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Pattern Identifi cation of the Heart and Small Intestine

The heart is located within the chest. The heart meridian descends to con- nect with the small intestine. The two organs are internally–externally connected. The main physiological functions of the heart are to govern blood vessels, store the spirit–mind and dominate the life activity. The heart opens into the tongue. The physiological functions of the small intestine are to separate the clear from the turbid and to absorb the decom- posed food.

The patterns of the heart can be classified into deficiency and excess. Deficient patterns are often caused by chronic conditions, constitutional deficiency and anxiety, while excessive patterns are often linked to cold retention, blood stasis, phlegm and fire disturbance.

Common signs and symptoms of the heart conditions include palpita- tions, chest pain, restlessness, insomnia, dream-disturbed sleep, poor memory and coma with delirium. The main pathology of the small intes- tine manifests as excessive heat in the small intestine.

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Heart qi deficiency, heart yang deficiency and sudden collapse of heart yang

Overview

These three patterns manifest deficiency of heart yang (qi), hypofunction of the heart and sudden collapse of yang–qi. Over time, heart qi deficiency may develop into heart yang deficiency and sudden collapse of heart yang. The main contributing factors include constitutional deficiency, chronic conditions and age-related debilitation.

Clinical manifestations

Heart qi deficiency causes mild or severe palpitations, chest tightness and shortness of breath that can be aggravated by physical exertion, sweating, mental fatigue, a pale complexion, a pale tongue with a white coating and a deficient pulse.

Heart yang deficiency further causes cold intolerance, cold limbs, pal- lor, cardiac pain, a pale and swollen tongue with a white slippery coating and a faint or regularly/irregularly intermittent pulse.

A sudden collapse of heart yang may even cause profuse cold sweating, cold limbs, pallor, cyanosis, faint breathing, mental confusion or coma, a pale or dark-purple tongue and an extremely faint pulse.

Analysis

Failure of heart qi to circulate blood may cause mild or severe palpitations, chest tightness and shortness of breath. Physical exertion consumes qi and thus aggravates the symptoms. Since sweat is the liquid of the heart, heart qi deficiency causes sweating. Failure of qi and blood to ascend to nourish the face and tongue causes a pale complexion and a pale tongue with a white coating. Weakness of heart qi to circulate blood causes a deficient pulse.

Over time, heart qi deficiency may impair heart yang, leading to qi stagnation and subsequent cardiac pain. Failure of yang–qi to warm the body causes cold intolerance, cold limbs and pallor. Yang deficiency may produce internal cold, causing a pale swollen tongue and a white slippery tongue coating. Failure of heart yang to circulate blood causes a faint or regularly/irregularly intermittent pulse.

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A sudden collapse of heart yang may cause scattering of zang-pectoral

qi, further leading to faint breathing. Failure of yang–qi to consolidate the

exterior causes cold profuse sweating. Failure of yang-qi to warm the body causes cold limbs. Failure of yang–qi to circulate blood to nourish the body causes pallor, cyanosis of the lips and an extremely faint pulse. Scattering of qi may disturb the heart–mind, resulting in mental confusion or even coma.

Differentiation

The distinctive points of heart qi deficiency include palpitations, short- ness of breath, mental fatigue and general qi deficiency symptoms. In summary, heart qi deficiency involves heart-related symptoms plus qi- deficiency symptoms.

Heart yang deficiency develops from heart qi deficiency, involving heart-related symptoms plus yang deficiency symptoms. It is distinctively characterized by cold intolerance, cyanosis and stasis.

A sudden collapse of heart yang develops from heart qi deficiency and heart-yang deficiency, involving heart-related symptoms plus yang deple- tion symptoms. It is distinctively characterized by aggravated symptoms of heart qi deficiency and heart yang deficiency, coupled with mental confusion or unconsciousness.

Distinctive notes

Common heart-related symptoms of the three patterns are mild or severe

palpitations and chest tightness with shortness of breath. Heart qi (yang)

deficiency can cause worsened symptoms upon physical exertion. A sud- den collapse of heart yang can cause life-threatening mental confusion, which requires immediate emergency measures.

Heart blood deficiency and heart yin deficiency

Overview

These two patterns manifest failure of heart yin and heart blood to nourish the heart. The main contributing factors include constitutional deficiency,

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loss of blood, chronic conditions consuming blood and internal fire trans- formed from emotion-induced qi stagnation.

Clinical manifestations

Common symptoms of the two patterns are palpitations and insomnia or

dream-disturbed sleep.

Heart blood deficiency also causes dizziness, poor memory, pallor or a sallow complexion, pale lips and nails, and a thready weak pulse.

Heart yin deficiency also causes tidal fever, night sweats, feverish sen- sations on the palms, soles and chest, rosy cheeks, a dry throat, a red tongue with a scanty coating and a thready rapid pulse.

Analysis

Failure of heart yin and heart blood to nourish the heart causes mild or severe palpitations. Failure of yin and blood to nourish the heart–mind causes insomnia or dream-disturbed sleep. Failure of blood to nurture the brain causes dizziness and a poor memory. Failure of blood to ascend to nourish the face and tongue causes a pale or sallow com- plexion and pale lips and nails. Deficiency of heart blood causes a thready pulse. