The name of chest obstruction and heartache first appeared in synopsis of golden chamber, which was discussed as a special article. The article "Syndrome and Treatment of Chest Obstruction, Heartache and Shortness of Breath" said: "The husband's pulse should be obtained too slowly, and the yang is slightly yin, that is, chest tightness and pain. If so, it is blamed for its extreme deficiency. Now we know that yang deficiency is in the upper jiao, so those with chest pain and heartache are also due to their yin strings. "
Chest obstruction and heartache is a kind of heart pulse disease, which is mainly caused by phlegm, blood stasis, qi stagnation and cold coagulation due to pathogenic factors blocking the heart collaterals, lack of vital qi, diet, emotion and cold pathogens. The main clinical manifestations are paroxysmal compression pain in the middle or left chest, and even symptoms such as heartburn, shortness of breath and inability to lie down. More common in coronary atherosclerotic heart disease. "In the classification of syndromes, it can be divided into six types: blood stasis, cold coagulation of heart pulse, internal resistance of phlegm, weakness of heart and qi, yin deficiency of heart and kidney, and yang deficiency of heart and kidney.
Main pathogenesis
Chest pain is. In light cases, there are occasional brief mild dull or dull chest pain, or faint paroxysmal discomfort in the middle or left chest; Severe pain, or squeezing colic. Often accompanied by palpitations, shortness of breath, poor breathing, and even shortness of breath, panic, pale face, cold sweat and so on. It is mostly induced by fatigue, satiety, cold, emotional excitement, etc., but it can also occur when there is no obvious inducement or when it is quiet.
The main pathogenesis is the obstruction of heart and pulse, and the pathological changes are the mixture of excess and deficiency. Its intrinsic deficiency can be qi deficiency, blood deficiency, yin deficiency and yang deficiency, and its exterior is blood stasis, phlegm turbidity, qi stagnation and cold coagulation. The acute attack period is dominated by excess, and the remission period is dominated by deficiency. The disease is located in the heart and closely related to the liver, spleen and kidney.
Dialectical method
1. Identify the site of pain
Limited to chest pseudoposition, mostly qi stagnation or blood stasis; Radiation to shoulders, larynx, upper abdomen, and even arms and fingers is more obvious; Chest pain and back pain are mostly caused by cold coagulation of heart pulse or sudden loss of yang.
2. Identify the nature of pain
It is the main reference to distinguish chest obstruction, heartache, cold, heat and deficiency, and make an accurate judgment by combining other symptoms and pulse conditions in clinic. For people who are afraid of cold, this kind of pain is like strangulation, which occurs when they catch cold, or the cold gets worse; Hot people have chest tightness and burning pain, and the heat is very painful; For patients with asthenia, the pain is slow, persistent or dull, and they like to massage; If it is true, the pain will be more dramatic, and its pain is like stinging and wringing; It belongs to qi stagnation and heavy pain; Belonging to blood stasis, the pain is like acupuncture, and the pain is local.
Determine the degree of pain
The pain lasts for a short time, that is, how light the deceased is in an instant and how long it lasts. If it lasts for hours or even days, it is often serious or critical. Generally, the number of pain attacks is directly proportional to the severity of the disease, that is, the occasional ones are light and the frequent ones are heavy. However, there are also cases with few attacks and serious illness, which must be analyzed and judged in combination with clinical manifestations. If pain breaks out under fatigue, those who can be relieved after rest or taking medicine are considered as indications, and those who can not be relieved after taking medicine are often considered as critical.
What are the symptoms of chest pain? 1. Cold pulse.
It is characterized by sudden heartburn, or heartburn through the back, backache through the heart, or severe cold pain, palpitation, shortness of breath, cold limbs, cold sweat, thin and white fur, and tight or rapid pulse. It is often caused or aggravated by sudden cold weather or feeling cold. Treatment should be warming channels to dispel cold, promoting blood circulation and relieving pain.
People with yang deficiency are endogenous due to insufficient cold, and they are easily influenced by cold pathogens, which will further damage Yang Qi. Therefore, cold coagulation of heart pulse is often accompanied by yang deficiency in clinic. It is advisable to cooperate with Yang Qi-warming agent to warm yang and dispel cold, instead of blindly using the method of dispelling cold, so as not to damage Yang Qi.
2. Qi stagnation in the heart
It is characterized by fullness and discomfort in the chest, sudden dull pain, pain without determination, and sometimes excessive wheezing, which is easily induced or aggravated when emotional exhaustion occurs, or abdominal distension and tightness, resulting in belching or shortness of breath, thin or greasy fur, and thready pulse. The treatment should be to regulate qi and blood and pulse.
For chest obstruction and heartache, according to the needs of the disease, incense crystals such as Radix Aucklandiae, Lignum Aquilariae Resinatum, Lignum Dalbergiae Odoriferae, Lignum Santali Albi, Rhizoma Corydalis, Cortex Magnolia Officinalis, and Fructus Aurantii Immaturus can be selected, but they should not be used for a long time to avoid the loss of healthy qi. If qi stagnation is accompanied by yin deficiency, you can choose bergamot and incense rafters to regulate qi without hurting the crystal of yin.
