Palpitation

Palpitation refers to unduly rapid action of the heart which is felt by the patient and accompanied by nervousness and restlessness .

Mild palpitation is mostly due to a sudden fright and overstrain . The general condition is comparatively good and the symptoms are of short duration . A serious case is often due to prolonged internal injury . The general condition is comparatively poor and the symptoms are severe .

Etiology and Pathogenesis

Disturbance of the mind :

A timid person is likely to have palpitation when he or she is frightened by strange noises , surprising objects , or dangerous environments . In Chapter 19 of Plain Questions , it says : Fright makes qi disturbed because the heart has nothing to rely on , the mind has no place to house and the thinking has nothing to focus on . There are other pathogenic factors causing palpitation , such as internal accumulation of phlegm heat , mental depression and anger , dysfunction of the stomach and upward perversion of phlegm Fire .

Insufficiency of qi and blood :

Persistent disease , weak constitution , loss of blood , or overthinking damages the heart and spleen , and impedes the production of qi and blood . Deficiency of qi and blood fails to nourish the heart , which affects the housing of the mind , causing palpitation .

Hyperactivity of the fire due to yin deficiency :

Injury of kidney yin by indulgent sexual activity , or debility after a prolonged disease renders the kidney water unable to check the heart fire . Disharmony between the heart and kidney with flaring fire disturbing the mind causes palpitation .

Retention of harmful fluid :

Retention of harmful fluid due to depression of the heart yang or due to deficiency of the spleen and kidney yang disturbs the heart , resulting in palpitation .

Differentiation

Disturbance of the mind :

Main manifestations : Palpitation , fear and fright , irritability , restlessness , dream - disturbed sleep , anorexia , white , thin tongue coating , a little bit rapid pulse . In cases of phlegm heat , yellow , sticky tongue coating , rolling , rapid pulse .

Analysis : Fear makes the qi flow disordered , and fright makes qi descend . A disturbed mind is out of self - control , so there are palpitation , fear and fright , dream - disturbed sleep , irritability and restlessness . White thin tongue coating and a little bit rapid pulse are the signs of disturbance of the mind . Yellow sticky coating , and rolling , rapid pulse indicate the presence of phlegm heat .

Insufficiency of qi and blood :

Main manifestations : Palpitation , lusterless complexion , dizziness , blurring of vision , shortness of breath , lassitude , pale tongue with tooth prints , thready , weak or intermittent pulse .

Analysis : Palpitation is due to insufficiency of qi and blood , which fails to nourish the heart . Lusterless complexion is due to the insufficient qi and blood unable to luster the complexion . Dizziness is due to the poor nourishment of the brain by the insufficient qi and blood . The heart dominates the blood and vessels and is manifested in the tongue . Therefore insufficient qi and blood makes the tongue pale with tooth prints , and the pulse thready , weak or intermittent .

Fire hyperactivity due to yin deficiency :

Main manifestations : Palpitation , restlessness , irritability , insomnia , dizziness , blurring of vision , tinnitus , red tongue with little coating , thready , rapid pulse .

Analysis : Kidney yin in deficiency state fails to check the heart fire , leading to disturbance of the mind , and resulting in palpitation , irritability and insomnia . When yin deficiency is present in the lower part of the body , and yang hyperactivity in the upper , there may be dizziness and tinnitus . Red tongue with little coating , and thready rapid pulse are the signs of yang hyperactivity due to yin deficiency .

Rentention of harmful fluid :

Main manifestations : Palpitation , expectoration of mucoid sputum , fullness in the chest and epigastric region , lassitude , weakness , cold extremities , white tongue coating , string - taut , rolling pulse . In case of deficiency of yang in the spleen and kidney , scanty urine , thirst without desire to drink , white , slippery tongue coating , deep , string - taut or rapid pulse .

Analysis : Accumulation of dampness forms the harmful fluid , which depresses the heart yang . When the yang qi is unable to reach the extremities , they are cold and weak . White tongue coating , string - taut , rolling pulse suggest the presence of harmful fluid . Unsmooth circulation of qi resulting from yang deficiency of the spleen and kidney gives rise to scantiness of urine and thirst without desire to drink . White , slippery tougue coating and deep , string - taut pulse are due to yang deficiency of the spleen and kidney and retention of fluid . Rapid pulse indicates the decline of the heart yang .

Treatment

Method : The Back - ( Shu ) and Front - ( Mu ) points of the heart , and points of the Heart and Pericardium Meridians are selected as the main points . Even movement is applied for disturbance of the mind to clam the heart . Reinforcing is used for insufficiency ofqi and blood to nourish the heart and ease the mind . Reinforcing combined with reducing is applied for fire hyperactivity due to yin deficiency to nourish yin and subdue the fire . For retention of harmful fluid , reducing method is applied first and then reinforcing in combination with moxibustion to warm yang and dissolve the harmful fluid .

Prescription : Xinshu ( B 15 ) , Juque ( Ren 14 ) , Shenmen ( H 7 ) , Neiguan ( P 6 ) . Supplementary points : Disturbance of the mind : Tongli ( P 5 ) , Qiuxu ( G 40 ) ; if accompanied with phlegm heat : Fenglong ( S 40 ) , Danshu ( B 19 ) .

Insufficiency of qi and blood : Pishu ( B 20 ) , Weishu ( B 21 ) , Zusanii ( S 36 ) .

Fire hyperactivity due to yin deficiency : Jucyinshu ( B 14 ) , Shenshu ( B 23 ) , Taixi ( K 3 ) .

Retention of harmful fluid : Shuifen ( Ren 9 ) , Guanyuan ( Ren 4 ) , Shenque ( Ren 8 ) , Yinlingquan ( Sp 9 ) .

Explanation : The combination of Shenmen ( H 7 ) , the Yuan - ( Primary ) point of the Heart Meridian , and Xinshu ( B 12 ) with Juque ( Ren 14 ) , the Front - ( Mu ) point of the heart , and Neiguan ( P 6 ) , the Luo - ( Connecting ) point of the Pericardum Meridian can regulate qi and blood of the heart to ease the mind . The combination of Tongli ( H 5 ) , the Luo - ( Connecting ) point of the Heart Meridian , and Qiuxu ( G 40 ) , the Yuan - ( Primary ) point of the Gallbladder Meridian , can calm the mind and regulate the gallbladder . Fenglong ( S 40 ) , the Luo - ( Connecting ) point of the Stomach Meridian , and Danshu ( B 19 ) , the Back - ( Shu ) point of the gallbladder , can dissolve phlegm and dispel heat . Pishu ( B 20 ) and Weishu ( B 21 ) can regulate the spleen and stomach to promote qi and blood production . Zusanii ( S 36 ) is an important point to reinforce qi and blood . Shenshu ( B 23 ) and Taixi ( K . 3 ) can replenish kidney yin . Jueyinshu ( B 14 ) can clear heart fire . Guanyuan ( Ren 14 ) , Shuifen ( Ren 9 ) and Yinlingquan ( Sp 9 ) can invigorate the heart yang , strengthen the spleen and remove the harmful fluid .

Remarks

Palpitation described here may be involved in neurosis , functional disorders of the vegetative nervous system and cardiac arrhythmia of various origins .