heart patterns Flashcards
Heart disease pattern main signs and symptoms. Make a mental note of what is NOT typically included in heart patterns
Pathological changes occur in the Heart most often when its major functions fail: that of governing blood, controlling blood vessels or housing the 神 shén. Four major clinical manifestations of Heart dysfunction include:
● P - Palpitations
● I - Sleep disturbance/ insomnia
● S - 神 shén disturbance / mental disorder
● C - Chest pain or distress
Major Heart Dysfunction Manifestations
Palpitations
Increase in Heart rate, contractions
Irregular Heartbeats
Presents as
Coronary Heart disease, Anemia, Cardioneurosis, Hyperthyroidism
In healthy individuals during exercise or emotional excitement
TWO TYPES OF PALPITATION
Fright palpitations 驚悸 jīng jì
Heart palpitations cause by a fright
Often external cause, Come and go quickly. short duration, mild
Patients do not usually seek medical assistance for fright palpitations
Continuous palpitations 怔忡 zhēng chōng
Refers to severe throbbing of the Heart
chest down to the umbilicus
progression of fright palpitations
internal causes
Worse w exertion
Extended duration of this condition is severe and may necessitate medical intervention
Sleep Disturbance
Insomnia is defined as a sleep disorder that may involve a lack of sleep, sleepiness, sleeping at inappropriate times, or oversleeping, including:
Difficulty in falling asleep after retiring to bed
Waking up early
Intermittent waking through span of attempted sleep
Restlessness at night
Inability to sleep during the night
Dream-disturbed sleep
Changes to qi, blood, yin and yang will affect the Heart 神 shén
Yin governs nighttime
Two major pathomechanisms of insomnia are:
Pathogenic factors (especially Heat) disturbing the 神 shén
At night, pathogenic Heat may cause the 神 shén to lose its anchor in the Heart and become restless
This Heat may come from the exterior, or arise from an interior pathogenic factor, such as deficiency or stagnation of vital substances
Often found in the elderly, chronic illness or late stages of febrile disease
Loss of nourishment to the Heart
Loss of nourishment may arise from either deficiency or excess
In cases of deficiency, a lack of qi, blood, yin or essence is unable to sufficiently nourish the Heart; therefore, it cannot anchor the 神 shén
In cases of excess, stagnation of qi, blood, phlegm, or food may actually block the flow of qi and blood to the Heart
Leads to a shortage of vital substances required for the nourishment of the 神 shén
神 shén Disturbance
煩燥 fán zào: irritability and restlessness (vexation and agitation)
臟躁 zàngzào: restless organ disorder (visceral agitation)
百合病 bǎi hé bìng: hysteria (Lily disease, hundred union disease)
癲 diān: yin madness
狂 kuáng: yang madness
痫 xián: epilepsy
There are two main reasons for 神 Shén disturbance:
1. Attack by pathogenic factors, in particular, heat and phlegm
Pathogenic Heat unsettles the 神 shén, leading to restlessness, irritability, vexation, incoherent speech, or even manic behaviors
In severe cases, heat pushes 神 shén out of the Heart, resulting in unconsciousness and coma
Pathogenic Heat is most often caused by external attack of heat, febrile
disease and emotional stress
It may also stem from internal organ disorder
Phlegm may be generated by improper diet, internal organ disorder or emotional stress
If phlegm obstructs the Heart orifices, the 神 shén is blocked from performing mental activities
Phlegm obstructing the Heart orifices can lead to chronic depression, inappropriate laughing or crying, madness, delirium, and even loss of consciousness
2. Qi, blood, yin, yang and essence deficiency
It is absolutely necessary for 神 shén to have these nutritional substances in order to maintain normal function
When nutrition is insufficient, possibly due to improper diet, aging, or chronic illness, the 神 shén loses the ability to function
This deficiency leads to poor memory, mental depression, disorientation, frequent attacks of sadness, possible hallucinations, 獨語 dú yǔ ‘soliloquies’, and 錯語 cuò yǔ ‘paraphasia’ (disordered speech)
Chest Pain or Distress
a sensation of pain, oppression discomfort and stifling in the chest
Stagnation in the chest may cause pain or chest distress, for example:
When pathogenic cold attack the Heart, it leads to obstruction of the vessels
Emotional stress, improper diet, or trauma due to injury can cause dysfunction of the 臟腑 zàngfǔ organs, leading to qi stagnation, phlegm, or blood stasis
Weak constitution, Improper diet, or chronic illness may all lead to qi deficiency, and when the qi is low, there is not enough power to circulate qi and blood, resulting in stagnation
Heart pattern may also manifest with the following signs and symptoms:
● Pale or dark facial complexion
● Canker sores
● Tongue ulcer
● Poor memory
● Excessive sweating
● Yellow urine with a painful and burning sensation
● Knotted, abrupt or intermittent pulse
● A red tongue tip or crimson tongue
HT physiological fx, pathological changes, clinical manifestations
HT patterns
XU:
SHI:
Heart Qi Deficiency Pattern 心氣虛証 xīn qì xū zhèng
Definition: A group of signs and symptoms caused by a weakness of motive force, which slows the
circulation of blood, resulting in the Heart losing nourishment
Clinical Manifestations: Fright or continuous palpitations, chest tightness, shortness of breath that
worsens on exertion, fatigue, pale face, spontaneous sweating
Tongue: Pale tongue with white coating
Pulse: Weak pulse, rapid pulse without strength, knotted pulse, or abrupt pulse
Key Symptoms: Fright or continuous palpitations, chest distress, plus qi deficiency signs and
symptoms
Etiology
Chronic illness, improper diet leading to malnutrition, aging, congenital weakness
● Qi deficiency can result from impaired body fluids or blood deficiency
● Long term emotional stress, such as worry and overthinking
HT QI XU TREATMENTS
Treatment Principle: Nourish the Heart, calm the Shen
Acupuncture: All with reinforcing method
● HT-5
● P-6
● BL-15
● Ren-6
● Ren-17
● ST-36
Herbal Formula: Yang Xin Tang, Nourish the Heart Decoction
Heart Yang Deficiency Pattern 心陽虛証 xīn yáng xū zhèng
Definition: A group of signs and symptoms that are a result of Heart qi deficiency and
weakness of motive force with internal pathogenic cold
Clinical Manifestations: Fright or continuous palpitations, chest distress with tightness or
pain, intolerance to cold, cold limbs, shortness of breath, fatigue, spontaneous sweating, a
pale face
Tongue: Pale flabby tongue with moist white coating
Pulse: Weak, slow, minute, knotted or deep without strength
Key Symptoms: Fright or continuous palpitations, chest pain or distress, irregular pulse, plus
yang deficiency signs and symptoms
Etiology
● Essentially, the same as for Heart Qi deficiency:
○ Emotions
○ Loss of Blood
● Heart yang deficiency may indirectly be caused by any of the causes of Kidney Yang
deficiency:
○ Congenital weakness
○ Emotional strain
○ Excessive sexual activity
○ Chronic illness
○ Overwork
○ Aging
HT YANG XU TREATMT
Treatment Principle: Tonify qi, warm qi
Acupuncture: all with reinforcing, moxa is applicable
● HT-5
● PC-6
● BL-15
● Ren-6
● Ren-17
● Du-14
Herbal Formula: Ginseng and Aconite Accessory Root Decoction—shen fu tang
Preserve the Primal Decoction—bao yuan tang
Heart Yang Collapse Pattern 心陽暴脫証 xīn yáng bào tuō zhè
Definition: A critical condition due to extreme Heart yang deficiency, leading to sudden
collapse of Heart yang
Clinical Manifestations: Sudden start of severe palpitations; profuse, cold, oily pearl-like
sweat; severely cold limbs; pale complexion; feeble breath; severe chest pain; cyanosis of the
lips; in severe case, even a loss of consciousness or coma
Tongue: n.a.
