Heart Patterns Flashcards
Functions of the heart
Governs Blood
Houses the Shen (mind)
Controls sweat
Opens into the mouth
Controls the blood vessels
Opens onto the tongue
Manifests in the complexion
General aetiology of heart patterns
Exterior pathogenic factors
Emotions (joy, sadness and grief, anger, worry)
Diet
Overwork
Exterior pathogenic factors affecting the Heart?
Fire
Heat
(If exterior pathogenic factors attack the heart, they penetrate the pericardium instead).
Which emotions affect the Heart
Joy - Excessive joy and overstimulation can injure the heart by slowing down Heart Qi, making it deficient, and dilating the heart.
Sadness and grief - Within the 5-element theory sadness and grief deeply affect the Heart Qi (as well as the Lungs). Prolonged sadness and grief will cause Qi deficiency which over time may lead to stagnation, which can turn into Heart-heat.
Anger - The rising of Liver-Yang or Liver-Fire can lead to Heart-Fire.
Worry - Worry knots Qi causing stagnation Lung and Spleen Qi due to shallow breathing and overthinking. Additionally, worry knots Heart Qi causing palpitations, tightness in the chest and insomnia.
Heart Qi deficiency - Clinical manifestations
*Palpitations
Shortness of breath on exertion
Pale face
Spontaneous sweating
Tiredness
Slight depression
Tongue: Pale or normal
Heart pathology
Palpitations (light and occassional)
Mental-emotional issues
Reflected in the Shen of the eyes
Depression, anxiety, insomnia
Heart Qi deficiency - Aetiology
Emotional problems (particularly sadness or grief)
Blood Loss (Blood is the mother or Qi. Therefore, Heart-blood deficiency will lead to Heart Qi deficiency).
Precursors to Heart Qi Deficiency
Kidney Qi deficiency
Gall Badder Qi deficiency
Developments from Heart Qi deficiency
Heart Yang deficiency
Lung Qi deficiency (especially with emotional stress)
Treatment Principle - Heart Qi deficiency
Tonify Heart Qi
Acupuncture points for Heart Qi deficiency
H5 - Tonifies Heart Qi
P6 - Tonifies Heart Qi (particularly useful in sadness)
BL15 - Back Shu, Tonifies Heart Qi, direct moxa
Ren17 - Gathering point of Qi, tonifies Qi of the upper burner (useful for sadness as tonifies both Lung and Heart)
Ren6 - tonifies whole body Qi
Du14 - Tonifies Heart Qi, direct Moxa
Heart Yang deficiency - Clinical manifestations
*Palpitations
Shortness of breath on exertion
bright Pale face
Slightly dark lips
Spontaneous sweating
Tiredness
A slight feeling of stuffiness in the heart area
Feeling cold
*Cold hands
Slight depression
Tongue: Pale slightly wet
Heart Yang deficiency - aetiology
The same as Heart Qi deficiency: Emotional problems (particularly sadness or grief)
Blood Loss (Blood is the mother or Qi. Therefore, Heart-blood deficiency will lead to Heart Qi deficiency).
Indirectly caused by any of the causes of Kidney Yang deficiency.
Heart Yang deficiency - pathology
Same as Heart Qi deficiency as included within Yang deficiency: Palpitations, shortness of breath, tiredness, sweating, pale face.
Feeling cold, cold hands - heart yang not transporting blood to the extremities.
Stuffiness in chest - Heart Yang not moving Qi in the chest leading to slight stagnation.
Slightly dark lips (severe/advanced cases) - Heart Yang failing to move Qi and blood causing a slight blood stasis.
Pale, wet tongue - Heart Yang cannot transport enough blood to the tongue, or transform fluids which accumulate on the tongue.
Deep, weak pulse - deficiency of Yang
Knotted (severe cases) - a slow pulse that stops at irregular intervals).
Heart Yang deficiency - Precursors
Kidney Yang deficiency - Kidney Yang is the source of all Yang energies of the body.
Heart Qi deficiency
Stomach/Spleen Yang deficiency.
