Ang coronary heart disease at angina ay may malaking katulad sa mga sintomas ng Tsinong Medicine tulad ng yang deficiency, qi stagnation, blood stasis, etc., kaya ito ay isinasaad sa mga kategorya ng "Xiong Bi", "Xin Tong", "Jue Xin Tong", "Zhen Xin Tong". Narito ang pagpapaliwanag sa Tsinong diagnosis at treatment.
1. Cause and Mechanism
Ang sakit ay madalas dulot ng aging, weakened organ functions, high-fat diet damaging the spleen and stomach, or emotional stress leading to qi stagnation, blood stasis, phlegm accumulation, which causes blockage in the channels, resulting in pain due to obstruction [1]. Ang "Jin Kui Yao Lue · Xiong Bi Xin Tong Duan Qi Bing Mai Zheng Zhi" ay nagsasaad na ang pangunahing sintomas ng "Xiong Bi" ay chest tightness, chest pain, shortness of breath, with the key pathology being extreme deficiency of yang energy in the chest; thus, the clinical presentation often shows a pattern of deficiency with excess [2]. The deficiency is mainly due to organ qi deficiency; the excess is mostly due to blood stasis and phlegm obstruction. Organ qi deficiency is primarily heart qi deficiency. Heart qi deficiency may lead to yang deficiency, loss of yang energy, weak movement, lack of clear yang, sluggish blood flow, and pain due to obstruction. The location of heart pain is in the heart, but its root is in the kidney. The kidney is the foundation of life, connected to the heart via meridians. Kidney yin deficiency cannot nourish the heart, leading to internal heat, which scorches the blood and forms stasis, obstructing the heart vessels, depriving the heart of nourishment, causing pain; kidney yang deficiency fails to warm the heart, also leading to heart yang deficiency, weak movement, and stasis formation. Blood stasis and phlegm obstruction are mostly due to blood stasis, as cold coagulation, heat accumulation, phlegm obstruction, qi stagnation, and qi deficiency can all lead to blood vessel stagnation, forming stasis. Stagnant blood does not disperse, obstructing the heart vessels, causing stabbing or gripping pain that does not move.
2. Diagnosis and Treatment
Based on the clinical manifestations of coronary heart disease and angina, it is categorized into two major types: real and deficiency syndromes [3]. Treatment follows the principle of "expel excess, tonify deficiency": during angina attacks, focus on treating the excess; when pain subsides, treat the deficiency; when both deficiency and excess are present, adjust according to their dominance.
2.1 Phlegm-Turbidity Obstruction Type: Symptoms include chest tightness like being blocked, pain radiating to shoulders and back, heavy limbs, obesity, greasy coating, slippery pulse. Treatment: Promote yang, resolve turbidity. Use Gu Lou Xie Bai Ban Xia Tang with modifications (Gua Lou, Ban Xia, Yan Hu Suo, Zhi Ke each 12g, Shi Chang Pu, Dan Shen each 15g, Xie Bai, Gui Zhi, Hou Po, Chen Pi each 10g). One dose per day, decocted and taken orally.
2.2 Qi Stagnation and Blood Stasis Type: Symptoms include stabbing or gripping chest pain, chest tightness, shortness of breath, palpitations, cyanotic lips or tongue with ecchymosis, fine, choppy, or irregular pulse. Treatment: Regulate qi, activate blood, unblock meridians. Use Xue Fu Zhu Yu Tang with modifications (Tao Ren, Hong Hua, Zhi Ke each 10g, Dang Gui Wei, Chi Shao, Yu Jin, Yan Hu Suo, Jie Geng each 12g, Chuan Xiong, Dan Shen each 15g). One dose per day, 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, fine weak pulse. Treatment: Tonify qi and nourish yin. Use Sheng Mai San with modifications (Tai Zi Shen 18g, Mai Dong, Yu Jin, Yuan Zhi each 12g, Bai Shao, Dan Shen, Fu Ling, He Shou Wu each 15g, Wu Wei Zi 10g, Ye Jiao Teng 20g). One dose per day, decocted and taken orally.
