Li, Cong Pu (1905-1989), originally a clinician and researcher at the South Hunan Chinese Medicine Research Institute.


According to Li, who has 10 years of clinical experience, using the logic, treatment, formulas and herbs from the Jin Gui Yao Lue (Essentials from the Golden Cabinet) to differentiate and treat Chest Painful Obstruction syndrome is effective. If at the same time you combine Spleen and Stomach treatment theory, then there will be a more marked effect.

Chest Painful Obstruction disease is located in the chest and back. The chest is the Heart and Lung’s expanse. “The back is yang, the Heart is yang within yang. The back is yang, the Lung is yang within yin.” (According to the Jin Gui [Golden Cabinet] chapter of the Su Wen [Basic Questions] ) When Heart and Lung yang qi is vacuous and declining or yin cold phlegm fluids congeal the yang qi, then the chest vessels are painfully obstructed and there is no flow. “When there is no flow there is pain” and Chest Painful Obstruction occurs. This disease mainly manifests in the two organs of the Heart and Lung. Therefore we must deeply understand the pathomechanism of “yang weakness” and “yin thinness” is related to pathology of the Spleen and Stomach.

Disease of the Child Weakens the Mother, Healthy Middle Raises the Clear.

Heart is the mother of the Spleen. Insufficient Heart yang brings about Spleen qi weakness. Spleen governs transportation and transformation, and is at the root of engendering the transformation of food and grain essence. Once the Spleen and Stomach decline, the duty of transformation is neglected. This not nourishing of Heart yang is the “disease of the child weakens the mother”. As it says (in the Pi Wei Lun [Spleen and Stomach Discussion’s] chapter on Pi Wei Cheng Shuai [Spleen and Stomach’s Rise and Fall]): “The cause of Spleen and Stomach insufficiency is yang qi insufficiency and yin qi surplus”. Lung is the child of the Spleen. If Spleen and Stomach is weak, then grain and water is not able to transport upward and the disease mechanism occurs as LU qi losing its nourishment and becomes stagnant. Heart and Lung both govern the movement of blood and qi. If both organs’ yang qi is weak, then qi and blood movement is inhibited and Chest Painful Obstruction occurs. Yang deficiency of the Heart and Lung is a result of the prior decline of Spleen and Stomach qi. In this type of Chest Painful Obstruction, treatment should tonify Spleen and Stomach, strengthen middle qi, ascend the clear and lower the turbid. This will heal Chest Painful Obstruction.

Case 1: Wen so-and-so, female, 71 years old.

Heart pain occurs often. When the climate turns cold or overcast and rainy, then the pain is especially severe. She feels cold qi from the hypochondrium rush up to the heart and chest. The disease is in the space between the breasts. She normally feels fullness in the chest, palpitations, dizziness, neck distention, shortness of breath with no strength, tired body and spirit, poor appetite, and can’t lie down.

Examination: Pulse appears vacuous and string-like, sometimes intermittent, tongue body is dark red. This already is Chest Painful Obstruction disease. With advanced age, vitality declines and blood loses its free flow.  Heart governs the body’s blood and pulse. Because Heart blood is vacuous and scant, and constructive and defensive are not circulating, we see a slow and intermittent pulse. A vacuous and string-like pulse is often seen in old age indicating channels and collaterals have lost their nourishment and the pulse type appears unsmooth. The main cause is Spleen and Stomach decline. Water and grain essence is not sufficient to nourish the Heart and Lung, and the Heart and Lung’s lack of the source of engendering and nourishing ability harms the qi mechanism. Blood does not circulate, qi stagnates, blood congeals and the rising and descending is obstructed. Chest Painful Obstruction disease ensues. Treatment should promote the central qi to harmonize the constructive, nourish the blood and vessels and unblock the Painful Obstruction. The formula to take is Huang Qi Jian Zhong Tang (Astragalus Decoction to Construct the Middle) modified.

Prescription: bei huang qi (wine-fried) 10g, yun (Yunnan) fu ling 9g, dang gui shen 10g, chuan (Sichuan) gui zhi 3g, hang (Hangzhou) bai shao (wine-fried) 5g, zi (Guangdong) dan shen (wine-fried) 9g, suan zao ren 9g, guang (Guangzhou) yu jin 5g, guang (Guangzhou) ju pi 5g, zhi gan cao 5g, dan sheng jiang 3g, da hong zao 3 pieces. 5 bags.

Return visit: Pulse and tongue same as before, chest fullness and heart pain are reduced, spirit is slightly improved, ability to taste gradually improves. Still gave Construct the Middle as the primary formula to allow the clear to rise, the Spleen yang strength to return, the Lung qi to be nourished and the Heart blood to be nourished. Li removed from the previous formula sheng jiang and da zao, and added xi (West) dang shen (rice-fried) 10g, and zhi (fried) yuan zhi 3g. 10 bags.

Third visit: Pulse is moderate, tongue is pale, physical energy has become good, chest fullness and heart pain are all eliminated, she is able to sleep peacefully at night, and her appetite gradually improves. Heart, Spleen and Lung yang qi gradually recover. Gave the above formula leaving out gui zhi and shao yao. After 10 bags health was restored.

In this case the disease root is Spleen and Stomach decline manifesting in the chest. This is why treatment throughout uses strengthening the middle method. If Spleen and Stomach qi is vigorous then Heart and Lung yang open and Chest Painful Obstruction is eliminated. The Construct the Middle Decoction modification leaves out jiao yi over concern that sweet flavor leads to fullness in the middle. Zhi gan cao, even though sweet flavors fill the middle, is okay because only a small amount is used. Zhi gan cao assists dang shen and huang qi’s qi boosting and is used to promote Heart blood spreading and disseminating. It also assists gui zhi and bai shao in harmonizing the constructive and defensive in order to smooth flow in the channels. When used in combination there is no increased fullness. If fullness is due to “vacuity taxation internal anxiety” then jiao yi must be used in the formula. This informs us that zhi gan cao and jiao yi’s function in the middle is similar but different.


Dan Shu Jian and Chen Zi Hua, “Four Treatment Methods of Chest Painful Obstruction from the Spleen and Stomach View,” Golden Cabinet of Ancient and Modern Famous Doctor’s Clinical Experience: Chest Painful Obstruction Heart Pain, Chinese Medicine Publishers, Beijing, August 1999, pps. 251-253.
Translation by Todd Flemion