Traditional Chinese Medicine for the Treatment of Geriatric Heart Disease: A Review

Abstract

Geriatric heart disease is a common disease in modern society. Due to the characteristics of advanced age and multiple underlying diseases, elderly patients with heart disease have a variety of types and treatment methods compared to other diseases. We searched the databases of CNKI, PubMed, and Web of Science to search for the causes and treatment methods of traditional Chinese and Western medicine for heart diseases using the terms "geriatric heart disease", "treatment", "ischemic heart disease", "pulmonary heart disease", "hypertensive heart disease", "rheumatic heart disease", "thyroid heart disease", "coronary heart disease", "arrhythmia", and "heart conduction block". The search also included the terms "reasonable emotional therapy", "Baduanjin", "TaiChi", "Wuqinxi", "Qigong", "acupuncture and moxibustion", "moxibustion", "guasha" and so on, auxiliary Chinese medicine therapies for geriatric heart disease. The results showed that traditional Chinese medicine (TCM) has a relatively comprehensive treatment plan for different types of geriatric heart disease. Generally, TCM combined with Western medicine or surgery can effectively improve heart function and treat the disease. Chinese exercise and TCM therapy also play an indispensable role in the auxiliary treatment of geriatric heart disease, effectively improving the living conditions of the elderly.

Abbreviations

IL-6, Interleukin-6

MAPK3, Mitogen activated protein kinases 3

MI/RI, Myocardial ischemia-reperfusion injury

RET, Rational emotional therapy

TCM, Traditional Chinese medicine

TNF, Tumor necrosis factor

INTRODUCTION

Article 2 of the Law of the People’s Republic of China on the Protection of the Rights and Interests of the Elderly stipulates that all citizens of the People’s Republic of China who have reached the age of 60 are classified as being elderly. With the increasing aging of society, the proportion of elderly people in China is also increasing. After entering old age, the functions of various organs gradually become impaired and the body’s resistance gradually weakens, leading to a series of elderly diseases. Geriatric heart disease is one of the more common geriatric diseases, posing a great threat to the physical health of the elderly. This review study mainly focuses on the overview and classification of geriatric heart disease, the etiology and pathogenesis theory of geriatric heart disease, as well as traditional Chinese and Western medicine treatment methods and adjuvant therapies, in order to provide a reference for the treatment of geriatric heart disease.¹

REVIEW OF GERIATRIC HEART DISEASE

Related studies have shown that as age increases, the density of capillaries in the cardiovascular system decreases, which can easily cause myocardial cell death and lead to ischemic damage to the heart. At the same time, thickening of arterial intima, increases in collagen fibers, and growth of smooth muscle in the middle membrane in elderly people lead to increasingly smaller lumens of small arteries, decreased diastolic function, and arteriosclerosis. In addition, elderly people are prone to developing aortic stenosis and valve calcification, which increases blood pressure and further increases the burden on the heart. In severe cases, it may pose a life-threatening risk. After the age of 60, the number of pacemaker cells in the sinoatrial node of elderly people decreases, and the degree of fibrosis in the atrioventricular tract and atrioventricular node continues to increase, which will seriously affect the conduction function of the heart in elderly people.² Traditional Chinese physicians believe that normal operation of blood is inseparable from the biochemical, promoting, and consolidating the effects of Qi, as well as the warmth of Yang Qi and nourishment of Yin fluid. Elderly people have weakened visceral function, exhausted essence and Qi, insufficient Qi and blood, and cannot stimulate blood circulation, leading to poor circulation of Qi and blood and the formation of blood stasis. Therefore, in traditional Chinese medicine (TCM), there is a saying that "the elderly have more blood stasis", and "blood stasis" is often the main cause of geriatric heart disease.³ TCM believes that "Qi is the handsome blood", Qi is bloody, Qi stagnation is blood stagnation, and Qi stagnation is an important reason for the formation of blood stasis. Qi deficiency agitation is weak, and the flow of blood can be caused by stasis, or Qi deficiency can lead to blood deficiency, and blood deficiency will cause blood stasis, which can also negatively affect blood flow. Therefore, the treatment is mainly based on "promoting Qi and invigorating blood". However, the elderly lack Sufficient Healthy-Qi, physiological function declines, and although there are pathogenic factors, but not sweating; Abdominal pain and constipation, if there is a bitter cold medicine, you can’t take it, otherwise the diarrhea will not stop, and so on. Therefore, we must pay attention to the principle of "sweating without injury, down without damage, warm without dryness, clear without condensation, elimination without steepness, and replenishment without stagnation".⁴

CLASSIFICATION OF GERIATRIC HEART DISEASE AND TREATMENT METHODS WITH TRADITIONAL CHINESE AND WESTERN MEDICINE

Classification, etiology, pathogenesis, and treatment mechanisms of geriatric heart disease

The morphology and pathology of the elderly heart change with age, often accompanied by other systemic diseases not involving the heart. The types of geriatric heart disease are more complex. The specific classification is shown in Table 1, which focuses on the etiology, pathogenesis, and treatment mechanisms of various types of geriatric heart disease from the perspective of TCM Qi and blood theory.

