阵发性心跳难忍3—4年。医诊阵发性心动过速。医先以西药治疗2年多不效，继又配合中药养心安神，疏肝泻火等治疗1年多仍不效。细审其证：心跳每呈阵发性，每次发病，先感脘腹悸动，继而热气上冲，冲至胸则胸满心悸不已，冲至咽喉则发憋而呼吸困难，冲至头则头胀头痛，烦乱不安，继而全身汗出，汗出之后，心悸，胸满，呼吸困难消失。开始发病时1个月发作仅1—2次，其后逐渐频繁，现在平均1日发作1～2次，每次少则几秒钟，多则1分钟。即使不发作，也经常感到头晕头痛，烦躁易怒，口苦咽干，白带多或阴痒，舌苔黄白，脉弦紧而涩。因思：弦脉者肝脉也，紧者寒湿互结也，涩者寒也滞也。综合脉证，乃肝郁气结，痰湿阻滞，上热下寒，水气上冲之证。拟用疏肝解郁，温阳化饮，清上温下，化饮降冲。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草10克，生姜3片，大枣5个，桂枝12克，茯苓15克，熟军3克，白术10克，龙骨15克，牡蛎15克。
服药6剂，诸证消减近半。又服10剂，诸证消失。
某医云：既为肝郁、痰滞之证，何用奔豚汤、柴胡枳桔汤等不效，今用柴胡加龙骨牡蛎汤反效也?答曰：柴胡枳桔汤、奔豚汤用于痰热脉滑者固为效方，然本证为上热下寒证，若但用疏肝化痰泻火则下寒不温，故今用柴胡加龙骨牡蛎汤。且本方含芩桂术甘汤，苓桂甘枣、茯苓甘草汤意，故治之得效也。
3．病在肾，治在心，本末未明，故治有误
赵××，女，30岁。
阵发性心跳过速，每日2—3次，3年多。医诊阵发性心动过速。医以西药治疗1年多不效，又以中药养心安神、平肝泻心火之法治疗近2年仍不效。邀余诊视，予柴胡加龙牡、奔豚、桂枝加桂汤约1月，俱不效。细询其证，除阵发性心悸每日1～2次，每次约1分钟外，并见其脉弦细而尺大，发病时脉弱而数尺脉弦。因思脉弦细者阴阳俱虚也，尺脉大者肾虚也，尺脉大而弦者肾阳不足寒水搏击也。前方之用柴胡加龙骨牡蛎、奔豚汤皆从肝治而未及病之所在也。因拟温-肾阳，化寒水。处方：山药10克，生地15克，山萸肉10克，茯苓10克，泽泻10克，丹皮10克，麦冬10克，白芍10克，附子10克，肉桂10克。
服药2剂，心悸1月未发，继服10剂，愈。
心房颤动
1.胶于活血，泥于补气，拘于瓜蒌，终归不解
吴××，男，6l岁。
胸满心悸1年多。医诊冠状动脉硬化性心脏病、心房纤颤。先用西药治疗半年多无效，后又以中药活血逐瘀、复脉、，补气养血、宽胸通阳等法治疗7个多月无效。尤其是近2个月来，心悸胸满特别严重，虽多次采用同步直流电转复亦未解决问题。细审其证，胸满心悸，时时逆气上冲，冲则心悸惊恐更甚，且时时汗出，脘腹悸动，舌苔白，脉弦细涩时见结促而紧。综合脉证，思之：脉沉弦细涩者，阳虚水饮上冲也。结促而紧者，亦寒甚阳气不足也。且脉见沉，沉者郁也。合之于证，乃阳虚气郁，逆气上冲，治宜理气通阳降冲。处方：人参10克，乌药10克，焦槟榔10克，沉香10克。
服药4剂，逆气上冲，心悸胸满俱大减，加肉桂4克，服药10剂，果愈。
某医云：此严氏治七情气逆之四磨汤也，为何用其治冠心病、心房纤颤?答曰：中医治病在辨证论治，此证逆气上冲，冲则心悸汗出乃中医所述之郁证、奔豚也。郁证者，自然当予理气，故予四磨汤治之。
2．泥于活血，滞于通阳，不予辨证，难于奏效
芦××，女，50岁。
3个月前，突患左侧面神经炎，虽用针灸、理疗、中药牵正之类不见好转。1个月前，又突感腹部悸动，逆气上冲，心悸气短，自汗时出，疲乏无力。经动态心电图、心电图、超声心动图等多项检查，诊为冠心病、心房纤颤、心室颤动。用西药、中药、同步直流电转复均无效。细审其证，既惊且恐，心悸频作，腹部悸动，逆气上冲，冲至胸则胸满心悸，冲至咽喉则憋闷气短，冲至头则头晕汗出，舌苔白，脉沉细弦涩。综合脉证，诊为阳虚为本，痰郁气结为标。治拟补气温阳以培本，温阳化饮降冲以治标。处方：人参10克，肉桂10克，半夏10克，炙草10克，茯苓10克。
服药2剂，诸证均减，继服20剂，诸证消失，心电图、动态心电图均正常。
某医云：此乃局方四七汤也。四七汤者，治七情所致之病方也，今心房颤动竟亦用之，吾不解也?答曰：汪昂《汤头歌诀》云：“人参补气，官桂平肝，半夏祛痰，甘草和中，并不用利气之药，汤名四七者，以四味治七情也。”本证素有气虚，痰饮，今复因气郁，故病作，所以用人参补气、肉桂平肝、半夏祛痰，甘草和中以治之也。
3．胶于养心安神，拘于宽胸通阳，不审脉证，不别兼证，其病不治
麻××，男，67岁
冠心病、心房纤颤7年多。先用西药治疗不效，后又配合中药养心安神、活血通脉、宽胸通阳等治疗3年多亦无明显效果。细审其证，心悸心烦，时时心跳有暂停之感，胸满，心前区时时刺痛，舌苔薄白，舌质微暗，脉虚弦涩结或结促兼见。综合脉证，诊为气血俱虚为本，气滞血瘀，湿郁不化为标。治拟补气养血以培本，理气活血，燥湿健脾以治标。处方：黄芪30克，当归10克，丹参30克，党参10克，黄精10克，生地10克，苍术15克，白术10克，青皮10克，陈皮10克，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克。
服药6剂，心悸胸满明显好转，继服18剂，诸证消失，为巩固疗效，又服18剂，诸证未作，心电图复查3次正常。
某医问：心悸为心病自当从心治，然用补心之药却无效何也?答曰：心悸一证，有心中悸、心下悸、脐下悸之别，本证之悸为胸部偏左之悸，为肝邪犯心之悸，故治之宜从肝，而不从心，前方之治心不愈者，即在此也。
4．胶于治心，泥于病名，不从辨证，其证难效
似××，男，40岁。
心悸心烦2年多。医诊心肌炎、心房纤颤。前后住院1年多，除西药外，仅只应用复脉汤、补心丹加减方即达400余剂，然始终不见效果。细审其证，胸满胸痛，头晕心烦，心悸乏力，手心热，舌苔白，脉弦细结涩或促结并见。综合脉证，思之：此肝郁血虚证也。治宜养血疏肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜3片，薄荷3克，丹参15克。
服药4剂，胸满心悸好转，但却发现胃脘痞满不适，于是加檀香10克、砂仁10克。
服药30剂，诸证消失，心电图连查3次，俱正常。
某医问：此逍遥散方也，何用于心脏病反效也?答曰：本证之脉、症均系肝郁血虚证，故以此方治之。至于为什么不用心药、心方，乃其脉为肝脉、心悸之部位为肝位，而非心位，故不用心药、心方也。
5．不审气血，不审寒热，不审本末，徒治其心，其病难治
程××，女，62岁。
心悸心烦3年多。医诊冠心病、心房纤颤、左束支传导阻滞。先用西药治疗2年不效，继又配合中药活血通阳、益气养阴等剂治疗1年多亦不效。细审其证，胸满胸痛，心悸气短，时时逆气上冲，身热汗出，失眠纳呆，舌苔薄白，脉弦紧结涩。综合脉证，诊为肝郁气结，心阳不振，水饮上冲之证。拟用疏肝理气，温阳化水，降冲定悸。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，茯苓10克，桂枝15克，生姜3片，大枣5个，龙骨15克，牡蛎15克，大黄3克。
服药6剂，心烦心悸，胸满胸痛，失眠等证均减，继服18剂，诸证消失，心电图复查4次均正常。
某医问：柴胡加龙骨牡蛎汤仲景方也，其用于心烦易惊尚可，何用于心脏病?答曰：柴胡加龙骨牡蛎汤者，一疏肝，二温阳，三化水，四镇惊，故用之效也。
房室传导阻滞
不知本末，但知治心，不从脉辨，但从症分，难于奏效
鲍××，男，29岁。
心烦心悸时作时止1年多。医诊房室传导阻滞、窦性心律不齐。先用西药治疗3—4个月不效，继又配合中药养心安神之剂治疗半年仍无功。细审其证，心悸心烦呈发作性，有时一天发作3～4次，有时数天才发作1次，每次发作之前，先突然心跳加快，数秒钟后，心跳突然暂停，其后才逐渐恢复正常，且平时经常感到胸胁苦满，头晕目眩，小腹不适，按之则悸动不已，口苦口干，舌苔白，脉弦涩不调。思之：脉弦者肝脉也；涩脉者寒也滞也。综合脉证，乃肝郁气结，心阳不振，水饮上冲也。证非病在心，乃肝邪犯心，水气冲心，不可治心，宜疏肝理气，温阳降冲。处方：柴胡10克，半夏10克，人参10克，黄芩10克，甘草10克，干姜3克，生姜3片，大枣5个，桂枝10克，茯苓10克。
在排除其他药物的情况下，服药2剂，诸证大减，宗效不更方之旨，又服上药20剂，诸证消失，果愈。
心室内传导阻滞胶于经验，因循守旧，不知随证，延误病期李××，男，45岁。
1年前，因心肌炎、完全性左束支传导阻滞，予中药清暑益气汤10剂，心电图恢复正常，症状完全消失。今年感冒后，又突发心肌炎、Ⅱ度左束支传导阻滞。急予清暑益气汤3剂，不效，又与4剂，仍不效，且有加重之势，心电图发现有Ⅲ度左束支传导阻滞，并日渐感到烦躁易怒，头晕脑胀，失眠，胸满胸痛，身烦热。细察其脉弦大而数，舌质红，苔黄。因思清暑益气汤者补气养阴，解表除湿，清热之方也，其用于脉弦大紧数者固为有效，其用于肝胆实火者则不可，肝胆实火者应予龙胆泻肝、当归龙荟、泻青丸之属，清暑益气汤实误也。又思龙胆泻肝汤用于兼有尿黄赤者尤良，当归龙荟、泻青丸适用于兼有便秘者，而本证大便不干而小便反赤，乃处龙胆泻肝汤。处方：龙胆草10克，栀子10克，黄芩10克，柴胡10克，生地10克，车前子10克，泽泻10克，木通10克，甘草10克，当归10克。
服药2剂，诸证均减，惟仍心烦失眠，舌苔黄，脉弦数。宗效不更方意，又思舌苔黄，胃家有热者，酌加芦荟4克，青皮10克，赤芍10克。
服药2剂，睡眠大增，心烦胸满骤减，24小时动态心电图观察无异常。继服7剂，诸证均失，愈。
某医问：老师本病为何始用清暑益气，后用龙胆泻肝?答曰：清暑益气治束支传导阻滞为过去屡试屡验之方，今用于本患者乃根据不成熟的经验而用之，及至碰钉子以后，始忆仲景之训，乃遵其观其脉证，随证治之，改用龙胆泻肝汤，药后果然效如桴鼓，实乃教训也。
窦房结阻滞
1．脾肾阳虚，湿浊不化，但予补气，不去温阳化湿，其病不愈
鄂××，男，45岁。
半个月以前，在院中站立说话时，突然感到心中空虚，极度疲乏软弱，头晕不能站立而摔倒在地，经过抢救神志才逐渐清醒，当时并没有引起大的注意，数天后又如此发作1次，清醒后仍一直头晕不能站立，软弱乏力，四肢厥冷，脉搏才1分钟2～5次，有时甚至长时间不见跳动1次。某医诊为气虚所致，予大剂独参汤治之不效，乃转至某院进行治疗。心电图明显异常，诊为窦房结暂停。因该院抢救措施较差，要求其再转院治疗。但患者及其家属反复要求，不得不请中医会诊。审其精神疲惫，头晕不能站坐，肢冷，脉迟缓而微紧。综合脉证，思之：脉迟缓者，脾肾阳虚不能温煦头目，湿浊不化也，治宜温脾肾化寒湿可也。又思《金匮》“近效方术附汤，治风虚头重眩，苦极，不知食味，暖肌补中，益精气。”因予术附汤。处方：附子10克，白术10克，生姜3片，大枣5枚，炙甘草10克。
服药1剂，头晕乏力好转，精神增加；继服6剂，头晕乏力消失，脉由每分钟5次增至65次。为了进一步确诊，又至上一级医院进一步检查，心电图连续3次均正常。
2．气阴俱虚，痰湿内郁，反予温阳除湿，其病不愈
邵××，女，54岁。
3天前，正在工作过程中，突然感到头晕目眩，软弱乏力而晕倒在地，不久即完全清醒，但清醒后仍然感到极度乏力，头晕目眩，次日又连续晕倒，神志不清2次。乃急至某院检查治疗，确诊为窦房结暂停。要求住院治疗。然因各种原因不能住院，邀中医以中药试之。察其除上证外，并见其数日失眠心悸，烦躁易怒，咽喉干而有异物阻塞感，舌苔白，脉濡弱迟缓。再询其进药否?答曰：除西药外，并曾服人参四逆汤，但服药后反觉更加头晕不适。综合脉证，思之：此乃气阴两虚，痰郁气结之证，而非阳虚也。乃予补气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，甘草10克，菖蒲10克，远志10克，生地10克。
药进1小时后，精神好转，头晕减轻，服药3剂后，诸证大减，精神倍增，继服30剂，愈。
预激综合征
1．胶于西医病名，不遵中医辨证，病在肝而治心，其病难愈
何××，男，45岁。
阵发性心跳难忍3—4年。医诊阵发性心动过速。医先以西药治疗2年多不效，继又配合中药养心安神，疏肝泻火等治疗1年多仍不效。细审其证：心跳每呈阵发性，每次发病，先感脘腹悸动，继而热气上冲，冲至胸则胸满心悸不已，冲至咽喉则发憋而呼吸困难，冲至头则头胀头痛，烦乱不安，继而全身汗出，汗出之后，心悸，胸满，呼吸困难消失。开始发病时1个月发作仅1—2次，其后逐渐频繁，现在平均1日发作1～2次，每次少则几秒钟，多则1分钟。即使不发作，也经常感到头晕头痛，烦躁易怒，口苦咽干，白带多或阴痒，舌苔黄白，脉弦紧而涩。因思：弦脉者肝脉也，紧者寒湿互结也，涩者寒也滞也。综合脉证，乃肝郁气结，痰湿阻滞，上热下寒，水气上冲之证。拟用疏肝解郁，温阳化饮，清上温下，化饮降冲。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草10克，生姜3片，大枣5个，桂枝12克，茯苓15克，熟军3克，白术10克，龙骨15克，牡蛎15克。
服药6剂，诸证消减近半。又服10剂，诸证消失。
某医云：既为肝郁、痰滞之证，何用奔豚汤、柴胡枳桔汤等不效，今用柴胡加龙骨牡蛎汤反效也?答曰：柴胡枳桔汤、奔豚汤用于痰热脉滑者固为效方，然本证为上热下寒证，若但用疏肝化痰泻火则下寒不温，故今用柴胡加龙骨牡蛎汤。且本方含芩桂术甘汤，苓桂甘枣、茯苓甘草汤意，故治之得效也。
3．病在肾，治在心，本末未明，故治有误
赵××，女，30岁。
阵发性心跳过速，每日2—3次，3年多。医诊阵发性心动过速。医以西药治疗1年多不效，又以中药养心安神、平肝泻心火之法治疗近2年仍不效。邀余诊视，予柴胡加龙牡、奔豚、桂枝加桂汤约1月，俱不效。细询其证，除阵发性心悸每日1～2次，每次约1分钟外，并见其脉弦细而尺大，发病时脉弱而数尺脉弦。因思脉弦细者阴阳俱虚也，尺脉大者肾虚也，尺脉大而弦者肾阳不足寒水搏击也。前方之用柴胡加龙骨牡蛎、奔豚汤皆从肝治而未及病之所在也。因拟温-肾阳，化寒水。处方：山药10克，生地15克，山萸肉10克，茯苓10克，泽泻10克，丹皮10克，麦冬10克，白芍10克，附子10克，肉桂10克。
服药2剂，心悸1月未发，继服10剂，愈。
心房颤动
1.胶于活血，泥于补气，拘于瓜蒌，终归不解
吴××，男，6l岁。
胸满心悸1年多。医诊冠状动脉硬化性心脏病、心房纤颤。先用西药治疗半年多无效，后又以中药活血逐瘀、复脉、，补气养血、宽胸通阳等法治疗7个多月无效。尤其是近2个月来，心悸胸满特别严重，虽多次采用同步直流电转复亦未解决问题。细审其证，胸满心悸，时时逆气上冲，冲则心悸惊恐更甚，且时时汗出，脘腹悸动，舌苔白，脉弦细涩时见结促而紧。综合脉证，思之：脉沉弦细涩者，阳虚水饮上冲也。结促而紧者，亦寒甚阳气不足也。且脉见沉，沉者郁也。合之于证，乃阳虚气郁，逆气上冲，治宜理气通阳降冲。处方：人参10克，乌药10克，焦槟榔10克，沉香10克。
服药4剂，逆气上冲，心悸胸满俱大减，加肉桂4克，服药10剂，果愈。
某医云：此严氏治七情气逆之四磨汤也，为何用其治冠心病、心房纤颤?答曰：中医治病在辨证论治，此证逆气上冲，冲则心悸汗出乃中医所述之郁证、奔豚也。郁证者，自然当予理气，故予四磨汤治之。
2．泥于活血，滞于通阳，不予辨证，难于奏效
芦××，女，50岁。
3个月前，突患左侧面神经炎，虽用针灸、理疗、中药牵正之类不见好转。1个月前，又突感腹部悸动，逆气上冲，心悸气短，自汗时出，疲乏无力。经动态心电图、心电图、超声心动图等多项检查，诊为冠心病、心房纤颤、心室颤动。用西药、中药、同步直流电转复均无效。细审其证，既惊且恐，心悸频作，腹部悸动，逆气上冲，冲至胸则胸满心悸，冲至咽喉则憋闷气短，冲至头则头晕汗出，舌苔白，脉沉细弦涩。综合脉证，诊为阳虚为本，痰郁气结为标。治拟补气温阳以培本，温阳化饮降冲以治标。处方：人参10克，肉桂10克，半夏10克，炙草10克，茯苓10克。
服药2剂，诸证均减，继服20剂，诸证消失，心电图、动态心电图均正常。
某医云：此乃局方四七汤也。四七汤者，治七情所致之病方也，今心房颤动竟亦用之，吾不解也?答曰：汪昂《汤头歌诀》云：“人参补气，官桂平肝，半夏祛痰，甘草和中，并不用利气之药，汤名四七者，以四味治七情也。”本证素有气虚，痰饮，今复因气郁，故病作，所以用人参补气、肉桂平肝、半夏祛痰，甘草和中以治之也。
3．胶于养心安神，拘于宽胸通阳，不审脉证，不别兼证，其病不治
麻××，男，67岁
冠心病、心房纤颤7年多。先用西药治疗不效，后又配合中药养心安神、活血通脉、宽胸通阳等治疗3年多亦无明显效果。细审其证，心悸心烦，时时心跳有暂停之感，胸满，心前区时时刺痛，舌苔薄白，舌质微暗，脉虚弦涩结或结促兼见。综合脉证，诊为气血俱虚为本，气滞血瘀，湿郁不化为标。治拟补气养血以培本，理气活血，燥湿健脾以治标。处方：黄芪30克，当归10克，丹参30克，党参10克，黄精10克，生地10克，苍术15克，白术10克，青皮10克，陈皮10克，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克。
服药6剂，心悸胸满明显好转，继服18剂，诸证消失，为巩固疗效，又服18剂，诸证未作，心电图复查3次正常。
某医问：心悸为心病自当从心治，然用补心之药却无效何也?答曰：心悸一证，有心中悸、心下悸、脐下悸之别，本证之悸为胸部偏左之悸，为肝邪犯心之悸，故治之宜从肝，而不从心，前方之治心不愈者，即在此也。
4．胶于治心，泥于病名，不从辨证，其证难效
似××，男，40岁。
心悸心烦2年多。医诊心肌炎、心房纤颤。前后住院1年多，除西药外，仅只应用复脉汤、补心丹加减方即达400余剂，然始终不见效果。细审其证，胸满胸痛，头晕心烦，心悸乏力，手心热，舌苔白，脉弦细结涩或促结并见。综合脉证，思之：此肝郁血虚证也。治宜养血疏肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜3片，薄荷3克，丹参15克。
服药4剂，胸满心悸好转，但却发现胃脘痞满不适，于是加檀香10克、砂仁10克。
服药30剂，诸证消失，心电图连查3次，俱正常。
某医问：此逍遥散方也，何用于心脏病反效也?答曰：本证之脉、症均系肝郁血虚证，故以此方治之。至于为什么不用心药、心方，乃其脉为肝脉、心悸之部位为肝位，而非心位，故不用心药、心方也。
5．不审气血，不审寒热，不审本末，徒治其心，其病难治
程××，女，62岁。
心悸心烦3年多。医诊冠心病、心房纤颤、左束支传导阻滞。先用西药治疗2年不效，继又配合中药活血通阳、益气养阴等剂治疗1年多亦不效。细审其证，胸满胸痛，心悸气短，时时逆气上冲，身热汗出，失眠纳呆，舌苔薄白，脉弦紧结涩。综合脉证，诊为肝郁气结，心阳不振，水饮上冲之证。拟用疏肝理气，温阳化水，降冲定悸。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，茯苓10克，桂枝15克，生姜3片，大枣5个，龙骨15克，牡蛎15克，大黄3克。
服药6剂，心烦心悸，胸满胸痛，失眠等证均减，继服18剂，诸证消失，心电图复查4次均正常。
某医问：柴胡加龙骨牡蛎汤仲景方也，其用于心烦易惊尚可，何用于心脏病?答曰：柴胡加龙骨牡蛎汤者，一疏肝，二温阳，三化水，四镇惊，故用之效也。
房室传导阻滞
不知本末，但知治心，不从脉辨，但从症分，难于奏效
鲍××，男，29岁。
心烦心悸时作时止1年多。医诊房室传导阻滞、窦性心律不齐。先用西药治疗3—4个月不效，继又配合中药养心安神之剂治疗半年仍无功。细审其证，心悸心烦呈发作性，有时一天发作3～4次，有时数天才发作1次，每次发作之前，先突然心跳加快，数秒钟后，心跳突然暂停，其后才逐渐恢复正常，且平时经常感到胸胁苦满，头晕目眩，小腹不适，按之则悸动不已，口苦口干，舌苔白，脉弦涩不调。思之：脉弦者肝脉也；涩脉者寒也滞也。综合脉证，乃肝郁气结，心阳不振，水饮上冲也。证非病在心，乃肝邪犯心，水气冲心，不可治心，宜疏肝理气，温阳降冲。处方：柴胡10克，半夏10克，人参10克，黄芩10克，甘草10克，干姜3克，生姜3片，大枣5个，桂枝10克，茯苓10克。
在排除其他药物的情况下，服药2剂，诸证大减，宗效不更方之旨，又服上药20剂，诸证消失，果愈。
心室内传导阻滞胶于经验，因循守旧，不知随证，延误病期李××，男，45岁。
1年前，因心肌炎、完全性左束支传导阻滞，予中药清暑益气汤10剂，心电图恢复正常，症状完全消失。今年感冒后，又突发心肌炎、Ⅱ度左束支传导阻滞。急予清暑益气汤3剂，不效，又与4剂，仍不效，且有加重之势，心电图发现有Ⅲ度左束支传导阻滞，并日渐感到烦躁易怒，头晕脑胀，失眠，胸满胸痛，身烦热。细察其脉弦大而数，舌质红，苔黄。因思清暑益气汤者补气养阴，解表除湿，清热之方也，其用于脉弦大紧数者固为有效，其用于肝胆实火者则不可，肝胆实火者应予龙胆泻肝、当归龙荟、泻青丸之属，清暑益气汤实误也。又思龙胆泻肝汤用于兼有尿黄赤者尤良，当归龙荟、泻青丸适用于兼有便秘者，而本证大便不干而小便反赤，乃处龙胆泻肝汤。处方：龙胆草10克，栀子10克，黄芩10克，柴胡10克，生地10克，车前子10克，泽泻10克，木通10克，甘草10克，当归10克。
服药2剂，诸证均减，惟仍心烦失眠，舌苔黄，脉弦数。宗效不更方意，又思舌苔黄，胃家有热者，酌加芦荟4克，青皮10克，赤芍10克。
服药2剂，睡眠大增，心烦胸满骤减，24小时动态心电图观察无异常。继服7剂，诸证均失，愈。
某医问：老师本病为何始用清暑益气，后用龙胆泻肝?答曰：清暑益气治束支传导阻滞为过去屡试屡验之方，今用于本患者乃根据不成熟的经验而用之，及至碰钉子以后，始忆仲景之训，乃遵其观其脉证，随证治之，改用龙胆泻肝汤，药后果然效如桴鼓，实乃教训也。
