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Palpitation, known as severe palpitation and restlessness, is commonly referred to as heart palpitations. The "Ming Li Lun of Cold-Damage Disease" states: "Palpitation refers to the feeling of unease in the heart, characterized by a throbbing and restless sensation, and an inability to feel at ease."

Palpitation is generally divided into two types: fright palpitation and severe palpitation. The former is often triggered by fear or anger, with the overall condition being relatively good and the illness mild; the latter occurs without any fright, with a self-perceived sense of palpitation and restlessness, a poorer overall condition, and a more severe illness. Yixue Zhengzhuan ．Severe Palpitation and Forgetfulness Syndrome" states: "Severe palpitation refers to a constant, uneasy throbbing in the heart that prevents one from feeling calm. Fright palpitation refers to a sudden, startling jump that feels as if one is about to faint, occurring intermittently."

bubble_chart Common Symptoms and Signs

1. Heart Qi Deficiency Palpitation: Restless palpitations, pale complexion, chest fullness with shortness of breath, fatigue, pale lips, cold hands and feet, frequent yawning or sighing, spontaneous sweating, reluctance to speak, weak and feeble pulse.
2. Heart Yang Deficiency Palpitation: Palpitations with shortness of breath, lack of energy, low voice, chest tightness, worse at night, aversion to cold and preference for warmth, cold limbs, clear and abundant urine, loose stools, deep and faint or deep and slow pulse, pale tongue with moist white coating.
3. Insufficiency of Heart Yin Palpitation: Palpitations with irritability, dizziness, tinnitus, red cheeks, dry mouth and itchy throat, insomnia with frequent dreams, low-grade fever and night sweats, thin and rapid pulse, red tongue with little or no coating.
4. Insufficiency of Heart Blood Palpitation: Palpitations with severe restlessness, dull complexion, irritability and insomnia, weakness in hands and feet, lack of energy, pale lips and nails, thin and weak pulse, pale tongue with thin white coating.
5. Fright Disturbing the Heart Palpitation: Palpitations with frequent fright, restlessness, easily awakened from dreams, small and rapid pulse, pale red tongue with thin white coating.
6. Heart Blood Stasis and Obstruction Palpitation: Palpitations with shortness of breath, chest tightness and hypochondriac pain, severe pain radiating to the shoulders and arms, dark purple lips and face, cold limbs, dry mouth and throat, choppy or intermittent pulse, bluish tongue or with ecchymosis, purple or crimson tongue, white or yellow coating.
7. Phlegm-Fire Disturbing the Heart Palpitation: Palpitations with irritability, mouth and tongue sores, bitter taste and dry throat, dizziness and insomnia, or vomiting blood and nosebleeds, slippery and rapid or wiry and rapid pulse, red tongue tip, yellow or greasy yellow coating.
8. Water Pathogen Attacking the Heart Palpitation: Palpitations with chest fullness, dizziness, scanty urine, pale tongue with slippery coating, deep and wiry pulse.

