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Introduction: Learn the self-created variant prescriptions of Zhigancao Decoction, Type A and Type B, by Mr. Chen Botao.

Zhigancao Decoction is indicated for: "Exogenous febrile diseases with intermittent or irregular pulse and palpitations."

Here, typhoid fever refers to typhoid fever in a broad sense, with symptoms of intermittent pulse and palpitations, including valvular heart diseases.

The original formula consists of nine herbs: Radix Glycyrrhizae Praeparata, Ramulus Cinnamomi, Radix Ginseng, Radix Rehmanniae Recens, Colla Corii Asini, Radix Ophiopogonis, Fructus Cannabis, Rhizoma Zingiberis Recens, and Fructus Jujubae.

Take seven liters of clear wine and eight liters of water, first boil the eight ingredients (excluding Colla Corii Asini), reduce to three liters, strain the dregs, and then add the gelatin. Let it dissolve completely, and take one liter warm, three times a day. This formula is also known as the "Fumai Tang" (Pulse-Restoring Decoction).

In this formula, Radix Glycyrrhizae Praeparata is used in large quantities as the sovereign herb to tonify the middle and restore the pulse. Radix Ginseng enhances heart qi as the minister herb, while Radix Rehmanniae Recens and Colla Corii Asini nourish heart blood. Fructus Cannabis softens and moisturizes heart yin, Ramulus Cinnamomi invigorates heart yang, and Rhizoma Zingiberis Recens and Fructus Jujubae harmonize nutrient qi and defensive qi as assistant herbs. Clear wine is used as the guide herb to promote the circulation of the medicine through the meridians and regulate blood circulation. This formula harmonizes both qi and blood, roots yin and yang in each other, balances strength and gentleness, and combines activity with stillness, making it a truly excellent prescription.

Wu Jutong removed ginseng, cinnamon twigs, ginger, and jujube, which tonify yang and boost defensive qi, and added white peony root to nourish the yin of the three yin meridians, naming it Modified Pulse-Restoring Decoction, to treat warm disease characterized by exuberant yang and damaged yin.

Although this modification is effective, completely removing the warm, mobile, and dynamic components from the original formula results in a recipe that bears the name of pulse restoration but lacks its actual effects, becoming rigid and unresponsive.

Ke Yunbo, inspired by the phrase "palpitations and throbbing heart" from the original text, once remarked: "The traditional inclusion of cannabis seeds is incorrect; it should be ziziphus spinosa seeds instead." However, he overlooked that while ziziphus spinosa seeds are effective for treating palpitations and insomnia, they are ineffective for addressing intermittent pulse.

Cannabis seeds are actually rich in nourishing yin and blood functions, not merely for moistening the intestines and promoting bowel movements.

When using ginseng in the formula, its potency is strong; if the price is high, it can be replaced with Pseudostellaria heterophylla or Codonopsis pilosula, but the dosage must be increased to 15–30g or more.

Alcohol serves to guide the medicine through the meridians. Simmering clear wine and water together promotes the dissolution of the active components of the herbs, regulates blood circulation, and holds profound significance. However, many people today overlook this, which is regrettable.

I have occasionally recommended patients with insufficient heart qi and palpitations to drink a small amount of clear wine, and they immediately felt relief in their chest. I have also personally tried this method with positive results. However, those with heart conditions must avoid excessive alcohol consumption.

Drawing from decades of experience, I have formulated two modified versions of the Zhì Gān Cǎo Tāng (Honey-Fried Licorice Decoction): Formula A and Formula B. By applying them based on pattern differentiation and treatment, satisfactory therapeutic outcomes have been achieved.

Party A: Radix Glycyrrhizae Preparata, Ramulus Cinnamomi, Radix Pseudostellariae, Radix Rehmanniae, Gelatinum Corii Asini, Radix Ophiopogonis, Fructus Trichosanthis, Bulbus Allii Macrostemonis, Radix Salviae Miltiorrhizae, Radix Aconiti Lateralis Preparata, Notoginseng Powder

Party B: Radix Glycyrrhizae Preparata, Ramulus Cinnamomi, Radix Pseudostellariae, Radix Rehmanniae, Gelatinum Corii Asini, Radix Ophiopogonis, Fructus Trichosanthis, Bulbus Allii Macrostemonis, Radix Salviae Miltiorrhizae, Radix Glehniae, Notoginseng Powder

Formula Principles and Modifications: For heart-yang deficiency, Aconite is most effective, and adding a small cup of clear wine to decoct together is recommended. For heart-yin deficiency, Radix Glehniae is selected to nourish yin and moisten the lungs, which is precisely suitable, and it is advisable not to add clear wine.

