



































050817-CR100.docx


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

11 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

EXPLORING GUT HEALTH IN HEART FAILURE: TCM AND WESTERN 

MEDICINE PERSPECTIVES 
 

 
1Dr. Wei Zhang, and 2Prof. Ming Liu, 
1Department of Cardiology, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China 
2Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China 

 

Abstract: Heart failure (HF) is a prevalent and life-threatening condition characterized by cardiac insufficiency, 

leading to physical limitations and edema. Aging populations have seen a surge in HF cases, with alarming 

mortality rates. Recent research has unveiled the significance of intestinal flora in HF pathogenesis, introducing 

the "intestinal hypothesis of heart failure." Traditional Chinese medicine (TCM), rooted in holistic principles and 

organ interactions, aligns with this perspective, emphasizing the interplay between the heart and small intestine. 

Various TCM conditions, such as heart impediment, heart cough, and heart water, relate to HF. 

This review synthesizes recent clinical and basic research endeavors in utilizing TCM to modulate intestinal flora 

for HF treatment. It sheds light on the potential of TCM as a complementary therapeutic approach to address the 

complexity of HF, aiming to provide innovative insights and a theoretical framework for HF prevention and 

management. 

Keywords: Heart failure, intestinal flora, traditional Chinese medicine, holistic approach, cardiovascular disease. 

 

 

Introduction  

Heart failure (HF), is a group of syndromes caused by ventricular filling and/or impaired ejection capacity due to 

various heart structural or functional diseases, with cardiac output unable to meet the needs of body metabolism, 

insufficient blood perfusion of organs and tissues, and blood stasis of lung and/or systemic circulation. The 

clinical manifestations are mainly physical activity limitation and edema caused by dyspnea and weakness [1]. 

With the growth of age, the prevalence of heart failure increases rapidly. The prevalence of people over 70 years 

old rises to more than 10%. The four-year mortality rate of heart failure reaches 50%, and the one-year mortality 

rate of patients with severe heart failure reaches 50%. It is the end-stage manifestation of cardiovascular disease 

and the main cause of death. Modern research indicates that intestinal flora plays an important role in the 

occurrence, development and treatment of heart failure, and "intestinal hypothesis of heart failure" has been 

proposed [2]. Traditional Chinese medicine (TCM) is a unique theoretical system of the Chinese nation. In its 

traditional theory, the viewpoints of "holism" of zang-fu organs and "the exterior-interior relationship between 

heart and small intestine" have something in common with the role of intestinal microorganisms. In the literature 

of traditional Chinese medicine, heart impediment, heart cough, heart water, heart distension, heart failure, heart 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

12 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

failure and other diseases are related to heart failure [3]. This study summarizes the clinical and basic research 

progress in the treatment of heart failure by regulating the intestinal flora in traditional Chinese medicine in recent 

years, in order to provide new ideas and theoretical basis for the prevention and treatment of the disease.  

1. Overview of intestinal flora  

The intestinal tract is the largest digestive, excretory and immune organ of the human body, as well as the largest 

bacterial reservoir and endotoxin pool, with about 100 trillion microorganisms stored therein, which constitute 

the intestinal flora [4]. During the evolution of intestinal flora, a symbiotic relationship was formed with the host 

cells. The intestine provides a good living environment for the growth and reproduction of microorganisms, and 

the intestinal flora plays an important role in maintaining the homeostasis, nutritional metabolism and health of 

the intestinal environment [5]. Studies have shown that the intestinal flora before birth is sterile. At birth, infants 

obtain the initial microflora from the mother's vagina and feces, which is mainly composed of Lactobacillus and 

Bifidobacterium, and the intestinal flora is basically formed by the age of 2 years old. Since then, the number and 

type of intestinal flora are increasing, and it reaches a steady state in adulthood [6]. The intestinal flora is affected 

by age, gender, diet, lifestyle, antibiotic use and other factors, and the intestinal flora of the normal population is 

in dynamic balance with the human environment. At present, the main effects of intestinal flora recognized in 

clinical practice include: (1) Natural biological protection barrier: The intestinal anaerobes mainly composed of 

Bifidobacterium can form a natural biological barrier on the intestinal surface to resist the invasion of pathogenic 

bacteria and bacteria [7]. (2) Regulate the nutrition metabolism of the body. The intestinal flora is an important 

physiological function for regulating the intestinal tract, and the carbohydrate in the body is the main energy 

source for host cells and the intestinal flora. When the host cells cannot normally digest the polysaccharide and 

cellulose in food, they need to be degraded under the assistance of the intestinal flora to effectively regulate the 

blood glucose and lipid levels of the body, and provide the basic energy for the body [8]. (3) immunoregulatory 

effect, intestinal anaerobes can enhance the immune ability and non-specific immune ability of the body by 

activating the activity of phagocytes of the body [9].  

