Insomnia and Palpitations
Water and Fire Disharmony
Palpitations combined with insomnia are a common complaint treated at an acupuncture clinic. There is often Heart Qi deficiency and Blood deficiency underlying this condition. When these differential diagnostics are present, acupuncture combined with herbal medicine is more effective than either treatment modality alone. Arrhythmias often occur in this situation and Chinese medicine can effectively eliminate or reduce the palpitations, insomnia and heart beat irregularities. Often, the arrhythmias are significantly easier to resolve when they are irregularly irregular. In other words, when there is no distinct pattern to the irregular heart beat it is a more simple matter to resolve.
Palpitations may occur in healthy individuals when experiencing fright, stress and anxiety. Caffeine, nicotine and alcohol may also cause temporary attacks. During pregnancy, it is not uncommon to experience palpitations. People experience palpitations as a feeling of a rapid heart beat or a beat that is excessively forceful. They may be perceived as skipped beats and may feel as if they are emanating from the chest, throat or neck. Recurrent episodes are indications for treatment as are palpitations accompanied by dizziness, chest pain or syncope.
Chinese medicine classifies palpitations due to a variety of conditions. They most commonly present as disturbance of the shen, Qi and Blood deficiency and Fire due to Yin deficiency. Shen disturbance is often due to fright and may be accompanied by pathogenic influences such as internal phlegm with heat, depression, anger, phlegm fire rising and stomach disorders. Qi and Blood deficiency affecting the heart may cause palpitations. The heart is damaged by blood loss, chronic diseases and constitutional weakness. Over-concentrated thinking may wear down the Heart and Spleen and damages the normal production of Qi and Blood. Chronic disease and overindulgence in sexual activity may deplete the Kidney Yin and lead to the inability of Water to harmonize with Fire. The Heart Fire then blazes upward and disturbs the shen. Dirty water stagnation may also result in palpitations. Often, chronic Spleen and Kidney Yang deficiency may lead to pathological fluid retention that gives rise to palpitations.
Prof. Wei Shui had an amazingly successful track record when treating palpitations, insomnia and arrhythmias. For the past twenty years, I have found that his approach to acupuncture and herbal medicine is easily implemented and highly effective. Prof. Shui noted that dizziness, obscured vision and/or dyspnea often accompany Qi and Blood deficiency related insomnia, palpitations and arrhythmias. He clearly outlined that external factors such as sudden fright may also lead to palpitations characterized by rapid and forceful heart beats that slowly return to a normal rate and rhythm. However, external events such as this may lodge within the body and create long term disharmony.
Let’s take a look at some of the acupuncture and herbal medicine approaches that Prof. Shui used. Acupuncture points for this condition usually included P6 (Neiguan), P7 (Daling), HT7 (Shenmen), HT5 (Tongli) and DU20 (Baihui). He often used a 1 inch needle, manually stimulating the points until a light reaction occured. He then retained the points for at least 5 to 10 minutes. Any discussion of the great professor benefits greatly from pointing out that he was a Qi Gong master. As such, his ability to stimulate a deqi response in patients was rapid and potent. As pointed out in the Neijing, a complete practitioner of Chinese medicine has a deep working knowledge of the movement of Qi through the channels and practices Qi Gong.
During an acute attack of palpitations when fright may be exacerbated by needling, Prof. Shui used herbal medicines, without acupuncture, such as Bi Zhi An Shen Wan or Ci Zhu Wan modified with Long Chi and Mu Li. I find that it is sometimes difficult to get good quality Long Chi and that it may be necessary to use Long Gu when it is unavailable. The deep sedative qualities of these herbs helps to calm the patient. When the patient is calm and the palpitations are not present, the acupuncture point prescription can be used effectively and clinical results are rapid. The application of HT7 and HT5 have the specific action to resolve palpitations.
If the Heart Blood is deficient, Gui Pi Tang helps to calm the patient. This is especially relevant for patients with a poor memory due to excessive mental activity, palpitations, insomnia, dizziness, a pale complexion, exhaustion and anorexia. The pulse is usually deficient and the tongue is pale or light pink. Tian Wang Bu Xin Dan is more appropriate when there is Heart Fire and Kidney deficiency. The principle is to nourish the Blood to calm the Qi. These patients often present with tachycardia, chest discomfort, insomnia, dizziness, mental restlessness, tinnitus, dry throat, mouth & tongue sores and a bitter taste in the mouth. If there is uncontrolled nocturnal seminal emission or Kidney deficiency related lower back pain, Zhu Sha An Shen Wan or Liu Wei Di Huang Wan is best suited for the patient. Naturally, a non-toxic replacement for Zhu Sha is indicated to modernize the former formula.
Damp Heat is often a culprit in causing palpitations. The tongue will have a greasy coating that is yellow and the pulse is slippery and rapid. The phlegm heat rises and leads to palpitations and insomnia. Wen Dan Tang with Suan Zao Ren and Yuan Zhi is an excellent choice to clear the damp heat, help to separate the clear from the turbid and to calm the stomach. These formulas and acupuncture points are but a few of the selections that Prof. Shui used to resolve this condition. His overall perspective and clinical experience was that most conditions of palpitations and insomnia resolve rapidly.
There are other approaches to acupuncture that are also widely accepted for the treatment of palpitations. Similar to Prof. Wae Shui’s approach, Back Shu and Front Mu points of the Heart combined with Heart and Pericardium channel points are primary selections across multiple schools of thought in acupuncture. Tonification of Qi and Blood to nourish the Heart and calm the mind remain important clinical approaches. Also, sedating needle techniques are important to clear deficiency and excess heat and also to reduce dampness. The commonly accepted standard acupuncture points for the treatment of palpitations are CV14, UB15, HT7 and P6. Supplementary points are added for specific conditions. Naturally, micro-acupuncture systems such as auricular acupuncture and scalp acupuncture are also well suited for the treatment of palpitations.
Herbal formulas such as An Shen Bu Xin Wan, Tian Wang Bu Xin Dan, Gui Pi Tang and Long Gu Mu Li Tang are commonly used in the clinic for the treatment of palpitations. Wen Dan Tang, however, is often overlooked. The obstruction of the free flow of Qi and Gallbladder Fire significantly contribute to palpitations. Wen Dan Tang is helpful in regulating Qi, transforming phlegm, clearing Gallbladder Fire and regulating the Stomach. Wen Dan Tang contains the following herbs: Zhu Ru, Zhi Shi, Ban Xia, Chen Pi, Fu Ling, Gan Cao, Da Zao and Sheng Jiang. Prof. Wae Shui’s addition of Suan Zao Ren and Yuan Zhi make the formula especially helpful in the resolution of palpitations and insomnia. Over the years, this formula modification has been adopted as a clinical standard by many. Wen Dan Tang is handy for a variety of other conditions including nausea, vomiting, dizziness, anxiety, timidness, a bitter taste in the mouth and constant hunger. In addition to the treatment of palpitations and insomnia, Wen Dan Tang is well suited for the treatment of chronic gastritis, bronchitis, PTSD (post traumatic stress syndrome) and peptic ulcers.