I. Introduction
Coronary atherosclerotic heart disease, referred to as coronary heart disease, is a kind of heart disease that affects the coronary circulation due to narrowing or even occlusion of coronary artery lumen by atherosclerosis. Due to the location of coronary atherosclerosis, the degree of lesions can be divided into several types, and in 1979 the World Health Organization divided it into five types: angina pectoris, myocardial infarction, cardiac arrhythmia, heart failure and cardiac arrest. Angina pectoris is a group of clinical syndromes caused by temporary ischemia and hypoxia of the myocardium with episodes of chest pain as the main manifestation, 95% of which are caused by coronary atherosclerotic heart disease. The disease occurs mostly in people over 40 years of age, more men than women, more brain workers, exertion, emotional excitement, satiety, cold, rainy weather, acute circulatory failure as common triggers. It is characterized by paroxysmal anterior chest crushing pain, mainly located in the posterior sternum, radiating to the precordial region and left upper limb, often occurring during labor or emotional excitement, lasting several minutes, and disappearing after rest or nitrate preparation. Angina pectoris belongs to the category of “chest paralysis” and “heart pain” in Chinese medicine.
Myocardial infarction is a serious type of coronary heart disease, which occurs when the coronary artery blood supply is drastically reduced or completely interrupted on the basis of coronary artery lesions, resulting in persistent and severe acute ischemia of the corresponding myocardium, causing ischemic necrosis of this part of the myocardium. The main clinical manifestations are persistent and severe retrosternal pain, increased serum cardiac enzymes, and progressive changes in the electrocardiogram. Cardiac arrhythmia, heart failure or shock often occur. It belongs to the scope of “true heart pain” in TCM.
Identification and treatment in Chinese medicine
1.Stagnation of heart blood
[Main symptoms] Stabbing pain in the chest, immovable, worse at night, with palpitations and restlessness, purple and dark tongue, sunken and astringent pulse.
[Treatment] Promoting Blood circulation to resolve blood stasis, promoting circulation and relieving pain.
[Formula] Blood Mansions and Blood Stasis Soup with addition and reduction.
Radix Angelicae Sinensis, Radix Rehmanniae, Radix Paeoniae Alba, Rhizoma Ligustici Chuanxiong, Rhizoma Peach, Rhizoma Safflower, Radix Bupleurum, Citrus Aurantium, Radix Platycodon, Radix Glycyrrhizae, etc.
2.Phlegm and congestion evidence
[Main symptoms] Chest tightness like suffocation and pain, or pain leading to the shoulders and back, shortness of breath and shortness of breath, heavy limbs, obesity, phlegm, greasy coating, slippery pulse.
[Treatment] Drain turbidity by promoting Yang, expel phlegm and open knots.
[Radix Piper betel, Allium and Hexachloropsis Tang with addition and subtraction.
Radix Piper betel, Radix Panax notoginseng, Allium sativum, etc.
(3) Yin-cold stagnation evidence
[Main symptoms] Chest pain through the back, cold pain, chest tightness, shortness of breath, palpitations, heavy panting, inability to lie down, pale face, cold extremities, white tongue coating, sunken pulse.
[Treatment] Pungent, warming, promoting Yang, opening paralysis and dispersing cold.
[Radix et Rhizoma] Radix Piperariae Allium and White Wine Soup with Citrus aurantium, Radix et Rhizoma Cinnamomi, Radix et Rhizoma Pseudostellariae, Radix Salviae Miltiorrhizae, Radix et Rhizoma Sandalwood.
Gui Zhi, Radix et Rhizoma Pseudostellariae, Allium sativum, Juniperus, Citrus aurantium, Sandalwood and Salvia.
(4) Heart and kidney yin deficiency evidence
[Main symptoms] Chest tightness and pain, palpitations and night sweats, sleeplessness, lumbar pain and knee weakness, tinnitus, dizziness, red tongue or purple spots, thin pulse with count or fine astringency.
