TCM Acupuncture and Massage

Chapter 44 Cardiovascular and Cerebrovascular System Diseases (2)
([-]) Diagnosis

Mainly refer to the following aspects.

1. Clinical manifestations mainly include symptoms and signs.Angina pectoris is the main clinical symptom of coronary heart disease. It can be distinguished from angina pectoris and myocardial infarction according to the location, nature, inducement, duration, relief mode and accompanying symptoms and signs of angina pectoris. The diagnosis of heart disease angina pectoris and myocardial infarction is crucial.

2. Electrocardiogram Electrocardiogram is the earliest, most commonly used and most basic diagnostic method in the diagnosis of coronary heart disease.

3. Nuclide myocardial imaging According to the medical history, this test can be done when the electrocardiogram cannot rule out angina pectoris.Nuclide myocardial imaging can show the ischemic area, the location and size of the definite ischemia.Combined with exercise test and re-imaging, the detection rate can be improved.

4. Coronary angiography is currently the "gold standard" for the diagnosis of coronary heart disease.Whether there is stenosis in the coronary artery, the location, degree, and scope of the stenosis can be determined, and the measures to be taken for further treatment can be guided accordingly.At the same time, left ventricle angiography can be performed to evaluate cardiac function.The main indications for coronary angiography are: ① For patients with severe angina pectoris despite medical treatment, arterial lesions should be clarified to consider bypass grafting; ② Chest pain resembling angina pectoris can not be diagnosed.

5. Ultrasound and Intravascular Ultrasound Echocardiography can examine the shape of the heart, wall motion and left ventricular function, and is one of the most commonly used examination methods at present.It has important diagnostic value for aneurysm, intracardiac thrombus, cardiac rupture, and papillary muscle function.Intravascular ultrasonography can clarify the shape and stenosis degree of the coronary artery wall, and it is a promising new technology.

6. Myocardial enzyme examination is one of the important means for the diagnosis and differential diagnosis of acute myocardial infarction.Acute myocardial infarction can be diagnosed clinically based on positive enzymatic changes such as sequence changes in serum enzyme concentrations and increases in specific isoenzymes.

([-]) Treatment

The treatment of coronary heart disease is mainly to improve coronary circulation and myocardial ischemia; reduce and prevent coronary spasm; prevent predisposing factors; reduce high blood viscosity; Blood lipids should be treated with blood lipid lowering; appropriate physical labor to prevent overwork; prevent arrhythmia; improve diet structure and eat less high-cholesterol foods; prevent myocardial infarction and sudden death as the principle.

At present, there are three kinds of treatment for coronary heart disease: drug therapy, interventional therapy and surgical operation.

1. Medication The most commonly used medicine at present is Shexiang Baoxin Pill, which is fragrant and warm, nourishes Qi and strengthens the heart.It can be used as daily prevention and first aid for patients with coronary heart disease.The medicine cures the disease, seeks the root of the disease, and has the functions of protecting the heart and improving cardiovascular function.

2. Interventional treatment includes percutaneous transluminal coronary angioplasty (PTCA), coronary atherectomy, coronary atherectomy and atherectomy, coronary atherectomy, percutaneous coronary laser angioplasty, Coronary artery stenting, etc.Currently the most widely used interventional therapy is percutaneous coronary angioplasty and coronary artery stenting.

3. Surgical treatment such as coronary artery bypass grafting, that is, coronary artery bypass grafting.In addition, it has been clinically proven that acupuncture has a good curative effect on certain types of coronary heart disease.

([-]) Prevention

Early detection, early diagnosis, and early treatment are of great significance to the curative effect and prognosis of the disease, and coronary heart disease is no exception.If the following situations occur, seek medical treatment in time to detect coronary heart disease as soon as possible so as not to delay the treatment.

1. Retrosternal or precordial dull pain, or constriction-like pain that radiates to the left shoulder and left upper arm during fatigue or mental stress, lasts for 3 to 5 minutes, and relieves itself after rest.

2. Those who experience chest tightness, palpitations, and shortness of breath during physical activity, and relieve themselves during rest.

3. Headaches, toothaches, and leg pains related to exercise.

4. Chest pain and palpitations when having a full meal, being cold or watching a thriller.

5. People who feel chest tightness and suffocation when the pillow is low at night, and need a high pillow to lie down to feel comfortable; people who have sudden chest pain, palpitations, and dyspnea when sleeping or lying down during the day, and need to sit up or stand up immediately to relieve it.

