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Condition Treated / Pain Conditions

Palpitations

Palpitations include fright palpitations and fearful throbbing and refer to an unpleasant and uncontrollable awareness of the rapid heart beat with panic or uneasiness.

Clinically palpitations are always paroxysmal and can be induced by emotional fluctuation or
overexertion. The associated symptoms of palpitations include shortness of breath, chest
stuffiness, or even dizziness and dyspnea.

The treatment of palpitations based on syndrome differentiation also applies to some diseases in Western medicine that present with palpitations such as arrhythmia (tachycardia, bradycardia, premature systole, atrial fibrillation or atrial flutter), cardiac insufficiency and neurosis.

Etiology and pathogenesis

1. Weak constitution: Congenital deficiency of constitution, deficiency of both the spleen and
stomach leading to inadequate qi and blood generation and transformation, or malnutrition due to
chronic diseases and overexertion or over-indulgence may result in deficiency of qi and blood,
failing to nourish the heart and subsequently palpitations.

2. Improper diet and overexertion: Overeating fatty, greasy food and fried food may produce
heat-fire and phlegm and the phlegm-fire in tum disturbs the heart, leading to palpitations; or
improper diet impairs the spleen and stomach and affects their function in transportation and
transformation, leading to internal retention of water-dampness, which in tum obstructs the normal
flow of heart qi and subsequently palpitations.

3. Emotional injuries: Out-flowing of heart-qi due to congenital timid temperament
plus sudden fright or emergent situation may cause continuous palpitations; or too much mental
stress impairs the heart and spleen and consumes the heart-blood, which in tum damages the function of the spleen and stomach, leading to inadequate qi and blood generation and transformation that fails to nourish the heart and subsequently causes palpitations; chronic depression, liver qi stagnation, blood stasis, obstruction of heart vessels, and malnutrition of heart-blood may result in palpitations; or fury damages the liver and causes upward-flare of liver-fire, which in tum disturbs the heart-mind and results in palpitations.

4. External contraction of pathogenic factors: Congenital deficiency of heart qi, retention
of wind, dampness and heat in the heart obstructing the heart-vessels and leading to blood stasis
and subsequently leading to uneasiness of the heart-mind; or wind, cold and damp-heat attack the
heart and damage qi and yin of the heart, leading to palpitations; or epidemic toxic due to febrile
diseases may disturb the heart mind, scorch the Ying-nutrient yin and cause malnutrition of the
heart and subsequently palpitations.

5. Drug poisoning: Overdose or severe toxic side effects of drugs may affect the heart and result
in palpitations, for example, overdose or inappropriate administration of Fu Zi (Radix Aconiti
Praeparata), Wu Tou (Radix Aconiti), or digitalis, adrenalin and atropine may induce palpitations).

As far as the pathogenesis is concerned, deficient syndromes are more common than excessive
syndromes, and the mixed deficient and excessive syndrome is also possible. Deficient syndromes are usually caused by malnutrition of the heart due to deficiency of qi, blood, yin and yang. Excessive syndromes are sually caused by obstruction of the flow of qi and blood due to phlegm-turbid, qi stagnation and blood stasis or exogenous pathogenic factors blocking the heart-vessels. The palpitations is located in the heart and closely related to dysfunction of the spleen, lung, liver and kidney. The pathogenesis of palpitations is the heart failing to be nourished or the heart failing to dominate mind.

Identification of Patterns

Chief symptoms Paroxysmal subjective feeling of an uncertain heartbeat accompanied by terror
and fright and restlessness.

The pattern of heart-gallbladder deficiency may be accompanied by lassitude,insomnia, dreaminess, a light-colored tongue with a thin coating and a wiry, thready pulse, and the palpitation is often provoked by fear.

The pattern of heart-spleen deficiency may be accompanied by dizziness and blurred vision, poor appetite, lassitude, lusterless complexion, insomnia, profuse dreaming, a pale tongue with a thin white coating and a thready, weak pulse.