Heart Yang deficiency - Developments
Heart blood stasis - Deficient Heart Yang failing to move Heart Qi leads to Heart Qi stagnation and then to Heart Blood Stasis (angina pectoris and coronary heart disease).
Heart Yang deficiency - treatment principles
Tonify and warm Heart Yang
Heart Yang deficiency - Acupuncture points
HE5 - Tonify Heart Qi
P6 - Tonify Heart Qi
BL15 - Tonifies Heart Yang if Moxa is used
Ren17 - Tonifies Heart Yang if Moxa is used (particularly useful when there is stuffiness in the chest).
Ren6 - With moxa Tonifies all Yang energies. Especially useful if derived from Kidney Yang deficiency.
Du14 - with direct moxa tonifies Heart-Yang
Heart Yang Collapse - Clinical Manifestations
Palpitiations
Shortness of breath
Weak and Shallow breathing
Profuse sweating
*cold limbs
*cyanosis of the lips
Greyish white complexion
Coma! (severe cases)
Tongue: very pale or bluish-purple, short
Heart-Yang collapse - Aetiology
Directly: Chronic and severe Heart Yang deficiency
Indirectly: Excessive sexual activity, chronic overwork, chronic illness.
Heart-Yang collapse - Pathology
The same as Heart-Yang deficiency but more severe.
Additionally: cyanosis of the lips - deficient yang Qi not moving the blood causing severe stasis.
Coma - complete collapse of the Heart Qi, mind has no ‘residence’. Deficient coma.
Short tongue: Deficient yang Qi cannot move the tongue muscle and internal cold contracts the tongue muscle.
Hidden pulse - a severe kind of deep pulse due to severe yang deficiency. Knotted is due to deficient Yang not giving the heart enough energy to beat regularly.
Heart-Yang collapse - precursors
Always derived from a chronic and severe Kidney Yang deficiency.
Stomach/Spleen Yang deficiency
Heart-Yang collapse - developments
Cardiac infarction/heart attack
Severe blood stasis
Heart-Yang collapse - treatment principle
Rescue Yang
Restore consciousness
Stop sweating
Heart-Yang collapse - Acupuncture
All reinforcing method, no needle retention, moxa must be used.
Ren4, Ren6, Ren8 - rescue Yang Qi and stop sweating if indirect moxa on ginger or aconite is applied.
Du4 - with moxa tonifies kidney Yang
St36, P6 - strengthen heart Yang
BL23 - with moxa strengthens Kidney Yang
Du20 - meeting point of all the Yang channels: rescues Yang and promotes resuscitation if used with direct moxibustion.
Heart Blood deficiency - Clinical manifestations
*Palpitations
Dizziness
*Insomnia
Dream-disturbed sleep
*Poor memory
Anxiety
Propensity to be startled
Dull-pale complexion
Pale lips
*Tongue: Pale, Thin, slightly dry
Heart Blood Deficiency - Aetiology
Diet - Spleen Qi deficiency - a diet lacking in nourishment or blood-producing (such as meat) can lead to Spleen Qi deficiency. Chronic Spleen Qi deficiency can lead to Blood deficiency which can in turn weaken the Heart and cause Heart-Blood deficiency.
Emotional Stress - Sadness, anxiety and worry, and grief over a long period can disturb the mind and depress the heart function. Since the heart governs blood this eventually leads to Heart-Blood deficiency.
Severe blood loss (Chinese medicine holds this to be the main cause of postnatal depression).
Heart Blood Deficiency - Pathology
Heart anchors the Shen - The mind is deprived of its residence - Insomnia, anxiety, dream-disturbed sleep, propensity to be startled.
Heart controls the mental faculties - Dull thinking, poor memory.
Blood is the mother of Qi - Heart Blood deficiency may also lead to Heart Qi deficiency.
Palpitations - Daytime (Qi deficiency) Nightime (Blood deficiency)
Dizziness - Blood not nourishing the brain
Pale, dry tongue - not enough blood reaching the tongue. Dryness differentiates from Heart-Yang deficiency
Heart Blood Deficiency - Precursors
Liver Blood deficiency - Liver is the mother of the Heart in 5-element theory.
