A neighbor, Ms. Liu, 71, has been suffering from “angina” for many years, and her chest hurts badly when she gets sick. At this time, her daughter rushed to give her a nitroglycerin, after the symptoms can be relieved. Although she has been to the doctor many times in the past few years, she has also taken a lot of drugs for coronary heart disease, but the effect has not been good. Recently, she came to Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine and was seen by Dr. Xu Fengqin, the chief physician. After the consultation, Xu Fengqin learned that the patient mainly suffered from retrosternal dullness, sometimes with burning pain, and the pain was very much like angina pectoris during the attack. After looking at her ECG, she did have mild T-wave changes. However, this patient had no history of hypertension, diabetes mellitus, hyperlipidemia, or family history of coronary heart disease. Careful questioning of the patient’s accompanying symptoms revealed that the patient had difficulty swallowing, and the symptoms were more pronounced when eating cold or hard things. Therefore, she advised the patient to have a flat-panel exercise ECG, which ruled out coronary artery disease, and a barium meal angiogram of the upper gastrointestinal tract, which finally confirmed the diagnosis of cardia incontinence. The difference is not to confuse the symptoms Xu Fengqin said, cardia achalasia is an esophageal motility disorder, characterized by lack of peristalsis and poor relaxation of the lower esophageal sphincter. Clinically, pancreatic achalasia is characterized by difficulty swallowing liquid and solid foods, weight loss, postprandial regurgitation, nocturnal choking and retrosternal discomfort or pain. As a specialist in cardiovascular system diseases, Fengqin Xu treats most patients with coronary angina, and it is true that some patients with coronary angina have been misdiagnosed as having gastric disease. However, pancreatic dystonia also shows chest pain, and its attacks are often related to mental factors, and can be relieved by nitroglycerin, so this disease is also easy to misdiagnose as heart disease. Xu Fengqin said that the difference between the two diseases is that the attacks of angina are mostly triggered by exertion and anger, while the chest pain of cardia failure is usually triggered by swallowing, and there is difficulty in swallowing. In fact, this point can be distinguished. In addition, this disease should be distinguished from esophageal neurosis, esophageal cancer and cardia cancer. Most of the esophageal neurosis is characterized by a feeling of foreign body obstruction from the pharynx to the esophagus, but there is no choking sensation when eating and no difficulty in swallowing. The differential diagnosis between this disease and esophageal cancer and pancreatic cancer is most important. The diagnosis of pancreatic achalasia is generally not difficult due to the characteristic upper GI barium meal, and the typical X-ray presentation is a bird’s beak-like narrowing of the lower esophagus. Esophageal kinetics and esophagoscopy can also be done to confirm the diagnosis and exclude esophageal scar strictures and esophageal tumors. The X-ray of cancerous esophageal stricture is characterized by local mucosal destruction and disorder, and moderate dilatation of the stricture, whereas this disease often results in extreme dilatation, but the mucosa is intact and there is no scar tissue or tumor. Xu Fengqin treated Ms. Liu with a combination of Chinese and Western medicine: she took nifedipine to relieve pancreatic spasm, and for the cause of the patient’s emotional disorder and phlegm-qi interaction, the patient was diagnosed as having qi stagnation and phlegm obstruction, and was treated with the traditional Chinese medicine formula Hanxia Houpu Tang with addition, adding some qi-regulating and blood-stasis activating drugs to the original formula. The patient’s symptoms were significantly relieved after use. Xu Fengqin said, according to the clinical manifestations of this disease, pancreatic dyscrasia belongs to the category of choking and regurgitation in Chinese medicine, the early stage of the disease is mostly due to liver depression and qi stagnation, wood over spleen and earth, weakness of the spleen and stomach and loss of transmission, resulting in water and food stagnation in the middle jiao, the disease may cause spleen and stomach qi and yin deficiency, qi stagnation and blood stasis. In the early stage, the most common cause is liver stagnation, phlegm and qi stagnation, and after prolonged illness, the main cause is spleen and stomach weakness or spleen and stomach yin deficiency. In early stage patients, the formula mostly used is Xuan Fu Dai Ochre Tang and Han Xia Hou Pao Tang plus some blood activating and stasis relieving herbs. In patients with prolonged disease, treatment should be done by tonifying Qi, strengthening the spleen, soothing the liver and relieving spasm, with the addition of Isokong San and Jin Ling Zi San, usually with the addition of San Ling, Curcuma longa, Wei Ling Xian and Paeoniae Gan Cao Tang, etc. In those with spleen and stomach yin deficiency, some yin nourishing herbs are added. Among them, Wei Ling Xian is pungent and warm, good at running, can pass through twelve meridians, has good effect of opening and relieving pain. The two drugs, San Leng and Curcuma longa, have been suspected by many doctors of being bitter and fierce in taste, and have the danger of depleting the vital energy and dare not use them lightly, but Zhang Xichun, a famous doctor in modern times, is unique in that among the many blood-activating drugs, he is most fond of treating diseases with San Shao and Curcuma longa, and believes that the two drugs are “not fierce in nature but very fast in building up their work, and their power of moving Qi can treat pain in the heart and abdomen, swelling and pain under the dorsum and all the evidence of blood clotting and stagnation of Qi. If used with ginseng and art, it can appease the stomach, regulate blood and blood”. Paeonia lactiflora and Glycyrrhiza glabra soup can soften the liver, soothe the tendons, and relieve pain. The addition of these drugs can facilitate the relief of pancreatic spasm and improve the therapeutic effect. If conservative treatment does not work well, lower esophageal dilatation or surgical treatment can be used. Daily maintenance is important to plan for a rainy day Psychological guidance Xu Fengqin said, so the cause of the disease is mostly related to mental factors, when the mental tension, emotional fluctuations will lead to the onset or aggravate the symptoms. Therefore, the patient should explain the condition in detail, let the patient emotional stability, and give some psychological guidance treatment, can also take sedatives. At the same time, it is also necessary to let family members understand and know about this disease, and create a good atmosphere in the family to avoid bringing heavy psychological pressure to the patient. Physical exercise Normally, patients should participate in some physical exercise within their ability, such as walking, doing radio exercises, playing taijiquan, etc., and also do some household chores, which can strengthen the overall quality, but also distract and relax. Less and more meals Due to pancreatic spasm, patients often have difficulty swallowing, so they should be allowed to eat less and more meals, chew and swallow slowly, and avoid stimulating diets such as too cold and too hot and spicy. In the case that solid food cannot be fed, the patient can be given liquid food. To ensure the patient’s nutritional supply, you can eat miscellaneous food paste: choose barley, millet, corn (peeled), red beans, peanuts, black sesame seeds, lotus seeds (heart removed), etc., soaked overnight in advance, and put it into the food grinder in the morning after waking up and crushed, you can also add milk or juice, etc., cooked into a thick paste, a small number of times to take. Rest easy The most common complication of this disease is aspiration respiratory tract infection. Bronchial and pulmonary infections can occur when esophageal reflux is inhaled into the airway, especially when sleeping. About 1/3 of patients may experience paroxysmal choking or recurrent respiratory infections during the night. To prevent spillage of food into the airway during sleep, which can cause aspiration pneumonia, the patient should be allowed to sleep with a high pillow or elevated head of the bed (about 30 degrees), and in severe cases, the esophagus needs to be irrigated before bedtime.