Coronary heart disease, also know as ischemic heart
disease, is commonly caused by atheromatous lesions of the coronary artery. Its
major clinical manifestations are angina pectoris and myocardial infarction.
Although
the terms angina pectoris and acute myocardial infarction were not used in ancient
times, descriptions of the clinical manifestations of coronary heart disease are
contained in the ancient texts of traditional Chinese medicine.
Etiology and
Pathogenesis
Precordial pain is the most prominent feature of coronary heart
disease. According to traditional medical theory, obstruction in the heart vessels
usually causes this pain. The vessels may be blocked by phlegm accumulation in
the chest, which obstructs the yang qi, and /or by blood stasis either due to
qi deficiency or due to qi stagnation.
Differential Diagnosis of Syndromes
1. Obstruction of yang qi in the chest due to accumulation of phlegm
Primary
manifestations: A feeling of oppression over the chest or chest pain radiating
to the back, accompanied by shortness of breath, white, thick, greasy coating
of the tongue and smooth pulse. (This condition is of the cold phlegm type; when
the tongue coating turns yellow and greasy, it becomes a phlegm-heat type.)
2.
Blood stasis caused by qi deficiency
Primary manifestations: Fatigue, shortness
of breath, palpitations accompanied by localized pain, dark purplish tongue with
thin coating and uneven pulse. (In cases with cold extremities, intolerance of
cold, pale and tender tongue and slow pulse, the blood stasis is due to yang deficiency;
in cases with profuse sweating, deadly cold limbs, listlessness and fading pulse
or even coma, the yang is exhausted and shock ensues. Some patients experience
yin and qi deficiencies together, manifested by a hot sensation in the palms and
soles, dry mouth, desire for cold drinks, reddened tongue with little or no coating
and thin, rapid pulse.)
3.Blood stasis caused by qi stagnation
Primary
manifestations: A fullness sensation or pain in the chest, dark purplish tongue
with thin coating, but no symptoms of qi deficiency, such as shortness of breath
and fatigue.
Treatment
1. Obstruction of yang-qi in the chest due to accumulation
of phlegm
Principle of treatment: Relieve the obstruction of the yang qi in
the chest.
Formula for choice: Trichosanthes, Chinese Chive, and White Liquor
Decoction; in this prescription, trichosanthes fruit eliminates phlegm and reverse
the adverse ascending of the qi; Chinese chive warms and activates the yang qi
in the chest and relieves pain; and white liquor acts as a guide drug.
2.
Blood stasis caused by qi deficiency
Principle of treatment: Invigorate the
qi and promote blood circulation.
Formula of choice: Yang-Invigorating and
Recuperation Decoction; in this recipe, astragalus root (huang qi) invigorates
the qi to promote blood circulation and strengthens the effect of the other ingredients
in removing blood stasis. Other ingredients are tangkuei (dang gui), red peony
root (chi shao), earth worm (di long), ligusticum root (chuan xiong), peach kernel
(tao ren), carthamus flower (hong hua).
In cases with yang deficiency, add
cuscuta seed (tu si zi), prepared lateral root of aconite (fu zi), and psoralea
seed (bu gu zhi) to warm and replenish the yang qi.
If there is collapse,
use Ginseng and Aconite Decoction combining with Aconite Decoction (including
prepared lateral root of aconite, poria, ginseng, ovate atractylodes rhizome,
white peony root); in these prescriptions, prepared lateral root of aconite and
ginseng recuperate the depleted yang and replenish the qi.
In cases of qi
and yin deficiencies, add scrophularia root (xuan shen), ophiopogon root (mai
dong), schisandra berry (wu wei zi), and fresh rehmannia root (sheng di ) to the
above prescriptions.
3. Blood stasis caused by qi stagnation
Principle
of treatment: Activate qi and remove blood stasis.
Formula of choice: Blood
House Stasis-Expelling Decoction; in this recipe, bitter orange (zhi ke) and bupleurum
root (chai hu) activate the stagnated qi; platycodon root (jie geng) acts as a
guide drug; and the other ingredients promote blood circulation and remove blood
stasis, including tangkuei (dang gui), fresh rehmannia root (sheng di huang),
peach kernel (tao ren), carthamus flower (hong hua), red peony root (chi shao),
licorice root (gan cao), ligusticum root (chuan xiong), achyranthes root (niu
xi).
Dr. Ming's TCM Medical Center,
Hua Xi Xiao Yuan, Hutian Developing
Area,
Huaihua city, Hunan province
China