Cardiovascular Health TCM | Dr. Yan Shifei (TCM Cardiology) | CMCS Shanghai

About Dr. Yan Shifei

Dr. Yan Shifei is Chief Cardiologist at Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai — one of China's foremost centres for integrative cardiovascular care and a national reference institution for the combined management of coronary artery disease, hypertension, and heart failure through classical TCM and evidence-based cardiology. She is recognised for her expertise in herbal cardioprotection, blood pressure management, lipid regulation, and the integrative treatment of complex cardiovascular patients in whom conventional pharmacotherapy alone has achieved inadequate control. Dr. Yan's clinical philosophy holds that cardiovascular disease in the TCM framework is not a disease of the heart in isolation — it is a systemic disorder of Qi, Blood, Phlegm, and Stasis that manifests in the cardiac vessels, and that durable cardiovascular control requires addressing the constitutional pattern that drives the pathology, not only the haemodynamic and biochemical parameters that measure it. Her department at Yueyang Hospital has established one of Shanghai's most comprehensive integrative cardiology programmes, combining classical herbal prescription, lifestyle medicine, and conventional pharmacotherapy into a unified care pathway for patients with coronary artery disease, hypertension, and metabolic cardiovascular risk.

Case Overview

Mr. Robert Sinclair (pseudonym), a 62-year-old British retired teacher based in Shanghai, presented with a three-year history of recurrent retrosternal chest tightness and pain consistent with unstable angina, worsened over the preceding month with increased frequency (2–3 episodes daily), prolonged duration (approximately 10 minutes), and associated dizziness on postural change. Blood pressure was poorly controlled at 160–180/95–105 mmHg despite existing antihypertensive therapy. Coronary angiography demonstrated LAD stenosis of approximately 60% and circumflex stenosis of approximately 40%. Lipid profile was significantly elevated. TCM diagnosis identified Chest Bi — Phlegm-Stasis Mutual Obstruction. Dr. Yan Shifei designed an integrative programme combining optimised Western cardiovascular pharmacotherapy with classical herbal prescription (Xuefu Zhuyu Tang combined with Gualou Xiebai Banxia Tang, modified) and structured lifestyle intervention. At three-month follow-up, angina had resolved, blood pressure was stable at 130–140/80–85 mmHg, lipid targets were achieved, and echocardiographic diastolic function had normalised. Six-month follow-up confirmed sustained remission.

Patient Background

• Name / Nationality: Mr. Robert Sinclair (pseudonym) — British; 62-year-old retired teacher based in Shanghai
• Age / Sex: 62-year-old male
• Chief Complaint: Recurrent chest tightness and pain for three years, significantly worsened with dizziness for one month
• History of present illness: Retrosternal pressure-like chest pain for three years, each episode lasting 3–5 minutes, relieved by rest or sublingual nitroglycerine; diagnosed with coronary artery disease and unstable angina at a local hospital; commenced aspirin, clopidogrel, atorvastatin, and isosorbide dinitrate with partial symptom control. Over the preceding month: angina frequency increased to 2–3 episodes daily, duration extended to approximately 10 minutes; dizziness developed, most pronounced on postural change; blood pressure 160–180/95–105 mmHg despite self-adjusted antihypertensive dosing
• Past medical history: Hypertension for 10 years, maximum recorded 190/110 mmHg; long-term nifedipine SR and hydrochlorothiazide with unstable control; no diabetes, no cerebral infarction; no smoking or alcohol
• TCM four examinations:
  • Inspection: Sallow, dusky complexion; obese build; purple-dark tongue with ecchymotic patches; white greasy coating
  • Auscultation/olfaction: Regular respiration; no abnormal odour
  • Inquiry: Chest tightness and fixed stabbing-cramping chest pain, worse at night; palpitations; shortness of breath; fatigue; dizziness with sensation of head heaviness; limb heaviness; adequate appetite; poor sleep with frequent dreaming and waking; loose stools 2–3 times daily
  • Palpation: Wiry, slippery, choppy pulse (弦滑涩脉)

