服药4剂，头痛身痛，寒热往来，胸满胸痛、脘腹胀痛等证俱减，体温降至37．8qC，饮食稍进，精神好转。某医问：结核性胸膜炎，中医称为悬饮，悬饮当予攻逐，如仲景《金匮要略》云：“病悬饮者，十枣汤主之。”而先生却不用何也?答曰：邪结少阳者必予和解，此仲景之意也。且《中医内科学》亦主张“邪犯胸肺，证状寒热往来，身热起伏，汗少，或发热不恶寒，有汗而热不解，咳嗽少痰，气急，胸胁刺痛，呼吸，转侧疼痛加重，心下痞硬，干呕，口苦，咽干，舌苔薄白或黄，脉弦数，治法和解宣利。方药：柴枳半夏汤加减。”而本证复有太阳、阳明之证，故不用十枣汤而用达原饮加减。继服16剂，诸证消失。停药1个月后，又因感冒而复发，经胸透又出现少量胸水。细审其证，除胸水胸痛而外，并见寒热往来，咳嗽少痰，气急，胸胁刺痛。予柴枳半夏汤加减。处方：柴胡15克，黄芩10克，瓜蒌15克，半夏10克，枳壳10克，桔梗10克，赤芍10克，白芥子6克，桑皮10克。
服药4剂，其效不著。再审其脉弦紧，胃脘有压痛。因思证见阳明腑实。改予达原饮加减为方：厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，菖蒲10克，大黄4克，枳实10克，桂枝10克，柴胡10克，白芷10克。
服药2剂，诸证果减，继服16剂，愈。
4．久病入络，但予祛饮，血络瘀滞，病邪不除
邢××，男，成。
结核性渗出性胸膜炎7个多月。医用抽胸水、抗痨药，氢化可的松等进行治疗后，虽然胸水已明显减少，但直到现在仍然没有全部吸收，为此曾反复进行胸穿，但只能抽出少量胸水。不得已，又以中药逐水之剂治疗，一周之后，诸证仍不减轻。细审其证，除包裹性胸水外，并见右侧胸痛，气微短，舌苔白，脉沉弦涩。综合脉证，诊为肝肺气郁，痰瘀共存。治拟疏肝理气，活血化痰。处方：柴胡10克，赤芍10克，枳壳10克，白芥子10克，陈皮10克，降香10克，杏仁10克，甘草10克。
服药2剂，胸满胸痛，气短等症好转，继服10剂，诸证消失，胸水消失，愈。
某医问：包裹性胸水反复治疗而不愈，而采用理气、化痰、活血即很快治愈者，其故何也?答曰：脉沉弦涩乃气滞、血瘀、寒凝之脉，气滞、血瘀、寒凝者，必予理气、活血、温经、化饮同施方解，因此应用理气、活血、温经、化饮而速效。
充血性心力衰竭
1．少火当益，反助壮火，耗气损正，水气不化
郝××，女，36岁。
2l岁结婚，结婚后不久发现心悸气短，偶而咳血。某院诊断为风湿性心脏病，二尖瓣狭窄，心房纤颤。经过治疗后，症状逐渐改善。3年多以前，怀第二胎后，病情突然加重，至产后病情更加严重，反复咳血，乃急至北京某院进行手术治疗。手术之后，虽然咳血已经停止，但却出现心房纤颤，心力衰竭，气短，心悸，浮肿，腹水，尿少。医以强心苷、抗心律失常药、利尿药，以及抗生素等进行治疗，约两年不见减轻。乃嘱患者转请中医进行治疗。察其证见呼吸极度困难，不能平卧，心悸心烦，全身浮肿，胸腹积水，发绀，口干口渴，舌质紫暗，苔少，脉细数促，手足心烦热而指趾反见厥冷。某医诊后认为系心肾阴虚，急予滋阴清热。处方：生地20克，麦冬10克，元参15克，石斛15克，龟甲20克，茯苓10克，知母10克，黄柏10克，五味子10克。
上药服1次后不久患者即感腹部坠胀，气短难续，并时见神昏谵语。为此又急邀李翰卿先生诊治。云：此病阴阳大衰，病重而剧，正虚邪实，攻补两难，若不急救心肾之阳，则病者不久于人世也。急处：附子0．3克，茯苓1克，白术0．3克，白芍3克，人参1克，杏仁1克，桂枝1克。
服药2个小时后，气短心悸好转，1个小时后开始排尿，其后又连续排尿4次。次日再诊，患者已可以平卧睡眠，呼吸困难明显好转，全身浮肿、腹水亦明显减轻。宗效不更方，继进3剂，浮肿全消，饮食增进，并能下地活动。一医云：如此危重之疾，竞用如此之剂，病重药轻，岂能顶事。急处下方：附子15克，人参15克，白芍15克，茯苓30克，白术20克，生地15克，麦冬15克，五味子15克。
服药1剂，病情又剧，尿少浮肿，呼吸难续。再邀李翰卿先生诊治。云：《内经》曰：壮火食气，少火生气，壮火散气。附子等药少则生气，多则散气，此病如此之重，只可生气，不可散气，再散其气则阴阳离绝也。再处：附子0．1克，茯苓1克，白术1克，白芍1克，生姜l小片，人参1克，杏仁1克。
次日再诊，病情大见好转。
2．胶着固涩，不知随证，治焉不错
郜××，男，30岁。
风湿性心脏病，二尖瓣狭窄与闭锁不全，心房纤颤，心力衰竭，经过某院治疗后，虽然心悸气短，难于平卧之状已明显改善，但腹胀腹水、浮肿尿少仍不见好转。乃邀某医以中药理气行水，温阳利水等治之，数剂后腹胀浮肿明显减轻，精神增加，但服至第10剂后，诸证不但不减，反见日趋加重，其后虽用药达200剂，症状不再改善。细审其证，除腹大青筋脐突，下肢浮肿，气短心悸之外，并见其口渴喜饮，体瘦而皮干，全身紫黯，尤以舌、唇、指为甚，稍一活动即气短难于接续，舌苔黄白而腻，脉沉滑数促结。因思脉沉者，气郁也；滑者，痰热也；促者，阳气大衰也；结者，气滞血瘀也。合之于证，乃气血大衰为本，气滞血瘀，水湿不化为标。治拟补气养血以培本，理气活血，利水除湿以治标。处方：黄芪30克，人参10克，当归10克，丹参30克，黄精10克，生地10克，陈皮10克，青皮10克，苍术15克，白术10克，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克，莱菔子10克，砂仁10克，防己15克，大腹皮10克。
某医云：老师在真武汤的临床应用一文中曾介绍说：真武汤温阳利水，用于心力衰竭有卓越的疗效，余临床用之亦确实如此，而此患者却不用此方何为也?余治此患者始见有效，其后不但不效，反见加重又何也?答曰：真武汤用于心肾阳虚，水饮内停的心力衰竭确有卓越疗效，这是众多医家都承认的。但是，它并不是治疗心力衰竭的唯一良药。至若其他原因的心力衰竭，因其不是心肾阳虚，水饮内停，所以当然也不会有效。至于为什么开始用真武汤有效而后没效果，那可能是先时是心肾阳虚，水饮内停，而后又变成其他证候的缘故。本证从目前的脉证看是气血大衰为本，气滞血瘀，水饮内停为标，所以采用人参、黄芪、白术、当归、黄精、生地的大补气血，柴胡、三棱、莪术、薄荷、青皮、陈皮、丹参的理气活血，苍术、白术、陈皮、砂仁、莱菔子、防己、大腹皮的利水化饮进行治疗。
服药1剂，腹胀浮肿，心悸气短均减；继服10剂，诸证大减，饮食、精神大增；又服上方30剂，腹水全消，精神倍增，并可到户外作一般的活动。前医云：仲景之观其脉证，知犯何逆，随证治之，确是诸病证治大法也。吾所不能取效者在于此耳。
