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Chest pain

胸痛 〔胸痛〕xiōng tòng

Also pain in the chest. From Plain Questions (素问 sù wèn). Any pain in any part of the chest. Chest pain is attributable to a variety of diseases including heart impediment, heart pain, true heart pain, reversal heart pain, phlegm-rheum, pulmonary welling-abscess, and pulmonary consumption. The chest corresponds to the upper burner and contains the heart and lung, and chest pain is the manifestation of heart or lung disease, especially heart disease; hence chest pain includes heart pain and in some contexts the two terms are synonymous. The stomach duct is contiguous to the chest, and in the past heart pain was often used to denote pain in the pit of the stomach. As a result, the terms chest pain, heart pain, and stomach duct pain have been confused. Chest pain proper (not including stomach duct pain) is attributed to heart qì vacuity, congealing cold with stagnant qì, heart blood stasis obstruction, dual vacuity of qì and yīn, phlegm turbidity obstruction, or pulmonary welling-abscess. For scorching pain in the chest and rib-side, see liver fire invading the lung.

Biomedical correspondence: pneumonia; pleurisy; intercostal neuralgia; coronary heart disease.

Patterns

Heart qì vacuity (心气虚 xīn qì xū): Chest pain due to heart qì vacuity is an intermittent dull pain of varying severity, with oppression in the chest, heart palpitation, shortness of breath, spontaneous sweating, and fatigue, all exacerbated following physical exertion, as well as bright-white facial complexion, pale tongue, and a pulse that is fine or forceless, vacuous, and large.

Medicinal therapy: Supplement heart qì. Use variations of Origin-Preserving Decoction (保元汤 bǎo yuán tāng). If there is concurrent blood vacuity, add Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī) and ass hide glue (Asini Corii Colla, 阿胶 ē jiāo); if there is blood stasis add chuanxiong (Chuanxiong Rhizoma, 川芎 chuān xiōng) and red peony (Paeoniae Radix Rubra, 赤芍药 chì sháo yào).

Acumoxatherapy: Base treatment mainly on CV and PC. Main points: CV-17 (Chest Center, 膻中 shān zhōng), PC-4 (Cleft Gate, 郄门 xī mén), and PC-6 (Inner Pass, 内关 nèi guān). For heart qì vacuity, add BL-15 (Heart Transport, 心俞 xīn shù), CV-14 (Great Tower Gate, 巨阙 jù què), HT-7 (Spirit Gate, 神门 shén mén), CV-4 (Pass Head, 关元 guān yuán), CV-6 (Sea of Qì, 气海 qì hǎi), BL-20 (Spleen Transport, 脾俞 pí shù), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ); needle with supplementation and add moxa.

Congealing cold with stagnant qì (寒凝气滞 hán níng qì zhì): congealing cold with stagnant qì is due to heart yáng vacuity. It is therefore similar to heart qì vacuity, but is marked by pronounced cold signs. It causes chest pain of varying severity, with distension and oppression. In severe cases, the pain stretches into the back, left shoulder, and arm. Other signs include somber-white complexion, spontaneous sweating, fear of cold, cold limbs (or reverse flow), a moist pale tongue that may be enlarged and have dental impressions, and a deep slow or bound intermittent pulse.

Medicinal therapy: Warm and free heart yáng. Use Trichosanthes, Chinese Chive, and White Wine Decoction (栝楼薤白白酒汤 guā lóu xiè bái bái jiǔ tāng). In severe cases, with yáng vacuity on the verge of desertion, pain like the cutting of a knife, dripping cold sweat, reverse flow of the limbs, and a faint pulse on the verge of expiration, use Ginseng and Aconite Decoction (参附汤 shēn fù tāng) or Ginseng, Aconite, Dragon Bone, and Oyster Shell Decoction (参附龙牡汤 shēn fù lóng mǔ tāng) to return yáng and stem counterflow.

Acumoxatherapy: To the main points given above, add BL-15 (Heart Transport, 心俞 xīn shù), BL-14 (Reverting yīn (jué yīn) Transport, 厥阴俞 jué yīn shù), CV-14 (Great Tower Gate, 巨阙 jù què), CV-6 (Sea of Qì, 气海 qì hǎi), CV-4 (Pass Head, 关元 guān yuán), LI-4 (Union Valley, 合谷 hé gǔ), and LR-3 (Supreme Surge, 太冲 tài chōng); needle with drainage and large amounts of moxa.

