Slow arrhythmia is a common cardiovascular disease characterized by a ventricular rate of less than 60 beats per minute, including abnormal autoregulation (including sinus bradycardia, sinus arrest, pathological sinus node syndrome, etc.) and various types of cardiac conduction block (including sinus atrioventricular block, atrioventricular block and intraventricular block). The treatment of this disease in western medicine is mainly to correct the cause, symptomatic treatment, such as drugs such as atropine, isoprenaline to temporarily increase the heart rate, and in severe cases to install a permanent pacemaker. However, for the poor areas of China, pacemaker placement is only a luxury. Chinese medicine has some advantages in the treatment of this disease. I have studied under Prof. Guo Weiqin since I started my medical career, and I believe that the pathology of this disease is based on the deficiency of heart and kidney yang and stagnation of blood vessels, which may develop into deficiency of both qi and yin and mutual obstruction of phlegm and stagnation over time. Now I would like to express my views on the understanding and treatment of this disease. Slow arrhythmia is equivalent to “palpitations”, “vertigo”, “dizziness”, “palpitation”, and “delayed pulse” in Chinese medicine. The category of “slow pulse evidence”, “syncope”, “decompensation”, etc. Su Wen – yin and yang, said “the late is yin”; Yuan – slippery life “diagnostic pivot” cloud: “late for the yin and yang deficiency of the symptoms, for cold, for insufficient.” The “endangered lake pulse” points out: “late to a breath to only three, Yang does not win Yin Qi and blood cold.” This indicates that the late pulse is a sign of Yang deficiency. Yang is weak and yin is stringy, the heart’s yang deficiency, then yang can not overcome yin, yin evil multiplies in the yang position, blood flow is delayed, the pulse is slow. From the analysis of clinical manifestations, many patients show fatigue, chest tightness and chest pain, cold fear, cold limbs, unfavorable or long urine, dizziness, sunken pulse or with knots, generation, fat tongue with teeth marks on the side, light and dull tongue, so the heart and kidney Yang deficiency is the root of this disease. Sun Simiao “a thousand gold wing formula・old age big example” cloud: “people fifty on, Yang Qi day decay, loss and day to day, heart power gradually recede, forget the front of the loss, Xingju laziness.” Heart Yang drumming heart beat, warm blood circulation; kidney Yang for a Yang Qi of the original, the role of warmth to promote the role of the internal organs, so the heart and kidney Yang Qi strength, directly affect the heart main blood function. Old age, or overindulgence, kidney yang deficiency, can not warm heart yang, heart and kidney yang deficiency, yin and cold within the Sheng, on the offense of Yang position, can lead to poor pulse path, blood flow sluggish. Yang deficiency can not warm the outside, the symptoms are cold fear and cold limbs. “If the heart is not clear, it is painful, with chest tightness and chest pain, which is reflected in the tongue with petechiae or petechiae. The heart is a Yang organ. If the heart is deficient in Yang, Yin will take over, and the mind will lose its surrender, so we see palpitations and palpitations. If the heart is not nourished and the brain is not moistened, the chest will be stuffy and dizzy, and the pulse will be sluggish, and in severe cases, the loss of nourishment of the clear orifices will lead to syncope. The disease is prolonged, yang loss and yin, heart loss of moistening, drumming weakness and slow pulse, clinical symptoms can be seen in both qi and yin deficiency, the pulse is mainly slow, sometimes see the promotion of pulse, but the number and weak. Heart and kidney yang deficiency, fire does not produce earth, spleen yang deficiency, transportation and transformation is unfavorable, water and drink stagnation, dampness gathered into phlegm, phlegm and turbidity on the offender, paralysis of the heart veins, resulting in a slow heart rate, the heart is fire and evil water, not self-safe and palpitations. As the “endangered lake pulse” cloud “late division of dirty disease or more phlegm”, suggesting that “phlegm” and “late pulse” relationship is very close. Phlegm for the Yin evil, its sticky nature, paralysis blocking the heart and veins, blood flow is not smooth, day after day into stasis, phlegm and stasis mutual obstruction, the pulse to slow. The “evidence and treatment of the Hui-supplement” said: “phlegm confused in the heart, for heart pain, palpitations, palpitation, palpitation, trance.” Therefore, phlegm