窦性心律失常
1．病邪在肝，但从心治，病位不同，取效尤难
甄××，男，45岁。
胸胁满闷，心烦心悸2年多。医诊窦性心律不齐。医者先用西药治疗一年多不效，继又配合中药养心安神、活血化瘀等法治疗7～8个月仍无功。细审其证，除胸胁苦满，心烦心悸外，并见其头晕头痛，纳呆食减，夏季则手心烦热，冬季不热，舌苔白，脉弦细结涩。因思：脉弦者肝脉也，细者血虚也，结者瘀也滞也；涩者寒也滞也。合之于症，乃肝郁血虚之证耳。因拟养血疏肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草6克，生姜3片，薄荷30克，茯苓10克，青皮10克。
服药2剂，诸证大减，继服20剂，诸证俱失，愈。
某医云：心脏病为何治肝而不治心?答曰：脉、证俱为肝病所以从肝论治。其心证乃肝之所为，故从肝治而心病得愈。且前医已屡用治心之方而不效，事实证明从心治不可从也。
2．病邪在肝，反与清心泻火，病位不同，焉能取效
邵××，女，28岁。
心烦心悸，有时突然感到心跳的厉害，有时突然有心跳暂停之状3年多。医诊窦性心动过速。先用西药治疗1年不效，继又配合中药养心安神泻火等治疗1年多亦无功。细审其证，除心烦心悸之外，并见头晕头痛，烦躁易怒，胸胁苦满，或时窜痛，月经失调，经前心烦心悸加剧，舌苔白，脉弦细数。思之：脉弦细者肝郁血虚也；数者热也。综合脉证，乃肝郁血虚，郁而化火也。前用养心安神泻火之不愈者乃肝病治心本末倒置之故也。拟用养血疏肝泻火。处方：柴胡10克，当归10克，白芍10克，茯苓10克，白术10克，甘草10克，生姜3片，薄荷3克，丹皮10克，栀子10克，丹参10克。
在停用其他任何药物的情况下，开始服用以上药物4剂。1个月之后，再诊云：原来每天都心悸心烦，服用上药4剂后，心悸心烦一直没有发作，为此没有再服任何药物，昨日心烦心悸又作，但不如以前的严重。继服上药20剂，果愈。
过早搏动
1．重复用药，相互抵触，难明正误
陈××，女，45岁。
失眠健忘，胸满心烦，时而汗出3年多。医诊神经官能症，房室传导阻滞，期前收缩。先用西药治疗一年多效果不著，继又配合中药疏肝理气，养血疏肝，养心安神等，以及按摩、气功、针灸等治疗7～8个月亦无明显改善，特别是近8～9个月以来，胸满胸痛，心烦心悸更加严重，经常感到一股热气突然上冲，冲至心胸即心悸不宁，冲至咽喉则感窒塞不通，呼吸极度困难，冲至头则头晕脑胀，全身汗出，继而全身软弱难于行动，为此长期不能坚持工作。细审其脉见濡缓而时滑时涩时结，舌苔薄白。思之：久病脉见濡缓者为气阴两虚，痰郁气结，滑、涩、结俱见者，为痰、郁并见。合之于症，乃气阴两虚，痰郁气结。治拟补气养阴，理气化痰同施。处方：黄芪15克，当归6克，麦冬10克，人参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，菖蒲10克，生地10克，远志10克。
服药6剂，诸证不减。因思病药根据经验是相符的，然其无效者何也?又思当今公费医疗者大多用药甚杂，中、西共用，丸、汤同施，中药配方尚且注重配伍之相须相使相反相畏，此用药如此之繁，难道无相反相畏者?因嘱患者暂停其他任何中、西药饵，仅仅服用上方4剂，以观效果。
连续服药4剂，诸证均减。患者云：朱老嘱我停用其他药物，我当时非常想不通，所以吃了汤药，又接服西药、丸药，但是因为爱人、父母阻挡而停用两天，真想不到停用西药、丸药以后，病情反而大见好转，为此又服药2剂，效果果然大增。继服40剂，诸证全部消失，并恢复工作。
2．胶于复脉，不辨兼证，久治不效
王××，女，50岁。
冠状动脉硬化性心脏病，期前收缩，心房纤颤2年多。医先予西药治之1年多效果不明显，又改请中医以炙甘草汤加减治之约半年多仍不见改善，又易医以养心安神，补气养血加苦参治之仍无功。细审其证，除心前区憋，心悸之外，并见头晕心烦，时时叹气，舌苔白，脉弦滑结代而微沉。因思弦脉者肝胆之脉也，滑脉者痰热也，结者郁结之证也，代者脏气衰也。综合脉证论之，乃肝郁气结，痰热不化，脏气衰败也。治拟疏肝理气，益气化痰。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜5片，大枣5个，瓜蒌18克。
眼药5剂，诸证俱减，继服上方50剂，诸证消失，心电图正常，愈。
阵发性心动过速
1．痰火郁结，反安心神，肝病心治，痰火反补，终非其治
贺××，女，35岁。
阵发性心动过速4年多。医先用西药治疗2年多不效，后又改用中药养心安神之剂500余付，始终不够理想。询其脉证，云：心悸呈阵发性，先开始时每月发作2～3次，最近发作尤其频繁，几乎每天发作1次。发作之始，先感心烦，继而逆气上冲，冲至心胸则心跳难忍，冲至咽喉、颈部则憋闷难于出气，冲至头则头晕汗出，汗出遍身之后即心悸好转，而全身却疲乏软弱；每次心跳发作，心率达100一120次／分，很少超过130次/分，发作以后即迅速转为80次／分左右。这种发作与情绪有很大关系，舌苔薄白，脉弦滑。综合脉证，思之：弦滑之脉有痰火郁结在肝胆也。又思前用诸方之不效者，一以实作虚治，二以肝作心治之故也。乃拟疏肝解郁，化痰泻火为方。处方：川芎10克，当归10克，黄芩10克，白芍10克，葛根15克，半夏10克，甘草10克，桑皮15克。
服药10剂，诸证果减，继服20剂，瘥。
2．肝郁气结，上热下寒，水饮上冲，不去温下，但予泻火，寒饮反郁，病证不愈
王××，女，40岁
服用四剂药后，头痛、身痛、寒热往来、胸满胸痛、脘腹胀痛等症状均减轻，体温降至37.8℃，饮食稍增，精神好转。某医生问：结核性胸膜炎，中医称为悬饮，悬饮应当用攻逐法治疗，如张仲景《金匮要略》所说：“患悬饮病的，用十枣汤主治。”而先生却不用此方，为什么呢？回答说：邪气结聚在少阳经的，必须用和解法，这是张仲景的本意。而且《中医内科学》也主张“邪气侵犯胸肺，症状表现为寒热往来，身热起伏，汗少，或发热不恶寒，有汗而热不解，咳嗽少痰，气急，胸胁刺痛，呼吸、转侧时疼痛加重，心下痞硬，干呕，口苦，咽干，舌苔薄白或黄，脉弦数，治法为和解宣利。方药：柴枳半夏汤加减。”而本证又兼有太阳病、阳明病的症状，所以不用十枣汤而用达原饮加减。继续服用十六剂，所有症状消失。停药一个月后，又因感冒而复发，经胸部透视又出现少量胸腔积液。仔细审查其症状，除胸腔积液和胸痛外，还见寒热往来，咳嗽少痰，气急，胸胁刺痛。给予柴枳半夏汤加减。处方：柴胡15克，黄芩10克，瓜蒌15克，半夏10克，枳壳10克，桔梗10克，赤芍10克，白芥子6克，桑白皮10克。
服用四剂药后，疗效不明显。再诊察其脉象弦紧，胃脘部有压痛。想到证候表现为阳明腑实证。改为给予达原饮加减作为方剂：厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，石菖蒲10克，大黄4克，枳实10克，桂枝10克，柴胡10克，白芷10克。
服用两剂药后，各种症状果然减轻，继服十六剂，痊愈。
4．久病入络，只予祛除湿饮，导致血络瘀滞，病邪不能去除
邢××，男，成年。
结核性渗出性胸膜炎七个多月。医生采用抽取胸腔积液、抗结核药物、氢化可的松等进行治疗后，虽然胸腔积液已明显减少，但直到现在仍未完全吸收，为此曾反复进行胸腔穿刺，但只能抽出少量胸腔积液。不得已，又以中药逐水之剂治疗，一周之后，各种症状仍不减轻。仔细审查其症状，除包裹性胸腔积液外，还见右侧胸痛，气微短，舌苔白，脉沉弦涩。综合脉象和症状，诊断为肝肺气郁，痰瘀共存。治拟疏肝理气，活血化痰。处方：柴胡10克，赤芍10克，枳壳10克，白芥子10克，陈皮10克，降香10克，杏仁10克，甘草10克。
服用两剂药后，胸满胸痛、气短等症状好转，继服十剂，所有症状消失，胸腔积液消失，痊愈。
某医生问：包裹性胸腔积液反复治疗而不愈，而采用理气、化痰、活血方法即很快治愈的，原因是什么呢？回答说：脉象沉弦涩是气滞、血瘀、寒凝的脉象，气滞、血瘀、寒凝的，必须用理气、活血、温经、化饮同时施治才能解决，因此应用理气、活血、温经、化饮而取得速效。
郝××，女，36岁。
21岁结婚，结婚后不久发现心悸气短，偶尔咳血。某医院诊断为风湿性心脏病，二尖瓣狭窄，心房纤颤。经过治疗后，症状逐渐改善。三年多以前，怀第二胎后，病情突然加重，至产后病情更加严重，反复咳血，于是紧急到北京某医院进行手术治疗。手术之后，虽然咳血已经停止，但却出现心房纤颤，心力衰竭，气短，心悸，浮肿，腹水，尿少。医生使用强心苷、抗心律失常药、利尿药，以及抗生素等进行治疗，约两年不见减轻。于是嘱咐患者转请中医进行治疗。观察其症状见呼吸极度困难，不能平卧，心悸心烦，全身浮肿，胸腹积水，发绀，口干口渴，舌质紫暗，苔少，脉细数促，手足心烦热而指趾反见厥冷。某医生诊后认为系心肾阴虚，紧急给予滋阴清热。处方：生地20克，麦冬10克，玄参15克，石斛15克，龟甲20克，茯苓10克，知母10克，黄柏10克，五味子10克。
上述药物服用一次后不久，患者即感到腹部坠胀，气短难续，并时常出现神昏谵语。为此又紧急邀请李翰卿先生诊治。他说：此病阴阳大衰，病重而剧，正虚邪实，攻补两难，若不急救心肾之阳，则病人不久于人世也。紧急处方：附子0.3克，茯苓1克，白术0.3克，白芍3克，人参1克，杏仁1克，桂枝1克。
服药2个小时后，气短心悸好转，1个小时后开始排尿，其后又连续排尿4次。次日再诊，患者已可以平卧睡眠，呼吸困难明显好转，全身浮肿、腹水亦明显减轻。遵循效不更方的原则，继进三剂，浮肿全消，饮食增进，并能下地活动。一位医生说：如此危重之疾，竟用如此之轻的剂量，病重药轻，岂能顶事。紧急开具下方：附子15克，人参15克，白芍15克，茯苓30克，白术20克，生地15克，麦冬15克，五味子15克。
服药一剂，病情又加剧，尿少浮肿，呼吸难续。再邀请李翰卿先生诊治。他说：《内经》说：壮火食气，少火生气，壮火散气。附子等药少则生气，多则散气，此病如此之重，只可生气，不可散气，再散其气则阴阳离绝也。再次处方：附子0.1克，茯苓1克，白术1克，白芍1克，生姜一小片，人参1克，杏仁1克。
次日再诊，病情大见好转。
郜××，男，30岁。
风湿性心脏病，二尖瓣狭窄与闭锁不全，心房纤颤，心力衰竭，经过某医院治疗后，虽然心悸气短，难于平卧之状已明显改善，但腹胀腹水、浮肿尿少仍不见好转。于是邀请某医生以中药理气行水，温阳利水等治之，数剂后腹胀浮肿明显减轻，精神增加，但服至第十剂后，各种症状不但不减，反见日趋加重，其后虽用药达二百剂，症状不再改善。仔细审查其症状，除腹大青筋脐突，下肢浮肿，气短心悸之外，还见其口渴喜饮，体瘦而皮干，全身紫黯，尤以舌、唇、指为甚，稍一活动即气短难于接续，舌苔黄白而腻，脉沉滑数促结。想到脉沉者，是气郁；滑者，是痰热；促者，是阳气大衰；结者，是气滞血瘀。合之于症状，乃气血大衰为本，气滞血瘀，水湿不化为标。治拟补气养血以培本，理气活血，利水除湿以治标。处方：黄芪30克，人参10克，当归10克，丹参30克，黄精10克，生地10克，陈皮10克，青皮10克，苍术15克，白术10克，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克，莱菔子10克，砂仁10克，防己15克，大腹皮10克。
某医生说：老师在真武汤的临床应用一文中曾介绍说：真武汤温阳利水，用于心力衰竭有卓越的疗效，我临床用之亦确实如此，而此患者却不用此方为什么呢？我治疗此患者始见有效，其后不但不效，反见加重又为什么呢？回答说：真武汤用于心肾阳虚，水饮内停的心力衰竭确有卓越疗效，这是众多医家都承认的。但是，它并不是治疗心力衰竭的唯一良药。至于其他原因的心力衰竭，因其不是心肾阳虚，水饮内停，所以当然也不会有效。至于为什么开始用真武汤有效而后没效果，那可能是先时是心肾阳虚，水饮内停，而后又变成其他证候的缘故。本证从目前的脉证看是气血大衰为本，气滞血瘀，水饮内停为标，所以采用人参、黄芪、白术、当归、黄精、生地的大补气血，柴胡、三棱、莪术、薄荷、青皮、陈皮、丹参的理气活血，苍术、白术、陈皮、砂仁、莱菔子、防己、大腹皮的利水化饮进行治疗。
服药一剂，腹胀浮肿，心悸气短均减轻；继服十剂，各种症状大减，饮食、精神大增；又服上方三十剂，腹水全消，精神倍增，并可到户外作一般的活动。前医说：张仲景的观其脉证，知犯何逆，随证治之，确是诸病证治大法也。我所不能取效的原因在于此耳。
甄××，男，45岁。
胸胁满闷，心烦心悸二年多。医生诊断窦性心律不齐。医生先用西药治疗一年多不效，继又配合中药养心安神、活血化瘀等法治疗七到八个月仍无功。仔细审查其症状，除胸胁苦满，心烦心悸外，还见其头晕头痛，纳呆食减，夏季则手心烦热，冬季不热，舌苔白，脉弦细结涩。想到：脉弦者是肝脉，细者是血虚，结者是瘀滞，涩者是寒滞。合之于症状，乃是肝郁血虚之证。因而拟定养血疏肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草6克，生姜3片，薄荷30克，茯苓10克，青皮10克。
服用两剂药后，各种症状大减，继服二十剂，各种症状俱失，痊愈。
某医生说：心脏病为何治肝而不治心？回答说：脉、证俱为肝病所以从肝论治。其心证乃肝之所为，故从肝治而心病得愈。且前医已屡用治心之方而不效，事实证明从心治不可从也。
邵××，女，28岁。
心烦心悸，有时突然感到心跳的厉害，有时突然有心跳暂停之状三年多。医生诊断窦性心动过速。先用西药治疗一年不效，继又配合中药养心安神泻火等治疗一年多亦无功。仔细审查其症状，除心烦心悸之外，还见头晕头痛，烦躁易怒，胸胁苦满，或时窜痛，月经失调，经前心烦心悸加剧，舌苔白，脉弦细数。思考：脉弦细者是肝郁血虚，数是热。综合脉证，乃是肝郁血虚，郁而化火也。前用养心安神泻火之不愈者乃是肝病治心本末倒置之故也。拟定用养血疏肝泻火。处方：柴胡10克，当归10克，白芍10克，茯苓10克，白术10克，甘草10克，生姜3片，薄荷3克，丹皮10克，栀子10克，丹参10克。
在停用其他任何药物的情况下，开始服用以上药物四剂。一个月之后，再诊时说：原来每天都心悸心烦，服用上药四剂后，心悸心烦一直没有发作，为此没有再服任何药物，昨日心烦心悸又作，但不如以前的严重。继服上药二十剂，果然痊愈。
过早搏动
1．重复用药，相互抵触，难明正误
陈××，女，45岁。
失眠健忘，胸满心烦，时而汗出三年多。医生诊断神经官能症，房室传导阻滞，期前收缩。先用西药治疗一年多效果不著，继又配合中药疏肝理气，养血疏肝，养心安神等，以及按摩、气功、针灸等治疗七到八个月亦无明显改善，特别是近八到九个月以来，胸满胸痛，心烦心悸更加严重，经常感到一股热气突然上冲，冲至心胸即心悸不宁，冲至咽喉则感窒塞不通，呼吸极度困难，冲至头则头晕脑胀，全身汗出，继而全身软弱难于行动，为此长期不能坚持工作。仔细审查其脉见濡缓而时滑时涩时结，舌苔薄白。思考：久病脉见濡缓者为气阴两虚，痰郁气结，滑、涩、结俱见者，为痰、郁并见。合之于症状，乃是气阴两虚，痰郁气结。治拟补气养阴，理气化痰同施。处方：黄芪15克，当归6克，麦冬10克，人参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，石菖蒲10克，生地10克，远志10克。
服用六剂药后，各种症状不减。想到病与药根据经验是相符的，然其无效者为什么呢？又想到当今公费医疗者大多用药甚杂，中、西共用，丸、汤同施，中药配方尚且注重配伍之相须相使相反相畏，此用药如此之繁，难道无相反相畏者？于是嘱咐患者暂停其他任何中、西药饵，仅仅服用上方四剂，以观效果。
连续服药四剂，各种症状均减轻。患者说：朱老嘱我停用其他药物，我当时非常想不通，所以吃了汤药，又接服西药、丸药，但是因为爱人、父母阻挡而停用两天，真想不到停用西药、丸药以后，病情反而大见好转，为此又服药二剂，效果果然大增。继服四十剂，各种症状全部消失，并恢复工作。
2．胶于复脉，不辨兼证，久治不效
王××，女，50岁。
冠状动脉硬化性心脏病，期前收缩，心房纤颤二年多。医生先予西药治之一年多效果不明显，又改请中医以炙甘草汤加减治之约半年多仍不见改善，又易医以养心安神，补气养血加苦参治之仍无功。仔细审查其症状，除心前区憋闷，心悸之外，还见头晕心烦，时时叹气，舌苔白，脉弦滑结代而微沉。想到弦脉者是肝胆之脉，滑脉者是痰热，结者是郁结之证，代者是脏气衰也。综合脉证论之，乃是肝郁气结，痰热不化，脏气衰败也。治拟疏肝理气，益气化痰。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜五片，大枣五个，瓜蒌18克。
服用五剂药后，各种症状俱减，继服上方五十剂，各种症状消失，心电图正常，痊愈。
贺××，女，35岁。
阵发性心动过速四年多。医生先用西药治疗二年多不效，后又改用中药养心安神之剂五百余付，始终不够理想。询问其脉证，说：心悸呈阵发性，开始时每月发作两到三次，最近发作尤其频繁，几乎每天发作一次。发作之始，先感心烦，继而逆气上冲，冲至心胸则心跳难忍，冲至咽喉、颈部则憋闷难于出气，冲至头则头晕汗出，汗出遍身之后即心悸好转，而全身却疲乏软弱；每次心跳发作，心率达一百到一百二十次／分，很少超过一百三十次/分，发作以后即迅速转为八十次／分左右。这种发作与情绪有很大关系，舌苔薄白，脉弦滑。综合脉证，思考：弦滑之脉有痰火郁结在肝胆也。又想到前用诸方之不效者，一以实作虚治，二以肝作心治之故也。于是拟定疏肝解郁，化痰泻火为方。处方：川芎10克，当归10克，黄芩10克，白芍10克，葛根15克，半夏10克，甘草10克，桑白皮15克。
服用十剂药后，各种症状果然减轻，继服二十剂，痊愈。
2．肝郁气结，上热下寒，水饮上冲，不去温下，但予泻火，寒饮反郁，病证不愈
王××，女，40岁
After taking four doses, symptoms such as headache, body pain, alternating chills and fever (alternating chills and fever), chest fullness and pain, and abdominal distension and pain all decreased. Body temperature dropped to 37.8°C, food intake slightly increased, and spirit improved. A certain doctor asked: Tuberculous pleurisy is called Xuan Yin (Hanging Fluid) in Traditional Chinese Medicine (TCM). Xuan Yin should be treated with purging methods, as Zhang Zhongjing stated in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): "For patients suffering from Xuan Yin, Shi Zao Tang (Ten Date Decoction) is the primary treatment." Why did you not use this formula? I replied: When pathogenic factors are bound in the Shaoyang (Lesser Yang) channel, reconciliation must be employed; this is the intent of Zhang Zhongjing. Furthermore, *Internal