Coronary angina is a heart disease caused by atherosclerotic stenosis of coronary arteries, or thrombosis or spasm on this basis, resulting in myocardial ischemia and hypoxia. The name “coronary angina pectoris” was not used in ancient times, but can be classified as “chest paralysis” and “heart pain” in traditional Chinese medicine. The term “heart pain” first appeared in the Shanhaijing, and was later discussed in the medical books of Mawangdui and the Yellow Emperor’s Classic of Internal Medicine. There are many western medical diseases with chest pain as the main manifestation, including lung diseases, pleural diseases and digestive system diseases, in addition to coronary heart disease. In Chinese medicine, there are also nine kinds of heart pains, such as “insect, injection, cold, heat, food, drink, wind, palpitation, qi and blood”. Coronary heart disease has both stable angina and unstable angina, which are similarly described in ancient literature. For example, in the Treatise on the Origin of Diseases, it is said that “the heart pains for a long time are caused by the wind and heat in the heart’s other ligaments, so that the disease does not die and the attacks sometimes occur”. This is similar to the description of symptoms of stable angina pectoris. It seems to be similar to unstable angina pectoris. Traditional Chinese medicine practitioners have accumulated rich experience in the treatment of angina pectoris in coronary heart disease in their long-term clinical practice: the Song Dynasty’s Taiping Shenghui Fang widely used aromatic, warming, and blood circulation drugs to treat chest pain; the Ming Dynasty’s Wang Kentang proposed that “to treat all kinds of heart pain, the main method is to open up depression and move qi, which is also the main method”, advocating moving qi and opening up depression to treat heart pain; Zhang Jingyue In the Ming Dynasty, Wang Kentang proposed that “the treatment of all kinds of heart pain should be based on opening up and moving qi. He advocated the use of insects to search and remove, and pungent incense to enter the bloodstream; Wang Qingren created the Blood Mansions and Blood Stasis Soup to treat “sudden chest pain”, the description of which is similar to that of angina pectoris in coronary heart disease; Lin Peiqin in the Qing Dynasty was good at using the pungent, slippery, and warm method to treat chest paralysis, meaning that it “rotates the clear yang of the upper jiao, and eases the phlegm between the diaphragm, so that it does not mix with the chest puffiness and knotted chest, and so on. The treatment of thoracic palsy is intended to “rotate the clear yang of the upper jiao and release the phlegm and qi between the diaphragm, so that it does not mix with the thoracic puffiness and chest problems. For the coronary heart disease angina pectoris pathology, Zhang Zhongjing believes that “Yang micro Yin string, that is, chest paralysis and pain, so it is, blamed for its extreme deficiency. Now the Yang deficiency is known in the upper jiao, so chest paralysis and heart pain, because of its yin strings also”. This is still a guiding meaning for clinical practice. “Yang Wei” refers to the deficiency of Yang in the chest, and “Yin string” refers to the stagnation of Yin evil in the chest. The yin evil here cannot be simply considered as yin-cold evil, but can also include phlegm, blood stasis, cold condensation, or even fire evil, but always with stagnation as the main cause. Therefore, the treatment of angina pectoris in coronary heart disease is either to invigorate blood, or to dissolve phlegm, or to cleanse drinks, or to warm the heart, or to clear depression and fire, always with the main focus on the declaration, which is to pass Yang. Although Zhong Jing thinks that Yang is weak, but in the chapter of chest paralysis and heart pain, except for Ren Shen Tang, most of them use the method of promoting Yang and declaring paralysis, especially the formula of Gua Gua Bai, which shows that Zhong Jing thinks that “Yin string” is the main aspect of the contradiction, and if the stagnant evil can be decluttered, then the Yang in the chest can be restored, and if the evil goes, then it is safe. The “yang micro-yin string” can be seen as a generalization of the etiology of angina pectoris in coronary heart disease. As the disease evolves and the heart yang