Discussion on myocardial infarction from the theory of "Fu-xie" and "Ying-wei theory"

Qian Ma ,Guan-Huan Yang,Hai-Dong Sun

1First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin,China; 2Graduate School of Tianjin University of Traditional Chinese Medicine,Tianjin,China; 3National Acupuncture Clinical Medical Research Center of Traditional Chinese Medicine,Tianjin,China; 4Tianjin Fourth Central Hospital,Tianjin,China.

Abstract Based on Fuxie theory,the pathogenesis of acute myocardial infarction (AMI) is described.By analyzing the similarity between the pathogenesis of Fuxie and the incidence of AMI,it is believed that incubated diseases is closely related to the occurrence and development of AMI.Incubated diseases is a relapse of AMI reason.From the perspective of Ying-wei theory,the pathogenesis of AMI and the imbalance of energy metabolism in the process of AMI are explained,which provides new ideas for Chinese medicine to explain myocardial infarction.

Keywords:Fu-xie,Ying-wei theory,Acute myocardial infarction,Pathogenesis

Introduction

Acute myocardial infarction (AMI) refers to the necrosis caused by acute occlusion of coronary artery blood supply and persistent and severe myocardial ischemia.AMI is one of the serious types of coronary heart disease and one of the diseases with high disability and mortality in the world.With the improvement of living standards,the incidence of cardiovascular disease in China is increasing day by day.Some studies have shown that from 2002 to 2015,AMI mortality rate of acute myocardial infarction in China showed an overall upward trend [1].From 2012,the AMI mortality rate in rural areas was significantly higher than that in urban areas,which will become an important factor threatening national life and health,increasing their cost of living,and increasing the national medical and health burden at the same time.

Western medicine believes that atherosclerosis is the basis of a series of cardiovascular and cerebrovascular diseases,and the core of atherosclerosis is oxidized low density lipoprotein (Ox-LDL).When vascular endothelium is injured,it promotes the formation of reactive oxygen species and accelerates the formation of Ox-LDL.Ox-LDL enters the vascular wall,destroys the endothelial cells of the vascular wall,and enlarges the gap between endothelial cells.Ox-LDL stimulates mononuclear phagocytes to enter the vascular wall,adhere to endothelial cells,ingest LDL and cholesterol to become macrophage-derived foam cells,when the receptors of macrophages and vascular smooth muscle cells engulf Ox-LDL,muscle-derived foam cells are formed.With the development of the disease,the above two kinds of foam cells degeneration,necrosis,disintegration,the formation of porridge-like necrosis,atherosclerotic plaques are formed.With the growth of atherosclerotic plaque,with the continuous death of the above-mentioned foam cells,it gradually becomes the necrotic core,and the persistent inflammatory reaction forms,and the atherosclerotic plaque becomes unstable.Activated macrophages secrete an enzyme to degrade collagen fiber cap,which is unstable and easy to rupture plaque formation.The ruptured plaque releases a large number of highly clotting substances into the vascular lumen,resulting in local thrombosis,which forms in the coronary artery of the heart and becomes myocardial infarction.

In traditional Chinese medicine,AMI is classified as "chest discomfort","heartache","angina pectoris" and "precordial pain with cold limbs".It was first seen in theNeijing.The basic pathogenesis is based on asthenia in origin and asthenia in superficiality,and heart vessel blockage stasis.Some scholars believe that: blood stasis due to qi deficiency is the basis of the disease [2],Pathogenic factors can include phlegm,muddy,blood stasis,cold and heat.

1 The Theory of "Fu-xie" and AMI

Incubated diseases theory originated from "Neijing".Another example is the "Plain Conversation".After continuous summary and development,it is widely used in the analysis of febrile disease,which is called "insidious pathogen warm disease".

