<Palpitations and Chest Tightness>: What Is Your Body Telling You? HW05
Palpitations and Chest Tightness: What Is Your Body Telling You?
___ From emergency signs and tests to everyday care
L4 HW05 Palpitations and Chest Tightness: What Is Your Body Telling You?
Oct 4, 2026 · @Jane
From emergency signs and tests to everyday care
— Modern medicine to find the cause, TCM to understand the whole person, daily habits to manage the triggers
Fang Tianliang · HONGDAHEALTH
Before you begin
In L3, Palpitations and Chest Tightness: What Should I Do?, we spent an afternoon with Xiaomin as her heart raced, and learned three things: first decide whether it is urgent; if it isn’t, sit down, breathe and make a note; if it keeps happening, get it properly checked.
This L4 goes one step further — not only what to do, but why.
Perhaps you have had palpitations on and off for months. Perhaps a doctor told you, “You have some ectopic beats, but nothing serious,” and you still don’t know what to do day to day. Perhaps you would like to try Traditional Chinese Medicine but don’t know where it is safe to start. Or perhaps you are looking after a parent who often feels tight in the chest.
This book has six parts, in the order a person travels from “my heart is racing” to “I know what I’m dealing with”:
1. Safety first: which situations cannot wait even a minute.
2. Finding the cause: where palpitations and chest tightness can come from, and what to have checked.
3. After diagnosis: how modern medicine treats the causes.
4. Another angle: how TCM sees it — deficiency, heat, stagnation, phlegm and stasis.
5. What you can do every day: sleep, exercise, triggers, breathing and ordinary foods from the kitchen.
6. Where you need professional help: medicinal-food herbs, Chinese patent medicines, classical formulas, and special groups of people.
One principle runs through the whole book: rule out danger first, then focus on care.
An action map
Before the main chapters, please remember this “action map”. Each time palpitations or chest tightness come, you can walk through it:
1. It is happening now → First ask: are there any danger signs?
2. Danger signs → Call for an ambulance straight away (999 in the UK, 120 in mainland China).
3. No danger signs → Sit down, breathe slowly, check your heart rate, make a note.
4. It keeps happening → Take your notes to your GP or a heart specialist.
5. Get tested → Turn guessing into knowing.
6. Cause found → Follow your doctor’s plan.
7. Day-to-day care → Sleep, exercise, coffee and alcohol, mood, food.
8. Thinking about TCM → Ask a TCM practitioner to assess the whole picture before deciding on any medicine.
Each chapter that follows fills in one step of this map.
Part 1 Safety first
Chapter 1 What do palpitations and chest tightness actually feel like?
Palpitations — xinji in Chinese medicine — means being clearly and uncomfortably aware of your own heartbeat. People describe it in many ways: “pounding”, “like it’s jumping out of my chest”, “a thud as if it skipped a beat”, “a hollow feeling”, “beating like a drum, all over the place”.
These descriptions are valuable to a doctor. Fast and regular, fast and irregular, or the occasional pause — each tends to point to different causes. So when you describe what you feel, be as specific as you can.
Chest tightness is a feeling of tightness, blockage, pressure or not being able to get enough air. It can come from the heart, such as reduced blood supply to the heart muscle; from the lungs, such as asthma or a blood clot in the lung; from the gullet and stomach, such as acid reflux; from the muscles and bones; or from emotional tension.
Why do the two so often come together? When the heart beats too fast or out of rhythm, it pumps less efficiently, and the chest can feel tight. In turn, the worry and fear that chest tightness brings can make the heart beat faster. Each feeds the other, so the more you worry, the worse you feel.
Understanding this loop is itself the first step out of fear.
Chapter 2 Warning signs and emergency action: please read this chapter more than once
When to call for an ambulance straight away
If any of the following happens, do not wait, and do not drive yourself to hospital:
1. A crushing, squeezing or heavy pain or discomfort in the chest that lasts more than a few minutes, does not ease with rest, or keeps coming back.
2. Pain or discomfort spreading to the left shoulder, left arm, jaw, neck, back or upper stomach.
3. Heavy sweating, feeling or being sick, looking pale, or cold, clammy skin.
4. Marked breathlessness, being unable to lie flat, or coughing up pink, frothy phlegm.
5. Fainting, or the world going dark as if you are about to faint.
6. A very fast heartbeat that will not settle, or a very slow one, with dizziness, weakness or chest tightness.
7. A sudden drooping face, slurred speech, or weakness on one side of the body.
8. Sudden chest pain on one side with breathlessness, especially after a long flight, surgery, bed rest, or a painful swollen leg — this may be a blood clot in the lung (pulmonary embolism).
A special note: in women, older people and people with diabetes, a heart attack may not be typical. There may only be chest tightness, breathlessness, extreme tiredness, upper stomach discomfort or a cold sweat. Don’t dismiss it just because it doesn’t look like someone clutching their chest on television.
What to do while waiting for the ambulance
• Have the person stop all activity and rest in a safe, comfortable position until the ambulance arrives; do not drive to hospital yourselves.
• If a doctor has previously prescribed emergency medicine such as a GTN (glyceryl trinitrate) spray, it can be used as that doctor instructed.