Heart blood stasis obstruction (心血瘀阻 xīn xuè yū zǔ): Heart blood stasis obstruction is a pattern of right vacuity and evil repletion, developing as a result of heart qì or heart yáng vacuity. It causes acute, usually stabbing chest pain of fixed location. In severe cases, it comes in sudden attacks, like the cutting of a knife, accompanied by a cold sweat, heart palpitation or fearful throbbing, and fear. After attacks, the patient is fatigued and listless. The tongue is green-blue or purple, dark and dull, sometimes with stasis macules. The pulse is sunken and fine, or rough, or bound and intermittent.

Medicinal therapy: Quicken the blood and transform stasis. Use House of Blood Stasis-Expelling Decoction (血府逐瘀汤 xuè fǔ zhú yū tāng) combined with Sudden Smile Powder (失笑散 shī xiào sǎn).

Acumoxatherapy: To the main points given above, add BL-15 (Heart Transport, 心俞 xīn shù), CV-14 (Great Tower Gate, 巨阙 jù què), BL-17 (Diaphragm Transport, 膈俞 gé shù), SP-10 (Sea of Blood, 血海 xuè hǎi), LR-3 (Supreme Surge, 太冲 tài chōng), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo); needle with drainage.

Dual vacuity of qì and yīn (气阴两虚 qì yīn liǎng xū): Chest pain from dual vacuity of qì and yīn is a continuous pain of varying severity associated with palpation, profuse dreaming and insomnia, spontaneous sweating, shortness of breath, and panting that are markedly exacerbated by physical exertion. There is a subjective feeling of heat effusion, a dry red tongue with scant fur and little liquid, yellow or reddish urine, and a forceless fine or rapid or bound or intermittent pulse.

Medicinal therapy: Boost qì and nourish yīn. Use Pulse-Engendering Powder (生脉散 shēng mài sǎn) or Honey-Fried Licorice Decoction (炙甘草汤 zhì gān cǎo tāng).

Acumoxatherapy: To the main points given above, add BL-15 (Heart Transport, 心俞 xīn shù), CV-14 (Great Tower Gate, 巨阙 jù què), BL-20 (Spleen Transport, 脾俞 pí shù), BL-23 (Kidney Transport, 肾俞 shèn shù), CV-6 (Sea of Qì, 气海 qì hǎi), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), KI-6 (Shining Sea, 照海 zhào hǎi), and KI-3 (Great Ravine, 太溪 tài xī); needle with supplementation.

Phlegm turbidity obstruction (痰浊阻遏 tán zhuó zǔ è): Chest pain due to phlegm turbidity obstruction is associated with cough and copious phlegm (clear thin phlegm-drool or thick and sticky), and shortness of breath or panting. In severe cases, the pain stretches through to the back and prevents the patient from lying flat. The tongue fur is white and moist or glossy, and the pulse is slippery.

Medicinal therapy: Transform phlegm and free yáng. Use Trichosanthes, Long-Stamen Onion, and Pinellia Decoction (栝楼薤白半夏汤 guā lóu xiè bái bàn xià tāng) or Unripe Bitter Orange, Long-Stamen Onion, and Cinnamon Twig Decoction (枳实薤白桂枝汤 zhǐ shí xiè bái guì zhī tāng). For phlegm-stasis obstruction use Trichosanthes, Long-Stamen Onion, and Pinellia Decoction (栝楼薤白半夏汤 guā lóu xiè bái bàn xià tāng) plus peach kernel (Persicae Semen, 桃仁 táo rén), carthamus (Carthami Flos, 红花 hóng huā), typha pollen (Typhae Pollen, 蒲黄 pú huáng), and ark shell (Arcae Concha, 瓦楞子 wǎ léng zǐ), to transform stasis.

Acumoxatherapy: To the main points given above, add ST-40 (Bountiful Bulge, 丰隆 fēng lóng), CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), to transform phlegm, and BL-17 (Diaphragm Transport, 膈俞 gé shù), SP-10 (Sea of Blood, 血海 xuè hǎi), LR-3 (Supreme Surge, 太冲 tài chōng), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), to transform stasis. Needle with drainage and add moxa.

Pulmonary welling-abscess (肺痈 fèi yōng): The main characteristics are a dull pain and coughing up of yellow phlegm that may contain pus and blood and that is fishy smelling. There is a dry mouth and thirst with no desire to drink. There may also be vexation and fullness, sweating, and sudden bouts of aversion to cold with heat effusion. The tongue is red and the pulse is slippery or slippery and rapid.

Medicinal therapy: Clear heat and push out pus. Use Thousand Gold Pieces Phragmites Decoction (千金苇茎汤 qiān jīn wěi jīng tāng).

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