Pectoral
pain and stuffiness
(CORONARY HEART DISEASE)
(Obstruction of qi and blood in the chest)
General
Introduction
pectoral pain and stuffiness is the disease caused
by stagnation of qi and blood in the chest. The main symptoms of the disease
manifested as chest and back pain, short breathing, asthma, even disabling
to lie down when it is in serious condition. In the cases of mild illness
condition, the patient feels chest pain and breathe with difficulty. Chest
pain and palpitating occur in serious cases and pericordial pain, back pain,cold
feeling in limbs in more serious cases.
Pectoral pain and stuffiness is different from stomach-ache
and chest pain. They may be differentiated by the site of pain, associated
symptoms, electro cardiogram, x-ray and other physical and chemical examinations.
The site of pectoral pain and stuffiness is at the
heart and lung and the onset of the disease is related to liver, spleen and
kidney. The causes of it are mainly the impairment or attack by exogenous
pathogenic cold and heat, emotions, diet, over-exertion, bleeding and emission.
The characteristics of the pathogenesis of pectoral pain and stuffiness is
deficiency in origin and excess in superficiality. The manifestation of deficiency
of origin and excess in superficiality. The manifestation of deficiency of
origin is the deficiency of qi, blood, yin and yang of the viscera, and of
the excess of superficiality, stagnation of qi and blood, accumulation of
phlegm are excessive cold and heart stagnation. The basic pathogenesis is
the stagnation of qi and blood caused by insufficiency or obstruction of the
heart, vessels and channels. Along with the development of the illness condition,
the crisis as cardialgia, exhaustion, palpitation, asthma and cough, edema
of limbs occurred.
The pericordial pain induced by coronary atherosclerotic
cardiopathy, angina pectoris, myocardiac infarction and pericarditis in western
medicine can be diagnosed and treated in the light of the disease described
in this chapter.
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Pathogenesis
and Pathology
The site of the pectoral pain and stuffiness is in
the heart and lung. The chest is the “dwelling place” of heart and lung. The
heart governs the blood circulation and the lung is in charge of qi. Provided
that the heart acts in coordination with the lung, the qi and blood will normally
circulate. The onset of the disease is closely related to health conditions
of kidney, live and spleen. The pectoral pain and stuffiness will be attacked
by the following pathogenic conditions :insufficiency of chest-yang, dysfunction
in viscera, failing of yin, yang, qi and blood to coordinate, infection of
exogenous pathogenic factors, excessive eating, drinking and contemplation,
stagnation of phlegm-dampness, and the vessels and channels being not in harmony.
The pathogenesis and pathology are summarized as follows:
- Attacking of heart by heat and cold pathogenic factors: The pectoral pain
and stuffiness may be caused by congenital insufficiency of heart-qi, and
heart-yang, and later invading of cold pathogen which then accumulated in
chest, resulting in insufficiency of heart-yang and stagnation of vessels
and channels. Therefore the disease is often occurred when the weather is
suddenly changing to cold. The yang insufficiency in origin involves deficiency
of heart-qi, heart-yang and of the spleen and kidney. The superficiality
is excessive cold. As for the origin and superficiality, we must differentiate
carefully which is the primary from which is the secondary. In addition,
invading of heart by extreme hot weather, then exhaustion of heart-qi also
induce cardialgia due to the obstruction of blood circulation.
- Impairing of the seven emotions: Anxiety and anger often cause the stagnation
of qi, and the obstructions of qi and blood circulation results in cardialgia.
The fluid may accumulated and burnt into phlegm, or prolonged stagnation
of qi changed to fire which will burn the fluid into phlegm. All of the
stagnation of phlegm in vessels and channels, accumulation and obstruction
of qi and blood, insufficiency of chest-yang will result in pectoral pain
and stuffiness.
- Excessive eating and drinking: Excessive eating of fat, sweet and greasy
food, or pungent and spicy foodstuff, or having an addiction to wine will
cause the impairment and dysfunction of the spleen and stomach. The indigestion
of foodstuff induce the formation of phlegm which blocked the vessels and
channels, thus the condition of stagnation of qi and blood stasis and the
obstruction of vessels and channels result in pectoral pain and stuffiness.
