Traditional Chinese Medicine (TCM) for Angina

Commonly recognized as chest pain, angina pectoris is a symptom of a heart condition known as coronary artery disease (CAD). Angina occurs when insufficient amounts of oxygen-carrying blood reach a portion of the heart, resulting in a squeezing feeling in the chest, arms, shoulders, neck or back. Using government research and statistics, the American Heart Association estimates that approximately ten million Americans suffer from angina and about a half-million new cases of stable angina occur each year. Roughly 5% of American men and women have angina.

Prior to the development of modern pharmaceutical drugs, doctors of Traditional Chinese Medicine (TCM) treated angina and other symptoms of coronary artery disease through the use of acupuncture, herbal remedies, qigong and tai chi. Today, these Oriental Medicine therapies are proving to still be useful as complementary and alternative treatments for cardiovascular disorders.

Traditional Chinese Medicine (TCM) Treatments for Angina

Traditional Chinese medicine (TCM) approaches to cardiovascular conditions combine physical, psychological, and pharmaceutical strategies that include herbal remedies, diet changes, acupuncture, and manipulations designed to improve the body's energy flow.

All major TCM treatments have been extensively researched in human and animal models. The results range from "no effect(s)" to "significant effect(s)." Studies done in different countries may use different standards and protocols, making comparisons between results difficult. Cardiovascular treatments are among the most frequently studied because of the significant number of sufferers, the severe effects on lifespan and health of many cardiovascular conditions, and the high expense of allopathic treatment.

Studies of angina patients in Asia, Europe, and North America indicate some degree of efficacy when acupuncture is used alone and in conjunction with other therapies, including herbal remedies, shiatsu massage, and conventional Western treatments.

In Traditional Chinese Medicine (TCM) theory, angina can result from several types of syndromes. It can occur when qi and blood stagnate in the heart, when there is a blockage in chest yang, obstruction of the heart by heat, cold, or phlegm, or when there is a deficiency in qi and yin of the kidney and heart. Qi is energy that moves through the channels (meridians) of the body, connecting the surface of the body to the internal organs. When qi is stagnant, then the balance between yin and yang are affected and deficiency occurs. In order to stimulate the movement of qi and to restore balance in the system, specific acupoints present along the meridians are stimulated, herbal medicine are used to balance the energy, or physical exercises like qi gong and tai chi are used to self-regulate the body.

Acupuncture for Angina

Studies indicate that acupuncture treatments in conjunction with patient education result in significant improvements over either intervention alone. In both Chinese and some Western studies, the frequency and severity of angina attacks were reduced following acupuncture treatments.

The results of animal model studies investigating the use of acupuncture for heart-related conditions indicates acupuncture at the Neiguan area (or Pericardium 6 — PC 6) may strengthen myocardial contractions by preventing earlier physiologic processes involved in angina attacks. Another team of researchers suggested in a 2006 study that acupuncture at the PC 6 and PC 4 acupoints might improve the stroke volume of the heart by enhancing the contractility of the left ventricle wall.

Other acupoints that may help alleviate angina when they are stimulated are Xinshu (B 15) and Shanzhong (Ren 17). Additional, several points on the fingertips, including Zhongchong (PC 9), Shaochong (HT 9), and Shaoshang (Lu 11), are highly effective for acute cases of angina.

An acupuncturist will choose the most effective acupuncture points for angina based upon your constitutional and the current symptoms you are experiencing.

Chinese Herbal Medicine for Angina

Chinese herbal remedies numbering in the thousands, from simple teas to complex decoctions (extracts obtained by boiling down a substance), are the most widely known and used component of Traditional Chinese Medicine (TCM). Various studies over the past two decades suggest that between 25% and 50% of cardiovascular patients are using herbal remedies.

