--- Etiology and Pathogenesis

(---) Etiology and Pathogenesis It is mainly seen in various myocarditis (such as rheumatic, viral, and bacterial), various organic heart diseases, drug poisoning (such as excessive use of digitalis, β-blockers, and calcium antagonists), and electrolyte disturbances. (II) Clinical Manifestations First-degree atrioventricular block often has no obvious clinical symptoms. Second-degree atrioventricular block type I patients may feel skipped heartbeats, while type II patients often experience palpitations, dizziness, and fatigue. Third-degree atrioventricular block patients exhibit symptoms similar to type I patients, but severe cases may develop cardiogenic cerebral ischemia syndrome (cyanosis, syncope, convulsions) and heart failure, even sudden death. (III) Electrocardiographic Examination

1. First-degree atrioventricular block: P-R interval is prolonged.

2. Second-degree atrioventricular block ① Type I: The P-R interval gradually lengthens until ventricular escape occurs (no QRS complex). After each escape, the first P-R interval shortens, repeating this cycle to form ratios such as 3:2, 4:3, and 5:4. ② Type I: The P-R interval remains constant, but every 1, 2, or 3 P waves, one QRS complex is missed. Thus, they are called 2:1, 3:2, and 4:3 atrioventricular blocks.

3. Third-degree atrioventricular block Both P-P and R-R intervals follow their own patterns, but there is no correlation between them. The atria beat independently, and the ventricles beat independently. (IV) Treatment

4. Treatment of the underlying cause For those caused by rheumatic fever, anti-rheumatic treatment should be given; for those poisoned by digitalis, the drug should be immediately discontinued and appropriate measures taken. For those triggered by acute infection, inflammation should be controlled.

