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25 Cards in this Set

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XIONG BI (Chest Blockage)
DEFINITION
XIONG BI (Chest Blockage)
Xiong Bi is a syndrome of heart functional disorder caused by qi and blood blockage in the chest.
Its main symptoms include chest distension and pain, or in severe cases left chest gripping pain (angina) with radiating pain to the back and the upper arm, breathlessness and dyspnoea.

Happen in middle and old ages.
XIONG BI (Chest Blockage)
ORTHODOX EQUIVELANTS
Coronary atherosclerotic cardiopathy and other coronary heart diseases, viral myocarditis, cardiomyopathy, rheumatic heart diseases, cardiac neurosis and pleurisy
XIONG BI (Chest Blockage)
CAUSES
• Cold evil attack
• Emotion
• Improper diet
• Overwork
• Old age
XIONG BI (Chest Blockage)
PATHOLOGICAL MECHANISMS
Deficiencies: heart, spleen, liver and kidney, qi and blood, yin and yang
Excess: cold freezing, qi stagnation, blood stasis, phlegm blockage and dampness suppression

• Cold evil:
Yin-cold evil invades when yang is constitutionally deficient and chest yang dysfunctional. Cold freezes and qi stagnates, blood circulation blocked.

• Emotions:
Worry and pensiveness impair spleen. Spleen qi deficient and abnormal fluid distribution causes phlegm formation.
Anger impairs liver, liver qi stagnate and transform into fire and burns fluid into phlegm.

• Improper diets:
Rich and greasy food and alcoholism impair spleen and stomach leading to formation of dampness and phlegm.

• Overwork and stress:
Drain spleen qi and kidney yin and yang.

• Old age leads to kidney yin or yang deficiencies:
Weakened kidney yang fails to power zang-fu’s yang (including heart yang)
Weakened kidney yin fails to nourish zang-fu’s yin
All these cause qi and blood blockage in chest and heart vessels and result in Xiong Bi.
XIONG BI (Chest Blockage)
Severe Manifestation
Angina is the extreme and the dangerous stage of Xiong Bi.


• Blood stasis and blocking of heart vessels – angina and heart attack (sudden severe cardiac and chest pain
• Suppressed heart yang and deficient heart qi fail to power – palpitation, knotted and intermittent pulses
• Scarce heart and kidney yang, water evil floods and abuses heart and lung – cough, dyspnoea and oedema
XIONG BI (Chest Blockage)
DIFFERENTIAL DIAGNOSIS
Xiong Bi Differentiation

