Journal of Acuherb in Medicine


Atherosclerosis

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Atherosclerosis

 

Atherosclerosis of the heart, better known as coronary heart disease, is classified in Traditional Chinese Medicine (TCM) as chest pain syndrome. It is characterized by pain in the chest, which may progress towards the back. Patients can also have shortness of breath, especially when lying flat. Symptoms of heart atherosclerosis have been mentioned in ancient medical texts as far back as the Han Dynasty (206BC-220AD). The famous medical work, Huang Di Nei Jing included a detailed description of this disease, saying, “Patients with chest pain syndrome may have pain inside the chest, fullness and distention in the lower chest, pain in the back of the shoulder as well as pain in the upper arm.” Another example of early writing on this subject is the description in the Synopsis of the Golden Chamber written by the famous Chinese medical doctor Zhang Zhong Jing who was also from the Han Dynasty. He wrote, “Chest pain syndrome usually presents as wheezing and cough, pain in the back of the shoulder and shortness of breath. The pulse at the first position will be slow and sinking while the pulse at the second position will appear rapid with slight tightness. In this case, Gualou Shebai Decoction ( Melon pedicel and Longstamen onion bulb ) should be used.” Since then, other works dealing with the symptoms, diagnosis and different treatments for atherosclerosis have been written at different times.

Causes

According to TCM theory, chest pain syndrome has the following causes:

1. Weakened health due to aging
According to TCM theory, elderly people gradually suffer a decline in kidney qi, resulting in different health problems. Declining kidney functions may be manifested as kidney yin deficiency and/or kidney yang deficiency. A deficiency in kidney yang can lead to yang deficiencies of the five yin organs (liverheartspleenlungs , and kidneys), which means that the functional aspects of these organs will have insufficient support. As a result, heart yang becomes deficient and fails to perform normal functions. On the other hand, if kidney yin becomes deficient, there will be insufficient yin nourishment of the five yin organs leading to heart yin deficiency. (In western terms, heart yang may actually be understood as the pumping action of the heart and is related to the sympathetic nervous system’s excitatory influence on the circulatory system. Heart yin, on the other hand, may be understood as metabolic nourishment of the heart. It is related to the parasympathetic nervous system’s inhibitory influences.) Deficiency of both heart yin and yang will ultimately lead to poor circulation of qi and blood  in the body, since the heart is responsible for “ruling” the blood. Consequently, qi will become too stagnant to “push” the blood around the body, and blood stasis (a condition where the blood
 is unable to flow smoothly) will occur. Blockage of the blood vessels in the heart and meridians  can then lead to chest pain. In western terms, this is known as angina.

2. Improper diet 
If our diet contains too much fatty and greasy food, digestion will be harmed. In TCM, it is said to affect the spleen harmony. As a result, the spleen cannot transform food and liquids into a nutritive essence used for qi and blood formation and then transport this essence throughout the body. The untransformed fluids and food start to accumulate and gradually form into an unhealthy dampness called “phlegm.” Phlegm dampness is one of the pernicious evils that has viscous (sticky) and stagnant properties. Therefore, it blocks the vessels and inhibits the flow of qi and blood, which in turn leads to chest pain.
The relationship between a person’s diet and chest pain in TCM is very important. This thinking is similar to the western medical view that eating too much cholesterol and fat is a factor in the development of atherosclerosis. 

3. Emotional disorder 
As already discussed, unhealthy phlegm dampness will lead to stagnation of qi and blood, which is considered a main cause of chest pain. Sometimes, emotional disorders lead to the formation of phlegm dampness. For example, “thinking too much”, (earth element of the five emotions), will harm the spleen (earth element of the five organs). Without healthy transformation of the spleen dampness will accumulate. Anger (wood element of the five emotions) also affects the liver (wood element of the five organs). As a result, the liver can lose its spreading
properties and fail to maintain the smooth flow of qi. The constrained liver qi will finally form into liver fire. It burns the body fluids and turns them into viscous (sticky) and unhealthy phlegm, which leads to chest pain.

