中医瑰宝苑 赵绍琴临证验案精选下
心悸1(病态窦房结综合征)
张某某，男性，43岁，建筑公司水泥工。1973年8月22日初诊，自1972年6月开始，反复发作头晕、憋气、心悸、心前区不舒及停跳现象，平时心率蛐～50次／分。上述症状发作时心率35～40次／分。，伴有停跳5～8次／分。自1973年5月起发作频繁，每次发病持续2～3小时。经某某医院诊断为“病态窦房结综合征”，住院两个月。经用阿托品、异丙基肾上腺素、706代血浆等各种西药治疗，效果不好。每星期仍发作1～2次，表现为头晕、憋气及停跳现象，心率每分钟不足40次。最后在药物治疗无效的情况下，动员患者安置人工心脏起搏器。患者考虑安装起搏器后，对今后劳动不方便，故不同意安装，前来门诊要求中医治疗。
初诊
当时表现，阵阵心慌，胸闷憋气，心烦，夜寐多梦。舌红体瘦，脉象沉迟，按之弦细且滑。检查：血压120／80毫米汞柱，心率46次／分，发育正常，呼吸平稳，颈静脉无怒张，两肺(一)，心界不大，心律整，心脏各瓣膜区未闻及病理性杂音。腹部无压痛，肝脾未触及，下肢无水肿。
中医辨证：从脉象沉迟、心慌气憋来看，似属心虚气弱，肝肾两亏。细诊两手寸关，沉取略弦且精。夫沉则主里，迟司脏病，精脉为痰，弦乃郁象}舌瘦尖红，心烦梦多，全是肝肾阴虚，虚热上扰，心阴不足为本，阴损及阳，心阳又虚是标。治疗必须养其心阴，助其心阳，滋补肝肾，泄其虚热，调理阴阳，平衡升降。
北沙参30克，麦门冬、枸杞子各15克，淡附片(先煎透)、菟丝子各12克，熟地黄18克，桂枝、仙茅、仙灵脾、党参各9克，金樱子10克。
服中药时，停用一切西药。进药6剂詹，自觉症状明显好转，胸闷憋气未发作，心脏无停跳现象，心率50次／分。
二诊
由某某医生应诊，认为病属心阳不足，改用辛温，壮阳、益气药物，用淡附片30克，黄芪24克，桂枝15克，麻黄6克，细辛6克……等。因方中升药过多，缺少育阴药，又无调整升降药物，故进药后，患者又出现胸闷憋气及心脏停跳现象，心率降至40次／分。
三诊
仍按初诊方，再加白芍15克，连服10剂，症状好转，未发生心慌憋气及头晕现象，心率上升到50～60次／分。继而连续服药30剂，病情稳定，无不适症状发生，心率维持在60分左右／分。
在1973年11月份患者出现较明显的心烦、多梦症状。小便色黄，脉象弦滑，舌红苔薄黄腻。认为证属阴分不足，虚热上扰，湿热积滞互阻不化，气机失调，升降失和，故心烦梦多，小溲色黄。改用滋肾水以制虚火，补下元少佐泄热。
沙参24克，党参、麦冬、天冬、金樱子、仙灵脾、仙茅、柴胡、黄芩、焦三仙各9克，生地黄12克，白芍15克，芡实、桑寄生各18克。
服上药1月余，病情稳定，未发生胸闷及头晕、心脏停跳等现象，心率维持在60次左右／分。继用前法调理3个月，停药1个月，病情稳定，未再反复，遂出院恢复工作。
[按]：病态窦房结综合征是现代医学的一个难治病，严重者必须安装人工起搏器。此例患者因为主观上不同意安装起搏器，改用中医中药治疗，给中医治疗出了一个难题。该病在中医看来，除了他的自觉症状心悸、胸闷、头晕等表现外，主要是脉象迟缓，甚至出现停跳现象。但脉迟不等于是完全阳虚，根据其舌瘦尖红，心烦梦多来看，是阴分不足，兼有郁热，故用调整阴阳，平衡升降的方法，从阴中求阳，张介宾云：“善补阳者，必于阴中求阳，则阳得阴助而生化无究。”故用熟地黄、沙参、麦门冬、枸杞子、菟丝子滋阴填精，配以桂附、仙茅、仙灵脾壮阳益命门之火，深得阴阳互根之妙。故服后即效，心率增加。
二诊由其他医生应诊，以脉迟为阳虚，改用单纯朴阳的方法，希求速效，反致心率下降，诸症再现。故三诊在初诊方上重加白芍，以救劫伤之阴，则又趋好转。当出现湿热积滞之象时即加入琉调泄热之品。总之，据证分析，随证用药，不拘于成见，不一味地以脉迟为阳虚，体现了中医辨证施治的精神。
心悸2(风湿性心脏病)
郝某某，女，70岁
初诊
自述患风湿性心脏病30余年。时时心悸胸闷，近日加重。伴见心烦急躁，夜寐梦多，脘腹胀满，暖气不舒，纳食欠佳。一身疲乏，无力以动。诊脉弦滑，至数不匀，三五一止歇，舌暗苔白且腻。证属湿热蕴郁，阻塞气机，肺失治节之权，三焦不畅。先用疏调三焦，宣畅气机方法。
苏叶、梗各10克，前胡6克，浙贝母10克，焦三仙各10克，元胡10克，川楝子10克，水红花子10克，香附10克，炒枳壳6克，七剂。水煎服。
二诊
药后胀满已宽，胸闷渐减，纳食见增。仍觉烦急梦多，夜不安寐。脉象弦数。舌红苔白略腻。肝胆郁热未清，继用清泄肝胆方法。
柴胡6克，黄芩10克，川楝子10克，蝉衣6克，僵蚕10克，片姜黄10克，竹茹6克，枳壳6克，焦三仙各10克，七剂，水煎服。
三诊
上药服后夜寐已安，烦急渐减。心悸胸闷均显著好转。脉象弦滑，时一止，舌红苔白。郁热虽得宣泄，络脉尚未和调。继以化瘀和络方法。
荆芥6克，防风6克，生地榆10克，赤芍10克，丹参10克，茜草10克，茅芦根各10克，焦三仙各10克，水红花子10克，七剂。水煎服。
四诊
诸证渐愈。诊脉已无止歇，舌红苔净。前方继进七剂，以善其后。
