▲Master Yan Zhenghua (1920.2-)
Heart palpitations refer to deficiency of qi and blood, yin and yang, or blockage of phlegm and blood stasis, etc. Causes the heart to beat sharply, panic and anxiety, and can not be independent as the main manifestation of a disease syndrome. Heart palpitations are often accompanied by shortness of breath, chest tightness, or even dizziness, wheezing, syncope, or pulses, or late, or irregular rhythm. In modern medicine, arrhythmias caused by various causes, such as tachycardia, bradycardia, premature contraction, atrial fibrillation or flutter, atrioventricular block, sick sinus syndrome, pre-excitation syndrome, cardiac Insufficiency and cardiac neurosis, etc., all manifestations of palpitations can refer to the syndrome differentiation and treatment of this disease.
The understanding of heart palpitations in traditional Chinese medicine has a long history. Zhang Zhongjing of the Han Dynasty said in “The Brief Introduction of the Golden Chamber”: “The pulsating of the inch mouth is weak, and the movement is the shock, and the weak is the palpitation.” It is believed that “deficiency leads to fright, palpitations, and calming soup is the master of it”. Yan Yonghe of the Song Dynasty also believed that the palpitation was caused by deficiency, and made a more detailed discussion on the change of symptoms and treatment methods of the palpitation: “It is also caused by timidity and timidity, and The heart is the official of the monarch, and the gods come out. The courageous person is the official of the righteousness, and the decision comes out. The heart is calm, the courage is not timid, the decision and thinking get what it is. Maybe you are shocked because of things, or you hear false sounds, or see differences Symptoms, climbing high and involved in danger, frightened mind, qi and salivation depression, then caused heart palpitations. Frightened palpitations, changed into various symptoms, or shortness of breath, palpitation, fatigue, spontaneous sweating, swollen limbs, tasteless food, depressed heart, restless sitting and lying It is also a time when the heart is empty and timid. The method of treatment is to strengthen the courage of the heart, and there are all those who are weak.” The appropriate treatment is to use Wendan Decoction and Yuanzhi Pill. Ming Wang Kentang’s “Criteria for Syndrome and Treatment” also believes that the causes of palpitations include sweating, vomiting, internal deficiency of righteousness and “draining of the camp and guard”.
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Professor Yan Zhenghua believes that palpitations are mainly located in the heart, but are closely related to the spleen, kidney and lung. , Liver and four viscera dysfunction. If the spleen fails to function properly, qi and blood have no source, or the heart is overworked and the blood is consumed too much, it can cause heart palpitations due to deficiency of both the heart and spleen. palpitations occur; if the lung qi is deficient or the lungs are dissipated and descending abnormally, it will affect the generation of zong qi or block the qi mechanism, which will inevitably affect the function of the heart and govern the blood vessels, resulting in poor blood circulation and palpitations; if the liver blood is insufficient, Palpitations can also occur when the heart is deficient. Palpitation is located in the heart, but it can be caused by the dysfunction of other organs. Therefore, clinical evidence should be examined to find the cause, and the treatment should be based on syndrome differentiation.
Professor Yan Zhenghua believes that, The basic etiology and pathogenesis of this syndrome is “the essence is empty and the standard is real”. Although the majority of the disease is deficiency syndrome, it can still be caused by deficiency, and the deficiency can be mixed. Deficiency often manifests as deficiency of viscera, qi, blood, yin and yang, phlegm turbidity, blood stasis, and internal stoppage of water, which can damage one viscera or involve multiple viscera. Heart-qi deficiency is common at the beginning, manifested as heart-qi deficiency, heart-spleen deficiency, heart-lung-qi deficiency, and heart-deficiency timidity. Deficiency and blood deficiency are mostly manifested as heart blood deficiency, liver and kidney yin deficiency, heart and kidney failure and other syndromes. Prolonged illness is depleted of righteous qi, yin and yang are damaged, and yang is damaged and yin. time. Liver qi stagnation or heart spleen deficiency can lead to phlegm turbidity, phlegm and blood endogenous, resulting in phlegm turbidity blocking collaterals or heart vein stasis. If the condition worsens and the heart yang is violently removed, the patient may experience dangers such as Jue off, convulsions, or even death.
