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The heart is the pivot of blood circulation. Each time the heart chamber beats, the pulse throughout the body moves accordingly. Therefore, when cardiac function is hyperactive (excessive excitement of cardiac function), the pulse appears large and forceful, or the pulse rate increases; when cardiac function is paralyzed (inhibition or failure of cardiac function), the pulse appears thin and weak, or the pulse rate decreases. Thus, a pulse that loses its equilibrium is generally caused by hyperactive cardiac function or paralyzed cardiac function. From this, we can see that although diseases of the heart are manifold, they can essentially be categorized into two main principles: hyperactive cardiac function and paralyzed cardiac function.

Let us first discuss diseases of hyperactive cardiac function: One type occurs when external pathogenic heat blazes within the Yangming Stomach Fu organ, steaming upwards to the heart, causing hyperactive cardiac function. The pulse is surging and forceful, or the pulse rate increases. A large dose of Baihu Tang (Clear Heat Decoction, composed of Gypsum, Anemarrhena, Licorice, and Rice) can be used to clear stomach heat. If there is also dry feces in the intestines with constipation, Dachengqi Tang (Major Order the Qi Decoction) or Xiaochengqi Tang (Minor Order the Qi Decoction) should be used酌情ly to purge the intestines. Then, as heat is discharged downwards, the hyperactive cardiac function will naturally return to equilibrium.

Another type arises from deficiency in the Yin aspect of the Lower Jiao, which fails to maintain connection with the Yang aspect of the Upper Jiao. The Sovereign Fire (referring to Heart Yang/Fire) within the heart floats and moves recklessly, leading to hyperactive cardiac function. Such individuals often suffer from dizziness, headache, distending pain in the eyes, and tinnitus. Their pulse is abundant at the top and deficient at the bottom, or trembling without root, with an increased pulse rate. Treatment with Jiawei Zuogui Yin (Modified Left Restoring Decoction) is appropriate. The prescription uses large doses of Shu Dihuang (Prepared Rehmannia Root), Sheng Dihuang (Raw Rehmannia Root), and Sheng Huai Shanyao (Fresh Chinese Yam), each 6 qian; Gouqizi (Lycium Fruit), Huainiu (Achyranthes Root), Sheng Longgu (Fossilized Bones), and Sheng Muli (Oyster Shell), each 5 qian; Jing Yurou (Cornus Fruit) 3 qian; and Yunling (Poria) slices 1 qian. This strengthens the source of Water (nourishes Kidney Yin) to control the floating fire, allowing hyperactive cardiac function to return to peace.

In another case, the Heart's Yang is naturally robust, and the Stomach Fu accumulates excess heat. This heat rises to assist the Heart Yang, causing hyperactive cardiac function. The pulse is forceful but not rapid, while the five centers (palms of hands and soles of feet) often feel burning hot. It is appropriate to use salty-cold substances (as stated in the *Neijing*: "For excessive heat inside, treat with salty-cold"). Substances such as Xiaosha (Mirabilite), Taiyin Xuanjingshi (Taiyin Crystal Stone), and Western Epsom Salt (Magnesium Sulfate) are对症 medications (take a small amount each time, three times daily, and it will heal over time). Since the Heart body belongs to Fire, and salty flavors belong to Water, administering salty-cold substances utilizes Cold to overcome Heat and Water to overcome Fire.

The Yuan Shen (Original Spirit) resides in the brain, while the Shi Shen (Acquired Spirit) originates from the heart. The Shi Shen refers to the spirit of thought. Frequent thinking generates heat in the heart because the human spirit belongs to Yang. Excessive thinking causes the Yang of the spirit to constantly manifest from the heart, leading to hyperactive cardiac function due to heat. Such individuals often experience confusion. Their pulse often appears slippery and solid because the heat generated by thinking often adheres to phlegm-fluids, resulting in a slippery yet forceful pulse. Dachengqi Tang (with less Houpo) can be used to clear heat and descend phlegm; add Hematite (Sheng Zheishi, 1.5 liang crushed and decocted together) and Gansui (Gansui 1 qian, finely ground and mixed into the decoction) to enhance the power of clearing heat and descending phlegm. Although the medicinal properties are potent, they achieve remarkable results and have proven effective repeatedly.