[按]：患者风湿性心脏病30余年，又见心动悸脉结代之脉证。若从俗则必用复脉汤治之。今赵师宣肺以畅气机而复其治节之权，次调肝以泄郁热，而安谋虑之脏，终以化瘀通络，乃治心脉之本。治法井然有序，故能获效于旬日之间。
心悸3(植物神经功能素乱)
蔡某，女，47岁
初诊
形体消瘦，面红唇紫，阵阵汗出，心烦急躁，夜寐梦多，自觉心中悸动不安，闻声易惊。近一年来月经前后不定，量少色深，夹黑色粒块状物。诊脉弦细且数，舌红少苔且干。证属阴分不足，热郁血分，扰动心神，故悸动不安也。治宜养血育阴，凉营和瘀之法。
生地黄10克，赤白芍各10克，生地榆1。克，丹参10克，茜草10克，柴胡6克，黄芩10克，川楝子10克，钩藤10克(后下)，七付
二诊
心中悸动渐减，已能安睡，仍觉梦多，烦急虽减而未全除。
脉仍弦细数，舌红少苔，已不甚干，大便偏干，继用前法进退，益以二至养阴为治。
生熟地黄各10克，赤白芍各10克，柴胡6克，生地榆10克，丹参10克，茜草10克，女贞子10克，旱莲草10克，夏枯草10克，七付
三诊
癸事适至，较前量多色红，黑渣减少。自觉心中舒畅，烦急续减，心悸渐安，舌红脉数，二便如常，阴分久亏，不易速复，仍用前法加减。忌食辛辣刺激之物，是为至嘱。
生熟地黄各10克，天麦门冬各10克，赤白芍各10克，生地榆10克，丹参10克，茜草10克，茯苓块15克，柴胡6克，七付
癸事已净，诸症向安。脉象细数，舌红苔薄。继用前法，并和胃气。
生熟地黄各10克，天麦门冬各10克，赤白芍各10克，丹参10克，生山药10克，香稻芽10克，宣木瓜10克。七付
[按]：素体阴虚，阴虚则阳亢，故见热郁火升之象。治疗首凉血清肝，次养血育阴，终和胃气，而养阴之法贯彻始终。知阴伤者难复，善调摄者能获预期之效。故为之至嘱。
心悸4(贫血待查)
陈某，男，24岁
1991年4月3日初诊。自觉头晕乏力，心慌，经检查：Hb：8g／dl、RBC；2，85～10 9／mm3，诊断为贫血待查。经治疗2
月余，Hb反下降至5，5～6g／dl.怀疑为再障。经病友介绍，求赵老医治。诊见患者面者面色眺自，头目眩晕，周身乏力，饮食不佳，心慌气短，动则汗出，心烦急躁，失眠梦多。舌红苔白腻，脉沉弦细数。Hb：6g／dl、RBC：3，0×10。／mm3，Bp；80／60mmHg。
辨证：肝胆郁热，气机阻滞。
治法z宣郁清热，调畅气机。
方药：蝉衣6克，僵蚕10克，片姜黄6克，大黄o.5克，川楝子6克，大腹皮10克，槟榔10克，竹茹6克，枳壳6克，半夏10克，焦三仙各10克，水红花子10克，7剂。停服其他药物，饮食清淡，每天早晚慢步行走1～2小时。
二诊
自觉症状减轻，精神较好，力增，血红蛋白已升到7克，仍梦多。上方去大黄、川楝子、大腹皮、槟榔，7剂
三诊
血红蛋白升到8克，余症皆减。继用前方加减。
蝉衣6克，僵蚕10克，片姜黄6克，大黄O.5克，雷丸10克，使君子10克，竹茹6克，枳壳6克，生牡蛎20克，7剂。
经上方加减继服4周后，5月15日再次化验；Hb130g／dl、RBC 4，4×10 9／mm3，Plt 150×10 9／mm3、BP 110／70mmhg。面色红润，饮食佳，余症皆除而告愈。
[按]，贫血属于“血虚”、“虚劳”范畴，传统治疗以滋补为原则。而老师治疗本病，则强调在脉、舌、色、症、化验检查等综合分析的基础上进行辨证施治，而不是看到贫血就认为是虚证。该患者头目眩晕，面色眺白，周身乏力，心慌气短，动则汗出，血红蛋白低等均表现出虚损之象。而脉沉弦细数，舌红，心烦急躁，失眠梦多等症，又为肝胆郁热之象。当以何为主?老师说：虚实之辨，微细在脉。脉沉主里病，弦主肝郁，数为热，细主阴伤。舌红乃为热郁可知，苔白腻乃为气机不畅之征。观其以前用药，皆为滋补之剂，滋补则壅滞助热，故疗效不显。因此老师用升降散调整气机之升降}配川楝子、枳壳舒肝解郁，清肝经之热；中焦乃气机升降之枢纽，脾胃乃气血生化之源，大腹皮、槟榔、枳壳、焦三仙、水红花子消食导滞，有助于脾胃之升降。老师着重于降胃气，以利于脾气上升。半夏、枳壳、竹茹清胆之热而和胃安神。诸药相合，服之病愈。另外饮食清淡和走路锻炼，也有利于气机升降和造血功能的恢复。
心悸5(冠心病)
谭某，女，51岁，1991年7月12日初诊。患者一年来自觉心悸气短，胸闷乏力，胸脘胀满，纳食不香，西医检查血脂较高，心电图异常，诊断为可疑冠心病，服用愈风宁心片，丹参片等疗效不佳。望其形，体胖丰腴；观其舌，舌胖苔精腻；查其脉，脉象濡措。全是痰湿阻滞，气机不畅之征。治阻宣郁闭，化痰湿之法。药用；苏子叶各10克，莱菔子10克，白芥子6克，杏仁10克，枇杷叶10克，猪牙皂6克，菖蒲10克，郁金10克，瓜萎10克，枳壳6克，焦三仙各10克。嘱其加强体育锻炼，忌食肥甘厚味，宜清淡饮食。服药20余剂后自觉症状见轻。又以此方服药30余剂，症状基本消失，纳食转佳，心电图正常，血脂下降至正常范围。
