the Use of Wen Dan Decoction in Heart Palpitations

Regarding Wen Dan Tang (Warm the Gallbladder Decoction)

Hello Dr.
Yang, I am currently seeing a cardiologist and a traditional Chinese medicine practitioner at Chang X Hospital (I had a stent placed two years ago).
Over the past few months, I have experienced occasional heart contractions or palpitations accompanied by nausea (the palpitations resolve immediately after the nausea).
I consulted the cardiologist, who indicated that I have mild palpitations, but multiple tests showed no abnormalities, so there is no need for additional medication.
However, this issue still occurs every few days.

In the traditional Chinese medicine department, my prescriptions are adjusted or maintained based on my follow-up visits.
Recently, for the aforementioned palpitations, I was prescribed 0.8 grams of Wen Dan Decoction, but after taking it for a week, my condition worsened (I cannot determine if this is related to the prescription).
During today's follow-up, the doctor listened to my concerns and, after examining my tongue, increased the dosage of Wen Dan Decoction to 1.2 grams.

I would like to seek your opinion on this matter.
My tongue appears to have a pale color on the sides and tip, with a thick white coating in the center, a shallow pulse, and the sublingual veins no longer show the previous swelling and branching.
I also have a constitution that tends to be dry and hot.
Thank you, Dr.
Yang, for your guidance and support.

Mr. Zhang, 50~59 year old female. Ask Date: 2015/10/05

Dr. Yang Junkui reply Traditional Chinese Medicine

The symptoms of palpitations cannot be confirmed as related to Wendan Decoction based solely on the patient's description.
Given the tendency for nausea, it is advisable to focus on the liver and stomach.
The presence of a thick, white tongue coating suggests the need to resolve phlegm.
In Traditional Chinese Medicine (TCM), in addition to taking a detailed patient history, it is essential to incorporate observation, olfaction, and pulse diagnosis.
A comprehensive connection of all symptoms is necessary before making a diagnosis and prescribing treatment.
It is recommended to consult a TCM clinic to confirm the constitution in order to provide targeted treatment and adjust the body accordingly.

Reply Date: 2015/10/05

More Info

Wen Dan Decoction, a traditional Chinese medicine formula, is often used to address various symptoms related to digestive and emotional disturbances, including heart palpitations. In your case, where you have a history of heart stenting and are experiencing occasional heart contractions accompanied by nausea, it is essential to consider both the physiological and psychological aspects of your symptoms.

Heart palpitations can arise from multiple factors, including anxiety, stress, electrolyte imbalances, or underlying heart conditions. Given your history of heart disease, it is crucial to monitor any new or worsening symptoms closely. The fact that your cardiologist has conducted multiple tests and found no significant abnormalities is reassuring, but your ongoing symptoms warrant further attention.

Wen Dan Decoction is traditionally used to "clear heat" and "transform phlegm," which can be beneficial for individuals with a "phlegm-heat" constitution. Your description of having a "dry heat constitution" aligns with the traditional understanding of this formula's application. The symptoms you describe, such as heart contractions and nausea, may be interpreted in TCM as a disharmony between the heart and the stomach, possibly due to phlegm accumulation or heat.

The increase in the dosage of Wen Dan Decoction from 0.8 grams to 1.2 grams may be an attempt by your TCM physician to enhance its efficacy in addressing your symptoms. However, it is essential to communicate any changes in your condition, especially if you feel that the symptoms have worsened after starting the decoction. The relationship between TCM herbs and individual responses can vary significantly, and what works for one person may not work for another.

Your tongue diagnosis, which shows a pale body with a thick white coating, suggests a possible deficiency in "qi" or "blood," along with the presence of phlegm. The shallow pulse may indicate a deficiency in the heart's energy or blood supply. These observations can guide the TCM practitioner in adjusting the herbal formula to better suit your current condition.

In terms of Western medicine, it is crucial to ensure that your heart's electrical system is functioning correctly, especially since you have experienced palpitations. If your symptoms persist or worsen, it may be beneficial to undergo further cardiac evaluation, such as an ambulatory Holter monitor, which can provide insight into your heart's rhythm over a 24-hour period.

In conclusion, while Wen Dan Decoction may provide some relief for your symptoms, it is essential to maintain open communication with both your cardiologist and TCM practitioner. If you experience any significant changes in your symptoms, such as increased frequency or severity of palpitations, or if you develop new symptoms like chest pain or shortness of breath, seek immediate medical attention. Balancing both Western and traditional approaches can often yield the best outcomes, ensuring that your heart health is monitored while addressing your symptoms holistically.

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