• The 999 call handler may sometimes advise chewing an aspirin. Follow the emergency service’s judgement and do not decide this yourselves — especially if the person is allergic to aspirin, has a bleeding problem, or takes blood thinners.
• Have the person’s list of medicines, medical history and test reports ready to hand to the ambulance crew.
If someone collapses
If the person does not respond and is not breathing normally, shout for help and call 999, and start chest compressions straight away: place the heel of one hand on the lower half of the breastbone with the other hand on top, keep your arms straight, and push hard and fast — 100 to 120 times a minute, about 5 to 6 cm deep. If there is a defibrillator (AED) nearby, get it as quickly as possible, switch it on and follow its spoken instructions — an AED needs no training, and anyone can use it.
We recommend that at least one person in every household takes a proper CPR course. It is a skill that genuinely saves lives.
The “take a pill and wait” mistake
Some families are used to taking a “heart-rescue” Chinese patent medicine first when someone has chest pain, and then “waiting to see”. We have to be clear: no Chinese patent medicine can replace calling for emergency help, or replace hospital treatment of a heart attack. In a heart attack, every minute counts, and every minute lost may mean permanent damage to the heart muscle.
The right order is always: call for emergency help first, then decide on any medicine under the guidance of the emergency service or a doctor.
Part 2 Finding the cause
Chapter 3 Where can palpitations and chest tightness come from?
Causes related to the heart
Ectopic beats. These include atrial and ventricular ectopic beats (extra beats), felt as a “thud” or a “skipped beat”. Occasional ectopic beats are common even in healthy people; but frequent ones, or ectopic beats in someone who already has heart disease, need a specialist assessment.
Atrial fibrillation (AF). A fast and completely irregular heartbeat, often with tiredness, chest tightness and breathlessness. One of the biggest risks of AF is a clot forming in the heart and causing a stroke, so once AF is diagnosed, the doctor will assess whether blood thinners are needed. It is more common in middle-aged and older people, people with high blood pressure, and people who drink a lot.
Supraventricular tachycardia (SVT). Often “switches on and off suddenly”, with a regular heart rate that can reach 150 beats a minute or more. It is not unusual in young people, and many people can have it dealt with long term by catheter ablation.
Angina and heart attack from coronary heart disease. Typically, chest tightness or pain comes on with exertion or strong emotion and eases with rest. If it does not ease with rest, or happens more and more often, an acute coronary syndrome must be considered.
Other heart conditions. Myocarditis (often after a cold or fever), cardiomyopathy, heart valve disease, heart failure, a slow heart rate and heart block.
Causes with little to do with the heart
Anxiety and panic attacks. Sudden intense fear with palpitations, chest tightness, trembling, sweating and a sense of doom, usually peaking within about ten minutes. This is a real, treatable problem — not “putting it on” and not “overthinking”. But this conclusion should only be reached after heart problems have been reasonably ruled out.
An overactive thyroid (hyperthyroidism). Palpitations, feeling hot, sweating, trembling, weight loss and irritability. A blood test of thyroid function can help tell.
Anaemia. When haemoglobin is low, the heart has to beat faster to deliver enough oxygen, so palpitations and breathlessness on exertion are noticeable.
Low blood sugar. Palpitations, sweating, trembling and weakness when hungry, easing after eating. People with diabetes who use glucose-lowering medicines need to watch for this.
Stimulants and medicines. Coffee, strong tea, energy drinks, alcohol, nicotine, and some cold remedies, slimming products, asthma inhalers and thyroid hormone tablets.
Others. Acid reflux (burning behind the breastbone, acid in the mouth, worse after a big meal or lying down), the menopause, fever and dehydration, low potassium after diarrhoea or vomiting, costochondritis (pain that is worse when the spot is pressed), asthma and other lung problems.
Knowing these causes is not so that you can diagnose yourself. It is so that you understand how wide the range is — you can’t tell them apart by feel, and only tests can point you in the right direction.
Chapter 4 Seeing a doctor: who to see, what to test, and how to understand the results
The key sentence: what we fear most about palpitations is not knowing what to eat — it is not knowing the cause. Tests exist to turn guessing into knowing.
How to describe your palpitations to a doctor
Appointments are often short. The more specific you are, the easier it is for the doctor. Try to answer these questions:
• How does it beat? Fast and regular, fast and irregular, or an occasional “pause, then a hard beat”? You can tap the rhythm out on the table for the doctor.
• How does it start and stop? Suddenly on and suddenly off, or gradually faster and gradually settling?
• How often, and for how long? Several times a day, or once every few months? Seconds, minutes or hours each time?
• When does it happen? During exercise, at rest, lying down, after meals, after coffee, when emotional, or on waking at night?
• What else comes with it? Chest pain, breathlessness, dizziness, blacking out, sweating, trembling?
In particular, palpitations during exercise, fainting or near-fainting, and a family member who died suddenly at a young age — always tell the doctor about these three.
Who should I see?
• In the UK, start with your GP, who will arrange tests or refer you to a specialist. In an emergency call 999; for urgent advice that is not an emergency, call NHS 111.
• In China, the first choice is usually the cardiology department.
• If an overactive thyroid is suspected, an endocrinologist; if acid reflux is the main problem, a gastroenterologist.