[按]：此患者平日好逸少劳，素体痰湿较盛，时至51岁，病初以更年期症候群治疗无效，经查出血脂较高，心电图异常后，按冠心病治疗，仍疗效不明显。接受赵老治疗后，积极配合，控制饮食，走路锻炼，前后治疗两月，心电图与血脂检查已基本正常。
胸痛1(冠心病)
蒋某，男，48岁，于1989年10月8日初诊。
自1987年8月患心肌梗塞，经医院抢救后病情缓解。仍遗留下胸痛时作，中脘满闷，不思饮食，乏力头晕等症。观其舌质红苔黄腻厚，脉濡缓，时有结代，血压偏高。证属湿浊不化，气机阻滞，升降失常。治宜宣郁化湿疏调升降，佐以活血通络方法。药用：荆芥6克，防风6克，蝉衣6克，片姜黄6克，旋复花10克，代赭石10克，半夏10克，薤白10克，瓜蒌30克，佩兰10克，杏仁10克，焦三仙各10克。嘱其改变一直以卧床休息为主的习惯，每日早晚走路锻炼各1至2小时；饮食宜清淡，服药7剂，心情舒畅，胸痛未作，头晕乏力见轻，胸脘胀满见舒，食欲好转，舌红苔白，脉滑数，湿郁渐化，仍以前法进退，药用：荆芥6克，防风6克，蝉衣6克，僵蚕10克，片姜黄6克，赤芍10克，丹参10克，大腹皮10克，槟榔10克，香附10克，焦三仙各10克，水红花子10克。服上方2周，饮食二便正常，精神振作，未见其他不适。改为益气养阴方法，药用：荆芥6克，防风6克，沙参10克，麦冬10克，炙甘草10克，丹参10克，赤芍10克，香附10克，郁金10克，焦三仙各10克，炒槐花10克，水红花子10克。1月后，去医院复查：心电图大致正常，血压正常。并能参加一些体育活动。
[按]，此病案系心肌梗塞后，胸痛未愈，在家卧床休息二年，精神负担很重。赵老根据脉、舌、色、症辨为湿阻气机，升降失常之证，先以宣郁化湿为治，仅服药7剂，症状大减，增强了患者战胜病痛的信心，积极配合，每天坚持走路锻炼，开始30分钟，逐渐增加到5个小时左右，3个月后可以去公园，爬山等活动。实践证明走路锻炼可以改善心脏冠状循环，增加心肌营养，有促进病愈的作用。
Jewels of Traditional Chinese Medicine: Selected Clinical Cases of Zhao Shaoqin, Vol. II
Palpitation Case 1 (Sick Sinus Syndrome)
Patient Zhang, male, 43 years old, cement worker at a construction company. First consultation on August 22, 1973. Since June 1972, he suffered from recurrent episodes of dizziness, shortness of breath, palpitations, discomfort in the precordial region, and skipped beats. His resting heart rate was typically 50-50 beats/min [Note: likely typo in original for range]. During symptom exacerbations, the heart rate dropped to 35-40 beats/min, accompanied by 5-8 skipped beats per minute. From May 1973 onwards, attacks became frequent, each lasting 2-3 hours. Diagnosed with "Sick Sinus Syndrome" at a certain hospital, he was hospitalized for two months. Treatment with Western medicines such as Atropine, Isoprenaline, and 706 plasma substitute yielded poor results. He still experienced 1-2 attacks per week, characterized by dizziness, shortness of breath, and skipped beats, with a heart rate below 40 beats/min. Finally, after drug therapy proved ineffective, he was advised to receive an artificial pacemaker. Considering that a pacemaker would hinder future labor, he refused implantation and sought treatment at the outpatient clinic using Traditional Chinese Medicine (TCM).
