Coronary artery disease is a type of disease that causes a series of clinical symptoms of myocardial ischemia due to the formation of stenosis, spasm or thrombosis on the basis of coronary atherosclerosis (AS) plaques, which is a major cause of death and disability. Although there are many ways to classify coronary artery disease, it is generally divided into stable angina (SA) and acute coronary syndrome (ACS), of which ACS can be divided into unstable angina (UA), non-ST-segment elevation myocardial infarction (non-ST-segment elevation myocardial infarction), and myocardial infarction (non-ST-segment elevation myocardial infarction). ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).The common pathological basis of ACS includes the following: (1) instability bleeding within the atheromatous plaque and rapid plaque enlargement; (2) plaque rupture or surface breakage, local platelet aggregation followed by thrombosis; (3) vasospasm, etc. The main difference between angina pectoris and myocardial infarction is whether myocardial necrosis occurs. Although UA and myocardial infarction have similar pathological basis, there are differences in treatment and prognosis due to the degree of myocardial damage. This article focuses on the treatment of coronary angina including SA and UA. Coronary angina is a group of clinical syndromes caused by temporary myocardial ischemia and hypoxia with episodic precordial discomfort as the main manifestation. It is usually seen in patients with at least 1 coronary artery or major branch lumen diameter stenosis ≥ 50%, and when physical activity or mental stress occurs, coronary blood flow cannot meet the needs of myocardial metabolism, resulting in myocardial ischemia and inducing angina. The clinical symptoms of this disease have been described in Chinese medicine as early as in the Nei Jing, such as “chest paralysis”, “heart pain”, etc. In severe cases, the symptoms are described as “true heart pain” and “syncope heart pain”. If the symptoms are severe, it is described as “true heart pain” or “syncope heart pain”. Since the first case of percutaneous intracoronary balloon dilatation and angina pectoris (PTCA) for the treatment of coronary artery disease in 1977, percutaneous coronary intervention (PCI) has become the most popular treatment for coronary artery disease, from PTCA to bare metal stents, drug-eluting stents, and the newly tried drug-eluting balloons. intervention (PCI) has become a major effective method for the treatment of coronary heart disease. The efficacy of PCI is more certain in patients with SA with evidence of widespread myocardial ischemia; urgent PCI (within 2 hours) should be performed in patients with non-ST-segment elevation ACS with very high-risk risk stratification (TIMI score or Grace score), and early PCI (within 72 hours) should be performed in patients with intermediate-to-high-risk non-ST-segment elevation ACS. However, revascularization including intervention and bypass grafting is only one of the treatments for cardiovascular disease, and secondary prevention with drugs remains the basis of coronary artery disease treatment. the COURAGE study suggests that in patients with stable angina, the benefit of intervention may be limited to improving angina symptoms and does not significantly improve patient prognosis, and does not reduce mortality or the incidence of myocardial infarction compared with drug therapy It does not reduce the incidence of mortality and myocardial infarction compared with drug therapy. The aim of pharmacological treatment of coronary heart disease is to prevent myocardial infarction and sudden death and to improve survival and quality of life. At present, the main clinical drugs used for the treatment of angina pectoris in coronary heart disease are as follows: 1. Anti-platelet drugs: including aspirin, thienopyridine, platelet glycoprotein (GP) IIb/IIIa receptor antagonists, etc. Aspirin can inhibit the synthesis of cyclooxygenase and thromboxane (TXA2), anti-platelet aggregation, as long as there is no contraindication, is still the preferred anti-platelet drugs. Clopidogrel, a thienopyridine drug, selectively and irreversibly inhibits platelet ADP receptors, blocks ADP-dependent activation of the GPIIb/IIIa complex, and reduces ADP-mediated platelet activation and aggregation. It is mainly used in acute coronary syndromes, after stent implantation and in those with contraindications to aspirin; prasugrel belongs to the third generation of thienopyridine antiplatelet agents, which can directly block P2Y12 receptors