证见心悸气短，胸闷心痛，或心前区痛，胸骨后闷，或引背内侧痛，痛引肩背，时发时止，严重者痛如针刺不可忍，唇面青紫，舌质紫暗、舌边有瘀点瘀斑，脉细涩或结代。此证于冠心病心绞痛、心肌梗塞等较为多见。治宜行气活血，宽胸定痛。药用：丹参、赤芍、制乳没、蒲黄、五灵脂、当归、桃仁、玄胡、橘皮、制香附等。若心血瘀阻，病发于阴寒凝滞，心络不通，疼痛剧者，加熟附６克，细辛３克，红花１０克，以温经通络止痛；心脉瘀阻严重，胁下症块积结而正气未衰者，加三棱、莪术各１０克，炮甲珠、地鳖虫各１２克，以活血化瘀，软坚散结；气郁化火，烦躁易怒，口苦咽干者，加丹皮、栀子各１０克，钩藤１２克，夏枯草、菊花各１５克，以清肝潜阳；病程辗转，心脉不和，湿热内阻，口苦脘痞，舌苔黄腻者，可选用黄连温胆汤加藿香、佩兰、川贝各１０克，苡仁３０克，以清热化湿，待苔腻得化，湿热稍挫，再用活血化瘀通络之品。
案例：余某，男，５２岁，湖北建设六公司干部。１９９２年４月１８日初诊。胸闷心痛反复发作２年，复发加重半年。患者素嗜烟酒。１９９０年６月因劳累诱发心痛，当时服用三七片、丹参片可缓解。１９９１年９月回江西老家探亲，因旅途劳顿，复加烟酒过度，以致心痛频发，再服前药无效。１９９１年１０月至省某医院诊治，经心电图、超声心电图、心脏摄片等检查，诊断为“冠心病心绞痛（劳力型）”住院１０天，予服硝酸甘油、心痛定等西药，稍有好转，但移时复发。现症：心前区痛，痛如针刺，胸部憋闷，每天发作４～５次，每次持续时间长则１～２分钟，短则数秒，发作时须用硝酸甘油方可缓解；心神不宁，睡眠不安；舌质红苔薄白，脉弦细。证属心脉瘀阻，气机郁滞，拟以活血化瘀，行气止痛为治。处方：丹参１５克，赤芍１５克，制乳没各６克，当归１０克，元胡１０克，合欢皮１０克，茯神２０克，橘皮络各１０克，炒蒌皮１５克，薤白１０克。上方一剂分三服，禁烟酒辛辣等物，停用硝酸甘油。
二诊：服药８剂，心痛发作次数减少至１～２次，疼痛时间亦缩短，睡眠尚可，舌脉同前。是血脉瘀阻，病难速去。上方适量加入活血化瘀之品。处方：丹参１５克，赤白芍各１５克，制乳没第三卷２０１各６克，炒蒲黄１０克，炒灵脂１０克，当归１０克，茯神１８克，炒蒌皮１０克，制香附１０克，薤白１０克，橘皮络各１０克，炒山楂１０克。连服１０剂，心痛缓解，偶有发作，症状亦轻。继以宽胸理气，养血和血之法调治而愈，复查心电图亦告正常。
（三）益气养阴气阴两虚是冠心病的常见病机。究其原因，或禀赋不足，素体虚弱，邪热犯心，心阴耗伤或思虑过度，积劳虚损，耗伤气阴。气阴亏损，运血无力，血脉瘀滞，则发心痛。此时治法，宜益气养阴，宁心安神，活血化瘀，对缓解病情有满意效果。
证见心悸怔忡，胸痛隐隐，或有刺痛，气短乏力，虚烦失眠，自汗盗汗，手足心热，口干少津，小便短黄，舌红少苔，或光剥无苔，脉细弱或细数或结代。国内大量心血管疾病研究资料表明，冠心病心绞痛和急性心肌梗塞时，临床多表现为气阴不足。治宜益气养阴，活血通络。药用：人参、麦冬、五味子、生地、当归、丹参、柏子仁、酸枣仁，炙远志、茯神等。若兼阴虚火旺，心烦失眠者，加炒黄连６克，炒栀子１０克，以清心泄热；肾阴亏虚，腰酸耳鸣，口干咽燥者，加龙骨、牡蛎、珍珠母各１５克，以潜镇宁心；气机郁滞，胸闷憋气，自感窒息者，加郁金、瓜蒌皮、薤白、陈皮各１０克，以宽胸散痹；心脉瘀阻，胸闷刺痛，舌边瘀点者，加三七６克，赤芍３０克，桃仁、红花各１０克，以活血化瘀；胸脘闷胀，纳食呆滞者，加炒山楂、炒二芽各１５克，香橼皮、炒枳壳各１０克，以理气和胃。据李氏经验，心气阴两虚，常伴有大肠津液不足。传导不及，易致大便干燥难解。在真心痛时，因腑气不通，大便用力过猛而猝死者不乏其例。故临床用药，须确保大便畅通，可用番泻叶１０～２０克，开水泡服当茶饮。为防气阴耗伤，亦可用生脉承气汤（人参、麦冬、五味子、芒硝、厚朴、大黄）与服，其他方药加减化裁与服。
案例：余某，男，７４岁，工人。１９８９年１１月２日初诊。胸闷心悸反复发作１年，复发加剧１月。１９８８年因劳累过度，又遇情绪恼怒，病发胸闷心痛，心悸短气，到武汉某医院诊治，心电图检查：ＳＴ段改变，心肌供血不足。眼底检查：眼底动脉硬化。诊断为“冠心病”，予服硝酸甘油片、消心痛、心痛定、脉通、复方丹参片等，心痛缓解。但情绪激动或劳作时心痛又发，如此辗转一年，特请李氏诊治。刻诊所见：胸闷不适，心痛隐隐，时有刺痛，时作时止，心悸短气，睡眠多梦，倦怠懒言，面色少华，遇劳则甚。舌质偏红，苔薄黄少苔，脉来细数。李氏断之曰：此心病日久，心气不足，阴亦耗损，心脉痹阻之证也，当益气养阴，活血通络，宁心安神为治。药用：太子参１５克，麦冬１０克，五味子１０克，丹参３０克，当归１０克，桃仁１０克，茯神３０克，枣仁２０克，制香附１０克，橘络１０克，炒蒌皮１５克，郁金１０克，山楂炭１５克，红枣６克。
二诊：上方服用５剂，胸闷心痛好转，精神渐振，惟睡眠欠佳，时发头昏，舌红苔薄黄，脉细略数。李氏谓：心气阴两虚，血脉痹阻，用益气养阴，活血通络等药自然有效。然心气阴两虚时，肾阴亦亏，心病得治，而肾阴虚显然，故有头痛等证也。可与上方加入滋养肝肾，清利头目之品。处方：太子参１５克，麦冬、五味子各１０克，丹参３０克，赤白芍、女贞子、旱莲草、夏枯草、野菊花、炒山楂各１５克，桃仁、橘络、制香附、炒柏仁各１０克，茯神３０克。连服１０剂，胸闷心痛消失，头昏得除，睡亦安神。惟有时心烦，舌红苔薄黄，脉细弦小数。继以养心安神，清热除烦之剂调治而愈。随访２年未发。
第三卷２０２四、心律失常辨治经验心律失常在临床中最为常见，可发生于各心脏疾患者，严重者可引起心力衰竭、休克、心脑综合征等。笔者随李氏侍诊多年，对其辨证治疗心律失常的规律有所领悟。李氏认为心律失常可分为虚实两类：实证多由痰滞、气郁、血瘀所致；虚证多与阴血不足、阳气虚衰有关。其临床特点：心悸、胸闷、胸痹、短气、乏力、脉结代、或疾或迟等，临床当循此而辨证处方用药。
（一）滋阴和阳心律失常者，每有气阴两虚之脉证。盖心主血脉，血以养心，而血气互用，所谓血载气，气帅血是也。外邪入心，心阴阳受损，气血亏虚，心失所养，鼓动无力，则心悸气短，脉结或代。当以滋阴养血，通阳复脉为主，兼以治标。通过调理阴阳，扶助阳气，藉以改善中枢神经系统和心血管系统，兴奋心肌，增加心排出量，改善微循环，是使异常心律复常的一个重要步骤。
证见心悸气短、自汗、少寐多梦、胃纳不振、疲乏无力，脉细或细数或结代，舌质淡红，苔薄黄或苔剥。此证多见于植物神经功能紊乱心肌病、冠心病等引起的房性或室性期外收缩、心动过速、心房纤颤等。治宜滋阴和阳、益气养血。药用：炙甘草、人参、生地、麦冬、阿胶、麻仁、茯神、炒山楂、砂仁、大枣等。若触事易惊，心悸不安，宜加龙牡、珍珠母、柏子仁、炙远志等，以重镇潜纳，宁心安神，定惊止悸；胸闷太甚，自感窒息，呼吸不畅，可加郁金、瓜蒌皮、薤白、橘皮等通阳利气，宽胸散痹；胸部刺疼，舌质紫暗，可加三七、丹参、赤芍、制乳没等，以活血消瘀，通络止痛；心烦不寐，口糜生疮，舌质红绛，是心火太旺，则宜加入丹皮、丹参、竹叶、玄参等育阴养血，清火除烦，甚者加黄连，以苦寒直折火势。
案例：张某，男，４０岁，干部。１９８２年９月１０日初诊。心悸短气，神志不安２年。患者长期在某市搞计划工作，２年前因过于劳顿，病发心悸不安。当时在省某医院附属医院做心电图检查，提示“频发性室性早搏”，对症治疗３月余，症状略见好转，惟停药后病情反复，近期病情加重。诊其脉，五、六息即见一止，心悸不安，夜间不眠。遇劳或失眠则心悸发剧，饮食二便尚可，舌边尖甚红，中有白苔。素嗜烟酒。证属劳心太过，阴液虚而不得濡润，阳气虚而不得畅通，遂致心主受累，而见脉结代心动悸之病。治宜益气补虚，滋阴和阳，宁心安神。处方：炙甘草１２克，人参１０克，生地１５克，阿胶１２克，炒麻仁１２克，茯神、龙骨各１５克，煅牡蛎１２克，桂枝３克，生姜３克，大枣１０克。上药一剂分三服，服时兑入米酒半汤匙合服，并嘱其戒烟酒、辛辣之品，以安神摄养为宜。药进１５剂，心悸失眠好转，脉搏仍有间歇，惟面部有时浮肿，腹满不适，爰以上方去龙牡、炙草，生地减量，而加茯苓、楂炭、橘皮、橘络以理气消胀。连服１５剂，心悸各证大减。以脉搏歇止偶尔见诊，则于前方中加入丹参、柏子仁养心安神。至年底，患者特来致谢，云服药３０剂后，复查心电图已见正常，现已参加工作云云。
（二）涤痰通络痰湿阻络是心律失常的又一重要病机。《证治汇补》所谓：“痰迷于心，为心痛惊悸怔忡恍惚。”李时珍亦云：“迟司脏病或多痰。”（《濒湖脉学》）可见痰湿亦能导致心律紊乱。因诸阳受气于胸，邪恋胸中，胸阳不振，津液不布，凝聚为痰，痰阻气机，则胸痛胸闷；痰浊阻滞，肺失宣降，第三卷２０３而有咳喘短气诸证。
本证凡以胸阳痹阻为主，即可以祛痰为法。
证见心痛闷胀，胸中窒闷或如累压，左肩背及左臂内侧有胀闷或痛麻，头晕眼花，泛恶欲吐，舌质红或暗淡，苔白腻，脉弦缓或弦滑，或迟或结代。其多见于冠心病、风心病、高心病等引起的早搏，传导阻滞或心房纤颤等。治宜涤痰通络。药用：瓜蒌实、薤白、法夏、川贝、炒枳实、橘皮、橘络、炒山楂等。若胸闷气短者，宜加党参、麦冬、五味子等益气复脉；心悸怔忡，可加炙甘草、柏子仁养心安神；心前区闷痛，加石菖蒲、檀香理气行滞；心痛彻背，背痛彻心，加赤白芍、丹参、乳没活血通络；血压升高，加生龙牡、天麻等重镇潜降。
案例：胡某，女，４３岁，工人。１９８３年３月１２日初诊。心悸胸闷喘气反复发作５年，复发加重１月。阵发性夜间呼吸困难，不能平卧，心有憋闷，头昏乏力，轻度咳嗽，有时咯少许粉红色痰，小便短少，舌质暗红，边有瘀点，苔白厚腻，脉结代。体检：口唇发绀，颜面轻度浮肿，两颧紫红，心率１０２次／分，律不齐，心尖闻及低音隆隆样舒张期杂音。心电图：Ｐ波增宽并有切迹，电轴右偏，心房颤动。Ｘ线检查：心房增大。某院诊断为风湿性心瓣膜病，二尖瓣狭窄，心衰Ⅱ°。
经长期抗感染、强心、利尿等处理，时好时发。此次发作，经某医院中药温阳利水之剂治疗，反致咳喘加剧，咯血不止。此非阳虚寒凝，乃胸阳痹阻，痰浊凝聚，脉络不通。治宜宣痹通阳，涤痰散结，活血止血。处方：炒蒌皮１５克、薤白１０克、川贝１０克、丹参３０克、赤芍３０克、当归１５克、制乳没各６克、茯苓３０克、血余炭１０克、白茅根３０克、仙鹤草３０克、木通１０克、三七粉６克（另包吞服）、炒山楂１５克、橘皮络各１０克。
服药５剂，咯血即止，胸闷缓解，咳喘亦轻，小便通利，浮肿先退，惟活动后稍有喘气，肢软乏力，舌质暗红苔薄白，脉结代。遂以上方去血余炭、仙鹤草、木通、太子参、麦冬、五味子，迭进６０余剂，诸证缓解。后以通阳散结、活血通络、养心安神之法调治收功。随访２年未发。
（三）解郁行滞情志失调是导致心律失常的病因之一。《灵枢·口问》谓：“心者，五脏六腑之大主也……故悲哀愁忧则心动，心动则五脏六腑皆摇。”《素问·举痛论》云：“惊则心无所倚，神无所归，虚无所定，故气乱矣。”可见，各种情志刺激都可能伤及心脏，心神受损又可影响其他脏腑，反过来又可以加重心脏病情。从临床观察，情志失调引起心律失常者以肝气郁结者为多见。因此调理脏腑气机、解郁行滞是治疗心律失常的一个方面。
证见胸闷心悸，失眠多梦，短气乏力，胁肋胀痛，情志抑郁，善太息，嗳噫频作，食纳呆滞，或咽中如物梗阻，吞咽不利，月经不调，甚或闭经，舌红苔薄白或薄黄，脉弦结代或细而结代。此证多见于心脏神经官能症、更年期综合征等有心律失常者。治宜疏肝解郁、养心安神。药用：柴胡、白芍、炒枳壳、制香附、郁金、陈皮、茯神、丹参、炒山楂等。若心悸怔忡，心律较快者，加龙牡、珍珠母等以定惊安神；心胸憋闷，有窒息感者，加蒌皮、薤白、苏梗等以宽胸理气；胸闷多痰，舌苔较腻者，加川贝、石菖蒲、橘红等化痰通络；心神不宁、夜不安寐者，加柏子仁、炙远志、合欢皮等养血安神；胸闷刺痛，难以耐受者，加桃仁、红花、赤芍等活血化瘀；心烦急躁，卧寐不安者，加炒栀子、黄连、玄参等清心除烦。
【背景信息】
书名：700.李培生老中医经验集 章节：正文(15/25) 类别：医论
【待处理原文】
证见心悸气短，胸闷心痛，或心前区痛，胸骨后闷，或引背内侧痛，痛引肩背，时发时止，严重者痛如针刺不可忍，唇面青紫，舌质紫暗、舌边有瘀点瘀斑，脉细涩或结代。此证于冠心病心绞痛、心肌梗塞等较为多见。治宜行气活血，宽胸定痛。药用：丹参、赤芍、制乳没、蒲黄、五灵脂、当归、桃仁、玄胡、橘皮、制香附等。若心血瘀阻，病发于阴寒凝滞，心络不通，疼痛剧者，加熟附６克，细辛３克，红花１０克，以温经通络止痛；心脉瘀阻严重，胁下症块积结而正气未衰者，加三棱、莪术各１０克，炮甲珠、地鳖虫各１２克，以活血化瘀，软坚散结；气郁化火，烦躁易怒，口苦咽干者，加丹皮、栀子各１０克，钩藤１２克，夏枯草、菊花各１５克，以清肝潜阳；病程辗转，心脉不和，湿热内阻，口苦脘痞，舌苔黄腻者，可选用黄连温胆汤加藿香、佩兰、川贝各１０克，苡仁３０克，以清热化湿，待苔腻得化，湿热稍挫，再用活血化瘀通络之品。
案例：余某，男，５２岁，湖北建设六公司干部。１９９２年４月１８日初诊。胸闷心痛反复发作２年，复发加重半年。患者素嗜烟酒。１９９０年６月因劳累诱发心痛，当时服用三七片、丹参片可缓解。１９９１年９月回江西老家探亲，因旅途劳顿，复加烟酒过度，以致心痛频发，再服前药无效。１９９１年１０月至省某医院诊治，经心电图、超声心电图、心脏摄片等检查，诊断为“冠心病心绞痛（劳力型）”住院１０天，予服硝酸甘油、心痛定等西药，稍有好转，但移时复发。现症：心前区痛，痛如针刺，胸部憋闷，每天发作４～５次，每次持续时间长则１～２分钟，短则数秒，发作时须用硝酸甘油方可缓解；心神不宁，睡眠不安；舌质红苔薄白，脉弦细。证属心脉瘀阻，气机郁滞，拟以活血化瘀，行气止痛为治。处方：丹参１５克，赤芍１５克，制乳没各６克，当归１０克，元胡１０克，合欢皮１０克，茯神２０克，橘皮络各１０克，炒蒌皮１５克，薤白１０克。上方一剂分三服，禁烟酒辛辣等物，停用硝酸甘油。
二诊：服药８剂，心痛发作次数减少至１～２次，疼痛时间亦缩短，睡眠尚可，舌脉同前。是血脉瘀阻，病难速去。上方适量加入活血化瘀之品。处方：丹参１５克，赤白芍各１５克，制乳没第三卷２０１各６克，炒蒲黄１０克，炒灵脂１０克，当归１０克，茯神１８克，炒蒌皮１０克，制香附１０克，薤白１０克，橘皮络各１０克，炒山楂１０克。连服１０剂，心痛缓解，偶有发作，症状亦轻。继以宽胸理气，养血和血之法调治而愈，复查心电图亦告正常。
（三）益气养阴气阴两虚是冠心病的常见病机。究其原因，或禀赋不足，素体虚弱，邪热犯心，心阴耗伤或思虑过度，积劳虚损，耗伤气阴。气阴亏损，运血无力，血脉瘀滞，则发心痛。此时治法，宜益气养阴，宁心安神，活血化瘀，对缓解病情有满意效果。
证见心悸怔忡，胸痛隐隐，或有刺痛，气短乏力，虚烦失眠，自汗盗汗，手足心热，口干少津，小便短黄，舌红少苔，或光剥无苔，脉细弱或细数或结代。国内大量心血管疾病研究资料表明，冠心病心绞痛和急性心肌梗塞时，临床多表现为气阴不足。治宜益气养阴，活血通络。药用：人参、麦冬、五味子、生地、当归、丹参、柏子仁、酸枣仁，炙远志、茯神等。若兼阴虚火旺，心烦失眠者，加炒黄连６克，炒栀子１０克，以清心泄热；肾阴亏虚，腰酸耳鸣，口干咽燥者，加龙骨、牡蛎、珍珠母各１５克，以潜镇宁心；气机郁滞，胸闷憋气，自感窒息者，加郁金、瓜蒌皮、薤白、陈皮各１０克，以宽胸散痹；心脉瘀阻，胸闷刺痛，舌边瘀点者，加三七６克，赤芍３０克，桃仁、红花各１０克，以活血化瘀；胸脘闷胀，纳食呆滞者，加炒山楂、炒二芽各１５克，香橼皮、炒枳壳各１０克，以理气和胃。据李氏经验，心气阴两虚，常伴有大肠津液不足。传导不及，易致大便干燥难解。在真心痛时，因腑气不通，大便用力过猛而猝死者不乏其例。故临床用药，须确保大便畅通，可用番泻叶１０～２０克，开水泡服当茶饮。为防气阴耗伤，亦可用生脉承气汤（人参、麦冬、五味子、芒硝、厚朴、大黄）与服，其他方药加减化裁与服。
案例：余某，男，７４岁，工人。１９８９年１１月２日初诊。胸闷心悸反复发作１年，复发加剧１月。１９８８年因劳累过度，又遇情绪恼怒，病发胸闷心痛，心悸短气，到武汉某医院诊治，心电图检查：ＳＴ段改变，心肌供血不足。眼底检查：眼底动脉硬化。诊断为“冠心病”，予服硝酸甘油片、消心痛、心痛定、脉通、复方丹参片等，心痛缓解。但情绪激动或劳作时心痛又发，如此辗转一年，特请李氏诊治。刻诊所见：胸闷不适，心痛隐隐，时有刺痛，时作时止，心悸短气，睡眠多梦，倦怠懒言，面色少华，遇劳则甚。舌质偏红，苔薄黄少苔，脉来细数。李氏断之曰：此心病日久，心气不足，阴亦耗损，心脉痹阻之证也，当益气养阴，活血通络，宁心安神为治。药用：太子参１５克，麦冬１０克，五味子１０克，丹参３０克，当归１０克，桃仁１０克，茯神３０克，枣仁２０克，制香附１０克，橘络１０克，炒蒌皮１５克，郁金１０克，山楂炭１５克，红枣６克。