First Consultation
Symptoms included intermittent palpitations, chest tightness and shortness of breath, irritability, and frequent dreams during sleep. The tongue was red and thin; the pulse was deep and slow, feeling wiry, fine, and slippery upon pressure. Examination: Blood pressure 120/80 mmHg, heart rate 46 beats/min, normal development, steady respiration, no jugular venous distension, lungs clear (-), heart size not enlarged, regular rhythm, no pathological murmurs heard over cardiac valve areas. Abdomen soft without tenderness, liver and spleen not palpable, no lower limb edema.
TCM Pattern Differentiation: Based on the deep and slow pulse, palpitations, and shortness of breath, this appears to be Heart Qi deficiency and weakness, with dual deficiency of the Liver and Kidney. Detailed examination of the Cun and Guan positions on both hands reveals a slightly wiry and fine quality upon deep pressure. A deep pulse indicates interior pathology; a slow pulse relates to Zang organ disease; a fine pulse suggests Phlegm; a wiry pulse indicates stagnation. A thin tongue with a red tip, irritability, and frequent dreams all point to Yin deficiency of the Liver and Kidney, with deficient heat disturbing upwards. Insufficiency of Heart Yin is the root cause; damage to Yin affecting Yang, leading to Heart Yang deficiency, is the branch manifestation. Treatment must nourish Heart Yin, assist Heart Yang, tonify the Liver and Kidney, drain deficient heat, regulate Yin and Yang, and balance ascending and descending mechanisms.
Prescription: Bei Sha Shen (Glehniae Radix) 30g, Mai Men Dong (Ophiopogonis Tuber) 15g, Gou Qi Zi (Lycii Fructus) 15g, Dan Fu Pian (Aconiti Lateralis Radix Praeparata, decocted thoroughly first) 12g, Tu Si Zi (Cuscutae Semen) 12g, Shu Di Huang (Rehmanniae Radix Praeparata) 18g, Gui Zhi (Cinnamomi Ramulus) 9g, Xian Mao (Curculiginis Rhizoma) 9g, Xian Ling Pi (Epimedii Folium) 9g, Dang Shen (Codonopsis Radix) 9g, Jin Ying Zi (Chrysanthemi Fructus) 10g.
Western medicines were discontinued while taking herbal medicine. After taking 6 doses, subjective symptoms improved significantly; chest tightness and shortness of breath did not recur, no skipped beats occurred, and the heart rate rose to 50 beats/min.
Second Consultation
Consulted by another doctor who believed the condition belonged to Heart Yang insufficiency, switched to acrid-warm, yang-strengthening, and Qi-tonifying herbs: Dan Fu Pian 30g, Huang Qi (Astragali Radix) 24g, Gui Zhi 15g, Ma Huang (Ephedrae Herba) 6g, Xi Xin (Asari Radix et Rhizoma) 6g, etc. Because the prescription contained too many ascending herbs, lacked Yin-nourishing herbs, and had no herbs to adjust ascending and descending mechanisms, the patient again experienced chest tightness, shortness of breath, and skipped beats after taking the medicine, with the heart rate dropping to 40 beats/min.
Third Consultation
Adhered to the first consultation prescription, adding Bai Shao (Paeoniae Radix Alba) 15g. Taken continuously for 10 doses, symptoms improved; no palpitations, shortness of breath, or dizziness occurred. The heart rate increased to 50-60 beats/min. Subsequently, continuous administration of 30 doses stabilized the condition with no adverse symptoms, maintaining the heart rate around 60 beats/min.
