Abstracts: In the present study, the author adopted acupuncture therapy to treat 300 cases of coronary heart disease by needling Tanzhong (CV 17 )-to-Jiuwei (CV 15 ), Juque(CV 14 ), Neiguan (PC 6), Zusanli (ST 36), Xinshu (BL 15), Jueyinshu (BL 14), etc. and adopting tonification manipulation. Results showed that after treatment, of the 300 cases, 204 (68.0% ) experienced significant improvement and 84 (28.0%) had improvement, the total effective rate was 96%. In 201 patients with ischemic ECG, 57 (28.4%) had marked amelioration, 93 (46.2 %) had amelioration, 39(l9.4 % ) had no any apparent change and 12 (6.0 %) worsened, with an effective rate of 74.6 %. Ultrasound cardiogram examination displayed that after acupuncture treatment, the amplitude of vibration of the back wall and the output of the left ventricle increased significantly, the nail fold microcirculation was bettered, and the blood viscosity and the vascular resistance all lowered.

Key words: Coronary heart disease Acupuncture therapy Tonification needling manipulation

Since 1975, our hospital has adopted acupuncture therapy to treat coronary heart disease and observed its therapeutic effect by employing indexes of electrocardiographic oscilloscope, ultrasound cardiogram, rheoencephalogram, nail fold microcirculation and blood rheology. We analyzed results of 300 cases of coronary heart disease and realized that acupuncture can function not only in effectively re1ieving angina pectoris, but also in lowering vasotonia and blood flow resistance, improving performance of the left ventricle and ameliorating blood circulation of the coronary artery and cerebral blood vessel and the nail fold microcirculation. In this way, both the principal and the secondary aspects of the disease were treated at the same time. It is summarized as follows.

Clinical observation:
1) General data: Coronary heart disease patients were selected according to standards formulated by National Symposium of General Survey and Prevention of Coronary Heart Disease and Hypertension held in 1974. Three hundred cases were subjected to this observation. Among them, 177 cases were male and 123 female; those with age less than 40 years accounting for 5.5 % and those above 6l years accounting for 28 %.

2) Typing and differentiation of syndromes Coronary heart disease belongs to xiongbi (Obstruction of qi in the chest) or zhenxintong (angina pectoris) in traditional Chinese medicine (TCM). It is referred to disturbance of coronary blood circulation. Due to variance of the Zang & Fu’s functions, individual difference and pathogenic factors, clinical symptoms and signs are also various. In spit of the focus being at the heart, the kidney, liver and spleen are also involved. It can be divided into 4 types: hyperactivity of yang due to yin-deficiency, deficiency of both qi and yin, stagnancy of sputum in meridians and stagnation of qi and blood stasis.
　　
3) Methods: Chief acupoints: Tanzhong (CV l7)-to-Jiuwei (CV 15), Juque (CV 14), and bilateral Neiguan (PC 6), Zusanli (ST 36), Xinshu (BL l5), and Jueyinshu (BL l4).
　　
Manipulations: All the abovesmentioned acupoints were stimulated with reinforcing needling method. In addition, when Tanzhong (CV 17) was needled, handle-scrapping method was employed, and the needle was manipulated continuously for 30 min. Thet8peutic course: The treatment was conducted once every other day, 10 sessions was as a short therapeutic course and 30 sessions as a long therapeutic course, then the acupuncture was given once or twice every week. Supplementary acupoints were added in the light of typing and differentiation of syndromes:

(1 ) Hyperactivity of yang due to yin--deficiency: Clinical manifestations are choking or stabbing pain in the precordial region, dizziness, headache, tinnitus, dryness in the eyes, restlessness, limb numbness, dryness of the mouth, dysphoria with feverish sensation in the chest, palms and soles, night sweating, dreaminess, yellowish urine, constipation, hypertension or higher blood pressure, red tongue with white or without coating, taunt pulse.

Therapeutic principles: Nourishing yin to suppress the hyperactive yang, dredging the heart meridian.

Acupoints: The aforementioned chief acupoints were used in combination with bi1ateral Taichong (LR 3) and Shenshu (BL 23).　　

Operation: Taichong(LR 3) was stimulated by using reducing method, causing the patient to experience sensations of soreness, distension, heaviness and tightness. Needles in Shenshu (BL 23 ) were manipulated with reinforcing method and retained for 30 min after achieving needling sensations.

Typical case: Mrs Liu, aged 58 years. She had been suffering from hypertension for more than l0 years, with blood pressure (BP) being 200/100 mmHg. She had underwent paroxysmal choking pain in the precordial region for 3 years, 3 -- 4 times every day, 3 -- 5 min every time, also accompanied with palpitation, vertigo, tinnitus, insomnia, dryness in the mouth, constipation, red tongue with thin white coating, taunt pulse. ECG suggested coronary insufficiency. Following 8 sessions of acupuncture treatment, her symptoms disappeared and her ECG returned to normal.

