Stable Angina (Chest Bi)
Overview
Chest Bi (xiongbi) is characterized by chest oppression and pain, which may radiate to the back, with panting and inability to lie flat. Stable angina is a common clinical manifestation. The disease arises from invasion of cold, improper diet, emotional dysregulation, and aging with deficiency, leading to obstruction of the heart vessels. The disease is located in the heart and involves the liver, spleen, and kidneys. The basic pathogenesis is obstruction of heart vessels, with both excess and deficiency: excess includes cold coagulation, qi stagnation, blood stasis, and phlegm turbidity; deficiency includes qi deficiency, yin damage, and yang decline. Treatment principles include unblocking yang and draining turbidity, invigorating blood and transforming stasis, supplementing qi and nourishing yin, and warming yang and tonifying deficiency.
Pattern differentiation (clinical patterns)
Heart Blood Stasis Obstructing the Vessels
Chest pain that is stabbing or gripping, fixed in location, worse at night, may radiate to the back or shoulders, accompanied by chest oppression, chronic and unremitting, aggravated by anger or fatigue; dark purple tongue with ecchymosis, thin coating, and a stringy choppy pulse.
Invigorate blood and transform stasis; unblock the vessels and relieve pain.
Qi Stagnation in the Chest
Chest fullness and oppression with intermittent dull pain, pain without fixed location, frequent sighing, induced or aggravated by emotional distress, possibly accompanied by abdominal distension relieved by belching or passing gas; thin or thin greasy coating, and a fine stringy pulse.
Soothe the liver and regulate qi; invigorate blood and unblock the collaterals.
Phlegm Turbidity Obstructing the Chest
Marked chest oppression with mild heart pain, profuse phlegm and shortness of breath, heaviness of limbs, obesity, prone to onset or aggravation on cloudy rainy days, accompanied by fatigue, poor appetite, loose stools, and expectoration of phlegm; enlarged tongue with teeth marks, turbid greasy or white slippery coating, and a slippery pulse.
Unblock yang and drain turbidity; eliminate phlegm and open the chest.
Connections
Daily care & prevention
Avoid cold exposure and keep the chest and abdomen warm; eat a light diet and avoid greasy, sweet, and raw-cold foods; maintain emotional stability and avoid extreme joy or grief; exercise moderately without inducing chest pain; carry emergency medication; keep a regular schedule, quit smoking, and limit alcohol; monitor blood pressure, lipids, and blood glucose regularly.
When to seek medical care
Chest pain lasting more than 20 minutes without relief, accompanied by sweating, nausea, dyspnea, or syncope; pain radiating to the left shoulder, back, jaw, or upper abdomen; no response to sublingual nitroglycerin; tachycardia or bradycardia with significant hypotension; seek immediate medical attention if these occur.