Xiong Bi Zhen Xin Tong Xuan Yin Wei Tong
Place of pain Chest Chest but sometimes shoulder, left upper back and upper arm Chest and hypochondria Epigastrium
Feature of pain Choking momentary pain relieved by rest and medicine Continuous severe and extreme pain not to be relieved Continuous distending pain aggravated by respiration Distending or dull pain
Accompanied symptoms Maybe radiating to left shoulder and back. Sudden onset after overwork, exertion and excitement Sweating, cold limbs, blue and purple lips and limbs, knotted and intermittent pulses Cough with phlegm, intercostal fullness and bulge Eructation, nausea, vomit and acid regurgitation
XIONG BI (Chest Blockage)
BIAN ZHENG LUN ZHI
There are 6 common syndromes: blood stasis, phlegm stagnation, yin-cold blockage, heart and kidney yin deficiency, qi and yin deficiency and yang qi deficiency.
XIONG BI (Chest Blockage)
Heart Blood Stasis
• Symptoms: chest stabbing and fixed pain more severe at night, palpitation, dull and purple or blue tongue, deep and uneven pulse
• Orthodox equivalents: acute myocardial infarction and angina
• Pathological mechanisms: chronic qi stagnation leads to blood stasis and collateral blockage
• Principle of treatment: Activate blood movement, resolve stasis, and remove blockages to stop pain
• Formula: Xue Fu Zhu Yu Tang
• Modifications: severe pain + wu ling zhi, yu jin, yan hu
XIONG BI (Chest Blockage)
chest stabbing and fixed pain more severe at night, palpitation, dull and purple or blue tongue, deep and uneven pulse
• Orthodox equivalents: acute myocardial infarction and angina
• Pathological mechanisms: chronic qi stagnation leads to blood stasis and collateral blockage
• Principle of treatment: Activate blood movement, resolve stasis, and remove blockages to stop pain
Formula: Xue Fu Zhu Yu Tang
Tao Ren 12
Hong Hua 9
Dang Gui 9
Chuan Xiong 4.5
Chi Shao 6
Niu Xi 9
Chai Hu 3
Jie Geng 4.5
Zhi Ke 6
Sheng Di Huang 9
Gan Cao 3
Modifications: severe pain + wu ling zhi, yu jin, yan hu
XIONG BI (Chest Blockage)
Phlegm Stagnation
• Symptoms: choking chest pain, may or may not radiating to back and shoulder, short of breath, overweight, heavy limbs and body, large amount of phlegm, greasy tongue coating, slippery pulse
• Orthodox equivalents: angina of coronary heart diseases, myocardiac infarction
• Pathological mechanisms: stagnation of phlegm and turbidity, obstruction of chest yang, the vessels and collaterals
• Principle of treatment: Activate yang to remove phlegm, turbidity and blockages
• Formula: Gua Lou Xie Bai Ban Xia Tang (Gua Lou, Xie Bai, Bai Jiu, Ban Xia)
• Modifications: severe phlegm stagnation + gan jiang, chen pi, bai dou kou
XIONG BI (Chest Blockage)
• Symptoms: choking chest pain, may or may not radiating to back and shoulder, short of breath, overweight, heavy limbs and body, large amount of phlegm, greasy tongue coating, slippery pulse
• Orthodox equivalents: angina of coronary heart diseases, myocardiac infarction
• Pathological mechanisms: stagnation of phlegm and turbidity, obstruction of chest yang, the vessels and collaterals
• Principle of treatment: Activate yang to remove phlegm, turbidity and blockages
• Formula: Gua Lou Xie Bai Ban Xia Tang (Gua Lou, Xie Bai, Bai Jiu, Ban Xia)
• Modifications: severe phlegm stagnation + gan jiang, chen pi, bai dou kou
XIONG BI (Chest Blockage)
Yin-Cold Blockage
• Symptoms: chest pain radiating to back and aggravated by cold, chest distension with short of breath, palpitation, unable to lie in supine position due to dyspnoea and breathing difficulties, extreme cold limbs, pale complexion, white tongue coating, deep and thready pulse
• Orthodox equivalents: angina of coronary heart diseases, pleurisy, cardiomyopathy
• Pathological mechanisms: cold evil invasion, yang qi deficiency and obstruction and blockage of qi movement
• Principle of treatment: pungent and warm to activate yang, expel cold and remove blockages