5. Increasing ventricular rate Atropine and isoproterenol are often used.

6. If drug treatment is not effective, consider implanting an artificial pacemaker (briefly). Professor Pei Zhengxue has been practicing medicine for 60 years and has accumulated extremely rich experience in the treatment of cardiovascular diseases. · Activating Blood Circulation and Removing Stasis Professor Pei Zhengxue believes that the fundamental principle for treating cardiovascular diseases is activating blood circulation and removing stasis. Regardless of the type of cardiovascular disease, it will ultimately lead to microcirculatory disorders in the coronary arteries—this is a common feature of all cardiovascular diseases, which in traditional Chinese medicine is referred to as "stagnant heart vessels," blockage, and pain caused by obstruction. For coronary artery lesions, modern medicine uses interventional treatments (coronary dilation, stenting, bypass surgery), which have made epoch-making contributions. However, it overlooks "reperfusion injury" (some patients still experience chest tightness, palpitations, and shortness of breath after intervention), and cardiac catheterization and angiography cannot detect coronary artery spasm, especially when emotions are agitated, sad, painful, or overly fatigued, leading to chest tightness, palpitations, and shortness of breath due to coronary spasm. Modern medicine's coronary vasodilators have therapeutic effects but lack preventive effects. In contrast, traditional Chinese medicine's blood-activating and stasis-removing drugs not only have therapeutic effects but also remarkable preventive effects. Activating blood circulation and removing stasis can both dilate coronary vessels, change blood flow conditions, increase blood flow, improve myocardial diastolic function, enhance myocardial contractility, reduce blood flow resistance, and lower myocardial oxygen consumption. It can also improve local microcirculation, ensuring true blood supply to the heart. Furthermore, activating blood circulation and removing stasis can activate capillary activity, promote tissue repair, reduce platelet aggregation, prevent blood coagulation, and inhibit thrombus formation. Cardiac blood stasis can lead to various symptoms, such as palpitations, shortness of breath, chest tightness, insomnia, irritability, excessive worry, suspicion, fear, doubt, and delusion, which in turn exacerbate cardiac symptoms. Therefore, in treatment, blood-activating and stasis-removing therapies should be applied throughout the entire course of the disease. Wang Qingren's Xuefu Zhuyu Tang can treat nineteen different symptoms, and its efficacy is entirely dependent on regulating cardiovascular blood supply. The Beijing Regional Collaborative Group's invention of Coronary Heart Disease No. II greatly improved the overall level of traditional Chinese medicine treatment for cardiovascular diseases, and Professor Pei Zhengxue added Sanqi and leeches on this basis, further enhancing the effect. Activating blood circulation and removing stasis is one of the important treatment methods in traditional Chinese medicine for coronary heart disease, and long-term use can achieve stable results that Western medicine cannot attain. II. Broadening the Chest and Regulating Qi Professor Pei Zhengxue believes that another major principle for treating cardiovascular diseases is broadening the chest and regulating qi. The Guabai Baijiu Soup and Guabai Banxia Soup from the "Jin Gui Yao Lue" are important prescriptions for broadening the chest and regulating qi. Guabai broadens the chest and regulates qi, clears heat and resolves phlegm; Bai regulates qi and resolves depression; Banxia regulates qi and resolves phlegm. Shiba Guilongzhi Tang, Ren Shen Tang, Fu Ling Xing Ren Gan Cao Tang, Ju Jiang Tang, Yi Zheng Fu Zi Tang, Chi Shi Zhi Wu Tou Wan, Gui Zhi Ginger Zhi Shi Tang, and Zhi Gan Cao Tang all serve to unblock chest yang and nourish qi and heart. III. Warming Yang and Transforming Water This can reduce the heart's preload, thereby alleviating the heart's burden. The "Su Wen · Six Visceral Organs Theory" states: "The heart is the root of life and the transformation of spirit. It is the sun among yang energies, connected to summer energy." This means the heart is the foundation of life, governing spiritual transformations, and its function depends on strong yang energy. The heart belongs to the fire organ, located in the chest, where "the chest is the yang position like the sky," hence the heart's title of "the sun among yang energies." The heart governs yang energy first, then blood vessels, and finally mental functions, all under the supervision of heart yang. If heart yang is deficient, it cannot subdue yin, and cold water from the lower jiao rises to the chest, especially when spleen and kidney yang are weak, leading to inevitable upward surging of cold water in the lower jiao, resulting in many heart diseases characterized by upward surging of water, known as "water heart disease." Symptoms include chest tightness, chest pain, palpitations, reverse fullness below the heart, upward rushing of qi to the chest, pale tongue with slippery coating, and tense or erratic pulse. Treatment involves warming and nourishing heart yang to address the root cause, descending rebellious qi and eliminating dampness to treat the symptoms, using Ling Gui Zhu Gan Tang. The "Shang Han Lun" says: "When there is reverse fullness below the heart and qi rushes upward to the chest, one feels dizzy, the pulse becomes deep and tight, sweating causes tremors, and the body shakes violently. Fu Ling Gui Zhi Bai Zhu Gan Cao Tang is the main prescription." IV. Calming the Spirit and Sedating the Mind If emotions are depressed, qi stagnates in the upper jiao, chest yang is not fully expressed, and blood vessels are out of harmony, it leads to chest oppression and heart pain, manifested as: chest and heart fullness, intermittent dull pain, pain with no fixed location, palpitations and shortness of breath, irritability, insomnia, quick temper, frequent sighing, and aggravation when emotions are disturbed. Professor Pei Zhengxue often uses Wendan Tang, Xiaoyao San, and Chaihu Jia Longgu Mu Li Tang to clear heat, calm the mind, soothe the liver, and sedate the spirit, thereby reducing the heart's burden. V. Maintaining Adaptability Professor Pei Zhengxue believes that the human body's adaptability is very strong. For congenital heart disease discovered during examinations in adults, there is no need to rush into surgical correction. Although there is congenital heart disease (such as atrial septal defect, ventricular septal defect, etc.), over decades of growth, the heart and the whole body have already adapted to the current state, and surgery should not be performed just for the sake of surgery—this is like "seeing the trees but not the forest." On the contrary, surgery can disrupt the original adaptive state of the heart and the whole body, achieving the opposite effect. For such patients, the main focus should be on maintaining the status quo, while preventing infection, avoiding fatigue, and keeping a cheerful mood. Professor Pei Zhengxue often says that traditional Chinese medicine is in no way inferior to modern medicine in treating cardiovascular diseases. The differentiation-based treatment of cardiovascular diseases mainly focuses on the following aspects:

7. Heart Qi Deficiency, Heart Yang Deficiency, and Loss of Yang Heart Qi deficiency develops into Heart Yang deficiency, which then progresses to Loss of Yang. Heart Qi deficiency, Heart Yang deficiency, and Loss of Yang are three pathological stages that deepen gradually. Palpitations and shortness of breath are basic symptoms of Heart Qi deficiency, and treatment involves tonifying qi and nourishing the heart. Professor Pei Zhengxue often uses Guipi Tang and Baoyuan Tang with Dingxin Wan as prescriptions. [Common Medications] Dang Shen 10g, Huang Qi 20g, Bai Zhu 12g, Dang Gui 10g, Gan Cao 6g, Mai Dong 10g, Zhu Fu Shen 12g, Chao Zao Ren 15, Rou Cong Rong 10g, Bai Zi Ren 10g, etc., decocted in water and taken orally. For those with Heart Yang deficiency, additional symptoms of yang deficiency appear on top of Heart Qi deficiency, such as feeling cold, spontaneous sweating, and edema, indicating Heart Yang deficiency. When qi deficiency reaches its extreme, yang deficiency occurs, and yang deficiency leads to water overflow, causing fear of cold and edema. Treatment involves warming and tonifying Heart Yang, and Professor Pei Zhengxue often uses Guipi Tang with warming yang herbs or Zhenwu Tang and Ling Gui Zhu Gan Tang. The "Shang Han Lun" says: "When there is reverse fullness below the heart and qi rushes upward to the chest, one feels dizzy, the pulse becomes deep and tight, sweating causes tremors, and the body shakes violently. Fu Ling Gui Zhi Bai Zhu Gan Cao Tang is the main prescription." [Common Medications] Fu Ling 12g, Gui Zhi 10g, Bai Zhu 12g, Fu Zi 6g, Gan Jiang 6g, Gan Cao 6g, etc., decocted in water and taken orally. For those with Loss of Yang, the face becomes pale, sweating is profuse, and the pulse is almost gone. Loss of Yang means the separation of yin and yang, and vital energy disperses, equivalent to shock in modern medicine. Treatment involves restoring yang and reversing the situation, and Professor Pei Zhengxue often uses Du Shen Tang, Si Ni Tang, and Shen Fu Tang as prescriptions. [Common Medications] Hong Shen 15–30g, Fu Zi Pian 10g, Gan Jiang 5g, etc., decocted in water and taken orally.

