754 HEART

28.CHEST PAIN 755

stagnution ate commonly seen together. Phlegm may also be congenital.
and wotry.Heat affecting the chest and febrile illnesses also casily damage Heart yin.If
Liver qi stagnation Kidney yin is weak then Heart yin won't be supported-Kidney Warer fails to balance Heart
Emotional imbalance can affect the movement of gr in different organ sys-tems Fire'.Once Heart yiw has been damaged,circulation of Blood is impaired byincreased Blood
and if these organ systems exert influence on the chest area then chest pain may viscosity and by deficient Heat which smoulders in the chest.The Heat can also congeal
result. The Liver system,including the Liver channel that traverses the chest,is the fluids into Phlegm and the increased Blood viscosity can contribute to Blood stagnation.As
one most notably affected by emotional upsets,especially stress,frustration and well as complication by Phlegm and Blood stagnation,Heart yin deficiency is frequently
anger. Obstruction of gi in other organs,such as the Heart or Lungs,can also cause complicated by other deficiencies,such as qi and Blood deficiency
chest pain,oppression,tightness,stuffiness,and difficulty getting a deep breath.Such
pain may be precipitated bygrief (a broken heart?),anxiety or overescitment.
Qi (and Blood) deficiency
Overwork,excessive worry or mental activity,irregular dietary habits,exces sive consumption
Frequently,the pain associated with Liver qi stagnation is of a muscular type,that
of cold,raw foods or prolonged illness can weaken Spleen gr.As the Lungs and Spleen are
is,the muscles of the chest wall,oesophagus or diaphragm are in a state of chronic the source of the gi and Blood of the body.weakness in these organs will inevitably lead to a
tension.This chronic tension can be exacerbated into tightness,discomfort and pain decrease in production of giand Blood.Other causes are acute or chronic haemorthage and
by increased stress. malnutri-tion.Qi and Blood are so closely related that deficiency of one often leads to
Several complications of qi stagnation can also lead to chest pain.Pro.looged deficiency of the other. Qi deficiency is often complicated by qi stagnation,Blood stagnation
gistagnation can lead to Blood stagnation and the development of obstructive or Phlegm and fluid accumulation.
heart disease Qi stagnation can generate Heat that ascends into the chest ， or
travels via the reverse controlling（克，p．70）cycle to injure the Lungs or through the GENERAL APPROACH TO TREATMENT
generative（sheng 生，p．70）cycle to the Heart．Iiver stagnation may also damage There are several approaches to treatment depending on the severity of the symptoms and
the Spleen and retard fluid movement,caus-ing accumulation of Dampness and the misture of excess and deficiency. The manifestations of chest pain are usually
congealing of fluids into Phlegm.The common feature of all types related to Livet excess(Phlegm,Cold,Heat,qi or Blood stasis),while the underlying cause,the root,is
gistagnation is provocation of aggravation by emotional turmoil and stress. deficient(gi,yin,yang or a mixture).What this implies is that in almost every case treatment
must be twofold-both reducing(excess)and supplementing (deficiency).
Blood stagnation During acute episodes with severe pain,TCM treatment addresses the manifestations
Blood stagnation is often the end result of other prolonged disorders affect ing the and attempts to eliminate the responsible pathogen.In se-vere cases,emergency
chest.Any pathology,excess or deficient,if long lasting enough,may lead to Blood management may be necessary(Box 28.2).Treatment of an acute episode usually involves
stasis or involve elements of Blood stasis. Cold pathologies (Cold and yang
strong dispersing drugs with the poten-tial to damage zoeg ,therefore,once the pain is
deficiency) can cause stagnation by constricting the vessels and slowing
circulation.Hot pathologies(Heat,Phlegm Heat and yin defi-ciency) can cause under control,root treat-ments should be phased in.
stagnation by 'evaporaring' Blood and increasing the vis cosity and stickiness of In non acute cases,both the manifestation and the root can be treated
Blood. Blood stagnation frequently complicatesyng deficiency,yin together,although in general it is better to focus first on resolving the ex cess,and then
deficiency.Phlegm obstruction and prolonged Liver qi stag nation. when the patient's condition is improving,phase in the root tonifying treatment.This is
primarily the case with herbal treatment,as ex-cess removing herbs can aggravate
Heart and Kidney yin deficiency deficiency and visa versa.The initial herbal approach is therefore weigbted towards
Kidney yin becomes damaged through overwork (especially while undet resolving Phlegm or Blood stasis,clearing Heat or warming and expelling Cold.Acupuncture
stress),late nights,shift work,insufficient sleep,and use of recreational drugs Kidney treatment is slightly different,in that it is possible to tonify deficiency and remove excess
jin may also be damaged by febrile illnesses,ageing and excessive sexual effectively at the same time without causing any problems.
activity,or,in women,by many pregnancies.
Heart yin may be damaged by emotional trauma,shock or ongoing anxiety
756 HEART

BOX 28.2 ACUTE CARDIAC EPISODE Peess

Sudden severe chest pain, especially when accompenied by shortness Doding,Surrey
of breath,sweating and arm or jaw pain,is cardiac in origin and must
be treated as potentially fatal.Paramedic attention should be sought
immediately.

Emergency management
·During an acute episode, emergency management may be necessary until
paramedic assistance is available.If a pulse cannot be detected CPR should be
started immediately. The principle of treatment is to
improve circulation of yang qi in the chest.
TCM MANAGEMENT
Main acupuncture points ·PC.6 (nel guan), PC.4 (xi men),BL.15(xin shu)
·Huatuo Jiaji points around T4-T5, Ren.17(shan zhong)All points are treated
with strong reducing stimulation,with the needie sensation radiating up the
arm or to the chest. The points can be needled
or pressed with strong finger pressure or other appropriate instrument.
Secondary points
Select from
·Ht.5(tong i)- if palpitations are severe ·PC.5(jian shi)-stuffiness in the chest.sense of
impending doom
·St 38(zu san li)-severe sweating collapse

Patent medicines
Guan Xin Su He Xiang Wan 心苏合香丸（Guen Xin Su Ho）

Many patients with pain of cardac origin will be taking various conven-tional
medications.The drug regime usually includes vasodilators like
nitrogylcerine,which act by dispersing accumulated qi,as well as adrenaline
blocking beta-blockers.Beta blockers are thought to be Cold in nature,with an
adverse long term effect on various organ systems.Cold drugs will dam age jang
and ultimately aggravate underlying jang deficiency.As treatment
progresses,patients may wish to decrease their reliance on conventional
medication.Any reduction of medication must be done slowly and under
supervision over a period of months,as sudden withdrawal can precipitate an
acute cardiac episode. Of course, this is only attempted as the patient's
condition improves.

1.Gascoigne S(1995) The Massal of Crasea M fr Adat Pras,Jigme

756 HEART

BOX 28.2 ACUTE CARDIAC EPISODE

Sudden severe chest pain, especially when accompanied by shortness of
breath,sweating and arm or jaw pain, is cardiac in origin and must be treated as
potentially fatal. Paramedic attention should be sought immediately.

Emergency management
·During an acute episode, emergency management may be necessary until paramedic
assistance is available. If a pulse cannot be detected CPR should be started immediately.
The principle of treatment is to improve circulation of yang qi in the chest.

TCM MANAGEMENT
Main acupuncture points
·PC.6 (nei guan), PC.4 (xi men),BI.15(xin shu)
·Huatuo Jiaji points around T4-T5, Ren.17(shan zhong)All points are treated with strong
reducing stimulation, with the needle sensation radiating up the arm or to the chest.
The points can be needled or pressed with strong finger pressure or other appropriate
instrument.

Secondary points
Select from
·Ht.5 (tong li) - if palpitations are severe
·PC.5 (jian shi) - stuffiness in the chest, sense of impending doom
·St.36 (zu san li) - severe sweating,collapse

Patent medicines
Guan Xin Su He Xiang Wan 冠心苏合香丸（Guan Xin Su Ho）

Many patients with pain of cardiac origin will be taking various conven-tional
medications. The drug regime usually includes vasodilators like nitrogylcerine,which act
by dispersing accumulated qi, as well as adrenaline blocking beta-blockers. Beta-blockers
are thought to be Cold in nature', with an adverse long term effect on various organ
systems. Cold drugs will dam-age yang and ultimately aggravate underlying yang
deficiency. As treatment progresses, patients may wish to decrease their reliance on
conventional medication. Any reduction of medication must be done slowly and under
supervision over a period of months, as sudden withdrawal can precipitate an acute
cardiac episode. Of course, this is only attempted as the patient's condition improves.

1.Gascoigne S(1995)The Manual of Conventional Medicine for Alternative Practitioners,

JigmePress Dorking,Surrey
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 Figure 28.8 TCM patterns and possible biomedical correlations

Figure 28.9 Summary of deficient chest pain patterns and complications

 28.CHEST PAIN 761

火邪热结 28.1 HEAT SCORCHING AND KNOTTING THE CHEST

胸痹
Pathophysiology
·If external Heat penetrates through the Four Levels (see pp.30, 33)and settles in the Heart or Pericardium,
the local qi is 'scorched and knotted'causing sharp burning pain in the chest. This pattern can also be
associated with external Heat affecting the Lungs or be the result of internally gener-ated Heat from qi
stagnation or Heart or Liver Fire.External patterns tend to be acute (and associated with some sort of
infection), while internally generated Heat tends to be a more chronic condition.

Clinical features
·burning, sharp, focal or retrosternal chest pain aggravated by cough,deep
breathing,movement, exertion and swallowing
fever
·irritability
·dry mouth and thirst
·rough laboured breathing
·cough with thick yellow mucus
·constipation
T red,with a yellow,rough coat
P rapid,or slippery and rapid

Treatment principle
Clear Heat, purge Fire
Invigorate Blood, disperse accumulation

Prescription
XIAO XIAN XIONG TANG 小陷胸汤
(Minor Sinking Into the Chest Decoction)
huang lian（Rhizoma Coptidis）黄连...... ......6g
ban xia＊ （Rhizoma Pinelliae Ternatae）半夏 9-12g
gua lou （Fructus Trichosanthis）栝楼..
Method:Decoction.(Source:Shi Yong Zhong Yi Nei Ke Xue)

Modifications
If Heat or Fire affects the Heart causing insomnia, dream disturbed sleep,anxiety and tongue
ulcers, add sheng di (Radix Rehmanniae Glutinosae ）生地 15g，dan zhu ye （Herba Lophatheri
Gracilis）淡竹叶 9g，gan cao （Radix Glycyrrhizae Uralensis） 甘草 6g and mu tong （Caulis Mutong）木
通 6g．
·With constipation， add da huang （Radix et Rhizoma Rhei）大黄 6-9g，
762 HEART
28.CHEST PAIN 763

zhi shi （Fructus Immaturus Citri Aurantii） 枳实 9g and hou po（Cortex Magnoliae Officinalis）厚朴
9g． Long Dan Xie Gan Wan 龙胆泻肝丸（Long Dan Xie Gan Wan）
When cough is severe, see also pp.77,84,90. -Liver Fire
If the Heat has damaged fluids producing symptoms of dryness,add xuan shen （ Radix
Scrophulariae） 玄参 12g，mai dong（Tuber Ophiopogonis Japonici） 麦冬 12g and sheng di （Radix Acupuncture
Rehmanniae Glutinosae）生地 15g． ·for external Heat use LI.11(qu cbi-),B1.13(fei sbu-),Lu.5(chi ze-),PC.8 (lao gong -),
With signs of Blood stasis (stabbing, burning pain,fixed pain),add herbs to invigorate Blood, Bl.15 (xin sbu -),Du.14(dazbui-),PC.3(que↓),Ren.17(shan zbong-)
remove Blood stasis and move qi like mu dan pi （ Cortex Moutan Radicis ） 牡 丹 皮 9g ， chi for Liver Heat use PC.5 (jian sbi),PC.6(nei guan),Bl.18(gan sbu -),Liv.2 (xing jian-),Liv.5(li
shao （ Radix Paeoniae Rubrae ） 赤 芍 12g ， pu huang （ Pollen Typhae ） 蒲 黄 9g ， yu jin （ Tuber gou-),GB.34 (yang ling quan -),Liv.14(qi men-),
Curcumae）郁金 12g and zhi shi （Fructus Immaturus Citri Aurantii）枳实 9g ·for hiatus hernia use St.36 (u san /), St.44 (nei ting-), Ren.13(shang wan),Ren.17 (sban
~bong-),PC.6(nei guan),Bl.21(wei shu)
Variations and additional prescriptions ·for structural or focal pain use ab sbi points and the metal and water points on the relevant
channels
Heat affecting the Pericardium
·If the Heat siks into the Pericardium, with fever, disorientation,delerium or impaired
Clinical notes
consciousness, the correct treatment is to clear Heat and Toxicity, and rescusitate with ZHI
·The chest pain in this pattern may correspond to disorders such as acute pericarditis,
BAO DAN(Greatest Treasure Special Pill 至宝丹，p．660）．
bronchitis, pneumonia, pleurisy,hiatus hernia,gastric reflux, peptic ulcer disease,
Other prescriptions for Heat in the chest psychogenic chest pain, costochondritis,stress related chest pain and smoke
·See also pp.709-711 for other formulae designed to treat external Heat in the chest. inhalation.
·In most cases,Heat type chest pain can respond reasonably well to correct treatment. Both
Stagnant Heat from Liver qi stagnation external and internal Heat patterns occur in those who are overworked, often with a pre-existing
·If the Heat is internally generated (most commonly by prolonged Liver qi stagnation), see Heart or Lung imbalance. Relapses occur at times of stress oroverwork.
also Liver qi stagnation, pp.770-771. With Liver Fire,the treatment is to clear Liver Fire with ·Acute infections may need antibiotic therapy if the patient is elderly of frail or does
LONG DAN XIE GAN TANG （ Gentiana Combination 龙 胆 泻 肝 汤 ， p ． 553 ） or SANG DAN XIE BAI not respond rapidly to herbal treatment.
TANG（Mulberry Leaf and Moutan Decoction to Drain the White 桑丹泻白汤，p.94). ·Costochondritis and hiatus hernia are treated very effectively with acupuncture
(particularly applied to ab sbi points), as is the pain associated with pericarditis and
Patent medicines other infammatory disorders.
Huang Lian Jie Du Wan 黄连解毒丸（Huang Lian Jie Du Wan）
-general Heat clearing formula for Heat affecting the Heart or Lungs Niu Huang Qing Huo
Wan 牛黄清火丸（Niu Huang Qing Huo Wan）
-severe Heat with constipation
Chuan Xin Lian Kang Yan Pian 穿心连抗炎片
(Chuan Xin Lian Antiphlogistic Tablets) - general Heat
Qing Fei Yi Huo Pian 清肺抑火片（Ching Fei Yi Huo Pien）
-Lung Heat
764 HEART 28.CHEST PAIN

28.2 PHLEGM OBSTRUCTION 765

·wheezing with thick white sputum
Pathophysiology T greasy white coat
· Phlegm obstruction can develop in those with yang or qi deficiency,qi stag- P slippery
nation,Heat in the chest and accumulation of Dampness and Phlegm.The symptom
痰浊闭阻 picture varies depending on the aetiology, and the relative mix-ture of underlying Phlegm Heat (Fire)
deficiency and Phlegm excess. Phlegm (and its varia-tions) is a common cause of chest 痰热
pain, and frequently complicates (or is complicated by) other patterns. The general rule If Phlegm stagnation generates Heat it is generally known as'Phlegm Heat'.If pre-existing stagnant Heat,
of treatment,however,is to resolve Phlegm before dealing with other complicating Fire or yin deficient Heat combines with Phlegm this is termed 'Phlegm Fire'. The greater the Heat signs
patterns. the more 'Fire'.
·Chest pain occurs when Phlegm obstructs the airways causing congestion and an ·suffocating, tight, oppressive burning sensation or pain in the chest
oppressive feeling of discomfort and tightness. Alternatively, Phlegm obstructs the ·thick yellow sputum
vessels of the Heart impeding Blood flow,creating a sense of pressure and pain. ·bitter taste in the mouth
·thirst
There are four subgroups of this pattern-Phlegm Fluids,Turbid Phlegm (which
·irritability and restlessness, possible clouding of consciousness
is somewhat thicker and stickier than Phlegm Fluids), Phlegm Fire and Wind ·dry stools or constipation
Phlegm. They represent progressions from the initial condition of Phlegm T greasy yellow coat
Fluids. P slippery rapid

Clinical features Wind Phlegm

痰饮
Phlegm Fluids 风痰
This type frequently co-exists with Heart and Kidney yang deficiency.Following This is a combination of excess yang (usually rising Liver yang) and Phlegm,and is described
resolution of the Phlegm Fluids, tonifying treatments should be applied(see p.777). in more detail in Wind Stroke, pp.658 and 672. See also Tremors, p.642.
· mild stuffiness, discomfort or tightness in the chest which is aggravated during wet or ·suffocating, tight sensation in the chest with occasional pain
cold weather ·stiffness or retraction of the tongue
·cough with thin watery sputum ·speech impairment
·nausea and poor appetite ·hemiplegia
·lethargy ·loose stools ·dizziness
·numbness and spasm in the limbs
T pale with a greasy white coat T greasy coat
P slippery P wiry and slippery

痰浊 Turbid Phlegm Treatment principle

This term describes Phlegm Fluids that have thickened and become more sticky and Open and unblock chest yang
viscous. +warm and transform Phlegm Fluids
·suffocating, tight or oppressive sensation in the chest, or chest pain radiating to the + transform Turbid Phlegm
+transform Phlegm and clear Heat (Fire)
shoulders or upper back, aggravated during cloudy or rainy weather + extinguish Wind and transform Phlegm
·tendency to obesity
feeling of heaviness in the body
·dizziness
766 HEART 28.CHEST PAIN