Pulse: minute, faint, or irregular pulse
Key Symptoms: Sudden, severe palpitations; profuse cold, oily, pearl-like sweat; plus Heart
yang deficiency and yang collapse signs and symptoms
Etiology
● Heart Yang Collapse usually develops out of Heart Yang Deficiency, but can also be caused by excessive pathogenic cold which damages the Heart yang, or phlegm obstructing the Heart orifice
HT YANG COLLAPSE TREATMT
Treatment Principle: Restore yang, tonify yuan qi, rescue qi from collapse
Acupuncture:
● Ren-4
● Ren-6
● Ren-8
● Du-4
● Du-14
● Du-20
Herbal Formula: Shen Fu Tang, Du Shen Tang, Sheng Mai San
● ST-36
● P-6
● BL-15
● BL-20
● BL-23
Heart Qi Deficiency vs. Heart Yang Deficiency vs. Heart Yang Collapse
When Heart Qi becomes insufficient due to chronic illness, improper diet, aging or congenital weakness, the
first pattern to emerge is: Heart Qi Deficiency
Without proper treatment, Heart Qi Deficiency may develop into Heart Yang Deficiency, which will present
with symptoms of COLD—DEFICIENCY COLD: Cold limbs, intolerance of cold, chest pain, pale facial complexion,
in addition to qi deficiency signs and symptoms.
Heart Yang Collapse develops out of chronic and severe Heart Yang Deficiency, and is the late and critical
illness stage. At this point, yin and yang separate, with yang failing to hold yin, with sudden collapse,
accompanied by profuse cold, oily sweat.
KEY POINTS:
1) Severity
2) Coldness and cold, oily sweat
Heart Blood Deficiency Pattern 心血虛証 xīn xuè xū zhèng
Definition: A group of signs and symptoms caused by blood deficiency that leads to the Heart losing nourishment
Clinical Manifestations: Fright or continuous palpitations, insomnia, dream-disturbed sleep,
dizziness, poor memory and concentration, pale or sallow complexion, pale lips, pale nails
Tongue: Pale
Pulse: Thin and weak
Key Symptoms: Palpitations, insomnia, poor memory, plus blood deficiency signs and
symptoms
Etiology
● This pattern is most often caused by chronic illness, which impairs the blood
● Improper diet
● Chronic bleeding
● Long-term emotional stress, such as overthinking and worry, which consumes blood
Note: Maciocia mentions that Heart Blood Deficiency may also be caused by Spleen and
Stomach disorder, which weakens the production of blood
Pathogenesis
● The heart governs blood and houses the Shen. When blood is deficient, and unable to
nourish the Shen, the Shen becomes unsettled, leading to poor memory and concentration, insomnia, and dream-disturbed sleep
● Heart blood deficiency also leads to the weakening of the motive force, causing
symptoms of fright palpitations or continuous palpitations
● When blood is insufficient, and unable to nourish and fill the body, symptoms such as a
pale and sallow complexion, along with pale, nails, lips and tongue develops
● Blood insufficiency also means that the blood cannot properly fill the vessels, resulting in
a thin and deficient pulse
HT BLOOD XU Tx
Treatment Principle: Nourish and tonify Heart Blood, Calm the Mind
Acupuncture: All with reinforcing method. Moxa may be used.
● HT-7
● BL-15, BL-17, BL-20
● ST-36
● Ren-4, Ren-6, Ren-14
● SP-6
Herbal Formula: 身棄四物湯 shēn qì sì wù tāng Ginseng Astragalus Four Substances Decoction
Heart Yin Deficiency Pattern 心陰虛證 xīn yīn xū zhèng
Definition: A group of signs and symptoms caused by yin deficiency affecting the heart
Clinical Manifestations: Palpitations, insomnia, dream-disturbed sleep, low-grade fever in the afternoon or evening, five-center heat, night sweats
Tongue: Red tongue with scanty coating
Pulse: Thin and rapid
Key Symptoms: Palpitations, insomnia, plus yin deficiency signs and symptoms
Deficiency Heat Signs
(Maciocia)
Empty Heat: Malar flush, feeling of heat especially in the evening, five palm heat, in a state of agitated
excitement, flustered and feeling sensations of heat
Tongue: Red without coating, redder tip with red points
Pulse: Floating-Empty and Rapid or ‘Fire-Rapid’
Etiology
● febrile diseases, high fevers can severely impair yin
● Excessive long-term overthinking and worry, which gradually costumes blood and yin fluids
● Chronic illness, impairs generation of yin
● chronic illness related to Liver and Kidney deficiency or aging
Pathogenesis
● When Heart yin is deficient, it fails to nourish
the Shen, which then becomes unstable,
causing palpitations
Pathogenesis
● Yin deficiency leads to a relative Yang excess, making it difficult for the Shen to be anchored at night, resulting in insomnia
● When deficiency heat flares up at night, it also disturbs the Shen, causing excessive dreaming and vexation (irritation)
● When a person falls asleep at night, heat combines with protective Wei Qi and evaporates the body fluids, leading to night sweats
● There may also be heat sensations in the five centers
Pathogenesis
Deficiency heat flaring upwards may cause:
● Irritability
● Anxiety
● Moodiness
● Malar flush
● A red cracked tongue
● A thin rapid pulse
HT YIN XU Tx
Treatment Principle: Nourish and tonify Heart Yin, calm the mind. If deficiency heat is pronounced, clear deficiency heat.
