The cough with expectoration of thick, sticky white sputum, together with the breathlessness and feeling of tightness and oppression of the chest, indicate the presence of Damp-Phlegm in the Lungs, which is confirmed by the swelling of the tongue body and the Slippery pulse. The general cold feeling, cold hands and feet, constipation and Weak Rear pulse positions also indicate Kidney-Yang deficiency, which obviously contributed to the formation of Phlegm. The Kidney deficiency is also evidenced by the absence of ‘spirit’ on the root of the tongue. Besides Damp-Phlegm in the Lungs, there is also Damp-Heat in the Lower Burner, which causes the yellow vaginal discharge.

The loss of weight which occurred in the previous 2 years and the rootless tongue coating point to the beginning of a situation of Kidney-Yin deficiency, which may sometimes develop from Kidney-Yang deficiency.

The treatment should concentrate first on resolving Damp-Phlegm and stimulating the descending of Lung-Qi and secondly on tonifying the Kidneys.

Box 38.1 summarizes the patterns underlying cough.

BOX 38.1 COUGH

Acute

• External invasion of Wind: acute cough, aversion to cold, fever, sore throat, runny nose, Floating pulse

• Heat or Phlegm-Heat in the Lungs: acute, barking cough with expectoration of yellow mucus, feeling of heat, thirst, Overflowing-Rapid pulse

• Residual dryness and Phlegm in the Lungs: acute, dry cough with difficult expectoration of scanty sputum after repeated bouts of dry coughing, tickling sensation in throat.

Chronic

• Damp-Phlegm in the Lungs: chronic cough with easy expectoration of profuse, white sputum, feeling of oppression of the chest, Swollen tongue with sticky coating, Slippery pulse

• Phlegm-Heat in the Lungs: loud chronic cough with expectoration of profuse yellow or greenish sputum, feeling of heat, feeling of oppression of the chest, Red and Swollen tongue with sticky yellow coating, Slippery-Rapid pulse

• Dry-Phlegm in the Lungs: chronic dry cough with occasional, difficult expectoration of scanty sputum, dry throat, Swollen tongue with a dry coating

• Lung-Qi deficiency: chronic, slight cough with weak sound, weak voice, Empty pulse

• Lung-Yin deficiency: chronic, dry cough, dry throat in the evening, night sweating, tongue without coating

Chest pain

Observation, Chapter 16; Symptoms and Signs, Chapter 63

Here ‘chest’ indicates the front of the chest. A pain in this area is usually due to either the Heart or Lung channel and it always denotes a Full condition (even though this may itself derive from an underlying Empty condition).

Chest pain can be differentiated according to its character. A fixed, pricking, stabbing or needle-like pain indicates Blood stasis. Chest pain accompanied by a feeling of distension of the chest itself and the hypochondrium indicates Qi stagnation and is usually accompanied by sighing and irritability. An intermittent, chronic chest pain that comes and goes also indicates Blood stasis but suggests an underlying Empty condition of Qi or Yang deficiency.

A stabbing or pricking chest pain indicates Blood stasis affecting the Heart channel (especially if it radiates down the left arm) and this often occurs against a background of Heart-Yang deficiency; it falls into the category of Chest Painful Obstruction Syndrome.

Chest pain accompanied by cough with expectoration of profuse yellow sputum is due to Phlegm-Heat in the Lungs and this may be seen in acute lung conditions, such as bronchitis, pneumonia or pleuritis.

A chest pain in a large area of the chest together with a cough, breathlessness and a red face indicates Lung-Heat. Chest pain extending to the hypochondrial region may be due to Damp-Heat in the Liver and Gall-Bladder channel, in which case it may be accompanied by feeling of heaviness and a sticky taste.

Pain in the heart region on the left side of the chest indicates either Heart-Blood stasis or Phlegm obstructing the Heart channel.

Chest pain extending to the upper back is usually due to Phlegm or Blood stasis.

Box 38.2 summarizes the patterns underlying chest pain.

Pain in the ribs

Symptoms and Signs, Chapter 63

‘Pain in the ribs’ refers to pain on the lateral aspect of the rib cage above the hypochondrial area.

The most common patterns causing pain in the ribs are Liver-Qi stagnation, Blood stasis and Damp-Heat in the Gall-Bladder. The characteristic symptoms of these patterns are listed in Box 38.3.

Feeling of oppression of the chest

Symptoms and Signs, Chapter 63

A feeling of oppression of the chest is the translation of the Chinese term Xiong Men. Western patients, at least in Anglo-Saxon countries, would seldom use this term and report this symptom as a feeling of tightness, discomfort in the chest, or the sensation of having a weight on the chest.