The "Dictionary of Traditional Chinese Medicine" explains Fuxie as: it refers to a disease that hides in the body and does not immediately develop.Fuxie has a broad sense and a narrow sense.In a narrow sense,Fuxie refers to insidious pathogen warm disease,which is another type of febrile disease that is different from the newly induced febrile disease.After feeling the external evil,the condition of the disease is not immediately formed due to the mild evil,and it lies in it.Because of external evils invading the human body,the righteousness is weak,unable to expel evils and go out,evils stay in the body,and wait for them.The broad sense of Fuxie not only includes the narrow sense of Fuxie,but also includes all the hidden pathogenic factors,such as internal injury of emotion,improper diet,imbalance of work and rest,that cause blood stasis,turbid phlegm,heat toxin and so on.Explained from the perspective of modern medicine: the pathogenic factors entered the body and failed to stimulate the immune system response at first.Therefore,there were no corresponding uncomfortable symptoms,but the pathogens were hidden in the body and accumulated over time,which coincided with abnormal climate changes or diet and emotions.Factors such as the body's immune function decline,the body's internal and external environment is disordered,pathogens take the opportunity to breed and multiply,and disease outbreaks.

1.1 Explore the pathogenesis of myocardial infarction from the theory of "Fu-xie"

Regarding the location of the evil influence,there are different opinions from different sources.The location of AMI is mainly in the heart,which is closely related to the lung,spleen and liver.The heart governs the blood vessel,and the smooth flow of blood depends on the powerful impetus of the vascular tonic,blood filling and heart qi.

Due to the influence of improper diet,bad living habits and other factors,pathological products such as blood stasis,blood,phlegm and muddy accumulate in the vessels,poor blood flow,depletion of heart qi,deficiency of heart qi,promotion of fatigue,further accumulation of pathological products such as blood stasis,blood,phlegm and muddy in the vessels,vicious circle,and finally lead to the occurrence of myocardial infarction.The lungs govern the qi of the whole body,the natural clear qi inhaled by the lungs and the qi of the water and valleys in the body are combined to form thethoracic qi,and the thoracic qi is enough to help the heart pulse,promote the qi and blood function normally.Lung dysfunction and insufficient inhalation of clear air will reduce the generation of thethoracic qi,weaken the power to promote blood circulation,poor blood circulation,and the evil spirits stay in the vasculature,waiting for an opportunity to break out,and myocardial infarction will occur.At the same time,the lung is in charge of spreading and descending,regulating the operation of the waterway,and the dysfunction of the lung is associated with the disturbance of water and fluid metabolism.The water fluid loses the way to communicate and accumulates in the body,forming water to drink to suppress evil,which will dissipate heat and accumulate phlegm over time,and lie in the vasculature,further affecting the vasculature and blood circulation.The spleen is the foundation of acquired nature,the source of qi and blood biochemistry,abnormal spleen transportation and chemistry,abnormal metabolism of water valley and water,lack of source of qi and blood,stagnation of water and fluid,insufficient blood in the vasculature,fatigue of the heart and qi,formation of blood stasis,and further blockage Vasculature.The liver is the cardinal,which controls the flow of blood,and the stagnation of liver qi will cause the qi and blood to flow unsmoothly,block the blood vessels,and may also lead to myocardial infarction.It can be seen that the key to the pathogenesis of myocardial infarction is qi deficiency and blood stasis.The evil qi that causes myocardial infarction accumulates in the vessel,and the generation of evil qi is closely related to the dysfunction of the five internal organs.

1.2 Elucidating the course of myocardial infarction from the theory of "Fu-xie"

The onset of Fu-xie can be divided into three stages: unonset,outbreak and recurrence.Studies have shown that the occurrence of myocardial infarction is a process of continuous accumulation of pathological factors,from the early onset to the emergence of obvious clinical symptoms and recurrence after infarction,which is highly similar to the pathogenesis of Fuxie.

1.2.1 Deficiency of righteousness,Fu-xie hidden in the blood vessels (unonset)

"The righteousness is inside,and evil is not to be done."."If the evil is gathered together,its qi will be empty."Adequate righteousness is the basis for normal body function,and insufficient righteousness is the internal basis for the disease.With sufficient righteousness,the viscera and meridians will be nourished,the qi,blood and body fluid will work,the body and spirit will be abundant,and the body and the external environment (natural environment and social environment) will be in harmony and unity.To achieve a healthy state of dynamic balance between yin and yang.