767
Prescriptions pcol gan cao （ Radix Glycyrrhizae Uralensis ） 甘 ． ． ． ． ． ． ． ． ． ． ． 3g gua lou （ Fructus
28.2.1 Phlegm Fluids 1
Ry-.
Trichosanthis）栝楼. .30g Method: Decoction. (Source: Shi Yong Zhong Yi Nei Ke Xue)
5
GUA LUO XIE BAI BAN XIA TANG 瓜楼薤白半夏汤
。
(Trichosanthes, Bakeri and Pinellia Combination) modified 28.2.3 Phlegm Heat (Fire)
gua lou （Fructus Trichosanthis）楼 30g HUANG LIAN WEN DAN TANG 黄连温胆汤
xie bai （Bulbus Allii）薤白.... ...12g (Coptis Decoction to Warm the Gall Bladder) modified
ban xia＊ （Rhizoma Pinelliae Ternatae）半夏 10g ban xia＊ （Rhizoma Pinelliae Ternatae）半夏
hou po （Cortex Magnoliae Officinalis）厚．．10g chen pi （Pericarpium Citri Reticulatae） 陈皮
zhi shi （Fructus Immaturus Citri Aurantii）枳实........ fu ling （Sclerotium Poriae Cocos）茯苓..........15g
fu ling（Sclerotium Poriae Cocos）茯苓... zhi shi （Fructus Immaturus Citri Aurantii）枳实..........
gan jiang （Rhizoma Zingiberis Officinalis）干．．．．．．．．．．．．．．．．6g zhu ru（Caulis Bambusae in Taeniis）竹茹....
xi xin＊（Herba cum Radice Asari）细辛....... gan cao（Radix Glycyrrhizae Uralensis） 甘草..
gui zhi （Ramulus Cinnamomi Cassiae）桂枝．．．．．．．．．．．．．．．．．．．．．6g huang lian（Rhizoma Coptidis）黄连...
Method: Decoction. (Source: Shi Yong Zhong Yi Nei Ke Xue) yu jin （Tuber Curcumae） 郁金.......
gua lou （Fructus Trichosanthis） 栝楼.
Modifications yw ycois of
Method: Decoction. (Source: Shi Yong Zhong Yi Nei Ke Xue).
·If pain radiates down the arm, add jiang huang (Rhizoma Curcumae Longae） 姜黄 10g and
chao bai shao （dry fried Radix Paeoniae Lactiflora）炒白芍 12g． Modifications
If palpitations are severe, add zhi gan cao (honey fried Radix Glycyrrhizae Uralensis ）炙甘草 ·With severe Phlegm Fire, or focal pain and distension, add fu hai shi （Pumice）浮海石 9g and
9g and bai zi ren （Semen Biotae Orientalis）柏子仁 9g. hai ge ke＾（Conchae Cyclinae Sinensis）海蛤壳 9g
With copious Phlegm, and wheezing or orthopnoea, add ting li zi （ Semen Descurainiae
With irritability and insomnia, combine with ZHU SHA AN SHEN WAN （Cinnabar
seu Lepidii）葶苈子 10g．
Pill to Calm the Spirit 朱砂安神丸，p．807）．
In all the Phlegm patterns, Blood stagnation is a frequent complicating factor.Where there
·If the Heat damages fluids, add sheng di (Radix Rehmanniae Glutinosae) 生 地 12g ， mai
are signs of Blood stasis (secondary to a Phlegm pattern ） ， herbs like dan shen （ Radix
dong（Tuber Ophiopogonis Japonici） 麦冬 9g and xuan shen（Radix Scrophulariae）玄参 12g．
Salviae Miltiorrhizae）丹参 15g，dang gui（Radix Angelicae Sinensis） 当归 9g，yi mu cao（Herba
·With constipation， add da huang （Radix et Rhizoma Rhei）大黄 6-9g or combine with GUN
Leonuri Heterophylli） 益母草 15g，tao ren （Semen Persicae）桃仁 9g，hong hua （Flos Carthami
TAN WAN （Vaporice Phlegm Pill 滚痰丸，p．694）．
Tinctorii ） 红 花 9g ， chi shao （ Radix Paeoniae Rubrae ） 赤 芍 9g ， and mu dan pi （ Cortex
Moutan Radicis）牡丹皮 9g are added as appropriate to invigorate Blood and clear stagnant 28.2.4 Wind Phlegm
Blood. DI TAN TANG 涤痰汤
(Scour Phlegm Decoction)
28.2.2 Turbid Phlegm ban xia＊ （Rhizoma Pinelliae Ternatae）半夏．．．．．9g
WEN DAN TANG 温胆汤
chen pi （Pericarpium Citri Reticulatae）陈皮．．．．．．．9g
(Bamboo and Hoelen Combination) modified
fu ling （Sclerotium Poriae Cocos）茯．．．．．．．．．．．．．．．．．．9g
ban xia＊ （Rhizoma Pinelliae Ternatae）半夏 9g zhi shi （Fructus Immaturus Citri Aurantii）枳实...............g
chen pi （Pericarpium Citri Reticulatae） 陈皮．．．．．．9g zhu ru （Caulis Bambusae in Taeniis）竹．．．．．．．．．．．．．．．．．．．．．．．．6g
fu ling (Sclerotium Poriae Cocos).........15g dan nan xing* (Pulvis Arisaemae cum Felle Bovis)
zhi shi （Fructus Immaturus Citri Aurantii）枳实．．．．．．．．．．．．．．．．．9g 胆南星......... ......9gshi chang pu （Rhizoma Acori Graminei）石菖蒲．．．．．．．．．．．．．．．
zhu ru （Caulis Bambusae in Taeniis）竹茹........9g 6g
768 HEART 28.CHEST PAIN 769

ren shen （Radix Ginseng）人参.... ......6g gan cao （Radix Glycyrrhizae Uralensis）甘草.. ·Turbid Phlegm: atherosclerosis, coronary heart disease, myocardial infarction.
........3g Method: Decoction. (Source: Sbi Yong Zhong Yi Nei Ke Xue) ·Phlegm Heat: acute and chronic bronchitis, pneumonia, myocarditis,pericarditis.
·Wind Phlegm:CVA,hypertension.
Modifications ·The Phlegm obstruction in this pattern often has its origin in the high fat diet popular in
·To increase the Heat clearing, Phlegm transforming, Wind suppressing strength of the Western nations. While cholesterol status is still a controversial predictor ofheart disease, it has
formula, other herbs, such as tian zhu huang (Concretio Silicea Bambusae Textillis ）天竺 been shown that diets rich in animal fats (low density lipoproteins) predispose to the devel-
黄 6g，zhu li（Succus Bambusae）竹沥 12g， sheng jiang （Rhizoma Zingiberis Officinalis） 生姜 opment of atherosclerotic plaques in the coronary vessels. Atheroscle-rotic disease is often
9g ， jiang can ＾ （ Bombyx Batryticatus ） 僵 蚕 9g ， di long ＾ （ Lumbricus ） 地 龙 9g and tian silent until it reaches the point where the obstruc-tion causes ischaemia of cardiac muscle,
ma（Rhizoma Gastrodiae Elatae）天麻 9g，may be added as appropriate． resulting in the characteristic chest stuffiness or pain.
Phlegm disorders require persistent treatment; herbs and their Phlegm dissolving properties
Patent medicines being the treatment of choice. Phlegm dissolving herbs often have significant anti-cholesterol
Phlegm Fluids
and anti-atherosclerotic action and their long term use (in conjuction with appropriate diet and
Fu ZiLi Zhong Wan 附子理中丸（Li Chung Yuen Medical Pills）
lifestyle changes,especially stopping smoking) can begin to remove the atherosclerotic plaques
from the artery walls. Acupuncture works well with herbs in these patterns, its qi moving
Turbid Phlegm
abilities helping to dissolve Phlegm and relieve pain. Where there is serious organ
ErChen Wan 二陈丸（Er Chen Wan）
damage,other forms of medical support will be necessary,and for bacterial infec-tions in
Ping Wei San 平胃散（Ping Wei San）
patients with weak constitutions, antibiotics may need to be taken in addition to or before
Xiang Sha Liu Jun Zi Wan 香砂六君子丸（Xiang Sha Liu Jun Wan）
treatment with herbs and acupuncture.
-Spleen deficiency with Phlegm

Phlegm Heat
Niu Huang Qing Huo Wan 牛黄清火丸（Niu Huang Qing Huo Wan）

Wind Phlegm
Yang Yin Jiang Ya Wan 养阴降压丸（Yang Yin Jiang Ya Wan）
Tian Ma Gou Teng Wan 天麻钩藤丸（Tian Ma Gou Teng Wan）

Acupuncture
St.40 (feng long -), Ren.17 (shan zhong -), PC.6 (nei guan),PC.5(jian shi),PC.4 (xi men -), Bl.13 (fei sbu), B1.15 (xin sbu), B1.14 (jue yin shu)
·with Phlegm Fluids add Lu.7 (lie que) and moxa to points on the trunk
·with Turbid Phlegm add Sp.3 (tai bai)
·with Phlegm Heat add PC.8 (lao gong -), Lu.6 (kong zui -) and Liv.2 (xing jian -)
·for Wind Phlegm see pp.657 and 673

Clinical notes
·Phlegm Fluids: cor pulmonale, angina, myocardial infarction, chronic bronchitis.
770 HEART 28.CHEST PAIN 771

28.3 LIVER QI STAGNATION Modifications

肝 气
郁 滞 Pathophysiology ·If pain (rather than distension) is prominent,add two or three of the following
胸痹 ·The Liver channel passes through the chest and thus influences the Heart and Lungs. Emotional stress herbs： chuan lian zi＊（Fructus Meliae Toosendan）川棟子 9g，yan hu suo （Rhizoma
constricts the qi in the Liver channel, and obstructs the free movement of qi, which accumulates in the Corydalis Yanhusuo）延胡索 9g，mo yao （Myrrha）没药 6g，ru xiang（Gummi Olibanum）
chest. This pattern is frequently complicated by Phlegm,qi deficiency and/or Heat. 乳香 6g，qing pi （Pericarpium Citri Reticulatae Viride）青皮 6g and bai jie zi （Semen
Sinapsis Albae）白芥子 6g or sheng pu huang （Pollen Typhae）生蒲黄 6g，or combine
Clinical features with SHI XIAO SAN （Break Into a Smile Powder 失笑散 p.782).
·mild, recurrent fullness, stuffiness,tightness or pain in the chest that is not localised, is With mild Blood stasis, add san qi fen (powdered Radix Notoginseng) 三七粉 3g，or combine
provoked by emotional turmoil and relieved by sighing,belching and relaxation with DAN SHEN YIN（Salvia Decoction 丹参饮，p．783）．
·frequent sighing If anxious or nervous, add one or two of the following herbs: zhen zhu mu ＾ （ Concha
·the patient may appear uptight, anxious, nervy or depressed Margaritaferae）珍珠母 30g，long chi＾（Dens Draconis）龙齿 15g or ci shi（Magnetitum）磁石 12g．
·dizziness,hyperventilation With hysteria or hyperventilation ， add xiao mai（Semen Triticum）小麦 60g，and da zao （Fructus Zizyphi
there may be epigastric distension and belching, after which the discom-fort is relieved Jujubae） 大枣 6g．
·irregular menstruation, premenstrual syndrome and breast tenderness With nausea and vomiting， add xuan fu hua （Flos Inulae）旋复花 9g，ban xia＊ （Rhizoma Pinelliae Ternatae）半
·if Heat has been generated by the stagnation, there may be a dry mouth,irritability, quick temper, facial 夏 9g and sheng jiang （Rhizoma Zingiberis Officinalis）生姜 3pce．
flushing and acid reflux
With Liver Heat disturbing the Stomach (indeterminate gnawing hunger,acid
T unremarkable or dark （qing 青）， or with red edges if there is Heat，or pale edges with Blood deficiency
reflux,vomiting, belching and bitter taste in the mouth), add huang lian （Rhizoma
P wiry
Coptidis）黄连 6g and wu zhu yu （Fructus Evodiae Rutaecarpae）吴茱萸 3g．
Treatment principle ·With acid reflux， add hai piao xiao＾（Os Sepiae seu Sepiellae） 海螵蛸 9g and mu li＾（Concha
Move and regulate Liver qi Ostreae）牡蛎 15g．
Strengthen theSpleen and harmonise Blood
Variations and additional prescriptions
Prescription With Spleen qi and Blood deficiency
CHAI HU SHU GAN SAN 柴胡疏肝散 ·With significant digestive symptoms, or qi and Blood deficiency,XIAO YAO SAN （Bupleurum and Dang Gui

(Bupleurum and Cyperus Formula) Formula 逍 遥 散 p ． 139 ） may be used instead to soothe the Liver, move qi, regulate the Spleen and
chai hu（Radix Bupleuri）柴胡 ·9g harmonise Blood,with any of the above modifications.

chen pi （Pericarpium Citi Reticulatae）陈皮.............g Witb stagnant Heat

bai shao （Radix Paeoniae Lactiflora）白 12g ·If chronic qi stagnation generates Heat, the correct treatment is to soothe qi and clear stagnant Heat
zhi ke （Fructus Citri Aurantii）枳壳．．．．．．．·9g with DAN ZHI XIAO YAO SAN （Bupleurum and Paeonia Formula 丹栀逍遥散 p．140）．
chuan xiong （Radix Ligustici Chuanxiong）川．．．．．．．．．．．．．．．．．．6g
W ith constipation
xiang fu （Rhizoma Cyperi Rotundi）香附.........6g
·With constipation due to stagnant Heat, combine with DANG GUI LONG HUI WAN （Dang Gui，Gentiana
zhi gan cao (honey fried Radix Glycyrrhizae Uralensis) Longdancao and Aloe Pill 当归龙荟丸）.
炙甘草... ........3g
Method:Decoction. (Source: Shi Yong Zhong Yi Nei Ke Xue)
7 HEART 28.CHEST PAIN773

7
2 dang gui （Radix Angelicae Sinensis） 当 30g long dan cao （Radix Gentianae Acupuncture
Longdancao）龙胆草 30g shan zhi zi （Fructus Gardeniae Jasminoides）山栀．30g Liv.14(qi mew),Liv.3(tai cbong-),PC.6(mgwax),PC.5(jiaw shi),B1.18(gu
huang qin （ Radix Scutellariac Baicalensis ） 黄 苓 30g huang lian （ Rhizoma sha),Ren.17(shan ghong),Lu.7(lie que),jin lang(M-HN·3)·with Heat
Coptdis）黄连．．30g huang bai（Cortex Phellodendn）黄 30g da huang（Radix et add Liv.2(xingjian-)
Rhizoma Rhei ） 大 黄 15g lu hui ＊ （ Herba Aloes ） 芦 荟 15g qing dai （ Indigo ·with deficiency add St.36(wsw +).Sp.6(han yin jiao+)and B1.20(pi sw+)
Pulverata Levis ） 青 货 15g mu xiang （ Radix Aucklandiae Lappae ） 木 香 6g she
xiang°（Secretio Moschus）麝香 1.5g Method: Grind the herbs to powder and Clinical notes
·The chest pain in this pattern may correspond to disorders such as pleurisy,globus
form into 6-gram pills with boney. The dose is 1 pill rwice daily,with ginger
hystericus,psychogenic chest pain,angina pectoris,costochondritis,hiatus
tea
hernia,oesophagitis,oesophageal spasm or gastric reflux.
This pattern generally responds well to correct treatment and appro-priate stress
Witb prominent distension and fulleess
·If distension and fullness in the lower chest and hypochondrium are prominent,with management strategies.Liver gi stagnation probably only represents coronary heart
a continuous stuffy sensation which improves for pressure on the chest and warm disease when associated with Phlegm or if it leads to Blood stagnation.That stagnation of
drinks,XUAN FU HUA TANG (Imwla Flower Decoction 旋复花汤）modified may be used. gi itself can precipitate a heart attack(where there already exists heart disease that may be
associated with Phlegm and/or Blood stasis) was shown in a study conducted by the Mayo
xuan fu hua（Flos Inulae）旋复花 12g yu jin（Tuber Curcumae）部金 9g xie
clinic.They found that the strongest predictor of a second heart attack was psychological
bai（Bulbus Allii）白 9g tao ren（Semen Persicae）桃仁 9g cong bai（Bulbus
stress.Similarly,the fact that Liver gr stagnation leading to Fire was dangerous in the
Allii Fistulosi）葱白.............6pce dang gui wei（tail of Radix Angelicae Sinensis）
presence of heart disease was shown by studies from Harvard University. They found the
当归尾 6g hong hua（Flos Carthami Tinctori）红花................6g gui zhi （Ramulus
risk of havinga second heart attack doubles after anger outbursts
Cinnamomi Cassiae）桂枝 6g qian cao gen（Radix Rubiae Cordifoliae）茜草根 3g
gua lou （ Fructus Trichosanthis ） 栝 楼 15g Method: Decoction.(Scource
Zhong Yi Na Ke Lin Cnang SheaC

Patent medicines
Chai lin Sbw Gan Wan 柴胡舒肝丸（Chai Hu Shu Gan Wan）
Shw Gan Wan 舒肝丸（Shu Gan Wan）
Xiao Yao Wan 逍遥丸（Xiao Yao Wan）
-with qr and Blood deficiency
Jis Wei Xiao Yao Wan 加味逍遥丸（Jia Wei Xiao Yao Wan）
-with stagnant Heat
Ma Xiang Sbuw Qi lan 木香顺气丸（Aplotaxis Carminative Pills）Dan Sbew Pian 丹参片（Dan Shen Pills）
-with mild Blood stasis
774 HEART 28.CHEST PAIN775

Method:Decoction.(Source Shi Yang Zong XNeKo Xu)