4. Attack of coldness evils 
In TCM, “coldness” is associated with increased viscosity (stickiness) and stagnant properties. An example of this is oil which becomes viscous and does not pour easily when it is cold. As coldness belongs to yin, its influence will inhibit heart 
yang. Without sufficient heart yang, the heart cannot “rule” the blood properly. Therefore, heart vessels and meridians become blocked, and chest pain results. 

Symptoms

In TCM, the symptoms of chest pain syndrome depend on the disharmony patterns.

1. Blockage of heart vessels due to a blood stasis pattern 
When qi becomes stagnant and blood stasis occurs, the patient feels sharp pain in the chest that stays in one spot because the blood is unable to circulate. (It should be noted that since blood stasis belongs to excessive evils, the pain is sharp. If the problem is due to deficiency, the pain is dull.) . Being classified as a yin evil, blood stasis will cause problems in yin environments, especially nighttime. Therefore, people with this problem usually feel more pain at night. On examination, the tongue appears dull and purple, and the pulse feels choppy and sinking, both of which are signs of blood stasis.

2. Blockage due to a phlegm dampness pattern 
An accumulation of unhealthy phlegm dampness constrains the heart yang, making the patient feel an obstructing pain in the chest. As the nearby heart meridian is blocked by the dampness, the pain progresses to the back of the shoulder. Since phlegm dampness is related to disharmony of the spleen, and the spleen rules the four limbs, individuals with this pattern may feel tired and have a heavy feeling in their limbs. They will also have a cough and shortness of breath. On examination, the tongue coating looks greasy and turbid, and the pulse feels smooth.

3. Deficiency of both qi and yin 
Qi is essential for pushing or circulating blood throughout the body. Yin properties are closely associated with blood. If qi and yin are deficient, blood flow will be slowed, leading to blood stasis. As a result, these patients experience paroxysmal (sharp, spasmodic) pain, which occurs from time to time. Insufficient yin nourishment of the heart causes it to beat faster and palpitations to occur. The yin deficiency can also result in a relative excess of yang or illusionary yang, which is not a true yang excess because it is caused initially by yin deficiency symptoms. The relative yang excess rises to the head, leading to dizziness and blurred vision. Patients may look pale and fatigued and have difficulty speaking. Shortness of breath due to qi deficiency can also be present. On examination, the tongue appears red with teeth marks, and the pulse feels weak.

4. Deficiency of heart yang 
Deficiency of heart yang causes disharmony of qi and blood flow and presents with symptoms of dull chest pain and shortness of breath. If the condition is severe, the pain may even spread to the entire back. Without sufficient heart yang, palpitations and spontaneous sweating will occur since sweat is thought to be the “fluid of the heart”. The pain is usually projected to regions along the heart meridian and progresses to the inner side of the upper arm and the armpit. On examination, the tongue looks pale, and the pulse feels frail, sinking and weak.

5. Obstruction of heart yang 
Obstruction of heart yang is usually triggered by an attack of cold evils. As a result of the cold attack, the yang qi movement cannot flow smoothly and becomes obstructed, causing pain in the chest. In severe cases, the pain radiates to the whole back and progresses along the heart meridian, affecting the inner side of the upper arm and armpit. After each episode, spontaneous sweating usually occurs. On examination, the tongue has a white coating, and the pulse is sinking and weak. Sometimes it may feel slow.

6. Deficiency of kidney yang 
A person with kidney yang deficiency will have cold limbs, an aversion to cold and suffer from loin (waist) pain A kidney deficiency often causes fatigue and frequent urination. As discussed before in the ‘Causes’ section, a kidney yang deficiency can lead to a deficiency of heart yang, which in turn, results in chest pain.

Diagnosis

Based on four examination techniques, TCM practitioners will diagnosis osteoporosis according to its clinical symptoms and further characterize it by the disharmony patterns displayed by each individual. At various stages of disease, different disharmony patterns are present and individuals with the same disease will be treated differently depending on the type of disharmony pattern they have. Atherosclerosis usually classify into 6 type: 

1. Blockage of heart vessels due to ae blood stasis pattern.
2. Blockage due to a phlegm dampness pattern
3. Deficiency of both qi and yin
4. Deficiency of heart yang
5. Obstruction of heart yang
6. Deficiency of kidney yang

Detailed descriptions of these have been given in the “symptoms” section.

