The heart is physiologically regarded as the sovereign organ, governing blood vessels and housing the spirit, serving as the master of the five organs and six bowels, opening to the tongue, and its manifestation is seen on the face. The circulation of blood relies on the propulsion of heart qi, and the vigor of the spirit is fundamentally based on heart blood. Diseases related to the heart primarily manifest as abnormalities in blood circulation and mental state, covering a wide range. This article mainly introduces Professor Zhang Qi’s clinical experience in the syndrome differentiation and treatment of coronary atherosclerotic heart disease, viral myocarditis, arrhythmias, and other heart-related diseases, with chest obstruction, heart pain, palpitations, and anxiety as the main manifestations.
Professor Zhang Qi believes that the differentiation of syndromes for chest obstruction, heart pain, palpitations, and anxiety can generally be divided into two categories: deficiency and excess. Deficiency refers to the insufficiency of heart qi, blood, yin, and yang, while excess often refers to conditions such as qi stagnation, blood stasis, and phlegm turbidity. However, deficiency and excess often coexist, leading to complex pathogenesis, and treatment methods should be adapted accordingly.
1. Differentiation and Treatment of Deficiency Syndromes
1. Qi Deficiency Syndrome
Qi is the master of the body. The “Lingshu: Evil Guests” states, “Zong qi accumulates in the chest, exits through the throat, traverses the heart meridian, and facilitates breathing.” This indicates that zong qi accumulates in the chest, performing functions such as regulating respiration and circulating blood and qi. The heart and lungs reside in the chest, and zong qi is the source of heart qi and lung qi. Since zong qi traverses the heart meridian, heart blood can circulate continuously; thus, qi is the commander of blood, and when qi moves, blood moves. Conversely, if qi is deficient and unable to propel blood circulation, it can lead to chest obstruction and heart pain. Professor Zhang Qi’s experience shows that chest obstruction and heart pain primarily due to qi deficiency are not uncommon in clinical practice, with main symptoms including shortness of breath, fatigue, spontaneous sweating, chest tightness or pain, which is often dull and worsens with activity, pale tongue, and weak or deep pulse. Treatment involves using ginseng and astragalus to tonify qi, with a self-formulated formula for nourishing qi and heart. The formula consists of: ginseng 15-20g, astragalus 30g, licorice 15g, chuanxiong 15g, angelica 15g, poria 15g, ophiopogon 15g, schisandra 15g, acorus 15g, polygala 15g, salvia 15g, and cinnamon twig 10g, with sanqi powder 10g taken in two doses, decocted in water.
The formula uses ginseng and astragalus to tonify qi, while chuanxiong, angelica, and salvia nourish blood and promote blood circulation. Schisandra and ophiopogon, along with ginseng, form the Sheng Mai Decoction, which tonifies heart qi and nourishes yin. Cinnamon twig and licorice combined assist heart yang, tonifying both heart qi and yin, nourishing heart yang, and achieving a balance between yin and yang. Poria, acorus, and polygala nourish the heart and calm the spirit, while sanqi has the effect of invigorating blood. The combination of salvia and chuanxiong promotes blood circulation and unblocks meridians, while tonifying qi and nourishing the heart can achieve the effect of tonifying without obstruction. This formula is effective for coronary heart disease with angina primarily due to qi deficiency, and Professor Zhang Qi has repeatedly used it with success. A brief introduction of recent cases is as follows:
Case 1: Tian, male, 55 years old, retired, first diagnosed in early March 2001. He has suffered from coronary heart disease and angina for 2 years. The patient reported that he could not engage in activities, and angina would occur when climbing stairs, while resting in bed would alleviate the symptoms. He came to the clinic for treatment, and the electrocardiogram showed significant ischemia. The patient experienced shortness of breath, fatigue, chest tightness, and frequent angina attacks with activity. He had previously used various Western medications without effect, and traditional Chinese medicine for invigorating blood and resolving stasis also showed no efficacy. His pulse was weak, and his tongue was pale. Based on the pulse and symptom analysis, this was attributed to the deficiency of zong qi unable to propel heart blood circulation, leading to chest obstruction and heart pain. The above formula was administered, and after taking 7 doses, the chest tightness and shortness of breath significantly improved. After taking this formula for 20 doses, the patient returned to the clinic looking happy, stating that he had not experienced angina since taking the formula for 10 doses, his shortness of breath had greatly reduced, he felt stronger overall, and his spirit had improved. A follow-up electrocardiogram showed improvement in ischemia, and he was advised to continue taking several more doses to consolidate the effect. The patient later returned to Shandong, and long-term observation was not possible.
