Introduction
Atherosclerosis is the common pathological basis of multiple cardiovascular and cerebrovascular events, including coronary heart disease, stroke, and peripheral arterial disease. Owing to its insidious onset, progressive course, and high disability rate, it has become a major chronic disease threatening public health. Dyslipidemia is fundamental to the development of atherosclerotic lesions. The lesions typically begin in the intima of the affected arteries, followed by intracellular and extracellular lipid accumulation, fibrous tissue proliferation, and calcium deposition. On this basis, intraplaque hemorrhage, erosion or rupture, and secondary local thrombosis may occur. According to the affected arterial site, atherosclerosis can be classified into atherosclerosis of the aorta and its branches, coronary arteries, carotid arteries, cerebral arteries, renal arteries, mesenteric arteries, and arteries of the extremities.
In traditional Chinese medicine (TCM), atherosclerosis is defined as “Bi syndrome”, referring to a systemic disease in which pathogenic factors such as phlegm, dampness, blood stasis, heat, and toxin obstruct the vessels and collaterals, adhere to the vascular channels, aggregate into masses, and fail to disperse. With prolonged disease, the pathogens enter the collaterals, causing stasis and obstruction of the vessels and the formation of accumulated masses within the collaterals, eventually leading to vascular accumulation. This further aggravates deficiency of Qi, blood, Yin, and Yang, and worsens vascular injury.
Since the publication of the Expert Consensus on the Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Atherosclerosis in 2017[
1] and the Expert Consensus on the Integrated Traditional Chinese and Western Medicine Prevention and Treatment of Atherosclerosis (2021)[
2], important guidance has been provided for standardizing integrated diagnostic and therapeutic pathways and improving the management of atherosclerosis. In recent years, substantial progress has been made in the diagnosis, treatment, prevention, and comprehensive management of AS in both traditional Chinese medicine (TCM) and Western medicine. Accordingly, this consensus incorporates the latest domestic and international research advances, with reference to the Expert Consensus on Lipid Management in Patients with Panvascular Disease (2025 Edition)[
3], the 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline[
4], and the 2025 European Society of Cardiology (ESC) guideline[
5]. Integrating clinical practice and expert experience in TCM, this consensus was led and drafted by the Department of Cardiology, The First People’s Hospital of Yunnan Province, to update the integrated traditional Chinese and Western medicine treatment strategies for atherosclerosis.
Diagnosis and assessment of atherosclerosis
Clinical manifestations
The clinical manifestations mainly depend on the symptoms caused by involvement of the relevant organs[
6].
(1) Aortic atherosclerosis: Most patients have no specific symptoms. Extensive atherosclerotic lesions of the aorta may lead to manifestations related to reduced aortic elasticity, such as increased systolic blood pressure and widened pulse pressure. X-ray examination may show upward and leftward protrusion of the aortic knob, and patchy or arc-shaped calcified shadows may sometimes be observed. Aortic atherosclerosis may lead to the formation of an aortic aneurysm and may also result in aortic dissection.
(2) Coronary atherosclerosis: In the early stage, coronary atherosclerosis may be asymptomatic. When atherosclerotic plaque accumulation causes stenosis or occlusion of the coronary lumen, myocardial ischemia, hypoxia, or necrosis may occur, leading to symptoms and signs of coronary atherosclerotic heart disease. The most common symptoms are chest tightness and chest pain; palpitations and shortness of breath may also occur.
(3) Atherosclerosis of the head and neck arteries: The internal carotid artery, basilar artery, and vertebral artery are most commonly involved. The intracranial entry site of the internal carotid artery is a predilection site, and lesions are often concentrated at vascular bifurcations. Atherosclerotic plaques may cause vascular stenosis, cerebral hypoperfusion, local thrombosis, plaque rupture, or embolization of plaque fragments, resulting in cerebrovascular events such as cerebral infarction. Long-term chronic cerebral ischemia may cause cerebral atrophy and may progress to vascular dementia.
(4) Renal artery atherosclerosis: This condition may cause refractory hypertension. In patients over 55 years of age with sudden-onset hypertension, the possibility of renal artery atherosclerosis should be considered. If renal artery thrombosis occurs, renal pain, oliguria, fever, and other symptoms may develop. Long-term renal ischemia may lead to renal atrophy and progress to renal failure.
(5) Atherosclerosis of the arteries of the extremities: The lower limb arteries are more commonly affected. Impaired blood supply may cause coldness and numbness of the lower limbs, as well as typical intermittent claudication, characterized by numbness, pain, or even spasms of the gastrocnemius muscle during walking, which resolves after rest and recurs upon walking again. In severe cases, persistent pain may occur, and arterial pulsation in the lower limbs, especially the dorsalis pedis artery, may be weakened or absent. Complete arterial occlusion may result in gangrene.
Imaging examinations
At present, sensitive and specific methods for the early diagnosis of atherosclerosis are still lacking. The diagnosis of atherosclerotic lesions involves two aspects: first, morphological assessment, including the location, extent, and severity of the lesions; and second, functional assessment, which evaluates whether atherosclerotic lesions have caused organ ischemia. The combined evaluation of morphology and function is used to guide treatment decisions, including the indications for revascularization and the selection of interventional or surgical procedures.
Ultrasonography can detect plaques in superficial arteries, such as the carotid and lower-extremity arteries, while Doppler ultrasound helps assess blood flow. X-ray examination may reveal aortic widening, protrusion of the aortic knob, and calcification of the arterial wall. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide non-invasive visualization of atherosclerotic lesions. Functional assessment combined with non-invasive imaging, such as CTA-based CT fractional flow reserve (CT-FFR), can evaluate the degree of organ ischemia.
Characteristic changes or evidence of myocardial ischemia shown by electrocardiography, echocardiography, radionuclide imaging, and stress testing are helpful for the diagnosis of coronary atherosclerotic heart disease. Selective angiography can demonstrate luminal stenosis or aneurysmal lesions. When combined with intravascular imaging techniques and invasive functional assessment, it can provide a comprehensive evaluation of both the morphology and function of the lesions, and remains one of the most important methods for diagnosing atherosclerosis. In patients with atherosclerosis, attention should also be paid to indicators related to abnormalities in glucose or lipid metabolism.