If the body's qi in the chest was lack,cold evil attacked while weak,which can make damage to the yang qi in the body,and deficiency of yang qi,the power of pushing and warmth is insufficient.The transfusion of blood and body fluid is weak,and finally produces pathological products such as blood stasis,phlegm,muddy and so on.Lying in the blood,phlegm,muddy and blood stasis have been accumulated for a long time,and can not be declared and transformed.The evil qi lying in the blood can accumulate and turn into poison and further corrode the blood.In this process,although there are pathological products such as blood stasis,muddy andphlegm and poison produced because of weakness,they can only be manifested as abnormal levels of blood sugar,blood lipids and blood pressure,metabolic disorders or intimal thickening of blood vessels,but because there is no obvious uncomfortable reaction in the body,often can not attract attention.

1.2.2 Accumulation of pathogens,spreading of Fuxie to cause disease (outbreak)

Disease pathogen lurks in the body for a period of time,under the action of inducement,sudden onset.Atherosclerosis is the basis of myocardial infarction.The lesion is characterized by the formation of scattered plaque lesions.According to the development of the lesion,it can be divided into three periods: lipid stria and lipid plaque,fibrous plaque and atherosclerotic plaque.When atherosclerotic plaque is formed,the lesion continues to worsen,secondary changes occur,thrombosis,vascular lumen further narrow,when the coronary artery is acute occlusion,myocardial infarction occurs.From the perspective of traditional Chinese medicine,patients with myocardial infarction have a long-term history of smoking,drinking,eating fat and sweet taste,continuous accumulation of pathological products such as blood stasis,muddy and phlegm,accumulation of disease pathogens,Loss of yang qi in the chest,yang qi in the chest can not be excited,unable to distribute blood,body fluid,blood stasis,phlegm,muddy and other pathological products in the blood,accumulate poison for a long time,and further corrode the blood.When emotional excitement,suddenly affected by cold evil and other factors,vascular contraction,stimulate myocardial infarction.

1.2.3 Righteousness is weak and evil exists,and the hidden residual evil spreads outward (relapse)

Relapse refers to the recurrence of the original disease after a period of time after the disease has recovered.The mechanism of recurrence is that the remaining evil is not exhausted,the righteousness is not restored,and the original disease recurs under the effect of the inducement.At present,the treatment of acute myocardial infarction mainly relies on reperfusion therapy to reopen the blocked blood vessel.The treatment methods include drugs or intervention.For this treatment,there is the possibility of re-infarction after blood reconstruction.Use drugs to dissolve the thrombus.If the thrombus is not completely dissolved and the evil qi is hidden in the blood,when it is affected by the inducing factors,it will break out again,that is,the infarction will be reinfarcted.At present,it is believed that the vascular response after stent implantation is mainly concentrated in thrombosis,inflammation,smooth muscle cell proliferation,migration and extracellular matrix deposition,in which the main pathological process is the migration of middle smooth muscle cells to intima.Accompanied by intimal collagen and macrophage deposition [3].In some ways,the vascular response after stent implantation is similar to the formation of blood stasis,which accumulates in the body as a hidden evil,waiting for the chance to arise,and myocardial infarction occurs again.

2 "Ying-wei Theory" and myocardial infarction

"Ying-wei Theory",which originated from"Neijing",is an important part of the theoretical system of traditional Chinese medicine,articles have systematically discussed the formation,operation,physiology,and pathology of the two qi of Ying-wei.Zhong-Jing Zhang inherited and carried forward the "Ying-wei theory",and enriched and developed its connotation by establishing the six classics dialectical theory system.The two qi of ying and wei are all transformed by the subtlety of water valleys,both of them flow in and out of the viscera and are popular in the meridians.The essence of ying qi is gentle and it travels in the veins.It is the main body guarding but belongs to yin,which has the effect of transforming blood,nourishing and moisturizing the whole body.The nature of qi is sick and slippery.It travels outside the veins.The main guard is outside but belongs to the yang.It plays the role of warmth and guarding.ying and wei are like qi and blood,one yin and one yang.The two are of the same origin and different in nature.The inner guard and the outer are complementary to each other.They are the roots of each other.They move along with each other and transform into each other.