Case 2: Xu, male, 57 years old, first diagnosed in December 1999. Diagnosed with “coronary heart disease and angina” at a hospital, he had previously used both Chinese and Western medications without effect. He was referred to Professor Zhang, who noted his dark complexion, chest tightness and pain, shortness of breath, and frequent palpitations, which worsened with activity. His tongue was pale with slightly purple edges, and his pulse was weak. Comprehensive symptom and pulse differentiation indicated qi deficiency and blood deficiency, with insufficient blood supply leading to heart pain. The treatment involved the above formula, and after taking over 30 doses, he felt stronger overall, and symptoms of chest pain, shortness of breath, and palpitations were all alleviated, with his pulse also becoming stronger. In May 2001, he returned for a follow-up visit, stating that since taking this formula, he had not experienced angina, and the electrocardiogram showed that he was basically normal and had recovered.
2. Qi and Yin Deficiency Syndrome
Heart qi deficiency and insufficient heart yin lead to a condition of both qi and yin deficiency, which on one hand fails to propel the circulation of blood and nutrients, and on the other hand cannot achieve the nourishing and moistening function, resulting in symptoms such as chest obstruction, heart pain, palpitations, and limb numbness. Ye Tianshi stated, “Insufficient blood leads to symptoms of chest pain that comes and goes, lack of appetite, and a wiry pulse; treatment should focus on nourishing the blood and harmonizing the stomach.” He also mentioned, “Wind and fire internally burn, harming the yin, leading to symptoms of heart pain radiating to the back, chest and ribs feeling distended, dry mouth, nocturnal emissions, and a small rapid pulse; treatment should focus on softening and resolving the wind and alleviating urgency, using the Sheng Di and Ejiao Decoction (Sheng Di, Ejiao, Oyster Shell, Xuan Shen, Dan Shen, Bai Shao, and Wheat).”
Ye’s description of heat injuring yin and causing chest pain is commonly seen in clinical practice, especially in cases of myocarditis. The differentiation characteristics include chest tightness and pain, shortness of breath, irritability, heat in the palms and soles, palpitations, irritability, dry mouth, red tongue with little coating or dark red with thin coating, and a thin rapid or wiry pulse. Professor Zhang Qi treats this with a self-formulated formula for tonifying qi and nourishing yin: American ginseng 15g, ophiopogon 15g, schisandra 15g, raw rehmannia 20g, xuan shen 15g, dan pi 15g, yuyu 20g, and chuan lian zi 10g, dan shen 15g. The formula includes American ginseng, schisandra, ophiopogon, raw rehmannia, and xuan shen to tonify qi and nourish yin, while dan shen, dan pi, and chuan lian zi invigorate qi, promote blood circulation, and unblock meridians, achieving a balance between tonifying and unblocking.
Case 3: Song, female, 11 years old, first diagnosed in May 2001. Diagnosed with “viral myocarditis” at a hospital, her mother reported that the child developed arrhythmia and shortness of breath after a cold and fever, feeling extremely fatigued. After treatment at several major hospitals showed no effect, she came to the clinic for treatment. Upon examination, her tongue was red, pulse was thin and rapid, with heat in the palms and soles, shortness of breath, and palpitations. The differentiation indicated that this was due to heat evil harming the nutrients and consuming qi, and the treatment should focus on nourishing qi, nourishing yin, and promoting circulation. The proposed formula was: raw rehmannia 10g, American ginseng 10g, ophiopogon 10g, schisandra 10g, yuyu 10g, xuan shen 10g, peony root 10g, white peony 10g, licorice 10g, chuan lian zi 5g, and bamboo leaf 5g, decocted twice daily. After taking this formula, her chest pain and heat in the palms and soles were alleviated, and after adjusting the formula, she was cured after taking 30 doses.
3. Yin and Yang Deficiency Syndrome
Heart yang is weak, unable to propel blood, and heart yin is deficient, failing to nourish and moisten, leading to a condition of both yin and yang deficiency, manifested as shortness of breath, palpitations, spontaneous sweating, mental fatigue, dry mouth with no desire to drink, weak or irregular pulse, commonly seen in coronary heart disease, myocarditis, arrhythmias, etc. Treatment should invigorate heart yang and nourish heart yin, with the principle of mutual assistance between yin and yang, represented by the formula Zhi Gan Cao Decoction.
This formula primarily uses roasted licorice to tonify the middle and invigorate qi, with ginseng, cinnamon twig, ginger, and clear wine to invigorate qi and assist heart yang to unblock the meridians; raw rehmannia, ophiopogon, and ejiao nourish the heart’s yin fluids. The mutual relationship between yin and yang is emphasized: “Without yin, yang cannot thrive; without yang, yin cannot transform.” Therefore, warming and assisting heart yang while nourishing heart yin is essential. Additionally, cinnamon twig, ginger, and jujube harmonize the nutritive and defensive qi, and clear wine facilitates the unblocking of the meridians. The formula is well-composed, and when used correctly, it often yields excellent results.
Professor Zhang Qi uses this formula to treat myocarditis, coronary heart disease, and arrhythmias, sometimes adding yuyu and dan shen to enhance the nourishing yin and invigorating blood effects. If qi deficiency is evident, astragalus is added; if yin deficiency is more pronounced, raw rehmannia, ophiopogon, and yuyu are emphasized; if yang deficiency is significant, cinnamon twig and ginger are heavily used, and sometimes black aconite is added to warm the kidneys and assist heart yang, often achieving good therapeutic effects. The formula consists of: roasted licorice 20g, raw rehmannia 15g, American ginseng 15g, cinnamon twig 10g, dried ginger 10g, ophiopogon 15g, ejiao 15g, hemp seed 10g, jujube 5 pieces, decocted in clear wine, taken twice daily.
Case 4: Ni, male, 53 years old, an official, first diagnosed on May 15, 1997. The patient worked as an editor for a publication in the forestry system and reported that due to overwork and lack of rest, he experienced shortness of breath and palpitations. After being diagnosed with coronary heart disease, atrial fibrillation, and paroxysmal tachycardia (140-150 beats/min) at a hospital, he sought treatment in traditional Chinese medicine due to lack of significant improvement. He presented with persistent palpitations, shortness of breath, cold hands and feet, and fear of cold. His tongue was pale red, with a white coating, and his pulse was rapid and irregular. The differentiation indicated a deficiency of both heart yin and yang, and treatment was based on Zhi Gan Cao Decoction: roasted licorice 25g, red ginseng 15g, raw rehmannia 20g, ophiopogon 15g, schisandra 15g, cinnamon twig 15g, dried ginger 10g, ejiao 15g, yuyu 20g, turtle shell 20g, jujube 5 pieces, decocted twice daily. On June 2, he returned for a follow-up: after taking 14 doses, the tachycardia significantly decreased to 110-120 beats/min, and the frequency of atrial fibrillation also reduced, occurring only once in the past week, and the episodes were milder. His pulse still showed irregularities, but less frequently, and his tongue remained red, with his hands and feet warming up. The treatment continued with the same formula. On July 3, he returned for another follow-up: after taking 21 doses, the patient reported feeling strong overall, with symptoms of palpitations and shortness of breath disappearing, and atrial fibrillation had not occurred for two weeks. His pulse was no longer irregular and was stronger than before. Due to the hot weather, the patient requested to have this formula made into pills for long-term use to consolidate the effect. Follow-up showed no recurrence of the disease, and he was advised to avoid overwork. Note: This patient presented with a fast heart rate, red tongue, and palpitations, indicating heart yin deficiency, while cold hands and feet and fear of cold indicated a deficiency of both heart yin and yang, with heart yin deficiency being more pronounced and yang deficiency being milder. Therefore, the treatment emphasized nourishing heart yin and kidney yin, using yuyu, turtle shell, and schisandra. The ginseng in the formula tonifies heart qi, while roasted licorice and cinnamon twig combined support heart yang, achieving a balance between tonifying qi and nourishing yin. The original formula used clear wine, but Professor Zhang Qi did not use it in this case due to the tachycardia, as alcohol can further accelerate the heart rate.
2. Differentiation and Treatment of Mixed Deficiency and Excess Syndromes
1. Qi Deficiency and Blood Stasis Syndrome
The formula for tonifying qi and nourishing the heart is suitable for cases primarily characterized by qi deficiency without significant blood stasis. If the differentiation indicates a clear presence of both qi deficiency and blood stasis, the previous formula may not be entirely appropriate. Since qi and blood are interdependent, when qi is abundant, blood flows; when qi is deficient, blood stagnates. As stated in the “Lingshu: True Evil of Needle” chapter, “When zong qi does not descend, the blood in the pulse coagulates and remains stagnant.” Yu Chang stated, “The five organs and six bowels, large and small meridians, circulate day and night without ceasing, relying on the great qi in the chest to regulate them.” Therefore, any prolonged qi deficiency will inevitably affect blood circulation, leading to qi deficiency and blood stasis.
Professor Zhang Qi believes that many heart diseases are caused by qi deficiency and blood circulation obstruction. Therefore, for treating such heart diseases and arrhythmias, using methods to tonify qi and invigorate blood has shown good efficacy, proposing the formula for tonifying qi and invigorating blood. The formula consists of: astragalus 30g, red ginseng 15g, ophiopogon 15g, schisandra 15g, red peony 15g, safflower 15g, dan shen 20g, chai hu 15g, chuanxiong 15g, raw rehmannia 20g, peach kernel 15g, zhi ke 15g, and platycodon 15g, with angelica 15g and licorice 15g. Astragalus, ginseng, ophiopogon, and schisandra are the first choice for tonifying heart qi and nourishing yin; the Xuefu Zhuyu Decoction with dan shen is effective for blood stasis in the vessels. The heart governs blood vessels and relies on great qi for regulation. When qi is deficient and unable to command blood circulation, it leads to both qi deficiency and blood stasis. Therefore, treatment should address both the deficiency of qi and the need to invigorate blood and resolve stasis, achieving the effect of promoting qi and unblocking blood flow.
Case 5: Gu, female, 68 years old, first diagnosed on May 3, 2001. She had a history of stable old myocardial infarction but recently experienced paroxysmal pain in the precordial area and shortness of breath due to overwork, feeling weak overall. She had previously used various medications for coronary heart disease with slight effects, fearing a recurrence of myocardial infarction, and came to traditional Chinese medicine for treatment. Her pulse was weak and rapid, and her tongue was purple and dry with little moisture. The differentiation indicated qi and yin deficiency with blood stasis, and treatment should focus on nourishing qi and yin while invigorating blood and unblocking the meridians: red ginseng 15g, astragalus 30g, ophiopogon 20g, schisandra 15g, dan shen 20g, red peony 15g, safflower 10g, chai hu 15g, chuanxiong 15g, raw rehmannia 20g, peach kernel 15g, zhi ke 15g, platycodon 15g, angelica 15g, and licorice 10g, decocted twice daily. After three follow-ups and taking 21 doses, her shortness of breath and palpitations significantly improved, and she did not experience angina. Her spirit and physical strength improved greatly, and the electrocardiogram showed stable conditions. Professor Zhang Qi’s experience indicates that treatment for coronary heart disease with qi deficiency and blood stasis is often effective with this formula. Using only blood-invigorating herbs initially may not only be ineffective but may also exacerbate shortness of breath and fatigue, which is frequently observed and should be noted.
2. Qi and Yin Deficiency with Blood Stasis Syndrome
Qi deficiency, yin deficiency, and blood stasis involve the heart, lungs, and kidneys. The lungs govern qi, the kidneys receive qi, and the heart and kidneys mutually restrain each other. Prolonged deficiency of qi and yin will eventually affect the kidneys, leading to yin deficiency and yang floating, resulting in palpitations and arrhythmias. Treatment should differentiate between yin and yang to avoid errors.
Clinical manifestations of qi and yin deficiency with blood stasis include chest pain, shortness of breath, fatigue, low back pain, dizziness, tinnitus, heat in the palms and soles, palpitations, and a red tongue with little moisture and a weak rapid pulse. Treatment should focus on tonifying qi, invigorating blood, and nourishing kidney yin, proposing a formula for tonifying qi, invigorating blood, and nourishing yin. The formula consists of: astragalus 30g, prince ginseng 20g, ophiopogon 20g, schisandra 15g, raw rehmannia 20g, angelica 15g, chuanxiong 15g, dan shen 20g, safflower 15g, chai hu 15g, red peony 15g, peach kernel 15g, zhi ke 15g, nu zhen zi 20g, yuyu 15g, turtle shell 20g, goji berries 20g, and licorice 15g.
Case 6: Wang, male, 65 years old, retired official, first diagnosed on April 1, 2001. He experienced palpitations, shortness of breath, frequent premature ventricular contractions, and tachycardia (up to 160 beats/min). Diagnosed with hyperthyroid heart disease and arrhythmia at a hospital, he had used anti-arrhythmic medications and beta-blockers, which slightly reduced his heart rate to 120 beats/min, but the frequency of premature contractions did not decrease. He sought treatment in traditional Chinese medicine. The patient appeared haggard, mentally exhausted, and had difficulty sleeping at night due to palpitations. His tongue coating was thin, with purple edges. Analyzing the symptoms and pulse, this indicated a condition of qi deficiency, yin deficiency, and blood stasis. The treatment focused on tonifying heart qi, nourishing yin, and invigorating blood: astragalus 50g, prince ginseng 20g, ophiopogon 20g, schisandra 15g, raw rehmannia 20g, peach kernel 15g, safflower 15g, goji berries 20g, angelica 20g, zhi ke 15g, chuanxiong 15g, chai hu 15g, dan shen 20g, xia ku cao 30g, yuyu 20g, and licorice 15g, decocted twice daily. On April 17, he returned for a follow-up: after taking 15 doses, his heart rate slightly slowed to 100-110 beats/min, and the frequency of premature contractions decreased. His pulse was no longer rapid, and he felt slightly stronger overall, but still experienced fatigue, weakness in the waist and legs, and heat in the palms and soles, indicating kidney yin deficiency. The treatment continued with the same formula, adding nourishing kidney yin herbs: astragalus 50g, prince ginseng 20g, ophiopogon 20g, schisandra 15g, chuanxiong 15g, dan shen 20g, safflower 20g, chai hu 20g, red peony 15g, angelica 20g, raw rehmannia 20g, peach kernel 15g, zhi ke 15g, goji berries 20g, nu zhen zi 20g, yuyu 20g, turtle shell 20g, decocted twice daily. On June 5, he returned for a follow-up: after taking 30 doses, his heart rate was around 80 beats/min, and premature contractions had not occurred. He felt strong overall, and the soreness in his waist and knees had lessened. The palpitations had disappeared, and tests showed that T3 and T4 levels had returned to normal, indicating recovery. He was advised to continue taking several more doses to consolidate the effect.
Note: This case was diagnosed by Western medicine as hyperthyroidism leading to tachycardia, with frequent premature contractions and a heart rate of up to 160 beats/min. After using beta-blockers, the heart rate decreased to 120 beats/min, but the premature contractions did not reduce, and the patient had difficulty sleeping at night, appearing haggard and expressionless, with symptoms of shortness of breath and palpitations, a purple tongue, and a white coating. Professor Zhang Qi combined symptom differentiation with disease differentiation, concluding that this was a case of qi and yin deficiency with blood stasis. The first formula used was for tonifying qi and invigorating blood. After taking 15 doses, the premature contractions significantly decreased, becoming only paroxysmal, and the heart rate also slowed slightly, with the patient feeling slightly stronger and able to sleep at night. In the second diagnosis, considering the weak pulse, qi and yin deficiency, and the root of qi being in the kidneys, with yin deficiency leading to floating yang, causing palpitations, the formula was adjusted to include goji berries, nu zhen zi, yuyu, and turtle shell to nourish kidney yin and stabilize qi. On June 5, after taking 30 doses, the premature contractions completely disappeared, the tachycardia significantly slowed, and serum T3 and T4 levels returned to normal, demonstrating the effectiveness of traditional Chinese medicine in syndrome differentiation and treatment.
3. Qi Deficiency, Yang Deficiency, and Blood Stasis Syndrome
The lungs govern qi, the kidneys are the root of qi, and the heart governs blood vessels. Heart disease is related to both qi deficiency and blood stasis, as well as the decline of kidney yang, which prevents the original qi from ascending.
Clinical manifestations include palpitations, chest tightness or pain, shortness of breath, fatigue, hoarseness, lethargy, cyanosis of the lips, soreness in the lower back, tinnitus, dizziness, frequent urination, and dark urine. The tongue is pale, purple, and dark, and the pulse is deep, slow, and weak. Treatment should focus on tonifying qi and invigorating blood, while also warming and tonifying kidney yang to restore qi and return to the source, proposing a formula for tonifying qi, warming yang, and invigorating blood. The formula consists of: red ginseng 15g, astragalus 25g, chuanxiong 15g, dan shen 15g, angelica 15g, peach kernel 15g, safflower 15g, zhi ke 10g, chai hu 10g, cinnamon 15g, aconite 10g, ginger 10g, ophiopogon 15g, and schisandra 15g, decocted twice daily.
Case 7: Shen, female, 63 years old, a professor at a university, first diagnosed on October 1, 1997. The patient worked at a university in Shenyang and had a pacemaker implanted due to third-degree atrioventricular block caused by coronary heart disease. In the past two months, due to family issues and overwork, she experienced arrhythmias, frequent premature contractions, and atrial fibrillation, with two episodes of syncope. After ineffective treatment with both Western and Chinese medicine, she came to Professor Zhang Qi for treatment, accompanied by her son. Symptoms included dizziness, palpitations, shortness of breath, and chest tightness. Upon examination, her pulse was slow and rough, her tongue was dark purple, and her blood pressure was 90/55 mmHg. The differentiation indicated heart qi deficiency and kidney yang deficiency, leading to blood circulation obstruction. The treatment focused on tonifying heart qi and warming kidney yang to invigorate blood: red ginseng 15g, astragalus 25g, chuanxiong 15g, dan shen 20g, angelica 20g, peach kernel 15g, safflower 15g, zhi ke 15g, chai hu 15g, red peony 15g, aconite 10g, ginger 15g, ophiopogon 15g, and schisandra 15g, decocted twice daily. On November 3, she returned for a follow-up: after taking 20 doses, her dizziness significantly decreased, and symptoms of palpitations and shortness of breath improved markedly. She felt strong overall, and since starting traditional Chinese medicine, she had only experienced atrial fibrillation twice, with very short durations. The premature contractions had completely disappeared, and she had not experienced syncope. Due to slight edema in the lower limbs from overwork, she returned for a follow-up visit. Upon examination, her pulse was slow without irregularities, and her tongue was still slightly purple. The formula was adjusted to increase astragalus to 30g, aconite to 15g, and added ze xie 15g and zhu ling 15g. On May 10, 1998, she called to report that after taking the formula for 30 doses, her dizziness, palpitations, and shortness of breath had basically disappeared, her physical strength had increased, and her spirit had improved, and she continued to work at the university, frequently praising the effects of traditional Chinese medicine.
Note: This patient had third-degree atrioventricular block and was treated with a pacemaker at a local hospital, with good results. However, due to family and work-related stress, she experienced arrhythmias (slow type), frequent premature contractions, and atrial fibrillation, with two episodes of syncope. After ineffective treatment with both Western and Chinese medicine, she came to Professor Zhang Qi for treatment. Based on pulse and symptom analysis, this was determined to be heart qi deficiency, kidney yang deficiency, and blood circulation obstruction. The treatment involved tonifying heart qi and lung qi with ginseng and astragalus, warming kidney yang with aconite and cinnamon, and invigorating blood with chuanxiong, dan shen, angelica, and safflower, while using chai hu and zhi ke to relieve stagnation and promote qi flow, allowing both qi and blood to circulate. The addition of schisandra and ophiopogon nourished and stabilized the yin fluids, preventing further damage to yin. The treatment yielded significant results and relief. The above two cases both presented with arrhythmias and frequent premature contractions, with the first case showing tachycardia and a weak pulse, while the second case showed a slow and rough pulse with a purple tongue and white coating, indicating kidney yin deficiency. Therefore, the treatment for the first case focused on nourishing qi and tonifying kidney yin, while the second case focused on tonifying qi and warming kidney yang, demonstrating the principle of treating similar diseases with different methods.
