TCM Syndrome Differentiation and Treatment of Coronary Heart Disease Angina Pectoris
The clinical manifestations of coronary heart disease angina pectoris closely resemble symptoms caused by insufficient heart yang and qi stagnation with blood stasis in Traditional Chinese Medicine (TCM). Therefore, TCM classifies this condition under categories such as “chest obstruction,” “heart pain,” “sudden heart pain,” and “true heart pain.” Below is a discussion on syndrome differentiation and treatment of this disease.
1 Etiology and Pathogenesis
This condition commonly arises in middle-aged and elderly individuals whose organ functions gradually decline. Excessive consumption of rich foods damages the spleen and stomach, or emotional disturbances lead to qi stagnation, blood stasis, and phlegm turbidity internally, obstructing meridians and causing pain due to blockage [1]. According to *Jin Kui Yao Lue: Pulse and Symptoms of Chest Obstruction, Heart Pain, and Shortness of Breath*, the main features of “chest obstruction” include chest tightness, heart pain, and shortness of breath, with the pathological key being extreme deficiency of “yang qi” in the chest. Thus, clinical presentations often reflect a pattern of fundamental deficiency with superficial excess [2]. Deficiency primarily involves organ qi deficiency; excess mainly manifests as blood stasis and phlegm obstruction. Among organ deficiencies, heart qi deficiency is most common. Heart qi deficiency may further lead to heart yang deficiency, resulting in inadequate yang qi, weak propulsion, failure of clear yang to rise, sluggish blood circulation, and obstruction causing pain. Although the primary site of heart pain is the heart, its root lies in the kidneys. The kidneys are the foundation of innate constitution, and the heart and kidneys are connected via meridians. Kidney yin deficiency cannot nourish the heart upward, leading to internal heat due to yin deficiency, which scorches blood and forms stasis, blocking the heart vessels and depriving the heart of nourishment, thus causing heart pain. Kidney yang deficiency leaves the heart without warmth, also leading to heart yang deficiency, weak propulsion, and stasis formation.
Phlegm and blood stasis obstruction is predominantly due to blood stasis, as cold coagulation, heat accumulation, phlegm obstruction, qi stagnation, and qi deficiency can all cause vascular stagnation, resulting in stasis. When blood stasis persists without dispersion, the heart vessels become blocked, causing sharp, stabbing pains that remain fixed in location.
2 Syndrome Differentiation and Treatment
Based on clinical manifestations of coronary heart disease angina pectoris, syndromes are categorized into two major types: real (excess) and deficient (deficiency) patterns [3]. Treatment follows the principle of “expel excess in excess conditions, supplement deficiency in deficiency conditions.” During acute angina episodes, excess factors dominate—treat the symptoms first. After symptom relief, deficiency becomes dominant—treat the root cause. In mixed deficiency-excess patterns, treatment should appropriately address both aspects based on their predominance.
2.1 Phlegm Turbidity Obstructing the Chest: Symptoms include oppressive chest tightness with pain, pain radiating to the shoulders and back, heavy limbs, obesity, greasy tongue coating, and slippery pulse. Treatment aims to promote yang and transform phlegm turbidity. Formula: Guallu Xiebai Banxia Tang modified (12g each of Trichosanthes fruit, Pinellia, Corydalis tuber, and Bitter Orange Peel; 15g each of Calamus rhizome and Salvia miltiorrhiza; 10g each of Garlic Chives and Cinnamon Twig). One dose daily, decocted and taken orally.
2.2 Qi Stagnation and Blood Stasis Type: Symptoms include sharp or cramping chest pain, chest tightness, shortness of breath, palpitations, dark purple spots or patches on lips and tongue, and fine, stagnant, or irregular pulse. Treatment aims to regulate qi, activate blood, and unblock collaterals. Formula: Xuefu Zhuyu Tang modified (10g each of Peach Kernel and Safflower, and Fructus Aurantii Immaturus; 12g each of Danggui Tail, Red Peony Root, Curcuma, Corydalis tuber, and Platycodon Root; 15g each of Ligusticum wallichii and Salvia miltiorrhiza). One dose daily, decocted and taken orally.
2.3 Combined Heart Qi and Yin Deficiency Type: Symptoms include intermittent dull chest pain, palpitations, shortness of breath, pale complexion, fatigue, dizziness, blurred vision, slightly red tongue or tooth marks, and weak, thready pulse. Treatment aims to tonify qi and nourish yin. Formula: Shengmai San modified (18g of Prince Ginseng, 12g each of Ophiopogon japonicus, Curcuma, and Polygala tenuifolia; 15g each of White Peony Root, Salvia miltiorrhiza, Poria, and Fo-ti root; 10g of Schisandra chinensis; 20g of Polygonum multiflorum). One dose daily, decocted and taken orally.
