Internal Med Exam 3 Chest Bi and Palpitations

Question 1

Chest Bi due to HT Blood Statis - indications?

Answer 1

Often coronary heart disease. Relatively chronic and severe chest pain, stabbing/crushing, fixed in location and usually worse at night or with sudden excitement, anger, emotion or exertion. Palpitations/irregular beats. Stuffiness/fullness in chest. Irritability, restlessness, easy anger or depression. HA w/fixed location, chronic. Spider veins on chest and face. Purplish lips/nails/sclera/conjuctiva. Maybe with LIV qi stagnation sx. T: dark red prurple with brown/purple spots and twc. P: deep and choppy or wiry, or intermittent.

Question 2

Chest Bi due to HT Blood Statis - tx strategy?

Answer 2

invigorate blood, dissolve blood stasis, unblock the channels, and relieve pain

Question 3

Chest Bi due to HT Blood Statis - basic Formula?

Answer 3

Xue Fu Zhu Yu Tang (Drive out Stasis in the Mansion of Blood Decoction)

Question 4

Chest Bi due to Turbid Phlegm Obstructing the Chest - indications?

Answer 4

(Usually leads to/combined w/blood stasis.) Milder, dull, tight pain in center of chest often w/ fullness/pressure/stifling sensation. Aggravated by cough, deep breathing, movement, exertion, swallowing. Sleepy, sluggish. Eating abnormal/irregular. Body feels heavy. Complexion usually pale with puffy face, toes, fingers, abdomen also maybe swollen, puffy. T: greasy thick white tc. P: slippery, moderate.

Question 5

Chest Bi due to Turbid Phlegm Obstructing the Chest - tx strategy?

Answer 5

unblock yang, dispel turbid phlegm, promote the movement of qi, stop pain

Question 6

Chest Bi due to Turbid Phlegm Obstructing the Chest - basic Formula?

Answer 6

Gua Lou Xie Bai Ban Xia Tang + Hou Po, Zhi Shi, Gui Zhi, Fu Ling, Gan Jiang, Xi Xin

Question 7

Chest Bi due to Yin Cold Congealing the HT - indications?

Answer 7

Severe crushing or constricting retrosternal chest pain which may be initiated or aggravated by cold weather or cold foods; fixed location but pain may radiate to the neck, jaw, left arm or through to the back. SOB/dyspnea/orthopnoea (dyspnea when lying down). Palpitations, aversion to cold, cold extremities, maybe cold sweat in severe cases. Complexion VERY pale and maybe slightly purplish, bluish (cyanosis). T: darker during attacks, pale after, with thing white tc. Puffy, swollen, maybe purple dots. P: deep, slow, thin, tight, weak, maybe irregular.

Question 8

Chest Bi due to Yin Cold Congealing the HT - tx strategy?

Answer 8

dissipate Cold, unblock yang, invigorate blood, stop pain

Question 9

Chest Bi due to Yin Cold Congealing the HT - basic Formula?

Answer 9

Dang Gui Si Ni Tang (Tangkuei decoction for Frigid Extremities)

Question 10

Chest Bi due to Stagnation of Qi in the Chest - indications?

Answer 10

Usually not heart disease - associated with depression. Mild, recurrent pain and/or fullness, stuffiness, tightness, heavy feeling in chest that is not localized, relieved by sighing, belching and relaxation. Frequent sighing, maybe epigastric distention with belching, hypochondrial discomfort/distention on 1 side/bilateral. Other LIV Qi stag s/s: tight neck/shoulders, TMJ, digestive probs, Irregular menstruation, PMS and breast tenderness. If Heat has been generated by the stagnation, there may be a dry mouth, irritability, quick temper, facial flushing and acid reflux. T: unremarkable or dark, or with red edges if there is Heat, or pale edges with Blood deficiency. P: wiry.

Question 11

Chest Bi due to Stagnation of Qi in the Chest - tx strategy?

Answer 11

move qi, relax the chest, soothe LIV and HT, stop pain

Question 12

Chest Bi due to Stagnation of Qi in the Chest - basic Formula?

Answer 12

Chai Hu Shu Gan San

Question 13

Chest Bi due to HT Qi Deficiency - indications?

Answer 13

Mild, dull, squeezing, intermittent chest pain. May have qi stag s/s - fullness/stuffiness in chest. SIGNIFICANT SOB/dyspnea with exertion. EASILY sweating (spontaenous, or lots of sweat with little movement.) FATIGUE - physical and mental, exhausted even by speaking, low voice/reluctance to speak. Easily flustered and panicky. Palpitations with anxiety. Complexion very pale/sallow, sometimes puffy. All sx initiated/aggravated by exertion. When the SP is involved there will be digestive sx like poor appetite, abdominal distention, and loose stools. T: pale and swollen with toothmarks, twc. P: weak, thin, maybe irregular.

Question 14

Chest Bi due to HT Qi Deficiency - tx strategy?

Answer 14

supplement HT qi, facilitate HT qi flow, stop pain

Question 15

Chest Bi due to HT Qi Deficiency - basic Formula?