2.4 Heart-Kidney Yin Deficiency Type: Symptoms include chest tightness and pain, palpitations, night sweats, restlessness, insomnia, dizziness, tinnitus, weak waist and knees, red tongue with little coating, fine rapid pulse. Treatment: Nourish heart and kidney. Use Zuo Gui Yin with modifications (Shu Di Huang 18g, Shan Zhu Yu, Huai Shan Yao, Gou Qi Zi, Dan Shen each 15g, Fu Ling, Mai Dong, Suan Zao Ren, Zhi Mu, Gui Ban Jiao each 12g). One dose per day, decocted and taken orally.
3. Case Example
Male patient, 58 years old, initial visit on July 15, 1991. Has had coronary heart disease for 3 years, hospitalized twice due to angina. History of preference for sour, spicy food, smoking, and drinking. This episode presented with knife-like chest pain, ECG showed anterior wall ischemia, improved after hospitalization. At examination: chest tightness, shortness of breath, nausea and vomiting upon drinking, bowel movement for 2 days, dark red tongue with white greasy coating, slippery and rapid pulse. After four diagnostic methods, this was identified as phlegm-damp obstruction with qi stagnation and blood stasis. Treatment: promote yang, resolve turbidity, regulate qi, remove stasis. Used Gu Lou Xie Bai Ban Xia Tang with modifications: Gua Lou, Dan Shen, Yu Jin each 15g, Fu Ling, Shan Zha each 18g, Xie Bai, Hong Hua, Ju Hong, Gan Cao each 6g, Tao Ren, Xiang Fu, Dang Gui each 10g. 5 doses, one per day, double-boiled, divided into two servings.
Second visit: no recurrence of chest pain, chest tightness reduced, still constipated; grayish complexion, dark red tongue, thin greasy yellow coating, slippery and wiry pulse. Prescription: Gua Lou, Dan Shen, Fu Ling each 15g, Xie Bai, Hong Hua, Ju Hong, Da Huang, Gan Cao each 6g, Tao Ren, Dang Gui each 10g, Suan Zao Ren 12g. 5 doses, one per day, double-boiled, divided into two servings.
Third visit: chest tightness gone, bowel movement normal, pale tongue, thin white coating, stringy fine pulse. ECG showed mild anterior wall ischemia. Prescription: Tai Zi Shen, Huai Shan Yao, Dan Shen each 25g, Mai Dong, Suan Zao Ren, Huo Ma Ren each 15g, Dang Gui, Tao Ren 10g, Hong Hua, Gan Cao each 6g. 10 doses. Follow-up for 2 months, condition stable.
4. Reflections
Coronary heart disease and angina are difficult-to-treat conditions. They are not just local heart issues, but often affect other organs. Therefore, clinical practice must carefully diagnose and avoid bias. Treatment should not only focus on the heart but also consider holistic treatment of other organs [4]. Only by consistently applying principles such as strengthening vital energy, resolving phlegm, removing stasis, and opening channels can optimal results be achieved.
Besides treatment, proper work-life balance, appropriate physical activity, maintaining mental well-being, avoiding emotional stress, limiting intake of animal fats and cholesterol-rich foods, and quitting smoking and drinking are crucial for prevention and treatment.
References
1 Lin Ruishi. On the Diagnosis and Treatment of Coronary Heart Disease and Angina. New Chinese Medicine, 1991, 23(1): 53.
2 Li Tianbao. Recent Progress in Treating Coronary Heart Disease and Angina with Traditional Chinese Medicine. New Chinese Medicine, 1992, 24(6): 51.
3 Lu Zhongxin. Preliminary Exploration of Causes, Pathogenesis, and Syndrome Differentiation of Coronary Heart Disease. New Chinese Medicine, 1994, 26(Supplement): 13.
4 Tan Guobiao. Overview of Traditional Chinese Medicine in the Past 10 Years on Coronary Heart Disease Diagnosis. New Chinese Medicine, 1995, 27(4): 57.
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