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Condition Treated / Pain Conditions

Chest Pain (Cardiac Pain)

Chest Pain (Cardiac Pain)
Cardiac pain refers to pain in the midway between the two nipples at the level o the fourth
intercostal space and the left-sided frontal part of the chest due to heart-vesse contracture or
obstruction. Those with mild conditions may present with suffocated ches stuffiness and unsmooth
respiration, and those with severe conditions may present wit stabbing or colic chest pain. The
cardiac pain may radiate ·to the back and the back pai may radiate to the chest. Other symptoms
include dyspnea with inability to lie flat, a pal complexion, profuse sweating, and cold extremities. Cardiac pain frequently occurs to th middle and elderly people and it occurs more in winter and spring.
The treatment of cardiac pain based on syndrome differentiation also applie to some diseases in
Western medicine that present with cardiac pain such as angin pectoris of coronary artery disease, myocardial infarction of coronary artery diseas myocardiopathy, viral myocarditis, pleuritis and cardiac neurosis.

Etiology and pathogenesis

1. Internal attack of pathogenic cold: Congenital yang deficiency, chest-yan insufficiency and
attack of pathogenic yin-cold may cause cold retention and stagnation, subsequently leading to
obstruction of chest-yang and blockage of the flow o qi as well as contracture or obstruction of
the heart-vessel.
2. Improper diet: Overeating fatty, sweet food and greasy food or alcohol addictio may damage the
function of spleen and stomach in transportation and transformatio leading to internal
phlegm-turbidity, which in turn obstructs the heart-vessel and qi flo and result in the contracture
or obstruction of the heart-vessel.
3. Emotional injuries: Worries and too much thinking may damage the spleen an cause spleen-qi
stagnation and generation of phlegm-dampness; depressed anger ma damage the liver and affect the liver's function in regulating the free flow of qi, leadin to liver-qi stagnation that later transforms into fire and produces phlegm by scorching th body fluid. Thus the mixed qi stagnation and phlegm may block the blood circulation an result in the contracture or obstruction of the heart-vessel.
4. Deficiency of the liver and kidney: Kidney-qi tends to decline with aging proces kidney-yang deficiency may fail to invigorate yang-qi of the five zang-organs and lead t deficiency of heart-qi or heart-yang; kidney-yin deficiency may fail to nourish the yin five zang-organs and lead to liver-yin deficiency and internal consumption of heart-yi which in tum results in phlegm retention, qi stagnation, blood stasis, and cold retentio that eventually obstructs the chest-yang and qi flow and leads to the contracture or obstruction of the heart-vessel.

The above etiological factors can occur alone or in combination. Cardiac pain is mainly located in
the heart and closely related to the liver, spleen and kidney. It is caused by deficiency of qi, blood, yin and yang. However it presents with more excessive symptoms such as phlegm-turbidity, blood stasis, qi stagnation and cold retention. The key of pathogenesis is the contracture or obstruction of the heart-vessel. The following is a diagram of etiology and pathogenesis:

Treatment based on syndrome differentiation

The root cause of cardiac pain is deficiency but its symptoms are excessive. Before cardiac pain is
treated, deficiency and excess should be distinguished first and acute or remission phases should be taken into consideration.

Excessive symptoms involve yin cold, phlegm-turbid, blood stasis and qi stagnation. The deficiency mainly refers to deficiency of yin, yang, qi and blood. The treatment principle should be to treat symptoms in acute phase and treat the root cause in remission phase or both aspects at the same time. The common syndrome patterns are as follows:

1. Heart-blood obstruction
Symptoms: Stabbing pain in the chest with a fixed position, the pain becomes worse at night,
intermittent palpitations and uneasiness, a dark-purple tongue and a deep and hesitant or a wiry
and hesitant pulse.
Treatment principle: To circulate the blood, resolve stasis, clear meridians and stop pain.
Major formula: Xue Fu Zhu Yu Tang

2. Internal obstruction of phlegm-turbid
Symptoms: Chest stuffiness and oppressive pain, the pain may radiate to the shoulder and back,
shortness of breath, fatigue, a heavy sensation in the limbs, profuse sputum, a pale tongue with a
greasy coating and a slippery pulse.
Treatment principle: To clear yang, remove turbidity, and resolve phlegm. Major formula: Kuo Lou
Xie Bai Ban Xia Tang

