bubble_chart Concept

Heart vessel obstruction pattern is a general term for symptoms such as poor circulation of qi and blood caused by stagnant blood obstructing the heart vessels or phlegm stagnation in the heart vessels, due to qi deficiency that cannot promote blood circulation. It is often secondary to conditions of heart qi or heart yang deficiency. The pathogenic factors are often overwork injuring qi, emotional discomfort, or phlegm turbidity accumulation.

The main clinical manifestations include: chest tightness, palpitation, heart pain like stabbing, pain radiating to the shoulders, back, and inner arms, severe pain that is unbearable, intermittent occurrence, purple-dark lips and tongue, ecchymosis on the edges of the tongue, and a fine, choppy, or knotted and intermittent or deep and wiry pulse.

Heart vessel obstruction pattern is commonly seen in diseases such as "chest impediment," "heart pain," and "palpitation."

This syndrome should be differentiated from "pattern of liver qi depression" and "pattern of liver depression and blood stasis."

bubble_chart Differentiation and Treatment

Heart vessel obstruction pattern can occur in various diseases, each with its own clinical characteristics.

If heart vessel obstruction pattern appears in palpitation, the clinical manifestations include frequent palpitations, chest tightness with palpitations or intermittent heart pain, dark purple lips and tongue, deep and wiry or thin and choppy pulse, etc. This is often due to insufficient yang qi in the heart, poor blood circulation, or invasion of wind-cold dampness Jingmai , leading to obstruction of heart qi and abnormal blood flow. For excess pattern, treatment should focus on invigorating the blood to unblock collaterals, nourishing the heart, and tranquilizing the mind. The prescription used is Peach Kernel, Carthamus and Four-Ingredient Decoction ( Yizong Jinjian ) with added Cinnamon Twig, Poria with Pine, and Tangshen. For deficiency pattern, treatment should focus on tonifying qi, nourishing the heart, tranquilizing the spirit, and calming the mind. The prescription used is Heart-Nourishing Decoction ( Zhengzhi Zhunsheng ) with added Salvia Decoction ( Shifang Gegua ).

If heart vessel obstruction pattern appears in heart pain, the clinical manifestations often include heart pain or chest tightness with pain, dark purple tongue texture, thin and choppy or deep and wiry pulse, etc. This is mostly caused by blood stasis in the heart vessels, obstruction of chest middle qi, leading to pain. Treatment should focus on invigorating blood and resolving stasis, widening the chest, and relieving pain. The prescription used is Blood House Stasis-Expelling Decoction ( Yilin Gaicuo ).

If heart vessel obstruction pattern appears in chest impediment, the clinical manifestations often include chest tightness with palpitations, dull pain, thin or greasy tongue coating, dark or deep red tongue texture, wiry and thin pulse, etc. This is mostly due to insufficient chest yang, insufficiency of heart qi, leading to blood vessel obstruction, or due to cold coagulation and vessel constriction, resulting in heart vessel obstruction. Treatment should focus on unblocking yang, relieving impediment, and dispersing cold. Commonly used prescriptions include Trichosanthes, Chinese Chive and Pinellia Decoction ( Jingui Yaolue ) or Aconite Mother Root Red Halloysite Pill ( Jingui Yaolue ) with added Salvia, Carthamus, Peach Kernel, and Cyperus to invigorate blood and regulate qi.