寒凝 28.4 COLD CONGEALING HEART BLOOD CIRCULATION Pathophysiology
心脉 ·Chest pain caused by obstruction of gi and Blood due to an accumulation of Cold is WU TOU CHI SHI ZHI WAN 鸟头赤石脂丸
胸痹 acute and intense and reflects a serious (and critical) heart con-dition.The priority of (Aconite and Halloysiuw Pilli) modified
treatment must be to rapidly expel Cold and pro-mote the circulation of gi and
Blood. The Cold in this pattern usually develops from an underlying pang deficiency This prescription is used in more severe cases,where pain is persistent and
and there will usually be evi-dence of systemic Cold. Once the acute episode or severe,radiating through to the back.
emergency is stabi-lised,the jng deficiency should be addressed (see Heart pang wu tou＊（Radix Aconit）鸟头 3g zhi fu zi＊（Radix Aconiti Carmichaeli Praeparata）制附子．．．．6-9g
chuan jiao （Pericarpium Zanthoxyli Bungeani）川．．．．．．6g gan jiang（Rhizoma Zingiberis Officinalis）干
deficiency,p.777). 姜 9g chi shi zhi（Halloysitum Rubrum）赤石脂 15g Method:Decoction.Wu tou is extremely toxic aod
racely used today. It must be boded for at lesst an hour to render it safe Today,rou gui (Cortex
Clinical features Cinnamomi Cassise）肉桂 s uually subetituted for wu tou Zhi fu zi is boiled for 30 manutes prior to the
·severe crushing or constricting retrosternal chest pain,which may be initiated other herbs（xianjia 先）（Source Shi Yang Zhong Yi Nui Ke Xue）
or aggravated by cold weather or cold foods,the pain may radiate to the
neck,jaww,left arm or through to the back Modifications
·shortness of breath,dyspnoca or orthopnoea ·With stagnant Blood (purple patches on the tongue,sharp pain,irregulat
·palpitations pulse ） ， add dan shen （ Radix Salviae Miltiorthizae ） 丹 参 30g ， chi shao
·aversion to cold,cold extremities （Radix Paeoniae Rubrae）赤芍 10g and yu jin（Tuber Curcumae）郁金 10g
·in severe cases there may be cyanosis,pallor,sweating and vomiting If there is significant wheezing and dyspnoea with thin sputum,add sheng
T normal,or pale with a thin white coat,or pale bluish or purple and swollen,with a jiang （ Rhizoma Zingiberis Officinalis ） 生 姜 15g ， chen pi （ Pericarpium Citri
white or greasy coat (depending on the degree of underly-ing yang deficiency) Reticulatae）陈皮 10g，fu ling（Scletotium Poriae Cocos）茯苓 15g，xing ren＊（Semen
P deep,slow,tight and maybe knotted or intermittent,or thready,slow and knotted or Pruni Armeniacae）仁 10g and bai dou kou（Fructus Amomi Kravanh）白豆蔻 6g
intermittent
Variations and additional prescriptions
Treatment principle Collapa of Heart yang
Warm and disperse Cold,invigorate Blood ·In severe cases the patient is cold and clammy,has cyanosis,extreme pallor,icy extremities
Remove obstruction and promote circulation of Heart yag and an imperceptible pulse indicating imminent collapse of Heart yang.The correct
approach is to administer an emergency medicine such as GUAN XIN SU HE XIANG WAN
（ Ligaid Styrax Pill for Coronary Heart Disease 冠 心 苏 合 香 丸 -see below),and institute the
Prescription
emergency acupuncture techniques outlined in Box.28.2,p.756 until paramedic ssistance
DANG GUI SI NI TANG 当归四逆汤
artives.An alternative approach used in hospitals in China is SHEN FU TANG (Ginseng and
(Dang Gui Devection for Frigid Extremitios)
Propared Acomite Denuction 参附汤，p．665） plus long gu＇（Os Draconis）龙骨 15-30g and mu
This prescription is suirable for relatively mild cases. li（Concha Ostreae）牡蛎 15-30g administeeed intravenously.
dang gui （Radix Angelicae Sinensis）当 9g
gui zhi（Ramulus Cinnamomi Cassiae）桂枝 9g
bai shao（Radix Paeonine Lactifiora）白芍 9g
xi xin＂（Herba cum Radice Asan）细 6g
mu tong（Caulis Mutong）木通 6g
zhi gan cao (boney fried Radix Glycyrrbizae Uralensis)
炙甘草 6gda zao（Fructus Zizyphu Jujubae）大枣 4pce
7 HEART 28.CHEST PAIN 777
7
6 Patent medicines
Gwaw Xin Su He Xiang Wan 冠心苏合香丸（Guan Xin Su Ho） 28.5 HEART YANG DEFICIENCY
-usually given togethet with whichever presctiption is applicable. This is a very popular pill Pathophysiology
and useful for patients with known cardiae disease to carry at all times. ·Heart yang deficiency is usually a complication of either or both Spleen or
Fw Zi Li Zhong Wan 附子理中丸（Li Chung Yuen Medical Pills） Kidney jang deficiency and there will often be symptoms of deficiency affecting
-good for warming anggenerally all three organs.When Heart yang（zong qi 宗气） is affected，the pumping power
Xiao Huo Lue Dan 小活络丹（Xiao Huo Luo Dan） of the Heart is impaired and Blood begins to pool in the coronary vessels.Heart
-a small dose of this very hot medicine may be useful in severe caes yang deficiency is at the root of several other patbologies,notably Phlegm
(through weakened fluid metabolism),acute severe pain from Cold
Acupuncture accumulation(see p.774),and Blood stagnation(from inadequate propulsion of
B1.15(xiw sw+ ),BL14(jwyw sh+),Ren.17(awbong+ ). Blood).
Ren.15(ji+ ),Du.14(d+St.36b+A),
PC.6(mwi gwaw-),PC.4(xim-) Clinical features
·treatment may be given frequently,every few hours in manageable cases *a suffocating,tight or dull chest pain,or stuffinessin the chest,which is provoked
·in severe cases see Box 28.2,p.756 or aggravated by exertion and exposure to cold
·in cases of collapse (with no available assistance),moxa can be butnt over Ren.8(shew ·shortness of breath with exertion,in severe cases(with pulmonary
gae).Spread a thin cloth over the navel and till it with salt.Burn large moxa cones over oedema)wheezing or orthopnoea
the salt until consciousness is restored.The cloth enables swift removal of the salt if ·cold intolerance and cold extremities
necessary. *palpitations
·listlessness and fatigue
Clinical notes *spontaneous sweating
·The chest pain in this pattern may correspond to disorders such as myocardial ·waxy pale complexion, with dark rings under the eyes and purple lips
infarction(if the pain persists for more than 15 minutes),angina pectoris,congestive ·lower back soreness
cardiac failure,coronary artery disease ·pitting oedema,worse in the lower limbs,with scanty urine
T pale bluish or purple and swollen,with a white or greasy coat
P deficient,thready,weak,slow or knotted and intermittent
·While such an emergency as Cold congealing Heart Blood may be dealt with Treatment principle
rapidiy and effectively using herbs and acupuncture in combination with Warm and tonify yang
Western medicine in a Chinese hospital,it is unlikely that our patients in the Warm and invigorate Heart jyang
West will be administered herbs before being taken to the casualty
department. However,if the cardiac pain is unresponsive to Western Prescription
treatment,there may be a place for the TCM management suggested here. LI ZHONGWAN 理中丸
·For patients in a high risk group (previous transitory angina with yang (Ginseng and Ginger Forwula)modified
deficiency),the patent medicine mentioned previously (Guaw Xin Su Hr Xiang This prescription is suitable for mild cases with signs of Heart and Spleen jang
Wan 冠心苏合香丸）should be carried at all times. deficiency.
ren shen（Radix Ginseng）人参
gan jiang（Rhizoma Zingiberis Officinalis）千姜
bai zhu（Rhizoma Atractylodis Macrocephalae）白·．．．．．．．．．．．9g
gui zhi （Ramulus Cinnamomi Cassiae）桂枝 9g
fu ling（Sclerotium Poriae Cocos）茯苓 9g
7 HEART 28.CHEST PAIN 779
7
8 zhi gan cao (honey fried Radix Glycyrchizae Uralensis)炙甘草 bai（Bulbus Allii Fistulosi）葱白 Spce，chen xiang （Lignum Aquilariae）沉香 3g．tan
xiang（Tignum Santali Albi）檀香 9g，xiang fu（Rhizoma Cyperi Rotundi）香附 9g，ji xue
Method: Decaction,(Source Shi Yang Zhong Yi Nui Kr Xai) teng （ Radix et Caulis Jixueteng ） 鸡 血 藤 15g ， ze lan （ Herba Lycopi Lucidi ） 泽 兰
9g，chuan xiong （Radix Ligustici Chuanxiong）川 6g，tao ren（Semen Persicae）桃仁
ZHEN WU TANG 真武汤 9g ， hong hua （ Flos Carthami Tinctorii ） 红 花 9g ， yan hu suo （ Rhizoma Corydalis
(Trae Warrier Decaction) modified Yanhusuo）延明索 9g，ru xiang（Gummi Olibanum）乳香 9g or mo yao（Myrrha）没药 9g
This prescription is selected when Heart and Kidney yang deficiency is causing
Variations and additional prescriptions
generalised and pulmonary oedema(as in congestive cardiac fail-ure),with
·In severe cases,see Box 28.2,p.756,The patient is cold and
dyspnoea,orthopnoea and frothy sputum.The correct treat-ment is to warm the
clammy,cyanotic,extremely pale with icy extremities and an imperceptible pulse
yang and promote urination.
indicatng imminent collapse of Heart jang.The correct approach is to administer
zhi fu zi ＊（ Radix Aconiti Carmichaeli Praeparata ）制附 子 ． 9g chao bai zhu (dry fried
an emergency medicine such as GUAN XIN SU HE XIANG WAN(Liqaid Styrax Pille
Rhizoma Atractylodis Macrocephalae)
for Coroeary Heart Disnase 冠心苏合香丸），and institute the emergency acupuncture
炒台术 9gsheng jiang（Rhizoma Zingiberis Officinalis）生姜 9g bai shao（Radix Paeoniae Lactiflora）白 12g
fu ling（Sclerotium Poriae Cocos）获．．．．．．．．．．．．．．．．．．．．．．．．．． 12g che qian zi（Semen Plantaginis）车前子
techniques until paramedic assistance arrives.An alternative approach used in
12g ze xie （ Rhizoma Alismatis Orientalis ） 泽 泻 12g Method:Decoction.Zhi fu zi should be decocied for 30 hospitals in China is SHEN FU TANG(Ginsng and Preparsd Acouite Deation 参附汤，
minutes before the other herbs （xiaw e 先煎），che qian zi is usually cooled in a muslio bag （bas jiae 包意） p．665）plus long gu（Os Draconis）龙骨 15-30g and mu li＇（Concha Ostreae）牡蛎 15-
（Soarce： Shi Yong Zing YiNa Ke Xaej.When fluids ace moving ，LI ZHONG WAN or the following prescription 30g administered intravenously．
JIN KUI SHEN QI WAN should be selected,dependingon the undedying partern.
Patent medicines
JIN KUI SHEN QI WAN 金匮肾气丸，p．874 Jiw Kui Shen QWan 金肾气丸（Sexoton Pills）
(Rehmannia Eight Farmwla) -used inbetween episodes of pain to strengthen the constitution Fu ZiLi Zhong
This is the representative Kidney yang strengthening formula,and is excel-lent as a Waw 附子理中丸（Li Chung Yuen Medical Pills）Xiao Hae Lao Dan 小活络丹（Xiao Huo Luo
general jang tonic.In cases of chest pain,it is used in between acute episodes of pain Dan）
to strengthen both Heart and Kidney yug. It is particularly useful following -a small dose of this very hot medicine may be useful in severe cases.Gwan
resolution of the acute phase of pulmonary or generalised oedema. Xin Su He Xiang Wan 冠心苏合香丸（Guan Xin Su Ho）
-for acute or severe pain during an episode
Modifications (apply to all three prescriptions)
·If the Cold and chest pain are relatively severe,add two or three of the following Acupuncture
herbs(where not already included):lu rong pian'(sliced Cornu Cervi Parvum ） 鹿 算 片 B1.15(xia h ),B1.14(jr yin sbu ),BL23(chew shw),
3g，chuan jiao（Pericarpium Zanthoxyli Bungeani）川椒 6g，wu zhu yu（Fructus Evodiae Ren.6(gi bai),Ren.4(ga )H(mei gwan),
Rutaecarpae）吴茱萸 6g，bi ba （Fructus Piperis Longi）草拔 3g，gao liang jiang （Rhizoma Ren.9(sbai fex),St.36(san l),Sp.6(an yin jiao)
Alpiniae Officinari）高良姜 9g，xixin＊（Herba cum Radice Asan）细辛 6g，zhi fu zi＊（Radix ·in severe cases see Box 28.2,p.756
Aconiti Carmichaeli Praeparata）制附子 6g or chi shi zhi （Halloysitum Rubrum）赤石脂 15g
With gi and Blood stasis,add two or three of the following herbs: cong Clinical notes
·The chest pain in thus pattern may correspond to disorders such as congestive
cardiac failure,angina pectoris,myocardial infarction and coronary artery
disease.
·In general,Heart yang deficiency is the predisposing pathology for more
serious(and possibiy fatal)cardiac episodes,but may respond
7 HEART 28.CHEST PAIN 781
8
0 well to TCM treatment when applied before the severity of the pain indicates an 瘀血痹 28.6 BLOOD STAGNATION
impending critical event.
·In cases with obvious oedema,Cold and/or severe pain, zhi fu zi （Radix 闭 Pathophysiology
Aconiti Carmichaeli Praeparata ） 制 附 子 is the essential ingredient,and ·Blood stagnation is most frequently encountered as a complication of an-
substitutes are inadequate. other pathology.Elements of Blood stasis are found in most chronic cases of
This pattern is frequently accompanied by severe Cold,Phlegm and/or Blood chest pain (and in some relatively acute types,see below).Blood stasis
stagnation. usually becomes prominent late in the course of a disease,and represents a
serious and perhaps life threatening development.Blood stasis is a com
mon feature of chronic chest pain patterns,and may involve some pathol
ogy of the coronary circulation or malignancy.
·Blood stagnation may also follow an acute external invasion of Wind Cold
Damp to the Heart (as in rheumatic fever),or a trauma to the chest wall.

Clinical features
·relatively chronic and severe chest pain,whch is stabbing or crushing.fixed in
location and usually worse at night or with sudden excitement,anger,emotion
or exertion
·palpitations, or sensations of the heart skipping beats during an attack
·stuffiness or fullness in the chest
·irritability,restlessness, easy anger or depression
·spider naevi on the chest and face
·purplish lips,nails,sclera,conjuntiva
·may be accompanying symptoms of Liver qi stagnation
T dark or red purple with brown or purple stasis spots and a thin white
coat.Sublingual veins are distended and dark.
P deep and choppy or wiry,or intermittent

Treatment principle
Invigorate Blood and eliminate Blood stasis
Open the Heart vessels and stop pain pite this walfun Prescription ofun
blood thinu as lom
XUE FU ZHU YU TANG 血府逐瘀汤
(Adbyranther and Persica Combination)modified
sheng di（Radix Rehmanniae Glutinosae）生地 30g
dan shen （Radix Salviae Miltiorrhizae）丹参 ........... 15g
tao ren（Semen Persicae）桃仁 12g
dang gui（Radix Angelicae Sinensis）归 9g
hong hua（Flos Carthami Tinctorii）红花 ..... -.. 9g
chi shao（Radix Paeoniae Rubrae）赤芍 9g
yan hu suo（Rhizoma Corydalis Yanhusuo）延胡索 9g
zhi ke （Fructus Citri Auranti）枳壳........... 6g

PT-P-prothonbi
782 HEART 28.CHEST PAIN 783

chai hu（Radix Bupleuri ）荣胡 6g chen xiang （Lignum Aquilariae ）沉香 . .... 6g niu Variations and additional prescriptions
xi（Radix Achyranthis Bidentatae）牛膝 6g gan cao （Radix Glycyrrhizae Uralensis）甘草 For wild caser
·In relatively mild cases，DAN SHEN YIN（Sahia Deation 丹参饮）may be sufficient.
4g Methed: Decoction.(Source Zhong Yi Nei Ke Liv Chaang Showc
dan shen（Radix Salviae Miltiorrhizae）丹参 30g tan xiang（Lignum Santali Albi）植香 5g sha
ren（Fructus Amomi）砂仁 5g Method:Decoction.
Modifications(where not already included)
·As noted above,Blood stagnation is often a complication of other
Pain following trauta
pathological conditions,frequently chronic Liver qi stagnation (see
When associated with trauma (for example following a motor vehicle accident
below),but also Cold,Phlegm,jang and yin deficiency etc,and prescription
or broken nb),the formula of choice is FU YUAN HUO XUE TANG （Rewise Heaith
should take these mechanisms into account. For example,if Cold or jang
by Inigorating the Biood Deio 复活血汤，p.578).This formula is usually only used for a
deficiency is responsible for the slowing down and stasis of Blood,warm
couple of weeks,depend-ing on how serious the trauma is.Initially,the patient
Blood invigorating herbs like chuan xiong(Radix Ligustici Chuanxiong ） 川 芎
should experience loose stools or diarthoea as the bruising and pain resolve.All
9g．yan hu suo（Rhizoma Corydalis Yanhusuo）延胡索 9g，jiang huang（Rhizoma
the modifications noted above apply to this formula also.
Curcumae Longae ） 姜 黄 9g ， hong hua （ Flos Carthami Tinctori ） 红 花 9g ， ru
xiang （ Gummi Olibanum ） 乳 香 9g and yue ji hua （ Flos et Fructus Rosae
In the past acte phast wen qi stagnation sigesbwne ofsour
Chinensis）月季花 9g should feature strongly in the selected prescription．
Because qi and Blood stagnation oceur so frequendy together,after the main
When Heat or jix deficiency dry the Blood and increase its viscosity,Blood
signs of Blood stasis have eased,qi stasis often becomes promi nent.In this
cooling and regulating hetbs are indicated. Herbs such as chi shao （ Radix
case(once the pain has been eased) use XIAO YAO SAN （Baplesrame and Dang
Paeoniae Rubrae ） 赤 9g ， sheng di （ Radix Rehmanniae Glutinosae ） 生 地 15-
Gui Formala 逍遥散 p．139）plus dan shen（Radix Salviae Miltiorrhizae）丹参 30g，zhi
30g ， dan shen （ Radix Salviae Miltiorrhizae ） 丹 参 15g and yu jin （ Tuber
xiang fu （prepared Rhizoma Cyperi Rotundi）制香附 6g and yu jin（Tuber Curcumae）
Curcumae）部金 9g are used．
郁金 10g．
Qi and Blood deficiency should be addressed with Blood nourishing and
regulating herbs， like dang gui （Radix Angelicae Sinensis）当 a 9g and ji xue Patent medicines
teng（Radix et Caulis Jixueteng）鸡血感 15g Xur Fu Zbu Yu Wan 血府连瘀丸（Xue Fu Zbu Yu Wan）
When Blood stagnation is combined with Phlegm,it is first necessary to Dan Sben Pian 丹参片（Dan Shen Pills）
distinguish Phlegm Fluids,Turbid Phlegm,Phlegm Heat or Wind Phlegm,and Jian Kang Wan 健康丸（Sunho Multi Ginseng Tablets）
combine with formulae from that section or add appropri-ate herbs Sbeng Tian Qi Pian 生田七片（Raw Tian Qi Ginseng Tablcts）
accordingly Jin Gu Die Sbang Wan 筋骨跌伤丸（Chin Koo Tieh Shang Wan）
If the pain is severe,add two or three of the following herbs:chuan lian zi ＊（Fructus Gman Xin An Kow Fu Ye 冠心安口服液（Guan Xin An Kou Fu Ye）
Meliac Toosendan ） 川 辣 子 9g ， yan hu suo （ Rhizoma Corydalis Yanhusuo ） 延 胡 索 9g ， mo Fu Ke Wx Jin Wan 妇科乌金丸（Woo Garm Yuen Medical Pills）
yao（Myrrha ）没药 9g，ru xiang （Gummi Olibanum ）礼香 9g，qing pi （Pericarpium Citri
Reticulatac Viride）青皮 6g and bai jie zi（Semen Sinapsis Albae）白芥子 6g．or combine with Acupuncture
SHI XIAO SAN（Break Inte a Smile Poader 失笑散）. BL15(xim sbw),BL14(jaw yin hw),BL17(gexbw-),BL13(jai sbu),haa tuo jia ji(M-BW-
sheng pu huang （ Pollen Typhae ） 生 用 黄 ． ． 6g wu ling zhi ＇ （ Excrementum Trogopteri seu 35)-from T3-T7 depending on tenderness,PC.6(mei gwaw-),PC.4(xi
Pteromi）五灵脂 6g Method:Grind equal amounts of each herb intoa fine poonder. Tbe dose is mw-),Ren.17(sbaw zhong),Du.12(shen hu),Du.10(ling Zmi),Sp.10(xwe bar-)
6grams of powder taken with the primary prescription or wine ·with jng deficiency add moxa
·with gi stagnation add Liv.3(tai cong-)
·with Phlegm add St.40(feng long-)
784 HEART 28:CHEST PAIN785

