Cardiac Neurosis: Acupuncture, Symptoms, and Psychological Care

Cardiac neurosis is a condition in the cardiovascular system characterized mainly by dysfunction of the small vessel system, potentially accompanied by other symptoms of neurosis, without evidence of organic heart disease.

The cardiovascular system is regulated by the nervous and endocrine systems, with the nervous system playing a dominant role. Higher nerve centers control and regulate the normal activity of the cardiovascular system through the sympathetic and vagus nerves. These two nerves antagonize and coordinate with each other to maintain a relatively stable heart rate. When the central nervous system is dysfunctional, the normal activity of the sympathetic and vagus nerves is disrupted, leading to cardiovascular dysfunction and a series of manifestations of excessive sympathetic tone.

Cardiac neurosis is primarily caused by dysfunction of the central nervous system, which in turn affects autonomic nerve function, leading to abnormal cardiovascular responses. Psychological factors play a significant role in the onset of cardiac neurosis, with common triggers including anxiety, emotional agitation, psychological trauma, or excessive fatigue. Additionally, insufficient physical activity and a lack of proper conditioning of the circulatory system can result in poor tolerance to even mild exertion or fatigue, making individuals more prone to excessive cardiovascular reactions and subsequent development of the condition. Clinical observations have also identified a beta-adrenergic receptor hyperfunction syndrome in these patients (as evidenced by the favorable therapeutic response to beta-blockers such as propranolol in treating cardiac neurosis).

[Diagnostic Points]

The clinical symptoms are complex and varied, with a tendency to relapse after improvement. In a small number of cases, the disease course can last for several years or even more than a decade.

1. Palpitations (Xinji)

The most common symptom is that patients are aware of their own heartbeat, along with precordial pulsations and discomfort. Symptoms are more pronounced after exercise or emotional excitement. Most patients present with increased heart rate, elevated cardiac output, and transient hypertension. Occasional premature beats or paroxysmal supraventricular tachycardia may occur. Even mild activity can cause a disproportionately noticeable increase in heart rate.

2. Precordial Pain (Xinqianqutong)

The location is not fixed, most commonly seen in the left anterior chest at the breast or below the breast, and may also occur beneath the sternum or in the right anterior chest. The nature of the pain varies; it is mostly brief stabbing pain lasting from 1 second to several seconds, or a mild dull ache persisting for several hours or longer. The occurrence of pain is unrelated to exertion and often appears after labor rather than during it.

3. Dyspnea (Huxi Kunnan)

It often presents as shallow, short, and irregular breathing accompanied by chest tightness, which tends to occur in crowded or poorly ventilated places.

Attacks sometimes occur at night. During an attack, the patient prefers to sit up or get up and open a window to take deep breaths; after a sighing-like respiration, they feel comfortable.

IV. Neurasthenia Syndrome

The patient frequently reports fatigue and dizziness, waking without feeling refreshed or energetic, and being listless during the day. They experience tiredness after exertion, and may also suffer from insomnia (Shimian), dream-disturbed sleep (excessive dreaming), and easy waking.

V. Others

The body type is predominantly asthenic, with an anxious, tense, or melancholic and indifferent facial expression. There is hyperhidrosis of the palms and axillae, and coarse tremor may be present when the fingers are extended. Low-grade fever (around 37°C) may also occur.

Examination: Deep tendon reflexes may be hyperactive. Cardiac auscultation often reveals a relatively strong heart beat with an accentuated first heart sound. Tachycardia is common, and occasionally a grade I–II systolic murmur may be heard at the apex or in the pulmonary valve area. Premature beats may occur occasionally.

Chest X-ray examination shows a normal cardiac silhouette. Electrocardiogram (ECG) often reveals sinus tachycardia, and some patients exhibit ST-T wave changes, most commonly presenting as ST-segment depression (either J-point depression or horizontal downward displacement) and/or low-voltage, biphasic, or inverted T waves. These ST-T changes are primarily confined to leads II, III, and aVF, and are labile—sometimes disappearing and sometimes worsening.

Treatment

I. Acupoints and Needling Techniques

1. **PC6 (Neiguan) (bilateral):** Located 2 cun above the palmar wrist crease, between the tendons of palmaris longus and flexor carpi radialis. Use two 30-gauge, 1.5 cun filiform needles. Routinely disinfect the local area. Insert perpendicularly about 1.3 cun toward TE5 (Waiguan). Needling sensation: local distension and pain, or radiating to the dorsum of the hand and the middle finger.

2. TE17 (Yifeng) [bilateral]: located in the depression between the earlobe and the mandibular angle. Use two No.30 gauge, 2-cun filiform needles, perform standard local disinfection, then insert approximately 1.6 cun in an inferomedial direction toward the mandible. Needle sensation: local distension and pain.

