Acupuncture Treatment of Chest Tightness and Palpitations
Chief Complaint: Chest tightness and palpitations chronic for eight years with an acute presentation for 2 weeks.
Medical History: The patient has been tested by a medical doctor for heart problems. The tests including an EKG, Stress Test, and blood values of cardiac enzymes show that the patient is within normal range. Her symptoms generally include tightness in the chest that is always present and palpitations while resting that can last as long as 20 minutes. On several occasions she experienced pain radiating down her left arm. The problem began 8 years ago after her fiance died. Prior to this incident she did not experience any of the signs and symptoms described above.
Questioning exam: Today the patient returned to the clinic after a month long break from treatment complaining of slight chest tightness and palpitations that come in the evening as she is relaxing or trying to go to sleep. Her appetite is good and she eats 3 meals per day consisting of the 4 food groups. The patient reports that her digestion is good meaning that she does not experience gas, bloating, stomach pain or acid regurgitation after eating. She has one bowel movement per day that is well formed and complete. She drinks 8 to 10 glasses of room temperature water per day. She enjoys a cup of coffee in the morning and tea or a carbonated soft drink in the afternoon. She urinates 4 to six times per day and the volume of urine relates to her intake of fluids. She reports that her body temperature is normal but she tends to dress warmly. She sweats with exertion during day and wakes once during the night feeling clammy and overheated Her energy is usually 7 to 8 our of 10 but today she reports feeling sluggish. She falls asleep easily and wakes 1x due to sensation of heat and dampness whereupon she falls back to sleep and wakes rested. She reports having vivid dreams that are not stressful. She typically can’t remember her dreams. The patient’s emotional state is good as she exhibits a positive attitude toward life. Her HEENT are mostly clear with a slight cigarette smokers cough. The patient’s menstrual cycle is pending any day. She experienced menarche at 13 years old. The interval of the cycle is typically 28 to 30 days with a duration of 4-5 days. The volume of blood is moderate and its color is red blood ending with a rusty red and is without clots. PMS symptoms include distended sensitive breasts, emotional upset, increased fatigue, and dull pain in the lower abdomen. She has skipped a cycle recently and notices that the interval seems to be getting longer in general. The flow has been erratic in the last 6 months changing from heavy to spotting in unpredictable patterns. She attributes the changes to the first signs of menopause.
Pulse exam: The pulse was felt on the middle and deep levels on both wrists. The right side was dominant. Both hands had a thin pulse felt in the middle level at the cun and guan position. The strength of the pulse increased at the deep level where the chi position could be felt. The rate was 92BPM with a regular rhythm.
Tongue exam: The tongue body is puffy top to bottom especially in the center. There is a deep crack from the Kidney area to the Stomach/Spleen region with a thin crack to the tip. The color is slightly red with a very red tip. The coating is thick and slightly yellow due to cigarette smoking. There are scallops on the sides. The sublingual veins are not distended. The patient is 5’6″ and 120#. She actively participates in the consultation. Her movements are fluid and graceful. There are no unusual odors.
OM Diagnosis: The diagnosis is Qi stagnation in the Heart channel due to emotional trauma. This Qi stagnation has created heat in the upper jiao and has blocked the cooling mist of kidney yin from reaching the heart.
Treatment Principle: Open the chest and cool the heart.
Point Prescription: Yin Tang pacifies wind and calms the shen – insomnia, agitation, restlessness
Ren 17 front Mu of pericardium, influential point of Qi regulates Qi and unbinds the chest
H 7 the source point for the heart and the shu stream point – cardiac pain, palpitation
Lu 9 source point for the lung and the shu stream point and the influential point of vessels palpitation and pain in the chest
P 6 the Luo point of the pericardium – cardiac pain, palpitation, stuffy chest,
K 7 Jing river point night sweating
Liv 3 the source point for the liver and the shu stream point – emotional upset, depression
Herbal Formula: herbs were not recommended.
Lifestyle Prescription: craniosacral therapy, aromatherapy and massage
Results: patient felt immediately better after her first treatment and was treated twice a week. after 1 month/8 treatments the palpitations were resolved to a few quick beats after getting into bed to go to sleep.
Synopsis: using he gu ci fa techninque on Ren 17 and combining this point with LI 4 and Lu 7 seemed to have the greatest effect on the chest tightness and i have found it very effective in treating asthma.