(2) Deficiency of both qi and yin
Clinical manifestations: Dull pain in the precordial region, chest stuffiness, shortness of breath (worsening during night), palpitation, lassitude and weakness, sweating if slightly moving about, soreness of the arms and shoulders, pale tongue and thin coating with less moisture, deep, thin, weak pulse or slow pulse with irregular intervals.

Therapeutic principles: Regulating yin and yang, tonifying qi and blood. Acupoint selection: In addition to the aforementioned chief acupoints, Qihai (CV 6) was taken.

Needling manipulations: Reinforcing method was adopted mainly and the needles were retained for 30 min after achieving needling sensations.

Typical case: Mr Zhang, aged 52 years. He had suffered from paroxysmal dull pain in the precordial region for 3 years, more than 10 times every day, about l -- 2 min every time. He also underwent chest stuffiness, shortness of breath, spontaneous perspiration, lassitude, pale tongue and thin white coating with less moisture, and deep pulse. ECG suggested a chronic coronary insufficiency. He was then treated with acupuncture- therapy and improved in clinical symptoms after about 10 sessions. Following 20 sessions of treatment, his symptoms disappeared and after 30 sessions, his ECG returned to normal basically.

(3) Stagnation Of sputum in meridian-collaterals
Clinical manifestations were paroxysmal angina in the precordial region, combined with cough, abundant expectoration, stuffy and full feeling in the chest, vertigo, palpitation, nausea, poor appetite, heaviness in the head as if wrapped by a piece of cloth, drowsiness and tiredness, abdominal distension and fullness, difficult urination, pale, enlarge and tender tongue with white greasy or white slippery fur, soft weak or taunt slippery pulse.

Therapeutic principles: Regulating qi and relieving mental stress, removing pathogenic sputum and dampness.

Acupoint selection: The aforementioned chief acupoints combined with Fenglong (ST40) and Zhongwan (CV l2).

Manipulations: Uniform reinforcing-reducing method was used for Zhongwan (CV l2) and reducing method applied mainly to Fenglong (ST 40).

Typical case: Mrs Deng, aged 44 years, paroxysmal angina in the precordial region for more than a year, 3 -- 4 times daily, 1 -- 2 min every time, cough, abundant sputum, chest stuffiness, palpitation, abdominal distension and fullness, reddish tongue with white greasy fur. Electrocardiographic oscilloscope suggested a chronic coronary insufficiency. After acupuncture treatment with the above-mentioned acupoints and needling manipulations was given to her, she immediately felt comfortable in the chest and ECG ST II, III, aVF, V5 went up to the base line from oblique downward 0. 1mV
below the base line, and T II, III, aVF V5 became erection from diphasic waves.　

(4) Stagnation of qi and blood stasis
Clinica1 manifestations: Paroxysmal angina or stabbing pain in the precordial region, fullness in chest, shortness of breath, palpitation, deep purple tongue or with ecchymoses, and with less fur, slippery, forceful or deep pulse.

Therapeutic principles: Regulating qi to soothe the chest oppression, promoting blood circulation to remove blood stasis.

Acupoint selection: The above-mentioned main acupoints in combination with Qihai (CV6), Xuehai (SP 10) and Geshu (BL 17).

Manipulations: Reinforcing needling method was used preferentially, adding moxibustion over Qihai (CV 6).

Typical case: Mrs Zhao, aged 5l years. She suffered from paroxysmal stabbing pain in the precordial region during the past 2 years, more than 10 times daily, 5 -- 10 min every time, choking feeling in the chest, palpitation, shortness of breath. deep purple tongue with ecchymoses and with less fur, and deep pulse. ECG suggested left heart insufficiency. About 1 min after acupuncture treatment with the aforementioned acupoints, her ECG TV5 turned to erection from biphasic wave, and the patient felt comfortable in the chest at once.

Results: The therapeutic effect was analyzed in accordance with national united standards revised in l979.
(l ) Angina pectoris: After one course of treatment, of the 300 cases, 204 (68% ) had marked improvement, 84 (28% ) had improvement, 9 had no changes and 3 worsened, the total effective rate was 96 %.
(2) The relationship between angina and the therapeutic effect
　　The angina pectoris was divided into severe, moderate and mild classes, respectively containing 60, 183 and 57 cases. The effective rates were 95%, 95% and l00%. Statistical analysis showed no significant difference among the three groups (P >0. l).
(3 ) ECG: ECG showed myocardial ischemia in 201 cases, arrhythmia in 51 cases, remote myocardial infarction in 48 cases. After treatment, 57 cases (l9%) had striking improvement, 93 (31% ) had improvement, 138 (46% ) had no changes and 12 (4 % ) aggravated, the effective rate was 50 %.
(4) State of application of Nitroglycerin after acupuncture
Before acupuncture, of the 300 cases, 261 took Nitroglycerin frequently, following acupuncture treatment, 2l0 (80. 5% ) stopped taking this drug, 42 (16. l% ) decreased the dosage and 9 (3. 4% ) cases continuously took the original dosage. While no one case aggravated. During acupuncture treatment, the therapeutic principles were flexible and often changed based on the concrete situations of the patients.