is injured for a long time, the main aspect of the pathogenesis can be changed to mainly positive deficiency, so Zhongjing also has ginseng soup to transport the qi and blood in the middle jiao to supplement the extreme deficiency of the heart. Later, in the Tang and Song dynasties, the aroma and warmth were used to disperse the stagnant evil and open up the paralysis, but Sun Simiao also did not forget to use Huang Qi, Ginseng and Angelicae to benefit the Qi and nourish the blood to treat heart pain. 1, remitting phlegm, promoting paralysis and opening Yang Modern medicine believes that the main pathological changes of coronary angina are the rupture and bleeding of coronary artery atheromatous plaque, leading to acute thrombosis and vascular occlusion, in which the stability of the plaque is the key factor to prevent acute thrombosis leading to myocardial ischemia. Atheromatous plaque is mainly due to lipid-like deposits in the intima of arteries, and stable plaque is mainly less lipid component in addition to the solidity of fibrous cap. Modern Chinese medicine believes that the accumulation of abnormal lipids belongs to the category of phlegm and turbidity. Zhongjing’s Guahuabai Baijiu Tang and Guahuabai Baihanxia Tang not only pass through Yang and promote paralysis, but also can expel phlegm and dispel turbidity, which is a major formula for treating coronary heart disease, in which Guahuabai can be reused up to 30 grams. Huang Yuan-young’s “Changsha Medicine Solution” cloud: “Gua pou, clearing the heart and moistening the lungs, washing away the dirt and removing the annoyance, opening the chest and diaphragm of the ganglion, cleaning the saliva of the gum, and most of all washing the stagnation”; Allium, pungent and slippery, good at opening congestion. It is used by Zhongjing for the pain of chest paralysis and discomfort. In the clinical application of Gua Gua Allium to treat angina pectoris in coronary heart disease, the following points should be identified: (1) the patient is phlegm-damp and obese; (2) the tongue is greasy or slippery, with a fat tongue; (3) the pulse is slippery or sunken; (4) the chest is tight and suffocating and painful. Clinical prescriptions should pay attention to the following points: (1) use Sharen, Chen Pi, Atractylodes, Poria, etc. to awaken the spleen and transport the dampness, so that the spleen is transported and phlegm and dampness are not generated; (2) use pungent and warm blood activators to remove blood stasis, such as Chuanxiong, Angelica, Safflower, Gui Zhi, etc., so that the blood vessels are harmonized and Yang Qi can be easily promoted; (3) use Qi-regulating drugs, such as Citrus Aurantium, Chai Hu, Su Stem, etc., so that the Qi and blood can move and phlegm can be easily remitted. In addition, the clinical application of Gua Gua Allium should also pay attention to the weak or thin pulse, little tongue coating, thin and red tongue, should not use such prescriptions. Such prescriptions are mostly pungent and warm, without phlegm-damp internal stagnation, chest Yang paralysis, easy to hurt Qi and consume Yin. 2, atherosclerosis inflammatory reaction and detoxification treatment The formation of atheromatous plaque is considered by modern medicine to be the result of a series of inflammatory reactions. Modern Chinese medicine believes that the inflammatory reaction is similar to the characteristics of “poison” in Chinese medicine, so Chinese medicine often takes detoxification treatment, but the clinical test cannot just treat the inflammation as heat poison, and only consider the method of clearing heat and detoxification. There are not only heat toxins, but also cold toxins and damp toxins. When the detoxification of the nature of the poisonous evil, such as heat toxicity manifested as red tongue, tongue coating yellow turbid greasy, heartburn, can be accompanied by heart fullness, you can choose to use Huang Lian, Scutellaria to clear the heat detoxification, “You fishery Zhai medical words” cloud “Huang Lian to clear the heart fire, with Guazhu, heliotrope drainage chest plankton as God”, such as the use of small sunken chest soup (Huang Lian, half ansia, Guazhu solid), accompanied by the rationalization of qi and activation of blood When cold toxicity is manifested as chest pain, which is very severe when cold, with a pale tongue, white fur, and tight pulse, wicker and pine can be used to disperse the cold and detoxify the toxin, such as using Broad Chest Pill; when damp toxicity is manifested as chest pain, thick and greasy tongue fur, and heavy limbs, patchouli and pelargonium can be used to aromatically detoxify the toxin on the basis of Gua Gua Bai Bai Han Xia Tang. “heartache” and “removing evil qi”. 