The pathogenic factor involved in Chest Painful Obstruction can be identified also according to
the character of the pain.

A distending pain indicates stagnation of Qi; if accompanied by a feeling of oppression or
tightness of the chest, it indicates Phlegm.

A burning pain denotes Heat (usually Phlegm-Heat), while a very severe pain indicates retention
of Cold in the blood vessels.

A stabbing pain that is fixed and feels like a knife blade indicates stasis of Blood.

Deficiency of Yang should be differentiated from retention of (internal) Cold:

• Retention of Cold: exposure to cold aggravates it, the patient has no aversion to cold and
  the limbs feel cold to the touch


• Yang deficiency: the patient has aversion to cold, likes to curl up and cover up, feels cold,
  the face is pale and the limbs feel cold to the touch.

Treatment

The "Essential Prescriptions of the Golden Chest" by Zhang Zhong Jing (c. AD 220) advocates
"penetrating Yang" as the main treatment for Chest Painful Obstruction. "Penetrating Yang"
means moving Yang Qi and penetrating the blood vessels with warm and pungent herbs such as
Gui Zhi Ramulus Cinnamomi cassiae.

The "Effective Formulae Tested by Physicians for Generations" (1349) by Wei Yi Lin
introduced Su He Xiang Wan Styrax Pill with fragrant and warm herbs to move Yang Qi in the
blood vessels.10(361) This formula is widely used nowadays as a patent remedy for angina
pectoris.

In later centuries many physicians resorted to moving Blood and eliminating stasis to treat Chest
Painful Obstruction. For example, the "Standards of Diagnosis and Treatment" (1607) advocates
using Hong Hua Flos Carthami tinctorii, Tao Ren Semen Persicae, Jiang Xiang Lignum
Dalbergiae odoriferae and the formula Shi Xiao San Breaking into a Smile Powder for the
treatment of Chest Painful Obstruction.11(362)

The "Collection of Rhymes of Contemporary Formulae" (1801) recommends using Dan Shen
Yin Salvia Decoction for Chest Painful Obstruction.12(363) This formula is still widely used