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Dr. Guo Shikui, an experienced TCM practitioner, has accumulated extensive knowledge in the prevention and treatment of coronary heart disease. He specializes in using methods such as invigorating blood circulation, resolving blood stasis, and warming the channels to treat angina pectoris and myocardial infarction. For moderate to severe angina, in addition to using decoctions based on syndrome differentiation, he often employs powdered formulations, which are effective and convenient for patients.

The powdered formula prescribed by Dr. Guo for alleviating angina pectoris features distinctive herbal combinations, categorized as follows:

Indicated for blood stasis pain. Symptoms include stabbing chest pain, fixed pain location, wiry pulse, and a dark purple tongue or stasis spots, with a generally robust physique.1. Xuejie Powder: 1.5 grams of Xuejie (Dragon’s Blood), taken in two doses.2. Ruyue Powder: 1.5 grams of Ruxiang (Frankincense) and 1.5 grams of Moye (Myrrh), ground together and taken in two doses.3. Ruxiang 1.5 grams, Moye 1.5 grams, Xuejie 1.5 grams, and Bingpian (Borneol) 1.5 grams, ground together, taken as 1 gram per dose.

Indicated for Qi deficiency and blood stasis, with a weak constitution and accompanying chest pain. Symptoms include fatigue, shortness of breath, chest pain, thin or weak wiry pulse, and a dull tongue.1. Hongshen Sanqi Powder: Equal parts of Hongshen (Red Ginseng) and Sanqi (Notoginseng), taken as 1 gram per dose.2. Hongshen Sanqi Xuejie Powder: Equal parts of Hongshen, Sanqi, and Xuejie, taken as 1 gram per dose.3. Hongshen 1.5 grams, Sanqi 1.5 grams, and 1 gram of Amber Powder, mixed and taken in two doses (for those with Qi deficiency, blood stasis, and insomnia).4. Hongshen Yuanhu Powder: Equal parts of Hongshen and Yuanhu (Rhizoma Chuanxiong), taken as 3 grams per dose.5. Hongshen 1.5 grams, Sanqi 1.5 grams, and Yuanhu 3 grams, mixed and taken as 2 grams per dose (the last two formulas are for Qi deficiency with phlegm and Qi stagnation).

Indicated for Qi stagnation and blood stasis. Symptoms include chest pain, chest tightness, and a wiry pulse, with a dark tongue or stasis spots.1. Yuanhu Powder: 3 grams of Yuanhu, taken in two doses.2. Guangmuxiang Powder: 1.5 grams of Guangmuxiang (Aromatic Wood) and 1.5 grams of Yuanhu, mixed and taken in two doses.3. Sanqi Yuanhu Powder: 1 gram of Sanqi and 3 grams of Yuanhu, mixed and taken in two doses.

Indicated for chest pain due to cold obstruction. Symptoms include chest tightness, severe chest pain triggered by cold, tight wiry pulse, and thin white tongue coating.1. Dinggui Powder: 1.5 grams of Dingxiang (Clove), 1 gram of Rougui (Cinnamon), and 0.5 grams of Tanshan (Sandalwood), ground together, taken in two doses.2. Chenxiang Powder: 1 gram of Chenxiang (Agarwood), 1 gram of Gongdingxiang (Clove), and 1 gram of Amber Powder, mixed and taken in three doses (for those with chest tightness and insomnia).

Indicated for chest pain due to cold and blood stasis. Symptoms include chest tightness and stabbing pain, fixed pain location, triggered by cold, dark tongue, and thin tongue coating.1. Chenxiang Powder: 1 gram of Chenxiang, 1 gram of Gongdingxiang, 1 gram of Sanqi, and 1 gram of Amber Powder, mixed and taken in three doses.2. Chenxiang Powder: 0.5 grams, Xuejie Powder 1 gram, Amber Powder 0.5 grams, Sanqi 1 gram, and Bingpian 0.5 grams, mixed and taken in five doses.

Indicated for Qi deficiency and blood stasis with cold obstruction. Symptoms include fatigue, shortness of breath, chest tightness, chest pain triggered by cold, wiry pulse, dark tongue, and thin white coating.2 grams of Hongshen, 0.5 grams of Chenxiang, 1 gram of Xuejie, 1 gram of Sanqi, 0.5 grams of Amber, and 0.5 grams of Bingpian, mixed and taken in five doses.All of the above powders are taken with warm water in divided doses throughout the day, and can also be taken as needed during episodes of chest pain for analgesic effects.

The use of powdered herbal formulations in treating angina pectoris offers advantages such as low dosage, ease of preparation, convenient administration, and rapid pain relief, making them popular among patients and valuable for practical application.Dr. Guo’s powdered prescriptions for angina pectoris reflect the principle of syndrome differentiation and treatment. As stated in the Su Wen (Plain Questions), “Heart obstruction leads to pulse blockage.” Dr. Guo believes that the direct causes of true heart pain and obstructive heart pain are blood vessel blockage, leading to pain. Therefore, he emphasizes invigorating blood circulation and resolving stasis as the fundamental treatment for heart pain.All the aforementioned powdered formulations embody the principle of invigorating blood and relieving pain.Moreover, since blood “congeals when cold and flows when warm,” Dr. Guo also places great importance on the role of aromatic warming in alleviating angina pectoris, considering it a key aspect of treatment.Dr. Guo’s various powdered prescriptions pay close attention to the relationship between Qi and blood, as “when Qi flows, blood flows; when Qi stagnates, blood stagnates.” Thus, Qi activation aids in blood activation, leading to the development of Qi-activating and blood-invigorating powders; since “Qi is the commander of blood,” Qi deficiency leads to blood stasis, hence the creation of Qi-invigorating and blood-activating powders; and since “cold Qi leads to blood congealing, warm Qi leads to blood flowing,” warming and invigorating blood powders are also formulated.

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