Chapter 38 Interrogations in relation to diagnoses of the chest and abdomen are discussed separately below. The chest, or thorax, refers to the part of the body enclosed by the ribs and breast bone. From the Chinese point of view, there is a difference between the front part of the chest, which is under the influence of the Heart and Lungs, and the sides of the chest, which are under the influence of the Liver and Gall-Bladder. The front of the chest is also the area where the Gathering Qi (Zong Qi) is concentrated (see Fig 12.1, p. 121). In addition, both the tongue and the pulse frequently reflect a pathology of the chest: a Purple area in the tongue’s chest area (see Fig 23.10 on p. 206), for example, or a pulse that is Weak and Deep on both Front positions. Chest symptoms often reflect very common pathologies such as Liver-Qi stagnation, Phlegm in the chest and Heart-Blood deficiency. Therefore, I specifically ask about chest symptoms quite early in the interrogation as patients are describing their symptoms. Observation, Chapter 20; Hearing, Chapter 53; Symptoms and Signs, Chapter 63 Case history 38.1 illustrates a pattern underlying chronic cough. Box 38.1 summarizes the patterns underlying cough. Observation, Chapter 16; Symptoms and Signs, Chapter 63 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. Chest pain extending to the upper back is usually due to Phlegm or Blood stasis. Box 38.2 summarizes the patterns underlying chest pain. Symptoms and Signs, Chapter 63 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. Symptoms and Signs, Chapter 63 Box 38.4 summarizes the patterns underlying a feeling of oppression of the chest. Symptoms and Signs, Chapter 63 Box 38.5 summarizes the patterns underlying a feeling of heat in the chest.
CHEST AND ABDOMEN
CHEST
WHY WE ASK
WHEN WE ASK
HOW WE ASK
Cough
Chest pain
Pain in the ribs
Feeling of oppression of the chest
Feeling of heat in the chest