bubble_chart Concept

Easily frightened refers to the symptom of being easily startled by events or frequently feeling inexplicably panicked, with a sense of unease and restlessness in the heart.

This symptom originates from Suwen. Zhizhenyao Da Lun. Lingshu. Baibing Shisheng chapter, also known as "Xi Jing" (喜驚).

This symptom is quite similar to "palpitation" and "severe palpitation," but "palpitation due to fright" is characterized by paroxysmal palpitations and restlessness. Zhengzhi Huibu: "Palpitation due to fright refers to sudden feelings of being startled, with unease and restlessness in the heart, and its occurrence is intermittent." Zhengzhi Huibu: "Severe palpitation is characterized by persistent palpitations and restlessness, with its occurrence being continuous." Therefore, severe palpitation is more severe than palpitation due to fright and is often a progression of the latter. Although both fright and palpitation are paroxysmal states of flusteredness, fright is associated with timidity and fragility, often triggered by sights or sounds. Leizheng Zhicai: "Fright is the loss of mental composure, caused by being startled by what one sees or hears, resulting in temporary panic." Palpitation, on the other hand, is different and should be distinguished. This section primarily discusses being easily frightened, while palpitation and severe palpitation are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Heart-Gallbladder Qi Deficiency︰Shortness of breath, lack of strength, low and weak speech, timidity and fearfulness, flusteredness, easily startled, light sleep with dreamfulness, pale tongue texture, thin coating, and weak pulse. The heart is the sovereign organ, from which mental activity arises; the gallbladder is the organ of uprightness, from which decision-making arises. When the heart qi is tranquil, the gallbladder qi is unafraid. If one experiences a great fright due to certain events, or hears empty sounds, or sees strange sights, or engages in endless contemplation, or cannot resolve troubling dreams, the gallbladder qi becomes impaired, the heart spirit becomes unsettled, and one becomes easily startled by events, manifesting as restlessness in sitting or lying down, flusteredness, and fearfulness. Shoushi Baoyuan states, "Suddenly startled... with a timid and fearful heart, as if afraid of being caught, all these are caused by heart deficiency with timidity." Yizong Bidu notes, "It is observed that when encountering external dangers, the strong-hearted and strong-gallbladder are unharmed, while the timid-hearted and timid-gallbladder are easily startled." The key points of clinical differentiation are: frequent startling accompanied by shortness of breath, spontaneous sweating, lack of strength, pale complexion, weak pulse, and other signs of insufficiency of heart qi, as well as habitual timidity, indecisiveness in handling matters, and other manifestations of the pattern of gallbladder deficiency. Treatment should focus on tonifying qi to nourish the heart and resolving phlegm to warm the gallbladder. Prescriptions such as Four Gentlemen Decoction and Gallbladder-Warming Decoction may be selected. Xiezheng Lun states, "When gallbladder qi is not robust, fright and vigilance easily arise; the Cinnamon Twig, Fossil Bone, Oyster Shell, and Liquorice Root Decoction is indicated."
2. Deficiency of Yin and Blood︰Restlessness and insomnia, tidal fever and night sweats, feverish sensation in the palms and soles, easily startled by events, dull complexion, red tongue with scant coating, and thready pulse. What governs a person is the heart, and what nourishes the heart is blood. When the heart blood is deficient, the spirit loses its anchor, making one prone to fright. The deficiency of the heart invariably stems from the deficiency of kidney essence. Yang is governed by yin, and the heart is rooted in the kidney. Instability above arises from below—this is the principle of mutual nourishment between essence and blood. Leizheng Zhicai states: "If the essence and blood of the three yin are depleted, and the yang within yin is insufficient, it leads to severe palpitations and fright." The key points for clinical differentiation are: frequent fright accompanied by symptoms of yin deficiency with internal heat, such as tidal fever and night sweats, vexing heat in the chest, palms, and soles, thirst at night, as well as signs of blood deficiency cervical malignancy with cachexia, such as a dull complexion and pale nails. The tongue may be pale or red, with thin or no coating, and the pulse is thready, rapid, and weak. Treatment should focus on nourishing yin and blood, calming the spirit, and soothing the heart. The recommended formula is Rehmannia Decoction with Angelica and Peony. Although this pattern and the fright caused by heart-gallbladder qi deficiency both belong to deficiency patterns, the former is due to insufficient yang qi, while the latter arises from deficiency of yin and blood. Their clinical manifestations are distinctly different, making them easy to distinguish.