Diagnostic Workup

Electrocardiogram

• Sinus rhythm; ST-T depression — consistent with myocardial ischaemia

Echocardiography

• Left ventricular wall thickening; impaired left ventricular diastolic function

Coronary Angiography

• LAD stenosis approximately 60%; circumflex stenosis approximately 40% — significant but below revascularisation threshold; optimal medical therapy indicated

Lipid Profile

• Total cholesterol 6.5 mmol/L; triglycerides 2.2 mmol/L; LDL-C 4.2 mmol/L — significantly above cardiovascular risk targets

24-Hour Ambulatory Blood Pressure Monitoring

• Mean blood pressure 165/100 mmHg; large diurnal variation; nocturnal dipping less than 10% — non-dipper pattern, associated with increased cardiovascular risk

Dr. Yan's pre-treatment assessment: The angiography tells us the anatomy: two-vessel disease, both below the revascularisation threshold, so optimal medical therapy is the correct strategy. But the patient has been on optimal medical therapy for three years and his angina is getting worse, not better. The blood pressure is uncontrolled despite two antihypertensives, and the lipids are far above target. The non-dipper pattern on the ambulatory monitoring is particularly concerning — it tells us the autonomic regulation of blood pressure is impaired, which in TCM corresponds to the Phlegm-Stasis pattern obstructing the clear Yang from ascending and descending normally. The tongue is the most informative finding: purple-dark with ecchymotic patches — that is Blood stasis, established and significant. The white greasy coating — that is Phlegm-Damp. The pulse is wiry, slippery, and choppy simultaneously — wiry for Liver constraint and hypertension, slippery for Phlegm, choppy for Blood stasis. This is a classic Phlegm-Stasis mutual obstruction pattern, and it will not resolve with antihypertensives and statins alone. We need to move the Blood, resolve the Phlegm, and open the chest.

TCM Diagnosis and Integrative Treatment Strategy

The TCM diagnosis established by Dr. Yan Shifei was Chest Bi — Phlegm-Stasis Mutual Obstruction (胸痹·痰瘀互结证). The corresponding Western diagnoses were coronary artery disease with unstable angina (NYHA Class II); hypertension Grade 3, very high risk; and dyslipidaemia.

The treatment principle was: activate Blood and resolve Stasis; resolve Phlegm and unblock the collaterals; tonify Qi and open the chest (活血化瘀，化痰通络，益气宽胸).

Herbal prescription — Xuefu Zhuyu Tang combined with Gualou Xiebai Banxia Tang, modified: Taoren 12g, Honghua 9g, Danggui 12g, Shengdihuang 12g, Chuanxiong 9g, Chishao 12g, Niuxi 12g, Jiegeng 9g, Chaihu 9g, Zhiqiao 9g, Gancao 6g, Gualou 15g, Xiebai 12g, Banxia 9g, Danshen 15g, Huangqi 30g. One decoction daily, taken warm in two divided doses. Rationale: Xuefu Zhuyu Tang (Drive Out Stasis from the Mansion of Blood) is the classical formula for Blood stasis in the chest — activating Blood, resolving Stasis, and moving Qi in the thoracic region; Gualou Xiebai Banxia Tang opens the chest, resolves Phlegm, and unblocks the Yang of the chest; Danshen augments the Blood-activating effect with modern evidence for coronary vasodilation; Huangqi tonifies the Qi that drives the Blood and supports cardiac function.

Western pharmacotherapy — optimised: Antiplatelet therapy continued: aspirin 100 mg daily; clopidogrel 75 mg daily. Lipid management: atorvastatin 20 mg nightly. Anti-ischaemic: isosorbide mononitrate SR 40 mg daily. Antihypertensive regimen revised: nifedipine SR and hydrochlorothiazide discontinued; amlodipine besylate 5 mg daily and valsartan 80 mg daily commenced — combination selected for superior 24-hour blood pressure control and renal protection; dose adjustment per blood pressure response. Sublingual nitroglycerine available for acute angina relief.