• If anxiety, poor sleep or panic is the main issue, once heart problems have been ruled out, a mental health or psychological service can help.
What to prepare before you go
1. A symptom diary. For each episode: date and time, how long it lasted, what you were doing, heart rate, regular or irregular, any chest pain, breathlessness or dizziness, and possible triggers.
2. Heart-rate evidence. Heart-rate or ECG recordings from a smartwatch taken during an episode are very valuable — save screenshots.
3. A complete list of everything you take. Prescribed medicines, Chinese patent medicines, herbs, supplements and slimming products — leave nothing out.
4. Previous test reports.
5. Family history. Has anyone in the family had heart disease early (men before 55, women before 65), or died suddenly and unexpectedly at a young age?
Common tests and the question each one answers
Test | Main question it answers |
Resting ECG | Your heart rhythm right now; any signs of reduced blood supply or a past heart attack |
24-hour or longer heart monitor (Holter) | How many ectopic beats in a day; any AF or fast rhythms; do they match your symptoms |
Full blood count | Is there anaemia |
Thyroid function | Is the thyroid overactive or underactive |
Salts (electrolytes), blood sugar, liver and kidney function | Triggers such as low potassium, low magnesium or low blood sugar |
Troponin and other heart-muscle markers | Used when heart-muscle damage is suspected |
Echocardiogram (heart ultrasound) | Heart structure, pumping function and valves |
Exercise test, CT coronary angiogram, etc. | Assessing coronary heart disease |
Event recorder or implantable loop recorder | When episodes are rare and an ordinary Holter misses them |
Understanding common terms on your test reports
When people get a report, the first thing they often see is a string of unfamiliar terms. Then they search online and grow more frightened the more they read. Below, the most common terms from palpitation and chest-tightness tests are put into plain language. The Chinese terms are given in brackets for readers comparing reports from China.
First, three principles for reading any report:
1. Read the conclusion first, then the details. The “conclusion” or “summary” at the end matters more than the numbers in the middle.
2. A single term is not a diagnosis. The same word can mean very different things in different people with different symptoms; it must be interpreted by a doctor in the light of your situation.
3. Don’t declare yourself “fine” or “doomed”. The explanations below are only to help you understand what the doctor is saying, not to replace the doctor’s judgement.
Common terms on an ECG
Term on the report | What it roughly means | How it is usually viewed |
Sinus rhythm (窦性心律) | The heartbeat starts from its normal natural “pacemaker”, the sinus node | This is the normal rhythm |
Sinus tachycardia / bradycardia (窦性心动过速 / 过缓) | Normal rhythm, but more than 100 / fewer than 60 beats a minute | Anxiety, fever, anaemia or an overactive thyroid can speed it up; a slower rate can be normal in people who exercise a lot. Interpret with symptoms |
Sinus arrhythmia (窦性心律不齐) | The heart rate rises and falls slightly with breathing | Very common in young people and usually normal |
Atrial / ventricular ectopic beats (PAC, APB, SVE / PVC, VPB, VE; 房性 / 室性早搏) | The upper / lower chambers beat early | Occasional ones are very common; frequent ones, runs, or ectopics with heart disease need specialist assessment |
Occasional / frequent (偶发 / 频发) | Few / many ectopic beats | A description of number; its meaning depends on the Holter burden |
Bigeminy / trigeminy (二联律 / 三联律) | An ectopic beat after every one / two normal beats | Suggests a higher number of ectopics; needs a doctor’s assessment |
Couplet, run of SVT / NSVT (成对早搏、短阵房速 / 室速) | Two or more early beats in a row | Runs of ventricular tachycardia (NSVT) in particular need further cardiology assessment |
ST-T changes / non-specific ST-T changes (ST-T改变) | A change in the shape of part of the ECG trace | May relate to reduced blood supply to the heart, or may mean nothing in particular; neither ignore it nor panic — let the doctor judge it alongside your symptoms |
Incomplete right bundle branch block (不完全性右束支传导阻滞) | A slight delay in the right-side electrical pathway | Common in healthy people; usually of little significance |
Left bundle branch block (LBBB; 左束支传导阻滞) | The left-side electrical pathway is blocked | The doctor will want to assess the heart’s structure and function further |
First-degree AV block (一度房室传导阻滞) | Conduction from the upper to lower chambers is slightly slow | Usually causes no symptoms and is of little significance; second- and third-degree block need attention |
Prolonged QT (QT间期延长) | The heart takes longer than usual to “reset” between beats | May raise the risk of certain rhythm problems; medicines and salts should be checked |
Left / right axis deviation (电轴左偏 / 右偏) | The overall direction of the heart’s electrical activity is shifted | A description in itself; interpret with the other findings |
Common terms on a Holter (24-hour monitor) report
Term on the report | What it roughly means | How it is usually viewed |
Total beats (总心搏数) | How many times the heart beat during the recording | Around 100,000 in 24 hours; used to work out the proportion of ectopic beats |
Average / maximum / minimum heart rate | The range of your heart rate over the day | Note when the fastest and slowest rates happened and what you were doing |
Ectopic count and percentage (burden; 早搏负荷) | Ectopic beats as a percentage of all beats | The higher the burden, the more a cardiology assessment is needed; don’t judge yourself against a single number found online |
Pause (长间歇 / 停搏) | A longer gap between two heartbeats | When the report highlights it, a doctor needs to assess whether it matters |
Symptom correlation (症状对应) | What the ECG showed when you pressed the button or wrote in your diary | Very valuable: it shows what your heart was actually doing at the moment you felt unwell |
This is why, while wearing a Holter monitor, you should keep a careful diary: the time, what you were doing, and how you felt.