Clinical notes
·The chest pain in this pattern may correspond to disorders such as angina 28.7 HEART (LUNG AND SPLEEN)Q/ DEFICIENCY
pectoris,myocardial infarction,coronary artery disease,cor pulmonale,trauma Pathophysiology
including contusions and nib or sternum fractures. ·The primary mechanism in this pattern is weak Heart qi （zongqi 宗气）which is
·Keep in mind that in most cases of chest pain,even though the manifestationis unable to propel Blood adequately,leading to pooling of Blood.Weakness of
excess,the root is deficient (except in trauma).Most Blood invigorating Lung gi contributes by allowing gi to accumulate in the chest instead of
herbs,especially those that 'smash stagnant Blood' （po xae 破）are quite dispersing descending as it should.
and prolonged use will damage heng gi.Strong Blood movers should be used
cautiously and reserved for short term use in severe cases. Clinical features
·mild,dull,intermittent chest pain
·stuffiness in the chest
·shottness of breath or dyspnoea with exertion
·palpitations with anxiety
·fatigue and weakness
·easily flustered and panicky
low voice or reluctance to speak
·pale or sallow complexion
·spontaneous sweating
·all symptoms initiated or aggravated by exertion
·when the Spleen is involved there will be digestive symptoms,like poor
appetite,abdominal distension and loose stools
T pale and swollen with toothmarks and a thin coat
P weak,thready,moderate or intermittent

Treatment principle
Tonify Heart gi,invigorate yang qi in the chest

Prescription
BAO YUAN TANG 保元汤
(Prisere the Baral Deaaction) modified 3727
ren shen（Radix Ginseng）人参 9g
huang qi （Radix Astragali Membranacei）黄芪 9g
dan shen （Radix Salviae Miltiorrhizae）丹参 9g
dang gui(Radix Angelicae Sinensis)9g
fu xiao mai（Semen Tritci Aestivi Levis）浮小麦 12g
rou gui （Cortex Cinnamomi Cassiae）肉桂 3g
da zao（lructus Zizyphi Jujubae）大枣 4pce
zhi gan cao (honey fried Radix Glycyrthizae Uralensis)炙甘草
3g
Method:Decoction(Source Shi Yong Zhang Nu Ku Xar)
786 HEART 28.CHEST PAIN 787

YANG XIN TANG 养心汤 28.8 HEART (AND KIDNEY) YIN DEFICIENCY
(Nownisb the Heart Deoution) 心肾阴 Pathophysiology
This formula is selected if both the Spleen and Heart qi are equally weak.huang qi This pattern causes chest pain in two ways:
（ Radix Astragali Membranacei ） 黄 芪 12g ren shen （ Radix Ginseng ） 人 参 9g fu ·First,deficient Heat can evaporate and concentrat body fluids making the
lig（Sclerotium Poriae Cocos）茯 9g fu shen（Sclerotium Poriae Cocos Pararadicis）茯神 9g Blood viscous and impeding its smooth circulation.This causes a feeling of
dang gui (Radix Angelicae Sinensis).suan zao ren （ Semen Zizyphi Spinosse ） 酸 枣 仁 9g 不胸痹
fullness and pain,although at this stage the stagnation has usually not caused
chuan xiong（Radix Ligustici Chuanxiong）川 6g ban xia＇（Rhizoma Pinelliae Ternatae）丰 the degree of obstruction necessary to make the pain severe.Acute febrile
夏 6g bai zi ren （Semen Biotae Orientalis）柏子 9g yuan zhi（Radix Polygalae Tenuifoliae） disease(usually where Heat enters the Blood) can produce the same
远志 6g wu wei zi（Fructus Schizandrae Chinensis）五味子 6g rou gui（Cortex Cinnamomi result,depending on the intensity of the fever
Cassiae）肉桂 3g zhi gan cao（honey fried Radix Glycythizae Uralensis）炙甘草．6g Method: ·Second,deficient Heat may directly 'scorch and burn' the Heart and chest.This
Decoction (Source.Sti Yong Zhong Yi Noi Ke Xu) gives rise to a distinctive burning sensation in the chest
Modifications(where not already included) ·Heart yin anchors the shew.The anxiety chat is characteristic of this pattern
·With stuffiness in the chest，add xuan fu hua（Flos Inulae）旋复花 9g may be aggravated by fear of the disease itself,which intensifies the anxi-ety
·With insomnia ， add bai zi ren （ Semen Biotae Orientalis ） 柏 子 仁 9g and ye jiao and tightness in the chest and so on,creating a self perpetuatng cycle
teng（Caulis Polygoni Multifiori）夜交藤 30g
Clinical features
·intermittent,relatively mild chest pain,which may be burning or suffocating
·fullness and discomfort in the chest
·palpitations with anxiety
·restlessness,irritability and insomnia
·nigbt sweats
·With spontaneous sweating ， add mu li ＇ （ Concha Ostreae ） 牡 蛎 15g ， ma huang gen （ Radix facial or malar flushing
Ephedrae）麻黄根 9g，fu xiao mai（Semen Triticl Aestivi Levis）浮小麦 15g ·dry mouth and throat
·With deptession，add he huan pi （Cortex Albizziae Julibrissin）合欢皮 12g ·sensation of heat in the palms and soles(five hearts hot)
·dizziness and tinnitus
Patent medicines ·tendency to constipation
Gmi Pi Wan 归脾丸（Gui Pi Wan） ·weak or sore lower back and knees
Bai Zi Yang Xin Waw 柏子养心丸（Bai Zi Yang Xin Wan） T red,dry and thin with little or no coat or peeled patches in the coat,in severe or
chronie cases there may be a deep narrow central crack that extends to to the
Acupuncture tip of the tongue
Sp.6(nanyna+),Ht.7(sn+),PC.6(mdigman),Lu.7( qae),Ren.17(zAaw P rapid and thready or intermittent
gbong),B1.15(xiw sbw+),BL17(gsbu),BL20(phw+),St.36(w+)·with insomnia add
an mian(N.HN-54) Treatment principle
Nourish Heart yir and calm the shew
Clinical notes Regulate Blood,cleaz Heat
·The chet pain in this pattern may correspond to disosders such as cardiac
failure,coronary artery disease and weakness following illness Prescription
·This pattern often combines with qi stagnation,Blood stagnation or Phlegm.The TIAN WANG BU XIN DAN 天王补心丹
symptoms of deficiency are more noticeable between ept-sodes of chest pain (Ginseng and Ziggpbus Formula)
This formula is selected when the sbew signs(anxiety,insomnia,panic at-
7 HEART 28.CHEST PAIN 789
8
8 tacks) are strong. This is the main representative formula for Heart and REN SHEN YANG YING TANG 人参养营汤
Kidney yir deficiency (Ginseng Nutritisv Combination) plus
sheng di （ Radix Rehmanniae Glutinosae ） 生 地 120 （ 24 ） g tian dong （ Tuber SHENG MAI SAN 生脉数
Asparagi Cochinchinensis ） 天 ． 30 （ 12 ） g mai dong （ Tuber Ophiopogonis (Gemerate the Puise Powsder)
Japonici）麦冬 30（12）g suan zao ren（Semen Zizyphi Spinosae）仁 30（12）g xuan These formulae are combined when gi and yin are both deficient. The resulting patrern
shen（Radix Scrophulariae）玄参 15(12)g dan shen （Radix Salviae Miltiorrhizae） has characteristics of both deficiencies-increased Blood viscosity,weak propulsion of Blood
丹．．．．．．15（12）g fu ling (Sclerotium Poriae Cocos).........15(12)g dang gui wei and shallow breathing.The features are mild stuffiness and pain,shortness of
(Extremitas Radicis Angelicae Sinensis) breath,fatigue,palpitations,irritability,dry mouth,a swollen red or pink tongue with surface
cracks and no coat, weak,thready and possibly slighty rapid pulse.The correct treatment is
当归尾 30(9)gwu wei zi（Fructus Schizandrae Chinensis）五味．．．．．．．．．．．
to tonify gi and nourish yon.
30 （ 9 ） g bai zi ren （ Semen Biotae Orientalis ） 柏 子 仁 30 （ 9 ） g ren shen （ Radix
Ginseng）人参 15(9)g jie geng(Radix PlatycodiGrandiflori) 15(9)g yuan zi（Radix shu di （ Radix Rehmanniae Glutinosae Conquitae ） 熟 地 12g huang qi （ Radix Astragali
Polygalae Tenuifoliae ） 远 15 （ 6 ） g zhi gan cao(honey fried Radix Glycyrrhizae Membranacei）黄芪 12g ren shen （Radix Ginseng ）人参 12g dang gui （Radix Angelicae
Uralensis) Sinensis ） 当 归 -9g bai shao （ Radix Paeoniae Lactiflora ） 台 芍 9g bai zhu （ Rhizoma
Atractylodis Macrocephalae ）白术．．．．．．．．．． 9g fu ling（Sclerotium Poriae Cocos ）茯
炙甘草 6(6)gMethod:Grind herbs to a powder and form into 9-gram pils winh
hooey. The brackers. (Source:Shr Ying Zdong Yi Na Kr Xar) 苓 .........9g mai dong （ Tuber Ophiopogonis Japonici ） 麦 冬 ． ． ． ． ． 9g wu wei zi （ Fructus
Schizandrae Chinensis）五味于．．．．．． 6g yuan zhi (Radix Polygalae Tenufoliae)...6g chen
pi （ Pericarpium Citri Reticulatue ） 陈 皮 ． ． ． ． ． 6g zhi gan cao(honey fried Radix
HUANG LIAN E JIAO TANG 黄连阿胶汤
Glycyrrhizae Uralensis)
(Coptis and Ass-Hide Gelatin Decection) 炙甘草 6grou gui（Cortex Cinnamomi Cassiae）肉桂 ......3g sheng jiang （Rhizoma
This formula is selected when the chest pain and yir deficiency follow febrile Zingiberis Officinalis ） 生 姜 3pce da zao （ Fructus Zizyphi Jujubae ） 大 枣 Apce Method:
disease (a kind of sbao yin syndrome,with pain or a sensation of Heat in the Decoetion.(Source:SA Yong Zhang Yi Xso)
chest,insomnia and irritability, palpitations,anxiety,sores in the mouth and on
the tongue, a red tongue with a dry yellow coat and a thready rapid ZHI GAN CAOTANG 炙甘草汤
pulse).The correet treatment is to clear Fire,nourish yin,stop irritability and (Baked Licorice Combimation)
calm the shew.
huang lian（Rhizoma Coptidis）黄连 12g
This formula,also specific for giand yin deficiency,is selected when palpi-
huang qin（Radix Scutellariae Baicalensis）黄苓 6g
tations and an intermittent or irregular pulse are prominent.
sheng di（Radix Rehmanniae Glutinosae）生地··· 24g zhi gan cao(honey fried
e jiao（Gelatinum Corii Asini）阿胶 9g
Radix Glycyrthizae Uralensis)
bai shao（Radix Paeoniae Lactiflora）台芍 6g
炙甘草 12g
ji zi huang(egg yolk) 2yolks Method: Decoction.E jiao is melted in the bot strained ren shen（Radix Ginseng）人参 6g
decoction (jg los 洋化）.The egg yolks are stirred into the strained decoction. （Source Shi
Yang Zdang Yi Ni Kr Xai)
gui zhi （Ramulus Cinnamomi Cassiae）桂枝 9g
mai dong（Tuber Ophiopogonis Japonici）麦冬 9g
e jiao（Gelatinum Corii Asini）阿胶 6g
huo ma ren （Semen Cannabis Sativae）火麻仁 9g
790 HEART 28.CHFST PAIN 791

sheng jiang（Rhizoma Zingiberis Officinalis）生姜 ........9g sweats,a pale or pink dry tongue with a red dry tip and thready rapid pulse
da zao（Fructus Zizyphi Jujubae）大 5pce dan shen （ Radix Salviae Miltorrhizae ） 丹 30g mai dong （ Tuber Ophiopogonis
Method:Decoctioo.E jiao is melted in the hot strained decoction ( rg Awa Japonici）麦 15g gua lou （Fructus Trichosanthis）栝楼．．．．．．． 15g yu jin（Tuber
样化）A possible alternative to buo ma ren（if it is unavailable）is da hu ma Curcumae）郁金 10g chi shao（Radix Paeoniae Rubrae）赤．10g ren shen（Radix
（Semen Linum Usitatissimurn）文明麻（Source Shi Yang Zhong Yi No KeXw） Ginseng）人参 9g wu wei zi（Fructus Schizandrae Chinensis）五味子．．．．．．．．．．．．．．
6g sha ren（Fructus Amomi）砂仁· 6g shi chang pu（Rhizoma Acori Graminei）石菖
YI GUAN JIAN 一贯 蒲 6g tan xiang（Lignum Santali Albi）檀香 4g Merbod Decoction.Sha ren is added
(Linking Decoction) towards the end of cooking(swxu)(Source: Zhong Yi Na Ke Lia Chang Shoe Co)
This formula is chosen when Liver and Kidney yin deficiency with gr stag nation The following modifications apply to all the preceding prescrip-tions,(where herbs
give rise to chest and hypochondriac pain,epigastric and abdomi-nal mentioned below are not already included)
distension,dry mouth and throat,acid reflux,a red dry tongue and a thready ·With Blood stagnation,add two or three of the following hetbs:dang gui （ Radix Angelicae
wiry pulse.The correct treatment is to nourish yiw and sptead Liver Sinensis）当归 9g，dan shen（Radix Salviae Miltiorrhizae）丹参 15g，chuan xiong（Radix Ligustici
sheng di （Radix Rehmanniae Glutinosae）生地．．．．．．．．．．．．．18-45g Chuanxiong ） 川 芎 6g ， mu dan pi （ Cortex Moutan Radicis ） 牡 丹 皮 9g ， chi shao （ Radix Paconiae
gou qi zi（Fructus Lycii）枸杞子 9-18g Rubrae）赤芍 9g，yujin（Tuber Curcumae）郁金 9g
sha shen（Radix Adenophorae seu Glehniae）沙参 9g With yang rising or deficient Heat (dizziness,blurring vision,facial flushing and
mai dong（Tuber Ophiopogonis Japonici）麦冬 9g numbness in the limbs),add two or three of the following herbs ： he shou
dang gui（Radix Angelicae Sinensis）当归 9g wu（Radix Polygoni Multiflori ）何首乌 12g，nu zhen zi （Fructus Ligustri Lucidi ）女贞子
chuan lian zi＊（Fructus Meliae Toosendan）川橡子 4.5g
12g．gou teng （Ramulus Uncariae）钩藤 12g，shi jue ming（Concha Haliotidis）石决明
Method Decoction.(Source Formsdar and Stnagi)
15g ， muli （ Concha Ostreae ） 牡 蛎 15g ， gui ban° （ Plastri Testudinis ） 龟 板 12g ， bie
jia°（Carapax Amydae Sincnsis）鳌甲 12g，zhen zhu mu（Concha Margaritaferae）珍珠母
ZUO GUI YIN 左归饮 15g，long gu＇（Os Draconis）龙骨 15g
(Restore the Lafi Devaction) With stagnant qi,herbs that gently regulate oi without warming or drying are
This formula is selected as the guiding formula when Kidney yio defi ciency is selected.Add two or three of the following hetbs:gua lou （Fructus Trichosanthis）栝
predominant. 楼 24g，yu jin（Tuber Curcumae）郁金 9g，zhi shi（Fructus Immaturus Citri Aurantii）枳实
shu di （Radix Rehmanniae Glutinosae Conquitac）熟地．．24g 6g ， mei gui hua （ Flos Rosae Rugosae ） 玫 瑰 花 6g ， he huan pi （ Cortex Albizziae
fu ling（Sclerotium Poriae Cocos）茯苓. 12g Julibrissin）合欢皮 12g，chuan lian zi＊（Fructus Meliae Toosndan）川橡子 6g ot yan hu suo
shan yao （Radix Dioscoreae Oppositae）山药 9g （Rhizoma Corydalis Yanhusuo）延胡索 9g
gou qi zi （Fructus Lycii）枸杞子 9g
shan zhu yu（Fructus Corni Officinalis）山茱萸 .9g Patent medicines
zhi gan cao(honey fried Radix Glycyrrhizae Uralensis) Tian Wang BuXin Dan 天王补心丹（Tian Wang Bu Xin Dan）
炙甘草.. 6g -excellent for Heart ya deficiency with jben disturbance
Method:Decoction,(Source: Shi Ying Zhang Yi Nui Kr Xai) Zmo Gai Wan 左归丸（Zuo Gui Wan）
Sheng Mai Wan 生脉丸（Sheng Mai Wan）
SHENG MAI SAN 生脉散
(Gemerate the Palse Pouder) plus
DAN SHEN YIN 丹参饮
(Sabia Decertion) modified
This combination is selected when jiw and Blood are both deficient,with chest
pain,palpitations,shortness of breath,fatigue and weakness,postural
dizziness,dry mouth and throat,insomnia,restlessness,forgetfulness,night
792 HEART 28.CHEST PAIN793

Liw Wai Di Hmang Wan 六味地黄丸（Liu Wei Di Huang Wan）

SUMMARY OF GUIDING FORMULAE FOR CHEST PAIN
-a general Kidney yen tonic formula Excess patterns
Zhw Sha An SbnWan 朱砂安神丸（Cinnabar Sedative Pills） Heat scorching and knotting gi in the chest-XiaoXian Xiong Tang 小陷胸汤
-this pill can be combined with any other prescription(for a few weeks only)to
treat Heart yin deficiency patterns with severe anxiety Phlegm obstructing Heart yang
·Phlegm Fluids-Gua Lou Xie Bai Ban Xia Tang 瓜楼白平夏汤
Acupuncture ·Turbid Phlegm-Wen Dan Tang 温胆汤
B1.15(xin shw+),B1.14(ju yin abw+),B1.23(sbew sbu+),Kid.3(mx+), ·Phlegm Fire-Huang Lian Wen Dan Tang 黄连温胆汤
Ht.7(sbee mm),Ht.5(tong),PC.6(wigwan),Ren.17(sbax zbong), ·Wind Phlegm-Di Tan Tang 涤痰汤
yin tang(M-HN-3),Lu.7(li gar),Kid.6(zhao hai)

Clinical notes Qistagnation-Chai Hu Sbu Gan Sa 柴胡疏肝散·with prominent stuffiness-Xwaw Fu

·The chest pain in this pattern may correspond to disorders such as angina Hua Tang 旋复花汤
pectoris,cardiae arrhythmia,convalescent stage of febrile disease and
tuberculosis. Cold congealing Heart Blood circulation
·Yin deficiency often combines with Blood stasis and/nr Phlegm,both of which ·mild cases-Dang Gui Si Ni Tang 当归四逆汤
presenta clinical challenge as Phlegm resolving and Blood stasis removing herbs ·severe cases-Wa Tou Chi Shi Zhi Wan 鸟头赤石脂丸
can both damage yin.The mild end of both categories of herbs can be used,but ·with collapse of jang＋Gman Xin Sw Fe Xiang Wan 冠心苏合香丸
should be monitored closely for unwanted effects.All patterns with yin
Blood stagnation-Xue Fu Zbu Yu Tang 血府逐瘀汤
deficiency generally require persistent and long term treatment.
·after trauma-Fu Yuax Huo Xue Tang 复元活血汤
·Herbs are generally better at replenishing yin than acupuncture,although the
combination of both is best. Deficient patterns
Heart jang deficiency-Li Zhong Wan 理中丸
·Heart and Kidney yang deficiency with pulmonary oedems-Zhen Ww Tang 真武汤
·in convalescent stage,with Kidney deficiency-Jin Kai Shex Qi Wan 金医肾气丸
·with collapse of jang＋Gman Xin Sa He Xiang Wan 冠心苏合香丸

