bubble_chart Concept

Palpitation, known as severe palpitation and restlessness, is commonly referred to as heart palpitations. The "Mingli Lun on Cold-Damage Disease" states: "Palpitation is the unease of the heart, characterized by a pounding and restless movement, a state of constant agitation and inability to find peace."

Palpitation is generally divided into two types: palpitation due to fright and severe palpitation. The former is often triggered by fear or anger, with the overall condition being relatively better and the illness milder; the latter occurs without any fright, with the individual feeling palpitation and restlessness, the overall condition being worse, and the illness more severe. Yixue Zhengzhuan states: "The so-called severe palpitation is a state where the heart feels a constant, uneasy movement and cannot find peace, occurring at any time. Palpitation due to fright is a sudden, jumping, and startling movement with a tendency to faint, occurring at certain times."

bubble_chart Pattern Analysis

1. Heart Qi Deficiency and Weakness︰Palpitation restlessness, complexion pallor, chest fullness shortage of qi, mental fatigue lack of strength, pale lips, cold hands and feet, frequent yawning or sighing, spontaneous sweating laziness in speech, weak and feeble pulse. The main pulse symptoms of palpitation, in addition to the aforementioned common symptoms, also include complexion pallor, physical fatigue lack of strength, tongue texture pale, tongue body swollen and tender, white coating, weak pulse; it is advisable to nourish the heart tonifying qi combined with tranquilize spirit and calm mind, using amber Heart-Nourishing Pill or Heart-Nourishing Decoction.
2. Heart Yang Deficiency︰Palpitation, shortness of qi, weakness, low voice and short breath, chest stuffiness, worse at night, fear of cold, preference for warmth, or even cold limbs, clear and abundant urine, loose stools, deep and faint pulse, or deep and slow pulse, pale tongue texture, white and moist tongue coating. The main symptoms and signs, in addition to the common symptoms mentioned above, include aversion to cold and cold limbs, chest oppression, pale complexion, pale or dark purple tongue texture, weak or intermittent pulse. Treatment: Warming and tonifying heart yang. Prescription: Cinnamon Twig, Liquorice, Fossil Bone, and Oyster Shell Decoction.
3. Insufficiency of Heart Yin︰Palpitation dysphoria, dizziness, blurred vision, flushed cheeks, tinnitus, dry mouth and itchy throat, insomnia with dreamfulness, low-grade fever, night sweats, thin and rapid pulse, red tongue texture, scanty or peeled coating. In addition to the above symptoms, palpitation may also present with low-grade fever, night sweats, vexing heat in the chest, palms, and soles, dry mouth, red tongue with scant fluid, and thin, rapid pulse. Treatment should focus on nourishing yin and reducing fire, tranquilizing the mind and calming the spirit. Recommended formulas are Dingxin Tang or Buyuan Yiyin Tang.
4. Heart Blood Deficiency︰心悸 severe palpitation，complexion dull，restlessness and insomnia，limbs lacking strength，low spirits，pale lips and nails，fine and weak pulse，tongue texture pale with thin white coating. This is generally caused by insufficient production of yin-blood, or secondary to loss of blood (such as excessive postpartum bleeding, menorrhagia and metrostaxis, traumatic bleeding, etc.). It may also result from excessive mental strain leading to deficiency of nutrient-blood and gradual depletion of yin-essence. This results in palpitation, restlessness, susceptibility to fright, insomnia, and forgetfulness. Associated symptoms include vertigo, dull complexion, pale lips and tongue, and a fine weak pulse. Treatment principle: Nourish the heart and replenish blood, tranquilize the spirit and calm the mind. Prescriptions: Returning to Spleen Decoction or Great Life-Endowing Pill.
5. Fright Disturbing the Heart︰Palpitation is characterized by being easily startled, restless, and uneasy; dreamfulness leads to waking easily, with a small and rapid pulse, and a pale red tongue with thin white coating. This condition is mainly caused by sudden fright, "fright causing disorder of qi," which leads to the inability of the heart-mind to remain settled, resulting in restlessness and palpitation. Additionally, "fear causing qi sinking," meaning fear damages the kidney, leads to deficiency of essential qi, resulting in unrelenting palpitation. Treatment should focus on settling the heart and calming the mind, tonifying the heart and supporting deficiency. The recommended formula is Cinnamon Twig Decoction minus Peony Root plus Dichroa Twig and Leaf with Fossil Bone and Oyster Shell Decoction for rescuing rebellion.
6. Heart Blood Stasis and Obstruction︰Palpitation, shortness of breath, chest tightness, hypochondriac pain, and in severe cases, pain radiating to the shoulders and arms, dark purple lips and face, reversal cold of limbs, dry mouth and throat, choppy or intermittent pulse, blue tongue texture, or with ecchymosis, or dark red, with white or yellow coating. The cause is mostly due to deficiency of heart qi or heart yang, resulting in weakened blood circulation. Alternatively, excessive seven emotions, overexertion, or exposure to cold may lead to blood vessel obstruction, forming heart blood stasis and obstruction. The key diagnostic points include palpitation accompanied by stabbing pain or stuffy pain in the chest, often radiating to the inner side of the arm, especially the left arm. The pain is generally severe, intermittent, and in severe cases, accompanied by cyanotic lips and face, reversal cold of limbs, dark red tongue texture or purple spots, scant coating, and faint or choppy pulse. Treatment should focus on regulating qi and resolving stasis, dispelling stasis to unblock collaterals. Prescriptions include Blood House Stasis-Expelling Decoction or Guanxin No. 2.
7. Phlegm-fire Disturbing Heart︰Palpitation dysphoria, oral ulceration and pain, bitter taste in mouth, dry throat, dizziness, insomnia, or hematemesis, epistaxis, slippery and rapid pulse, or wiry and rapid pulse, red tongue tip, yellow or yellow and greasy tongue coating. The causes are often internal eruption of emotional fire, or internal stagnation of six excesses transforming into fire, or excessive consumption of spicy foods, or overuse of warming and tonifying medications. The key points of pattern identification are restlessness with palpitations, irritability and insomnia, oral ulceration, or stiffness of the tongue making speech difficult, red tongue with greasy coating, slippery and rapid pulse. Treatment should focus on clearing heat and resolving phlegm, tranquilizing the mind and calming the spirit. The recommended formulas are Gallbladder-Warming Decoction or Modified Mind-Stabilizing Pill.
8. Water Pathogen Attacking Heart︰Palpitation, chest fullness, dizzy vision, scanty and hesitant urination, pale tongue texture with slippery and moist coating, deep and wiry pulse. This syndrome is mostly caused by deficiency of heart yang leading to upward flooding of water retention. It can be divided into two types: The first is due to debilitation of heart yang combined with spleen and lung qi deficiency, which fails to distribute body fluids, leading to retention and formation of water retention or upward rising of qi. The key diagnostic points are counterflow fullness in the epigastrium, qi rushing up to the chest, palpitation, shortness of breath, dizzy vision, chest oppression, cough, expectoration of thin white phlegm, slippery and moist tongue coating, and deep and wiry pulse. The treatment should focus on unblocking yang and resolving retention, using Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction with modifications. The second type arises from debilitation of heart yang compounded by deficiency of kidney yang, allowing cold water in the lower energizer to go unchecked and flood upward. The key diagnostic points include dizziness and palpitation accompanied by dysuria, muscle twitching, deep pulse, pale tongue texture with white and slippery coating, or symptoms such as soreness and stiffness in the shoulders and back, abdominal pain and diarrhea, or limb edema. The treatment should focus on warming the interior to dissipate cold and promoting urination to eliminate yin, using True Warrior Decoction with modifications.

