Scholarly article on topic 'Acupuncture Treatment of Chest Bi Syndrome'

Acupuncture Treatment of Chest Bi Syndrome Academic research paper on "Clinical medicine"

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Academic research paper on topic "Acupuncture Treatment of Chest Bi Syndrome"

Teaching Round

Acupuncture Treatment of Chest Bi Syndrome

Hu Jinsheng ÄJI^^

Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China

CASE HISTORY

A male, a retired officer of 61 years old, paid his first visit on May 12, 2006. The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain, with irregular attacks. Each attack would last several seconds to several minutes. The attack was accompanied with heavy oppressed sensation in the precordial region, palpitation, lassitude, and in severe cases, sweating, which was once diagnosed by a hospital as 'coronary heart disease'. Recalling the case history, the patient said that several days before he got angry with others because of some affairs in work, and he was not so used to the life pattern since he had just retired from his busy working post. At usual times, he was quick tempered and peevish. In recent days, he had poor appetite, and loose stool.

Physical examination at the moment showed that the patient had a slightly thin body figure, sallow complexion, and fairly good mental status. The blood pressure was 150/95 mmHg, and the heart rate was 88 beats/min. The heart border was slightly broadened, and the heart sounds weak. The Electrocardiograph (ECG) showed low-leveling T, and inferiorly moved S-T. There showed tenderness in the precordial region; and obvious tenderness on the back, involving the heart, pericardium and the left Geshu (BL 17) parts. The tongue proper was dull-pale with white-slightly sticky coating, and the pulse feeble-wiry-hesitant- slightly rapid.

DISCUSSION

Prof. Hu: Would you please make syndrome-

differentiation based on the patient's clinical manifestations?

Dr. Zhang: Based on the patient's clinical manifestations, I think this is a syndrome due to ^/'-deficiency and emotional changes. The quick temper the patient usually had, the upset mental status due to the recent anger with others, and the retirement contributed to the disease. The above factors can affect the liver's function in governing normal flow of qi and the heart's function in dominating blood and housing the mind, leading to qi stagnation that further leads to unsmooth flow of blood, and qi deficiency that lacks of propelling force. Disturbance of qi and blood circulation can bring about qi stagnation and blood stasis, which obstruct the channels and collaterals, resulting in chest Bi syndrome of deficiency type. According to the location-differentiation, the heart and liver are involved; according to nature-differentiation, it is a cold syndrome. Based on the excess-deficiency differentiation, the patient's symptoms of qi stagnation belong to an excess syndrome; while the symptoms of lassitude, sweating, poor appetite and loose stool are the manifestations of the deficiency syndrome. Therefore, based on the comprehensive analysis, it should be a syndrome with mixture of excess and deficiency.

Dr. Li: I agree to Dr. Zhang's analysis that this is a case of chest Bi syndrome with mixture of excess and deficiency. Based on the above syndrome differentiation, we can make further analysis. The deficiency mainly refers to qi-deficiency of the heart

and spleen. The above symptoms of lassitude, sweating, pale tongue proper and feeble pulse are the typical manifestations of ^/-deficiency; palpitation is a typical sign of heart disease; and poor appetite and loose stool are the symptoms of spleen-deficiency. Thus, I think this is a case with qi-deficiency of the heart and spleen.

Prof. Hu: You've made very good analyses. This is a case of chest Bi syndrome. The patient had just retired from his busy working post and was not so used to the new life pattern. That can be the main cause, which is called 'exhaustion of ying', recorded in TCM classics.

Dr. Wang: I agree to the analyses of my two colleagues. This case of chest Bi syndrome belongs to a zang-fu disease. As to the concept of 'exhaustion of ying', it's the first time for me to hear about it. Prof. Hu, would you please explain it to us?

Prof. Hu: In ancient TCM books, 'exhaustion of ying referred to diseases of mental depression in people who had lost their official positions, which is very similar to the present retirement syndrome. It is recorded in Plain Questions (^ fn|): "For those patients who have turned from high position down to low position, although are not invaded by exo-pathogens, they would have the disease in the interior, called 'loss of honor'; and those who have turned from rich to poor would have the disease called 'exhaustion of essence'".

The explanation of 'exhaustion of ying and essence' in the TCM dictionary is like this: a consumptive disease due to psychic problems. It is explained in Source and Course of Miscellaneous Diseases Ml^M ■ ft^h^Sl) that 'exhaustion of ying and essence is a mental disease'; And that 'people who have become poor and lost high position would have mental depression and anxiety, and anger and grief, which would cause injury of the interior zang-fu organs, leading to stirring up of fire in the various channels and injury of the primordial-qi. The

disease would get worse day by day, accompanied with poor appetite, lassitude and emaciation.'

To analyze the causative factor, the patient had just retired from his busy and high position, and turned from busy working to having nothing to do, and from high position to ordinary status, which made him very hard to get used to the new life pattern, hence the occurrence of exhaustion of ying. Moreover, the quarrel with others made him have mental depression and emotional changes, further leading to qi stagnation and blood stasis, hence the onset of the chest Bi syndrome mainly due to qi-deficiency and blood stasis. Chest Bi syndrome mainly refers to pain in the chest and precordial regions. For mild cases one can only feel stuffiness in the chest, but for severe cases one may have colic chest pain, accompanied with shortness of breath. The chest belongs to the upper-/iao, which stores the heart and lung. And Bi means obstruction, the obstruction of qi and blood. Therefore, chest Bi is mainly due to obstruction of chest yang, invasion of pathogenic yin to the heart and lung, and stagnation of qi.