• Formula: Gua Lou Xie Bai Bai Jiu Tang (Gua Lou, Xie Bai, Bai Jiu)
• Modifications: + zhi shi, gui zhi, fu zi, dan shen, tan xiang to reinforce the effects. With large amount of phlegm + sheng jiang, chen pi, fu ling, xing ren. More severe cases, use Su He Xiang Wan
XIONG BI (Chest Blockage)
• Symptoms: chest pain radiating to back and aggravated by cold, chest distension with short of breath, palpitation, unable to lie in supine position due to dyspnoea and breathing difficulties, extreme cold limbs, pale complexion, white tongue coating, deep and thready pulse
• Orthodox equivalents: angina of coronary heart diseases, pleurisy, cardiomyopathy
• Pathological mechanisms: cold evil invasion, yang qi deficiency and obstruction and blockage of qi movement
• Principle of treatment: pungent and warm to activate yang, expel cold and remove blockages
• Formula: Gua Lou Xie Bai Bai Jiu Tang (Gua Lou, Xie Bai, Bai Jiu)
• Modifications: + zhi shi, gui zhi, fu zi, dan shen, tan xiang to reinforce the effects. With large amount of phlegm + sheng jiang, chen pi, fu ling, xing ren. More severe cases, use Su He Xiang Wan
XIONG BI (Chest Blockage)
Heart and Kidney Yin Deficiency
• Symptoms: chest distension and dull pain, palpitation, night sweat, vexation, insomnia, lower back and knee aches, tinnitus, dizziness, red tongue with or without ecchymosis, little coating, thready and rapid or thready and uneven pulse
• Orthodox equivalents: coronary heart diseases, cardiac neurosis
• Pathological mechanisms: long term illness leads to weakened constitution and heart and kidney yin deficiencies with inadequate supply to the vessels and stagnation of qi and blood
• Principle of treatment: nourish yin to strengthen kidney and nourish heart to pacify shen
• Formula: Zuo Gui Wan
• Modifications: severe heart yin deficiency + mai dong, wu wei zi, suan zao ren, bai zi ren; more chest dull pain + dang gui, chuan xiong, dan shen, yu jin; yin deficiency leads to yang exuberance + shou wu, nu zhen zi, gou teng, shi jue ming, mu li.
XIONG BI (Chest Blockage)
• Symptoms: chest distension and dull pain, palpitation, night sweat, vexation, insomnia, lower back and knee aches, tinnitus, dizziness, red tongue with or without ecchymosis, little coating, thready and rapid or thready and uneven pulse
• Orthodox equivalents: coronary heart diseases, cardiac neurosis
• Pathological mechanisms: long term illness leads to weakened constitution and heart and kidney yin deficiencies with inadequate supply to the vessels and stagnation of qi and blood
• Principle of treatment: nourish yin to strengthen kidney and nourish heart to pacify shen
• Formula: Zuo Gui Wan
• Modifications: severe heart yin deficiency + mai dong, wu wei zi, suan zao ren, bai zi ren; more chest dull pain + dang gui, chuan xiong, dan shen, yu jin; yin deficiency leads to yang exuberance + shou wu, nu zhen zi, gou teng, shi jue ming, mu li.
XIONG BI (Chest Blockage)
Formula: Zuo Gui Wan
Shu Di Huang 6-60
Shan Yao 6
Gou Qi Zi 6
Fu Ling 6
Shan Zhu Yu 3-6
Zhi Gan Cao 3
• Modifications: severe heart yin deficiency + mai dong, wu wei zi, suan zao ren, bai zi ren; more chest dull pain + dang gui, chuan xiong, dan shen, yu jin; yin deficiency leads to yang exuberance + shou wu, nu zhen zi, gou teng, shi jue ming, mu li.
XIONG BI (Chest Blockage)
Qi and Yin Deficiency
• Symptoms: on and off chest distension and dull pain, palpitation, short of breath, lassitude, indolence of speech, dull complexion, dizziness and blurred vision, aggravated by exertion, reddish tongue with or without teeth marks, weak and thready pulse or knotted and intermittent pulse
• Orthodox equivalents: latent coronary heart diseases, cardiac neurosis, cardiomyopathy, remote myocardial infarction
• Pathological mechanisms: long term Xiong Bi, qi and yin deficient. Deficient qi fails to move blood and deficient yin causes uneven vessels and collaterals
