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Palpitation (Ji) refers to a sensation of trembling and unrest in the heart, where one cannot feel at ease; it is also known as Zhengchong (Palpitations with anxiety). This condition belongs to the Heart. Due to Heart Qi deficiency, there is this trembling sensation, resembling the fear of being caught. However, although there are nine types of palpitation symptoms, their treatment methods can be categorized into three. The first is Qi deficiency: excessive sweating/venting may lead to depleted Qi and weak Shen (Spirit), causing the Heart Qi to be too weak to maintain control. The second is fluid retention below the heart: water qi invades the Heart, and the Heart Fire fears the water, preventing peace. The third is related to sweat: sweat is the fluid of the Heart; excessive sweating depletes fluids, leaving the Heart empty and without support. Treatment should follow the specific symptoms: either nourishing the Shen, or tonifying Qi, or warming the meridians and separating/drainage of fluids.

Tremor (Zhen) refers to the body shaking and swaying. It is generally caused by excessive sweating, vomiting, or purging, which leads to a deficiency of Qi and Blood. In Shanghan (Cold Damage) diseases, tremor indicates deficiency and cold. When a patient is about to sweat, if they have a constitutionally weak state, they will experience intense heat followed by chills, and finally resolve through sweating. "Zhen" is close to "Chanli" (Shivering and trembling), but is milder. "Chan" involves a struggle between righteous Qi (Zhengqi) and pathogenic factors (Xieqi); this struggle causes full-body shivering. "Zhen," however, results from deficiency without reaching the stage of intense struggle, manifesting merely as body shaking. If sweating is performed after purging, resulting in cold tremors, it indicates that both exterior and interior are deficient. For patients with blood disorders who undergo sweating, leading to cold shivering, it indicates a dual deficiency of Qi and Blood. All such cases involve bodily shaking. If the patient exhibits severe shaking, even wanting to beat the ground, accompanied by noise, this is due to excessive sweating damaging Yang meridians, causing them to fail in supporting the body, leading to shaking. This differs from simple shivering/trembling and requires formulas that warm the meridians, assist Yang, nourish blood, and tonify Qi. Another theory states that dual deficiency of Qi and Blood fails to nourish sinews and bones, causing loss of bodily support and shaking. Major tonification of Qi and Blood is required; for instance, Renshen Yangying Tang (Ginseng Nourishing the Ying Decoction) has been used effectively. One case of continuous body shaking preventing sleep was cured using Shiwai Wandan Tang (Ten-Ingredient Phlegm-Calming Decoction) with doubled doses of Renshen (Ginseng).

Shivering and Trembling (Chanli) refers to limb vibration caused by the struggle between Yin and Yang. The classics state: "Chan" is the physical shaking of the body, while "Li" is the internal mental trembling/fear. Although similar in appearance, they are distinct. Furthermore, there is a distinction between interior and exterior. "Chan" is external and belongs to Yang; "Li" is internal and belongs to Yin. When pathogenic factors struggle with righteous Qi externally, it manifests as "Chan," which indicates recovery. When pathogenic factors struggle internally, it manifests as "Li," indicating worsening of the condition. "Chan" suggests strong righteous Qi, whereas "Li" suggests victorious pathogens. Some argue that compared to Zhen, Chan is more severe; compared to Li, Chan is external while Li is internal. Confusing Chan and Li is incorrect. In Shanghan disease, around the seventh day, when resolution is imminent, the patient must first shiver (Chan) before sweating resolves the illness. Because righteous Qi prevails during Chan, sweating occurs and the disease resolves. If it is "Li," there is no external shivering, only internal mental trembling, head nodding, and jaw clenching, leading to cold reversal. This is due to internal Yin excess and extreme deficiency of righteous Qi, unable to overcome pathogens; Jiangfu Sini Tang (Ginger and Aconite Counterflow Decoction) should be used to rescue the situation. Thus, the classics say: "When Yin is attacked by pathogens internally, Li occurs." If righteous Qi is internally solid, pathogens cannot struggle, and sweating occurs without shivering. If pathogens attempt to exit but the patient is inherently weak, the struggle manifests as Zhen; if severe, it becomes Chan. After Chan, fever and sweating resolve the disease. If righteous Qi cannot overcome pathogens, shivering occurs without sweating, making it difficult to treat. If sweating occurs within half a day or by night, resolution is possible. On the fifth, seventh, eleventh, or fourteenth day, sudden coldness, jaw clenching, and shivering require immediate administration of hot Ginger-Rice Soup to assist Yang Qi; shortly after, shivering stops, sweating occurs, and the disease resolves.