Coronary Artery Disease (CAD) & Chinese Medicine
Keywords: Chinese medicine, Chinese herbal medicine, cardiology, coronary artery disease, CAD

In Chinese medicine, depending on the main presenting manifestations, coronary artery disease is traditionally categorized as chest impediment (xiong bi), chest pain (xiong tong), true heart pain (zhen xin tong) and reversal heart pain (jue xin tong), i.e., heart pain with chilled limbs. The disease causes of CAD as listed in the Chinese medical literature include former heaven natural endowment insufficiency, habitual bodily exuberance, damage by the seven affects, unregulated stirring and stillness, faulty diet, aging, and enduring disease. It may also be due to iatrogenesis, and, in the future, it is possible that Chinese doctors will add contraction of external evils to this list.

As in so many cardiovascular diseases, the disease mechanisms of CAD mostly involve a combination of vacuity and repletion. In this case, there is a root vacuity with one or more tip or branch repletions. The root vacuity is a qi, yin, and/or yang vacuity. Often, the vacuity aspect of this disease progresses from simple qi vacuity initially to yin or yang vacuity or possibly even yin and yang dual vacuity at a later stage. Qi governs the blood, and the heart controls the blood. This means that the heart qi pushes the blood throughout the vessels of the entire body. Therefore, if, for any reason, the qi becomes vacuous and weak, the propulsion of blood loses its force and the blood may become static and stagnant. Qi vacuity blood stasis is one of the most commonly seen pattern combinations in real-life CAD cases. Besides giving rise to heart blood stasis and other disease mechanisms explained below, heart qi vacuity presents with such common qi vacuity signs as shortness of breath, spontaneous sweating, and general weakness. In addition since the heart spirit is an accumulation of qi and thus depends on an abundance of qi, if heart qi is vacuous, the spirit becomes damaged and unstable, giving rise to easy fright.

The qi also governs transformation. Specifically, spleen qi governs the movement and transformation of foods and liquids. The spleen qi can only perform its function of engendering the qi by moving and transforming food and drink if it is fortified and exuberant. If the qi becomes vacuous and lacks its force, movement and transformation will also become weak and dampness and phlegm may be engendered. Furthermore, because the spleen is the latter heaven root of qi and blood engenderment and transformation, a weak spleen aggravates heart qi and blood vacuity.

Dampness and phlegm are yin evils and impede and obstruct the flow of qi, blood, and yang. Dampness is a heavy, turbid evil and commonly sinks to the lower body. Therefore, it is not often directly involved in the disease mechanism of CAD. However, long-term accumulation of dampness will lead to the engenderment of phlegm, sometimes referred to as phlegm dampness, and phlegm may lodge in the chest. Accumulation of phlegm in the chest hinders the spreading and out-thrusting of chest yang. Because chest yang and qi govern the movement of blood, this may lead to disharmony of the heart vessels with blockage and obstruction. Hence, chest pain and heart palpitations may also manifest when phlegm is present.

Furthermore, qi is yang and has the function of warming the body. In fact, yang is nothing other than a lot of qi in one place. Therefore, if qi becomes vacuous, yang will also tend to become vacuous and damaged. Since it is also heart-chest yang which propels the blood throughout the body, a vacuity of heart qi and yang is a commonly seen pattern in CAD. In this case, besides qi vacuity and impediment signs, there will typically be signs and symptoms of vacuity cold, such as aggravation of symptoms with cold and improvement with heat, cold hands and feet, and a pale white facial complexion.

Heart yang is rooted in kidney yang, the root of true yang of the entire body. Therefore, prolonged heart yang vacuity may eventually affect kidney yang. Kidney yang governs water transformation. If kidney yang becomes vacuous and weak, water loses its transformative fire, accumulates, and overflows into the tissues. Water is yin and flows downward. Hence, it initially accumulates in the most yin parts of the body, lower limbs. However, as these parts begin to "fill up" with fluids, it also begins to accumulate in the abdomen and to flood the heart. When flooding the heart, it disturbs the heart's regular stirring or beating and leads to palpitations. Furthermore, it may collect in the lungs and hinder the normal downbearing of qi, giving rise to coughing and panting. As a yin evil, water also blocks and obstructs yang and blood. Hence, during the later stages of CAD, water accumulation also often leads to the engenderment or aggravation of blood stasis. This pattern, often referred to as yang vacuity with water flooding, is a disharmony between kidney fire and water or yin and yang. It is a relatively severe pattern which often presents during the advanced stages of this disease.