TCM syndrome differentiation
Basic syndrome patterns
Atherosclerosis may present with no clinical symptoms in its early stage. In later stages, patients may experience localized stabbing pain, distending pain, burning pain, cold pain, numbness or flaccidity of the limbs, or hard masses, local cyanotic swelling, and visible superficial blue veins. It may also be accompanied by chest tightness, chest pain, fatigue, lassitude, or a dusky complexion.
Diagnostic criteria for syndromes
(1) Intermingling of phlegm and blood stasis
Major symptoms: excessive phlegm and localized stabbing pain.
Minor symptoms: obesity, chest tightness, limb numbness or flaccidity, dizziness, or nausea.
Tongue and pulse: dark tongue with signs of blood stasis; yellow greasy, thick greasy, or dry coating; wiry and slippery pulse.
(2) Intermingling of phlegm-heat
Major symptoms: excessive phlegm, burning pain, dry mouth, or halitosis.
Minor symptoms: obesity, chest tightness and distending pain, burning pain, irritability, heaviness and fatigue, dizziness, intermittent snoring during sleep, limb numbness, dry stool or sticky and unsatisfactory defecation, and yellow or turbid urine.
Tongue and pulse: red tongue with yellow dry coating; slippery and rapid pulse.
(3) Dual deficiency of Qi and Yin
Major symptoms: fatigue and lassitude, dry mouth with little desire to drink.
Minor symptoms: emaciation, lusterless complexion, faint chest pain, weak defecation or dry stool.
Tongue and pulse: red or pale tongue with scant coating; thready and weak pulse. If accompanied by blood stasis, the tongue may be pale and dark or show purple spots, and the pulse may be deep and hesitant.
(4) Qi stagnation with blood stasis
Major symptoms: localized distension and oppression, wandering pain, or even stabbing pain aggravated by pressure.
Minor symptoms: hard masses, local cyanotic swelling, emotional depression, irritability, dusky complexion, or visible superficial blue veins.
Tongue and pulse: purple-dark tongue or tongue with ecchymoses; hesitant pulse.
(5) Yang deficiency with blood stasis
Major symptoms: stabbing pain and cold pain.
Minor symptoms: dull complexion, listlessness, aversion to cold, fatigue, and somnolence.
Tongue and pulse: pale-dark tongue, or tongue with ecchymoses and tortuous sublingual collaterals; thin white coating; deep, thready, hesitant, or weak pulse.
Treatment of atherosclerosis
General treatment
(1) Appropriate diet. A balanced diet should be followed, emphasizing dietary diversity, cereals as the staple food, and a proper combination of refined and coarse grains. The daily diet should include cereals and tubers, vegetables and fruits, livestock and poultry meat, fish, eggs and dairy products, soybeans, nuts, and other foods. For individuals with hypercholesterolemia or those at high risk of cardiovascular disease, excessive cholesterol intake should be restricted; saturated fats should be replaced with unsaturated fats; trans fatty acids should be avoided; and excessive sodium intake should be limited. For overweight and obese individuals, comprehensive management strategies, including caloric restriction and increased physical activity, are recommended to reduce and maintain body weight.
(2) Appropriate exercise. Regular physical exercise, such as Baduanjin, Tai Chi, and Five-Animal Exercises, is recommended. Regular exercise has beneficial effects on improving blood pressure and lipid profiles, lowering blood glucose, reducing obesity, and alleviating systemic inflammatory responses. Adults should engage in at least 150 minutes of moderate-intensity physical activity per week to reduce cardiovascular disease risk. For adults who are unable to meet the recommended amount of physical activity due to disease or physical condition, moderate- or vigorous-intensity physical activity below the recommended level may still be beneficial.
(3) Smoking and alcohol control. Smoking should be discouraged, exposure to secondhand smoke should be avoided, and smokers should quit as early as possible. Alcohol consumption should be avoided.
(4) Regulation of emotions and daily living. Emotional regulation should be encouraged, with a calm state of mind, reduced excessive desires, regular daily routines, and a proper balance between work and rest. Healthy sleep and a positive psychological state should be maintained.
TCM treatment
Syndrome differentiation and treatment
(1) Intermingling of phlegm and blood stasis
Treatment principle: Activate blood circulation and resolve phlegm, regulate Qi and relieve pain.
Recommended formula: Gualou Xiebai Banxia Decoction (
Jin Gui Yao Lue) combined with Taohong Siwu Decoction (
Yi Zong Jin Jian) with modifications[
7].
Composition: Trichosanthis Fructus (Gua Lou) 20 g, Allii Macrostemonis Bulbus (Xie Bai) 10 g, Pinelliae Rhizoma (Ban Xia) 9 g, Rehmanniae Radix (Di Huang) 12 g, Angelicae Sinensis Radix (Dang Gui) 15 g, Paeoniae Radix Rubra (Chi Shao) 9 g, Chuanxiong Rhizoma (Chuan Xiong) 9 g, Persicae Semen (Tao Ren) 6 g, and Carthami Flos (Hong Hua) 6 g.
Modifications: If phlegm and blood stasis transform into heat and, over time, accumulate into toxin, presenting with aggravated local pain, dizziness, blurred vision, dry mouth, and bitter taste, Chuanxiong Rhizoma (Chuan Xiong) may be removed, and Coptidis Rhizoma (Huang Lian), Phellodendri Chinensis Cortex (Huang Bai), Gardeniae Fructus (Zhi Zi), Taraxaci Herba (Pu Gong Ying), Polygoni Cuspidati Rhizoma et Radix (Hu Zhang), Puerariae Lobatae Radix (Ge Gen), Salviae Miltiorrhizae Radix et Rhizoma (Dan Shen), and Moutan Cortex (Mu Dan Pi) may be added.
(2) Intermingling of phlegm-heat
Treatment principle: Clear heat and dry dampness, resolve phlegm and unblock the collaterals.
Recommended formula: Xiao Xianxiong Decoction (
Shang Han Lun) combined with Huanglian Wendan Decoction (
Liu Yin Tiao Bian) with modifications[
8].
Composition: Trichosanthis Fructus (Gua Lou) 10 g, Coptidis Rhizoma (Huang Lian) 6 g, Pinelliae Rhizoma (Ban Xia) 9 g, Poria (Fu Ling) 15 g, Citri Reticulatae Pericarpium (Chen Pi) 6 g, Aurantii Fructus Immaturus (Zhi Shi) 9 g, Bambusae Caulis in Taenias (Zhu Ru) 6 g, Aurantii Fructus (Zhi Ke) 9 g, Acori Tatarinowii Rhizoma (Shi Chang Pu) 10 g, and Curcumae Radix (Yu Jin) 12 g.
Modifications: If phlegm-heat transforms into toxin, presenting with aggravated local redness, swelling, heat, and pain, as well as irritability, Simiao Yongan Decoction may be added, including Lonicerae Japonicae Flos (Jin Yin Hua), Scrophulariae Radix (Xuan Shen), Phellodendri Chinensis Cortex (Huang Bai), Rehmanniae Radix (Di Huang), Scolopendra (Wu Gong), Bombyx Batryticatus (Jiang Can), and Hirudo (Shui Zhi). Hirudo (Shui Zhi) may be ground into powder and taken after mixing with water.
Dual deficiency of Qi and Yin
Treatment principle: Replenish Qi and nourish Yin, activate blood circulation and unblock the vessels.
Recommended formula: Shengmai Powder (
Yi Xue Qi Yuan) combined with Renshen Yangrong Decoction (
Tai Ping Hui Min He Ji Ju Fang) with modifications[
9].
Composition: Ginseng Radix et Rhizoma (Ren Shen) 9 g (decocted separately), Ophiopogonis Radix (Mai Dong) 12 g, Schisandrae Chinensis Fructus (Wu Wei Zi) 6 g, Angelicae Sinensis Radix (Dang Gui) 9 g, Astragali Radix (Huang Qi) 30 g, Atractylodis Macrocephalae Rhizoma (Bai Zhu) 15 g, Poria (Fu Ling) 15 g, Cinnamomi Cortex (Rou Gui) 6 g (added later), Rehmanniae Radix Praeparata (Shu Di Huang) 9 g, Polygalae Radix (Yuan Zhi) 9 g, Citri Reticulatae Pericarpium (Chen Pi) 6 g, Paeoniae Radix Alba (Bai Shao) 15 g, and Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gan Cao) 6 g. Modifications: If Qi deficiency is accompanied by blood stasis, with localized chest stabbing pain and limb numbness, Persicae Semen (Tao Ren), Carthami Flos (Hong Hua), Chuanxiong Rhizoma (Chuan Xiong), Notoginseng Radix et Rhizoma (San Qi), Cinnamomi Ramulus (Gui Zhi), Olibanum (Ru Xiang), Myrrha (Mo Yao), and Spatholobi Caulis (Ji Xue Teng) may be added. If Yin deficiency is accompanied by blood stasis, with needle-like chest pain, dull complexion or malar flush, and dry desquamating skin, Scrophulariae Radix (Xuan Shen), Rehmanniae Radix (Di Huang), Paeoniae Radix Rubra (Chi Shao), Salviae Miltiorrhizae Radix et Rhizoma (Dan Shen), Moutan Cortex (Mu Dan Pi), Trionycis Carapax (Bie Jia) (decocted first), and Achyranthis Bidentatae Radix (Niu Xi) may be added. Clinical experience suggests that for patients with coronary heart disease presenting with Qi deficiency and blood stasis, accompanied by Yin deficiency with internal heat, the following prescription may be used: Ginseng Radix et Rhizoma (Ren Shen) 9 g, Astragali Radix (Sheng Huang Qi) 15 g, Centellae Herba (Ji Xue Cao) 15 g, Anemarrhenae Rhizoma (Zhi Mu) 12 g, Abri Herba (Ji Gu Cao) 15 g, Aesculi Semen (Suo Luo Zi) 6 g, Salviae Miltiorrhizae Radix et Rhizoma (Dan Shen) 15 g, Chuanxiong Rhizoma (Chuan Xiong) 10 g, Carthami Flos (Hong Hua) 10 g, Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gan Cao) 6 g, and Dioscorea opposita Thunb (Chao Shan Yao) 15 g.
(4) Qi stagnation with blood stasis
Treatment principle: Soothe the liver and regulate Qi, activate blood circulation and unblock the collaterals.
Recommended formula: Xuefu Zhuyu Decoction (
Yi Lin Gai Cuo) with modifications[
10].
Composition: Angelicae Sinensis Radix (Dang Gui) 15 g, Rehmanniae Radix (Di Huang) 12 g, Persicae Semen (Tao Ren) 6 g, Carthami Flos (Hong Hua) 6 g, Paeoniae Radix Rubra (Chi Shao) 9 g, Chuanxiong Rhizoma (Chuan Xiong) 9 g, Bupleuri Radix (Chai Hu) 6 g, Platycodonis Radix (Jie Geng) 6 g, Aurantii Fructus (Zhi Ke) 9 g, and Achyranthis Bidentatae Radix (Niu Xi) 9 g. Modifications: If blood stasis is not obvious, stabbing pain is mild, and emotional constraint is predominant, Persicae Semen (Tao Ren) and Carthami Flos (Hong Hua) may be removed. If defecation is difficult, Cistanches Herba(Rou Cong Rong) may be added.
(5) Yang deficiency with blood stasis
Treatment principle: Warm Yang and replenish Qi, activate blood circulation and resolve blood stasis.
Recommended formula: Guizhi Fuling Pill (
Jin Gui Yao Lue) combined with Danggui Sini Decoction (
Shang Han Lun) with modifications[
11].
Composition: Cinnamomi Ramulus (Gui Zhi) 12 g, Poria (Fu Ling) 12 g, Moutan Cortex (Mu Dan Pi) 9 g, Persicae Semen (Tao Ren) 9 g, Paeoniae Radix Alba (Bai Shao) 12 g, Angelicae Sinensis Radix (Dang Gui) 12 g, Asari Radix et Rhizoma (Xi Xin) 3 g, Tetrapanacis Medulla (Tong Cao) 6 g, Jujubae Fructus (Da Zao) 9 g, and Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gan Cao) 6 g.
