TCM and Geriatric Cardiovascular Disorders
By Dr. Hong-Yen Hsu
According to the National Health Examination Survey, about 5 million Americans have ischemic heart disease (IHD). It is the leading cause of death in males over age 35 and in all persons over age 45. For both sexes, there is more than a fivefold increase in the incidence of
myocardial infarction, a form of IHD, in the 40-to- 60-year-old population when compared with persons younger than 40. In those 65 and older without a history of infarction, more women than men have angina, the tell-tale sign of heart disease.
Chest pain, palpitation, and shortness of breath are the primary symptoms of heart disease, though all three symptoms need not be present for a diagnosis to be made. As a further complication, the elderly often suffer from more than one ailment, and symptoms associated with heart disease may be symptoms of other diseases as well. This overlapping of symptoms can frustrate an accurate diagnosis, as can an absence of symptoms such as palpitation and shortness of breath in patients whose physical activity has been sharply curtailed. Finally, chest pain in the elderly is sometimes not as severe as that seen in the middle-aged.
According to Western medicine, palpitation occurs when a vegetative nervous dysfunction develops, such as anemia or arrhythmia. TCM attributes palpitation to anxiety, a deficiency of heart blood, a deficiency of heart qi or yang, or kidney deficiency. In the elderly, palpitation is usually caused by qi and blood deficiency, blood stagnancy, or yin deficiency.
1. Heart qi and heart blood deficiency marked by palpitation, dizziness, lassitude, shortness of breath, poor complexion, pale lips and tongue, and thready and weak pulse or weak and soft pulse can be treated with Ginseng and Longan Combination, which tonifies qi and blood, nourishes the heart, and calms the spirit. If heart qi is severely deficient, increase the dosage of ginseng and astragalus; if heart blood is severely deficient, add raw rehmannia and cooked rehmannia. A small dosage of gardenia can be added for clearing heart heat and relieving restlessness.
2. Hyperactivity of fire due to yin deficiency and marked by palpitation, anxiety, irritability, dizziness, tinnitus, insomnia with restless sleep, heat sensation in the chest, palms, and soles; soreness and weakness in the lower back and knees, night sweats, red tongue with scant coating, and thready and rapid pulse is best treated with Ginseng and Zizyphus Formula, which nourishes yin, clears fire, tonifies the heart, and tranquilizes the mind. For severe palpitation and insomnia, add polygonum stem, dragon bone, and oyster shell.
3. Heart blood stagnancy with palpitation, chest pain, chest stuffiness, purple tongue or ecchymoses, and string-taut or hesitant pulse is commonly treated with Salvia and Cnidium Combination, which promotes blood circulation and removes blood stagnancy.
4. Heart yang deficiency characterized by palpitation, shortness of breath, aversion to cold, cold extremities, spontaneous sweating, irritability, insomnia, pale complexion, pale and flabby tongue with thin, white coating, and thready and weak pulse responds to treatment with Cinnamon and Dragon Bone Combination. This formula warms yang and arrests palpitation. For heart yang deficiency with fluid retention due to spleen yang deficiency and manifested by palpitation, dizziness, edema, and loose stools, add ginseng, atractylodes, and hoelen. If the heart is attacked by fluids retained due to kidney yang deficiency and marked by edema, palpitation, dyspnea, cold lower body, and lassitude in the loins and legs, add prepared aconite and dry ginger.
5. Qi and yin deficiency marked by palpitation, anxiety, irritability, fatigue, shortness of breath, insomnia, dry mouth, constipation, and irregular and thin pulse is commonly treated with Baked Licorice Combination, which supplements qi, nourishes yin, and restores the pulse.
Chest pain is often associated with diseases of the heart and lungs, such as respiratory tract infection, pneumonia, cardiac valvular disease, angina pectoris, cardiac neurosis, coronary heart disease, and cardiac infarction. What follows is a discussion only of chest pain associated with cardiovascular disorders.
According to TCM, kidney qi declines with age. Consequently, chest pain caused by qi deficiency and blood stagnancy is very common in the elderly. Alternately, kidney yang deficiency can result in deficiency of heart yang and yang obstruction in the chest; or kidney yin deficiency can produce excess heart fire, which transforms fluids into phlegm and blocks the meridians. Either of these two scenarios can result in chest pain.
1. Heart and kidney yin deficiency characterized by dizziness, tinnitus, chest pain, sensations of heat and oppression in the chest, palpitation, anxiety, insomnia, lassitude in the loins and knees, dry mouth, red tongue with scant coating, and thready and string-taut pulse can be treated with Ginseng and Ophiopogon Formula combined with Achyranthes and Rehmannia Combination. Both formulas nourish kidney and heart yin.
2. Heart and kidney yang deficiency with chest pain, palpitation, shortness of breath, fatigue, soreness and weakness in the loins, aversion to cold, cold limbs, pale complexion, purple tongue with thin, white coating, and deep and thready pulse or knotted and intermittent pulse is effectively treated with Ginseng and Aconite Combination combined with Eucommia and Rehmannia Combination. When used simultaneously, these two formulas warm both heart and kidney yang.
3. Qi and blood stagnancy with chest pain or colicky pain, dark purple tongue, and string-taut pulse is treated with Persica and Achyranthes Combination or Salvia and Cnidium Combination. Both formulas promote blood circulation and relieve pain.
4. Qi deficiency and blood stagnancy with chest pain, feeling of oppression in the chest, palpitation, shortness of breath, purple tongue with ecchymosis, and thready and string-taut pulse or intermittent pulse are commonly treated with Baked Licorice Combination and Pteropus and Bulrush Formula, which tonify qi and promote blood circulation. Pharmaceutical and clinical studies have been shown that salvia can increase myocardial perfusion and astragalus can improve cardiac performance. For patients with qi and/or yang deficiency or blood stagnancy, these herbs may be added to any of the above-mentioned formulas.
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