The pattern of effulgent fire due to yin deficiency may be accompanied by restlessness, insomnia, dizziness and blurred vision, tinnitus, soreness in the loins, dry mouth, a red tongue with a thin white coating and a thready, rapid pulse.

The pattern of obstruction of heart vessels may be accompanied by oppression in the chest, paroxysmal pain in the heart, shortness of breath, lassitude, a dark purple tongue with possible ecchymosis and a thready, rough or irregular pulse.

The pattern of water qi intimidating the heart may be accompanied by oppression in the chest, inability to supinate, expectoration of profuse frothy sputum, coldness in the body and limbs, a pale tongue with a white slippery coating and a slippery, rapid and racing pulse.

Treatment

(1) Primary treatment

Principal points Neiguan (PC 6), Ximen (PC 4), Shenmen (HT 7), Xinshu (BL 15) and Juque (CV14).
Supplementary points In the pattern of heart-gallbladder deficiency, add Danshu (BL 19) and
Tongli (HT 5); in the pattern of heart-spleen deficiency, add Pishu (BL 20) and Zusanli (ST 36); in
the pattern of effulgent fire due to yin deficiency, add Shenshu (BL 23) and Taixi (Kl 3); in the
pattern of obstruction of heart vessels, add Danzhong (CV 17) and Geshu (BL 17); in the pattern of
water-qi intimidating the heart, add Shenque (CV 8) and Qihai (CV 6); in case of susceptibility
to fright, add Daling (PC 7); in case of hydrosis, add Gaohuang (BL 43); in case of restlessness and fever, add Laogong (PC 8); in case of tinnitus, add Zhongzhu (TE 3); and in case of edema, add Shuifen (CV 9). Explanation Neiguan (PC 6) and Ximen (PC 4), the respective Luo-Connecting Point and Xi-Cleft Point of the pericardium channel, are selected to regulate heart-qi and conduct qi and blood. Shenmen (HT 7), the Yuan-Source Point of the heart channel, is used to tranquilize the heart and subside palpitations. The joint use of Xinshu (BL 15) and Juque (CV 14), the respective Back-Shu Point and Front-Mu Point of the heart, is used to benefit heart-qi and tranquilize the heart-spirit to regulate qi dynamics of the heart. Cooperation from all of the above points can calm and
tranquilize the frightened spirit.

(2) Alternate methods of treatment

Auricular acupuncture Select Sympathesis (AH 6a), Shenmen (TF 4), Heart (CO 15), Spleen (CO 13), Liver (CO 12), Gallbladder (CO 11) and Kidney (CO 10). Puncture the points using a mild stimulation. Needle embedding or ear-pressure with wang bu liu xing (Semen Vaccariae) is applicable as well.

(3) Commonly-used patent Chinese herbal products:

1. Ren Shen Gui Pi Wan Actions: Supplements qi, strengthens the spleen, nourishes blood and calms the mind. Indications: Palpitations due to deficiency of both the heart and spleen.
2. Shen Fu Qiang Xin Wan Actions: Supplements qi, invigorates yang, strengthens
the heart and induces diuresis. Indications: Palpitations due to heart-yang deficiency or water-retention affecting the heart.
3. Shu Xin Ke Li Actions: Promotes blood circulation and resolves stasis, nourishes yin and
supplements qi. Indications: Palpitations of due to heart-blood stasis.
4. Zhi Gan Cao He Ji Actions: Supplements qi, nourishes yin, invigorates yang and tonifies blood.
Indications: Palpitations due to deficiency of qi and blood.
5. Guan Xin Sheng Mai Kou Fu Ye Actions: Supplements qi, generates fluids; promotes blood
circulation and clears meridians. Indications: Palpitations due to hyperactivity of fire due to
yin deficiency.

Life stye recommendations

1. Keep regular diet habits, avoid hot, spicy food or roast or fried food as well as cigarettes,
alcohol and strong tea and take low-fat and low-salt food;
2. Keep mental fitness and regular emotion and avoid terror stimulation and too much mental stress;
3. Keep healthy life style, avoid overexertion, and do proper physical exercises to
keep normal circulation of qi and blood and healthy.

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