Fructus Trichosanthis and Bulbus Allii Macrostemonis unblock heart-yang and are mainly used for chest impediment. Radix Salviae Miltiorrhizae activates blood and dispels stasis. Notoginseng concurrently treats heart area pain and is also effective for pain in the liver, gallbladder, and spleen areas.

Cassia twig stimulates heart yang and serves as the pivotal element in the formula, completing the function of restoring the pulse. Combined with licorice, it forms Cassia Twig and Licorice Decoction, used to treat "profuse sweating causing the patient to press their hands against the chest, with palpitations and a desire for pressure."

Occasionally, a small amount of Storax Pill or Guanxin Storax Pill can be administered in divided doses to stimulate cardiac function and enhance the aromatic awakening effect, serving as an emergency measure. This represents a flexible application of the principles of the Baked Licorice Decoction.

Modified Baked Licorice Decoctions A and B differ by only a single herb, with the selection tailored to the syndrome. The modifications are based on the severity of the imbalances in qi, blood, yin, and yang, each with its unique application.

One,

In one case, Mr. Li, a 69-year-old worker, was treated.

Pale complexion, mental fatigue, anemic appearance, chest tightness, paroxysmal angina pectoris, insomnia and restlessness, frequent urination and reduced appetite, dry throat and body chills, dizziness and toothache, pulse weak and wiry with diminished stomach qi, tongue pale with yellow coating and light red body.

ECG examination: Atrial fibrillation, myocardial damage.

Approaching seventy years old, palpitations and timidity have persisted for a long time, with deficiency of healthy qi and lingering pathogenic factors. Due to physical weakness, frequent attacks have occurred, and there have been several episodes of shock. This indicates insufficiency of heart yang and deficiency of heart yin. The condition is serious and should not be overlooked.

Quickly administer 5 doses of Formula A. After taking the medication, the condition improved significantly, with all symptoms greatly alleviated. Consequently, this formula was taken regularly. After 20 doses, the condition gradually stabilized.

Thereafter, be mindful of wind and cold, moderate diet, abstain from tobacco and alcohol, and avoid anger. Within 3 to 6 months, episodes may occur less frequently or not at all, and occasional episodes can be gradually relieved with Formula A. Following this regimen for regulation, although the condition has not yet been completely eradicated, about seventy to eighty percent has already been cured, which is indeed a gratifying outcome.

Two

Another case treated was that of You Mou, female, 33 years old, a worker.

Symptoms included dizziness, chest tightness, fatigue and somnolence, preference for cold drinks, and a body coldness more severe than usual. She often felt the need to protect her cardiac area with her left hand for comfort; squatting worsened her chest tightness, and riding in a vehicle with her left hand raised to hold the handrail triggered palpitations.

Each time her heart condition was triggered by overexertion, symptoms included dizziness and nausea, and in severe cases, simultaneous vomiting and diarrhea, accompanied by pale complexion and a state resembling shock.

Subsequently diagnosed with viral myocarditis sequelae at a hospital in Shanghai. The condition varies in severity, with intermittent flare-ups persisting for over ten years. The pulse reveals two beats followed by a skipped beat, and the tongue shows a pale yellow coating with a red body.

According to traditional Chinese medicine diagnosis, the condition was attributed to deficiency of both Qi and Yin in the heart, predominantly with heart Yin deficiency. After administering five doses of the modified formula, all clinical symptoms showed improvement, with only dryness in the eyes and dry stool occurring approximately every 2–3 days, indicating insufficient nutrient Yin

Continue the same prescription adding 10g of Cannabis Seed, administer another 5 doses, and gradually, chest tightness began to ease. The symptom of often using the left hand to protect the heart area has disappeared, left-hand movement gradually became more free, riding in vehicles with upward, downward, rotating, and lifting movements returned to normal, and the sensation of dry eyes also improved, with bowel movements becoming once a day.