Table 1. Classification, traditional Chinese medicine pathogenesis, and treatment mechanism of geriatric heart disease.

	Etiology and pathogenesis	Mechanism of traditional Chinese medicine treatment
Ischemic cardiomyopathy	In traditional Chinese medicine, there is a saying that “the heart governs the blood vessels”. The heart must be used in order for the blood vessels to flow smoothly and orderly; On the contrary, diseases that affect the heart and body can all affect the blood and meridians, exacerbating blood stasis.5	Replenishing Qi, invigorating blood and regulating menstruation, warming menstruation and relieving pain, relieving cough and asthma, etc., the medicinal taste is mainly bitter and sweet, and the medicinal properties are mostly cold and warm, mainly attributed to the liver, heart and lung meridians.6
Pulmonary heart disease	Insufficient positive Qi in the body, repeated feeling of wind and cold, weak lung injury Qi, stagnation of phlegm and fluid, and obstruction of the airway. Long term lung injury must extend to the heart, causing blood stasis in the lungs, imbalance of yin and yang, water evil invading the heart, and deficiency of blood and qi leading to heart qi deficiency and disease.7	Promoting lung circulation and dispelling cold, eliminating phlegm and relieving asthma, warming yang and promoting diuresis, supplementing Qi and strengthening spleen; clearing heat and promoting the circulation of organs, resolving phlegm and opening up orifices, commonly used traditional Chinese medicine mainly focuses on warming yang and tonifying spleen, dispelling dampness and phlegm, promoting blood circulation and dispersing blood stasis.8
Hypertensive heart disease	It is caused by the imbalance of yin and yang, the evil of water, and the deficiency of blood and Qi.	Hypertensive heart disease is mainly caused by imbalance of yin and yang, water evil invading the heart, and deficiency of blood and Qi. Therefore, treatment should be based on principles such as supplementing Qi and blood, regulating yin and yang, promoting blood circulation to drive away evil, dispersing wind and unblocking collaterals.9
Rheumatic heart disease	Evil lies in the heart, causing heart valve distortion, hindering the circulation of Qi and blood in the heart, and damaging the yin and yang of the heart. Over time, insufficient heart Qi and heart yang, combined with blood stasis, can cause restlessness and disordered heartbeat, leading to heart failure.10	Rheumatic heart disease is classified as heart kidney yin deficiency type, and traditional Chinese medicine with warming yang and promoting diuresis effects can be used; if it is of the heart blood stasis type, traditional Chinese medicine that promotes blood circulation, removes blood stasis, regulates Qi and unblocks collaterals can be chosen for treatment; If it is of the Qi and blood deficiency type, you can choose traditional Chinese medicine that replenishes blood, nourishes the heart, and replenishes Qi to calm the mind.11
Hyperthyroidism heart disease	Seven emotions fail, liver Qi stagnates, Qi stagnation transforms into fire, attacking the head, and over time, the internal generation of deficiency fire leads to disease.12	Hyperthyroidism induced heart disease is mainly characterized by promoting Qi circulation, relieving depression, nourishing yin and yang, and promoting blood circulation to remove blood stasis in traditional Chinese medicine.13
Hypothyroidism heart disease	This deficiency is characterized by excess, and the deficiency of kidney yang runs through the entire process. The disease is located in the heart and kidneys.	Hypothyroidism induced heart disease is mainly characterized by warming the kidneys and promoting yang, warming and tonifying spleen yang, nourishing Qi and water, and promoting blood circulation.14
Coronary heart disease	Insufficient Qi and blood, deficiency of yin and yang, Qi deficiency and blood stasis, phlegm stasis obstructing collaterals.	The treatment of coronary heart disease is generally based on syndrome differentiation, with the main focus on promoting blood circulation and removing blood stasis, warming and promoting heart yang, eliminating phlegm and unblocking collaterals, regulating Qi and widening the chest, dispelling dampness and unblocking collaterals, and clearing phlegm and heat.15
Arrhythmias	Lack of heart blood, yin deficiency and excessive fire, heart deficiency and timidity, water consumption affecting the heart, blood stasis blocking the meridians.	The treatment for arrhythmia includes nourishing yin and blood, purging fire and calming the mind, calming the heart and palpitations, clearing heat and phlegm, promoting blood circulation and removing stasis, nourishing Qi and yin, clearing heat and nourishing blood, etc.16
Heart conduction block	Deficiency of both heart and spleen, stagnation of dampness and pathogenic factors, leading to blockage of the heart meridian, poor blood flow and onset of disease, can cause deficiency of the heart and spleen. Spleen deficiency leads to loss of vital energy and nourishment of the heart, resulting in deficiency of Qi and yin in the heart, ultimately leading to stagnation of the heart meridian.17	Heart conduction block is often treated with methods such as tonifying Qi and blood, nourishing Qi and warming yang, clearing the heart and removing heat, promoting Qi and relieving depression, nourishing the heart and calming the mind, dispelling phlegm and promoting blood circulation and removing blood stasis.18

