Heart Skipping a Beat, Palpitations Out of Nowhere? Doctor Luo Tianyi’s Zhi Gan Cao Tang (Restore the Pulse Decoction) Case

Patient search words: heart skipping a beat / palpitations / premature beats / irregular heartbeat ｜ Medical terms: xin dong ji (palpitations) · jie mai (knotted pulse) · qi yin liang xu (qi and yin deficiency)

Opening scene: this is a formula Doctor Luo Dalun has drunk himself

💬 Note from Doctor Luo: Today’s case will feel very familiar to many of you — I have talked about a similar formula before, and what’s more, I once had this very illness myself, and it was Zhi Gan Cao Tang that cured me. Let me keep that story for the end: first I’ll walk you through Doctor Luo Tianyi’s case, and then I’ll tell you mine.

Who was the patient? Fifty-four, with inherently weak middle qi

In the sixth month of the gengchen year of the Zhiyuan era, during the reign of Emperor Shizu (Kublai Khan) of the Yuan dynasty (c. 1280 AD), there was a patient named Xu Bowei (许博威), aged 54 — past middle age, which in ancient times meant he was already approaching old age.

💬 Note from Doctor Luo: Doctor Luo Tianyi opened the record with four characters: zhong qi ben ruo — “the middle qi is inherently weak.” What is middle qi? It is the qi of the spleen and stomach. When the spleen and stomach are full and strong, the upright qi of the chest is full and strong as well. A person whose upright qi is chronically insufficient is exactly the kind of person most easily wounded by external pathogens.

How did the illness start? A cold, purged with cold medicine and chilled by pears

The cause here is very clear: bing shang han ba jiu ri — he caught an external contraction (a cold) and went eight or nine days without recovering. Seeing that he was running a high fever, the physicians gave him cold, cooling purgatives (rhubarb and the like) to “drain the fire.” And they did not stop there — afterward they made him eat three or four pears, and pears are cold-natured too.

That was the ruin of him: the yang qi of his spleen and stomach was wounded. As a result his four limbs turned cold, and he kept having spells of dizziness and clouded consciousness (shi hun kui), his mind unclear.

💬 Note from Doctor Luo: Look at this sequence — the middle qi was already insufficient to begin with; an external pathogen invaded, and the body ran a fever to fight it off; then the physician purged with cold medicines, draining away the yang; and then the pears wounded the spleen yang on top of it. This is the classic mistreatment that wounds the yang. By the time Doctor Luo Tianyi was called in, the man was on the verge of collapse.

One touch of the pulse, and Doctor Luo Tianyi knew: this is a knotted pulse

Doctor Luo Tianyi took his pulse. The pulse “moved and then stopped, and sometimes returned of its own accord” — it beat, then paused, then came back by itself after a moment. This is the knotted pulse (jie mai).

💬 Note from Doctor Luo: You’ve probably heard the phrase “mai jie dai, xin dong ji” — knotted and intermittent pulse with palpitations. The knotted pulse and the intermittent pulse are two different pulses. Knotted pulse (jie mai): the heartbeat is slow, beating then stopping, with pauses that follow no fixed rhythm — the heart “steals beats” irregularly. Intermittent pulse (dai mai): the skipped beats follow a regular rhythm — at fixed intervals it stops for one beat. Ordinary people call this “stealing a beat” (tou ting), and Western medicine calls it premature beats (extrasystoles) — there are ventricular premature beats and atrial premature beats; the atrial ones are generally easier to treat, the ventricular ones harder. There is also an abrupt pulse (cu mai), where the heart beats fast and skips a beat in the middle. These are all pathological pulses.

A pile of symptoms — every one a signal of deficiency and cold

Now look at the symptoms: xin dong ji (palpitations) — he felt as though something were moving inside his heart, a hollow “drop” in the chest; yi qi — endless belching and hiccuping, qi rising up out of him; a greenish-yellow complexion; diminished spirit and energy; mu bu yu kai — his eyes would not even open; juan wo e ren yu — he was weary and lay down constantly, hating to hear people talk.