The principle behind using herbal remedies is to stimulate the regular flow of qi through the meridians in order to restore the balance between yin and yang. By encouraging qi to flow freely without obstruction, blood circulation is restored and the pain of angina diminishes. Specific Chinese herbal medicine formulas include Bao Yuan Tang (Protect the Source Decoction) for Heart Qi deficiency, Xue Fu Zhu Yu Tang (Stasis in The Mansion of Blood Decoction) for qi and blood stagnation, and Gua Luo Xie Bai Bai Jiu Tang (Trichosanthes Fruit, Chinese Chive, and Wine Decoction) for Heart Yang deficiency with Phlegm. These formulas contain such ingredients as trichosanthes fruit (from the gourd family), macrostein onion, pinellia tuber, Chinese chive, safflower, and Chinese angelica root, to name a few.

When using Chinese herbal medicine, the practitioner will customize the herbal prescription to meet the specific needs of your condition. A variety of single herbs are commonly added or subtracted to maximize the clinical effectiveness of the treatment.

Qigong and Tai Chi Exercise

The physical activities qi gong and tai chi help the body and the mind through concentration and precise movements that gently stretch and energize the body. The resulting harmony unblocks energy flow—or, in the Western perspective, improves respiratory, circulatory, and cardiovascular activity. A major advantage of tai chi exercise is its adaptability; effective routines can be designed for practitioners of any age and in any physical condition, including those with disabilities or limited mobility. Tai chi is an option for low- and intermediate-risk cardiovascular patients, both before and after surgery, due to its low impact, meditative nature.

A Chinese study that included women with coronary heart disease found significant reductions in frequency and severity of angina attacks as well as a lowering of blood pressure following a course of qigong exercise. Another study showed that patients' general health, blood pressure, bodily pain, social functioning, and depression were all improved following a 16-week course of qigong (the ancient Chinese healing art comprised of meditation, and controlled movement and breathing).

Treatment Risks

• Acupuncture and massage have an extremely low risk when performed by a trained and experienced professional. Every acupuncturist should possess a license to practice as regulated by his or her state.

• Exercise programs should be undertaken after discussion with a healthcare provider. Seek an experienced qigong or tai chi instructor to receive proper guidance in these exercises.

• Herbal compounds have the potential to harm as well as heal, as do all medicines. The active ingredients in some herbs and herbal compounds interact with other herbs as well as prescription and over-the-counter medicines. Consultation with a Chinese herbalist, as well as a physician, is always recommended.

What is Traditional Chinese Medicine (TCM)?

Traditional Chinese medicine (TCM) is based on the theory that the human body and mind function through the flow of certain forces (yin and yang) and a “vital energy” (qi). The production and circulation of yin, yang and qi are controlled by systems consisting of complementary organs, such as the liver and gallbladder, lung and large intestine, and spleen and stomach. Each organ system is associated with one of the five essential elements that make up the human body: wood, metal, earth, fire, and water. The goal of TCM treatments is to stimulate the appropriate organs and the meridians (or channels) through which qi, yin and yang flow to achieve proper movement and balance of these elements.

What is Angina Pectoris?

There are three types of angina—stable, unstable, and variant. Stable angina is the most common form of angina. It follows a pattern that can be predicted. The pain and tightness of the chest and possibly the arm, shoulder, neck, and back occur when the heart is overexerted. Stable angina can be controlled and it does not necessarily indicate that a heart attack is eminent. Unstable angina cannot be predicted and it occurs when the body is at rest or being overexerted. It is not as common as stable angina and it requires immediate medical intervention, as it can indict a heart attack. Variant angina is less likely to occur. It happens when the body is at rest and usually during the nighttime. It is an acute pain that can be relieved with medication.

Additional Resources

Ballegaard S., Jensen G., Pedersen F., Nissen V.H. (1986): Acupuncture in severe, stable angina pectoris: A randomized trial. Acta Medicine Scandinavia 220(4):307-313.

Kim D.D., Sanchez A., Duran R.G., Kanetaka T., Duran W.N. (2007): Endothelial nitric oxide synthase is a molecular vascular target for the Chinese herb Danshen in hypertension. American Journal of Physiology and Heart Circulation Physiology 295(5)H2131-H2137.

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