Summary: After acupunture treatment, of the 300 cases of coronary heart disease, the total effective rates of symptoms and ischemic ECG were 96 % and 74. 6% respectively. It indicates that acupuncture is significantly effective for treatment of coronary heart disease.

Discussion:
1.Differentiation of syndromes and treatment of coronary heart disease　According to the theory of TCM, coronary heart disease belongs to the mixed syndromes of both deficiency and excess, i. e., deficiency in origin and excess in superficiality. In clinic, it was found that despite variances in the cause of disease, pathogenesis and symptoms and signs, the blood stasis syndrome exists in nearly all the coronary heart disease patients, manifested by angina pectoris, deep purple tongue with ecchymoses, disturbance of microcirculation (indicated by nail fold microcircu1ation), increase in blood viscosity and blood lipid, as well as lowering in RBC electrophoretic rate. In differentiation of syndromes, deficiency and excess of the superficiality and origin of this disease should be understood first. In regard to the excess in superficiality, we should identify sputum syndrome or blood stasis syndrome, while concerning deficiency in origin, we need to distinguish yin-or yang, qi-or blood-deficiency type. When it is treated, the excess of superficiality should be considered first, then it is followed by treatment of the origin. If needed, both the symptoms and cause of angina pectoris are treated at the same time. For eliminating pathogens to treat superficiality, therapeutic principles of promoting blood circulation and removing blood stasis, warming and activating chest-yang, dispelling pathogenic sputum are adopted predominantly; and for strengthening body resistance to consolidate the constitution, principles of warming yang, reinforcing qi, nourishing yin or tonifying the kidney are used.

2. The effect of acupuncture therapy for emergency treatment of acute myocardial infarction Regarding treatment of acute myocardial infarction, clinical practice demonstrates that when administration of drugs could not achieve satisfactory results in suppressing violent colic induced by myocardial ischemia, acupuncture stimulation often works well. In addition, acupuncture can relieve patients fright feeling, and lower sympathetic excitability to slow down the heart rate, hence, reducing the possibility of arrhythmia. It can also lighten the degree of myocardial injury and reduce the range of myocardial infarction and the occurrence of complications.

3. Selection of acupoints
During treatment of coronary heart disease, we Selected "shu" and" mu" points of the yin-and yang-meridian, exterior and interior meridians in combination. Jueyinshu (BL l4) the " shu-point" of the pericardium, was used in combination with Tanzhong (CV 17), the" mu-point" of the pericardium and a converging point of qi, to promote circulation of qi and blood; Xinshu (BL 15), the" shu-point" of the heart was employed in combination with Juque (CV14), the “mu-point"of the heart, to dredge meridian qi. The above-mentioned four acupoints were used together for nourishing the kidney, invigorating qi and blood, replenishing yin and restoring normal function of the body to consolidate the constitution. Zusanli (ST 36) can function in tonifying the kidney, reinforcing qi and blood, and removing pathogenic dampness. Sanyinjiao (SP 6) can function in dredge meridians, eliminating blood stasis and dampness. In addition, Sanyinjiao(SP 6) serves as a converging point of the Liver, Spleen and Kidney. Meridians and thus is capable of reinforcing the spleen, liver-yin and kidney-yang. Neiguan (PC 6) can get rid of pathogenic heat in the chest, promote diuresis and remove dampness to accelerate free flow of qi. These three acupoints were employed together could treat the secondary aspects of the coronary heart disease including sputum-dampness, blood stasis, etc. The aforementioned 7 acupoints of yin- and yang, exterior- and interior- meridians were used in combination and could treat the symptoms and causes at the same time, balancing qi and blood by way of connection among yin- and yang meridians, Zang and fu-organs.

4. Mechanisms of the effect of acupuncture in treatment of coronary heart disease
It is wel1 known that angina pectoris results from decrease of coronary blood flow and myocardial ischemia. The above-mentioned results indicated that after acupuncture treatment, the amplitude of vibration of the back wall of the left ventricle and the cardiac output increased significantly, vascular resistance and blood viscosity lowered, thus, improving coronary circulation, lessening cardiac pre- and post-1oad, and lowering myocardial oxygen consumption. As a resu1t, angina pectoris was relieved at last.
　　In a word, from long-term clinical experience, I realize that acupuncture therapy is a good method for coronary heart disease both in treating the superficiality and origin and in emergency treatment. Therefore, it is well received by the coronary heart disease patients.

By Sun Xuewen