- Insufficiency of qi and blood: The syndrome manifested manifested as anxiety
and over-exertion impairing the heart and spleen, vital qi not been restored
during the convalescence of serious illness, dysfunction of the spleen and
stomach, lacking of the source to generate qi and blood. The deficiency
of qi and blood causes the heart failing to be nourished. When a patient
has a great blood loss, his heart will not be nourished and the blood circulation
obstructed, thus occurred the pectoral pain and stuffiness. Insufficiency
of qi and blood in the heart and not been restored a long time will cause
insufficiency of heart-yang. The situation of deactivation of lucid yang
and slow flow of the blood will eventually result in cardialgia. If the
insufficiency of qi and blood in heart could not be recovered for a long
time, it will cause deficiency of yin and blood, thus the blood vessels
are disable to be nourished and manifested as contracture and pain.
- Deficiency of liver and kidney: Multiple pregnancy and emission can cause
impairment of kidney-qi, ages over 50 will gradually induce weakening of
sexual function of both sexes. Owing to the liver and kidney having a common
source, insufficiency of yin and essence of life will not nourish the viscera-yin,
hence resulting in deficiency of heart-yin, pectoral pain and stuffiness
and cardialgaia. If there is hyperactivity of fire due to yin deficiency
and the fire of deficiency type flaring up, the heart-yin may also be burnt
and lead to the exhaustion of blood vessels and cardialgia.
In summary, in the development of pectoral pain and
stuffiness, the main syndrome is deficiency in origin and excess in superficiality.
The manifestation of excess in superficiality are stagnation of qi, blood
stasis, accumulation of phlegm, excessive cold and heat stagnation. The deficiency
syndrome in origin may be differentiated into deficiency of heart-qi, deficiency
of heart blood, deficiency of heart-yang, deficiency of liver- and kidney-yin,
deficiency of spleen and kidney-yang and deficiency of lung-qi. The pectoral
pain and stuffiness may be caused by one or more of these pathological changes.
The further development of the pectoral pain and
stuffiness may lead to many other diseases, If the heart and vessels are stagnated
by blood stasis, excess of yin leading to prostration of yang, a sudden severe
and persistent pain occurs in the chest and heart, so developing into genuine
cardialgia. If the heart vessels are obstructed, and yin yang exhausted, the
prostration syndrome occurs. If there is deficiency of qi and blood in the
heart and the heart is failing to be nourished, may appear severe palpitation,
knotted and intermittent pulse. If the accumulated fluid invade upwards the
heart and lung, cough, asthma and edema in limbs may occur.
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DIFFERENTIATION
AND TREATMENT OF COMMON SYNDROMES
Ⅰ.Main points of the differentiation
- Differentiation of deficiency and primary and excess,from secondary: Most
of the syndromes of pectoral and stuffiness are deficiency in origin and
excess in superficiality. The deficiency syndromes in origin may be divided
into several types: deficiency of heart-qi(including of lung-qi),deficiency
of heart blood, deficiency of heart-yang, deficiency of spleen- and kidney-yang
and deficiency of liver- and kidney-yin. The excess syndromes in superficiality
include stagnation of qi, blood stasis, accumulation of phlegm, excessive
cold, accumulation of heat. If the pectoral pain and stuffiness manifested
primarily as deficiency syndrome and feeble pulse, the origin should be
treated. If it manifested mainly as excess syndrome and replete pulse, the
superficiality should be treated.
- Differentiation
of the properties of pain: There are several kinds of cardialgia in pectoral
pain and stuffiness in clinical practice, namely oppressive pain, stabbing
pain, burning pain, colicky pain and vague pain. Oppressive pain: paroxysmal,
heavy sensation of oppression with light pain.
