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).  

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