of middle-aged and elderly people.The occurrence of this disease is closely related to the degree and number of coronary artery atherosclerosis stenosis, but a small number of young patients with coronary atherosclerosis are not serious, or even without atherosclerosis, can also develop the disease.There are also some elderly people with severe coronary atherosclerotic stenosis who do not necessarily have clinical manifestations of coronary heart disease such as chest pain and palpitations.Therefore, the pathogenesis of coronary heart disease is very complicated. Generally speaking, organic disease is more common, and coronary artery spasm also mostly occurs in coronary arteries with atherosclerosis.The disease mostly occurs after the age of 40, with more men than women, more mental workers than manual workers, and more urban than rural areas. The average prevalence rate is about 6.49%, and the prevalence rate increases with age. The most common cardiovascular disease in humans.With the improvement of people's living standards, the prevalence of coronary heart disease in my country is increasing year by year, and the age of the disease tends to be younger. Therefore, my country is facing the challenge of cardiovascular diseases in the 21st century. Can it curb the harm to human health? The key to the "first killer" is prevention.

([-]) Etiology and pathogenesis

Coronary heart disease is myocardial damage caused by the imbalance between coronary blood flow and myocardial demand caused by coronary artery functional changes or organic lesions.The basic lesion of this disease is the blood vessels that supply myocardial nutrients—coronary arteries have atherosclerosis.It is mainly related to the following aspects.

1. Age The disease is more common in middle-aged and elderly people over the age of 40, and it progresses rapidly after the age of 49. The incidence of myocardial infarction and sudden death from coronary heart disease is directly proportional to age.In recent years, the incidence of coronary heart disease tends to be younger.

2. Gender Among the various races in the United States, the mortality rate of coronary heart disease in men is significantly higher than that in women.According to statistics in 1979, the mortality rate of coronary heart disease among white males aged 35 to 44 was 5.2 times that of females.In my country, the ratio of male to female is about 2:1.However, after women's menopause, due to the obvious decrease of estrogen level and the increase of LDL, the incidence of coronary heart disease in women increases significantly at this time. Some data show that after the age of 60, the incidence rate of women is higher than that of men.

3. Occupational mental workers are more likely to be sick than manual workers, and they often work with a sense of urgency.

4. People who often eat a high-calorie diet, more animal fat, and cholesterol are prone to this disease.At the same time, a large amount of food is also prone to this disease. Researchers in Germany, the world's most obese country, believe that "fat is because of eating too much." Therefore, to control the incidence of coronary heart disease, in addition to controlling high-fat diet intake , we must also pay attention to controlling food intake.

5. Blood lipid abnormalities caused by genetic factors, excessive fat intake, or lipid metabolism disorders.Such as total cholesterol, triglycerides, LDL, VLDL increased, while HDL decreased, susceptible to this disease.

6. Blood pressure Elevated blood pressure is an independent risk factor for coronary heart disease.The harm caused by atherosclerosis caused by elevated blood pressure, the most common ones are coronary arteries and cerebral arteries.60-70% of patients with coronary atherosclerosis have high blood pressure, and those with high blood pressure suffer from this disease 4 times more than those with normal blood pressure.

7. Smoking Smoking is a major risk factor for coronary heart disease.Compared with non-smokers, the morbidity and mortality of this disease are increased by 2 to 6 times in smokers, and it is directly proportional to the number of cigarettes smoked every day.

8. Obesity Obese people who exceed the standard weight (10% overweight are mild, 20% are moderate, and 30% are severe obesity) are prone to this disease, especially those who gain weight rapidly.But at present, it is believed that more attention should be paid to the research on the method of evaluating body weight.You can't just look at the body mass index, but the thickness of subcutaneous fat should be measured.Prospective research data have shown that central obesity has a greater risk.

9. Diabetes The fact that diabetes can easily cause cardiovascular disease has been recognized.Data show that the incidence of this disease in diabetic patients is twice that of non-diabetics.

10. If there is a person who is susceptible to the disease at a young age in the genetic family, the chance of his close relatives being affected can be 5 times that of a family without this situation.

([-]) Classification and clinical manifestations
1. Classification The World Health Organization classifies coronary heart disease as follows:

(1) Primary cardiac arrest.

(2) Angina pectoris.

(3) Myocardial infarction.

(4) Heart failure in ischemic heart disease.

(5) Arrhythmia. 2. Clinical manifestations The clinical manifestations of coronary heart disease are more complicated and can basically be divided into two types:
(1) One is asymptomatic coronary heart disease or occult coronary heart disease. This type of patient is only found to have ischemic changes in the ECG during physical examination or hospitalization for other diseases for routine examination.

(2) The other kind of patients have diverse symptoms due to differences in age, gender, environment, and disease progression.For example, angina pectoris-type coronary heart disease often manifests as crushing or constricting pain after the upper or middle segment of the sternal body, which can spread to the precordial area. The frequency of attacks can be multiple times a day, or once a few days or weeks.Myocardial infarction-type coronary heart disease manifests as ischemic necrosis of the myocardium, and about 1-1% of patients have symptoms of general fatigue and chest discomfort before the onset.There are also patients with sudden onset, and the way of onset is common with new angina pectoris or sudden aggravation of old angina pectoris.Heart failure and arrhythmia-type coronary heart disease are caused by the proliferation of fibrous tissue due to long-term insufficient blood supply to the myocardium.Cardiac enlargement, heart failure, and arrhythmia are the three main symptoms of this type of coronary heart disease.Sudden death type coronary heart disease is one of the most harmful types of coronary heart disease.Sudden death of coronary heart disease is caused by severe arrhythmia caused by transient myocardial dysfunction and electrophysiological disturbance on the basis of coronary artery disease.

(End of this chapter)