Principles of treatment
Aiming at the pathogenesis of palpitations, Professor Yan Zhenghua determined that the treatment of this disease is tonifying deficiency and reducing In fact, adjust the blood.
■ benefits Qi nourishes yin and calms the mind
Professor Yan Zhenghua believes that heart palpitations are more common after middle age, when the body’s physiological function declines; Improper restraint, damage to the spleen and stomach, and insufficient metaplasia can lead to weakness of qi and blood, insufficiency of heart and pulse, and loss of nourishment.
Treating and nourishing qi and nourishing yin, soothe the nerves and set the mind, Fangxuan Shengmai Powder is added or subtracted.
Professor Yan Zhenghua believes that American ginseng nourishes qi, nourishes yin and clears heat, Schisandra chinensis nourishes yin and calms the mind, and Ophiopogon japonicus nourishes yin and clears the heart and eliminates vexation. , Raw oyster calms the nerves, Danshen activates blood, regulates the meridians and calms the nerves, and the combination of various medicines can make the mind and spirit nourished and refreshed.Zhiding, every clinical result is good. If the deficiency of heart yin is severe, add yin-tonifying products such as Nansha ginseng and Beisha ginseng; if phlegm turbidity blocks the heart and collaterals, add turmeric and calamus phlegm and dredging the collaterals; , Zhuojia safflower, fragrance, blood circulation and collaterals.
▲ Ophiopogon japonicus
■ Promoting blood circulation and resolving phlegm, dredging collaterals and calming shock< /span>
Professor Yan Zhenghua believes that the heart meridian is the channel through which qi, blood and body fluids that nourish the heart are transported and distributed. Blocking the heart collaterals can affect the flow of qi and blood in the collaterals, resulting in blockage of blood stasis in the collaterals.
Treatment should warm yang and activate blood, resolve phlegm and dredge collaterals.
Professor Yan Zhenghua’s commonly used blood-activating drugs include safflower, Jiangxiang, Salvia miltiorrhiza, and Chuanxiong; commonly used phlegm-removing and meridian-relieving drugs include turmeric, Quangualou, Shichangpu, etc. For those with qi stagnation, combine with dried tangerine peel, Citrus aurantium, Cyperus officinalis, and Chuanxiong; for those with cold congealing disease, add Xiebai to warm yang and dredge collaterals. At the same time, Professor Yan Zhenghua pointed out that this treatment method is only a palliative treatment method in the treatment of palpitations and syndromes, so the treatment should take care of the “principal deficiency”, and be compatible with products that nourish the mind, such as raw astragalus, Ophiopogon japonicus, and Schisandra chinensis.
▲ Safflower
Treatment by Type
On the basis of treatment principles, Professor Yan Zhenghua also follows the principle of syndrome differentiation to diagnose and treat palpitations and one disease. The specific diagnosis and treatment principles and medication rules are as follows.
■ guilt Cowardice
The main symptoms are heart palpitations, panic, restlessness, insomnia, frequent dreams and easy awakening, bad smelling noises, dull appetite, thin white fur, thin pulse or stringy pulse.
Treatment is mainly to calm the shock, nourish the heart and soothe the nerves.
The commonly used prescription is the addition and subtraction of Anshen Dingzhi Pill. Commonly used drugs: cinnabar, keel, oyster, amber, jujube seed, Polygala, Poria, Shouwu Teng, ginseng, Chinese yam, asparagus, Shengdi, Shudi, Schisandra, etc.
▲cinnabar
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■ Heart Blood Deficiency Syndrome
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Heart-blood deficiency syndrome is characterized by palpitations, shortness of breath, dizziness, insomnia, forgetfulness, dull complexion, and lethargyFatigue, anorexia, pale red tongue, and weak pulse are the main symptoms.
Treatment is to nourish qi and blood, nourish the heart and soothe the nerves.