💬 Note from Doctor Luo: This whole cluster of symptoms is the portrait of yang deficiency and exhausted vitality. A greenish-yellow face is not a yang (excess) sign — it is a deficiency sign, and possibly leaning toward cold. Eyes that won’t open, lying down too tired even to listen to talk — would you call that a state of excitement or a state of collapse? Collapse, obviously. And the ice-cold limbs — is the yang qi strong? It is not.

The pattern: external pathogen wounds the upright, qi and yin run low, and the heart “steals a beat”

Where did this illness come from? An external pathogen invaded the pericardium channel and the heart channel, producing heart disease; at the same time, the struggle between upright qi and the pathogen consumed too much, leaving qi and yin both deficient (qi yin liang xu) — the qi was drained, and the fluids and blood — the “liquid substances” of the body — were drained as well; the heart was left depleted, and so it began skipping beats.

💬 Note from Doctor Luo: Many people don’t know what “the heart stealing a beat” feels like, but you can actually feel it yourself — a hollow “drop,” a “jolt” in the chest, as if the heart turned over once, went “thump.” If you take your pulse at that moment, you’ll find that in the middle of the beating it misses a beat. You can test this in daily life: I’ve met many people who felt no discomfort in their hearts at all, but the moment you felt their pulse you’d catch a beat-skip, once or twice a minute — more often in the elderly. That is not necessarily serious, but it is a dysrhythmia, and in some cases it is very serious indeed.

The prescription: Doctor Zhang Zhongjing’s Zhi Gan Cao Tang — a balancing-scale formula

In his Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases), the great physician Doctor Zhang Zhongjing left a formula for exactly this condition — Zhi Gan Cao Tang (Honey-Fried Licorice Decoction), also known as Fu Mai Tang (Restore the Pulse Decoction) — which is famously effective for “mai jie dai, xin dong ji” (knotted-intermittent pulse with palpitations).

💬 Note from Doctor Luo: Zhi Gan Cao Tang is a remarkable formula. People assume that yang deficiency calls for warming the yang and yin deficiency calls for nourishing the yin, but many of Doctor Zhang Zhongjing’s formulas are balancing formulas — cold and hot medicinals placed together like a set of scales, with the physician adding and subtracting on either side according to the patient’s condition. If heat and yin deficiency predominate, increase the cold medicinals such as sheng dihuang and maimendong; if yang deficiency predominates, increase the warming medicinals such as guizhi and renshen.

How the formula works (Doctor Luo Tianyi explained it very clearly himself):

• Renshen (ginseng) with dazao (red dates) — sweetly tonify the insufficient qi, boosting the upright qi of the heart and lungs (white ginseng or sun-dried ginseng works; red ginseng can be used when both qi and blood are depleted)
• Guizhi (cinnamon twig) — warms the yang and opens the blood vessels (when the heart’s vessels are congealed and stuck, they must be warmed open)
• Shengjiang (fresh ginger) — warms the middle (the heart belongs to yang and to fire, so it must be kept warm)
• Huomaren (fire hemp seed) — moistens dryness and lubricates the intestines to move the stool (and the dose in this formula is not small)
• Ejiao (donkey-hide gelatin) — nourishes the blood
• Maimendong (ophiopogon tuber) — nourishes yin and clears deficiency heat
• Sheng dihuang (raw rehmannia root) — cools the blood and nourishes yin

💬 Note from Doctor Luo: Doctor Luo Tianyi wrote, “wu zang wei ruo, rong wei he liu, shi yi run zhi” — when the five viscera are weak, the ying (nutritive) and wei (defensive) qi flow like a river, and therefore we moisten them. Fluids and blood draw on the same shared resources; the heart governs the blood vessels; fever consumes the body fluids, and when fluids run low the blood runs low too, and the heart behaves abnormally. So while warming the yang, he paired it on the other side with medicinals that nourish the blood vessels, nourish yin, and moisten dryness. The ancients valued huomaren for its moistening, stool-moving action, but modern research has shown that it can help repair damaged myocardial cells — the ancients did not know that, but this herb truly cannot be left out.