Most of the cases of
qi stagnation are related to emotional changes. If the patients have the
sensation of oppression and pain simultaneously, obesity, abundant sputum,
greasy tongue fur, it may be caused by accumulation of phlegm. The insufficiency
of heart-qi manifested as feelings of oppression and a dull pain, exacerbated
afterlight exercise, short breathing, asthma and perspiration. The symptoms
manifested as oppressive pain in chest, bleeding or onset postmenstruation,
palpitating and sleeplessness, pale tongue, it belongs to deficiency syndrome
of heart blood.
Stabbing pain: The symptoms of this type belong to blood stasis that
involve pain feeling as stabbing, fixed location without moving, dark
purple tongue proper with or without ecchymosis, or dark purple sublingual
muscles. The blood stasis may be induced by various causes, so it must
be diagnosed in the light of the comprehensive analysis of illness conditions.
Burning pain: The symptom is always caused by fire-heat and divided into
two types of excess and deficiency. The syndrome of fire excess type involves
burning pain feeling in chest, restlessness, dysphoria, sleeplessness,
and dry mouth with bitter taste. The phlegm-fire syndrome manifested as
oppressed feeling with burning pain in chest, thick yellow sputum and
yellow greasy tongue fur. Most of the syndrome of fire of yin deficiency
manifested as light burning pain in chest, dysphoria with feverish sensation
in chest, palms and soles, dizziness, palpitating, red and thin tongue
proper, and less tongue fur.
Colicky pain: The syndrome of accumulation of cold pathogens in heart
channels manifested as colicky or twisting pain, onset suddenly or induced
by cold pathogen, exacerbated when attacked by clod, aversion to cold,
cold feeling in limbs, oppressed feeling in chest as being suffocated.
The syndrome of yang deficiency and interior cold involves the symptoms
of yang deficiency, aversion to cold, lying with bending gesture, pale
and thick tongue proper, In addition, the violent cardialgia of this type
are often caused by over exertion, emotional changes and excessive eating
and drinking. Therefore in the diagnosis of this disease should inspected
in accordance with the syndrome and not to be limited to “cold”.
Vague pain: Most of the syndromes of dull pain feeling, onset after exercise,
short breathing and tiredness are belonging to deficiency of qi or yany.
If the syndromes are vague pain in chest, dysphoria, dizziness and tinnitus,
it belongs to deficiency of yang.
- Differentiation of mild from severe, and positive from negative illness
conditions.
- Differentiation of mild and severe illness conditions: In general, pain
is the indication of mild and sever conditions. The judgement may adhere
to the followings:
- Frequency of its onset: attacking frequently, severe; occasionally,
mild;
- Duration of each onset: The mild cases cured in a twinkling. The
persistent cases are serious and the more serious one continued for
several hours;
- Fixed or unfixed locations of its onset: If the location of pain
is fixed, the condition is severe, and the mild one on the contrary;
- Deficiency or excess of the pain: mild condition, excessive syndrome
and pulse; severe condition, deficient syndrome and pulse;
- Course of the disease: In general, the incipient and short-term
cases are mild, and the severe cases are on the contrary.
In summary, in the judgement of the illness condition of pectoral pain
and stuffiness, a comprehensive analysis of regional and systemic conditions
is necessary for obtaining correct conclusions.
- Differentiation of positive from negative conditions of cardialgia:
The genuine cardialgia is the serious state of pectoral pain and stuffiness.
Because the serious cardialgia may endanger one’s life, it is important
to observe the positive and the negative conditions. The differentiation
is generally started with the symptoms of emotion, breathing, perspiration,
warm or clod in palms and soles, tongue and pulse. If the spirit of the
patient is normal, breath evenly, normal sweating, mild condition and
short duration, warm palms and soles, normal tongue proper and slow pulse,
the state is defined as positive. If the patient is in low spirit and
has the symptoms of dysphoria, short breathing or asthma spontaneous perspiration
or greasy sweating, palpitating, nervous, nausea and vomiting, cold or
purple limbs, violent and persistent cardialgia without resolving, pain
spreading to shoulder, back, left forearm, throat stomach and abdomen,
purple tongue proper, infrequent or rapid, knotted and intermittent pulse,
the situation is defined as negative. This condition must be watched closely
to prevent syncope or exhaustion.
