Coronary atherosclerotic heart disease (CHD) has a high incidence, disability rate, and mortality rate, which severely affect people's health, work, and life. Based on its clinical manifestations, traditional Chinese medicine (TCM) has classified CHD as “chest impediment” and “heart pain” for the treatment. The course of CHD is protracted, and the pathogenesis is complex and changeable. Moreover, different disease stages have different syndrome characteristics. Thus, this article aimed to summarize the classification and distribution characteristics of the TCM syndrome in various stages of CHD, such as before and after percutaneous coronary intervention therapy, disease progression, age, and complications, to provide references for the TCM clinical diagnosis and treatment of CHD.
Keywords: Coronary heart disease, different disease stages, review, traditional Chinese medicine syndromes
|How to cite this URL:|
Xia YM, Gao H, Wang QS, Feng X, Wang YQ, Xu ZX. Characteristics of traditional chinese medicine syndrome in patients with coronary heart disease at different disease stages. World J Tradit Chin Med [Epub ahead of print] [cited 2022 Aug 8]. Available from: https://www.wjtcm.net/preprintarticle.asp?id=337872
| Introduction|| |
Coronary atherosclerotic heart disease (CHD) is associated with high morbidity, disability, and mortality, which greatly affect human health, work, and life. Based on its clinical manifestations, CHD can be classified as Xiongbi (chest impediment) and Xintong (heart pain) in traditional Chinese medicine (TCM).
The pathogenesis of CHD is complex. This may be due to the dual deficiency of qi and blood and the abnormal debilitation of yin or yang. Qi stagnation, cold coagulation, blood stasis, phlegm turbidity, blood stasis, and stasis-heat toxins constitute the outer phenomena. In addition, deficiency-excess complexes can cause the disease. Its pathogenesis involves the formation of dampness, heat, deficiency, and other change rules in different stages. These reflect the dynamic and changeable characteristics of CHD pathogenesis. Clinical doctors and researchers mostly based the classification of the different stages of CHD on the occurrence and development characteristics of the disease, clinical experience, TCM theory, and modern medical knowledge. Thus, this article aimed to summarize the classification and distribution characteristics of TCM syndrome types in the different stages of CHD, such as before and after percutaneous coronary intervention (PCI) therapy, disease progression, age, and complications, to provide a reference for the clinical diagnosis and treatment of CHD.
| Different Stages Classification and Traditional Chinese Medicine Syndromes Distribution of Coronary Atherosclerotic Heart Disease|| |
Classification by before and after percutaneous coronary intervention
PCI is the most common treatment for CHD. It can immediately relieve clinical symptoms by placing the stent at the site of vascular stenosis or occlusion. According to the time of PCI in patients, CHD can be divided into two stages, before PCI and after PCI, to analyze the changes in the pathogenesis and syndrome of coronary heart disease. The results showed that, compared with before operation, symptoms such as chest fullness and chest pain were effectively alleviated. However, the symptoms such as aversion to cold, fatigue, and abdominal distension were not significantly alleviated.
Before the operation, the pattern of phlegm turbidity obstruction and heart blood obstruction patterns were more common. After the operation, the pattern of phlegm turbidity obstruction, pattern of dual deficiency of qi and yin, and heart-kidney yang deficiency pattern were the main symptoms. Although the pathogenesis before and after PCI is mainly based on virtual reality, the proportions of deficiency patterns and excess patterns are different., However, studies found that the rate of in-stent restenosis was increasing annually, and the incidence of poor postoperative prognosis or angina pectoris was high. With the extension of the course of disease after PCI, most patients still complain of chest pain. The clinical syndrome types mainly include blood stasis pattern and the pattern of qi deficiency with blood stasis. The difference between before and after PCI was gradually reduced.,, This may be related to the injury of the local vein by interventional therapy. In addition, the application of anticoagulants after surgery cannot relieve the symptoms of the qi deficiency pattern. It is thus suggested that PCI may alleviate the symptoms of patients within a short period of time. However, it is difficult to fundamentally address the pathogenic factors. The distribution of TCM syndrome types before and after PCI is shown in [Figure 1].
