Heart And Pericardium Syndromes Flashcards
Heart Qi Deficiency
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
6) Pathological precursors
7) Pathological developments
1)
Heart-Qi deficiency
Clinical manifestations
Palpitations, shortness of breath on exertion, pale face, spontaneous sweating, tiredness, slight depression.
2)
Tongue: Pale or normal colour.
Pulse: Empty, In severe cases, the Heart pulse could feel slightly Overflowing and Empty (i.e. it feels very
superficial and somewhat pounding with a light pressure of the finger but empty with a heavier
pressure).
Key symptoms: palpitations, tiredness, Empty pulse..
3)
Pathology
This pattern includes general signs of Qi deficiency (such as shortness of breath, sweating, pallor, tiredness and Empty pulse) and palpitations, which is the cardinal sign of Heart-Qi deficiency. In this
case the palpitations will be only light and occasional.
It is important to define ‘palpitations’ here. ‘Palpitations’ indicates a subjective feeling of the patient in being aware of the heart beating in an uncomfortable way. We are not usually aware of our heart’s beating, but if we become aware of it and it is a vaguely unpleasant sensation, this is called ‘palpitations’.
It should be noted that ‘palpitations’ has nothing to do with the rate or rhythm of the heart. The patient may often experience ‘palpitations’ as if the heart were beating more rapidly but this is not necessarily so.
Vice versa, someone’s pulse may be rapid but, if they are not aware of it, this symptom would not be
defined as ‘palpitations’. It is therefore important, when we ask about ‘palpitations’, to explain to the
patient what we mean. If we ask a patient ‘do you experience palpitations?’, most patients would assume we are asking whether the heart beats faster. For this reason, I usually ask ‘are you ever aware of your heart beat in an uncomfortable way?’
‘Palpitations’ is a subjective feeling of the patient who is uncomfortably aware of the heart beating;
it has nothing to do with the objective rate or rhythm of the heart
4)
Aetiology: a) Blood loss. b) Emotional problems (especially lack of joy or sadness). c) Chronic illness.
5)
Treatment Principle: Tonify Heart Qi.
Examples of Points: He 5, He 7, He 9, Pc 6, Pc 7, Bl 15, Bl 14, Bl 43, Bl 44, Ren 6, Ren 14 Ren 17. Needle technique: Tonification.
Other applicable techniques: Moxa.
Heart Yang Deficiency
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Palpitations/awareness of the heartbeat which is worse when tired, cold or on
exertion, feeling cold, spiritual fatigue, shortness of breath on exertion.
AccompanYing symptoms: Spontaneous sweating, bright white complexion, slightly dark lips, mild stuffy feeling in heart area, cold hands.
2)
Pulse: Deep, Weak, especially front left position, and Slow. Knotted in severe cases.
Tongue Body: Pale, Wet, Swollen.
3)
Pathology: Heart Qi Deficiency symptoms (as Qi is part of Yang). Feeling of cold and cold hands are due to Heart Yang not transporting Blood to extremeties to warm them. Mild stuffy feeling in chest is due to Heart Yang failing to move Qi leading to Qi stagnation in chest. Lips may be slightly dark because deficient Yang fails to move Qi and Blood which leads to slight Blood stasis.
4)
Aetiology: a) Emotional problems (especially lack of joy or sadness). b) Chronic illness. c) Kidney- Yang Deficiency. d) Heavy blood loss.
5)
Treatment Principle: Tonify and Warm Heart Yang.
Examples of Points: He 5, He 7, Pc 6, Pc 7, Pc 9, Bl 14, Bl 15, Bl 43, Bl 44, Ren 6, Ren 14, Ren 17, Du 14.
Needle technique: Tonification.
Other applicable techniques: Moxa.
Heart Blood Deficiency
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Insomnia (difficulty falling asleep), poor memory, anxiety, easily startled.
AccompanYing symptoms: Palpitations/awareness of the heartbeat which is worse during the afternoon and evening and when at rest and when anxious, dizziness, dull pale complexion, pale lips, feeling uneasy.
2)
Pulse: Thin or Choppy, especially front left position. Tongue Body: Pale, Dry. May be Thin in severe cases.
3)
Pathology: Insomnia, anxiety, easily startled and poor memory due to Shen being deprived of its ‘residence’. In cases of Heart Blood Deficiency the Heart Qi is not rooted, causing palpitations/awareness of the heartbeat. Dizziness is caused by the Blood not nourishing the brain.
4)
Aetiology: a) Poor diet – irregular eating habits and not enough Blood nourishing foods. b) Anxiety and worry. c). Heavy blood loss.
5)
Treatment Principles: Nourish Heart Blood. Pacify Shen.
Examples of Points: He 7, Pc 6, Ren 14, Ren 15, Ren 4, Bl 17, Bl 20, Bl 43, Bl 15, Bl 44. Needle technique: Tonification.
Other applicable techniques: Moxa.
