Introduction
Arrhythmia refers to abnormal frequency and rhythm of heart beating. Clinical manifestations are rapid or slow heart rate, irregular heart beating, or early heart beating, flutter, vibration, stoppage of beating and other related syndromes. Arrhythmia is usually either rapid arrhythmia or slow arrhythmia. Arrhythmia is similar to palpitation and severe palpitation in TCM. This disease is usually caused by weak constitution, emotional stimulation and invasion of pathogenic factors that lead to malnutrition of the heart due to deficiency of qi, blood, yin and yang; or by phlegm-fire attacking the heart and stagnation of heart blood. In severe cases even sudden loss of heart yang and separation of yin and yang may be caused.

Syndrome Differentiation
1. Asthenia of the Heart and Gallbladder
Palpitation, susceptibility to fright, restlessness, insomnia and dreaminess, light-colored tongue with white fur, taut and thin pulse.

2. Interior Disturbance of Phlegm-Fire
Palpitation and chest oppression, restlessness and susceptibility to rage, insomnia and disturbed sleep, dry stool and brown urine, red tongue with yellow and greasy fur, slippery and rapid pulse.

3. Insufficiency of heart blood
Palpitation and dizziness, lusterless complexion, lassitude, amnesia and insomnia, light-red tongue with thin and white fur, thin and weak pulse or slow pulse with irregular intervals and slow regular intermittent pulse.

4. Stagnation of Blood in Collaterals
Palpitation and shortness of breath, stabbing pain in the chest, or cyanotic lips and nails, puplish tongue or tongue with ecchymoses, thin and unsmooth pulse or slow pulse with irregular intervals and slow regular intermittent pulse.

5. Inactivation of Heart Yang
Palpitation, dizziness, cold body and limbs, chest oppression and shortness of breath, edema and scanty urine, light-colored and bulgy tongue or with purplish appearance, thin and white tongue fur, deep and slow pulse or slow pulse with irregular intervals and slow regular intermittent pulse.

Treatment
1. Body acupuncture
Prescription: Xinshu (BL 15), Jueyinshu (BL 14), Tanzhong (CV 17), Juque (CV 14), Neiguan (PC 6), Shenmen (HT 7) and Sanyinjiao (SP 6).

Modification: For asthenia of the heart and gallbladder, Yanglingquan (GB 34) and Daling (PC 7) are added; for phlegm-fire disturbing the heart, Fenglong (ST 40) and Taiyuan (LU 9) are added; for insufficiency of heart blood, Zusanli (ST 36) and Xuehai (SP 10) are added; for stagnation of blood in the collaterals, Geshu (BL 17) and Ximen (PC 4) are added; for inactivation of heart yang, Qihai (CV 6), Guanyuan (CV 4) and Shenshu (BL 23) are added; for dizziness, Baihui (GV 20) and Fengchi (GB20) are added; for syncope, Shuigou (GV 26) and Suliao (GV 25) are added.
Performance: The needling techniques are selected according to the manifestations of syndromes. Tanzhong (CV 17) is needled 1 cun horizontally toward the root of the left breast to direct the sensation of needling to the precordial region with strong stimulation. Back-Shu acupoints and Qihai (CV 6), Guanyuan (CV 4) and Zusanli (ST 36) can be moxibusted after needling. For mild cases, the needling is done once a day or once every other day. For severe cases, the retention of needles can be prolonged and manipulated once 3 - 5 minutes, once or twice a day.

2. Ear acupuncture
Prescription: Heart (CO15), Subcortex (AT4), Sympathetic Nerve (AH6a), Adrenal Gland (TG2p) and Ear Shenmen (TF4).

Performance: Each time 2 - 3 acupoints are selected and needled with filiform needles and moderate and strong stimulation. The needles are retained for 30 - 60 minutes.