窦房结阻滞
1．脾肾阳虚，湿浊不化，但予补气，不去温阳化湿，其病不愈
鄂××，男，45岁。
半个月以前，在院中站立说话时，突然感到心中空虚，极度疲乏软弱，头晕不能站立而摔倒在地，经过抢救神志才逐渐清醒，当时并没有引起大的注意，数天后又如此发作1次，清醒后仍一直头晕不能站立，软弱乏力，四肢厥冷，脉搏才1分钟2～5次，有时甚至长时间不见跳动1次。某医诊为气虚所致，予大剂独参汤治之不效，乃转至某院进行治疗。心电图明显异常，诊为窦房结暂停。因该院抢救措施较差，要求其再转院治疗。但患者及其家属反复要求，不得不请中医会诊。审其精神疲惫，头晕不能站坐，肢冷，脉迟缓而微紧。综合脉证，思之：脉迟缓者，脾肾阳虚不能温煦头目，湿浊不化也，治宜温脾肾化寒湿可也。又思《金匮》“近效方术附汤，治风虚头重眩，苦极，不知食味，暖肌补中，益精气。”因予术附汤。处方：附子10克，白术10克，生姜3片，大枣5枚，炙甘草10克。
服药1剂，头晕乏力好转，精神增加；继服6剂，头晕乏力消失，脉由每分钟5次增至65次。为了进一步确诊，又至上一级医院进一步检查，心电图连续3次均正常。
2．气阴俱虚，痰湿内郁，反予温阳除湿，其病不愈
邵××，女，54岁。
3天前，正在工作过程中，突然感到头晕目眩，软弱乏力而晕倒在地，不久即完全清醒，但清醒后仍然感到极度乏力，头晕目眩，次日又连续晕倒，神志不清2次。乃急至某院检查治疗，确诊为窦房结暂停。要求住院治疗。然因各种原因不能住院，邀中医以中药试之。察其除上证外，并见其数日失眠心悸，烦躁易怒，咽喉干而有异物阻塞感，舌苔白，脉濡弱迟缓。再询其进药否?答曰：除西药外，并曾服人参四逆汤，但服药后反觉更加头晕不适。综合脉证，思之：此乃气阴两虚，痰郁气结之证，而非阳虚也。乃予补气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，甘草10克，菖蒲10克，远志10克，生地10克。
药进1小时后，精神好转，头晕减轻，服药3剂后，诸证大减，精神倍增，继服30剂，愈。
预激综合征
1．胶于西医病名，不遵中医辨证，病在肝而治心，其病难愈
何××，男，45岁。
Paroxysmal unbearable palpitations for 3–4 years. Diagnosed with paroxysmal tachycardia. The physician first treated with Western medicine for over 2 years without effect, then combined with Chinese medicine to nourish the heart and calm the spirit, soothe the liver and purge fire, etc., for over 1 year, still without effect. Carefully examining the syndrome: Palpitations occur paroxysmally. Each time an episode occurs, there is first a sensation of palpitation in the epigastrium and abdomen, followed by a rush of hot qi upward. When it rushes to the chest, there is chest fullness and incessant palpitations; when it rushes to the throat, there is suffocation and dyspnea; when it rushes to the head, there is head distension and headache, restlessness and unease. Subsequently, the whole body sweats. After sweating, palpitations, chest fullness, and dyspnea disappear. At the beginning of the illness, episodes occurred only 1–2 times per month, gradually becoming more frequent. Now, on average, there are 1–2 episodes per day, each lasting from a few seconds to 1 minute. Even when not having an episode, there is often dizziness and headache, irritability and anger, bitter taste in the mouth and dry throat, excessive leukorrhea or vaginal itching. The tongue coating is yellow and white; the pulse is wiry, tight, and choppy. Thinking thus: A wiry pulse indicates the liver pulse; a tight pulse indicates cold-dampness binding together; a choppy pulse indicates cold and stagnation. Synthesizing the pulse and symptoms, this is a syndrome of liver qi depression and knotting, phlegm-dampness obstruction, upper heat and lower cold, and water qi rushing upward. The treatment plan is to soothe the liver and relieve depression, warm yang and transform fluid retention, clear the upper and warm the lower, transform fluid retention and direct rebellious qi downward. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Huang Qin (Scutellariae Radix) 10g, Dang Shen (Codonopsis Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Gui Zhi (Cinnamomi Ramulus) 12g, Fu Ling (Poria) 15g, Shu Jun (Rhei Radix et Rhizoma Preparated) 3g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