4. Qi Deficiency and Chest Yang Obstruction
The chest is governed by yang qi, and the heart resides in the chest; thus, chest yang is heart yang. If yang qi is abundant, as Yu Chang stated, “When the fire of Li shines in the sky,” the yin receives the influence of yang qi, allowing fluids to be distributed throughout the body, and qi and blood circulate smoothly without obstruction. If yang qi is weak, phlegm and dampness will accumulate, affecting the circulation of qi and blood, leading to a series of symptoms associated with coronary heart disease.
The main symptoms include pain in the chest, which may radiate to the back, shortness of breath, a plump tongue, a white greasy coating, and a pulse that is deep and slippery or rapid. The treatment should focus on tonifying qi, unblocking yang, and resolving obstruction, proposing the modified Guo Lou and Xie Bai Decoction. The formula consists of: guo lou 20g, xie bai 20g, cinnamon twig 15g, ban xia 15g, yu jin 10g, poria 15g, and ginseng 15g. This formula uses guo lou and xie bai as the main ingredients, with guo lou opening the chest and clearing phlegm, and xie bai dispersing chest obstruction and promoting yang. Both herbs have the effect of opening the chest and unblocking yang qi. Ban xia and poria resolve phlegm, while cinnamon twig warms and harmonizes the nutritive and defensive qi. Yu jin opens stagnation and regulates qi. However, the root cause of this disease is insufficient heart qi, so ginseng is added to tonify qi, achieving a balance between tonifying and unblocking, allowing the obstruction to clear and yang qi to circulate, thus alleviating all symptoms.
Clinical observations show that this pattern is common in coronary heart disease, and this formula has shown significant efficacy, alleviating symptoms of chest obstruction and heart pain, with some cases showing significant improvement in electrocardiograms. Ginseng, as stated in the “Compendium of Materia Medica,” has the effects of tonifying qi, calming the spirit, and nourishing the heart and enhancing intelligence. According to Professor Zhang Qi’s experience, in cases where this pattern is present, if pain cannot be controlled with Guo Lou and Xie Bai Decoction, adding ginseng will alleviate the pain. Coronary heart disease fundamentally stems from heart deficiency, and ginseng is the primary herb for tonifying qi and nourishing the heart, especially when used in combination with astragalus for enhanced efficacy.
Case 8: Wang, female, 54 years old, a midwife, first diagnosed on May 15, 1999. She had a history of coronary heart disease and had been stable with Western medication. Recently, due to family issues, she experienced frequent episodes of chest tightness and angina, worsening at night, preventing her from sleeping. She felt weak overall, with shortness of breath, and the electrocardiogram showed ST segment depression in V5 and inverted T waves in II and III leads. She had previously used various Western medications, such as Mixinli, with no significant effect. Upon examination, her pulse was deep and rapid, and her tongue had purple edges with a greasy white coating. The differentiation indicated heart qi deficiency, heart yang deficiency, and phlegm dampness obstruction. The treatment should focus on tonifying qi and resolving phlegm obstruction: ginseng 15g, astragalus 30g, guo lou 20g, xie bai 20g, ban xia 15g, cinnamon twig 15g, acorus 15g, yu jin 10g, poria 15g, schisandra 15g, dan shen 20g, and licorice 15g, decocted twice daily. On May 24, during the second follow-up, after taking 7 doses, her angina significantly decreased, with fewer episodes and less pain. In the past three days, she had not experienced any episodes, but still felt chest tightness and shortness of breath occasionally with activity. Overall, she felt stronger, and her pulse was deep and strong. The treatment continued with the same formula. On June 5, during the third follow-up, she had not experienced angina for over ten days, felt strong overall, and her spirit had returned to normal, but still had some discomfort in the chest. Her pulse was deep and strong, and her tongue coating had become thinner. The follow-up electrocardiogram showed that the ST segment had returned to normal, and the inverted T waves had flattened.
Note: This case presented with frequent episodes of unstable angina, which did not respond to various treatments. Based on her tongue coating and pulse, which were deep and weak, and her overall weakness, although it was primarily due to chest yang obstruction from phlegm dampness, qi deficiency was still the main issue. Therefore, ginseng and astragalus were added to tonify qi, achieving a good effect with a combination of tonifying and unblocking.