Common terms on an echocardiogram (heart ultrasound) report
Term on the report | What it roughly means | How it is usually viewed |
Ejection fraction (EF / LVEF; 射血分数) | The proportion of blood pumped out with each beat — a measure of pumping function | Generally above 50% is normal; about 40–49% is mildly reduced, and 40% or below is clearly reduced. Go by the reference range on your report and your doctor’s explanation |
Trivial / mild regurgitation (瓣膜少量 / 轻度反流) | A small amount of blood leaks back as a heart valve closes | Very common in healthy people; usually physiological and needs no treatment |
Impaired relaxation / diastolic dysfunction (左室舒张功能减低) | The heart relaxes and fills a little less well | Common with age and high blood pressure; manage blood pressure and other risk factors |
Dilated chamber / thickened wall (心腔扩大 / 室壁增厚) | A heart chamber is enlarged, or the heart muscle is thicker | The doctor will look for the cause, such as high blood pressure, valve disease or a heart-muscle condition |
Common blood tests
Test | What it roughly means | How it is usually viewed |
Low haemoglobin (Hb) | Anaemia | The cause of the anaemia needs to be found |
Low TSH, high free T4 (FT4) | Suggests an overactive thyroid | A common cause of palpitations; needs treatment by an endocrinologist |
Low potassium / magnesium (K / Mg) | Low body salts | Can trigger ectopic beats and rhythm problems; the cause should be found and corrected |
Raised troponin | The heart muscle may have been damaged | Especially important with acute chest pain; needs immediate assessment |
Raised BNP / NT-proBNP | May suggest the heart is under extra strain | Also affected by age and kidney function; needs the doctor’s overall judgement |
Raised D-dimer | Clotting or clot breakdown may be happening in the body | Mainly used to rule out a clot; a mild rise has many causes and does not mean there is definitely a clot |
After reading your report, ask the doctor these three questions
1. Does this result need treatment? Or just watching?
2. Do I need a repeat test? When?
3. In what situations should I come back quickly, or call 999 straight away?
Write down the doctor’s answers. The next time your heart races, you will have your own personal “user guide”.
“The doctor says I’m fine, but I still feel awful”
This is the sentence many readers find most confusing.
“Reassuring test results” means, precisely: no heart problem needing urgent treatment has been found at this time. It does not mean your discomfort isn’t real. It means that the focus can now move to triggers, lifestyle, mood and overall wellbeing.
Remember too: normal tests in the past do not mean everything will always be normal. If the nature, frequency or accompanying symptoms of your episodes clearly change, go back to the doctor and take your notes.
Part 3 After diagnosis
Chapter 5 How modern medicine treats the causes
Treating the cause
Once the cause is found, much of the problem is often solved: an overactive thyroid is treated; anaemia is treated with iron while the reason for it is found; low potassium is corrected; a medicine causing it is adjusted; caffeine is cut back.
Heart-rhythm problems
• Occasional ectopic beats with a structurally normal heart: usually managed by watching and removing triggers; medicine is not always needed.
• Troublesome or high-burden ectopic beats: the doctor may use medicines such as beta-blockers, and sometimes consider catheter ablation.
• Supraventricular tachycardia (SVT): an episode can be stopped with a technique the doctor has taught you, or with medicine in hospital; for repeated episodes, catheter ablation has a high success rate.
• Atrial fibrillation: treatment covers three things — assessing whether blood thinners are needed to prevent stroke; controlling the heart rate; and, where needed, restoring and maintaining a normal rhythm. Blood pressure, weight, alcohol and sleep apnoea are managed at the same time.
Coronary heart disease
This includes antiplatelet medicines, statins to lower cholesterol, control of blood pressure and blood sugar, medicines to relieve angina, and, when needed, a stent or bypass surgery. Taking medicines regularly over the long term and cardiac rehabilitation are very important.
Anxiety and panic
Cognitive behavioural therapy (CBT) is well supported by research; where needed, the doctor may also prescribe medicine. Regular exercise, breathing practice and mindfulness all help.
Important: if you already take prescribed medicines, please don’t stop or reduce them yourself because you have started Chinese medicine or food therapy. Discuss any change with your doctor.
Part 4 Another angle: how TCM sees it
Chapter 6 Deficiency, heat, stagnation, phlegm and stasis: five directions in TCM
Names and basic ideas
In TCM, palpitations are called xinji (心悸). Milder episodes that come and go, often set off by fright, are called jingji (惊悸, “fright palpitations”); more persistent and severe ones are called zhengchong (怔忡). Chest tightness and chest pain mostly fall under xiongbi (胸痹, “chest blockage”).
TCM holds that “the heart governs the blood vessels” and “the heart houses the spirit”. It looks not only at the heartbeat, but also at the tongue, the pulse, sleep, appetite, feeling hot or cold, sweating and mood — the state of the whole person.
