by Li Yongtang
　　(The First People 's Hospital of Yuhang City, Zhejiang Province 311100)

TCM holds that angina pectoris is a pathogenic state induced by stagnant heart-Qi,
　　stagnancy of Qi and blood, or obstruction of the heart Orifice due to blood stasis or turbid phlegm. Based on TCM differentiation, the author divided angina pectoris of coronary heart disease into the following types, namely stagnation of Qi and blood, deficiency of Yin , insufficiency of Yang , deficiency of both Yin and Yang , and stagnation of Qi and phlegm-dampness. Using acupuncture treatment to relieve the symptoms, the author gained quite a good short-term therapeutic effect. Some examples are introduced in the following.

Stagnation of Qi and Blood
　　1. Clinical manifestations: Paroxysmal precordial colicky or pricking pain, accompanied with girdle sensation, chest distress, palpitation, red tongue with petechiae and little coating, and wiry-uneven-forceful pulse.
　　2. Principle of treatment: Regulating the flow of Qi, soothing chest oppression, and promoting blood circulation by removing blood stasis.
　　3. Point selection: Danzhong (CV 17), Neiguan (PC 6), Zhongwan (CV 12), Zusanli (ST 36), and SanYin jiao (SP 6) (all on both sides).
　　4. Manipulation: For Danzhong (CV17), downward-subcutaneous insertion is required. For Neiguan (PC 6), either upward-oblique insertion or perpendicular insertion should be applied to induce local needling sensation or to direct the needling sensation to the middle finger. For SanYin jiao (SP 6), the needling sensation should be made to radiate
　　to the medial side of the foot. The needles are generally retained for 20-30 minutes and manipulated once every 5 minutes.
　　5. Illustrative case: Mr. Yu, a worker of 58 years old, was often tied up by chest pain from January to May of 1996. The pain would be alleviated when he took “Kai Xiong Shun Qi Wan (Bolus for Soothing Qi in the Chest). From August 1996, he began to experience more frequent pricking pain in his left chest. The electrocardiographic examination suggested chronic coronary insufficiency. Though being treated, he still suffered from an unstable disease condition. Later, some family affairs made the pain in his left chest worsened. The frequency of episodes increased to several times a day. On examination, he was found with a purplish dull tongue with petechiae, deep-wiry-uneven pulse, and blood pressure 19.5/12kPa. After being treated with the above prescription, the patient felt that the pain was greatly alleviated and the vague pain decreased to 1-2 times a day after 3 treatments. The pain basically disappeared after 6 treatments.

Deficiency of Yin
　　1. Clinical manifestations: Paroxysmal chest distress with colicky pain, dizziness and vertigo, tinnitus, palpitation, dry throat, dysphoria with feverish sensation in the chest, palms and soles, poor sleep, dry stool, red tongue with little coating, wiry-thready pulse, and hypertention.
　　2. Principle of treatment: Nourishing Yin, suppressing the excessive Yang, and dredging the meridian and collaterals of the heart.
　　3. Point selection: Shaofu (HT8), Ximen (PC4), XinYin g (a point of liver-heat), Taixi (KI3), and Taichong (LR 3) (all from both sides).
　　4. Manipulation: Withdraw the needle from Shaofu (HT8) upon the arrival of Qi; give strong stimulation on Ximwen (PC4) or make the needling sensation radiate to the palm; for XinYin g (a point of liver heat located at 0.5 cun lateral to the middle point of the fifth and sixth thoracic vertebrae), oblique insertion for 1-5 cun, or perpendicular insertion for 0.5 cun should be performed to make the needling sensation radiate to the precardiac region of the left rib; retain the needle on Taixi (KI3) upon arrival of Qi; and give strong manipulation on Taichong (LR3) so as to produce a soreness-distension-heavy needling sensation. The time for needle retention is generally 15-20 minutes during which the needles should be manipulated once every 5 minutes.
　　5. Illustrative case: Mr. Zhao, a teacher of 44 year old, complained of left chest pain in March 1997 when he was preparing his lessons. Usually, each episode lasted 3-5 minutes. He also experienced several attacks of pricking pain in the chest during lectures, accompanied with chest distress and shortness of breath. The other accompanying symptoms and signs were colicky and tense chest pain during the night, yellow urine, constipation, red tongue with little coating, and wiry-thready pulse. The blood pressure was 23/15kPa. Electrocardiographic examination showed left axis deviation and chronic coronary insufficiency. Having been treated with the above prescription, the patient got his blood pressure down to 20/12kPa, and his left chest pain basically disappeared. 12 treatments later, his blood pressure returned to normal.

Insufficiency of Yang
　　1. Clinical manifestations: Pale complexion, sweating upon slight exertion, general weakness, cold limbs, palpitation, paroxysmal chest distress and dull pain ,profuse urine, loose or watery stool, pale tongue with thin-white coating, and normal or sliht low blood pressure.
　　2. Principle of treatment: Warming Yang , replenishing Qi, and promoting blood circulation by removing blood stasis.
　　3. Point selection: Baihui (GV 20), Quchi (LI11), Zusanli (ST36), SanYin jiao ( SP 6), and Qihai (CV 6).
　　4. Manipulation: Generally, gentle needling (reinforcing method ) should be adopted. Moxibustion can be applied on all the points except Baihui (GV 20).
　　5. Illustrative case: Shi, a worker of 48 years old, complained of paroxysmal stabbing pain in the left chest in June 1996,accompanied with shortness of breath and palpitation, which became worsened while climbing up. Electrocardiographic examination suggested chronic coronary insufficiency. The pain could be alleviated by oral nitroglycerin. The recent attack of the left-chest colicky pain was induced by hundred walking, but the oral nitroglycerin could only alleviate the pain for one hour. The patient also presented with such accompanying symptoms as profuse urine, loose stool, pale complexion, spontaneous sweating, pink tongue with little coating, thready-weak Pulse, and blood pressure 12/8kPa. After 3 treatments with the above prescription, the pain was greatly reduced, and after 6 treatments all the symptoms were alleviated.