2. The correlation between intestinal flora imbalance and heart failure  

In the current research, people's understanding of the pathological and physiological mechanism of heart failure 

has changed significantly. It is believed that heart failure is not only a hemodynamic disease, but also involves 

multiple system disease states in metabolism, neuroendocrine and inflammation. Some basic studies have shown 

that changes in the composition of the intestinal flora and its metabolites are related to the occurrence and 

development of heart failure [10].  

3.1. Intestinal flora imbalance  

The latest evidence indicates that the intestinal flora of patients with heart failure is different from that of healthy 

people. Pasini [11] et al. confirmed that the number of intestinal pathogenic bacteria in patients with HF, such as 

Salmonella, Campylobacter, Shiga, Yersinia, Candida and other foreign bacteria was increased, while the number 

of native bacteria, such as Bifidobacterium and lactic acid bacteria was decreased. Moreover, the age, gender and 

body mass index were not statistically significant compared with those of the healthy control group, suggesting 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

13 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

that patients with HF had dysbacteriosis [12]. 16S rRNA gene sequencing showed that the number of Actinomyces 

and Bifidobacterium was increased, while the number of Macromonas was decreased in patients with heart failure. 

Metagenomics and metabolomics analyses have revealed that the basic characteristics of the flora changes in 

patients with chronic heart failure are the decrease of C. pratense and the increase of active rumen cocci [13]. 

Bifidobacterium, Lactobacillus and Bacteroides are beneficial bacteria in intestinal flora and play an important 

role in body health. When HF occurs, its balance is damaged and the number of flora is significantly reduced, 

which is closely related to the severity of the disease. At the same time, the number of intestinal pathogenic 

bacteria such as Escherichia coli and yeast-like fungi in the patient was significantly increased, which was 

positively correlated with the levels of hs-CRP and BNP, and negatively correlated with LVEF, further promoting 

the deterioration of the disease. Therefore, the imbalance of intestinal flora in patients with HF is closely related 

to the level and condition of inflammatory response [14].  

3.2. Increased permeability of the intestinal barrier and endotoxin translocation  

Patients with heart failure not only have an imbalance of the intestinal flora, but also have increased permeability 

of the intestinal barrier and endotoxin translocation. Under physiological conditions, there is a layer of mucosal 

barrier between the intestinal contents and intestinal tract of human body, which is mainly composed of mucus 

secreted by intestinal epithelial cells and connexins tightly connected at the top of epithelial cells, to prevent 

intestinal epithelial cells and immune cells from directly contacting bacteria in the intestinal tract and inhibit 

inflammation and infection [1]. In the case of heart failure, the body will adjust the blood distribution throughout 

the body to ensure the supply of vital organs, of which intestinal ischemia and hypoxia occur earliest, and 

intestinal mucosal structure will suffer from ischemia-reperfusion injury. Patients with heart failure will have 

increased carbon dioxide pressure in gastric mucosa. Even in the condition of low-level activity, the weakened 

intestinal wall circulation and microcirculation disorder of patients will lead to intestinal mucosal edema and 

malabsorption, further resulting in weakened immune defense function and weakened resistance to bacterial 

adhesion, which is conducive to the migration of bacteria and toxins to extra-intestinal tissues and organs [15]. 

Endotoxin is a lipopolysaccharide (LPS) present in the cell wall of Gram-negative bacteria, which contains a 

hydrophilic polysaccharide moiety and a hydrophobic lipid A. The decline of intestinal barrier function results in 

the migration of large amount of endotoxin in the intestinal lumen to the extra-intestinal tissue, which is called 

endotoxin translocation. Endotoxin can cause submucosal edema, necrosis of the cells at the top of the intestinal 

villi, and increased intestinal permeability, thereby destroying the function of the intestinal barrier. Bacterial 

translocation may be controlled in some cases, but endotoxin can still pass through the "leaky" intestinal mucosa, 

causing the activation of inflammation and the release of cellular mediators [16]. Microbial and lipopolysaccharide 

levels in the blood have been considered markers of impaired intestinal barrier.  