Modifications: If Yang deficiency is prominent, with cold pain, aversion to cold, fatigue, and somnolence, Zingiberis Rhizoma (Gan Jiang) and Aconiti Lateralis Radix Praeparata (Zhi Fu Zi) (decocted first) may be added. If blood stasis is prominent, with stabbing pain as the main manifestation, Carthami Flos (Hong Hua) may be added.
Chinese patent medicines
(1) Xuezhikang Capsules[
12]
Indications and effects: Eliminates dampness and resolves phlegm, activates blood circulation and resolves blood stasis. It is indicated for hyperlipidemia of the intermingling of phlegm and blood stasis pattern, manifested as heaviness of the head, dizziness, chest oppression, epigastric fullness, obesity, dark tongue, and greasy coating.
Dosage and administration: Oral administration, 2 capsules each time, twice daily. Each capsule contains 0.3 g.
Precautions: Contraindicated in patients with active hepatitis or unexplained elevation of serum aminotransferases, and in patients allergic to this product. Blood lipids, liver function, and creatine phosphokinase should be monitored regularly. Use with caution during pregnancy and avoid use during lactation.
(2) Compound Danshen Dripping Pills[
13,
14]
Indications and effects: Promotes Qi movement and activates blood circulation, resolves blood stasis and relieves pain. It is indicated for angina pectoris of coronary heart disease due to Qi stagnation and blood stasis, manifested as fixed stabbing chest pain that worsens at night and a purple-dark tongue.
Dosage and administration: Oral or sublingual administration, 10 pills each time, three times daily. Each pill weighs 27 mg. A course of treatment lasts 28 days.
Precautions: Contraindicated during pregnancy and lactation. Use with caution in patients with allergic constitution or spleen-stomach deficiency cold. If gastrointestinal reactions occur after oral administration, sublingual administration or administration after meals is recommended. Patients with bleeding tendency or those receiving anticoagulant or antiplatelet therapy should be monitored carefully.
(3) Xinsuning Capsules[
15]
Indications and effects: Clears heat and resolves phlegm, calms the heart and relieves palpitations. It is indicated for ventricular premature beats of the intermingling of phlegm-heat pattern, manifested as palpitations, restlessness, chest oppression, irritability, dry mouth, bitter taste, insomnia, and excessive dreaming.
Dosage and administration: Oral administration, 3–5 capsules each time, three times daily. Each capsule contains 0.48 g.
Precautions: Administration after meals is recommended to reduce gastrointestinal discomfort. If nausea or other adverse reactions occur, the dose may be reduced or the medication discontinued. Use with caution in patients with bradycardia or atrioventricular block.
(4) Tongxinluo Capsules[
16][
17]
Indications and effects: Replenishes Qi, activates blood circulation, unblocks the collaterals, and relieves pain. It is indicated for angina pectoris of coronary heart disease due to dual deficiency of Qi and Yin with stasis obstructing the heart collaterals, manifested as chest tightness and chest pain, palpitations, spontaneous sweating, shortness of breath, fatigue, and purple-dark tongue.
Dosage and administration: Oral administration, 2–4 capsules each time, three times daily. Each capsule contains 0.26 g.
Precautions: Should be taken after meals. Contraindicated in patients with bleeding disorders, pregnant women, women during menstruation, and patients with stroke of the Yin deficiency with excessive fire pattern.
(5) Shexiang Baoxin Pills[
18][
19]
Indications and effects: Aromatically warms and unblocks, replenishes Qi and strengthens the heart. It is indicated for angina pectoris and myocardial ischemia of the Qi stagnation and blood stasis pattern, manifested as episodic chest pain, chest oppression, and fixed pain.
Dosage and administration: Oral administration, 1–2 pills each time, three times daily; or taken at the onset of symptoms. Each pill weighs 22.5 mg.
Precautions: Administration after meals is recommended. Use with caution in patients with spleen-stomach weakness, lactating women, individuals with allergic constitution, and athletes. It should not be used together with Chinese herbal prescriptions containing Veratri Radix et Rhizoma, Trogopterori Faeces, or Halloysitum Rubrum.
(6) Suxiao Jiuxin Pills[
20]
Indications and effects: Promotes Qi movement and activates blood circulation, dispels blood stasis and relieves pain. It is indicated for angina pectoris of coronary heart disease due to Qi stagnation and blood stasis, manifested as chest pain, hypochondriac pain, chest oppression, palpitations, and cyanotic complexion.
Dosage and administration: Sublingual administration, 4–6 pills each time, three times daily. Each pill weighs 40 mg.
Precautions: Contraindicated in pregnant women and patients allergic to this product. It should not be used alone for cold congealing with blood stasis or Yin deficiency with blood stasis patterns. Use with caution in individuals with allergic constitution and patients with moderate to severe heart failure. If angina attacks persist during treatment, nitrates should be added as appropriate.
Indications and effects: Replenishes Qi, activates blood circulation, resolves blood stasis, and relieves pain. It is indicated for angina pectoris of coronary heart disease due to dual deficiency of Qi and Yin with blood stasis, manifested as stabbing chest pain, palpitations, shortness of breath, spontaneous sweating, night sweating, fatigue, and lassitude.
Dosage and administration: Taken after meals with warm water, 3 capsules each time, three times daily. Each capsule contains 0.3 g. A course of treatment lasts 42 days.
Precautions: Use with caution in pregnant women, women during menstruation, and patients with bleeding tendency.
Indications and effects: Warms Yang, replenishes Qi, activates blood circulation, and unblocks the vessels. It is indicated for sick sinus syndrome of the Yang deficiency with blood stasis pattern, manifested as palpitations, chest oppression, aversion to cold, cold limbs, pale complexion, and purple-dark lips and tongue.
