Tcm Path Ii Final Palpitations

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Define Palpitations "Xin Ji" in TCM

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"a Subjective Sense" the person feels it/ a condition when a person's heart rate becomes so irregular, accelerated, or forceful that she is aware of it, experiencing nervousness, anxiety, or terror

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Palpitations relevant Biomed conditions

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Hyperthyroidism, neurosis, tachycardia, heart failure

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Palpitations/Xin Ji Etiology Pathogenesis (8)

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W/C/D invade, Severe blood loss, improper diet, emotional stress, Constitutional HT/GB Xu, Constitutional Ki Yin Xu, Constitutional HT Yang Xu, Constitutional Ki Yang Xu

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W/C/D Etiology/Patho

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W/C/D can invade and obstruct channels and collaterals, over time obstruction to heart causing heart blood stasis w palps

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Severe Blood Loss Etiology pathogenesis

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hemorrhage from any cause will fail to nourish HT and deprive spirit of residence so palps (post partem)

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Improper diet or overthinking etiology/pathogenesis

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overburden Sp, production phlegm and damp. OR Sp Qi Xu impacts HT in form of HT Qi or Blood Xu. Blood stasis may also result from the above

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Emotional Stress Etiology and Pathogenesis

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LV Qi stag from emotions leads to blood stasis and phlegm accum. Both obstruct HT vessels causing palps/OR LV Qi stag generates heat which accelerates HT Rate causes Pals/ LV Qi stag can result in Sp Qi Xu which results in decreased blood production and lack of nourishment to HT

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Constitutional HT/GB Qi Xu explanation

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constitutional Qi Xu of HT/GB manifests as lack of self-confidence, timidity, indecisiveness. HT malnourished and Shen easily disturbed by sudden, frightening events

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Constitutional Ki Yin Xu explanation

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If KI Yin (water) cannot nourish the HT (fire), loss of communication between KI and HT ensues. HT Fire becomes hyper and Palps result

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Constitutional HT Yang Xu explanation

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when chronic or severe illness exhausts HT Yang the vessels of the HT cannot be warmed, poor circ results in Blood stasis leading to palps (this is deficiency cold)

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Constitutional KI Yang Xu explanation

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KI Yang fails to warm and steam water, fluids overflow and block the HT Yang causing Palps

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Jing Ji (Fright Palps) VS. Zheng Chong (Fearful Throbbing)

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Jing Ji (fright palps) PT is in overall good condition Excess or mixed Excess/Defic patterns

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Jing Ji (Fright Palps) VS. Zheng Chong (Fearful Throbbing)

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Pt has significant Zang Fu Defic. Poor Health, Poor Prognosis, Serious HT Dz/ Palps w significant Systemic Probs

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5 Excess Xin Ji Patterns

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Phlegm Fire Harassing HT/Congested Fluids overflow to HT/ HT Blood stasis/Phlegm Fire/ Patho Cold

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4 Deficiency Xin Ji Patterns

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HT Qi Xu/HT blood or Yin Xu/Yin Xu w Empty Fire/ Yang Xu w Empty COLD

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Excess Xin Ji Patterns S&S- Phlegm Fire Harassing HT

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irritability, warm sensation in chest, insomnia, DDS, nausea, lack of appetite

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Excess Xin Ji Patterns S&S- Congested fluids Overflowing to HT

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dizzi, stifling sensation in chest, SOB, dyspnea, edema (usually weak KI Yin & Yang

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Excess Xin Ji Patterns S&S- HT Blood Stasis

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agitation, stabbing chest Px, cyanotic lips, purple spots on tongue, irregular pulse

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Excess Xin Ji Patterns S&S- Phlegm-Fire

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Rapid, slippery, forceful pulse

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Excess Xin Ji Patterns S&S- Pathogenic Cold

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Slow Pulse

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Deficiency Xin Ji Patterns S&S- HT Qi Xu

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empty feeling in HT, SOB, Fatigue, dizzi, aggravated by exertion

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Deficiency Xin Ji Patterns S&S- HT Blood or yin Deficiency

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weakness, restless in HT or chest, aggravated by mental strain

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Deficiency Xin Ji Patterns S&S- Yin Deficiency w empty fire

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thin, weak, rapid pulse

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Deficiency Xin Ji Patterns S&S- Yang Xu w Empty Cold

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Deep, slow pulse

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Palps Xin Ji HT/SP Xu S&S

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Palps worse w exertion, better w rest, dizzi, pale cxn, forgetful, fatigue, poor appetite, insomnia w difficulty falling asleep frequent vivid dreams

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Palps Xin Ji HT/Sp Xu T&P

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T= pale w thin coat, P=thin, weak

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Palps Xin Ji HT/Sp Xu Treatment Principles

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1. Supplement HT and Sp to promote production Qi & Blood, 2. Calm Spirit

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HT/Sp Xu Formula

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Gui Pi Tang

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Xin Ji HT/GB Qi Xu S&S

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palps, timidity, easily frightened or startled, insom w light sleep, frequent vivid sometimes DDS, wake w a start, SOB, fatigue, copious clear urine