3.3. Metabolites of Intestinal Microflora  

The known intestinal metabolites related to heart failure include trimethylamine oxide (TMAO), short-chain fatty 

acids (SCFAs), and bile acids. The intestinal flora has been shown to participate in TMAO formation by producing 

trimethylamine (TMA), which, once in the blood, is transported to the liver and then converted to TMAO under 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

14 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

the catalysis of flavin monooxygenase (FMO) [17]. Plasma TMAO levels were elevated in patients with heart 

failure and the E. coli to Shiga ratio was positively correlated with blood trimethylamine oxide levels in patients 

with compensated heart failure, indicating a correlation between intestinal flora imbalance and blood 

trimethylamine oxide levels [13]. In a 5-year follow-up of 720 patients with stable heart failure, the mean TMAO 

of enrolled patients was 5.0μmol/L, which was higher than that of patients without heart failure (3.5μmol/L; 

P<0.001). Patients with higher plasma TMAO levels had a 3.4-fold increased risk of death. After adjusting for 

traditional cardiovascular risk factors and BNP, an increase in TMAO levels still predicts an increase in the 5-

year mortality rate [18]. Another key metabolite of intestinal flora, short-chain fatty acids (SCFs), is the main 

energy source of the intestine. SCFs not only maintain the stability of the intestinal barrier, but also regulate the 

immune system, improve the microenvironment of the intestinal mucosa, and maintain the normal function of the 

intestinal mucosa, playing a defense function against the invasion of pathogenic bacteria and harmful substances 
[19]. In addition, SCFAs can be recognized by specific host receptors and improve the prognosis of heart failure 

by regulating host blood pressure and inhibiting ventricular remodeling [20]. Short-chain fatty acid-producing 

bacteria in the intestines of patients with heart failure are significantly reduced. 16s RNA analysis of intestinal 

microorganisms showed a significant reduction in SCFA-producing bacteria in intestinal microorganisms of 

patients with heart failure, e.g., Eubacterium rectal, Dorea Longicatena [21,22]. Short-chain fatty acids play an 

important role in the regulation of inflammation and the maintenance of the integrity of the intestinal barrier. 

SCFA can exhibit multiple effects [23], which can exert anti-inflammatory and pro-inflammatory effects on 

macrophages, and induce the release of inflammatory mediators such as nitric oxide (NO), IL-6, and IL-12 by 

activating intestinal macrophages, thereby preventing myocardial hypertrophy and fibrosis [24]. The metabolism 

of bile acids depends on the action of intestinal flora. The composition and content level of bile acids in patients 

with HF are significantly changed compared with those in the normal control group, especially the change of 

secondary bile acid spectrum. Specific secondary bile acids (such as ursodeoxycholic acid) can inhibit the 

inflammatory response caused by NF-KB by regulating FXR bile acid receptors. Studies have also shown that 

targeted treatment of FXR can reduce myocardial cell apoptosis and fibrosis, thereby improving the prognosis of 

heart failure [25].  

3. Exploration of TCM theory of heart failure based on intestinal flora  

4.1. Heart-spleen correlation  

The concept of holism and the theory of the integration of five zang-organs are the important theory and essence 

of TCM, and the correlation between heart and spleen is an important part of the theory of the integration of five 

zang-organs. It is mentioned in lingshu meridian that "the pulse of the Taiyin of the spleen foot, the branches of 

which are connected from the stomach to the septum and into the heart……the great collateral of the spleen, is 

called big bag, which comes out three inches into the axilla and spreads over the chest and hypochondrium". It is 

recorded in Su Wen Ping Ren Qi Lun that "the great collateral of the stomach is named Xuli, which runs through 

the septum and collaterals lung. It comes from under the left breast, so its movement should be based on the hand, 

and the pulse should be based on qi". The spleen is located in the middle energizer and serves as the hub of qi 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

15 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

movement of the whole body. It is recorded in Su Wen Bielun of Meridians that "the food qi enters the stomach 

and disperses the essence into the liver, while the yin qi flows into the tendons. When the food qi enters the 

stomach, the turbid qi will return to the heart and the pathogen will be transferred to the pulse. The meridian qi 

flows through the meridians and is transferred to the lung, which faces hundreds of meridians and is used for 

seminal emission. Mao pulse combines with essence and moves qi to the fu. The spirit of the government is clear, 

so it will remain in the four zang-forces, and the qi will be weighed ". According to zang-fu theory, the heart 

stores spirit, which is the sovereign of five-zang and six-fu, and has the function of commanding the physical and 

psychological activities of the whole body. The spleen, however, controls the transportation and transformation 

of qi and blood, serving as the source of biochemical transformation of qi and blood, as well as providing the 

material basis for the sovereign function of the heart. It indicated that the normal operation of spleen could 

promote the smooth flow of other organs, facilitate the coordination of qi and blood, and prevent the invasion of 

pathogenic factors [3]. The heart and spleen are separated in anatomical position by only one layer of diaphragm, 

which is in similar position. They are closely related through the meridian system. It is recorded in lingshu 

meridian that the branches of spleen meridian of foot Taiyin were connected with heart meridian of lesser yin of 

hand "from stomach, from diaphragm to heart". "Miraculous pivot, the don't" "foot taiyin is, up to the thigh, in 

yangming. And don't all line, knot in the pharynx, penetration of the tongue ... Hand less Yin is, don't into the Yu 

Yuan axillary between two tendons, belong to the heart, walk on the throat, out of the surface, eye inner canthus 

". It could be seen that the difference between the two meridians met at the throat, further connecting the heart 

and spleen. Combined with the running of meridians and collaterals, it was characterized by the intersection of 

yin and yang, which resembled an endless loop, thus laying a more adequate foundation for the related theories 

of heart and spleen" [26]. Therefore, it indicates that the relevant theories of heart and spleen can guide the research 

on the relationship between intestinal flora and heart failure from the perspective of meridians and collaterals in 

traditional Chinese medicine.  

Studies have found that in the human intestinal micro-ecological system, the normal flora can produce a variety 

of enzymes and participate in the digestion and absorption of nutrients [27]. If the normal community structure of 

the intestinal flora is changed, symptoms such as gastrointestinal discomfort will occur, and related intestinal 

diseases will continue to occur over time, which are consistent with the clinical manifestations of spleen 

deficiency syndrome in traditional Chinese medicine [28]. Spleen deficiency syndrome is a common syndrome in 

TCM clinical practice, and its main manifestation is digestion and absorption dysfunction, accompanied by 

systemic qi deficiency. Studies have found that spleen deficiency syndrome is closely related to the changes of 

intestinal flora [29]. Studies have found that Bifidobacterium in feces of patients with diarrhea due to spleen 

deficiency is significantly reduced, and the number of Bifidobacterium in feces is significantly increased after 

treatment with invigorating spleen. Animal experiments showed that the spleen deficiency mouse model prepared 

with Radix et Rhizoma Rhei decoction also had significant microecological imbalance, and the intestinal 

Lactobacilli and Bifidobacterium were decreased to different degrees [30]. Animal experiments showed that the 

mouse model of spleen deficiency constipation could be established by decocting Folium sennae in water. The 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

16 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

total number of intestinal microorganisms after gavage was significantly lower than that in the normal group, and 

the E. coli and lactic acid bacteria were significantly increased, proving that the balance of intestinal microecology 

in the mouse model of spleen deficiency constipation was damaged to a certain extent [31].  

4.2. Heart and small intestine exterior-interior  

The heart and small intestine communicate with each other and collateral with each other on the meridians and 

collaterals to form the exterior-interior relationship. It is recorded in lingshu meridian that "the pulse of heart and 

hand with less yin originates from the heart and goes out to belong to the heart system and the lower diaphragm 

collaterals and small intestine …", "the pulse of small intestine and hand with greater yang originates from the 

end of little finger and enters the deficiency basin to collateral the heart and travels down the pharynx to reach 

the stomach, which belongs to the small intestine." "Su Wen Gu Kong Lun" said: "Those who supervise the pulse, 

… enter the collateral brain, … penetrate the heart." Lingshu meridian said: "The pulse of the sun is sufficient, 

and the straight pulse enters the collaterals from the top", "The pulse of the yin and kidney is insufficient, and the 

ridge (the ridge leads to the brain) belongs to the kidney, and its branches exit from the lung and enter the 

collaterals and are injected into the chest". It is stated in Su Wen Zang Qi Shi Lun that "for patients with heart 

disease, pain in the chest, fullness of the hypochondrium, pain in the hypochondrium, above the back and 

shoulders and between the nails, and pain in the two arms". From the perspective of clinical symptoms, the painful 

parts of patients with heartache tend to radiate to the scapular region, which is very consistent with the running 

paths of small intestinal meridians. Small intestinal diseases are often accompanied by physical and mental 

diseases such as depression and anxiety. Studies have confirmed that small intestinal diseases can be transmitted 

along the meridians and collaterals, leading to the dysfunction of the heart in governing spirit. Many studies have 

shown that the trends of meridians and collaterals in multiple meridians, such as the governor vessel, manual 

Taiyang (GV 16), and foot Yangming (GV 20), are interconnected, and together they construct the meridian 

network system associated with the connection of the heart with the small intestine in the human body [28-29]. 

The exterior-interior relationship between the heart meridian and the small intestine meridian determines their 

physiological and pathological connections. The heart and small intestine physiologically function with each 

other. "Classic of Difficulties" reads: "Heart camp, lung guard, Yangqi traffic, the former residence on the; Large 

intestine, small intestine, Yin qi, former residence in the next, so a far cry from also ". On the one hand, the 

function of "heart governing blood vessel" is based on the sufficiency of "heart yin" and "heart yang", and the 

combination of the two plays a role in promoting the small intestinal mass transfer through the meridian 

connection. On the other hand, the small intestine mainly receives the exuberant nutrients and secretes away the 

pure and turbid to realize the digestion and absorption of the human body as well as the downward transmission 

of the dross to the large intestine and bladder. The normal function of the small intestine is an important condition 

for harmonizing blood vessels, nourishing the five internal organs, and draining the dross. The heart and small 

intestine interact pathologically. "On the Causes and Symptoms of Diseases": "those who suffer from excessive 

salivation after heartache and stop drinking take advantage of the collaterals of the heart; those who stop drinking 

will behave like water and liquid ... The small intestine and the internal organs of the heart will also absorb the 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

17 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

moisture descending into the small intestine to urinate, so there is no need to stop drinking in the heart collaterals 

... If the multiplication of cold and heat causes the internal organs to be irregular, and the drinking of body fluid 

and water stops accumulating, the upper part is forced by the heart to make the heart qi unable to communicate, 

so the pain will be excessive salivation". According to the provisions, if the normal function of the small intestine 

"saturated with urine" is affected, it will lead to dysfunction of transmission. The production of nutrient substances 

is reduced, so that they cannot provide the sustenance and supply for the normal blood vessels. On the one hand, 

it causes the normal blood vessels to promote the decline of blood function, and on the other hand, it causes the 

state of qi and blood deficiency in the body, leading to the slowdown of blood movement, and eventually blood 

stasis. If the function of "clearing away turbidity" in the small intestine is out of control, the ascending and 

descending of "turbid" substances will be out of control, and those who are clear will not ascend, which will lead 

to diarrhea, while those who are turbid will not descend, which will produce pathological products such as phlegm 

and water-dampness, and phlegm and blood stasis will lead to dishonor of heart blood and depression of heart 

yang [20].  

4. Research on the treatment of heart failure with traditional Chinese medicine based on the 

regulation of intestinal flora  

The important relationship between heart and spleen has been expounded as early as in Internal Classic and 

Classic of Difficulties. For example, it is mentioned in the Plain Questions on Yin and Yang Correspondence 

Theory that "heart begets blood, and blood begets spleen". "Su Wen Yu Ji Zhen Zang Lun Pian" also mentioned: 

"The five zang-organs are nourished by qi from their organs ... The heart is nourished by qi from the spleen and 

transmitted to the lung. Qi is given up to the liver and ends up in the kidney. ...... Grant gas in the spleen, grant 

gas in my son also ... ". Spleen, stomach and five elements belong to soil, while heart and five elements belong 

to fire. Heart and spleen are related. In addition, Yin and Yang of heart and spleen are interlinked, and qi and 

blood are mutually complementary. The related theories of heart and spleen came into existence in Qin and Han 

Dynasties, flourished in Song Dynasty, matured in Ming and Qing Dynasties, and gradually improved in modern 

times. On the treatment of chest stuffiness and heartache, Professor Deng Tietao, a master professor of Chinese 

medicine, proposed that "the key of tonifying heart and qi is to invigorate spleen" and "phlegm and blood stasis 

are related", and emphasized the related theory of heart and spleen, pointing out that the dysfunction of spleen 

and stomach transportation and transformation caused by improper diet, internal injuries caused by seven 

emotions, and aging and tonifying deficiency existed in dampness and turbidity, which gathered to produce 

phlegm, which grew into blood stasis over time, leading to chest stuffiness and stroke. Deng Lao used modified 