3. **KI23 (Lingxu)** [Left side]: Located in the third intercostal space, 2 cun lateral to the Conception Vessel (CV). A 30-gauge, 2-cun filiform needle is used. After routine local disinfection, insert the needle obliquely along the intercostal space toward the axilla, at a depth of approximately 1.8 cun (transverse needling). Needle sensation: local distension and pain.

4. **Shenfeng (KI23, left side)**: Located in the 4th intercostal space, 2 cun lateral to Danzhong (CV17). A 30-gauge, 2-cun filiform needle is inserted transversely along the intercostal space toward the axilla, approximately 1.8 cun in depth, after routine local disinfection.

Needling sensation: local distension and pain.

2. Methods

The patient assumes a supine position, and the above points are needled following standard technique, retaining the needles for 40 minutes. Upon needle removal, cupping is applied to the two chest points for about 1 minute. Treatment is performed once daily, with 10 sessions constituting one course of treatment, followed by a 5-day rest before resuming acupuncture.

**【Commentary】**

For patients with cardiac neurosis, acupuncture treatment using the methods described above yields favorable outcomes—symptoms are often eliminated or alleviated within approximately ten sessions. After recovery, recurrence may easily occur due to psychological factors or other triggers, yet the same treatment remains effective upon reapplication. During remission periods, patients should be advised to engage in regular physical exercise and to avoid psychological stress and other stimuli as much as possible, in order to reduce the frequency of episodes.

Clinical Presentation and Diagnostic Differentiation

Cardiac neurosis manifests with a constellation of symptoms that closely mimic organic heart disease, most notably persistent or recurrent chest pain, palpitations, dyspnea, and fatigue. However, thorough cardiovascular examination reveals no structural or ischaemic abnormalities, distinguishing it from conditions such as coronary artery disease. The differential diagnosis frequently involves cardiac neurosis vs panic attack, a comparison that is critical for appropriate management. While both share acute episodes of chest discomfort and heightened autonomic arousal, panic attacks are typically paroxysmal, peak within minutes, and are accompanied by intense fear of dying or losing control. In contrast, cardiac neurosis symptoms and treatment strategies must account for its chronic, fluctuating course and the absence of a discrete trigger. The chest pain in cardiac neurosis is often described as stabbing, persistent, and triggered by emotional stress rather than exertion, and it may persist for hours or days. Recognizing these nuances allows clinicians to avoid unnecessary invasive cardiac workups and instead focus on functional assessment. A structured clinical interview and use of validated questionnaires can help differentiate the two conditions, ensuring that patients receive appropriate reassurance and targeted intervention rather than misattribution to a psychiatric label alone.

Pathophysiological Mechanisms: The Anxiety–Vascular Axis

The genesis of cardiac neurosis lies in a complex interplay between the central nervous system, the autonomic nervous system, and the microvasculature. Higher nerve centers, when subjected to chronic psychological distress, dysregulate the balance between sympathetic and parasympathetic output, leading to aberrant vasomotor responses in the small coronary vessels. This dysfunction, without evidence of epicardial coronary stenosis, is central to understanding how cardiac neurosis causes anxiety in a bidirectional manner: anxiety precipitates vascular instability, and the resulting somatic sensations—especially chest discomfort—amplify anxiety, creating a self-perpetuating loop. Neuroimaging and psychophysiological studies have shown that patients with cardiac neurosis exhibit heightened amygdala and insular reactivity to emotional stimuli, alongside reduced vagal tone. These findings explain why symptoms are often provoked by mental stress rather than physical exertion. The condition thus represents a functional disorder of the heart–brain axis, where the perception of cardiac distress is real, albeit not due to structural damage. This perspective reframes the traditional cardiocentric view and underscores the necessity of integrating neurological and psychiatric dimensions into the disease model, paving the way for targeted interventions that address both the vascular and emotional components.

Integrated Management: Pharmacological and Non‑Pharmacological Approaches

Effective treatment of cardiac neurosis requires a multimodal strategy that alleviates acute somatic distress while addressing the underlying psychological contributors. For immediate cardiac neurosis chest pain relief, short‑acting anxiolytics or low‑dose beta‑blockers may be employed to reduce tachycardia and the subjective sensation of heavy chest pressure. However, long‑term success hinges on cardiac neurosis psychological treatment, which should form the cornerstone of management. Cognitive‑behavioral therapy (CBT) has demonstrated robust efficacy in breaking the worry–symptom cycle by helping patients reinterpret benign cardiopulmonary sensations and reduce hypervigilance. Other evidence‑based modalities include mindfulness‑based stress reduction, biofeedback, and psychodynamic therapy, particularly when trauma or unresolved emotional conflict is present. The selection of cardiac neurosis symptoms and treatment must be individualized; for instance, patients with prominent shortness of breath may benefit from respiratory retraining, while those with debilitating fear might require exposure‑based techniques. Education about the non‑organic nature of the condition is essential, as is collaboration between cardiologists, psychiatrists, and primary care physicians. By combining pharmacological support with robust psychological intervention, clinicians can help patients achieve sustained relief, reduce healthcare utilization, and restore quality of life.