5. Yin Deficiency and Yang Hyperactivity Syndrome
Yin deficiency and yang hyperactivity are often seen in cases of concurrent heart and liver disease, where liver stagnation transforms into heat, leading to heart yin deficiency. This results in yin deficiency and yang hyperactivity, causing heat to generate wind, in addition to chest pain and tightness, often accompanied by irritability, dizziness, or headache, dry eyes, tinnitus, limb numbness, or tremors. The tongue is red and dry, with a thin coating, and the pulse is wiry and rapid. The treatment should focus on nourishing yin, subduing yang, calming the liver, and clearing heat, proposing the formula for nourishing yin and subduing yang. The formula consists of: gou teng 20g, jue ming zi 20g, huai niu xi 15g, huang qin 15g, ju hua 15g, xuan shen 20g, raw rehmannia 20g, yuyu 20g, raw oyster shell 20g, zhi zhi 30g, pearl shell 30g, and white peony 20g, and licorice 15g. This formula uses raw rehmannia, xuan shen, and yuyu to nourish yin, while zhi zhi, pearl shell, and raw oyster shell subdue yang. Bai shao, huang qin, and jue ming zi calm the liver and clear heat, while gou teng and ju hua clear the head and extinguish wind. Huai niu xi guides heat downward, making this an effective formula for treating yin deficiency and yang hyperactivity.
This pattern is often seen in patients with hypertension combined with coronary heart disease. Many patients use antihypertensive medications to lower blood pressure, but symptoms persist or only slightly improve, such as dizziness and headache, while palpitations and heat remain. Using this formula can clear heat, reduce chest pain, alleviate various symptoms, and lower blood pressure, but differentiation must confirm yin deficiency and yang hyperactivity for effectiveness.
Case 9: Zhang, male, 48 years old, first diagnosed on August 15, 1999. He had hypertension and coronary heart disease, with blood pressure fluctuating between 180/110 mmHg, experiencing headaches, heat in the palms and soles, chest tightness, and shortness of breath. His tongue was red, with a dry white coating, and his pulse was wiry and rapid. He used antihypertensive medication (Bodidin) daily, which lowered his blood pressure, but he still experienced headaches, irritability, and insomnia, with heat in the palms and soles. He sought treatment from Professor Zhang Qi. Based on the pulse and symptoms, this was determined to be liver yang hyperactivity and heart yin deficiency. The proposed formula was administered, and after taking over 20 doses, his blood pressure stabilized at around 150/90 mmHg, and symptoms of headache, irritability, and heat were alleviated.
3. Treatment of Excess Syndromes Should Differentiate Blood Stasis and Phlegm Obstruction
1. Heart Blood Stasis Syndrome
The heart governs blood vessels, and when blood circulation is obstructed for a long time, it leads to heart blood stasis. The main symptoms include palpitations, chest tightness, or stabbing pain in the precordial area, which may radiate to the shoulder and back, and in severe cases, the pain is unbearable, with cyanosis of the lips and nails, dark red tongue, or purplish spots, and a choppy pulse. This is caused by blood stasis obstructing the heart vessels and qi stagnation. The treatment should focus on invigorating blood, resolving stasis, unblocking the meridians, and Professor Zhang Qi prefers to use the modified Xuefu Zhuyu Decoction for treatment. The formula consists of: angelica 15g, raw rehmannia 15g, peach kernel 15g, safflower 15g, zhi ke 15g, red peony 15g, chuanxiong 15g, chai hu 15g, platycodon 10g, dan pi 15g, huai niu xi 15g, dan shen 15g, and licorice 10g.
Wang Qingren established this formula to treat blood stasis in the heart, exploring the organs and meridians, particularly focusing on the heart and liver, as the heart generates blood and the liver stores blood. The liver’s meridian connects to the chest and ribs, and when it is smooth, qi and blood flow freely; when it is obstructed, qi and blood stagnate. This formula is effective for treating liver blood stasis, and the addition of dan pi and dan shen enhances its efficacy.
For example, Professor Zhang treated a 43-year-old woman with palpitations and chest tightness, who was unable to endure the symptoms, especially in the afternoon. She was hospitalized at a certain hospital, suspected of having coronary heart disease, but her electrocardiogram showed no typical myocardial ischemia changes. Her pulse was wiry, her tongue was purple, and she experienced heat in the palms and soles. The differentiation indicated liver blood stasis, with heat disturbing the heart. The formula was administered, and after taking 4 doses, her symptoms of heat in the palms and soles significantly decreased, and her palpitations and chest tightness were alleviated. After half a month of treatment with this formula, she was cured.
Another case involved Li, a 41-year-old female patient with coronary heart disease for over three years, who experienced chest tightness and severe stabbing pain radiating to the shoulder and back, with paroxysmal chest obstruction that was difficult to endure. Her electrocardiogram showed insufficient coronary blood supply. She had previously used Pan Shengdian and Guo Lou and Xie Bai Decoction with slight relief, but the symptoms recurred. Her tongue was dark purple, her coating was white, and her pulse was deep and slow. She reported that her symptoms would worsen with emotional stress or fatigue. The differentiation indicated heart blood stasis and qi stagnation, and the treatment focused on invigorating blood and resolving stasis, using the previous formula with the addition of xie bai and cinnamon twig to unblock heart yang. After taking 6 doses, her chest tightness significantly decreased, and her symptoms improved markedly. The treatment continued with slight adjustments, and after taking over 40 doses, her electrocardiogram returned to normal, and her symptoms disappeared, with her condition stabilizing. Follow-up after six months showed no recurrence.