The commonly used formula is Guipi Decoction. Commonly used drugs: Astragalus, ginseng, Atractylodes, Zhigancao, Rehmannia glutinosa, Angelica, Longan, Shouwu Teng, Poria, Polygala, Suanzaoren, etc.
▲ Longan meat
< span>■ Insufficiency of chest yang syndrome
Insufficiency of chest yang is characterized by palpitations, restlessness, chest tightness, shortness of breath, pale complexion, and cold body shape Cold limbs, pale tongue with white coating, weak or thin pulse are the main symptoms.
Treatment is to warm up the heart and yang, soothe the nerves and set the mind.
The representative formula is Guizhi Gancao Longgu Muli Decoction and Shenfu Decoction. Commonly used drugs: Guizhi, Fu Pian, ginseng, Astragalus, Ophiopogon japonicus, Lycium barbarum, Zhigancao, keel, oyster, Shouwuteng.
▲ Guizhi
< span>■ Water Qi Lingxin Syndrome
Water Qi Lingxin Syndrome is characterized by palpitations, dizziness, chest tightness and fullness, lack of thirst Desire to drink, lack of urination, or lower extremity edema, cold body and cold limbs, nausea, vomiting, salivation, pale and fat tongue, white and slippery coating, slippery pulse or thin and slippery pulse.
Treatment is to invigorate the yang of the heart, transform the qi and move the water, and calm the heart and the mind.
Representative formula is the addition and subtraction of Linggui Zhugan Decoction. Commonly used drugs: Alisma, Polyporus, Psyllium, Poria, Guizhi, Zhigancao, Ginseng, Atractylodes, Astragalus, Polygala, Suanzaoren, etc.
▲ Plantain
■ Yin Deficiency and Fire Prosperity
Yin Deficiency and Fire Prosperity Syndrome is characterized by palpitations, insomnia, five heart upsets and heat, dry mouth, Night sweats, tinnitus, backache, dizziness, irritability, red tongue, little or no moss, and thin pulse.
Treatment is to nourish yin and clear fire, nourish the heart and soothe the nerves.
Common prescriptionsAddition and subtraction for Tianwang Buxin Dan and Cinnabar Anshen Pill. Commonly used drugs: Shengdi, Scrophulariaceae, Ophiopogon japonicus, Asparagus, Angelica, Salvia miltiorrhiza, ginseng, Zhigancao, cinnabar, Poria, Polygala, Suanzaoren, Shouwuteng, etc.
▲ Scrophularia
< span>■ Blood Stasis Obstructing Heart Syndrome
Blood stasis block heart syndrome with palpitations, chest tightness and discomfort, heartache The pain is like acupuncture, the lips and nails are bruised, the tongue is dark purple or has ecchymosis, and the pulse is astringent or knotty.
Treatment by promoting blood circulation, removing blood stasis and dredging collaterals.
The representative formula is peach kernel safflower decoction combined with cinnamon licorice, dragon bone and oyster soup. Commonly used drugs: peach kernel, safflower, salvia, red peony root, Chuanxiong, Corydalis, Shengdi, angelica, cinnamon, licorice, keel, oyster, Shouwu vine, etc.
▲ Licorice
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< span>Examples of medical cases
Li, Male, 63 years old. First visit on August 21, 2008. Complained of palpitations for 10 years. 10 years ago, there was “premature atrial contraction” in the preexisting examination, and palpitations were occasionally felt afterwards, but they did not pay attention to it because it did not affect life. Recently, palpitations have occurred frequently due to exogenous symptoms. The exogenous symptoms have been cured, but the palpitations still persist. For further treatment , come to see a doctor. Palpitations, fatigue, sweating, irritability, poor sleep, shortness of breath, dizziness, the above symptoms aggravate after exertion, dry throat, thirst, not wanting to drink, appetite, loose stools, dark tongue, yellow and greasy coating, sublingual Blue and purple, pulse knot generation. He had a history of diabetes mellitus and superficial atrophic gastritis.
Differentiation:Qi and Yin deficiency.
Treatment method:Replenishing Qi and nourishing Yin, and calming the mind.