After taking 6 doses, nearly half of the symptoms subsided. After another 10 doses, all symptoms disappeared.
A certain physician asked: Since this is a syndrome of liver depression and phlegm stagnation, why did Ben Tun Tang (Panic Disease Decoction) and Chai Hu Zhi Jie Tang (Bupleurum and Aurantium Decoction) fail, while Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell) was effective? I replied: Chai Hu Zhi Jie Tang and Ben Tun Tang are indeed effective formulas for phlegm-heat with a slippery pulse. However, this case is an upper-heat and lower-cold syndrome. If one only uses methods to soothe the liver, resolve phlegm, and purge fire, the lower cold will not be warmed. Therefore, Chai Hu Jia Long Gu Mu Li Tang was used. Moreover, this formula contains the essence of Qin Gui Zhu Gan Tang (Scutellaria, Cinnamon Twig, Atractylodes, and Licorice Decoction), Ling Gui Gan Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction), and Fu Ling Gan Cao Tang (Poria and Licorice Decoction). Hence, it was effective.
3. Disease in the Kidney, Treatment focused on the Heart: Failure to clarify root and branch leads to erroneous treatment.
Zhao XX, Female, 30 years old.
Paroxysmal tachycardia, 2–3 times daily, for over 3 years. Diagnosed with paroxysmal tachycardia. Treated with Western medicine for over 1 year without effect. Treated with Chinese medicine to nourish the heart, calm the spirit, level the liver, and purge heart fire for nearly 2 years, still without effect. Invited me to examine. Prescribed Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell), Ben Tun Tang (Panic Disease Decoction), and Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon Twig) for about 1 month, all without effect. Carefully inquiring into the syndrome: Besides paroxysmal palpitations occurring 1–2 times daily for about 1 minute each, the pulse was wiry and fine with a large chi (cun guan chi) position. During episodes, the pulse was weak and rapid, with the chi position being wiry. Thinking thus: A wiry and fine pulse indicates deficiency of both yin and yang. A large chi pulse indicates kidney deficiency. A large and wiry chi pulse indicates insufficient kidney yang and striking of cold water. The previous prescriptions of Chai Hu Jia Long Gu Mu Li Tang and Ben Tun Tang all treated from the liver perspective and did not reach the site of the disease. Therefore, the plan is to warm kidney yang and transform cold water. Prescription: Shan Yao (Dioscoreae Rhizoma) 10g, Sheng Di Huang (Rehmanniae Radix) 15g, Shan Zhu Yu (Corni Fructus) 10g, Fu Ling (Poria) 10g, Ze Xie (Alismatis Rhizoma) 10g, Dan Pi (Moutan Cortex) 10g, Mai Dong (Ophiopogonis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Fu Zi (Aconiti Lateralis Radix Preparata) 10g, Rou Gui (Cinnamomi Cortex) 10g.
After 2 doses, palpitations did not recur for a month. After continuing for 10 doses, cured.