Doctor Luo Tianyi’s adjustments: for a yang-deficient man, tilt the scale toward warmth

This patient’s yang had been badly wounded — his pattern leaned toward yang deficiency. How did Doctor Luo Tianyi adjust? He increased the doses of guizhi and renshen — urgently supporting the upright qi and raising the yang; and reduced sheng dihuang — fearing its coldness would damage the yang further.

💬 Note from Doctor Luo: The reverse applies too: if you treat myocarditis and meet a classic yin deficiency — a tongue that is thin and small, extremely red, with the surface nearly sprouting prickles — that means strong deficiency fire and insufficient fluids, and sheng dihuang must be increased; it often takes 60 grams or more to see results. This is the wisdom of Chinese medicine: Doctor Zhang Zhongjing levels the scale for you, and you fine-tune it to the patient in front of you.

The setback: the first dose did nothing! It turned out to be the medicine

The prescription was written and one dose was taken — no effect. Doctor Luo Tianyi pondered: did the pulse and the disease match? Or… was the quality of the medicine poor?

So he went back to the market, and in the herb shop he specifically picked out the strongest-smelling, best-quality herbs, decocted them fresh, and took them. The result — one dose halved the illness; a second dose cured it completely.

💬 Note from Doctor Luo: This is exactly my own experience — two doses and it was over. Note that this case was probably seen before Doctor Luo Tianyi became an imperial physician — after that his medicines were specially supplied; but in those days, buying herbs on the street, the quality varied enormously. Good medicine and bad medicine differ in efficacy by a mile.

Doctor Luo Dalun’s own story: one bowl of Zhi Gan Cao Tang that changed how he saw Chinese medicine

💬 Note from Doctor Luo: Back when I was studying Chinese medicine, the study pressure was intense. Reading every day consumed my heart-blood, and my qi and yin were badly damaged, so I developed the skipped beats myself — it was awful. My heart would go “thump” and seem to turn over, hard to stop; I’d sit there reading and the skipping kept on, and I was frightened. At the time I didn’t dare tell my family. Even though I was studying Chinese medicine, I didn’t have much faith in it back then, so I went to a Western hospital instead and saw the head of cardiology at the largest hospital in town. He ordered myocardial enzyme tests; nothing showed up. He said I might have had myocarditis that had recovered, but the premature beats remained, so he treated me as a myocarditis patient and prescribed medicine — it did nothing at all. I was in so much pain I felt I was saying goodbye to life. I sat by the roadside watching the people go by, and my spirits were very low.

💬 Note from Doctor Luo: Then it suddenly struck me: I study Chinese medicine! So I opened the Shang Han Lun (Treatise on Cold Damage), found the passage on “xin dong ji, mai jie dai” (palpitations with a knotted-intermittent pulse), copied out the Zhi Gan Cao Tang prescription, and took it to a pharmacy — that was the earliest prescription I ever wrote. The pharmacy staff even grumbled that the prescription was too small and awkward to fill, clearly copied out of a book. I prepared it exactly as the book said — with the ejiao and the yellow wine — and drank one bowl that night — and before long, the skipped beats slowly began to disappear! The next morning I drank another bowl, and I was well! Only then did I understand how precious Chinese medicine is, and how fast it can work. I finished the remaining doses to consolidate the cure. I was young and cocky, so I marched back to the Western hospital to show off to the cardiology chief: “I’m cured!” He asked how. I said Chinese medicine — Zhi Gan Cao Tang. The chief thought the formula was for the liver: “Do you have liver trouble?” I said no, the formula is simply called Zhi Gan Cao Tang. Walking out, I saw all the patients lined up at the clinic door, and I thought to myself: if you truly master Chinese medicine, a very large proportion of these patients could be cured with herbs! That was the beginning of my love for Chinese medicine. So I have a special attachment to Zhi Gan Cao Tang, and in later years I used it to regulate skipped heartbeats for many people, with excellent results.