Medicine of TCM* also advocates that when pathogens invade the chest and lungs, presenting with alternating chills and fever, fluctuating fever, scanty sweating, or fever without aversion to cold, sweating but unresolved fever, cough with scanty sputum, shortness of breath, stabbing pain in the chest and hypochondrium exacerbated by breathing or turning, epigastric hardness, dry retching, bitter taste in the mouth, dry throat, thin white or yellow tongue coating, and wiry-rapid pulse, the treatment method is reconciliation and dispersion-promotion. The prescription is Chai Zhi Ban Xia Tang (Bupleurum, Citrus Aurantium, and Pinellia Decoction) modified. Since this case also presents with Taiyang (Greater Yang) and Yangming (Yang Brightness) symptoms, Shi Zao Tang was not used, but Da Yuan Yin (Origin-Reaching Drink) modified was chosen. After continuing to take sixteen doses, all symptoms disappeared. One month after stopping medication, the condition relapsed due to a common cold, and a small amount of pleural effusion appeared again on chest fluoroscopy. Carefully examining the symptoms, besides pleural effusion and chest pain, there were alternating chills and fever, cough with scanty sputum, shortness of breath, and stabbing pain in the chest and hypochondrium. Chai Zhi Ban Xia Tang (Bupleurum, Citrus Aurantium, and Pinellia Decoction) was prescribed modified. Prescription: Chai Hu (Bupleuri Radix) 15g, Huang Qin (Scutellariae Radix) 10g, Gua Lou (Trichosanthis Fructus) 15g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Zhi Ke (Aurantii Fructus Immaturus) 10g, Jie Geng (Platycodonis Radix) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Bai Jie Zi (Sinapis Semen) 6g, Sang Bai Pi (Mori Cortex) 10g.
After taking four doses, the effect was not significant. Re-examining the pulse, it was wiry-tight, and there was tenderness in the epigastrium. Considering the syndrome manifested as Yangming Fu-organ excess (Excess Syndrome of the Yangming Bowel), Da Yuan Yin (Origin-Reaching Drink) was prescribed modified: Hou Po (Magnoliae Officinalis Cortex) 10g, Cao Guo (Tsaoko Fructus) 10g, Bing Lang (Arecae Semen) 10g, Huang Qin (Scutellariae Radix) 10g, Zhi Mu (Anemarrhenae Rhizoma) 10g, Chang Pu (Acori Tatarinowii Rhizoma) 10g, Da Huang (Rhei Radix et Rhizoma) 4g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Gui Zhi (Cinnamomi Ramulus) 10g, Chai Hu (Bupleuri Radix) 10g, Bai Zhi (Angelicae Dahuricae Radix) 10g.
After taking two doses, various symptoms indeed decreased. Continuing for sixteen doses led to recovery.
4. Long-standing disease enters the collaterals; only removing fluid fails to resolve blood stasis in collaterals, so pathogens remain.
Patient Xing XX, Male, Adult.
