This is a complicated pattern as it is the combination of four other patterns and their features at the same time: Phlegm, Heart Blood Stagnation, Heart Qi Stagnation,  and Cold.

If Phlegm is the dominant one out of the above four patterns, the pulse is rather Slippery instead of Wiry, Choppy or Knotted. Regardless the Phlegm in the Heart is of Hot or Cold nature, it can cause a swollen tongue, a feeling of chest oppression, feeling of heaviness, shortness of breath with inability to lie down, and spitting of phlegm. Di Tan Tang, together with Long-stamen onion builbs, Snake gourds and Crow-dipper rhizome, is more suitable for treatment if Phlegm is the main feature.

Heart Blood Stagnation causes stabbing or pricking pain which comes and goes. This pain often occurs around the Heart or chest area but may also spread to the upper back or shoulder. In additional to that, the patients' lips, face, nail and tongue can turn to purple color due to the Stagnation of Heart Blood. Xue Fu Zhu Yu Tang is more recommended if these features are more obvious.

Emotional symptoms such as mental restlessness or depression are caused by both Heart Qi and Blood Stagnation. Chai Hu Shu Gan San is recommended if Heart Qi Stagnation is more dominant.

Finally, there are also Cold pattern features such as cold hands or feeling of cold. This Coldness  can congeal muscle and worsen chest pain discussed above. In this case, it is suggested to use Dang Gui Si Ni Tang together with Immature bitter orange, Long-stamen onion bulbs and Cinnamon twigs.