Heart Blood Deficiency - Developments
Heart Yin deficiency - Blood is part of Yin.
Heart Blood deficiency may effect the Spleen as Heart is the mother of Spleen in 5-elements causing pensiveness and brooding.
Heart Blood Deficiency - treatment principle
Nourish Blood
Tonify the Heart
Calm the Shen
Heart Blood Deficiency - Acupuncture
All with reinforcing method, moxa can be used
HE7 - Nourishes Heart-Blood and calms the Shen.
Ren14, Ren15 - Tonify Heart Blood and calm the Shen (anxiety)
Ren4, BL17 (Gathering point for Blood), BL20 (Spleen Back Shu) - Tonify Blood
Heart-Fire blazing - Clinical Manifestations
*Palpitations
*Thirst
*Mouth and tongue ulcers
Mental restlessness
Feeling agitated
Feeling hot
Insomnia
Dream-disturbed sleep
Red face
Dark Urine or blood in the urine
Bitter taste (after a bad’s night sleep)
*Tongue: Red, tip redder and swollen with red points, yellow coating. There may be a midline crack reaching the tip.
Heart-Fire Blazing - Aetiology
Emotional stress - Chronic anxiety, constant worrying, and depression over a long period can lead to Qi stagnation, which can eventually lead to fire.
Diet - Excessive hot–energy foods (spices, red meat, but especially alcohol)
Heart-Fire Blazing - Pathology
Excess, Full Heat - thirst, red face, feeling of heat.
Red tongue, rapid overflowing or hasty pulse.
Ulcers - The tongue is an offshoot of the heart, and fire can flare up toward the tongue (ulcers with red rim usually fire, a white rim may be empty-heat/yin deficiency).
Mental restlessness/insomnia - Excess heat disturbing the mind. More severe than Heart-yin deficiency.
Frequent night waking and disturbing dreams.
Red face - heat flaring upwards and manifesting in the complexion (whole face red rather than malar flush of yin deficiency).
Bitter taste - The heart opens into the tongue, and controls taste. Differs from Liver-fire as bitter taste only in the morning and only after a sleepless night.
Dark urine/blood - Heart fire transmitting to the small intestine and from this to the Bladder (Greater Yang)
Heart-fire Blazing - precursors
Liver-Fire - Liver is the mother of the Heart within 5-element theory. Also shared emotional origin of Heart/Liver patterns. Anger, frustration and resentment may lead to Liver-Fire as these are recognised by the Shen housed in the Heart Liver-Fire is transmitted to the Heart.
Heart-Fire Blazing - Developments
Spleen-Heat
Stomach-Fire
Heart-Fire Blazing - Treatment Principle
Clear the Heat.
Drain Fire
Calm the Shen
Heart-Fire Blazing - Acupuncture points
HE9, HE8 - Reduce Fire
HE7 Calm the Shen
Ren15 - Calms the Shen and clears Heat
SP6, KID6 - Promote Yin and cool Fire.
LI11 - Clears Heat
DU24, DU19 Calm the Shen
Phlegm- Fire harassing the Heart - Clinical Manifestations
*Palpitations
*Thirst
A feeling of oppression in the chest
Mental restlessness
Expectoration of phlegm
Rattling sound in the throat
Feeling agitated
Insomnia
Dream-disturbed sleep
*Incoherent speech
*Mental confusion
*Rash behaviour
*Tendency to hit or scold people
*Muttering to oneself
*Uncontrolled laughter or crying
*Shouting
*Manic behaviour
Depression
*Tongue: Red, swollen, yellow dry sticky coating, deep heart crack, the tip may be red and swollen with red points.
Phlegm-Fire Harassing the Heart - Aetiology
Emotional Stress - severe emotional problems and depression lead to stagnation of Qi, eventually turning to Fire.
Diet - Excessive consumption of hot greasy foods creates Heat and Phlegm
Phlegm-Fire Harassing the Heart - Pathology
Excess pattern
Mental symptoms - Phlegm obstructing the Heart offices and disturbing the Shen.
It differs from Heart-Fire in that it involves a lack of insight due to phlegm clouding the mind and the agitation caused by Fire.