and has 10-100 times more antiplatelet activity than clopidogrel, and is less affected by metabolism, but its bleeding events are significantly higher than those of clopidogrel, especially in elderly, low weight and patients with previous ischemic cerebrovascular attacks. Ticagrelor is a cyclic pentylenetriazolopyridine that acts directly on ADP receptors without hepatic metabolism, is not affected by in vivo metabolism, has better efficacy than clopidogrel, and the antagonism of ADP receptors is reversible, so it does not increase the risk of bleeding. GP IIb/IIIa receptor antagonists, including abciximab, etibatide, and tirofiban, may be significantly beneficial in UA patients undergoing PCI, while in The benefit is not obvious for low-risk patients who are not going to undergo PCI. 2. Antithrombin drugs: including heparin and low-molecular heparin, mostly used in UA patients, can reduce the incidence of myocardial infarction and myocardial ischemia in patients, and the benefit is greater when combined with aspirin. Before or during the interventional treatment, it is recommended to give preference to common heparin, and it can be combined with GP IIb/IIIa receptor antagonist; after surgery or for those who receive early conservative treatment and delayed PCI, it is recommended to use low-molecular heparin. 3. Statins: Statins can effectively reduce serum total cholesterol (TC) and low-density lipoprotein (LDL-C), and therefore can reduce cardiovascular events. Statins also have the effects of slowing down the progression of AS plaque, stabilizing plaque and anti-inflammation. The target value of LDL-C for patients with coronary artery disease is <2.60 mmol/L, for very high risk patients the target value is LDL-C <2.07 mmol/L, and for high or intermediate risk patients LDL-C should reduce LDL-C levels by at least 30-40%. High-risk patients who also have high triglycerides (TG) or low high-density lipoprotein (HDL-C) may consider a combination of statins and fibrates (fenofibrate) or niacin. the PROSPER study showed that statins significantly reduced the risk of myocardial infarction in older adults up to patients over 80 years of age, who could benefit from statins. 4. β-blockers: β-blockers have both prognostic and symptom-reducing effects and should be used as the initial treatment for stable angina as long as they are not contraindicated. Patients with a history of myocardial infarction, abnormal left ventricular systolic function, or heart failure should be on long-term or even lifelong β-blockers. β-blockers reduce the risk of death and reinfarction in patients with stable angina after myocardial infarction. Beta-blockers with intrinsic sympathomimetic activity are less cardioprotective, and beta-blockers without intrinsic sympathomimetic activity are recommended. Clinical application should start with a small dose and increase the dose step by step, so that the resting heart rate is not less than 50 beats/min. 5, angiotensin-converting enzyme inhibitors (ACEI): ACEI should be used in all patients with coronary angina with combined diabetes, heart failure, abnormal left ventricular systolic function, hypertensive disease or chronic kidney disease, and long-term ACEI is also recommended for other patients with coronary artery disease, but the benefit may be less in low-risk patients. A meta-analysis including 33,960 patients with coronary artery disease showed that ACEIs reduced overall mortality and major cardiovascular events in patients with coronary artery disease, including those without left ventricular dysfunction or heart failure. Patients with chronic angina who cannot tolerate ACEI may be switched to angiotensin receptor antagonists (ARBs) as an alternative treatment. 6, nitrates: nitrates are endothelium-dependent vasodilators that dilate coronary arteries and improve myocardial tissue perfusion, thereby improving angina symptoms. Nitrates can reflexively increase sympathetic nerve tone to speed up the heart rate, so the clinical application is often combined with beta-blockers. 