Source: TCM Book Friends Association
IIntroduction: Coronary heart disease (CHD) is pathologically characterized by a deficiency of righteous qi internally, with phlegm and blood stasis obstructing the heart. There are four key aspects to focus on in treatment, and Elder Deng often uses a modified Wen Dan Tang (Warm Gallbladder Decoction). I recall that Elder Xiong Jibai also had experience using a ten-ingredient Wen Dan Tang for CHD with phlegm-heat accumulation. Of course, Wen Dan Tang is a widely applicable formula, not limited to the treatment of CHD. (Editor/Xu Jingting)
Coronary Atherosclerotic Heart Disease
Author/Deng Tietao
Although Traditional Chinese Medicine (TCM) does not have a specific term for coronary atherosclerotic heart disease (commonly known as coronary heart disease), this condition has long existed objectively. TCM literature describes various terms such as “true heart pain,” “chest obstruction,” “palpitations,” and “sudden fainting,” which have different discussions regarding this disease, essentially summarizing the content of syndrome differentiation and treatment for CHD. Patients with CHD often present with main symptoms of chest tightness, heart pain, and shortness of breath, along with palpitations, dizziness, limb numbness, and fatigue. TCM believes that individuals over 40 years old often experience a decline in vital energy. This disease is more prevalent after the age of 40, as the yang energy diminishes with age, and some patients may develop chronic conditions leading to deficiency of qi and blood. Therefore, qi deficiency is one of the common pathophysiological mechanisms of CHD. Additionally, according to the principle that qi governs blood and the interdependence of yin and yang, some patients may also develop the disease due to insufficient heart yin. Symptoms such as chest tightness, heart pain, dizziness, and limb numbness, or a dark red tongue with a greasy coating, are manifestations of qi stagnation, blood stasis, and phlegm-dampness obstructing the heart vessels. These factors collectively form a pathophysiological mechanism of deficiency of righteous qi internally, with phlegm and blood stasis obstructing the heart. The deficiency of righteous qi (including heart qi deficiency and heart yin deficiency) is the internal cause of this disease—its essence, while phlegm and stasis are factors that continue to develop the disease—its manifestation. The former belongs to deficiency, while the latter belongs to excess, indicating that CHD is a syndrome of deficiency and excess, with qi deficiency, yin deficiency, phlegm-dampness, and blood stasis constituting the four main aspects of the pathophysiology of CHD. Based on this understanding of the pathophysiology of the disease, the treatment principle should be to unblock and supplement, combining both approaches. The proposed treatment principles are to tonify qi, resolve phlegm, and unblock stasis for the treatment of CHD. Since the author has worked in Guangdong for a long time, where the climate is humid, patients are prone to phlegm due to dampness, thus early treatment often emphasizes resolving phlegm. However, whether resolving phlegm or unblocking stasis, the goal is to open the meridians and restore balance. Emphasizing the principles of tonifying qi, resolving phlegm, and unblocking stasis, treatment measures should focus on the spleen and stomach. Based on the author’s experience, Wen Dan Tang is often selected for treatment in clinical practice. The basic prescription includes: Ban Xia (Pinellia) 9g, Yun Ling (Poria) 12g, Ju Hong (Red Tangerine Peel) 6g, Zhi Qiao (Bitter Orange) 6g, Gan Cao (Licorice) 5g, Zhu Ru (Bamboo Shavings) 9g, Dang Shen (Codonopsis) 15g, Dan Shen (Salvia) 12g. Wen Dan Tang resolves phlegm and regulates qi, with Dang Shen tonifying qi and supporting righteousness; Dan Shen invigorating blood and unblocking stasis; using Zhi Qiao instead of Zhi Shi is to gently regulate the middle and lower qi, as Zhi Qiao is milder and avoids excessive consumption of qi that can lead to stagnation. If qi deficiency is significant, Huang Qi (Astragalus) and Wu Zhua Long (Five-Clawed Dragon) can be added, or 6g of Jilin Ginseng can be cooked separately, or 1.5g of Ren Shen (Ginseng) can be chewed, which also yields good results, but Dang Shen should not be used excessively, generally not exceeding 15-18g, as this disease has a mix of deficiency and excess, and excessive use can lead to stagnation, which is not conducive to resolving phlegm and unblocking stasis; if heart pain is significant, it can be combined with Shi Xiao San or San Qi powder for oral administration; if there is spleen qi deficiency, it can be combined with Si Jun Zi Tang; if there is concurrent yin deficiency, Sheng Mai San can be used; if there is hypertension, add Cao Jue Ming (Cassia Seed), Sang Ji Sheng (Mulberry Mistletoe), and Zhen Zhu Mu (Mother of Pearl); if there is hyperlipidemia, add Shan Zha (Hawthorn), He Shou Wu (Fo-Ti), and Mai Ya (Barley Sprout); if there is kidney deficiency, add Yin Yang Huo (Epimedium); if there is blood deficiency, add Ji Xue Teng (Spatholobus). The patterns of TCM treatment for CHD are still being explored and summarized in various regions. Generally speaking, in terms of treatment principles, phlegm and stasis obstruction should emphasize “unblocking,” such as aromatic opening methods, warming yang methods, and invigorating blood and resolving stasis methods. Deficiency of righteous qi (including qi deficiency and yin deficiency) should emphasize “tonifying,” such as qi tonification methods, warming yang methods, and nourishing yin methods.
Practice has proven that the principles of tonification and unblocking are inseparable in the treatment of CHD. Clinically, whether to unblock first or tonify first, or to emphasize unblocking more than tonifying, or vice versa, or to alternate between unblocking and tonifying, should be determined based on the specific type of CHD and the individual situation. One should not only focus on tonifying deficiency while neglecting the unblocking of phlegm and stasis, nor should one excessively unblock without supporting the foundation and righteousness.
I Copyright Statement
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This article is excerpted from “Contemporary Famous Doctors’ Syndromes and Treatments Collection,” published by Hebei Science and Technology Publishing House. Author/Deng Tietao.
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