2.1 Elucidate the pathogenesis of myocardial infarction from the "Ying-wei theory"

Modern medicine believes that the cause of acute myocardial infarction is the imbalance between coronary blood flow and myocardial demand.From the perspective of traditional Chinese medicine,the occurrence of myocardial infarction is the obstruction of the heart and the loss of the heart.Only when the heart is full of qi,the pulse is clear,and the blood is full,the blood can run normally in the pulse,the qi and blood flow in the collaterals of the heart,and the heart can be maintained to maintain the normal function of the heart.If the heart qi is insufficient,the agitation is weak,the qi and blood in the collaterals is not good,the operation is astringent,the heart collaterals are blocked,and if the heart collaterals are blocked,then there will be angina pectoris.If the blood in the vein is insufficient,the heart loses nourishment,and if there is no nourishment,there can also be angina pectoris.Ying qi and wei qi has the comprehensive function of qi,blood,yin and yang: 1) Nourishing body: the qi of ying and wei is subtly transformed from water valley,enriching the whole body along with the meridians,nourishing the body; 2) Outward appearance of spirit: ying qi turns into blood,and "those who are in blood,the spirit is also." Therefore,The spirit is the external image of Ying-qi; 3) Gasification circulation: Yingwei qi,as a kind of qi,is the driving force of life,which has the functions of promotion,warmth,defense,fixation,gasification and nutrition.It's gasification function can be shown as: promoting the transformation and metaplasia of different substances in essence,qi,blood and body fluid,participating in the process of metabolism in the body,participating in the process of material transformation and energy transformation,and can rise and fall in and out,communicate up and down,inside and outside,and adjust the circulation; 4) Reconciling yin and yang: Ying belongs to yin and wei belongs to yang,and they interact with each other,restrict each other,balance and transform,so as to maintain the health of the body.The cause of myocardial infarction is analyzed from the point of view of Ying-wei theory: Ying-wei two qi cooperate with each other to regulate the movement of qi,blood and body fluid inside and outside the meridians.Ying qi promotes pulse blood to run all over the body,osmosis of body fluid inside and outside the pulse,and nourishment of viscera and muscles.Under the action of gasification and osmosis of Ying-wei,the body fluid overflows in the pulse to irrigate the viscera,and spreads outside the pulse to osmosis.Ying belongs to qi and has the function of fixing yang qi.It can enter the pulse alone in the viscera meridian,mainly protect the blood,in order to maintain the normal operation of pulse blood and the physiology of nourishing the viscera [4].Ying-qi can transform the blood and run in parallel with the blood.If the ying qi is insufficient,the blood in the pulse is deficient,the viscera cannot be nourished,and the heart blood is insufficient,while the blood is the mother of qi,and if the blood is insufficient,the qi cannot be transformed,and if the heart qi is insufficient,the blood in the artery can not be pushed to run.If the qi and blood is stagnant,it will cause pain,and it will develop into this disease.

2.2 Discuss the imbalance of energy metabolism in the process of myocardial infarction from the "Ying-wei theory"

Under normal circumstances,cardiomyocytes can produce energy substance ATP,through two metabolic pathways: anaerobic glycolysis and aerobic oxidative phosphorylation,in which aerobic metabolism in mitochondria is the main energy release pathway to maintain the normal function of the heart.The heart needs adequate blood oxygen supply to maintain its normal function,but when myocardial infarction occurs,the coronary artery is partially occluded,myocardial ischemia and hypoxia,and production is reduced,at this time the heart is in a state of "energy starvation".From the perspective of Ying-wei theory,Ying-wei qi originates from the subtlety of water valley,participates in the process of material and energy transformation,nourishes viscera,meridians and collaterals,and provides energy for life activities.Ying -qi turns into blood,Wei-qi circulates all over the body,carrying blood to nourish the viscera body,if Ying-qi is insufficient,blood metaplasia is lack of source,Weiqi is insufficient,blood is not smooth,qi deficiency and blood stasis,qi and blood is insufficient,the heart is not nourished,the supply of blood oxygen to maintain the normal function of the heart is insufficient,and the myocardial demand is not satisfied.