TCM treatment for geriatric heart disease

Treat heart disease and pay attention to regulating Qi and blood. Qi is yang, blood is yin, and the coordination of yin and yang is the fundamental basis for treating diseases. Therefore, for those with insufficient yang Qi in the heart, it is not advisable to use Xin Wen for a long time. Attention should be paid to protecting yin. For those with insufficient yin blood in the heart, it is necessary to add Qi regulating products while supplementing blood and nourishing yin. Especially for elderly patients who are old and weak, with Qi deficiency and blood stasis, this is the basic point of differentiation. The treatment mainly focuses on "removing blood stasis" and "supplementing deficiency", and is based on differentiation and treatment. Specific cases are discussed below.

Yang Xiaojing¹⁹ selected 90 elderly patients with ischemic heart disease who were admitted to hospital. The control group was treated with isosorbide dinitrate tablets combined with compound Danshen tablets, while the study group was treated with modified Siwu decoction on the basis of the control group. The treatment effects and total myocardial ischemic load index levels of the two groups were compared. The latter could help elderly patients with ischemic heart disease suppress myocardial ischemic load, which had a positive significance for the disease recovery process. Xie Feng²⁰ explored the mechanism of Ganjiang Fuzi Tang in treating myocardial ischemia-reperfusion injury (MI/RI), screened 16 active ingredients of Ganjiang Fuzi Tang, and predicted 0 targets for its treatment of MI/RI. Among them, aconitine, β-sitosterol, 10 gingerol, AKT serine/threonine kinase 1, interleukin-6 (IL-6), tumor necrosis factor (TNF), mitogen activated protein kinases 3 (MAPK3), and TP53 may be the core effective compounds and targets of Ganjiang Fuzi Tang in treating MI/RI.

Chen Weijia²¹ included 68 patients aged 45-80 years who met the diagnostic criteria for chronic pulmonary heart disease in remission (Qi deficiency and blood stasis syndrome) in the study. The study investigated the effectiveness and safety of adding the TCM Bu Fei Huo Xue Tang to conventional Western medicine treatment for patients with chronic pulmonary heart disease in remission (Qi deficiency and blood stasis syndrome) caused by chronic obstructive pulmonary disease. The results showed that Bu Fei Huo Xue Tang could significantly improve the patients’ symptoms, enhance their quality of life, improve cardiopulmonary function, reduce hospitalization times, days, and costs, and improve coagulation indicators. Liang Qijun²² preliminarily revealed the mechanism of action of Yifei Huoxue Tang: Yifei Huoxue Tang promotes the proliferation of lung tissue cells, enhances the activity of Na⁺ - K⁺ adenosine triphosphate in lung tissue, corrects pathological conditions, regulates vasodilator and vasoconstrictor substances, dissipates blood clots, and reduces blood viscosity.

Zhao Qiuhong²³ selected 70 patients with hypertensive heart disease as the research subjects to investigate the therapeutic effect and improvement in heart function with Jiawei Tongqiao Huoxue Tang combined with metoprolol tartrate tablets. After treatment, the patients’ serum B-type natriuretic peptide level, left ventricular end systolic volume index, C-reactive protein level, and left ventricular end diastolic volume index were all lower than before treatment, and the values were significantly lower in the observation group compared to the group treated with metoprolol tartrate tablets alone (all p < 0.05). Through extensive clinical verification, the combination of TCM and Western medicine can effectively improve the cardiac function of elderly patients with hypertensive heart disease, reduce blood pressure viscosity, control inflammatory cytokine levels, and effectively control the symptoms and complications of hypertensive heart disease.

