Scholarly article on topic 'Acupuncture Treatment of Palpitation'

Acupuncture Treatment of Palpitation Academic research paper on "Clinical medicine"

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Academic research paper on topic "Acupuncture Treatment of Palpitation"

Teaching Round

Acupuncture Treatment of Palpitation

Hu Jinsheng ^^^

Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China

CASE HISTORY

A female patient, a translator in a Beijing translation company, aged 33 years, paid her first visit on March 10, 2006, with the chief complaint of palpitation for 3 days. The patient stated that 3 days before, she received uterine curettage for artificial abortion, when she got nervous tension. After the operation, she felt dizziness and palpitation, and precordial discomfort, which was diagnosed as paroxysmal tachycardia. She was treated right away by pressing the carotid sinus and the eyeball, but with no effects. Then, she came to us for treatment. The patient used to have a weak body constitution, and was very sensitive. She would have palpitation upon sudden events, which would disappear quickly after she calmed down. Her sleep was sometimes good and sometimes bad, appetite ok, and feces and urine normal.

Physical examination at the moment showed that the patient was slightly thinly built, with good mental status and quick reactivity. The blood pressure was 96/60 mmHg, and the heart rate 128 beats/min. The rhythm was normal and the heart border was not broadened, and with no heart murmurs. The TCM examination showed that the patient had a good mental status, but with pale complexion, pale tongue proper with thin-white coating, and thready-rapid pulse.

DISCUSSION

Prof. Hu: Would you please give your TCM differentiations based on the patient's clinical manifestations?

Dr. Zhang: I think this is a case of palpitation. According to location-differentiation, the zang-fu

organs, mainly the heart, should be affected. Based on the pathogenic analysis, the weak body constitution of the patient would make her have deficiency of qi and blood of the heart, leading to failure of the heart to be nourished, and when encountered with sudden fear and fright, she would have her heart lack of support and her mind lack of dominance, resulting in restlessness of the mind, hence the palpitation. In view of the nature-differentiation, this should be a deficiency syndrome, since the patient often had the deficiency signs, such as palpitation, unstable sleeping quality, pale tongue proper, and rapid pulse.

Dr. Wang: I agree to the analysis of Dr. Zhang. From the knowledge of basic TCM theories, we've learned that palpitation is a typical sign of pathologic changes of the heart, which can be seen in the various types of heart disease. In clinic, the commonly-seen deficiency syndromes of the heart include deficiency of the heart-yin, insufficiency of the heart-yang, insufficiency of the heart-qi, and deficiency of the heart blood. From the clinical manifestations of the patient we can not find the characteristics of deficiency of yin and insufficiency of yang, so we can think that this patient has mainly insufficiency of the heart-qi and deficiency of the heart blood. In addition to palpitation, a typical symptom of the heart disorder, the patient had the signs of insufficiency of qi, such as weak body constitution, pale complexion, and pale tongue proper. While the signs of dizziness, pale complexion, pale tongue proper, unstable sleeping quality, and thready pulse are all the characteristics of deficiency of the blood. Therefore, we can think that this is a palpitation due to deficiency of both qi and blood.

Dr. Li: I agree to the differential analyses of the two colleagues. This should be a quite simple case. But I still have some questions about clinical differential application. It has been mentioned above that palpitation is a typical sign of pathologic changes of the heart, which can be seen in the various types of heart disease. Then, do all the palpitation patients have pathologic changes of the heart? What are the main symptoms of the heart disease?

Prof. Hu: I'd like to say that you've made very good differentiations. This case is relatively easier to differentiated. And Dr. Li has raised very good questions, which are the problems generally encountered in the TCM study.

Diagnosis and treatment based on an overall analysis of the symptoms and signs are the principle in TCM treatment. The purpose of differential treatment is to differentiate the normal physical status of the human body with the abnormal pathologic changes, that is, the depth of pathological invasion to the human body, the kind and nature of the causative factors, and the excess and decline of the struggle between the vital energy and pathogenic factor, so as to establish correct treating principles and adopt effective therapeutic measures. Syndrome-differentiation is the basic skill for evaluating the TCM clinical level, which may directly influences the therapeutic results.

There are many methods in TCM differentiation, namely, the eight principal-syndrome differentiation, etiological differentiation, channel-differentiation, qi-blood-body fluid differentiation, zang-fu differentiation, six-channel differentiation, wei-qi and ying-blood differentiation, and tri-jiao differentiation, in which zang-fu differentiation is the basic method adopted in the TCM differential treatment. Zang-fu differentiation is a differential method used to analyze the clinical symptoms by taking the pathological changes of the zang-fu organs as the guiding principles. Zang-fu differentiation is widely used in the various clinical fields. Generally, all the differential methods should be finally focused on zang-fu differentiation. Therefore, to master the

zang-fu differential characteristics of a disease is of significance for application of the zang-fu differentiation.

