Read this first
When to worry
Palpitations are the one symptom on this site where the medical assessment genuinely comes first, without exception. Most turn out to be benign, and the traditional readings describe something real — but a minority are arrhythmias, and arrhythmias are not distinguishable from benign palpitations by how they feel. Read this list before the rest of the page.
Get help now — same day or emergency
- Palpitations with chest pain, breathlessness, or fainting — especially if you have fainted while your heart was racing.
- A racing heartbeat that does not settle after several minutes of rest, particularly with dizziness.
- Palpitations with one-sided weakness, slurred speech, or loss of vision.
- A known heart condition, or a family history of sudden cardiac death, with new palpitations.
- Palpitations with heavy bleeding, or with black stools.
Get it looked at within days
- Palpitations that wake you at night, or that come on at rest rather than with exertion.
- A pulse that feels irregular, or that you can feel skipping and then a thump.
- Palpitations with a thyroid history, or with unexplained weight loss and tremor.
- Palpitations that began with a new medicine, a cold remedy, an energy drink, or a stimulant.
- Palpitations in pregnancy that are new and frequent.
None of the traditional material below is a substitute for an ECG. If the episodes are intermittent, ask about a monitor rather than accepting a normal resting ECG as the answer — an arrhythmia that lasts four minutes is invisible on a ten-second strip.
One rule for this whole list: if you are not sure whether a line applies to you, treat it as though it does — and get it checked. Uncertainty is a reason to be seen, not a reason to wait.
Four things called palpitations
The word covers four different experiences, and the difference is more useful than the word. Each points at a different traditional reading and, more importantly, at a different level of urgency.
Aware of the beat at rest
No racing and no irregularity — just an unwelcome awareness of the heart, often at night, lying down, in a quiet room.
Points to Often anxiety, poor sleep, caffeine or anaemia. Read traditionally as blood or heart deficiency when the pulse is thin and the face pale.
Sudden racing, then stopping
Onset is abrupt, the rate is fast and regular, and it ends suddenly, sometimes with a need to urinate afterwards.
Points to This is the description of a supraventricular tachycardia. It is a medical pattern, not a traditional one, and it needs a monitor rather than a tonic.
Skipping, then a thump
An irregularity — a pause, then a heavy beat. Often more noticeable at rest and less so during exercise.
Points to Ectopic beats, usually benign. The traditional reading is often blood deficiency or qi and yin deficiency. Assessment first, pattern second.
Racing with heat, sweat and tremor
Fast, with sweating, weight loss, a fine tremor, and heat intolerance.
Points to Thyroid until proven otherwise. This is a blood test, not a tongue reading, and it is cheap.
What the patterns describe
The traditional account of palpitations is more careful than its reputation suggests. The classical distinction is between 惊悸 — palpitations with a fright, acute and situational — and 怔忡 — a continuous, internal throbbing that persists without any trigger. The second is treated as the more serious, because it means the heart is not being supported rather than being startled. That distinction survives translation reasonably well, and it maps onto the practical difference between palpitations that happen in anxious moments and palpitations that happen on the sofa.
The second classical contribution is the location. The text locates the palpable impulse below the left breast and calls it the great network of the stomach, carrying the ancestral qi. That is an observation of the apex beat, and it is worth noticing that the tradition placed it under the stomach rather than under the heart — a reminder that the organs of this system are not the anatomically named ones.
What the tradition cannot do is tell you whether your palpitations are atrial fibrillation. The reason this page leads with the red flags rather than with patterns is not caution for its own sake: it is that the traditional categories describe a sensation and the sensation is identical in the benign and the dangerous cases. Only a recording separates them.
Which patterns it belongs to
These are the patterns this symptom is conventionally grouped under. They are not competing diagnoses — most people meet one, and the point of the list is to show you which questions separate them.
Palpitations with pallor, dizziness on standing, numbness, a thin pulse, a pale tongue, light periods.
The most common traditional reading for a thin, fluttery awareness at rest.
Read the pattern page →Palpitations on stairs, breathlessness, spontaneous sweating, fatigue, a weak pulse.
For palpitations on exertion, with breathlessness and a soft voice.
Read the pattern page →Night sweats, five-palm heat, sore lower back, a red tongue with little coat, a rapid thin pulse.
Palpitations with night sweats and heat, often around menopause.
Read the pattern page →Palpitations in anxious periods, rib-side tightness, sighing, a wiry pulse, palpitations that stop on holiday.
For palpitations that arrive with tension and pass when it does.
Read the pattern page →The signs behind it
Each line below is one entry in the sign table — the same table the self-check draws its follow-up questions from. The tier says how strongly that sign points at the pattern: a defining sign is expected, a common one is usual, a supporting one is optional.
