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Below is a brief description of the major chest and rib-side symptoms, with links to entries that provide more detail.

Inquiry-ChestAbdomenRegions

Heart and Chest

Heart palpitation (心悸 xīn jì); fright palpitation (惊悸 jīng jì); fearful throbbing (怔忡 zhēng chōng): Heart palpitation is a strong or rapid heartbeat that is felt by the patient, associated with fright and flusteredness. When triggered by emotional stimulus, it is sometimes referred to as fright palpitation. When heart palpitation arises spontaneously without emotional stimulus, it is more severe and affects a greater area (sometimes stretching as far as the umbilicus), it is called fearful throbbing, since it causes fear and panic. All three signs result from

• insufficiency of heart blood or heart yīn allowing yáng qì to become disproportionately powerful;
• insufficient heart yáng or heart yáng laboring to move the blood; or
• phlegm or blood stasis hampering the movement of blood.

Chest pain (胸痛 xiōng tòng): Also called pain in the chest. Pain anywhere in the chest. It occurs in heart disease, lung disease, and liver disease.

In heart disease, chest pain is in the anterior of the chest at the position of the heart. The pain can radiate into the shoulder and along the medial side of the left arm. It is attributed to chest yáng failing to move or to the obstructive effect of phlegm, stasis, and cold in heart vessel obstruction.

In lung disease, it is associated with breathing disorders and is mostly attributable to phlegm turbidity causing obstruction or fire damaging the network vessels of the lung. It is observed in intense lung heat or phlegm-fire congesting the lung, and sometimes in rheum collecting in the chest and rib-side. It is especially prominent in pulmonary welling-abscess.

In liver disease, chest pain is associated with distension and pain in the rib-side and occurs in depressed liver qì.

Oppression in the chest (胸闷 xiōng mèn): A feeling of constriction and discomfort in the chest. It indicates that yáng qì is failing to move or that evils are causing obstruction. Oppression in the chest occurs in heart disease, notably heart yáng vacuity and heart vessel obstruction, and in lung patterns involving phlegm, such as cold phlegm obstructing the lung or phlegm-heat congesting the lung. Less commonly, it occurs in spleen patterns involving dampness and in depressed liver qì.

In heart disease, oppression in the chest in severe cases is accompanied by pain and shares the same pathomechanisms as pain in the chest (see previous item). The two occurring together are often referred to as stifling oppression and pain in the heart and chest (心胸憋闷疼痛 xīn xiōng bié mèn téng tòng).

Distending pain in the breasts (乳房胀痛 rǔ fáng zhàng tòng): This usually occurs before or during menstruation. It is attributed to depressed liver qi.

Rib-Side

Distension and pain in the rib-side (胁肋胀痛 xié lèi zhàng tòng): Also called distending pain in the rib-side or distension and pain in the chest and rib-side. Painful fullness and distension in the lower lateral parts of the chest. It is a sign of depressed liver qì.

Scorching pain in the rib-side (胁肋灼痛 xié lèi zhuó tòng): Pain with heat sensation in the chest and rib-side. When the pain is dull, it is caused by liver yīn vacuity; when acute, it is attributed to liver fire flaming upward.

Propping fullness in the chest and rib-side (胸胁支满 xiōng xié zhī mǎn): A term seen in older texts, denoting severe fullness and distension that makes the patient feel as though her chest is propped up.

Cough and Expectoration

Cough (咳嗽 ké sòu): Cough reflects lung qì ascending counterflow attributable to disturbances of diffusion and downbearing. It can occur in any lung pattern. It is often associated with expectoration of phlegm and in some cases with coughing of blood (see below). A dry cough (干咳 gān ké) is a cough with little or no expectorate, attributable to dryness evil invading the lung or to yīn vacuity with lung dryness.

Expectoration of phlegm (咯痰 kǎ tán): Expectoration of phlegm accompanies cough in most cases, not only in phlegm patterns, that is, patterns in which phlegm is prominent, but in a variety of lung patterns due to different causes. The color and consistency of phlegm expectorated through coughing help to identify the disease pattern.

• Clear thin phlegm indicates qì vacuity (qì failing to retain fluids).
• Phlegm that is white rather than clear indicates wind-cold fettering the lung or phlegm obstructing the lung.
• Little or no phlegm indicates lung yīn vacuity or dryness invading the lung.
• Thick yellow phlegm indicates wind-heat invading the lung, intense lung heat, or phlegm-fire congesting the lung.

Coughing of blood (咳血 ké xuè): Sometimes seen in severe patterns of lung yīn vacuity or dryness evil invading the lung.