Tuberculous exudative pleurisy for over seven months. After treatment with thoracentesis, anti-tuberculosis drugs, and hydrocortisone at a hospital, although pleural effusion significantly decreased, it had not completely absorbed until then. Thoracentesis was repeated repeatedly, but only small amounts of fluid could be drawn. Reluctantly, water-draining herbal medicine was used. After one week, symptoms still did not decrease. Careful examination revealed encapsulated pleural effusion, right-sided chest pain, slight shortness of breath, white tongue coating, and deep-wiry-choppy pulse. Synthesizing pulse and symptoms, the diagnosis was Liver-Lung Qi stagnation with coexisting Phlegm and Blood Stasis. Treatment aimed to soothe the Liver, regulate Qi, invigorate Blood, and transform Phlegm. Prescription: Chai Hu (Bupleuri Radix) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Zhi Ke (Aurantii Fructus Immaturus) 10g, Bai Jie Zi (Sinapis Semen) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Jiang Xiang (Dalbergiae Odoriferae Lignum) 10g, Xing Ren (Armeniacae Semen Amarum) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g.
After two doses, chest fullness, chest pain, and shortness of breath improved. After ten more doses, all symptoms disappeared, pleural effusion resolved, and recovery occurred.
A certain doctor asked: Why did encapsulated pleural effusion fail to heal despite repeated treatments, but heal quickly with Qi-regulating, Phlegm-transforming, and Blood-invigorating methods? I replied: A deep-wiry-choppy pulse indicates Qi stagnation, Blood stasis, and Cold coagulation. Such conditions require simultaneous Qi regulation, Blood invigoration, Meridian warming, and Fluid transformation to resolve. Hence, using these methods yielded rapid results.
Congestive Heart Failure
1. Shao Huo (Ministerial Fire) should be tonified, but instead Zhuang Huo (Flaming Fire) is aided, consuming Qi and damaging Zheng Qi, preventing Water-Qi transformation.
Patient Hao XX, Female, 36 years old.
Married at 21, shortly after marriage developed palpitations and shortness of breath, occasional hemoptysis. Diagnosed with Rheumatic Heart Disease, Mitral Stenosis, and Atrial Fibrillation at a certain hospital. Symptoms gradually improved after treatment. Over three years ago, after conceiving the second child, the condition suddenly worsened. Postpartum, it became even more severe with recurrent hemoptysis, leading to emergency surgery at a Beijing hospital. Although hemoptysis stopped post-surgery, Atrial Fibrillation, Heart Failure, shortness of breath, palpitations, edema, ascites, and oliguria appeared. Treatment with cardiac glycosides, anti-arrhythmics, diuretics, and antibiotics showed no improvement for about two years. The patient was referred to TCM. Examination revealed extreme dyspnea, inability to lie flat, palpitations, irritability, generalized edema, pleuroperitoneal effusion, cyanosis, dry mouth/thirst, purple-dark tongue body, scanty coating, fine-rapid-hurrying pulse, hot palms/soles but cold fingers/toes. Another doctor diagnosed Heart-Kidney Yin Deficiency and urgently prescribed Yin-nourishing and Heat-clearing herbs: Sheng Di (Rehmanniae Radix) 20g, Mai Dong (Ophiopogonis Tuber) 10g, Yuan Shen (Scrophulariae Radix) 15g, Shi Hu (Dendrobii Caulis) 15g, Gui Jia (Testudinis Carapax et Plastrum) 20g, Fu Ling (Poria) 10g, Zhi Mu (Anemarrhenae Rhizoma) 10g, Huang Bo (Phellodendri Cortex) 10g, Wu Wei Zi (Schisandrae Fructus) 10g.
Shortly after taking the first dose, the patient felt abdominal heaviness/distension, worsening shortness of breath, and episodes of confusion with delirious speech. Mr. Li Hanqing was urgently invited. He stated: This disease involves severe decline of Yin and Yang, being critical with deficiency of Zheng Qi and excess of Pathogens, making attack and tonification difficult. Without urgently rescuing Heart-Kidney Yang, the patient will not survive long. Urgent prescription: Fu Zi (Aconiti Lateralis Radix Preparata) 0.3g, Fu Ling (Poria) 1g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 0.3g, Bai Shao (Paeoniae Radix Alba) 3g, Ren Shen (Ginseng Radix) 1g, Xing Ren (Armeniacae Semen Amarum) 1g, Gui Zhi (Cinnamomi Ramulus) 1g.
Two hours after taking the medicine, shortness of breath and palpitations improved. Urination started one hour later, followed by four consecutive voids. On the next day's re-examination, the patient could lie flat to sleep, dyspnea improved significantly, and generalized edema/ascites reduced markedly. Following the principle of not changing effective formulas, three more doses were given. Edema completely resolved, appetite improved, and the patient could get out of bed. One doctor commented: For such a critical illness, using such a light dosage seems ineffective due to heavy disease and light medicine. An urgent stronger prescription was made: Fu Zi (Aconiti Lateralis Radix Preparata) 15g, Ren Shen (Ginseng Radix) 15g, Bai Shao (Paeoniae Radix Alba) 15g, Fu Ling (Poria) 30g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 20g, Sheng Di (Rehmanniae Radix) 15g, Mai Dong (Ophiopogonis Tuber) 15g, Wu Wei Zi (Schisandrae Fructus) 15g.
After one dose, the condition worsened again: oliguria, edema, and severe shortness of breath. Mr. Li Hanqing was consulted again. He cited the *Nei Jing*: "Zhuang Huo consumes Qi, Shao Huo generates Qi, Zhuang Huo scatters Qi." Small doses of Fu Zi generate Qi, large doses scatter Qi. Given the severity, only Qi generation is needed, not scattering. Further scattering would lead to separation of Yin and Yang. Revised prescription: Fu Zi (Aconiti Lateralis Radix Preparata) 0.1g, Fu Ling (Poria) 1g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1g, Bai Shao (Paeoniae Radix Alba) 1g, Sheng Jiang (Zingiberis Rhizoma Recens) 1 small slice, Ren Shen (Ginseng Radix) 1g, Xing Ren (Armeniacae Semen Amarum) 1g.
On the next day's re-examination, the condition improved greatly.
2. Clinging to astringency without adapting to the syndrome leads to error.
Patient Gao XX, Male, 30 years old.