Five common directions
To make it easier to understand, TCM’s common views of palpitations and chest tightness can be grouped into five directions. Real people usually show a mix of several, so what follows is only for understanding the approach — not for labelling yourself.
1. Deficiency (虚). Not enough qi, blood, yin or yang, so the heart is not properly nourished. Typical signs: tiring easily, breathlessness, a pale complexion, palpitations after the slightest effort. Within this there are differences — some lean towards qi-and-blood deficiency, some towards qi-and-yin deficiency, some towards yang deficiency. For example, some people have a dry mouth and sweat a lot; others feel cold with cold hands and feet.
2. Heat (热). Usually heat arising from yin deficiency, or an over-active “heart fire”. Typical signs: restlessness, a dry mouth, hot palms and soles, light sleep, a red tongue.
3. Stagnation (郁). Blocked flow of qi, often linked to emotions. Typical signs: chest tightness, frequent sighing, bloating under the ribs, worse when upset.
4. Phlegm (痰). Phlegm-turbidity obstructing the chest. Typical signs: a smothering tightness in the chest, a heavy body, a lot of phlegm, a thick greasy tongue coating, worse after big meals or in damp weather.
5. Stasis (瘀). Blood not flowing freely. Typical signs: a stabbing chest pain in a fixed place, worse at night, a dark purplish tongue.
One situation needs a special mention. If palpitations come with breathlessness, swollen legs and passing less urine, TCM calls this “water-fluid assailing the heart” (水饮凌心). This often corresponds to a more serious problem such as heart failure in modern medicine, and must be seen by a cardiologist first.
Two maps, each with its own job
A TCM “pattern” is a theoretical language for organising a group of symptoms and signs. It is not the same as a Western diagnosis such as ectopic beats, AF or coronary heart disease.
Modern medical tests first help us decide whether there is danger and which disease is behind the palpitations. Traditional Chinese Medicine observes the whole person through a different system and offers care based on its pattern diagnosis. The two answer questions that are not quite the same, and there is no need to force a one-to-one match.
Understanding this avoids two common misunderstandings: first, thinking “the TCM doctor says I have qi deficiency, so my heart must be fine”; and second, thinking “the cardiologist says I have ectopic beats, so I should take the Chinese medicine for ectopic beats”.
Part 5 What you can do every day
Chapter 7 Managing triggers, keeping a steady rhythm
Five actions for the moment it happens
For palpitations without danger signs, you can follow the five actions from L3. Practise them now and then, so you don’t fumble when it really happens:
1. Stop and sit down. Don’t keep rushing on or stand there forcing yourself through it.
2. Breathe slowly. Count to four breathing in and six breathing out, for five to ten rounds.
3. Check your heart rate. Feel your pulse or look at your watch: roughly how fast, regular or irregular?
4. Think back to triggers. Coffee, strong tea, energy drinks, a late night, an empty stomach, stress. If you have drunk very little water today, have some.
5. Make a note. Time, how long it lasted, what you were doing, heart rate, anything else you felt.
If it has not eased after a few minutes, or any danger sign appears along the way, call 999 straight away.
Sleep
Lack of sleep is one of the most common triggers for palpitations. Aim for seven to eight hours a night at regular times; put your phone away an hour before bed; keep the bedroom quiet, dark and cool. If you snore heavily, are very sleepy during the day, or your family notices you stop breathing at night, ask to be checked for sleep apnoea — it is closely linked with AF and high blood pressure.
Exercise
Regular exercise lowers the resting heart rate, improves heart function and eases anxiety.
• Good choices: brisk walking, jogging, swimming, cycling, tai chi, Baduanjin qigong.
• Intensity: enough to sweat lightly — you can talk but not sing.
• How much: at least 150 minutes of moderate activity a week, spread over most days.
• Caution: if you have heart disease, ask your doctor before you start, and consider a cardiac rehabilitation programme; if you get chest pain, marked breathlessness or dizziness during exercise, stop at once and seek medical help.
Coffee, tea, alcohol and smoking
Caffeine affects people differently. If you notice palpitations after coffee or strong tea, try cutting down to one cup a day, in the morning only, and see what changes over a while; energy drinks are best avoided. Keep alcohol low — drinking is a known trigger of AF. If you smoke, stopping is one of the most important things you can do for your heart.
Breathing and relaxation
• 4-6 breathing: breathe in for four seconds and out for six, five minutes at a time, two or three times a day.
• Belly breathing: one hand on your chest, one on your belly; as you breathe in, let your belly rise.
• Progressive muscle relaxation: starting from the feet, tense each group of muscles for five seconds, then let go, working up to the face.
Practise regularly, and it will be there for you when palpitations start.
Acupressure
• Neiguan (PC6): about three finger-widths above the wrist crease, between the two tendons. Press and rub for one to two minutes; traditionally used for palpitations, chest tightness and nausea.
• Danzhong (CV17): the midpoint between the nipples. Rub gently to help ease the chest.
Press until you feel a mild ache, never too hard. Acupressure is a way to help you relax; it does not replace treatment.
Mood
• Write your worries down, and give them a set “worry time” rather than letting them run all day.
• Check your pulse and heart rate less often. After reassuring tests, constant self-checking tends to feed the anxiety.
