Palpitation and anxiety

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Textbook Prescriptions Cardiac

Essentials of Chinese Acupuncture (Beijing, Shanghai and Nanjing Colleges of Traditional Chinese Medicine, 1980) — the standard prescriptions of the Chinese colleges.

Points

BL15 Xinshu bilateral

Back-Shu of the Heart; regulates heart qi and blood

Even method.
- ⚠ Pneumothorax
CV14 Juque midline

Front-Mu of the Heart; regulates heart qi and calms

Even method.
HT7 Shenmen bilateral

Yuan-Source of the Heart; calms the spirit

Even method.
PC6 Neiguan bilateral

Luo point of the Pericardium; regulates the heart and settles anxiety

Even method.

Needling Safety

Cited hazards for these points. Tick what applies to the patient to see the cautions that follow from it.

BL15 Xinshu
- ⚠ Pneumothorax risk: too deep an insertion can puncture the pleura. World Health Organization 1999, Section II §5.2 (Lung and pleura), p. 25

Treatment Principle

Calm the heart with even method on its Back-Shu and Front-Mu points.

Indications

Qi and blood deficiency: pallor, shortness of breath, weakness, poor sleep, dizziness, blurred vision, pale swollen tongue with tooth marks, thin forceless pulsePhlegm-fire: agitation and restlessness, sleep troubled by dreams, yellow tongue coating, rolling rapid pulseRetained fluid: mucoid sputum, fullness of chest and epigastrium, fatigue, white tongue coating, wiry rolling pulsePalpitations ranging from intermittent to continuous violent pounding

Method

Even method on the base points; the book allows needling or moxibustion on the fluid-retention additions.

⚠ Cautions

Palpitations with chest pain, fainting, breathlessness, or a very fast or irregular pulse need urgent medical assessment and an ECG; arrhythmia must be excluded before treating as anxiety. BL15 overlies the lung: needle obliquely and shallowly to avoid pneumothorax. CV14 lies over the liver and heart: do not needle deeply, particularly with hepatomegaly. Moxa or strong stimulation at CV4 and CV6 is contraindicated in pregnancy.

About

The textbook's base prescription for palpitation and anxiety, used for all three of its patterns with extra points for each.

Rationale

BL15 and CV14 are the heart's Back-Shu and Front-Mu points; with HT7, the Source point of the Heart, and PC6, the Luo point of the Pericardium, they harmonise heart qi and blood and act together to tranquillise.

Clinical Notes

Additions by pattern: qi and blood deficiency, CV6 to strengthen qi and BL20 and BL21 to support the spleen and stomach that produce qi and blood; phlegm-fire, ST40 and GB34 to clear phlegm-fire from the stomach; retained fluid, CV4, BL22, ST36 and CV17 (needled or warmed) to strengthen the spleen, invigorate yang and move water through the three burners. The book links the condition to neurosis, autonomic dysfunction and cardiac arrhythmia of various causes, and gives an ear-acupuncture option.

Sources

Beijing College of Traditional Chinese Medicine, et al. Essentials of Chinese Acupuncture. Beijing: Foreign Languages Press, 1980. Chapter III, Palpitation, anxiety, p. 350–352.

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