Heart Yin Deficiency
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Palpitations/awareness of the heartbeat which gets worse as the day goes on and during the night and when at rest, insomnia (waking up during the night), feeling of heat (hot and bothered), easily startled, poor memory, anxiety.
AccompanYing symptoms: Dream-disturbed sleep, mental restlessness, fidgeting, malar flush, feeling of heat in the afternoon and evening, night sweats, dry mouth and throat, 5-palm heat.
2)
Pulse: Floating, Empty, esp front-left position and Rapid.
Tongue Body: Red tip; partially Peeled, or Peeled; possibly Mid-line Crack reaching to the tip.
3)
Pathology: Heart Yin Deficiency includes Heart Blood Deficiency (Blood is a part of Yin) leading to symptoms of Shen disturbance such as insomnia, dream-disturbed sleep, easily startled, poor memory, anxiety. Malar flush, five-palm heat and feeling of heat are due to Empty Heat which arises from long-standing Yin Deficiency.
4)
Aetiology: a) Long-standing anxiety and worry. b) Overwork - always on the go. b) After effect of external attack of Heat. c) May stem from Kidney Yin Deficiency (as deficient Kidney Yin cannot rise to nourish and cool the Heart).
5)
Treatment Principles: Nourish Heart Yin. Nourish Kidney Yin if necessary. Clear Empty Heat (if necessary). Pacify Shen.
Examples of Points: He 7, He 3, He 6, Pc 7, Pc 6, Ren 14, Ren 15, Ren 4, Kid 6, Bl 15, Bl
44. Needle technique: Tonification.
Heart Fire Blazing
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Strong palpitations/awareness of the heartbeat which tends to be worse when agitated, pronounced mental restless, panic attacks, agitation, insomnia, dream-disturbed sleep.
AccompanYing symptoms: Thirst, mouth and tongue ulcers which are red and painful, bitter taste after a bad night’s sleep, red face, feels hot, in severe cases dark urine or blood in urine.
2)
Pulse: Full, Overflowing, especially front left position, Rapid.
Tongue Body: Red, Redder tip with Red Spots. May be a Midline Crack reaching the tip. Tongue Coat: Yellow.
3)
Pathology: Symptoms of Heat are thirst, red face and feeling hot. Mental restlessness and dream- disturbed sleep are due to Heat in the Heart disturbing the Shen. Ulcers due to Heat rising up to the tongue from the Heart. Heart opens into the tongue and controls taste therefore Heat may lead to a bitter taste. Heart Fire transfers to Small Intestine, and then Bladder, causing urinary symptoms.
4)
Aetiology: a) Emotional problems, especially chronic anxiety, worry or depression. b) Poor diet – excessive consumption of spicy foods and alcohol. c) Recreational drugs d) Transferred from Liver Fire.
5)
Treatment Principles: Clear Heart Fire. Pacify Shen.
Examples of Points: He 9, He 8, He 7, He 5, He 3, Pc 6, Pc 8, Ren 14, Ren 15, Du 24, Bl 15, Bl 44. Needle technique: Even or Reduction.
Phlegm-Fire Harassing the Heart
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Strong palpitations/awareness of the heartbeat which may be worse when agitated,
severe mental restlessness and agitation, sometimes alternating with depression and dullness,
confusion.
Accompanying symptoms: Dream-disturbed sleep, bitter taste, thirst, red face, feeling of oppression
of the chest, expectoration of phlegm, rattling sound in the throat. In severe cases, manic behaviour,
aphasia or coma.
2)
Pulse: Full, Slippery, Wiry or Overflowing, especially in front left position, and Rapid.
Tongue Body: Red, Swollen, deep Midline Crack which reaches to the tip.
Tongue Coat: Yellow, Sticky.
3)
Pathology: All symptoms due to Fire and/or Phlegm. Mental symptoms due to the Heart orifices
being obstructed by Phlegm, resulting in no resting place for the Shen. Phlegm derives from deficient
Spleen Qi being unable to transform and transport fluids, which accumulate into Phlegm. Interior
Heat facilitates this process by condensing fluids. Other symptoms due to Fire in the Heart. Phlegm
leads to lack of clarity and Heat to manic behaviour.
4)
Aetiology: a) Severe emotional problems. b) Poor diet - too much hot greasy food.
5)
Treatment Principles: Clear Heart Fire. Resolve Phlegm. Pacify Shen. Open the Heart’s orifices.
Examples of Points: Pc 5, He 7, He 8, He 9, Pc 7, Ren 14, Ren 15, St 40, Liv 2, Liv 3, Du 20, GB 13
and Du 24, GB 15, Bl 15, Bl 44.
Needle technique: Even or Reduction.
Phlegm Misting the Heart
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Very dull eyes, confusion and depression.
AccompanYing symptoms: Palpitations/awareness of the heartbeat, rattling sound in throat, incoherent speech or aphasia, heavy feeling chest. In severe cases, unconsciousness, lethargic stupor, vomiting of phlegm.