Lastly, heart qi vacuity has a tendency to lead to heart yin vacuity. Heart yin is the basis of heart qi out of which the yang qi is transformed. Therefore, heart qi is only engendered if there is sufficient heart yin. Conversely, if heart qi becomes vacuous and weak, heart yin may also be damaged. Hence, after an initial heart qi vacuity, a combined heart qi and yin dual vacuity is a very commonly seen scenario. In this case, signs and symptoms in individual patients tend to move more towards yin vacuity or more towards qi vacuity depending on the patient's habitual bodily constitution and on other disease mechanisms. However, treatment needs to focus on both boosting qi and nourishing yin. Simply treating one or the other will not lead to satisfactory results. Common manifestations of qi and yin dual vacuity are fatigue and lack of strength, palpitations, possibly tachycardia, spontaneous sweating, dry mouth and throat, insomnia, a red tongue with thin fur, and a fine, weak and rapid pulse.

Of course, yin vacuity of the heart is not always associated with qi vacuity. It may also present on its own. Because heart yin is rooted in kidney yin, if heart yin becomes vacuous, kidney yin will also eventually become depleted and debilitated. In that case, general yin detriment signs are more pronounced and qi vacuity signs may be absent. In this case, patients commonly present with night sweats, burning pain in the chest, insomnia, heat in the five hearts, and heart palpitations which are worse at night.

If, for any reason, qi becomes stagnant, such as due to liver depression, it cannot perform its function of moving and freeing the flow of blood. Hence, blood becomes static and stagnant. Furthermore, liver depression qi stagnation may also transform heat and fire. If enduring depressive heat consumes and damages yin fluids, this may lead to or aggravate yin vacuity. In this case, yin vacuity may fail to control yang and yang may ascend hyperactively. Should this occur, liver heat and yang hyperactivity signs and symptoms, such as easy anger, severe restlessness, and a red facial complexion, will present besides the foregoing yin vacuity signs and symptoms. This pattern, either by itself or in combination with other patterns, often presents in CAD secondary to or complicated by hypertension.

As explained above, spleen qi vacuity may lead to damp accumulation which in turn may congeal into phlegm. However, phlegm may also have its root in liver depression transforming heat and fire. This heat steams and condenses the normal body fluids into phlegm. Hot phlegm then blocks the chest and impedes the free flow of qi, giving rise to further heat. In that case, besides signs and symptoms of phlegm obstruction, there will also be clear signs and symptoms of replete heat or fire effulgence.

Representative Chinese research: Clinical trial 1
In this clinical trial,¹ 40 patients suffering from CAD were treated primarily employing the method of quickening blood and transforming stasis. Out of the 40 cases, 25 were male and 15 were female. Their age was 55-60 years in 10 cases, 61-65 years in 16 cases, and 66-70 in 14 cases. Their disease course had lasted less than one year in 10 cases, 1-3 years in 18 cases, and three years or more in 12 cases. Twenty-nine patients also suffered from hypertension and 11 cases also suffered from diabetes. All 40 cases were diagnosed with CAD according to the criteria published in Shi Yong Zhong Xi Bing Jie He Lin Chuang Shou Ce (Clinical Handbook of the Practice of Integrated Chinese-Western Medicine).

