Angina Pectoris

(Heart and/or Lung pain, Chest Bi) 

Xin Tong

Western medicine Diagnosis of Angina

 – coronary heart disease, chronic bronchitis, etc. 

Chinese Medicine Diagnosis of Angina  

- Stagnation of Qi and Blood. Pathogen in chest Luo causing tight pain that may radiate to the back and be accompanied by dyspnea.

General Characteristics of Angina

-Chest pain that radiates to left arm or middle finger

-Heart blood vessels spasm (comes and goes)

-Attacks are usually under 5 minutes, not over 15 minutes

-If up to 15 minutes or more = infarction

-Infarction = blockage Infarction More heavy and dangerous, especially if pain radiates through to the back The radiating pain is usually over 15 minutes

**Some may happen without pain, or pain in the abdominal region

 The first complaint is usually difficulty breathing

Chinese Medicine basic pattern

- blockage patter, too much Yin, no more Fire Other signs are perspiration, low blood pressure, pale face, cold hands and feet (general Yang collapse symptoms)

Principle of treatment:

rescue Yang: Use Fu Zi, Gui Zhi, Hong Hua, Tao Ren to boost Yang and warm King Fire

Herbal Formula: Si Ni Tang, with Tao Ren, Hong Hua

Acupuncture: Pericardium 6, Du 9, Du 26, Moxa Du 20, Kidney 1, Ren 4, 6, 14, 17, Stomach 36, Large Intestine 4 1.

1-For 2 weeks the patient must lie in bed and do nothing, within 24-48 hours do not even turn over

2. Do not eat for 24 hours, avoid bowel movements (teas, soups, juice)

3. After 2 days, a trained person may move the legs of the patient,

4.  3-5 days the patient can move legs and arms, after 10 days the patient may be allowed to walk around the room.

Etiology (causes) of Angina:

1. External Pathogen Invasions:

-External Cold- stagnates Heart meridian Qi-Summer Heat

Tongue -

Injures Heart meridian Qi

2. Emotion-over thinking, worry, anger, joy, sad, fear

3. Diet-injures spleen producing Phlegm which blocks Heart meridian Qi.

4. Deficiency-chronic illness and over work injures Qi and Blood-Liver and Kidney Deficiency

– injures Heart Differentiation:

1. Stomach Ache -lower pain which does not radiate into the chest and down the left arm. Accompanied by belching, flatulence, acid regurgitation

2. Hypochondriac-Chest Pain-related with cough and febrile disease history, accompanied by liver Qi stagnation symptoms.

Chinese Medicine Differentiation and Treatment

Phlegm

deficiency – lack of nourishment to Heart meridian.Seen more in males after age 40. Lasts a few seconds to a few minutes. Pain radiates to left arm and/or neck, break sweat, become fearful/scared, breathing becomes difficult, can be crushing chest pain, palpitations,

T- purple (especially sub-lingual),

P- uneven, irregular, or wiry.

Etiology - Sudden change to cold weather, overeating, excess emotional factors, over-fatigued  

Principle of Treatment:

promote Qi circulation, connect Yang Qi, remove stagnation to relieve pain

Acupuncture points

- hand jueyin, front-mu, Pericardium 6 (yin wei -heart and chest), Heart 6 and Pericardium 4 (xi-clefTongue -pain), Ren 14 (mu), 17 (Qi influential, Pericardium mu) - short of breath – Ren 22, Lung 6

- excess Phlegm – Ren 12, Stomach 40

- Qi and Blood stagnation – Liver 3, Bladder 17

- Kidney Heart Yang deficiency – Bladder 14, 15, 23

- Heart and Spleen Yang deficiency – Bladder 15, 20, Stomach 36

Herbal Medicine Formula:  Gua Lou Xie Bai Ban Xia Tang, Wen Dan Tang

Phlegm Heat dry stool, dysphasia

Herbal Medicine Formula: Di Dan Tang

 Phlegm Wind numbness/dizziness

Herbal Medicine Formula: Ban Xia Bai Zhu Tian Ma Tang

Blood Stasis in Heart intermittent stabbing fixed pain, worse at night, dark purple sublingual veins, P- uneven deep or irregular

Principle of Treatment: promote circulation, remove

Blood Stasis

Acupuncture points – hand jueyin and shaoyin, Ren 14, Bladder 15, Pericardium 4 and Heart 6 (xi-cleft pain), Ren 17 and Bladder 17 (Qi and blood) herbal treatment - Stasis – Lung 11, Heart 9

Herbal Medicine Formula: Xue Fu Zhu Yu Tang

Stagnated Fire Attacking Heart Burning heart pain, thirsty, irritable, rough breathing, fever, constipation. T- red, yellow coat Pulse - rapid

Principle of Treatment: Purge fire, clear heat to remove stagnation and promote blood circulation.