6. Those who experience palpitation, chest tightness, shortness of breath or chest pain and discomfort during sexual life or straining to defecate.

7. Those who hear the sound of gongs and drums or other noises around them cause palpitation and chest tightness.

8. Recurrent irregular pulse, unexplained tachycardia or bradycardia.People often say that we should "prevent problems before they happen", and Chinese medicine also advocates preventing diseases before they occur, and preventing diseases from becoming worse.Everyone should establish the awareness of disease prevention in daily life. After getting sick, we should actively treat it as soon as possible, so that prevention and treatment can be organically combined. Only in this way can we reduce the incidence rate and improve the curative effect, and help patients recover their functions as soon as possible and improve their quality of life. , to achieve true health.

[-]. Point massage

([-]) Acupuncture therapy

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

Neiguan—inner forearm, 2 cun above the transverse wrist crease, between the palmar longus tendon and the flexor carpi radialis tendon.

Sanyinjiao—3 cun above the medial malleolus, on the posterior border of the medial tibia.

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

Zusanli - 3 inches below the calf's nose, a transverse finger (middle finger) is opened beside the front edge of the tibia.

Intermittent—on the palm side of the 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 iliac—the face, the center of the tip of the nose.Quze—in the cubital crease, the ulnar border of the biceps tendon.Chize—in the cubital crease, in the depression on the radial side of the biceps tendon.Daling - at the midpoint of the palmaris crease, between the palmar longus tendon and the flexor carpi radialis tendon.

Tanzhong—chest, on the front midline, level with the fourth intercostal space, and the midpoint of the line connecting the two nipples.

Fenglong—8 inches above the lateral malleolus, two fingers (middle finger) apart from the front edge of the tibia.

([-]) Self-massage
Self-massage therapy for coronary heart disease is an adjuvant therapy. If you have a recent myocardial infarction, you should not do massage therapy. Only after your condition is stable can you cooperate with massage therapy.You can do it once after waking up and before going to bed.

1. Wipe the forehead Use the palms of two hands and four fingers to wipe the forehead and both sides of the head for 2 minutes.

2. Rub the ears. Rub the index fingers of both hands on the nail cavity just behind the opening of the external auditory canal for 1 minute to generate local heat.

3. Pinch the acupoints Alternately pinch Neiguan, Shenmen, Tanzhong, Zusanli, Sanyinjiao and Yongquan points on both sides with both hands.

4. Stand up by patting the chest and back, relax your arms, and swing the chest and back from left to right 50 to 100 times.

5. Hold the pectoralis muscle with both thumbs close to the chest, two hands and four fingers sticking to the armpit, relatively hold it with the hands, breathe in and out, lift and grasp, slowly grasp the pectoral muscle, and do it for 2 minutes.

6. To comb the ribs, use the middle fingers of both hands to massage the Tanzhong point for 1 minute.Then spread five fingers, rub along the ribs from inside to outside, repeat 50 times.

7. Knead Zhangmen and Qimen Use the thenar muscles of both hands to rub Zhangmen (at the lower edge of the free end of No.11 rib) and Qimen (under the nipple, level with the sixth intercostal space) for 1 minute each.

hypertension

I. Overview

([-]) Relevant knowledge

在尽量减轻或排除各种干扰因素，非同日3次静息血压（静坐5～15分钟）测量≥140/90mmHg（18.7/12.0kPa）则可诊断为高血压。高血压可分为原发性高血压和继发性高血压。前者多见，目前病因尚不明；后者血压的升高是由原发病引起。一般所说的高血压均是指原发性高血压。我国高血压患者数量已达1.1亿，并且还在以每年300多万人的速度增长。

([-]) Etiology and pathogenesis

The etiology of hypertension is unknown, and the factors related to the onset are: 1. Age The incidence rate tends to increase with age, and the incidence rate is high for those over 40 years old. 2. Those who consume a lot of salt have a high incidence of hypertension. Some people think that if the salt is less than 2g/day, hypertension will hardly occur; 3%, >4g/day incidence rate 3%.

3. The incidence of obesity is high.

4. Genetic About half of hypertensive patients have a family history.

5. Environment and Occupation Noisy working environment and excessive mental work are prone to high blood pressure, and the incidence of high blood pressure in cities is higher than that in rural areas.