The patients were divided into two groups: cold phlegm stasis and hot phlegm stasis. The basic prescription for both groups consisted of Rhizoma Corydalis Yanhuso (Yan Hu Suo), Radix Ligustici Wallichii (Chuan Xiong), Fructus Crataegi (Shan Zha), Lignum Dalbergiae Odoriferae (Jiang Xiang), Fructus Trichosanthis Kirlowii (Gua Lou), and Flos Carthami Tinctorii (Hong Hua), 15g each. For patients suffering from cold phlegm stasis, Radix Codonopsitis Pilosulae (Dang Shen), 20g, Ramulus Cinnamomi Cassiae (Gui Zhi), 10g, and Bulbus Allii (Xie Bai), 15g, were added. For patients suffering from hot phlegm stasis, Radix Scutellariae Baicalensis (Huang Qin), and Radix Scrophulariae Ningpoensis (Xuan Shen), 15g each, were added. Furthermore, the following additions were made based on presenting symptoms and signs: For pronounced angina pain, 15 grams each of Feces Trogopterori seu Pteromi (Wu Ling Zhi) and Pollen Typhae (Pu Huang) were added. For pronounced hypertension, 25 grams of Ramulus Uncariae Cum Uncis (Gou Teng), 15 grams of Radix Achyranthis Bidentatae (Niu Xi), and 50 grams of Conchae Margaritiferae (Zhen Zhu Mu) were added. For insomnia with profuse dreams, 25 grams each of Semen Zizyphi Spinosae (Suan Zao Ren) and Caulis Polygoni Multiflori (Shou Wu Teng) were added. For pronounced chest oppression, 20 grams of Cortex Magnoliae Officinalis (Hou Po) were added. One packet of these medicinals was decocted in water and administered per day, with 10 days equaling one course of treatment. In addition, patients suffering from pronounced hypertension were administered Fu Fang Jiang Ya Pian (Compound Lower the [Blood] Pressure Tablets), and patients suffering from diabetes received phenethyldiguanide (Phenformin).

Marked improvement meant that, during normal daily activity, no angina was experienced and that the ECG returned to normal. Some effect meant that, after treatment, light activity did not lead to angina pain but more strenous activity could still initiate a pain attack and that the ECG's S-T depression increased by at least 0.05mV but that the ECG overall did not return to normal. No effect meant that, after treatment, neither the disease symptoms abated nor the ECG improved. According to these criteria, 20 cases experienced marked improvement, 18 experienced some improvement, and two did not improve. In addition, prior to treatment, 16 cases presented with a dark tongue and 24 cases with a dark red tongue with static macules. After treatment, the tongue was pale red in 38 cases and still dark in two cases. Prior to treatment, 21 cases also presented with yellow fur and 19 cases with slimy, white fur. After treatment, the fur was thin and white in 38 cases and still yellow in two cases. Prior to treatment, the pulse was deep and fine in 21 cases and bowstring, fine, and rapid in 19 cases. After treatment, the pulse was harmonious and moderate in 38 cases and still deep and fine in two cases.

Clinical trial 2
All 70 patients in this clinical trial² suffered from CAD and were divided into two groups: a Xue Fu Zhu Yu Tang (Blood Mansion Expel Stasis Decoction) group of 40 cases (below referred to as the treatment group) and a Western medicine group of 30 cases (below referred to as the control group). Out of the 40 cases in the treatment group, 22 were male and 18 were female. The youngest was 35 years old, the oldest 72 years, with an average age of 49. Ten cases had suffered from the disease less than one year, 17 cases had suffered from the disease 1-5 years, and 13 cases had suffered from the disease for more than five years. Twenty cases also presented with hypertension, 15 with hyperlipidemia, 32 with abnormal blood rheology, nine with cardiac arrhythmias, and six with diabetes. Out of the 30 cases in the control group, 17 were male and 13 were female. The youngest was 34 years old, the oldest 74 years, and the average age was 50. Six cases suffered from the disease less than one year, nine cases suffered from the disease 1-5 years, and 15 cases suffered from the disease for more than five years. Nine cases also presented with hypertension, 11 with hyperlipidemia, 23 with abnormal blood rheology, three with cardiac arrhythmias, and four with diabetes.

The treatment group was prescribed the following formula: Radix Angelicae Sinensis (Dang Gui), Semen Pruni Persicae (Tao Ren), uncooked Radix Rehmanniae Glutinosae (Sheng Di), and Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 15g each, Radix Achyranthis Bidentatae (Niu Xi) and Radix Ligustici Wallichii (Chuan Xiong), 12 g each, Flos Carthami Tinctorii (Hong Hua), Fructus Citri Aurantii (Zhi Ke), Radix Platycodi Grandiflorii (Jie Geng), and Radix Bupleuri (Chai Hu), 10g each, and Radix Glycyrrhizae Uralensis (Gan Cao), 6g. One packet of these medicinal was decocted in water and administered per day in two divided doses, morning and evening. Treatment was continued for three weeks. During treatment, all other medications were stopped. The control group was administered isosorbide dinitrate tablets, 10mg, and dipyridamole (Perssantine) tablets, 25mg, three times daily for the period of three weeks.