Answer 15

Bao Yuan Tang + Gan Mai Da Zao Tang

Question 16

Chest Bi due to HT Yin Deficiency - indications?

Answer 16

Chronic, intermittent, relatively mild chest pain which may be burning or suffocating. Maybe fullness/stuffiness in chest. Aggravated by lack of sleep, overexertion, improper diet. Often emo imbalance - palps w/anxiety, forgetful, irritable, agitated, ungrounded, floating energy, huper, wired byt emoty inside. Night sweat esp on chest. Facial/malar flushing, hot flashes. Dry mouth and throat. Hot palms and soles. Dizziness and tinnitus. Tendency to constipation. Weak/sore lower back and knees if KD yin def. T: red, dry and thin with little/no coat or peeled patches. In severe/chronic cases there may be a deep narrow central crack that extends to the tip of the tongue. P: rapid, thin, weak

Question 17

Chest Bi due to HT Yin Deficiency - tx strategy?

Answer 17

nourish yin, clear Heat, invigorate blood, supplement HT

Question 18

Chest Bi due to HT Yin Deficiency - basic Formula?

Answer 18

Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart)

Question 19

Chest Bi due to HT Yang Vacuity - indications?

Answer 19

Chronic chest pain, dull, usually mild but can be very intense, sharp if exposed to cold. Also full/stifling etc. chest sensation, usually triggered by cold weather/food/drink. Often whole body is cold, especially chest and back. Hands and feet very cold, yang qi impacts whole body circulation. Skin color uneven, purple/white, like marble, white when pushed on; looks normal when warm. Also - fatigued, palps, maybe spontaneous (cold) sweat if combined qi and yang def. Dark undereye circles, purple lips and nails, often pitting edema esp in legs. T: pale, dark, twc. P: slow, weak, thin, irregular.

Question 20

Chest Bi due to HT Yang Vacuity - tx strategy?

Answer 20

warm yang, tonify qi, facilitate HT yang qi flow, stop pain

Question 21

Chest Bi due to HT Yang Vacuity - basic Formula?

Answer 21

Shen Fu Tang + Gui Zhi Gan Cao Tang

Question 22

List all 7 patterns of Chest Bi.

Answer 22

HT Blood Stasis. Turbid Phlegm Obstructing the Chest. Yin Cold Congealing the HT. Stagnation of Qi in the Chest. HT Qi Deficiency. HT Yin Deficiency. HT Yang Vacuity.

Question 23

Herbs that nourish the HT and calm the spirit?

Answer 23

Wu Wei Zi, Suan Zao Ren, Bai Zi Ren, He Huan Pi, Yuan Zhi, Ye Jiao Teng

Question 24

Herbs that anchor, settle and calm the Spirit?

Answer 24

Long Gu, Long Chi, Mu Li, Hu Po, Ci Shi

Question 25

Palpitations due to HT-GB Qi Vacuity - indications?

Answer 25

Palps which may be initiated by anxiety/fright. Apprehension, easily frightened and startled, timidity, anxiety. Insomnia, dream disturbed sleep, waking feeling anxious. Spontaneous sweating especially when nervous, ex. sweaty palms. SOB, lethargy and fatigue. T: normal or with pale body and twc. In congenital/long-standing cases may be a deep narrow crack to tip. P: slightly weak, thready and rapid OR thready and wiry.

Question 26

Palpitations due to HT-GB Qi Vacuity - tx strategy?

Answer 26

supplement HT and GB, suppress fright, and calm spirit

Question 27

Palpitations due to HT-GB Qi Vacuity - basic Formula?

Answer 27

An Shen Ding Zhi Wan [ingredients listed to be specific, not needed to memorize for Internal Med 1 test - Long Chi, Hu Po, Ci Shi, Zhu Sha*, Fu Shen, Shi Chang Pu, Yuan Zhi, Ren Shen] *NO LONGER USED.

Question 28

Palpitations due to HT-SP deficiency - indications?

Answer 28

Chronic palpitations with or without anxiety, generally worse at night.Aggravated by extertion/fright/poor diet. Combined w/HT sx: insomnia, with particular difficulty falling asleep (and switching off the mind) and dream disturbed sleep; anxiety, phobias, panic attacks; forgetfulness, poor memory, poor concentration. Also: Postural dizziness. Blurring vision, spots in the visual field. Combined w/SP sx: Fatigue and weakness. Poor appetite, abdominal distention after eating. Sallow complexion. Easy bruising. Heavy or prolonged menstrual period. T: pale, twc. P: thready and weak.

Question 29

Palpitations due to HT-SP deficiency - tx strategy?

Answer 29

boost qi, tonify blood, strengthen SP, nourish HT, calm Spirit

Question 30

Palpitations due to HT-SP deficiency - basic Formula?

Answer 30

Gui Pi Tang

Question 31

Palpitations due to HT Yin deficiency with Vigorous Fire - indications?

