The relationship between anxiety disorders and palpitations in Chinese medicine
Modern TCM internal medicine textbooks and many large reference books conventionally classify “palpitations” as palpitations or arrhythmia diseases. By reviewing the relevant literature, we believe that panic and palpitation in Chinese medicine belongs to the category of neurological disorders and is particularly closely related to anxiety disorders, which is discussed below.
I. The basic meanings of panic and palpitation are similar to the expression of anxiety
In Chinese philology, fright is derived from horse, and the original meaning is that the horse is frightened. For example, “Shuowen” says, “The horse is frightened.” In the Warring States Strategy, it is written that “Xiangzi arrived at the bridge and the horse was frightened”. The extended meaning includes the following.
① startled, shocked, such as “the palace is shocked” (Chu Shi – Invocation), “his life is like a fright” (Lu Shi Chun Qiu – Shen Da), “shocked a hundred miles” (Yi – Zhen Gua);
② panic, fear, such as “the king of Qin was frightened and led himself up” (Warring States Strategy – Yan Strategy), “hearing the sound of people also startled” (Shi Zhong Shan Ji);
(3) chaos, such as “no one dares to speak directly, his life is as frightened” (Lv’s Spring and Autumn Period), “the fine dust barrier road up, frightened flowers messy eyes floating” (Northern Zhou – Yu Xin “Chivalrous”). In addition, there are also frightened (panic, fear), frightened (panic terror, frightened), frightened suspicion (panic doubt), frightened sip (very concerned, fearful look), frightened tigers rest (trembling, fearful look) and other words that express fear, fear.
The word “palpitations” is a form of sound, from the heart, the sound of the quarter, the original meaning of the fear, the heart jumping. For example, “palpitations, the heart also moved” (Shuowen); “fear palpitations Ruoxi loss of breath” (Chu Shu – mourning chaos), note: “palpitations, fear also”; “suddenly soul palpitations to the spirit of moving” (“dreaming of Tianwu Yin stay”). In addition, palpitation also has the words palpitation shock (shock), palpitation tremble (fear shaking), palpitation heart (heart with fear), palpitation horror (fear), palpitation fear (if fear), palpitation horror (fear), palpitation confusion (panic confusion) and other words that express fear, fear.
The word “frightened” means: panic and palpitation, very worried and afraid. For example, “I was so worried about the high rank and favor of my father, but I thought of my own performance, and I was so worried about the heavy responsibility that I was frightened and palpitated. The ape cries and the tiger whistles, and one is frightened and palpitated” (“Apples and Wilderness: The Warriors of the End”); “The affectionate girl, frightened by her friend’s suffering, appears more frightened and palpitated than Dao Jing” (“Song of Youth”).
Anxiety is the primary and necessary clinical manifestation of anxiety disorders, with fear and dread as the core symptoms. For example, in panic attacks it manifests as a sudden and frightening experience, as if suffocation is imminent and madness is on the horizon. In generalized anxiety disorder it is manifested as persistent fear without a clear object or fixed content, or fearfulness, or nervousness. It can be seen that although the terms “panic”, “palpitation”, “panic attacks” and “anxiety” are different, they all have “fear” and “dread” as their basic meanings.
Second, the clinical manifestations of palpitation and anxiety disorders are similar
The name of “panic and palpitation” was first proposed in the Jin Kui Yao: “The pulse at the inch mouth is moving and weak, moving is panic, weak is palpitation.” In the Song Dynasty, Chen Wuzhe first divided palpitation into “frightening palpitation” and “agitation palpitation”, and Yan Youhe’s “Jisheng Fang” changed “agitation palpitation” to “palpitation”. “. Regardless of whether “palpitation” in Chinese medicine necessarily involves rapid heartbeat, it certainly involves such mental symptoms as “fear” and “dread”, and is often associated with other mental symptoms such as insomnia. The symptoms are often interdependent with other psychological symptoms such as insomnia.
First of all, mental panic, restlessness, or even trance are common manifestations of “panic and palpitation” disease. For example, the “three causes of extreme a disease evidence formula” cloud: “palpitations, then because of things have a big fright …… so make panic and palpitations, called heart panic chills”; “miscellaneous disease source rhinoceros candle” contains: “frightened … … touch easily frightened. … touch easily startled also. Palpitations, heart paralysis disease. Not because of the external touch, natural beating restlessness”; “blood evidence” clearly pointed out: “palpitations, fear and timidity of the so-called. The “blood evidence” clearly states: “palpitations, fear and timidity, the sudden fear and fear of the so-called”; “medical prescription examination” also cloud: “palpitations, the heart is tense, trance, as people will be arrested.”
Secondly, palpitations mostly occur together with insomnia and dreaminess. For example, the Zhongzangjing records that “the gallbladder is also the internal organs of the Zhongzheng, called the General …… deficiency is typhoid, cold is fear and fear, head dizziness, can not sleep alone; the real is injury to heat, heat is palpitations, the spirit does not guard, lying up restless” “(heart disease) Deficiency is more palpitations and fears, tigers and sleeplessness, pain in the chest, abdomen and waist and back, joy (one for good) and sorrow, sometimes dizziness. Heart accumulation of Qi, long does not go, then bitter and worried, pain in the heart, the real person happy and laughing, dreams of fire. The heart is full of gas, then dream of joy and laughter, and fear.” The “Taiping Sheng Hui Fang” records: “The bile deficiency can not sleep, is the five organs of the deficiency of evil gas dry in the heart. The heart has anxiety, ambush gas in the gallbladder, so sleep and restlessness, heart palpitations, mental weakness, cover the heart gas worry, liver and gallbladder deficiency cold, resulting in no sleep.”