Wendan Decoction to treat coronary heart disease and obtained the effect of replenishing qi and removing 

dampness. The practice proved that the effect was quite good. The common pathological mechanism for the 

occurrence and development of cardiovascular and cerebrovascular diseases is "phlegm and blood stasis 

correlation". The dysfunction of spleen and stomach is the key, and it is closely related to the function of intestinal 

flora. Specifically, it refers to the production of TMA when eating fatty, sweet, and greasy products rich in choline 

under the related action of intestinal flora. TMA is considered as the biological marker of "phlegm and blood 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

18 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

stasis". TMA enters blood and is converted into TMAO in liver, which promotes the progression of atherosclerotic 

plaques, activates platelet aggregation, promotes the formation of arterial thrombosis, and eventually leads to the 

occurrence of atherosclerotic diseases. These are the pathological bases of blood vessel occlusion caused by 

"phlegm and blood stasis mutual junction". Professor Lu Zhizheng is good at using the methods of regulating 

spleen and stomach to treat chest impediment and heartache in clinical application, including invigorating spleen 

and nourishing blood, warming yang in principle, enlivening spleen and resolving dampness, invigorating spleen 

and eliminating phlegm, and the curative effect is significant. Modern research has also shown that drugs related 

to the regulation of spleen and stomach can prevent atherosclerosis by promoting gastrointestinal digestion and 

absorption function, improving energy and material metabolism, reducing vascular pressure by regulating lipid 

metabolism, and reducing intimal damage and lipid deposition by improving lipid peroxidation damage. It can be 

seen that based on the "intestinal flora", it is a feasible way to explore the effective treatment of cardiovascular 

diseases from the spleen and stomach. At the same time, increasing evidence also shows that intestinal flora is 

involved in the cardiovascular pharmacological effects of Chinese medicine. For example, the study has revealed 

that the efficacy of Shenling Baizhu Powder in the treatment of cardiovascular disease of spleen deficiency 

syndrome is related to the structural changes of intestinal flora. Ding Weijun et al. established the spleen 

deficiency mouse model by gavage with Radix et Rhizoma Rhei and given Shenling Baizhu Powder for treatment. 

The results showed that Shenling Baizhu Powder could significantly increase the content of intestinal 

Bifidobacterium, reduce the number of Enterococcus and Escherichia coli, and foster probiotics. They indirectly 

inhibited the opportunistic pathogens and pathogenic bacteria, and played a good role in regulating the recovery 

of the dynamic balance of intestinal flora.  

5. Summary and prospect  

The pathogenesis of heart failure is complex, and the mortality and re-hospitalization rate are high, which are still 

difficult problems in the medical field. In recent years, with the deepening of research on intestinal flora, the 

correlation between heart failure and intestinal flora has been gradually found, which provides a new idea and 

direction for the treatment of this disease. Due to the blood stasis of gastrointestinal circulation, there are changes 

in the morphology and function of the intestinal tract as well as changes in the composition and metabolites of 

the intestinal flora in heart failure. The continuous aggravation of heart failure can further aggravate the imbalance 

of intestinal function and the disorder of intestinal flora, thus forming a vicious circle. Chinese medicine can cut 

off the vicious circle in many ways, restore the steady state of intestinal microorganisms, and alleviate the 

metabolic disorders and inflammatory reactions caused by the imbalance of intestinal flora. Due to the advantages 

of multiple targets and low toxicity, Chinese medicine has been widely used for the prevention and treatment of 

heart failure. Although more and more studies have confirmed that Chinese medicine can treat heart failure by 

regulating the intestinal flora, most of them remain in the phenotypic studies and lack of further exploration of 

the specific mechanism. At the same time, due to the complexity of Chinese medicine components and the 

diversity of intestinal flora, the interaction between them also needs further study. It is hoped that the advantages 

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

19 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

of traditional Chinese medicine can be continuously exerted in the future to provide a more effective method for 

the treatment of heart failure [32].  

Acknowledgement  

Shaanxi Provincial Science and Technology Plan Project (2021JM-481).  

