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Friday, 5 February 2010

Why and How Traditional Chinese Medicine can treat Coronary Heart Disease?



Dr Tiejun Tang
Coronary heart disease (CHD) is a common heart disease. It is caused by narrowing of the coronary arteries, resulting in blood supply insufficiency. It leads to myocardial ischemia changes or anoxic change of the heart. Clinical symptoms include sudden chest pain, an oppressive feeling in the chest and palpitations. In some severe case death will occur.

Statistical data from Department of Health shows CHD is the biggest killer in U.K. More than 1.4 million people suffer from angina. 275,000 people have a heart attack annually. CHD kills more than 110,000 people in England every year [1].

Hypertension, hyperlipidemia and diabetes are common risk factors of CHD. Some unhealthy life style factors such as smoking, alcohol, lack of exercise, stress at work can increase the chance of CHD.

CHD can be diagnosis by ECG, heart ultrasonic scan and coronary angiography.

Western medicine has many advantages in the treatment of CHD, but it still has limitations. For example: there are side effects of most antihypertensive and antilipemic drugs, some of them serious; the high restenosis rate within 6 months after percutaneous transluminal coronary angioplasty (PTCA)[2] ; the high risk and the high financial implication of surgical intervention, i.e coronary bypass.

The symptom of CHD had been firstly recorded in the Neijing (Yellow Emperor's Canon of Medicine 475B.C.-221B.C.) In this classic book angina is named as xiong bi, or xintong. Arrhythmia is named as xinji, or zhengchong. From that time our ancestors began to use Chinese herbs and acupuncture for the treatment of this disease. In modern China we combine traditional Chinese medicine (TCM) and western medicine together to treat CHD. Many clinical and laboratory research published now indicates that some Chinese herbs in addition to acupuncture may have a very good effect for treating the symptoms of myocardial ischaemia with a positive outcome for those patients affected [3,4].

Within the TCM framework the pathology of CHD may be understood to be due to deficiency in the root and excess in the branch. Deficiency of the root includes heart, kidney, spleen, yin and /or yang deficiency. Excess branch include qi stagnation, cold obstruction, phlegm blockage and blood stasis. Different cases will have individual pathology presentation. The treatment principle should vary according to the syndrome differential diagnosis.

If cold obstructing the heart, warming heart method should be selected. Where phlegm is blocking the heart, expel phlegm method should be used; if heart blood stasis, the stagnation need to removed from the heart meridian; if liver and kidney yin deficiency, nourishing yin method should be used; if heart yang deficiency, warming yang method should be selected.

Chinese medicine can prevent CHD by reducing the risk facts such as hypertension, high cholesterol, diabetes and arteriosclerosis.

Herbs functions that inhibit liver yang and nourishing kidney yin often have a good effect on lowing blood pressure. For example: Tian ma (Rhizoma Gastrodiae), Gou teng (Rmaulus Uncariae cum Uncis), Ju hua (Flos Chrysanthemi), Gou qi zi(Fructus Lycii); Herbs functions that remove blood stasis often have good effects on improving microcirculation and increase coronary circulation. For example: Dan shen(Radix Salviae Miltiorrhizae), Chi shao (Radix Paeoniae Rubra), San qi (Radix Notoginseng), Chuan xiong (Rhizoma Ligustici Chuangxiong); Some herbs can reduce cholesterol, like Shan zha (Fructus Crataegi), Ze xie (Rhizoma Alismatis), Jue ming zi (Semen Cassiae), He shou wu (Radix Polygoni Multiflori); Some herbs has function to reduce blood sugar, like Shan yao (Rhizoma Dioscoreae), Mai men dong (Radix Ophiopogonis), Tian hua fen (Radix Trichosanthis), Shu di huang (Radix Rehmanniae Praeparata).

Chinese medicine selects different herbs according to different condition. Sometimes decoction may be used and sometimes patent pills may be prescribed. Usually herbs combined with acupuncture will make the treatment more efficient.

In the treatment of CHD Chinese medicine have showed the following advantages:

Firstly, Chinese medicine has a Multi-target effect. One decoction or pills contains several different ingredients. Each ingredient acts on different pathology change. It can treat disease from the branch to the root at same time.

Secondly, it is nature therapy, nearly no side effect. You can bring your blood pressure down without getting side effect such as dry cough, headache or edema; you can reduce cholesterol without damage your liver function.

Thirdly, the effect of Chinese medicine is stable and sometimes it has a bidirectional regulating function. Compare to western medicine, it has much less rebound effect on blood pressure. Some herb pills not only simply reduce blood lipid, it has a balance or regulation function. For example, our research shows Kaixin capsule can balance among the subfractions of lipoprotein and inhibit arteriosclerosis[5].

Few years ago the UK Government had committed to reducing the death rate from CHD and stroke and related diseases in people under 75 by at least 40% (to 83.8 deaths per 100,000 population) by 2010. Can we hit this target this year? I suggest all the patients and doctors have a second idea, it maybe a better solution in fighting against CHD.

Reference
1. http://www.dh.gov.uk/en/Healthcare/NationalServiceFrameworks/Coronaryheartdisease/index.htm
2. Drachman DE. et.al. Restenosis: Intracoronary brachytherapy. Current Treatment Options in Cardiovascular Medicine. 2002; 4(2) :109-118.
3. Tiejun Tang, Weikang Wu. Progress of Experimental Study in Traditional Chinese Medicinal Herbs Against Myocardial Ischemia. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine. 2003;13 (2):111-113,118.
4. Tiejun Tang. The prosecution and application of rat model of experimental coronary heart disease. International Journal of Cardiovascular Medicine (Chinese Edition) 1999; 1(4): 318-320.
5. Tiejun Tang et al. Effect of Kaixin Capsule on Blood Lipid and Lipoprotein Subfractions in Experimental Rats with Coronary Heart Disease. Journal of Guangzhou University of Traditional Chinese Medicine 1999; 16 (3): 223-225.