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