Answer 31

Palpitations more frequent at night, easily brought on by a start or fright. Insomnia, waking with palpitations or panic attacks and anxiety. Maybe KID yin def sx. Sensation of heat in the palms and oles. Night sweats, dry mouth and throat, dizziness and tinnitus, restlessness and fatigue, pooer concentration/memory, forgetfulness, lower back ache, dry stools or constipation, possibly mouth/tongue ulcers. T: red and dry with little/no coat, cracks, red tip if HT Fire Blazing. P: thin and rapid, weaker and deeper in KD/HT positions.

Question 32

Palpitations due to HT Yin deficiency with Vigorous Fire - tx strategy?

Answer 32

nourish yin, drain Fire, supplement HT, calm Spirit

Question 33

Palpitations due to HT Yin deficiency with Vigorous Fire - basic Formula?

Answer 33

Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart)

Question 34

Palpitations due to HT Yang Vacuity - indications?

Answer 34

Chronic palpitations that come and go, worse in cold weather/season. MAY have heart disease. Accompanied by cold sensation (whole body, hands, feet) and aversion to cold. Cold leading to chest tightness. initiated/aggravated by exertion and relieved with rest. SOB with exertion, in severe cases dyspnea/orthopnea.Stuffiness/discomfort in the chest. Listlessness and fatigue, oversleeping. Palps may have chest pain with cold sweat. Waxy pale complexion, or dark purplish if severe cold. Pitting edema in lower body, in which cases urine is scanty, OR nocturia/frequent urination. T: pale twc, maybe puffy, swollen, toothmarked with water retention, bluish/purplish if severe cold. P: deep, slow, weak esp HT position

Question 35

Palpitations due to HT Yang Vacuity - tx strategy?

Answer 35

warm and supplement HT yang, quiet spirit, alleviate palpitations

Question 36

Palpitations due to HT Yang Vacuity - basic Formula?

Answer 36

Gui Zhi Gan Cao Long Gu Mu Li Tang + Shen Fu Tang

Question 37

Palpitations due to Water and Phlegm-Fluid Overflowing to the HT - indications?

Answer 37

Chronic palpitations, usually with heart or kidney disease dx. SEVERE edema, worse in lower body, with scanty, infrequent, low volume urination. Edema is pitting, like clay, with loose skin that may be purple. Fatigue. Pale complexion, puffy swollen face. SP def sx like watery/loose stools (d/t water retention d/t yang def SP fails to govern Water).

Question 38

Palpitations due to Water and Phlegm-Fluid Overflowing to the HT - tx strategy?

Answer 38

warm HT yang to control water, transform water and phlegm-fluid, quiet spirit, alleviate palpitations

Question 39

Palpitations due to Water and Phlegm-Fluid Overflowing to the HT - basic Formula?

Answer 39

Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodis, and Licorice decoction)

Question 40

Palpitations due to Obstruction of the HT by Blood Stasis - indications?

Answer 40

Very chronic, stubborn palpitations with considerable chest pain (many have heart disease dx), comes and goes, worse at night, stuffiness/fullness/pressure in chest, mood swings, irritability/restlessness/easy anger/depression, purplish lips/nails/sclera/conjuctiva, dark undereye circles, spider veins on chest and face, maybe stagnant LIV qi signs. T: dark/red purple with brown/purple spots, thin white coat, distended dark sublinguals. P: deep and choppy, maybe wiry with pain OR thin, intermittent (with heart disease).

Question 41

Palpitations due to Obstruction of the HT by Blood Stasis - tx strategy?

Answer 41

invigorate blood, dissolve blood stasis, regulate qi, unblock the channels

Question 42

Palpitations due to Obstruction of the HT by Blood Stasis - basic Formula?

Answer 42

Tao Ren Hong Hua [Tao Ren, Hong Hua, Dan Shen, Xiang Fu, Yan Hu Suo, Qing Pi, Dang Gui, Chuan Xiong, Sheng di Huang]

Question 43

Palpitations due to Phlegm-Fire Harassing the HT - indications?

Answer 43

Evil Qi attacking HT = excess pattern. Palpitations can be acute OR chronic. Maybe emo sx - anxiety, depression, frustration, nervousness. (Can trigger/be triggered by palps or may not be associated.) Lots of Heat and Phlegm s/s: irritability, red face/lips, yellow/thick Phlegm (if white it’s thick, concentrated), thirst, concentrated urine, acid reflux/heartburn/constipation, insomnia. Foggy/heavy head, chest tightness, thick greasy tc, nausea, sticky often incomplete loose stools with mucus, sluggish body sensation, dizziness/vertigo.T: red tip or body and thick greasy yellow coat. P: rapid and slippery, maybe wiry.

Question 44

Palpitations due to Phlegm-Fire Harassing the HT - tx strategy?

Answer 44

clear Heat, resolve Phlegm, quiet HT, calm Spirit

Question 45

Palpitations due to Phlegm-Fire Harassing the HT - basic Formula?

Answer 45

Huang Lian Wen Dan Tang