Congestive Heart Failure (CHF) Colorado

Congestive heart failure is a condition that occurs at the late stages of heart disease, when myocardial contraction is significantly weakened, and the cardiac output so severely diminished as not to meet the blood demand by the body's tissue cell metabolism. It is marked by venous blood blockage and stasis and related symptoms. In traditional Chinese medicine, this condition falls into the categories of palpitation, severe palpitation, edema, phlegm retention, and obstruction of the heart-qi.

Heart diseases invariably have their origin in insufficiency of the heart-qi and the lung-qi caused by either exopathogens and internal injuries, or irregular diet and unfulfilled emotional needs. Left unattended, that insufficiency progresses to weaken the function of the kidney, which in turn fails to sustain normal heart-yang and spleen-yang activities. When the latter happens, clinical symptoms such as shortness of breath, aversion to cold in the extremities, and palpitation begin to materialize. On the other hand, prolonged suffering from qi insufficiency causes the generation of yin fluids to dwindle, resulting in insufficiency of both qi and yin, or impairment of both yin and yang. With the functions of the lungs, the spleen, and the kidneys impaired, the body's water metabolism becomes dysfunctional, and water retention (edema) is inevitable, which, for the mere fact that water retention and blood stasis are each other's pathogenesis, also leads to blood stasis.

Therefore, heart failure is a condition rooted in insufficiency and manifested by excessive symptoms. That is, insufficiency in qi and yang manifested by blood stasis and water retention.

Ingredients: Ren Shen (Ginseng), Mai Dong (Ophiopogon Root), Wu Wei Zi (Schizandra)

Clinical Application:
Zhang used a modification of Sheng Mai San to treat 25 cases of heart failure in pulmonary heart disease, with satisfactory results.(1)

Pan, et al. treated 60 cases of chronic cardiac insufficiency with a formula called Jiu Xin Tang (heart-rescuing decoction). The formula consisted of: Ren Shen, Mai Dong, Wu Wei Zi, San Qi, processed Fu Zi, Gan Jiang, Dan Shen, processed Gan Cao, and Fang Ji. A total effective rate of 93.33% was reported.(2)

Niu, et al. treated 64 cases of congestive heart failure with a formula called Xin Shuai Tang (heart failure decoction). The formula consisted of: Ren Shen (or Tai Zi Shen), Wu Wei Zi, Bai Zhu, Mai Dong, Yi Mu Cao, Fu Ling, Che Qian Zi, Ting Li Zi, Huang Qi, and Dan Shen. The results: 38 cases significantly improved, 24 cases improved, 2 cases with no response; the total effective rate was 96.9%.(3)

Wang treated 32 cases of congestive heart failure based on the principle of treating stasis and retention with herbs that are pungent in flavor and warming in property. She included these herbs in her formula: Dang Gui, Chuan Xiong, Qiang Huo, Huang Qi, Ze Xie, He Huan, Gua Lou Ren, Fu Ling, Zhu Ling, Mu Xiang, Bai Zhu, and Xi Xin. The results: 16 cases were resolved, 9 cases significantly improved, 4 cases improved, and 3 cases with no response.(4)

Treatment with Chinese Patent Medicine
Jiang, et al. treated 32 cases of chronic congestive heart failure with Xue Fu Zhu Yu Kou Fu Ye (an oral medication for removing blood stasis). The patent medicine was made from Tao Ren, Hong Hua, Chuan Xiong, Chi Shao, Sheng Di Huang, Dang Gui, Chai Hu, Shao Yao, Zhi Ke, and Gan Cao. The medication was administered 10-20ml a time, three times a day. The results: 26 cases significantly improved, 5 cases improved, and 1 case with no response; the total effective rate was 96.8%.(5)

He, et al. randomly divided 100 congestive heart failure patients into three groups. Group A, with 33 patients, were treated with digoxin; Group B, with 34 patients, were treated with a patent formula called Xin Shuai He Ji (heart failure mixture) consisting of these herbs: Huang Qi, Ren Shen, Zao Ren, Dang Shen, Wan Nian Qing, and Ze Xie; and Group C, with the remaining 33 patients, were treated with both digoxin and Xin Shuai He Ji. The results: Groups A, B, and C, respectively, had 16, 19, and 29 cases that significantly improved; 12, 11, and 11 cases that improved; and 5, 4, and 2 cases with no response; the three groups had a total effective rate of 84.8%, 88.2%, and 93.9%, respectively.(6)

Wan, et al. treated 38 cases of chronic heart failure with Qiang Xin Jiao Nang (cardiotonic capsules). The herbs used in making the patent medicine included Ren Shen, Huang Qi, Fu Zi, etc. The medicine was administered to the patients four capsules at a time, three times a day. In addition to the medication, the patients were also put on a low-salt diet. The results: 22 cases significant improved, 15 cases improved, 1 case with no response; the total effective rate was 97.2%.(7)