Tan Jinglin²⁴ found that the main mechanism of Ma Huang Jia Shu Tang in treating rheumatic heart disease may be that the flavonoids in the formula can reduce oxidative stress mediated by prostaglandin endoperoxide synthase 2, protein kinase B alpha, etc., reduce the expression of inflammatory factors such as nitric oxide synthase 2, peroxidase proliferator activated receptor, IL-6, IL-8, CXCL8, MAPK3, etc., thereby exerting anti-inflammatory effects, effectively protecting myocardial cells, and achieving the effect of treating rheumatic heart disease. In addition to using TCM formulas, the combination of Chinese and Western medicine achieved twice the results with half the effort. Zhang Xianzheng²⁵ compared the effect of nifedipine tablet treatment with Qiangxin Lishui Tang combined with nifedipine in 88 patients with rheumatic heart disease, and the results showed that the latter had better improvement in function and reduced risk of heart failure than the former.

Geng Xiaoyin²⁶ selected 83 patients with hypothyroidism heart disease to investigate the therapeutic effect of Shenqi Fugui Decoction on hypothyroidism heart disease. Compared with using thyroid tablets alone, Shenqi Fugui Decoction promoted overall regulation of the body, promoted the metabolic function of tissues and cells throughout the body, promoted the recovery of thyroid function, improved the function of the pituitary thyroid axis, promoted the self-secretion ability of the thyroid gland, and significantly improved thyroid function and energy metabolism. In addition, extensive clinical verification showed that the combination of TCM and Western medicine could effectively improve cardiac function and shorten the course of disease in elderly patients with hyperthyroidism or hypothyroidism heart disease.

Yan Xiaoli²⁷ randomly selected 134 patients who met the inclusion criteria for coronary heart disease and followed the primary prevention plan for coronary heart disease. The control group of patients received targeted treatment based on their own comorbidities, and the treatment group received Gualou Xiebai Banxia Tang granules in addition to the control group. After 12 weeks, the data of both groups of patients were evaluated. The results showed that Gualou Xiebai Banxia Tang modified granules combined with conventional Western medicine had significant therapeutic effects in people at high risk of coronary heart disease. It could effectively reduce blood lipids and had good therapeutic effects on improving symptoms such as chest tightness, shortness of breath, fatigue, dizziness, sticky stools, excessive phlegm, palpitations, etc. It greatly improved the patients’ quality of life.

Eighty patients with Zhan Chengsi’s slow selective arrhythmia were randomly divided into an observation group and a control group, with 40 cases in each group. The control group received routine treatment, while the observation group were supplemented with modified Ma Huang Fu Zi Xi Xin Tang in addition to routine treatment. After 30 days, the latter group had lower TCM symptom scores than the former: 1) The slowest heart rate, resting heart rate, and 24-hour average heart rate were all higher than the former. 2) The dispersion of transmural repolarization was lower than before treatment and lower than the former. 3) The patient’s plasma viscosity, whole blood high shear viscosity, whole blood low shear viscosity, and fibrinogen levels were all lower than before treatment, and lower than the former. All of these findings were statistically significant (p < 0.05, 0.01), and Ma Huang Fu Zi Xi Xin Tang could effectively improve arrhythmia symptoms, blood rheology, and accelerate heart rate.²⁸

After extensive clinical validation of TCM, we used data mining methods to analyze the clinical medication patterns of TCM in the treatment of elderly pulmonary heart disease, coronary heart disease, arrhythmia, and other related conditions. An analysis was conducted on commonly used single TCMs, as shown in Figure 1 (frequency > 20), and the clinical application of combined traditional Chinese and Western medicine is shown in Table 2.

Figure 1.

A single high-frequency traditional Chinese medicine used to treat geriatric heart disease (frequency ≥ 20 times) (A) Pulmonary heart disease; (B) Rheumatic heart disease; (C) Coronary heart disease; (D) Arrhythmi.

Table 2. Treatment of common heart diseases in the elderly.

	Traditional Chinese medicine	Combination of traditional Chinese medicine and Western medicine
Ischemic cardiomyopathy	Epigallocatechin gallate, quercetin, baicalin, resveratrol, genistein, tanshinone IIA, etc; Chinese herbal formula: She Xiang Xin Tong Ning, Gan Jiang Fu Zi Tang, Su Xiao Xin Tong Drop Pills, Radix Salvia, Radix Astragalus, Radix Ligusticum, Radix Angelica, Carthamus tinctorius, Radix Panax, etc.29-32
Pulmonary heart disease	Dan Lou Fang, Dan Hong Fang, Bu Fei Huo Xue Tang, Ma Huang Tang, Fu Ling Si Ni Tang combined with Wen Xin Granules, Wen Fei Hua Yu Tang, Kuan Xiang Chang Fei Yin, Po Ge Jiu Xin Tang, Tong Fei Yang Xin Tang, Zhen Wu Tang, Yi Qi Wen Wen Yang Hua Yu Tang, Shen Fu Injection and San Zi Yang Qin Tang, Qi Shen Yi Qi Drop Pills, Xin Mai Long, Qi Li Qiang Xin Tang, Shen Song Yang Xin Capsules, etc.33-43	Low molecular weight heparin calcium combined with Yiqi Fumai injection, Danshen injection combined with Cycloadenosine Glucosamine, Danhong injection combined with Prostaglandin, Isosorbide Mononitrate combined with She Xiang Bao Xin Pill, Danhong injection combined with recombinant human brain natriuretic peptide, Cheling Fuzi Tang combined with Tovastatin, Shenmai injection combined with Furosemide and dopamine, Huangqi combined with Dobutamine, Phentolamine, etc.44-51
Hypertensive heart disease	Xie Dan Tong Luo Wan.52	Jiawei TongQiao Huoxue Tang combined with metoprolol, Wenxin Granules combined with metoprolol, Shexing Baoxin Pill combined with trimetazidine, Danxiong Tongluo Tang combined with metoprolol, Qili Qiangxin Capsule combined with milinone, Xuefu Zhuyu Tang combined with metoprolol, Yiqi Yangyin Tongluo Tang combined with metoprolol, etc.53-58
Rheumatic heart disease	Danggui SiniTang, Yiqi TongbiTang, Mahuang Jiazhu Tang, Wenyang Tongmai Zhibi Tang, Shengmai San combined with Guizhi Gancao Longgu Muli Tang, Linggui Zhugan Tang, etc.59-63	Amiodarone combined with Xinmailong injection, Qiangxin Lishui Tang combined with nifedipine, Jiawei Shengmai San combined with carvedilol, enalapril, Lixin Pill combined with trimetazidine, enalapril, etc.64-66
Hyperthyroidism heart disease	Shu Gan Yi Qi Yang Ying Tang, Xiao Yao San Jia Wei, Jia Xin Tang, etc.67-70	Jiawei Zhibai Dihuang Tang combined with Methomydazole, Danshen freeze-dried powder combined with Pannanjin.71,72
Hypothyroidism heart disease	Yiqi Wenyang Lishui Fang, Zhujing Wan, Wenxin Granules combined with Shenfu injection, Puerarin injection, Shenqi Fugui Tang, etc.73-76	Levothyroxine tablets combined with Jiawei Zhenwu Tang, Yiqi Zhenxin Tang combined with levothyroxine tablets, Yangxin tablets combined with levothyroxine sodium, Shenmai injection combined with trimetazidine tablets, etc.77-80
Coronary heart disease	Yiqi Huoxue Tongyang Xiezhuo Fang, Shen Shao tablets, Tongmai Yangxin Pill, Gualou Xiebai Banxia Tang, Tongmai Huaban Tang, etc.81-84
Arrhythmias	Tongmai Yangxin Pill, Mahuang Fuzi Xixin Tang, Puerarin Injection, Huoxue Xingqi Modified Formula, Shuyu Yangxin Tang, Yiqi Yang Huoxue Method, Ningxin Tie combined with Jiawei Guipi Tang, Wenyang Fumai Tang, Linggui Zhugan Tang combined with Shengmai Yin Modified, Zhigancao Tang Modified, Shenwu Guanxin Tang, Shutiao Tang, etc.85-95	Shen Song Yang Xin Capsules combined with metoprolol or amiodarone tartrate, Wen Xin Granules combined with metoprolol or amiodarone, betaloc or valsartan, Zhi Gan Cao Tang combined with metoprolol, Shen Xian Sheng Mai Oral Liquid combined with isosorbide mononitrate sustained-release capsules, Jiawei Huang Lian Wen Dan Tang with propafenone, Ding Xin Tang combined with metoprolol, Dan Hong injection combined with bisoprolol, An Shen Fu Mai Tang combined with metoprolol succinate, etc.96-103
Heart conduction block	Wen Xin Tong Mai Tang, Ma Huang Fu Zi Huang Qi Tang, Ma Huang Fu Zi Xi Xin Tang, Shen Hua San Xiang Tang.104-107

