A racing heart is difficult to think about clearly, because the symptom itself interferes with clear thinking. This is the overview article for this site’s series on heart palpitations, and it starts where the thinking should start: not with what to take, but with sorting out which kind you have.
In Summary
- A beating heart means life. Beating hard enough to notice is asking whether something urgent needs doing.
- Short-lived palpitations have a use. Palpitations that interfere with living need sorting into categories.
- 1. An underlying condition. Lung and cardiac disease, thyroid disease, autonomic and psychiatric conditions, effects of food and medication including caffeine and alcohol. If there is no psychological component, treat the condition.
- 2. Psychological cause. Anyone’s heart races in circumstances that warrant it. The tell is that it settles when the situation passes.
- 3. No diagnosable disease, but a physical cause. KTM calls this mibyeong (미병 未病) — not yet disease, but an imbalance among the organs that could become one.
- 4. Both at once. The usual case, and the reason the categories are worth holding loosely.
- Two organ systems produce this often enough to name: the digestive tract and, less directly, the lung.
- The awkward case — nothing found on testing, no severe stress — is generally category three.
Start By Asking Why
If palpitations are troubling you, the first question is not what to do about them. It is: why is my heart beating hard enough that I notice?
A heart that beats means you are alive. A heart that beats hard enough to intrude is asking a question — is there something urgent I should be doing? Short-term palpitations have a use, and answering that question is it.
When they persist past usefulness and start interfering with living, they need sorting.
Four Categories
1. There is an underlying condition
Plenty of conditions produce palpitations:
- Lung and cardiac disease — arrhythmia, heart failure, cardiac ischaemia, myocardial damage
- Thyroid disease
- Autonomic disorders
- Psychiatric conditions
- Effects of food or medication — caffeine, alcohol among them
If there is an underlying condition and no psychological component, the work is managing the condition. Everything else in this article is secondary to that.
2. The cause is psychological
Anyone’s heart races when the circumstances call for it. That is the system working.
The distinguishing feature is straightforward: when psychological factors are the main cause, the palpitations quieten once the event passes.
Where this is the main driver, relying on medication or treatment alone does less than addressing the stress and finding some steadiness. If professional help would be useful, psychiatric care or a psychological therapist is the appropriate direction.
3. No diagnosable disease, but a physical cause
KTM has a concept for this: mibyeong (미병 未病). Not yet a diagnosed disease, but a state in which the balance among the organs has broken down enough that it could become one.
An example makes it concrete. The stomach’s digestive capacity drops, and fluid stagnates in and around it. This is not a disease. But lie down at night and it can provoke the heart, and the person is kept awake by palpitations that no test will explain.
4. Both at once
Most of the time, palpitations are the product of physical and psychological factors together.
People who develop conditions that cause palpitations frequently have accumulated psychological stress. And when the five organs including the heart are not in good order, psychological stress sets the chest racing more easily. The two feed each other, which is why the categories above are a thinking tool rather than a filing system.
Two Organ Systems Worth Naming
The digestive tract
Digestive conditions are treated as a digestive matter, but several reach the heart.
Reflux. One of its main symptoms is chest pain, frequently mistaken for a cardiac problem. In KTM terms, acid rising means the stomach holds too much heat — heat rises, as fire does. Stomach heat builds from several factors acting together: a constitution born with a hot stomach (the Soyangin types), excessive spicy or heating food and alcohol, and heat generated in the liver by stress and transmitted to the stomach. Management: do not lie down straight after eating, eat smaller amounts more often, avoid what irritates the stomach.
Functional dyspepsia. No structural abnormality is found, which makes it hard to diagnose and inclined to persist. Upper abdominal pain, fullness after meals, early satiety. In KTM terms the stomach is failing to move and digest, the tract is tightened, and fluid is stagnating — described as cold-damp (한습 寒濕) in the stomach. Cold-damp has the properties of cold water: it spreads and settles under gravity. Which is why people with functional dyspepsia notice palpitations particularly when lying down. Improve the digestion and the problem resolves.
Metabolic syndrome. Not a digestive disease, but tied to eating patterns. Take in too much and damp accumulates in the spleen and stomach; accumulated damp tangles and produces heat. The route to the heart is much the same as with reflux.
Simply knowing that the stomach can be the source helps with managing this — not least because cardiac symptoms arising independently of any digestive condition are still influenced by how a person eats.
The lung
Read through KTM, lung disease does not easily produce palpitations. The lung sends qi and blood through the body, which makes it functionally similar to the heart; the two assist one another. So the lung does not trouble the heart by becoming overactive, the way the liver or the digestive organs do.
The trouble runs the other way. When the lung weakens, the heart carries more of the load, and the overload can produce arrhythmia, congestion, heart failure or palpitations. A small number of conditions do this directly — pulmonary hypertension raises the pressure the heart must work against, increasing its burden and its rate. But even without such a diagnosis, reduced lung function can overload the heart.
Looked at more closely, there is a second route: when lung function falls, the opposing action of the liver strengthens, and liver heat produces the racing chest. The Taeeumin types fall into this pattern often.
The remedy where a weakened lung has burdened the heart is exercise. It improves lung function and turns qi outward, and the palpitations resolve.
What to Do, By Category
If psychological factors seem to be the main cause — addressing the stress and finding steadiness matters more than medication or treatment alone.
If the palpitations seem out of proportion to the stress — the first task is establishing whether there is an underlying condition. If there is, treat it and manage the other factors alongside.
The awkward case is the one where the hospital finds nothing and the person does not feel especially stressed. That is generally category three — mibyeong — and it is the situation in which constitutional reasoning has the most to contribute.
Palpitations make cool judgement difficult, which is precisely the trouble. Holding steady long enough to work through these categories, with a clinician or with reading, is most of the way to a sensible answer.
The Eight Constitutions
Which route a given person takes depends on where the relevant organs sit in their constitutional hierarchy. The eight articles below work through each in turn — and it is worth noticing, reading across them, that the same symptom yields opposite instructions. The wood and earth constitutions are parasympathetic-tense and benefit from sweating; the metal and water constitutions are sympathetic-tense and are depleted by it. Sauna for one, swimming pool for the other.
- Pancreotonia and Gastrotonia (the Soyangin types): heat, not fear
- Hepatonia: heat from the liver that rarely settles in
- Cholecystonia: cold below, heat with nowhere to go
- Pulmotonia: the same Taeyangin, a different temperament
- Colonotonia: a signal to stop watching the world
- Renotonia: a Soeumin who looks like a metal type
- Vesicotonia: the stomach just below the heart
- The five organs behind the symptom
Summary
Four questions, in order: is there a condition, is there a situation, is there an imbalance, or is it some of each. The answer decides everything that follows, and the categories matter more than any single remedy.
The hardest case to sit with — clean tests, no obvious stress, and a heart that will not settle — is the one the constitutional reading was built for.
