Rapid throbbing of the heart. Distinction is made between fright palpitation (heart palpitation in the narrow sense) and fearful throbbing.
Fright palpitations are brought on by fright or emotional stimulus and thus are clearly paroxysmal in nature. They occur in both vacuity and repletion patterns. In Western medicine, they are often found to be a nervous disorder. Fearful throbbing occurs continually, and although it is associated with a feeling of fear, it is not brought on by emotional stimulus. It is more severe than fright palpitation and is experienced as a violent throbbing felt not only in the chest, but even as low as the umbilical region. It is observed in patients in a poor state of health and always forms part of vacuity patterns. From the biomedical perspective, it is usually the manifestation of organic rather than nervous disease. In some older books the terms fright palpitation and fearful throbbing appear to have been used interchangeably.
Heart palpitation occurs in a wide variety of patterns and combinations of patterns. The basic patterns include heart-gallbladder vacuity timidity; dual vacuity of the heart and spleen; yīn vacuity with effulgent fire; insufficiency of heart qì; insufficiency of heart yáng; dual vacuity of qì and yīn; water-rheum intimidating the heart; blood stasis obstruction; phlegm-fire harassing the heart.
Patterns
Heart-gallbladder vacuity timidity (心胆虚怯 xīn dǎn xū què) arises when the heart fails to store the spirit and the gallbladder lacks decisiveness. There is a tendency to fear and fright which brings on heart palpitation. Other signs include reduced sleep and profuse dreaming, thin white tongue fur, and a stirred rapid pulse or a vacuous stringlike pulse.
Medicinal therapy: Calm fright and stabilize the mind; nourish the heart and quiet the spirit. Spirit-Quieting Mind-Stabilizing Pill (安神定志丸ān shén dìng zhì wán) is an appropriate formula.
Acumoxatherapy: Base treatment mainly on HT, PC, GB, and back transport points. Select HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), BL-15 (Heart Transport, 心俞 xīn shù), BL-19 (Gallbladder Transport, 胆俞 dǎn shù), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ); needle with supplementation.
Dual vacuity of the heart and spleen (心脾两虚 xīn pí liǎng xū) manifests in heart palpitation or fearful throbbing by causing insufficiency of heart blood that deprives the heart of nourishment. Other signs include lassitude of spirit and shortness of breath, forgetfulness, insomnia, dizzy head and vision, lusterless complexion, spontaneous sweating, pale red tongue, and a fine weak pulse.
Medicinal therapy: Supplement the blood and nourish the heart; boost qì and quiet the spirit. Use Spleen-Returning Decoction (归脾汤guī pí tāng).
Acumoxatherapy: Base treatment mainly on HT, SP, ST, and back transport points. Main points: HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), and BL-15 (Heart Transport, 心俞 xīn shù). Add HT-5 (Connecting Lǐ, 通里 tōng lǐ), BL-17 (Diaphragm Transport, 膈俞 gé shù), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), to engender heart blood. Add BL-20 (Spleen Transport, 脾俞 pí shù), and CV-12 (Center Stomach Duct, 中脘 zhōng wǎn) for dual vacuity of heart and spleen. Needle with supplementation and use moxa on the back transport points. For insomnia, add ST-45 (Severe Mouth, 厉兑 lì duì). For shortness of breath, add BL-13 (Lung Transport, 肺俞 fèi shù).
Effulgent yīn vacuity fire (阴虚火旺 yīn xū huǒ wàng) arises in kidney yīn vacuity when water fails to help fire and prevents the stirring of heart fire (noninteraction of the heart and kidney), or when water fails to restrain fire and the ministerial fire becomes hyperactive and harasses the heart spirit. This condition occurs in patients who do a great deal of mental work. Heart palpitation are accompanied by vexation, heat in the hearts of the palms and soles, reduced sleep and profuse dreaming, dizzy head and vision, tinnitus, upbearing fire flush, lumbar pain, red tongue with thin yellow fur, and a fine rapid pulse.
