Altern Ther Health Med. 2021 Sep;27(5):68-72.
To explore and establish the diagnosis, syndrome classification and syndrome differentiation criteria of palpitations below the heart in traditional Chinese medicine (TCM) in order to lay a foundation for the clinical diagnosis, treatment and research of palpitations below the heart.
In the early stage of this study, we searched the literature related to palpitations below the heart in TCM in domestic and foreign databases, analyzed the results and developed an expert consultation questionnaire. Using the Delphi method, a survey was conducted by 19 expert TCM practitioners. The survey results were statistically analyzed, aggregated and categorized to create the next round of questionnaires, and the process was repeated was repeated for a total of 4 rounds of expert opinions and until a consensus was achieved. Finally, the questionnaire items were classified into the main diagnosis (primary disease) and secondary diagnosis (secondary disease) for each syndrome.
This study was completed ahead of schedule after 2 rounds of expert questionnaire surveys. A total of 19 exceptional TCM experts from all over China reached a consensus on 1 diagnostic standard and 4 syndrome types. The main diagnoses of palpitations below the heart included "conscious sub cardiac epigastric beating," "throbbing at the lower part of the heart" and "palpitation rhythm consistent with the pulse and obvious pulsation in the heart area," while the secondary diagnosis was "palpitation obvious after nervous tension, fatigue, drinking water or changing body position." Based on the balance of TCM Yin (negative, dark, feminine) and Yang (positive, bright, masculine) energy, TCM syndrome differentiation (Bian Zheng - the comprehensive analysis of clinical information obtained from the 4 main diagnostic TCM procedures: observation, listening, questioning, and pulse analysis, that is used to guide the choice of treatment by acupuncture and/or TCM) of palpitations below the heart are differentiated as heart yang deficiency syndrome, middle yang deficiency syndrome, kidney yang deficiency syndrome and phlegm drink syndrome, and the main and secondary syndromes of each are established. In the consultation process, the expert opinions were highly correlated, questionnaire reliability was strong and the results were credible.
The criteria proposed in this study do not claim to be the best or the most accurate, but they do provide some guidelines for practitioners, a basis for clinical differentiation and treatment with TCM and a basis for further randomized controlled trials in the future. Further research is needed in order to reach a consensus regarding TCM treatment of palpitations below the heart.
探索建立心悸中医（TCM）的诊断、证候分类和辨证标准，为心悸的临床诊断、治疗和研究奠定基础。
本研究早期在国内外数据库中检索心悸的中医相关文献，对检索结果进行分析，拟定专家咨询问卷。采用德尔菲法对 19 位中医专家进行问卷调查，对调查结果进行统计学分析、汇总分类，制作下一轮问卷，共进行了 4 轮专家意见调查，直至达成共识。最后，将问卷条目分类为各证型的主要诊断（主病）和次要诊断（次病）。
本研究在进行了 2 轮专家问卷调研后提前完成。来自全国各地的 19 位杰出中医专家就 1 个诊断标准和 4 个证型达成共识。心悸的主要诊断包括“自觉心下胃脘部跳动”“心下悸动”“心悸节律与脉象一致，心下区搏动明显”，次要诊断为“紧张、疲劳、饮水或改变体位后心悸明显”。基于中医阴阳（阴、暗、女性）能量的平衡，心悸的中医辨证（辨证-综合分析从 4 个主要的中医诊断程序中获得的临床信息：观察、听诊、询问和脉象分析，用于指导针灸和/或中医的治疗选择）分为心阳不足证、中阳不足证、肾阳不足证和痰饮证，确立了各证型的主、次证。在咨询过程中，专家意见高度相关，问卷可靠性强，结果可信。
本研究提出的标准并不声称是最好或最准确的，但为从业者提供了一些指导，为中医临床辨证治疗提供了依据，也为未来的随机对照试验奠定了基础。需要进一步研究，以达成中医心悸治疗的共识。