In the treatment group, 24 patients suffered from angina. Of these, 12 experienced marked improvement, nine experienced improvement, and three experienced no effect. In the control group, 20 cases suffered from angina. Of these, seven experienced marked improvement, five cases improvement, and eight cases did not improve. Hence, control of angina in the treatment group was significantly better than in the control group (P < 0.05). As improvement of the ECG, out of the 40 cases in the treatment group, 14 showed marked improvement, 23 improvement, and three did not improve. In the control group, out of the 30 cases, 10 improved markedly, 15 improved, and five did not improve. Therefore, normalization of the ECG in the treatment group was significantly better than in the control group (P < 0.01). As for changes in blood rheology, 32 out of 40 cases in the treatment group presented with elevated blood viscosity prior to treatment, while 23 out of 30 cases in the control group showed elevated blood viscosity prior to treatment. After treatment, mean blood rheology values improved significantly in the treatment group (P < 0.01) but not in the control group.

Clinical trial 3
All patients selected for this clinical trial³ suffered from angina pain at least twice weekly. Patients suffering from hypertension, pronounced pulmonary heart disease, cardiac arrhythmias, or other organic cardiac diseases were not enrolled. The 130 cases were then divided into three groups according to the applied treatment method: 1) integrated Chinese-Western medical treatment, 2) Chinese medicine only, and 3) Western medicine only. The integrated Chinese-Western medicine treatment group included 64 patients, 30 were males and 34 females. Their age ranged from 41-85 years, with an average of 56. Their disease had lasted between 2.5 months and 27 years, with an average of 6.4 years. Forty-one cases suffered from simple angina and 23 cases from unstable angina. The Chinese medicine treatment group included 35 patients, 21 males and 14 females. Their age ranged from 42-78 years, with an average of 54. Their disease had lasted between three months to 23 years, with an average of 5.6 years. Twenty-four cases suffered from simple angina and 11 cases from unstable angina. The Western medicine treatment group included 31 patients, 19 males and 12 females. Their age ranged from 41 to 80 years with an average of 56. Their disease had lasted between five months and 28 years, with an average of 5.7 years. Twenty-two cases suffered from simple angina and nine cases from unstable angina.

The Chinese medicine treatment group was administered self-composed Tong Mai Huo Xue Tang (Free the Flow of the Vessels & Quicken the Blood Decoction) which consisted of: Radix Panacis Ginseng (Ren Shen), 10g, Radix Puerariae (Ge Gen), 24g, Radix Astragali Membranacei (Huang Qi), 30g, Tuber Curcumae (Yu Jin) and Radix Angelicae Sinensis (Dang Gui), 15g each, Radix Lisgustici Wallichii (Chuan Xiong) and Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 12g each, and powdered Radix Pseudoginseng (San Qi), 3g washed down with the decoction. One packet of these medicinals was decocted in water and administered orally per day. Modifications were made according to signs and symptoms. For marked blood stasis, Semen Pruni Persicae (Tao Ren) and Flos Carthami Tinctorii (Hong Hua) were added. For phlegm turbidity blockage and obstruction, Rhizoma Pinelliae Ternatae (Ban Xia) and Fructus Trichosanthis Kirlowii (Gua Lou) were added. For devitalized heart yang, Bulbus Allii (Xie Bai) and Ramulus Cinnamomi Cassiae (Gui Zhi) were added. For heart yin depletion and vacuity, the above prescription was combined with Sheng Mai San (Engender the Pulse Powder). The Western medicine group was administered isosorbide 5-mononitrate, 40mg once daily. The integrated Chinese-Western medicine combination group was adminstered both of the treatments outlined above. Treatment was administered for a total of six weeks. During treatment, all other anti-angina medicines were stopped, and patients were instructed to maintain a regular lifestyle. If angina occurred, sublingual nitroglycerine was administered. During treatment, the following parameters were monitored: frequency and intensity of the angina pain, amount of nitroglycerine used, ECG changes, and changes of other disease manifestations.
Treatment effect and ECG changes after treatment are illustrated in tables 1 and 2.