3. Yin-cold retention
Symptoms: Chest pain radiating to the back, the pain becomes worse with cold, chest stuffiness,
shortness of breath, palpitations, or even dyspnea with inability to lie flat,a pale complexion, cold limbs, a white tongue coating and a deep and thready or a deep and tense pulse.
Treatment principle: To warm and clear yang, unblock the obstruction and dissipate cold.
Major formula: Kuo Lou Xie Bai Bai Jiu Tang [218l

4. Yin-deficiency of the heart and kidney
Symptoms: Chest stuffiness and pain, palpitations, night sweats, restlessness, insomnia,
soreness and weakness in the lumbar area and knee joints, tinnitus, dizziness, a dark-red tongue or a tongue with ecchymosis and a scanty coating and a thready and rapid or abrupt pulse.
Treatment principle: To nourish kidney-yin, benefit the heart and calm the mind.
Major formula: Zuo Gui Yin qi stagnation, adopt Chai Hu Shu Gan San to nourish the kidney and soothe the liver.

5. Deficiency of both qi and yin
Symptoms: Chest stuffiness and intermittent dull pain, palpitations, shortness of breath,
lassitude, a lusterless cbmplexion, dizziness, blurred vision, the symptoms become worse after
fatigue, a red and tender tongue with teethmarks and a scanty coating and a thready and weak or
knotted or intermittent pulse.
Treatment principle: To supplement qi, nourish yin, circulate the blood and clear the collaterals.
Major formula: Sheng Mai San and Ren Shen Yang Ying Tang

6. Yang deficiency of the heart and kidney
Symptoms: Chest stuffiness and pain, shortness of breath, or even chest pain radiating to the
back, palpitations, spontaneous sweating, cold intolerance, cold limbs, lumbar soreness, fatigue, a
pale complexion, pale or bluish-purple lips and fingernails, a pale or dark-purple tongue and a
deep and thready or a deep and extremely faint pulse.
Treatment principle: To supplement qi, warm yang, circulate the blood and clear the collaterals.
Major formula: Shen Fu Tang and You Gui Yin.and Wu Wei Zi (Fructus Schisandrae) to warm yang and nourish yin.

Commonly-used patent Chinese herbal products

1. Su Xiao Jiu Xin Wan Actions: Activates qi flow and circulates the blood, resolves stasis and stops pain. Indications: Cardiac pain due to heart-blood obstruction.
2. Di Ao Xin Xue Kang Jiao Nang Actions: Circulates the blood, resolves stasis, activates qi
flow and stops pain. Indications: Cardiac pain due to heart-blood obstruction.
3. Fu Fang Dan Shen Di Wan Actions: Circulates the blood, resolves stasis,
activates qi flow and stops pain. Indications: Cardiac pain due to heart-blood obstruction.

4. Guan Xin Su He Wan (Di Wan or Jiao Nang) Actions: Regulates qi, soothes the chest and stops
pain. Indications: Cardiac pain due to qi stagnation and blood stasis.

5. Zi Xin Yin Kou Fu Ye Actions: Nourishes the heart-yin, circulates the blood and stops pain.
Indications: Cardiac pain due to heart-yin deficiency.

Life style recommendations

1. Stop smoking, reduce alcohol drinking, and avoid raw, cold, sweet food and fatty food;
2. Keep mental fitness and avoid depressed anger;
3. Take adequate rest, do proper physical exercises and avoid wind-cold;
4. Avoid sexual indulgence and overexertion.

Summary

Cardiac pain can be caused by factors such as internal attack of pathogenic cold, improper diet,
emotional injuries and weak constitution due to aging process. Cardiac pain is located in the
heart and closely related to the liver, spleen and kidney.The key pathogenesis is the contracture
or obstruction of the heart-vessel. The root cause of cardiac pain is deficient but its symptoms
are more excessive. The deficiency mainly refers to deficiency of qi, blood, yin and yang.
Excessive symptoms are caused by phlegm-turbidity, blood stasis, cold retention and qi
stagnation. The treatment should target on symptoms in acute phase, target on the root cause
in remission phase and target on both aspects for the mixed deficiency or excess.

Pain Care Acupuncture Clinic is your local acupuncture office in Torrance, CA . specializing in treating injuries and chronic pain. Dr. Ming Chen and Dr. Lu Yang, Both acupuncturists who also the oriental medical doctor ( O.M.D. ) can pinpoint the cause of the injury and suggest the best treatment methods for you. You need our doctor to listen to the whole story and examine you, so that you can get started treating on your injuries or chronic pain and get you on the track toward recovery.

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310-316-5707

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