• Talk to someone you trust; seek counselling if you need it.
Risk factors
Check your blood pressure regularly, keep a healthy weight, and have your cholesterol and blood sugar checked. It sounds obvious, but it is the most solid foundation for protecting your heart.
Chapter 8 Everyday foods from the kitchen
This chapter is only about ordinary foods — things you can make in your own kitchen and that most people can eat every day. Herbs that need a TCM assessment are covered in Chapter 9.
First, lay a heart-friendly foundation
Whatever your constitution, these principles apply:
• Less salt: no more than 5 g of salt a day. Pickled foods, instant noodles and processed meats are hidden sources.
• Less sugar and refined carbohydrate: keep sweet drinks and cakes to a minimum.
• Good fats: eat fish twice a week; use olive or rapeseed oil instead of animal fats. High-dose fish oil supplements (for example more than 1 g a day) have been linked to a higher risk of AF in some studies, so people with AF should ask their doctor before taking them.
• More vegetables, fruit, whole grains, beans and nuts: they provide potassium, magnesium and fibre.
• Regular meals: eat dinner until about 70% full, and avoid a big meal within three hours of bed — this can reduce reflux and night-time palpitations.
The food-care focus for palpitations: open the chest, move the qi, support digestion
Unlike food care for poor sleep alone, everyday food care for palpitations and chest tightness puts more emphasis on helping the qi in the chest “flow smoothly”, while looking after the digestion. These are all everyday ingredients. Choose one or two that suit you; steady, long-term use matters more than eating a lot at once.
Dried tangerine peel (chenpi) — the kitchen staple for moving qi and easing the chest. If you feel tight in the chest, bloated, or blocked after meals, add a small piece of tangerine peel to porridge or soup, or steep it in hot water. It moves the qi gently and is a very typical everyday ingredient in food care for palpitations and chest tightness.
Fresh ginger — warms the stomach and moves the qi. If you feel the cold, have cold hands and feet or a poor appetite, add a few more slices of ginger when cooking. Use less if you tend to a dry mouth and feel “heaty”.
Millet and Chinese yam — the foundation for the digestion. If you tire easily, have a poor appetite or loose stools, a breakfast of millet and Chinese yam porridge is a good habit. In TCM, good digestion is the source of qi and blood.
Job’s tears (coix seed) — for a heavy body and thick tongue coating. Cook it into porridge with millet and Chinese yam to support digestion and clear dampness. Not to be eaten in large amounts during pregnancy.
Red dates and dried longan — for tiring easily and a sallow complexion. Add a few when cooking porridge. They are warming and sweet, so use fewer if you tend to a dry mouth, feel “heaty”, or have high blood sugar.
Lily bulb, lotus seeds and white fungus — for restlessness, a dry mouth and unsettled sleep. Simmer them together into a sweet soup, with only a little sugar. Eat less if your digestion is “cold” and your stools are loose.
Three everyday combinations
Tangerine-peel, millet and Chinese yam porridge. Cook millet and Chinese yam into porridge, adding a small piece of tangerine peel near the end. For chest tightness with bloating, poor appetite and tiredness — an everyday breakfast.
Ginger and red date drink. Simmer a few slices of ginger and a few red dates. For people who feel the cold with cold hands and feet; good in winter. Not for those with a dry mouth who easily feel “heaty”.
Lily bulb, lotus seed and white fungus soup. For restlessness, a dry mouth and light sleep — an evening sweet soup.
Three limits of food care
1. Food care is an everyday foundation, not treatment. It cannot replace tests or the medicines your doctor prescribes.
2. If you have diabetes, kidney disease or stomach problems, watch the sugar content of foods and your own restrictions.
3. If you have followed your own understanding for a while and it doesn’t feel right, or your symptoms change, stop and see a doctor first.
Part 6 Where you need professional help
Chapter 9 Medicinal-food herbs: why ask a TCM practitioner first?
In the Chinese tradition there is a group of substances that sit between food and medicine, such as astragalus root (huangqi), sour jujube seed (suanzaoren), ophiopogon root (maidong), schisandra berry (wuweizi), American ginseng (xiyangshen), honey-fried liquorice root (zhigancao), Chinese chive bulb (xiebai) and Solomon’s seal (yuzhu). They often appear in medicinal dishes and herbal teas, and online articles often present them as “heart-nourishing teas” or “calming recipes”.
These herbs are not off limits. But two things make them unsuitable for readers to combine on their own from a book:
First, each has clear properties and a specific range of use. Astragalus is mainly qi-tonifying and not suitable during a cold with fever, or for people with yin deficiency and heat; ophiopogon is mainly yin-nourishing and not suitable for people with weak digestion and loose stools or a thick greasy tongue coating; sour jujube seed is calming and needs caution in pregnancy. Used correctly, they support health; used wrongly, they can make things worse.
Second, they may interact with medicines you already take. For example:
• Ginseng and American ginseng may affect how well blood thinners such as warfarin work, and may affect blood sugar.
• Liquorice, taken for a long time or in larger amounts, may raise blood pressure and cause fluid retention and low potassium; low potassium can itself trigger heart-rhythm problems, which is especially risky for people taking diuretics or digoxin.