二诊：上方服用５剂，胸闷心痛好转，精神渐振，惟睡眠欠佳，时发头昏，舌红苔薄黄，脉细略数。李氏谓：心气阴两虚，血脉痹阻，用益气养阴，活血通络等药自然有效。然心气阴两虚时，肾阴亦亏，心病得治，而肾阴虚显然，故有头痛等证也。可与上方加入滋养肝肾，清利头目之品。处方：太子参１５克，麦冬、五味子各１０克，丹参３０克，赤白芍、女贞子、旱莲草、夏枯草、野菊花、炒山楂各１５克，桃仁、橘络、制香附、炒柏仁各１０克，茯神３０克。连服１０剂，胸闷心痛消失，头昏得除，睡亦安神。惟有时心烦，舌红苔薄黄，脉细弦小数。继以养心安神，清热除烦之剂调治而愈。随访２年未发。
第三卷２０２四、心律失常辨治经验心律失常在临床中最为常见，可发生于各心脏疾患者，严重者可引起心力衰竭、休克、心脑综合征等。笔者随李氏侍诊多年，对其辨证治疗心律失常的规律有所领悟。李氏认为心律失常可分为虚实两类：实证多由痰滞、气郁、血瘀所致；虚证多与阴血不足、阳气虚衰有关。其临床特点：心悸、胸闷、胸痹、短气、乏力、脉结代、或疾或迟等，临床当循此而辨证处方用药。
（一）滋阴和阳心律失常者，每有气阴两虚之脉证。盖心主血脉，血以养心，而血气互用，所谓血载气，气帅血是也。外邪入心，心阴阳受损，气血亏虚，心失所养，鼓动无力，则心悸气短，脉结或代。当以滋阴养血，通阳复脉为主，兼以治标。通过调理阴阳，扶助阳气，藉以改善中枢神经系统和心血管系统，兴奋心肌，增加心排出量，改善微循环，是使异常心律复常的一个重要步骤。
证见心悸气短、自汗、少寐多梦、胃纳不振、疲乏无力，脉细或细数或结代，舌质淡红，苔薄黄或苔剥。此证多见于植物神经功能紊乱心肌病、冠心病等引起的房性或室性期外收缩、心动过速、心房纤颤等。治宜滋阴和阳、益气养血。药用：炙甘草、人参、生地、麦冬、阿胶、麻仁、茯神、炒山楂、砂仁、大枣等。若触事易惊，心悸不安，宜加龙牡、珍珠母、柏子仁、炙远志等，以重镇潜纳，宁心安神，定惊止悸；胸闷太甚，自感窒息，呼吸不畅，可加郁金、瓜蒌皮、薤白、橘皮等通阳利气，宽胸散痹；胸部刺疼，舌质紫暗，可加三七、丹参、赤芍、制乳没等，以活血消瘀，通络止痛；心烦不寐，口糜生疮，舌质红绛，是心火太旺，则宜加入丹皮、丹参、竹叶、玄参等育阴养血，清火除烦，甚者加黄连，以苦寒直折火势。
案例：张某，男，４０岁，干部。１９８２年９月１０日初诊。心悸短气，神志不安２年。患者长期在某市搞计划工作，２年前因过于劳顿，病发心悸不安。当时在省某医院附属医院做心电图检查，提示“频发性室性早搏”，对症治疗３月余，症状略见好转，惟停药后病情反复，近期病情加重。诊其脉，五、六息即见一止，心悸不安，夜间不眠。遇劳或失眠则心悸发剧，饮食二便尚可，舌边尖甚红，中有白苔。素嗜烟酒。证属劳心太过，阴液虚而不得濡润，阳气虚而不得畅通，遂致心主受累，而见脉结代心动悸之病。治宜益气补虚，滋阴和阳，宁心安神。处方：炙甘草１２克，人参１０克，生地１５克，阿胶１２克，炒麻仁１２克，茯神、龙骨各１５克，煅牡蛎１２克，桂枝３克，生姜３克，大枣１０克。上药一剂分三服，服时兑入米酒半汤匙合服，并嘱其戒烟酒、辛辣之品，以安神摄养为宜。药进１５剂，心悸失眠好转，脉搏仍有间歇，惟面部有时浮肿，腹满不适，爰以上方去龙牡、炙草，生地减量，而加茯苓、楂炭、橘皮、橘络以理气消胀。连服１５剂，心悸各证大减。以脉搏歇止偶尔见诊，则于前方中加入丹参、柏子仁养心安神。至年底，患者特来致谢，云服药３０剂后，复查心电图已见正常，现已参加工作云云。
（二）涤痰通络痰湿阻络是心律失常的又一重要病机。《证治汇补》所谓：“痰迷于心，为心痛惊悸怔忡恍惚。”李时珍亦云：“迟司脏病或多痰。”（《濒湖脉学》）可见痰湿亦能导致心律紊乱。因诸阳受气于胸，邪恋胸中，胸阳不振，津液不布，凝聚为痰，痰阻气机，则胸痛胸闷；痰浊阻滞，肺失宣降，第三卷２０３而有咳喘短气诸证。
本证凡以胸阳痹阻为主，即可以祛痰为法。
证见心痛闷胀，胸中窒闷或如累压，左肩背及左臂内侧有胀闷或痛麻，头晕眼花，泛恶欲吐，舌质红或暗淡，苔白腻，脉弦缓或弦滑，或迟或结代。其多见于冠心病、风心病、高心病等引起的早搏，传导阻滞或心房纤颤等。治宜涤痰通络。药用：瓜蒌实、薤白、法夏、川贝、炒枳实、橘皮、橘络、炒山楂等。若胸闷气短者，宜加党参、麦冬、五味子等益气复脉；心悸怔忡，可加炙甘草、柏子仁养心安神；心前区闷痛，加石菖蒲、檀香理气行滞；心痛彻背，背痛彻心，加赤白芍、丹参、乳没活血通络；血压升高，加生龙牡、天麻等重镇潜降。
案例：胡某，女，４３岁，工人。１９８３年３月１２日初诊。心悸胸闷喘气反复发作５年，复发加重１月。阵发性夜间呼吸困难，不能平卧，心有憋闷，头昏乏力，轻度咳嗽，有时咯少许粉红色痰，小便短少，舌质暗红，边有瘀点，苔白厚腻，脉结代。体检：口唇发绀，颜面轻度浮肿，两颧紫红，心率１０２次／分，律不齐，心尖闻及低音隆隆样舒张期杂音。心电图：Ｐ波增宽并有切迹，电轴右偏，心房颤动。Ｘ线检查：心房增大。某院诊断为风湿性心瓣膜病，二尖瓣狭窄，心衰Ⅱ°。
经长期抗感染、强心、利尿等处理，时好时发。此次发作，经某医院中药温阳利水之剂治疗，反致咳喘加剧，咯血不止。此非阳虚寒凝，乃胸阳痹阻，痰浊凝聚，脉络不通。治宜宣痹通阳，涤痰散结，活血止血。处方：炒蒌皮１５克、薤白１０克、川贝１０克、丹参３０克、赤芍３０克、当归１５克、制乳没各６克、茯苓３０克、血余炭１０克、白茅根３０克、仙鹤草３０克、木通１０克、三七粉６克（另包吞服）、炒山楂１５克、橘皮络各１０克。
服药５剂，咯血即止，胸闷缓解，咳喘亦轻，小便通利，浮肿先退，惟活动后稍有喘气，肢软乏力，舌质暗红苔薄白，脉结代。遂以上方去血余炭、仙鹤草、木通、太子参、麦冬、五味子，迭进６０余剂，诸证缓解。后以通阳散结、活血通络、养心安神之法调治收功。随访２年未发。
（三）解郁行滞情志失调是导致心律失常的病因之一。《灵枢·口问》谓：“心者，五脏六腑之大主也……故悲哀愁忧则心动，心动则五脏六腑皆摇。”《素问·举痛论》云：“惊则心无所倚，神无所归，虚无所定，故气乱矣。”可见，各种情志刺激都可能伤及心脏，心神受损又可影响其他脏腑，反过来又可以加重心脏病情。从临床观察，情志失调引起心律失常者以肝气郁结者为多见。因此调理脏腑气机、解郁行滞是治疗心律失常的一个方面。
证见胸闷心悸，失眠多梦，短气乏力，胁肋胀痛，情志抑郁，善太息，嗳噫频作，食纳呆滞，或咽中如物梗阻，吞咽不利，月经不调，甚或闭经，舌红苔薄白或薄黄，脉弦结代或细而结代。此证多见于心脏神经官能症、更年期综合征等有心律失常者。治宜疏肝解郁、养心安神。药用：柴胡、白芍、炒枳壳、制香附、郁金、陈皮、茯神、丹参、炒山楂等。若心悸怔忡，心律较快者，加龙牡、珍珠母等以定惊安神；心胸憋闷，有窒息感者，加蒌皮、薤白、苏梗等以宽胸理气；胸闷多痰，舌苔较腻者，加川贝、石菖蒲、橘红等化痰通络；心神不宁、夜不安寐者，加柏子仁、炙远志、合欢皮等养血安神；胸闷刺痛，难以耐受者，加桃仁、红花、赤芍等活血化瘀；心烦急躁，卧寐不安者，加炒栀子、黄连、玄参等清心除烦。
[Background Information]
Book Title: 700. Collected Experiences of Old TCM Physician Li Peisheng Chapter: Main Text (15/25) Category: Medical Theory
