Bradycardia
Overview
Bradycardia falls under the TCM categories of 'palpitations' (xin ji), 'severe palpitations' (zheng chong), 'dizziness' (xuan yun), and 'syncope' (jue zheng), characterized by a slow pulse (chi mai) or knotted/intermittent pulse (jie dai mai). The disease is located in the heart and involves the spleen, kidney, and liver. The basic pathogenesis is deficiency of heart qi and debilitation of heart yang, leading to insufficient propulsion, or phlegm and blood stasis obstructing the collaterals with poor flow of heart vessels. It commonly occurs in the elderly and debilitated or those with chronic illness, manifesting as palpitations, shortness of breath, fatigue, dizziness, and even amaurosis or syncope. Pattern differentiation should distinguish deficiency and excess; deficiency mainly involves qi, yang, yin, and blood depletion, while excess mainly involves phlegm turbidity, blood stasis, and cold coagulation, often with mixed deficiency and excess.
Pattern differentiation (clinical patterns)
Deficiency of Heart Qi
Palpitations and shortness of breath aggravated by exertion, mental fatigue and weakness, spontaneous sweating, pale complexion, pale tongue with thin white coating, and a weak or slow pulse.
Tonify heart qi; nourish the heart and calm the spirit.
Debilitation of Heart Yang
Palpitations and severe palpitations, chest oppression and shortness of breath, aversion to cold with cold limbs, pale complexion, mental fatigue and weakness, pale swollen tongue with white slippery coating, and a deep slow or knotted intermittent pulse.
Warm and tonify heart yang; boost qi and restore the pulse.
Phlegm and Blood Stasis Obstructing the Collaterals
Palpitations and chest oppression, stabbing or oppressive pain, dizziness and heaviness of the head, profuse sputum, dusky complexion, cyanotic lips and nails, dark purple tongue with ecchymosis and white greasy coating, and a choppy or knotted intermittent pulse.
Transform phlegm and invigorate blood; unblock the collaterals and restore the pulse.
Connections
Daily care & prevention
Keep warm and avoid cold stimulation; maintain regular daily routines and avoid overexertion and emotional agitation; consume warm and tonifying foods such as longan, red dates, Chinese yam, and mutton in moderation; avoid raw, cold, greasy, and sweet foods; practice Baduanjin and Taijiquan moderately to promote qi and blood circulation; monitor heart rate regularly and record episodes of dizziness and amaurosis; avoid sudden standing to prevent orthostatic hypotension.
When to seek medical care
Syncope, loss of consciousness, or convulsions; heart rate persistently below 40 beats/min; accompanied by chest pain, dyspnea, pale complexion, or cold limbs; frequent amaurosis or falls with injury; palpitations and discomfort after pacemaker implantation. Seek immediate medical attention in these situations.