Guide language: chronic cor pulmonale is clinically common heart and respiratory system disease, is closely related to smoking, is mainly due to the lung, pulmonary vascular or thoracic chronic disease, their illnesses out painless, harm is bigger, the case fatality rate is high, the impact on the quality of life in patients with late, some patients complicated with respiratory, heart failure and death.

01
The course of chronic pulmonary heart disease is slow, the harm is great, and the pathogenesis is complex

1, an overview of the

Chronic cor pulmonale, referred to as “cor pulmonale, clinical disease is the main pathophysiological basis of hypoxic pulmonary hypertension, the resulting pulmonary vasoconstriction and the change of the structure, lead to the right ventricle hypertrophy of expansion and, to induce chronic cor pulmonale, illnesses out slowly, harmfulness is large, some patients complicated with heart failure and even death.

The prevalence of the disease in the northern and central regions of the country is 15 percent of the population aged over 15 years, with an estimated 25 million people affected nationwide.
There was no “pulmonary heart disease” in ancient Chinese medicine, but it belongs to the category of “lung distension” and “asthma syndrome” in modern Chinese medicine.
At present, the focus of research on chronic cor pulmonale is on the classification of syndromes and the effectiveness and mechanism of TCM treatment.

Different treatment schemes have been reported by different doctors. The research on the syndrome elements and the correlation between the syndromes is not very in-depth, and there is no TCM treatment scheme that has been widely recognized and can be promoted.
In clinical syndrome differentiation, there is a lack of syndrome specification of chronic cor pulmonale.
The differences in the understanding of TCM syndromes and characteristics of TCM syndromes are not conducive to the prevention and treatment of TCM, as well as the promotion and application of TCM, and greatly limit the in-depth and development of related research.

2. Pathogenesis

Chronic pulmonary heart disease is mainly caused by chronic obstructive pulmonary disease (COPD), primary pulmonary hypertension, severe retrospinal process and sleep apnea hypopnea syndrome and other diseases, which are delayed, mistreated and eventually developed.

Pulmonary hypertension is the main pathological basis, the formation of pulmonary hypertension factors include: 1, functional factors, mainly chronic hypoxia, acid accumulation, causing pulmonary vasoconstriction, increased pressure, forming manifestations of pulmonary hypertension.
II. Anatomic factors: the alveolar structure is destroyed, which further leads to vascular bed damage, inflammation involving small vessels leads to vasculitis, and chronic hypoxia leads to the destruction of pulmonary vascular institutions and pulmonary vascular remodeling.

Among them, functional factors are the main factors of the disease. Persistent pulmonary hypertension, which exceeds the load of the right heart, leads to compensatory right heart hypertrophy, which can then develop into right heart failure. In addition, repeated pulmonary infection, acid-base balance disorder, and chronic hypoxia can further damage the myocardium and aggravate heart failure.
Chronic cor pulmonale is the terminal stage of lung disease. The pathological process is related to the abnormal inflammatory response of the lungs to harmful gases, particles and pathogenic microorganisms.

Smoking is a kind of potential risk factors, long-term smoke exposure causes pulmonary vascular reconstruction of rsa, the smoke stimulated repeatedly respiratory tract mucous membrane can cause mucus gland hyperplasia, mucus secretion increased, ciliary motion is abate, trypsin activity, lysozyme level, elevated levels of circulating immune complex, result in pulmonary arterial endothelial cells, epithelial cells such as PKC activation, vascular smooth muscle cell proliferation, migration, pulmonary vascular remodeling, and the formation of pulmonary hypertension.

Exposure to chemical raw materials and occupational dust can directly cause damage to bronchial mucosa and lung tissue. The main pathological changes are inflammatory infiltration and obvious lymphocyte reaction.
Among the air pollutants, the ones that have the greatest impact on human beings are carbon dioxide, carbon monoxide, nitrogen dioxide, chlorine gas, sulfur dioxide and total suspended matter.
Atmospheric particles are inhaled and deposited in the alveoli, causing the increase of interleukin-6 and TNF-a in the body cells, mediating the immune inflammatory response, and finally causing the damage to the structure and function of airway mucosal epithelium and respiratory system.

3. Clinical manifestations

Chronic pulmonary heart disease (CPH) is a chronic disease of lung deficiency, lung gas loss or lung gas loss, airway obstruction, lung fullness, and failure to condense and drop. Few people have no cough or sputum, and seek medical treatment simply with slight shortness of breath, chest tightness, shortness of breath, fatigue, and palpitation.
According to the severity of the syndromes of chronic cor pulmonale, clinical syndrome differentiation can be guided.

The patient only saw chest swelling and fullness, slight cough and asthma, fatigue, relatively mild syndrome, stable condition.
Where see agitated, phlegm more difficult to be, can not supine, nasal alar incitement mouth and shoulder, prompt critical condition.
If you see signs of delirium and panting, your condition is critical and you need urgent treatment.

02
To understand the syndromes and syndromes of chronic pulmonary heart disease, Chinese medicine has a unique insight into the disease

1. General situation

According to the epidemiological survey, women have a slightly higher prevalence rate of chronic cor pulmonale in rural areas than men. The reason may be that the living standard in rural areas is relatively poor, resulting in poor room environment, more smoke and dust in the air, combined with the influence of dietary habits, women are more affected by the environment.

