2. Heart Disease Syndrome Differentiation

2. Heart Disease Syndrome Differentiation

(1) Heart Qi Deficiency, Heart Yang Deficiency, and Death of Yang

Palpitations and shortness of breath, along with a fine and irregular pulse, are the basic symptom clusters of heart qi deficiency. If accompanied by cold limbs and spontaneous sweating, it is heart yang deficiency. Further progression of heart yang deficiency leads to pallor, cold sweat, cool extremities, and a nearly undetectable pulse—this is death of yang. Heart qi deficiency, heart yang deficiency, and death of yang represent three progressively deepening pathological stages. Extreme qi deficiency leads to yang deficiency, and extreme yang deficiency leads to death of yang—this is a fundamental concept in TCM pathogenesis. For heart qi deficiency and heart yang deficiency, the treatment is to tonify qi and calm the heart, using Yang Xin Tang (by Wang Kentang); for death of yang, urgent measures are needed to restore yang, using Shen Fu Tang or Si Ni Tang (by Zhang Zhongjing).

(2) Heart Blood Deficiency, Heart Yin Deficiency, and Death of Yin

Palpitations, forgetfulness, insomnia, and excessive dreaming are the basic symptom clusters of heart blood deficiency. If accompanied by tidal fever, bone-steaming, five-heart vexation, and night sweats, it is heart yin deficiency. Further progression of heart yin deficiency leads to agitation, rapid breathing, dry skin, and warm hands and feet—this is death of yin. Heart blood deficiency, heart yin deficiency, and death of yin are also three progressively deepening pathological stages. Extreme blood deficiency leads to yin deficiency, and extreme yin deficiency leads to death of yin—this is another fundamental concept in TCM pathogenesis. For heart blood deficiency and heart yin deficiency, the treatment is to nourish blood and calm the spirit, using Tian Wang Bu Xin Dan (by Wei Yilin); for death of yin, it is advisable to tonify qi and nourish yin, using Sheng Mai San (from "Qianjin Fang").

(3) Excessive Heart Fire

Chest discomfort and restlessness, inability to sleep due to emptiness, red tip of the tongue, and fine, rapid pulse are the basic symptom clusters of excessive heart fire. If accompanied by oral and lingual erosion, short and涩 urine, it indicates that heart fire has moved to the small intestine (organ heat moving to腑). Heart fire resides in the chest; when it rises upward, it causes chest discomfort and insomnia, along with a red tongue. The heart and small intestine are mutually related as exterior and interior, connected through the meridians. Although heart fire ascends, it can also descend along the meridians into the small intestine. "The small intestine is the organ responsible for receiving and transforming substances, expelling the refined and retaining the impure." It has the function of separating clear from turbid, so when the small intestine is hot, the urine becomes reddish and涩. Oral and lingual erosion occurs because the small intestine's dampness is carried upward by the fiery nature of heart fire. For excessive heart fire, the treatment is to drain fire and calm the spirit, using Huang Lian A Jiao Tang (by Zhang Zhongjing); for heart fire moving to the small intestine, it is advisable to guide the heat downward, using Dao Chi San (from "Xiaoyuer Yaozheng Zhijue").

(4) Phlegm Obstructing the Heart Orifice

Confusion of consciousness (restlessness, mania, laughter, speech), slippery pulse, and greasy tongue are the basic symptom clusters of this syndrome. Treatment involves guiding out phlegm, opening the orifice, and calming the spirit, using Sheng Tie Luo Yin (from "Yixue Xinwu"). The heart governs the spirit, and when the heart orifice is blocked, consciousness becomes confused. Slippery pulse and greasy tongue are the pulse and tongue manifestations of phlegm, as the blockage of the heart orifice is caused by phlegm.

(5) Heart Blood Stasis

Pain in the precordial region, radiating to the arm, palpitations and shortness of breath, purple-dark tongue, and a rough, irregular pulse are the basic symptom clusters of this syndrome. Treatment involves activating blood circulation, resolving stasis, and promoting the flow of yang, using Guan Xin II Hao (a collaborative formula from Beijing) or Gua Lou Xie Bai Ban Xia Tang (by Zhang Zhongjing). A rough pulse and a purple-dark tongue indicate blood stasis, while precordial pain and palpitations suggest that the site of blood stasis is in the heart.

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