Some time ago, a friend suffered from panic attacks due to work exhaustion and lack of sleep time, and he did not care at first, but in the following days, there were signs of gradual aggravation, especially after working overtime and staying up late, he felt panic attacks and often had intermittent heartbeats. When my friend went to the hospital for a checkup, the doctor diagnosed him with “premature beats” and needed to further check the 24h ambulatory electrocardiogram (also called Holter), which revealed frequent ventricular premature beats, with more than 5,000 premature beats in 24 hours. He was advised to take medication. So what are premature beats all about? One or several premature ectopic beats sometimes occur during the pacing of the heart and are called premature beats, also known as preterm contractions, or premature beats for short. There are many causes of premature beats, and some healthy people may also have premature beats, which are called functional premature beats. In healthy people, premature beats are often caused by artificial factors, such as emotional stress, full meals, overwork, upper respiratory tract infections, biliary system disorders, electrolyte disorders, and medications. Patients with heart disease are more likely to have premature contractions, which are called pathological premature contractions. Heart diseases that predispose to premature beats include coronary heart disease, hypertensive heart disease, rheumatic heart disease mitral stenosis, pulmonary heart disease, myocarditis, cardiomyopathy, pericarditis, etc. Other diseases that cause premature beats are hypothyroidism, anemia, hypokalemia, etc. What are the symptoms of premature beats? Usually, you cannot feel your heart beating. When a premature beat occurs, the heart can be felt because of the strong contraction of the ventricles, and then there is a pause after the beat, so the heart can feel like it is stopping. The sensation is not consistent among people. Some people say that the heart swings a little, some feel that the heart wants to jump out of the throat, and some have obvious panic discomfort. In addition, it may be accompanied by chest tightness, nausea, cough, dizziness and other discomforts. Some people even experience frequent premature beats without any sensation or symptoms, which are only detected during a doctor’s auscultation or an electrocardiogram. What are the dangers of premature beats? Clinically, functional or physiological premature beats are very common. They can occur in normal people when they are overworked, stressed, excited or anxious, or when they smoke a lot, drink alcohol, coffee or strong tea, or when they are resting or sleeping in bed. These functional premature contractions disappear when the trigger is removed and no evidence of heart disease can be seen after a thorough examination of the patient. In some healthy people, the presence of a few premature contractions can be very stressful and frightening, which can lead to an increase in premature contractions. The presence of premature beats is an important sign of myocardial ischemia and injury. For example, premature beats in patients with myocardial infarction in coronary artery disease often indicate severe myocardial ischemia; premature beats in patients with wind heart disease often indicate cardiac insufficiency; premature beats in patients with hypertensive heart disease are often associated with ventricular hypertrophy and strain. If there is severe heart disease, then frequent premature beats can lead to myocardial ischemia, angina pectoris, or heart failure. Frequent atrial premature beats are often a sign of atrial fibrillation in heart patients, and frequent ventricular premature beats can develop into ventricular tachycardia or even sudden death due to ventricular fibrillation. Therefore, if a patient with heart disease has frequent premature beats, he or she should go to the hospital for active treatment. In general, premature beats in the elderly and children are often organic in nature. If angina pectoris or heart failure is present with premature beats, they are definitely organic. Premature beats in people with heart disease manifestations such as shortness of breath or heart enlargement, or with factors predisposing to coronary heart disease (hypertension, hyperlipidemia, diabetes, obesity, family history, etc.), are mostly organic. What does TCM know about premature beats? Premature beats are a modern diagnosis in Western medicine and belong to the electrocardiogram. In Chinese medicine, there is no such diagnosis since ancient times, but the symptoms are included in “palpitations” and “palpitations of the heart”. This formula is still commonly used in clinical practice to treat premature beats with very good results. According to TCM, the evidence of premature beats is generally divided into deficiency and reality. Deficient symptoms are usually caused by deficiency of Qi and blood and loss of nourishment of the heart and mind, resulting in palpitations. The actual symptoms are caused by disturbance of the heart by liver fire, internal stagnation of water-drink, stagnation of qi and blood, etc., resulting in disturbance of the heart and mind. Clinical evidence of deficiency of heart qi and yin, deficiency of heart yang, stagnation of heart blood, and deficiency of heart and spleen are common. The above types of symptoms can be treated with appropriate treatment methods, which can have a good effect on premature beats. 1. Heart Qi and Yin deficiency Common symptoms include: palpitations, shortness of breath, fatigue, dizziness, heart trouble, sleeplessness, chest tightness and pain, increased number of premature ventricles at night or during labor, red tongue with little coating and weak pulse. Treatment: Benefit heart qi and nourish heart yin. The formula is based on Sheng Wei Wei Drink with added flavor (Red Ginseng, Mai Dong, Wu Wei Zi, Sheng Di, Fire Ma Ren, Sour Date Palm, Zhi Mu). You can also use drugs such as Tianwang Tonic Heart Dan. 2, Heart Yang deficiency Common symptoms include: palpitations, chest tightness, heart pain, dizziness, coldness, shortness of breath, swelling of the lower limbs, early morning and early night, and increased movement. The mouth and lips are purple, the tongue is pale, the coating is white and smooth, and the pulse is rapid or knotted. The treatment is to warm and tonify the heart yang. The formula is Bao Yuan Tang with Gui Gan Long Mu Tang plus reduction (Astragalus, Ginseng, Roasted Licorice, Cinnamon, Gui Zhi, Poria). Common symptoms include palpitations, chest tightness, heart pain, ventricular premature increase with disease progression, purple tongue and astringent pulse. Treatment is to activate blood circulation, resolve blood stasis, calm the heart and tranquilize the mind. 4, heart and spleen deficiency Common symptoms include palpitations, dizziness and forgetfulness, increased number of ventricular mornings due to exertion, fatigue, lack of appetite, yellowish complexion, light and tender tongue, weak and knotted pulse. The treatment is to tonify the heart and spleen. The formula is GUI Spleen Tang plus reduction (Radix et Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Radix et Rhizoma Glycyrrhiza Uralensis, Porcupine, Fructus Ziziphi, Fructus Jujubae, Fructus Longan, Fructus Jujubae). In conclusion, TCM treatment for premature beats is best based on the identification of the symptoms, and the conclusion of whether the symptoms are deficiency, or lack of nourishment of the heart and mind, or actual, or disturbance of the heart and mind, can only be made after examination and diagnosis. If you have more premature beats and obvious symptoms, you’d better go to the hospital for outpatient consultation before taking Chinese medicine.