Rheumatic Heart Disease, Mitral Stenosis and Insufficiency, Atrial Fibrillation, Heart Failure. After hospital treatment, palpitations, shortness of breath, and orthopnea improved significantly, but abdominal distension, ascites, edema, and oliguria persisted. A doctor was invited to treat with Qi-regulating water-moving and Yang-warming water-promoting herbs. After several doses, distension and edema reduced, and spirit improved. However, by the tenth dose, symptoms worsened. Despite 200 doses, no further improvement occurred. Careful examination revealed distended abdomen with visible veins and protruding umbilicus, lower limb edema, shortness of breath, palpitations, thirst with desire to drink, emaciation with dry skin, generalized purple-dark complexion (especially tongue, lips, fingers), shortness of breath upon slight exertion, yellowish-white greasy tongue coating, and deep-slippery-rapid-hurrying-interrupted pulse. Analysis: Deep pulse indicates Qi depression; Slippery indicates Phlegm-Heat; Hurrying indicates severe Yang deficiency; Interrupted indicates Qi stagnation and Blood stasis. Combined with symptoms, the root is severe Qi and Blood deficiency, while the branch is Qi stagnation, Blood stasis, and failure of Water-Dampness transformation. Treatment aimed to tonify Qi and Blood for the root, and regulate Qi, invigorate Blood, promote urination, and remove Dampness for the branch. Prescription: Huang Qi (Astragali Radix) 30g, Ren Shen (Ginseng Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Huang Jing (Polygonati Rhizoma) 10g, Sheng Di (Rehmanniae Radix) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Qing Pi (Citri Reticulatae Pericarpium Viride) 10g, Cang Zhu (Atractylodis Rhizoma) 15g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Chai Hu (Bupleuri Radix) 10g, San Leng (Sparganii Rhizoma) 10g, E Zhu (Curcumae Rhizoma) 10g, Bo He (Menthae Haplocalycis Herba) 3g, Ye Jiao Teng (Polygoni Multiflori Caulis) 30g, Lai Fu Zi (Radish Seed) 10g, Sha Ren (Amomi Fructus Rotundus) 10g, Fang Ji (Stephaniae Tetrandrae Radix) 15g, Da Fu Pi (Arecae Pericarpium) 10g.
Another doctor asked: In your article on Zhen Wu Tang (True Warrior Decoction), you stated it has excellent effects for Heart Failure due to its Yang-warming and water-promoting properties. I have seen this clinically too. Why was this formula not used here? And why did my initial treatment show some effect but later worsen the condition? I replied: Zhen Wu Tang is indeed excellent for Heart Failure caused by Heart-Kidney Yang Deficiency with internal retention of Water-Fluid, acknowledged by many physicians. However, it is not the only remedy for all Heart Failure. Other causes of Heart Failure, not involving Heart-Kidney Yang Deficiency and Water retention, will naturally not respond. The initial effectiveness might have been because the condition was initially Heart-Kidney Yang Deficiency with Water retention, which later transformed into other syndromes. Currently, the pulse and symptoms indicate severe Qi/Blood deficiency as the root, and Qi stagnation/Blood stasis/Water retention as the branch. Therefore, Ren Shen, Huang Qi, Bai Zhu, Dang Gui, Huang Jing, and Sheng Di were used to strongly tonify Qi and Blood; Chai Hu, San Leng, E Zhu, Bo He, Qing Pi, Chen Pi, and Dan Shen to regulate Qi and invigorate Blood; Cang Zhu, Bai Zhu, Chen Pi, Sha Ren, Lai Fu Zi, Fang Ji, and Da Fu Pi to promote urination and transform fluids.
After one dose, abdominal distension, edema, palpitations, and shortness of breath decreased. After ten more doses, symptoms greatly reduced, and appetite/spirit increased significantly. After thirty more doses of the same formula, ascites completely resolved, spirit doubled, and outdoor activity became possible. The previous doctor remarked: Zhang Zhongjing's principle of observing pulse and symptoms, identifying deviations, and treating according to the syndrome is indeed the general law for all diseases. My failure to achieve efficacy lay in ignoring this.
Sinus Arrhythmia
1. Pathogen in the Liver, but treated from the Heart; different locations make efficacy difficult.
Patient Zhen XX, Male, 45 years old.
Chest/hypochondriac fullness, irritability, and palpitations for over two years. Diagnosed with Sinus Arrhythmia. Western medicine treatment for over a year failed. Combined with TCM methods like calming the Heart and nourishing Spirit, and invigorating Blood and resolving stasis for 7-8 months, still ineffective. Careful examination revealed chest/hypochondriac distress, irritability, palpitations, dizziness, headache, poor appetite, summer palm heat but no winter heat, white tongue coating, and wiry-fine-interrupted-choppy pulse. Analysis: Wiry pulse belongs to the Liver; Fine indicates Blood deficiency; Interrupted indicates Stasis/Stagnation; Choppy indicates Cold/Stagnation. Combined with symptoms, this is Liver Qi Stagnation and Blood Deficiency. Treatment aimed to nourish Blood and soothe the Liver. Prescription: Chai Hu (Bupleuri Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Bo He (Menthae Haplocalycis Herba) 30g, Fu Ling (Poria) 10g, Qing Pi (Citri Reticulatae Pericarpium Viride) 10g.
After two doses, symptoms greatly decreased. After twenty more doses, all symptoms vanished, and recovery occurred.
Another doctor asked: Why treat the Liver for Heart Disease? I replied: Both pulse and symptoms indicate Liver pathology, so treatment focuses on the Liver. The Heart symptoms are caused by the Liver; thus, treating the Liver cures the Heart disease. Previous doctors repeatedly used Heart-calming formulas without success, proving that treating from the Heart is incorrect.
2. Pathogen in the Liver, but treated with clearing Heart and draining Fire; different locations prevent efficacy.
Patient Shao XX, Female, 28 years old.
Irritability, palpitations, sudden severe heartbeat sensations, and occasional pauses for over three years. Diagnosed with Sinus Tachycardia. Western medicine for one year failed. Combined with TCM calming Heart, nourishing Spirit, and draining Fire for over a year, also ineffective. Careful examination revealed irritability, palpitations, dizziness, headache, irritability/easily angered, chest/hypochondriac distress, intermittent wandering pain, irregular menstruation, exacerbated palpitations/irritability pre-menstrually, white tongue coating, and wiry-fine-rapid pulse. Analysis: Wiry-fine pulse indicates Liver Stagnation and Blood Deficiency; Rapid indicates Heat. Synthesis: Liver Stagnation and Blood Deficiency transforming into Heat. Previous failure of Heart-calming/drain-fire methods resulted from confusing the root (Liver) with the branch (Heart). Treatment aimed to nourish Blood, soothe the Liver, and drain Fire. Prescription: Chai Hu (Bupleuri Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Fu Ling (Poria) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Bo He (Menthae Haplocalycis Herba) 3g, Mu Dan Pi (Moutan Cortex) 10g, Zhi Zi (Gardeniae Fructus) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g.
