ZHANG YUE JIAN Senior Physician
Coronary Heart Disease
Many bad habits in our modern lifestyle increase the viscosity and fat content of the blood. When fat accumulates on arterial walls, it causes atherosclerosis. Coronary artery atherosclerosis is when the damage happens to the artery that supplies blood to the heart. Coronary heart disease refers to myocardial infarction due to embolism or myocardial ischemia caused by coronary artery atherosclerosis. It is commonly seen in the elderly. Angina is a common symptom that presents as chest pain or pressure over the chest that lasts 3-5 minutes. Some people experience fluster, palpitation, vertigo, and blurred vision due to an arrhythmia. In the more severe cases, one may experience coughing, shortness of breath, weakness and sweating that is worsened with movement. Even worse, one may have persistent and severe chest pain, which indicates a heart attack. Coronary heart disease is very likely to be life threatening if not treated promptly. There are many risk factors, including smoking, hypertension, hypercholesterolemia, diabetes, obesity, and lack of physical activity.
TCM believes the causes of coronary heart disease are:
-Exogenous pathogens with cold property: This is secondary to Yang deficiency in the chest. Exogenous pathogens with cold property blocks Qi circulation and Yang expression, and results in coronary artery blockage.
-Uncontrolled dietary habits: High-fat diet and chronic alcohol abuse may injure the digestive system and cause accumulation of “phlegm” in the body that blocks the expression of Yang and Qi.
-Kidney Qi deficiency: Decreased visceral function is part of the aging process. Kidney Qi deficiency directly relates to Yang deficiency in other visceral systems. Reduced Yang leads to poor circulation, including poor circulation to the heart.
-Emotional trauma: Lack of physical activity and depression also negatively affect the circulation of Qi and blood, and cause coronary artery blockage.
TCM differential diagnosis and treatment for angina due to coronary artery disease:
-Arterial blockage due to cold: It presents as sudden stabbing chest pain and cold intolerance. Chest pain is worse and triggered by cold. It is accompanied by paleness, cold limbs, and cold sweat.
Treatment: Increase circulation and the expression of Yang to remove coldness and blockage.
-Blockage due to phlegm: It presents as pressure and pain in the chest as if the person can’t breathe. The body feels heavy. The person is usually obese.
Treatment: Encourage the expression of Yang to remove blockage and phlegm.
-Coronary artery blockage: It presents as moderate to severe stabbing chest pain that always happens at the same location, and doesn’t get better over time.
Treatment: Improve blood flow to the heart to reduce pain.
-Heart and kidney Yang deficiency: It presents as intermittent chest pain, palpitation, night sweats, anxiety, insomnia, back pain, and tinnitus.
Treatment: Nourish the heart and kidney systems, and improve blood flow.
-Qi and Yin deficiency: It presents as intermittent chest pressure or chest pain, palpitation, shortness of breath, pale complexion, fatigue, and lack of desire to converse.
Treatment: Nourish Qi and Yin, and improve blood flow.
Additionally, physical exercises can improve cardiovascular function and reduce the incidence of angina. It is best to exercise in early morning before breakfast or in the evening after dinner. Avoid exercise during an angina episode. Avoid eating within 15 minutes post-exercise. Avoid exercise on extremely windy, cold or hot days. A few simple exercises to consider are:
-Walking: Start with a normal pace, then gradually increase the speed, stride length and duration. Increase elevation as tolerated. Walk once or twice a day, 20-30 minutes each time. The walk should be comfortable and relaxing.
-Walking stairs: Walking stairs daily for 10 minutes can be an excellent exercise as well for those with normal cardiovascular function.
-Aerobic exercise: This type of exercises is gentle and relaxing. It is perfect for those with angina.
Coronary heart disease prevention
Coronary artery disease is directly related to many lifestyle factors. Here are a few health tips to prevent coronary heart disease:
-Keep blood pressure in normal ranges: Reduce sodium intake and stress.
-Weight loss: Maintain adequate amount of physical activities.
-Diet and cholesterol: A good diet comprises of grains, legumes, vegetables, and fruits, which are fiber-rich and low fat. Avoid added sugar, sweets, fatty meat, organ meats, egg yolk, and whole milk products.
-Smoking: Quit smoking. Even if you were a smoker, stopping smoking still reduces your risk of coronary heart disease.
-Keep blood sugar in normal ranges: Increase exercise intensity, and reduce starch and sugar intake.
Natural foods that are good for coronary heart disease patients:
-Malt: It is rich in protein that is superior to animal protein. It reduces blood viscosity to prevent atherosclerosis. One bowl of malt congee in the morning is good for heart health.
-Corn: It is rich in vitamin E and A, and unsaturated fatty acid. It removes excess cholesterol in the artery and prevents atherosclerosis. One boiled corn on the cob a day is good for the middle-aged and elderly.
-Fruits and vegetables: Garlic lowers triglycerides, cholesterol and blood viscosity. Potato improves elasticity of blood vessels and prevents deposit of fat and atherosclerosis. Eggplant, tomato, green onion, and Chinese cabbage can reduce blood lipids, reduce blood pressure, and dilate the coronary artery to improve myocardial function. Chinese date, Chinese hawthorn, kiwi, orange and lemon are also heart healthy foods.
Those with coronary heart disease should exercise gently, control portion size, increase dietary fiber to prevent constipation, and avoid straining while on the toilet. Avoid showers immediately after meals. Avoid cold showers. Ensure good ventilation in the bathroom. Avoid emotional situations. Maintain a positive outlook.
Case Study:
This is a male patient who was experiencing chest pain and discomfort when walking up the stairs or walking too fast. Symptoms are relieved within 2-3 minutes of rest. Additionally, he also experienced dry mouth, fatigue and weakness. This is typical presentation of angina and correlates with Qi and Yin deficiency type in TCM differential diagnosis. He was prescribed with a herbal formula that comprised of asiabell root (dang shen), dwarf lilyturf tuber (mai dong), five-flavor berry(wu wei zi), bitter orange (zhi qiao), finger citron fruit (fo shou), red sage root (dan shen) and glehnia root (sha shen). The formula regulates Qi, nourishes Yin and improves circulation. The patient was under TCM care with the exclusion of any western medicine. His symptoms were significantly reduced and he was stable after being on the herbal formula for a month. The patient continued to work on his diet and physical activity, and only used the herbal prescription sporadically. His quality of life has greatly improved.