Palpitation refers to a subjective sensation of unduly rapid heart beats which is usually accompanied by nervousness and restlessness. It is mostly paroxysmal in character and induced by emotional upsets or overstrain, and is often associated with insomnia, dizziness, tinnitus and amnesia. Palpitation may be seen in various kinds of organic diseases, arrhythmia, anemia, hyperthyroidism and vegetative neurosis, and syndrome differentiation and treatment of such cases may be found in this section.

Etiology and Pathogenesis

A. Mental disorder: Timidity, fright and rage may lead to impairment of the liver and kidneys, deficiency of yin and hyperactivity of fire. As a result, the heart-qi and gallbladder-qi are weakened, the mind becomes uncontrollable and palpitation ensues.

B. Undernourishment of the heart: A weak constitution resulting from prolonged illness, impairment of the heart and spleen by Anxiety and overstrain and consumption of yin-blood after blood loss may cause an under-nourished status of the heart, which leads to palpitations.

C. Deficiency of kidney-yin: Insufficiency of yin-essence resulting from prolonged illness, sexual indulgence, frequent emissions and frequent childbirth impair kidney-yin. Deficiency of kidney-yin leads to flaming-up of asthenia-fire and disturbance of heart and mind, resulting in palpitations.

D. Deficiency of yang-qi: Serious or longstanding diseases may consume and weaken yang-qi, so that the heart and blood vessels are not warmed and nourished, and palpitation occurs. In addition, obstruction of heart-yang by fluid retention resulting from the deficiency of spleen-yang and kidney-yang or accumulation of blood stasis in the heart after a prolonged suffering of by-syndrome may also lead to palpitations.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

Palpitations of the sthenic type are caused by phlegm, fire or blood stasis. Those due to phlegm-fire are usually accompanied by irritability, chest fullness and upset, feverish sensations, insomnia and dreaminess; those due to phlegm retention, by dizziness, chest and epigastric fullness, dyspnea and edema; and those due to blood stasis, by cardialgia and cyanosis of lips and nails. Palpitations of the asthenic type usually appears as marked subjective heart throbbing. Those with deficiency of hear-qi or heart-yang are characterized by palpitations aggravated by exercise, hollow sensations, shortness of breath and fatigue; while those with deficiency of heart-blood or heart-yin by palpitations aggravated by mental stress and vexation.  

B. Therapeutic principles 

The therapy of nourishing blood, benefiting qi, tonifying yin and warming yang should be employed for cases of asthenic type. That of warming yang and activating qi, clearing away heat and eliminating phlegm, activating blood circulation and eliminating blood stasis is adopted for the cases of sthenic type. Since mental intranquility and subjective heart throbbing are the chief symptoms of this disorder, despite asthenic or sthenic types, drugs for calming and nourishing the heart and tranquiling the mind such as Magnetitum, Os Draconis, Dens Draconis, Concha Ostreae, Semen Ziziphi Spinosae, Semen Biotae, etc., should be applied.

Classification and Treatment

A. Deficiency of heart and gallbladder

Manifestations: Palpitations, restlessness, timidness, insomnia dreamfulness, thin white tongue coating and feeble, rapid or slow irregular pulse.

Therapeutic principles: Nourish the heart and tranquilize the mind.

Prescription: The Modification of Tranquilizing Pill

Poria 15 g
Radix Polygalae 10 g
Radix Codonopsis Pilosulae 12 g
Rhizoma Acori Graminei 10 g
Dens Draconis (decocted first) 30 g
Magnetitum 30 g
Semen Ziziphi Spinosae 15 g
Cinnabaris (mixed with decoction) 0.6 g
Radix Glycyrrhizae Praeparata 10 g

B. Insufficiency of heart blood

Manifestations: Palpitations, dizziness, pallor, fatigue, reddish tongue and thready and weak pulse.

Therapeutic principles: Tonify blood, nourish the heart, benefit qi and tranquilize the mind.

Prescription: The Modified decoction for Invigorating the Spleen and Nourishing the Heart

Radix Pseudostellariae 12 g
Radix Astragali Praeparata 12 g
Radix Angelicae Sinensis 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae Praeparata 10 g
Lignum Pini Poriaferum 10 g
Semen Ziziphi Spinosae 12 g
Caulis Polygoni Multiflori 30 g
Pericarpium Citri Reticulatae 10 g

Remarks: For cases with slow and irregular pulse due to deficiency of qi and blood, use the Decoction of Glycyrrhizae Praeparata, composed of Radix Ginseng, Radix Glycyrrhizae Praeparata, Colla Corii Asini, Radix Ophiopogonis, Radix Rehmanniae, and Ramulus Cinnamomi. For cases with impairment of heart-yin during the late stage of febrile disease, use the Modification of the Powder for Restoring Pulse Beat including Radix Ginseng, Radix Ophiopogonis, Fructus Schisandrae, Radix Adenophorae Strictae, Rhizoma Polygonati Odorati and Radix Scrophulariae.