|Figure 1: The syndrome characteristics of coronary atherosclerotic heart disease patients before and after percutaneous coronary intervention|
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Classification by disease progression
Stages of coronary atherosclerotic heart disease
Some scholars have divided CHD into four stages: Stable, active, interventional, and end stages. In general, the proportion of blood stasis pattern is the largest, whereas the proportion of blood deficiency syndrome is the lowest among the four stages. Among them, blood stasis pattern, phlegm turbidity pattern, qi deficiency pattern, yin deficiency pattern, and yang deficiency pattern are the main patterns in the stable stage, with qi deficiency pattern and blood stasis pattern accounting for the highest proportion and phlegm turbidity pattern accounting for the smallest proportion. Internal toxin patterns and patterns of retained heat are the main syndromes in the active stage. The Yang deficiency pattern and qi deficiency pattern are the main patterns after interventional therapy, with the proportion of excess pattern reduced.
In the end stage, phlegm pattern, water retention pattern, blood stasis pattern, yin deficiency pattern, yang deficiency pattern, and qi deficiency pattern are the main patterns, while one half accounts for the deficiency pattern, and the other half accounts for the excess pattern.,,, CHD not only has the same etiology and pathogenesis throughout the whole process of the disease but also has different dynamic changes in each stage. The above studies are presented in [Table 1].
|Table 1: Syndrome characteristics of coronary heart disease in stable, active, after interventional therapy, and end stage|
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The stages of coronary atherosclerotic heart disease
According to the changes in the occurrence and development of CHD, some studies have divided CHD into the early, acute, remission, and convalescent stages. Among them, the pattern of qi stagnation in the chest and the pattern of dual deficiency of qi and yin are the main patterns in the early stage. The pattern of cold congealing in heart vessels, pattern of blood stasis and yang deficiency, pattern of qi stagnation and phlegm obstruction, and pattern of heart yang deficiency are the main patterns in the acute stage. The heart − kidney yang deficiency pattern, heart − lung qi deficiency pattern, and pattern of liver depression and spleen deficiency are the main syndromes in the remission stage; heart qi deficiency pattern, pattern of dual deficiency of qi and yin, pattern of yang deficiency, and qi stagnation are the main syndromes in the convalescent stage. The four stages are related to overwork, bad mood, and cold weather. The syndrome factors are related to cold, phlegm, qi, blood stasis, and deficiency of the heart, lung, spleen, and kidney. The above contents are provided in detail in [Table 2].
|Table 2: Syndrome characteristics of patients with coronary heart disease in the early stage, acute stage, remission stage, and convalescent stage|
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Syndrome characteristics of coronary atherosclerotic heart disease in different age groups
With the growth and development of the human body, the body's viscera, qi, and blood also change. The physiological characteristics and pathology vary in different age groups; therefore, different clinical symptoms and syndrome characteristics are associated with varying age. Thus, considering the age of patients is important for classifying TCM syndromes of CHD.
Patients can be divided into premature CHD and nonpremature CHD according to their age at CHD onset. In general speaking, the patients' coronary arteries with premature CHD mainly have single branch lesions and less severe lesions. In men, premature CHD is associated with higher serum triglyceride (TC), total cholesterol (TG), low-density lipoprotein cholesterol, and platelet and increased body mass index. In women, premature CHD is associated with a higher serum TC level., Furthermore, blood stasis pattern is the most common type of premature CHD., Zhai et al. found that the pattern of qi deficiency with blood stasis, foul turbidity and phlegm obstruction, and qi stagnation and blood stasis were the main syndromes in patients with premature CHD. On the other hand, patterns of qi stagnation and blood stasis, phlegm obstructing the heart vessels, and qi deficiency with blood stasis were the main syndromes in patients with nonpremature CHD. Zhu et al. pointed out that the pattern of phlegm turbidity and blood stasis was the main syndrome of premature CHD. In this pattern, the method of activating blood and resolving stasis, resolving phlegm, and moving qi to treat diseases have a better effect.