First of all, we should be familiar with the characteristics of zang-fu diseases, especially for the diseases of the five zang organs as described below.

The characteristics of heart diseases: palpitation, insomnia, and with knotted-intermittent pulse.

The characteristics of lung diseases: cough, asthma, and with phlegm.

The characteristics of spleen diseases: poor appetite, abdominal distension, and with loose stool.

The characteristics of liver diseases: emotional changes, hypochondriac distending pain, susceptibility to sighing, and with wiry pulse.

The characteristics of kidney diseases: soreness and weakness of the waist and knee joints, and with frequent night urination, seminal emission, and impotence.

The mastering of the characteristics of zang-fu diseases can help guiding the clinical application of differential treatment. The treating principle is determined on the basis of syndrome-differentiation. Only when we have made accurate syndrome differentiation, can we be able to set up good principle of treatment.

Take palpitation for example. Whenever we come across a palpitation case, we must first consider the heart problem. Since the heart dominates blood circulation, which is accomplished through the function of the heart dominating qi. In clinic, once the heart qi is insufficient with decreased propelling force, there may appear palpitation. The heart dominating blood circulation is the function of the heart-qi. This function needs material nourishment. The function of the heart dominating qi is closely related with the function of the heart storing blood. Therefore, the pathologic changes in qi, blood, yin, and yang of the heart can all bring about the symptoms with palpitation as the main symptom. Here, the 'main' symptom is very important, because palpitation can sometimes appear as an acc-

ompanying symptom due to pathologic changes of other zang-fu organs affecting the heart.

As to the other main symptoms of heart disease, the commonly-seen symptoms are insomnia, and knotted-intermittent pulse. Insomnia usually indicates the affection of yin-blood of the heart, while knotted-intermittent pulse mostly indicates the affection of qi and yang of the heart. From the above, we can see that once there appear the three main symptoms of the heart channel like palpitation, insomnia, and knotted-intermittent pulse, we must, first of all take pathological changes of the heart channel into consideration.

If no more questions, let's discuss the principle of treatment and the point selection.

Dr. Li: After listening to Prof. Hu's explanation on palpitation, now I have a better understanding about it. As to the treatment, I think soothing the heart and calming the mind should be taken as the main principle for treatment.

The point prescription: Daling (PC 7), Shenmen (HT 7), Neiguan (PC 6), Shanzhong (CV 17), Juque (CV 14), Qihai (CV 6), and Zusanli (ST 36).

The analysis: Daling (PC 7) and Shenmen (HT 7) are selected for nourishing the heart and tranquilizing the mind. Daling (PC 7) can also subside down the heart-fire, and Shenmen (HT 7) is the yuan (source) point of the Heart Channel. Neiguan (PC 6) is used for strengthening the effect of tranquilizing the mind. Being the upper sea of qi, the selection of Shanzhong (CV 17) is mainly for strengthening qi of the heart and lung. As a front-Mu point of the Heart Channel, Juque (CV 14) is used for treating pathological changes of the heart. And Qihai (CV 6) and Zusanli (ST 36) can give the effect of replenishing qi and generating blood.

Dr. Wang: I agree to Dr. Li's idea. But I think some Back-Shu points should be added, such as Xinshu

(BL 15), Feishu (BL 13), and Pishu (BL 20) to regulate the functions of the heart, lung and sleen, for the heart dominates blood while the lung dominates qi, and the relationship between the heart and lung is the relationship between the blood and qi, which have the inter-propelling and inter-nourishing relationship; and the spleen is the source for formation of qi and blood. To regulate the functions of the above-mentioned zang-fu organs can help the normal performence of the heart function.

Dr. Zhang: I suggest the adding of auriculo-acupuncture. The auricular points such as Ear-Shenmen, Subcortex, Sympathesis, Heart, and Spleen can be selected. The auricular seed-embedding method can be used for enhancing the therapeutic effects.

Prof. Hu: You've given very good principle of treatment and point selection. I suggest the adding of Baihui (GV 20), Shenting (GV 24) and Yintang (EX-HN 3) to strengthen the mind-tranquilizing effect, which is effective for the patient's anxiety, restlessness, irritability, and insomnia.

TREATMENT AND RESULT

The above-mentioned method was adopted in the treatment. 3 minutes after the needling, the symptoms disappeared, with the heart rate restored to 82 beats/min. Later, she received 5 regulatory treatments with acupuncture at the Back-Shu points combined with auricular seed-embedding, after which the patient had all her symptoms disappeared and had good mental status. Then, she was asked to relax mentally, do physical exercise, and give by herself the pressing-kneading manipulation at bilateral Neiguan (PC 6) once daily, 5 minutes on each side. The follow-up survey for 6 months showed no recurrence.

(Translated by Wang Xinzhong ^)