TRADITIONAL CHINESE MEDICINE-ASSISTED THERAPY FOR GERIATRIC HEART DISEASE

Rational emotive therapy

Rational emotional therapy (RET) is a new psychological therapy method proposed by American psychologist Ellis, which is increasingly being used in the clinical nursing field in China.¹⁰⁸ Many clinical studies have confirmed that RET can guide individuals to transform irrational thoughts and concepts, establish positive thinking habits, and thereby improve treatment compliance and efficacy. Elderly patients with heart disease often experience depression due to disease interference and neglect of their children’s care. RET can alleviate symptoms and improve patient treatment compliance. Liu Zhihua found that RET combined with aerobic exercise interventions could effectively improve heart function, enhance exercise endurance and psychological resilience, and alleviate anxiety and depression symptoms in patients with coronary heart disease.¹⁰⁹ Cao Yuan also conducted relevant research and found that RET combined with exercise rehabilitation nursing based on metabolic equivalence could help improve cardiovascular function, healthy behavior, and quality of life of elderly patients with chronic heart failure.¹¹⁰ RET is an intervention method based on personality and psychological therapy, which changes the negative emotions caused by the patient’s illness, actively cooperates with treatment and nursing; that is, moderate humanistic care can improve the patient’s treatment progress and treatment compliance, and the effect is significant. RET coincides with emotional therapy in TCM and belongs to a branch of "theory of Zangxing". The emotional management concept of "favorable guidance" in TCM supports patients in venting their emotions through appropriate methods, and then explores and strengthens psychological resources in an orderly manner. Through the integration of physical and mental management, it gradually alleviates patients’ negative emotions and states.¹¹¹

Exercise therapy

Exercise therapy is often combined with RET. Experts agree that appropriate resistance exercise and aerobic endurance exercise can effectively prevent and treat heart disease. Ancient TCM books also describe the important role of exercise in the health of the body. Laolao Hengyan said, "Sometimes there is a little labor, but... it is not stagnant". Appropriate exercise can promote the circulation of muscles and blood without stagnation, regulate the smooth flow of Qi and blood, dispel diseases and be able to resist disease, and delay aging.¹¹² Sports guidance techniques such as Wuqinxi, Daoyin martial, Baduan Jin, Yijin Jing, and Neiwaijia martial arts have all been shown to have good effects in preventing diseases and anti-aging.

Baduanjin

Ba Duan Jin was first proposed in Ge Hong’s "Biography of Immortals" during the Jin Dynasty. At present, the Eight Section Brocade of Fitness Qigong has been revised and organized by the General Administration of Sport of China. It has the effects of promoting Qi and blood circulation, regulating the five organs and six viscera, and long-term exercise can soften muscles and strengthen the body and bones. Sun Ning found that elderly patients with stable angina pectoris can practice the Eight Section Brocade in an upright position, using a single lift to regulate the spleen and stomach. A backward-looking posture can improve a variety of injuries. To relieve heart fire, one needs to shake one’s head and tail, and to strengthen the kidneys and waist, one needs to use both hands and feet. Practicing the Eight Section Brocade for a period of time, combined with a rehabilitation training system, can improve blood lipid levels and enhance heart function.¹¹³ Meanwhile, Ba Duan Jin can restore the balance of yin and yang in the heart and lungs by regulating the circulation of Qi and blood. As a moderate intensity aerobic exercise, it is suitable for patients with stable heart failure and heart failure with preserved left ventricular ejection fraction.¹¹⁴ Mao Shuai selected 110 clinically stable myocardial infarction patients who underwent successful reperfusion of the infarct-related artery. After 12 weeks of 45-minute Baduanjin exercise twice a week, it was found that Baduanjin exercise therapy was effective in reversing poor left ventricular reconstruction and improving clinical outcomes of the patients.¹¹⁵

