The heart governs the blood vessels and houses the spirit， while the gallbladder， as the mother of the heart， is responsible for decision-making. The meridians and collaterals of the heart and gallbladder are interconnected， and their physiological and pathological functions， as well as the flow of

qi

and blood， are closely related. Together， they govern the pivot and control the mind. The heart serves as the master of the spirit， and the gallbladder functions as the pivot of the spirit. When the gallbladder pivot fails， the heart and spirit lose nourishment， and pathogenic factors may cause palpitations. The pathological processes resulting from pivot dysfunction vary among individuals， and treatment should be tailored accordingly. For example， those who are prone to worry and overthinking often experience stagnation of

qi

， leading to phlegm transforming into fire and disturbing the heart and mind. Individuals with robust and urgent constitutions may have impaired

qi

circulation at the pivot， leading to the transformation of

qi

into fire， with gallbladder fire ascending along the meridians. When these two fires meet， the heart is heated， and heart fluids are consumed. Those with weak constitutions are prone to fear and deficiency， resulting in coldness， weakened pivot function， and loss of warmth in the heart and mind. Clinically， treatment can be based on the harmony of the heart， gallbladder， and spirit， i.e.， by identifying the pathological changes caused by pivot dysfunction and applying formula-based interventions， the function of the heart–gallbladder pivot can be restored to treat palpitations.