The extended discussion: Doctor Luo Tianyi named this case “the pure and concentrated flavor of medicinals”

The case concluded, but Doctor Luo Tianyi added a long reflection and gave the case a name — Yao Wei Zhuan Jing, “the pure and concentrated flavor of medicinals” (药味专精).

💬 Note from Doctor Luo: Doctor Luo Tianyi said: “Fan yao yong kun chong cao mu, sheng zhi you di” — every medicine, be it insect, herb, or plant, grows in its own native place; this is what we call dao-di herbs (geo-authentic herbs). Take Huai shan yao (Chinese yam): the best comes from Wen County in Jiaozuo, Henan — a child with a cough drinks it and the cough stops on the spot, while yam from other regions is far less effective, because the trace elements, climate, and humidity of that soil are different. “Gen ye hua shi, cai zhi you shi” — whether you use the root, the leaf, the flower, or the fruit, and when you harvest it, each has its proper time. Leave its native place and its nature and flavor change; if the qi and flavor are incomplete, the efficacy is greatly reduced. Then there is the difference between fresh and aged herbs, and between fine and coarse quality. Hence his conclusion: “Yong zhi bu xiao, shi yi zhi guo ye” — if the medicine you use fails to cure, that is the physician’s fault!

💬 Note from Doctor Luo: I feel the weight of those words from personal experience. Someone bought sanqi (notoginseng) and took it for a whole year with no reaction; then he took the dao-di 25-head sanqi ground into powder that I recommended, and he felt dizzy after a single dose — people with deficient blood do get dizzy from blood-moving medicine, but why did he react after one dose? Because the medicine was genuinely good and genuinely potent. And take my own example: when I was overtired, my skipped beats would flare up; I took granule preparations and they did nothing — I tried many times, no effect; then I bought raw herbs and decocted them, and one dose cured it — because Zhi Gan Cao Tang basically works in a single dose for this condition. When granules show no effect after two or three days, it’s because the strength is insufficient.

💬 Note from Doctor Luo: The Neijing (Yellow Emperor’s Inner Classic) says: “Si sui bei wu, qi wei zhi zhuan jing ye” — prepare your medicinals according to the year, and choose those whose qi and flavor are pure and concentrated, of especially fine quality. The quality of Chinese medicine today is uneven, and counterfeits and inferior goods are everywhere. Many old practitioners sigh: how is it that the older I get, the less effective my prescriptions become? The truth is that counterfeit medicines are multiplying. The responsibility falls mainly on us practitioners — Chinese medicine must advocate for good medicine, help patients choose good herbs, vigorously promote dao-di herbs and reduce counterfeits; otherwise we fail our patients.

A final word on the name: why Zhi Gan Cao Tang?

One last note: the formula is named after zhi gancao (honey-fried licorice). Zhi gancao harmonizes the middle and boosts the qi — modern analysis shows it has effects similar to hormones, and in this formula its dose is very large indeed. As for the difference between zhi gancao and plain gancao, Doctor Luo Dalun says, “we’ll go into that in detail another time.”

What to take away

• A skipped heartbeat is a common dysrhythmia, not necessarily a catastrophe — but it is a signal that the heart is under strain and the body’s qi and fluids are depleted; in serious cases it must be taken seriously.
• Zhi Gan Cao Tang is a balancing formula: warm and cool medicinals in one scale, adjusted to the patient — more warming herbs when yang is deficient, more cooling herbs when yin is deficient.
• When a classic formula “doesn’t work,” check the medicine first: herb quality, provenance (dao-di), freshness, and processing all change efficacy dramatically — one of Doctor Luo Tianyi’s first doses failed purely because the pharmacy herbs were poor.
• Doctor Luo Dalun’s own cure is one of the most convincing demonstrations: two bowls of Zhi Gan Cao Tang ended his own skipped beats, and launched his lifelong commitment to Chinese medicine.

Case source: Weisheng Baojian (Precious Mirror of Hygiene), medical case of Doctor Luo Tianyi (case title: Yao Wei Zhuan Jing — The Pure and Concentrated Flavor of Medicinals); commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).