Dosage and administration: Oral administration. For chronic cardiac insufficiency, administer 120 mg (2 pills), 240 mg (4 pills), or 360 mg (6 pills) each time according to cardiac function class I, II, or III, respectively, three times daily; one course lasts 2 months. After cardiac function normalizes, change to a maintenance dose of 60–120 mg (1–2 pills). For severe sick sinus syndrome, administer 300–600 mg (5–10 pills) each time, three times daily, for 3–6 months. For other arrhythmias, such as premature beats and atrial fibrillation, myocardial ischemia, or angina pectoris, administer 120–240 mg (2–4 pills) each time, three times daily; one course lasts 1–2 months.
Precautions: Administration after meals is recommended. Contraindicated in pregnant women and patients with glaucoma. Avoid use in patients with Yin deficiency with internal heat, liver Yang hyperactivity, or phlegm-fire exuberance. It should not be used together with Chinese herbal prescriptions containing Veratri Radix et Rhizoma, Trogopterori Faeces, or Halloysitum Rubrum. Use with caution in lactating women, athletes, patients with hepatic dysfunction, patients taking digitalis preparations, patients with tachycardia, individuals with allergic constitution, and patients with poorly controlled hypertension.
Indications and effects: Resolves phlegm and lowers turbidity, activates blood circulation and resolves blood stasis. It is indicated for hyperlipidemia of the intermingling of phlegm and blood stasis pattern, manifested as obesity, oily complexion, dizziness, heaviness of the body, and thick greasy tongue coating.
Dosage and administration: Oral administration, 2 tablets each time, three times daily, before meals. Each tablet weighs 0.73 g. A course of treatment lasts 8 weeks.
Precautions: Take orally before meals. Contraindicated in patients with spleen-stomach deficiency cold or loose stools, and in pregnant women.
(10) Ginkgo Ketone Ester Dripping Pills[
24]
Indications and effects: Activates blood circulation, resolves blood stasis, and unblocks the collaterals. It is indicated for coronary heart disease and cerebral arteriosclerosis of the blood stasis pattern, manifested as chest pain, headache, dizziness, tinnitus, and memory decline.
Dosage and administration: Oral administration, 8 pills each time, three times daily. Each pill contains 5 mg of ginkgo ketone ester.
Precautions: Use with caution in patients with heart failure, pregnant women, and individuals with allergic constitution. Use with caution in patients with bleeding tendency or those receiving anticoagulant or antiplatelet therapy. Contraindicated in patients allergic to this product.
(11) Danlou Tablets[
25][
26]
Indications and effects: Relieves chest oppression and unblocks Yang, resolves phlegm and dissipates masses, activates blood circulation and resolves blood stasis. It is indicated for angina pectoris of coronary heart disease due to intermingling of phlegm and blood stasis, manifested as chest pain, chest oppression, excessive phlegm, shortness of breath, and obesity.
Dosage and administration: Take after meals, 5 tablets each time, three times daily. Each film-coated tablet weighs 0.3 g.
Precautions: Contraindicated in pregnant women. Use with caution in postpartum women and patients with loose stools or diarrhea. Some patients may develop loose stools after administration; a small number of patients may experience dry mouth during treatment.
(12) Yindan Xinnaotong Soft Capsules[
27]
Indications and effects: Activates blood circulation and resolves blood stasis, promotes Qi movement and relieves pain, and aids digestion and resolves food stagnation. It is indicated for cardiovascular and cerebrovascular diseases of the Qi stagnation and blood stasis pattern, manifested as chest pain, headache, dizziness, palpitations, and poor appetite.
Dosage and administration: Oral administration, 2–4 soft capsules each time, three times daily. Each capsule contains 0.4 g.
Precautions: Contraindicated in patients allergic to this product; use with caution during pregnancy.
(13) Yangxinshi Tablets[
28]
Indications and effects: Replenishes Qi and nourishes the heart, activates blood circulation and unblocks the vessels. It is indicated for angina pectoris of coronary heart disease due to dual deficiency of Qi and Yin, manifested as chest oppression with dull pain, palpitations, shortness of breath, insomnia, excessive dreaming, fatigue, and reluctance to speak.
Dosage and administration: Oral administration, 2–3 tablets each time, three times daily. Each tablet weighs 0.6 g.
Precautions: Contraindicated in pregnant women. Gastric discomfort may occur. Use with caution in patients with Yin deficiency with internal heat.
(14) Xuefu Zhuyu Capsules[
29]
Indications and effects: Activates blood circulation and dispels blood stasis, promotes Qi movement and relieves pain. It is indicated for chest impediment and headache of the Qi stagnation and blood stasis pattern, manifested as chest pain, headache, internal heat with vexation, palpitations, insomnia, and dark-red tongue.
Dosage and administration: Oral administration, 6 capsules each time, twice daily. Each capsule contains 0.4 g. One course lasts 1 month.
Precautions: Contraindicated in pregnant women and patients allergic to this product. Administration after meals is recommended. Use with caution in patients with spleen-stomach weakness or allergic constitution. It should not be used together with Veratri Radix et Rhizoma, Sargassum, Euphorbiae Pekinensis Radix, Euphorbiae Kansui Radix, Kansui Radix, or Genkwa Flos.
TCM-specific therapies
(1) Acupuncture
Acupoints: Acupoint selection mainly focuses on points of the Hand-Jueyin Pericardium Meridian and Hand-Shaoyin Heart Meridian, combined with specific Back-Shu and Front-Mu points. The main acupoints include Neiguan (PC6), Ximen (PC4), Danzhong (CV17), Jueyinshu (BL14), Xinshu (BL15), and Juque (CV14). Additional acupoints may be selected according to syndrome differentiation: for Qi stagnation with blood stasis, add Taichong (LR3), Xuehai (SP10), and Geshu (BL17); for internal obstruction of phlegm-turbidity, add Fenglong (ST40) and Zhongwan (CV12); for dual deficiency of Qi and Yin, add Zusanli (ST36) and Sanyinjiao (SP6).
Indications: Applicable to all syndrome types, particularly effective for chest pain caused by Qi stagnation with blood stasis.