Pulmonary heart disease often combines with infection, with phlegm-heat accumulating and qi counterflow leading to blood stasis, resulting in symptoms such as chest tightness and shortness of breath, cough with thick and sticky phlegm that is difficult to expel, and often presenting with heart failure symptoms, cyanosis of the lips, and liver enlargement. In such cases, simply using heat-clearing and phlegm-resolving methods may not yield significant effects. Using this formula to invigorate blood and relieve stagnation, combined with clearing the lungs and resolving phlegm, yields better results. Invigorating blood and resolving stasis can adjust heart blood circulation and reduce blood viscosity, improving and promoting blood circulation, increasing pulmonary blood flow and myocardial blood supply, thus showing good efficacy in treating pulmonary heart disease and heart failure.
This formula can also be used to treat cerebral arteriosclerosis, lacunar cerebral infarction, and hyperlipidemia, with clinical manifestations including dizziness, forgetfulness, irritability, and other symptoms of qi stagnation and blood stasis. For example, Zhang, male, 53 years old, was diagnosed with cerebral arteriosclerosis and hyperlipidemia by Western medicine. He had previously received intravenous injections of We Brain Road and phosphatidylcholine, but his symptoms worsened, leading him to seek traditional Chinese medicine treatment. He appeared overweight and healthy, with a rosy complexion, but complained of dizziness, forgetfulness, and excessive sleepiness. A CT scan of the brain showed mild cerebral atrophy. His sublingual veins were cyanotic, and his pulse was deep, slippery, and strong, with normal blood pressure. The formula was administered with the addition of chrysanthemum 15g, jue ming zi 15g, sandspurry 15g, and mulberry leaf 15g. After taking 10 doses, his dizziness significantly decreased. After half a month of treatment with this formula, his dizziness disappeared, irritability resolved, and his spirit improved, with all symptoms disappearing. Follow-up after six months showed no recurrence.
2. Qi Stagnation and Phlegm-Dampness Obstruction Syndrome
The heart and spleen have a mother-son relationship; when heart qi is deficient, it affects the spleen’s function. The spleen and stomach are interrelated, and when the spleen and stomach function is disordered, phlegm and dampness can develop internally. Qi stagnation and phlegm dampness intertwine, affecting the smooth flow of the meridians, forming another pattern of coronary heart disease. The “Jin Gui Yao Lue” states, “Chest obstruction, with qi stagnation in the chest and shortness of breath, is treated with the Rehmannia and Apricot Decoction, and the Tangerine Peel and Zhi Ke Ginger Decoction is also indicated.” Tangerine peel, zhi ke, ginger, poria, and apricot are all herbs that harmonize the stomach, resolve phlegm, and descend qi. Therefore, using these herbs to treat this type of coronary heart disease is appropriate.
This pattern shares similarities with chest yang obstruction but differs in that chest yang obstruction primarily affects the heart and lungs. Symptoms such as wheezing, coughing, chest and back pain, shortness of breath, and a deep pulse are indicative of lung and heart obstruction. This pattern, however, involves the heart and extends to the spleen and stomach, with clinical manifestations often accompanied by digestive symptoms such as nausea and vomiting. During angina attacks, there may be a desire to vomit, accompanied by qi counterflow. The tongue is plump, with a white greasy coating, and the constitution is often overweight, with excessive phlegm, dizziness, palpitations, etc. The treatment should focus on harmonizing the stomach, resolving phlegm, and unblocking the meridians, proposing the modified Wen Dan Decoction. The formula consists of: ban xia 20g, chen pi 15g, poria 20g, licorice 15g, bamboo leaf 15g, zhi ke 15g, acorus 15g, ginger 15g, yu jin 10g, and apricot 15g.
The characteristics of this formula are that it treats both the heart and stomach. The Wen Dan Decoction has the effect of harmonizing the stomach, resolving phlegm, and descending qi. Yu jin and acorus unblock stagnation and promote qi flow, while apricot benefits the lungs and descends qi. If the tongue is red and the palms and soles are hot, indicating yin deficiency, nourishing stomach yin herbs such as dendrobium, schisandra, and ophiopogon can be added. If there is fear of cold, cold hands and feet, and loose stools, warming herbs such as bai zhu and cinnamon can be added.
This pattern of coronary heart disease is not uncommon and is often misdiagnosed as a gastric disorder. In such cases, it is essential to conduct a thorough examination, including an electrocardiogram, to rule out angina to avoid misdiagnosis and mistreatment.
Copyright Statement: This article is sourced from “Chinese Century: One Hundred Clinical Practitioners of Traditional Chinese Medicine – Zhang Qi” published in October 2002 by China Traditional Chinese Medicine Publishing House, edited by Zhang Peiqing et al. This article is for reference and learning purposes only and does not serve as medication guidance. Please do not self-medicate. Copyright belongs to the relevant rights holders. If there is any infringement, please contact for deletion!