One Iced Coffee and Your Chest Won't Settle Down? Heart Palpitations, Explained

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By Hansung Jang, L.Ac. · Lena Kim Acupuncture

You had one coffee. Just one, and not even a large one. Two hours later you are sitting at your desk and you can feel your own heartbeat in your throat. It is not painful. It is not dramatic. It is just there, thudding, and now you are paying attention to it, which makes it worse.

Or it happens at night. You lie down, the room goes quiet, and suddenly your heart is the loudest thing in the house. You check your pulse. It seems fine. You check it again anyway.

Heart palpitations are one of the most unsettling things a body can do, partly because they are invisible to everyone else. You cannot show someone this. You went to your doctor, they ran an EKG, and it came back normal, which was a relief for about a day. Then it happened again and you were left with the same question: if nothing is wrong, why does it keep happening?

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What Heart Palpitations Actually Are When the Tests Come Back Normal

First, the important part. A normal EKG is genuinely good news. It means the electrical system of your heart is working. What it does not tell you is why your nervous system keeps hitting the accelerator.

Most benign palpitations are a nervous system phenomenon rather than a heart phenomenon. The autonomic nervous system has two branches: sympathetic, which speeds things up, and parasympathetic, which slows them down. When the sympathetic side runs high for too long, and this happens with poor sleep, chronic stress, dehydration, low blood sugar, and yes, caffeine, the heart becomes more sensitive to ordinary signals. You start feeling beats that were always there. Caffeine matters more than people expect, because sensitivity to it varies enormously between individuals based on how fast you metabolize it. Two people can drink the same cold brew and have completely different afternoons.

East Asian medicine has been describing this cluster for a very long time, and with unusual precision. It distinguishes between a sensation the patient feels, called Kye (계-悸), and a pulsation a practitioner can actually palpate in the abdomen, called Dong (동-動). It also connects palpitations to fluid metabolism, which sounds odd until you notice how often the same person reports feeling puffy, dizzy on standing, heavy-limbed, and prone to muscle twitching. In the traditional language, this pattern of unsettled fluid plus an unsettled mind travels together.

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The Herb Traditionally Used for This Pattern

Here is the person this pattern usually belongs to.

They stand up from the couch too quickly and the room grays out for half a second. Their left eyelid has been twitching for three days and they keep meaning to mention it to someone. Their rings are looser in the morning than they are by four in the afternoon. One coffee stays with them for six hours, which was not true five years ago and they cannot pinpoint when it changed. Underneath all of it is a low, constant sense that things are not quite settled, and they have trouble describing it to anyone becau

se no single piece of it sounds serious enough to bring up.

The primary herb associated with this picture is Poria (Fu Ling 茯苓), a fungus that grows on pine roots. It has traditionally been used for exactly this cluster. In classical East Asian medicine it occupies an unusual position because it addresses two things at once that Western thinking regards as unrelated: water metabolism and anxiety. The classical framing is that when fluid does not circulate properly in the lower body, it produces a restlessness that shows up as a fluttering heart and an unsettled mind.

It rarely appears alone. The best known pairing is with Cinnamon Twig (Gui Zhi 桂枝) and Licorice (Gan Cao 甘草), a combination used for centuries for this presentation. Where sleep is the dominant complaint, Sour Jujube Seed (Suan Zao Ren 酸棗仁) is often added, traditionally used for the specific frustration of being exhausted all day and then wide awake the moment your head touches the pillow.

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When Heart Palpitations Need a Physician First, Not an Acupuncturist

This part is not negotiable, so it comes before anything else.

Please see a physician, not an acupuncturist, if any of the following apply:

• Palpitations with chest pain or pressure

• Palpitations with fainting, near-fainting, or graying vision

• Palpitations with shortness of breath at rest

• A known heart condition, or a family history of sudden cardiac death or arrhythmia

• Palpitations that start abruptly, race at a rate you cannot count, and stop abruptly

• Anything that wakes you from sleep with a sense of alarm

  
  

These need a cardiac workup, and East Asian medicine is not the right first stop. We will tell you this directly if you come to us with these symptoms.

Also worth ruling out before assuming a pattern: thyroid dysfunction, anemia, perimenopause, dehydration, and stimulant or medication side effects. Palpitations are a symptom with a long differential, and a good practitioner wants those excluded, not glossed over.

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Why "I'm Anxious and I Can't Sleep" Isn't One Condition

In East Asian medicine, that sentence describes at least three different situations, and they take different herbs entirely.

The overheated version. A flushed red face, irritability, a person who runs hot, sleeps poorly, and describes themselves as easily set off. That pattern points toward Coptis (Huang Lian 黃連), a distinctly cooling herb, not toward Poria.

The depleted version. The person who gets more anxious the more exhausted they become, who is unusually irritable when hungry, and who paradoxically sleeps better after eating well or after a course of tonifying herbs. That pattern points toward Ginseng (Ren Shen 人蔘).

The unsettled version. Autonomic instability. Dizzy standing up, disproportionately reactive to caffeine, twitchy, fluttery, with that sense of things not being settled. This is the Poria picture.

All three patients walk in and say the same sentence. Choosing wrong does not just fail to help. Giving a cooling herb to someone who is depleted, or a warming tonic to someone who is already overheated, generally makes them worse. This is precisely why we do not prescribe from a symptom.