2.3 Myocardial infarction and mitochondrial autophagy

Under normal circumstances,the main function of mitochondria in cardiomyocytes is to perform aerobic respiration to release ATP,which is the center of energy production in the cell.During myocardial infarction,myocardial cells are ischemia and hypoxia,and local myocardial necrosis occurs.At this time,the number and function of mitochondria will change in the myocardium.

Mitochondrial autophagy is a defense mechanism of the body,which is the process of "self-cleaning" of damaged mitochondria in cells.Under physiological conditions,the process of mitochondrial autophagy can clear the functionally defective mitochondria and the reactive oxygen species produced by the oxidation process,provide raw materials for the synthesis of new mitochondria,promote cell survival,and maintain at a certain stable level.Under stress,the process of mitochondrial autophagy is disordered,producing a large number of reactive oxygen species that can not be cleared in time,releasing apoptotic factors,inducing cell apoptosis,damaging normal mitochondria and promoting inflammatory response.Mitochondrial autophagy directly determines the amount of energy produced by clearing damaged mitochondria and regulating the number of mitochondria,so it is also closely related to the process of myocardial energy metabolism.When stress occurs,the quality control system of mitochondria is disordered,some of the morphology and structure of mitochondria are damaged,the energy production is reduced,and the cardiomyocytes are in a state of "starvation".At this time,increasing the level of autophagy of mitochondria can remove the damaged mitochondria in time,recover useful cellular components,make the energy of cardiomyocytes "balance between supply and demand" and maintain the diastolic and contractile state of the heart.However,when the heart is in a state of stress for a long time (such as myocardial infarction),the number of defective mitochondria and reactive oxygen species in cardiomyocytes exceeds the ability of mitochondrial autophagy and accumulates in cells,resulting in cardiomyocyte death.The defective mitochondria and reactive oxygen species that can not be removed destroy the structure and function of normal mitochondria,affecting the number of normal mitochondria,resulting in the decrease of ATP synthesis,the energy needs of cardiomyocytes can not be met,and then lead to cardiac systolic and diastolic dysfunction,cardiac systolic and diastolic dysfunction will damage normal mitochondria,so that the number of mitochondria continues to decrease,the intracellular environment is unstable,and ATP synthesis is blocked again [5].

2.4 "Ying-wei theory" and mitochondrial autophagy

The relationship between mitochondria and Ying Weiqi: 1) Qi is the most basic substance that makes up the human body and maintains all kinds of life activities.Mitochondria are the productive structures that exist in most eukaryotic cells,and both of them are the basic substances that make up life; 2) Ying-wei has the comprehensive function of yin,yang,qi,blood and body fluid.As a kind of qi,it participates in the process of energy metabolism and material conversion.As a "cell power factory",mitochondria provide the necessary energy for life activities and are the basis of material metabolism.Both are the material basis of life activities.3) The ATP produced by mitochondria participates in the redox reaction of the body and provides heat for the body,which is the embodiment of the promotion and warming effect of Ying-wei; 4)The process of mitochondrial autophagy can scavenge reactive oxygen species and damaged mitochondria and protect cells from damage,which reflects the defensive role of Wei-qi.In view of the functional similarity between mitochondrial function and Yingwei,this paper tries to explain the relationship between myocardial infarction and mitochondrial autophagy from the perspective of Ying-wei theory.