• Blood-moving herbs such as danshen (salvia root), sanqi (notoginseng) and danggui (angelica root) may increase the risk of bleeding when taken with blood thinners or antiplatelet medicines.
So the best way to use these medicinal-food herbs is this: first ask a TCM practitioner to look at your tongue and pulse, your medical history and the medicines you take, and then decide what to use, how much, and for how long.
Chapter 10 Chinese patent medicines: six people with palpitations, six quite different choices
By now, many readers will be asking: “Which one should I take?”
This chapter does not set out to answer that question. What we want to make clear is something more important: why you should never buy a medicine just because the label says “palpitations”.
Six people’s stories
Imagine six people, each telling a doctor, “My heart keeps racing.”
The first person has ectopic beats on a Holter monitor, tires easily, has a dry mouth, and feels worse after the slightest effort. A TCM practitioner sees a pattern of qi and yin deficiency with some stasis, and might consider a Chinese patent medicine of the type of Wenxin Keli (稳心颗粒), which tonifies qi and yin and moves the blood. However, its package insert states that people with a slow heart rhythm (bradyarrhythmia) must not take it — a medicine that seems to “treat ectopic beats” does not suit every heart-rhythm problem.
The second person has no clear rhythm problem but tires very easily, is short of breath, sweats a lot and has a dry mouth. A TCM practitioner sees a pattern of qi and yin depletion, and might consider a formula like Shengmai Yin (生脉饮). When buying, note that there are versions made with ginseng, red ginseng or codonopsis.
The third person has palpitations with poor sleep and many dreams, a poor appetite, a sallow complexion and tiredness. A TCM practitioner sees heart-and-spleen deficiency, and might consider Guipi Wan (归脾丸). But if she actually has a dry mouth, a red tongue and restlessness — a yin-deficient constitution — Guipi Wan would not be suitable.
The fourth person gets chest tightness and palpitations every time work is stressful or after an argument, sighs a lot, and feels bloated under the ribs. A TCM practitioner sees liver qi stagnation, and might consider a qi-moving patent medicine like Xiaoyao Wan (逍遥丸).
The fifth person has already been diagnosed with coronary heart disease by a cardiologist, with stabbing pain in the front of the chest and a dark purplish tongue. Alongside standard Western treatment, a doctor might consider a blood-moving patent medicine like Fufang Danshen Diwan (复方丹参滴丸). Extra care is needed if it is combined with blood thinners or antiplatelet medicines — and it can never replace emergency care.
The sixth person has palpitations with restlessness, poor sleep, a dry mouth, forgetfulness and dry stools. A TCM practitioner sees heart yin deficiency, and tradition would bring to mind the famous formula Tianwang Buxin Wan (天王补心丸). But there is an important warning: the traditional recipe of many Tianwang Buxin Wan products contains cinnabar (zhusha), which is mainly mercury sulphide. It should not be taken long term, and is even less suitable for pregnant women, children, and people with liver or kidney problems. The same formula name from different makers, or in different forms, may not have the same ingredients — a traditional formula can be excellent, but you must read the ingredient list of the actual product.
What do these six stories show?
All six people say “my heart is racing”, but the overall picture behind it is completely different. The same medicine may suit one person, not suit another, and even harm a third.
That is why:
1. Diagnosis comes before medicine. Palpitations and chest tightness must first be checked for important causes such as rhythm problems and coronary heart disease.
2. Pattern diagnosis is a job for a professional. Tongue, pulse, history and current medicines all need to be weighed together.
3. Follow the package insert or your practitioner’s advice. This book gives no doses for any Chinese patent medicine.
4. Reassess regularly. People change, and so do their needs; it is not wise to keep taking one formula indefinitely.
There are many other Chinese patent medicines marketed for palpitations and chest tightness. Some contain insect or animal ingredients, toad venom (chansu), musk or cinnabar, which need particular caution. They are not suitable for a one-by-one introduction in a book for the general public, and even less suitable for buying on your own.
Readers in the UK should also know that most Chinese patent medicines are not licensed as medicines here, and some ingredients are restricted or banned. If in doubt, check with the MHRA or a qualified practitioner.
About classical formulas
As well as patent medicines, TCM practitioners often use herbal decoctions. The line from the Shanghan Lun (Treatise on Cold Damage) — “With a knotted, intermittent pulse and a stirring heart, Zhigancao Tang governs it” — is very well known. But Zhigancao Tang (Honey-Fried Liquorice Decoction) contains a large amount of liquorice; taken long term, it can raise blood pressure and lower potassium, which can in turn trigger rhythm problems. Classical formulas can be adjusted to the individual, but they must be prescribed by a qualified TCM practitioner after seeing you in person. Never copy an ancient formula yourself.
Chapter 11 Special groups and medicine interactions
Pregnancy. A slightly faster heart rate and occasional palpitations are common in pregnancy; but marked palpitations, chest pain, breathlessness or fainting need prompt medical attention. Don’t use any Chinese patent medicine or herb on your own during pregnancy; among foods, Job’s tears, hawthorn and rosebuds should also be used with caution.
Older people. Heart-attack symptoms are often atypical, and AF is more common. With several conditions and several medicines at once, the risk of interactions between Chinese and Western medicines is higher. Keep a complete, up-to-date list of medicines at home.
