The most spectacular revolution that Chinese medicine brings to our understanding of the body is in the realisation that our emotions exist within our body. This revolution will fundamentally change the role of doctors in treating patients. Nowhere is this more dramatically displayed than in the relation between Heart and Kidney.
The Heart is seen, just as William Harvey himself thought, as the centre of our spirit. The Kidneys are seen as storing the material strength of our body and provide the physical platform for the Heart to flourish: together they form an axis through the ShaoYin channel.
This axis has been compared to two spinning magnets who are constantly interplaying and pushing each other around. When these get out of synch we can get a variety of symptoms from palpitations to panic.
Panic attacks are seen in Western medicine as occurring in the brain, but ask any person suffering one and they will say that the symptoms they feel are definitely occurring in the body. Only the sense of panic, of impending doom, can be said to be in the brain (or mind).
So when my patient came in and told me of his palpitations, chest pain, erratic breathing, light-headedness and sense of impending doom I was all prepared to explain to him that this was 'just' a panic attack... before I saw his ecg.
ECG's are difficult things to read and pointless explaining further unless you plan on 'interrogating' peoples heart energy (Qi) on a daily basis. However, in this ecg those inverted T-waves shouldn't be there, they are pathological. In essence what they tell you is there is scar tissue in the heart.
His story was that 4 years ago he had had pericarditis, inflammation of the surface of the heart and pericardium. It had been severe and scarred his heart, leaving these tell-tale electrical disturbances.
Since then, he told me, he had effectively suffered a 4 year non-stop panic attack. This day had been worse which is why he had come in, but the problem never really went away. Interestingly it had been helped in the past for a few hours each day by ACE-inhibitors but he had stopped taking these ('interesting' because these are drugs that interfere with the communication between heart and kidney).
I explained to the patient that the problem was that the Heart and Kidney were not communicating properly. The Heart was picking up a problem with the scar tissue and sending distress calls to the Kidney (possibly through the hormones ANP or BNP). The Kidney was responding appropriately by pumping out adrenaline (the adrenal is part of the Kidney) to help the Heart out. The problem was that the Heart didn't need this kind of help and so the whole process was pathological.
The excess-adrenaline was then causing his symptoms of panic-attack.
Interrupting this miscommunication between heart and kidney should help the problem, I explained, and that I thought beta-blockers (drugs that prevent the Heart from 'hearing' the adrenaline) may help him.
The drug I chose was metoprolol whose indications are:
It is these last indications that are so intriguing... anxiety... for in Western medicine these are seen as brain problems but Chinese physiology teaches these as heart-kidney problems. Normally anxiety is occurring at an energetic level but in this patient it had a physical root.
The iv metoprolol worked wonderfully, fixing his chest pain and palpitations within minutes and then almost completely curing his sense of lightheadedness. Instead of admitting him I was able to discharge him a much happier man.
I explained he needed to see a cardiologist for follow up and started him on a very low dose of metoprolol. I'm sure the cardiologist will probably think that (if the beta-blocker is still working) it is simply working for his 'anxiety' symptoms... but that is to fail to understand the deeper physiology.