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Treats conditions caused by excessive effort and overexertion, leading to blood stasis above the diaphragm (upper thoracic region), often accompanied by a sensation of shortness of breath. If hematemesis (vomiting blood) has not healed, taking too many tonifying or cooling medicines, or using various carbonized herbs to forcibly stop bleeding, can also cause this condition; all such cases are suitable for taking this medicine to resolve the stasis.

Sanqi (Radix Notoginseng, 2 qian, finely ground) Yadanzi (Semen Cocculus, 40 grains, peeled)
The above two herbs are taken with boiled water, twice daily. When taking Yadanzi, it must not be chewed broken; if chewed, it becomes extremely bitter and difficult to swallow, and even if forced down, it is often vomited out.

A boy, aged fourteen, was herding cattle in the wild during summer. Other herd children were playing, forcing his neck and back into a bent position, stuffing his head inside, binding his hands upside down, and leaving him there, jokingly calling it "watching melons." He was later rescued by others, but his breathing had ceased. He was made to sit cross-legged, and his lower back and waist were beaten for a long time before he regained consciousness. He only felt something blocking his chest and diaphragm, pressing on the "Great Qi" (vital energy) in the chest, hindering respiration. At its worst, his breathing stopped again, eyes rolled upward, and his body arched backward. This was certainly because when he was suffocated and struggled desperately without success, hot blood surged upward with the force of his struggle and stagnated above the diaphragm. He was treated with Sanqi (3 qian, finely ground) alone, taken with boiled water, and was completely cured after two doses.

Another person, aged forty-seven, had suffered from chronic hematemesis. The physician considered him weak and prescribed tonifying medicines. After taking more than ten doses, he felt tightness in the chest, and the bleeding worsened. Later, someone told him of a simple prescription for stopping hematemesis: Dahuang (Radix et Rhizoma Rhei) and Rougui (Cortex Cinnamomi), each 5 fen, finely ground, taken with boiled water. One dose stopped the bleeding. However, due to the previous misuse of tonifying medicines, he often felt uncomfortable in the chest, had reduced appetite, and experienced soreness, lassitude, and weakness in the four limbs. I palpated his pulse, which appeared deep and firm (chen lao), knowing that blood stasis above the diaphragm was the cause. I prescribed fifty peeled Yadanzi grains, taken with sugar water, twice daily, and he recovered in a few days.

Treats palpitations (zheng tong) caused by Heart deficiency.

Longyanrou (Arillus Longan, 1 liang) Suanzaoren (Semen Ziziphi Spinosae, 5 qian, stir-fried and crushed) Yurou (Fructus Corni, 5 qian, pits removed) Baiziren (Semen Platycladi, 4 qian, stir-fried and crushed) Sheng Longgu (Os Draconis, 4 qian, finely ground) Sheng Muli (Concha Ostreae, 4 qian, finely ground) Sheng Ming Rushiang (Resina Incensi, 1 qian) Sheng Ming Moyao (Resina Olibani, 1 qian)

For palpitations caused by heat, add Shengdi (Radix Rehmanniae) in varying amounts (several qian). If the pulse is deep, slow, and powerless, the palpitations are mostly due to the sinking of Great Qi in the chest; refer to my postscript on Shengxi Tang and other case records for treatment methods.

The *Neijing* states, "The Heart stores the Spirit (Shen)." Since the Spirit resides in the Heart, it relies on the Qi and Blood of the Heart for protection. Sometimes, when Qi and Blood in the Heart are deficient and lose their protective function, the Spirit within loses autonomy, resulting in the onset of palpitations. Therefore, the formula uses Longyanrou to nourish Heart Blood, Suanzaoren and Baiziren to tonify Heart Qi, Longgu to enter the Liver and calm the Hun (Ethereal Soul), and Muli to enter the Lung and stabilize the Po (Corporeal Soul). The Hun and Po are the left and right assistants of the Heart Spirit. Moreover, these two herbs combined with Yurou strongly converge scattered Heart Qi and help gather the Qi transformation of the Triple Burner. However, the Heart's function is to move Blood; the Heart organ constantly possesses expanding and contracting forces, and the heart chambers have opening and closing mechanisms. If medicines are used solely for tonification and convergence, there is a fear that they may hinder these movements. Thus, small amounts of Rushiang and Moyao, which promote the circulation of Qi and Blood, are added to harmonize. For cases where Heat accompanies the Heart condition, Shengdi is used because it not only generates Blood to tonify deficiency but is also excellent at cooling Blood and clearing Heat; therefore, its addition should be adjusted according to the severity of the Heat.

