1. Background

Angina pectoris (AP), a primary symptom of coronary heart disease (CHD), is encompassed within the traditional Chinese medicine (TCM) diagnosis of “real-heart pain” or “chest pain.” This is because TCM diagnoses are generally formulated based on patterns of clinical signs and symptoms, in line with the framework recognized by the World Health Organization’s International Classification of Diseases, 11th Revision (ICD-11) [1,2].

In its early stages, CHD may be asymptomatic. However, as atherosclerotic plaques accumulate and significantly obstruct coronary blood flow, myocardial ischemia, hypoxia, and eventually necrosis may occur, resulting in acute myocardial infarction (AMI) [3]. Modern medical treatments for AMI include thrombolytic therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). These interventions aim to restore blood flow to the ischemic myocardium, limit infarct size, reduce mortality, and improve long-term prognosis [4].

Despite their effectiveness, conventional Western medical treatments for AP and AMI present certain limitations, such as high costs, adverse drug reactions, and procedural risks. In contrast, TCM has a long-standing history of treating real-heart pain, with perceived advantages including lower financial burden, fewer side effects, and broader acceptance among both patients and healthcare providers in China and internationally [2-6]. Recent big data analyses indicate that integrative approaches combining TCM and Western medicine have become increasingly common in clinical practice for AP management [3-5].

This article aims to provide a concise review of recent evidence (2020–2025) on the integrative treatment of real-heart pain using TCM and Western medicine, with particular attention to angina pectoris and myocardial infarction.

2.Methods
Relevant evidence was collected from major academic databases including CNKI, Wanfang, PubMed, and ResearchGate. The search covered literature published between January 1, 2020, and June 20, 2025, focusing on the integrative treatment of coronary heart disease (CHD), angina pectoris (AP), and myocardial infarction (MI).

Inclusion criteria comprised randomized controlled trials (RCTs), systematic reviews, meta-analyses, and clinical guidelines that investigated the combined use of traditional Chinese medicine (TCM) and Western medicine in the treatment of AP or MI. Exclusion criteria included expert opinion articles, case reports, and uncontrolled studies.

Search terms included both English and Chinese keywords: "angina pectoris," "myocardial infarction," "integrated treatment," "real-heart pain," "true heart pain" (真心痛), and "chest pain" (胸痛). Searches in CNKI and Wanfang were conducted in both languages by bilingual reviewers. Chinese-language articles included in the final review were translated into English using official translation tools provided by CNKI and Wanfang.

The review process followed the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [7].

A total of 16 clinical publications met the inclusion criteria, comprising randomized controlled trials (RCTs), systematic reviews, meta-analyses, and clinical guidelines related to the integrative treatment of real-heart pain (angina pectoris and myocardial infarction) using combined traditional Chinese medicine (TCM) and Western medical approaches.

The reviewed studies included patients both post–percutaneous coronary intervention (PCI) and those who had not undergone PCI. Across both patient groups, integrative treatment consistently demonstrated superior clinical outcomes compared to conventional Western medicine alone. Reported improvements included enhanced symptom relief, better control of anginal episodes, improved cardiac function, reduced inflammatory markers, and improved quality of life. These outcomes will be elaborated in detail in the following sections.

3. Results

There are 16 clinical reports, including RCTs, systematic reviews, meta-analyses, medical guidelines, fulfilling the inclusion criteria regarding integrative treatment of "real-heart pain" (AP, myocardial infarction) using integrative TCM and Western medicine. The cases include patients after PCI and who have not undergone PCI. Both types of patients showed significant multifaceted improvements with integrative treatment than conventional treatment alone, as will be elaborated as follows.

