for the making of Blood, when they are pathologically transformed into Phlegm, Blood cannot
be produced and moved properly and it stagnates. On the other hand, since there is a process of
mutual exchange between Blood and body fluids, when Blood stagnates over a long period of
time, it will interfere with the transformation of fluids and contribute to forming Phlegm. For this
reason, in chronic conditions of Chest Painful Obstruction, especially in the elderly, stasis of
Blood and Phlegm are both present.

If both Kidney and Heart Yang are deficient, body fluids accumulate and overflow towards the
Heart and Lungs resulting in cough and oedema.

Differentiation

It is important to differentiate Chest Painful Obstruction from other conditions with similar
symptoms.

Phlegm-Fluids in Chest-Hypochondrium

In Chest Painful Obstruction there is a feeling of oppression and pain in the chest which may
also extend to the shoulder or left breast. The pain is elicited by tiredness, exposure to cold,
overeating or emotional stress. There is usually a history of breathlessness.

In the case of Phlegm-Fluids in chest and hypochondrium there is a feeling of distension and
pain in the chest and hypochondrial region. The pain is continuous and is worse on breathing and
turning one's body. There is also a feeling of fullness over the ribs and a cough with profuse
white-watery sputum.

Epigastric Pain

The pain of Chest Painful Obstruction may sometimes extend to the epigastrium and could be
confused with epigastric pain, i.e. pain originating from a Stomach disharmony. However, with
epigastric pain there is also belching, hiccups, sour regurgitation and other Stomach or Spleen
symptoms which are absent in Chest Painful Obstruction.

True Heart Pain

True Heart pain is not so much a different condition as a further and serious development of
Chest Painful Obstruction when there is severe stasis of Blood over a long period of time. True
Heart pain is continuous and is accompanied by cold sweating, a pale-purplish face, cyanotic lips
and limbs, a Minute or Knotted pulse and a Bluish-Purple tongue.