paralysis, chest Yang does not spread, the heart pulse loses warmth, and the clinical symptoms are heart pain, stuffiness, palpitations and palpitations, accompanied by fatigue, heavy head and dullness, nausea and vomiting, dryness of the mouth and inability to drink, and other signs of phlegm and dampness. In summary, the disease is based on the deficiency of heart and kidney yang, with blood stagnation and phlegm-dampness internal obstruction as the symptoms. If the disease is prolonged and the yang is lost to the yin, there may be serious evidence of deficiency of both yin and yang, and it always belongs to the evidence of deficiency of cold, phlegm and stasis. Treatment: “Yin and Yang is the way of heaven and earth, the outline of everything, the parent of change, the origin of life and death, and the house of the gods,” said Su Wen – Yin Yang Ying Xiang Da Lun. The treatment of disease must seek its origin. …… Those who have seek it, those who do not seek it, those who are strong are to blame, those who are deficient are to blame.” Based on the fact that deficiency of heart and kidney yang and stagnation of blood vessels are the main pathological basis of slow arrhythmia, and following the principles of Nei Jing, “those who lose benefit”, “those who get cold get heat”, “those who labor get warm, those who get knotted get loose, those who stay get attacked Professor Guo Weiqin adopted the principle of “Benefiting Qi, warming Yang and activating Blood” to treat the slow arrhythmias, focusing on overall regulation, taking into account both the symptoms and the root cause, and helping to eliminate the evil. Ephedra is hard and warm, entering the lung, bladder and heart meridians. Ben Jing”: Ephedra “main stroke …… remove cold and heat, break Y firm accumulation”, “Pearl sac”: “remove the cold in the camp, the sun, Shao Yin sweat”, “Sun Hua Zi Materia Medica”. “open the nine orifices, regulate the blood vessels, and fight the miasma of the mountains.” It can be seen that ephedra has the function of dispersing and breaking up accumulation, regulating the blood vessels and dispelling cold. Yang Qi deficiency, phlegm and stagnant cold evil accumulate under the heart, disturbing the heart and mind and causing palpitations, and the pulse comes to be sluggish and untidy. “The knotted is dispersed, the retained is attacked”, ephedra pungent and warm, dispersing the cold in the camp, attacking the subcardiac accumulation, as the main remedy for the symptoms. Modern pharmacological research: ephedra has ephedrine effect, has a mild and long-lasting vasoconstrictor effect, dilate the coronary arteries, improve myocardial blood supply; on the heart has a strong excitatory effect, can make the heart rate increase. Su Wen – Yin Yang Ying Xiang Da Lun said: “the form is not enough, warm up the gas”. Radix et Rhizoma Ginseng is sweet and flat in taste and enters the qi branch of the Taiyin meridian of the hand and foot, with the effect of benefiting qi and nourishing blood. Ben Cao Zong Xin”: “Mainly tonifies the middle and benefits the qi, harmonizes the spleen and stomach, and removes annoyance and thirst. It is used to tonify and nourish the weakness of the middle energy, and it is deeply appropriate”; “The Compendium of Materia Medica” records: “Curing lung deficiency and benefiting lung energy”. The spleen is the essence of the latter, the spleen is deficient in biochemical sources, the heart is also deficient; spleen qi is robust, the heart is nourished, blood vessels are filled. The lung is facing the hundred arteries, the main section, the blood flow depends on the lung qi to spread and regulate, the lung qi is full then the blood to promote the regulation can be restored to normal. Therefore, we take Radix Codonopsis to nourish the spleen and lung to regulate the heart vessels. ”The loss is beneficial”, “the labor is warm”, “the main of the strong fire to eliminate the shade”. Slow arrhythmias are based on deficiency of heart and kidney yang. The kidney yang is the root of all yang, and plays a role in promoting warmth to all organs of the body. Xian Ling Spleen, also known as Epimedium, is pungent, sweet and warm, and enters the liver and kidney meridians. Shennong Ben Cao Jing: “Mainly used for impotence and injury, pain in the stem, urination, and to benefit the vital energy and strengthen the will”. The Materia Medica: “Cures all cold wind and strain, tonifies the waist and knees, and strengthens the heart”. Compendium of Materia Medica: “Epimedium, warm in nature but not cold, can benefit the essence, and is suitable for those who are deficient in true