臨床治療｜小改「炙甘草湯」治療竇性心律過速

"Dr. hsiao, my palpitations and chest tightness have improved by 80% since I started treating you. I have never felt so comfortable." Mr. S gave me a thumbs up with satisfaction.

Before coming to see the doctor, Mr. S had numerous heart tests, but no abnormalities were found except that his heart rate jumped to 100-110 beats from time to time, which is medically called sinus tachycardia. The cardiologist prescribed Inderal, which relieves the heart rhythm, and advised him to relax and take medicine only when he feels uncomfortable. It does provide temporary relief after taking it, but it will feel better again after a while. Mr. S has also seen many Chinese medicine doctors, and everyone told him that it was due to a deficiency of both heart qi and yin. The symptoms were accurate when taking pulses, but he was not feeling better after taking medicine.

Qi and Yin deficiency is a vicious cycle. The human heart is like the engine of a car, the driving force that makes the whole car run. The faster you run, the greater the power your heart outputs, and the more heat it generates. Just like a car has a water tank to prevent the engine from overheating, the human body also has a sweating mechanism to prevent the heart from overheating. Specifically, it allows excessive heat to be discharged with sweat at the expense of losing some body fluids. However, with the massive loss of body fluids, the cooling and heat dissipation function is getting worse and worse. The heart has been working in an overheated environment for a long time, which further worsens the heart function that is already weak and qi-deficient. In a non-exercise state, Mr. S's heart palpitations and sweating profusely are clear evidence that both the heart's power (qi) and body fluids (yin) are insufficient and he has entered a vicious cycle.

The Zhigancao Decoction in the prescription is designed to break this vicious cycle. One hand strengthens the mind to increase and repair the engine power, and the other hand nourishes yin and fills the water tank with water to help the engine cool down and dissipate heat. In theory, through such a two-pronged "repair", the vicious cycle can be broken and chaos can be rectified. Considering that Mr. S's heart rate was too fast and he was obviously overheated, I made a small twist on the Zhigancao decoction in the initial prescription. On one side, I lightened the dosage of cinnamon twigs to reduce dissipation and heat production, and on the other side, I added coptis and gardenia. The two medicines directly hurt the heart. Such a configuration is like dragging the entire repair process to the freezer, and it is naturally difficult for the engine to overheat.

After taking the medicine for a week, Mr. S's heart rate dropped to about 80, but he still felt chest tightness, shortness of breath, and difficulty breathing. The pulse in his right hand seemed sticky and blurred. In the second diagnosis, the original prescription was added with Pinellia ternata, Poria cocos, almonds, and Xie Bai to resolve the phlegm in a wide range. The third diagnosis showed that the shortness of breath was significantly improved, and although there were occasional recurrences, it was generally stable and well.

Adjust the prescription according to the disease to help patients find comfortable breathing.