In the differentiation of palpitations, it is essential to first distinguish between deficiency and excess. Generally, deficiency pattern are predominant, while excess pattern are less common. However, external factors often trigger symptoms due to internal deficiency, leading to a combination of deficiency and excess. Treatment typically focuses on tonifying deficiency, with the elimination of pathogenic factors as a secondary approach. For deficiency pattern, the primary methods include tonifying qi, nourishing blood, enriching yin, and warming yang, with the possible addition of herbs that tranquilize the mind and calm the spirit. For excess pattern, the main strategies are purging fire, eliminating phlegm, promoting blood circulation, and calming fright. In cases where deficiency and excess coexist, it is crucial to identify the primary and secondary aspects and the urgency of the condition to guide the treatment accordingly.

bubble_chart Documentation

1. Zhengzhi Huibu: "The heart is what governs a person, and blood is what nourishes the heart. When the heart blood is deficient, the spirit and qi lose their hold. When the spirit departs, the dwelling becomes empty, and when the dwelling is empty, stagnation occurs, leading to the accumulation of phlegm. When phlegm resides in the heart, this is the origin of palpitation due to fright." "When there is stagnant water and qi that invades the heart, there will be a gurgling sound in the chest, and the deficient qi will flow. Since water has ascended, the heart fire dislikes it, hence the pounding and jumping, causing a feeling of unease, and the pulse will be predominantly wiry." "When yang qi is internally deficient, the area below the heart feels empty, resembling palpitation due to fright, and the right pulse is large and weak." "When yin qi is internally deficient, deficient fire moves recklessly, causing palpitation, emaciation, vexing heat in the chest, palms, and soles, a red face, dry lips, and the left pulse is faint or large and weak."
2. Zhangshi Yitong．Palpitation: "Palpitation refers to severe palpitation. There is a fearful jumping and pounding sensation below the heart, a state of severe palpitation and unease, where there is no external disturbance, but the heart itself is restless and unsettled, which is what is called palpitation."