yang”. This product enters the kidney to help yuan yang, pungent and warm to pass through the meridians, warming yang and dispersing cold, to the heart and kidney yang deficiency, cold guest pulse medium-sized slow arrhythmia play a good therapeutic effect. Zhang Zhongjing pointed out: “the first for the qi knot in the meridian, long then blood injury into the luo”, “the meridian year persistent disease, the disease must be in the luo”. Yang deficiency, blood flow is sluggish, over time into stasis, paralysis and obstruction of the veins and ligaments. Modern pharmacological studies have shown that blood-stasis activating drugs can increase coronary blood flow, resist cardiac arrhythmias, improve blood supply to the sinus node and atrioventricular node, and improve their autoregulation and conduction. Chuanxiong, also known as Rhizoma Ligustici, is a pungent and warm medicine with the ability to invigorate blood circulation, dispel wind and relieve pain. It is used in the Compendium of Materia Medica: “Dries dampness, stops diarrhea and dysentery, moves qi and opens depression. In the Materia Medica, Chuanxiong rhizoma “treats all wind, all qi, all strain, all blood …… regulates all the veins, breaks up the blood and nourishes the new blood”. Chuanxiong can both move the head and eyes upwards, and open up depressions in the middle, reaching Yang in Yin and penetrating Yin in Yang. The blood vessels are harmonized, Yang Qi is regulated, cold Qi is dispersed, Qi is relaxed, and blood circulation is restored to normal. Research has proven that chuanxiongzin can inhibit vascular smooth muscle contraction caused by catecholamines and 5-hydroxytryptamine, dilate coronary arteries, reduce cerebrovascular resistance, increase coronary blood flow, improve myocardial ischemia and hypoxia, reduce myocardial oxygen consumption, and inhibit platelet aggregation, prevent thrombosis, improve microcirculation, and also play a central sedative and hypotensive role. In modern life, people are sedentary and less active, resulting in spleen stagnation, loss of transport and transformation, for a long time, phlegm and dampness within; and because of over-eating fried, fatty, sweet and cold products, more obstruct the spleen transport, help dampness and phlegm. The phlegm is a yin evil, easy to attack the heart and chest Yang position, resulting in heart Yang paralysis, the heart complex is inaccessible for a long time, making the heart rate slow and difficult to regulate. The “knotted one is dispersed”, with the half-xia dispersing the water under the heart and dispelling the phlegm in the veins and ligaments. Panxia, pungent and poisonous, enters the heart meridian of the spleen and stomach. Shennong Ben Cao Jing: Han Xia “main cold and fever, subcardiac firmness, lower gas, throat and throat swelling pain, dizziness and chest distension ……”. The famous medical doctor: “eliminate the heart and abdomen chest and diaphragm phlegm-heat full of knots”. It is a very good way to get rid of the phlegm in the camp. It also helps the spleen to transport and transform phlegm, so that the phlegm is eliminated, the spleen is healthy, the qi and blood are filled, the blood vessels are harmonized and the heart rate returns to normal. The disease is prolonged, with deficiency of both qi and yin, resulting in shortness of breath and weakness, dry mouth and throat, dizziness, tinnitus like cicada, red tongue with little coating, thin and weak pulse. On the basis of the basic formula of Fu Dou Hefei, we add Mai Dong, Xuan Shen and Wu Wei Zi to nourish Yin and help Yang. As Jing Yue Quan Shu said, “Those who are good at nourishing yang must seek yang in yin, then yang will be helped by yin and biochemically endless; those who are good at nourishing yin must seek yin in yang, then yin will be raised by yang and the source of water will be inexhaustible.” Mai Dong is sweet and cold in nature, enters the lung, stomach and heart meridian, nourishes yin, clears the heart, nourishes the stomach, nourishes yin and moistens the lung. It is used to nourish yin and clear the heart, nourish the stomach and nourish the lungs. It is reported that maitake contains a variety of steroidal saponins and flavonoids, which have a certain therapeutic and preventive effect on a variety of experimental arrhythmias; at the same time, maitake also improves cardiac function and anti-myocardial ischemic effect. Wu Wei Zi, acidic and warm in taste, enters the lung, kidney and heart meridians. Effects: Astringing the lung and nourishing the kidney, nourishing the heart and generating fluid, collecting sweat and astringent essence. Shennong Ben Cao