Lecture Notes on Biomedical and Traditional Chinese Medicine (TCM) Approaches for Chest Pain

Overview

• Emphasis on integrating traditional Chinese medicine with biomedical knowledge.
• Importance of understanding traditional systems and applicable modern reviews for some diseases.
• Highlighting the importance of vigilance in clinic for conditions like chest pain.

Anatomical and Biomedical Basics of Chest

• **Identification of Chest Anatomically:
  • Body above the diaphragm, thoracic region with the rib cage.
  • 12 thoracic vertebrae (sometimes 13), each with attached ribs.
• Markers of the Thoracic Region: Ribs, thoracic vertebrae (T1-T12).
• Key Organs in Thoracic Region: Lungs, heart, pericardium; liver and stomach may also be involved in chest pain.

Traditional Chinese Medicine (TCM) Approach

• Channels involved: Hand and leg Yin channels, gallbladder channel, stomach channel.
• Pain Triggers: Excess (heat/fire, cold, static blood, phlegm, Qi constraint) and deficiency (mainly Yang deficiency).
• Heart Health and Yang Deficiency: Heart Yang governs chest fluid dynamics. Patterns of heart disease often linked to heart Yang deficiency, blood stasis, and phlegm accumulation.
• Lungs Conditions: Pain from lung conditions often associated with cough. Lung heat or phlegm heat are common patterns.
• Stomach Conditions: Esophageal reflux often mistaken for heart issues. Symptoms similar to severe acid reflux.
• Anxiety: Often manifests as chest pain; requires differential diagnosis in TCM.
• Chronic Chest Pain: Often seen in the elderly, episodic, linked to blood/yin deficiency, difficult to treat comprehensively.

Miscellaneous Internal Patterns

1. Consumption Pattern: Linked to pulmonary tuberculosis, indicated by dull chest pain, yin-deficient heat signs, possible weight loss, clubbing of fingers.
2. Blood Stasis: Fixed, piercing pain. Possibly coronary artery disease equivalent in modern biomedicine. Indicators include rough/choppy pulse, dark complexion.
3. Heart Vessel Obstruction (Coronary Artery Disease): Pain described as oppressive/piercing, radiating, with palpitations, irregular heartbeat. Stress-related Chi stagnation and fleem.

Liver-Stagnation Related Patterns

• Binding Depression: Pain in chest and rib-side, distending, mobile, worse with emotions. Linked to acute anxiety attacks.
• Liver Fire: Burning pain, liver fire symptoms, emotional disturbance, red tongue, wiry pulse.

Non-TCM Causes of Chest Pain

1. Spinal Misalignment: Manual adjustments by chiropractors may help.
2. GERD: Gastroesophageal reflux, worsened by lying down, triggered by specific foods, liver Yang overacting on stomach.
3. Anxiety: Involving heart/liver both leading to chest pain due to Qi stagnation, blood deficiency.
4. Trauma: Bruised/broken ribs; relevant in contact sports or after falls.
5. Referral Guidelines: Knowledge on when to refer patients for further medical care.

Red Flags and Western Medicine Considerations

• Angina: Stable vs. Unstable angina, referral urgency based on symptom severity.
• Coronary Artery Disease (CAD): Leading cause of death; symptoms differ by sex, age, risk factors include advanced age, sedentary lifestyle, poor diet, smoking.
• Pulmonary Embolism (PE): Sharp chest pain, asymmetric ankle swelling, shortness of breath, urgent 911 referral.
• Pneumothorax: Sudden sharp unilateral pain, shortness of breath; requires careful diagnosis.

Final Tips

• Accurate Diagnosis: Combining TCM patterns with biomedical evaluations for comprehensive care.
• Proper Referral Protocol: Understanding when and how to refer patients to Western medicine specialists.

Helpful Resources

• Book Recommendation: Medical Red Flags and Referrals: An Acupuncturist’s Guide by Blue Poppy Press.