References  

Guo Jintao, Meng Qingshu, Fan Huimin, Liu Zhongmin. V Research progress on the role of intestinal flora 

imbalance in heart failure [J]. Advances in Cardiology, 2018, 39 (04): 619-622. DOI: 10. 16806/J. CN KI. 

ISSN. 1004-3934. 2018. 04. 028.   

Nagatomo Y, Tang W H. Intersections between microbiome and heart failure:revisiting the gut hypothesis [J]. J 

Card Fail, 2015, 21(12):973[980].   

Guo Shasha, Chen Haoyu, Li Yan, Su Wenge. Exploration of the correlation between intestinal microecology 

and heart failure based on the theory of "correlation between heart and spleen" [J]. Journal of Shandong 

University of Chinese Medicine, 2020, 44 (03): 267-271. DOI: 10. 16294/j. CN KI. 1007-659 x. 2020. 03. 

009.   

Zhang Guang, Luo Fuli, Dong Bicheng, Wu Guoqing. Research progress on correlation between regulation of 

intestinal flora and CKD in TCM and western medicine [J]. Asia Pacific Traditional Medicine, 2021, 

17(09):176-179.   

Wu Wenjuan, Wu Jizhen, Huang Gairong, Qian Peng, Zhang Guojun. Study on the correlation between intestinal 

flora imbalance and heart failure in elderly patients with idiopathic pulmonary fibrosis [J]. Chinese Journal 

of Geriatric Cardio-Cerebrovascular Diseases, 2022, 24(01):14-16.  [6] Jia Shuwei, Wu Zhenli. Intestinal 

flora imbalance and heart failure [J]. Journal of Microcirculation, 2019, 29(04):74-77.   

Iacob S, Iacob DG. Infectious threats, the intestinal barrier, and its trojan horse:dysbiosis[J]. Front Microbiol, 

2019, 10:1676.   

Wu Ningbo, Sun Hongxiang, Zhao Xiaoyun, et al. MAP3K2-regulated intestinal stromal cells define distinct stem 

cell niche[J]. Nature, 2021, 592(7855):606-610.   

Guo Chunjun. Immune activation kickstarts the gut microbiota[J]. Cell Host Microbe, 2021, 29(3): 318-320.   

Sandek A, Swidsinskia, Schroedl W, et al. Intestinal blood flow in patients with chronic heart failure:a link with 

bacterial growth, gastrointestinal symptoms, and cachexia[J]. J Am Coll Cardiol, 2014, 64(11):1092-1102.   

Pasini E, Aquilani R, Testa C, et al. Pathogenic gut flora in patients with chronic heart failure [J].  

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

20 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

Jacc Heart Fail, 2016, 4(3):220-227.   

Jia Shuwei, Wu Zhenli. Intestinal flora imbalance and heart failure [J]. Journal of Microcirculation, 2019, 

29(04):74-77+82.   

Deng Xinyi, Jiang Hong, Li Xianlun. Research progress on the association of intestinal flora with heart failure 

[J]. China Medical Journal, 2020, 55(12):1301-1303.   

Xiong Yanhua, Zeng Wenping, Fang Juan. Relationship between the severity of chronic heart failure and 

intestinal flora in the elderly [J]. China Journal of Microecology, 2021, 33 (06): 662-665+669. DOI: 10. 

13381/j. CN Ki. CJM. 202106008.   

Li Guojing, Liu Lingmei. Research progress on the relationship between intestinal flora changes and heart failure 

[J]. Internal Medicine, 2021, 16 (05): 643-645.   

Zhong Shishun. Intestinal mucosal barrier dysfunction and Bifidobacterium [J]. Foreign Medicine (Physiology, 

Pathology and Clinical), 2003, (04):432-435.   

Qian Shaohuan, Kang Pinfang, Wang Hongju. Research progress of intestinal flora and cardiovascular disease 

[J]. Journal of Qiqihar Medical College, 2020, 41(08):1000-1002.   

Tang W H, Wang Z, Fan Y. Prognostic value of elevated levels of intestinal microbe-generated metabolite 

trimethylamine-N-oxide in patients with heart failure[J]. Journal of the American College of Cardiology, 

2014, 64:1907-1914.   

Goverse G, Molenaar R, Macia L, et al. Diet-derived short chain fatty acids stimulate intestinal epithelial cells to 

induce mucosal tolerogenic dendritic cells[J]. J Immunol, 2017, 198(5):2172-2181.   