However, as the formula contained blood-activating herbs such as Cinnamon Twig, Salvia Root, and Notoginseng, it is no surprise that menstruation persisted for a week without ceasing after taking the medication. The pulse still exhibited intermittent beats every two to three pulses, likely due to the long-standing heart condition, as intermittent pulse patterns are not easily resolved in a short period. Afterwards, the patient was advised to take this formula with modifications as needed for regular use and has remained well to this day.

Three

Also treated Ms. Wang, female, 60 years old, a cadre originally from Beijing, who has been temporarily staying in Nantong with her children and grandchildren since retirement.

Chief complaint: Occasional premature beats, chest tightness, dizziness, spontaneous sweating, and numbness in the left hand. The patient is relatively thin, prone to irritability, with sleep and appetite generally good and mental condition acceptable.

Previously in the capital, successive treatments with both Chinese and Western medicine had produced no significant results, or if there was an effect, it quickly recurred. Recently, at the recommendation of family, I have turned to you for treatment.

When the pulse is weak, wiry, and rapid, and the tongue coating is pale yellow with a red body, indicating that at the age of sixty, the deficiency of heart qi and yin has persisted for a long time, the modified Zhi Gancao Tang Formula B was initially prescribed in 15 doses with effective results. Later, Schisandra chinensis (Wu Wei Zi) was added to astringe heart qi and calm the spirit, yielding significant efficacy. After another 15 doses, symptoms such as palpitations, premature beats, chest tightness, dizziness, and spontaneous sweating resolved.

I have suffered from hypertension and hypertensive heart disease for 18 years. Given my constitution of yin deficiency and yang hyperactivity, coupled with intense work and study, I have also experienced myocardial damage.

After self-administering Formula B with Schisandra chinensis for over a year, the myocardial damage disappeared, demonstrating that this formula is also effective for cases of heart yin deficiency accompanied by myocardial damage.

Some patients with heart yin deficiency often crave cold drinks and cold foods, which aligns with the statement in the *Inner Classic*: "When the heart is deficient, heat is retained internally." If mistakenly treated as deficiency-cold, adverse consequences will occur immediately.

Fourth

Patient Sha, female, aged 67, has a history of hypertension and a constitution characterized by yin deficiency, with longstanding heart disease.

In autumn 1988, she took 10 doses of the modified B formula of Zhigancao Decoction (Roasted Licorice Decoction) with good efficacy. The condition relapsed in spring 1989. At that time, I was away on business in Wuhan and had not yet returned, so she was admitted to a hospital in Nantong City for two months, improving enough to be discharged.

Shortly afterward, the heart condition recurred, presenting with chest tightness and pain in the left chest and the anterior and posterior areas of the heart region. A period of mental tension followed, during which both Chinese and Western medications were administered indiscriminately. This led to symptoms of facial flushing, restlessness, and insomnia. The patient urgently sent someone to seek treatment.

Concerned about the potential transformation of yin deficiency into yang hyperactivity, I advised reducing the dosage of cinnamon twig in the original formula by half. However, the patient’s family, having only a superficial knowledge of medicine, completely omitted it from the prescription. Unexpectedly, after taking the modified formula, the patient immediately experienced loose stools, reduced appetite, and abdominal discomfort.

After deep contemplation, I insisted on maintaining the original dosage of cinnamon twig in the prescription to support cardiac function and regulate the balance of yin and yang. As expected, the patient was able to lie down and rest peacefully after taking the medicine, and all the symptoms disappeared.

This clearly demonstrates that the composition of classical prescriptions involves a precise combination of cold, hot, warm, and cool properties. The appropriate dosages are specifically tailored to the condition and cannot be compared to haphazard or indiscriminate formulations.

In the harsh winter season, some patients are reluctant to consume decoctions. Depending on the condition's requirements, either the A-formula or B-formula can be used for symptom-based treatment, or switching to an ointment formulation is also suitable, particularly for women and children.