Table 1: Treatment effect comparison between the three treatment groups

Table 2: Post-treatment ECG changes comparison between
the three treatment groups

Clinical trial 4
In this clinical trial,⁴ all 74 patients were diagnosed with acute myocardial infarction (AMI) according to 1979 WHO diagnostic criteria. The patients were divided into two groups. One group was treated with the methods of boosting the qi and enriching yin, transforming stasis and eliminating stasis (below referred to as the treatment group). The other group was treated with the methods of transforming phlegm and eliminating stasis (below referred to as the control group). Each group consisted of 37 patients. Out of the 37 patients in the treatment group, 29 were male and eight were female. Their age ranged from as young as 38 to as old as 84 years. The average age was 64.4. Nine cases suffered from anterior myocardial infarction, 14 from anteriorseptal infarction, 10 cases from inferior myocardial infarction, and four from a no-Q-wave infarction. Out of the 37 patients in the control group, 28 were male and nine were female. Their age ranged from as young as 40 to as old as 82 years, with an average age of 64.5. Eleven cases suffered from anterior myocardial infarction, 12 from anteriorseptal infarction, nine cases from inferior myocardial infarction, and five from a no-Q-wave infarction.

All patients received regular Western medical care in the hospital, such as electrocardiographic and blood pressure monitoring, pain therapy, sedation, and coronary microcirculation enhancement. In addition, the treatment group was administered the following Chinese medicinals: Radix Codonopsitis Pilosulae (Dang Shen), 15g, Tuber Ophiopogonis Japonici (Mai Men Dong), 10g, Fructus Schisandrae Chinensis (Wu Wei Zi), 10g, Radix Astragali Membranacei (Huang Qi), 15g, Rhizoma Polygonati (Huang Jing), 15g, Semen Pruni Persicae (Tao Ren), 10g, Flos Carthami Tinctorii (Hong Hua), 10g, Radix Ligustici Wallichii (Chuan Xiong), 12g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 12g, Fructus Trichosanthis Kirlowii (Gua Lou), 15g, Bulbus Allii (Xie Bai), 10g, Rhizoma Pinelliae Ternatae (Ban Xia), 10g, and alcohol-prepared Radix Et Rhizoma Rhei (Da Huang), 10g. The control group received the following prescription: Semen Pruni Persicae (Tao Ren), 12g, Flos Carthami Tinctorii (Hong Hua), 10g, Radix Ligustici Wallichii (Chuan Xiong), 12g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 12g, Fructus Trichosanthis Kirlowii (Gua Lou), 15g, Bulbus Allii (Xie Bai), 10g, Rhizoma Pinelliae Ternatae (Ban Xia), 10g, alcohol-prepared Radix Et Rhizoma Rhei (Da Huang), 10g, Fructus Citri Aurantii (Zhi Ke), 10g, Caulis Bambusae In Taeniis (Zhu Ru), 10g, and Radix Angelicae Sinensis (Dang Gui), 10g. These formulas were prepared as water decoctions and one packet was taken daily. This treatment was continued for 30 days.

Treatment effects were analyzed by comparing frequency of cardiac arrhythmia, heart function, and post-infarction angina pain. In the treatment group, arrhythmia occurred in 48.65% of patients prior to treatment and 8.11% after treatment. In comparison, in the control group, arrhythmia occurred in 45.95% of patients prior to treatment and in 37.84% after treatment. In the treatment group, 21 patients improved from heart function II and III to heart function I. In the control group, five cases improved from heart function II and III to heart function I. Further, six patients (16.2%) in the treatment group experienced angina pain following the 30-day period after the acute myocardial infarction. In the control group, 19 cases (51.4%) suffered from angina pain after the 30 days of treatment.

Representative case histories: Case 1
The patient was a 54-year-old female⁷ who came to the hospital on March 4, 1979. Three months prior to the visit, she had quarreled with her neighbors and was emotionally depressed and oppressed. Thereafter, she suddenly experienced heart pain. Thus she was rushed to the hospital. There, she was diagnosed with angina due to coronary heart disease. However, her emotions kept fluctuating and she often felt precordial pain, continuous rib-side pain as well as chest oppression and inhibition. Only sighing relieved the pain a bit. Her tongue was dark with thin white fur and her pulse was bowstring. Hence, the diagnosis was heart pain and the pattern was qi stagnation. Thus, a combination of modified Xiao Yao San (Rambling Powder) and Tong Mai San (Free the Flow of the Vessels Powder)⁸ was prescribed. Modified Xiao Yao San consisted of Radix Bupleuri (Chai Hu), 7g, and Radix Angelicae Sinensis (Dang Gui), Radix Albus Paeoniae Lactiflorae (Bai Shao), Sclerotium Poriae Cocos (Fu Ling), Flos Mume (Lu Mei Hua), Rhizoma Cyperi Rotundi (Xiang Fu), Tuber Curcumae (Yu Jin), Fructus Citri Sarcodactylis (Fo Shou), and Cortex Albizziae (He Huan Pi), 10g each. One packet of this prescription was prepared as a water decoction. In addition, the patient took six grams of Tong Mai San (Free the Flow of the Vessels Powder) soluble granules. After continuing this treatment for an entire month, the patient's emotional state opened up and her angina disappeared and did not recur.

