From ‘The Study of Kampo Clinical Practice and Diagnosis’ by Terasawa Katsutoshi (寺泽捷年), and translated into Chinese by Wang Ningyuan.

A 34-year-old housewife presented with paroxysmal palpitations and vertigo.

Approximately six months earlier, while driving through an intersection on a rainy day, the vehicle in front of her stopped suddenly. She was unable to brake in time and rear-ended the other car. Fortunately, she sustained no obvious injuries, and the accident was resolved without incident. However, following the accident, she began experiencing several episodes of palpitations every day.

During each episode, she felt as though a ball-like object surged upward from the epigastrium and beside the umbilicus toward the chest. Within a few seconds it reached the chest, her pulse gradually accelerated, and palpitations developed, accompanied by a sensation of chest oppression, uneasiness, and vertigo.

When the attacks were mild, this state lasted 10–20 minutes before resolving completely. During more severe attacks, however, she experienced intense anxiety, a sensation of heat in the face, vertigo, and even transient loss of consciousness. She was required to remain in bed for 2–3 hours before recovering. There was no associated nausea or vomiting.

She had previously sought treatment locally. Electrocardiography and other examinations revealed no abnormalities. She was prescribed a sedative, which reduced the severity of the attacks and improved her sleep, but the frequency remained essentially unchanged, with palpitations occurring one to two times daily.

Height: 152 cm
Weight: 45 kg
Blood pressure: 108/72 mmHg
Temperature: 36.7°C
Pulse: 72 beats/min

Her complexion was slightly flushed, the lower limbs were cold, her appearance was otherwise normal, there was sweating of the hands and feet, the pulse was weak, and the tongue was normal with a thin white coating.

Abdominal examination: The abdominal strength was slightly weak.

• Pulsation above the umbilicus (++) (脐上悸（++)
• Epigastric pulsation (心下悸)
• Splashing sound in the stomach (胃部振水音)
• Tension of the rectus abdominis muscles (腹直肌拘挛)

Abdominal strength: 2/5 (腹力 2/5)

A 24-hour Holter ECG captured changes during an attack. Her resting heart rate was 70 beats/min but gradually increased over several minutes to 120 beats/min, at which point she perceived the palpitations. Ten minutes later, the pulse rate gradually declined and returned to normal. During the attacks there was no hyperventilation. Arterial blood gas analysis, electroencephalography, blood biochemistry, and other investigations revealed no abnormalities.

Discussion

Although this condition resembles paroxysmal tachycardia, it was excluded because the pulse increased gradually rather than abruptly. It must also be differentiated from hyperventilation syndrome; however, there was no hyperventilation during the attacks, and arterial blood gas analysis was normal, allowing this diagnosis to be excluded. The condition would generally be diagnosed as cardiac neurosis or neurosis.

From the perspective of Kampo medicine, this presentation represents the pathological state of Qi Counterflow (Running Piglet Qi, 奔豚气). Most cases of Running Piglet Qi are triggered by events involving intense fear, shock, or frightening memories. In this case, the precipitating factor was becoming the responsible party in a traffic accident.

Treatment Course

The patient was prescribed Guìzhī Jiā Lónggǔ Mǔlì Tāng granules and Língguì Zhúgān Tāng granules, 7.5 g of each daily in three divided doses, while continuing the previously prescribed 2 mg sedative as needed.

On the day treatment began, she noticed warmth returning to her lower limbs. Beginning on the second day, she experienced only one mild attack. During the following two weeks, she had only three attacks in total. After taking a cumulative dose of 10 mg of the sedative, it was discontinued. After one month of treatment, the attacks had almost completely disappeared, and after three months the herbal treatment was discontinued.

This pattern corresponds to the indication for Língguì Gānzǎo Tāng. However, because granules of Língguì Gānzǎo Tāng were unavailable, Guìzhī Jiā Lónggǔ Mǔlì Tāng combined with Língguì Zhúgān Tāng was used as a substitute.

Terasawa Katsutoshi (寺泽捷年)

Born in 1944, Terasawa Katsutoshi is a renowned Japanese Kampo physician and Medical Doctor. He served as Professor of Kampo Medicine at the Graduate School of Chiba University and Director of the Kampo Department at Chiba Central Medical Center. He studied under Fujihira Ken, Ogura Shigenari, and Itō Kiyoo. 

He has held numerous distinguished positions, including Director of the World Health Organization (WHO) Collaborating Centre, Vice President of Toyama Medical and Pharmaceutical University, Director of its affiliated hospital, President of the Japan Society for Oriental Medicine, President of the Society of Japanese and Oriental Medicine, and President of the East Asian Medical Association.

His principal works include Clinical Kampo Medicine (originally published as Kampo Diagnosis and Treatment: Learning from Clinical Cases), Research on Yoshimasu Tōdō: The Thought that Founded Japanese Kampo, Studies on Kampo Abdominal Diagnosis: Mechanisms of Pattern Formation, Complete Translation of Hōgi Zasshi, Complete Translation of Ikai no Tetsuzui, and Supplement to the Iken Collection.