Ⅱ. Differentiation of pectoral pain and stuffiness from stomach-ache and pectoralgia
(chest pain)
Pectoral pain and stuffiness: The pain is mainly in the chest accompanied
by chest pain spreading to back, palpitating, short breathing and difficult
to lie down. It is easily diagnosed by the electrocardiogram and other physical
and chemical examinations.
Stomach-ache: The location of the pain is mainly below the dovetail accompanied
by belching, acid regurgitation, fullness or distention of abdomen, and is
related to dirt. It is diagnosed by x-ray barium meal examination of fibergastroscopy.
Chest pain: The location of the pain is similar to that of the pectoral pain
and stuffiness but not in the left chest and it is usually caused by tuberculosis.The
persistence of the pain is usually related to cough and respiration and accompanied
by cough ,asthma, cold and heat. It can be diagnosed by x-ray and other physical
and chemical examination.
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Measures of Prevention and Nursing
Ⅰ.Prevention
- Pay
attention to keep up the spirits avoiding depression. The emotional changes,
such as melancholy and anxiety will induce the obstruction of blood vessels
and the flow of qi, and finally resulting in precordial pain. Therefore, to
keep the spirit in a cheerful frame, avoid exciting and melancholy is very
important for prevention the attack of precordial pain.
- Pay attention to the daily life and the weather. The changes in weather(clod,
hot, fine, rain )have significant effect on the attack of precordial pain.
When one is infected by pathogenic cold which obstruct the chest-yang, or
infected by pathogenic heat which invade the heart, the precordial pain may
be occur. Therefore pay attention to the daily life and take note to the changes
of the weather are very important to prevent the attack of precordial pain.
- Pay attention to the diet, avoid fat and greasy food and partiality for
a particular kind of food. In the theory of traditional Chinses medicine,
eating excessive fat, sweet and greasy food is liable to form phlegm which
will block the channels, induce accumulation of phlegm, obstruction of the
flow of qi, and finally result in precordial pain. The results of investigations
carried out in recent years revealed that the incidence of the disease in
those who are fond of sweet and greasy food is higher than that of ordinary
person. Similarly, the person who has food preference is liable to be attacked
by the disease. Therefore, it is important to balance the diet at ordinary
times. In addition, the irritant agents such as wine and cigarettes should
be prohibited because they also affect the normal functions of the viscera.
- Pay attention to strike a proper balance between work and rest, and persist
in proper physical exercises. Overworking is liable to impair the state of
qi, blood, yin and yang of the heart and other internal organs. The habit
of loving ease and hating work will result in the obstruction of the flow
of qi and blood. It is important to strike a proper balance between work and
rest and persist in proper physical exercises, so as to prevent or reduce
the attacking of precordial pain.
Ⅱ. Nursing
- Make the patients in cheerful spirit and build up their confidence in overcoming
the disease, free their mind of misgivings, alleviate undue nervousness, so
as to benefit the normal functioning of the blood circulation and the flow
of qi, and the coordination of the internal organs.
- Lead the patients to have proper exercise follow in order and advance step
by step, for example, take a walk, play shadow boxing(Chinses Taiji) thereby
restoring to health.
- Avoid eating excessive fat and sweet food, prohibit alcoholic drinks, and
have more meals a day with less food at each.
- When the precordial pain has attacked, keep calm, don’t be frightened and
take quick-acting analgesic to prevent the exacerbation of the illness condition.
- Don’t eat excessive food and don’t be overworked after remission of the
disease.
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Therapeutic Principle
Promoting blood circulation to relieve stasis and activating Qi to stop pain,
Activating yang to disperse accumulation and promoting the circulation of Qi
to expel phlegm, tonifying the liver and kidney and blood to restore pulse.
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Recipe
Ginseng, Astraglus, Chinese cassia bark,Red sage root,Sandawood,
Amomum fruit, Liquorice,Ejiao, wild or spine jujube seed. Hemp seed, Macrostem
onion, Pinellia tube, Chinese anglica root, Prepared aconite root, Dodder seed
& etc.
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