TCM Water-Qi Ascending Syndrome and Western Cardiac Diseases

The patient suddenly feels a burst of qi surging upward from below—from the lower abdomen, or from the navel, or from the throat—as if a little pig were running inside the body, with a sensation of oppression so severe as to feel near death. At the same time there is epigastric and hypochondriac distending pain; upon standing up there is dizziness and vertigo, tinnitus and brain ringing, and in severe cases even a sense of sudden death. In TCM this disease belongs to the water-qi ascending syndrome, also called running-piglet (bentu) disease. In modern medicine this belongs to cardiac disease; coronary heart disease, cor pulmonale, and heart failure can all cause the above symptoms. Some patients also have cough and wheezing, chest oppression, shortness of breath, aversion to greasy food, irritability and easy anger, precordial pain even radiating to the back, numbness of the fingers, cyanosis, and edema.

Usually it is an early warning sign of serious cardiac disease and requires attention. Blood tests in such patients mostly show hyperlipidemia, and cardiac imaging shows cardiovascular atherosclerosis or blockage, coronary stenosis, or plaques. It can be diagnosed through blood work, echocardiography, cardiac MRI, and cardiac angiography. This disease is mostly seen in people over 40, but it now also shows a tendency toward younger ages. Patients can also easily develop cardiac sudden death upon exertion, colds, cold exposure, or overeating; therefore in daily life one must avoid exertion and catching cold and must not overeat.

Representative TCM formulas for treating this condition include the Ling-Gui series of formulas, Da Jianzhong Tang (Major Middle-Warming Decoction), and Bentu Tang (Running Piglet Decoction). Modern Chinese patent medicines such as Compound Salvia Pellets (Fufang Danshen Diwan), Wenxin Granules, Jiuxin Pills, Ginkgo Biloba Tablets, and Shengmai Yin can also treat such diseases, but they must be selected rationally under the guidance of a professional physician.

The water-qi ascending disease is easy to treat for the symptoms but hard to treat for the root. As long as one finds the formula corresponding to the patient's symptoms, one can usually relieve the symptoms in a short time, but it is very hard to radically cure such diseases. Patients prone to the water-qi ascending syndrome mostly have the habit of not exercising. Some patients are congenitally weak, with a family history of heart disease and breathing difficulties since childhood. Other patients eat too much rich and sweet food, leading to high blood lipids and blocked cardiovascular vessels.

When treating such diseases, besides routine medication, one must also instruct the patient to eat a light diet and exercise more, especially push-ups and sprint-type exercises; these are of great benefit to improving the patient's heart function. Insisting on more than 40 push-ups a day can significantly prolong the life of coronary heart disease patients. But for elderly patients, reversing this trend through diet and exercise is not easy; severe cases require surgery.

Here the medication indications for the various commonly used formulas for this disease are further explained.

Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction): Poria (Fuling) 30g, Cinnamon Twig (Guizhi) 10g, Atractylodes (Baizhu) 10g, prepared Licorice (Zhi Gancao) 6g.

Linggui Zhugan Tang comes from Zhang Zhongjing's Treatise on Cold Damage. This formula is the representative formula for heart-spleen yang deficiency with water-qi attacking upward. Article 67 of the Treatise on Cold Damage: "In cold damage, after vomiting or purging, there is reversal and fullness below the heart, qi surging up to the chest, dizziness upon rising, and a deep tight pulse; if sweating is promoted, the channels are stirred and the body shivers and shakes, Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction governs." Later TCM holds this formula to be the main formula for phlegm-fluid diseases. Besides treating the water-qi ascending syndrome caused by cardiac disease, this formula can also treat many other diseases. The key to using it lies in the patient having symptoms such as "reversal and fullness below the heart, qi surging to the chest, dizziness upon rising, deep tight pulse, stirring of the channels upon sweating, and shivering of the body."

Guizhi Jia Guizhi Tang: Cinnamon Twig (Guizhi) 15g, White Peony (Baishao) 9g, fresh Ginger (Shengjiang) 9g, prepared Licorice (Zhi Gancao) 6g, Jujube (Dazao) 4 pieces.

