Acupuncture Treatment for Chest Bi （胸痹）

The Introduction of Chest Bi

Definition

Chest Bi (Obstruction of Qi in the Chest, ) is a disease characterized by a feeling of suffocation and pain in the chest, extending to the shoulder and sometimes the arm. It is commonly seen in middle-aged and senior people. “Bi” means “blockage” in its original sense.

 Clinical features

(1)Mild

• Chest tightness.
• Palpitations.
• No obvious cardiac pain.

(2) Severe

• Sensation of suffocation in the chest.
• Severe, radiating cardiac pain to the left shoulder, arm, and jaw.
• Accompanying symptoms include sweating, cold limbs, and purple lips and hands.

Correspondence to Western medical diseases

Angina pectoris, cardiac infarction (heart attack), coronary heart disease, hypertensive heart disease, pulmonary heart disease, and rheumatic heart disease may be classified as Chest Bi in TCM.

The Etiology of Chest Bi

• Invasion of Wind, Cold, Damp and lack of exercise, which cause blockage of Qi and Blood resulting in chest pain.
• Emotional frustration leads to Liver-Qi stagnation and Spleen deficiency, which may produce Phlegm-Damp.
• Irregular diet such as overeating fat, fried, or greasy food and drinking alcohol may damage the Spleen and generate Phlegm-Damp to block the Heart vessels.
• Constitutional weakness: Kidney-Yang deficiency in the elderly fails to keep Blood warm, thus creating Blood stasis; a Phlegm-Damp constitution is often seen in overweight people, which may easily cause the blockage of cardiac vessels.

The Pathology of Chest Bi

Chief pathology

Root (Ben) deficiency with branch (Biao) excess. Root deficiency includes Heart, Kidney, Yin, or Yang deficiency. Branch excess indicates Phlegm, Blood stasis, Qi stagnation, Cold, and Dampness.

 Organs involved

The chief organ involved in Chest Bi is the Heart. Associated organs include the Liver, Spleen, Stomach, Kidney, and Lung.

Pathology for the chief symptoms

• Chest pain caused by Heart vessel stagnation or blockage.
• Palpitations and a Knotted pulse are caused by Heart-Yang or Heart-Qi deficiency failing to pump blood.
• Dyspnea and edema are due to Heart- or Kidney-Yang deficiency leading to water retention. The retained fluids shooting to the Heart cause palpitations, while the fluids shooting to the Lung cause dyspnea; fluids overflowing to the skin cause edema.

How to Diagnose and differentiate Chest Bi(see Table 6)

Diagnosis

• Diagnosis is based on clinical features, together with medical history, X-ray, EKG, and ultrasound exam.

Basic points: CV 14, CV 17, or BL 15/14, PC 4/6, HT 6/7.

Disease differentiation

(1)Stomachache
By location:

• Stomachache is mainly in the epigastric region below the sternum, whereas cardiac pain is in the chest, mainly on the left side.

Radiation:

• Stomach pain, if severe, can radiate to the back (no radiation to the arm), whereas cardiac pain radiates to the neck, arm, shoulder, and jaw.

Basic points: CV 14, CV 17, or BL 15/14, PC 4/6, HT 6/7.

Accompanying symptoms:

• Stomachache usually combines with nausea, vomiting, bloating and gas, constipation or diarrhea.
• Chest Bi is often accompanied by palpitations and insomnia.

Medical history:

• If there is a previous history of digestive problems (peptic ulcer, gastritis), then it is more likely a stomachache.
• If there is a previous history of a heart condition, then it is more likely a Chest Bi.

Age:

• Chest Bi: Middle age to senior patients are more affected; males are more affected than females.
  Gastric pain: Usually affects younger people.

(2)Xuan Yin (, Pleurisy):

• Can present with chest pain, which usually refers to the hypochondriac region or sides of the chest.
• The pain consistently presents for days or weeks.
• It is usually accompanied by Lung symptoms such as cough or Phlegm.
• Aggravated by breathing or turning.

