Traditional Chinese medicine interpretation of extracellular traps in acute cardiovascular events of coronary heart disease from the perspective of the stasis-toxin theory

Coronary heart disease (CHD) is pathologically based on coronary atherosclerosis, with inflammation permeating the entire disease process—from atherosclerotic plaque formation to acute cardiovascular events—and playing a crucial role in acute attacks. Extracellular traps (ETs), which possess pro-thrombotic, pro-inflammatory, and tissue-injuring-inducing properties, are mesh-like DNA-protein complexes released primarily by neutrophils and macrophages. Based on academician CHEN Keji′s stasis-toxin theory, this paper proposes that ETs structurally correspond to "tangible blood stasis" and functionally to "intangible toxin," and that their excessive formation and toxic amplification may represent a key microscopic pathological basis for acute CHD attacks. By analyzing the involvement of ETs in blood flow obstruction, endothelial injury, inflammatory response amplification, and plaque rupture, this paper elucidates a dynamic pathogenic mechanism characterized by "stasis generating toxin, toxin exacerbating stasis, and the intermingling of stasis and toxin." Furthermore, in light of contemporary biomedical evidence, the potential significance of therapeutic strategies aimed at activating blood circulation, resolving stasis, detoxifying, and unblocking collaterals in regulating ETs is explored. This perspective aims to deepen the understanding of the mechanisms underlying acute cardiovascular events from the viewpoint of the stasis-toxin theory and to provide novel research directions for the integrative prevention and treatment with integrated Chinese and western medicine.