Pectoral Pain & StuffinessPectoral Pain & Stuffiness

TCM Diagnoses and Treatments Obstruction of Qi & blood in the chest.

Main Symptoms:Main Symptoms: Chest & back pain, short breathing, asthma, even disability to lie down

In mile case:In mile case: Feels chest pain & breath with difficult

In more serious case:In more serious case: chest pain & palpitation, pericardial pain, back pain, cold limbs

OrgansOrgans: Heart & Lung

Western medicine disease related:Western medicine disease related: coronary; atherosclerotic cardiopathy; angina pectoris, myocardiac infarction, pericarditis

Etiology & Pathology:

Main Points for differentiationMain Points for differentiation

A) Def. & ExcessA) Def. & Excess

Most case: includes bothMost case: includes both

Def. : Ht. Qi, Ht. Blood, Ht. Yang, Sp & kid Def. : Ht. Qi, Ht. Blood, Ht. Yang, Sp & kid yang, Liv. & Kid Yin, yang, Liv. & Kid Yin,

Excess: Qi Stag. , Blood stasis, phlegm, Excess: Qi Stag. , Blood stasis, phlegm, cold heatcold heat

B) Properties of painB) Properties of pain1) Oppressive Pain

2) Stabbing pain

3) Burning pain

4) Colick or twisting pain

5) Dull pain

Pectoral pain & stuffiness

Stomach-ache

Chest pain

Location Left chest pain spreading to back

Stomach area

Not in the left chest

Other sym. Palpitating, short breathing, difficult to lie down

Belching, acid regurgitation, fullness or distention of abdomen, related to diet

Usually caused by tuberculosis cough, asthma, cold & heat

Main Points for therapeutic PrinciplesMain Points for therapeutic Principles

Treating the superficiality first & the Treating the superficiality first & the origin secondorigin second

But: But:

if superficiality is not severe & origin if superficiality is not severe & origin has been def. already, should treat has been def. already, should treat by both reinforcement & resolvingby both reinforcement & resolving

TreatmentTreatment 1). Heart blood stag.

Signs & Symptoms:

– Main Sym. : Stabbing pain in the chest, fixed, worse at night

– Concurrent sym.: palpitating, restlessness, oppression in the chest, feel comfortable after massage

– Tongue: dark purple

– Pulse: deep & uneven

• Treatment Protocol:

– Prompting blood circulation– Remove blood stasis & stop pain

Formula:

Modifications:

Chest Pain -- Jiang Xiang, San Qi, Yu Jing, Yan Hu So

Oppressed feeling-- Xuan Fu Hua, Gua Lou Pi, Qing Pi, Sha

RenPalpitation

-- Long Gu, Mu Li, Dai Zhe Shi

Xue Fu Zhu Yu Tang

Dang Gui Sheng Di Tao Ren Hong Hua Zhi Ke

Cai Hu Gan Cao Niu Xi Chi Shao Chuan xiong

TreatmentTreatment 2) Phlegm accumulate in the chest

Signs & Symptoms:

– Main Sym. : Oppressed & asphyxia feeling & pain in the chest, pain sometime spreading to shoulder & back

– Concurrent sym.: obesity, excessive sputum, fullness feeling in St.

– Tongue: Mucous & greasy coating

– Pulse: slippery

• Treatment Protocol:

– Activating Yang to eliminate phlegm– Relieving Stag.

Formula:

Modifications:

Smooth Qi to relieve phlegm

-- Su Zi, Su Geng, Zhi ke, Chen Pi, Fu Ling

Fullness in the St. nausea, no appetite, bitter taste

-- Huang Lian Weng Dan Tang

Gua Lou Xie Bai Ban Xia Tang

Gua Lou Xie Bai Ban Xia

TreatmentTreatment 3) Cold Accumulation

Signs & Symptoms:

– Main Sym. : Chest pain spreading to back, worse by cold, onset after infect by cold

– Concurrent sym.: oppressed feeling in the chest, short breathing, palpitation, asthma in severe case, disable to lie down, pale complexion, cold limbs.

– Tongue: white coating

– Pulse: deep thready & tense

• Treatment Protocol:

– Warm up Yang to release cold– Stop pain

Formula:

Modifications:

Warm Upper Jiao & move Qi-- Tan Xiang

Move Heart Blood-- Dan Sheng

Move Stag. Qi-- Zhi Shi

Cough with abundant sputum-- Sheng Jiang, Ju Pi, Fu Ling, Xin Ren

Severe cold symptom-- Fu Zi, Wu Tou, Rou Gui, Gan Jiang, Shu Jiao

Gua Lou Xie Bai Bai JiuTang

Gua Lou Xie Bai Bai Jiu

TreatmentTreatment 4) Kid. & heart Yin Def.

Signs & Symptoms:

– Main Sym. : Dull pain in the chest

– Concurrent sym.: palpitation, night sweating, restlessness, sleeplessness, sore lower back, weakness of knee joints, dizziness, tinnitus

– Tongue: red thin body, less coating

– Pulse: thready & rapid

• Treatment Protocol:

– Nourish Yin & tonify Kid.– Nourish heart to calm down the mind

Formula:

Modifications:

Tonify Kid Yin: -- Nu Zheng Zi, Han Lian Cao, Tian Dong, Mai Dong,

Tonify Ht. blood:-- Dan Shen, Wu wei zi

Restlessness:-- Dan Pi, Ze Xie, Mai dong, Wu wei zi, Bo zi ren, suan zhao

renDizziness due to empty fire goes up

-- Shou Wu, Gou Teng, Shi Jue Ming, Sheng Mu LiOppressed feeling in chest & pain

-- dang gui, Dan Shen, Chuan Xiong, Yu Jing

Zuo Gui Yin

Shu Di Shan Yu rou San Yao Gou Qi Zi Fu Ling Gan Cao

TreatmentTreatment 5) Qi & Yin Def.

Signs & Symptoms:

– Main Sym. : Oppressed feeling & dull pain in chest

– Concurrent sym.: palpitation, short breathing, lassitude, don’t want to talk, dim complexion, dizziness, constipation or loose stools

– Tongue: light red body with or without teeth mark

– Pulse: thready & weak or knotted & intermittent

• Treatment Protocol:

– Nourish Qi & Yin– Prompting blood circulation & open the channels

Formula:

Modifications:

tonify Yin:

ren shen, mai dong, wu wei zi

Ren shen yang rong Tang

Ren shen Gan cao Dang gui Bai shao Shu di Rou gui

Da zhao Huang qi Bai zhu Fu ling Wu weizi Yuan zhi

TreatmentTreatment 6) Yang Qi Def.

Signs & Symptoms:

– Main Sym. : Oppressed feeling & dull pain in chest, getting worse by cold attacking

– Concurrent sym.: palpitation, short breathing, cold limbs pain or sore on lower back or knee joints, pale complexion

– Tongue: light whitish or dark purple body

– Pulse: thready & deep

• Treatment Protocol:

– Warm yang Qi– Prompting blood circulation

Formula:

Modifications:

Yin def.-- Mai dong, wu wei zi

Kid yang def. cause water accumulation in the chest-- Zhen Wu Tang

You Gui Yin

Shu di Tu Si Zi Rou Gui Wu Wei Zi Lu Rong Gan cao

Shen Fu Tang

Ren shen Fu zi