However, with the improvement of living standards in recent years, the incidence of chronic cor pulmonale in women is significantly lower than that in men, while the incidence of chronic cor pulmonale in men is significantly higher than that in women due to risk factors such as smoking.
For patients with chronic pulmonary history, it is recommended to quit smoking clinically. Long-term smoke exposure leads to pulmonary vascular reconstruction and multiple inflammatory reactions of airway mucosa, thus aggravating the development of the disease.

Chronic pulmonary heart disease is mainly composed of a variety of chronic lung diseases, repeated attacks, prolonged and difficult to heal the development, combined with such patients have a history of chronic pulmonary diseases, the elderly healthy qi is relatively weak, the function of the viscera decreased, the lungs and kidney deficiency, the healthy qi weakness can not protect outside, evil gas is easy to penetrate the viscera, susceptible to evil disease.
Therefore, age is one of the main factors affecting chronic cor pulmonale, and the incidence of disease increases with age.

Therefore, for patients with cor pulmonale in remission period because of the attention to health to enhance the healthy qi, pay attention to regulating the spleen and stomach, prevent the deterioration of pathogenic feelings, vigilance from becoming.
The incidence of chronic cor pulmonale is mostly concentrated in the Qingming Festival, Grain Rain, Winter Solstice, Minor Cold, Snow, that is, spring and winter festival, followed by autumn, the least in summer.
It is mainly concentrated in winter and spring. In this season, the climate changes are more intense, and the disease is mainly caused by cold pathogenic factors. The human body is relatively deficient in Yang Qi.

2. Distribution of syndromes

According to the comprehensive literature and clinical studies, the common empirical syndromes of chronic pulmonary heart disease include: phlegm heat obstructing the lung and phlegm turbidity obstructing the lung; deficiency syndromes include deficiency of qi and Yin in lung and kidney and deficiency of qi in lung and kidney, and deficiency and deficiency of qi in lung and kidney are more common; deficiency and deficiency are mainly: deficiency of Yang and flooding in water, deficiency of lung and kidney and qi and phlegm stasis obstructing the lung.
Chronic pulmonary heart disease, lung qi stagnation, spleen dysfunction, body fluid is not normalized.

Lung heart disease with phlegm turbidities obstructs the lung, and the disease is long and deep. The lung deficiency cannot be treated, regulate the operation of blood vessels, and the blood is unable to promote blood vessels. Then the blood becomes astringent and stagnant, forming the syndrome of lung and kidney qi deficiency, phlegm stasis and lung obstruction.
In the early stage, chronic cor pulmonale originated from the lungs and extended to the spleen and kidney, mostly belonging to deficiency of Qi and deficiency of Qi and Yin.

In the late stage, the main diseases are lung, kidney and heart, deficiency of qi and Yang, or deficiency of Yin and Yang. Clinically, deficiency of qi and Yin and deficiency of lung and kidney are more common.
In clinical treatment, due to the two aspects of treating the root cause and treating symptoms, dispelling pathogenic factors and strengthening positive factors are applied together, which is standard and solid. The treatment principle is mainly to dispelling pathogenic factors and promoting lung, lowering qi and resolving phlegm, warming Yang and promoting water, etc.

3. Distribution of syndrome elements

According to the literature and clinical study results, the main disease location elements of chronic cor pulmonale are lung, kidney, spleen, heart, mind, surface, meridians and so on.
Chronic cor pulmonale disease is first in the lung, then affect the spleen and kidney, later can reach the heart, the heavy involvement of the mind.
A variety of chronic pulmonary diseases lead to lung deficiency and loss, the lung does not host qi, then the lung main qigong disorder, the lung is not declared healthy, it is difficult to turbidity qi out, and difficult to clear qi in.

If the qi machine is blocked between the lungs, the lung is not declared to be reduced, the water function is abnormal, and the phlegm and turbidities are endogenous, and the airway is blocked, the lung distention disease such as chest swelling, cough and asthma appears.
Spleen is the main transport and source of phlegm. Spleen is the mother of lung. Lung disease affects kidney, lung qi deficiency is damaged, and son disease affects mother.

The syndromes of disease are: phlegm, qi deficiency, heat, Yin deficiency, blood stasis, Yang deficiency, water drinking, water stagnation, dampness, external wind, cold, closed and so on.
The basic pathogenesis of chronic cor pulmonale is always the original deficiency and standard solid. The lesion is in the lung in the early stage, then affects the spleen and stomach, and in the late stage, affects the heart, xinshen, meridians and collaterals.
In general, Qi deficiency and Qi Yin deficiency are the main ones, with the combination of phlegm and turbidities, water drinking and blood stasis as the marks. The original deficiency and evil solid are each other’s cause and effect.

Conclusion: The disease location elements of chronic cor pulmonale are mainly concentrated in lung, kidney, spleen, heart, etc.
The main symptoms are phlegm, qi deficiency, heat and so on.
The general characteristics of the disease are: deficiency and solid mixed, the acute phase is mainly solid, the remission phase is mainly deficiency.
At present, there are many diagnosis and treatment methods for this disease, but there is no ideal drug for effective targeted treatment. Therefore, research on the pathogenesis of pulmonary heart disease and early intervention treatment can delay the development of the disease and improve its prognosis, which has important benefits for patients.