Lan ZZ reported the effectiveness and safety of TCM Luhong Recipe on patients with ST elevation myocardial infarction (STEMI) after PCI. The treatment group was given basic medical treatment + Luhong Recipe, and the control group was given basic medical treatment + placebo, both given for 12 weeks. The results showed that the treatment group was significantly better than the control group in heart functional indexes (LVEF, FS, LVEDV, LVESV), TCM clinical syndromes, quality of life score, and total effective rate (81.39% vs 60.97%). Besides, the incidence of cardiac insufficiency events within 24 weeks of the treatment group showed a decreasing trend, and no abnormal laboratory and symptoms of adverse drug reactions were found related to the TCM drug [8]. Jia XR reported similar results using TCM Shuguan Recipe for STEMI patients after PCI [9].

Chen and Wang reported Xuefu Zhuyu decoction combined with acupuncture therapy for 60 CHD patients after PCI. The results showed the integrated treatment group was significantly higher in cardiac functional indexes CO, SV, LVEF, while lower in anxiety and depression scores than the control group (P<0.05) [10]. Dai XX et al reported similar study on 98 stable angina pectoris patients after PCI, the results were that Xuefu Zhuyu decoction integrated treatment group showed higher total effective rate, improved cardiac function, and lower levels of serum inflammatory factors IL-6 and hs-CRP than those of the control group (all P<0.05) [11].

Wang J, et al. used Wushen decoction as integrated treatment, and conventional treatment alone as control for 88 AMI patients after PCI. The results showed that the hemorheological indexes, levels of CRP and TNF-α, serum MDA and SOD, LVESD, the incidence of cardiovascular adverse events in the integrated treatment group were significantly lower than those in the control group (P<0.05); while the LVEF in the integrated treatment group was significantly higher than that in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between both groups (P>0.05) [12]. While Yang and Liao investigated the effect of integrated treatment with Astragalus Baoxin decoction in patients with myocardial infarction after PCI. The results showed that the TCM decoction could effectively improve the cardiac function of patients with myocardial infarction after PCI, stabilize the levels of oxidative stress and inflammatory factors in patients, and improve the degree of vascular endothelial and myocardial injury and clinical symptoms in patients compared to the control group (all P<0.05) [13].

The most recent published RCT by Wu ZH et al reported integrated treatment with Xinbishun Recipe involving 80 AMI patients after PCI. The results showed that the total clinical effective rate, myocardial function and vascular endothelial function indexes, serum levels of nitric oxide improved better in the treatment group than the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The total incidence of cardiac adverse events in the integrated treatment group was lower than that in the control group at 6 months follow-up (P<0.05) [14].

There are 7 reports reviewed above about various TCM recipes used in combination with conventional treatment for CHD patients after PCI. All the results point out that the integrative treatment is more effective in improving significantly the total effective rates, clinical symptoms, quality of life and prognosis of the patients investigated, without increasing the incidence of adverse drug reactions, than those of the control group treated with conventional medicine alone.

The integrative treatment with TCM on the basis of conventional treatment has also been reported to bring significant improvements than the conventional treatment alone for CHD patients who have not undergone PCI, as elaborated herewith.

Meng LL, et al. analyzed the clinical effect of Yiqi Tongmai decoction in the treatment of AP after myocardial infarction and its effect on the quality of life of totally 90 patients. The results showed that the total effective rate of the treatment group was significantly higher than the control group (95.56% vs 77.78%, P<0.05), while the incidence of cardiac adverse events in the treatment group was significantly lower than the control group (6.67% vs 22.22%, P<0.05) [15]. Zhang S also studied the effect of Yiqi Tongmai decoction in the treatment of 70 CHD patients complicated with AP. Besides better clinical results, the plasma viscosity and hematocrit of the treatment group were significantly lower than the control group (P<0.05) [16].

Li JL, et al. reported a systematic review involving 12 RCTs (quality of the studies was C) with a total of 925 patients to evaluate the integrated treatment with Xiaoxianxiong decoction for CHD patients with AP. The results showed that the integrated treatment group could improve total ECG and AP clinical effective rates significantly than those of the control group (P<0.05) [17].

