Palpitation & Anxiety

SYMPTOMS AND SIGNS: Palpitation and anxiety are often related. They are two self felt symptoms which can be intermittent in mild cases; or there may be continuous and uncontrollable violent throbbing of the heart in severe cases. They are often accompanied with insomnia, forgetfulness, vertigo, dizziness and tinnitus. They are mostly seen in neurosis, functional disorders of vegetative nervous system and cardiac arrhythmia of various origins. Others, such as anemia due to iron deficiency, anemia due to deficient red cell production, hyperparathyroidism may also show palpitation and anxiety. 

ETIOLOGY AND PATHOLOGY: Feelings of palpitation and anxiety are usually connected with the heart caused by mental activities, Qi, blood and heart Yang deficiency, water retention, or blood stasis. The most common etiologic factors and pathological changes are followings: 

  1. Mental disturbance: someone with weak mentality is easily frightened by a sudden strong noise, or some other special circumstances. 
  2. The deficiency of heart blood: after chronic diseases, any excessive blood loss, or over thinking may all lead to heart and spleen deficiency, This blood deficiency will cause the malnourishment of the heart, causing palpitations and anxiety. 
  3. The deficient fire attacks upward and disturbs the normal mind causing palpitation and anxiety.
  4. Yang deficiency of the heart.
  5. Water retention due to spleen and kidney Yang deficiency attacks the heart. 
  6. Blood stasis obstructs heart.

DIFFERENTIATIONS: 

1. The Mental Disturbance Type:

Indications: Palpitation, easily frightened and fearful, mindlessness, insomnia, thin white tongue coating, rapid and weak pulse or intermittent and uneven pulse. 

Treatment & Formulas: Tonify the heart and tranquilize the disturbed mind. 

Products:

    • Suan Zao Ren Tang (Zizyphus Combination, Item No. 2251): It is the formula to nourish the blood and tranquilize the disturbed mind by clearing the heat in the liver. It is very good for treating palpitation and anxiety, amnesia, neurasthenia, night sweating, etc. 
    • Wen Dan Tang (Bamboo and Hoelen Combination Item No. 2228): This is very commonly used for palpitation, anxiety, insomnia, neurosis, cardiac hyperfunction, gastrointestinal disorders, gastrointestinal weakness, which are due to mental weakness and damp phlegm combined with internal fire. 
    • Chai Hu Jia Long Gu Mu Li Tang (Bupleurum and Dragon Bone Combination, Item No. 2154): This is very effective for palpitation, nervousness, anxiety, habitual insomnia hypertension, and arteriosclerosis due to the disharmony of liver and spleen. 

2. The Heart Blood Deficiency Type:

Indications: Palpitation, dizziness, insomnia, poor memory, pale face, fatigue, slight red tongue, thin or no coating, thready and weak pulse, or intermittent and uneven pulse. 

Treatment & Formulas: Tonify the blood of heart, strengthen the Qi function and nourish the mind.

Products:

    • Gui Pi Tang (Ginseng and Longan Combination, Item No. 2261): This is a tonic formula for blood and Qi by promoting the functions of spleen and heart. 
    • Zhi Gan Cao Tang (Baked Licorice Combination Item No. 2119): A very good formula for cardiac diseases, palpitation, dyspnea and hypertension, which are due to the deficiency of heart Qi and blood. 

3. The Excessive Deficient Fire Type:

Indications: Palpitation, restlessness insomnia dizziness, blurry vision, hot sensation of the souls and palms, tinnitus, sore and weak sensations at lumbar regions, red tongue, thready and rapid pulse.

Treatment & Formulas: Tonify the Yin so as to clear the deficient fire, nourish the heart and tranquilize the mind. 

Products:

    • Tian Wang Bu Xin Dan (Ginseng and Zizyphus Formula, Item No. 2055): It tonifies the Yin (or blood) of heart and kidney so as to clear the deficient fire and tranquilize the mind. 
    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron, and Rehmannia Formula, Item No, 2123): It is for the excessive fire due to the kidney Yin deficiency type. Symptoms will show more kidney Yin deficiency symptoms. 

4. The Heart Yang Deficient Type:

Indications: Continuous and uncontrollable violent throbbing of the heart, pale complexion, suffocating feeling at chest, shortness of breath, or chest pain radiates to right shoulder or neck, cold limbs and body, pale tongue, forceless pulse or deep and thready pulse. 

Treatment & Formulas: Warm and tonify the heart Yang, calm the disturbed mind. 

Products

5. The Water (Fluids) Retention Type:

Indications: Palpitation, dizziness, oppression and fullness of chest and gastric region, cold limbs and body, scanty urine, or edema of lower body, thirsty but no desire to drink, nausea, vomiting, white and smooth tongue coating, wiry and slippery pulse.

Treatment & Formulas: Promote the Qi and water (fluids) circulations by strengthening the Yang. 

Products:

    • Ling Gui Zhu Gan Tang (Hoelen and Atractylodes Combination, Item No. 2130): This is a very good formula for palpitation due to fluid retention of stomach. It is also very effective for vertigo, tinnitus, dyspnea, chronic headache, insomnia, temporary and nearsightedness. 
    • Zhen Wu Tang (Vitality Combination, Item No. 2170): It eliminates the water retention by its diuretic and warming functions. It is often used for the palpitation due to the water attacking upward which is caused by the kidney Yang deficiency. This kind of palpitation is usually accompanied with asthma, cough, short of breath, dysuria, edema, pale tongue, deep pulse. 
    • Chai Hu Gui Jiang Tang (Bupleurum, Cinnamon, and Ginger Combination, Item No. 2152): This is good for fluid retention due to the disharmony of spleen (stomach) and liver. It is for palpitation, nervous exhaustion, insomnia, coughing, wheezing, diarrhea, etc., which are all due to fluid retention. 

6. The Blood Stasis Type:

Indications: Palpitation, restlessness, fullness and suffocating of chest, thoracic pain occasionally, or purplish lips and fingernails, purplish tongue or with petechiae, uneven or intermittent pulse. 

Treatment & Formulas: Regulate the Qi, promote the circulation of blood and resolve the blood stasis. 

Products:

    • Si Wu Tang (Tang-kuei Four Combination, Item No. 2060): This is a blood tonic. It will be more effective when added to Tao Ren (Persica Semen, Item No. 1163), Hong Hua (Carthamus Flos, Item No. 1148), and some other herbs according to the patient's situation. 

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