Medicinal therapy: Enrich yīn and clear fire; nourish the heart and quiet the spirit. Use formulas like Coptis and Ass Hide Glue Decoction (黄连阿胶汤huáng lián ē jiāo tāng).
Acumoxatherapy: Base treatment mainly on HT, PC, KI, and back transport points. Select HT-7 (Spirit Gate, 神门 shén mén), PC-4 (Cleft Gate, 郄门 xī mén), BL-15 (Heart Transport, 心俞 xīn shù), BL-23 (Kidney Transport, 肾俞 shèn shù), BL-14 (Reverting yīn (jué yīn) Transport, 厥阴俞 jué yīn shù), KI-3 (Great Ravine, 太溪 tài xī), KI-6 (Shining Sea, 照海 zhào hǎi), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo). Needle with even supplementation and drainage.
Heart qì vacuity (心气虚 xīn qì xū) is the result of constitutional vacuity, degeneration of health with old age, or enduring illness. It gives rise to heart palpitation by causing feeble movement of blood that deprives the heart of nourishment. In such cases, heart palpitation or fearful throbbing is accompanied by lassitude of spirit and lack of strength, lusterless complexion, spontaneous sweating, laziness to speak, clouded or dizzy head, pale tongue with white fur, and a fine weak or moderate sunken pulse.
Medicinal therapy: Nourish the heart and boost qì; quiet the spirit and stabilize mind. A representative formula is Four Gentlemen Panting Decoction (喘四君子汤chuǎn sì jūn zǐ tāng).
Acumoxatherapy: Base treatment mainly on HT, PC, CV, and back transport points. Select HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), BL-15 (Heart Transport, 心俞 xīn shù), CV-6 (Sea of Qì, 气海 qì hǎi), CV-4 (Pass Head, 关元 guān yuán), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ). Needle with supplementation and use moxa.
Heart yáng vacuity (心阳虚 xīn yáng bù zú) shares the same causes as insufficiency of heart qì and differs by the further presence of cold signs. Heart palpitation are exacerbated by physical movement and is accompanied by physical cold and cold limbs, a somber-white facial complexion, oppression in the chest and shortness of breath, a pale tongue with white fur, a forceless sunken fine or vacuous weak pulse.
Medicinal therapy: Warm and supplement heart yáng; quiet the spirit and stabilize mind. A representative formula is Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction (桂枝甘草龙骨牡蛎汤guì zhī gān cǎo lóng gǔ mǔ lì tāng).
Acumoxatherapy: Base treatment mainly on HT, PC, CV, and back transport points. Select HT-7 (Spirit Gate, 神门 shén mén), BL-15 (Heart Transport, 心俞 xīn shù), CV-14 (Great Tower Gate, 巨阙 jù què), PC-6 (Inner Pass, 内关 nèi guān), and GV-4 (Life Gate, 命门 mìng mén); needle with supplementation and add moxa.
Dual vacuity of qì and yīn (气阴两虚 qì yīn liǎng xū) causes heart palpitation or fearful throbbing accompanied by reddening of the cheeks, coughing of blood-flecked phlegm, oppression in the chest, shortness of breath, lusterless complexion, spontaneous or night sweating, red tongue with little fur, and a rapid fine pulse that may be irregular.
Medicinal therapy: Treat by boosting qì and nourishing the heart and by enriching yīn blood. A representative formula is Honey-Fried Licorice Decoction (炙甘草汤zhì gān cǎo tāng).
Acumoxatherapy: Base treatment mainly on HT, PC, CV, and back transport points. Select HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), BL-15 (Heart Transport, 心俞 xīn shù), CV-14 (Great Tower Gate, 巨阙 jù què), CV-6 (Sea of Qì, 气海 qì hǎi), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo). Needle with supplementation. If vacuity fire signs are not pronounced, moxa can also be used. For spontaneous or night sweating, add LI-4 (Union Valley, 合谷 hé gǔ), SI-3 (Back Ravine, 后溪 hòu xī), and HT-6 (Yīn Cleft, 阴郄 yīn xī). For coughing of blood and oppression in the chest, add LU-5 (Cubit Marsh, 尺泽 chǐ zé) and BL-13 (Lung Transport, 肺俞 fèi shù). For pronounced vacuity fire, add HT-8 (Lesser Mansion, 少府 shào fǔ), needling with drainage.