Tai Chi

Tai Chi is a continuous transformation of reality and emptiness, and every set in the boxing frame is very important. After the set, there is a process of changing breathing and strength. From the end of each action to the beginning of the next action, there is a process of changing strength, which is also a process of "cathode generating yang and anode generating yin". Tai Chi is a health practice suitable for all ages, and it can effectively relax muscles and nerves, as well as regulate heart and lung function. Lan Qing found that Tai Chi is safe and effective for patients with coronary heart disease, myocardial infarction, coronary artery bypass grafting surgery, and heart failure, and also that it is suitable for community implementation.¹¹⁶ Cai Qian found that Tai Chi can effectively alleviate depression and anxiety in patients with heart failure.¹¹⁷ Qiu Qian found that Tai Chi had a significant effect on improving the cardiopulmonary function of patients with atrial fibrillation after radiofrequency ablation, and that it was beneficial for the recovery and improvement of their postoperative quality of life.¹¹⁸

Qigong

Qigong is a traditional Chinese method for health, wellness, and disease control. It is a physical and mental exercise method that uses breathing adjustment, physical activity adjustment, and consciousness adjustment as means to strengthen the body, prevent and treat diseases, exercise and prolong life, and develop potential. The exercise method of the five organs and six viscera, mainly based on extreme abdominal breathing, can significantly enhance cardiovascular function and digestive absorption function. Lucio Pippa found that Qigong had a rehabilitation effect on patients with stable chronic atrial fibrillation. Qigong training was well tolerated, and compared to baseline, the patients could walk an average of 114 meters (27%) more at the end of treatment (p < 0.001), and an average of 57 meters (13.7%) more after 16 weeks (p = 0.008).¹¹⁹ Cai Yunxiao found that Baduanjin had a positive impact on the self-care ability of patients with coronary atherosclerotic heart disease after stent implantation, had a positive impact on the cardiopulmonary function of patients, and could also reduce the frequency of angina attacks in patients.¹²⁰ At the same time, some studies have used the Five Elements Palm to study improvements in rheumatic heart disease, hypertrophic non-obstructive heart disease, accompanied by atrial fibrillation and heart failure. It was found that in two patients treated with the Five Elements Palm, the right ventricle of the patient with rheumatic heart disease was significantly dilated and reduced, while in the patient with hypertrophic non-obstructive heart disease, atrial fibrillation was reversed to sinus rhythm, which could correct cardiac dysfunction.¹²¹

Wuqinxi

Hua Tuo created the "wu qin xi" based on the "er qin xi" ("Bear Classic and Bird Extension") in Zhuangzi. According to the "Biography of Hua Tuo" in the "Chronicles of the Later Han Dynasty", there is a technique called the "wu qin xi": one is called the tiger, two is called the deer, three is called the bear, four is called the ape, and five is called the bird. It is also used to treat diseases and strengthen the legs and feet, and be used to conduct pull-ups. When the body is unwell, it performs the "One Bird Play", sweating profusely, and due to its powder, the body is light and easy to eat. It is widely practiced by people over 90 years of age, deaf ears and bright eyes, strong teeth.¹²² Wuqinxi has been shown to improve elderly diseases. Chen Yongying summarized the effects of practicing Wuqinxi for 30 days on blood lipid levels and antioxidant enzyme activity in elderly people, and found that it could significantly reduce serum triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels, while increasing serum high-density lipoprotein cholesterol levels and superoxide dismutase and catalase activities.¹²³

Moxibustion therapy

Acupuncture

Acupuncture dredges the meridians, regulates yin and yang, and strengthens the healthy and eliminates pathogenic factor by stimulating the meridians and acupoints. Acupuncture is widely used in the treatment of geriatric heart disease. Yang Haiyan selected 120 elderly patients with coronary atherosclerotic heart disease for a comparative study of drug therapy and warm needle therapy, and found that warm needle combined with drug therapy could effectively reduce the level of blood lipids, thereby effectively improving patients’ symptoms.¹²⁴ Acupuncture has been shown to prevent and treat angina pectoris and reduce the incidence of coronary heart disease in patients with rheumatoid arthritis.¹²⁵ In addition, needling the Neiguan point on the right hand for 1 minute was shown to effectively improve symptoms in patients with paroxysmal supraventricular tachycardia.¹²⁶ At the same time, acupuncture as an auxiliary therapy has been shown to have a significant effect on ischemic heart disease.¹²⁷ Professor Wang Ying clinically used acupuncture and medicine to treat premature beats, which had a remarkable effect and greatly improved the quality of life of patients.¹²⁸