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Clinical manifestations include palpitations, shortness of breath, chest tightness and heart pain, or precordial pain, retrosternal oppression, or pain radiating to the medial back, shoulder, and back. The pain comes and goes intermittently. In severe cases, the pain is like needle pricks and unbearable, with cyanosis of the lips and face, a purplish-dark tongue body, ecchymoses and petechiae on the tongue edges, and a fine, choppy pulse or intermittent pulse (Jie Dai Mai). This syndrome is relatively common in coronary heart disease (CHD), angina pectoris, myocardial infarction, etc. The treatment should focus on promoting Qi circulation and activating blood circulation, broadening the chest to relieve pain. Medicines used include: Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Paeziae Radix Rubra (Chishao), processed Frankincense and Myrrh (Zhi Rumu), Polygoni Orientalis Pollen (Puhuang), Trogopterori Faeces (Wulingzhi), Angelicae Sinensis Radix (Danggui), Persicae Semen (Taoren), Corydalis Rhizoma (Yanhu), Citri Reticulatae Pericarpium (Jupi), and processed Cyperi Rhizoma (Zhi Xiangfu), etc. If there is obstruction of Heart blood stasis, caused by Yin-cold stagnation and blockage of Heart collaterals with severe pain, add 6g of prepared Aconiti Lateralis Radix (Shu Fuzi), 3g of Asari Radix et Rhizoma (Xixin), and 10g of Carthami Flos (Honghua) to warm the meridians, unblock collaterals, and relieve pain; if Heart vessel obstruction is severe, with masses accumulating under the hypochondrium but healthy Qi not yet exhausted, add 10g each of Bupleuri Radix (Sanleng) and Curcumae Rhizoma (Ezhu), and 12g each of Testudinis et Chelonis Carapax et Plastrum (Pao Jiazhu) and Eupolyphaga seu Steleophaga (Dibiechong) to invigorate blood circulation, resolve stasis, soften hardness, and dissipate nodules; if Qi stagnation transforms into fire, causing irritability and anger, bitter taste in the mouth, and dry throat, add 10g each of Moutan Cortex (Danpi) and Gardeniae Fructus (Zhizi), 12g of Uncariae Ramulus cum Uncis (Gouteng), and 15g each of Prunellae Spica (Xiakucao) and Chrysanthemi Flos (Juhua) to clear the Liver and submerge Yang; if the disease course is prolonged, Heart vessels are disharmonious, damp-heat obstructs internally, with bitter taste in the mouth and epigastric fullness, and a yellow, greasy tongue coating, one may choose Huanglian Wendan Tang plus 10g each of Pogostemonis Herba (Huoxiang), Elsholtziae Herba (Peilan), and Fritillariae Thunbergii Bulbus (Chuanbei), and 30g of Coicis Semen (Yiren) to clear heat and transform dampness. Once the greasy coating resolves and damp-heat is slightly subdued, then use herbs that invigorate blood, resolve stasis, and unblock collaterals.
Case: Yu, male, 52 years old, cadre of Hubei Construction Company No. 6. First consultation on April 18, 1992. Recurrent chest tightness and heart pain for 2 years, worsened for half a year. The patient has a long-standing habit of smoking and drinking alcohol. In June 1990, heart pain was triggered by overwork, which could be relieved at that time by taking Sanqi Tablets and Danshen Tablets. In September 1991, upon returning to his hometown in Jiangxi to visit relatives, due to travel fatigue and excessive smoking and drinking, heart pain occurred frequently again, and taking the previous medicines was ineffective. From October 1991, he sought diagnosis and treatment at a certain hospital in the province. After examinations