A feeling of oppression of the chest accompanied by slight breathlessness, sighing, a cough and expectoration of phlegm indicates retention of Phlegm in the Lungs, which is the most common cause of this symptom. A feeling of oppression of the chest without a cough and without expectoration of phlegm, and accompanied by slight breathlessness, sighing and a feeling of a lump in the throat, indicates stagnation of Lung-Qi with Lung-Qi failing to descend; this is usually caused by emotional problems such as sadness or worry. Although a feeling of a lump in the throat is usually related to Liver-Qi stagnation, stagnation of Lung-Qi caused by emotional problems is a very frequent cause of this symptom together with a feeling of oppression of the chest.

Another very common cause of a feeling of oppression of the chest is rebellious Qi of the Penetrating Vessel, which is more common in women. However, before diagnosing rebellious Qi of the Penetrating Vessel, we should check whether the feeling of oppression of the chest is accompanied by other relevant symptoms such as abdominal distension or fullness, pain or fullness around the umbilicus, or epigastric tightness.

In a few cases, a severe stagnation of Liver-Qi from emotional problems may also cause a feeling of oppression of the chest.

Box 38.4 summarizes the patterns underlying a feeling of oppression of the chest.

Feeling of heat in the chest

Symptoms and Signs, Chapter 63

Excluding external invasions of Wind-Heat, a feeling of heat in the chest is due to Full- or Empty-Heat of the Lung or Heart channels. If there is a feeling of heat in the chest, accompanied by thirst, insomnia, palpitations, agitation and a Red tip of the tongue, this indicates Heart-Fire; if there is a feeling of heat in the evening, dry mouth at night, insomnia, night sweating and five-palm heat, it is due to Heart Empty-Heat.

A feeling of heat in the chest accompanied by a cough, hot hands, a red face and expectoration of yellow mucus is due to Lung-Heat; if it is accompanied by night sweating, a feeling of heat in the afternoon, five-palm heat, a dry throat at night and a dry cough it indicates Lung Empty-Heat.

Box 38.5 summarizes the patterns underlying a feeling of heat in the chest.

Palpitations

Symptoms and Signs, Chapter 63

When we ask patients about palpitations it is important to explain to them the meaning of this symptom, as most patients mistakenly identify ‘palpitations’ with tachycardia, that is, the pulse beating faster than normal. In reality, palpitations are not related to the rate or speed of the pulse but simply indicate a subjective and uncomfortable sensation of being aware of one’s heartbeat.

Palpitations are a symptom that is always related to the Heart and may appear in any of the Heart patterns.

Palpitations with an acute onset may be due to external stimuli such as a fright or an overwhelming emotional upset, in which case they are called ‘fright palpitations’ (Jing Ji).

Palpitations that extend upwards towards the chest and throat and downwards towards the umbilicus and abdomen are called Zheng Chong, which I translate as ‘panic palpitations’ (literally it means ‘panic and anxiety’). This type of palpitations is due to rebellious Qi in the Penetrating Vessel affecting the Heart and is considered more severe than ordinary palpitations.

Case history 38.2 illustrates a pattern underlying palpitations.

Case history 38.2

A 44-year-old woman had been suffering from palpitations for 8 years. ‘Palpitations’ was just a subjective symptom of a feeling of her heart thumping in her chest and was not associated with tachycardia. The palpitations were always worse before her period. She also complained of nausea and an epigastric pain, which was experienced just under the sternum, a sticky taste and a feeling of lump in the throat. She experienced a dry mouth occasionally, and occasionally suffered from tinnitus.

Her periods were basically normal, coming every 4 weeks, lasting 6 days and they were not painful. The only problem associated with the periods was premenstrual tension.

Her complexion was dull and sallow without lustre and her eyes were very dull and lacked lustre to an extreme degree.

Her tongue was of a normal colour, except for a Red tip. It had a Heart crack and, although it could not be defined as being peeled, the coating was not sufficient. Her pulse was Fine on the right and Floating-Empty on the left.

Diagnosis:

The aggravation of the palpitations before the period, together with the nausea, epigastric pain under the sternum and the feeling of lump in the throat, indicate a condition of rebellious Qi in the Penetrating Vessel, as this vessel flows through the stomach, connects with the heart, traverses the chest and goes over the throat (on its way to the face).

However, the pulse, being Fine on the right, and the dull-sallow complexion clearly show a condition of Blood deficiency, while the Floating-Empty nature of the pulse on the left side and the insufficient coating on the tongue show the beginning of Yin deficiency (of the Liver, Kidneys and Heart). In this case, therefore, the condition of rebellious Qi in the Penetrating Vessel is secondary to the condition of Blood and Yin deficiency; in other words, the Qi of the Penetrating Vessel rebels upward because there is a deficiency of Blood and Yin. In fact, the Penetrating Vessel is the Sea of Blood and it is therefore easily affected by Blood deficiency. The treatment principle in this case, therefore, should be to nourish Blood and Yin (of the Heart and Liver) primarily and to subdue rebellious Qi in the Penetrating Vessel secondarily.

The Heart crack and the very dull appearance of the eyes indicate a disturbed Mind and a strong propensity to emotional problems.

Only gold members can continue reading. Log In or Register to continue