Panic Disorder
Overview
Jingji (panic disorder) is characterized by paroxysmal palpitations, restlessness, terror, and a sense of impending death. The disease is located in the heart and closely related to the liver, gallbladder, spleen, and kidney. Its causes include emotional dysregulation and fright damaging the spirit, or chronic illness with qi deficiency of the heart and gallbladder, or internal harassment by phlegm-heat and yin deficiency with fire hyperactivity. The basic pathogenesis is disturbed heart-spirit, malnourishment of the heart vessels, or pathogenic factors harassing the heart. Pattern differentiation distinguishes deficiency and excess: deficiency patterns include qi deficiency of heart and gallbladder, dual deficiency of heart and spleen, and yin deficiency with fire hyperactivity; excess patterns include internal harassment by phlegm-heat and liver depression transforming into fire. Treatment follows the general principle of calming the heart and tranquilizing the spirit; for deficiency, tonify the heart and spleen and benefit qi and yin; for excess, clear heat and resolve phlegm, soothe the liver and drain fire.
Pattern differentiation (clinical patterns)
Qi Deficiency of Heart and Gallbladder
Restless palpitations, susceptibility to fright and fear, inability to sit or lie still, scanty sleep with profuse dreams, shortness of breath and spontaneous sweating, fatigue and lack of strength, pale tongue with thin white coating, and a fine weak pulse.
Benefit qi and calm fright; tranquilize the spirit and stabilize the will.
Dual Deficiency of Heart and Spleen
Palpitations and severe palpitation, insomnia and forgetfulness, sallow complexion, dizziness and blurred vision, fatigue and lack of strength, poor appetite and loose stools, pale tongue with thin white coating, and a fine weak pulse.
Tonify the heart and spleen; nourish blood and tranquilize the spirit.
Internal Harassment by Phlegm-Heat
Recurrent palpitations, chest oppression and irritability, insomnia with profuse dreams, bitter taste and sticky phlegm, heaviness of the head and dizziness, red tongue with yellow greasy coating, and a slippery rapid pulse.
Clear heat and resolve phlegm; calm the heart and tranquilize the spirit.
Yin Deficiency with Fire Hyperactivity
Palpitations with easy fright, irritability and insomnia, five-center heat, dry mouth and throat, night sweats, tinnitus and soreness of the lower back, red tongue with scanty coating, and a fine rapid pulse.
Nourish yin and descend fire; nourish the heart and tranquilize the spirit.
Connections
Daily care & prevention
Maintain emotional balance and avoid fright and overexertion. Keep a regular schedule with adequate sleep; avoid strong tea, coffee, and pungent irritants. Practice deep breathing and meditation to calm the heart-spirit. Moderate exercise such as Baduanjin and Taijiquan harmonizes qi and blood. During an attack, stay calm and apply acupressure to Neiguan (PC6) and Shenmen (HT7). Eat a light diet; for heart-spleen deficiency, consume longan, jujube, and Chinese yam; for phlegm-heat, eat radish and winter melon. Follow up regularly and take medication as prescribed.
When to seek medical care
If palpitations are accompanied by severe chest pain, profuse sweating, pale complexion, and cold limbs, be alert to true heart pain (angina) and seek emergency care immediately. Frequent panic attacks severely affecting daily life, or the emergence of suicidal thoughts or severe depression, warrant prompt psychiatric referral. Palpitations with syncope, convulsions, or extremely rapid or slow pulse require urgent ECG. Persistent or progressively worsening symptoms should prompt exclusion of hyperthyroidism, arrhythmia, and other organic diseases.