such as electrocardiogram (ECG), echocardiogram, and cardiac radiography, he was diagnosed with "Coronary Heart Disease Angina Pectoris (Exertional Type)" and hospitalized for 10 days. He was given Western medicines such as Nitroglycerin and Nifedipine (Xintongding), showing slight improvement, but relapsed after some time. Current symptoms: precordial pain, like needle pricks, chest oppression, occurring 4-5 times a day, lasting 1-2 minutes each time when long, or just a few seconds when short; relief requires Nitroglycerin during attacks; restless mind, disturbed sleep; red tongue body with thin white coating, wiry and fine pulse. The syndrome belongs to obstruction of Heart vessels by blood stasis and stagnation of Qi mechanism. The treatment plan is to invigorate blood circulation, resolve stasis, promote Qi circulation, and relieve pain. Prescription: Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 15g, Paeziae Radix Rubra (Chishao) 15g, processed Frankincense and Myrrh (Zhi Rumu) 6g each, Angelicae Sinensis Radix (Danggui) 10g, Corydalis Rhizoma (Yuanhu) 10g, Albiziae Cortex (Hehuanpi) 10g, Polygalae Semen Preparatum (Fushen) 20g, Citri Reticulatae Pericarpium and its vascular bundles (Jupi Luo) 10g each, fried Peplopericarpium (Chao Loupi) 15g, and Allii Macrostemonis Bulbus (Xiebai) 10g. One dose of the above prescription is divided into three servings. Avoid tobacco, alcohol, and spicy foods, and stop using Nitroglycerin.
Second consultation: After taking 8 doses, the frequency of heart pain attacks decreased to 1-2 times, the duration of pain also shortened, and sleep was acceptable. Tongue and pulse remain the same. This indicates that blood vessel obstruction by stasis is difficult to remove quickly. Appropriately add herbs that invigorate blood circulation and resolve stasis to the above prescription. Prescription: Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 15g, Red and White Paeziae Radices (Chi Bai Shao) 15g each, processed Frankincense and Myrrh (Zhi Rumu) 6g each, fried Polygoni Orientalis Pollen (Chao Puhuang) 10g, fried Trogopterori Faeces (Chao Lingzhi) 10g, Angelicae Sinensis Radix (Danggui) 10g, Polygalae Semen Preparatum (Fushen) 18g, fried Peplopericarpium (Chao Loupi) 10g, processed Cyperi Rhizoma (Zhi Xiangfu) 10g, Allii Macrostemonis Bulbus (Xiebai) 10g, Citri Reticulatae Pericarpium and its vascular bundles (Jupi Luo) 10g each, and fried Crataegi Fructus (Chao Shanzha) 10g. After continuous intake of 10 doses, heart pain was relieved, occasional attacks occurred, and symptoms were mild. Subsequently, treated with methods to broaden the chest, regulate Qi, nourish blood, and harmonize blood, leading to recovery. Follow-up ECG was also normal.
(3) Tonifying Qi and Nourishing Yin: Qi and Yin deficiency is a common pathogenesis of coronary heart disease. The reasons are either congenital insufficiency and inherent weakness, where pathogenic heat invades the Heart consuming Heart Yin, or excessive thinking and accumulated fatigue damaging Qi and Yin. When Qi and Yin are depleted, the power to move blood is insufficient, leading to blood vessel stasis and causing heart pain. At this time, the treatment method should be to tonify Qi and nourish Yin, calm the Heart and tranquilize the mind, and invigorate blood circulation to resolve stasis, which has satisfactory effects in alleviating the condition.
