The Heart governs the blood and houses the mind, therefore most problems of the Heart involve the blood and mind. The mind needs blood for nourishment and vitality, and the blood needs emotional stability so as to not be consumed. Exterior pathogenic factors do not directly affect the Heart, although Heat and Fire can reach the Pericardium (i.e. infectious or epidemic febrile diseases showing Heat in the Ying level with high fever, delirium, skin eruptions, and possible coma).
Excessive joy can make the Heart Qi slow and become deficient, but this rarely shows in patients so great attention to this is not warranted. Sadness makes Lung Qi deficient, this dissolves all Qi in the body, and since the Heart governs all emotions, its Qi is drastically affected. Also, if anger is chronic and causes stagnation and Fire in the Liver, it will transfer to the Heart.
Heart Qi deficiency
Signs & symptoms: palpitations, mild physical activity causes shortness of breath and/or feelings of oppression in the chest, spontaneous sweating, fatigue, listless, pale complexion, lack warmth to connect with people, trouble making conversation, trouble communicating one’s meaning or intentions (slow), absence of joy, amenorrhea, scanty and/or late periods.
Tongue: normal or pale colour with white coating, may have midline crack (the deep crack when combined with a fold on the bridge of the nose and a horizontal fold on the earlobe shows a predisposition to heart disease).
Pulse: may be empty, feeble, knotted, or intermittent
This pattern may be seen after blood loss, from emotional problems, heart disease, arrhythmia, neurosis, and heart failure.
Heart Yang deficiency (& collapse)
Signs & symptoms: palpitations, mild physical activity causes shortness of breath and/or feelings of oppression in the chest, spontaneous sweating, fatigue, listless, bright-pale complexion, intolerance to cold (not relieved by clothing or blankets), cold limbs, limb edema, cyanotic lips, lack warmth to connect with people, trouble making conversation, trouble communicating one’s meaning or intentions (slow), absence of joy, chest pain with cold limbs & sweat (heart attack)
Collapse: key symptoms are cyanotic lips, cold limbs and sweats, and a hidden minute pulse.
Tongue: pale swollen with a white moist coating
Pulse: deep weak, thin feeble, or knotted pulse
This pattern may be seen indirectly from Kidney Yang deficiency (chronic illness, excess sexual activity especially if exposed to cold after intercourse, chronic retention of Dampness, old age), after blood loss, from emotional problems, various physical heart diseases, heart failure, or circulatory failure caused by various acute or chronic diseases.
Heart Blood deficiency
Signs & symptoms: palpitations, dizziness, insomnia (trouble falling asleep), vivid dreams that can make one feel like their sleep was not quality, poor memory, numbness in the limbs, easily forget the words they wish to use and simple routine things in life (i.e. keys), anxiety, easily startled, easily fatigued, pale dull complexion, pale lips, may have dry &/or itchy skin, shyness, sense of vulnerability, withdrawn, amenorrhea, scanty periods, late menses. This pattern could also lead to Kidney and Heart disharmony (Kidney and Heart Yin deficiency leading to Kidney Yin not nourishing the Heart Yin, hence, deficient Heart Fire). This pattern will be discussed under the Kidney section.
Tongue: pale thin, may be dry
Pulse: thin, may be weak or choppy
This pattern is usually associated with a Spleen/pancreas Qi deficiency (poor diet not creating enough blood or damaging the Spleen/pancreas function), anemia, arrhythmia, hypertension, hyperthyroidism, anxiety or worry, or blood loss.
Heart Yin deficiency
Signs & symptoms: palpitations, irritability, dream disturbed sleep, easily startled, insomnia (falls asleep with only slight difficulty but sleeps shallow or wake often during the night), vivid dreams sometimes to the point of disturbing the sleep, five center heat sensation, anxiety, jumpy, chatty, fidgety, restless, flighty, malar flush (rosy cheeks), night sweats, tidal fevers, dry mouth, throat, and lips, cankers of the tongue, trouble with public speaking, tendency to quick and hasty words, poor memory for people or place names, amenorrhea, scanty periods. In menopausal women this pattern shows hot flashes, irritability, and dryness of the vagina. It should be noted that Heart Yin deficiency includes that of Heart Blood deficiency because Blood is a part of Yin. Yin deficiency seems to happen more in mid-to-old aged peoples, where Blood deficiency is more common in younger peoples (especially women). May show chest pain.
Tongue: red with dry scanty or dry with no coating (peeled), red tip with redder spots, midline crack that may reach the tip and be quite deep depending on the severity of disease and constitutional weakness (the deep crack when combined with a fold on the bridge of the nose and a horizontal fold on the earlobe shows a predisposition to heart disease).
Pulse: thin or thready and rapid, if severe may show floating and empty.
This pattern is often seen with chronic anxiety and a very busy or hectic lifestyle like that of the West. May also be seen in more in hot climates, tachycardia, arrhythmia, anemia, neurasthenia, hypertension, hyperthyroidism, and generalized anxiety disorders.
Signs & symptoms: palpitations, thirst, irritability, insomnia and dream disturbed sleep (dreams of fire are common), cankers of the tongue (more red and painful), agitation, anxiety, mental restlessness, impulsive, whole face red, dark urine that may contain blood and/or be painful (this is a result of Heart Fire transmission to the Small Intestine, i.e. Mu Tong), constipation with dry stool (possible hematemesis), epistaxis, delerium, manic episodes, bitter taste, Fire can make blood reckless resulting in heavy periods or flooding and trickling. May show chest pain.