Acupuncture:
● HT-7
● Ren-14
● Ren-15
● Ren-4 tonify qi
● HT-6 night sweats
● SP-6
● KID-7
Note: KID-7 tonifies Kidneys, and combined with HT-6, stops sweating (KD-7 + HT-6)
Heart Blood Deficiency vs. Heart Yin Deficiency
both: palpitations, insomnia, dream-disturbed sleep, and a thin pulse.
Heart Blood deficiency is mainly caused by bleeding, chronic illness, long-term emotional stress or malnutrition, which
each consumes or lead to inadequate generation of blood. Insufficient blood failing to nourish the heart as well as Shén manifests in dizziness, poor memory and concentration, low spirits, depression, pale complexion and pale tongue.
Heart Yin deficiency is caused mainly by febrile disease, chronic illness, or long-term emotional stress which consumes yin and gives rise to yin deficiency. Yin is unable to anchor yang, leading to a relative excess of yang. Therefore, Heart Yin Deficiency manifests more as yin deficiency heat, such as low-grade fever in the afternoon or evening, night sweats and
five-center heat. Deficiency heat flaring upward may cause irritability, anxiety, moodiness, malar flush, a red cracked tongue and a rapid pulse.
KEY POINTS:
1) Facial and tongue color: pale color vs. red color
2) Heat signs and symptoms vs. no heat signs and symptoms
3) Shén: fails to be nourished vs. disturbed by heat
Heart Fire Blazing Pattern 心火亢盛証 xīn huǒ kàng shèng zhèng
Definition: internal excess that flares up the disturbs the Heart Shen. aka Excess Heart Fire—心火亢盛 xīn huǒ kàng shèng.
Clinical Manifestations: Red face and lips, irritability, anxiety, vexation, insomnia, bitter taste, thirst, canker sores on lips or tongue.
Tongue: Red tongue tip, or deep red tongue with yellow coating
Pulse: Rapid
In some cases, there are manic behaviors, delirium, nosebleed, vomiting blood, or skin sores or boils. There may also be painful and burning urination.
Key Symptoms: Insomnia, irritability, anxiety, a red tongue tip, canker sores, plus internal excess
heat signs and symptoms.
Etiology
● Improper diet, such as overeating hot, spicy, greasy foods
● Overconsumption of alcohol or heat-generating herbs
● Emotional stress, which can transform stagnation into heat
● Other disorders of internal organs can also generate internal
heat
Pathogenesis
● When pathogenic heat flares upwards, it disturbs the Shen, preventing it from anchoring and
settling, leading to insomnia, anxiety, manic behavior, irritability or even delirium
● If heat following the Heart channel flares upwards, there is a red tongue tip and canker sores
● If heat damages the channels and collaterals, vomiting or nosebleed may result
● Heat toxicity may accumulate in the channels and collaterals, causing local qi and blood to stagnate, leading to skin sores or boils
● Red face, thirst, constipation and yellow urine are all signs of excessive internal heat
● Since the Heart and Small Intestine are internally and externally related, pathogenic heat may transform from the Heart into the Small Intestine, leading to painful, burning urination
● If pathogenic heat impairs the vessels, it may cause there to be blood in the urine (hematuria)
Heart Fire Blazing TX
Treatment Principle: Drain fire from the Heart, calm the mind
Acupuncture:
● HT-7, HT-8, HT-9
● Ren-15 calm shen
● SP-6
● LI-11
● Du-19 powerful for sev anxiety
● Du-24
Herbal Formulae: Xie Xin Tang, Dao Chi San
Phlegm-Fire Harassing the Heart Pattern 痰火擾心証 tán huǒ rǎo xīn zhèng
Definition: Heart fire combining with phlegm, which disturbs the Heart Shen and manifests with various types of shen-disturbed condition. exogenous febrile diseases and endogenous disease
HEAT SX + MENTAL
Clinical Manifestations: Fever, irritability, red face and eyes, thirst, heavy breathing, bitter taste in
the mouth, maniac agitation, incoherent speech, mental confusion, rash and violent behavior,
uncontrolled laughter or crying, shouting, muttering to oneself, or even coma and delirium
Tongue: Red tongue with yellow greasy coating
Pulse: Slippery and rapid
Key Symptoms: Exogenous: acute, short course, high fever, profuse phlegm, and coma or delirium.
