Cold-damage disease with knotted and intermittent pulse, severe palpitation, Prepared Liquorice Decoction is the main treatment

bubble_chart Note

• Severe palpitation refers to a pounding and uneasy sensation in the heart region.
• If it is caused by excessive sweating or purging, it is mostly due to deficiency; if not caused by sweating or purging, it is mostly due to heat. If there is a desire to drink water and difficulty in urination, it belongs to fluid retention; if there is diarrhea with cold limbs, it belongs to cold.
• In the current case of cold-damage disease, severe palpitation occurs without sweating or purging, and there are no signs of fluid retention, heat, cold, or deficiency. However, based on the knotted and intermittent pulse indicating insufficiency, Prepared Liquorice Decoction is prescribed because the patient's usual state of blood and qi deficiency cannot withstand the cold pathogen, hence the pulse cannot continue smoothly.
• At this time, even though the exterior symptoms of cold-damage disease are not yet resolved, they are not the primary concern. The urgent need is to tonify the middle and generate blood to restore the pulse, with the main focus on promoting the circulation of nutritive and defensive qi.

bubble_chart Collected Annotations

• Cheng Wu-ji said: "When the pulse stops and then resumes on its own, it is called a knotted pulse; when it does not resume on its own, it is called an intermittent pulse, due to the deficiency of blood and qi, which cannot continue."
• Cheng Zhi said: "This is another method for those who advocate tonification. It is called cold-damage disease because there is pathogenic qi that has not been resolved. The heart governs blood, and a knotted and intermittent pulse with severe palpitation indicates blood deficiency and the inability of vital qi to continue. Therefore, drastic tonification of yin to generate blood, and further promotion of yang to disperse cold, is necessary. Without yang, there is nothing to hold the weak yin, hence the formula uses Cinnamon Twig Decoction without Peony Root, and is steeped in clear wine. This is to rescue vital qi at the brink of exhaustion and to avoid cold in the middle when the pulse is weak. Observing Minor Center-Fortifying Decoction, one then knows that there is a method for tonifying yang in cold-damage disease; observing Prepared Liquorice Decoction, one then knows that there is a method for tonifying yin in cold-damage disease."
• Cheng Yingmao said: "This is also discussed in terms of the pulse. Pathogenic qi lingering and knotting is called a knotted pulse; healthy qi deficiency and decline is called an intermittent pulse. When cold-damage disease presents with this and severe palpitation, it is due to internal deficiency of vital qi, hence Prepared Liquorice Decoction is used to benefit yin, calm blood, and harmonize nutritive and defensive qi as the main treatment." He also said: "Taiyang deteriorated pattern mostly belongs to yang exhaustion; shaoyang deteriorated pattern also belongs to yin exhaustion, as shaoyang and jueyin are exterior and interior, and the nutritive yin is injured. Prepared Liquorice Decoction is used to harmonize the nutritive qi and nourish yin qi as the treatment."

bubble_chart Formula

Prepared Liquorice Decoction formula
Liquorice Root 4 liang (roasted) Fresh Ginger Rhizome 3 liang (sliced) Cinnamon Twig 3 liang Ophiopogon Tuber half sheng Hemp Seed half jin Chinese Date 12 pieces (crushed) Ginseng 2 liang Donkey-hide Gelatin 2 liang Unprocessed Rehmannia Root 1 jin
The above nine ingredients are cooked with 7 sheng of clear wine and 8 sheng of water. First, boil the eight ingredients, take 3 sheng, remove the dregs, and add Donkey-hide Gelatin, melting it completely. Take 1 sheng warm, three times a day. Also known as Pulse-Restoring Decoction.

bubble_chart Collected Explanations

• Zhang Lu said: "For those with dry body fluids, it is advisable to prevent the risks of constipation and astringency. Ophiopogon Tuber and Unprocessed Rehmannia Root nourish the source of transformation in the bladder; Hemp Seed and Donkey-hide Gelatin specifically address the dryness and tightness of the large intestine. This prevents the exhaustion of yin, the drying of fire, and the withering of blood. This is Zhongjing's marvelous method for rescuing yin and dispelling yang."
• Ke Qin said: "In cases of deficient pulses, Zhongjing uses Peony Root to nourish yin for yin deficiency, and Cinnamon Twig to promote yang for yang deficiency. In severe cases, Ginseng is added to generate the pulse. However, Ophiopogon Tuber is never used. Could it be that in the treatment of cold-damage disease, the emphasis is on supporting yang? Or is it that yin cannot be rapidly tonified? In this case, where there is a deficient middle and knotted or intermittent pulse, Unprocessed Rehmannia Root is used as the sovereign herb, and Ophiopogon Tuber as the minister herb, drastically tonifying true yin. This has opened the path for later scholars to enrich yin. However, although Rehmannia and Ophiopogon Tuber have a sweet taste, their nature is cold, and they are not herbs that promote sprouting and flourishing. It is essential to use Ginseng and Cinnamon Twig to promote yang in the pulse, Fresh Ginger Rhizome and Chinese Date to harmonize nutrient-defense, Donkey-hide Gelatin to tonify blood, Sour Jujube to calm the spirit, and Liquorice Root to moderate and prevent rapid descent. The strong action of clear wine facilitates upward movement. By harmonizing the interior and exterior, palpitations can be calmed and the pulse restored. Using seven sheng of wine and eight sheng of water, only three sheng are taken after prolonged decoction to ensure the qi is not too harsh. This is the method of using wine for deficient individuals, and it is known that Rehmannia and Ophiopogon Tuber work well with wine. For this syndrome, Sour Jujube should be used, and for lung atrophy, Hemp Seed is appropriate. If genuine Donkey-hide Gelatin is unavailable, tortoise-plastron glue can be used as a substitute."