Chen, et al. treated 35 cases of chronic congestive heart failure with IV injection of 60-100ml of Shen Mai Zhu She Ye plus 200ml of 5-10% glucose solution. Shen Mai Zhu She Ye was a solution made from Ren Shen and Mai Dong. One unit of treatment consisted of 15 injections. The results: 11 cases significantly improved, 19 cases improved, 5 cases with no response; the total effective rate was 85.7%.(8)

In treating 58 congestive heart failure patients, Xu, et al. compared the effects of Shen Mai Zhu She Ye and dobutamine, and reported that the former had a significantly higher total effective rate (96.6% vs. 81.3%, P<0.001).(9)

Wei, et al. treated 40 cases of chronic congestive heart failure with Shen Fu Zhu She Ye. The patients were treated with a daily IV injection of 100ml of the patent medicine plus 150ml of 5% glucose solution, and one unit of treatment consisted of 20 injections. The results: 19 cases significantly improved, 15 cases improved, 6 cases with no response; the total effective rate was 85%; both the blood pressure and heart rate showed a significant difference before and after the treatment.(10)

Differentiation Treatment
Based on traditional Chinese medicine's theory of treating diseases by differentiating symptoms and signs, Liang, et al. treated 80 cases of chronic congestive heart failure by applying different treatments to the following subgroups: patients with insufficiency of the heart and kidney-yang, patients with blood stasis due to qi insufficiency, patients with water retention due to yang insufficiency, patients with depleted heart-yang, and patients with both qi and yin insufficiencies. The results: 46 cases significantly improved, 26 cases improved, and 8 cases with no response; the total effective rate was 90%.(11)

Similarly, in treating 86 chronic congestive heart failure patients, Tan, et al. applied different treatments based on the differentiation treatment theory. Specifically, patients with heart-qi insufficiency were treated with Dang Shen, Huang Qi, Dan Shen, Bai Bu, Suan Zao Ren, and processed Gan Cao; patients with both qi and yin insufficiencies were treated Ren Shen, Sha Shen, Dan Shen, Bai Zi Ren, processed Gan Cao, Mai Dong, Sheng Di Huang, and Wu Wei Zi; patients with blood stasis due to qi insufficiency were treated with Ren Shen, Dang Dui, Yi Mu Cao, Dang Shen, Dan Shen, Chi Shao, Gua Lou Ren, and San Qi; patients with heart-yang insufficiency were treated, with Ren Shen, processed Fu Zi, Fu Ling, Gan Jiang, Gan Cao, Gui Zhi, and Bai Zhu; patients with water retention due to yang insufficiency were treated processed Fu Zi, Fu Ling, Zhu Ling, Ting Li Zi, Che Qian Zi, Dan Shen, Yin Yang Huo, Bai Zhu, Gui Zhi, and Ze Xie; patients with phlegm retention were treated with Ren Shen, Dan Shen, soaked Ban Xia, Gua Lou, Xie Bai, Bai Jie Zi, Fu Ling, Ting Li Zi, Xi Xin, Gan Jiang, and Gan Cao; patients with both depleted yin and yang were treated with Ren Shen, Long Gu, Mu Li, processed Fu Zi, Zao Pi, Bai Shao, Rou Gui, Gan Jiang, Dang Gui, processed Gan Cao, and Huang Qi. The results: 26 cases significantly improved, 52 cases improved, 8 cases with no response; the total effective rate was 90.7%.(12)

In treating 60 cases of congestive heart failure of the heart and kidney-yang insufficiency type, Luo used a modification of the formula Zhen Wu Tang. The modified formula contained these herbs: Fu Ling, processed Shao Yao, processed Fu Zi, Bai Zhu, Sheng Jiang, Ren Shen, and Ting Li Zi. One unit of treatment consisted of 21 days. A comparison group of 21 cases was treated with Xin Bao Wan (heart-treasuring bolus). The results: of the treatment group, 29 cases were resolved, 6 cases significantly improved, 21 cases improved, and 4 cases with no response, with a total effective rate of 93.33%; in comparison, the respective numbers for the comparison group were 7, 3, 5, 6, and 71.4%.(13)

In treating chronic cardiac insufficiency, Shi, et al. became aware that some patients complained about spasm and pain in the toes after being treated with digitalis. Calcium was not a viable remedy for these patients as it would enhance the related toxicity of digitalis. Therefore, they used acupuncture as an alternative. In their acupuncture treatment, the acupoints Taichong (Liv 3), Sanyinjiao (Sp 6), and Hegu (LI 4) were treated by the reinforcing method. The results: 29 cases were significantly improved after one session, 2 cases were significantly improved after two sessions, and one case was significantly improved after three sessions; the total effective rate was 100%.(14)

Hu treated 15 cases of acute left heart failure by needling the acupoints Lieque (Lu 7) and Neiguan (P 6). The results: all clinical symptoms disappeared; 14 cases had their heart rate decreased by 20 beats/minute, and the remaining one case had the heart rate decreased by 10 beats/minute.(15)