A 44-year-old man experiencing paroxysmal chest tightness, shortness of breath, and fatigue following a respiratory infection was managed using a simple four-herb daily tea to tonify Qi and move blood.

Case ID: CHC-0020

Case Summary

This case describes a 44-year-old man who presented with lingering cardiovascular and systemic symptoms one month after recovering from acute bronchitis. The original report documented a conventional diagnosis of chest tightness (with an ECG showing sinus bradycardia) and a TCM assessment of Chest Bi (Xiong Bi) driven by Qi deficiency and blood stasis. The patient was managed using a gentle, sustained herbal tea substitute designed to rebuild his foundational energy and restore proper blood circulation.

Patient Presentation

• Patient: 44-year-old male.
• Main Complaint: Paroxysmal chest tightness, shortness of breath, and fatigue.
• History: Over a month prior to the consultation, the patient suffered from a respiratory illness characterized by fever, headache, cough, and fatigue. He was diagnosed with bronchitis at another hospital. While the acute symptoms (fever, cough, headache) resolved after initial treatments, he was left with persistent, paroxysmal chest tightness. Each episode lasted a few minutes and could be relieved by rest. He also reported shortness of breath after physical activity, profound fatigue, occasional chest pain, a poor appetite, and shallow sleep with frequent awakenings. His bowel movements and urination were normal.

Examination and Diagnosis

• Conventional Diagnosis: Chest tightness. An electrocardiogram (ECG) revealed sinus bradycardia (a slower-than-normal heart rate).
• TCM Tongue and Pulse: The tongue was pale red with a thin coating. The pulse was moderate and slow (脉缓).

TCM Assessment

The original practitioner interpreted the presentation as Chest Bi (Chest Impediment) driven by Qi Deficiency and Blood Stasis (胸痹 – 气虚血瘀证).

According to the core principles of yin and yang Chinese Medicine, acute illness can severely deplete the body’s foundational energy (Qi). In TCM theory, Qi acts as the commander and motive force that pushes blood through the vessels. The original report noted that the patient’s recent respiratory infection had damaged his vital Qi. Without sufficient Lung and Spleen Qi (the “engine”), his blood circulation became sluggish, eventually forming micro-stasis in the chest.

This trapped, stagnant blood caused the paroxysmal chest tightness and occasional pain. Meanwhile, the lack of Lung Qi resulted in shortness of breath upon exertion, and the weakened Spleen Qi explained his fatigue and poor appetite. Finally, because Qi and blood were too depleted to properly nourish his Heart and anchor his spirit, his sleep became shallow and easily disturbed.

Treatment Approach

The primary treatment principle was to tonify Qi, nourish the blood, move Qi, and unblock the collaterals (益气养血，行气通络). Rather than prescribing a heavy, bitter medicinal decoction, the practitioner utilized a “tea substitute” (代茶饮)—a simplified, highly focused herbal combination designed to be sipped daily over a longer period to gently rebuild the patient’s constitution.

Herbal Formulas and Modifications

• Formula Prescribed (August 1, 2022): A precise, four-herb combination.
• Action and Composition:
  • Tonifying the Engine: Huang Qi (Astragalus, 15g) served as the chief herb to strongly tonify the Spleen and Lung Qi, directly addressing the fatigue and shortness of breath while providing the energy needed to move the blood.
  • Unblocking the Vessels: Dan Shen (Salvia, 15g) was used to invigorate and nourish the blood, clearing the stasis in the chest without being overly harsh or drying.
  • Stopping Pain: Cu Yan Hu Suo (Vinegar-processed Corydalis, 10g) was added to specifically move stagnant Qi and relieve the physical chest pain.
  • Harmonizing and Restoring: Zhi Gan Cao Pian (Honey-fried Licorice, 10g) was included to tonify the Spleen, harmonize the stomach to improve appetite, and historically, to “restore the pulse” in cases of cardiovascular weakness.
• Administration: The patient was instructed to decoct these four herbs in water and drink the liquid as a daily tea. He was prescribed 30 doses (a one-month supply).

Follow-Up

• September 2022 (One Month Later): At the follow-up consultation one month later, the source reported that all of the patient’s symptoms—including the chest tightness, fatigue, shortness of breath, and poor sleep—had completely resolved, and he experienced no further discomfort.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is its focus on the post-viral or post-illness recovery phase. Conventional medicine successfully cleared the patient’s acute bronchitis infection, but the patient remained physically impaired.

The original practitioner recognized that while the pathogen was gone, the “machinery” of the body was left severely depleted. Attempting to force the chest tightness away with heavy blood-thinners or aggressive cardiovascular medications would have further exhausted the patient. By utilizing a simple, elegantly constructed herbal tea centered around Huang Qi, the treatment strategy gently but persistently rebuilt the patient’s Qi. This case beautifully demonstrates the TCM concept that sometimes the most effective way to clear a blockage (blood stasis) is simply to give the body the energy (Qi) it needs to clear the blockage itself.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：气虚血瘀胸痹扰，茶饮妙方气血调]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 22, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation