病 案
TCM Case:Chest Bi
Ms Liang，68 years old
Main complaint:Repeated stabbing pain1) in the left aspect of the chest for 3 months with aggravated symptoms in the last 2 months
Medical History:The patient has a history of hyperlipidemia2).Three months ago,the patient suffered of left sided stabbing pain in the chest for 2 minutes induced by fatigue.The symptoms resolved themselves with rest and the patient did not receive treatment for her symptoms.The pain on the left aspect of the chest occurred 2 to 3 times each day in the past 2 months.She was hospitalized in an AAA hospital and was given various western medication(Isosorbide Dinitrate3),Betaloc4),Aspirin5),Simvastatin6),and Perindopril7))which relieved the symptoms.Two days prior，she did a lot of housework and lifed heavy objects which triggered severe chest pain later diagnosed as angina pectoris8).
Presenting symptoms:Fixed stabbing pain in the left aspect of the chest that occurs after heavy physical labor lasting from 2 to 3 minutes accompanied by chest oppression，palpitations，feverish feeling in the palms and soles and dizziness.
Tongue and Pulse:Purple darkish tongue body with thin and white coating and a deep and wiry pulse.
Physical Examination:Temperature:36.8℃；pulse:78 bpm；repiration:18 bpm；blood pressure:130 mmHg/76 mmHg(17.3 kPa/10.1 kPa).
The patient is mentally active and cooperative.The skin and sclera are nonicteric.No hemorrhagic spots，macules and papules.No lip cyanosis and no distended jugular veins.No enlarged lymph nodes are found.Clear breath sounds are heard bilaterally.There is no projection at the precordium9),the cardiac exam is normal and grade 2-3/6 systolic murmur without conduction is present.No abnormal findings of the liver and spleen.No percussion tendernss over the renal region.Flat abdomen without mass or bloating.No pitting edema in the lower limbs..
Other Medical Test Results:
ECG:V1-V5 ST segment depresses at least 0.05 mv，low and flat T wave show myocardial ischemia10).
Echo:atherosclerosis of the aorta caused a decreased function of the left ventricle.
Coronary Angiography11):stenotic left anterior descending coronary artery at 65%.
Blood Fat:TRIG 2.3 mmol/L，TC 5.67 mmol/L，LDL 3.8mmol/L
Pattern Differentiation
The patient is elderly with a weak constitution and Zang-fu organs as well as a deficient heart qi.Therefore，the heart is too weak to promote blood flow leading to blood stasis obstructing the heart vessels.This blockage causes severe fixed stabbing pain in the chest.When the patient performs physical labor，she depletes her qi which further damages and weakens the heart qi triggering the acute chest pain.The blood stasis in the heart accompanied by the lack of nourishment is seen in the chest oppression and palpitation.If the blood stagnates for a long period of time new blood can not be produced resulting in blood depletion.The symptoms of feverish sensation in palms and soles，dizziness，purple darkish tongue，and deep and wiry pulse are all signs of internal retention of blood stasis and qi stagnation.
Diagnosis
TCM Diagnosis:Chest Bì due to blood stasis in the heart and heart qi depletion
Western Medicine Diagnosis:Angina pectoris
Treatment(https://www.daowen.com)
The main pathomechanism of this case is blood stasis and qi stagnation in the heart vessels causing the chest pain.
Principles:
·Invigorate blood and dissolve stasis
·Disperse obstruction and arrest pain
·Tonify qi and strengthen the heart
Formula:Modified Xuè Fǔ Zhú Yū Tāng(Blood Mansion Stasis Expelling Decoction)
注释：
1）stabbing pain 刺痛，针刺痛
2）hyperlipidemia 高脂血症
3）Isosorbide Dinitrate 硝酸异山梨酯（消心痛）
4）Betaloc 倍他乐克，甲氧乙心定
5）Aspirin 阿司匹林（加热镇痛药）
6）Simvastatin 辛伐他丁
7）Perindopril 培哚普利（哌林多普利）
8）Angina pectoris 心绞痛
9）precordium 心前区，心窝
10）myocardial ischemia 心肌缺血
11）Coronary Angiography 冠状动脉造影（术），冠状血管造影术