Atrial Fibrillation
1. Adhering to blood-invigorating, stuck on qi-tonifying, constrained by Gua Lou, ultimately unresolved.
Wu XX, Male, 61 years old.
Chest fullness and palpitations for over 1 year. Diagnosed with Coronary Artherosclerotic Heart Disease and Atrial Fibrillation. Treated with Western medicine for over half a year without effect. Then treated with Chinese medicine methods such as invigorating blood and driving out stasis, restoring pulse, tonifying qi and nourishing blood, opening the chest and unblocking yang for over 7 months, also without effect. Especially in the last 2 months, palpitations and chest fullness were particularly severe. Although synchronized direct current cardioversion was used multiple times, the problem was not resolved. Carefully examining the syndrome: Chest fullness and palpitations, frequent upward rushing of rebellious qi. When it rushes, palpitations and fright increase significantly. There is also frequent sweating and palpitation in the epigastrium/abdomen. Tongue coating is white. Pulse is wiry, fine, and choppy, occasionally showing knotted (jie) and intermittent (cu) rhythms, and tight. Synthesizing pulse and symptoms: A deep, wiry, fine, and choppy pulse indicates yang deficiency with water-fluids rushing upward. Knotted, intermittent, and tight pulses indicate severe cold and insufficient yang qi. Furthermore, a deep pulse indicates depression/stagnation. Combined with the syndrome, this is yang deficiency with qi stagnation and rebellious qi rushing upward. Treatment should regulate qi, unblock yang, and direct rebellious qi downward. Prescription: Ren Shen (Ginseng Radix) 10g, Wu Yao (Linderae Radix) 10g, Jiao Bing Lang (Arecae Semen Preparatum) 10g, Chen Xiang (Aquilariae Lignum Resinatum) 10g.
After 4 doses, rebellious qi rushing upward, palpitations, and chest fullness decreased significantly. Added Rou Gui (Cinnamon Bark) 4g. After taking 10 doses, indeed cured.
A certain physician asked: This is Si Mo Tang (Four Grinds Decoction) by Yan Shi for treating seven emotions and rebellious qi. Why use it to treat Coronary Heart Disease and Atrial Fibrillation? I replied: Traditional Chinese Medicine treats based on syndrome differentiation. This syndrome of rebellious qi rushing upward, causing palpitations and sweating upon rushing, corresponds to the TCM concepts of Depression Syndrome (Yu Zheng) and Panic Disease (Ben Tun). For Depression Syndrome, regulating qi is naturally indicated. Thus, Si Mo Tang was used.
2. Stuck on blood-invigorating, hindered by unblocking yang, failing to differentiate syndromes makes efficacy difficult.
Lu XX, Female, 50 years old.
Three months ago, suddenly suffered from left facial neuritis. Despite acupuncture, physical therapy, and Chinese medicine like Qian Zheng San (Straightening Powder), there was no improvement. One month ago, suddenly felt abdominal palpitation, rebellious qi rushing upward, palpitations, shortness of breath, spontaneous sweating, fatigue, and weakness. After dynamic ECG, ECG, echocardiography, etc., diagnosed with Coronary Heart Disease, Atrial Fibrillation, Ventricular Fibrillation. Western medicine, Chinese medicine, and synchronized direct current cardioversion were all ineffective. Carefully examining the syndrome: Fearful and terrified, frequent palpitations, abdominal palpitation, rebellious qi rushing upward. When it rushes to the chest, there is chest fullness and palpitations; when it rushes to the throat, there is stifling and shortness of breath; when it rushes to the head, there is dizziness and sweating. Tongue coating is white. Pulse is deep, fine, wiry, and choppy. Synthesizing pulse and symptoms, diagnosed as Yang Deficiency as the root, Phlegm Depression and Qi Knotting as the branch. Treatment plan: Tonify qi and warm yang to nourish the root; warm yang, transform fluids, and direct rebellious qi downward to treat the branch. Prescription: Ren Shen (Ginseng Radix) 10g, Rou Gui (Cinnamon Bark) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Zhi Gan Cao (Honey-fried Licorice Root and Rhizome) 10g, Fu Ling (Poria) 10g.
After 2 doses, all symptoms decreased. Continuing for 20 doses, all symptoms disappeared. ECG and dynamic ECG were normal.
A certain physician asked: This is Ju Fang Si Qi Tang (Local Formula Four Seven Decoction). Si Qi Tang is a formula for diseases caused by seven emotions. How can it be used for Atrial Fibrillation? I do not understand. I replied: Wang Ang's "Tang Tou Ge Jue" (Song of Formulas) states: "Ren Shen tonifies qi, Guan Gui (official cinnamon) levels the liver, Ban Xia dispels phlegm, Gan Cao harmonizes the middle. It does not use qi-regulating herbs. The decoction is named Si Qi because four ingredients treat seven emotions." This patient has had chronic qi deficiency and phlegm-fluids. Now, due to qi depression, the disease manifested. Therefore, Ren Shen was used to tonify qi, Rou Gui to level the liver, Ban Xia to dispel phlegm, and Gan Cao to harmonize the middle.
3. Adhering to nourishing the heart and calming the spirit, constrained by opening the chest and unblocking yang, failing to examine pulse and syndrome, failing to distinguish concurrent syndromes, the disease cannot be cured.
Ma XX, Male, 67 years old.
Coronary Heart Disease and Atrial Fibrillation for over 7 years. Treated with Western medicine without effect. Then combined with Chinese medicine to nourish the heart, calm the spirit, invigorate blood, unblock vessels, open the chest, and unblock yang for over 3 years, also without obvious effect. Carefully examining the syndrome: Palpitations, vexation, occasional sensation of heartbeat pause, chest fullness, frequent stabbing pain in the precordial area. Tongue coating is thin and white, tongue body slightly dark. Pulse is deficient, wiry, choppy, knotted, or alternating knotted and intermittent. Synthesizing pulse and symptoms, diagnosed as Qi and Blood Deficiency as the root, Qi Stagnation and Blood Stasis, Dampness Depression failing to transform as the branch. Treatment plan: Tonify qi and nourish blood to nourish the root; regulate qi, invigorate blood, dry dampness, and strengthen the spleen to treat the branch. Prescription: Huang Qi (Astragali Radix) 30g, Dang Gui (Angelicae Sinensis Radix) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Dang Shen (Codonopsis Radix) 10g, Huang Jing (Polygonati Rhizoma) 10g, Sheng Di Huang (Rehmanniae Radix) 10g, Cang Zhu (Atractylodis Rhizoma) 15g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Qing Pi (Citri Reticulatae Pericarpium Viride) 10g, Chen Pi (Citri Reticulatae Pericarpium) 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.
