Palpitations are an uncomfortable awareness of the beating of the heart, and can include sensations such as pounding or fluttering. Arrhythmia is an irregularity of heart rhythm, and may not be noticed by the person experiencing it. Chinese medicine distinguishes between two types of palpitations: those with organic dysfunction of the heart and those without. The former are typically chronic and involve actual weakness of the heart muscle or disordered signaling, while the latter are typically triggered by emotional stimuli. In the latter case, the person may perceive their heart rate as racing or skipping beats even though objective examination does not detect any abnormality.
Palpitations and arrhythmias may occur after a severe illness that affects qi and yin, or causes fluid to congeal into phlegm or phlegm-heat. Similarly, a pathogenic invasion during childhood, such as a severe wind-cold-dampness or wind-dampness-heat pathogen, can affect the stability of the Heart in later years, similar to the situation observed in rheumatic fever.
The spirit can be congenitally unstable and easily disturbed by changes in the person's environment and emotional state. In severe cases, even minor upsets can destabilize the spirit, leading to significant palpitations. Prolonged, excessive, or unexpressed emotions such as grief, sadness, anxiety, or depression can disperse Heart qi, while prolonged worry or anxiety can deplete Heart blood. A major trauma or sudden severe shock can disrupt the Heart-Kidney axis, leading to palpitations and other spirit disturbances. Prolonged Liver qi constraint can also affect the Heart in various ways, such as generating heat or fire that is transmitted to the Heart via the generating cycle, failing to mobilize body fluids and causing them to congeal into phlegm or phlegm-heat, failing to lead blood and resulting in blood stasis, or withholding qi from the Heart due to a failure of qi flow via the generating cycle.
Preexisting or Concurrent Illness
Continuing respiratory diseases such as asthma or chronic obstructive pulmonary disease can weaken ancestral qi and gradually diminish Heart and Kidney qi. Prolonged Spleen and Kidney yang qi deficiency can fail to support Heart yang and result in poor fluid metabolism, which places extra strain on the Heart.
Exhaustion, Overwork, and Age
Extended periods of overwork, lack of sleep, and excessive demands on qi, blood, yin, or yang can lead to deficiency. Working excessively long hours or laboring to the point of exhaustion depletes Spleen and Kidney yang qi. Any activity that excessively taxes the Spleen will weaken qi and blood, generating dampness and phlegm. Lack of sleep depletes yin, while profuse sweating or other fluid loss, as well as a hectic and busy lifestyle with insufficient rest, deplete Heart qi and yin. The normal aging process depletes the Kidneys, making people more susceptible to disruptions of the Heart-Kidney axis. This can also result from behaviors that deplete Heart and Kidney yin, such as stimulant drug use, prolonged emotional stress, reduced sleep, and overwork. It can emerge during the withdrawal phase of long-term sedative or anxiolytic drug use, or be more acute, occurring after a severe shock or trauma, or a severe febrile illness.
A shock or trauma experienced by the mother during pregnancy can affect the fetal spirit. When acquired later in life, it is the result of a sudden, violent, or extreme shock or fright, especially during childhood, when the spirit is more unstable. It is often the combination of a congenital Heart and Gallbladder weakness and some critical event that most effectively drains Heart and Gallbladder qi. This pattern can sometimes be more acute, following a debilitating illness that drains qi. Because the spirit is so destabilized, it cannot cope with change and is easily disturbed by trivial events. Palpitations may occur spontaneously and gradually worsen until they are more or less constant. People with this pattern may be prone to anxiety and obsessive worry about their health, setting up a self-perpetuating cycle in which anxiety about their heart condition causes palpitations, which in turn causes more anxiety and so on.
Treatment of palpitations involves two approaches. In the case of organic dysfunction of the heart, the disorder is likely to be chronic and the functional strength of the Heart weakened. These disorders require tonifying yang, yin, or blood, or activating and dispersing a pathogen. Non-organic disorders of the heart require methods that settle, sedate, and calm the spirit. Acupuncture is particularly effective. Bear in mind that organic and non-organic dysfunction patterns often overlap, so a mixture of approaches may be required.