In November 1973, the patient exhibited more pronounced irritability and frequent dreams. Urine was yellow; the pulse was wiry and slippery; the tongue was red with a thin, greasy yellow coating. This pattern was identified as Yin insufficiency, with deficient heat disturbing upwards, and damp-heat accumulation obstructing transformation. Qi mechanism dysfunction and imbalance of ascending/descending led to irritability, frequent dreams, and yellow urine. The treatment shifted to nourishing Kidney Water to control deficient fire, tonifying the lower Yuan with slight addition of heat-draining herbs.
Prescription: Sha Shen (Glehniae Radix) 24g, Dang Shen 9g, Mai Dong (Ophiopogonis Tuber) 9g, Tian Dong (Asparagi Radix) 9g, Jin Ying Zi 9g, Xian Ling Pi 9g, Xian Mao 9g, Chai Hu (Bupleuri Radix) 9g, Huang Qin (Scutellariae Radix) 9g, Jiao San Xian (Fried Hawthorn, Medicated Leaven, and Malt) 9g, Sheng Di Huang (Rehmanniae Radix) 12g, Bai Shao 15g, Qian Shi (Euryales Semen) 18g, Sang Ji Sheng (Taxilli Caulis) 18g.
After taking the above medicine for over a month, the condition remained stable. No chest tightness, dizziness, or skipped beats occurred; the heart rate maintained around 60 beats/min. Continued regulation using the previous method for 3 months, then stopped medication for 1 month. The condition remained stable without recurrence, allowing discharge and return to work.
[Commentary]: Sick Sinus Syndrome is a difficult disease in modern medicine; severe cases require artificial pacemakers. This patient, refusing pacemaker implantation subjectively, turned to TCM, posing a challenge. In TCM, besides subjective symptoms like palpitations, chest tightness, and dizziness, the main signs are a slow pulse, even with skipped beats. However, a slow pulse does not equate to complete Yang deficiency. Given the thin red-tipped tongue, irritability, and frequent dreams, it indicates Yin insufficiency with stagnant heat. Thus, the method of adjusting Yin and Yang, balancing ascending and descending, seeking Yang within Yin was used. Zhang Jiebin stated: "Those skilled in tonifying Yang must seek Yang within Yin, so that Yang receives assistance from Yin and generation is endless." Therefore, Shu Di Huang, Sha Shen, Mai Men Dong, Gou Qi Zi, and Tu Si Zi were used to nourish Yin and fill essence, paired with Gui Zhi, Fu Zi, Xian Mao, and Xian Ling Pi to strengthen Yang and benefit Mingmen Fire, deeply grasping the mutual root of Yin and Yang. Hence, immediate effect was seen with increased heart rate.
The second consultation by another doctor, interpreting the slow pulse as Yang deficiency, used pure Yang-strengthening methods seeking rapid effect, which instead caused heart rate decline and recurrence of symptoms. Thus, in the third consultation, Bai Shao was heavily added to the initial prescription to rescue damaged Yin, leading to improvement. When signs of damp-heat accumulation appeared, herbs to regulate and drain heat were added. In summary, analyzing patterns and prescribing according to changes, not adhering to preconceptions nor blindly attributing slow pulses to Yang deficiency, embodies the spirit of TCM syndrome differentiation and treatment.
Palpitation Case 2 (Rheumatic Heart Disease)
Patient Hao, female, 70 years old.
First Consultation
Reported suffering from Rheumatic Heart Disease for over 30 years. Frequent palpitations and chest tightness, aggravated recently. Accompanied by irritability, frequent dreams, abdominal distension and fullness, belching with discomfort, and poor appetite. General fatigue and weakness. Pulse was wiry and slippery, irregular with pauses (every three or five beats); tongue dark with white, greasy coating. Pattern: Damp-heat accumulation obstructing Qi mechanism, Lung losing its regulatory authority, San Jiao (Triple Burner) unsmooth. Initial treatment: Regulate San Jiao, promote smooth Qi mechanism.
Prescription: Su Ye (Perillae Folium) and Su Geng (Perillae Caulis) 10g each, Qian Hu (Peucedani Radix) 6g, Zhe Bei Mu (Fritillariae Cirrhosae Bulbus) 10g, Jiao San Xian 10g each, Yuan Hu (Corydalis Rhizoma) 10g, Chuan Lian Zi (Meliae Fructus) 10g, Shui Hong Hua Zi (Alternantherae Sessilis Fructus) 10g, Xiang Fu (Cyperi Rhizoma) 10g, Chao Zhi Ke (Aurantii Fructus Pericarpium stir-fried) 6g. 7 doses. Decoct in water and take orally.
Second Consultation
After medication, distension relieved, chest tightness gradually reduced, appetite increased. Still felt irritable with frequent dreams, restless sleep. Pulse wiry and rapid. Tongue red with white, slightly greasy coating. Liver-Gallbladder stagnant heat not cleared. Continue clearing and draining Liver-Gallbladder heat.
Prescription: Chai Hu 6g, Huang Qin 10g, Chuan Lian Zi 10g, Chan Yi (Bombyx Batryticatus) 6g, Jiang Can (Bombyx Batryticatus) 10g, Pian Jiang Huang (Curcumae Longae Rhizoma) 10g, Zhu Ru (Bambusae Caulis in Taenia) 6g, Zhi Ke 6g, Jiao San Xian 10g each. 7 doses, decoct in water.
Third Consultation
After taking the above medicine, sleep stabilized, irritability gradually reduced. Palpitations and chest tightness significantly improved. Pulse wiry and slippery, occasional pause; tongue red with white coating. Stagnant heat vented, but collaterals not yet harmonized. Continue resolving stasis and harmonizing collaterals.
Prescription: Jing Jie (Schizonepetae Spica) 6g, Fang Feng (Saposhnikoviae Radix) 6g, Sheng Di Yu (Sanguisorbae Radix) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Dan Shen (Salviae Miltiorrhizae Radix) 10g, Qian Cao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Mao Gen (Imperatae Rhizoma) and Lu Gen (Phragmitis Rhizoma) 10g each, Jiao San Xian 10g each, Shui Hong Hua Zi 10g. 7 doses, decoct in water.
Fourth Consultation
All symptoms gradually healed. Pulse regular without pauses; tongue red with clean coating. Continue previous prescription for 7 doses to consolidate recovery.
[Commentary]: Patient had Rheumatic Heart Disease for over 30 years, presenting with palpitations and knotted/intermittent pulse. Conventionally, Fu Mai Tang (Decoction to Restore the Pulse) would be used. Here, Master Zhao promoted Lung Qi to smooth the mechanism and restore regulatory authority, then regulated Liver to drain stagnant heat and calm the organ of planning, finally resolving stasis and unblocking collaterals to treat the root of Heart vessels. The treatment method was orderly, achieving results within ten days.
Palpitation Case 3 (Autonomic Nervous System Dysfunction)
Patient Cai, female, 47 years old.
First Consultation
Emaciated body, red face, purple lips, intermittent sweating, irritability, frequent dreams, subjective palpitations and restlessness, easily startled by noise. Menstrual cycle irregular for the past year, scanty flow, dark color, containing black granular clots. Pulse wiry, fine, and rapid; tongue red with little coating and dry. Pattern: Yin insufficiency, heat stagnating in Blood level, disturbing Heart Spirit, causing palpitations and restlessness. Treatment: Nourish Blood and Yin, cool Ying level and resolve stasis.
Prescription: Sheng Di Huang 10g, Chi Shao and Bai Shao 10g each, Sheng Di Yu 10g, Dan Shen 10g, Qian Cao 10g, Chai Hu 6g, Huang Qin 10g, Chuan Lian Zi 10g, Gou Teng (Uncariae Ramulus cum Uncis) 10g (added later). 7 doses.
Second Consultation
Palpitations gradually decreased, able to sleep peacefully, still frequent dreams, irritability reduced but not fully resolved. Pulse still wiry, fine, and rapid; tongue red with little coating, not very dry. Stool slightly dry. Continue previous method with adjustments, adding Er Zhi Wan (Two Solstice Pill) for Yin nourishment.
Prescription: Sheng Di Huang and Shu Di Huang 10g each, Chi Shao and Bai Shao 10g each, Chai Hu 6g, Sheng Di Yu 10g, Dan Shen 10g, Qian Cao 10g, Nu Zhen Zi (Ligustri Lucidi Fructus) 10g, Han Lian Cao (Ecliptae Herba) 10g, Xia Ku Cao (Prunellae Spica) 10g. 7 doses.
Third Consultation
Menstruation arrived, heavier than before, red color, fewer black clots. Felt comfortable in chest, irritability continued to decrease, palpitations calmed. Tongue red, pulse rapid, urination and defecation normal. Long-standing Yin deficiency is hard to recover quickly; continue previous method with modifications. Avoid spicy and stimulating foods, strongly advised.
Prescription: Sheng Di Huang and Shu Di Huang 10g each, Tian Dong and Mai Men Dong 10g each, Chi Shao and Bai Shao 10g each, Sheng Di Yu 10g, Dan Shen 10g, Qian Cao 10g, Fu Ling Ku (Poria Cocos with Wood) 15g, Chai Hu 6g. 7 doses.
Menstruation ended, all symptoms趋向 peace. Pulse fine and rapid, tongue red with thin coating. Continue previous method, harmonize Stomach Qi.
Prescription: Sheng Di Huang and Shu Di Huang 10g each, Tian Dong and Mai Men Dong 10g each, Chi Shao and Bai Shao 10g each, Dan Shen 10g, Sheng Shan Yao (Dioscoreae Rhizoma) 10g, Xiang Dao Ya (Oriza Sativa Germinatum fragrant) 10g, Xuan Mu Gua (Chaenomelis Fructus) 10g. 7 doses.
[Commentary]: Constitution inherently Yin deficient; Yin deficiency leads to Yang hyperactivity, hence signs of heat stagnation and fire rising. Treatment first cooled Blood and cleared Liver, then nourished Blood and Yin, finally harmonized Stomach Qi, with Yin nourishment贯穿 throughout. Knowing Yin injury is hard to recover, good self-care yields expected results. Hence the strong advice.
Palpitation Case 4 (Anemia Pending Investigation)
Patient Chen, male, 24 years old.
First consultation on April 3, 1991. Subjective dizziness, fatigue, palpitations. Examination: Hb 8g/dl, RBC 2.85-10^9/mm3, diagnosed as Anemia pending investigation. After over 2 months of treatment, Hb dropped to 5.5-6g/dl. Suspected Aplastic Anemia. Introduced by colleague to seek treatment from Old Master Zhao. Presentation: Pale complexion, dizziness and vertigo, general fatigue, poor diet, palpitations, shortness of breath, sweating upon exertion, irritability, insomnia with frequent dreams. Tongue red with white greasy coating; pulse deep, wiry, fine, and rapid. Hb 6g/dl, RBC 3.0×10^9/mm3, BP 80/60 mmHg.
Pattern Differentiation: Liver-Gallbladder stagnant heat, Qi mechanism obstruction.
Treatment Method: Promote depression, clear heat, smooth Qi mechanism.
Prescription: Chan Yi 6g, Jiang Can 10g, Pian Jiang Huang 6g, Da Huang (Rhei Radix et Rhizoma) 0.5g, Chuan Lian Zi 6g, Da Fu Pi (Arecae Pericarpium) 10g, Bing Lang (Arecae Semen) 10g, Zhu Ru 6g, Zhi Ke 6g, Ban Xia (Pinelliae Rhizoma) 10g, Jiao San Xian 10g each, Shui Hong Hua Zi 10g. 7 doses. Stop other medications, light diet, slow walking 1-2 hours morning and evening.
Second Consultation
Subjective symptoms reduced, spirit better, strength increased, Hemoglobin rose to 7g, still frequent dreams. Remove Da Huang, Chuan Lian Zi, Da Fu Pi, Bing Lang from previous prescription. 7 doses.
Third Consultation
Hemoglobin rose to 8g, remaining symptoms decreased. Continue previous prescription with modifications.
Prescription: Chan Yi 6g, Jiang Can 10g, Pian Jiang Huang 6g, Da Huang 0.5g, Lei Wan (Vermiparum) 10g, Shi Jun Zi (Quisqualis Fructus) 10g, Zhu Ru 6g, Zhi Ke 6g, Sheng Mu Li (Ostreae Concha) 20g. 7 doses.
After continuing modified prescription for 4 weeks, re-examination on May 15: Hb 130g/L [Note: Original says g/dl which is likely typo for g/L or similar unit conversion context, standard is g/L], RBC 4.4×10^9/mm3, Plt 150×10^9/mm3, BP 110/70 mmHg. Complexion ruddy, good diet, all other symptoms removed, cured.
[Commentary]: Anemia belongs to "Blood Deficiency" and "Deficiency Labor" categories; traditional treatment focuses on tonification. However, Master Zhao emphasizes syndrome differentiation based on comprehensive analysis of pulse, tongue, complexion, symptoms, and lab tests, rather than assuming deficiency solely from anemia. This patient showed deficiency signs: dizziness, pale face, fatigue, palpitations, shortness of breath, sweating, low Hb. But pulse deep/wiry/fine/rapid, red tongue, irritability, insomnia indicated Liver-Gallbladder stagnant heat. Which takes precedence? Master said: Distinction between excess and deficiency lies subtly in the pulse. Deep indicates interior disease, wiry indicates Liver stagnation, rapid indicates heat, fine indicates Yin injury. Red tongue confirms heat stagnation; white greasy coating indicates Qi mechanism obstruction. Previous medications were all tonics; tonification causes stagnation and aids heat, hence poor efficacy. Therefore, Master used Sheng Jiang San (Ascending and Descending Powder) to adjust Qi mechanism ascent/descent; paired with Chuan Lian Zi and Zhi Ke to soothe Liver, resolve stagnation, and clear Liver channel heat; Middle Jiao is the pivot of Qi mechanism, Spleen and Stomach are source of Qi and Blood production; Da Fu Pi, Bing Lang, Zhi Ke, Jiao San Xian, Shui Hong Hua Zi digest food and guide stagnation, aiding Spleen/Stomach ascent/descent. Master focused on descending Stomach Qi to facilitate Spleen Qi ascending. Ban Xia, Zhi Ke, Zhu Ru clear Gallbladder heat and harmonize Stomach to calm Spirit. Combined, these herbs cured the disease. Additionally, light diet and walking exercise aided Qi mechanism and hematopoietic function recovery.