Prescription:American ginseng (separately fried) 6g, raw astragalus 30g, Ophiopogon japonicus 10g, Schisandra chinensis 6g, fried jujube kernels (smashed ) 18g, Polygala 10g, 20g each (broken and fried first), Salvia miltiorrhiza 15g, Poria 30g, Coix seed 30g, Shouwuteng 30g, and lotus seed heart 3g. 7 doses, decocted in water, 1 dose per day.
Second consultation on August 28, 2000: After taking the above 7 doses, the patient’s symptoms were relieved. Symptoms such as dizziness, irritability, palpitations, etc. occur occasionally, aggravated after exertion, anorexia, dry stools, 1 line a day, poor sleep, dull tongue, white and greasy coating, bruising under the tongue, and uneven pulse. The top is changed to 30g of fried jujube kernels, 30g of raw longmu, 10g of fragrant parsnips, 12g of turmeric, and 15g of acacia peel.
Recipe:American ginseng (separately fried) 6g, raw astragalus 30g, Ophiopogon japonicus 10g, Schisandra 6g, fried jujube kernels (broken ) 30g, Polygala 10g, Raw Longmu (broken, fried first) 30g, Salvia 15g, Poria 30g, Raw Coix Seed 30g, Shouwu Teng 30g, Lotus Seed Heart 3g, Cyanophora 10g, Turmeric 12g, Acacia Bark 15g . 10 doses, decocted in water, 1 dose per day.
Three consultations on September 7, 2000:After taking the above 10 doses, the patient’s symptoms improved significantly, and the original symptoms were greatly reduced. It is aggravated after exertion, nausea, sleep can, feces, dull tongue, white and greasy coating, bruising under the tongue, and uneven pulse. After taking 10 doses of the above, the palpitations disappeared, and there was no recurrence after 3 months of follow-up.
Press:The patient in this case is deficient in both heart qi and heart yin, resulting in the above symptoms. The heart is located in the chest, the heart qi is insufficient, and the zong qi in the chest is weak, so the breath is short. The heart is the sanctuary of the gods. If the heart is insufficient, it is easy to cause the spirit to be unsteady, the mind will be shaken, and the sleep will be poor; if the qi is deficient and the outer is not firm, the sweat will be profuse. Due to deficiency of heart yin, there is a lack of body fluids such as dry mouth and throat. Therefore, in the treatment of this case, Professor Yan used the basic principles of nourishing qi, nourishing yin, and calming the mind as the basic principles of treatment, and the addition and subtraction of Shengmai Powder as the basic formula.
In the prescription, American ginseng is used as the monarch medicine to replenish Qi and Yin; raw Astragalus tonifies qi, Ophiopogon japonicus, Schisandra chinensis nourishes yin, and the three medicines are combined to strengthen the effect of American ginseng to nourish qi and yin, and it is the minister medicine; Raw oyster, Salvia miltiorrhiza, and Shouwu Teng have the effect of nourishing the heart and soothing the nerves, while Poria coix and raw coix seed tonic for the heart and spleen are all adjuvant medicines; all medicines are used in combination, and the syndrome and symptoms are combined, so as to achieve the effect of curing diseases. After taking 7 doses in a row, the patient’s symptoms improved significantly, but there were still clinical manifestations of aggravation of symptoms after exertion. Therefore, on the basis of keeping the prescription, the patient’s clinical symptoms basically disappeared after taking 20 doses. good clinical treatment effect.
▲Schisandra
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[Sently]
Due to the difference of each person’s constitution and condition, the prescriptions and doses in this case are only applicable to the patients in this case at that time. ‘s condition. Without the diagnosis and treatment of TCM syndrome differentiation, the prescription and dosage in this case shall not be copied and used. If necessary, readers should go to regular hospital for diagnosis and treatment, so as not to delay the disease. ■
[Content sorted from: “China Journal of Traditional Chinese Medicine” November 4, 2020 Fifth Edition, excerpted from “Complete Works of Yan Zhenghua’s Research on Chinese Pharmacy Thought and Clinical Drug Use”]