3, coronary heart disease angina pectoris attack and remission treatment focus on different angina pectoris attack: angina pectoris attack, the disease mechanism to qi stagnation, cold condensation, phlegm, blood stasis blocking blood vessels. At this time, the treatment should be aromatic warmth, urgent opening of the paralysis as the main method, in order to make the pass is not pain. The only method to open the paralysis is to use aromatic, warm and good-passage medicine to achieve the purpose of quick pain relief. For example, in the “The Secret of Wai Tai”, the Southern Dynasty’s Shen Shi used musk and niuhuang to treat chest paralysis; in the “Taiping Sheng Hui Fang”, Gao Liang Jiang and Gui Xin were used together with musk and xiang, such as musk and angelica; in the “Sheng Ji Zong Lu”, Shen Xiang Tang and Ding Xiang Tang were used to treat prolonged heart pain, and in the “Taiping Hui Min and Pharmaceutical Bureau Formula”, Su He Xiang Wan was used. In the Yuan Dynasty’s “Royal Medicine Institute Formula”, Shen Xiang Wan and Tong Qi Tang were used for treating heart and chest pain; in the Qing Dynasty, Ye Tian Shi used Liang Jiang, Jiang Huang, Cang Zhu and Clove for treating “spleen syncope and heart pain”, “for the pungent aroma to open it”. In recent years, many Chinese patent medicines, such as Guanxin Suhe Wan, Musk Heart Protection Wan, Quick-acting Heart Relief Dan, Su Bing Dripping Wan, Broad Chest Aerosol, etc., among which ice chips, Suhe Xiang, Liang Jiang, etc., all have the effect of aromatic opening of the orifice and promoting chest yang, and wicker, fine spice, sandalwood, Suhe Xiang, musk, etc., can not only dispel cold and open paralysis, but also promote yang, dilate coronary arteries and improve myocardial blood supply. Angina pectoris in remission: Chinese medicine treatment of coronary heart disease in remission, to reduce or prevent angina pectoris, cardiovascular disease events as the purpose, at present most of the rule of activating blood circulation and removing blood stasis. According to the different conditions, the clinical treatment can be taken to calm the mind and invigorate blood, benefit qi and blood, extinguish wind and blood, dispel phlegm and invigorate blood, etc. In the Song Dynasty, the representative formula of “Taiping Huimin and Pharmaceutical Bureau Formula” has been used to this day, in addition to the widespread use of blood dried up, frankincense, myrrh and other blood-stasis activators. The treatment of chest paralysis and cardiac pain with insects and pungent moisteners has been influential to later generations. Modern pharmacological research has proved that it has the effects of dilating coronary arteries, anti-platelet adhesion and aggregation, and preventing thrombosis. Coronary angina is often induced by platelet aggregation on the basis of plaque rupture and activation of a series of coagulation mechanisms leading to thrombosis, so activating blood circulation and removing blood stasis has become a major method in the modern treatment of coronary angina. In mild cases, the blood-activating drugs such as Danshen, Yujin, Red Peony and Safflower can be used; in heavy cases such as severe pain, purple and dark tongue, tight and astringent pulse, the blood-activating drugs such as Sanling and Curcuma can be used to break the blood. It can also be slowly eliminated, but the fierce open and broken products can not build this miracle. You can also use worm medicine to invigorate blood circulation, such as leech, dragon, scorpion and so on, especially leech is better, Zhang Xicun that “where the blood-breaking drugs, more injury to the qi, but leech taste salty special into the blood, in the qi part of no damage”. 