[Treatment] Nourishing Yin and benefiting the kidney, nourishing the heart and calming the mind.
[Formula] Zuo Gui Drink plus reduction.
Radix Rehmanniae, Cornus officinalis, Lycium barbarum, Chinese yam, Poria, Licorice, etc.
(5) Qi and Yin deficiency
[Main Evidence] Chest tightness and vague pain, sometimes stopping, palpitation and shortness of breath, laziness and laziness of speech, less florid face, dizziness and dizziness, more so in case of exertion, red tongue or tooth marks, weak pulse or knotted generation.
[Treatment] Benefiting Qi and nourishing Yin, invigorating Blood and promoting circulation.
[Radix et Rhizoma] Combination of Radix et Rhizoma with Radix et Rhizoma Ginseng and Yang Ying Tang, plus reduction.
Ginseng, Radix Astragali, Atractylodes Macrocephala, Poria, Glycyrrhiza Uralensis, Radix et Rhizoma Macrocephala, Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix et Rhizoma Polygonati, Fructus Schisandrae.
6.Yang Qi deficiency evidence
[Evidence] Chest tightness and shortness of breath, or even chest pain through the back, palpitations, sweating, aversion to cold, cold limbs, lumbar soreness, weakness, pale face, pale or blue lips and nails, pale white or purple tongue, sinking or sinking pulse.
[Treatment] Benefiting Qi, warming Yang, invigorating Blood and promoting circulation.
[Radix et Rhizoma ginseng and Radix et Rhizoma spp.
Ginseng, Radix et Rhizoma, Cinnamon, Radix Rehmanniae, Cornu Cervi Pantotrichum, Fructus Lycii, Cortex Eucommiae, etc.
Third, regulation and care
Patients with coronary artery disease should actively treat primary diseases and comorbidities, such as hypertension, diabetes, hyperlipidemia, etc. Pay attention to the tendency of obesity, actively prevent and treat hidden coronary heart disease and angina pectoris, avoid exertion, cold stimulation, emotional excitement, full meals and surgery and other triggering factors. Patients with angina pectoris, which is prone to myocardial infarction, should be especially vigilant. Carry a cardiac care kit with you for emergency use and master the use of it. If you encounter a situation that may cause an angina attack, take one nitroglycerin tablet as a precaution. If angina or myocardial infarction occurs, you can try to give first aid while escorting to the hospital. Diet should be light and nutritious, food should be low fat, low cholesterol, less animal fat, egg yolk, offal, especially brain, liver, kidney, etc.. Eat more vegetables, fruits, beans and their products, preferably vegetable oil, sesame oil, peanut oil, soybean oil and other vegetable oils as cooking oil. The elderly should also not enter more sugar products, so as not to affect the sugar metabolism, indirectly make cholesterol higher, promote diabetes, and promote atherosclerosis. Obese overweight people should limit the amount of food and calories to lose weight. Try to quit smoking, because smoking will cause small arteries to contract and increase cholesterol. The elderly who have the habit of drinking alcohol, a small amount of alcohol does not hurt, as long as the amount of alcohol consumed each night does not exceed 20-25m1, and will not increase coronary heart disease, but also improve blood circulation. But a lot of alcohol or drinking strong alcohol, the same toxic effects. Drinking tea is generally harmless, but should not be too strong. Coffee can stimulate blood lipids and blood sugar increase, it is best not to drink or drink less. Supervise the patient to be properly active and persistent. Physical activity can regulate mental work and mental tension, especially for the elderly who like to sit still and do not like activity is particularly important. Physical activity can also promote the balance of lipid metabolism and the formation of coronary artery collateral circulation. Proper activity can reduce and control weight, improve cardiopulmonary function, and enhance resilience. However, the amount of activity should be moderate and vary from person to person, do not blindly heavy exercise activities, so as not to cause discomfort. In the premise of ensuring adequate rest and sleep to carry out physical activities within the ability, such as walking, jogging, health care