Zhang YZ systematically reviewed 15 RCTs involving 1398 post AMI patients treated with the benefiting qi and activating blood circulation TCM recipe on the basis of conventional treatment to evaluate its effect on ventricular remodeling and long-term prognosis after AMI. The results showed that integrative treatment could inhibit ventricular remodeling, improve cardiac function, reduce the syndrome score of qi deficiency and blood stasis, reduce the incidence of major adverse cardiovascular events (MACE) and improve the long-term prognosis in patients suffering from AMI. The possible cellular and molecular mechanisms of the effects were also mentioned, such as inflammation, apoptosis and autophagy, by regulating cytokine binding and related kinase activities [18].

Chen W, et al. conducted meta-analysis on nine RCTs with low risk of bias involving 824 CHD patients with AP. The results showed that compared to the conventional medicine alone, the integrative treatment with TCM and conventional medicine led to a better quality of life, lower incidence and duration of AP, lower total cholesterol concentration of the treatment group than the control group (P<0.05) [19].

Chen Y, et al. reported a large scale multi-centre cohort study involving 22 hospitals and 1042 AP patients to evaluate the efficacy of TCM in the prevention and treatment of stable AP in patients with CHD. A total of 423 patients were treated with standardized conventional medicine alone (control group) and 619 with a combination of TCM and conventional medicine (treatment group). Both groups underwent follow-up for 1 year. The results showed that the incidence of primary endpoint events in the treatment group decreased by 0.45% (P>0.05) and the incidence of secondary terminal events decreased by 5.25% compared to the control group (P<0.05). The total AP score decreased in both groups, but more prominent in the treatment group. It was concluded that integrated treatment reduced the incidence of cardiovascular events in patients with stable AP (grade Ⅱ endpoint) and effectively improved the curative effect compared to conventional treatment alone [20].

Yu LH, et al. reported a prospective real-world cohort study involving 690 CHD inpatients with stable AP, with 327 patients in the integrated treatment group and 363 patients in the conventional treatment group. The patients were divided into integrated treatment and conventional treatment groups according to whether they had been taking Chinese medicine for more than 6 months per year. They were followed up for 1 year. The results showed that the occurrence of composite cardiovascular events (CVE) including cardiac death, non-fatal myocardial infarction, revascularization, stroke, all-cause death, and readmission due to angina attack, heart failure, or malignant arrhythmia, during follow-up was significantly lower in the integrated treatment group than in the conventional treatment group (5.8% vs 10.2%; P<0.05). Hence it was concluded that integrated treatment could improve patients’ prognosis and reduce the occurrence of CVE [21].

There are 7 reports reviewed above about various TCM recipes used in combination with conventional treatment for CHD patients with AP who have not undergone PCI. All the results point out that the integrative treatment is more effective in improving significantly the total effective rates, clinical symptoms, quality of life, and prognosis of the patients investigated, without increasing the incidence of adverse drug reactions, than those treated with conventional medicine alone.

To facilitate readability, all the reviewed evidences in the present study are summarized in the table below.

4. Conclusions

This concise systematic review of evidence published over the past five years demonstrates that the integrative use of traditional Chinese medicine (TCM) alongside conventional Western medicine in the treatment of coronary heart disease (CHD) with angina pectoris (AP) or myocardial infarction is associated with higher clinical effectiveness, improved patient prognosis, enhanced quality of life, and minimal adverse effects, compared to conventional therapy alone.

However, limitations remain. The overall quality of evidence is modest, with potential biases including publication bias, sample population bias, lack of double-blinding, and heterogeneity in study design. Most studies originate from a single-country context and may not be generalizable globally. Therefore, to validate and expand upon these findings, further high-quality research is needed—particularly large-scale, multi-center randomized controlled trials (RCTs) and mechanistic investigations involving diverse populations and international collaboration.

5. References

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2. https://www.who.int/standards/classifications/frequently-asked-questions/traditional-medicine

3. Chinese Association of Integrative Medicine (2023). Clinical Pratice Guideline of Integrative Chinese and Western Medicine for Coronary Atherosclerosis.

4. Chinese Association of Integrative Medicine (2023). Diagnosis and treatment Guideline of Integrative Chinese and Western Medicine for Acute Myocardial Infarction.