Herbal Medicine Formula: Xiao Xian Xiong Tang

Cold stagnation severe pain, cold weather triggers this pain, cold symptoms/body, dyspnea, T- white slippery, P- wiry tense or deep thin (yang deficiency)

Principle of Treatment: warm Yang Qi, expel Cold, promote Qi circulation

Acupuncture points – sedate, Moxa, hand jueyin and shaoyin, Ren, Bladder 14, 15 (HT PC), Pericardium 6 and Heart 5 (Luo stagnation), Ren 4 and 6 (invigorate Yang Qi) - coldness – Moxa Bladder 12, 13

Heart Meridian Blocked By Cold Sudden onset of heart pain which radiates to back, usually in cold season or sudden cold weather, cold body with cold sweat, palpitations. Tongue - slight purple, thin white coat Pulse - tense

Principle of Treatment: expel cold and remove stagnation to relieve pain

Herbal Medicine Formula: Dang Gui Si Ni Tang

Heart Qi deficiency dull pain, shortness of breath, comes and goes, palpitations, fatigue, pale face, T- pale, P- irregular

Principle of Treatment: nourish Heart Qi

Acupuncture points – Ren 17, 14, Heart 6 (pain), Ren 6, Stomach 36 (Yuan and Spleen Qi) - Yang deficient Cold – Ren 4, 8, Du 4, Moxa

Herbal Medicine Formula: Bao Yuan Tang

Heart Yin deficiency dull pain that comes and goes, Yin deficiency-symptoms, T- red with scanty coat, P- thin rapid

Principle of Treatment: nourish Heart Yin

Acupuncture points – tonify, hand and foot shaoyin, Bladder 15, 23, Kidney 3, 6, Pericardium 6, Spleen 6

Herbal Medicine Formula: Tian Wang Bu Xin Dan

Heart Yang Deficiency Pain and palpitations, almost can’t function, fatigued, cold, agg by cold and exertion Tongue - pale Pulse - weak, deep

Principle of Treatment: Nourish yang Qi and invigorate heart Yang

Herbal Medicine Formula: Ren Shen Tang + Shen Qi Wan - Kidney yang deficiency + Zhen Wu Tang - edema  

Qi Stagnation in Heart Fullness in chest and Heart with moving dull pain. Pain agg. By emotional stress. Accompanied by Qi stagnation symptoms. Tongue - pale, purple, red tip P - wiry  

Principle of Treatment: soothe liver and regulate Qi to relieve pain.

Herbal Medicine Formula: Chai Hu Shu Gan San

Turbid Phlegm stagnation pain with feeling of pressure from the inside (oppression), difficult to breathe, heavy limbs and body, fullness, sticky mouth, nausea, T- swollen with turbid greasy coat, P- slippery

Principle of Treatment: invigorate Yang Qi, eliminate Phlegm, remove stagnation

Acupuncture points – sedate hand jueyin, foot yangming, Ren 14, 17, Pericardium 4 (xi-cleft), Stomach 40 and Lung 9 (Phlegm) - digestive fullness – Stomach 36, Ren 12 - Heat with Phlegm – Stomach 44, Large Intestine 4, Spleen 9  

Alternative Treatment Methods for Angina 

Ear Acupuncture – Heart, Small intestine, sympathetic, subcortex, yuan zhong, Lung LR, chest, occiput, blood pressure groove,

strong stimulation electro – between Hua Tou Jia Ji and first Bladder line on the back, puncture 30 degrees oblique 1.5 cun deep from T1-T4, Pericardium 6, strong stimulation for 20 minutes with continuous frequency,

– Xi-cleft, Ren 14 to 17, rapid continuous frequency Herbal point applications

–Chinese Herbs for Angina -  Dan Shen, San Qi, Ru Xiang, Mo Yao, Bing Pian, mix into powder with cream and apply to Ren 14, 17, Bladder 14, 15, Pericardium 6 everyday at night injection

– Dan Shen, Bladder 14, 15, Xi-cleft

emergency acupressure for Angina– Pericardium 6, Bladder 15, Heart 4, 5, start gently then increase pressure over a few minutes until applying very strong stimulation, 50 minutes.