The heart and liver functions of this patient have been affected mainly, and he also has a weak constitution, it should be a case with mixture of excess and deficiency. Qi-deficiency has caused unsmooth flow of qi and blood. Based on the clinical manifestations, the location-differentiation suggests that the heart and liver are involved. Based on nature-differentiation, this case does not have obvious cold and heat signs, but has more cold of the deficiency type. According to the deficiency-excess differentiation, this case belongs to a syndrome with mixture of deficiency and excess.

Now, please tell me the principle of treatment and point selection.

Dr. Wang: Really, I've never thought of that early in Chinese history there had been already the record of such a syndrome called 'exhaustion of ying and essence'. Thank you for your explanation, through

which I have had a better understanding about psychic factors leading to diseases in TCM.

Dr. Li: I was told that in ancient times there was the record about treatment of diseases by means of the theory of inter-promoting and inter-acting relation in five elements, is that so?

Prof. Hu: Yes, it is. For instance, the interacting relation in five elements was used to treat mental diseases caused by five emotions, such as anger prevailing over anxiety; anxiety, fear; fear, joy; joy, melancholy; and melancholy, anger. There were quite a lot such records in history.

Take the story of Hua Tuo for example. Hua Tuo was the famous physician in the Eastern Han Dynasty. It was recorded that once the head of a county fell ill. Hua Tuo thought that he could only be cured by being greatly enraged. Therefore, Hua Tuo accepted lots of his money and things, but did not treat him. Later, he even left and let the patient stay alone, leaving a letter scolding him seriously. The patient was really enraged, and sent people to track down and kill Hua Tuo. Understanding the intention of Hua Tuo, the patient's son stopped those people, which made the patient so extremely angry that he spit out several liters of black blood. He was then cured. This is the method of inducing the patient to spit out the blood stasis by using the theory of 'rage causing upward adverse flow of liver-qi'.

Take the story of Zhang Congzheng for another example, treating disease by laugh. Once the wife of the head of a county was ill and had no appetite. She had taken drugs prescribed by many physicians for nearly six months, but ineffective. Then the head of the county asked Zhang Congzheng to treat his wife. Zhang Congzheng said, "This disease is very hard to treat by drugs. We need two persons to give performance and make her laugh." Then the head of the county ordered two persons to give amusing performance for her, which made her laugh heartedly. The following day, she again watched amusing

performances and had hearted laugh. Besides, two persons having good appetite were arranged to sit beside her, and they kept speaking highly of the delicious food. The wife also felt like to taste some. Several days later, the mental state of the wife improved and the appetite increased. She was recovered without taking any medicine. Later, she gave birth to a son. This is the therapeutic method of 'joy prevailing over melancholy'.

Dr. Li: Thank you Prof. Hu, for your wonderful lecture.

Dr. Zhang: According to the diagnostic result that qi-deficiency brings about stagnation of qi, leading to unsmooth flow of qi and blood, the principle of treatment should be supplementing the heart-qi, soothing the liver and regulating the circulation of qi, and dredging the collaterals to check pain.

The point selection: Xinshu (BL 15), Juque (CV 14), Yinxi (HT 6), Geshu (BL 17), Neiguan (PC 6), Shanzhong (CV 17), Hegu (LI 4), Taichong (LR 3), and Zusanli (ST 36).

The analysis: The selection of Xinshu (BL 15) and Juque (CV 14) is the combination of the Back-Shu point with the Front-Mu point, which can relieve colic pain of the heart. Being a Xi (cleft) point of the Paricardium Channel, Yinxi (HT 6) can relieve acute pain. Geshu (BL 17) is used for promoting blood circulation and removing blood stasis, and when combined with Neiguan (PC 6) and Shanzhong (CV 17), it can strengthen the effect of promoting the circulation of qi and blood. Hegu (LI 4) and Taichong (LR 3) are used for regulating qi, blood, yin and yang. Zusanli (ST 36) is used for strengthening the vital-qi. The whole prescription can produce the effects of supplementing qi and dredging the channels, and promoting blood circulation to check pain.

Prof. Hu: I myself agree to the above principle of treatment and method of treatment. Here, I'd like to call your attention that in the treatment of chest Bi

syndrome, auriculo-acupuncture can be used in combination. The specific points can be Ear-Shenmen, Heart, Liver, Subcortex, and Chest. Besides, the patient should be advised to avoid emotional changes and take part in some beneficial activities, so as to make him sooner get used to the new life pattern and come out of the shadow of exhaustion of ying and essence.

TREATMENT AND RESULTS

The above acupuncture treatment was applied for the patient with the corresponding reinforcing-reducing method, combined with needling at the A-shi points on the thorax back and limbs. After one such

treatment, the patient had his pain alleviated. At the same time, he was asked to adjust well his mental state, avoid emotional changes, and increase outdoor activities. His appetite was improved, and the chest choking pain alleviated. After 10 treatments, the above symptoms were relieved, and ECG findings improved. The symptoms of tenderness on the precordial region back, pericardium and left Geshu (BL 17) part were alleviated obviously. The patient became cheerful, with disappearance of all the symptoms. The follow-up survey half a year later reported everything all right.

(Translated by Wang Xinzhong i^^)