2.4.1 Deficiency of Ying-wei and excessive autophagy of mitochondria

The normal exertion of the physiological function of the heart depends on the patency of heart collaterals,which depends on the stimulation and promotion of Ying-wei gasification.If the gasification function of Ying-wei is abnormal,the heart blood is insufficient,and the heart collaterals are lost in nourishment.If the function of Ying-wei is abnormal,the heart function is not smooth,and the heart function is abnormal.Maintaining a normal level of mitochondrial autophagy helps to clear damaged mitochondria and reactive oxygen species to maintain cell homeostasis and protect cardiomyocytes.However,excessive autophagy of cardiac mitochondria can cause excessive clearance of normal mitochondria,and even cause apoptosis of cardiomyocytes,resulting in a reduction of intracellular ATP production,which can not supply the energy needed for the physiological activities of cardiomyocytes,so that the process of energy metabolism is maladjusted,which further leads to cardiac dysfunction and aggravates the disease.From this point of view,mitochondrial autophagy is excessive,that is,ying-qi gasification is weak,fine substances are consumed excessively and can not be transformed,heart collaterals and blood are lost in nourishment,Wei-qi is deficient in source,then the pulse tube cannot be firmly protected,and the blood is stagnated in the pulse if the qi is weak,which leads to the blockage of heart collaterals,which leads to the pathogenesis of "blood stasis due to qi deficiency" in myocardial infarction.

2.4.2 Ying-wei stagnation and mitochondrial autophagy deficiency

Qi is the handsome of blood,while qi is the line of blood and the distribution of body fluid.Ying-wei qi stagnation.The dyskinesia of rising and falling qi appears a series of pathological conditions,such as blood stasis,phlegm-dampness coagulation and so on.Blood stasis,muddy,phlegm and other tangible pathogens stop in the heart collaterals,the qi of Ying -wei shall not be released,and the heart collaterals shall not be nourished and become ill.On the other hand,Ying-qi gasification is disadvantageous,viscera disharmony,essence,qi,blood and body fluid movement is abnormal,for a long time,it becomes visible evil such as phlegm and blood stasis,blocking heart collaterals and causing myocardial infarction.Insufficient autophagy of mitochondria can lead to the accumulation of damaged mitochondria in the body,which leads to the disorder of the intracellular environment of cardiomyocytes,the decrease of ATP synthesis and the aggravation of myocardial infarction.From a certain perspective,damaged mitochondria and ischemic myocardial tissue are blood stagnant in the myocardium.To a certain extent,it can affect the rise and fall of Ying-wei and block Ying-qi,Wei-qi circulation is blocked,it becomes a sign of Ying-wei stagnation.Ying-wei is stagnant,blood circulation is obstructed,qi stagnation and blood stasis,it is known as "myocardial infarction".

Conclusion

As one of the most serious types of coronary heart disease,myocardial infarction seriously endangers human health.To understand the pathogenesis of myocardial infarction from the perspective of "Fu-xie" in Chinese medicine,it is found that the occurrence and development process of myocardial infarction is similar to that of Fu-xie,which suggests that we should follow the "preventive treatment" of Chinese medicine.Take precautions before getting sick,actively avoid factors that induce myocardial infarction,and improve living habits,preventing changes in the existing disease.When symptoms of coronary atherosclerosis appear,active treatment should be carried out and cardiovascular risk factors should be controlled at the same time,such as: lowering blood pressure,regulating lipids,and controlling blood sugar to prevent further deterioration of the disease,prevention of relapse after illness and reperfusion of myocardial infarction After treatment,actively take medication to prevent recurrence of myocardial infarction."Ying-wei theory" originated from "Neijing" and was developed by Zhong-Jing Zhang to enrich its connotation.Qi and blood run in the meridians.The theory of syndrome differentiation of the six channels is essentially the theory of syndrome differentiation of qi,blood and body fluid,while the two qi of Yingwei and Wei are shaped like qi,blood,yin and yang,and can reflect the comprehensive functions of qi,blood,yin and yang and body fluid.Qi and blood run in the meridians.The theory of syndrome differentiation of the six channels is essentially the theory of syndrome differentiation of qi,blood and body fluid,while the two qi of Ying and Wei are shaped like qi,blood,yin and yang,and can reflect the comprehensive functions of qi,blood,yin and yang and body fluid.The abnormality of energy metabolism and the changes of morphology and function of mitochondria in the process of myocardial infarction were discussed from the point of view of "Ying-wei theory".It is suggested that the target of traditional Chinese medicine in the treatment of myocardial infarction may be related to mitochondria and need to be further studied.