Chest bi-syndrome is a disorder characterized by oppression and pain over the chest or back and is accompanied by dyspnea and shortness of breath. The cases of coronary atherosclerotic heart disease, lobar pneumonia, pulmonary abscess, pleurisy, pericarditis and intercostal neuralgia with chest pain as the predominant symptom may be differentiated and treated by the principles mentioned in this section.

Etiology and Pathogenesis

Physiologically, the heart controls blood and the lungs govern qi, and functional coordination of the heart and lungs maintains the normal circulation of qi and blood. However, any factors leading to dysfunctioning of zang-fu organs and disturbances of yin, yang, qi and blood may cause chest bi-syndrome. The common causes are as follows: (1) an attack of exogenous cold leads to stagnation of qi; (2) immoderate diet and drinking impairs the function of spleen and stomach, causing the accumulation of phlegm-dampness and the obstruction of meridians and vessels with impediment of qi and blood circulation; (3) emotional upsets such as Anxiety, anger, etc., cause stagnation of qi with formation of phlegm, fire and blood stasis blocking the chest yang; and (4) aging, debility, overstrain and disease may lead to hypofunction of spleen and stomach, insufficiency of qi and blood, or deficiency of the liver-yin, kidney-yin and hear-yin, resulting in retardation of blood and qi circulation.

The above causes and pathogenesis may coexist, and when they do the condition becomes more complicated. Chest bi-syndrome may further develop to other disorders, such as angina pectori (after the obstruction of heart meridians by blood stasis), collapse-syndrome (by exhaustion of yin and yang), palpitations and slow-floating pulse (resulting from insufficiency of qi and blood), or cough, dyspnea, edema (resulting from deficiency of hear-yang and kidney-yang and retention of fluid in the heart and lungs), etc.

 Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between primary and secondary syndrome, as well as asthenia and sthenia syndrome: Chest bi-syndrome usually manifests itself as a primary asthenia-syndrome and a secondary sthenia-syndrome. Generally speaking, deficiencies of hear-qi, heart-yang, kidney-yang, heart-yin and kidney-yin are the types of asthenia-syndrome commonly seen, while qi stagnation, blood stasis, phlegm-dampness, cold hyperactivity and heat accumulation are the common types of sthenia-syndrome.

(b) Identification of the character of pain: A dull pain usually occurs in cases with deficiency of healthy qi, a burning pain in those with asthenic heat or sthenic fire, a colicky pain in those with yang-deficiency or cold stagnation, a stabbing pain in those with obstruction of meridians by blood stasis and an aching pain in those with stagnation of phlegm or qi.

B. Therapeutic principles

The basic principle of treatment should be focused on dredging meridians, which is accomplished by dispelling evils first and followed by tonifying, or both simultaneously. For dispelling evils, the principles of activating blood circulation and eliminating blood stasis, regulating qi and easing the chest, dissipating phlegm and eliminating dampness, expelling heat and dredging fu-organs and activating yang by acrid-warm drugs are commonly applied. For tonifying purposes, the therapies of benefiting qi and nourishing kidneys, warming yang and benefiting qi, as well as tonifying blood and benefiting qi are the common principles. In cases of abrupt onset of sustained unendurable precordial pain, palpitations, dyspnea, profuse sweating and coldness of limbs, emergency treatment should be employed to prevent the development of collapse-syndrome.

Classification and Treatment

A. Stagnation of heart-blood

Manifestations: Wandering and stabbing pain over the chest which is aggravated at night, palpitations, dark purplish tongue with or without petechiae and deep and uneven pulse.

Therapeutic principles: Activate blood circulation, eliminate blood stasis, dredge meridians and relieve pain.

Prescription: The Modified Decoction for Removing Blood Stasis in the Chest

Radix Salviae Miltiorrhizae 15-30 g
Flos Carthami 10 g
Rhizoma Chuanxiong 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Rubra 12 g
Radix Curcumae 10 g
Lignum Dalbergiae Odoriferae 9 g
Pericarpium Citri Reticulatae 10 g

Remarks: Add Lignum Santali and Radix Notoginseng powder (mixed with the decoction) for cases with severe chest pain. Use Radix Salviae Miltiorrhizae Decoction containing Radix Salviae Miltiorrhizae, Fructus Amomi and Lignum Santali for cases with mild blood-stasis syndrome.

B. Accumulation of phlegm-dampness

Manifestations: Chest oppression and pain in the shoulders and back, profuse expectoration, epigastric upset, shortness of breath, dyspnea, heavy feeling of the limbs, obesity, turbid, greasy tongue coating and smooth pulse.

Therapeutic principles: Activate yang, eliminate phlegm and dampness and release stagnation.

Prescription: The Modified Decoction of Trichosanthis, Allii Macrostemi and Pinelliae

Fructus Trichosanthis 30 g
Rhizoma Pinelliae 10 g
Bulbus Allii Macrostemi 10 g
Radix Salviae Miltiorrhizae 30 g
Poria 15 g
Pericarpium Citri Reticulatae 10 g
Radix Curcumae 10 g
A moderate amount of wine may be added as a guiding ingredient.

Remarks: For cases with nausea, poor appetite, foul smell in the mouth and yellow, greasy tongue coating caused by phlegm-dampness changing into heat, add Radix Scutellariae, Rhizoma Coptidis, Fructus Crataegi and Fructus Aurantii to clear away phlegm-heat. For cases with coexistence of phlegm-dampness and blood-stasis, apply at the same time the therapies of activating yang and eliminating phlegm and that of activating blood circulation and eliminating blood stasis.