According to TCM theory, individual with chest pain syndrome should be differentiated from either a fluid retention syndrome in the throat, stomach pain or emergency heart pain.

Fluid Retention Syndrome in the Thorax (Chest):
‘Fluid retention syndrome in the thorax’ is an accumulation of fluid dampness in the thorax. Its presentation is similar to chest pain syndrome. Both lead to chest pain, but fluid retention syndrome is usually associated with persistent distension of the lower chest region, which will be aggravated by coughing, spitting and breathing. Shortness of breath might also be present.

Stomach Pain:
Some forms of chest pain originate from the stomach area and can easily be confused with chest pain syndrome. However, stomach pain is usually associated with hiccupping, flatulence (gas) and regurgitation of stomach acid.

Emergency Heart Pain:
Emergency heart pain is a complication of chest pain syndrome. It is marked by persistent, severe heart pain. Patients look pale, have purple lips, cold limbs and sweat. The pulse is frail and weak. This is an emergency and must be treated immediately by trained medical staff, preferably in a hospital emergency room.

Treatment

TCM treatments are syndrome basis, below are the usual clinical syndromes associated with atherosclerosis:

1. Obstruction of heart-blood

Therapeutic aims: activating the blood and removing the obstructions.

Sample of Prescription: (1) Dan Shen Drink (丹參飲)

dah shen

Red sage root

tan xiang

Sandalwood

sha ren

Fruit of Villous Amomum

In the prescription, red sage root specializes in activating the blood and removing the blood stasis, moreover, it can ease the pain that induced by the stasis. The sandalwood warms the middle burner and helps to regulate the qi circulation in the region. Villous Amomum fortifies the transforming and transporting functions, which help to dispel the qi stagnation in the middle burner. The three herbs interact and promote each other to resume the balance of the heart.

Sample of Prescription: (2) Decoction of Driving out Stasis in the Mansion of Blood (血府逐瘀湯)

dang gui

Chinese angelica root

chi shao

Red peony root

chuan xiong

Szechuan lovage

tao ren

Peach kernel

hong hua

Safflower flower

chai hu

Hare’s ear root

zhi qiao

Orange fruit

In the prescription, angelica, lovage, kernel and safflower flower specialized in activating the blood and removing stasis; hare’s ear regulates the liver functions, orange fruit enhances the qi circulation. The qi dominates the blood movement, as a result, the body’s blood circulation can be improved and cardiac pain is eased.

2. Obstruction of turbid phlegm 
Therapeutic aim: dispelling the turbid phlegm.

Sample of prescription: Decoction of Melon pedicel, Longstamen onion bulb and Pinella tuber (瓜蔞薤白半夏湯加減).

Prevention

TCM always stresses balance and harmony. Paying attention to the following points will help individuals maintain good cardiovascular health.

1. Healthy diet
According to TCM theory, the diet is closely related to spleen health, which in turn is essential for the transformation of food into qi and blood in the body. The accumulation of dampness from improper spleen function is the main cause of chest pain syndrome. Hence, it is extremely important to maintain a healthy diet and avoid fatty, greasy foods.

2. Exercise 
Appropriate exercise helps promote qi and blood flow in the body. Their smooth circulation is essential to maintain cardiovascular health. However, individuals need to avoid over-exercising, as this can exhaust too much qi in our bodies. This is especially important for people who are deficient in qi or yang because over-exercising can trigger chest pain syndrome. It is a good idea to get the advice of your healthcare provider before starting an exercise regimen. 

3. Emotional health 
Proper relaxation and rest are also important for good cardiovascular health. Lack of relaxation and rest can lead to emotional disorders. In TCM, this is said to harm the health of the liver or spleen. The liver maintains the smooth flow of qi while the spleen is essential for transforming fluid and food. If disharmony occurs in these organs, the circulation of qi and blood will be affected which, in turn, causes blood stasis and finally leads to chest pain. 

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