Heart（Lung and Spleen） gi deficiency-Bao Ywiaw Tang 保元汤

Heart and Kidney yin deficiency-Tian Wang Bu Xin Daw 天王补心丹

·with gi and yiw deficiency,with severe palpitations-Zhi Gaw Cao Tang 炙甘草汤
·with Liver yin deficiency and gi stagnation-Yi Gwan Jian 一貫煎
·predominant Kidney yn deficiency-Zuo Gui Wan 左归丸

Endnote
For more information regarding hetbs marked with an asterisk*,an open circle°
or a hat',see the tables on pp.944-952
Disorders of the Heart

29. Palpitations
Heart qi deficiency
Heart yang deficiency
Heart yin deficiency
Heart Blood and Spleen gi deficiency
Heart and Gall Bladder gi deficiency
Phlegm Heat
Spleen and Kidney yang deficiency
Blood stagnation
 PALPITATIONS 29.PALPITATIONS 797
deficiency,Heart Blood and Spleen
29jingji 惊悸，zbeng chong 怔忡
deficiency,Heart and Gall Bladder
Palpitations are an unpleasant and sometimes alarming awareness of the deficiency and Phlegm Heat tend to BOX 29.1 SOME BIOMEDICAL
give rise to palpitations through CAUSES OF PALPITATIONS
beating of the heart.The teem palpitations includes not only an awareness of
the heart racing (tachycardia),but also any sensation in the chest,such as disturbance of the shen-jing ji. ·anxiety/stress
However,as noted above,because ·fever
'pounding', 'llip flops', 'thumping', 'skipping', or 'fluttering
the Heart and shew are so closely ·anaemia
Chinese medicine descnbes two types of palpitations,with and without ·hyperthyroidism
organic dysfunction.The first type （ heng chong 怔 忡 ） is due to organic related,disturbance of one can ·neuresthenia
lead to disturbance of the other
easily ·myocarditis
dysfunction of the heart or other organ system. Zheng cong palpitations are ·myocardial infarction
generally chronic,and brought on by even mild exertion,stress and the distinctions between the two
and ·paroxysmal supraventricular tachycardia
fatigue.The othet type （ jing ／ 惊 悸 ） is primatily a disorder of the sber and is types may be clinically blurred. ·mitral stenosis (4ft venfuee)
provoked by anxiety,fright or some other emotion.The patient suffering jing ·coronary ischaemia
·heart failure
ji is generally in otherwise good health and the heart pathology is relatively AETIOLOGY ·hypovolaemia
benign Heart yang and qi aortic incompetence
·atrioventricular block
The mechanisms of these two broad types of palpitations are quite deficiency
Kidney jang deticiency is often at ·pulmonary embolism
different,although in practice there is often considerable overlap due to the the
root of Heart yang deficiency,and ·pericardiis
intimnate relationship between the Heart and shen. Zheng chong involves ·sick sinus syndrome
Spleen gr defciency is often atthe ·rheumatic fever
an actual weakness of the heart muscle or disordered signalling to the of Heart qi deficiency.In addition,
root ·hypokalaemia
heart.The palpitations associated with this type may include irregularities in Heart qi is easily dispersed by ·menopause
·hypercapncea
heart rate,tachycardis,badycardia,fbrillation,missed beats and signs of prolonged,excessive ot
circulatory disturbance.Jingji on the other hand,is frequentiy a subjective goief,sadness,anxiety
unexpressed or Drugs
palpitation,that is,the heart is perceived by the patient to be racing or ·caffeine
depression.
Excessive coffee(bitter in taste) ·alcohol
skipping beats but objective examination may detect no abnormality. The consumption appears to disperse ·amphetamines
most common sensation associated with jing ji is an awareness of Heart gi,especially when consumed ·salbutamol
accelerated heart rate,provoked by some emotion or fright. In jing ,the shen in unusually large or unaccustomed ·tricyclic antidepressants
is destabilised and becomes vulnerable and hy persensitive in the absence of ·adrenaline
quantities.Excessive sweating can ·atropine
a sound residence,namely the Heart. damage Heart jang and
also
Of the commonly recognised patterns associated with palpitations,Heart qi.
gi and yng deficiency,Spleen and Kidney yang deficiency and Blood
Heart yin deficiency(with Heat)
stagnation are most often associated with organic heart disease-zbeng
chong.Heatt jin
Heart yin,like Heart Blood,is depleted by ongoing emotional distress of any
kind,but especially shock,anxiety or worry.Any factors that damage Kidney ot
Liver yin may also lead to depletion of Heart yix,due to lack of support
through the generative （ theng 生 ， p ． 70 ） cycle ． Heart yon can also be
damaged by excessive sweating and by febrile diseases.

Heart Blood (and Spleen qi)deficiency

Heart Blood is most commonly depleted by prolonged worry or anxiety.The
condition may also develop or be exacerbated if the Spleen is weak. In
addition,if too much fluid is lost through haemorrhage or excessive
sweating.then Heart Blood can be damaged.Finally,any factors that deplete
Liver Blood will eventually also deplete Heart Blood.
796
798 HEART 29 PALPITATIONS 799

Heart and Gall Bladder deficiency Kidney jang deficiency may be an inberited condition,or may develop as a
This pattern describes a personality type that may be congenital or result of age,chronic illness,overexertion,overexposure to cold
acquired.When congenital,it may be due to a significant shock that damaged conditions,excessive lifting or standing,or in men by excessive ejaculation and
the foetal shew during the mother's pregnancy.Wben acquired it is the result of in women by having many pregnancies.
some sudden and violent or extreme shock or fright,especially during
childhood,as the sbew is more unstable in the young. Often it is the Blood stagnation
combination of a congenital Heart and Gall Bladder weakness and some critical Blood stagnation is usually a complication of some other Heart pathology.and
event that most effectively drain Heart and Gall Bladder gu This pattern can typically occurs late in the course of an illness. The Heart 'rules the Blood',that
occasionally be more acute,following a debilitating illnesses that drains qi is,it is responsible for physically moving Blood around the body.If it
Because the shew is so destabilised,it cannot cope easily with change and malfunctions,it is common tosee symptoms of cireulatory dysfunction and
can be easily disturbed by trivial events Palpitations may occur spontaneously stagnation of Blood.Specitically,pooling of Blood in the vessels occurs if the
and gradually worsen over time until they are constant. These patients are pumping action of the Heart is weak(from Heart gi or jang deficiency),and
prone to anxiety,and worry about their health can set up a self perpetuating congealing of the Blood due to increased viscosity can occur if there is a lack of
cycle-anxiety about their heart condition causes palpitations which in turn fluids (Heart Blood or yin deficiency).In addition,circulation may be
causes more anxiety and so on. compromised by Cold (yang deficiency)ot obstructed by Phlegm.
The involvement of the Gall Bladder here refers to the anxiety,timidity and
TREATMENT
'lack of gall'(that is,fearfulness)to which these patients are prone In the Chinese
language (as in English) thete is an implicit understanding of the telationship The treatment of palpitations involves two approaches In the cases of zheng
between the Gall Bladder and courage,indeed to be bold of courageous is to ong,the disorder is likely to be chronic and the functional strength of the Heart
have a ＇big Gall Bladder＇（da daw 大胆）. is weakened.Zheng chong disorders are primarily deficiency patterns and
treatment requires tonification of yangyie or Blood.These patterns generally
Phlegm Heat take longer to treat satisfactonily than the milder jing/ patterns.
Phlegm Heat can be generated in several ways.First,the presence of Phlegm or Jingji disorders,on the othet hand,ate primanily disorders of the she
Dampness due to Spleen weakness of overconsumption of Phlegm producing Treatment requires methods that settle,sedate and calm the
foods causes stagnation and Heat. Second, overconsumption of Phlegm Heat sbee.Acupuneture is particularly effective in calming the shen.In
foods(rich,greasy,spicy food and alcohol)and tobacco can cause an general,jing/ipatterns respond quickly (with the exception of congenital Heart
accumulation of Phlegm Heat directly Third,any pre-existingHeat in the and Gall Bladder deficiency).Bear in mind when deciding upon treatment that
body,due to Liver gr stagnation,yin deficiency or external invasion can congeal zbng chong and jingipatterns often overlap and a mixture of approaches
fluids into Phlegm,and subsequently Phiegm Heat. Phlegm Hear patterns are including tonifying, Blood activating and sbew calming may be required.
also observed in the convalescent stage of a febrile illness.

Spleen and Kidney yang deficiency

Failure of Spleen and Kidney yang'r fluid transforming and metabolising action
may lead to an accumulation of pathogenic fluids above the diaphragm These
accumulated fluids can disrupt Heart function.Spleen yang is weakened by
excessive consumption of cold raw food and irregular eating habits,or by too
many cold natured herbs (or antibiotics) in the treatment of a febrile
disease.Excessive mental strain of prolonged concentration may deplete Spleen
gi The damage is aggravated when an irregular diet is combined with excessive
mental activity (frequently seen in students and overworked executives).
 29.PALPITATIONS 801

29.1 HEART QI DEFICIENCY

Pathophysiology
·Heart gi powers the regular and rhythmic contraction of the Heart.
Weakened Heart gi leads to a disruption of the regularity and strength of
contraction.This can give rise to missed beats,tachycardin,bradycardia or
irregularity of rhythm.

Clinical features
·palpitations initiated or aggravated by exertion and relieved with rest
·Gtful sleep,insomnia
shormess of breath
·dizziness
·physical and mental farigue
·pale complexion
·spontancous sweating
T pale with a thin white coat
P chready and weak,possibly irregular

Treatment principle
Tonify and nourish Heart g

Prescription
WU WEI ZITANG 五味子汤
(SobigandraDecationmodified
6g
wu wei zi（Fructus Schizandrae Chinensis）五味子 ．．．．9g

mai dong（Tuber Ophiopogonis Japonici）麦 芪1

huang qi （Radix Astragali Membranacei）黄 2g
ren shen（Radix Ginseng）人参 -9g

suan zao ren （Semen Zizyphi Spinosae）破象仁 12g

bai zi ren（Semen Biotae Orientalis）柏子 仁 9g

he huan pi（Cortex Aibzziae Julibrissin）合欢

gan cao （Radix Glycyrrhizae L＇ralensis）甘草... 皮 9g
Method: Decoction.(Source:Shi Yang Zhong 12 Nai Kr Xon)
- 3g

Modifications ·With severe gi deficiency，add huang jing （Rhuizoma Polygonati）黄精

12g,and increase the dose of huang qi to 24g ·With copious sweating ，add mu li＇
（Concha Ostreae）牡蛎 18g，ma huang gen （Radix Ephedrae）麻黄根 12g，fu xiao mai
（Semen Tritici Aestivi Levis）浮小麦 12g
With severe insomnia,add ye jiao teg (Caulis Polygoni Multflon)
802 HEART 29.PALPITATIONS 803

夜交藤 15g and long chi（Dens Draconis）龙齿 10g 29.2 HEART YANG DEFICIENCY
心阳虚寒
Patent medicines
Gai Pi an 归脾丸（Gui Pi Wan）
Pathophysiology
·Heart yang deticiency is a more serious pathology than Heatt qi deficiency,and is
Sheng Mai W＇an 生脉丸（Sheng Mai Wan）
more hkely to develop if there is constitutional or pre-existing Spleen and Kidney
Bai Zi Yang Xin Wan 柏子养心丸（Bai Zi Yang Xin Wan）
yong deficiency.The palpitations are generally more severe and the Heart is
Ding Xian 定心丸（Ding Xin Wan）
relatively weaker. In addition to the contractile weakness of the Heart, signs of
Acupuncture Cold and fluid accumulation may appear. Heart yang deficiency is associated with
BL15(xtixn sbw+),PC.5(jiam zbeng chong
sbi+),Ht.7(dbewmew+),Ht.5(fomg4) 。 Ren.14(wque+),St.36(w+),Ren.6( Clinical features
gi bai+) ·palpitations initiated or aggravated by exertion and relieved with rest
·with spontancous sweating,add B143(gao hasang shu)and shortness of breath with exertion,in severe cases dyspnoea or orthopnoea
Du.14(da) ·stuffiness or discomfort in the chest
·listlessness and fatigue
Clinical notes ·cold extremities,aversion to cold
·The palpitations in this pattern may be associated with disorders such as ·spontancous sweating
anaemia,sinus tachycardia,premature ectopic bears,anxiety of sick sinus syndrome. ·waxy pale complexion,dark rings under the eyes,purple lips,cyanosis
·This pattern is closely related to and often precedes the next pattern,Heart yang *pitting oedema,in which cases urine is scanty,or nocturia or frequent urination
deficiency T pale bluish or pale purple and swollen,with a white or greasy coat P
·This pattern generally responds well to correct TCM treatment. deficient,thready,weak,slow or knotted and intermittent
·Qi gong,tai chi,yoga or a carefully monitored and graded exercise program can grdually
build the gi and strengthen the Heart.
Treatment principle
Warm,tonify and strengthen Heart yang

Prescription
GUI ZHI GAN CAO LONG GU MULITANG 桂枝甘草龙骨牡蛎汤(Cinmamon,Licoric,Dragow Bowe
and Oyster Sbell Decection) modified
gui zhi （Ramulus Cinnamomi Cassiae）桂枝．．．．．．．．．．．．．6g
long gu＇（Os Draconis）龙骨 ·... ··.... 15g
mu li＇（Concha Ostreae）牡蛎 30g
ren shen（Radix Ginseng）人参 9g
zhi fu zi＇（Radix Aconiti Carmichaeli Praeparata）制附子 9g fu ling（Sclerotium Poriae Cocos）茯苓·
15g

zhi gan cao(honey fried Radix Glycyrrhizae Uralensis)

炙甘草 6gMethod:Decoction. Zhi fu zi should be cooked for 30 manutes before the
ocher herbe are added（xian jia 先监）（Source Zhang Yi Na Ke Lin Chnng Sae C）
804 HEART 29.PALPITATTONS 805

（ Lignid Styrax Pille for Cononary Heart Disean 冠 心 苏 合 香 丸 ） ， and institute the
ZHEN WU TANG 真武汤 emergency acupuncture techniques outlined in Box.28.2until paramedic
(True Warrior Denation)modified assistance arrives, An aIternative approach used in hospitals in China is SHEN FU
This formula is selected if there is Heart and Kidney yang deficency with TANG (Gineng and Preparrd Acoole Deaction 参 附 汤 ， p ． 665 ） plus long gu ＇ （ Os
generalised and pulmonary oedema,scanty urine,dyspnoca,orthopnoea and Draconis ） 龙 骨 15-30g and mu li （ Concha Ostreae ） 牡 蛎 15-30g administered
frothy sputum.The correct treatment is to warm the jangand promote intravenously．
urination until the fluid balance is controlled.When fluids are moving the
original prescription or another suitable tonifying prescription should be Patent medicines
selected. Jin Kai ShexQiWan 金匮肾气丸（Sexoton Pills）
zhi fu zi＇（Radix Aconiti Carmichaeli Praeparara）制附子．．9g chao bai zhu(dry fried Fu Zi Li Zhong Waw 附子理中丸（Li Chung Yuen Medical Pills）
Rhizoma Atractylodis Macrocephalae) -good for warming yang generally,inclusing Heart jang
炒白水 9gsheng jiang （ Rhizoma Zingiberis Officinalis ） 生 Xiao Hao Lao Dan 小活络丹（Xiao Huo Luo Dan）
＆ ． ． ． ． ． ． ． ． ． ． ． ． ． 9g bai shao （ Radix Pacoriae Lactflora ） 白 号 12g fu -a small dose of this very hot medicine may be useful in severe cases
ling （ Sclerotium Poriae Cocos ） 茯 苓 12g che qian zi （ Semen
Plantaginis ） 车 前 ． 12g ze xie （ Rhizoma Alismatis Orientalis ） 泽 泻 12g Acupuncture
Method: Decoction.Zhi fu zi should be cooked for 30 minutes befte the BL.15(xin sbw+ ),BL14(juyin sbw+),PC.6(igwan+),
other hecbs are added （ xae e 夫 京 ） ， che qian zi is usually cooked in a Ht.5.(rongA),Ht.7(sben men+),Ren.4(gan aa+),St.36(+)
msin bag （Aas iae 包点）（Source：SN Yong Zhoeg Vi Nei Kr Xa）
Clinical notes
Modifications ·The palpitations in this pattern may be associated with disorders such as
·With Cold,add two or three of the following herbs:lu rong pian （ sliced congestive cardiac failure,atrial fibrilation or coronary artery disease
Cornu Cervi Parvum）鹿茸月 3g，chuan jiao（Pericarpium Zanthoxyli Bungeani） ·Symptoms of mild Heart yang deficiency may respond well to correct TCM treatment,fluid
川 板 6g ， wu zhu yu （ Fructus Evodiae Rutaecarpae ） 吴 茱 萸 6g ， bi ba （ Fructus metabolism especially improves fairly quickly.Long term therapy is necessary to maintain
Piperis Longi）草拔 3g．gao liang jiang（Rhizoma Alpiniae Officinan）高良姜 9g，xi the result. In severe cases it can be difficult to treat,especially patients presenting with
xin＊（Herba cum Radice Asari）如辛 6g or chi shi zhi（Halloysitum Rubrum）赤石 Heart and Kidney jang deficiency.These patients are usually on the maximum dose of
脂 15g conventional medicine
·In general,Heart yuang deficiency is the predisposing pathology for more serious(and
possibly fatal) cardiac episodes.
Variations and additional prescriptions
Witb Kidnry yang dgfciemy
·If Kidney jang is deficient, conside: JIN KUI SHEN QI WAN （Rehmanaia Eigbr Formala 金肾气丸，p．874）or YOU GUI WAN （Exoia andRehmannia Formala 右归丸，p．559）once the
palpitations are under control. Both of these formulae are suitable for long term use.

