🌿 Folk Prescriptions

Coronary heart disease is the most common form of organ disease caused by atherosclerosis. Over the past decade, domestic scholars have conducted systematic research, summarized as follows:
1. Etiology and Pathogenesis
Traditional Chinese medicine believes coronary heart disease arises from aging and physical decline, weakening of zang-fu organs, imbalance of yin-yang and qi-blood, influenced by seven emotions and six exogenous pathogens, leading to qi stagnation and blood stasis, obstruction of chest yang, internal generation of phlegm-turbidity, blocking heart vessels and causing disease. Mao believes it stems from spleen-kidney yang deficiency, insufficient heart qi, spleen lacking warmth, accumulation of phlegm-turbidity. Liu believes when lung qi is deficient, heart qi lacks strength, blood circulation is impaired, obstruction causes pain. Lu believes angina is mainly due to liver qi stagnation, phlegm-turbidity obstruction, cold coagulating blood stasis, and heart vessel blockage. Zhao believes all aspects are closely related to blood stasis.
Modern studies show: those who habitually eat rich, fatty foods have higher plasma lipoprotein levels than normal; among personality types, Type A individuals have twice the risk of coronary heart disease compared to Type B, mainly due to higher blood viscosity and platelet aggregation in Type A; hyperlipidemia, hemodynamic abnormalities, blood rheology issues, impaired cardiac function, and microcirculatory disorders are the physiological basis for qi stagnation and blood stasis, phlegm obstruction.
2. Objective Research on Syndrome Differentiation
Zhou found that heart deficiency correlates with varying degrees of left ventricular diastolic dysfunction. Cheng found that patients with heart qi deficiency have impaired left ventricular systolic and diastolic function, with diastolic performance parameters being more sensitive. Yu believes plasma atrial natriuretic peptide (ANP) activity can serve as an objective indicator for heart qi deficiency. Huang believes whole blood viscosity in blood rheology can be a key reference for diagnosing qi stagnation and blood stasis. Jia believes increased platelet membrane glycoprotein (GP Ib) is a relatively specific marker for blood stasis in coronary heart disease. Guo found significantly elevated thromboxane B2 (TXB2), β-thromboglobulin (β-TG), and platelet factor 4 (PF4), along with decreased 6-keto-PGF1α in coronary heart disease patients. Compared to qi deficiency (mainly qi deficiency with blood stasis), blood stasis shows higher TXB2, β-TG, PF4, and lower protein C antigen (PC:AG); qi deficiency shows lower 6-keto-PGF1α, with β-TG and PF4 less elevated, and PC:AG compensatorily increased. Chen found elevated endothelin (ET) in both real and deficient groups, with greater elevation in the real group. He found that the underlying deficiency in angina is closely related to cellular immune deficiency, particularly imbalance between Ts and Th cells, while the manifest excess relates to humoral immune overactivity. The former may be the core of coronary heart disease’s immune mechanism, thus emphasizing strengthening the body and restoring Ts/Th balance in treatment. The latter may be a secondary event in the pathogenesis, requiring concurrent elimination of pathogenic factors to suppress humoral immune overactivity, inhibit pathological autoantibodies and immune complex formation, and accelerate their clearance.
Studies indicate that excessive free radical production and/or reduced clearance are key biochemical mechanisms in many diseases, especially ischemia-reperfusion injury in coronary heart disease. Some believe increased cell aggregation and elevated plasma viscosity are the main physicochemical foundations of phlegm syndrome in coronary heart disease. Qiu believes blood stasis syndrome has the pathological characteristic of increased blood viscosity. Chen believes yin-deficient patients predominantly exhibit sympathetic nervous system hyperactivity, while yang-deficient patients show heightened vagus nerve function.
3. Treatment of Coronary Heart Disease
Based on the pathogenesis of deficiency at root and excess at manifestation, TCM treatment emphasizes "tonification as unblocking," integrating tonification with unblocking, focusing on overall functional regulation to achieve abundant qi and smooth blood flow, ensuring unobstructed vessels. Methods of tonifying while unblocking include tonifying qi and activating blood, warming yang and activating blood, tonifying qi and nourishing yin while activating blood, nourishing blood and activating blood.
Tonifying qi and activating blood is a common method for treating coronary heart disease recently. It yields more sustained and stable results than purely activating blood and unblocking channels. Zhang observed the clinical effects of Bu Yang Huan Wu Tang on coronary heart disease: the Bu Yang Huan Wu Tang group showed significant reductions in serum lipid peroxidation (LPO), apolipoprotein B100 (ApoB100), and LPO/SOD, ApoB100/ApoA ratios, while serum SOD and ApoA levels significantly increased. The effectiveness in relieving angina was similar to the control group, but electrocardiogram improvement was superior. Jiang’s Qixue Chongji treated 30 cases of qi deficiency and blood stasis type coronary heart disease angina, compared to 25 controls given Fufang Danshen Tablets (3 tablets/day). The effective rates were 90% and 60%, respectively, with the treatment group significantly better. Xu’s study on Tongxinluo Capsule for coronary heart disease angina showed a 94.49% effective rate in the treatment group, significantly better than the control group’s 78%. The total effective rate of electrocardiogram improvement was 71.05% in the treatment group, markedly better than the control group’s 47.33%.
Warming yang and activating blood therapy mainly applies to coronary heart disease with yang deficiency and cold coagulation. Liu used Yiqi Wenyang Huoxue herbs (Xiangshexinnaole) in a clinical observation of 345 coronary heart disease patients, achieving an 88.1% effective rate in relieving angina and a 72.9% total effective rate in improving ECG ischemia. Guo used aromatic warming unblocking agents for cold coagulation type, achieving rapid results.
Nourishing blood, activating blood, and resolving phlegm therapy is mainly used for treating phlegm-turbidity excess type coronary heart disease. Li made a granule from Astragalus, Sea Algae, and Fritillaria, using Fufang Danshen Tablets as control. The angina remission rates were 57.5% and 16.67%, respectively, with better ECG improvement in the treatment group. Fang proposed that if long-term use of blood-activating drugs fails, consider "stasis" caused by "phlegm," and treat accordingly. His self-designed "Tongguan Tang" showed significant efficacy in treating angina.
Tonifying qi and nourishing yin therapy is mainly used for qi-yin deficiency type coronary heart disease. Wang used Tongguan Shengmai Yin, combining tonifying qi and nourishing yin with activating blood, showing significantly better results than the control group. Wang used Shengmai Wen Dan Tang to treat 235 cases of coronary heart disease, achieving an 84% total effective rate.
The advantage of TCM in treating coronary heart disease lies in regulating the body’s overall function, emphasizing the relationship between qi and blood, improving adaptation to internal and external environmental changes. Mastering the balance between unblocking and tonifying, local and systemic differentiation, it focuses not only on local heart treatment but also on overall improvement, indicating broad development prospects for TCM in coronary heart disease treatment.