Could present as bipolar.
Phlegm-Fire Harassing the Heart - Precursors
Spleen Deficiency (possibly Lung/Kidneys) - presence of Phlegm
Spleen deficiency leads to the formation of Phlegm, but Fire contributes as it condenses it.
Phlegm-Fire Harassing the Heart - developments
Yin deficiency - Heart Fire may injure Yin
Spleen Qi deficiency - Phlegm obstructs Qi
Blood Stasis - Fire condenses Blood and phlegm is linked to Blood through Body fluids.
Phlegm-Fire Harassing the Heart - Treatment
Clear the Heart
Drain Fire
Resolve Phlegm
Calm the Shen
Open the Mind’s offices.
Phlegm-Fire Harassing the Heart - Acupuncture points
P5 - Resolves phlegm from the mind and clears orifaces
H7 - Calms the Shen
H8, H9 - clear Heart-Fire
P7 - Calms the Shen and clears Heart-Fire
Ren15 - Pacifies the Mind
BL15 - Clear Heart-Fire
Ren12 - Tonifies Spleen to resolve phlegm
ST40 - resolves phlegm
SP6 - resolves phlegm and calms the Shen
BL20 - Tonifies the Spleen to resolve Phlegm
LIV2 - subdues Fire to conduct it downwards
GB13 and DU24 Calm the Shen
GB17 Opens the Mind’s orifices.
Phlegm misting the Mind - Clinical manifestations
*Mental Confusion
Unconsciousness
Lethargic stupor
Incoherent Speech
Slurred Speech
Aphasia
Vomiting of Phlegm
*A rattling sound in the throat
Mental depression
Very dull eyes
*Tongue: Swollen with thick sticky coating, midline crack reaching the tip (Heart crack)
Phlegm misting the Mind - Aetiology
Constitution - in children
Diet - Excessive consumption of greasy raw foods leads to the formation of Phlegm. Severe emotional problems such a long-standing anxiety can combine with the dietary origin to obstruct the Heart.
Phlegm misting the Mind - Pathology
Excess pattern
Similar to Phlegm-Fire harassing the Heart with the absence of Fire and seen in different patients and situations.
Children - Speach difficulties or mental retardation
Adults - Maybe after an attack of Wind-stroke causing coma, paralysis and aphasia.
Mental confusion, lethargic stupor and unconsciousness - Phlegm obstructing the Heart and therefore the Shen/Mind.
Apasia - Heart opens into the tongue and the phlegm stops the tongue from moving.
Vomiting and rattling sounds in the throat are caused by phlegm obstructing the chest.
Swollen tongue body, sticky coating, slippery pulse - phlegm.
Phlegm misting the Mind - Precursors
Spleen, Lung and Kidney deficiency leading to Phlegm - in adults.
Phlegm misting the Mind - Developments
Qi deficiency - Obstruction of Qi by Phlegm
Dryness and blood stasis - long-standing retention of Phlegm.
Phlegm misting the Mind - Treatment Principles
Open the Heart
Resolve Phlegm
Open the Mind’s orifices
Phlegm misting the Mind - Acupuncture points
*P5 - resolves Phlegm from the Heart
H9 - Clears the Heart and opens its orifices (if unconscious, could be bled)
BL15 - Clears the Heart and is particularly useful in children to clear Phlegm from the Heart. Will stimulate the child’s intellectual abilities and speech.
ST40 - resolves Phlegm
DU26 - restores consciousness
REN12 and BL20 - tonify the Spleen to resolve Phlegm
DU14 - clears the Heart and tonifies Heart-Yang; heart-yang mobilises the Phlegm.
Heart-Qi Stagnation - Clinical manifestations
Palpitations
A feeling of distension or oppression of the chest
Depression
A slight feeling of a lump in the throat
Slight shortness of breath
Sighing
Poor Appetite
Slight nausea
Cold limbs
Slightly purple lips
Pale complexion
Tongue: Slightly pale-purple on the sides in the chest area.
Heart-Qi Stagnation - Aetiology
Emotional stress - Sadness, grief, worry.
More likely to occur when there is a pre-existing Liver-Qi stagnation.