bubble_chart Differentiation of Similar Patterns

Pattern of liver qi depression and heart vessel obstruction pattern: Both syndromes may present with symptoms such as chest tightness or retrosternal stuffy pain due to depression and stagnation of qi movement, which can easily be confused clinically. However, the pattern of liver qi depression is often caused by emotional distress leading to liver depression qi stagnation and impaired liver function in dispersing and regulating qi. The heart vessel obstruction pattern has various causes, such as constitutional yang deficiency leading to yin occupying the yang position, or excessive consumption of rich and greasy food causing internal phlegm-dampness that affects the chest, or emotional disturbances leading to prolonged qi depression and blood stasis, or overexertion damaging the original qi, resulting in qi deficiency that cannot assist blood circulation, leading to blood and qi stagnation and obstruction of the heart vessels. The difference between the two syndromes lies in the location of the disease: the former is in the liver, while the latter is in the heart; the former primarily affects qi, while the latter mainly affects blood. Clinically, although both syndromes may present with chest tightness, the chest tightness in the pattern of liver qi depression is more widespread and milder, often accompanied by stuffy pain in the hypochondriac regions or slight abdominal distension and fullness, and may improve after sighing. In women, it is often associated with dysphoria, irritability, menstrual irregularities, and breast distension. The chest tightness in heart vessel obstruction pattern is usually localized to the precordial area or retrosternal region, and may also include heart pain radiating to the back, palpitations, shortness of breath, cyanosis of the lips and tongue, and irregular pulse. The treatment principles also differ: the pattern of liver qi depression is primarily treated by soothing the liver, regulating qi, and relieving depression; the heart vessel obstruction pattern has various treatment methods, including promoting yang to remove obstruction, invigorating blood and resolving stasis, resuscitation with aromatics, and resolving phlegm to eliminate turbidity.

Pattern of liver depression and blood stasis and heart vessel obstruction pattern: The heart governs blood, and the liver stores blood, and they are closely related. Both syndromes may present with chest tightness and cyanosis of the lips and tongue due to qi stagnation and blood stasis. However, the disease causes, mechanisms, and clinical characteristics of the two syndromes differ, and they have different symptoms that require careful differentiation. The liver is the jueyin organ, responsible for dispersion and storing blood. The pattern of liver depression and blood stasis is often caused by impaired liver qi dispersion, prolonged qi depression leading to poor blood circulation, static blood accumulation, and the formation of masses, as described in "Jingui Yaolue" (Jingui Yaolue): "Liver stagnancy, the person often desires to press on their chest." Therefore, the clinical manifestations include fixed stabbing pain in the hypochondriac region or a stuffy mass under the ribs. The heart governs blood and is connected to the vessels, with qi commanding blood. Qi moves blood, circulating through the meridians and zang-fu organs. The heart vessel obstruction pattern is often caused by poor blood circulation and obstruction of the heart vessels, or qi deficiency leading to poor blood circulation. Therefore, the clinical manifestations include chest tightness, heart pain, and palpitations. It is evident that the former syndrome is located in the liver, while the latter is located in the heart. The former may present with abdominal masses and tympanites, indicating that the degree of static blood stasis in the pattern of liver depression and blood stasis is more severe than in the heart vessel obstruction pattern, clearly distinguishing the two.

bubble_chart Documentation

• Leizheng Zhicai‧Chest Impediment: "Chest impediment refers to the stagnation of yang qi in the chest, which over time leads to the dominance of yin over yang, resulting in obstruction and binding. The symptoms include chest fullness, labored breathing, shortness of breath, pain radiating to the heart and back, caused by the stagnation of yang qi in the chest, allowing turbid yin to rise and obstruct the normal flow of qi. In severe cases, it can lead to qi stagnation, coughing, and chest pain that penetrates to the back."
• Leizheng Zhicai‧Chest Impediment: "For chest and back pain, use the Back-Warming Powder. Generally, for yang deficiency, use sweet and warm herbs such as Poria, Cinnamon Twig, Bighead Atractylodes, and Licorice Decoction. For yin congealing, use warm and unblocking herbs like Middle-Regulating Decoction. For fluid counterflow, use pungent and dispersing herbs such as Evodia Decoction. For stuffiness and obstruction, use pungent and warm herbs like Trichosanthis Fruit, Longstamen Onion Bulb, and Pinellia Decoction. For wheezing and counterflow, use bitter and descending herbs like Cinnamon Twig Decoction with Magnolia Bark and Apricot Kernel. For long-standing obstruction, combine with unblocking collaterals, such as Inula Flower Decoction."