2. Heart Disease Differentiation

2. Heart Disease Differentiation

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

Palpitations, shortness of breath, and a weak or irregular pulse are the basic symptom complex of Heart Qi Deficiency. If accompanied by cold intolerance and spontaneous sweating, it is Heart Yang Deficiency; further progression leads to pallor, cold sweat, cold extremities, and a nearly undetectable pulse, which indicates Collapse of Yang. Heart Qi Deficiency, Heart Yang Deficiency, and Collapse of Yang represent three progressively worsening pathological stages. Extreme Qi deficiency results in Yang deficiency, and extreme Yang deficiency leads to Collapse of Yang—this is one of the fundamental concepts of TCM pathogenesis. For Heart Qi Deficiency and Heart Yang Deficiency, tonify Qi and calm the heart using the Yangxin Decoction (Wang Kentang); for Collapse of Yang, restore Yang and rescue from collapse using the Shenfu Decoction (Wei Yilin) or the Sini Decoction (Zhang Zhongjing).

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

Palpitations, forgetfulness, insomnia, and excessive dreaming constitute the basic symptom complex of Heart Blood Deficiency. If accompanied by tidal fever, bone-steaming heat, vexation in the five hearts, and night sweats, it is Heart Yin Deficiency; further progression leads to restlessness, coarse breathing, difficulty in respiration, and warm hands and feet, indicating Collapse of Yin. Heart Blood Deficiency, Heart Yin Deficiency, and Collapse of Yin are two progressively deepening pathological stages. Extreme blood deficiency results in Yin deficiency, and extreme Yin deficiency leads to Collapse of Yin—this is one of the basic concepts of TCM pathogenesis. For Heart Blood Deficiency and Heart Yin Deficiency, nourish the blood and calm the spirit using the Tianwang Buxin Dan (Wei Yilin); for Collapse of Yin, tonify Qi and nourish Yin using the Shengmai Powder (Sun Simiao).

(3) Excessive Heart Fire

Chest discomfort, restlessness, insomnia, a red tongue tip, and a fine, rapid pulse are the basic symptom complex of Excessive Heart Fire. If accompanied by oral and lingual ulcers and reddish, turbid urine, it indicates that Heart Fire has shifted its heat to the Small Intestine (organ heat shifting to腑). The source of Heart Fire lies in the chest; when it becomes excessive, the upward inflammatory trend intensifies, with these symptoms as the core. Since the Heart and Small Intestine are interior-exterior counterparts connected by meridians, even though the fire ascends, it can also descend along the meridians into the Small Intestine. The Small Intestine “receives and stores food, transforming it and expelling waste,” playing a role in separating clear from turbid substances; when the Small Intestine is hot, the urine becomes reddish and turbid. Oral and lingual ulcers occur because the dampness of the Small Intestine rises upward due to the fiery nature of Heart Fire. For Excessive Heart Fire, drain the fire and calm the spirit using the Huanglian A Jiao Decoction (Zhang Zhongjing); for Heart Fire shifting to the Small Intestine, guide the heat downward using the Daochi San (Qian Yi).

(4) Phlegm Obstructing the Heart Orifice

Confusion of mind (restlessness, mania, laughter, speech), slippery pulse, and greasy tongue are the basic symptom complex of this condition. It is advisable to resolve phlegm, open the orifice, and calm the spirit using the Shengtie Luo Ci/(Cheng Zhongling). The Heart governs the spirit; when the Heart orifice is blocked, mental clarity is lost. A slippery pulse and greasy tongue are phlegm-related pulse and tongue manifestations, indicating that phlegm is the cause of the Heart orifice blockage.

(5) Heart Blood Stasis

Anterior chest pain radiating to the arm, palpitations, shortness of breath, a dark purple tongue, and a rough, irregular pulse are the basic symptom complex of this condition. It is advisable to activate blood circulation, remove stasis, and unblock the Heart’s flow using the Guanxin No. 2 (Beijing Regional Collaboration Group) or the Gualou Xiebai Banxia Decoction (Zhang Zhongjing). A rough pulse and a dark purple tongue indicate blood stasis; anterior chest pain and palpitations suggest that the site of blood stasis is in the Heart.