Case 2
The patient was a 51-year-old male⁹ who came for diagnosis on January 3, 1977. He had been diagnosed with coronary heart disease two years prior. Initially, he experienced retrosternal pain which radiated to the left neck, shoulder, and back. With every attack, the pain approached the precordial area. However, the pain resolved. During the recent two months, the retrosternal pain became fixed and took on a boring and stabbing nature. In addition, the patient began suffering from chest fullness and glomus as well as heart vexation and a dry mouth. His tongue was dark purple and the sublingual veins were static and purple. His pulse was choppy or rough. Hence, the disease diagnosis was heart pain and the pattern discrimination was blood stasis. He was prescribed a combination of Xue Fu Zhu Yu Tang (Blood Mansion Expel Stasis Decoction) as a bulk herb prescription and Tong Mai San (Free the Flow of the Vessels Powder) in soluble powder form. The bulk herb prescription contained the following medicinals: Semen Pruni Persicae (Tao Ren), Flos Carthami Tinctorii (Hong Hua), Radix Angelicae Sinensis (Dang Gui), Radix Ligustici Wallichii (Chuan Xiong), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Achyranthis Bidentatae (Niu Xi), and Fructus Citri Aurantii (Zhi Ke), 10g each, uncooked Radix Rehmanniae Glutinosae (Sheng Di), 12g, Radix Bupleuri (Chai Hu), 7g, and Radix Platycodi Grandiflori (Jie Geng) and mix-fried Radix Glycyrrhizae Uralensis (Gan Cao), 6g each. This prescription was prepared as a water decoction and one packet was taken daily. In addition, six grams of Tong Mai San were administered daily. After taking these medicinals for a week, the frequency of the angina attacks markedly lessened and the stabbing nature of the pain disappeared. After taking the medicinals for a month, the symptoms of stasis had disappeared and the pain had stopped.

Case 3
The patient was a 60-year-old male¹⁰ who came for diagnosis on January 15, 1975. The patient was admitted to the hospital with coronary artery disease and heart failure. At the time of admission, his blood pressure was low, his body temperature was 36EC, and his heart rate 48bpm. After having been in the hospital for more than one month, he still repeatedly suffered from heart palpitations, chest oppression, shortness of breath, and, although it was summer, aversion to cold. When he sweat, his fear of cold was very pronounced. He also suffered from dizziness with lack of strength, insomnia, frequent clear, long urination, and sometimes some low back soreness. His tongue fur was ashen black and his pulse was slow and moderate without force. Hence, his pattern discrimination was heart and kidney yang vacuity with loss of internal containment of the spirit. Treatment, therefore, focused on warming the kidneys and arousing yang, quieting the spirit and stabilizing fright. The prescribed formula contained: Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Pian), Herba Epimedii (Xian Ling Pi), Conchae Ostreae (Mu Li), Fructus Citri Aurantii (Zhi Ke), Semen Cuscutae Chinensis (Tu Si Zi), Fructus Schizandrae Chinensis (Wu Wei Zi), 9g each, Radix Astragali Membranacei (Huang Qi), Radix Salviae Miltiorrhizae (Dan Shen), Semen Zizyphi Spinosae (Suan Zao Ren), 15g each, and Caulis Polygoni Multiflori (Ye Jiao Teng), 30g. One packet of these medicinals prepared as a water decoction was taken daily. After seven days, the aversion to cold and sweating had improved, the heart palpitations had reduced, and the man's body temperature was 36.5EC. However, his tongue was still black and he suffered from lack of strength. Hence, nine grams each of Radix Codonopsitis Pilosulae (Dang Shen) and Radix Angelicae Sinensis (Dang Gui) were added to the original formula and it was taken for another 14 days. Thereafter, all symptoms had disappeared, the man's blood pressure and the heart rhythm were normal, his tongue fur was thin and slimy, and his pulse was fine and moderate at 66bpm. Therefore, the patient was discharged from the hospital but was prescribed the following formula in order to secure the treatment effect:¹¹ Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Pian), Herba Epimedii (Xian Ling Pi), Semen Cuscutae Chinensis (Tu Si Zi), Radix Codonopsitis Pilosulae (Dang Shen), Fructus Schizandrae Chinensis (Wu Wei Zi), Os Draconis (Long Gu), and Conchae Ostreae (Mu Li), 9g each, Radix Astragali Membranacei (Huang Qi), Radix Salviae Miltiorrhizae (Dan Shen), and cooked Radix Rehmanniae Glutinosae (Shu Di), 15g, Semen Zizyphi Spinosae (Suan Zao Ren), 12g, and Caulis Polygoni Multiflori (Ye Jiao Teng), 30g. Follow-up revealed that the disease condition had remained stable.