3. Phlegm-fire Disturbing Heart︰Restless and distracted, easily startled during sleep, dry mouth with bitter taste, pale red tongue with yellow greasy coating, slippery and rapid pulse. The patient typically has abundant phlegm constitution or sudden anger damaging the liver, qi depression transforming into fire, scorching fluids into phlegm, phlegm-fire harassing upward, unsettling the spirit, and being easily startled by events. *Hong Lu Dian Xue* states: "Startledness... phlegm stirred by fire." Although this pattern shares heat manifestations with startledness due to yin-blood deficiency, the distinction lies in deficiency versus excess. The key clinical diagnostic points are: frequent startledness accompanied by impatience and talkativeness, even manic agitation, dizziness, headache, bitter taste in the mouth, red tongue with yellow greasy coating, wiry-slippery-rapid pulse, and other signs of excess fire combined with phlegm pattern. Treatment should focus on clearing the heart and dispelling phlegm, with Coptis Rhizome Gallbladder-Warming Decoction as the selected formula.
4. Exuberance of Heart Fire︰Flushed face, red eyes, mouth and tongue sores, dysphoria, easily startled, red tongue with rapid pulse. Suwen. Zhizhenyao Da Lun: "Pain, soreness, and fright are all related to fire." Fright disorders originate in the heart, mostly due to excessive heart fire causing blood disturbance and unsettled spirit, leading to convulsions, commonly seen in children. This syndrome shares obvious heat signs with phlegm-fire disturbing heart, which presents with frequent fright. However, phlegm-fire disturbing heart is primarily characterized by phlegm, with a thick, greasy, and yellow tongue coating, while excessive heart fire is dominated by fire. The key clinical diagnostic points are: frequent fright accompanied by mouth and tongue sores, thirst with a desire for cold drinks, and a thin yellow tongue coating. Treatment should focus on clearing the heart and reducing fire, using formulas such as Redness-Removing Powder.
5. Liver Depressionblood Deficiency︰Distension and fullness in the chest and hypochondrium, emotional discomfort, dysphoria, irritability, and tendency to be easily startled. Complexion and nails appear pale, tongue coating is thin, tongue body dark or pale, and pulse is thin and weak. Liver depression causes discomfort, transforming into fire that scorches fluids, damaging liver blood, which in turn depletes heart blood, leading to the liver failing to store the ethereal soul and the heart failing to govern the spirit. As a result, the ethereal soul and spirit become scattered and disordered, making one prone to being easily startled. Xiezheng Lun states: "Blood-related diseases cause fright." In *Mai Yin Zheng Zhi*: "Due to blood deficiency, the liver governs blood; without sufficient blood nourishment, it becomes weak, hence the tendency to be easily startled." This condition and fright due to yin-blood deficiency both manifest as a pale complexion and nails, as well as a thin pulse. The key points for clinical differentiation are: accompanying symptoms such as liver depression causing discomfort, distension and fullness in the chest and hypochondrium, irritability due to deficiency-heat, menstrual irregularities, thin tongue coating, dark or pale tongue color, and a thin, wiry pulse. These differ from fright due to yin-blood deficiency, which presents with symptoms like yin deficiency with internal heat. Treatment should focus on nourishing blood and relaxing the liver, regulating qi, and calming the spirit. The recommended formula is Peony and Gardenia Peripatetic Powder with modifications.

The symptom of being easily startled is commonly seen in clinical practice, and the disease causes and mechanisms of disease that lead to being easily startled are also diverse. In addition to the aforementioned discussions, ancient medical texts also record: "Yangming cold extremities, ... easily startled" (Suwen．Jue Lun); "Those with water diseases, when lying down, are startled" (Suwen．Ping Rebing Lun); "The second yang is urgent, leading to being startled" (Suwen．Daqi Lun). These have not been discussed here, and in clinical practice, it is necessary to carefully analyze, examine the evidence to find the cause, and adopt appropriate treatment methods.

bubble_chart Documentation

1. Shoushi Baoyuan："Severe palpitation, palpitation due to fright, and forgetfulness are three symptoms with different names but the same illness."
2. Suwen.Yangming Maijie Chapter: "When the foot Yangming meridian is diseased, it dislikes people and fire... Therefore, those who are startled by the sound of wood are because earth dislikes wood."