Expectoration of pus and blood (咳吐脓血 ké tǔ nóng xuè): Coughing of phlegm with pus and blood is a sign of pulmonary welling-abscess (肺痈 fèi yōng), which develops when phlegm-heat causes qì and blood to stagnate, giving rise to putrefaction.

Breathing

Breathing disorders are attributable to impaired lung diffusion and downbearing and to the kidney failing to absorb qì. Since the lung and heart are both driven by ancestral qì, certain heart conditions can also affect breathing. Breathing disorders include three levels of breathing difficulty (panting, shortness of breath, and scantness of breath), wheezing, and rough breathing.

Panting (气喘 qì chuǎn, 喘 chuǎn): The most severe breathing disorder marked by labored breathing, with short rapid breaths with discontinuity between breaths (failure to catch the breath), as well as signs not seen in other breathing disorders, including flaring nostrils (‍鼻翼煽动 bí yì shān dòng), open mouth and raised shoulders (张口抬肩 zhāng kǒu tái jiān), also called raised-shoulder breathing (肩息 jiān xī), and inability to lie flat. Distinction is made between vacuity and repletion panting.

Vacuity: Panting that develops gradually, makes a faint low sound with short hasty breathsand is relieved only when a long inhalation is achieved is vacuity panting. It varies in severity at different times and is exacerbated by physical exertion. It occurs in patients with lung-kidney depletion when the kidney fails to absorb qì, the downbearing of lung qì is disturbed, and vacuous qì floats upward. Vacuity panting also occurs in kidney vacuity water flood with water-cold shooting into the lung.

Repletion: Panting that develops suddenly, with rough loud breathing, deep long inbreaths, and relief experienced on exhalation is repletion panting. It is accompanied by oppression in the chest, raised head and protruding eyes (仰首突目 yáng shǒu tú mù), and a replete and a forceful pulse. It is usually observed in people with firm bodies and strong constitutions. It occurs most commonly in wind-cold fettering the lung, intense lung heat, phlegm-heat congesting the lung, and cold phlegm obstructing the lung. It also occurs in qì depression damaging the lung, when depressed liver qì affects breathing.

Wheezing (哮 xiāo): Wheezing is a high-pitched whistling sound made by breathing when the airways are congested with phlegm. The sound is often described as a frog rale in the throat because its sound is similar to the prolonged low croaking sound of a frog, although this term is also used to describe other phlegmy breathing sounds. Wheezing always occurs with panting. It is caused by phlegm obstructing the airways and occurs in phlegm-heat congesting the lung, cold phlegm obstructing the lung, or wind-cold fettering the lung. Conditions of chronic wheezing and panting correspond to asthma in biomedicine.

Shortness of breath (短气 duǎn qì): Breathing marked by short rapid shallow breaths with discontinuity between breaths (difficulty in catching the breath), but without flaring nostrils, open mouth and raised shoulders, and inability to lie flat, which indicate panting. It takes the form of vacuity and repletion patterns.

• Vacuity patterns are characterized by short faint breaths, with general weakness of the body, lassitude of spirit, dizzy head, and lack of strength. They are caused by insufficiency of lung qì or great vacuity of original qì.
• Repletion patterns are marked by rough short breaths, accompanied by breathing, asphyxiating oppression in the chest, distension of the chest and abdomen. It is caused by phlegm-rheum, stagnant qì, or blood stasis obstructing the chest and abdomen.

Scantness of breath (少气 shǎo qì): A mild feeling of breathlessness, accompanied by a faint low voice. It is mostly attributed to (lung) qì vacuity and occurs in all vacuity taxation patterns. Also called scantness of qì (气少 qì shǎo), although this is term may also loosely mean qì vacuity.

Rough breathing (气粗 qì cū): Respiration that produces a harsh crackling sound. It is attributable to the presence of phlegm in the lung.

Faint breathing (息微 xī wēi): Breathing that is not easily detected either visually or audibly. It is mostly a sign of lung qì vacuity.

Yawning (呵欠 hē qiàn): Opening the mouth wide and taking a deep breath as an involuntary reaction to fatigue or boredom. It is attributable to depressed liver qì, to qì stagnation and blood stasis, or to spleen-kidney yáng vacuity. It often appears in smallpox.

Sighing (太息 tài xī): Also called frequent sighing (善太息 shàn tài xī). Sighing is a natural deep long audible expulsion of breath that reflects an effort to relieve stuffiness in the chest resulting from weariness, relief, or frustration or relieve pathological oppression in the chest. Frequent sighing, which is a greater tendency to sighing as a result of illness, reflects inhibition of qì dynamic that is most commonly associated with depressed liver qì but that may also indicate qì vacuity.

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