With all other medications stopped, the above prescription was taken for four doses. One month later, re-examination showed that daily palpitations/irritability had ceased since the four doses, with no other meds taken. Yesterday, mild recurrence occurred, less severe than before. Continuing for twenty doses led to cure.
Premature Beats
1. Repetitive and conflicting medications make determining correctness difficult.
Patient Chen XX, Female, 45 years old.
Insomnia, forgetfulness, chest fullness, irritability, and occasional sweating for over three years. Diagnosed with Neurosis, AV Block, and Premature Contractions. Western medicine for over a year was ineffective. Combined with TCM soothing Liver/regulating Qi, nourishing Blood/soothing Liver, calming Heart/nourishing Spirit, plus massage, Qigong, and acupuncture for 7-8 months, no obvious improvement. Especially in the last 8-9 months, chest fullness/pain, irritability, and palpitations worsened. Frequent sensation of rising heat: reaching the heart/chest causes palpitations; reaching the throat causes obstruction and extreme dyspnea; reaching the head causes dizziness/fullness, whole-body sweating, followed by weakness making movement difficult. Long-term inability to work. Pulse analysis: Soft-slow with intermittent Slippery-Choppy-Interrupted qualities; thin white tongue coating. Analysis: Long-standing disease with soft-slow pulse indicates Qi-Yin Deficiency and Phlegm-Qi Knotting. Slippery, Choppy, and Interrupted qualities together indicate coexisting Phlegm and Stagnation. Diagnosis: Qi-Yin Deficiency with Phlegm-Qi Knotting. Treatment aimed to tonify Qi and nourish Yin while regulating Qi and transforming Phlegm. Prescription: Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 6g, Mai Dong (Ophiopogonis Tuber) 10g, Ren Shen (Ginseng Radix) 10g, Wu Wei Zi (Schisandrae Fructus) 10g, Zhu Ru (Bambusae Caulis in Taenia) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Fu Ling (Poria) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Chang Pu (Acori Tatarinowii Rhizoma) 10g, Sheng Di (Rehmanniae Radix) 10g, Yuan Zhi (Polygalae Radix) 10g.
After six doses, symptoms did not decrease. Considering the prescription matched the syndrome based on experience, why was it ineffective? I reasoned that public healthcare patients often use mixed medications (Chinese/Western, pills/decoctions). Even Chinese prescriptions emphasize compatibility (mutual enhancement/reduction, mutual opposition/fear). With such complex usage, surely there are opposing interactions? I instructed the patient to stop all other Chinese and Western medicines and take only the above decoction for four doses to observe effects.
After four continuous doses, symptoms decreased. The patient reported: Initially confused by Dr. Zhu's instruction to stop other meds, I took the decoction and continued Western/pill meds. However, family members intervened, stopping them for two days. Unexpectedly, stopping Western/pill meds led to significant improvement. Taking two more doses increased efficacy. After forty doses, all symptoms disappeared, and work resumed.
2. Clinging to Fu Mai Tang (Restore the Pulse Decoction) without distinguishing concurrent syndromes leads to prolonged ineffectiveness.
Patient Wang XX, Female, 50 years old.
Coronary Atherosclerotic Heart Disease, Premature Contractions, Atrial Fibrillation for over two years. Western medicine for over a year was ineffective. TCM treatment with Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) modified for half a year showed no improvement. Another doctor used Heart-calming/Qi-Blood tonifying plus Ku Shen (Sophorae Flavescentis Radix) without success. Careful examination revealed precordial oppression, palpitations, dizziness, irritability, frequent sighing, white tongue coating, and wiry-slippery-interrupted-replaced-micro-deep pulse. Analysis: Wiry pulse indicates Liver/Gallbladder; Slippery indicates Phlegm-Heat; Interrupted indicates Knotting/Stagnation; Replaced indicates Organ Qi Decline. Synthesis: Liver Qi Stagnation, untransformed Phlegm-Heat, and declining Organ Qi. Treatment aimed to soothe the Liver, regulate Qi, tonify Qi, and transform Phlegm. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Huang Qin (Scutellariae Radix) 10g, Ren Shen (Ginseng Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 5 slices, Da Zao (Jujubae Fructus) 5 pieces, Gua Lou (Trichosanthis Fructus) 18g.
After five doses, symptoms decreased. After fifty more doses, symptoms vanished, ECG normalized, and recovery occurred.
Paroxysmal Tachycardia
1. Phlegm-Fire Knotting, but calming the Spirit is used; treating Liver as Heart, tonifying Phlegm-Fire, ultimately incorrect.
Patient He XX, Female, 35 years old.
Paroxysmal Tachycardia for over four years. Western medicine for over two years failed. Over 500 doses of Heart-calming THERAPY were ineffective. Pulse/Symptom inquiry: Paroxysmal palpitations, initially 2-3 times/month, recently almost daily. Onset: Irritability, then rebellious Qi rushing up. Reaching heart/chest: unbearable heartbeat; reaching throat/neck: suffocation; reaching head: dizziness/sweating. After whole-body sweating, palpitations improve, but exhaustion ensues. Heart rate during attacks: 100-120 bpm, rarely >130 bpm; rapidly returns to ~80 bpm post-attack. Strongly related to emotions. Thin white tongue coating, wiry-slippery pulse. Analysis: Wiry-slippery pulse indicates Phlegm-Fire knotting in Liver/Gallbladder. Previous failures resulted from treating Excess as Deficiency and treating Liver as Heart. Treatment aimed to soothe the Liver, resolve stagnation, transform Phlegm, and drain Fire. Prescription: Chuan Xiong (Ligustici Chuanxiong Rhizoma) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Huang Qin (Scutellariae Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Ge Gen (Puerariae Lobatae Radix) 15g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sang Bai Pi (Mori Cortex) 15g.
After ten doses, symptoms decreased. After twenty more doses, cured.
2. Liver Stagnation and Qi Knotting, Upper Heat Lower Cold, Water-Fluid Rushing Up; failing to warm the Lower and only draining Fire causes Cold-Fluid stagnation and non-resolution.
Patient Wang XX, Female, 40 years old