Ang coronary heart disease ay ang pinakakaraniwang form ng arteriosclerosis that causes organ disease. Sa nakalipas na sampung taon, ang mga lokal na scholars ay nagawa ang isang sistemang pag-aaral, at sumusunod ang buod:
1. Cause and mechanism
Ang TCM ay naniniwala na ang coronary heart disease ay dulot ng pagbaba ng kalusugan sa edad, weakened organ function, imbalance ng yin-yang at qi-blood, at ang impluwensya ng seven emotions at six evils, na nagdudulot ng qi stagnation and blood stasis, yang deficiency in the chest, internal generation of phlegm, at heart meridian blockage. Si Mao ay naniniwala na ang coronary heart disease ay dulot ng spleen-kidney yang deficiency, insufficient heart qi, spleen losing warmth, and phlegm accumulation. Si Liu ay naniniwala na kapag lung qi ay weak, heart qi has no strength, blood circulation is not smooth, and blockage leads to chest pain. Si Lu ay naniniwala na ang angina is mainly due to liver qi stagnation, phlegm obstruction, cold congealing blood, and heart meridian stasis. Si Zhao ay naniniwala na ang lahat ay malapit sa blood stasis.
Modern studies show: those who love rich, fatty foods have higher plasma lipoprotein levels than normal; among emotional factors, "type A" behavior individuals have twice the chance of developing CHD compared to "type B" individuals, mainly because type A individuals have higher blood viscosity and platelet aggregation; hyperlipidemia, hemodynamic abnormalities, blood rheology issues, impaired cardiac function, and microcirculation disorders are the physiological basis for qi stagnation and blood stasis, phlegm obstruction.
2. Objective research on differentiation
Xu's study shows that heart deficiency is associated with varying degrees of left ventricular diastolic dysfunction. Cheng believes that patients with heart qi deficiency have impaired left ventricular diastolic and systolic functions, with diastolic performance parameters being more sensitive. Yu believes that plasma atrial natriuretic peptide (ANP) activity can serve as an objective indicator for heart qi deficiency. Huang believes that whole blood viscosity in blood rheology can be an important reference index for diagnosing qi stagnation and blood stasis. Jia believes that increased platelet membrane glycoprotein (GP Ib) is a more specific diagnostic marker for blood stasis in CHD. Guo found that TXB2, β-thromboglobulin (β-TG), and platelet factor 4 (PF4) were significantly elevated in CHD patients, while 6-keto-PGF1α was decreased. Compared to qi deficiency (mainly qi deficiency and blood stasis), blood stasis is mainly characterized by elevated TXB2, β-TG, PF4, and decreased protein C antigen (PC:AG); qi deficiency is mainly characterized by low 6-keto-PGF1α, with less pronounced increases in β-TG and PF4, and compensatory increase in PC:AG. Chen found that ET was elevated in both real and deficient groups of CHD, with the real group showing greater elevation. He believes that the fundamental deficiency in angina is closely related to cellular immune deficiency, especially imbalance between Ts and Th cells, while the manifesting excess is related to humoral immune overactivity. The former may be the core of CHD immunological mechanisms, thus emphasizing strengthening the body and restoring balance between Ts and Th. The latter may be a secondary event in CHD pathogenesis, so treatment should also address eliminating pathogenic factors to suppress humoral immune overactivity, inhibit production of pathological autoantibodies and immune complexes, and accelerate their clearance.
Studies show that excessive free radical production and/or impaired clearance are biochemical mechanisms behind many diseases, especially ischemia-reperfusion injury in CHD. It is believed that increased cell aggregation and elevated plasma viscosity are the main physicochemical bases for phlegm syndrome in CHD. Qiu believes that blood stasis syndrome has the pathological characteristic of increased blood viscosity. Chen believes that yin-deficient patients tend to have sympathetic dominance, while yang-deficient patients tend to have increased vagal function.
3. Treatment of CHD
Based on the pathogenesis of CHD being fundamentally deficient and manifesting excess, TCM treatment emphasizes using tonification to achieve unblocking, tonification within unblocking, and combining tonification with unblocking, focusing on overall functional regulation to achieve balanced qi and blood, and smooth flow of vessels. Methods of tonification within unblocking include tonifying qi and activating blood, warming yang and activating blood, tonifying qi and nourishing yin to activate blood, nourishing blood and activating blood, etc.
Tonifying qi and activating blood is a common method in recent years for treating CHD. It has more lasting and stable effects than purely activating blood methods. Zhang observed the clinical effects of Bu Yang Huan Wu Tang on CHD, finding that serum lipid peroxidation (LPO), apolipoprotein B100 (ApoB100), and LPO/SOD, ApoB100/ApoA ratios significantly decreased in the Bu Yang Huan Wu Tang group, while serum SOD and ApoA levels significantly increased. The effectiveness in relieving angina was similar to the control group, but ECG improvement was better. Jiang's Qixue Chongji treated 30 cases of qi deficiency and blood stasis type CHD angina, compared to 25 cases in the control group given compound danshen tablets (3 tablets/day). The effective rate was 90% vs. 60%, with the treatment group showing significantly better results. Xu's clinical study on Tongxinluo capsule for CHD angina showed that the treatment group had an effective rate of 94.49%, significantly better than the control group's 78%. The total effective rate of ECG improvement was 71.05% in the treatment group, significantly better than the control group's 47.33%.
Warming yang and activating blood method is mainly suitable for CHD patients with yang deficiency and cold stagnation. Liu used the aromatic yang-warming and blood-activating medicine Xiangshen Xinnaole to treat 345 cases of CHD clinically, achieving a 88.1% effective rate in relieving angina and a 72.9% total effective rate in improving ECG ischemia. Guo used aromatic warming and unblocking agents to treat cold stagnation type, with quick results.
Nourishing blood and activating blood to remove phlegm method is mainly used for treating CHD with phlegm abundance. Li made granules from astragalus, seaweed, and fritillary, using compound danshen tablets as control. The significant relief rate for angina was 57.5% vs. 16.67%, with better ECG improvement. Fang proposed that if long-term use of blood-activating drugs fails, one should consider that "stasis" is caused by "phlegm," and should treat based on phlegm, creating the "Tongguan Tang" for significant efficacy in treating angina.
Tonifying qi and nourishing yin method is mainly used for treating qi-yin deficiency type CHD. Wang used Tongguan Shengmai Yin, which tonifies qi and nourishes yin and activates blood, showing significantly better results than the control group. Wang used Shengmai Wen Dan Tang to treat 235 cases of CHD, achieving a total effective rate of 84%.
The advantage of TCM in treating CHD lies in regulating the overall function of the body, emphasizing the relationship between qi and blood, and improving the body's adaptation to internal and external changes. Mastering the balance between unblocking and tonification, local and global, not only focuses on local heart treatment but also considers overall improvement, making TCM treatment of CHD have broad development prospects.
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