• Principle of treatment: tonify qi and nourish yin, promote circulation and remove collateral blockage
• Formula: Sheng Mai San with Ren Shen Yang Rong Tang
• Modifications: more chest pain + dan shen, san qi, yi mu cao, yu jin, wu ling zhi; knotted and intermittent pulse + Zhi Gan Cao Tang
XIONG BI (Chest Blockage)
• Symptoms: on and off chest distension and dull pain, palpitation, short of breath, lassitude, indolence of speech, dull complexion, dizziness and blurred vision, aggravated by exertion, reddish tongue with or without teeth marks, weak and thready pulse or knotted and intermittent pulse
• Orthodox equivalents: latent coronary heart diseases, cardiac neurosis, cardiomyopathy, remote myocardial infarction
• Pathological mechanisms: long term Xiong Bi, qi and yin deficient. Deficient qi fails to move blood and deficient yin causes uneven vessels and collaterals
• Principle of treatment: tonify qi and nourish yin, promote circulation and remove collateral blockage
Formula: Sheng Mai San with Ren Shen Yang Rong Tang
• Modifications: more chest pain + dan shen, san qi, yi mu cao, yu jin, wu ling zhi; knotted and intermittent pulse + Zhi Gan Cao Tang
XIONG BI (Chest Blockage)
Sheng Mai San with Ren Shen Yang Rong Tang
Zhi Gan Cao Tang
Sheng Mai San
Ren Shen 9-15
Mai Men Dong 9-12
Wu Wei Zi 3-6
Ren Shen Yang Rong Tang (Ren Shen Yang Ying Tang)
Bai Shao 9
Dang Gui 3
Chen Pi 3
Huang Qi 3
Rou Gui 3
Ren Shen 3
Bai Zhu 3
Zhi Gan Cao 3
Shu Di Huang 22.5
Fu Ling 22.5
Yuan Zhi 15
Sheng Jiang 3
Da Zao 2
Zhi Gan Cao Tang
Zhi Gan Cao 12
Gui Zhi 9
Sheng Di Huang 48
Mai Dong 9
E Jiao 6 dissolve in strained
Huo Ma Ren 9 crush
Sheng Jiang 9
Da Zao 30
XIONG BI (Chest Blockage)
Yang Qi Deficiency
• Symptoms: chest distension, short of breath, or even chest pain radiating to the back, palpitation, spontaneous sweating, aversion to cold, cold limbs, lower back ache and weakness, pale complexion, pale and blue purple lip and nail, pale or dull purple tongue, deep and thready or faint pulse
• Orthodox equivalents: angina of coronary heart diseases, cardiomyopathy, viral myocarditis
• Pathological mechanisms: yang qi extreme deficiency. Chest yang fails to power. Qi mechanism fails and blood stagnates.
• Principle of treatment: tonify qi and warm yang, promote circulation and remove collateral blockage
• Formula: Sheng Fu Tang with You Gui Yin
• Modifications: heart yang depletion, use large amount ren shen and fu zi and add long gu, mu li. Yin and yang both deficient + mai dong, wu wei zi
XIONG BI (Chest Blockage)
• Symptoms: chest distension, short of breath, or even chest pain radiating to the back, palpitation, spontaneous sweating, aversion to cold, cold limbs, lower back ache and weakness, pale complexion, pale and blue purple lip and nail, pale or dull purple tongue, deep and thready or faint pulse
• Orthodox equivalents: angina of coronary heart diseases, cardiomyopathy, viral myocarditis
• Pathological mechanisms: yang qi extreme deficiency. Chest yang fails to power. Qi mechanism fails and blood stagnates.
• Principle of treatment: tonify qi and warm yang, promote circulation and remove collateral blockage
• Formula: Shen Fu Tang with You Gui Yin
• Modifications: heart yang depletion, use large amount ren shen and fu zi and add long gu, mu li. Yin and yang both deficient + mai dong, wu wei zi
XIONG BI (Chest Blockage)
Shen Fu Tang
You Gui Yin
Shen Fu Tang
Ren Shen 12
Fu Zi 15
You Gui Yin
Shu Di Huang 6-60
Shan Yao 6
Shan Zhu Yu 3
Gou Qi Zi 6
Zhi Gan Cao 3-6
Du Zhong 6
Rou Gui 3-6
Fu Zi 3-9
XIONG BI (Chest Blockage)
a. What are the common syndromes of Xiong Bi
There are 6 common syndromes: blood stasis, phlegm stagnation, yin-cold blockage, heart and kidney yin deficiency, qi and yin deficiency and yang qi deficiency.
XIONG BI (Chest Blockage)
b. Compare the Bian Zheng Lun Zhi of yin-cold blockage, phlegm stagnation and blood stasis.
Heart Blood Stasis