4, exertional angina treatment of Chinese medicine Exertional angina has a distinctive feature, that is, angina is triggered by exertion every time. The movement consumes qi, regardless of the tongue and pulse, qi deficiency is mostly a major aspect of its pathogenesis. Patients with severe exertional coronary angina often have three branches of coronary artery lesions, which are complex and severe, with stenosis of more than 90%, and some patients cannot even be treated by percutaneous coronary intervention and coronary artery bypass grafting because of the complex lesions. In the clinical treatment of such patients with coronary angina, it is crucial to promote the opening of myocardial tissue capillary neovascularization and collateral circulation and increase myocardial blood perfusion, for which Western medicine still lacks effective methods. In traditional Chinese medicine, there is a method to promote the growth of new muscle and the regeneration of blood vessels in the treatment of surgical sores. Clinical treatment of angina pectoris in coronary artery disease can also refer to this method to promote the collateral circulation of coronary arteries. Astragalus can be used clinically with more than 30 grams of Astragalus, which “benefits qi, generates blood and muscle (Ben Cao Bei Yao)” and “mains carbuncles and gangrenous sores for a long time (Shen Nong Ben Cao Jing)”, benefiting qi to support toxicity, resolving decay and generating muscle, and is a sacred medicine for sores. It can be combined with blood nourishing and invigorating herbs such as angelica, salvia, red peony, etc. The combination of qi-boosting and blood-boosting herbs not only helps to activate blood circulation and promote blood flow, but also helps to induce qi-boosting herbs to enter the blood, so as to achieve the purpose of qi mastering blood vessels, qi taking in blood vessels, promoting blood vessel regeneration and improving blood circulation in the heart muscle. In the treatment of exertional angina pectoris with qi deficiency, it is necessary to supplement not only heart qi, lung qi and zong qi, but also middle qi and yuan qi, so that the zong qi, which is the main blood vessel and blood flow, can be generated. The heart is damaged, and its Ying and Wei are regulated. The Ying comes out of the middle Jiao, and if the Spleen and Stomach are strong, the Ying and Blood can be produced; the Wei Qi comes out of the lower Jiao, and if the Kidney Qi in the lower Jiao is sufficient, the Wei Qi can be nourished. Clinically used for the treatment of coronary heart disease, such as astragalus, yellow essence, party ginseng, etc. These drugs, especially astragalus, can greatly supplement the heart and lung qi, but not the kidney qi, yuan qi. Ginseng or American ginseng, on the other hand, can nourish the qi of the heart and lungs and the kidney energy, and in combination with astragalus, can greatly enhance the power of nourishing qi and activating blood. If you have the conditions, it is advisable to use ginseng and American ginseng, whose power to nourish the qi is far beyond that of party ginseng and astragalus. For example, the “Rixu Yuanjian” cloud, “ginseng is a great tonic for the vital energy, and the punch and the essence of the beauty, not biased, so in the yin tonic yin, in the Yang tonic Yang, can warm can clear, can ascend can descend, the three jiao and treatment, five organs salty tone”. Coronary heart pain angina mostly occurs in the middle-aged and elderly, the scripture said “forty and Yin Qi since half”, so clinical coronary heart disease angina patients with or without kidney deficiency symptoms, there can be a certain degree of kidney deficiency. Because the blood vessels are condensed when they encounter cold and dispersed when they encounter heat. Therefore, the kidney tonic should be on the warm side, warmth does not produce fire and dryness, the use of drugs can choose Xian Ling spleen, cuscuta, Ba Ji Tian, Chinese wolfberry, etc.. Zhu Liangchun believes that Xian Ling Spleen tonifies the kidney yang, but warm and not dry, not only tonifies the kidney yang, but also can harmonize yin and yang. Baji Tian, Chen Shiduo said it “warm but not hot, strengthen the spleen and open the stomach, both benefit the yuan yang, and fill the kidney water … has a quick effect and near work.” The combination of Xianling spleen, Baji Tian and Astragalus, Radix Codonopsis, can achieve the purpose of both the zong qi and yuan qi. In the clinical treatment of exertional angina pectoris, attention should also be paid to nourishing the heart and calming the mind, not until symptoms of insomnia, dreaminess and other disturbances of the mind appear. Even if the above symptoms do not appear, the application of sour date palm, cypress seed, nightshade vine, and farro, etc., nourishes the heart and calms the mind, which is also beneficial in regulating the balance of sympathetic nerve function and increasing the ability of the heart muscle to resist ischemia and hypoxia. For those who suffer from exertional angina, chest tightness and chest pain when moving, we use the following formula: Astragalus membranaceus 30g, red ginseng 5g (single decoction to be taken, if there are signs of internal heat, use American ginseng 10g), Salvia miltiorrhiza 30g, Crataegus jiao 30g, Semen cuscutae 30g, Pueraria lobata 30g, Xianling spleen 20g. For chest congestion, add 10 grams of Radix Rehmanniae and 20 grams of Siberian stems to broaden the chest and move Qi; for pain, add 3-5 grams of Panax ginseng powder and 10 grams of Yuanhu to resolve blood stasis and relieve pain. In this formula, Astragalus, Ginseng or Radix et Rhizoma Ginseng are used to tonify both Zong Qi and Yuan Qi, while Xian Ling Spleen and Semen Cuscutae are used to tonify Kidney Qi and Yuan Qi, supplemented by Salviae Miltiorrhizae and Hawthorn to activate blood circulation and remove blood stasis. For chest congestion, the main purpose is to smooth the flow of Qi, with the addition of Radix et Rhizoma Pinelliae and Radix et Rhizoma Pinelliae, so that the flow of Qi will lead to the flow of blood; for chest pain, the main purpose is to invigorate the blood vessels and relieve pain, with the addition of Panax Ginseng and Yuan Hu, so that the flow of blood will lead to the flow of Qi, with the addition of Pueraria Mirifica to help the rising of the clear yang, so that the Qi can be restored and the blood vessels can be penetrated. It can be used for reference. In addition, in coronary heart disease with stable angina pectoris, there is also phlegm and dampness stagnation, paralysis of Yang Qi (chest Yang) is the main patient, the patient mostly has a thick and greasy tongue coating or greasy dirt, a fat tongue and an obese body. If the Yang Qi rises and develops, it will clear the turbidity, but the turbidity will curb the momentum of its rise and development, and the Qi and blood will be blocked or paralyzed, resulting in chest pain. This kind of chest pain should be treated with the method of Gua Gua Allium, together with the method of Qi management to awaken the spleen and remove turbidity, not just supplementing Qi and activating blood. 5, the treatment of unstable angina Coronary heart disease unstable angina includes spontaneous angina, initial exertional angina, worsening exertional angina. Spontaneous angina is mostly caused by spasm on the basis of coronary artery atherosclerosis, in which some patients can also have no obvious coronary artery lesions. In traditional Chinese medicine, the pathogenesis of vasospasm is mostly wind and cold. In clinical practice, two types of wind evidence are common: one is deficiency of liver and kidney, internal disturbance of deficient wind, and transverse blood vessels, such patients are often accompanied by hypertension, and the treatment can be based on Tianma and Hooked Vine Drink and Qiju Dihuang Wan, with the addition of white peony, silkworm, scorpion and gentiana to soften the liver and quench the wind and relieve spasm, combined with Danshen, red flower and Chuanxiong to activate blood stasis and harmonize blood vessels; the second is cold clotting of blood vessels, such patients are often clinically manifested as vicious cold and fear of cold, especially in the chest and back. Especially in the chest and around the heart acupuncture point on the back, but also see the hands and feet are not warm, nails purple and dark. Angina pectoris occurs at night or during sleep. When the pain is relieved, the main treatment should be to benefit the temperature and heart yang, together with the treatment of activating blood circulation and removing blood stasis. The clinical application of this method should pay attention to the following points: (1) the combination of pungent, sweet and warm, imitating Zhang Zhongjing Gui Zhi Gan Cao Tang, the medicine with Gui Zhi, Allium and Licorice, Gui Zhi and Allium can be used up to about 30 grams, in order to take the effect of pungent, sweet, through Yang, warm