Syndrome differentiation

(1)Tips for differentiation
Determine root deficiency and branch excess.

Attack phase:

• Usually dominated by branch excess.
• Need to further determine whether the problem is
  • Cold accumulation.
  • Phlegm blockage.
  • Blood stasis.
  • Qi stagnation.

Remission phase:

• Usually dominated by root deficiency.
• Need to further determine if the problem is
  • Heart-Qi deficiency.
  • Qi and Yin deficiency.
  • Heart-, Spleen-, or Liver-Yang deficiency.
  • Liver-, Kidney-, or Heart-Yin deficiency.

Use the characteristic symptoms to help differentiate:

• Fixed stabbing pain which is worse at night, a deep-purple tongue, and a choppy pulse indicate Heart-Blood stasis.
• A suffocating feeling in the chest, overweight, a thick sticky tongue coating, and a soggy or slippery pulse indicate retention of Phlegm.
• Sudden severe pain which can be relieved by warmth and aggravated by cold indicates stagnation of Cold in the chest.

Principle of Treatment

Determine which root deficiency and branch excess are involved and which is more important. Treat the branch first if the branch is urgent and treat the root if the

branch is not urgent

1) Acupuncture
(1)Basic points

• CV 14 or 17
• BL 15 or 14
• PC 4 or 6
• HT 6 or 7

(2)Rationale for the points

• PC 6 — opens the chest, regulates Qi, helps digestion.
• BL 15 — Back Shu of the Heart, nourishes the Heart.
• CV 17 — Front Mu of Pericardium, Upper Sea of Qi, opens the chest, regulates Qi, especially in the Heart and Lungs.
• HT 5 — luo-connecting point, moves Blood, circulates collaterals to stop pain.
• HT 7 — calms the Mind.
• HT 6 — Xi Cleft point, good for acute pain.
• CV 14 — moderates Heart pain, angina.
• Huatuojiaji T 4–T 5 — can substitute for BL 15, 14.

(3)Palpation for tenderness

• Palpate Back Shu points to find tenderness and reaction points, which may not be exactly on meridians. Feel and look for nodules, tenderness, or color change. Usually there is tenderness on BL 15, 14 or at left KI 22. Needle these points for the best results.

(4)Modifications

• Liver-Qi stagnation (common with Heart-Blood deficiency and Phlegm) — add LR 3, 5.
• Liver-Yang Rising (Hypertension) — add GB 20, LI 11, LR 3.

Moxibustion

• PC 6
• ST 36
• CV 17
• BL 14, 15

Moxa for 20 min.

Auricular

• Heart
• Small intestine
• Shenmen
• Subcortex
• Sympathetic
• Kidney
• Liver
• Spleen
• Chest
• Adrenal gland
• Endocrine

Choose four points each time. Needle 20–30 min; avoid strong stimulation or use seeds.

Herbal patent medicine

• Guanxin Suhe Wan
• Fu Fang Danshen Pian

How to prevent Chest Bi

• Keep warm. Avoid EPF invasion, especially during winter. Many heart attacks happen upon weather change or during cold weeks.
• Regulate emotions. Avoid anger, overjoy, excessive worry, or fear (emotional stress).
• Regulate lifestyle. Sleep and eat at regular times. Do not overwork or overrest.
• Regulate diet. Do not eat too much, especially fatty, sweet, and rich foods. Quit smoking and drinking alcohol.
• In seniors, vital Qi is weak. Encourage proper exercises: Qigong, Taiji (exercises that are not too physically demanding).

Suggestions

• Acupuncture has very good results for relief of chest pain. In animal experiments, it has been shown to produce improved Heart blood supply and stronger Heart contractions, and it improves the electrical balance of cardiac membrane.
• If the condition is not relieved with acupuncture, it is best to combine with other methodologies, such as herbals or Western medicine, to save lives.