C. Yin-deficiency with fire-hyperactivity 

Manifestations: Palpitations, restlessness, insomnia, dizziness, feverish sensation of palms and soles, lumbago, tinnitus, red tongue with little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin, clear away fire, tonify the heart and tranquilize the mind.

Prescription: The Modification of King of Heaven Tonic Pills for Mental Discomfort

Radix Rehmanniae 15 g
Radix Ophiopogonis 10 g
Radix Scrophulariae 15 g
Radix Pseudostellariae 10 g
Radix Adenophorae Strictae 12 g
Fructus Schisandrae 10 g
Radix Salviae Miltiorrhizae 15 g
Radix Glycyrrhizae Praeparata 6 g
Semen Ziziphi Spinosae 15 g
Cinnabaris (mixed with decoction) 0.6 g
Lignum Pini Poriaferum 10 g

Remarks: For cases with hyperactivity of prime-minister fire manifested with feverish sensation over the chest, palms and soles and nocturnal emissions, use the Bolus of Anemarrhenae, Phellodendri and Rehmanniae.

D. Deficiency of heart-yang

Manifestations: Palpitations, restlessness, shortness of breath, chest distress, pale complexion, coldness of limbs, pale tongue and weak or deep and thready pulse.

Therapeutic principles: Tonify and warm heart-yang and tranquilize the mind.

Prescription: The Modified Decoction of Ramulus Cinnamomi, Glycyrrhizae, Os Draconis and Concha Ostreae

Ramulus Cinnamomi 10 g
Radix Glycyrrhizae Praeparata 10 g
Os Draconis (decocted first) 30 g
Concha Ostreae (decocted first) 30 g
Poria 15 g
Radix Astragali Praeparata 12 g
Rhizoma Polygonati 12 g
Rhizoma Zingiveris (dried) 5-10 g

Remarks: For serious cases with polyhidrosis, coldness of limbs, dyspnea and cyanosis of face and lips, add Radix Ginseng, Radix Aconiti Lateralis Praeparata and Pill of Starnum Nigrum to recuperate the depleted yang and rescue the patient from danger. Use the Modified Decoction of Ephedrae, Aconiti Lateralis and Asari with Glycyrrhizae, Polygonati and Rehmanniae for those with deficiency of both heart-yang and kidney-yang and interior accumulation of yin-cold manifested by palpitation with hollow sensation, slow and deep pulse, aversion to cold and coldness of limbs.

E. Impairment of heart by fluid retention

Manifestations: Palpitations, dizziness, fullness in the chest and epigastrium, nausea, salivation, edema, dyspneic cough, white and moist tongue coating and wiry and smooth pulse.

Therapeutic principles: Activate heart-yang and promote the circulation of qi and body fluids.

Prescription: The Modified Decoction of Poria, Ramulus Cinnamomi, Atractylodis Macrocephalae and Glycyrrhizae

Poria 30 g
Rhizoma Atractylodis Macrocephalae 10 g
Ramulus Cinnamomi 10 g
Radix Glycyrrhizae Praeparata 6 g
Rhizoma Pinelliae 10 g
Rhizoma Zingiveris Recens 10 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Alismatis 10-30 g
Radix Salviae Miltiorrhizae 15 g

F. Stagnation of heart-blood

Manifestations: Palpitations, restlessness, chest distress, cardialgia, cyanosis of lips and nails, dark purplish tongue with petechiae and uneven or slow and irregular pulse.

Therapeutic principles: Activate blood circulation, dissipate blood stasis, regulate qi and dredge meridians.

Prescription: The Modification of Persicae and Carthami Decoction

Flos Carthami 10 g
Radix Salviae Miltiorrhizae 15-30 g
Radix Paeoniae Rubra 10 g
Rhizoma Chuanxiong 10 g
Lignum Santali (decocted later) 10 g
Radix Curcumae 10 g
Ramulus Cinnamomi 6 g
Radix Glycyrrhizae Praeparata 10 g
Poria 15 g
Pericarpium Citri Reticulatae 10 g

Experiential Prescriptions

A. Radix Codonopsis Pilosulae (15 g), Radix Scrophulariae (15 g), Radix Ophiopogonis (10 g) and Fructus Schisandrae (9 g); prepared as decoction; applicable to cases due to qi and yin deficiency.

B. Lignum Pini Poriaferum 910 g), Semen Ziziphi Spinosae (15-30 g) and Rhizoma Coptidis (3 g); applicable to cases caused by insufficiency of yin-blood and characterized by feverish sensation and insomnia.

C. Arillus Longan, Semen Juglandis, Semen Sesami and Fructus Jujubae; steamed or decocted for 30-60 minutes; a small amount to be taken daily; applicable to cases with insufficiency of qi and blood and deficiency of yin and yang.

Copyright 1995 Hopkins Technology