Sheng Ji Zong Lu records: “Treating deficiency cold in the liver and gallbladder, less sleep at night, sleep that is alarming, palpitations, restlessness of the mind, dizziness of the eyes, restlessness of the heart, and weakness of the limbs. Tonifying the liver, removing gallbladder cold, and harmonizing Qi. Wu tonic soup formula” “to treat bile deficiency sleep and restlessness, mental fear and timidity, sour date pill formula” “to treat bile deficiency cold, headache heart palpitations, sleep and restlessness, often as people will be arrested, the spirit is not guarded, Wu Wei Zi Tang formula” “For the treatment of bile deficiency and coldness, mental deficiency, restlessness, dizziness of the head and eyes, fear and fear of not being able to live alone, Dioscorea pills formula”. It is written in “Taiping Huimin Hefei Dangbao Fang”: “(Ding Zhi Yuan) for the treatment of unstable heart qi, deficiency of the five viscera, trance and palpitation, sorrow and grief, erroneous and false forgetfulness, nightmares of dreams and sleep, terror and restlessness, joy and anger without time, drama in the morning and evening, and drama in the evening and the morning” “(Ping Tiao Zhen Xin Dan) for the treatment of husbands and women with deficiency of heart qi and unstable will. (Longtooth Zhenxin Dan) treats deficiency of heart and kidney qi in husbands, unstable will, unpredictable dreams, palpitations and disturbances, kidney qi injury, less blood and more qi, tiredness of limbs, sore feet and shins, unstable sleep and sleep, dreaming and spermatorrhea, white turbidity, gradually weakness” “(Longtooth Zhenxin Dan) treats deficiency of heart and kidney qi, palpitations and forgetfulness, dreaming and sleep, spermatorrhea, less color, sore feet and shins”.
Some researchers have found that although they are two different diseases with separate contents, they are often in a relationship of mutual mastery and subordination by reviewing ancient literature on “sleeplessness” and “palpitation”. The statistical results of 134 kinds of medical books and medical cases about sleeplessness show that 37.4% of insomnia combined with palpitation and anxiety symptoms.
Modern medical anxiety disorder is a neurological disorder characterized by widespread and persistent anxiety or recurrent panic attacks. Patients often have a premonition of panic, and are distracted and worried all day long, and are restless, as if they have a sense of imminent disaster; they often show excessive alertness, are sensitive to external stimuli, and are prone to startle reactions; they have difficulty falling asleep and are easily awakened during sleep; they are easily irritated; and they often have symptoms of autonomic dysfunction such as tachycardia. Some studies have shown that 54% of insomnia patients have moderate to severe anxiety. It is suggested that insomnia and anxiety disorders also have a relationship of mutual dominance and subordination.
It is easy to see that the main clinical manifestations of palpitation in Chinese medicine and anxiety disorders are similar, both showing nervousness and fear, sensitivity to external stimuli, easily frightened, and often accompanied by insomnia and other neurological symptoms.
Taking a step back, even if the palpitations are understood as a rapid beating of the heart due to fear, it is still very closely related to anxiety disorders. This is because in acute anxiety, tachycardia is its primary manifestation, accounting for 100%; in generalized anxiety, the incidence of palpitations and chest tightness is 72.4%. In addition, the presence of a hyperfunctioning sympathetic nervous system in patients with anxiety disorders and their susceptibility to cardiac rhythm variability has led to frequent clinical misdiagnosis of anxiety disorders as cardiac arrhythmias. This is another way to illustrate the relationship between panic disorder and anxiety disorders.
Third, palpitations and anxiety disorders have certain similarities in terms of treatment
From the treatment of palpitation disease by doctors in the past, the method of tranquilizing the mind is the main treatment of palpitation disease, and tranquilizing medicine is the necessary drug for the treatment of palpitation disease. For example, in the Song Dynasty, Yan Youhe’s “Ji Sheng Fang – Palpitations and Palpitations – Jian Fu Men”, it is said that “palpitations and palpitations are caused by the weakness of the heart and the timidity of the guts”, and it is advisable to “calm the heart to strengthen the guts”, and Yuan Zhi Wan is chosen as the treatment formula. Another example is “Medical Heart Enlightenment – No Sleeping”, which says: “Those who are frightened and restless are also frightened and scared in their dreams, and are treated with An Xin Ding Zhi Wan.” Modern research has found that the tranquilizer Yuan Zhi in the formula of Yuan Zhi Wan and An Xin Ding Zhi Wan has a good anti-anxiety effect. From another point of view, modern anti-anxiety drugs such as paroxetine, lorazepam, and buspirone can reduce or disappear neurotic symptoms such as nervousness, fear, and dread, which can certainly be included in the category of tranquilizers from the perspective of Chinese medicine. In addition, Chinese medicine preparations for the treatment of anxiety disorders also basically contain tranquilizers. For example, the anxiety disorder treatment has obvious efficacy of the suppression of the health capsule contains Yuan Zhi, Yu Jin, calamus, niuhuang, sour date and other tranquilizers, five heart nimble heart soup composition of tranquilizers (fried sour date, bamboo leaf heart, lotus seed heart, shouwu vine, mother of pearl, etc.) as the main medicine. Therefore, there are some similarities in the treatment of panic disorder and anxiety disorder in Chinese medicine.
IV. Summary
From the above discussion, we can see that the basic meaning of fright, palpitation and palpitation is “fear” and “dread”, and that palpitation in Chinese medicine is a disease in which “fear” is the main manifestation. “fear” as the main manifestation, and often accompanied by insomnia and other psychiatric symptoms of the disease, and anxiety is very close to the relationship. We must not interpret the palpitation disease in Chinese medicine as a simple palpitation or arrhythmia disease. At the same time, clarifying the close relationship between palpitation disorders and anxiety disorders can help provide new ideas and methods for the study of anxiety disorders in Chinese medicine.