2. Heart Disease Pattern Differentiation

2. Heart Disease Pattern 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 cluster of heart-qi deficiency; if accompanied by cold limbs and spontaneous sweating, it is heart-yang deficiency. Further development of heart-yang deficiency leads to pale complexion, cold sweat, cold limbs, and a nearly absent pulse—this is death of yang. Heart-qi deficiency, heart-yang deficiency, and death of yang are three progressively deepening pathological stages. Extreme qi deficiency leads to extreme yang deficiency, and extreme yang deficiency leads to death of yang—this is a basic concept of TCM pathogenesis. Treatment for heart-qi deficiency and heart-yang deficiency is to tonify qi and calm the heart, using Yang Xin Tang (by Wang Kentang); for death of yang, immediate efforts are needed to restore yang, using Shen Fu Tang and Si Ni Tang (by Zhang Zhongjing).

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

Palpitations, forgetfulness, insomnia, and frequent dreaming are the basic symptom cluster of heart-blood deficiency. If accompanied by tidal heat and bone-steaming heat, five-heart heat, and night sweats, it is heart-yin deficiency; further development of heart-yin deficiency leads to symptoms such as restlessness, difficulty 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 extreme yin deficiency, and extreme yin deficiency leads to death of yin—this is also one of the basic concepts of TCM pathogenesis. Treatment for heart-blood deficiency and heart-yin deficiency is to nourish blood and calm the spirit, using Tian Wang Bu Xin Dan (by Wei Yilin); for death of yin, it is recommended to tonify qi and nourish yin, using Sheng Mai San (from "Qianjin Fang").

(3) Excessive Heart Fire

Hot chest, restlessness and inability to sleep, red tip of the tongue, and a fine, rapid pulse are the basic symptom cluster of excessive heart fire. If accompanied by oral and lingual erosion, short and涩 urine, it means heart fire has moved heat to the small intestine (organ heat moving to腑). Heart fire is located in the chest; when it rises upward, it causes restlessness and insomnia, along with a red tongue; since the heart and small intestine are mutually connected through meridians, even though the fire rises upward, it can also descend along the meridians to the small intestine. "The small intestine is the organ responsible for receiving and transforming substances, expelling the refined and retaining the impure," so when the small intestine is heated, the urine becomes red and涩. Oral and lingual erosion occurs because the small intestine's dampness is carried upward by the fire. Treatment for excessive heart fire is to purge fire and calm the spirit, using Huang Lian A Jiao Tang (by Zhang Zhongjing); for heart fire moving heat to the small intestine, it is recommended to guide the heat downward, using Dao Chi San (from "Xiaoyuer Yaozheng Zhijue").

(4) Phlegm Obscuring the Heart Orifice

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

(5) Heart-Blood Stagnation

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