but not dispersed; (2) in addition to Licorice, combined with other sweet and warm Qi tonic, such as Astragalus, Radix Codonopsis, Ginseng, etc., in order to play the effect of beneficial Qi and warm Yang main pulse; (3) in the pain relief period, without wicker (3) During the period of pain relief, wicker, ginger, pine, ice chips and other proprietary Chinese medicines should not be used to avoid depletion of qi and injury to yin, fire and dryness, which may cause the condition to linger. Even during the pain attack, the disease should be stopped. (4) Combine with pacifying and tranquilizing herbs to subdue liver yang, quench liver wind and astringent heart qi, such as mother-of-pearl, dragon bone and five-flavored seeds, which help to calm the internal wind and astringent heart qi in the blood vessels. Compared with stable angina, unstable angina has pathological changes such as platelet activation, easy adhesion and aggregation, thrombosis, and inflammatory reaction, in addition to vasospasm factors. According to Chinese medicine, this is a sign of blood stagnation and blood stagnation, phlegm and toxicity. In view of this pathology, combined with clinical signs such as purple tongue, petechiae, petechiae, yellow, thick or dry tongue coating, clinical treatment should pay attention to the following points: (1) reuse of blood activating and stasis removing drugs, such as Chuanxiong, Angelica, Radix Paeoniae, Yuanhu, etc., even on the basis of supporting the righteousness, add blood breaking and stasis dispersing drugs, such as Tu Yuan, Di Long, Tao Ren, leech, etc.; (2) pay attention to, promote paralysis and resolve phlegm. Qi flow is blood flow, pungent open and bitter descend, qi flow can be reached, so that the stasis can be dispersed and phlegm can be eliminated, paralysis can be opened and veins can be opened. If the tongue is dark red, thick and greasy or yellow, apply Guahuabai class, add Huanglian, Hujian, Hovenia, Rhubarb, etc. to clear the heat and detoxify and smooth the Qi flow; if the tongue is yellow, thick and dry, purple and red or red, add Scutellaria, Danshen, Hujian, Red Peony, Rhubarb, etc. to clear the heat and poison; (3) even if there is heat, the medicine should not be bitter and cold, and should be combined with warm and fluent products such as Allium, Jiang Huang, Gui Zhi, etc. in the formula to prevent the cold from condensing the blood vessels and impeding the blood flow. (3) even if there is heat, the medicine should not be bitter and cold, and should be combined with warming and ventilating products such as Allium, Ginger, Cinnamon, etc., to prevent the cold from clotting the blood vessels and impeding the blood flow. In addition, clinically we often see a serious exertional angina, which occurs within 1 to 3 hours after lying down and can be relieved by sitting and standing for a few minutes. Such angina pectoris can be clinically divided into three types: (1) normal pulmonary artery pressure (PADP) before the onset of angina pectoris, and no significant changes during the attack. Angina attack, mainly due to the increase in myocardial oxygen consumption exceeds the reserve capacity of fixed narrow coronary arteries, the patient’s cardiac function is still normal; (2) angina attack although there is an increase in PADP, but no manifestation of cardiac insufficiency; (3) angina attack that there is already elevated PADP, first appearing cardiac insufficiency, reflexively caused by accelerated heart rate, increased blood pressure, increased myocardial oxygen consumption. This is a more serious kind of exertional angina pectoris. In the treatment of such angina pectoris, the first two are basically the same as exertional angina pectoris, while the latter should be used to benefit qi and activate blood, together with blood circulation and diuresis. The latter should be used to promote blood circulation and blood stasis, accompanied by invigorating blood and water. Do not overuse the products that activate blood stasis and promote paralysis and Yang, so as not to break the Qi and aggravate the condition. In clinical practice, we can use ginseng, astragalus and other qi tonics as well as salvia, jiao hawthorn, kudzu, motherwort, zelen, and psyllium to invigorate the blood and promote water, so as to reduce the burden on the heart, and we can expect satisfactory results.