2.4 Heart-Kidney Yin Deficiency Type: Symptoms include chest tightness with pain, palpitations, night sweats, restlessness, insomnia, dizziness, tinnitus, soreness in waist and knees, red tongue with little coating, and fine rapid pulse. Treatment aims to nourish heart and kidney. Formula: Zuo Gui Yin modified (18g of Rehmannia glutinosa, 15g each of Cornus officinalis, Chinese Yam, Goji berry, and Salvia miltiorrhiza; 12g each of Poria, Ophiopogon japonicus, Ziziphus jujuba seed, Anemarrhena, and Tortoise Shell Glue). One dose daily, decocted and taken orally.
3 Case Example
A male patient, aged 58, was first seen on July 15, 1991. He had a 3-year history of coronary heart disease and had been hospitalized twice due to angina. He had a history of consuming spicy and sour foods and drinking alcohol and smoking. This episode presented as severe knife-like chest pain. Electrocardiogram showed ischemia in the anterior wall of the heart. After hospitalization, symptoms improved. On examination: chest tightness and shortness of breath, nausea and vomiting after drinking, constipation for two days, dark red tongue with white greasy coating, and slippery rapid pulse. After integrating four diagnostic methods, the diagnosis was phlegm-dampness obstructing the middle energizer with qi stagnation and blood stasis. Treatment aimed to promote yang, transform phlegm, move qi, and resolve stasis. Formula: Guallu Xiebai Banxia Tang modified: 15g each of Trichosanthes fruit, Salvia miltiorrhiza, and Curcuma; 18g each of Poria and Hawthorn; 6g each of Garlic Chives, Safflower, Tangerine Red, and Licorice; 10g each of Peach Kernel and Cyperus rotundus, and 10g of Angelica sinensis. Five doses, one daily, reheated and divided into two servings.
Second visit: No recurrence of chest pain, reduced chest tightness, continued constipation; grayish complexion, dark red tongue with thin greasy yellow coating, slippery and wiry pulse. Formula: 15g each of Trichosanthes fruit, Salvia miltiorrhiza, and Poria; 6g each of Garlic Chives, Safflower, Tangerine Red, Rhubarb, and Licorice; 10g each of Peach Kernel and Angelica sinensis; 12g of Ziziphus jujuba seed. Five doses, one daily, decocted again and divided into two servings.
Third visit: Chest tightness resolved, bowel movement normalized, pale tongue with thin white coating, stringy fine pulse. ECG indicated mild ischemia in the anterior wall of the heart. Formula: 25g each of Prince Ginseng, Chinese Yam, and Salvia miltiorrhiza; 15g each of Ophiopogon japonicus, Ziziphus jujuba seed, and Hemp Seed; 10g each of Angelica sinensis and Peach Kernel; 6g each of Safflower and Licorice. Ten doses. Follow-up for two months showed stable condition.
4 Reflections
Coronary heart disease angina pectoris is a difficult-to-treat condition. It is not merely a local cardiac lesion but often affects other organs. Therefore, clinical practice must carefully assess the syndrome and avoid rigid adherence to single approaches. Treatment should not focus solely on the heart but consider holistic organ-level therapy [4]. Only by consistently applying principles of strengthening vital energy, resolving phlegm, eliminating stasis, and unblocking meridians can overall constitution improve, leading to optimal outcomes in treating coronary heart disease angina pectoris.
Beyond treatment, reasonable work-life arrangements, balanced labor and rest, moderate physical activity, mental well-being, avoidance of emotional stress, limiting intake of animal fats and cholesterol-rich foods, and quitting smoking and drinking are crucial for preventing and managing coronary heart disease angina pectoris.
References
1 Lin Ruishi. On the Syndrome Differentiation and Treatment of Coronary Heart Disease Angina Pectoris. New Traditional Chinese Medicine, 1991, 23(1): 53.
2 Li Tianbao. Recent Advances in TCM Treatment of Coronary Heart Disease Angina Pectoris. New Traditional Chinese Medicine, 1992, 24(6): 51.
3 Lu Zhongxin. Preliminary Exploration of Etiology, Pathology, and Syndrome Classification of Coronary Heart Disease. New Traditional Chinese Medicine, 1994, 26(Supplement): 13.
4 Tan Guobiao. Overview of TCM Syndrome Differentiation of Coronary Heart Disease in the Past 10 Years. New Traditional Chinese Medicine, 1995, 27(4): 57.