boxing exercises, calligraphy and painting, in order to increase the contraction of the heart muscle, improve coronary blood flow. If you can adhere to half an hour of activity every day, the incidence of coronary heart disease and the string of death will be reduced. Coronary heart patients should maintain a good routine and not change the rhythm of life suddenly. Keep a good mental outlook, maintain a happy and optimistic state of mind, avoid emotional excitement, excessive mental tension and all mental stimulation. Do not be angry, happy or afraid. Watch TV, movies, novels and other recreational activities should be selected to avoid stimulating sudden changes in the condition and business. Keep the stool smooth and regular, constipation should not be excessive force to avoid accidents. Eat more fruits and vegetables, and use laxatives if necessary. Avoid cold stimulation. Winter season, the temperature is low, it is advisable to move indoors, do not go out too early. Wear a mask when going out; avoid walking against the wind. Get up slowly at night and pay attention to dressing to keep warm. Once angina or myocardial infarction occurs in coronary artery disease, first of all, do not panic, but remain calm. The patient’s emotional tension is extremely detrimental to the condition, and must promptly help the patient eliminate fear and establish confidence in overcoming the disease. Patients should rest in bed and reduce activities as much as possible to reduce the burden on the heart, while opening windows to allow air circulation or inhalation of oxygen. If a health care box is available, sedative painkillers can be taken and the patient should be rushed to the hospital for resuscitation. Do not let the patient walk or take the bus to the hospital, so as not to increase the burden on the patient’s heart muscle and expand the scope of myocardial infarction. Patients with myocardial infarction, the acute attack to absolute bed rest, quiet rest, three days no visitation, all activities by others to help. In mild cases, the patient can get up after 2-3 weeks, and in more severe cases or with complications, the bed rest time should be extended appropriately. The prognosis of this disease can be predicted from the pain condition and accompanying symptoms. Because the elderly originally have low compensatory capacity of the organism and poor drug effect, when coronary heart disease recurring attacks, especially patients who have already had angina pectoris and myocardial infarction, they should pay more attention to the changes of the disease and pay attention to timely treatment.
Fourth, food therapy and experimental formula
Pueraria lobata starch 30g, japonica rice 100g, boil porridge, morning and evening or warm in the morning and afternoon to share. Used for coronary heart disease, angina pectoris.
Dried ginger, galangal, 3g each, 250g of round-grained rice, boil porridge, and take it in the morning and evening with warmth. Used for coronary heart disease and angina pectoris with Yang Qi deficiency and cold.
Allium sativum 10-15g, 100g of round-grained rice, boil porridge, and take it in the morning and evening with warmth. Hawthorn slices 15-30g, decocted in water to remove slag, add sugar to drink as tea. Used to treat coronary heart disease, angina pectoris, hyperlipidemia.
Salvia miltiorrhiza 30g, 500g white wine, soaked, 10ml before each meal, 2-3 times daily.
Safflower 100g, 500g of white wine, soaked, 10ml before meals, 2-3 times a month.
1g of each of Trigonella and Curcuma longa powder, taken with warm water, 2-3 times a day.
Yanhuosuo, Yujin, Sandalwood, each divided into equal parts, 2-3g each time, warm water, 2-3 times a day.
Ginseng, Panax ginseng powder, sedum powder, blood exhaust powder (2:1:1) and mix well, 2g each time, warm water, 2-3 times a day.
Ginseng, Panax ginseng and amber powder (2:2:1) are finely ground and mixed together, 0.6g each time, three times a day. For coronary heart disease with Qi stagnation and blood stasis.
2 parts each of Camellia Sinensis, Fructus Sinensis and Clove, 1 part each of Boswellia Serrata, Myrrh and Ice, powdered together and taken with warm boiled water. 1.5-2g each time, 2-3 times a day.