Lifestyle intervention: Diet: low-salt (<5 g/day), low-fat, low-sugar, high-fibre; reduced animal fat and cholesterol; increased vegetables, fruit, and whole grains; Phlegm-Damp constitution dietary support — yam, coix seed, and hyacinth bean incorporated for Spleen-strengthening and Phlegm-resolving properties. Exercise: moderate aerobic activity (walking, Tai Chi, Baduanjin) at least five times weekly, 30 minutes per session, at an intensity producing mild perspiration without fatigue. Emotional regulation: stress reduction through music, reading, and leisure travel; avoidance of emotional agitation and anxiety. Sleep hygiene: consistent sleep schedule; avoidance of stimulants before bed; warm foot bath and warm milk to promote sleep onset.

Treatment Course and Outcomes

At Two Weeks

• Chest tightness and pain significantly reduced; angina frequency decreased to 1–2 episodes per week, duration shortened to 2–3 minutes
• Dizziness improved; blood pressure 150–160/90–95 mmHg
• Repeat ECG: ST-T depression improved

At One Month

• Angina essentially resolved — only occasional post-exertional episodes, rapidly relieved by rest
• Dizziness markedly reduced; blood pressure stable at 140–150/85–90 mmHg
• Lipid reassessment: TC 5.2 mmol/L; TG 1.8 mmol/L; LDL-C 3.2 mmol/L — all improved toward target

At Three Months

• All symptoms fully resolved; quality of life significantly improved
• Blood pressure stable at 130–140/80–85 mmHg — target achieved
• Echocardiography: left ventricular wall thickening improved; diastolic function normalised

Six-Month Follow-Up

• Sustained remission — no recurrence of angina, dizziness, or blood pressure instability; patient maintaining lifestyle modifications independently

Dr. Yan's clinical reflection: The echocardiographic improvement in diastolic function at three months is the finding I find most significant, because diastolic dysfunction in hypertensive heart disease is notoriously difficult to reverse with antihypertensives alone. The combination of blood pressure control, Blood-activating herbal therapy, and the lifestyle modifications — particularly the Tai Chi and the dietary changes — appears to have produced a degree of cardiac remodelling that pharmacotherapy alone had not achieved over three years. In TCM terms, when the Phlegm-Stasis obstruction is resolved and the Qi is tonified, the heart muscle can receive adequate nourishment and begin to recover its structural and functional integrity. The tongue at three months had lightened considerably — the ecchymotic patches were fading, the coating was less greasy. The body was telling us the same story as the echocardiogram.

Expert Commentary — Dr. Yan Shifei

1. Phlegm-Stasis Mutual Obstruction: The TCM Framework for Metabolic Cardiovascular Disease

The TCM pattern of Phlegm-Stasis mutual obstruction (痰瘀互结) is the most clinically prevalent pattern in patients with combined coronary artery disease, hypertension, and dyslipidaemia — the metabolic cardiovascular phenotype that now represents the dominant cardiovascular disease burden in both China and the West. In TCM pathophysiology, the sequence is consistent: dietary excess and constitutional Spleen weakness impair the transformation and transportation of food essence, producing Phlegm-Damp; Phlegm-Damp obstructs the flow of Qi and Blood, producing Blood stasis; Phlegm and Stasis combine to obstruct the cardiac vessels, producing Chest Bi. The modern biomedical correlates are equally consistent: dyslipidaemia (Phlegm) drives endothelial dysfunction and atherosclerotic plaque formation; platelet aggregation and impaired fibrinolysis (Blood stasis) produce the thrombotic events that convert stable plaque to acute coronary syndrome. The classical formula Xuefu Zhuyu Tang has been evaluated in multiple randomised controlled trials in patients with stable coronary artery disease and has demonstrated measurable effects on platelet aggregation inhibition, endothelial nitric oxide production, and inflammatory marker reduction — biological mechanisms that directly correspond to its classical action of activating Blood and resolving Stasis in the chest.