7, other: dihydropyridine and non-dihydropyridine calcium antagonists have anti-anginal effects, long-acting calcium antagonists can be used as the initial treatment of anti-anginal drugs, not necessarily after the ineffectiveness of other drugs used or added, its effectiveness and safety has been confirmed in the ACTION, CAMELOT, ALLHAT and ASCOT study. The non-dihydropyridine calcium antagonists diltiazem or verapamil may be used as alternative therapy for patients with contraindications to beta-blockers. The metabolic improvement drugs trimetazidine and potassium channel openers nicorandil and If channel blocker ivabradine are mostly used as adjuvant therapy for coronary artery disease at present due to their short duration of application and less evidence of relevant studies. Second, the Chinese medicine treatment of angina pectoris in coronary heart disease The Suwen Paralysis Theory points out that "chest paralysis, the pulse is not blocked". The basic pathogenesis of chest paralysis is summarized as "the inability of the pulse to pass," which causes pain if it does not pass. In the book of "The Essentials of the Golden Killing? The main manifestations of chest paralysis are summarized in "Chest Paralysis, Heart Pain, Heart Pain, and Short Qi", and the key to its pathology is "Yang Wei Yin String", that is, "Yang Qi" in the chest. It is believed that the key to the pathology is "Yang Wei Yin String", that is, "Yang Qi" in the chest is deficient, and Yin Cold and Phlegm are on the Yang position, paralyzing the heart veins and causing pain if they do not pass, which is a deficiency of the original and a real evidence, and created a series of Gua Gua Bai Bai agents for clinical use, which is still a major treatment for angina pectoris of coronary heart disease. In the Ming Dynasty, for example, Yu Tuan's "Medical Zhengzhuan" pointed out that the disease was related to "dirty blood rushing to the heart"; in the Qing Dynasty, Ye Tianshi emphasized that the disease had entered the ligaments for a long time and advocated the use of blood circulation to treat chest paralysis and heart pain; Wang Qingren proposed blood stasis in the Blood Mansion and created the Blood Mansion and Blood Stasis Treatment for chest paralysis and heart pain. Chen Keji, integrating the experience of his predecessors and the evidence of the disease, believed that the basic pathogenesis of "blocked veins" lies in blood stagnation, and advocated the treatment of coronary heart disease by activating blood and resolving blood stasis, and developed blood activation and resolving blood stasis preparations such as Guanxin No. 2, Guaixinache Capsules and Xiong Shao Capsules for clinical use, which significantly improved the efficacy compared with the previous treatment of coronary heart disease by simply applying the method of promoting palsy and promoting Yang. On this basis, academician Chen Keji, according to the pathological mechanism of coronary heart disease angina pectoris and the priority of different stages of the disease, summarized the treatment of coronary heart disease angina pectoris as three passages and two tonics, namely "aromatic warming", "promoting palsy and promoting yang" and "activating blood circulation and removing blood stasis". The treatment of angina pectoris in coronary heart disease is summarized as three passages and two tonics, namely, "aromatic warming", "promoting paralysis and Yang", "activating blood circulation and removing blood stasis" and "tonifying kidney" and "tonifying qi and blood", which play a role in guiding the clinical treatment of angina pectoris in coronary heart disease. 1, angina attack treatment: angina is the signal of myocardial ischemia and hypoxia, improving myocardial ischemia and hypoxia is the key to relieve pain. The basic pathogenesis of Chinese medicine during the onset of pain is that the heart is closed and blocked, and the pain is painful if it does not pass, mainly due to the standard, which can be different from qi stagnation, blood stasis, cold condensation, heat knots, phlegm blockage, etc. The treatment should be urgent to treat the standard, and should be warming and dispersing cold, moving qi and activating blood, ventilating yang and opening phlegm as a method to achieve the purpose of pass without pain. The aromatic and warming products are mostly used for warming and dispersing the veins, which are aromatic, warm and good at moving, and have the power to open the veins and promote paralysis, and also to relieve pain quickly. Many modern aromatic and warm Chinese medicines such as Suhexiang Pill, Su Bing Dripping Pill, Guanxin Suhe Pill, Quick-acting Heart Relief Pill, Broad Chest Pill, Broad Chest Aerosol, etc. can be taken, sprayed or swallowed during the onset of angina, which can quickly relieve vascular spasm, increase coronary blood flow and improve myocardial blood supply. However, aromatic and warming medicines are mostly pungent and dispersing, so they should not be taken for a long time to avoid dispersing qi and consuming yin, and if necessary, they can be combined with heart qi and heart yin medicines to get the effect of opening the veins without hurting the positive. In addition, on the basis of aromatic and warming, it can be appropriately combined with liver and qi regulating products, such as Su Stem, Chai Hu and Xiang Fu, etc. to regulate the qi mechanism, so that the qi can move the blood. 