Collapue of Heart yang

·In severe cases see Box28.2,p.756.The patient is cold and clammy.cyanotic,pale and has icy extremities and a fibrillating pulse,indicating imminent collapse of Heart yang.The correct appoach is to
administer an emergency medicine such as GUAN XIN SU HE XIANG WAN
806 HEART 29.PALPITATIONS 807

wu wei zi （ Fructus Schizandrae Chinensis ） 五 味 子 30 （ 9 ） g bai zi ren （ Semen Biotae Onentalis ） 柏 子 仁

29.3 HEART YIN DEFICIENCY 30 （ 9 ） g ren shen （ Radix Ginseng ） 人 参 15(9)g jie geng (Radix Platycodi Geandiflori)15(9)g yuan
Pathophysiology zhi（Radix Polygalae Tenuifoliae）志 15（6）g zhu sba（Cinnabatis）朱砂（optional）6（0.5）g Mechod:Grind
阴虚 herbs (except zhu sha) to a powder and form into.9-gram pills with booey.If used,cour the outside
·Heart yin deficiency can cause palpitations in two ways-by creating deficient Heat of the pals with the zhu sba. The dose is one pill 23 times daily,May also be decoced with the
and by not stabilising and anchoring the zhen.When there is jiw deficiency,the false dosage in brackers.When decocted the zhu sha is taken as powder with the strained decoction. This
Heat that atises agitates the shew and Heart.When the she is not anchored by yon is an excellent formula foc long term use in treating ji deficiency with db in which case the zhu sba
for Blood),the resulting instability causes the hen to be more vulnerable to sudden is deletcd(Souroc: Jhv Yong Zhong Yi Nui Ke Xae)
fright or shock,and palpitations easily ensue
SHENG MAI SAN 生脉散
Clinical features (Gemerate the Pulss Poader) modified
·palpitations, easily brought on by a start or fright This formula is selected if the palpitationsoccur following a febrile illness which
·insomnia,waking with palpitations or panic attacks and anxiety has consumed Heart qr and yiw.The signs and symptoms are a stifling sensation
·sensation of heat in the palms and soles(five hearts hot) in the chest,shortness of breath,sweating,dry mouth and thirst,poor sleep,a pale
·night sweats red and dry tongue and a knotted or irregular pulse.This may occur following
·dry mouth and throat profuse sweating (as in heat stroke).
dizziness and tinnitus ren shen（Radix Ginseng）人参. 9-15g
·restlessness and fatigue mai dong（Tuber Ophiopogonis Japonici）麦·9-12g
·poor concentration andmemory,forgetfulness wu wei zi （Fructus Schizandrae Chinensis）五味．．．．3-6g
·lower back ache gui zhi(Ramulus Cinnamomi Cassiae).............6g
·dry stools or constipation long gu（Os Draconus）龙骨．．．．．．．15g
*possibly mouth or tongue ulcers mu li＇（Concha Ostreae）牡蛎 ·.·... 30g
T red and dry with bttle or no coar Mechod:Decoction.(Source:
P thready and rapid

ZHU SHA AN SHEN WAN 朱砂安种丸

Treatment principle
(Cimmabar Pill to Cal tbe Spirit)
Nourish Heart yi,caim the shew
Clear Heat This formula is selected when severe or continuous palpitations are
accompanied by insomnia,anxiety and Heat It is more sedative than the primary
formula and designed to treat and control the symptoms quickly.Because it
Prescription contains zhu sha,it is not suitable for prolonged use and once the condition is
TIAN WANG BU XIN DAN 天王补心升 under control other mote tonifying formulse should be used.
(Ginseng and Zigphas Forneua) huang lian（Rhizoma Coptidis）黄连 45g
This is the basic Heart(and Kidney)yin deficiency formula,and is selected when the zhu sha＊（Cinnabaris）朱砂 30g
sber symptoms (anxiety,insomnia,panic attacks) are prominent dang gui （Radix Angelicae Sinensis）当 30g
sheng di（Radix Rehmanniae Glutinosae）生地 120（24）g sheng di （Radix Rehmanniae Glutinosae）生地 30g
tian dong（Tuber Asparagi Cochinchinensis）天．30（12）g fu ling（Scleronium Poriae Cocos）茯苓 30g
mai dong（Tuber Ophiopogonis Japonici）麦冬 30（12）g suan zao ren（Semen Zizyphi Spinosae）酸枣仁 30g
suan zao ren（Semen Zizyphi Spinosae）酸枣仁 30（12）g yuan zhi（Radix Polygalae Tenuifoliae）远志 15g
xuan shen（Radix Scrophulariae）玄 15（12）g
dan shen （Radix Salviae Miltiorrhizae）丹 15（12）g
fu ling (Sclerotium Poriae Cocos)................15(12)g
dang gui （Radix Angelicae Sinensis） 当．30（9）g
808 HEART 29.PALPTTATIONS 809

zhi gan cao(honey fried Radix Glycyrthizae Uralensis) suan zao ren （ Semen Zizyphi Spinosue ） 酸 仁 15g zhi mu （ Rhizoma
炙甘草 15gMechod:Grind herbs(except zhu sha)to a powderand form into 3- Anemarrhenae Asphodeloidis ） 知 母 9g fu ling （ Sclerotium Potiae Cocos ） 茯 苓
gram pills with honey.Coat the outside of the pills with the zhu sha. The dose is 1-2 15g chuan xiong（Radix Ligustici Chuanxiong）川芳 -..............6g gan cao（Radix
pills reduced by 90%,If decocted the zhu sha (0.5g)is taken with the strained Glycyrthizae Ltalensis）甘草 3g Method:Decoction,(Souice: Shi Yong Zhing Yi Na
decoction（cang 冲屋）（Source Sh Yong ZhonYas Xar） Kr Xo)

Patent medicines
HUANG LIAN E JIAOTANG 黄连阿胶汤 Tian Wang Bu Xin Dan 天王补心丹（Tian Wang Bu Xin Dan）
(Captis and Arr-Hide Gelatin Devaction) modified -excellent for Heart yie deficiency with ibew disturbance
This formula is selected when Heart yin deficiency follows a febrile disease (a Zao Gai Wan 左归丸（Zuo Gui Wan）
type of shao yin syndrome,with palpitations and anxiety,a sensation of heat in Sbeng Mai Waw 生脉丸（Sheng Mai Wan）
the chest,insomnia and irritsbility,sores in the mouth and tongue,a red tongue Liw Wei Di Hmang Waw 六味地黄丸（Iiu Wei Di Huang Wan）
with a dry yellow coat and a thready rapid pulse).The correct treatment is to -a general Kidney yin tonic formula
clear Fire,nourish yin,stop irritability and calm the shew. Suan Zao Ren Tang Pian 酸枣仁汤片（Tabellae Suanzaoren）
huang lian（Rhizoma Coptidis）黄连 12g CZbu Wan 磁未丸（Ci Zhu Wan）
e jiao＂（Gelatinum Coni Asini）阿.................9g -this pill is usually combined with one of the other formulae above
huang qin（Radix Scutellariae Baicalensis）黄芩．6g
bai shao （Radix Paeoniae Lactiflora）白号 6g Acupuncture
long chi＇（Dens Draconis）龙齿 9-15g BL23(shew shw+),B1.15(xin sbu),Kid.3(taixi+),Ht.5(tong4).
mu li'(Concha Ostrese).......................15-30g Kid.6(hao hai+),Ht.7(sben me),PC.6(mi goan),PC.7(da Eng),
ji zi huang(egg yolk) 2 yolks Liv.3(tai chong+),BL.18(gan zhw +),Ren.17(shan ghong)
Method: Deccction.E jiao is melted in the hot strained decoction ( g ·with Fire add Ht.8(shao fu)
洋化）.The egg yolks are sticred into the strained decoction.（Source： Shi Yong
Zhaeg Yi Nei Ke Xar) Clinical notes
·The papitations in this pattern may be associated with disorders such as
YI GUAN JIAN 一贯煎 menopausal syndrome,neuresthenia,mitral stenosis,hyperthyroidism,anxicty
(Linking Decaction)plus neurosis,fever of unknown origin,convalescence following a febrile disorder or
SUAN ZAO REN TANG 酸枣仁汤 coronary artery disease.
The palpitations in this pattern often respond well to treatment although long
(Zigpbur Cambinaion)modified
term resolution may depend on the biomedical syndrome with which they are
This formula is used when signs of Liver and Kidney yin deficiency ate
associated.For example,hyperthyroid conditions can be difficult to cure with
prominent.The Heat resulting from the deficiency can accelerate the
TCM and may need to be controlled by drugs or surgery if TCM treatment is
Heart.Because Liver yin is weak,it is often complicated by gi stagnation.The
ineffective,before lasting results can beacheived.
main features are palpitations, insomnia,'five heatts hot',night
sweats,dizziness,tinnutus,irritability,lower back pain,dry eyes,blurred
vision,photophobia,headaches,epigastric and abdominal distension,acid reflux
and a thready or wiry and rapid pulse.
sheng di （ Radix Rehmannine Glutinosae ） 生 地 18-45g gou qi zi （ Fructus Lycii ） 枸 杞 子 9-18g sha shen （ Radix Adenophorae seu Glehnuae ） 沙 参 9g mai dong （ Tuber
Ophiopogonis Japonici）麦冬 9g dang gui （Radix Angelicae Sinensis）当归 9g chuan lian z＊（Fructus Meliae Toosendan）川棟子 4.5g
810 HEART 29.PALPITATIONS 811

dang shen （Radix Codonopsis Pilosulae ）党 12g chao bai zhu(dry

心脾 29.4 HEART BLOOD AND SPLEEN Q/ DEFICIENCY
fried Rhizoma Atractylodis Macrocephalae)
两虚 Pathophysiology
·Heart Blood and Spleen gr deficiency has elements of both gbeng cbong and
炒白术........ 9gdang gui（Radix Angelicae Sinensis）当 9g long yan rou
jing/i,with gi deficiency contributing to weakness of Heart fnction,and Heart Blood （Arllus Euphoriae Longarae）龙眼 9g yuan zhi（Radix Polygalae Tenuifoliae）
deficiency failing to anchor and stubilise the thew. It occurs most commonly when 志 6g mu xiang （Radix Aucklandiae Lappae）本香 6g zhi gan cao (honey fried
Heart Blood is depieted by emotional distress and the Spleen is weak and unable to Radix Glycyrchizae Uralensis)
炙甘草 6gMethod:Decoction.(Source:Shi Yong Zhang Yi No Ke Xa)
support the Heart. Prolonged overwork and worry in combination with irregular diet
(commonplace in our modern society) easily deplete the Hearr and Spleen. ZHI GAN CAO TANG 炙甘草汤
Sometimes this type of palpitations is seen as an acute episode following
(Baked Licerice Combimation)
hnemorrhage,especially uterine or postpartum.
This is an important formula for gi and Blood (or yin) deficiency type palpitations (or
arrhythmias) that are brought on by activity and are accompanied by a
Clinical features
knotted,intermittent or irregular pulse,the latter being an important indicator for the
*palpitations with or without anxiety,generally worse at night
use of this formula.This pattern has elements of both zeng chong and jingi
*insomnia,with particular difficulty falling asleep (and switching off the
sheng di （ Radix Rehmanniae Glutinosae ） 生 地 24g zhi gan cao(boney fried Radix
mind) and dream disturbed sleep Glycyrthizae U'ralensis)
·anxiery,phobias,panic attacks 炙甘草 12gren shen（Radix Ginseng）人参 6g gui zhi （Ramulus Cinnamomi
·forgetfulness,poor memory,poor concentration Cassiae ） 桂 枝 .g mai dong （ Tuber Ophiopogonis Japonici ） 麦 冬 ． ． ． ． ． ． 9g e
·postural dizziness jiao（Gelatinum Corii Asini）阿胶 -6g huo ma ren（Semen Cannabis Sativae）火麻仁 9g
·blurring vision,spots in the visual field sheng jiang （Rhizoma Zingiberis Officinalis）生姜 9g da zao （Fructus Zizyphi Jujubae）
·fatigue and weakness 大 5pce Method: Decoction.E jiao is meltud in the hot strainad decortion (ng As 洋
·poot appetite,abdominal distension after eating 化）（Source： Sa／ Yong Zineg Y7 Ne Ke Xo）
·sallow complexion
·easy bruising Modifications (applicable to both formulae,where the herbs are not
·heavy or prolonged menstrual periods already included)
T pale with a thin white coat ·With severe palpitations，add hu po（Succinum）琥珀 2g and zhu sha （Cinnabaris）朱砂 1g
P thready and weak If Heart Blood is very deficient,add shu di (Radix Rehmanniae
Glutinosae Conquitae ） 热 地 30-50g ， bai shao （ Radix Paeoniae
Treatment principle Lactiflota）自芍 15g and e jiao＇（Gelatinum Corii Asini）阿胶 15g
Strengthen and nourish the Heart and Spleen With Liver Heat,add shan zhi zi(Fructus Gardeniae Jasminoidis) 山 栀 子
Tonify gi and Blood,calm the shew 9gand chai hu（Radix Bupleuri）柴胡 6g
With severe insornia,add one or two of the following herbs:wu wei zi （ Fructus
Prescription Schizandrae Chinensis）五味子 6g，bai zi ren（Semen Biotae
GUI PITANG 归牌汤
(Ginseng and Longan Combination)
This formula is selected when there is obvious digestive weakness and signs of shen
disturbance.
zhi huang qi (honey fried Radix Astragali Membranacei)

炙黄芪 15gsuan zao ren（Semen Zizyphi Spinosae）酸枣仁 12g fu ling

（Sclerotium Potia Cocos）茯苓 12g
812 HEART 29.PALPITATIONS 813

Orientalis）柏子仁 9g．ye jiao teng （Caulis Polygoni Multifloni）夜交藤

30g，he huan pi（Cortex Albizziae Julibrissin）合欢皮 9g．long chi 29.5 HEART AND GALL BLADDER QI DEFICIENCY
心虚胆祛
（Dens Draconis）龙齿 10g，mu li＇（Concha Ostreae）牡蛎 30g Pathophysiology
With abdominal and epigastric fullness,poor appetite,a greasy or glossy ·In Heart and Gall Bladder deficiency palpitations,the sbew is congenitally
tongue cost，add ban xia＊（Rhizoma Pinelliae Ternatae）半夏 10g and chen pi unstable,or disrupted by a major shock or fright.The instability causes the
（Pericarpium Citri Reticulatae）陈皮 10g patient toexperience palpitations and anxiety with seemingly trivial events.In
With forgetfulness and poor concentration,add shi chang pu （Rhizoma Acori congenital cases there will usually be a long,often lifelong history of emotional
Graminei）石落潇 6g timidity.

Patent medicines Clinical features

Gui Pi Wan 归脾丸（Gui Pi Wan） ·palpitations, which may be initiated by anxiety or a fright
Bai Zi Yang Xin Wan 柏子养心丸（Bai Zi Yang Xin Wan） ·apprehension, easily frightened and startled,timidity,anxiety
·insomnia,dream disturbed sleep,waking feeling anxious
Dang Gui JiJing 当归鸡精（Tang Kuei Essence of Chicken）
·spontaneous sweating
Bu Nao Wan 补脑丸（Cerebral Tonic Pills）
·shortness of breath
Acupuncture
Sp.6(sax yain jiao+),St.36(+)H5(+),B1.20(s)yin tang(M-HN-3),Ht.7(sben ·lethargy and fangue T normal or witha pale body and a thin white coat;in congenital or
men+),BL15(xr sbw+),BL17(ge shar+) long standing cases there may be a deep narrow crack to the tip
·with forgetfulness,add Du.20(bai bwi),B1.52(zhisb) P slightly weak,thready and rapid or thready and wiry
·with much dreaming,add B1.42(po hu)
·with anxiety,add Du.19 (how ding) and Du.24(xben ting) Treatment principle
Sertle the mind,calm the she
Clinical notes Nourish and tranquilise the Heart, tonify H7FGls
·The palpitations in this pattern may be associated with disorders such as
neurosis,anaemia,thrombocytopoenia,neuresthenia,chronic fatigue syndrome,post tanify H7Fels o
partum haemorrhage,sinus tachycardia.premature ectopic beats,sick sinus Prescription
syndrome and arrhythmia DING ZHI WAN 定志丸 insommia
·Heart and Spleen deficiency palpitations are generally very responsive to (Settie the Emotions Pill)modified
treatment,which should continue until it is clear the Spleen is strong This prescription is useful for palpitations and congenital shew instabilicy in a frail and
enough to make sufficient Blood.Careful diet and eating patterns will timid person.It is suited to long term use.
enhance the result.A strictly regular bedtime routine should be adhered ren shen（Radix Ginseng）人参 90g
to. fu ling（Sclerotium Poriae Cocos）茯苓 90g
·Acupuncture can be very effective at tonifying Spleen gu but if the patient shi chang pu（Rhizoma Acori Graminei）石蓄 60g
is already very Blood deficient,herbs will probably be necessaty as well yuan zhi（Radix Polygalae Tenuifoliae）远志 60g
In women who lose blood (and thus Heart Blood) through heavy periods,Blood long gu＇（Os Draconis）龙骨 .... 60g
tonics and Blood replenishing and iron-rich foods should be taken after each period. hu po（Succinum）琥珀 30g
Iron supplements are also useful. Method:Grind herbs to a powder and form into 9-gram pilis with honey The
dose is 1 pill twice daly May also be decocte wth an0% reduction in dosage
(Source: Fiwwwilar andStrategin)

Modifications
·With Blood deficiency，add dang gui （Radix Angelicae Sinensis）当归 60g and bai
shao（Radix Paeoniae Tactiflora）白芍 60g
814 HEART 29.PALPITATIONS 815

GUI ZHI JIA LONG GU MU LITANG 桂枝加龙骨牡蛎汤

(Cinmamon and Dragon Bone Combination)
29.6 PHLEGM HEAT
This formula is selected if following a major shock or trauma,there are palpitations with
anxiety,insomnia and dream or nightmare distuzbed sleep.hair loss,spontancous sweating, Pathophysiology
loss of appetite, dizziness,depression,lack of motivation,a sightly pale tongue and a hollow ·Phlegm Heat has both the cloying nature of Phlegm and the sber agitating quality of
slow pulse.This is typical of severed communication between the Heart and Kidneys due to Heat The Phlegm in this pattern(usually the insubstantial type),can 'obstruct (or mist) the
shock. orifices of the Heart'.This can lead to a disturbance of cardiac function or clouding of the
gui zhi （Ramulus Cinnamomi Cassiae）桂枝 -....... 98 shew and an exagerated awareness of the Heart. The Heat component also agitates the
bai shao（Radix Paeoniae Lactiflora） 白芍 9g sben.This pattern sometimes co-exists with Heart and Gall Bladder qi deficiency
long gu＇（Os Draconis）龙骨 ···..15-30g (p.813),and can follow a febrile illness that has congealed Fluids into Phlegm.
mu li（Concha Ostreae）牡蛎 15-30g Clinical features
sheng jiang（Rhizoma Zingibetis Officinalis）生姜 9g ·palpitations with anxiety and nervousness
da zao （Fructs Zizyphi Jujubae）大枣 4pce ·dizziness and vertigo
gan cao（Radix Glycyrrhizae Uralensis）甘草.........6g ·insomnia,with waking in the early hours, perhaps around 4am,unable to fall back to
Method Decocton (Sourcel Foealr ond Statgi) sleep
·irritability and restlessness