In severe cases of hyperactive cardiac function, the force driving blood upward is so strong that it can cause rupture of cerebral blood vessels. This corresponds to the "Great Jue" syndrome described in the *Neijing* ("blood and qi moving together upwards") and is equivalent to the dangerous condition known in Western medicine as cerebral congestion. The cause of this syndrome lies in the excessive rising of Liver Wood Qi and the failure of Lung Metal Qi to descend properly. Consequently, Metal fails to control Wood, and the rampant Liver Qi attacks the Heart, causing hyperactive cardiac function. If accompanied by Chong Qi rushing upward, the pulse becomes wiry, hard, and forceful, significantly different from normal. When early signs appear—such as headache, occasional dizziness, slight hemiplegia, or numbness in limbs—one must take preventive measures. Treatment should involve formulas that clear the Lung, calm the Liver, and restrain the Chong Qi, assisted by heavy doses of herbs that guide blood downward. Taking the formula for ten to dozens of doses will gradually soften the pulse, preventing unexpected disasters. Previously, lacking adequate treatments in medical texts, I formulated Jianling Tang (Building High Terrace Decoction), which has been consistently effective. Even if treatment cannot prevent the onset, if a person suddenly faints but recovers consciousness quickly, indicating minor cerebral vessel rupture, immediate administration of this decoction can save their life. Continued use for several doses can completely cure headaches, resolve cerebral congestion, heal minor ruptures, and slowly improve limb paralysis. Originally, this decoction was prepared using rust water; scraping a few qian to one liang of iron rust to decoct with the herbs is even better.

There are conditions that resemble hyperactive cardiac function but are not, specifically Palpitations (Zhengchong). The heart naturally beats to circulate blood, but healthy people do not perceive this. Only those with palpitations feel constant unease and beating in the chest. The spirit in the heart relies on Qi and Blood. When Qi and Blood are severely deficient, the spirit loses its foundation. Although the heart beats normally without hyperactivity, the spirit feels unable to withstand the vibration. The pulse is typically fine and weak, or rapid. Treatment should preserve Qi using Cornus (Shanzhuyu), Sour Jujube Seed (Suanzaoren), and Chinese Yam (Huai Shanyao); nourish Blood using Longan Aril (Longyanrou), Prepared Rehmannia (Shudihuang), and Biota Seed (Baiziren); and calm the spirit using Fossilized Bones (Longgu), Oyster Shell (Muli), and Cinnabar (Zhusha, taken finely ground). If Qi deficiency is severe, add Ginseng (Renshen); if Blood deficiency involves heat, add Raw Rehmannia (Shengdihuang).

Some cases involve swelling of the heart body or blood stasis, narrowing the atrial openings. The turbulence of blood entering and exiting causes the heart to beat noticeably. This resembles hyperactive cardiac function but is distinct. The pulse is typically choppy (Se) or slow. Treatment with Huoluo Xiaoling Dan (Activate Collaterals and Effect Lingering Pain Decoction) plus Fresh Chinese Yam (Sheng Huai Shanyao) and Longan Aril (Longyanrou), each 1 liang, decocted and taken as soup, is suitable. Alternatively, use 3 liang of Acorus (Jie Changpu) and 2 liang of Polygala (Yuanzhi), ground into powder. Take 2 qian per dose, washed down with brown sugar water, three times daily. Over time, it will self-heal. Acorus opens the orifices of the heart, and Polygala resolves stasis (due to containing dilute hydrochloric acid). Together, they tonify the heart, while brown sugar water aids blood circulation.