2)
Pulse: Slippery, especially front left position.
Tongue Body: Swollen, Midline Crack reaching the tip. Tongue Coat: Thick, Sticky.
3)
Pathology: All symptoms due to Phlegm (no Fire symptoms). Heart opens into the tongue and Phlegm prevents the tongue from moving causing aphasia. Phlegm obstructs the Heart orifices causing mental symptoms. Vomiting and rattling sound in the throat caused by Phlegm obstructing the chest. There is normally a background of Spleen Qi Deficiency which contributes to the formation of Phlegm.
4)
Aetiology: a) Children – constitutional. b) Adults – i) Poor diet - excess cold, greasy, raw food ii) long-standing emotional problems. c) May occur after an attack of Wind-stroke.
5)
Treatment Principles: Open the Heart’s Orifices. Resolve Phlegm. If necessary restore Consciousness.
Examples of Points: He 9, Pc 5, Bl 15, St 40, Du 26. Needle technique: Even or Reduction.
Phlegm Misting the Heart
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1) Key symptoms: Very dull eyes, confusion and depression.
AccompanYing symptoms: Palpitations/awareness of the heartbeat, rattling sound in throat, incoherent speech or aphasia, heavy feeling chest. In severe cases, unconsciousness, lethargic stupor, vomiting of phlegm.
2) Pulse: Slippery, especially front left position.
Tongue Body: Swollen, Midline Crack reaching the tip. Tongue Coat: Thick, Sticky.
3) Pathology: All symptoms due to Phlegm (no Fire symptoms). Heart opens into the tongue and Phlegm prevents the tongue from moving causing aphasia. Phlegm obstructs the Heart orifices causing mental symptoms. Vomiting and rattling sound in the throat caused by Phlegm obstructing the chest. There is normally a background of Spleen Qi Deficiency which contributes to the formation of Phlegm.
4) Aetiology: a) Children – constitutional. b) Adults – i) Poor diet - excess cold, greasy, raw food ii) long-standing emotional problems. c) May occur after an attack of Wind-stroke.
5) Treatment Principles: Open the Heart’s Orifices. Resolve Phlegm. If necessary restore Consciousness.
Examples of Points: He 9, Pc 5, Bl 15, St 40, Du 26. Needle technique: Even or Reduction.
Other Heart syndromes
- Heart Yang Collapse
- Heart-Qi stagnation
- Heart Vessel Obstructed
Small Intestine Full Heat
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Abdominal pain, scanty and dark urine, burning pain on urination, severe mental
restlessness.
AccompanYing symptoms: Tongue/mouth ulcers, deafness, uncomfortable feeling and heat sensation in the chest, thirst with a desire to drink cold liquids, blood in urine, insomnia.
2)
Pulse: Overflowing, esp. left, front position, and Rapid. Possibly Wiry on left, rear position. Tongue Body: Red with Redder and Swollen tip.
Tongue Coat: Yellow.
3)
Pathology: Next stage of syndrome ‘Heart Fire Blazing’. All symptoms arise from Full Heat of Heart or Small Intestine. Heart Fire causes mental restlessness, tongue ulcers, pain in the throat, and thirst. Heart Fire radiates to Small Intestine and interferes with its function of separating fluids in the Lower Burner and burns the fluids causing scanty and dark urine and pain on urination. In severe cases of Heat, this may cause blood to extravasate resulting in blood in the urine. The SI channel, which enters the ear, may be obstructed by Fire causing deafness.
4)
Aetiology: a) Long-standing and/or severe emotional problems. d) Poor diet – excess hot food and alcohol.
5)
Treatment Principle: Clear Heart and Small Intestine Fire.
Examples of Points: SI 2, SI 5, SI 8, He 5, He 8, St 39. Needle technique: Even or reduction.
Small Intestine Qi Pain
1) Symptoms
2) Pulse and Tongue
3) Pathology
4) Aetiology
5) Treatment
1)
Key symptoms: Lower abdominal twisting pain which may extend to back, borborygmi.
AccompanYing symptoms: Abdominal distension, dislike of pressure on abdomen, flatulence, abdominal pain relieved by emission of wind, pain in testes.
2)
Pulse: Deep, Wiry, esp. on rear positions. Tongue Coat: White.
3)
Pathology: Symptoms mainly due to Stagnation of Qi in Small Intestine and Liver
4)
Aetiology: a) Poor diet - excess consumption of cold or raw food. b) Long-standing and/or severe emotional problems causing Liver Qi Stagnation.
5)
Treatment Principles: Move Qi in the Lower Burner. Disperse the Liver. Examples of Points: Ren 6, GB 34, Liv 13, Sp 6, St 27, St 29, Liv 3, St 39.
Needle technique: Even or reduction. Other applicable techniques: Moxa.
Acute or rare Small Intestine Syndromes
- Small Intestine Qi Tied