Chen Mingtai, Li Meihuan, Zhang Jian, Zhong Zhang, Luan Jienan. Exploration of the relationship between 

cardiovascular disease and intestinal microecology based on the theory of "the heart and the small intestine 

exterior-interior" [J]. World Chinese Medicine, 2020, 15(19):2920-2926.   

Zhang Zhonghe, Xia Hao. Research progress on the relationship between short-chain fatty acids and 

cardiovascular disease [J]. Journal of Chinese PLA Medicine, 2020, 32(10):112-116.   

Chen Xi, Li Hanyu, Hu Xiaomin, et al. Current understanding of gut microbiota alterations and related therapeutic 

intervention strategies in heart failure[J]. Chinese Medical Journal, 2019, 132(15): 1843-1855.   

mailto:topacademicjournals@gmail.com


    

 American Journal of Medical and Physical Education 
Vol.8, Issue 4; July-August 2023; 

ISSN: 2994-0524 

Impact Factor: 6.14 

1252 Columbia Rd NW, Washington DC, United States 

https://topjournals.org/index.php/AJMPE; mail: topacademicjournals@gmail.com 

 

 

 

 

21 | A m e r i c a n  J o u r n a l  o f  M e d i c a l  a n d  P h y s i c a l  E d u c a t i o n  

|  https://topjournals.org/index.php/AJMPE 

Vinolo MA, Rodrigues HG, Nachbar RT, et al. Regulation of inflammation by short chain fatty acids [J]. 

Nutrients, 2011, 3(10):858-876.   

Yang Fei, Wang Congyu, Wang Lin, Wang Junkui, Liu Fuqiang, Ji Xincai. Advances in the study of heart failure 

and intestinal flora imbalance [J]. Journal of Clinical Internal Medicine, 2020, 37(02): 142-144.   

von HS, Schefold JC, Jankowska EA, et al. Ursodeoxycholic acid in patients with chronic heart failure:a double-

blind, randomized, placebo-controlled, crossover trial[J]. Journal of the American College of Cardiology, 

2012, 59(6):585-592.   

Zhuang Jing, Wang Ruiping. Exploration on the correlation between the theories of heart and spleen and the 

brain-gut axis [J]. China Journal of Traditional Chinese Medicine Information, 2019, 26(09): 12-14.   

Zhang Chenyang, Liu Tianhao, Wang Wei, Yao Zheng, Yi Yang, Xiao Qian, Chen Wenhui. On intestinal 

microenvironment as an important biological basis for the treatment of liver disease from the spleen [J]. 

Chinese Journal of Traditional Chinese Medicine, 2019, 34(07):2877-2880.   

He Yunshan, Hui Huaying, Tan Zhoujin. The role of characteristic intestinal flora of spleen and stomach diseases 

in TCM diagnosis and treatment [J]. World chinese journal of digestology, 2019, 27(10): 605-610.   

Jiang Xiaoyan, Xie Weichang, Zhou Daqiao, Li Jian, Guo Shaoju, Huang Bin. Effect of Lichang Decoction on 

intestinal microecology, metabolites and inflammatory factors in patients with ulcerative colitis of spleen 

deficiency and dampness stagnation type [J]. New traditional chinese medicine, 2019, 51(02):142-146.   

Li Qiuming, Zhang Yajie, Zhang Dafang, Liu Jia, Li Lijing. The microecological regulation of Spleen-

Strengthening antidiarrheal granule on mouse model of spleen deficiency and imbalance of antibiotic 

intestinal flora [J]. China Journal of Basic Medical Science of Traditional Chinese Medicine, 2010, 

16(12):1119-1120.   

Lin Tianyao. Study on the mechanism of Cai's Spleen-Strengthening Tongbian Decoction in the treatment of 

constipation due to spleen deficiency and long-term clinical efficacy observation [D]. Guangzhou: 

Guangzhou University of Traditional Chinese Medicine, 2017:  

Zhao Dandan, Qu Huiyan, Yang Tianshu, Zhang Xiaoqing, Yang Tao, Zhou Hua. Overview of research on the 

regulation of intestinal flora in the prevention and treatment of heart failure by traditional Chinese 

medicine [J]. Journal of Cardio-Cerebrovascular Diseases of Integrated Chinese and Western Medicine, 

2021, 19(03):438-441.   

mailto:topacademicjournals@gmail.com