Procedure: After routine disinfection, filiform needles are inserted into the selected acupoints. After the arrival of Qi, an even reinforcing-reducing manipulation is applied. Warm needling may be added for cold congealing or Qi deficiency patterns. Needles are retained for 20–30 minutes. Treatment is generally performed 3–5 times per week, and once daily during the acute stage. Four weeks constitute one course of treatment, and 2–3 consecutive courses may be administered according to the patient’s condition.
Precautions: Acupuncture should be used with caution in patients who are extremely fatigued, hungry, or excessively nervous. It is contraindicated in patients with bleeding tendency. Needling should be avoided at sites with local skin infection or ulceration.
(2) Moxibustion
Acupoints: Commonly selected acupoints include Danzhong (CV17), Xinshu (BL15), Jueyinshu (BL14), Neiguan (PC6), Zusanli (ST36), Guanyuan (CV4), and Qihai (CV6).
Indications: Applicable to Qi stagnation with blood stasis, Yang deficiency with blood stasis, and deficiency-cold chest impediment. It is particularly suitable for patients presenting with aversion to cold, cold limbs, chest pain aggravated by cold exposure, shortness of breath, and fatigue.
Procedure: ① Mild moxibustion: One end of a moxa stick is ignited and held 2–3 cm above the acupoint. The site is warmed until the patient feels comfortable warmth and the skin becomes slightly flushed. ② Warm needling moxibustion: After acupuncture and the arrival of Qi, a small segment of moxa is attached to the needle handle and ignited, allowing heat to be transmitted through the needle into the deeper part of the acupoint. ③ Indirect moxibustion, such as ginger-partitioned moxibustion: Several small holes are made in a slice of fresh ginger, which is placed over the acupoint; a moxa cone is then placed on the ginger slice and ignited. Each acupoint is treated for 5–15 minutes, 2–3 times per week. Eight weeks constitute one course of treatment.
Precautions: Moxibustion is absolutely contraindicated in excess-heat patterns and Yin deficiency with effulgent fire, manifested as flushed face, red eyes, dry mouth and tongue, and vexing heat in the five centers. Moxibustion on the head and face should be used with caution in patients with uncontrolled hypertension. Patients with decreased skin sensation should be carefully monitored to prevent burns.
(3) Acupoint application therapy
Basic formula: Salviae Miltiorrhizae Radix et Rhizoma, Chuanxiong Rhizoma, Notoginseng Radix et Rhizoma, Borneolum Syntheticum, and Allii Macrostemonis Bulbus, in equal proportions, ground into fine powder.
Acupoints: Commonly selected acupoints include Danzhong (CV17), bilateral Xinshu (BL15), bilateral Neiguan (PC6), and Xuli/Ashi point.
Indications: Applicable to all syndrome types, especially Qi stagnation with blood stasis and phlegm-turbidity obstruction.
Procedure: Chinese medicinals that activate blood circulation, resolve blood stasis, unblock Yang, and dissipate masses are ground into fine powder and mixed with ginger juice, vinegar, or honey to form a thick paste. The patient assumes a sitting or lying position, and the application site is exposed. An appropriate amount of paste, approximately the size of a soybean, is placed in the center of hypoallergenic adhesive tape or gauze. The medicated tape is accurately applied to the selected acupoint and gently pressed to secure it. Patients should be informed that mild local warmth, burning, or itching may occur after application and is generally considered a normal reaction. If severe stabbing pain or allergic reaction occurs, the application should be removed immediately. In adults, the application is generally retained for 4–6 h, with the duration adjusted according to individual skin sensation and tolerance. The initial application time should be shortened. Treatment is performed 2–3 times per week or every other day. Four weeks constitute one course, and 2–3 consecutive courses may be administered. Reinforced application during the coldest days of winter, known as “Sanjiu application”, may enhance the therapeutic effect.
Precautions: Contraindicated in patients allergic to the medicinals used or to adhesive tape. It should not be applied to areas with skin damage, infection, or rash. Use with caution on the abdomen and lumbosacral region in pregnant women. Use with caution in patients with severe skin diseases.
(4) Auricular acupressure
Auricular points: Commonly selected auricular points include Heart, Small Intestine, Sympathetic, Shenmen, Subcortex, and Chest.
Indications: Applicable to all syndrome types and may be used as an adjunctive therapy to relieve chest pain, palpitations, anxiety, insomnia, and related symptoms.
Procedure: Vaccaria seeds are attached to small pieces of adhesive tape and applied to the selected auricular points. Patients are instructed to press the seeds 3–5 times daily, 1–2 minutes for each point each time, until soreness, numbness, distension, or mild pain is felt. Both ears are used alternately, and the seeds are replaced every 3–5 days. Continuous stimulation may be maintained with regular replacement. Four weeks constitute one course of treatment.
Precautions: Avoid use in areas of auricular inflammation or frostbite. Use with caution in patients allergic to adhesive tape.
TCM-specific therapies for coronary atherosclerosis emphasize holistic regulation and individualized treatment. The above methods may be used alone, but combined application is encouraged, such as acupuncture combined with moxibustion, or oral Chinese medicine combined with acupoint application. These therapies may also be integrated with modern pharmacological treatment to achieve better clinical efficacy. All procedures should be performed under the guidance of qualified TCM practitioners. A clear diagnosis and accurate syndrome differentiation are prerequisites for safe and effective treatment. Owing to their simplicity, convenience, affordability, and clinical effectiveness, these therapies play an important role in the primary and secondary prevention and rehabilitation of coronary heart disease.
Western medical treatment
Risk factor management
Risk factors associated with atherosclerosis, including hypertension, diabetes mellitus, dyslipidemia, and obesity, should be actively controlled. A balanced diet should be maintained, sodium intake should be reduced, body weight should be controlled, appropriate physical labor and exercise should be encouraged, and alcohol consumption should be avoided.
