bubble_chart Concept

Palpitation below the heart refers to a throbbing sensation in the area below the heart (stomach). The Neijing does not mention the term "palpitation below the heart," but the Suwen．Bi Lun contains the phrase, "In cases of heart impediment, the pulse is obstructed, and when agitated, there is a drumming below the heart." The Huangdi Suwen Zhijie states, "Drumming refers to movement." This indicates that "drumming below the heart" implies a palpitation in that area. The first record of palpitation below the heart appears in the Cold-Damage Disease Treatise, which includes a dedicated section on "palpitation due to fright." The Zhubing Yuanhou Lun discusses the "palpitation condition" in the context of cold-damage disease, focusing on the symptom of "palpitation below the heart" mentioned in the

Cold-Damage Disease Treatise{|113|}. Cheng Wu-ji, in his {|114|}Cold-Damage Disease Mingli Lun{|115|}, treats "palpitation" as a separate topic for discussion. The {|116|}Zhengzhi Zhunsheng{|117|} states, "Palpitation refers to severe palpitation." Since then, physicians throughout history have included palpitation (including palpitation below the heart) in discussions under the categories of "palpitation due to fright" and "severe palpitation." However, the explanation of palpitation below the heart has not gone beyond the scope of the {|118|}Cold-Damage Disease Treatise{|119|}. Palpitation below the heart, palpitation, and palpitation below the navel occur in different locations. The palpitation below the heart discussed in this text refers to the epigastric region. For palpitations in other areas, please refer to the relevant sections.

bubble_chart Pattern Analysis

1. Water Pathogen Attacking Heart︰The heart often palpitates, which worsens with excessive drinking, accompanied by dizziness, vomiting, difficulty in urination, a wiry and slippery pulse, a swollen tongue body, and a slippery, white, moist tongue coating. The predominance of pathogenic factors is due to retained fluid in the stomach that fails to disperse, ascending to harass the heart. "The heart belongs to fire and abhors water; when water stagnates internally, the heart becomes restless" (from *The Expository of Cold Damage Diseases*). Palpitations worsen with drinking, difficulty in urination, dizziness, a wiry and slippery pulse, and a swollen tongue. The treatment should focus on eliminating fluid retention and unblocking yang. The recommended formula is Poria and Liquorice Decoction, or Pinellia and Ephedra Pills.
2. Heart Yang Deficiency︰Palpitations with restlessness, relieved by pressure, accompanied by shortness of breath, chest tightness, fear of cold, cold limbs, pale red tongue texture, and weak small pulse. Partial deficiency is predominant, and the conditions can transform into each other. It is described as "due to internal weakness of yang qi, emptiness below the heart, and stirring of healthy qi, resulting in palpitations" ("Cold-Damage Disease Clarification Theory"). The key diagnostic points are: the patient's characteristic of "crossing hands to cover the heart" and "desiring pressure," accompanied by shortness of breath, fear of cold, and weak small pulse. Treatment should focus on warming and unblocking heart yang. The recommended formulas are Cinnamon TwigLiquorice Root Decoction, orPoria, Cinnamon Twig, White Atractylodes and Licorice Decoction.
3. Yin Deficiency︰Palpitations below the heart, occurring intermittently, accompanied by vexing heat in the chest, palms, and soles, flushed cheeks, dizziness, tinnitus, a thin and rapid pulse, a red tongue texture with scant coating. The root cause is yin deficiency, while the manifestation is exuberant fire. Fire pertains to yang, and yang governs movement. When yin essence lacks its support, there is frenetic stirring of ministerial fire, leading to palpitations. The palpitations below the heart, along with vexing heat in the chest, palms, and soles, a thin and rapid pulse, as well as flushed cheeks and scant tongue coating, are characteristic signs. Treatment should focus on nourishing yin and reducing fire, with Anemarrhena, Phellodendron, and Rehmannia Pill as the primary remedy.
4. Phlegm-Fire Intermingling︰Palpitation and restlessness in the heart region, susceptibility to fright, bitter taste in the mouth, insomnia with dreamfulness, or vomiting of phlegm-drool, slippery and rapid pulse, red tongue texture with yellow greasy coating. The root is phlegm, while fire is the manifestation. {|###|}"Phlegm-fluid retention stagnates in the middle energizer, obstructing the meridians and preventing their free flow, while stagnant fire clashes with phlegm in the heart region" (Zhengzhi Zhunsheng), leading to palpitation in the heart region. The characteristics include palpitation and restlessness in the heart region, susceptibility to fright, bitter taste in the mouth, slippery and rapid pulse, and yellow greasy coating. The treatment should focus on clearing heat and resolving phlegm, with Phlegm-Guiding Decoction as the primary prescription.

Palpitations are a subjective symptom experienced by patients, varying in intensity and often worsening with emotional distress or anger. Clinical practice indicates that, in addition to medication and acupuncture, promoting mental well-being and a cheerful mood are essential factors in treating palpitations.

bubble_chart Documentation

1. Jingui Yaolue．phlegm-fluid retention cough disease Pulse and Symptom Treatment: "When a patient drinks a lot of water, they will inevitably experience sudden dyspnea and fullness. If they eat little but drink a lot, water will stagnate below the heart. In severe cases, this leads to palpitations, and in mild cases, shortness of breath."
2. Zhubing Yuanhou Lun．cold-damage disease Palpitation Condition: "Palpitations refer to a throbbing sensation below the heart. This occurs after the patient has been treated for cold-damage disease with sweating and then purgation. Internal deficiency heat causes thirst, and drinking water leads to water qi attacking the heart, resulting in chills and palpitations below the heart."
3. Zhangshi Yitong．Mental Disorders Section: "Palpitations below the heart can be due to qi deficiency or blood deficiency, and may be related to fluid retention or fire. In cases of qi deficiency, yang qi is internally weak, leading to emptiness below the heart and internal movement causing palpitations. Unstable heart qi and insufficiency of the five zang-organs can result in sorrow, sadness, unhappiness, forgetfulness, palpitations due to fright, and dizziness. Treatments include the Mind-Stabilizing Pill, Poria with Pine Decoction, or Six Gentlemen Decoction with Acorus and Milkwort Root. For blood deficiency, yin qi is internally weak, and deficiency fire moves recklessly. Use Returning to Spleen Decoction with Salvia and Ophiopogon Tuber. For fluid retention, water stagnates below the heart, overwhelming the restricted element. The heart, which fears water, cannot remain calm, leading to constant throbbing. Use Pineilia Poria Decoction, Poria and Liquorice Decoction, or Two Old Ingredients Decoction with White Atractylodes Rhizome, Polyporus, and Alisma. For cases with exterior pathogens and fluid retention, use Pineilia Ephedra Pill or Minor Green-Blue Dragon Decoction. For excessive fire, water cannot control fire, leading to intermittent palpitations and restlessness. Use Celestial Emperor Heart-Tonifying Pill, and if ineffective, Six-Ingredient Pill with five flavors, Ophiopogon Tuber, and Milkwort Root. For palpitations caused by pathogenic qi, identify the specific pathogen before treatment. For cases with depleted nutrient-defense and intermittent pulse, tonify qi, nourish blood, and generate essence with Prepared Liquorice Decoction. For palpitations due to phlegm-fluid retention, use Phlegm-Guiding Decoction with Zao Ren. For intermittent palpitations caused by phlegm and fire, use Gallbladder-Warming Decoction with Chuan Lian."