2, angina pectoris remission treatment: coronary heart disease remission pathogenesis is mostly deficient and real: deficient, the heart of the Qi and blood yin and Yang deficiency or with liver, spleen, kidney visceral deficiencies; real as above. The treatment of coronary artery disease in remission is just two methods: to supplement the deficiency should be supplemented with vital energy, heart energy and nourishment of Yin and Blood, while identifying the Qi and Blood yin and Yang to qualify, and dividing the liver, spleen and kidney viscera to locate; to promote paralysis should be aromatic warmth, promote paralysis and Yang, invigorate the Blood and remove blood stasis, identifying its cold and heat properties, the severity of stagnation and the depth of the disease location, either to invigorate the Blood, or remove blood stasis, or to promote the circulation, or to promote paralysis and remove phlegm, with the aim of making the Heart and Zong Qi to transport the Blood, and to promote the blood vessels. The aim is to make the heart qi and zong qi to transport the blood vessels and to promote blood vessel paralysis. As this disease is a lifelong disease and has a long course, there is often a pathological process of Yang loss and Yin, Yin loss and Yang, and a mixture of cold and heat, which can lead to paralysis of the heart and blood vessels due to deficiency, and can also lead to paralysis of the heart and blood vessels due to blood stasis, Qi stagnation, phlegm blockage, cold condensation, heat nodules, etc., which can damage the right qi and eventually lead to the coexistence of deficiency and reality. Therefore, clinical prescriptions and medicines should be used to treat both the symptoms and the root cause of the disease, with tonicity in the middle of the treatment and ventilation in the middle of the tonicity. The treatment method of three passages and two tonics summarized by academician Chen Keji is worth understanding and applying as an outline. Common clinical evidence of Chinese medicine include blood stagnation, Qi deficiency and blood stasis, phlegm and paralysis, as well as Qi and Yin deficiency and heart and kidney Yin deficiency caused by prolonged illness, which can be used as reference for the identification and treatment of stable angina pectoris. Unstable angina: UA is a more serious clinical condition between stable angina and acute myocardial infarction. Compared with stable angina, UA has the characteristics of heavy pain, long duration, poor efficacy of nitrate drugs, and easy to develop into acute myocardial infarction or sudden death. Combined with the clinical manifestations and pathological changes of UA, UA has the pathological mechanism of blood stasis, long-standing disease into the ligaments, and stasis of heart veins, and the degree of blood stasis is more serious than that of SA. The degree of blood stasis is more serious than that of SA. Due to the difference of patient's endowment, UA patients can show different pathological mechanisms such as qi stagnation and blood stasis, qi deficiency and blood stasis, yang deficiency and blood stasis, and phlegm and stasis mutual obstruction. Therefore, the clinical treatment of UA, in addition to paying attention to the general rules of angina treatment, we should also pay attention to the following aspects: (1) warming Yang emphasizes the heart and kidney, activating blood without forgetting to dispel blood stasis: the pathological mechanism of UA is characterized by Yang deficiency and blood stasis are more serious, Chinese medicine treatment should focus on warming Yang to open blood vessels. The treatment of activating blood circulation and removing blood stasis in UA should be pungent, warm and moist, and break down blood stasis and disperse nodules; (2) Combination of disease and evidence, and careful examination of deficiency and reality: Different types of UA patients have different disease mechanisms. For example, the first onset of exertional angina pectoris is mainly based on the symptoms, and should be used to invigorate blood circulation and eliminate stasis, and the appropriate application of blood-breaking and stasis-dispersing drugs can improve the efficacy; worsening