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Xin Ji HT/GB Qi Xu T&P

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T=thin, white coat, P= slight rapid, weak in L Cun position

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Xin Ji HT/GB Qi Xu Treatment Principles

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1. Supplement Qi, 2. Stop Fright, 3. Calm Spirit

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HT/GB Qi Xu Formula

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An Shen Ding Zhi Wan

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Xin Ji HT/KI Yin Xu w/ Effulgent Fire S&S

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palps, insomnia, irritability, restlessness, 5 center heat, dizziness, tinnitus, forgetfulness, dry mouth, night sweats, sore low back

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Xin Ji HT/KI Yin Xu w/ Effulgent Fire T&P

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T= red scant or no coat, P= rapid, thin

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HT/KI Yin Xu w/ effulgent fire Treatment Principles

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1. Nourish yin 2. Downbear Fire 3. Supplement HT/KI 4. Calm Shen

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HT/KI Yin Xu w/ effulgent Fire Formula

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Tian Wan Bu Xin Dan

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Xin Ji Ht Qi, Blood and Yin Xu S&S

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Palps, SOB, Fatigue, Pale Cxn, spontaneous sweats or night sweats

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Xin Ji Ht Qi, Blood and Yin Xu T&P

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T= red w scanty or no coat, P= knotted or intermittent (bound) or skipping

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HT Qi, Blood and Yin Xu Treatment Principles

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1. Boost Qi 2. Nourish Blood and Yin 3. Calm Spirit

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HT Qi, Blood and Yin Xu Formula

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Zhi Gan Cao Tang

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Xin Ji Phlegm-Fire Harassing HT S&S

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palps w irritability or restlessness, susceptible to fright, insom, DDS, chest full w expectorate copious phlegm, heavy head; aversion to eat, belch, acid regurge, N,V, distention in epi, bitter taste, dizzi

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Xin Ji Phlegm-Fire Harassing HT T&P

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T= yellow greasy coat, P= rapid, slippery

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Phlegm-Fire Harassing HT Treatment Principles

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1. Clear Heat 2. Transform Phlegm, 3. Harmonize ST, 4. Calm Spirit

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Phlegm-Fire Harassing HT Formula

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Huang Lian Wen Dan Tang

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More True Cardiac DZ (3)

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Heart Yang Xu, Oppression HT by water and phlegm-fluids, Obstruction HT by Phlegm Fluids

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HT Yang Xu S&S

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Palps w chest stuffiness or Px, SOB; pale Cxn, COLD extremities and torso

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HT Yang Xu T&P

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T= Pale P= weak, deep, thin, slow

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HT Yang Xu Treatment Principles

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1. Warm and Supplement Yang, 2. Calm Spirit

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HT Yang Xu Formulas (2 together)

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Shen Fu Tang + Gui Zhi Gan Cao Long Gu Mu Li Tang

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Oppression HT by Water and Phlegm-Fluids S&S

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palps w dizziness, fullness and discomfort chest and epi, scanty urine, edema lower limbs; cold extremities and torso, thirst no desire, expectorate phlegm and mucus, N, V

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Oppression HT by Water and Phlegm-Fluids T&P

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T= pale, puffy, w/ white slippery moist coat, P= slippery, wiry, or deep wiry

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Oppression HT by Water and Phlegm-Fluids Treatment Principles

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1. Warm HT yang 2. Transform phlegm-fluids 3. Calm Spirit

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Oppression HT by Water and Phlegm-Fluids Formula

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Ling Gui Zhu Gan Tang

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Obstruction HT by Blood Stasis S&S

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Palps w chest stuffy and intermittent stabbing chest Px, cyanotic lips and nails

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Obstruction HT by Blood Stasis T&P

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T= purple w stasis macules P= choppy, knotted or intermittent

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Obstruction HT by Blood Stasis Treatment Principles

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1. Quicken Blood 2. Dissolve Stasis 3. Rectify Qi 4. Open C&C 5. Calm Spirit

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Obstruction HT by Blood Stasis Formula

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Xue Fu Zhu Yu Tang

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General Points for HT Palpitations (4)

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PC6, HT7, BL15, CV14

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HT/GB Qi Xu Points (2)

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HT5, GB40

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HT/Sp Qi Xu Points (3)

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BL17, BL20, ST36

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Effulgent Fire Points (4)

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BL14, KI3, SP6, BL23

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Phlegm-Heat Points (4)

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ST40, ST36, LI11, BL19

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Heart yang Xu Points 3 + Moxa

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CV6, CV4, CV8 + moxa

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Phlegm-Fluids Points (5)

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CV9, Sp9, CV4, CV8, CV14

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Blood Stasis Points (4)

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SP10, CV6, BL17, CV17

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Auricular points (4)

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Shen Men, HT, Symp, Subcortex

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HT Qi, Blood, Yin Xu Points(3)

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HT5, HT6, Sp6

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Which herb can we add to help SP handle heavy settlers?

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Shen Qu

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Chest Bi