bubble_chart Concept

Chest tightness can also be referred to as chest stuffiness, chest fullness, or chest stuffiness and fullness, which refers to the subjective feeling of obstruction and discomfort in the chest.

Chest tightness and chest fullness are symptoms. Chest stuffiness is a mechanism of disease, meaning "stuffiness is the same as obstruction, not smooth and comfortable" (Danxi Xinfa). Since there are many causes for the obstruction of chest stuffiness and fullness, the symptom of chest tightness can appear in various diseases.

Clinically, chest tightness can also be accompanied by chest distension or chest pain, which is then referred to as chest distension and tightness or chest stuffy pain. Since the causes and mechanisms of disease for chest tightness, chest distension, and chest pain are generally similar, they can appear simultaneously at different stages of the same disease. Among the three, chest tightness is generally mild, chest distension is more severe, and chest pain is even more severe.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰fever, aversion to cold, headache, body pain, cough or wheezing, chest oppression, tongue coating white, floating or tight pulse. If there is recurrent fluid retention in the lungs, compounded by external cold invasion, the coughing and wheezing become pronounced, with chest oppression, breathlessness, dysphoria, and even inability to lie down comfortably. Apart from chest oppression, there must also be symptoms of an exterior cold pattern such as fever, aversion to cold, and a floating-tight pulse. Treatment should aim to disperse with acrid-warm herbs, using modified Ephedra Decoction and similar formulas. If there is recurrent internal fluid retention combined with external wind-cold invasion, in addition to the exterior pattern, the coughing and wheezing will be particularly severe, accompanied by copious white or frothy phlegm, even dysphoria and inability to lie down. Jingui Yaolue refers to this as "lung distension." Treatment involves dispersing pathogens and eliminating retained fluids, suppressing cough and relieving asthma. Once the fluids are cleared and wheezing subsides, the symptoms of chest oppression and breathlessness will naturally resolve. Modified Minor Green-Blue Dragon Decoction with Gypsum Decoction can be used.
2. Heat Stagnation in the Lung︰The fever is severe, with slight aversion to cold or no aversion to cold, thirst with a desire to drink, abnormal rising of qi causing cough and counterflow, coughing up yellow phlegm, wheezing and chest oppression, or dark urine and dry stools, a red tongue with yellow coating, and a rapid, forceful pulse. When pathogenic heat congesting the lung is caused by unresolved external contraction of wind-heat, with the pathogenic heat entering the interior and obstructing the lung, symptoms such as high fever, irritability and thirst, chest oppression, rapid breathing, a red tongue with yellow coating, and a rapid, forceful pulse manifest as an interior excess heat pattern. The treatment should focus on clearing and purging internal heat, using a modified version of Ma Xing Shi Gan Tang.
3. Lung Abscess︰Chest tightness is often accompanied by dull pain in the chest, fever, cough, expectoration of yellow, turbid, foul-smelling sputum, or vomiting of pus and blood, dry throat, dry mouth without thirst, red tongue with yellow coating, rapid or slippery pulse. If caused by lung abscess, there must be symptoms such as chest tightness with pain, coughing up foul-smelling yellow sputum or vomiting pus and blood, dry mouth, yellow tongue coating, slippery and rapid pulse, and other manifestations of lung abscess. Treatment should focus on clearing the lung and removing toxins, expelling pus. The prescription used is Phragmites Stem Decoction with modifications.
4. Heart Blood Stasis and Obstruction︰Chest tightness and breathlessness, especially at night, may be accompanied by dull chest pain or pain radiating to the shoulders and arms. Palpitation or shortness of breath, a dark purple tongue or static blood spots, and a weak or irregular pulse. The obstruction of heart vessel static blood, as mentioned in Neijing: "Heart obstruction means the vessels are blocked," inevitably causes chest tightness and a dull, distending pain behind the xiphoid process. If the condition is solely due to static blood, there must be signs of static blood (chest pain, ecchymosis on the tongue, etc.). Treatment should focus on activating blood and dispelling stasis, using Blood House Stasis-Expelling Decoction. There are also cases where "phlegm-fluid retention serves as an accomplice" (Jingui Yaolue Xindian), which must present with symptoms such as cough and phlegm-fluid retention. As stated in Jingui Yaolue·"Treatment of Chest Obstruction, Heart Pain, Shortness of Breath, and Abnormal Pulse": "Chest obstruction with a mass due to qi stagnation, qi knotted in the chest, chest fullness…" Treatment should aim to eliminate phlegm-fluid retention and invigorate blood to resolve stasis, using Immature Orange Fruit, Longstamen Onion Bulb, and Cinnamon Twig Decoction.
5. Liver Qi Depression︰Chest tightness and discomfort, often sighing to relieve it, accompanied by hypochondriac pain, dizziness and blurred vision, bitter taste in the mouth, dry throat, or alternating chills and fever. Irritable and prone to anger. Or women with menstrual irregularities. The tongue is normal or has a thin yellow coating, and the pulse is wiry and thin. Due to stagnation of liver qi causing discomfort, chest tightness along with hypochondriac pain, sighing, dizziness and blurred vision, bitter taste in the mouth, dry throat, irritability and tendency to anger, women with menstrual irregularities, and a wiry, thin pulse are all clinical manifestations of constrained liver qi. Treatment should focus on soothing the liver and relieving depression, using Bupleurum Liver-Soothing Powder with modifications.

Chest tightness is a symptom, with excess pattern being more common and deficiency pattern less so. Excess pattern may be caused by qi stagnation, pathogenic heat, phlegm-fluid retention, or static blood obstructing the chest and diaphragm. Treatment may involve dispersing qi stagnation, purging excess heat, clearing phlegm, or removing static blood, tailored to the specific condition. The chest houses the heart and lungs, and chest tightness (or chest stuffiness) is often a manifestation of heart and lung disorders, which is distinct from epigastric stuffiness associated with stomach disorders, and should be carefully differentiated.

bubble_chart Documentation

1. Linzheng Zhinan Yi'an．Chest Impediment: "Chest stuffiness may be caused by sudden cold stagnation within; by mutual stagnation of cold and heat; by substantial qi filling the chest leading to stuffiness; by qi deficiency resulting in a fullness syndrome of deficiency type; or by dryness-induced stuffiness due to depletion of lung and stomach fluids. It may also be caused by the spread of upper energizer dampness turbidity leading to stuffiness."

bubble_chart Differentiation

Since ancient medical texts often referred to the chest and the epigastric region collectively as the "heart," chest stuffiness and epigastric (stomach) stuffiness are easily confused and should be differentiated (see the entry on epigastric stuffiness). Among the sensations of oppression, stuffiness, and distension, oppression and stuffiness are rarely accompanied by pain, whereas distension is often accompanied by pain.