Pharmacological treatment
(1) Treatment of hypertension
Patients with hypertension may be treated with antihypertensive drugs, including the following categories: ① Diuretics: furosemide tablets 20–40 mg, 1–2 times daily; or bumetanide tablets 1 mg, 1–3 times daily. ② β-blockers: metoprolol sustained-release tablets 47.5–95 mg/day; or bisoprolol tablets 5–10 mg/day. ③ Calcium channel blockers: nifedipine sustained-release tablets 30–60 mg/day, amlodipine tablets 5–10 mg/day, or felodipine sustained-release tablets 5–10 mg/day. ④ Angiotensin-converting enzyme (ACE) inhibitors: enalapril tablets 10–20 mg/day, or captopril tablets 25–50 mg/day. ⑤ Angiotensin receptor blockers (ARBs): irbesartan 150–300 mg/day, telmisartan capsules 40–80 mg/day, or olmesartan medoxomil 20 mg/day.
(2) Treatment of hyperlipidemia
Lipid-lowering therapy can prevent plaque progression and reduce the occurrence of acute cardiovascular and cerebrovascular events. Lifestyle intervention is required for all high-risk individuals, including restriction of dietary cholesterol intake. Intensive lipid-lowering therapy may be considered when appropriate, with a target LDL-C level of < 1.8 mmol/L. Statins are the mainstay of therapy, such as atorvastatin calcium tablets 10–20 mg once nightly. Adverse reactions to statins should be carefully monitored.
If necessary, a cholesterol absorption inhibitor may be added, such as ezetimibe 10 mg orally once daily. If the LDL-C target is still not achieved, early use of a PCSK9 inhibitor should be considered. Evolocumab injection 420 mg may be administered subcutaneously once monthly. This agent is suitable for homozygous familial hypercholesterolemia, and LDL-C levels should be assessed 4–8 weeks after administration. For patients requiring long-term stable lipid lowering, inclisiran 284 mg may be considered for subcutaneous injection; after the initial dose, a second dose is given at 3 months, followed by dosing every 6 months.
(3) Treatment of type 2 diabetes mellitus
The treatment goals are to improve glycemic control, control body weight, and manage other risk factors for atherosclerotic cardiovascular disease (ASCVD). Metformin is recommended as first-line therapy, at 1500–2000 mg/day in 2–3 divided doses. Agents with cardiovascular benefits may also be considered, including SGLT2 inhibitors, such as dapagliflozin 10 mg/day, empagliflozin 10 mg/day, and canagliflozin 100 mg/day; and GLP-1 receptor agonists, such as semaglutide 0.25–1 mg once weekly with gradual dose escalation, liraglutide 0.6–1.8 mg once daily, dulaglutide 0.75–1.5 mg once weekly, and exenatide 5–10 μg twice daily, to reduce cardiovascular risk.
(4) Antiplatelet therapy
Antiplatelet therapy inhibits platelet adhesion and aggregation, prevents thrombosis, and helps prevent the progression of vascular occlusive lesions. It is used for the prevention of coronary heart disease and cerebral arterial thromboembolism.
The main agents include:
① COX inhibitors: The irreversible COX inhibitor aspirin, 100–300 mg once daily. Adverse reactions include gastrointestinal bleeding and aspirin allergy. Enteric-coated preparations or acid-suppressive agents may reduce gastric irritation. Contraindications include allergy, severe untreated hypertension, active peptic ulcer, local bleeding, and bleeding diathesis. For patients with gastrointestinal intolerance, the reversible COX inhibitor indobufen, 100–200 mg twice daily, is recommended. ② Adenosine diphosphate (ADP) receptor antagonists: clopidogrel 75 mg once daily, or ticagrelor 90 mg twice daily. ③ Phosphodiesterase inhibitors: cilostazol 100 mg twice daily may be considered for patients with peripheral atherosclerosis.
(5) Anticoagulant and thrombolytic therapy
For patients with arterial thrombosis causing luminal stenosis or occlusion, thrombolytic agents may be used, such as urokinase, streptokinase, and recombinant tissue plasminogen activator, followed by anticoagulants or novel oral anticoagulants. The selection of anticoagulant therapy should be based on the risks of ischemic and bleeding events and the overall treatment strategy.
Commonly used agents include heparin, with an initial intravenous dose of 5000–10,000 units followed by 100 units/kg every 4 h according to body weight, or intravenous infusion of 20,000–40,000 units/day; low-molecular-weight heparin 100 IU/kg per dose by subcutaneous injection once or twice daily; warfarin, with an average initial dose of 5 mg/day and gradual dose adjustment while monitoring INR ≥ 2.0; dabigatran 150 mg twice daily; and rivaroxaban, 15 mg twice daily during the first 3 weeks of treatment for acute pulmonary embolism, followed by a maintenance dose of 20 mg once daily. Coagulation function should be monitored during treatment.
(6) Vasodilator therapy
Vasodilator therapy can relieve vasospasm and promote collateral circulation. Drug selection should be based on the site of atherosclerosis. For acute myocardial infarction, nitroglycerin tablets may be administered sublingually, 1 tablet each time; 1 tablet may be repeated every 5 minutes, with a total dose not exceeding 3 tablets. For the prevention and treatment of angina pectoris, isosorbide mononitrate sustained-release tablets may be used at 20–80 mg once daily. For cerebral atherosclerosis, nicergoline may be selected at 20–60 mg/day in 2–3 divided doses. For peripheral atherosclerosis, beraprost sodium tablets may be administered at 40 μg each time, three times daily after meals.
(7) Antioxidant therapy
Natural and synthetic antioxidants play important roles in the prevention and treatment of atherosclerosis through different mechanisms. Commonly used agents include vitamin C, vitamin E, probucol, and coenzyme Q10.
(8) Anti-inflammatory therapy
Inflammatory responses are key contributors to atherosclerotic plaque instability, and inhibition of inflammation is therefore important in the treatment of atherosclerosis. Anti-inflammatory agents include statins, aspirin, and ACE inhibitors. Recent studies have shown that colchicine also has certain cardiovascular protective effects. Several large clinical trials have demonstrated that long-term use of low-dose colchicine has favorable effects on cardiovascular outcomes in both acute and chronic coronary syndromes.