5. Deng J, He J, Wang J, Chang CW, Jiao Y, et al. (2023) Reporting quality of randomized controlled trials of angina pectoris with integrated traditional Chinese and western medicine interventions: A cross-sectional study. BMC Med Res Methodol 23: 124.

6. Ferraro R, Latina JM, Alfaddagh A, Michos ED, Blaha MJ, et al. (2020) Evaluation and Management of Patients With Stable Angina: Beyond the Ischemia Paradigm: JACC State-of-the-Art Review. J Am Coll Cardiol 76: 2252-2266.

7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021: 372.

8. Lan ZZ (2021) Observation and mechanism of Lu Hongfang on patients with yang deficiency and blood stasis pattern after PCI after ST-segment elevation myocardial infarction (Ph.D. dissertation, Shanghai University of Traditional Chinese Medicine).

9. Jia XR (2024) Clinical study on the effect of Shu Guanfang on myocardial motor function after PCI in STEMI patients (Master's thesis, Nanjing University of Chinese Medicine).

10. Chen Y, Wang J (2022) Analysis of the clinical effect and psychological state of Xuefu Zhuyu decoction combined with acupuncture therapy on patients with coronary heart disease after PCI. Contemporary Journal of Clinical Medicine.

11. Dai XX, Wang GH, Liao J, Fan L (2024) The efficacy of Xuefu Zhuyu decoction in the treatment of angina pectoris after percutaneous coronary intervention and its effect on the rehabilitation of cardiac function in patients. World Compound Medicine.

12. Wang J, Guo JY, Yang HL, Li G, Zhang YF (2024) Effect of Wushen decoction plus or minus treatment on hemorheology and cardiac function in patients with myocardial infarction after PCI. Modern Chinese Medicine, 2024.

13. Yang WH, Liao R (2023) Application of Astragalus Baoxin decoction after coronary intervention in myocardial infarction. Bright Chinese Medicine 411: 283-285.

14. Wu ZH, Zhang Q, Deng SR (2025) Xinbishun in the Treatment of Heart-qi Yin Deficiency Syndrome after Myocardial Infarction. Bright Chinese Medicine 465: 1552-1555.

15. Meng LL, He GL (2020) Clinical observation of Yiqi Tongmai decoction in the treatment of angina pectoris after myocardial infarction. Bright Chinese Medicine 342: 676-678.

16. Zhang S (2021) Clinical observation of Yiqi Tongmai decoction in the treatment of coronary heart disease complicated with angina. Bright Chinese Medicine 375: 2379-2381.

17. Li JL, Kang N, Li LJ, Zhang SH, Dai W (2020) A Systematic Review on Modified Xiaoxianxiong Decoction Combined with Conventional Western Medicine in the Treatment of Angina Pectoris in Coronary Heart Disease. Bright Chinese Medicine 356: 2961-2967.

18. Zhang YZ (2022) Efficacy and mechanism exploration of Tongguan capsule on ventricular remodeling after acute myocardial infarction (Ph.D. dissertation, Guangzhou University of Chinese Medicine).  

19. Chen W, Wang B, Ge Y, Xu H, Jiang C, et al. (2021) A systematic review and meta-analysis of clinical research on treating angina pectoris of coronary heart disease with traditional Chinese medicine to promote blood circulation and remove blood stasis. Annals of Palliative Medicine 10: 10506-10514.  

20. Chen Y, Xiao X, Xu XL, Zhang ZP, Deng Y (2021) Traditional Chinese Medicine in the prevention and treatment of stable angina pectoris in patients with coronary heart disease based on the theory of "phlegm and blood stasis" under guidance of evidence-based medicine: A prospective cohort study. J Tradit Chin Med 41: 150-156.

21. Yu L, Wang Z, Xu C, Liu A, Li T, et al. (2023) Integrated Chinese and Western medicine for stable angina pectoris of coronary heart disease: a real-world study including 690 patients. Frontiers in cardiovascular medicine 10: 1194082.