Clinic studies suggest that coronavirus disease 2019 (COVID-19) is associated with a high incidence of cardiac arrhythmias. Severe acute respiratory syndrome coronavirus 2 infection may cause injury to cardiac myocytes and increase arrhythmia risk. There are well-documented cardiac complications of COVID-19 in patients with and without prior cardiovascular disease. There is growing evidence showing that arrhythmias are also one of the major complications.
In TCM, arrhythmia is discussed in palpitation(Xin Ji心悸) and panic attack(Jing Kong, 惊恐), refers to the unduly rapid heartbeat which is felt by the patient and accompanied by nervousness, feel fear, restlessness, insomnia, forgetfulness and dizziness.
Dr Xue Shengbai in his book, the Damp warm febrile disease(27th section) says: The damp warm disease is treated following the therapies, all of the manifestations are disappeared, but the patient still has palpitations and night mare, which is due to lingering evils still stays inside and results in gall bladder stagnation. Dr. Wu Tang in his book, Systemic Differentiation of Warm Pathogen Disease(14th section) says: Warm febrile disease in low Jiao, the heat is deeply and severe, which causes the patient suffers from thin, rapid and irregular pulse, severe palpitation at chest, and even chest pain. The formula is San Jia Fu Mai Tang(Three Shells for Recovering pulse decoction)。 In 11th section of in his book also says: Warm Febrile disease in Shaoyin, the true Yin trends to be exhausted, the deficient fire burns heart, resulting in anxiety and insomnia. Huang Lian E Jiao Tang is good for it.
What is the etiology, pathogenesis and therapy?
Based on Warm Febrile warm disease, the pathogens of Covid-19 deplete Qi, blood, Yin and Yang of the heart, which is the root of palpitation post Covid-19, and lead to phlegm and body fluid accumulation, Qi stagnation, blood stasis, and heat and fire lingering in the heart, which is the branch of palpitation post Covid-19.
- Qi and Blood deficiency of Heart: Pathogens of Covid-19 lingers inside, the overtreatment during the Covid-19, all of these damage Qi and blood of spleen and heart manifested as palpitation and shortness of breath.
Manifestations: palpitation, shortness of breath, easy to be frightened, poor sleep and memory, restlessness, sweating at palms, pale tongue with white and thin coating, deep, weak, knotted and intermittent pulse.
Treatment Strategy: reinforce Qi and blood of spleen and heart, calm the mind.
Formula: Gui Pi Tang.
For significant palpitation and irregular pulse, the Zhi Gan Cao Tang is used. For frightened, the Long Gu, Mu Li is added.
Acupuncture points: PC6, UB15, UB17, St36,UB20.
- Yang deficiency of heart: The lingering dampness during Covid-19 and over used medicine or other therapies during Covid-19, which consumes the heart Yang, and fails warms the heart manifested as the following.
Manifestations: palpitation is worse after moving, fullness of chest, cold extremities and puffy lower legs, pale face and tongue, white and watering coating, deep and weak pulse.
Treatment Strategy: Warm and tonify the heart Yang, calm the heart spirit.
Formula: Gui Zhi Jia Long Gu Mu Li Tang
For significant heart Yang Qi deficiency, add Ren Shen, Fu Zi. If there is accompanied Yin deficiency, add Mai Men Dong, Bai He and Wu Wei Zi. For significant fullness of chest, edema of legs, the Ling Gui Zhu Gan Tang is used.
Acupuncture points: Ht 7, PC6, UB15(moxa), Ren17(moxa). For Qi deficiency, add St36, Ren12.
- Heart fire due to Yin deleted: The high fever, or over promoting sweat during Covid-19 injures the heart and Yin, and results in heart fire. The deficient fire disturbs heart spirit manifested as the following.
Manifestations: Palpitation and anxious, nervous and anxiety, poor sleep and night mare, hot sensation of five palms, dizziness and red face, soreness of low back, red tongue with less coating, thin and rapid pulse.
Treatment strategies: Generate Yin and clear away heat, nourish heart and calm spirit.
Formula: Huang Lian E Jiao Tang.
For anxious and anxiety, add Suan Zao Ren, Mu Li. For soreness of low back and hot flash, add Huang Bai and Zhi Mu. For heat and fire is not severe, the Tian Wang Bu Xin Dan is used.
Acupuncture points: Ht7, PC6, Ki6, UB23. For anxious and anxiety, add Yintang, Si Shen Chong, Ear Shen Men. For soreness of low back and hot flash, add Sp6, Ear Jian.
- Heat phlegm disturbing heart: The lingering heat after Covid-19 burns fluid of lung, turning to heat phlegm, which disturbs the heart manifested as the following.
Manifestations: Frequent palpitation, trend to be scared, fullness of chest and anxiety, insomnia and night mare, thirsty and constipation, red tongue with yellow greasy coating, slippery and wiry pulse.
Treatment strategy: Clear heat and resolve phlegm, tranquilize the heart mind.
Formula: Huang Lian Wen Dan Tang.
Usually add Zhi Zi, Gua Lou, Suan Zao Ren for increasing clear heat and resolving phlegm. For significant anxiety, add Shi Jue Ming, Zhen Zhu Mu. The heat and fire injure Yin, add Mai Men Dong, Yu Zhu.
Acupuncture points: Ht4, PC4, Lu5, Lu10.
- Blood stasis blocking heart: Heart Qi and deficiency post Covid 19, weak Qi fails to push the blood. Heat phlegm blocks the heart vessels. All of them result in blood stasis blocking heat vessels manifested as the flowing.
Manifestations: palpitation and anxiety, chest distress and needling pain, purple tongue and choppy or knotted pulse.
Treatment strategy: regulate Qi and remove blood stasis, open meridian.
Formula: Xue Fu Zhu Yu Tang.
For blood stasis due to Yang deficiency and cold, add Gui Zhi, Fu Zi. For significant Qi stagnation, add Tan Xiang, Qing Pi. For damp phlegm with fullness of chest, add Gua Lou, Xie Bai and Ban Xia.
Acupuncture points: PC3, Ht3, Sp10, Ren6.
Ear points: Ht, sympathy, subcortical, Small intestine.
Cupping: Ren 17, Ren14, UB14, UB15.