I. Rapid Arrhythmias

I. Rapid Arrhythmias

Rapid arrhythmias include various types of premature beats, sinus tachycardia, supraventricular and ventricular tachycardia, atrioventricular flutter, and fibrillation. Clinically, they often manifest as palpitations, discomfort in the precordial region, fatigue, a rapid pulse, or even irregularities in the rhythm. From a traditional Chinese medicine perspective, these conditions are often caused by qi and yin deficiency, blood stasis within the vessels, long-term heat accumulation in the blood, or heat disturbing the mind. Among these, qi and yin deficiency are the root cause; blood stasis, long-term heat accumulation, and heat disturbing the mind are merely secondary manifestations. Treatment primarily focuses on nourishing yin and tonifying qi, using the Zhi Gan Cao Tang with modifications: 20 g of Zhi Gan Cao, 10 g of Gui Zhi, 6 g of Gan Jiang, 10 g of A Jiao (dehydrated), 4 dates, 10 g of Dangshen, 20 g of Mai Dong, 20 g of Sheng Di, 10 g of Ma Zi Ren, 20 g of Dan Shen, 20 g of Ku Shen, 10 g of Wu Wei Zi, decocted in water and taken orally, one dose per day. Clinical adjustments were made: if the patient also experienced restlessness, insomnia, sores in the mouth and tongue, or frequent palpitations and dreams, 3 g of Huang Lian and 3 g of Zhu Sha were added (mixed and taken separately); if the patient also experienced insomnia, frequent dreams, fatigue, lack of energy, and poor appetite, 30 g of Huangqi, 6 g of Yuan Zhi, and 15 g of Chao Zao Ren were added; if the patient experienced palpitations, excessive sweating, and general body aches after an external infection, 20 g of Bai Shao were added to the original formula; if the patient also experienced chest discomfort and a deep, fine, and tense pulse, with a purple-dark tongue bearing signs of blood stasis, the above formula was combined with Guan Xin No. II (composed of Dan Shen, Chi Shu, Chuan Xiong, Hong Hua, and Jiang Xiang), which is prescribed for coronary artery disease and angina pectoris, especially when the patient is diagnosed with blood stasis; alternatively, the formula Gui Chuan Jiayi, consisting of 10 g of Gui Zhi, 6 g of Chuan Xiong, 10 g of Ge Gen, 20 g of Dangshen, 10 g of Mai Dong, 6 g of Wu Wei Zi, 15 g of Zi Shi Ying, 15 g of Sheng Long Mu, 10 g of Ling Qi Shi, 15 g of Zhen Mu, and 6 g of Gan Cao, was used; if the patient also experienced irritability, anger, fear, or insomnia with frequent dreams, 15 g of Sheng Long Mu, 3 g of Zhi Lu Xiang, 15 g of Chao Zao Ren, 15 g of Bai Zi Ren, 10 g of Yuan Rou, and 10 g of Shan Yu Rou were added to the original formula; for cases caused by skin diseases, the formula Chai Hu Jia Long Gu Mu Li Tang with modifications was used.

Case 1: Xu ××, male, 62 years old, a cadre, had suffered from palpitations and precordial discomfort for eight years. He visited our department on October 26, 1996. Physical examination revealed: pulse 100 beats per minute, blood pressure 16/10 kPa; cardiac examination showed clear heart sounds, with an irregular heartbeat, and 6–10 premature beats could be heard per minute. No pathological murmurs were heard in the precordial region. Electrocardiogram showed: ① myocardial ischemia, ② frequent multi-source premature beats. Combined with a rapid pulse, irregularities in the rhythm, and a red tongue with a thin yellow coating showing signs of blood stasis, the traditional Chinese medicine diagnosis was qi and yin deficiency, blood stasis within the vessels. Treatment focused on tonifying qi and nourishing yin while resolving blood stasis; the formula was: 20 g of Zhi Gan Cao, 10 g of Gui Zhi, 6 g of Sheng Jiang, 10 g of A Jiao (dehydrated), 4 dates, 10 g of Dangshen, 20 g of Sheng Di, 20 g of Mai Dong, 10 g of Ma Zi Ren, 20 g of Dan Shen, 20 g of Ku Shen, 10 g of Gua Lou, 10 g of Peng Bai, 6 g of Ban Xia, 6 g of Hong Hua, 10 g of Chuan Xiong, decocted in water and taken orally, one dose per day. After taking the formula for more than 20 doses, the chest pain had disappeared, but the patient still felt mild palpitations, occasionally fatigue, and discomfort in the epigastric region. The tongue was red with a thin yellow coating, and the pulse was fine and rapid. The above formula was modified by removing Chuan Xiong and Hong Hua, adding 6 g of Sha Ren, 10 g of Tan Xiang, 10 g of Bai Zhu, 12 g of Fuling, and after taking more than 20 doses, all symptoms had disappeared. The heart rate was 86 beats per minute, with only 1–2 premature beats heard per minute. Electrocardiogram showed occasional atrial premature beats.

Case 2: Zhao ××, female, 50 years old, a farmer. She had episodic palpitations for two years, accompanied by pain in the upper right abdomen, insomnia, and frequent dreams. She visited our department on January 4, 1997. Physical examination revealed: pulse 104 beats per minute, blood pressure 12/8 kPa; heart sounds were clear, heart rate 110 beats per minute, regular rhythm, and a blowing-like murmur could be heard in the precordial region. The abdomen was flat and soft, with tenderness in the upper right abdomen. Electrocardiogram showed sinus tachycardia. Western medical diagnosis: ① sinus tachycardia; ② chronic cholecystitis; ③ hysteria. Combined with a red tongue with little coating and a tense, rapid pulse, the traditional Chinese medicine diagnosis was liver depression leading to fire, with fire disturbing the mind. Treatment focused on soothing the liver, releasing depression, and calming the spirit; the formula was Chai Hu Jia Long Gu Mu Li Tang combined with Gan Mai Da Zao Tang with modifications: 10 g of Chai Hu, 10 g of Huang Qin, 10 g of Dangshen, 6 g of Ban Xia, 6 g of Sheng Jiang, 6 g of Gan Cao, 4 dates, 3 g of Sheng Da Huang, 15 g of Sheng Long Mu, 30 g of Fu Mian, 3 g of Huang Lian, 6 g of Xiang Fu, 6 g of Yuan Zhi, decocted in water and taken orally, one dose per day. After taking this formula for more than 10 doses, her palpitations, insomnia, and frequent dreams improved, but she still experienced pain in the upper right abdomen. Therefore, the above formula was modified by removing Yuan Zhi and Chao Zao Ren, adding 10 g of Zhi Shi, 10 g of Mu Xiang, and 20 g of Qian Jin Cao, and after taking more than 20 doses, all symptoms had disappeared.