Patent medicines ·nausea,vomiting or indeterminste gnawing hunger

Bu Nao Waw 补脑丸（Cerebral Tonic Pills） *poor appetite
Ding Xiw Wan 定心丸（Ding Xin Wan） ·belching
Yang Xin Ning Shex W＇an 养心宁神丸（Ning San Yuen Medical Pills） ·acid reflux
·bitter taste in the mouth
Acupuncture *abdominal distersion
BL15(xax sbw+),PC.6(mi T red tip or body and a greasy yellow coat
guan).Ht5(fong ),Ht.7(sbew.mew+).Ren.14(w gae),Du.20(bai P rapid and slippery or wiry
ha),GB.40(giwxx),BL.7(tong hiax),Ht.9(shao cbong),Du.19(bow
ding),Du.24(shew ning) Treatment principle
Clear Heat,transform Phlegm
Clinical notes Harmonize the Stomach,calm the shew
·The palpitations in this pattern may be associated with disorders such as anxiety
neurosis,neuresthenia,involutional psychosis,premenstrual syndrome,sinus Prescription
tachycardin,depression or panic attacks. WEN DAN TANG 温胆汤
·This pattern,especially when congenital,can be difficult to treat and obtain a (Bamboe and Hoeles Combnation)modified
lasting resulr.Combining with psychotherapy of some sort may be useful.Acute suan zao ren（Semen Zizyphi Spinosae）酸仁 15g
palpitations with anxiety after shock or trauma is more responsive to fu ling（Sclerotium Poriae Cocos）茯苓 12g
treatment,especially when acupuncture treatment is given frequently. In these zhu ru（Caulis Bambusae in Taeniis）竹茹 9g
acute types,acupuncture is particulatly useful. zhi shi （Fructus Immaturus Citri Aurantii）枳实 9g
ban xia＊（Rhizoma Pinelliae Ternatae）夏 9g
chen pi （Pericarpium Citri Reticulatae）陈皮 9g
yuan zhi（Radix Polygalae Tenuifolize）远志 .....6g
gan cao（Radix Glycyrchizae Utalensis）甘草 6g
Method:Decoction:(Source SM Yong Zhong Yi Nai Ky Xm)
816 HEART 29.PALPITATIONS 817

ban xia＊（Rhizoma Pinelliae Ternatae ）午夏 9g huang qin（Radix Scutellariae

Modifications Baicalensis）黄芩 9g long gu＇（Os Draconis）龙骨 24g mu li（Concha Ostreae）牡蛎
·If Heat is severe，add huang lian （Rhizoma Copuidis）黄连 6g
24g fu ling（Sclerotium Poriae Cocos）茯苓 12g gui zhi （Ramulus Cinnamomi
·With severe Phlegm Heat(thick yellow greasy coat,woolly headedness,dizziness),add
Cassiae）桂枝 6g da huang（Radix et Rhizoma Rhei）大费.g sheng jiang（Rhizoma
tian zhu huang (Concretio Silicea Bambusae Textillis)天竺黄 9g，zhu li（Succus Bambusae）竹
Zingiberis Officinalis ） 生 姜 3pce da zao （ Fructus Zizyphi Jujubae ） 大 枣 .5pce
沥 10g and dan nan xing （Pulvis Arisaemae cum Felle Bovis）胆南星 6g．See also Variations
Method: Decoction This i an extremely useful formula for me disturbance in
and Additional Prescriptions,below
robust patients with Heat.It ts uidely used for disorders due t fright,shock or
With severe palpitations,panic attacks, or if the patient is easily startled,add
drug withdrawl,where palpitations,fullne in the chest,irnitability and
zhen zhu mu（Concha Margaritaferae）珍珠母 30g，long chi （Dens Draconis）龙齿
agiration are prominent (Source Foraalar sad Stragin)
15g and mu li（Concha Ostreac）牡蛎 15g
With food stagnation and obvious digestive disharmony,add two or three of
the following herbs:jiao shen qu (baked Massa Fermentata)焦神曲 10g，jiao shn Patent medicines
zha（baked Fructus Crataegi）焦山 10g，chao mai ya （dry fried Fructus Hoedei Er Chew Wan 二陈丸（Er Chen Wan）plus Hang Liax Jir Da Wax
黄连解毒丸（Huang Lian Jie Du Wan）
Vulgatis Germinantus ） 炒 麦 芽 10g ot chao lai fu zi （ dry fried Semen Raphani
Sativi）炒菜服子 15g
Ha Po Bao Long Waw 琥 珀 拖 龙 丸 （ Po Lung Yuen Medical Pills ） Niu
·With constipation ， add da huang （ Radix et Rhizoma Rhei ） 大 黄 6-9g and gua
Huang Qing IIno Wan 牛黄清火丸（Niu Huang Qing Huo Wan ）-severe
louren（Semen Tnchosanthis）栝楼仁 15g cases
Chai Hu Jia LongGwMaLiSan 柴胡加龙骨牡蛎散
Variations and additional prescriptions (Bupleurum and Dragon Bone Combination)-for robust individuals with qi
Sepere Phicgn Hear stagnation and Heat or Fire causing palpitations,extreme
In very severe cases,with continuous palpitations,vertigo,tinnitus,a very thick restlessness,fullness in the chest,agitation and insomnia
yellow tongue coat and constipation,the correct treatment is to drain Fire and
drive out Phlegm with GUN TAN WAN(Vaporicy Phiegw Pil 滚痕丸）
Acupuncture
duan meng shi (calcined Lapis Micae seu Chlorit) Ht.5(fong4).PC4(xmzw-)。B1.13(fw-),Lu.5(ci)
煅石 30gjiu da huang （wine fried Radix et Rhizoma Rhei）酒大黄．．．．240g St.40(feng Jong-),GB.34(yang ling qman-),PC.5(jan sbe)
huang qin（Radix Scutellariae Baicalensis）黄芩 -240g chen xiang（Linum Aquilariae） ·with insomnia add St.45( dad)
沉香 15g Method:Gried berbs to a pouder and form intu small piwih water The ·with constipation add St.25(tiaw sur-)
dose is 6.9 grams once or rucdaith ginger tea.(Source SAr Yang Zhong Yi Nw Kr ·with anxiety add Du.19(bow ding)and Du.24(shen ting)
Xw)
Clinical notes
Phiew Ileal witb Ieart and Liver Fire ·The palpitations in this pattern may be associated with disorders such as
·Palpitations that occur at rest and that are accompanied by fullness in the anxiety neurosis,convalescence following a fever or carly schizophrenia.
chest and irritability,with constipation,heaviness in the body.difficuity ·The Phlegm Heat symptoms associated with this pattern generally respond well to
twisting at the waist,a red tongue and wiry rapid pulse ate due to Phlegm correct treatment. When associated with schizophrenia the prognosis is much less
reliable.
Heat and gr stagration with Heart and Livet Fire The cortect treatment is to
·This is a common pattern during the convalescent phase of a febrile
clear Phlegm Heat and Fire,move gi and calm the Jhee with CHAI HU JIA disease.
LONG GU MU LI TANG(Buplearww and Drager Bowe Combination 柴胡加龙骨壮蛎汤）
chai hu（Radix Bupleuri）柴胡 9g dang shen （Radix Codonopsis Pilosulae）党参 9g
818 HEART 29.PAIPITATIONS 819

Modifications
脾肾 29.7 SPLEEN AND KIDNEY YANG DEFICIENCY
阳虚 ·With nausea and vomiting,add ban xia" (Rhizoma Pinelliae Ternatae)半夏 10g
Pathophysiology With epigastric and abdominal distension,and loss of appetite,add hou po
·In this pattern Spleen and Kidney yang deficiency is the toot of weakened Fluid （ Cortex Magnoliae Officinalis ） 厚 朴 10g ， shen qu （ Massa Fermentata ） 神 曲
metabolism and distribution.Phlegm Fluids（tanyin 疾饮）accumulate in the lower and 10g，dang shen （Radix Codonopsis Pilosulae）党参 15g
middle ias causing oedema in the lower body.Eventually the Phlegm Fluids back up With obvious Kidney yang deficiency and Cold(cold extremities,cold
from below and collect in the upper jiao,disrupring the Heart and Lungs,causing intolerance,bluish lips),add two or three of the following herbs:hu lu ba
upper body oedema.Heart yang may be intact The difference between this pattern （ Semen Trigonellae Foeni-graeci ） 葫 芦 巴 10g ， ba ji tian （ Radix Morindae
and Heart yang deficiency is that here,the Spleen and Kidney yang deficiency is Officinalis）巴戟天 10g，rou gui （Cortex Cinnamomi Cassiae）肉桂 6g or xian ling
fundamental and reflected in the middle and lower jim sy mptoms Yang deficiency pi（Herba Epimedii）仙灵牌 10g
patterns are associated with gheng coong type palpitations. If sweating is severe,add two or three of the following herbs:ten shen （Radix Ginseng）
人参 9g，zhi gan cao （honey fried Radix Glycyrrhizae Uralensis）炙甘草 6g，wu wei zi（Fructus
Clinical features Schizandrae Chinensis）五味子 6g，duan long gu（calcined Os Draconis）煅龙骨 15g or duan
·palpitations and shortness of breath,which are worse for exertion mu li＇（calcined Concha Ostreae）煅壮蛎 15g
·dizziness or vertigo
·chest and epigastric fullness and discomfort ZHEN WU TANG 真武汤，p．778
·wheezing and coughing with thin watery sputum (Trat Warrior Denaction)
·low voice,reluctance to speak This formula is used in severe cases,when the palpitations are associated with
·nausea or vomiting wheezing and coughing,dyspnoca or orthopnoea,scanty urine and relatively severe
·poor appetite,abdominal distension,loose stools oedema.These symptors indicate that Kidney jang is seriously failing to eliminate fluids
·lower back cold and aching,cold extremities that are backing up and affecting the Heart.The correct treatment is to powerfully
·facial or eyelid oedema, or pitting leg and ankle oedema,with scanty ot difficult urination,or warm jarg to move fluids.When fluids ate moving,a mote tonifying formula should be
nocturia and frequent urination
used.
T pale and swollen,with a greasy white coat
P slippery and wiry or soggy,or deep,slow and possibly knotted or intermittent (if Heart jngis
involved) Follow up treatment
·Once the palpitations have subsided and fluid metabolism is improving.a basic Spleen
and/or Kidnes jang strengthening formula may be phased in.Consider JIN KUI SHEN QI
Treatment principle
WAN (Rehania Light Iormal 金匮肾气丸，p．874），YOU GUI WAN（Lucenemia and Rehmanaia
Warm and Transform Phlegm Fluids
Forwala 右归丸，p．559），FU ZI LI ZHONG WAN（Acomitr，Ginieng and Ginger Formala 附子理
Strengthen the Spleen and resolve Damp 中丸，p．873）depending on thecombination of Spleen and Kidney deficiency

Prescription Patent medicines

LING GUI ZHU GAN TANG 苓桂术甘汤 Jin Kui Shex Qi Wan 金肾气丸（Sexoton Pills）plus
(Atracdader and Hoein Combimation) Fu Zi Li Zhong Wan 附子理中丸（LiChung Yuen Medical Pills）or LiZhong Wan 理中丸（Li
This formula is suitable for relatively mild cases. Zhong Wan）
fu ling（Sclerotium Poriae Cocos）茯苓 30g
bai zhu （Rhizoma Atractylodis Macrocphalae）白术 15g
gui zhi（Ramulus Cinnamomi Cassiae）桂枝 9g
gan cao（Radix Glycyrrhuzae Uralensis）甘草 6g
Method: Decoction(Source Zinng Yi Nei Ke Lin Chang Shau Cr)
820 HEART 29.PALPITATIONS 821

Acupuncture
B1.15(xw w+A),B1.20(psh+ ),BL.22(sawjashw+ ) 29.8 BLOOD STAGNATION
B1.23(sbewshw+ ),BL13(sbw+),Ren.9(shaifen+ ),
PC.4(xa mrn),St.40(frng lang-),St.28(sbwi dao-),Du.4.(ming+) Pathophysiology
·Blood stagnation type palpitations are chronic and usually follow some other
Clinical notes long term pathology that affects the Heart or chest,typically yang
·The palpitations in this pattern may be assocated with disorders such as congestive cardiac deficiency.Phlegm or gi stagnation. Palpitations from Blood stagnation may
failure,chronic nephritis,chronic bronchitis,angina pectoris or coronary artery disease also follow an external invasion of Wind Cold Damp to the Heart(as occurs in
Spleen and Kidney yang deficiency symptoms genetally respond well to correct
rheumatic fever).Stagnant Blood obstructs the channels of the Heart
treatment.Once Fhaid metabolism improves and the accumulated fluids are moving,the
disrupting the smooth flow of giand Blood and consequently Heart function,so
palpitations should improve.Herbal medicine may be the treatment of choice to warm
irregulat beats and pain may occur. This pattern is clearly associated with
yang and move Fluids,although intensive acupuncture and moxibustion will certainly
gheng chong.
enhance the result.
Clinical features
*palpitations and occasional chest pain that are worse at nighr
·stuffiness or fullness in the chest
·irritability,restlessniess,easy anger or depression
·purplish lips, nails,sclera, conjunctiva
·spider naevi on the chest and face
·possibly signs of stagnant Liver q
T dark ot red purple with brown or putple stasis spots and a thin white
coat;sublingual veins are distended and dark
P deep and choppy or wiry,or intermittent

Treatment principle
Invigotate the circulation of Blood,expel stagnant Blood
Regulate gi and open the channels

Prescription
XUE FU ZHU YU TANG 血府逐瘀汤
(Acbyrantbes and PersicaCombination)
tao ren（Semen Persicae）桃仁 12g sheng di（Radix Rehmanniae Glutinosae）生地
9g hong hua （ Flos Carthami Tinctoru ） 红 花 9g chuan niu xi （ Radix Cyathulae
Officinalis ） 川 牛 滕 9g dang gui （ Radix Angelicae Sinensis ） 当 ． ． ． ． ． ． ． ． ． ． 9g chi
shao（Radix Paconiae Rubrae）赤芍 9g chuan xiong（Radix Ligustici Chuanxiong）川号
6g zhi ke（Fructus Citri Auranti）枳壳 -6g jie geng（Radix Platycodi Grandiflori）桔梗
6g chai hu （ Radix Bupleuri ） 柴 胡 -6g gan cao (Radix Glycyzrhizac Uralensis)3g
Method:Decoction(Source Shi Yong Zhang Yi Nai Kr Xai)
822 HEART 29.PALPITATIONS 823

Modifications Clinical notes

·With Heat，add dan shen （Radix Salviae Miltiorrhizae）丹参 12gand huang ·The palpitations in this pattern may be associated with disorders such as
qin （Radix Scutellariae Baicalensis）黄芩 9g rheumatic heart disease,angina pectoris,coronary artery disease or mitral
stenosis.
·With Heat in the Liver，add yu jin（Tuber Curcumae）金 9g
·With chest pain,add yan hu suo (Rhizoma Corydalis Yanhusuo) 延 胡 索 9g ， mo ·The diagnosis of Blood stagnation may occasionally be one of exclusion,if in
yao（Myrrha）没药 6g，ru xiang（Gummi Olibanum）乳香 6g a case of chronic palpitations all other treatments have failed,then a
With insomnia or depression,add he huan pi (Cortex Albizzine Julibrissin）合 provisional diagnosis of stagnant Blood may be made,even in the absence
欢皮 12g of other objective signs
·With headache，add man jing zi（Fructus Vitcis）蔓荆子 9g and bai ji li（Fructus ·Blood stagnation symptoms can respond reasonably well to correct and
Tobuli Terrestris）白蒺 9g prolonged treatment and the palpirations should improve (although if the
·With Hleart gi deficiency,delete chai hu,jie geng and zhi ke,and add dang underlying pathology is too deep,that is,there is excessive tissue damage
shen （ Radix Codonopsis Pilosulae ） 党 参 30g ， huang jing （ Rhizoma already,then the results are much less certain).
Polygonati）黄精 12g，and huang qi（Radix Astragali Membranacei）黄芪 30g ·Long term use of Blood stagnation removing formulae alone is not
advisable in frail or eldedly patients. An appropriate tonic formula may need
to be added to prevent excessive dispersal of gr and Blood.
With yang deficiency,delete chai hu and jie geng,and add zhi fu zi （Radix Aconiti Carmichaeli Praeparata）制附子 6g，rou gui（Cottex Cinnamomi Cassiae）肉桂 3g，xian ling pi（Herba Epimedii）仙灸牌
12g and ba ji tian （Radix Morindae Officinalis）巴载天 9g
With jin deficiency,delete chai hu, jie geng,chuan xiong and zhi loe,and add mai dong （Tuber Ophiopogonis Japonici ）麦冬 10g，yu zhu （Rhuzoma Polygonati Odorati ）玉竹 10g，nu zhen zi
（Fructus Ligustri Lucidi）女贞子 10g and han lian cao（Herba Ecliptae Prostratae）早连草 10g
With Blood defciency,add shu di (Radix Rehmanniae Glutinosae Conquitae）热地 15g．gou qi zi（Fructus Lycii）枸杞子 15gand he shou wu（Radix Polygoni Multiflon）何首鸟 15g

Patent medicines
XmFu Zhw Yu Wan 血府逐瘀丸（Xue Fu Zhu Yu Wan）
Dan Sheu Pian 丹参片（Dan Shen Pills）
Jian Kang Wan 健康丸（Sunho Multi Ginseng Tablets）
Sbeng TnaxQi Pian 生田七片（Raw Tian Qi Ginseng Tablets）
Jin Gu Die Shang Wan 筋骨跌伤丸（Chin Koo Tieh Shang Wan）
Guan Xin An KamwY 冠心安口服液（Guan Xin An Kou Fu Ye）
Fu Ke WuJin Wan 如科乌金丸（Woo Garm Yuen Medical Pills）

Acupuncture
B1.15(xiw sbur-),B1.17(gesbw-),B1.14(j y sbw-),PC.4(xme-),PC.5(jian sbi-),PC.6(weiguax),Sp.6(san yn jia-),1.4(begw-).Hr.5(2ong -),Sp.10(xarbai)
824 HEART