Endogenous: chronic or recurrent. Manic behavior plus heat-phlegm signs and symptoms
Etiology
● Exogenous febrile disease due to exopath.
factors attacking
● Excessive emotional stress - qi stag - fire
Pathogenesis
● Exopathogenic factors can invade and cause heat to scorch the interior, leading to an excess of yang
● Long-term or excessive emotional stress can cause qi stagnation, which can transform into fire, also
known as “five emotions transform into fire”
● Internal excess heat scorches the fluids and generates phlegm
● Accumulation of heat and phlegm then rises, and harasses the Heart, disturbs the Shen and leads to insomnia and dream-disturbed sleep, irritability and agitation
● Other symptoms include mental symptoms such as: coma, delirium, manic behavior, rash and violent
behavior, mental confusion, incoherent speech, and uncontrolled laughter or crying
● Heat tends to move upwards, causing a red face, eyes and tongue
● If heat impairs fluids, thirst will ensue
● Other heat signs include: heavy breathing, bitter taste in mouth, yellow urine, yellow tongue coating, constipation, rapid pulse
● Phlegm accumulated in the throat may cause a rattling sound, thick greasy tongue coating and slippery pulse
Phlegm Fire Harass HT treatmt
Treatment Principle: Clear Heat from the Heart, transform phlegm, open the orifices, calm the
Shen
Acupuncture:
● Yang Mania: Du-14, Du-16, Du-26, PC-6, ST-40
● Wind-Stroke: Du-20, Du-26, ST-40, LIV-3, KI-1, jing well points on hands
● Insomnia: HT-7, HT-9, SP-6, Anmian, ST-40
Herbal Formulae:
● 黃連溫膽湯 huáng lián wēn dǎn tāng—Coptis Decoction to Warm the Gallbladder
● 溫膽湯 wēn dǎn tāng—Warm Gallbladder Decoction
Heart Fire Blazing vs. Phlegm-Fire Harassing the Heart
BOTH patterns involve excess heat invading the Heart, and therefore share many of the same signs and symptoms, such as irritability, red face, restlessness, agitation,
fidgeting, fever, vexation, insomnia, yellow urine, constipation, red tongue with yellow coating and rapid pulse.
In addition Phlegm-Fire
Harassing the Heart also manifests in signs of phlegm obstruction, such as: abnormal manic behavior, shouting,
uncontrolled laughing or crying, slurred or incoherent speech, rattling sounds in the throat, yellow sputum, a thick
yellow greasy tongue coating and a slippery pulse.
KEY POINTS:
1) Shen disturbance: normal behavior vs. abnormal manic behavior. Both patterns present with signs and symptoms caused by heat disturbing the shen, such as restlessness, irritability, agitation, or fidgeting. In
Phlegm-Fire Harassing the Heart, patients demonstrate more extreme abnormal manic behavior, such as
improper laughter, shouting and crying.
2) Tongue and pulse
Phlegm Misting the Heart Pattern 痰迷心証 tán mí xīn qiào zhèng
Definition: phlegm obstructing the Heart orifice, presenting with abnormal mental behavior
PHLEGM, NO HEAT
Clinical Manifestations: Mental fatigue, somnolence or stupor, abnormal behavior accompanied by cough with phlegm, or breathing with phlegm sounds in the throat.