exertional angina pectoris, due to the long duration of the disease, often evolved from the development of stable exertional angina pectoris, similar to the Chinese medicine "prolonged heart pain", should be both attack and supplementation, using the benefit of heart Qi, replenish the zongqi, kidney yuan, invigorate blood The spontaneous type of angina pectoris has no obvious relationship with activity, and is more common at night and in the early hours of the morning, so the treatment should focus on warming the Yang and dispersing the cold, and also use the method of activating the Blood to dispel stasis. For patients with cardiac insufficiency, on the basis of benefiting qi to support the righteousness, coupled with promoting blood circulation and promoting water circulation, it is expected to receive better therapeutic effect. 4, post-interventional coronary angina: In recent years, research on integrated Chinese and Western medicine interventions for post-interventional coronary heart disease has made some progress. Chen Keji et al. used a multicenter, randomized, double-blind controlled study to clinically observe the efficacy of blood-vitalizing and stasis-transforming Chinese medicinal preparations combined with conventional Western medicine in the treatment of post-PCI coronary artery disease patients, demonstrating that the addition of blood-vitalizing and stasis-transforming preparations to conventional Western medicine treatment significantly reduced the incidence of angina pectoris, reduced restenosis formation and reduced the occurrence of endpoint events in patients within six months after PCI, indicating that blood-vitalizing and stasis-transforming Chinese medicinal preparations can further improve the outcome of patients with coronary artery disease after interventional therapy. Some studies have observed that PCI has a certain improvement effect on blood stasis evidence, but not on qi deficiency evidence. On the contrary, PCI exacerbated the evidence of Qi deficiency to a certain extent, thus, for patients with post-interventional coronary artery disease, TCM evidence-based treatment should focus on benefiting Qi and supplementing with activating blood circulation. Experimental studies have demonstrated that Chinese medicine intervention in coronary heart disease after coronary intervention has the effects of inhibiting vascular smooth muscle cell proliferation, protecting vascular endothelial cells, correcting dyslipidemia and anti-platelet aggregation, showing good clinical application prospects, which is worth further validation to provide reliable evidence for expanding clinical application. Although clinical guidelines for the treatment of angina pectoris in coronary artery disease have been established at home and abroad in recent years based on a series of clinical studies and systematic evaluations, there are still individual differences in their efficacy, and individualized treatment is still the main way to achieve the desired efficacy in the treatment of angina pectoris in coronary artery disease. Other factors such as aspirin resistance, non-perfusion and slow perfusion of myocardial tissue after hematologic reconstruction, systemic inflammatory response after myocardial ischemia, and endothelial dysfunction are not yet ideal interventions in modern medicine. Modern pharmacological research shows that TCM has a wide range of pharmacological effects, such as anti-platelet adhesion aggregation, inhibition of thrombosis, vasodilation, improvement of vascular endothelial function, regulation of inflammatory response, promotion of myocardial capillary regeneration and increase in myocardial tissue perfusion, which can act on many pathological aspects of angina pectoris in coronary heart disease. How to complement the advantages of Chinese and Western medicine, using the microscopic morphology of modern Western medicine and the pathophysiological observation of molecular biology to improve the targeting of Chinese medicine treatment; using the concept of holistic identification and individualized treatment of Chinese medicine, integrated Western medicine targeted treatment to produce a better overall comprehensive effect, requires the combination of pharmacology, pharmacology, toxicology, clinical and bioinformatics and other multidisciplinary, and then promote the translation of research results into clinical applications, to provide new contributions to This will facilitate the translation of research results into clinical applications and make new contributions to clinical efficacy.