Table of Contents

Zhigancao Tang TCM Medical Record

Author: Nan Kaiyang Editor: Gu Yuxi Translator: Gu Yuxi

TCM Medical Record：

24-year-old male, chief complaint: palpitations for three years, particularly noticeable at night. Western medical examination revealed mild myocardial ischemia. Recently, palpitations have worsened, severely affecting sleep. Tongue presentation: pale red tongue with white, slippery coating, prominent teeth marks, suggestive of water retention affecting the heart. Poor physical strength, easily fatigued. Six-channel differentiation: heart yang deficiency, water qi assailing the heart. Initially, Fuling Gancao Tang (Poria and Licorice Decoction) was prescribed. After taking it, palpitations recurred a few days after stopping the medication.

Upon follow-up, the patient reported periodic constipation, a generally sedentary lifestyle, and insomnia at night. The revised differentiation was insufficient heart and stomach motility, leading to yin-blood deficiency due to the stomach’s inability to transform fluids, thus failing to nourish the heart spirit. The heart yang, lacking support, became deficient and dispersed. When yin-blood is deficient, the Shaoyin Heart Master loses its nourishment, and floating yang qi disturbs the heart spirit, hence “palpitations.” Yang not entering yin leads to insomnia, belonging to the blood deficiency syndrome. Additionally, given the patient’s palpitations varied significantly with changes in body position, spleen deficiency was considered as the cause of inability to transport and transform water qi, leading to its stagnation below the heart.

Prescription:：

Zhigancao 25g
Dangshen 15g
Gan Dihuang 42g
Huangmingjiao 15g (melted)
Maimendong 20g
Guizhi 20g
Huomaren, Fuling, Sheng Baizhu 25g
Shengjiang 8 slices
Dazao 5 pieces (pitted)
Nuomi Jiu (Glutinous Rice Wine) 200ml

First image:

Second image:

Follow-up：

After five doses of the medication, the patient’s symptoms disappeared.

A half-month later, follow-up revealed the patient still reported a slight pulsation before sleep, but it was different from the previous rapid beating. Now, they clearly felt their heart beating powerfully and regularly, and their insomnia was relieved.

A two-month later follow-up showed no recurrence; the heart was beating normally.

A one-year later follow-up showed no recurrence.

This prescription was issued on August 30, 2023.

Notes：

The second picture was taken after finishing the medication.

Notice the detail in the first picture: there’s a crack on the upper lip, which disappeared after drinking the medicine.

The most significant aspect of this medical case is that the hospital’s examination findings and the Traditional Chinese Medicine (TCM) differential diagnosis aligned perfectly with the symptoms, making it a very classic case.

It’s important to differentiate: one shouldn’t automatically use zhigancao tang just because myocardial ischemia is present.

Actually, for simple myocardial ischemia, I usually only use Guizhi Gancao Tang. This formula is very effective and works quickly. You can use it as a base and then add or subtract herbs according to the symptoms.

Disclaimer:

The experiences and insights shared above represent the author’s personal usage and understanding, and are provided for reference only as part of academic exchange. Please do not blindly replicate or apply them; any consequences arising from such actions are solely your responsibility. As individual constitutions vary, medication should be tailored accordingly. It is advisable to use such treatments under the guidance of a qualified physician. If you have additional experiences to share, comments and submissions are welcome.
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