Case 4
The patient was a 78-year-old male¹² who was first examined by the author of this case history on February 22, 1978. The man had suffered from coronary artery disease for more than 10 years and from angina pain for even longer. Electrocardiogram revealed a third degree AV block. His main signs and symptoms were heart palpitations, chest pain with chest oppression, headache, trembling hands and red fingers, occasional constipation but sometimes two bowel movements per day, purple lips, and a crimson tongue with slimy, white fur and static speckles on the edges of the tongue. The pulse was bowstring and bound. The heart rate was 42bpm and there were irregularly intermittent beats. Hence, the pattern was discriminated as heart qi and blood stasis and stagnation due to congealed cold and constructive heat mutually binding and inhibiting the movement of the vessels. Hence, the treatment principles were to quicken the blood and transform stasis, course and free the flow of the heart network vessels. The formula administered consisted of: Radix Salviae Miltiorrhizae (Dan Shen), Fructus Trichosanthis Kirlowii (Gua Lou), and uncooked Radix Rehmanniae Glutinosae (Sheng Di), 15g each, Bulbus Allii (Xie Bai), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Angelicae Sinensis (Dang Gui), and Semen Pruni Persicae (Tao Ren), 9g each, Flos Carthami Tinctorii (Hong Hua), Radix Ligustici Wallichii (Chuan Xiong), and Lignum Santali Albi (Tan Xiang), 6g each, and Pericarpium Zanthoxyli Bungeani (Chuan Jiao), 1.5g. One packet of these medicinals was taken daily in the form of a water decoction. After taking this prescription for 14 days, ECG analysis showed that the AV block had lessened to a first-degree condition and that there was a sinus rhythm. Furthermore, the man's headache and the trembling of the hands had disappeared and his pulse was bowstring and forceful with a heart rate of 68bpm without intermittent beats. This showed that the disease condition had markedly improved. Hence, a formula to quicken the blood and transform stasis with the addition of qi-boosting medicinals was administered to further stabilize the treatment effect. Follow-up several months later showed no recurrences of the angina or the cardiac arrhythmia.

Case 5
The patient was an 84-year-old female¹³ who came to the hospital because the frequent precordial pain she had been suffering from for five years had become more severe during the past week. For five years, she had been suffering from recurrent repressed emotions and taxation thinking with accompanying chest oppression, qi stifling, heart palpitations, sweating, cold limbs, and severe heart pain which radiated to the left shoulder, upper back, and medial arm as well as the little finger. Self-administration of isosorbide dinitrate was not effective. Diagnosis revealed a fat bodily shape, a dark facial complexion, an enlarged, fat, dark-colored tongue with static macules and speckles at the tip, teeth-marks, purple, congested sublingual veins, and thin, white fur. The pulse was bound or regularly interrupted. Her blood pressure was 97/195mmHg, and an ECG showed the presence of 107 atrial fibrillations per minute and coronary vessel insufficiency. Based on the foregoing, the woman's Chinese medical diagnosis was chest impediment and her pattern was discriminated as cold congelation and phlegm turbidity with stasis obstructing the heart vessels. Her Western medical diagnosis was ischemic heart disease, angina, and atrial fibrillation. Treatment focused on warming yang and transforming turbidity, quickening the blood, expelling stasis, and freeing the flow of the vessels. Hence, the following prescription was administered: Radix Salviae Miltiorrhizae (Dan Shen), 30g, Rhizoma Nardostachydis (Gan Song), 25g, Fructus Trichosanthis Kirlowii (Gua Lou), Bulbus Allii (Xie Bai), Ramulus Cinnamomi Cassiae (Gui Zhi), and Rhizoma Pinelliae Ternatae (Ban Xia), 12g each, Semen Pruni Persicae (Tao Ren), Radix Ligustici Wallichii (Chuan Xiong), mix-fried Radix Glycyrrhizae Uralensis (Gan Cao), Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), and Rhizoma Coptidis Chinensis (Huang Lian), 10g each, and Radix Platycodi Grandiflorii (Jie Geng), 6g. One packet of these medicinals was administered daily as a water decoction for six days. Thereafter, the chest oppression and qi stifling, heart palpitations, and heart and chest pain were all greatly reduced. The sweating and cold limbs were eliminated. Examination revealed a dark tongue with slightly slimy fur, and the pulse was only occasionally bound. Since the formula had been effective, it was not modified, and another six packets were prescribed. Thereafter, all this patient's symptoms were eliminated. Still, the medicinals were continued for another month to secure the treatment effect. Repeat ECG revealed a sinus rhythm of 76bpm and the ECG was normal. Follow-up half a year later revealed no recurrences of the angina.