- Palpitations Blood deficiencydefining ·Kidney yin deficiencycommon ·Qi deficiencysupporting ·Kidney yang deficiencysupporting ·Liver yin deficiencysupporting ·Liver yang risingsupporting
Not every sign listed here will apply to you — a sign only counts alongside the others. The self-check is the place to weigh them against your own answers.
Telling them apart
Four questions do most of the work. Each one splits the field in half, and after two or three the pattern is usually clear enough to act on — or clear enough to know that the answer is medical rather than traditional.
| Question | If yes | If no |
|---|---|---|
| Does it start and stop suddenly? | Yes, abrupt onset and abrupt end, regular and fast → this is the arrhythmia description. Ask for a monitor. | Gradual, situational, worse when anxious → the traditional readings are more relevant. |
| Is it irregular, with pauses? | Yes → assessment first. Ectopics are usually benign but the determination is made by a recording, not by how it feels. | Regular awareness, no skipping → look at the other questions. |
| Is there pallor, a thin pulse and heavy periods? | Yes → blood deficiency in the tradition, and a full blood count in ordinary medicine. Both, not either. | No pallor → blood deficiency is less likely. |
| Is there heat, sweating and weight loss? | Yes → thyroid function. This is the single most treatable cause on the page. | No heat signs → look at sleep, stimulants and anxiety. |
What you can do at home
None of this treats a named condition, and none of it replaces assessment. These are the ordinary measures attached to this symptom — low risk, and worth doing while you work out what is actually going on.
- Cut caffeine and alcohol for two weeks and see whether the frequency changes. This is the cheapest test available and it is positive often enough to be worth doing first.
- Learn to take your own pulse and note the rate and regularity when symptoms happen. A note with a rate beside it is far more useful than a description of the sensation.
- If episodes are short and unpredictable, ask about a wearable or an event monitor rather than relying on a resting ECG in a quiet clinic.
- Do not treat palpitations with stimulant herbal tonics before they have been assessed. Several traditional "heart" formulas contain ingredients that increase the rate.
- If you faint, or nearly faint, while the heart is racing, treat that as an emergency rather than as part of the pattern.
Classical sources
Quoted in the original, with our own translation and the chapter it comes from. We do not reproduce existing English translations — they are someone else's reading.
胃之大络，名曰虚里，贯鬲络肺，出于左乳下，其动应衣，脉宗气也。 wèi zhī dà luò, míng yuē xū lǐ, guàn gé luò fèi, chū yú zuǒ rǔ xià, qí dòng yìng yī, mài zōng qì yě
The great network of the stomach is called Xuli. It passes through the diaphragm, networks with the lungs, and emerges below the left breast; its movement is visible through the clothing, and it is the vessel of the ancestral qi.
乳之下其动应衣，宗气泄也。 rǔ zhī xià qí dòng yìng yī, zōng qì xiè yě
When the movement below the breast is visible through the clothing, the ancestral qi is leaking away.
寸口脉动而弱，动即为惊，弱则为悸。 cùn kǒu mài dòng ér ruò, dòng jí wéi jīng, ruò zé wéi jì
When the cunkou pulse is moving yet weak: the movement is fright, the weakness is palpitation.
The first two citations come from the same passage and differ only in emphasis: the first identifies the impulse, the second calls the same finding pathological when it is pronounced. Worth noting that some editions print 其动应手 where others print 其动应衣, a one-character difference that changes whether the observation is by touch or by sight. The third citation is the origin of the distinction between 惊 and 悸 that runs through the later literature, and it is a statement about the pulse rather than about the sensation — which is a fair illustration of how much of this tradition is built on examination rather than on description.
Terms used on this page
One concept, several names. The standard term comes first; pinyin and characters are there so you can search and cross-check; older aliases are what you will meet in other people's writing.
| Standard term | Pinyin | 中文 | Also written as |
|---|---|---|---|
| Palpitation | xīn jì | 心悸 | 怔忡 (continuous throbbing), 惊悸 (fright palpitation) |
| Fright palpitation | jīng jì | 惊悸 | situational, triggered |
| Continuous throbbing | zhēng chōng | 怔忡 | the more serious of the two |
| Ancestral qi | zōng qì | 宗气 | pectoral qi, 大气 |
Check your own pattern
Palpitations is a symptom, and symptoms appear in several patterns. The self-check weighs twelve questions against all twelve patterns and shows you what fits — and what doesn't quite.
Start the self-checkAbout four minutes. No account, nothing stored on a server, and an address for the printable report is optional.