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Heart Pattern Differentiation in Chinese Medicine

Etiology of Heart Patterns

Emotions affecting the Heart

While Sadness relates to the Lungs in 5 Element Theory, Sadness affects the Heart Qi because the Heart and Lungs are closely related and mutually assist each other. Sadness weakens Lung Qi which can cause Heart Qi to become deficient. Prolonged sadness and Deficient Qi can also lead to Stagnation of Qi, which can lead to Heart Fire.

While Anger affects the Liver directly, it affects the Heart indirectly. Anger causes Liver Yang to rise, which can eventually be transmitted to the Heart, causing Heart Fire.

Blood Loss or severe bleeding affecting the heart

Severe blood loss from hemorrhage or long term illness can deplete Heart blood (Heart rules Blood), and this can lead to Heart Qi Deficiency

Heart Qi Deficiency

Signs

The signs include not only general Qi deficiency signs, but signs specific to Heart Qi Deficiency, like palpitations.

  • Palpitations (Key Sign)
    - Due to Heart Qi Deficiency
  • Fatigue, Shortness of Breath, Spontaneous Sweating, Pale Face
    - Due to Qi Deficiency
  • Tongue: Normal color, Pale color in severe cases
    - Midline crack to tip with swollen sides in severe cases of Heart Qi Deficiency.
  • Pulse: Empty
    - Due to Qi Deficiency

Treatment Principle

  • Tonify Heart Qi

Acupuncture Points

  • HT-5 (Tongli)
    Tonifies Heart Qi
  • P-6 (Neiguan)
    Tonifies Heart Qi, Calms the Mind
  • BL-15 (Xinshu)
    With moxa. Back Shu Point of the Heart, Warms and Tonifies Heart Yang
  • REN-17 (Shanzhong)
    With Moxa. Influential Point of Qi. Warms and Tonifies Heart Yang
  • REN-6 (Qihai)
    With Moxa. Warm and Tonify Yang of the whole body, use if Heart Yang Deficiency is due to Kidney Yang Deficiency

Heart Yang Deficiency

Signs

  • Palpitations, shortness of breath on exertion, fatigue, sweating
    Heart Qi Deficiency
  • Discomfort in the chest and heart region
    Heart Yang failing to move Qi in the chest
  • Sensation of cold, cold limbs and hands, bright pale face
    Yang Deficiency, Cold signs

Tongue

  • Pale, wet, and swollen tongue due to Yang Deficiency

Pulse

  • Deep and weak pulse
    yang Deficiency
  • Knotted in severe cases
    Heart Yang not properly moving Blood

Etiology

Because the Kidneys are the source of Yang for all the internal organs, chronic Kidney Yang Deficiency can lead to Heart Yang Deficiency.

Treatment Principle

Tonify and warm Heart Yang

Points

  • HT-5 (Tongli)
    Tonifies Heart Qi
  • P-6 (Neiguan)
    Tonifies Heart Qi, Calms the Mind
  • BL-15 (Xinshu)
    With moxa. Back Shu Point of the Heart, Warms and Tonifies Heart Yang
  • REN-17 (Shanzhong)
    With Moxa. Influential Point of Qi. Warms and Tonifies Heart Yang
  • REN-6 (Qihai)
    With Moxa. Warm and Tonify Yang of the whole body, use if Heart Yang Deficiency is due to Kidney Yang Deficiency
  • DU-14 (Dazhui)
    With Moxa. Tonify Heart Yang

Method

  • Tonify all Points, moxa used where applicable

Heart Blood Deficiency

Signs

  • Palpitations (more pronounced in the evening)
    Due to the Heart Blood Deficiency affecting Heart Qi
  • Insomnia, poor memory, anxiety, dream disturbed sleep, easily startled
    Due to the heart not properly housing the Shen
  • Dull pale complexion, pale lips, dizziness
    Due to Blood Deficiency

Tongue

  • Pale and slightly dry
    Due to Blood Deficiency

Pulse

  • Choppy or Fine pulse
    Due to Blood Deficiency

Etiology

  1. Spleen Qi Deficiency (dietary insufficiencies, over-thinking) can cause Blood Deficiency and then Heart Blood Deficient. Therefore, Heart Blood Deficiency is often associated with Spleen Qi Deficiency.
  2. Chronic worry and anxiety disturbs the Shen, which depresses the Heart function and leads to Heart Blood Deficiency.
  3. Severe hemorrhage (e.g. in childbirth) or any cause of Deficient Blood.

Treatment Principle

Tonify the Blood and Heart, soothe the Shen

Points

  • HT-7 (Shenmen)
    Tonifies Heart Blood and calms the Shen
  • P-6 (Neiguan)
    Tonifies Heart Qi and calms the Shen
  • REN-14 (Juque)
    Tonifies Heart Blood and calms the Shen, especially with anxiety and restlessness
  • REN-15 (Jiuwei)
    Tonifies Heart Blood and calms the Shen
  • REN-4 (Guanyuan)
    Tonifies Blood
  • BL-17 (Geshu)
    Influential Point of Blood
  • BL-20 (Pishu)
    Back Shu Point of the Spleen, Tonifies Spleen, which in turn produces more Blood

Method

  • Tonify all Points, use moxa where applicable

Heart Yin Deficiency

Signs

  • Palpitations
    Heart Yin Deficiency affecting Heart Qi
  • Insomnia, wakes often, mental restlessness, easily startled, poor memory, anxiety
    Heart Blood Deficiency
  • Sensation of Heat that is pronounced in the evening, low grade fever, malar flush, night sweats and Five Palm Heat, dry mouth and throat
    Heart Yin Deficiency

Tongue

  • Red with no coat, possible red tip or red points

Pulse

  • Fine and rapid or floating empty and rapid

Etiology

Chronic anxiety, worry, and a busy lifestyle can damage Yin and cause Yin Deficiency.

