How Traditional Chinese Medicine Describes the Onset of Chest Pain in Chest Bi Syndrome

Bi, in Traditional Chinese Medicine, refers to bi syndrome, a disease of limb pain or numbness caused by external pathogenic factors such as wind, cold and dampness. Chest bi refers to a disease whose main symptoms are stuffy pain in the chest, in severe cases chest pain penetrating to the back, and panting so severe that one cannot lie down; in mild cases there is a feeling of chest tightness and somewhat labored breathing, in severe cases there is chest pain, and in the most serious cases heart pain penetrates to the back and back pain penetrates to the heart. In the Han dynasty, Zhang Zhongjing in the Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet) proposed the name "chest bi" and summarized its pathogenesis as "yang faint and yin wiry"; treatment should warm and free the flow and dissipate cold, with formulas such as Gualou Xiebai Baijiu Tang (Trichosanthes and Allium Macrostemon Decoction with White Wine) and Gualou Xiebai Banxia Tang (Trichosanthes, Allium Macrostemon and Pinellia Decoction).

Chest bi in Traditional Chinese Medicine generally refers to heart diseases in modern medicine, such as coronary atherosclerotic heart disease, such as angina pectoris and myocardial infarction. Chest bi heart pain is also called heart pain. It is a disease pattern caused by deficiency and depletion of vital qi, diet, emotions, cold pathogenic factors and the like, in which phlegm turbidity, blood stasis, qi stagnation and cold congelation block the heart vessels, with paroxysmal stuffiness and pain in the Tanzhong (mid-chest) area or the left chest as the main clinical manifestations, but it is not chest stuffiness (fullness and blockage in the chest without pain, or referring to stuffy pain in the chest).

In chest bi heart pain, mild cases have occasional brief and slight chest stuffiness or dull pain, or a paroxysmal vague discomfort in the Tanzhong area or the left chest; in severe cases the pain is intense, or presents as a pressing, crushing colicky pain. It is often accompanied by palpitations, shortness of breath, labored breathing, and even panting, fright and restlessness, pale complexion, and spontaneous cold sweats. It is mostly induced by fatigue, a heavy meal, cold and emotional agitation, and may also occur without obvious triggers or at rest.

Traditional Chinese Medicine holds that the formation and occurrence of chest bi heart pain are mostly related to factors such as internal invasion of cold pathogenic factors, improper diet, emotional fluctuations, excessive fatigue and overexertion, and old age with bodily weakness. The basic pathogenesis is blockage of the heart vessels, including excess patterns such as cold pathogenic factors, phlegm dampness, qi stagnation and blood stasis. However, deficiency patterns such as qi deficiency, yin deficiency, yang deficiency and dual deficiency of qi and yin can also lead to failure to nourish the heart vessels and poor blood flow in the heart vessels.

Therefore, clinically there are three particular manifestations: first, sudden stuffiness and pain in the left chest or the Tanzhong area. Second, repeated episodes. Third, onset triggered by emotional fluctuations. Chest bi pain generally begins as sudden stuffiness and pain in the left side or the Tanzhong area, with pain described as burning pain, colicky pain, stabbing pain or dull pain, a vague discomfort, and so on. The pain often radiates to the shoulders and back, forearms, throat and stomach region, and in severe cases can radiate along the pathways of the Hand Shaoyin and Hand Jueyin meridians to the middle finger or little finger, often accompanied by palpitations.

Chest bi is the angina pectoris of coronary heart disease, or myocardial infarction. The pain often occurs suddenly and stops suddenly, generally lasting a few seconds or several tens of seconds, and recurs repeatedly; rest or medication can quickly relieve the pain. In terms of age, chest bi patients are mostly seen in people above middle age. The causes that trigger chest bi, namely angina pectoris of coronary heart disease or myocardial infarction, generally include excessive grief, excessive joy or excessive anger, as well as climate changes, binge eating and drinking, and excessive fatigue; a small number of patients may also develop it without external causes and at rest.