Clinical manifestations include palpitations and frightful palpitations (Zhengchong), dull chest pain or stabbing pain, shortness of breath and fatigue, empty irritability and insomnia, spontaneous sweating and night sweats, heat in the palms and soles, dry mouth with little saliva, short and yellow urine, red tongue with little coating or peeled coating without coating, and fine, weak, or rapid pulse, or intermittent pulse (Jie Dai Mai). Extensive domestic research data on cardiovascular diseases indicate that clinical manifestations of coronary heart disease angina pectoris and acute myocardial infarction often show Qi and Yin deficiency. The treatment should focus on tonifying Qi and nourishing Yin, invigorating blood circulation, and unblocking collaterals. Medicines used include: Ginseng Radix et Rhizoma (Renshen), Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), Rehmanniae Radix (Shengdi), Angelicae Sinensis Radix (Danggui), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Biota Seed (Baiziren), Ziziphus Jujuba Seed (Suanzaoren), Prepared Polygalae Radix (Zhi Yuanzhi), and Polygalae Semen Preparatum (Fushen), etc. If accompanied by Yin deficiency with hyperactive fire, causing irritability and insomnia, add 6g of fried Coptidis Rhizoma (Chao Huanglian) and 10g of fried Gardeniae Fructus (Chao Zhizi) to clear the Heart and drain heat; if Kidney Yin is deficient, with sore waist and tinnitus, dry mouth and throat, add 15g each of Dragon Bone (Longgu), Oyster Shell (Muli), and Pearl Mother-of-Pearl (Zhenzhumu) to submerge and settle, calming the Heart; if Qi mechanism is stagnant, with chest tightness, suffocation sensation, add 10g each of Curcumae Radix (Yujin), Peplopericarpium (Gualoupi), Allii Macrostemonis Bulbus (Xiebai), and Citri Reticulatae Pericarpium (Chenpi) to broaden the chest and dissipate obstruction; if Heart vessels are obstructed, with chest tightness, stabbing pain, and ecchymoses on tongue edges, add 6g of Notoginseng Radix et Rhizoma (Sanqi), 30g of Paeziae Radix Rubra (Chishao), and 10g each of Persicae Semen (Taoren) and Carthami Flos (Honghua) to invigorate blood circulation and resolve stasis; if chest and epigastrium are full and distended, with poor appetite, add 15g each of fried Crataegi Fructus (Chao Shanzha) and fried two types of germinated grains (Chao Er Ya), and 10g each of Citri Grandis Exocarpium (Xiangyuapi) and fried Aurantii Fructus Immaturus (Chao Zhike) to regulate Qi and harmonize the Stomach. According to Mr. Li's experience, Heart Qi and Yin deficiency is often accompanied by insufficient fluids in the Large Intestine. Inadequate conduction easily leads to dry and difficult-to-pass stools. In cases of true heart pain, due to blocked Fu-organ Qi, deaths from straining during defecation are not uncommon. Therefore, in clinical medication, it is necessary to ensure smooth bowel movements. Senna Leaf (Fanxieye) 10-20g can be brewed in boiling water and drunk as tea. To prevent consumption of Qi and Yin, Shengmai Chengqi Tang (Ginseng Radix et Rhizoma, Ophiopogonis Radix, Schisandrae Fructus, Mirabilite, Magnoliae Officinalis Cortex, Rhei Radix et Rhizoma) can also be taken together, along with other modified prescriptions.
Case: Yu, male, 74 years old, worker. First consultation on November 2, 1989. Recurrent chest tightness and palpitations for 1 year, aggravated for 1 month. In 1988, due to excessive fatigue and emotional anger, chest tightness and heart pain, palpitations, and shortness of breath occurred. Diagnosis at a certain hospital in Wuhan: Electrocardiogram showed ST segment changes and insufficient myocardial blood supply. Fundus examination showed retinal arteriosclerosis. Diagnosed with "Coronary Heart Disease," given Nitroglycerin tablets, Isosorbide Dinitrate (Xiaoxintong), Nifedipine (Xintongding), Maibingtong, Compound Danshen Tablets, etc., heart pain was relieved. However, heart pain recurred when emotionally excited or working. After a year of such fluctuations, Mr. Li was specifically consulted. Current symptoms: chest discomfort, dull heart pain with occasional stabbing pain, coming and going, palpitations and shortness of breath, dream-disturbed sleep, fatigue and reluctance to speak, lackluster complexion, worsening with exertion. Tongue body is slightly red with thin yellow and scant coating, pulse is fine and rapid. Mr. Li concluded: This is a long-standing Heart disease, with insufficient Heart Qi and damaged Yin, resulting in obstruction of Heart vessels. The treatment should be to tonify Qi and nourish Yin, invigorate blood circulation, unblock collaterals, calm the Heart, and tranquilize the mind. Medicines used: Pseudoginseng Radix (Taizishen) 15g, Ophiopogonis Radix (Maidong) 10g, Schisandrae Fructus (Wuweizi) 10g, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 30g, Angelicae Sinensis Radix (Danggui) 10g, Persicae Semen (Taoren) 10g, Polygalae Semen Preparatum (Fushen) 30g, Ziziphus Jujuba Seed (Zaoren) 20g, processed Cyperi Rhizoma (Zhi Xiangfu) 10g, Citrus reticulata vascular bundle (Juluo) 10g, fried Peplopericarpium (Chao Loupi) 15g, Curcumae Radix (Yujin) 10g, Charred Crataegi Fructus (Shanzha Tan) 15g, and Jujubae Fructus (Hongzao) 6g.
Second consultation: After taking 5 doses of the above prescription, chest tightness and heart pain improved, spirit gradually revived, but sleep was still poor, with occasional dizziness. Tongue is red with thin yellow coating, pulse is fine and slightly rapid. Mr. Li said: Heart Qi and Yin deficiency, blood vessel obstruction, using herbs to tonify Qi and nourish Yin, invigorate blood circulation, and unblock collaterals is naturally effective. However, when Heart Qi and Yin are deficient, Kidney Yin is also deficient. Although the Heart disease is being treated, Kidney Yin deficiency is obvious, hence symptoms like headache occur. Add herbs to nourish Liver and Kidney, and clear and benefit the head and eyes to the above prescription. Prescription: Pseudoginseng Radix (Taizishen) 15g, Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Wuweizi) 10g each, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 30g, Red and White Paeziae Radices (Chi Bai Shao), Ligustri Lucidi Fructus (Nvzhenzi), Ecliptae Herba (Hanliancao), Prunellae Spica (Xiakucao), Wild Chrysanthemum Flower (Yejuhua), and fried Crataegi Fructus (Chao Shanzha) 15g each, Persicae Semen (Taoren), Citrus reticulata vascular bundle (Juluo), processed Cyperi Rhizoma (Zhi Xiangfu), and fried Biota Seed (Chao Bairen) 10g each, Polygalae Semen Preparatum (Fushen) 30g. After continuous intake of 10 doses, chest tightness and heart pain disappeared, dizziness was eliminated, and sleep became peaceful. Occasionally, there was irritability, red tongue with thin yellow coating, and fine, wiry, small, and rapid pulse. Subsequently treated with formulas to nourish the Heart, tranquilize the mind, clear heat, and eliminate irritability, leading to recovery. Follow-up for 2 years showed no recurrence.
Volume 3, Page 202
IV. Experience in Differentiation and Treatment of Arrhythmia
Arrhythmia is the most common in clinical practice and can occur in various heart diseases. Severe cases can cause heart failure, shock, cardiocerebral syndrome, etc. Having attended Mr. Li for many years, I have gained some understanding of the laws of his differentiation and treatment of arrhythmia. Mr. Li believes that arrhythmia can be divided into two categories: excess and deficiency. Excess syndromes are mostly caused by phlegm stagnation, Qi stagnation, and blood stasis; deficiency syndromes are mostly related to insufficiency of Yin and Blood, and decline of Yang Qi. Its clinical characteristics include palpitations, chest tightness, chest bi-syndrome, shortness of breath, fatigue, intermittent pulse (Jie Dai Mai), or rapid or slow pulse, etc. Clinically, one should differentiate and prescribe medications according to these signs.