([-]) Clinical manifestations

According to the priority of onset and the progress of the disease, it can be divided into slow-progressive type and rapid-progressive type, with slow-progressive type being more common.

1. Slow progressive hypertension

(1) Early manifestations: Most of them are asymptomatic in the early stage. Occasionally, elevated blood pressure is found during physical examination, or symptoms such as dizziness, headache, vertigo, tinnitus, insomnia, fatigue, and lack of concentration after mental stress, emotional excitement, or fatigue may be Caused by advanced mental dysfunction.In the early stage, the blood pressure only rises temporarily, and as the disease progresses, the blood pressure continues to rise, and the organs are involved.

(2) Brain manifestations: headache and dizziness are common.It is mostly induced by emotional agitation, fatigue, climate change or withdrawal of antihypertensive drugs.A sudden increase in blood pressure.Severe headache, visual impairment, nausea, vomiting, convulsions, coma, transient hemiplegia, aphasia, etc.

(3) Cardiac manifestations: In the early stage, the heart function is compensated, and the symptoms are not obvious; in the later stage, the heart function is decompensated, and heart failure occurs.

(4) Renal manifestations: Long-term hypertension causes renal arteriosclerosis.When renal function declines, it can cause nocturia, polyuria, protein in urine, casts and red blood cells.Low urine concentration function, phenol red excretion and urea clearance disorders.Azotemia and uremia occurred.

(5) Arterial changes.

(6) Fundus changes. 2. Accelerated hypertension is also called "malignant hypertension", which accounts for 1% of hypertension.Malignant hypertension can occur at any age, but it is most common in 30-40 years old.The blood pressure increased significantly, and the diastolic blood pressure was mostly above 17.3Kpa (130mmHg), and there were symptoms such as fatigue, thirst, and polyuria.Rapid loss of vision, retinal hemorrhage and exudation, often bilateral papilledema.Rapid proteinuria, hematuria and renal insufficiency.Heart failure, hypertensive encephalopathy and hypertensive crisis may also occur, the course of the disease progresses rapidly, and most of them die of uremia.

([-]) Diagnosis and staging
1. Blood pressure criteria recommended by the World Health Organization

（1）正常血压：收缩压≤18.64Kpa（140mmHg），舒张压≤12.1Kpa（90mmHg）。

（2）成年人高血压：收缩压≥21.3Kpa（160mmHg），舒张压≥12.65Kpa（95mmHg）。

(3) Borderline hypertension refers to blood pressure between the above two.In addition, if the patient has a history of hypertension and is currently taking antihypertensive drugs, even if the blood pressure is lower than 140/90mmHg, it should also be diagnosed as hypertension.

2. Staging of hypertension

(1) Phase I: mild symptoms.

(2) Phase II: functional impairment of heart, liver and kidney.

(3) Stage III: organic damage to heart, liver and kidney.Most patients are asymptomatic and their blood pressure levels do not parallel their symptoms.

([-]) Treatment

1. Generally, the onset of hypertension is related to the dysfunction of the central nervous system, and attention should be paid to the combination of work and rest.

2. Antihypertensive drug treatment
(1) Angiotensin-converting enzyme inhibitors: captopril and enalapril are currently used.

(2) Calcium antagonists: a group of drugs with different chemical structures and different mechanisms of action.Because it inhibits the influx of calcium ions through the calcium channel on the cell membrane, it is called a calcium channel antagonist.Commonly used drugs are verapamil, diltiazem, nifedipine, and nitrendipine.

(3) Vasodilators: directly relax vascular smooth muscle, dilate blood vessels, and lower blood pressure.Commonly used drugs are sodium nitroprusside, chlorinated, hydralazine.

(4) Antihypertensive drugs acting on the sympathetic nervous system:

①Central sympathetic depressants: there are clonidine, methyldopa and other drugs.

② Sympathetic ganglion blockers: Alfonate is commonly used in the treatment of hypertensive encephalopathy.

③ Sympathetic postganglionic blockers: deplete the storage of norepinephrine in the sympathetic nerve endings, and achieve the purpose of lowering blood pressure.Commonly used drugs are guanethidine and reserpine.

④ Adrenergic receptor blockers: including alpha receptor blockers and beta receptor blockers.Representative drugs of the former include prazosin and doxazosin; the latter include benzalol and acetrolol.