Tongue: Thick, greasy tongue coating
Pulse: Slippery
Key points: Abnormal mental behavior combined with phlegm signs and symptoms
N.b.: This pattern can be subdivided into yin manic psychosis (癲 dián), epilepsy (癎 xián) and
Phlegm (痰厥 tán júe)
Etiology
● This pattern is caused mainly by an invasion of
dampness which obstructs the circulation of Qi
● Emotional stress leading to qi stagnation
Pathogenesis
● Dampness invasion may be due to external environment or weather
● Improper diet such as overconsumption of sweet, greasy, raw or cold food
● Overconsumption of alcohol
● When qi fails to move and distribute body fluids, fluid accumulates, generating phlegm
● Chronic illness with Lung, Spleen or Kidney deficiency, or a weak constitution may also cause a dysfunction of water metabolism, which generates phlegm
Phlegm Misting the Mind (Heart) TX
Treatment Principle: Open the Heart, resolve Phlegm, open the Mind’s orifices
Acupuncture: all with reducing method, except for Ren-12 BL-20, which are tonified
● PC-5
● HT-9
● BL-15
● ST-40
● DU-26
● Ren-12
● BL-20
● Du-14
Herbal Formulae: 涤痰汤 dí tán tāng Scour Out the Phlegm Decoction
滚痰丸 gǔn tán wán Flushing Away Roiling Phlegm Pill
導痰湯 dǎo tán tāng Guide Out the Phlegm Decoction
Phlegm Misting the Heart vs. Phlegm-Fire Harassing the Heart
Both manifest in signs and
symptoms of phlegm obstruction, including abnormal behavior, a thick greasy tongue coating, and a slippery pulse.
Phlegm-Fire Harassing the Heart, also known as ‘yang madness’, involves excess heat and violent
behavior, exhibiting irritability, restlessness, slurred or incoherent speech, shouting and uncontrollable
crying or laughing.
Phlegm Misting the Heart, regarded as ‘yin madness,’ does NOT involve any type of heat signs, but instead manifests in depressive behavior such as stupor, mental confusion, depression, muttering,
aphasia and lethargy.
KEY POINTS TO DISTINGUISH PATTERNS:
1) Depression and stupor vs. excitement and irritability
2) Excess heat signs vs. no obvious heat signs
Heart Vessels Obstructed Pattern 心脈瘀阻 xīn mài yū zǔ
Definition: A group of signs and symptoms caused by pathogenic factors such as blood stasis, turbid phlegm, excess cold, or qi stagnation obstructing the heart vessels, resulting in
palpitations, pain and oppression in the chest
Clinical Manifestations: Continuous palpitations, tight sensation or distress in the chest, intermittent chest pain attacks, and pain radiating to the shoulders and arms.
Tongue and pulse: n.a.
Key Symptoms: Palpitations, chest tightness and distress with pain
Etiology
● Ext pathogenic attack
● Improper diet, such as greasy, cold foods
● Emotional stress, lasting a long time
● Chronic illness
All of these factors can generate pathogenic cold, phlegm, blood
stasis or qi stagnation
Pathogenesis
● If blood stasis obstructs the vessels there will be a sharp, stabbing pain, which is worse in the evening and presents with a purple tongue and choppy pulse
● If phlegm obstructs the vessels, there is a heavy and tight pain sensation in the chest, and the patient usually presents with obesity, a thick greasy tongue coating, and a
slippery pulse
● When pathogenic cold obstructs the vessels, it causes severe pain with sudden onset and
pain is relieved by warmth
● If Qi stagnation obstructs the vessels, it leads to distending pain and is usually induced or
aggravated by emotional stress
Pathogenesis
● The heart channel passes through the shoulder down the arm, so when
pathogenic factors obstruct the Heart
vessels, pain may radiate from the shoulder down the arm Heart primary channel.
Heart Blood Stasis 心血瘀阻證 xīn xuè yū zǔ zhèng TX
Treatment Principle: Move Blood, eliminate stasis, tonify and warm Heart Yang, calm the
Mind
Acupuncture: All with reducing method during an attack, or even method in between attacks. Moxa is applicable when there is Heart Yang deficiency.
● PC-6
● PC-4
● BL-15
● Ren-17
● HT-5
● HT-7
Herbal Formula: Heart Blood Stasis due to Blood Stasis 血府逐瘀湯 xuè fǔ zhú yū tāng—Drive Out Stasis from the Mansion of Blood Decoction
Actions: Invigorates blood, dispels blood stasis, spread the qi of the Liver, and unblocks the channels