Causes of paralyzed cardiac function vary, requiring different treatments. For instance, in Shaoyang/Wenbing patterns indicated by Baihu Tang, the pulse is surging and forceful. If Baihu Tang is not administered promptly, this forceful pulse may gradually become thin and weak, marking a transition from hyperactive to paralyzed cardiac function. This stage is extremely dangerous. Urgent administration of a large dose of Baihu Jia Renshen Tang (Baihu Decoction plus Ginseng) is required, doubling the Ginseng dosage. Decoct into a large bowl and drink warm in divided doses to ensure continuous medicinal effect. Administer two doses per day to reverse the condition. Generally, when external heat transmits to Yangming, presenting with excess heat and deficient pulse, Baihu Jia Renshen Tang is indicated (hence Ginseng is added after sweating, vomiting, or purging in Shanghan). However, here the pulse shifts from excess to deficiency because the heart has been damaged by heat, becoming paralyzed and forming a critical condition. Doubling Ginseng assists heart pulse movement, curing the paralysis.

If the Heart's Yang is inherently weak, compounded by cold fluid accumulation in the Stomach overflowing above the diaphragm and suppressing Heart Yang, the heart gradually approaches paralysis. The pulse is exceptionally fine and slow. Treatment with Liyin Tang (Regulate Fluids Decoction) for over ten doses eliminates cold fluids, restoring Heart Yang and normalizing the pulse. Some cases present with sensations of internal heat, generalized fever, or deafening tinnitus. Refer to the cured cases recorded after Liyin Tang for accurate diagnosis.

Paralysis caused by infectious bacteria filling the heart, such as in Cholera where all six pulses are closed, requires treating both the paralysis and its cause. Cardiac stimulants must be combined with antibacterial agents, such as my formulated Jijiu Huisheng Dan (Emergency Rescue Pill) and Weisheng Fangyi Baodan (Health Epidemic Prevention Treasure Pill). Borneol (sublimated from Camphor) in these pills stimulates the heart to remove paralysis. Cinnabar and Menthol Ice eliminate bacteria causing the paralysis. Thus, they are effective regardless of whether Cholera is caused by cold or heat (Jijiu Huisheng Dan is slightly cool, especially effective for heat-induced Cholera; Weisheng Fangyi Baodan is warm, effective for both cold and heat etiologies).

When the spirit lacks tranquility and feels unsupported, causing frequent fright and palpitations, the presentation opposes cardiac paralysis. Western anesthetics may provide temporary relief, but the root cause is heart weakness. Tonifying the heart is the fundamental treatment. Carefully examine the pulse: if rapid and slippery, it indicates Heart Blood deficiency with heat. Use Longan Aril and Prepared Rehmannia to tonify deficiency, Raw Rehmannia and Scrophularia to clear heat, and Fossilized Bones and Oyster Shell to stabilize the spirit and calm the soul, eliminating palpitations. If the pulse is weak and forceless, it indicates Heart Qi deficiency. Use Ginseng and Atractylodes to tonify Qi, combined with Raw Rehmannia and Scrophularia to prevent heat from tonification, and Sour Jujube Seed and Cornus to consolidate the spirit and regulate Qi transformation. This approach is similar to treating weak-pulse palpitations. However, in weak-pulse palpitations, cardiac movement remains normal, whereas here, the driving force is weak, and the heart body trembles intermittently, like carrying a heavy load with insufficient strength. The heart weakness here is more severe than in palpitations.

Palpitations occurring at night, waking the patient upon falling asleep, are often due to phlegm-fluid retention below the heart. The Heart belongs to Fire, and phlegm-fluids to Water. Fire fears being oppressed by Water, causing palpitations. Combine phlegm-resolving and heart-nourishing herbs. Use Erchen Tang (Two-Aged Decoction) plus Danggui, Changpu, and Yuanzhi, decocted and taken with 3 fen of fine Cinnabar powder. Add Scrophularia for heat. This ensures peaceful sleep without palpitations.