(5) Diuretic and antihypertensive drugs: including thiazide drugs, chlorthalidone, furosemide, triamterene and other drugs.

3. Principles of drug treatment
(1) Individualization: According to the pathophysiological characteristics, disease progression and complications of different patients, different drugs and different doses are used.

(2) Combined medication.

(3) Hierarchical treatment: For general hypertension, drugs with less side effects are used first, and one or more drugs with different mechanisms of action can be gradually added if satisfactory curative effect is not obtained.Consider graded treatment.

Grade I: Diuretics, β-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors, one drug can be used, and another drug can be used if one is ineffective.

Class II: Combined medication, two drugs are used together, starting from a small amount until it is effective, if it is ineffective, transfer to the third class.

Grade Ⅲ: Combined use, three drugs used together.

Grade Ⅳ: If the effect of tertiary treatment is not satisfactory, guanethidine or clonidine can be used instead.

([-]) "Three Threes" of Hypertension Health Care Prescription

Hypertension is the "number one killer" that threatens the health of middle-aged and elderly people.Strict prevention and treatment of hypertension and its concurrent cardiovascular and cerebrovascular diseases such as angina pectoris, myocardial infarction and stroke are particularly important for the health and longevity of hypertensive patients.The health prescription "three threes" proposed by experts is "three and a half minutes", "three and a half hours" and "three glasses of water".

1. Three and a half minutes When getting up at night, after waking up and opening your eyes, continue to lie flat for half a minute; sit on the bed for another half minute; then hang your legs down the edge of the bed for half a minute, and finally get down to the ground for activities.Because, clinically found: cerebral thrombosis, cerebral hemorrhage, sudden cardiac death, etc. often occur at night. The 24-hour ambulatory electrocardiogram monitoring shows that the heartbeat of many patients is stable throughout the day, except that there are several large fluctuations at night, and most of them suffer from insufficient cardiovascular and cerebrovascular blood supply due to sudden changes in body position when the patients get up to go to the bathroom at night. , especially the elderly have slow neuromodulation and are more prone to danger. Even ordinary people should pay attention to avoid fainting caused by sudden changes in body position. "Three and a half minutes" is easy to learn, and you will know it at a glance.It doesn't cost a penny, as long as it is put into practice, at least 50% of cardiovascular and cerebrovascular patients can be prevented from sudden death.

2. Three and a half hours walk for half an hour in the morning; sleep for half an hour at noon; walk for half an hour at night.Life is movement!Many people do not put exercise on the same important position as meals and sleep.The World Health Organization has also emphasized the benefits of naps at the International Sleep Conference, but the nap time should not exceed half an hour.The World Health Organization believes that the best exercise is walking, especially reminding cardiovascular and cerebrovascular patients; walking exercise should pay attention to "[-]". "three"

It means to walk more than 3000 meters every day, and guarantee 30 minutes, and insist on being constant and moderate. Excessively intense exercise is not good for the body. "Five" means to exercise more than five times a week. "Seven" refers to heart rate + age = 170 after exercise.For example: for a 50-year-old person, the heart rate should reach 120 beats after exercise (of course, those in excellent health can reach 190 beats; those in poor health should not exceed 150 beats).Such a moderate amount of exercise can maintain aerobic metabolism. If the amount of exercise is too large and the heart rate is too fast, it will become anaerobic metabolism, which is not conducive to health.

3. Three glasses of water means drinking a glass of warm water before going to bed at night, drinking a glass of warm water when you wake up in the middle of the night, and drinking a glass of warm water when you get up in the morning.Because the blood flow is slow at night, it is easy to form thrombus. Drinking a glass of water before going to bed can dilute the blood.Waking up in the middle of the night, especially in summer, when you sleep and sweat a lot, you have to drink a glass of water when you get up in the middle of the night.Of course, don't deliberately drink water in the middle of the night to affect your rest.Get up in the morning and drink a glass of water, because 8 to 10 in the morning is the peak period of blood pressure, and heart and brain thrombosis is very easy to form. Drinking a glass of water can dilute the blood and prevent thrombosis. In addition, it can also play a role in laxative.

The "three threes" of hypertensive patients are simple, effective, and habitual, which will be of great benefit to health and longevity.

(End of this chapter)