Palpitation Case 5 (Coronary Heart Disease)
Patient Tan, female, 51 years old. First consultation on July 12, 1991. For one year, subjective palpitations, shortness of breath, chest tightness, fatigue, chest/epigastric distension, poor appetite. Western medicine checks showed high blood lipids, abnormal ECG, diagnosed as suspected Coronary Heart Disease. Took Yu Feng Ning Xin Pian and Dan Shen Pian with poor efficacy. Observation: Fat constitution; Tongue: Puffy with greasy coating; Pulse: Soft and slippery. All signs of Phlegm-Damp obstruction and Qi mechanism dysfunction. Treatment: Promote depression, open closure, resolve Phlegm-Damp.
Prescription: Su Zi (Perillae Fructus) and Su Ye 10g each, Lai Fu Zi (Radish Seed) 10g, Bai Jie Zi (Sinapis Semen) 6g, Xing Ren (Armeniacae Semen Amarum) 10g, Pi Pa Ye (Loquat Leaf) 10g, Zhu Ya Zao (Gleditsiae Spina) 6g, Chang Pu (Acori Tatarinowii Rhizoma) 10g, Yu Jin (Curcumae Radix) 10g, Gua Lou (Trichosanthis Fructus) 10g, Zhi Ke 6g, Jiao San Xian 10g each. Advised to strengthen physical exercise, avoid rich/greasy foods, eat light diet. After 20+ doses, subjective symptoms lightened. Another 30+ doses with same prescription, symptoms basically disappeared, appetite improved, ECG normal, blood lipids dropped to normal range.
[Commentary]: Patient preferred leisure over labor, inherent Phlegm-Damp abundance. At age 51, initial treatment for Menopausal Syndrome was ineffective. After finding high lipids and abnormal ECG, treated as CHD with little effect. Under Master Zhao's treatment, cooperated actively, controlled diet, walked/exercised. Two months total treatment, ECG and lipid checks basically normal.
Chest Pain Case 1 (Coronary Heart Disease)
Patient Jiang, male, 48 years old. First consultation on October 8, 1989.
Since August 1987, suffered Myocardial Infarction, condition relieved after hospital rescue. Sequelae: Intermittent chest pain, epigastric fullness, loss of appetite, fatigue, dizziness. Tongue red with thick yellow greasy coating; pulse soft and slow, occasionally knotted/intermittent; blood pressure high. Pattern: Damp-turbidity not transforming, Qi mechanism obstruction, abnormal ascending/descending. Treatment: Promote depression, resolve dampness, regulate ascending/descending, assisted by activating Blood and unblocking collaterals.
Prescription: Jing Jie 6g, Fang Feng 6g, Chan Yi 6g, Pian Jiang Huang 6g, Xuan Fu Hua (Inulae Flos) 10g, Dai Zhe Shi (Haematitum) 10g, Ban Xia 10g, Xie Bai (Allii Macrostemonis Bulbus) 10g, Gua Lou 30g, Pei Lan (Elsholtziae Herba) 10g, Xing Ren 10g, Jiao San Xian 10g each. Advised to change habit of bed rest, walk 1-2 hours morning/evening; light diet. After 7 doses, mood pleasant, no chest pain, dizziness/fatigue lightened, chest distension relieved, appetite improved. Tongue red with white coating, pulse slippery and rapid, damp stagnation gradually resolving. Continue previous method with adjustments.
Prescription: Jing Jie 6g, Fang Feng 6g, Chan Yi 6g, Jiang Can 10g, Pian Jiang Huang 6g, Chi Shao 10g, Dan Shen 10g, Da Fu Pi 10g, Bing Lang 10g, Xiang Fu 10g, Jiao San Xian 10g each, Shui Hong Hua Zi 10g. After 2 weeks on above prescription, diet and excretion normal, spirit vigorous, no other discomfort. Changed to Tonify Qi and Nourish Yin method.
Prescription: Jing Jie 6g, Fang Feng 6g, Sha Shen 10g, Mai Dong 10g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma honey-fried) 10g, Dan Shen 10g, Chi Shao 10g, Xiang Fu 10g, Yu Jin 10g, Jiao San Xian 10g each, Chao Huai Hua (Sophorae Flos stir-fried) 10g, Shui Hong Hua Zi 10g. One month later, hospital review: ECG roughly normal, BP normal. Able to participate in some sports activities.
[Commentary]: This case involved unresolved chest pain post-MI, bed rest at home for two years, heavy psychological burden. Master Zhao differentiated based on pulse, tongue, complexion, symptoms as Damp obstructing Qi mechanism and abnormal ascending/descending. Initially treated with promoting depression and resolving dampness; only 7 doses greatly reduced symptoms, boosting patient's confidence to fight illness. Cooperated actively, persisted in walking exercise daily, starting 30 mins, gradually increasing to ~5 hours. After 3 months, could visit parks, climb mountains. Practice proves walking exercise improves coronary circulation, increases myocardial nutrition, and promotes healing.