Moxibustion

Moxibustion stimulation of the Xinshu acupoint can directly reach the five visceral diseases, while stimulation of the Tanzhong acupoint can achieve the effects of regulating Qi, reducing adverse reactions, broadening the chest, and promoting diaphragmatic function. Stimulating the Juque and Neiguan acupoints can achieve the effects of promoting blood circulation, unblocking collaterals, and promoting Qi and relieving pain. Stimulating the Shenmen and Zusanli acupoints can also achieve the effects of warming and unblocking the heart meridians, promoting blood circulation, and dispelling dampness and cold. The combined stimulation of various acupoints can achieve the goals of removing blood stasis, relieving pain, promoting blood circulation, and dispelling dampness and cold. Moxibustion and traditional Chinese medicine are used to treat coronary atherosclerotic heart disease. A previous study found that compared with the control group, the indexes related to ventricular remodeling in the observation group were more significantly improved, the TCM syndrome was relieved better, and the total effective rate of treatment was higher.¹²⁹

Guasha

Guasha is guided by the theory of meridians and acupoints in TCM. Through specially designed guasha tools (cow horns) and corresponding techniques, a certain medium is dipped and repeatedly scraped and rubbed on the surface of the body, causing local changes such as red millet granules or dark red bleeding points to appear on the skin. According to the theory of meridians and acupoints in TCM, using a scraping device to stimulate the corresponding meridians and acupoints on the surface of the body to stimulate the circulation of Qi and blood throughout the body and clear the meridians can achieve the therapeutic goal of promoting blood circulation, removing blood stasis, dispelling pathogenic factor, and detoxification, thereby relieving discomfort symptoms such as chest tightness, shortness of breath, palpitations, and precordial pain. Guasha can also dilate the skin blood vessels, causing red blood cells and platelets to leak into subcutaneous adipose tissue, thereby inducing immune stress response and reducing pro-inflammatory factors such as IL-6, IL-8, TNF-α, etc., further affecting body fat metabolism, improving lipid metabolism disorders, and promoting a virtuous cycle of heart health. Zhang Wei¹³⁰ investigated 120 heart disease patients who received rehabilitation scraping therapy more than twice a week, and the results showed that the clinical effective rate reached over 90%, and the clinically significant effective rate reached over 80%.

DISCUSSION

Geriatric heart disease is a complex and multifactorial disease that requires the selection of appropriate treatment methods based on the disease itself and the physical characteristics of the elderly.

In the diagnosis of TCM, the same kind of diseases can be divided into different subtypes according to the patient’s physique, such as coronary heart disease and blood stasis type. Commonly used Chinese medicines include Radix Salvia, Panax notoginseng, Prunus davidiana, and Carthamus tinctorius, etc. For the phlegm turbidity type, commonly used TCMs include Descurainia sophia, Allium macrostemon, Pinellia ternata, and Citrus reticulata, etc. For the cold condensation type, commonly used TCMs include Moschus berezovskii Flerov, Radix Panax, Bos taurus domesticus Gmelin, and Borneolum syntheticum, etc. For the heart Qi deficiency type, commonly used Chinese medicines include Pseudostellaria heterophylla, Panax quinquefolium, Radix Ophiopogon, Schisandra chinensis and so on. Arrhythmia can be divided into heart deficiency and timidity types, and the use of calming and replenishing Qi pills can be used. For the type of heart and blood insufficiency, Gui Spleen Soup, Guizhi Licorice Keel Oyster Soup, etc. can be used. For the yin deficiency and fire prosperous types, cinnabar soothing pills, Hezhi Baidihuang pills, Coptis Ejiao soup, etc. can be used. Different medication methods are used according to different disease types. At the same time, the elderly must pay attention to the diagnosis of drugs as much as possible. The medication should not be too biased, the dose should not be too heavy, the disease should be stopped, the combination of dietary therapy, exercise and drug therapy should be applied, and the drugs and auxiliary treatment methods can often achieve twice the results with half the effort.

In clinical practice, the combination of TCM prescriptions, treatment methods, and Chinese style characteristic therapies, whether used alone or in combination with Western medicine, are increasingly being used in the treatment of geriatric heart disease, and the effect is significant. However, there are also some issues. Firstly, there is heated debate in clinical research regarding the formulation of TCM. Secondly, the efficacy targets or pathways of TCM or herbal formulas are complex and require extensive experimental research to investigate and confirm. Once again, evidence-based medicine for the treatment of geriatric heart disease with TCM is relatively insufficient, and the indicators for improving heart function are mostly commonly used in Western medicine. Whether TCM indicators can be used as efficacy evaluation indicators may require a lot more research.

DECLARATION OF CONFLICT OF INTEREST

All the authors declare no conflict of interest.