(1) Nourishing Yin and Harmonizing Yang: Patients with arrhythmia often have signs and pulses of Qi and Yin deficiency. The Heart governs blood vessels, and blood nourishes the Heart. Qi and Blood interact, as described: "Blood carries Qi, and Qi commands Blood." When external pathogens enter the Heart, damaging Heart Yin and Yang, leading to Qi and Blood deficiency, the Heart loses nourishment, and its pumping power is insufficient, causing palpitations, shortness of breath, and intermittent or alternating pulse (Jie or Dai Mai). The treatment should primarily focus on nourishing Yin and nourishing Blood, unblocking Yang to restore the pulse, while treating the branch symptoms. By regulating Yin and Yang, supporting Yang Qi, thereby improving the central nervous system and cardiovascular system, exciting the myocardium, increasing cardiac output, and improving microcirculation, this is an important step to restore abnormal heart rhythm to normal.
Clinical manifestations include palpitations, shortness of breath, spontaneous sweating, little sleep with many dreams, poor appetite, fatigue and weakness, fine or rapid or intermittent pulse (Jie Dai Mai), pale red tongue body, thin yellow or peeled coating. This syndrome is commonly seen in atrial or ventricular premature beats, tachycardia, atrial fibrillation, etc., caused by autonomic dysfunction, cardiomyopathy, coronary heart disease, etc. The treatment should focus on nourishing Yin and harmonizing Yang, tonifying Qi and nourishing Blood. Medicines used include: Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao), Ginseng Radix et Rhizoma (Renshen), Rehmanniae Radix (Shengdi), Ophiopogonis Radix (Maidong), Donkey-hide Gelatin (Ejiao), Sesame Seed (Maren), Polygalae Semen Preparatum (Fushen), fried Crataegi Fructus (Chao Shanzha), Amomi Fructus (Sharen), and Jujubae Fructus (Dazao), etc. If easily startled by events, with uneasy palpitations, add Dragon Bone (Longgu), Oyster Shell (Muli), Pearl Mother-of-Pearl (Zhenzhumu), and Prepared Polygalae Radix (Zhi Yuanzhi) to heavily settle and submerge, calming the Heart and tranquilizing the mind, stabilizing fright and stopping palpitations; if chest tightness is too severe, with a sense of suffocation and breathing difficulty, add Curcumae Radix (Yujin), Peplopericarpium (Gualoupi), Allii Macrostemonis Bulbus (Xiebai), and Citri Reticulatae Pericarpium (Jupi) to unblock Yang, facilitate Qi, broaden the chest, and dissipate obstruction; if chest stabbing pain with purplish-dark tongue body, add Notoginseng Radix et Rhizoma (Sanqi), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Paeziae Radix Rubra (Chishao), and processed Frankincense and Myrrh (Zhi Rumu) to invigorate blood circulation, eliminate stasis, unblock collaterals, and relieve pain; if irritability and insomnia, oral ulcers, crimson tongue body indicate excessive Heart Fire, add Moutan Cortex (Danpi), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Bambusae Folium (Zhuye), and Scrophulariae Radix (Xuanshen) to nourish Yin and nourish Blood, clear fire and eliminate irritability; in severe cases, add Coptidis Rhizoma (Huanglian) to directly suppress the fire with bitter cold.
Case: Zhang, male, 40 years old, cadre. First consultation on September 10, 1982. Palpitations, shortness of breath, and mental unrest for 2 years. The patient worked in planning in a certain city for a long time. Two years ago, due to excessive fatigue, palpitations and unrest occurred. An electrocardiogram at the affiliated hospital of a provincial hospital indicated "frequent ventricular premature beats." Symptomatic treatment for over 3 months led to slight improvement, but the condition relapsed after stopping medication, and recently worsened. His pulse stops every 5-6 breaths, with palpitations and unrest, and insomnia at night. Palpitations worsen with exertion or insomnia. Diet and excretion are acceptable. Tongue edges and tip are very red, with white coating in the center. Long-standing habit of smoking and drinking. The syndrome belongs to excessive mental labor, where Yin fluids are deficient and cannot moisten, and Yang Qi is deficient and cannot flow smoothly, thus affecting the Heart Master, presenting as intermittent pulse (Jie Dai Mai) and palpitations. The treatment should focus on tonifying Qi and supplementing deficiency, nourishing Yin and harmonizing Yang, calming the Heart and tranquilizing the mind. Prescription: Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao) 12g, Ginseng Radix et Rhizoma (Renshen) 10g, Rehmanniae Radix (Shengdi) 15g, Donkey-hide Gelatin (Ejiao) 12g, fried Sesame Seed (Chao Maren) 12g, Polygalae Semen Preparatum (Fushen) and Dragon Bone (Longgu) 15g each, calcined Oyster Shell (Duan Muli) 12g, Cinnamon Twig (Guizhi) 3g, Fresh Ginger (Shengjiang) 3g, and Jujubae Fructus (Dazao) 10g. One dose of the above medicine is divided into three servings. Mix with half a tablespoon of rice wine when taking. Advise quitting smoking, alcohol, and spicy foods, focusing on calming the mind and nurturing health. After taking 15 doses, palpitations and insomnia improved, but the pulse still had interruptions, and sometimes facial edema and abdominal fullness/discomfort occurred. Therefore, remove Dragon Bone (Longgu), Oyster Shell (Muli), and Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao) from the above prescription, reduce the dosage of Rehmanniae Radix (Shengdi), and add Poria (Fuling), charred Crataegi Fructus (Zha Tan), Citri Reticulatae Pericarpium (Jupi), and Citrus reticulata vascular bundle (Juluo) to regulate Qi and reduce distension. After continuous intake of 15 doses, palpitations and other symptoms greatly reduced. Since pulse interruptions were occasionally seen, add Salviae Miltiorrhizae Radix et Rhizoma (Danshen) and Biota Seed (Baiziren) to the previous prescription to nourish the Heart and tranquilize the mind. By the end of the year, the patient specially came to express gratitude, stating that after taking 30 doses, follow-up ECG was normal, and he has returned to work.
(2) Purging Phlegm and Unblocking Collaterals: Phlegm-dampness obstructing collaterals is another important pathogenesis of arrhythmia. As stated in "Zhengzhi Huibu": "Phlegm confuses the Heart, causing heart pain, fright, palpitations, Zhengchong, and confusion." Li Shizhen also said: "Slow pulse governs Zang diseases or much phlegm" ("Binhu Mailue"). Thus, phlegm-dampness can also lead to arrhythmia. Because all Yang receive Qi in the chest, if pathogens linger in the chest, Chest Yang fails to rise, fluids are not distributed, condensing into phlegm, phlegm obstructs Qi mechanism, causing chest pain and tightness; phlegm-turbidity blocks, Lung loses dispersing and descending functions, leading to cough, wheezing, and shortness of breath.
For this syndrome, if Chest Yang obstruction is predominant, the method can be to dispel phlegm.