Treatment Principle

  • Tonify and nourish Heart Yin
  • Nourish Kidney Yin
  • Calm the Shen

Points

  • HT-7 (Shenmen)
    Tonifies Heart Blood and Heart Yin and calms the Shen
  • P-6 (Neiguan)
    Calms the Shen
  • REN-14 (Juque)
    Calms the Shen, especially where there is anxiety
  • REN-15 (Jiuwei)
    Calms the Shen, especially where there is anxiety
  • REN-4 (Guanyuan)
    Tonifies the Yin and Anchors the Shen
  • HT-6 (Yinxi)
    Tonifies Heart Yin and stops night sweats
  • SP-6 (SanYinjiao)
    Tonifies Yin and calms the Shen
  • KI-7 (Fuliu)
    Tonifies the Kidneys, Stops night sweats with HT-6
  • KI-6 (Zhaohai)
    Tonifies Kidney Yin and improves sleep

Method

  • Tonify all Points
  • No moxa

Heart Fire Blazing

Signs

  • Palpitations
  • Mouth and tongue ulcers
    Heart heat affecting the Heart
  • Mental restlessness, agitation, impulsiveness, insomnia, and dream disturbed sleep
    Heat disturbing the Shen
  • Blood in the urine or dark urine
    Heart Fire moving to the Small Intestine
  • Bitter taste in the mouth
    Heart opens to the Tongue
  • Thirst and a sensation of heat
    General heat signs

Tongue

  • Red with a very red tip
    Heart Area
  • Swollen with red points
  • Yellow coat with a possible midline crack

Pulse

  • Rapid and Full especially in the Heart position
  • Possibly irregular

Etiology

  1. Emotional problems e.g. chronic anxiety, constant worrYing and depression can lead to Heart Fire. Over a long time, these Emotions can lead to Stagnation of Qi, which leads to Fire.

    Especially, when Qi stagnation is associated with mental depression it can turn into Fire and produce Heart Fire Blazing. Often patients with chronic depression will show Signs of this pattern although they may appear subdued.
  2. Heart Fire is often transmitted from Liver Fire. Therefore, any of the causes of Liver Fire (anger, resentment and frustration) can cause Heart Fire.

Treatment Principle

Clear the Heart and Soothe the Shen

Points

  • HT-9 (Shaochong)
    Clears heart Fire
  • HT-8 (Shaofu)
    Clears heart Fire
  • HT-7 (Shenmen)
    Calms the Shen
  • REN-15 (Jiuwei)
    Calms the Shen and clears Heat
  • SP-6 (SanYinjiao)
    Nourishes Yin and cools Fire
  • KI-6 (Zhaohai)
    Nourishes Yin and cools Fire

Heart Blood Stagnation

Signs

  • Palpitations
    Heart Qi involved
  • Pain in the chest and Heart region, which may radiate down inner left arm
    Due to Blood stagnation in the chest
  • Oppression, constriction, and/or discomfort in the chest
    Due to Blood stagnation in the chest
  • Cyanosis of lips and nails, cold hands

Tongue

  • Purple tongue

Pulse

  • Knotted Pulse

This pattern closely resembles a Western diagnosis of angina pectoris. This pattern derives from other Heart patterns, usually Heart Yang Deficiency, sometimes Heart Blood Deficiency or Heart Fire. Signs, therefore, vary according to the origin and there will be additional symptoms depending on which pattern was also involved.

When Heart Yang is Deficient, it cannot circulate the Blood in the chest. Heart Blood then stagnates in the chest, causing pain and feeling of stuffiness. The symptoms vary widely from mild pricking to intense stabbing. Other Heart patterns do not have this symptom. the pain is typically in bouts, worse on exertion or in Cold weather.

If Heart Fire is the cause, Heat congeals the Blood in the chest causing stagnation.

If Heart Blood is Deficient, Qi can become Deficient, and eventually become unable to push the Blood. in addition, when Blood is extremely Deficient, it can stagnate.

Etiology

Emotional problems, especially anxiety, grief, resentment or repressed anger over a long periods cause Blood Stagnation in the chest. Unexpressed emotions tend to be held in the chest and interfere with the circulation of Qi and Blood.

Treatment Principle

  • Regulate Blood, remove stasis, tonify and warm Heart Yang (or sedate Heart Fire or tonify Heart Blood), calm the Shen

Points

  • P-6 (Neiguan)
    Regulates Heart Blood and opens the chest
  • P-4 (Ximen)
    Xi Cleft Point, useful to stop Heart pain during acute attack
  • HT-7 (Shenmen)
    Calms the Shen
  • REN-17 (Shanzhong)
    Regulates Qi and Blood in the chest and stimulates the Zong Qi. If Heart Yang is Deficient, moxa can be used.
  • BL-14 (JueYinshu)
    Regulates Blood
  • BL-17 (Geshu)
    Regulates Blood
  • SP-10 (Xuehai)
    Regulates Blood
  • KI-25 (Shencang)
    Local point to move Qi and Blood in the chest area. Especially useful if Heart Yang Deficiency is associated with Kidney Yang Deficiency.