After 6 doses, palpitations and chest fullness improved significantly. Continuing for 18 doses, all symptoms disappeared. To consolidate efficacy, another 18 doses were taken. Symptoms did not recur. ECG re-examination 3 times was normal.
A certain physician asked: Palpitations are heart diseases and should be treated from the heart. Why was using heart-nourishing medicines ineffective? I replied: Palpitations can be distinguished into palpitations in the heart center, below the heart, and below the umbilicus. The palpitation in this case is in the left side of the chest, caused by liver pathogen invading the heart. Therefore, treatment should focus on the liver, not the heart. The reason previous heart-focused treatments failed lies here.
4. Adhering to treating the heart, stuck on disease names, not following syndrome differentiation, efficacy is difficult.
Si XX, Male, 40 years old.
Palpitations and vexation for over 2 years. Diagnosed with Myocarditis and Atrial Fibrillation. Hospitalized for over 1 year. Except for Western medicine, only modified Fu Mai Tang (Pulse Restoring Decoction) and Bu Xin Dan (Heart Nourishing Pill) were used, totaling over 400 doses, yet no effect was seen. Carefully examining the syndrome: Chest fullness and pain, dizziness and vexation, palpitations and fatigue, hot palms. Tongue coating is white. Pulse is wiry, fine, knotted, choppy, or alternating knotted and intermittent. Synthesizing pulse and symptoms: This is Liver Depression and Blood Deficiency syndrome. Treatment should 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) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Bo He (Menthae Haplocalycis Herba) 3g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 15g.
After 4 doses, chest fullness and palpitations improved. However, epigastric stuffiness and discomfort were discovered. Therefore, Tan Xiang (Sandalwood Wood) 10g and Sha Ren (Amomi Fructus) 10g were added.
After 30 doses, all symptoms disappeared. ECG checked 3 consecutive times, all normal.
A certain physician asked: This is Xiao Yao San (Free Wanderer Powder). Why did it work effectively for heart disease? I replied: The pulse and symptoms of this case are all indicative of Liver Depression and Blood Deficiency syndrome. Therefore, this formula was used. As for why heart medicines and heart formulas were not used, it is because the pulse is a liver pulse, and the location of palpitation is the liver region, not the heart region. Hence, heart medicines and formulas were not used.
5. Not examining qi and blood, not examining cold and heat, not examining root and branch, merely treating the heart, the disease is difficult to cure.
Cheng XX, Female, 62 years old.
Palpitations and vexation for over 3 years. Diagnosed with Coronary Heart Disease, Atrial Fibrillation, Left Bundle Branch Block. Treated with Western medicine for 2 years without effect. Then combined with Chinese medicine to invigorate blood, unblock yang, tonify qi, and nourish yin for over 1 year, also without effect. Carefully examining the syndrome: Chest fullness and pain, palpitations and shortness of breath, frequent upward rushing of rebellious qi, fever and sweating, insomnia, poor appetite. Tongue coating is thin and white. Pulse is wiry, tight, knotted, and choppy. Synthesizing pulse and symptoms, diagnosed as Liver Depression and Qi Knotting, Heart Yang Flaccidity, Water-Fluids Rushing Upward. Treatment plan: Soothe the liver and regulate qi, warm yang and transform water, direct rebellious qi downward and stabilize palpitations. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Dang Shen (Codonopsis Radix) 10g, Huang Qin (Scutellariae Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Fu Ling (Poria) 10g, Gui Zhi (Cinnamomi Ramulus) 15g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g, Da Huang (Rhei Radix et Rhizoma) 3g.
After 6 doses, vexation, palpitations, chest fullness, chest pain, insomnia, etc., all decreased. Continuing for 18 doses, all symptoms disappeared. ECG re-examination 4 times was normal.
A certain physician asked: Chai Hu Jia Long Gu Mu Li Tang is a formula from Zhang Zhongjing. It is suitable for vexation and easy fright. Why is it used for heart disease? I replied: Chai Hu Jia Long Gu Mu Li Tang has four functions: one, soothe the liver; two, warm yang; three, transform water; four, settle fright. Hence, it is effective.
Atrioventricular Block
Not knowing root and branch, only knowing to treat the heart, not differentiating by pulse, only dividing by symptoms, efficacy is difficult.
Bao XX, Male, 29 years old.
Vexation and palpitations occurring intermittently for over 1 year. Diagnosed with Atrioventricular Block and Sinus Arrhythmia. Treated with Western medicine for 3–4 months without effect. Then combined with Chinese medicine to nourish the heart and calm the spirit for half a year, still without merit. Carefully examining the syndrome: Palpitations and vexation are paroxysmal. Sometimes 3–4 times a day, sometimes once every few days. Before each episode, there is sudden acceleration of heartbeat, followed by a sudden pause of heartbeat after a few seconds, after which it gradually returns to normal. Usually, there is frequent bitter fullness in the chest and hypochondrium, dizziness and vertigo, lower abdominal discomfort. Pressing causes incessant palpitation. Bitter taste in the mouth, dry throat. Tongue coating is white. Pulse is wiry, choppy, and irregular. Thinking thus: A wiry pulse is the liver pulse; a choppy pulse indicates cold and stagnation. Synthesizing pulse and symptoms, this is Liver Depression and Qi Knotting, Heart Yang Flaccidity, Water-Fluids Rushing Upward. The disease is not in the heart, but liver pathogen invading the heart, water qi rushing to the heart. One should not treat the heart directly. Treatment should soothe the liver and regulate qi, warm yang and direct rebellious qi downward. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Ren Shen (Ginseng Radix) 10g, Huang Qin (Scutellariae Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Gan Jiang (Zingiberis Rhizoma) 3g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Gui Zhi (Cinnamomi Ramulus) 10g, Fu Ling (Poria) 10g.
Excluding other medications, after 2 doses, all symptoms decreased significantly. Following the principle of not changing the formula when effective, another 20 doses of the above prescription were taken. All symptoms disappeared, indeed cured.
Intraventricular Conduction Block: Adhering to experience, sticking to conventions, not adapting to syndromes, delaying the disease course.
Li XX, Male, 45 years old.