Clinical manifestations include heart pain with fullness, chest oppression or feeling of weight, distension or numbness/pain in the left shoulder/back and medial left arm, dizziness and blurred vision, nausea and vomiting tendency, red or dark-dull tongue body, white greasy coating, wiry-slow or wiry-slippery pulse, or slow or intermittent pulse (Jie Dai Mai). It is commonly seen in premature beats, conduction blocks, or atrial fibrillation caused by coronary heart disease, rheumatic heart disease, hypertensive heart disease, etc. The treatment should focus on purging phlegm and unblocking collaterals. Medicines used include: Trichosanthis Fructus (Gualou Shi), Allii Macrostemonis Bulbus (Xiebai), Pinelliae Rhizoma Preparatum (Fa Xia), Fritillariae Thunbergii Bulbus (Chuanbei), fried Aurantii Fructus Immaturus (Chao Zhishi), Citri Reticulatae Pericarpium (Jupi), Citrus reticulata vascular bundle (Juluo), and fried Crataegi Fructus (Chao Shanzha), etc. If chest tightness and shortness of breath, add Codonopsis Radix (Dangshen), Ophiopogonis Radix (Maidong), and Schisandrae Fructus (Wuweizi) to tonify Qi and restore the pulse; if palpitations and Zhengchong, add Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao) and Biota Seed (Baiziren) to nourish the Heart and tranquilize the mind; if precordial oppressive pain, add Acori Tatarinowii Rhizoma (Shichangpu) and Santalum Album (Tánxiāng) to regulate Qi and move stagnation; if heart pain radiates to the back and back pain radiates to the heart, add Red and White Paeziae Radices (Chi Bai Shao), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Frankincense and Myrrh (Rumu) to invigorate blood circulation and unblock collaterals; if blood pressure rises, add raw Dragon Bone (Longgu) and Oyster Shell (Muli), Gastrodia Rhizome (Tianma), etc., to heavily settle and submerge.
Case: Hu, female, 43 years old, worker. First consultation on March 12, 1983. Recurrent palpitations, chest tightness, and wheezing for 5 years, aggravated for 1 month. Paroxysmal nocturnal dyspnea, inability to lie flat, chest oppression, dizziness and fatigue, mild cough, sometimes expectorating a small amount of pink sputum, oliguria, dark red tongue body with ecchymoses on edges, thick white greasy coating, intermittent pulse (Jie Dai Mai). Physical examination: cyanotic lips, mild facial edema, purple-red malar flush, heart rate 102 beats/min, irregular rhythm, low-pitched rumbling diastolic murmur heard at the apex. Electrocardiogram: widened P waves with notching, right axis deviation, atrial fibrillation. X-ray examination: enlarged atria. Diagnosed by a certain hospital as rheumatic valvular heart disease, mitral stenosis, heart failure grade II.
After long-term anti-infection, cardiotonic, and diuretic treatments, the condition fluctuated. During this attack, treatment with Chinese medicine to warm Yang and promote urination at a certain hospital反而 exacerbated cough and wheezing, with persistent hemoptysis. This is not Yang deficiency with cold coagulation, but rather obstruction of Chest Yang, condensation of phlegm-turbidity, and blockage of collaterals. The treatment should focus on resolving obstruction, unblocking Yang, purging phlegm, dissipating nodules, invigorating blood circulation, and stopping bleeding. Prescription: fried Peplopericarpium (Chao Loupi) 15g, Allii Macrostemonis Bulbus (Xiebai) 10g, Fritillariae Thunbergii Bulbus (Chuanbei) 10g, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 30g, Paeziae Radix Rubra (Chishao) 30g, Angelicae Sinensis Radix (Danggui) 15g, processed Frankincense and Myrrh (Zhi Rumu) 6g each, Poria (Fuling) 30g, Hair Carbon (Xueyu Tan) 10g, Imperatae Rhizoma (Baimaogen) 30g, Agrimoniae Herba (Xianhecao) 30g, Akebiae Caulis (Mutong) 10g, Notoginseng Powder (Sanqi Fen) 6g (packaged separately for swallowing), fried Crataegi Fructus (Chao Shanzha) 15g, Citri Reticulatae Pericarpium and its vascular bundles (Jupi Luo) 10g each.
After taking 5 doses, hemoptysis stopped, chest tightness relieved, cough and wheezing lightened, urination became smooth, edema subsided first, but slight wheezing after activity, soft limbs and fatigue remained. Tongue body dark red with thin white coating, intermittent pulse (Jie Dai Mai). Therefore, remove Hair Carbon (Xueyu Tan), Agrimoniae Herba (Xianhecao), Akebiae Caulis (Mutong), Pseudoginseng Radix (Taizishen), Ophiopogonis Radix (Maidong), and Schisandrae Fructus (Wuweizi) from the above prescription, and continuously administer more than 60 doses, leading to relief of all symptoms. Later, treated with methods to unblock Yang, dissipate nodules, invigorate blood circulation, unblock collaterals, and nourish the Heart and tranquilize the mind, achieving success. Follow-up for 2 years showed no recurrence.
(3) Resolving Stagnation and Promoting Movement: Emotional imbalance is one of the causes of arrhythmia. "Ling Shu · Kou Wen" states: "The Heart is the great master of the five Zang and six Fu organs... therefore sorrow, grief, worry, and anxiety cause the Heart to move, and when the Heart moves, all five Zang and six Fu organs shake." "Su Wen · Ju Tong Lun" says: "Fright causes the Heart to have no support, the Spirit to have no return, emptiness to have no stability, thus Qi becomes chaotic." Thus, various emotional stimuli can damage the Heart, and damage to the Heart Spirit can affect other Zang organs, which in turn can worsen the Heart condition. From clinical observation, arrhythmias caused by emotional imbalance are mostly due to Liver Qi stagnation. Therefore, regulating Zang organ Qi mechanism, resolving stagnation, and promoting movement is one aspect of treating arrhythmia.
Clinical manifestations include chest tightness and palpitations, insomnia with many dreams, shortness of breath and fatigue, distending pain in hypochondrium, emotional depression, frequent sighing, frequent belching, poor appetite, or sensation of foreign body obstruction in the throat with difficulty swallowing, irregular menstruation, or even amenorrhea, red tongue with thin white or thin yellow coating, wiry-intermittent pulse (Xian Jie Dai Mai) or fine-intermittent pulse (Xi Er Jie Dai Mai). This syndrome is commonly seen in patients with cardiac neurosis, menopause syndrome, etc., who have arrhythmia. The treatment should focus on soothing the Liver, resolving stagnation, nourishing the Heart, and tranquilizing the mind. Medicines used include: Bupleuri Radix (Chaihu), Paeziae Radix (Baishao), fried Aurantii Fructus Immaturus (Chao Zhike), processed Cyperi Rhizoma (Zhi Xiangfu), Curcumae Radix (Yujin), Citri Reticulatae Pericarpium (Chenpi), Polygalae Semen Preparatum (Fushen), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), and fried Crataegi Fructus (Chao Shanzha), etc. If palpitations and Zhengchong with faster heart rate, add Dragon Bone (Longgu) and Oyster Shell (Muli), Pearl Mother-of-Pearl (Zhenzhumu), etc., to stabilize fright and tranquilize the mind; if chest oppression with a sense of suffocation, add Peplopericarpium (Loupi), Allii Macrostemonis Bulbus (Xiebai), Perillae Caulis (Sugeng), etc., to broaden the chest and regulate Qi; if chest tightness with much phlegm and thicker greasy coating, add Fritillariae Thunbergii Bulbus (Chuanbei), Acori Tatarinowii Rhizoma (Shichangpu), and Tangerine Peel (Juhong) to transform phlegm and unblock collaterals; if restless mind and sleepless nights, add Biota Seed (Baiziren), Prepared Polygalae Radix (Zhi Yuanzhi), and Albiziae Cortex (Hehuanpi), etc., to nourish Blood and tranquilize the mind; if chest tightness with stabbing pain, intolerable, add Persicae Semen (Taoren), Carthami Flos (Honghua), and Paeziae Radix Rubra (Chishao), etc., to invigorate blood circulation and resolve stasis; if irritability and restlessness, sleep disturbance, add fried Gardeniae Fructus (Chao Zhizi), Coptidis Rhizoma (Huanglian), and Scrophulariae Radix (Xuanshen), etc., to clear the Heart and eliminate irritability.