Water qì intimidating the heart (水气凌心 shuǐ qì líng xīn) has its root in spleen-kidney yáng vacuity and is associated with signs of impaired movement of water such as short voidings of scant urine and swelling of the lower limbs. In addition to these signs, heart palpitation are accompanied by glomus and fullness in the chest and stomach duct, thirst with no desire to drink, physical cold and cold limbs, dizziness, vomiting and ejection of drool, pale tongue with glossy fur, and a slippery stringlike pulse or a slippery fine sunken pulse.
Medicinal therapy: Supplement yáng, promote qì transformation, and move water. A representative formula is Poria, Cinnamon Twig, White Atractylodes, and Licorice Decoction (苓桂朮甘汤líng guì zhú gān tāng).
Acumoxatherapy: Base treatment mainly on ST, HT, PC, CV, and back transport points. Select HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), BL-15 (Heart Transport, 心俞 xīn shù), BL-22 (Triple Burner Transport, 三焦俞 sān jiāo shù), BL-20 (Spleen Transport, 脾俞 pí shù), CV-17 (Chest Center, 膻中 shān zhōng), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and ST-40 (Bountiful Bulge, 丰隆 fēng lóng). Needle with supplementation.
Heart blood stasis obstruction (心血瘀阻 xīn xuè yū zǔ) is traceable to depressed liver qì and lung qì congestion, and spleen, kidney, and lung vacuity. In such patterns, heart palpitation are accompanied by periodic heart pain like the stabbing of a needle. Other signs include oppression in the chest, green-blue or purple nails, a tongue that is purple in color or bears stasis speckles, and a rough or interrupted pulse.
Medicinal therapy: Quicken the blood and transform stasis; rectify qì and free the network vessels. A representative formula is Peach Kernel and Carthamus Brew (桃仁红花煎táo rén hóng huā jiān).
Acumoxatherapy: Base treatment mainly on HT, PC, SP, LR, and back transport points. Select BL-15 (Heart Transport, 心俞 xīn shù), HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), CV-17 (Chest Center, 膻中 shān zhōng), BL-17 (Diaphragm Transport, 膈俞 gé shù), SP-10 (Sea of Blood, 血海 xuè hǎi), LI-4 (Union Valley, 合谷 hé gǔ), and LR-3 (Supreme Surge, 太冲 tài chōng); needle with even supplementation and drainage.
Phlegm-fire harassing the heart (痰火扰心 tán huǒ rǎo xīn) causes heart palpitation induced by fright, accompanied by oppression in the chest, vexation and agitation, profuse nightmares, and dry mouth with bitter taste. Other signs include insomnia, constipation, yellow or reddish urine, slimy yellow tongue fur, and a slippery stringlike pulse.
Medicinal therapy: Clear heat and transform phlegm; quiet the heart spirit. A representative formula is Coptis Gallbladder-Warming Decoction (黄连温胆汤huáng lián wēn dǎn tāng).
Acumoxatherapy: Base treatment mainly on ST, HT, PC, GB, and back transport points. Select HT-7 (Spirit Gate, 神门 shén mén), PC-6 (Inner Pass, 内关 nèi guān), BL-15 (Heart Transport, 心俞 xīn shù), ST-40 (Bountiful Bulge, 丰隆 fēng lóng), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), and LU-5 (Cubit Marsh, 尺泽 chǐ zé); needle with drainage. For oppression in the chest, add CV-17 (Chest Center, 膻中 shān zhōng). For vexation, add PC-5 (Intermediary Courier, 间使 jiān shǐ). For insomnia, nightmares, and profuse dreaming, add ST-45 (Severe Mouth, 厉兑 lì duì).