Standard cautions also apply. If you are pregnant or nursing, take diuretics, blood pressure medication, blood thinners, sedatives, or medication for heart rhythm, or have surgery scheduled, talk to a licensed East Asian medicine practitioner and your physician before taking any herbal formula. Herbs that influence fluid balance can interact with diuretics in particular.

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Jang's Clinical Note

The thing I most want patients to hear about palpitations is that the normal EKG is not a dismissal. I have had people arrive almost apologetic, as if the clean test result means they made the whole thing up. They did not. They are feeling something real. What the test told us is where not to look.

Most of the intake goes to sorting out which of the three pictures I am looking at, because that decision determines everything downstream. What happens when they stand up quickly. Whether they get more anxious when hungry or less. What one cup of coffee does to them now compared to five years ago. Whether the sleep problem is falling asleep or waking at 3 a.m., because those point in different directions.

I ask about caffeine without judgment, because people underreport it. If someone is drinking cold brew at 3 p.m. in August and sleeping six hours, I am not going to out-prescribe that with herbs, and I would rather say so than take their money. For the same reason I say the cardiac part out loud every time. Being overly cautious and sending someone to a cardiologist is a much better outcome than the alternative.

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Jang Hansung, L.Ac, Associate Director

Lena Kim Acupuncture - Lake Forest & Newport Beach, CA

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한국어 요약

커피 한 잔에 심장이 두근거리고, 밤에 누우면 심장 소리가 유난히 크게 느껴지시나요. 병원에서 심전도를 찍었는데 정상이라고 해서 오히려 더 답답하셨을 수도 있습니다.

정상 심전도는 좋은 소식입니다. 심장의 전기적 기능에는 문제가 없다는 뜻이니까요. 다만 그 검사가 알려주지 않는 것이 있습니다. 심장 자체에 이상이 없어도, 자율신경이 계속 과항진되어 있으면 이런 증상이 나타날 수 있다는 점입니다. 수면 부족, 만성 스트레스, 탈수, 저혈당, 그리고 카페인이 겹치면 교감신경 톤이 높아지고, 원래 있던 심박을 유난히 크게 느끼게 됩니다. 카페인 대사 속도는 사람마다 크게 달라서, 같은 커피를 마셔도 반응이 전혀 다릅니다.

한의학에서는 이 상태를 오래전부터 정밀하게 구분해 왔습니다. 환자가 느끼는 두근거림(悸)과 실제로 복부에서 만져지는 박동(動)을 나누고, 이런 두근거림을 수분 대사와 연결해서 봅니다. 실제로 이런 분들은 붓는 느낌, 일어설 때 어지러움, 몸이 무거움, 근육 떨림을 함께 호소하는 경우가 많습니다.

복령(茯苓)은 두근거림, 기립성 어지럼, 불안, 근육 떨림, 소변이 시원치 않으면서 몸이 무거운 증상에 전통적으로 사용되어 왔고, 계지(桂枝)·감초(甘草)와 함께 쓰이는 조합이 가장 잘 알려져 있습니다. 수면이 주 문제라면 산조인(酸棗仁)을 더하기도 합니다.

반드시 먼저 병원으로 가셔야 하는 경우가 있습니다. 흉통이나 압박감을 동반할 때, 실신하거나 눈앞이 흐려질 때, 안정 시에도 숨이 찰 때, 심장 질환 병력이나 급사·부정맥 가족력이 있을 때, 갑자기 시작해서 셀 수 없이 빠르다가 갑자기 멈출 때, 자다가 놀라 깰 때입니다. 갑상선 질환, 빈혈, 갱년기, 탈수, 약물 부작용도 먼저 감별해야 합니다.

"불안하고 잠이 안 온다"는 호소를 한의학에서는 최소 세 갈래로 봅니다. 얼굴이 붉고 열이 많으며 쉽게 욱하는 흥분형은 황련(黃連) 계열, 피곤할수록 오히려 예민해지고 배가 고프면 유독 날카로워지며 잘 먹고 나서야 잠이 오는 허약형은 인삼(人蔘) 계열, 그리고 일어설 때 어지럽고 카페인에 유독 예민하며 떨림이 있는 자율신경 불안정형이 복령(茯苓) 계열입니다. 세 분 모두 진료실에서 똑같은 문장을 말씀하십니다. 방향을 잘못 잡으면 도움이 안 되는 정도가 아니라 오히려 나빠집니다. 그래서 증상 하나만 보고 처방하지 않습니다.

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Before You Try Anything

We take a full intake before recommending any formula. The right approach depends on your specific pattern and constitution, not a general symptom list. With palpitations and anxiety this matters more than almost anywhere else, because three patients describing the identical symptom can need three opposite formulas, and one of them may need a cardiologist rather than either.

If your chest has been unsettled and you have been told everything looks fine, come talk with us and we will help you work out which direction you actually belong in.

Lena Kim Acupuncture

📍 Lake Forest, Newport Beach, Irvine & Orange County, CA

📞 949-943-6161

🌐 www.lenakimacu.com

We offer a complimentary 15-minute consultation to see if East Asian medicine is right for you.

Medical Disclaimer: This article is for educational purposes only and is not medical advice. Herbal formulas should be taken under the guidance of a licensed practitioner. Individual results vary. Consult a licensed healthcare provider before starting any herbal regimen, especially if you are pregnant, nursing, or taking medications.