bubble_chart Differential Analysis

1. Heart qi deficiency and heart yang deficiency palpitation: Both belong to the pattern of heart deficiency, and their disease causes are generally similar. They are often caused by the decline of visceral qi in the elderly, prolonged illness without recovery, or injury to qi and blood due to excessive sweating or purging. The common symptoms of both are: palpitation, shortness of breath, spontaneous sweating, and worsening with activity or exertion. The key points for differentiation are: For heart qi deficiency palpitation, in addition to the common symptoms mentioned above, it is accompanied by a pale complexion, fatigue, a pale and swollen tongue with a white coating, and a weak pulse. For heart yang deficiency palpitation, in addition to the common symptoms mentioned above, it is accompanied by cold limbs, chest tightness, a pale or purplish tongue, and a faint or irregular pulse. Treatment methods: For the former, it is advisable to nourish the heart and tonify qi while tranquilizing the spirit and calming the mind. The prescription used is Amber Heart-Nourishing Pill or Heart-Nourishing Decoction. For the latter, it is advisable to warm and tonify heart yang. The prescription used is Cinnamon Twig, Liquorice, Fossil Bone, and Oyster Shell Decoction.
2. Insufficiency of heart yin and insufficiency of heart blood palpitation: Both belong to the pattern of heart deficiency. The disease causes are also generally the same, usually due to insufficient sources of yin-blood generation, or secondary to blood loss (such as excessive postpartum bleeding, menorrhagia and metrostaxis, traumatic bleeding, etc.), or due to excessive mental strain leading to nutrient-blood deficiency and hidden consumption of yin essence. The common symptoms of both are palpitation, heart vexation, easy fright, insomnia, and forgetfulness. The key points of differentiation: In addition to the above symptoms, insufficiency of heart yin palpitation is accompanied by low fever, night sweating, five-center heat, dry mouth, red tongue with little fluid, and thin rapid pulse; insufficiency of heart blood palpitation is accompanied by vertigo, dull complexion, pale lips and tongue, and thin weak pulse. Treatment: The former should nourish yin and reduce fire, tranquilize the mind and calm the spirit, using Dingxin Decoction or Buyuan Yiyin Decoction; the latter should nourish the heart and benefit blood, tranquilize the spirit and calm the mind, using Returning to Spleen Decoction or Heche Great Life-Endowing Pill.
3. Fright disturbing heart palpitation: This syndrome is mainly caused by sudden fright, "fright causing disorder of qi" leading to the heart spirit being unable to control itself, resulting in restlessness and palpitation; also "fear causing qi sinking" which is so-called fear damaging the kidney, essential qi becoming timid, leading to restless palpitation. Treatment should set the heart and calm the mind, tonify the heart and support deficiency, using Cinnamon Twig Decoction minus Peony Root plus Dichroa Twig and Leaf Fossil Bone Oyster Shell Jiuni Decoction.
4. Heart blood stasis and obstruction palpitation: The cause is mostly due to heart qi deficiency or heart yang deficiency, leading to weak blood circulation. Or due to excessive seven emotions, overwork and cold exposure, leading to blood vessel obstruction and forming heart blood stasis and obstruction. The key points of differentiation are palpitation, accompanied by stabbing or dull pain in the chest, often radiating to the inner arm, especially the left arm, generally severe pain, intermittent, and in severe cases accompanied by cyanotic lips and face, cold limbs, dark red tongue or purple spots, little coating, and thin or choppy pulse. Treatment should regulate qi and resolve stasis, dispel stasis to unblock collaterals, using Blood House Stasis-Expelling Decoction or Guanxin No. 2.
5. Phlegm-fire disturbing heart palpitation: The cause is mostly seen in internal fire from emotional factors, or internal depression of six excesses transforming into fire, or due to excessive consumption of spicy food, excessive use of warming and tonifying drugs. The key points of differentiation are heart vexation and palpitation, irritability and insomnia, mouth and tongue ulcers, or stiff tongue and difficulty speaking, red tongue with greasy coating, and slippery rapid pulse. Treatment should clear heat and resolve phlegm, tranquilize the mind and calm the spirit, using Gallbladder-Warming Decoction or modified Mind-Stabilizing Pill.
6. Water pathogen attacking heart palpitation: This syndrome is mostly caused by heart yang deficiency leading to water retention rising. The syndrome can be divided into two: One is heart yang deficiency, combined with spleen and lung qi deficiency, unable to distribute body fluids, leading to retention and fluid rising. The key points of differentiation are epigastric fullness, rising qi impacting the chest, palpitation and shortness of breath, head and eye vertigo, chest stuffiness, cough, expectoration of thin white phlegm, slippery tongue coating, and deep wiry pulse. Treatment should unblock yang and transform fluid, using Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction with modifications. The other is heart yang deficiency, combined with kidney yang deficiency, lower energizer water cold unconstrained, leading to water pathogen rising. The key points of differentiation are head vertigo and palpitation, accompanied by difficulty urinating, muscle twitching, etc., deep pulse, pale tongue, white slippery coating, or shoulder and back soreness, or abdominal pain and diarrhea, or limb edema. Treatment should warm the interior and dissipate cold, promote water and eliminate yin, using True Warrior Decoction with modifications.

Palpitation differentiation should first pay attention to distinguishing deficiency and excess. Generally, deficiency pattern is the main, excess pattern is rare, but often due to internal deficiency combined with external factors, leading to deficiency and excess combined syndrome. Treatment generally focuses on tonifying deficiency, with dispelling pathogen as auxiliary. Deficiency pattern focuses on tonifying qi, nourishing blood, enriching yin, warming yang, and can add tranquilizing mind and calming spirit drugs; excess pattern focuses on purging fire and sweeping phlegm, moving stasis and calming fright. For combined deficiency and excess, the primary and secondary should be distinguished, and treated accordingly.

bubble_chart Literary Supplement

1. Zhengzhi Huibu："The heart is what governs a person, and blood is what nourishes the heart. When the heart blood is deficient, the spirit and qi lose their hold. When the spirit departs, the dwelling becomes empty, and when the dwelling is empty, stagnation occurs, leading to phlegm accumulation. When phlegm resides in the heart, this is the origin of palpitations and fright.""When there is stagnant water and qi affecting the heart, there is a gurgling sound in the chest, and the deficient qi flows irregularly; as water ascends, the heart fire dislikes it, causing a throbbing sensation, making one feel uneasy, and the pulse is notably wiry.""When yang qi is internally deficient, the area below the heart feels empty, resembling palpitations, and the right pulse is large and weak.""When yin qi is internally deficient, deficient fire moves recklessly, causing palpitations, emaciation, heat in the five centers, red face, dry lips, and the left pulse is faint or large and weak."
2. Zhangshi Yitong．Palpitation: "Palpitation refers to severe palpitations. There is a fearful throbbing and a restless movement below the heart, a sense of severe palpitation and anxiety, without any external cause, the heart moves uneasily on its own, which is what is called palpitation."