C. Stagnation of yin-cold

Manifestations: Chest pain referring to the back which is aggravated by cold, oppression over the chest, palpitation or even dyspnea, pale complexion, coldness of limbs, white tongue coating and deep and thready tense pulse.

Therapeutic principles: Expel cold and activate stagnated yang with acrid-warm drugs.

Prescription: The Modification of Trichosanthis, Allii Macrostemi and Rice Wine

Fructus Trichosanthis 30 g
Bulbus Allii Macrostemi 10 g
Ramulus Cinnamomi 6-10 g
Radix Salviae Miltiorrhizae 15-30 g
Lignum Santali (decocted later) 10 g
Pericarpium Citri Reticulatae 10 g
Radix Aconiti Lateralis Praeparata 5 g
Vingar (added to the prepared decoction) 30 g

Remarks: For serious cases with marked accumulation yin-cold manifested as precordial pain referring to the back, coldness of the trunk and limbs, dyspnea, deep and tense pulse, apply the Pill of Aconiti and Halloysitum Rabrum and the Pill of Storax which is composed of Radix Aconiti Lateralis Praeparate, Rhizoma Zingiveris (dried), Radix Glycyrrhizae, Ramulus Cinnamomi, Halloysitum Rubrum and Pericarpium Zanthoxyli.

D. Deficiency of heart-yin and kidney-yin

Manifestations: Dull pain and oppression over the chest, palpitations, restlessness, insomnia, night sweating, soreness and weakness of lumbus and knees, dizziness, tinnitus, red tongue with or without petechiae and thready and rapid or uneven pulse.

Therapeutic principles: Tonify yin, nourish the kidneys and heart and calm the mind.

Prescription: The Modification of Zuogui Decoction

Radix Rehmanniae 10 g
Radix Rehmanniae Praeparata 10 g
Fructus Corni 10 g
Rhizoma Dioscoreae 10 g
Cortex Moutan Radicis 10 g
Radix Ophiopogonis 10 g
Fructus Schisandrae 6 g
Fructus Lycii 10 g
Radix Salviae Miltiorrhizae 15 g
Poria 15 g
Lignum Dalbergiae Odoriferae 9 g

Remarks: Add Concha Haliotidis, Radix Paeoniae Rubra, Caulis Spatholobi and Ramulus Uncariae cum Uncis for cases with dizziness, feverish sensation over the head and face and numbness of limbs.

E. Deficiency of qi and yin

Manifestations: Intermittent dull pain and oppression over the chest, palpitations, shortness of breath, fatigue, lusterless complexion, dizziness aggravated by strain, red tongue with teeth marks on its margin and thready or slow, irregular pulse.

Therapeutic principles: Nourish yin, benefit qi, activate blood circulation and dredge collaterals.

Prescription: The Modified Powder for Restoring Pulse Beat with Ginseng Decoction for Nourishing Qi and Ying

Radix Codonopsis Pilosulae 15 g
Radix Ophiopogonis 10 g
Fructus Schisandrae 10 g
Radix Salviae Miltiorrhizae 15-30 g
Rhizoma Polygonati 15 g
Radix Astragali 12 g
Radix Rehmanniae Praeparata 12 g
Radix Angelicae Sinensis 10 g
Poria 15 g
Pericarpium Citri Reticulatae 10 g
Radix Glycyrrhizae Praeparata 6 g

F. Deficiency of yang-qi

Manifestations: Dull pain and oppression over the chest and referring to the back, palpitations, shortness of breath, sweating, fatigue, aversion to cold, coldness of limbs, knees and loins, pale complexion, pale or cyanotic lips and nails, pale or dark purplish tongue and deep and thready or feeble pulse.

Therapeutic principles: Benefit qi, warm yang, activate blood circulation, dredge collaterals.

Prescription: The Modified Decoction of Ginseng and Aconiti Lateralis

Praeparata Radix Codonopsis Pilosulae 15-30 g
Radix Aconiti Lateralis Praeparata 9 g
Ramulus Cinnamomi 6-10 g
Poria 15-30 g
Radix Rehmanniae Praeparata 12 g
Fructus Corni 10 g
Radix Salviae Miltiorrhizae 30 g
Fructus Psoraleae 10 g
Radix Glycyrrhizae Praeparata 6 g

Experiential Prescriptions

A. Three grams of Radix Ginseng powder and 3 grams of Radix Notoginseng powder; taken with warm water 2 to 3 times a day; applicable to the chest bi-syndrome caused by qi deficiency and blood stasis.

B. Fifteen grams of Lignum Santali prepared as decoction and mixed with 2 grams of Lignum Aquilariae Resinatum powder; taken orally in two divided doses daily; applicable to the chest bi-syndrome due to stagnation.

C. Semen Sesami (500 g), Semen Juglandis (500 g) and Semen Persicae (raw, 250 g) prepared as powder and mixed with 500 grams of sugar; one spoonful taken every morning; applicable to the chest bi-syndrome caused by kidney deficiency and blood stasis.

D. Rhizoma Coptidis (3 g), Rhizoma Pinelliae (6 g) and Semen Trichosanthis (9 g) prepared as decoction; applicable to chest bi-syndrome due to the accumulation of phlegm-heat.

E. Rhizoma Pinelliae (6 g), Semen Trichosanthis (9 g) and Bulbus Allii Macrostemi (9 g) prepared as decoction; applicable to chest bi-syndrome resulting from the accumulation of phlegm-dampness.

Copyright 1995 Hopkins Technology