Guizhi Jia Guizhi Tang also comes from Zhang Zhongjing's Treatise on Cold Damage. Article 117: "When fire needles are used to induce sweating and the needled sites are attacked by cold, with nodules raised and reddened, running piglet will surely arise; qi rises from the lower abdomen to the heart. Moxa each nodule with one cone, and give Guizhi Jia Guizhi Tang, increasing the Cinnamon Twig by two liang." The water-qi ascending syndrome in this formula surges from the lower abdomen (the small belly) toward the heart (the epigastrium), caused by abnormal abdominal artery pulsation. Zhang Zhongjing attributed it to mistreatment with fire needles, but in reality many patients develop this symptom without fire needles, and Guizhi Jia Guizhi Tang is also effective.

Linggui Wei Gan Tang: Poria (Fuling) 30g, Cinnamon Twig (Guizhi) 10g, Schisandra (Wuweizi) 10g, prepared Licorice (Zhi Gancao) 6g.

This formula comes from Clinical Guide to Medical Practice (Linzheng Zhinan Yi'an), used by Ye Tianshi to treat kidney qi's failure to secure, with qi rising from the lower abdomen to the chest and even to the crown of the head, dizziness and vertigo, a face as red as if drunk, palpitations, a regularly irregular pulse, chest oppression, shortness of breath, and wheezing. It is especially suitable for older patients; this disease is mostly seen in COPD patients with concurrent heart disease.

Bentu Tang: prepared Licorice (Zhi Gancao) 10g, Ligusticum (Chuanxiong) 10g, Angelica (Danggui) 10g, processed Pinellia (Fabanxia) 20g, Scutellaria (Huangqin) 10g, raw Pueraria (Sheng Gegen) 25g, White Peony (Baishao) 10g, fresh Ginger (Shengjiang) 20g, plum root bark 15g.

This formula comes from Zhang Zhongjing's Essentials from the Golden Cabinet (Jinkui Yaolue). In the chapter on the Pulse, Patterns, and Treatment of Running-Piglet Qi Disease it states: "Running piglet, with qi surging up to the chest, abdominal pain, and alternating chills and fever, Bentu Tang governs." This disease has the symptom of qi surging to the chest, as well as abdominal pain and alternating chills and fever. The Pueraria used in this formula is an important herb for treating cerebrovascular and cardiovascular diseases, and the Angelica and Ligusticum already contain the later approach of using activating blood and resolving stasis to treat such diseases.

Linggui Xihong Tang: Poria (Fuling) 30g, Cinnamon Twig (Guizhi) 10g, Rubia (Qiancao) 10g, Safflower (Honghua) 6g; for high blood pressure, add Achyranthes (Niuxi) 10g.

This is Professor Liu Duzhou's empirical formula, used for coronary heart disease patients who have both water-qi ascending symptoms and symptoms of qi-blood stasis obstruction such as precordial pain and finger numbness.

Da Jianzhong Tang: Sichuan pepper (Jiaozhu) 10g, dried Ginger (Ganjiang) 10g, Ginseng (Renshen) 6g.

This formula comes from Essentials from the Golden Cabinet. In the chapter on Abdominal Fullness, Cold-Running Qi, and Food Stagnation it states: "Great cold pain in the chest and abdomen, vomiting so that one cannot eat, cold in the abdomen, upward surging visible under the skin with a head and feet, and pain above and below that cannot be touched—Da Jianzhong Tang governs." This formula is suitable for the water-qi ascending syndrome caused by craving cold and raw foods or triggered in cold seasons. At such times one must use very acrid and hot substances to warm and scatter; Sichuan pepper and dried Ginger are both very acrid and hot, and Ginseng greatly supplements original qi. Modern medicine has confirmed that this formula has a cardiotonic effect and can treat heart failure patients with the above symptoms.

The above are the commonly used formulas. In addition, Fuling Guizhi Dazao Gancao Tang, Fuling Guizhi Xingren Yiyiren Tang, Fuling Guizhi Baijiezi Gancao Tang, Fuling Guizhi Shengjiang Gancao Tang, Wuling San, and Zhenwu Tang can also be used to treat the water-qi ascending syndrome. Those who are interested can study the indications of these formulas themselves and distinguish carefully when prescribing clinically; they are not enumerated one by one here.