Women around the menopause. Hot flushes, palpitations and poor sleep are common, but thyroid and heart problems should be ruled out before considering care under a TCM practitioner’s guidance.
Teenagers and young adults. Energy drinks, late nights and exam stress are common triggers. But palpitations during exercise, fainting, or a family history of sudden death always need a specialist heart check.
People taking blood thinners (such as warfarin or the newer oral anticoagulants). Danshen, sanqi, danggui, ginkgo and ginseng may affect clotting or how well the medicine works. Tell your doctor before taking any Chinese patent medicine, herb or tonic, and have your blood monitored as advised.
People with chronic kidney or liver disease. Chinese patent medicines are also processed by the liver and kidneys; products containing heavy metals such as cinnabar should be avoided.
What can family members do?
During an episode: sit with them and don’t let them walk off alone. Ask three questions: Does your chest hurt? Can you breathe properly? Do you feel dizzy? If any answer worries you, call 999. If they cannot be woken and are not breathing normally, start chest compressions immediately and get an AED as quickly as possible.
Day to day: help them keep a symptom diary, go with them to follow-up appointments, and keep an up-to-date medicine list for older parents. Don’t dismiss new symptoms because “the last tests were fine”, and don’t panic every time either — a calm, prepared presence is itself a comfort to someone with palpitations.
Epilogue
Xiaomin’s next few months
Back to Xiaomin.
After that episode in the meeting, she took her symptom notes to the doctor and had an ECG, blood tests, a Holter monitor and an echocardiogram. The doctor told her no dangerous heart problem had been found for now; the focus would be managing her triggers, with regular check-ups.
She moved her coffee to a single cup in the morning, tried to be in bed before eleven, walked briskly for twenty minutes each morning, and stopped for a few rounds of slow breathing when stress built up. Breakfast was often a bowl of tangerine-peel, millet and Chinese yam porridge.
Later she also saw a TCM practitioner, who looked at her tongue and pulse, asked about her sleep, appetite and mood, took her test results into account, gave her advice, and asked her to come back after a while for a review.
A few months on, the biggest change in Xiaomin was not only in her symptoms. She now knew where her triggers lay, and she no longer jumped to the worst conclusion every time her heart gave a “thud”.
She kept up her check-ups as her doctor advised, and adjusted her sleep, coffee and exercise to how her body felt. When she wanted TCM care, she asked the practitioner to reassess her current state, rather than taking the same formula for months on end.
Palpitations still came now and then. But she knew: when she could watch and wait, when she should book a doctor, and when not to wait even a minute.
Action list
During an episode:
1. Danger signs → call 999 straight away.
2. No danger signs → sit down, breathe slowly, check your heart rate, make a note.
3. Never take someone else’s medicine, and never use a Chinese patent medicine instead of emergency care.
This week:
• ☐ Start a symptom diary
• ☐ Make a complete list of everything you take (including Chinese patent medicines, herbs and supplements)
• ☐ If episodes keep happening, book an appointment with your GP
This month:
• ☐ Have the basic tests: ECG, full blood count, thyroid function, salts, and if needed a Holter monitor and echocardiogram
• ☐ Cut back on caffeine and alcohol, and settle into regular sleep
• ☐ Start daily breathing practice and moderate exercise
Long term:
• ☐ Build an everyday diet foundation with ordinary foods
• ☐ Before using Chinese herbs or patent medicines, ask a TCM practitioner for an assessment
• ☐ Keep up regular check-ups; if your symptoms change, see a doctor again promptly
Appendix 1: Symptom diary template
Date and time | How long | What I was doing | Heart rate / rhythm | Other symptoms | Possible triggers | What helped |
e.g. 5 Oct, 15:20 | about 10 min | In a meeting | about 110/min, occasional pauses | Chest tightness, no pain | Two coffees at lunch, short sleep | Sat down, slow breathing |
Appendix 2: Taking the next step safely
Everyday food care: the everyday foods mentioned in this book can be found, with ways to use them, at the HONGDAHEALTH shop.
Chinese herbs and patent medicines: for Chinese patent medicines, classical formulas, or herbs that need a pattern diagnosis, please first book a HONGDAHEALTH TCM consultation, where a qualified practitioner will consider your symptoms, tongue, medical history and current medicines together.
Closing words: understanding your heartbeat, and yourself
Palpitations and chest tightness are among the body’s most common signals — and among the most frightening.
They may be nothing more than the trace of a cup of coffee, a sleepless night, or an anxious spell; or they may be the heart genuinely calling for help. We can’t tell by feel, but we can respond with a method.
When you finish this book, we hope you will be clear about:
what cannot wait;
when to get checked;
what to have checked;
what modern medicine does next;
what you can do yourself, every day;
and, if you want to use TCM, how to take that next step safely.
May every reader stay calm when the heart races, and know what to do when the chest feels tight.
A gentle reminder
This book is general health information. It is not a personal diagnosis or treatment advice, and cannot replace an assessment by a doctor, TCM practitioner or other qualified health professional. Any Chinese patent medicines and herbs mentioned should only be used under professional guidance; follow the package insert and your practitioner’s advice. In an emergency, call your local emergency number straight away.
Fang Tianliang · HONGDAHEALTH
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