Deficiency of Both Yin and Yang
　　1. Clinical manifestations: Chest distress with paroxysmal pain, palpitation, shortness of breath, disinclination to talking, general wetness, spontaneous sweating, vexation, insomnia, feverish sensation in the chest, palms and soles, pale or red tongue with thin white or little coating, and deep-thready-weak or thready-wiry pulse.
　　2. Principle of treatment: Regulating the balance between Yin and Yang , and replenishing and tonifying Qi and blood.
　　3. Point selection: Lieque (LU7), Houxi (SI3), Zusanli (ST36), and SanYin jiao (SP 6).
　　4. Manipulation: Moderate stimulation (uniform reinforcing and reducing method) should be adopted on Lieque (LU 7) and Houxi (SI 3). Needle retention is carried out on Zusanli (ST 36) and SanYin jiao (SP 6) upon arrival of Qi for 15-20 minutes, during which the needles are manipulated once every 5 minutes.
　　5. Illustrative case: Ms. Guo, an office staff of 43 years old, reported pricking pain in her left chest since Mad 1997. The attacks tended to be more frequent de strain and stress. She presented with a pale complexion, slight cyanosis of the lips, shortness of breath, disinclination to talking, dizziness and vertigo, red tongue with little coating, and thready-weak pulse. Examination showed hemoglobin 9.8g/L, WBC 5.2 ×109 /L, and blood pressure 12/8kPa. After 6 treatments, her chest distress was greatly improved, with only occasional dull pain in her left chest. 12 treatments later, the patient rid completely herself of all her symptoms.

Stagnation of Qi and Phlegm-Dampness
　　1. Clinical manifestations: Dizziness and vertigo, palpitation, chest distress, occasional nausea, paroxysmal precardiac colicky pain (or with serious coughing), pink-red tongue with white-sticky coating, and soft-slow or soft-rolling pulse.
　　2. Principle of treatment: Regulating the flow of Qi, soothing the chest oppression, resolving phlegm, and clearing away dampness.
　　3. Point selection: Jianshi (PC 5), Zhongwan (CV 12), Yinlingquan (SP 9), and Fenglong (ST 40).
　　4. Manipulation: Except for Zhongwan (CV 12) which needs moderate stimulation, short strong stimulation should be given to the rest 3 points. Needle retention is performed for 15 minutes, during which the needles should be manipulated once every 5 minutes.
　　5. Illustrative case: Mr. Liu, a worker of 40 years old, complained of unstable blood pressure since February 1996. He began to have chest distress and palpitation in the second half of 1996, and paroxysmal left-chest pain in early 1997 due to strain and stress. The accompanying symptoms and signs included reversed flow of Qi and cough, dizziness and vertigo, obstructed sensation in the throat after slight movement, pink tongue with white-sticky coating, and soft-slow pulse. Electrocardiographic examination showed chronic coronary insufficiency. After one session of the treatment, the obstructed sensation in the throat disappeared. After 3 treatments, the oppressed chest was soothed. And after 6 treatments, all the symptoms were gone.

Comment
　　Acupuncture has been proved to be effective in relieving or eliminating the angina pectoris, and improving the state of myocardial ischemia. But at the acute stage of the disease, acupuncture treatment should be immigrated with western medicine for emergency rescue. It has been found through clinical research that acupuncture can prolong the ejection time, increase the cardiac output, decrease the oxygen consumption of myocardium, reinforce the myocardia, lower down the preload, and improve the left ventricular compliance so as to increase the cardiac output and heighten the stroke amplitude of the left posterior ventricular wall.
　　TCM holds that angina pectoris of coronary heart disease is caused by insufficiency of chest-Yang, and stagnation of Qi and blood due to deficiency and injury of the Zang-Fu organs, imbalance of Yin and Yang as well as mental and climatic influences. T4 and T5 are the passways of the sympathehc postganglionic fibers which control the heart, where acupuncture can ensure a free flow of Qi and blood in the meridian and collaterals. Jianshi (PC 5) and Neiguan (PC 6) are two points of the Pericardium Channel, and acupuncture on them can give the effect of dredging the Pericardium Channel. Danzhong (CV 17) is the Front-Mu point of the Pericardium, so acupuncture on it can help soothe the chest oppression by regulating the circulation of Qi and blood so as to stop pain. The combined use of Sanyinjiao (SP 6) and Zusanli (ST 36) can relieve the symptoms of the spleen and stomach due to coronary heart disease. Therefore, stimulation on the above points can regulate the functions of the disturbed sympathetic nerve system so as to expand the coronary artery and increase the volume of blood flow, so that the cardiac muscle can have a sufficient supply of oxygen; and what's more, to adjust the long excited state of the sympathetic nerve, relax the tension of the surrounding vessels, reduce the resistance to the out-pumping of the heart, lower down the consumption of oxygen of the cardiac muscle, thus promoting a free flow of Qi and blood in the meridian and collaterals.