• Symptoms: chest stabbing and fixed pain more severe at night, palpitation, dull and purple or blue tongue, deep and uneven pulse
• Orthodox equivalents: acute myocardial infarction and angina
• Pathological mechanisms: chronic qi stagnation leads to blood stasis and collateral blockage
• Principle of treatment: Activate blood movement, resolve stasis, and remove blockages to stop pain
• Formula: Xue Fu Zhu Yu Tang
• Modifications: severe pain + wu ling zhi, yu jin, yan hu


7.5.2. Phlegm Stagnation

• Symptoms: choking chest pain, may or may not radiating to back and shoulder, short of breath, overweight, heavy limbs and body, large amount of phlegm, greasy tongue coating, slippery pulse
• Orthodox equivalents: angina of coronary heart diseases, myocardiac infarction
• Pathological mechanisms: stagnation of phlegm and turbidity, obstruction of chest yang, the vessels and collaterals
• Principle of treatment: Activate yang to remove phlegm, turbidity and blockages
• Formula: Gua Lou Xie Bai Ban Xia Tang (Gua Lou, Xie Bai, Bai Jiu, Ban Xia)
• Modifications: severe phlegm stagnation + gan jiang, chen pi, bai dou kou

7.5.3. Yin-Cold Blockage
• Symptoms: chest pain radiating to back and aggravated by cold, chest distension with short of breath, palpitation, unable to lie in supine position due to dyspnoea and breathing difficulties, extreme cold limbs, pale complexion, white tongue coating, deep and thready pulse
• Orthodox equivalents: angina of coronary heart diseases, pleurisy, cardiomyopathy
• Pathological mechanisms: cold evil invasion, yang qi deficiency and obstruction and blockage of qi movement
• Principle of treatment: pungent and warm to activate yang, expel cold and remove blockages
• Formula: Gua Lou Xie Bai Bai Jiu Tang (Gua Lou, Xie Bai, Bai Jiu)
• Modifications: + zhi shi, gui zhi, fu zi, dan shen, tan xiang to reinforce the effects. With large amount of phlegm + sheng jiang, chen pi, fu ling, xing ren. More severe cases, use Su He Xiang Wan
XIONG BI (Chest Blockage)
Compare the Bian Zheng Lun Zhi of Heart and Kidney Yin Deficiency, Qi and Yin Deficiencyand Yang Qi Deficiency.
7.5.4. Heart and Kidney Yin Deficiency

• Symptoms: chest distension and dull pain, palpitation, night sweat, vexation, insomnia, lower back and knee aches, tinnitus, dizziness, red tongue with or without ecchymosis, little coating, thready and rapid or thready and uneven pulse
• Orthodox equivalents: coronary heart diseases, cardiac neurosis
• Pathological mechanisms: long term illness leads to weakened constitution and heart and kidney yin deficiencies with inadequate supply to the vessels and stagnation of qi and blood
• Principle of treatment: nourish yin to strengthen kidney and nourish heart to pacify shen
• Formula: Zuo Gui Wan
• Modifications: severe heart yin deficiency + mai dong, wu wei zi, suan zao ren, bai zi ren; more chest dull pain + dang gui, chuan xiong, dan shen, yu jin; yin deficiency leads to yang exuberance + shou wu, nu zhen zi, gou teng, shi jue ming, mu li.

7.5.5. Qi and Yin Deficiency

• Symptoms: on and off chest distension and dull pain, palpitation, short of breath, lassitude, indolence of speech, dull complexion, dizziness and blurred vision, aggravated by exertion, reddish tongue with or without teeth marks, weak and thready pulse or knotted and intermittent pulse
• Orthodox equivalents: latent coronary heart diseases, cardiac neurosis, cardiomyopathy, remote myocardial infarction
• Pathological mechanisms: long term Xiong Bi, qi and yin deficient. Deficient qi fails to move blood and deficient yin causes uneven vessels and collaterals
• Principle of treatment: tonify qi and nourish yin, promote circulation and remove collateral blockage
• Formula: Sheng Mai San with Ren Shen Yang Rong Tang
• Modifications: more chest pain + dan shen, san qi, yi mu cao, yu jin, wu ling zhi; knotted and intermittent pulse + Zhi Gan Cao Tang

7.5.6. Yang Qi Deficiency

• Symptoms: chest distension, short of breath, or even chest pain radiating to the back, palpitation, spontaneous sweating, aversion to cold, cold limbs, lower back ache and weakness, pale complexion, pale and blue purple lip and nail, pale or dull purple tongue, deep and thready or faint pulse
• Orthodox equivalents: angina of coronary heart diseases, cardiomyopathy, viral myocarditis
• Pathological mechanisms: yang qi extreme deficiency. Chest yang fails to power. Qi mechanism fails and blood stagnates.
• Principle of treatment: tonify qi and warm yang, promote circulation and remove collateral blockage
• Formula: Sheng Fu Tang with You Gui Yin
• Modifications: heart yang depletion, use large amount ren shen and fu zi and add long gu, mu li. Yin and yang both deficient + mai dong, wu wei zi