Chest Impediment ( Xiong Bi)

Question 1

What is chest impediment?

Answer 1

 Obstruction of Qi and blood in the chest.

Always a combination of access and efficiency. Root is usually a deficiency of SP, HT or KD

Characterized by chest oppression that may radiate to left upper back, shoulder and down the arm + respiratory symptoms such as; SOB, dyspnea, orthopnea, Sharp crushing pain.
Symptoms depend on type of impediment.

Question 2

Chest Impediment

GENERAL RED FLAGS

Two main diseases

Answer 2

⚡️sustained intense chest pain ( lasting 30 min or more), palpitations,fear, dread, breathless, vomiting, cold sweat
Example: MI
⚡️ Sudden onset SOB
⚡️tearing chest pain radiating to back
Features of shock!
Example: Pulmonary Embolism

Question 3

Main western diseases in the Chest Impediment category ?

Answer 3

Pleurisy
Pulmonary Embolism
Carcinoma of bronchus
Angina pectoris
Myocardial infarction MI
Hiatal hernia
Carcinoma of esophagus

Question 4

Red flag

PLEURISY

Inflammation of the pleura

Answer 4

•Stabbing pain bellow nipple
•worse on Inhalation  (very painful as pleura is rubbing against each other)
•shallow breathing
•Constricted chest
•Hemoptysis ( vomiting blood)

Like breathing in shards of glass

Question 5

Reg flag

PULMONARY EMBOLISM

Embolus detaches from thrombus and occludes a lung artery

Answer 5

•Ranges from severe chest pain to shock!
•Sudden SOB, pallor, drop in BP

Question 6

Red Flag

CARCINOMA OF THE BRONCHUS

Men +40
Malignancy

Answer 6

•fatigue
•weighloss
• Hemoptysis
•chronic

Question 7

Red flag

ANGINA PECTORALIS

Answer 7

•goes away with rest! ( no like in MI)
• YANG XU Signs: Worse with exercise, cold, excitement, over acting
• Sudden bouts of Severe chest pain, may radiate, nausea, vomiting

Question 8

Reg flags

MYOCARDIAL INFRACTION

Call 911

Blocked coronary artery decreases xue to HT and causes necrosis

Answer 8

• sudden severe, radiating chest pain at rest

Question 9

Red flags

HIATAL HERNIA

Protrusion of upper part of ST through diaphragm into thoracic cavity

Answer 9

• Chest pain on sternum
• Nausea, belching, hiccups,regurgitation,dyspnea

Question 10

Red flags

CARCINOMA OF ESOPHAGUS

Malignancy

Answer 10

• retrosternal pain on swallowing
• tiredness, weight loss, enlarged lymph

Question 11

Etiology and pathogenesis of chest impediment

cold pathogens with pre-existing Yang xu

Explain how cold pathogens and pre-existing yang xu can cause chest inpediment?


Answer 11

Constrict vessels and blocks yang -
Blood stasis with sharp pain

Question 12

Etiology of chest impediment

emotional stress

Explain how emotional stress causes chest impediment? 

Answer 12

Causes SP qi xu and LR qi xu -blood stasis with pain and distension

Question 13

Etiology and pathogenesis of chest impediment

IMPROPER DIET

How does improper diet causes chest impediment ?

Answer 13

Greasy/raw foods hinders SP/ST-Slim blocks circulation of Qi and blood- Blood stasis

Question 14

Etiology and pathogenesis of chest impediment

AGING/XU CONSTITUTION

How does aging and xu
Constitution cause chest impediment ?

Answer 14

Kd yin /yang xu- HT yin and xue xu or HT yang xu

Question 15

Etiology and pathogenesis of chest impediment

EPI damp -heat invading

How does EPI damp heat invading cause chest impediment?

Answer 15

Fever, long-term heat damage (e.g rheumatic fever) damages yin and Yang 

Question 16

7 Points

Points for Chest Impediment

Hint: Special Points

Answer 16

PC6- command point of chest

PC4- xi cleft of PC
action: acute chest pain / break blood stasis

HT6- xi cleft
action: acute pain/ move blood
empirical point to tonify HT YIN

CV14- front mu HT

CV17- Influetial point of qi ( great for qi xu)

BL14- Back shu PC

BL15- Back shu HT

Question 17

4 Points

Points specific for
heart blood stasis

Fix, stabbing chest pain, more severe at night, palpitations, restless

Answer 17

MOVE XUE:

BL17- blood back shu

Sp10- sea of blood

MOVE QI: not for xu conditions

LR3 LI4

Question 18

2 points

points specific for
phlegm stagnation

Oppressive pressure / pain w/ sense of suffocation, possible radiation

Answer 18

RESOLVE PHLEGM:

St40- empirical point phlegm

Sp9- empirical point damp

Question 19

Name points specific for ** cold congealed in chest** to add to the main chest impediment points

Acute onset chest pain, radiating, aggravated by cold, SOB, palpitations, difficult respiration, pale complexion, cold limbs

Answer 19

DISPERSE COLD:

DU4- Ming man

CV4- Guan Yuan

REN8

Apply Moxa

Question 20

Name points specific for Qi and Yin Xu to add to the main chest impediment points

Intermittent dull and oppressive chest pain, SOB, palpitations, worse with exertion, fatigue, dizziness, vertigo

Answer 20

TONIFY QI

CV6- qi hai

ST36- ZSL

NOURISH YIN, clean deficient heat:

KD6

LR3

SP6

Question 21

Name points specific for Yang Qi exhaustion to add to the main chest impediment points

Chest oppression which with SOB, dull pain, aggravated with by cold, palpitations, sweating, fatigue, cold intolerance, pale complexion, cyanotic lips, nails, tongue

Answer 21

TONIFY YANG

REN4

DU4

Question 22

What is the main difference between angina pectoralis and MI?

Answer 22

angina pectoralis gets better with rest worse with exertion