3. Obstruction of orifices due to turbid phlegm
It is characterized by severe chest distress, mild heartache, obesity, excessive phlegm and shortness of breath, and it is easy to attack or aggravate in rainy days, accompanied by fatigue, anorexia in loose stool, sticky mouth, nausea, spitting, greasy or slippery fur and slippery pulse. Treatment should be based on activating yang, removing turbidity, resolving phlegm and resolving stagnation.
Those suffering from chest obstruction, heartache and phlegm obstruction include concretio silicea bambusae, Rhizoma Arisaematis, Rhizoma Pinelliae, Fructus Trichosanthis, Caulis Bambusae, Rhizoma Atractylodis, Radix Platycodi, Raphani Semen, Fritillaria thunbergii, etc. You can choose as appropriate. However, since spleen is the source of phlegm, products for invigorating spleen and eliminating dampness should be properly combined.
4. Blood stasis block
It is characterized by severe chest pain, such as tingling, pain in fixed parts, even heartburn, backache, or shoulder and back pain, accompanied by chest tightness, and rage can be aggravated. The tongue is dark red or purple-red, with ecchymosis, blood stasis under the tongue, thin coating, astringent or knotted pulse, and accelerated pulse. Treatment should be based on promoting blood circulation, removing blood stasis, dredging veins and relieving pain.
Cold (exogenous cold pathogen or endogenous cold pathogen due to yang deficiency) can cause blood stasis, such as qi stagnation and blood stasis, so this type is the most common, with blood stasis as the main symptom and corresponding complications. Asari and Ramulus Cinnamomi can be added for patients suffering from cold to warm and disperse cold. For patients with qi stagnation, Lignum Aquilariae Resinatum and Lignum Santali Albi can be added to regulate qi and relieve pain; Radix Astragali, Radix Codonopsis and Rhizoma Atractylodis Macrocephalae are added for patients with qi deficiency. If blood stasis syndrome is severe and chest pain is severe, Olibanum, Myrrha, Radix Curcumae, Rhizoma Corydalis, Lignum Dalbergiae Odoriferae and Radix Salviae Miltiorrhizae can be added to enhance the effects of promoting blood circulation, regulating qi and relieving pain.
The method of promoting blood circulation and removing blood stasis is a common method for treating chest obstruction and heartache, which can be selected from Notoginseng Radix, Rhizoma Chuanxiong, Radix Salviae Miltiorrhizae, Radix Angelicae Sinensis, Carthami Flos, Lignum sappan, Radix Paeoniae Rubra, Herba Lycopi, Achyranthis Radix, Semen Persicae, Caulis Spatholobi, Herba Leonuri, Hirudo, Semen Vaccariae, Cortex Moutan and Fructus Crataegi, but they must be used together on the basis of syndrome differentiation to achieve better curative effect. In addition, when using the method of promoting blood circulation and removing blood stasis, we should pay attention to the type and dosage, and pay attention to whether there is bleeding tendency or signs. Once found, stop using it immediately and handle it accordingly.
5. Lack of spirit
It is characterized by dull pain in the chest, chest tightness, shortness of breath, exercise is beneficial, palpitation and fatigue, mental fatigue, pale face, or easy sweating, red tongue, fat tongue, thin white fur, slow or knotted pulse. Treatment should be to nourish the heart and encourage the heart pulse.
If palpitation, shortness of breath, dizziness and fatigue, chest tightness and dull pain, dry mouth and throat, upset and insomnia, red tongue or tooth marks occur at the same time, it is deficiency of both qi and yin, and Angelica sinensis, Radix Rehmanniae, Radix Rehmanniae Preparata and Radix Ophiopogonis can be used to nourish yin and replenish blood; Ginseng, Fructus Schisandrae Chinensis and Radix Glycyrrhizae Preparata tonify heart qi; Semen Ziziphi Spinosae, Semen Platycladi and Shen Fu nourish the heart and soothe the nerves.
Ginseng, Radix Codonopsis, Radix Astragali, Fructus Jujubae, Radix Pseudostellariae, etc. It is often used as a medicine for invigorating the heart. If qi deficiency is obvious, you can add less cinnamon and less excessive internal heat. Ophiopogon japonicus, Polygonatum odoratum and Polygonatum sibiricum can also be added.
6. Loss of heart yin
It is characterized by chest pain, burning pain, or dull pain, palpitation, feverish sensation in the five senses, dry mouth and throat, hot flashes and night sweats, reddish brown, thin or peeling fur, rapid pulse or knots. The treatment should be nourishing yin and clearing away heat, nourishing the heart and calming the nerves.
7. Heart-yang deficiency
It is characterized by chest tightness or heartburn, shortness of breath, palpitation, spontaneous sweating and more severe exercise. Mental fatigue, fear of cold, pale complexion, warm or swollen limbs, pale and fat tongue, white and greasy fur, and slow pulse. Treatment should be nourishing yang and warming heart yang.