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**General Principles**
Generally, Jing Ji (Palpitations due to fright) is attributed to Phlegm and Fire. Zheng Chong (Constant palpitations) is attributed to Blood deficiency with internal Heat. (Zhu Danxi)

**Internal Causes**
The Heart governs the human body, and the Heart nourishes Blood. Once Heart Blood becomes deficient, Shen Qi (Spiritual Energy) loses its residence. When Shen Qi departs, the Heart mansion becomes empty; when empty, Qi stagnates and transforms into Phlegm. Phlegm residing in the position of the Heart is the origin of Jing Ji. (Zheng Zhi Hui Bu)

**External Manifestations**
Jing Ji manifests as a sudden sensation of being frightened, with a terrified and restless heart, where episodes occur at specific times. Zheng Chong manifests as a constant state of terror and restlessness within the heart, where episodes occur without specific timing. (Yi Xue Zheng Zhuan)

**Deficiency of Liver, Gallbladder, and Heart**
Some cases arise from anger injuring the Liver, or fright injuring the Gallbladder, causing the Mother organ (Liver) to weaken the Child organ (Heart), resulting in insufficient Heart Blood. Alternatively, excessive striving by the wealthy, or sorrow by the poor, overthinking, or dealing with complex affairs can disturb the Heart Sovereign, leading to Jing Ji and Zheng Chong symptoms, characterized by a Wiry pulse. (Zheng Zhi Hui Bu)

**Stagnant Phlegm**
Hearing loud noises, seeing strange objects, encountering danger or crisis, losing will upon certain events, or experiencing great fright and terror can cause Heart Qi to rebel, leading to Heart deficiency and Phlegm retention. This causes a terrified appearance, and in severe cases, palpitations leading to faintness, characterized by a Slippery pulse. (Zheng Zhi Hui Bu)

**Fluid Retention**
When retained fluids and Water Qi ascend to invade the Heart, there is a gurgling sound in the chest, and Qi moves vacuously. Since Water ascends, Heart Fire dislikes it, causing violent palpitations and a depressed mood, characterized by a predominantly Wiry pulse. (Zheng Zhi Hui Bu)

**Qi Deficiency**
Internal deficiency of Yang Qi leads to a hollow sensation below the Heart, resembling palpitations, characterized by a large but forceless Right pulse. (Zheng Zhi Hui Bu)

**Blood Deficiency**
Internal deficiency of Yin Qi leads to reckless movement of Deficient Fire, causing palpitations, emaciation, heat in the five centers (palms, soles, and chest), flushed face, and dry lips. The Left pulse is weak or vacuously large and forceless. (Zheng Zhi Hui Bu)

**Phlegm Knotting**
Consumption of rich and greasy foods accumulates into Phlegm and Fluids. The mouth is not dry, and skin remains moist. Sudden fright triggers palpitations, characterized by a Wiry, Slippery, and forceful pulse. (Zheng Zhi Hui Bu)

**Qi Stagnation**
In individuals with depressive temperaments, Qi stagnation generates Saliva. Saliva and Qi contend, disturbing the Heart Spirit. The pulse must be Deep and Knotted or Wiry. (Zheng Zhi Hui Bu)

**Yin Fire**
Rising Yin Fire causes dizziness, blurred vision, tinnitus, loose teeth, abdominal sounds, and incessant Zheng Chong. One should nourish Yin and suppress Fire, adding herbs that nourish the Heart. If long-term use fails, it indicates Rootless and Unanchored Fire, characterized by a Vacuously Hollow pulse, requiring Warm Tonification formulas for cure. (Zheng Zhi Hui Bu)

**Pulse Diagnosis**
At the Cun Kou (Radial artery), if the pulse is Agitated and Weak: Agitation indicates Fright, Weakness indicates Palpitations. In cases of Fright, the pulse stops and returns; the patient’s eyes do not move, and they cannot exhale smoothly. (Jing Yue Quan Shu - Bi Du)