Diagnosis and treatment of atherosclerosis at major sites
(1) Coronary atherosclerosis
When coronary atherosclerosis causes luminal stenosis and angina pectoris, vasodilators should be used on the basis of lipid-lowering and antiplatelet therapy, such as isosorbide mononitrate tablets 40 mg or 60 mg once daily. β-blockers, such as metoprolol tartrate tablets 25 mg twice daily, may also be used. In patients with severe lesions, marked luminal stenosis, or occlusion, interventional or surgical treatment may be performed, including percutaneous transluminal balloon angioplasty, stent implantation, and bypass grafting[
30].
(2) Atherosclerosis of the head and neck arteries
When atherosclerosis of the head and neck arteries progresses to an advanced stage, arterial stenosis may occur, which may further lead to stroke. Treatment may refer to the
Chinese Consensus on the Diagnosis and Treatment of Atherosclerosis of the Head and Neck Arteries. In addition to the basic pharmacological treatments described above, carotid endarterectomy or carotid artery stenting may be performed after comprehensive evaluation[
31].
(3) Renal artery atherosclerosis
The basic treatment of renal artery atherosclerosis focuses on lipid-lowering therapy. For hypertension caused by renal artery stenosis, ACE inhibitors/ARBs, calcium channel blockers, β-blockers, and other agents may be selected. ACE inhibitors/ARBs may be used in unilateral renal artery stenosis, but should be used with caution in patients with a solitary functioning kidney or bilateral renal artery stenosis. Urine output and renal function should be closely monitored when treatment is initiated. If urine output decreases sharply or serum creatinine rises rapidly by more than 44.2 μmol/L after medication, acute renal insufficiency should be considered, and the dose should be reduced immediately or the drug discontinued. Stent implantation or balloon angioplasty may be performed when necessary[
32].
(4) Peripheral atherosclerosis
Peripheral atherosclerosis most commonly involves the lower extremities. Treatment includes lipid-lowering therapy with statins, antiplatelet therapy, and anticoagulation, together with basic management such as blood pressure and glucose control according to the patient’s condition. If vascular occlusion causes symptoms such as intermittent claudication, rest pain, or ulcers, phosphodiesterase III inhibitors, such as cilostazol 0.1 g twice daily, may be used. Prostaglandin agents may also be used, including alprostadil 5–10 μg diluted in 10 mL normal saline or 5% glucose and administered by slow intravenous injection, as well as oral beraprost, which have vasodilatory and anti-atherosclerotic effects. Selective 5-hydroxytryptamine 2 receptor antagonists, such as sarpogrelate 100 mg three times daily, may improve ulcers, pain, cold sensation, and other symptoms caused by chronic arterial occlusive disease. If pharmacological treatment is ineffective, percutaneous balloon angioplasty, stent implantation, atherectomy, laser angioplasty, cutting balloon angioplasty, drug-coated balloon angioplasty, cryoballoon angioplasty, pharmacological thrombolysis, or thrombectomy may be performed[
33].
Prognosis, outcomes, prevention, and care
Prognosis and outcomes
The prognosis of this disease varies according to the location and severity of the lesions, the rate of progression of vascular stenosis, the extent of damage to the affected organs, and the presence or absence of complications. Prognosis is poor when lesions involve arteries supplying important organs such as the heart, brain, and kidneys.
From the perspective of traditional Chinese medicine, patients diagnosed with excess patterns generally have a relatively favorable early prognosis, whereas those diagnosed with deficiency patterns or mixed deficiency-excess patterns tend to have a poorer early prognosis. In addition, the phlegm obstruction pattern is associated with more severe coronary lesions and a higher risk of adverse cardiovascular events after percutaneous coronary intervention (PCI).
Prevention and care
Primary prevention of atherosclerosis should be actively promoted. Once atherosclerosis has developed, timely treatment should be provided to prevent disease progression and strive for reversal of lesions. For patients who have developed complications, prompt treatment is necessary to prevent deterioration and prolong survival. In traditional Chinese medicine, great emphasis has long been placed on the concept of “preventive treatment of disease”, which includes preventing disease before its onset, preventing progression after disease has occurred, and preventing recurrence after recovery.
(1) Enhancing disease awareness
Attention should be paid to the impact of comorbidities on cognitive function, and medical care should be sought in a timely manner. In accordance with the TCM concept that “superior physicians treat disease before it arises”, regular assessment of constitutional imbalances through the four diagnostic methods of TCM should be performed, with early intervention when appropriate.
(2) Strengthening self-management
Patients should strictly follow medical advice regarding medication and attend regular follow-up visits. The TCM principle of time-based medication administration may be incorporated, such as taking tonifying medicines in the morning and calming medicines in the evening. Regular TCM-based constitution regulation may also be considered.
(3) Regulating emotions
A calm and balanced mental state should be maintained. The TCM health-preservation principle of “tranquility and freedom from excessive desires” may be applied. The five-tone therapy—gong, shang, jue, zhi, and yu—may be used to regulate the five zang organs. Baduanjin and Tai Chi may be practiced to guide Qi and blood circulation. Psychological intervention should be provided when needed, and patients should be encouraged to actively participate in social activities.
(4) Emphasizing follow-up and emergency response
Patients should be educated to recognize warning signs of cardiovascular emergencies and master basic emergency response methods. Traditional Chinese medicine emergency medicines such as Angong Niuhuang Pills may be kept available when appropriate, and patients should be familiar with emergency acupressure methods involving acupoints such as Danzhong (CV17) and Neiguan (PC6).
(5) Lifestyle care
Daily routines should conform to the changes of Yin and Yang across the four seasons: going to bed later and rising early in spring and summer, going to bed early and rising early in autumn, and going to bed early and rising later in winter. Cold protection and warmth preservation should be emphasized to safeguard Yang Qi. A balance between work and rest should be maintained, and traditional exercises may be practiced to dredge the meridians and collaterals. Diet should follow the principle that “the five grains nourish and the five fruits assist”, with a light, low-salt, low-fat diet and avoidance of overeating. Medicinal and edible substances such as hawthorn and Salvia miltiorrhiza may be added as appropriate. Regular bowel movements should be maintained to preserve the physiological state that “the six fu organs function through unobstructed passage”, ultimately achieving a state of balanced Yin and Yang and harmonized Qi and blood.
The Author(s) 2026. This article is published by Higher Education Press at journal.hep.com.cn.
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