2. The Non-Dipper Hypertension Pattern and TCM Yang Regulation

The non-dipper pattern — defined as a nocturnal blood pressure reduction of less than 10% from daytime values — is associated with significantly increased risk of cardiovascular events, target organ damage, and all-cause mortality, independent of mean blood pressure level. In conventional cardiology, the non-dipper pattern is managed primarily by timing antihypertensive doses to achieve better nocturnal coverage. In TCM, the failure of blood pressure to fall at night reflects a disruption of the normal Yang Qi cycle — Yang should consolidate and descend at night, allowing the body to rest and repair; when Phlegm-Stasis obstructs the channels, Yang cannot descend normally, and the blood pressure remains elevated through the night. The antihypertensive regimen revision in this case — replacing nifedipine SR and hydrochlorothiazide with amlodipine and valsartan — provided superior 24-hour coverage and addressed the non-dipper pattern pharmacologically. The herbal formula addressed it constitutionally: by resolving the Phlegm-Stasis obstruction that was preventing normal Yang descent, the formula supported the restoration of normal circadian blood pressure variation. The combination produced blood pressure control that three years of prior pharmacotherapy had not achieved.

3. Lifestyle Medicine as TCM Constitutional Correction

The lifestyle interventions prescribed in this case — dietary modification, Tai Chi, emotional regulation, and sleep hygiene — are not generic cardiovascular risk reduction advice. They are targeted constitutional corrections for the Phlegm-Damp Spleen-deficiency pattern that underlies the Phlegm-Stasis cardiovascular phenotype. The dietary modifications — low-fat, low-salt, high-fibre, with yam, coix seed, and hyacinth bean — directly address the Spleen weakness and Phlegm-Damp accumulation that are the root of the pattern. Tai Chi and Baduanjin are not simply aerobic exercise — they are movement practices that simultaneously strengthen the Spleen through physical activity, soothe the Liver through meditative attention, and regulate the autonomic nervous system through controlled breathing, addressing three of the four pathological mechanisms in this patient simultaneously. The evidence base for Tai Chi in hypertension management is now substantial, with meta-analyses demonstrating systolic blood pressure reductions of 15–20 mmHg in hypertensive patients practising Tai Chi regularly — an effect size comparable to a single antihypertensive agent. In this patient, the lifestyle modifications were not adjuncts to the pharmacotherapy and herbal therapy — they were the third pillar of a genuinely integrative cardiovascular programme.

How CMCS Shanghai Coordinated This Case

CMCS Shanghai supported Mr. Sinclair and his family from initial consultation through six-month follow-up, including: priority appointment coordination with Dr. Yan Shifei at Yueyang Hospital with bilingual review of all prior cardiology records, angiography reports, and medication history; bilingual interpretation throughout all TCM four-examination consultations, integrative treatment planning discussions, and Western pharmacotherapy review sessions; coordination of ECG, echocardiography, coronary angiography, lipid panel, and 24-hour ambulatory blood pressure monitoring with bilingual results communication and clinical summary for the patient's cardiologist in the UK; bilingual pharmacy support for herbal decoction preparation and concurrent medication schedule to ensure no herb-drug interactions; monthly cardiovascular monitoring with bilingual progress summaries communicated to the patient's GP and cardiologist overseas; three-month echocardiographic and lipid reassessment coordination with bilingual comparative results report; and six-month follow-up comprehensive cardiovascular summary provided to the patient's overseas medical team for continuity of care.

For international patients with coronary artery disease, hypertension, or complex cardiovascular conditions seeking integrative TCM care in Shanghai, Dr. Yan Shifei's team at Yueyang Hospital offers a clinically rigorous, evidence-informed approach — combining classical herbal cardioprotection, optimised Western pharmacotherapy, and structured lifestyle medicine to achieve cardiovascular control that neither system achieves alone. CMCS ensures that expertise is accessible: in the patient's language, with overseas physicians informed at every step, from the first integrative consultation through long-term follow-up.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.