Epigastric glomus and Subsidence of Lower Stomach Are Signal Symptoms
By Ju Bong Kang, KMD
Action and Diagnosis
This prescription treats arrhythmia or intermittent pulse caused by qi, yin, and blood deficiencies in the heart and lungs. It is because, in the process of cold damage or febrile disease, a lot of moisture is consumed due to excessive sweat, urine, or diarrhea. Alternatively, a lot of heart heat was generated by excessive heart activity due to overwork or thoughtfulness. In the process of discharging this heat through breathing, a lot of moisture and nutrition of the lungs and heart were consumed. This leads to a lack of qi, yin and blood, which results in arrhythmia or intermittent pulse.
This prescription is formulated by increasing the dose of Zhigancao in Guizhi-Qu-Shaoyao-Tang and adding drugs that reinforce qi, blood, yin, and nutrition. That is, to relieve the irregular beating of the heart, a lot of sweet flavor of Gancao is added, so the urgency of the heart is reduced, and the irregular pulse is calmed. Pharmacologically, Zhigancao’s urine suppression function prevents the lack of body fluid, which can play an important role in normalizing the heartbeat.
Although this prescription invigorates yin and blood, Shaoyao is not used because it relaxes the smooth muscle in the digestive tract. That is, it prevents the body fluid and blood supply to the heart and lung of the upper energizer from converging toward the middle energizer of the spleen and stomach.
There is a case to add Shaoyao. If a patient has hypertonicity with arrhythmia, it is necessary to add Shaoyao. In particular, Wenjing-Tang(溫經湯) containing Shaoyao can be considered if there is a signal symptom of blood stasis along with deficiency of qi and blood in a patient with chronic arrhythmia. For arrhythmia symptoms, can use Zhigancao-Tang, Wenjing-tang is often required for patients with deficiency-syndrome in weak pulse; this prescription contains blood-supplying drugs and promoting blood circulation drugs, along with Zhigancao-Tang’s Maimendong Renshen, Ejiao, and Gancao.
Among the constituent drugs, Zhigancao and Shengdihuang are the monarch drugs of this prescription.
Zhigancao preserves body fluid by reducing urine discharge, thus alleviating the urgency of the heartbeat and reinforcing the activity of the heart and lungs through the qi-benefiting effect. Shengdihuang nourishes Yin blood and clears and descends the heart fire.
Renshen and Dazao are minister drugs. Renshen helps Gancao invigorate qi and assists Shengdihuang in generating fluid, thus stabilizing arrhythmia and intermittent pulse. Dazao, the monarch drug, also helps Gancao and Shengdihuang benefit qi, develop fluid and alleviate the urgency of the heart beating with a sweet flavor.
Ejiao, Maimendong, and Humaren also function as minister drugs, as Renshen and Dazao. Renshen and Dazao reinforce qi while replenishing Yin and blood.
Ejiao supplements blood, replenishes Yin, and moistens dryness. Maimendong nourishes Yin, moistens the lungs, and clears the heart-fire to help the monarch drug Shengdihuang, respectively.
Guizhi and Shengjiang have pungent and warm properties and act as adjunct drugs. They promote activating Yang and harmonizing Ying and Wei in supplementing and reinforcing body fluid with the aid of monarch and minister drugs. Thus, they facilitate the flow of body fluid and blood and eliminate and prevent the stagnation of dampness and phlegm.
Gancao is not only a monarch drug that alleviates the urgency of the heartbeat but also mediates all other drugs and acts as a guiding drug.
In abdominal diagnosis, there is no Shaoyao in Zhigancao-Tang. Therefore, there is no hypertonicity. Instead, Renshen’s signal symptoms, epigastric glomus, and Dihuang’s signal symptoms, such as palpitation and subsidence of the lesser abdomen, appear. In addition, skin dryness and constipation may occur due to the lack of body fluid. Even arrhythmia is present, but the pulse is not severely weak, and the tongue is red and dry.
Contents in the Source Text
If arrhythmia and heart palpitation appear due to cold damage, Zhigancao-Tang should be used. “Shang Han Lun.”
Application
When high blood pressure, hyperthyroidism, heart valve disease, and asthma appear along with arrhythmia, Zhigancao-Tang can be used if the pulse is not weak.
Distinction
Wenjing-Tang: When a patient with arrhythmia has a weak pulse and hypertonicity appears, use Wenjing-Tang or quote suitable drugs of Zhigancao-Tang to Wenjing-Tang.