One year ago, due to Myocarditis and Complete Left Bundle Branch Block, prescribed Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction) for 10 doses. ECG returned to normal, symptoms completely disappeared. After catching a cold this year, suddenly developed Myocarditis and Second-Degree Left Bundle Branch Block. Urgently given Qing Shu Yi Qi Tang for 3 doses, no effect. Given 4 more doses, still no effect, with worsening trend. ECG showed Third-Degree Left Bundle Branch Block. Increasingly feeling irritable, dizzy and head distension, insomnia, chest fullness and pain, body restlessness and heat. Carefully observing the pulse: Wiry, large, and rapid. Tongue body red, coating yellow. Thinking thus: Qing Shu Yi Qi Tang is a formula to tonify qi and nourish yin, release the exterior, drain dampness, and clear heat. It is effective for wiry, large, tight, and rapid pulses, but not for Liver-Gallbladder Excess Fire. For Liver-Gallbladder Excess Fire, Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction), Dang Gui Long Hui Wan (Angelica and Gardenia Pill), or Xie Qing Wan (Drain Green Pill) should be used. Using Qing Shu Yi Qi Tang was actually a mistake. Also considering: Long Dan Xie Gan Tang is especially good for cases with yellow-red urine. Dang Gui Long Hui Wan and Xie Qing Wan are suitable for cases with constipation. In this case, stool is not dry, but urine is red. Therefore, Long Dan Xie Gan Tang was prescribed. Prescription: Long Dan Cao (Gentianae Radix et Rhizoma) 10g, Zhi Zi (Gardeniae Fructus) 10g, Huang Qin (Scutellariae Radix) 10g, Chai Hu (Bupleuri Radix) 10g, Sheng Di Huang (Rehmanniae Radix) 10g, Che Qian Zi (Plantaginis Semen) 10g, Ze Xie (Alismatis Rhizoma) 10g, Mu Tong (Akebiae Caulis) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Dang Gui (Angelicae Sinensis Radix) 10g.
After 2 doses, all symptoms decreased, but still vexation and insomnia, yellow tongue coating, wiry and rapid pulse. Following the intent of not changing the formula when effective, considering the yellow tongue coating indicating stomach heat, Lu Hui (Aloe) 4g, Qing Pi (Citri Reticulatae Pericarpium Viride) 10g, Chi Shao (Paeoniae Radix Rubra) 10g were added appropriately.
After 2 doses, sleep increased significantly, vexation and chest fullness decreased abruptly. 24-hour dynamic ECG observation showed no abnormalities. Continuing for 7 doses, all symptoms disappeared, cured.
A certain physician asked: Teacher, why was Qing Shu Yi Qi Tang used initially for this disease, and later Long Dan Xie Gan Tang? I replied: Qing Shu Yi Qi Tang for treating bundle branch block was a formula that had been repeatedly tested and verified in the past. Using it for this patient was based on immature experience. After hitting a wall, I recalled Zhongjing's instruction: "Observe the pulse and syndrome, treat according to the syndrome." I changed to Long Dan Xie Gan Tang. The medicine was indeed effective as if striking a drum. This is truly a lesson.
Sinus Node Block
1. Spleen-Kidney Yang Deficiency, turbid dampness failing to transform. Merely giving qi-tonification, not warming yang and transforming dampness, the disease will not heal.
E XX, Male, 45 years old.
Half a month ago, while standing and talking in the courtyard, suddenly felt emptiness in the heart, extreme fatigue and weakness, dizziness unable to stand, fell to the ground. Consciousness gradually cleared only after rescue. At the time, it did not attract much attention. Several days later, it happened again. After clearing consciousness, still persistent dizziness unable to stand, weakness and fatigue, cold limbs. Pulse was only 2–5 beats per minute, sometimes even long intervals without a beat. A certain physician diagnosed Qi Deficiency and gave a large dose of Du Shen Tang (Single Ginseng Decoction) without effect. Transferred to a certain hospital for treatment. ECG obviously abnormal, diagnosed as Sinus Node Pause. Because the rescue measures at that hospital were poor, he was required to transfer to another hospital. But the patient and family repeatedly requested, so TCM consultation was invited. Examining his spirit: Exhausted, dizziness unable to sit or stand, cold limbs. Pulse is slow,迟 (chi), and slightly tight. Synthesizing pulse and symptoms: A slow and chi pulse indicates Spleen-Kidney Yang Deficiency failing to warm the head and eyes, and turbid dampness failing to transform. Treatment should warm Spleen and Kidney and transform cold-dampness. Also recalling "Jin Gui" (Essential Prescriptions of the Golden Cabinet): "Jin Xiao Fang Shu Fu Tang (Near-Efficacy Formula Atractylodes and Aconite Decoction) treats wind-deficiency heavy head and vertigo, extreme suffering, inability to taste food, warms muscles and tonifies middle, benefits essence and qi." Therefore, Shu Fu Tang was given. Prescription: Fu Zi (Aconiti Lateralis Radix Preparata) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Zhi Gan Cao (Honey-fried Licorice Root and Rhizome) 10g.
After 1 dose, dizziness and fatigue improved, spirit increased. Continuing for 6 doses, dizziness and fatigue disappeared. Pulse increased from 5 beats per minute to 65 beats per minute. To further confirm diagnosis, went to a higher-level hospital for further examination. ECG 3 consecutive times was normal.
2. Qi and Yin both deficient, internal depression of phlegm-dampness. Conversely giving warming yang and draining dampness, the disease will not heal.
Shao XX, Female, 54 years old.
Three days ago, while working, suddenly felt dizzy and vertigo, weakness and fatigue, fainted to the ground. Soon fully conscious, but still felt extreme fatigue, dizzy and vertigo. The next day fainted continuously twice, unconscious twice. Urgently went to a certain hospital for examination and treatment, confirmed as Sinus Node Pause. Requested hospitalization. However, due to various reasons could not be hospitalized. Invited TCM to try Chinese medicine. Observing besides the above symptoms, also saw several days of insomnia and palpitations, irritability and anger, dry throat with foreign body sensation. Tongue coating white. Pulse soft, weak, slow, and chi. Asked again if he took medicine? Answered: Except for Western medicine, also took Ren Shen Si Ni Tang (Ginseng and Counterflow Decoction with Ginseng), but after taking medicine, felt more dizzy and uncomfortable. Synthesizing pulse and symptoms: This is Qi and Yin Dual Deficiency, Phlegm Depression and Qi Knotting syndrome, not Yang Deficiency. Therefore, gave Qi-tonification and Yin-nourishment, Qi-regulation and Phlegm-resolution. Prescription: Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 6g, Ren Shen (Ginseng Radix) 10g, Mai Dong (Ophiopogonis Radix) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Zhu Ru (Bambusae Caulis in Taenia) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Fu Ling (Poria) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Shi Pu (Acori Tatarinowii Rhizoma) 10g, Yuan Zhi (Polygalae Radix) 10g, Sheng Di Huang (Rehmanniae Radix) 10g.
One hour after taking medicine, spirit improved, dizziness reduced. After 3 doses, all symptoms decreased significantly, spirit doubled. Continuing for 30 doses, cured.
Pre-excitation Syndrome
1. Adhering to Western disease names, not following TCM syndrome differentiation. Disease in Liver but treating Heart, the disease is difficult to heal.
He XX, Male, 45 years old.