Tongue: deep red with red tip and red spots, yellow coating, midline crack that may reach the tip and be quite deep depending on the severity of disease and constitutional weakness (the deep crack when combined with a fold on the bridge of the nose and a horizontal fold on the earlobe shows a predisposition to heart disease).
Pulse: full rapid, may be intermittent.
This pattern is seen in emotional disturbances (chronic generalized anxiety, anger, worry, most notably depression), external pathogenic Fire, Liver Fire, neurosis, chronic mouth ulcers, urinary tract infections, overeating of spicy pungent deep fried foods, and over-consumption of alcohol.
Heart Blood Stasis
Signs & symptoms: palpitations, stabbing pain, constriction, or oppression in the heart region that may radiate to the left shoulder, medial (inner) aspect of left arm, or through to the back, this pain becomes more severe at night, shortness of breath, fatigue, cyanotic lips and nails, cold hands (lack of circulation to the limbs), feeling of impending doom. This may be caused by or complicated with Phlegm (overweight, expectoration of sputum, greasy tongue coating, nausea), or Yin type Cold obstruction (Heart Yang deficiency can’t move the blood in the chest which shows sudden attacks of severe pain, cold limbs, intolerance to cold, pale tongue, deep slow pulse, brought on by physical exertion or cold weather), Heart blood deficiency, or Heart Fire. This pattern also typically causes irregular menstruation and dysmenorrhea.
Tongue: purple (may show purple spots)
Pulse: uneven, knotted, or intermittent
This pattern is seen in patients suffering from angina pectoris, pericarditis, coronary artery disease, myocardial infarction. Causes are most commonly old age, chronic Yang deficiency, cold weather, Phlegm, and emotional problems (grief, anxiety, and anger not properly dealt with will stagnate in the chest impeding circulation of Qi and Blood. Smooth flow of Qi and Blood is needed for the proper functioning of the mind, and a smoothly functioning mind is needed for proper circulation of Qi and Blood).
Phlegm covering the Heart-Mind orifices
Signs & symptoms: mental confusion, palpitations, dementia, unconsciousness, fatigue (heavy feeling), cloudy thinking, apathy, haziness, abnormal behavior, soliloquy, nausea, fullness in the chest and epigastrium, Phlegm rattling sound in the throat, aphasia, dull complexion, copious expectoration of sputum, mental diseases (depression, bipolar, mentally handicapped, introverted, talking to oneself, delusional, blackouts, staring), these people are usually not dangerous to others (possibly to themselves), coldness, passive, ‘slacker’ behavior, not logical thinking. When combined with Wind, this pattern can manifest post-stroke (coma, paralysis, aphasia). This pattern more relates to Dian Zheng.
Dian Zheng: this resembles a more depressive side to mental disorder. From TCM point of view this is characterized by Phlegm covering the Heart and mind, it is the passive stage. Quiet, do not do much, talk to themselves quietly, sleep a lot, may not eat or sleep much. The Fire is now small but still there and covered by Phlegm. It will slowly build because of the Phlegm stagnation and lead to Fire Kuang (mania) once again. The Spleen is also a major producer of Phlegm so it must be strengthened. An underlying Yin deficiency may also be contributing to the build up of Heat and the coagulating of the Damp from the Spleen into Phlegm, therefore the Yin must be nourished.
Tongue: swollen with thick sticky slippery whitish coating, may have midline crack with prickles in it (a deep crack when combined with a fold on the bridge of the nose and a horizontal fold on the earlobe shows a predisposition to heart disease).
This pattern is seen in constitutionally weak children. This results in mental retardation and/or speech difficulties. It can also be seen in adults who eat too much greasy-cold-raw (Phlegm forming) foods and have or are currently experiencing severe emotional difficulties. Epilepsy, hysteria, depression, neurosis, after effects of Wind-stroke, and coma, all may also show this pattern.
Phlegm-Fire disturbing the Heart-Mind
Signs & symptoms: mental restlessness, palpitations, manic episodes, fidgety, insomnia, vivid dreams that disturb sleep, easily frightened, bitter taste, delerium, strange speech, confusion, harsh behavior, violent, aggressive, uncontrollable laughter, singing, shouting, or crying, talking to oneself, depression, aphasia, flushed red face, dark urine (may see blood), constipation with dry stool, hallucinations, if severe enough patient may fall into a coma. This is a major pattern of Kuang Zheng.
Kuang Zheng: is a Fire (Yang) pattern that is usually complicated with Phlegm covering the Heart, mind, spirit, Hun (ethereal) and Po (physical) soul (Dian Zheng). This manifests as blockage accumulating and causing Heat until the point of bursting resulting in Fire surging upwards.
Tongue: red with greasy yellow coating, tip may be deep red and swollen with red spots, may have midline crack with prickles in it (a deep crack when combined with a fold on the bridge of the nose and a horizontal fold on the earlobe shows a predisposition to heart disease).
Pulse: full, slippery or wiry, and rapid.
This pattern is often seen in Schizophrenia, Bipolar manic-depression, neurosis, hysteria, menopausal syndrome, gram-negative sepsis, encephalitits, apoplexy, or epilepsy. It may be caused by severe emotional problems that cause stagnation and turn to Fire, a diet of rich spicy hot and greasy foods, and external pathogenic invasion (epidemic febrile diseases).