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Palpitations due to fright (disquietude of the mind caused by sudden fright) originally belong to disorders of the Upper Jiao, but they are further differentiated into upper and lower patterns based on specific manifestations. This is because the Heart and Kidney are physiologically interconnected: if Heart Qi fails to descend and interact with the Kidney, it results in fright and insomnia; conversely, if Kidney Qi fails to ascend and interact with the Heart, it also leads to insomnia and the manifestation of fright. Therefore, these two presentations require distinct differentiation, and their therapeutic methods should differ accordingly.

How then can one distinguish whether the pathology lies in the upper or the lower? Generally speaking, when Heart Qi does not interact with the Kidney, the patient experiences inability to sleep throughout the day; whereas when Kidney Qi does not interact with the Heart, the patient suffers from difficulty sleeping throughout the night. Using this criterion for differentiation best aligns with the clinical reality.

If a patient presents with daytime palpitations and insomnia, Zhi Jing Bu Xin Tang (Calm Fright and Tonify Heart Decoction) should be administered. One dose allows for sleep, two doses alleviate the palpitations and fright slightly, and four doses result in complete recovery. This formula focuses on tonifying the Heart rather than the Kidney. Its efficacy lies in guiding the interaction between the Heart and Kidney, without the need to specifically treat deficiency in the Kidney Meridian. Since Kidney Qi is not severely deficient initially, by tonifying the Heart, Kidney Qi will naturally ascend to interact with the Heart. Once the Kidney Qi is nourished, how could Heart-Kidney non-interaction occur?

In cases of nighttime palpitations and insomnia, this indicates exhaustion of Kidney Water. Ding Jing Bu Shen Tang (Stabilize Fright and Tonify Kidney Decoction) should be used urgently. The brilliance of this formula lies in vigorously tonifying Kidney Water without directly tonifying the Heart, as sufficient Kidney Water naturally communicates upward to the Heart. The combination of Rou Gui (Cinnamon Bark) and Huang Lian (Coptis Rhizome) within the formula facilitates the rapid interaction between the Heart and Kidney. Furthermore, combined with herbs possessing astringent properties such as Bei Wu Wei (Schisandra Berry) to strongly strengthen the Qi of True Yin, Fire and Water achieve mutual balance (Water-Fire Mutual Interaction), thereby preventing palpitations and insomnia.

Zhi Jing Bu Xin Tang (Calm Fright and Tonify Heart Decoction)
Ren Shen (Ginseng Radix et Rhizoma) (5 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma) (5 qian)
Fu Ling (Poria) (5 qian)
Chao Zao Ren (Ziziphus Seed, Stir-fried) (5 qian)
Dan Sha (Cinnabar) (2 qian)
Zhu Ru (Bamboo Shavings) (1 pill)
Yuan Zhi (Polygalae Radix) (1 qian)
Gan Cao (Licorice Root) (1 qian)
Mai Dong (Ophiopogonis Tuber) (5 qian)
Huang Lian (Coptidis Rhizoma) (3 fen)
Rou Gui (Cinnamon Bark) (3 fen)
Ban Xia (Pinelliae Tuber) (8 fen)
Bei Wu Wei (Schisandrae Chinensis Fructus) (1 qian)
Decoct with water and take orally.

Ding Jing Bu Shen Tang (Stabilize Fright and Tonify Kidney Decoction)
Shu Di (Rehmanniae Radix Praeparata) (1 liang)
Shan Zhu Yu (Corni Fructus) (5 qian)
Shan Yao (Dioscoreae Rhizoma) (5 qian)
Bei Wu Wei (Schisandrae Chinensis Fructus) (2 qian)
Niu Xi (Achyranthis Bidentatae Radix) (3 qian)
Wei Rui (Polygonati Odorati Rhizoma) (5 qian)
Dang Gui (Angelicae Sinensis Radix) (5 qian)
Dan Pi (Moutan Cortex) (3 qian)
Sha Shen (Glehniae Radix or Adenophorae Radix) (1 liang)
Yi Yi Ren (Coicis Semen) (5 qian)
Qian Shi (Euryales Semen) (5 qian)
Bai Jie Zi (Sinapis Semen) (3 qian)
Rou Gui (Cinnamon Bark) (1 qian)
Huang Lian (Coptidis Rhizoma) (2 fen)
Ba Ji Tian (Morindae Officinalis Radix) (5 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma) (3 qian)
Decoct with water and take orally.