According to the WHO age segmentation standard, CHD can be divided into four age groups: Youth, middle-aged, junior elderly, and senior elderly. The study found that excess pattern is the main syndrome in young and middle-aged patients, while deficiency pattern is the main syndrome in elderly patients. Blood stasis is the main syndrome factor in middle-aged patients, and the pattern of qi deficiency with blood stasis and pattern of phlegm obstructing the heart vessels are the common syndromes of CHD in all ages. Among them, the onset of CHD at about 40 years of age was characterized by a single coronary artery disease and acute onset. A family history of CHD, diabetes, hyperlipidemia, and smoking was the important risk factors. The pattern of qi stagnation and blood stasis accounts for the largest proportion of patients aged 40–60 years. This may be attributed to body constitution and emotional characteristics. Yang and qi deficiency patterns appear in patients aged over 61 years, which is significantly related to yang qi deficiency and disease severity in elderly patients.,, The difference in syndrome characteristics in various age groups is related to the physiological characteristics and emotional changes in this age group. Excess patterns are more common in young and middle-aged patients, and deficiency patterns are more likely to appear in elderly patients. Congenital hereditary factors, bad living habits, and bad eating habits are closely related to patients with younger disease onset. The details are listed in [Table 3].
|Table 3: Syndrome characteristics of coronary heart disease in different age groups|
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| Traditional Chinese medicine Syndrome Characteristics of Coronary Atherosclerotic Heart Disease and its Complicated Disease in Different Stages|| |
Clinically, coronary heart disease is often associated with heart failure, hypertension, diabetes, chronic kidney disease, and cerebral infarction, among other diseases. According to the different characteristics, pathogenesis transformation, and clinical manifestations of CHD and its complicated disease, they can be divided into different stages.
Coronary heart disease complicated by heart failure
According to the guideline for the diagnosis and treatment of chronic stable angina pectoris and the guideline for the diagnosis and treatment of chronic heart failure (2007 Edition), the clinical symptoms, cardiac structure, and dynamic changes in cardiac function of patients, CHD complicated with heart failure can be divided into preheart failure, preclinical heart failure, clinical heart failure, and end stages. There are obvious differences in chest pain, respiration, arrhythmia, and changes in the face, lip, throat, and neck pulse at each stage. The main qualitative syndrome factors include yang deficiency, qi deficiency, blood stasis, and phlegm-fluid. The main disease locations were the heart and spleen. The pathogenetic condition of CHD complicated with heart failure patients is more serious. Hence, in different stages of disease development, clinical syndromes are significantly different and the deficiency and excess of the disease are more complex.
Coronary heart disease complicated with hypertension
CHD complicated with hypertension is a common clinical comorbidity. It is mainly divided into four stages: Stages 0–3. The main syndrome factors are wind, qi stagnation, blood stasis and emotion, and ascendant hyperactivity of the liver yang through the whole process of the disease. These show that CHD complicated with hypertension has changed from light to heavy and from simple to complex in the process of disease development. Nevertheless, its basic pathogenesis is still deficiency-excess complex.
Coronary heart disease complicated with diabetes mellitus
The quality of life of patients with CHD and diabetes mellitus is lower than that of patients with simple CHD. Their cardiovascular symptoms are not typical, and the characteristics of the tongue and pulse are more complex., According to the characteristics of disease development, CHD with diabetes is divided into the following: CHD complicated with prediabetes stage, CHD complicated with diabetes mellitus stage, and CHD complicated with chronic complications of diabetes mellitus. The syndrome factors mainly involve yin deficiency, qi deficiency, qi stagnation, and blood stasis. The disease is mainly located in the heart and spleen. It reflects the mutual influence of the pathogenesis of CHD and diabetes mellitus. In addition, it causes chronic loss of visceral qi and blood with disease development.