8. Heart Blood Deficiency, Heart Yin Deficiency, and Loss of Yin Palpitations, forgetfulness, insomnia, and excessive dreaming are basic symptoms of Heart Blood Deficiency, and treatment involves nourishing blood, calming the mind, and soothing the heart. Professor Pei Zhengxue often uses Guipi Tang as a prescription. [Common Medications] Dang Shen 10g, Huang Qi 20g, Bai Zhu 12g, Dang Gui 10g, Gan Cao 6g, Mai Dong 10g, Zhu Fu Shen 12g, Chao Zao Ren 15, Bai Zi Ren 10g, etc., decocted in water and taken orally. As Heart Blood Deficiency progresses, symptoms such as bone-steaming heat, five-heart heat, and night sweats appear, indicating Heart Yin Deficiency. When blood deficiency reaches its extreme, it becomes Yin Deficiency, and treatment involves nourishing Heart Yin. Professor Pei Zhengxue often uses Tian Wang Bu Xin Dan as a prescription, which is the best remedy for Heart Yin Deficiency. [Common Medications] Dang Shen 10g, Fu Ling 12g, Xuan Shen 10g, Dan Shen 20g, Ju Jing 20g, Dang Gui 10g, Wu Wei Zi 3g, Mai Dong 10g, Tian Dong 10g, Bai Zi Ren 15g, Suan Zao Ren 15g, Sheng Di Huang 12g, etc., decocted in water and taken orally. If Heart Yin Deficiency further progresses, symptoms such as dry skin, irritability, and hot sweat like oil appear, and hands and feet become warm—this indicates Loss of Yin. Heart Blood Deficiency, Heart Yin Deficiency, and Loss of Yin are three pathological stages that deepen gradually. Treatment involves nourishing qi and Yin, and Professor Pei Zhengxue often uses Sheng Mai San as a prescription. If Western medicine diagnoses arrhythmia, Professor Pei Zhengxue first advocates the "Jin Gui Yao Lue" recipe of Zhi Gan Cao Tang: Zhi Gan Cao 12g, Sheng Jiang 6g, Gui Zhi 10g, Dang Shen 10g, Sheng Di Huang 12g, A Jiao 10g (similar to gelatin), Mai Dong 10g, Ma Ren 10g, four dates, decocted in water and taken orally. Secondly, he often recommends the Shanghai University of Traditional Chinese Medicine President Huang Wen Dongfang's "Half Fragrant Herb Chen Branch Red, Golden Tea Three Liang Whole Heart Rhythm," which includes Ban Xia, Gua Wei, Yu Jin, and tea tree roots—Yu Jin 6g, tea tree roots 30g, decocted in water and taken orally.

9. Blood Stasis in the Heart Blood stasis in the heart is seen in various cardiovascular diseases, especially coronary heart disease (angina pectoris or myocardial infarction), rheumatic heart disease, and heart failure. It often manifests as pain in the precordial region, feeling of stuffiness, stabbing pain, or squeezing pain. Treatment should focus on unblocking stasis and activating blood circulation and removing stasis. Professor Pei Zhengxue often uses Beijing Collaborative Group's Coronary Heart Disease No. II with Sanqi and leeches, Wang Qingren's "Xuefu Zhuyu Tang," the empirical formula "Shan Dan Hua Kai Wu Ze Chuan," and "Five Waters Spread Sea Sanqi" as examples. [Common Medications] Chi Shao 10g, Chuan Xiong 10g, Hong Hua 6g, Dan Shen 20g, Jiang Xiang 10g, Sanqi 3g (diluted), Leeches 10g (diluted), etc., decocted in water and taken orally.

10. Chest Yang Not Flowing (Chest Yang Obstruction) Chest Yang not flowing is essentially the same as Western medicine's coronary heart disease, meaning that qi and blood in the chest are blocked and unable to flow freely. When qi and blood are blocked, symptoms such as chest and back pain, shortness of breath, coughing up phlegm, and dyspnea appear—when something is blocked, it hurts. The "Su Wen" says: "True heart pain, hands and feet turn blue to the joints, heart pain is severe, one day you're fine, the next you're dead; one night you're fine, the next you're dead." Treatment involves unblocking chest yang and clearing phlegm to broaden the chest. Professor Pei Zhengxue often chooses the "Jin Gui Yao Lue" recipe.

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