Jing: “Mainly beneficial to Qi, coughing and rebellious upper Qi, labor injuries and leanness, replenishing deficiencies, strengthening Yin, and benefiting men’s essence”. This product combined with maidenhair and ginseng, i.e., raw pulse drink, tonifies both deficiencies of heart qi and yin. Modern research: Wu Wei Zi has an excitatory effect on the central nervous system, while Sheng Wei Drink has the effect of protecting the myocardium, enhancing myocardial contractility, increasing coronary blood flow and improving the myocardium’s ability to resist hypoxia. Xuan Shen, bitter, salty and cold, is used to nourish Yin and lower fire, detoxify and soften hardness. It is used to nourish yin and lower fire, detoxify and soften the body. The “Rihuazi Materia Medica”: “nourishing deficiency and strain, heart alarm and agitation”, “Justice of the Materia Medica”: “healing the chest and diaphragm, heart and lung heat evil ……”. The application of this product can nourish Yin and clear the heart, remove annoyance and calm the panic. Modern research found that: the total flavonoid glycosides contained in Xuan Shen can sedate, lower blood pressure, strengthen the heart and dilate blood vessels. In cases of phlegm-stasis paralysis, the symptoms include chest pain, dullness, dizziness, abdominal distention and vomiting, dull tongue, petechiae and white greasy coating. The treatment is based on the original formula with the addition of Guahu, Allium, Salvia and Panax notoginseng. The Golden Killing Book: “Yang with a slight yin string, i.e. chest paralysis and pain, so it is because of its extreme deficiency. Now the Yang deficiency is known in the upper jiao, so chest paralysis and heart pain, because of its Yin string.” “chest paralysis can not lie down, heart pain through the back, Guazhu Allium and half a summer soup,” “chest paralysis in the heart of the plankton, stay in the chest, chest full, under the duress reverse robbing the heart, heliotrope Allium and Gui Zhi Tang is the main.” Yang deficiency evil closed, the chest and back of the Qi paralysis and impassable, so see chest tightness chest pain, even and back. The chest pains can be relieved by opening the chest and removing phlegm with Gua Pou and dispersing the knots with Allium, so that the paralysis can be passed and the chest yang can be expanded. Salvia miltiorrhiza, bitter and slightly cold, belongs to the heart and liver meridian, has the function of activating blood and cooling blood, calming the mind and tranquilizing the heart, draining pus and relieving pain. It has the function of invigorating the blood, cooling the blood, calming the mind and relieving pain. Cures forgetfulness and palpitations and sleeplessness. The Materia Medica Huiyan: “Dan Shen is good at treating blood, removing stagnation and generating new energy, and regulating menstruation and smooth veins.” Western medicine found that: Salvia contains tanshinone, tanshinin and tanshin acid, which can dilate coronary arteries, increase coronary blood flow, improve myocardial ischemia, improve cardiac function, regulate heart rhythm, regulate blood lipids, inhibit atherosclerotic plaque formation, anti-fibrosis, enhance immunity and anti-tumor. Therefore, it can treat slow arrhythmias in terms of pathological mechanism. Panax ginseng, first seen in the Compendium of Materia Medica, is sweet, slightly bitter and warm, entering the liver, stomach and large intestine meridians. Effects: Stopping bleeding and dispersing blood stasis, subduing swelling and relieving pain. According to “Yulan Yu Jue Jie”, Panax ginseng “harmonizes the camp and stops bleeding, opens the veins and removes blood stasis. It moves blood stasis and converges new blood. …… all blood stasis is broken; …… all new blood is stopped”. The main chemical components of Panax notoginseng include Panax notoginseng saponin and flavonoid glycosides, which can significantly increase the recovery rate of sinus rhythm, prolong the duration of sinus rhythm, shorten the maintenance time of arrhythmia, reduce the reperfusion arrhythmia after myocardial ischemia in rats, non-competitively inhibit the effect of isoprenaline to increase heart rate, and scavenge oxygen free radicals. In addition, Panax notoginseng also has hemostatic, platelet aggregation inhibition, anti-thrombosis, vasodilatation, antihypertensive, anti-myocardial ischemia and anti-atherosclerosis effects. In conclusion, the herbs benefit qi and warm yang, invigorate blood and resolve phlegm, so that yang temperature is warmed, blood vessels are opened, phlegm and stagnation are removed, veins are cleared, and sinus rhythm is restored.