Coronary heart disease complicated with nephropathy
Studies have shown that CHD is an important factor affecting the morbidity and mortality of patients with chronic kidney disease and end-stage renal disease. As such, chronic kidney disease and end-stage renal disease also increases the risk of CHD; therefore, CHD complicated with nephropathy has more complex clinical manifestations., CHD complicated with nephropathy can be divided into five stages. The main syndrome factors are wind, cold coagulation, qi stagnation, and blood stasis. The pathogenesis is based on qi deficiency and yin deficiency. Pathological factors, such as qi, fire, phlegm, and blood stasis, are present in each stage of the disease. This suggests that the syndrome characteristics of CHD complicated with nephropathy have complicated pathogenesis.
Coronary heart disease complicated by stroke
CHD complicated by stroke can be divided into three stages: Acute, convalescence, and sequelae. Among them, the syndrome factors in the acute stage are mainly wind and heat, followed by spleen qi deficiency and kidney yin deficiency. In the convalescence stage, spleen qi deficiency, phlegm-fliud, spleen qi deficiency, kidney yin deficiency, liver blood deficiency, kidney yang deficiency, phlegm-fliud, and wind are the main syndrome factors. It reflects the evolution process of the disease from acute to chronic, from severe to mild. The TCM syndrome classification characteristics of CHD with its complicated disease at different stages are shown in [Table 4].,,,,
|Table 4: Traditional Chinese medicine syndrome of coronary heart disease and its complicated disease in different stages|
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| Summary and Prospect|| |
In the acute onset of CHD, the symptoms are significant; the harm is great; the course of the disease is protracted; and the risk of seriously damaging the qi and blood of the viscera and bowels is high. Therefore, early detection, timely treatment, and intervention for CHD are very important. Targeted treatment can greatly improve patients' survival rate and quality of life by identifying the syndrome of CHD at different stages.
For further studies of TCM diagnosis and treatment of CHD, we suggest that the relationship between physicochemical indicators and TCM syndromes should be determined. Moreover, the physicochemical indicators and TCM syndromes must be combined to determine the syndrome types of CHD at different stages. This is helpful in improving the accuracy of differentiating the syndrome diagnosis. According to the symptoms of different stages, we can identify the exterior, interior, deficiency, and excess of the disease to prevent and treat the disease in a timely manner in the early stage. Moreover, CHD is mainly characterized by a deficiency-excess complex pattern, and we can use current Western medicine and operations to relieve clinical symptoms of excess pattern rapidly, combined with TCM to adjust the patients' deficiency pattern. Our results indicate that due to differences in climate and eating habits in various regions, there is a great discrepancy the distribution of TCM syndromes with CHD between North and South China. Therefore, at different stages, the disease should be analyzed in combination with seasonal climate and geographical environment. The treatment should be based on the climate, locality, and individual physique. According to the diagnosis of CHD in different stages and types, clinicians could prevent the disease in the early stage, relieve patients' clinical symptoms in the acute exacerbation stage, treat CHD based on a comprehensive understanding of the basic pathogenesis, and prevent disease recurrence in the convalescence stage. Prevention and treatment of CHD through multiple means are a great advantage of TCM.
Financial support and sponsorship
This study was financially supported by The National Natural Science Foundation of China (Grant NO.82074333), Shanghai TCM Science and Technology Innovation Program (Grant NO. ZYKC201701017), Shanghai Key Laboratory of Health Identification and Assessment Construction Program (Grant NO. 21DZ2271000).
Conflicts of interest
There are no conflicts of interest.
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Shanghai University of Traditional Chinese Medicine, No. 1200 Cailun Road, Shanghai 201203
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]