Western medicine states: In the human body, the relationship between the Heart and Lungs is particularly important, comparable to that of the Brain. Organs of great importance are protected most carefully; thus, the Brain is protected by eight bones of the skull, while the Heart and Lungs are protected by the ribs and sternum. The Heart and Lungs are physically connected and functionally interdependent. The Heart's function affects the whole body; Heart disease harms the entire body, highlighting the Heart's significance. However, structurally, the Heart is merely composed of red muscle, its capability primarily governing expansion and contraction to circulate blood vessels. It has four chambers: left and right upper, and left and right lower. The left upper chamber mainly receives oxygenated blood from the lungs; the right upper chamber mainly receives deoxygenated blood returning from the body; the left lower chamber mainly pumps oxygenated blood to circulate throughout the body; the right lower chamber mainly receives returning blood from the upper chamber to pass through the lungs, exchange gases, and return as oxygenated blood to the left upper chamber. Oxygenated blood from the left upper chamber falls into the left lower chamber, enters the main vessel, and nourishes the whole body. Deoxygenated blood from the right upper chamber falls into the right lower chamber, ascends to the lungs to expel carbon dioxide and absorb oxygen. Thus, all blood in the body passes through the Heart and Lungs. The Heart circulates blood throughout the body without pause, receiving and emitting blood in real-time; its beating is the force of expulsion. Verified by a stopwatch, the heart beats 75 times per minute, 4,500 times per half-hour, and 108,000 times per day. Normally, people do not perceive their heartbeat; feeling one's heartbeat indicates an abnormality in the Heart meridian. The left atrium is denser than the right, and the left ventricle is nearly twice as dense as the right ventricle, likely because the left chambers handle oxygenated blood and work harder, hence becoming denser. The Heart is located in the chest, slightly to the left, corresponding to the fourth to seventh ribs, with its apex between the fifth and sixth ribs, about one to half an inch below the nipple, facing the sternum horizontally. When diseased, one feels pulsations all around. Diseases of the Heart organ itself include thinning or thickening of the heart walls, pathology of the heart valves, pathology of the pericardium, or pathology of the major vessels. Similar to eye diseases affecting the cornea, pupil, or lens, heart disease does not necessarily affect every part. Generally, Heart disease manifests more on the left side due to the greater workload of the left chambers. Heart diseases include several types: First, enlargement of the Heart organ, sometimes slightly larger or more than half again in size. This occurs because pathology in the heart valves obstructs blood flow, causing excessive labor in expansion and contraction. Increased labor leads to enlargement, similar to swelling in limbs due to overuse. Severe enlargement renders the pumping function inefficient. Second, abnormalities in the size or width of the heart valves (too small, too large, too narrow, or too wide) are unfavorable. Blood flows from the upper to the lower chambers; after entering, the valve closes to prevent reflux. Similarly, the valve leading to the main vessel opens to allow ejection and closes afterward. If too narrow/small, blood exits poorly; if too wide/large, ejection is incomplete, or blood returns, disrupting normal circulation. Third, regarding heartbeat: Healthy individuals do not perceive their heartbeat. Pathological palpitations are consciously perceived and may be palpable. However, this symptom has true and false forms. True palpitations result from intrinsic Heart disease or general bodily weakness affecting the Heart. False palpitations occur occasionally due to fear or anxiety, despite no organic Heart disease; these are temporary. Physicians must distinguish carefully. Regular, uninterrupted heartbeat, comfortable in any sleeping position, and normal respiration generally indicate a healthy Heart. Concern arises with irregular, intermittent beating, inability to sleep, discomfort lying on the left side, suggesting valve pathology and stagnant blood flow. This can lead to distension, pulmonary involvement (cough, dyspnea, asthma), cerebral involvement (dizziness, headache, stroke-like symptoms), hepatic involvement (blood accumulation), or gastric involvement (indigestion, postprandial discomfort, exacerbated palpitation). Palpitations under the rib cage are often mistaken for Heart issues but are usually due to indigestion and internal wind, common in weak individuals and women; mild stomach-tonifying and purgative herbs suffice.

Note: Western medicine distinguishes true and false palpitations. True palpitations are palpable; false ones are not. True palpitations are divided into two: intrinsic Heart disease (e.g., valve abnormalities), treatable with Dingxin Tang (modifying Rushiang and Moyao to 3 qian each, adding Danggui and Danshen 3 qian each); or non-Heart disease caused by systemic weakness affecting the Heart, treated with formulas for consumption (lao zhai). False palpitations correspond to Zhengtong (palpitations). The driving force of blood circulation is not abnormally strong, so they are not palpable. Due to Qi and Blood deficiency, the Spirit is also deficient; even normal, gentle Heart contractions feel like impacts to the Spirit, causing fear and panic. For such cases, Dingxin Tang is effective, preferably decocted with rust water. The use of rust aligns with Western views on blood tonification but primarily utilizes its heavy, sedating nature to calm the Spirit. A single-herb formula, Tieyang Tang, is recorded; reviewing its clinical cases reveals the efficacy of rust. However, for palpitations caused by sinking of Great Qi, this formula is strictly contraindicated.