SUMMARY OF GUIDING FORMULAE FOR

PALPITATIONS
Heart gi deficiency-WFxWei Zi Tang 五味子汤 Disorders of the Heart
Heart yang deficiency-Gui Zhi Gan Cao Long Gu.Mu La Tang
桂枝甘草龙骨壮蛎汤
·Heart and Kidney yang deficiency with puimonary oedema-Zhen W Tang 真武汤·Kidney
pang predominant-Jin Kui Sben Qi Wax 金匮肾气丸 30.Insomnia
Heart yn deficiency-Tian Wang Bu Xin Dan 天王补心丹
·following a febrile disease-Huang Lian E Jiao Tang 黄连阿胶汤
·with anxiety and insomnia-Zhw Sha An Sben Wan 朱砂安神丸
·Liver and Kidney yin deficiency predominant·YiGwan Jian 一貫煎 Sman Zao Ren Excess patterns
Tang 酸枣仁汤 Liver qi stagnation
Heart Fire
Heare Blood and Spleen gi deficiency-Gui Pi Tang 归脾汤 Stomach disharmony
·with qi and yin deficiency,with severe palpitations and an irregular pulse- Phlegm Heat
Zhi Gan Cao Tang 炙甘草汤
Stagnant Blood
Heart and Gall Bladder gi deficiency-Ding Zhi Waw 定态丸
·as a resule of shock-Gwi Zhi Jia Lang Gw Mx Li Tang Deficient patterns
桂枝加龙骨牡蛎汤 Heart and Spleen deficiency
Heart and Kidney yin deficiency
Phlegm Heat-Wen Dan Tang 温胆汤
Heart and Gall Bladder deficiency
Spleen and Kidney yang deficiency-Ling Gad Zhw Gax Tang 苓 桂 术 甘 汤 ·with Liver yiw and Blood deficiency
severe fhuid accumulation-Zben W Tang 真武汤

Blood stagnation-Xar Fu Zhu Yu Tang 血府逐瘀汤

Endnote
For mote information regarding hetbs marked with an asterisk,an open
circle or a hat',see the tabes on pp.944-952
30INSOMNIA 30.INSOMNIA 827

bwmei 不寐

Insomnia describes a variety ofdifferent symptoms associated with sleep

disturbance,including inability to sleep,difficulty falling asleep,frequent
waking,restlessness at night,disordered sleep cycle and dream disturbed sleep
Approximately one third of all adults experience occasional or persistent sleep
disturbances. Sleep deprivation or diszuption of circadian thythm can lead to
serious impairment of daytime functioning Most adults sleep 7 to 8hours per
night,although the timing,duration and internal structure of sleep vary
considerably among apparently healthy individuals and as a function of age
When assessing a patient complaining of insomnia, it is important to
distinguish true insomnia from transitory insomnia due to external ot temporary
changes.Outside noise,sudden weather changes,inappropriate bedroom
temperatures,consumption of coffee or other stimulants prior to bedtime,eating
late,tecent emotional upsets,vigorous exercise and the disordered biothythms of
shiftworkers may all cause a person to sleep poodly.Once these factors are
removed,sleep usually returns to normal and the sleep disturbance cannot be
considered true insomnia.Similarly,sleep disturbance due to pain,itching,asthma the intellectual and spintual aspects of consciousness.In practical terms,the
and breathing disorders should not be diagnosed as insomnia. shew is most closely associated with our conscious awareness,and is
In TCM,insomnia is associated with instability or agitation of the shew.This can essentially our ability to perceive,interact and communicate with our world
occurs because: clarly.In addition,the sew and the Heatt share an intimate and
·the shew is not adequately anchored and secured due to deficiency of Blood or interdependent relationship (TCM describes the Heart as the residence of
yan the aben).Shew pathology is therefore associated with disturbances of
·overstimulation and agitation by Heat prevent the shew from settling quietly consciousness and perception,and some aspects of Heart function
when the time comes for sleep
Consciousness is the province of sbr,however sben can be divided into a
·the shew is 'locked in'and agitated by constraint from gi and/or Blood stagnation number of subgroups,each with its own particular facet of consciousness
and association with an organ sys
Shen
tem.That aspect of sbew especially
The sber is at the most rarefied end of the spectrum of the densities of The most
disturbed by the rising gr of anger
condensed is jing,in between are the various functional types of
or repression of emotion is
(,eiqggietc.)These three aspects of gi are termed the 'three treasures'(Fig 30.2)
termed the hwx 瑰，and is linked
and are the subject of considerable philosophical debate and the focus of daoist
to the Liver.The bww is implicated
meditation techniques.Indeed,it is the transformation of jinginto sher that
preoccupies some of the daoist and other esoteric schoob of Chinese in some types of sleep distur-
philosophical thought and practice.Blood and yow are more condensed(and bance,particularly that involving
therefore material)chan gi,but less dense than jing sleepwalking Other facets of ibew
The shew plays a key role in higher mental functions,including many of are the yi（意，associated with the
Spleen），po（线，Lungs），and
826 （志，Kidneys）.
Because shew is so refined
subtie
and ir must be anchored by
the material jing (or Blood and
more
jin),otherwise it has a tendency
to float away. The interaction of
828 HEART 30.INSOMNIA 829

jing and sher produces the lighe' of consciousness It is this interaction thar is observed Heart Fire
in the twinkle of a clear eye-in Chinese the jing sber（精种）Observation of an individuals Prolonged worry,anxiety and depression,or a sudden shock can retard the
jing thew is the first indication of the state of their consciousness and ultimately their movement of Heart gi.The resulting accumulation of gi creates a focus of
health or capacity to recover from illness.This lightness and subrleness,however,means pressure in the chest,which then generates Heat,furthet affecting the
that nben is the least stable form of gi,and thus easily unsettled. Heart.This type of qi accumulation is slightly different to Liver qi stagnation in
There are two broad categories of shen disturbance,deficiency and excess The that the focus of Liver qi stagnation is usually below the diaphragm(although
deficiency patterns are mostly due to the shew not being anchoted by Heart yin or its effects may be systemic).Heart Fire may also develop if Fire is transmitted
Blood,so it simply 'floats away',or is dissipated instead of resting in the Heart. These from the Liver to the Heart.Heart Fire(like Liver Fire) is mote likely to occur in
patterns usually manifest with symptoms like insomnia,dream disturbed sleep,anxiety those with some pre-existing Heat,whether from diet or congenital factors.
with palpitations,phobias and disonentation. A different type of Heart Fire may occur during severe febrile diseases.This
Excess pattens are mostly associated with Heat and Phlegm.The Heat can directly occuts when external Heat penetrates deep into the body,lodging at the ying
affect the Heart (as in Heart Fire) or be more systemic (as in Heat in the Blood).Either or Blood level (of the Four Levels,pp.38-43).In this situation,high fever is
way,the sben is continually agitated by the presence of the Heat,and
accompanied by delirium and disordered consciousness as the Fire severely
restlessness,agitation,and delussonal or manic behaviour result
disturbs the shew.
Due to the Heart's central position as the 'emperor' of the gangorgans,it (and the
Heart yin deficiency,especially if prolonged,is often associated with Heart
resident sben) are affected by all emotional patterns.Some are more damaging than
Fire.Mixtures of Fire and jin deficiency are clinically more common than pure
others,particularly prolonged worry and anxiety,or sevete shock ot
Heart Fire If the insomnia is very chronic,it may develop into the Heart and
terror,Ulrimately,however,any emotional imbalance will involve the Heart and sber.
Kidney yie deficient pattern.
Insomnia may accompany many syndromes and disorders,and can be a major
obstacle to recovery if it is severe. Insomnia may be a symptom of such conditions as
Stomach disharmony
neurological and psychiatric disorders,neurosis,hypertension,cerebral
This syndrome is usually due to overinduigence or irregular dietary habits
arteriosclerosis,hyperthyroidism,various fevers,hepatitis,menopausal and premenstrual
(eating late at night,midnight snacks,eating while upset,earing too quickly
syndrome and anaemia.
etc.)that weaken the Spleen and Stomach so that digestion is impaired.It is
essentially a type of food stagnation. If bad dietary habits persist,it can become
AETIOLOGY
mote severe and overlap with the next pattern,Phlegm Heat
Liver qi stagnation, stagnant Heat, Liver Fire
Frustration,anger,resentment,prolonged emotional rurmoil,repressed Phlegm Heat
emotions and stress disrupt the circulation of Liver qi. When Liver gi stagnares Phlegm Heat can be generated in several ways.Dampness and Phiegm can be
it can disrupt the generative cycle （sbeng 生，p．70）of the five phases（ww xig the result of Spleen weakness or ovezconsumption of Phlegm producing
五 行 ） resulting in a poor supply （ of qr and Blood ） tothe Hcart. Liver of foods(rich,greasy,sweet,spicy foods and alcohol),which then causes stagnation
stagnation constrains the hww and shew causing tension and insomnia.Long and the generation of Heat.Any pre-existing Heat in the body.whether from
term gi stagnation can also lead to Blood stagnation with the same,albeit Liver gi stagnation with stagnant Heat or Fire,yin deficiency or external
more severe,result. pathogen,can congeal fluids into Phiegm,and subsequently Phlegm Heat.This
When gi stagnates for any length of time,the resulting pressure can generate pattern often occurs in theconvalescent stage of a febrile illness,after external
Heat,which at a certain intensity may be redefined as Fire.Hete the Heat takes over as Heat has concentrated fluids into Phlegm.
the primary agitator of the shen Liver Fire is more likely in those with a yang or hot Failure of fluid metabolism as a result of gi or yang deticiency (affecting
constitution,and in those with a diet rich in heating substances
Kidney,Spleen or Heart) can lead to accumulation of fluids,which over time
congeal into Phlegm:Once Phlegm is ptesent,Heat can be generated by the
resulting obstruction.
830 30.INSOMNIA 831
HEART

Heart Blood and Spleen qi deficiency yir damage,in which case their condition is suddenly greatly exacerbated
Overwork,physical and mental exhaustion,worry,irregular diet and too much
cold,raw or sweet food can damage the Spleen,which then fails to generate Liver yin and Blood deficiency
sufficient qi and Blood.Simularly,any situation that overwhelms the Spleen's As well as the various activitics and events that can damage Heart and Kidney
abiliry to replace qi and Blood,like a prolonged or severe illness can lead to qi yin(see above),Liver yiw and Blood can also be weakened by prolonged qi
and Blood deficiency. The primaty weakness in this pattern is in the stagnation and the generation of stagnant Heat or Fire,overuse of the eyes and
Spleen,which is unable to generate enough Blood to nourish the Heart and chronic Liver disease
anchor the sben.
Heart Blood and Spleen gr weakness can be more acute,following a post Heart and Gall Bladder deficiency
partum haemorzhage or difficult pregnancy and labour. This pattern is Heart and Gall Bladder deficiency describes a personality type that may be
common in women who return to work too soon following congenital or acquired.When congenital,it may be due to a significant shock that
pregnancy,without fully recovering their investment of gi and Blood. It also damaged the developing foetal shew during the mother's pregnancy.The pattern
occurs in those who breast-feed for lengthy periods of time while expending may be acquired easily in children (the shew is unstable when young)who ate
energy working or looking after demanding children (and husbands).The brought up in an abusive or fearful environment, or in adults or children who
elderly are another group who frequently suffer from insufficient giand experience a violent or extreme shock or fright.It may also
Blood.

Heart and Kidney yin deficiency

In Chinese medicine the relationship between the Heart and Kidney is one of
the fundamental relationships of the body and mind. This relationship
functions on both a physical and a mental level.On the physical level Kidney
Water(jix)keeps Heart Fire in check,preventing a runaway blaze and
overheating,and Heart Fire catalyses Kidney Water,preventing stagnation and
accumulation of fluids On the mental level,the Fire of the shew arises from a
stable base of Kidney jing(summed up in the sparkle of jing shew in the
eyes),and jing and shenr rely on each other for clear expression of mental
consciousness
If Kidney yor is damaged (by overwork,excess sexual activiry,insufficient
rest and sieep,ageing etc.)there may be a breakdown in the relationship
berween the Heart and Kidney (via the controlling cycie),whereby Kidney
Water no longer keeps Heart Fire in check. The uncontrolled blazing of Heart
Fire causes agitation of the shen and the resulting insomnia can be severe.If
Heart Fire remains unchecked Heart yoe will be damage.The sbrm then has
no 'anchor' and insomnia can become chronic. Heart yiw may abso be
damaged by stimulant and recreational drugs (inchading coffee) or excessive
mental stress.This is a very common cause of insomnia and one characterised
by quite severe mental restlessness,anxiety and occasionally totual inability
to sleep
At a more superficial level,the communication between the Heart(dr)and
Kidneys(h)can be severed by major shock or trauma.This can occur in
otherwise robust individuals,in which case the insomria (and usually anxiery
or panic attacks)is accompanied by fewer systemic symptoms since the y of
the organs is not damaged.It may also occur in someone with pre-existing
832 HEART 30.INSOMNIA 833

deficient varieties,as in excess patterns thete are often complicating lifestyle features-
BOX 30.1 KEY DIAGNOSTIC POINTS
bike unbappiness or stress at home or at work and habitual mental emotional
These are general guides only responses that have to be dealt with for a satisfactory result.The deficiency patterns
·difficulty falling asleep,but once asleep stays asleep-Blood deficiency generally respond qutte well to treatment,although herbal and/or acupuncture
·waking frequently during the night,often feeling hot-yin deficiency treatment may need to be combined with an appropriate nourishing diet. Obvious and
·repeated waking around 2-4am,worse when stressed-Liver qv
stagnation,stagnant Heat or Fire casily modifiable aggravating factors,such as coffee,excessive visual stimulation at might
(like staying up late watching television),heavy exercise at night and excessive alcohol
·lots of wild dreaming-possible involvement of the hun should be avoided.
·talking during sleep,sleepwaiking·possible invelvement of the hun
·recurrent frightening dreams that cause waking-Heart and Gall Bladder deficiency

·waking with palpitations and panic attacks-Heart and Kidney yin deficiency
·chronic insomnia with feverishness at night but no sweating-Blood stagnation

sometimes follow other debilitating illnesses that plunder qu

Because the shen is so destabilised it cannot cope easily with change and can be easily disturbed by trivial events,so even a minor change in routine may be enough to trigger episodes of
sleeplessness.
The involvement of the Gall Bladder bere refers to the timidity and lack of gall'(that is,fearfulness)which characterise patients with this pattern.In the Chinese language (as in English) there
is an implicit understanding of the relationship between the Gall Bladder and courage,indeed to be bold and courageous is to have a＂big Gall Bladder＇（da daw 大胆）

Blood stagnation
Blood stagnation insomnia usually follows some external trauma,extreme emotional sbock or head injury. It can also be the result of othee chronic disorders that
eventually cause Blood stagnation,especially extreme or prolonged emotional turmoil and qrstagnation.When associated with trauma the insomnia is usually
acute,otherwise there is usually a long history of persistent insomnia. Blood stagnation frequently co-exists with other patterns such as qi yiw or jang deficiency,etc.

TREATMENT
Treatment with acupuncture and herbs usually produces a reliable result in most types of insomnia.Many patients with chronic insomnia will be taking sedative
medication of some sort (often benzodiazepines,see anxiety p.868).and they should be slowly weaned off the drugs over a period of weeks or months as the
TCM treament takes effect. Adjuvant therapy is useful in most types of insomnia,particularly relaxation or meditation to calm the mind.
The most important distinction is between excess and deficient types of insomnia. The excess varieties tend to be more difficult to treat than the
834 HEART 30.INSOMNIA 835

肝气 30.1 LIVER QI STAGNATION,STAGNANT HEAT,FIRE cu bai shao(vinegar fried Radix Paeoniae Lactifora)醋台行
郁滞 9g bai
Pathophysiology zhu（Rhizoma Atractylodis Macrocephalae）白术 9g fu ling（Sclerotium Poriae
·Liver qi stagnation,g stagnation with stagnant Heat and Liver Fire ate a Cocos）茯苓 ...9g bo he （Herba Mentha Haplocalycis）薄荷 6g suan zao ren
continuum of conditions with similar aetiology and escalating severity （Semen Zizyphi Spinosae）酸仁 15g he huan pi（Cortex Albizziae Julibrissin）合欢
Typically,Liver qi stagnation precedes the development of Heat,which at a certain 皮 12g Methed:Decaction or as pooder When the formula is decocted,bo be
intensity is redefined as Fire. All patterns have emotional rurmoil especially sbould be added at the end of cooking （w 后下）
anger,resentment and frustration as common aetiological features,with LiverFire
exacerbated by a Hot constitution and/or a diet richin alcohol and heating DAN ZHI XIAO YAO SAN 丹栀逍遥散
foods.Liver qi stagnation without Heat is less likely to cause insomnia than with (Buplearam and Paronia Foraia) modified
Heat,and Liver Fire is the more likely cause This formula is selected when qi stagnation has generated some Heat.The
·Qi stagnation alone causes insomnia by disrupting the smooth flow of qiin the
clinical fearures are the same as for Liver gi stagnation,with the addinional
郁热 chest,restricring the unhindered movement of the sben.When there is Heat,the sben is
features of red,sore eyes,facial flushing,irritability,anger,bitter taste in the
continually being agitated and disturbed.
mouth,red edges on the tongue and a wiry,rapid puise.
chai hu （ Radix Bupleuri ） 柴 胡 12g dang gui （ Radix Angelicae
Clinical features
Sinensis）当 9g cu bai shao (vinegat fried Radix Paconiae Lactiflora)
·difficulty falling asleep,insomria,dream disturbed sleep,waking in the carly hours
醋白芍 12gbai zhu（Rhizoma Atractylodis Macrocephalae）白术 9g fu
of the morning(typically between 2 and 4 am),worse when stressed
ling （ Sclerotum Poriae Cocos ） 茯 苓 9g shan zhi zi （ Frucrus Gardeniae
·depression,irritability,moodiness

, frontal or temporal headaches,shoulder and neck tension,teeth grinding at night Jasminoidis）山桅子．．．9g mu dan pi（Cortex Moutan Radicis）牡丹皮．．．．．．．．．
·hypochondriac tension or discomfort 9g bo he （ Hezba Mentha Haplocalycis ） 薄 荷 6g ren dong teng （ Ramulus
·frequent sighing Lonicerae Japonicae）忍冬藤 9g ye jiao teng （Caulis Polygoni Multfloti）夜交 12g

肝 ·dizziness
·sensation of something lodged in the throat(plum stone gr)
·irregular menstruation,premenstrua syndrome and breast tenderness
zhen zhu mu＇（Concha Margaritaferae）珍珠 15g should be decocted for 30
minures prior to the other herb()obe should be added at the end of
cooking （os 后下）（Source：Shi Ying Zhang Y）No Ke Xu)

火 ·poor appetite
·alternating constipation and diarthoes
T unrematkable or dark（ging 青）with a thin white or yellow coat ，or with red edges and a
LONG DAN XIE GAN TANG 龙胆泻肝汤
(Gentiana Combimation) modified
thick yellow coat with Heat or Fure
This formula is selected for Liver lire. At this stage the Heat is severe.The
Pwiry
clinical features include insomnia,extreme restlessness and frequent waking,all
worse with emotional stress,irritability,short temper,thirst with desire to
Treatment principle
drink,bitter taste in the mouth,red,sore eyes,severe temporal
Soothe Liver gi,Calm the sben
headaches,concentrated or painful urination,constipation,a red tongue with a
thick yellow coat and a wiry, forceful and rapid pulse.
Prescription
long dan cao （Radix Gentianae Longdancao）龙胆 9g
XIAO YAO SAN 逍遥散
(Bupieuram and Dang Gui Forwala) modified
This prescription is selected when there is gi stagnation without Heat.
chai hu（Radix Bupleuri）柴胡
dang gui （Radix Angelicae Sinensis）当归 9g