**Treatment Methods**
For Phlegm, resolve Phlegm and calm fright. For Fluids, expel water and eliminate retention. For Blood deficiency, nourish and regulate Heart Blood. For Qi deficiency, harmonize Heart Qi. For Phlegm knotting, use descending methods. For Qi stagnation, use soothing methods. For rising Yin Fire, treat the Kidneys, and palpitations will cease spontaneously. If caused by sudden external fright, use heavy sedatives. The method of "Ping" (Calming) involves making the patient familiar with previously seen or heard stimuli so that they naturally no longer feel frightened. (Zheng Zhi Hui Bu)

**Medication**
The main formula is An Shen Wan. For severe Heart deficiency, add Fu Shen (Poria with Hostwood) and Ren Shen (Ginseng). For unsettled Spirit, add Bai Zi Ren (Biota Seed), Suan Zao Ren (Ziziphus Seed), and Yuan Zhi (Polygala Root). For Phlegm, add Bei Mu (Fritillaria Bulb), Nan Xing (Arisaema Rhizome), Ban Xia (Pinellia Tuber), and Shi Chang Pu (Acorus Rhizome). Alternatively, induce vomiting.
For Water-Fluid retention, use Xiao Ban Xia Fu Ling Tang (Minor Pinellia and Poria Decoction). For Qi deficiency, use Ren Shen (Ginseng) [and implied tonics]. For Blood deficiency, use Si Wu Tang (Four Substance Decoction). For Kidney deficiency, use Di Huang Tang (Rehmannia Decoction). For Yang deficiency, use Ba Wei Wan (Eight-Ingredient Pill). For Phlegm knotting, use Wen Dan Tang (Warm the Gallbladder Decoction) or Gun Tan Wan (Rolling Phlegm Pill). For Qi stagnation, use Si Qi Tang (Four-Seven Decoction).

**Appendix: Bei Die (Low Spirits/Depression)**
Symptoms include chest stuffiness, loss of appetite, a constant feeling of inadequacy in the heart, preference for dark rooms, or hiding when seeing people at the door, appearing lost in spirit. This is Bei Die disease. Caused by Heart Blood deficiency, treat with Ren Shen Yang Rong Tang (Ginseng and Longevity Decoction). Caused by Spleen-Stomach disharmony, treat with Liu Jun Zi Tang (Six Gentlemen Decoction), adding Yi Zhi Ren (Alpinia Fruit) and Yuan Zhi (Polygala Root).

**Appendix: Shi Zhi (Loss of Will)**
Caused by unfulfilled desires or regret over excessive indulgence, manifesting as sighing, night talking, and a sense of loss. Treat with Wen Dan Tang (Warm the Gallbladder Decoction), adding Ren Shen (Ginseng) and Bai Zi Ren (Biota Seed) to make pills, coated with Chen Sha (Cinnabar). Take three times daily.

**Selected Formulas for Jing Ji and Zheng Chong**

**Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill)**
Treats Heart chaos, irritability, chaotic Qi in the chest, nausea, and latent Heat above the diaphragm.
Huang Lian (Coptis Rhizome) (1.5 liang), Zhu Sha (Cinnabar) (1 liang), Sheng Di Huang (Rehmannia Root) (1 liang), Gui Shen (Angelica Sinensis Root) (1 liang), Zhi Gan Cao (Prepared Licorice Root) (0.5 liang).
Grind into powder, mix with steamed dough soaked in water, make pills the size of millet seeds. Take 15 pills per dose, swallowed with saliva.

