Experience Treating Coronary Heart Disease with Modified Gualou Guizhi Zhishi Xiebai Decoction Combined with Danshen Yin
The patient, Zhao, was an elderly man from Shandong with advanced cancer and concurrent coronary heart disease. Recently, he had been experiencing chest tightness and shortness of breath due to coronary heart disease, along with abdominal distension and poor appetite. Several Chinese patent medicines for coronary heart disease had not worked well, and his family sought my help. I advised him to first take a decoction for several days to rapidly relieve the symptoms, and then switch to patent medicines for consolidation once symptoms eased.
Based on the patient's main symptoms, I prescribed a combination of Gualou Guizhi Zhishi Xiebai Decoction and Danshen Yin with modifications. The formula was as follows: Tianhuafen (Trichosanthes root, i.e., Gualou root) 12 g, Guizhi (Ramulus Cinnamomi) 15 g, Xiebai (Bulbus Allii Macrostemonis) 12 g, Danshen (Radix Salviae Miltiorrhizae) 30 g, Tanxiang (Lignum Santali Albi) 3 g, Sharen (Fructus Amomi) 3 g, Yujin (Radix Curcumae) 12 g, Zhishi (Fructus Aurantii Immaturus) 6 g, and fried Baizhu (Rhizoma Atractylodis Macrocephalae) 12 g. Two doses, decocted in water, taken morning and evening. After one dose, the patient's chest tightness eased slightly. After completing the second dose, the chest tightness had essentially disappeared.
Why did this formula work so quickly for coronary heart disease? It is because both formulas used here are historically classic formulas for treating "chest impediment" (xiongbi, i.e., coronary heart disease in modern medicine); the two combined create a strong synergistic effect, making the result even more remarkable.
Gualou Guizhi Zhishi Xiebai Decoction comes from the Jingui Yaolue (Synopsis of the Golden Chamber). The formula is composed of Gualou (Fructus Trichosanthis), Guizhi, Xiebai, Zhishi, and Houpo (Cortex Magnoliae Officinalis). The Jingui Yaolue notes that its action treats "chest impediment with fullness in the heart, accumulated qi binding in the chest, chest fullness, and qi in the hypochondrium adversely rising upward to strike the heart." In short, this means chest tightness, chest pain, hypochondriac pain, abdominal distension, and adverse qi flow—a pattern of qi stagnation and blood stasis, which are the typical symptoms of coronary heart disease. The same passage also notes that "Renshen Tang (Ginseng Decoction) also treats this," indicating that Zhang Zhongjing also used Renshen Tang to treat chest impediment; the chest impediment treated by Renshen Tang should correspond to myocardial ischemia.
Xiebai in Gualou Guizhi Zhishi Xiebai Decoction is the same scallion-like bulb we commonly eat (qitou). Modern pharmacological research shows that Xiebai has a strong blood-activating and stasis-resolving effect and good therapeutic efficacy in coronary heart disease; the patent medicine Xuezhitong Jiaonang is made from Xiebai extract. It should be noted that this patient had also used Xuezhitong Jiaonang before without effect, so the efficacy of Xiebai alone for chest impediment is still limited.
In this formula, I replaced the Houpo in Gualou Guizhi Zhishi Xiebai Decoction with Baizhu, because this patient was elderly and frail; I therefore switched to Baizhu to fortify the spleen and supplement qi, to avoid Houpo consuming qi. This is a flexible, adaptable application. The combination of Zhishi and Baizhu forms Li Dongyuan's Zhishi Baizhu Wan, which broadens the chest and eliminates distension—well suited to this patient.
Danshen Yin comes from the Shifang Ge Kuo. The formula is composed of Danshen, Tanxiang, and Sharen, and treats "heart pain and various epigastric pains." Danshen Yin is the representative ancient formula for treating chest pain. Modern times also use compound Danshen dripping pills for coronary heart disease, but this patient had used this patent medicine before without good effect. This also shows that patent medicines made solely from Danshen extract are not as effective as the compound formula Danshen Yin.
Yujin is a specific herb for treating chest impediment and chest pain; adding Yujin further strengthens this formula's efficacy. Patients with coronary heart disease find chest tightness and shortness of breath very distressing; if rapid results are not achieved, they easily lose confidence in treatment. Combining multiple formulas allows the patient to feel results faster and build confidence in TCM treatment.
The formula I composed here can be used universally for chest tightness, shortness of breath, abdominal distension, and poor appetite caused by coronary heart disease, without the need for additions or subtractions. If the patient has chronic coronary heart disease, the formula may even be prepared as pills using refined honey as a binder for long-term use. For those with myocardial ischemia, this formula may be combined with Danggui Buxue Decoction (Huangqi 30 g, Danggui 6 g), plus Renshen (Radix Ginseng) or Xiyangshen (Radix Panacis Quinquefolii) 3-10 g.