References
1. Zuo Bi-hui, "The treatment of 40 cases suffering from Coronary Heart Disease with the method of quickening blood and transforming stasis," Si Chuan Zhong Yi (Sichuan Journal of Chinese Medicine), #8, 1996, p.28.
2. Xiao Jun-lu, "Xue Fu Zhu Yu Tang (Blood Mansion Expel Stasis Decoction) in the treatment of 40 cases suffering from coronary heart disease," Si Chuan Zhong Yi (Sichuan Journal of Chinese Medicine), #7, 1999, p. 30-31.
3. Li Fu-xian, Wei Mao-chun and Sun Min, "Combined Chinese and Western Medical Treatment of 64 Cases suffering from Angina secondary to Cardiovascular Heart Disease," Si Chuan Zhong Yi (Sichuan Journal of Chinese Medicine), #7, 1999, p.32-33.
4. Zhang Jing-chun et al., op. cit.
5. Sun Xin-fang, "Chuan Xiong Yin (Ligusticum Drink) plus Guan Mai Ning (Coronary Vessel Quieting [Medicine]) in the treatment of 32 patients suffering from angina due to cornonary heart disease," Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), #6, 2000, p. 244.
6. Guan Mai Ning (Coronary Vessel Quieting) tablets contain Radix Salviae Miltiorrhizae (Dan Shen), Caulis Milettiae seu Spatholobi (Ji Xue Teng), Rhizoma Corydalis Yanhusuo (Yan Hu Suo), Semen Pruni Persciae (Tao Ren), Flos Carthami Tinctorii (Tao Ren), Sanguis Draconis (Xue Jie), Resina Myrrhae (Mo Yao), resina Olibani (Ru Xiang), Radix Angelicae Sinensis (Dang Gui), Radix Polygoni Multiflori (He Shou Wu), Rhizoma Polygonati (Huang Jing), Radix Puerariae (Ge Gen) and Borneol (Bing Pian). These tablets quicken blood, transform stasis, move qi, and stop pain.
7. Gao Zhen-hua, "Gao Yong-jiang's experience in the discrimination and treatment of angina secondary to coronary heart disease," Zhong Yi Za Zhi (Journal of Chinese Medicine), #8, 1995, p.460.
8. Tong Mai San granules consist of the following medicinals: Lignum Aquillariae Agallochae (Chen Xiang), Lignum Santali Albae (Tan Xiang), Resina Olibani (Ru Xiang), Radix Pseudoginseng (San Qi). These medicinals are powdered and between 3-6g must be administered per day.
9. Gao Zhen-hua, p. 461.
10. Dai Ge-min, "Jiang Chun-hua's experience in the treatment of coronary heart disease," Shan Xi Zhong Yi (Shanxi Journal of Chinese Medicine, #1, 2001, p. 3.
11. The author of this case history does not state how long exactly the formula was continued; the Chinese original simply states "for an extended period of time."
12. Dai Ge-min, op. cit., p.4.
13. Zou Xin-ying, "The Treatment of 26 Cases of Angina Pectoris Due to Cold Phlegm & Stasis," Si Chuan Zhong Yi (Sichuan Chinese Medicine), #11, 1996, p. 32