**Zhen Xin Wan (Settling the Heart Pill)**
Treats Heart Blood deficiency, Zheng Chong, frequent dreams, and fear of falling from cliffs.
Suan Zao Ren (Ziziphus Seed) (2.5 qian), Che Qian Zi (Plantago Seed) (1.5 liang), Bai Fu Ling (Poria) (1.5 liang), Mai Dong (Ophiopogon Tuber) (1.5 liang), Wu Wei Zi (Schisandra Berry) (1.5 liang), Fu Shen (Poria with Hostwood) (1.5 liang), Rou Gui (Cinnamon Bark) (1.5 liang), Shu Di Huang (Prepared Rehmannia Root) (1.5 liang), Long Chi (Dragon Teeth/Fossilized Bones) (1.5 liang), Tian Dong (Asparagus Tuber) (1.5 liang), Yuan Zhi (Polygala Root) (1.5 liang), Shan Yao (Dioscorea Rhizome) (1.5 liang), Ren Shen (Ginseng) (1.5 liang), Zhu Sha (Cinnabar) for coating (1.5 liang).
Make honey pills the size of wutong seeds. Take 3 qian per dose on an empty stomach with rice soup.

**Ding Zhi Wan (Calming Will Pill)**
Yuan Zhi (Polygala Root) (1 liang), Chang Pu (Acorus Rhizome) (2 liang), Fu Shen (Poria with Hostwood) (3 liang), Fu Ling (Poria) (3 liang), Ren Shen (Ginseng) (1 liang), Long Chi (Dragon Teeth) (1 liang).
Make honey pills, coat with Chen Sha (Cinnabar). Take 3 qian with rice soup.

**Hu Po Yang Xin Dan (Amber Nourishing Heart Pill)**
Treats palpitations and susceptibility to fright.
Hu Po (Amber) (2.5 qian), Long Chi (Dragon Teeth) (separately ground, 1 liang), Yuan Zhi (Polygala Root) (5 qian), Shi Chang Pu (Acorus Rhizome) (5 qian), Fu Shen (Poria with Hostwood) (5 qian), Ren Shen (Ginseng) (5 qian), Suan Zao Ren (Ziziphus Seed) (5 qian), Sheng Di Huang (Rehmannia Root) (7 qian), Gui Shen (Angelica Sinensis Root) (7 qian), Huang Lian (Coptis Rhizome) (3 qian), Bai Zi Ren (Biota Seed) (5 qian), Zhu Sha (Cinnabar) (3 qian, separately ground), Niu Huang (Calculus Bovis/Bovine Calculus) (1 qian, separately ground).
Grind into powder, make pills with pig heart blood, size of millet seeds, coat with gold leaf. Take 5 qian with Deng Xin Cao (Juncus Decoction).

**Gui Pi Tang (Restore the Spleen Decoction)** (See Stroke section for formula)
**Si Qi Tang (Four-Seven Decoction)** (See Qi Disorders section for formula)
**Tian Wang Bu Xin Dan (Heavenly Emperor Heart-Nourishing Pill)** (See Stroke section for formula)

**Wen Dan Tang (Warm the Gallbladder Decoction)** (From Qian Jin Fang)
Ban Xia (Pinellia Tuber), Zhi Shi (Immature Bitter Orange), Zhu Ru (Bamboo Shavings), Ju Pi (Citrus Peel), Gan Cao (Licorice Root), Bai Fu Ling (Poria).
Take 1 to 4 qian per dose, decoct with Sheng Jiang (Fresh Ginger) and Da Zao (Jujube).
If Heart deficiency, add Ren Shen (Ginseng) and Suan Zao Ren (Ziziphus Seed).
If internal irritability and heat, add Huang Lian (Coptis Rhizome) and Mai Men Dong (Ophiopogon Tuber).
If dry mouth and tongue, remove Ban Xia, add Mai Men Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandra Berry), and Tian Hua Fen (Trichosanthes Root).
If exterior heat persists, add Chai Hu (Bupleurum Root).
If internal deficiency with spontaneous diarrhea, remove Zhi Shi, add Bai Zhu (Atractylodes Macrocephala Rhizome).
If internal heat and irritability, add Zhi Zi (Gardenia Fruit).