Heart-Qi Stagnation - Pathology
Distension in the chest and the slight feeling of a lump in the throat and sighing all indicate Heart-Qi stagnation.
Pale complexion - stagnant Heart-Qi in the chest fails to ascend to the face.
Poor appetite/nausea - Heart-Qi not descending towards the stomach.
Heart-Qi Stagnation - Precursors
Liver Qi stagnation - affects the free flow of Qi to any organ so when subjected to emotional distress the Heart-Qi is easily affected.
Heart-Qi deficiency - sadness and grief, deficient Qi dies not circulate properly and may lead to stagnation. Thus Qi can be both deficient and stagnant.
Heart-Qi Stagnation - Developments
Heart-Blood stasis - a more serious pattern
Liver Qi stagnation
Heart-Qi Stagnation - Treatment Principle
Move Heart-Qi
Open the chest
Calm the Shen
Heart-Qi Stagnation - Acupuncture
P6 - Opens the chest, moves Qi and Calms the Shen.
HE5 - moves Heart Qi and calms the Shen.
HE7 - Calms the Shen
LU7 - moves Qi in the chest
ST40 - opens the chest and moves Qi in the chest.
Heart-Blood stasis (stagnation) - clinical manifestations
Palpitations
*Stabbing or pricking pain in the chest which may radiate to the inner aspect of the left arm or to the shoulder.
Feeling of oppression of constriction of the chest
*Cyanosis of lips or nails
Cold hands
*Tongue: Purple in its entirety or only on the sides in the chest area
Heart-Blood stasis (stagnation) - Aetiology
Emotional stress - Heart-Blood is the physiological basis for the Mind.
Heart-Blood stasis (stagnation) - Pathology
Derived from other Heart patterns mostly Heart-Yang deficiency, Heart-Blood deficiency or Heart Qi stagnation. Additional symptoms will help to determine the origin pattern.
Either mixed deficiency/excess pattern or Excess depending on the origin pattern.
Chest pain is the key symptom.
Cyanosis of the lips and cold hands are due to stagnant Heart-Blood not reaching the face and hands.
Purple tongue - reflects stasis of Blood and may be blueish reflecting the internal cold from deficiency of Yang causing stasis of Blood.
Heart-Blood stasis (stagnation) - Precursors
Heart-Yang deficiency.
Heart-Qi stagnation
Liver Qi stagnation - The Liver channel affects the chest, and the loss of free flow of Liver-Qi may easily affect the Heart. Leading to Heart-Qi stagnation first and then Heart-Blood stasis.
Heart-Blood stasis (stagnation) - Developments
Phlegm - due to the interaction of these two pathogenic factors. A long-term consequence of Blood stasis, especially in the elderly, can be dryness.
Heart-Blood stasis (stagnation) - Treatment Principle
Move Blood
Eliminate Stasis
Tonify and warm Heart-Yang
Calm the Shen
Heart Qi Xu pulse
EP - Slow, Irregular rate/rhythm, Rough vibration
LDP - Reduced, feeble/absent, flat
Heart Yang Xu Pulse
EP - Rapid or slow, arrhythmic, interrupted
LDP - Deep, absent or empty, flat
Heart Blood Xu - Pulse
Increases more than 12/beats/min on exertion
LDP - Thin
Heart Yin Xu - Pulse
EP - Hesitant
LDP - Tight, also thin is Yin Xu comes from Blood Xu, or robust or reduced pounding if Yin Xu is more from Heat.
Heart Fire Blazing - Pulse
EP - Rapid, Full/Overflowing, possibly Rate and Rhythm changes
LDP - Robust Pounding
Phlegm - Fire Harassing the Heart - Pulse
LDP - Tense-tight, slippery
LMP - Tense, robust pounding
RMP - Feeble/Empty
Phlegm misting the mind - Pulse
LDP - Slippery, Feeble
RMP - Feeble, empty, reduced
RDP - Reduced, possibly feeble
Heart Qi Stagnation - Pulse
LDP - Flat, tense
Heart Blood Stagnation - Pulse
LDP - Flat, Choppy, later: Deep, thin, feeble
