1. Palpitations Loesha Stoutenbeek

2. Firstly… In Traditional Chinese Medicine Palpitations is the cardinal symptom for Heart Patterns for a number of different diagnosis and patterns. Once a patient sights palpitations as a chief complaint or a symptom more questions would be necessary to make more precise pattern diagnosis. *more about this later…

3. What are Palpitations? Palpitations normally described as feelings of the heart beating too fast or too hard, skipping a beat or fluttering. Palpitations are an uncomfortable experience of the heart beat and it is subjective as described by the patient. It can often be felt in ones chest, throat or neck. Patient might say they can hear their heart beat in their ears. It should also be noted that a fast or irregular heart beat can cause palpitations but that palpitations do not neccessarilly mean a fast or irregular heart beat.

4. * Generally Palpitations are harmless unless experienced in combination with: Shortness of breath (sob) Chest pain (arm pain, jaw pain) Spontaneous Sweating Dizziness and/or fainting

5. General cause of Palpitations? Generally palpitations are harmless and caused by: Anxiety/stress Panic attacks (possibly caused by stress) Over exertion in physical activity Ingestion of stimulant (ie: caffeine, amphetamines, red bull, other drugs) Palpitations can also be a symptom of another medical condition such as: thyroid disorder, anemia, low BP, hypoglycemia, abnormal electrolyte balance (dehydration), obesity.

6. Heart Related problems that might cause palpitation are: Congestive heart failure Arrhythmia Coronary artery disease (atherosclerosis) Cardiac valve problems Myocardial condition

7. WM treatment for Palpitations: When/if there is no other dx for Heart conditions or other medical conditions often stress reduction techniques and alternative therapies such as Acupuncture, Taichi, yoga, meditation are recommended. When palpitations are a symptom of a diagnosed medical condition medication/herbs or other treatment can be prescribed accordingly.

8. Traditional Chinese Medicine treatment For Palpitations

9. Palpitations (as a TCM diagnosis) Causes from TCM perspective. Weak Constitution Long-term stress and emotions strain. Prolonged illness Poor Diet and/or Lifestyle (e.i. drug use) Overwork, stress

10. Patterns. Heart Qi Stagnation. Deficiency of Heart and Spleen. Yin deficiency (kidney) with empty Fire. Deficiency of Heart Yang. Blood stasis blocking the heart. Phlegm Heat disturbing the heart.

11. Heart Qi stagnation Caused by Anxiety and worry. Possibly preceded by Liver Qi stagnation. Clinical s/s: Palpitations, feeling of distention and oppression of the chest. Depression. Slight lump in throat. Some shortness of Breath, sighing. Lack of appetite. Weak cold limbs. Slightly purple lips and pale complexion. T: Pale on the sides. P: Empty, slightly overflowing on the left front position. Treatment Principle: Move Heart Qi, open the chest and calm the Shen.

12. Prescription: Ht 5, 7 Ren 15, 17 Pc 6 Lu 7 St 40 LI 4, 10

13. Deficiency of Heart and Spleen Often caused by emotional problems, poor/unbalanced diet or prolonged illness causing the Spleen and heart to weaken. Clinical s/s: Palpitations, SOB, dreamful sleep, dizziness, heavy limbs, lacking appetite, loose stools, pale complexion. T: pale with thin coating. P: weak. Treatment principle: nourish the heart, strengthen spleen and replenish blood.

14. Prescription: Ht 3, 5, 7 Pc 6 Sp 4, 6 St 36 Ren 6, 14, 17 LI 10 BL 15, 20

15. Deficiency of Heart Yang Qi Causes is normally longstanding chronic illness with possibly previous Yin deficiency or empty fire. Can be caused by indirect Kidney-Yang deficiency. Clinical s/s: Palpitations which worsen with exertion, SOB, feeling of chest oppression, dizziness, cold limbs, pale complexion. T: pale with thin coating. P: weak and deep. Treatment Principle: warm and nourish the heart yang, calm the Shen.

16. Prescription: Ht 3, 7 Sp 4, 6 Ren 6, 14 ST 36 LI 10 BL 15, 20

17. Yin deficiency with Empty Fire Often casue by constitution and/or prolonged mental stress or illness. Sexual indulgence. Over work. Clinical s/s: Palpitations (worse with strain), lumbago, weak knees, restlessness, insomnia, tinnitus, dizziness, dry mouth, night sweats, 5 palms hot. T: red with very little coating. P: thin and rapid. Treatment Principle: Replenish Yin, reduce fire, nourish heart.

18. Prescription: Ht 6, 7 Sp 6 Ren 4 Ki 3, 6, 7 BL 15, 18, 20, 23, 25, 52

19. Blood stasis blocking the heart Generally caused by poor diet en lack of exercise. Clinical s/s: Palpitations, chest discomfort, intermittent zinging pain in chest, purple lips, nails and tongue, ecchymosis. T: purple. P: slow, irregular or intermittent pulse. Treatment Principle: promote blood circulation, remove blood stasis, promote smooth Qi flow.

20. Prescription: Ht 3, 7 Sp 10 Ren 14 Pc 6 Liv 3 LI 4, 10 BL 14, 15

21. Phlegm Heat disturbing the Heart Casued by longstanding emotional stress and poor diet, namely consumption of greasy fatty foods. Clinical s/s: Palpitations induced by fear (easy to scare). Chest oppression, restlessness, nausea, heavy head, dizziness, bitter taste in mouth. T: Red with yellow greasy coating. P: wiry and rapid. Treatment Principle: Clear away heat and resolve phlegm, calm the Shen

22. Prescription: Ht 7 Sp 9 Ren 14, 17 Pc 6 St 40 LI 11 BL 15, 20

23. Anxiety & Palpitations Western Medicine characterizes/labels Anxiety as a disorder. Anxiety, like palpitations is a sign or symptom as well as a diagnosis for disorders such as PTSD, OCD or SAD. IN TCM anxiety can be characterized as Jing Ji (fear & palpitations) Zheng Chong (panic & throbbing) Li Ji (rebellious qi of the Chong Mai).

24. Li Ji Chong Mai (sea of blood, sea of 12 channels) is a very profound and primary channel. Developed early in the womb from which other extraordinary channels including the Ren Mai can branch from. Originates between the Kidneys, vital for reproduction and healthy Wei Qi and Zong Qi. The Chong Mai has the paramount task of connecting Kidney and Heart, Jing and Shen. When this connection isn’t developed properly or there is an imbalance or dysfunction pycho-emotional issues can occur with as a result Anxiety and/or palpitations.

25. Conclusion: Palpitations are often a symptom or sign and more investigation needs to be done to determine the cause and course of treatment. Palpitations can be linked to organ or Channel imbalance. When palpitations are sighted as a sign or symptom we must should find the cause and must decide whether it’s caused by a serious condition. Patient might need to be referred to a doctor for medical tests.

26. I thank you for your time and attention.

27. Bibliography: Maciocia, Giovani. The foundation of Chinese Medicine, 2nd Edition. Elsevier Churchill Livingstone. 1989. (p. 465- 469) Dr. Gu, Richard. SITCM Lecture: Internal Medicine in TCM. Sydney, Australia, 2014 Qi Jing Ba Mai. Eight Extraordinary Channels. Singsong Dragon. 2013 (p. 45- 50) http://www.webmd.com/heart-disease/guide/what-causes-heart- palpitationshttp://www.webmd.com/heart-disease/guide/what-causes-heart- palpitations (10/03/2016)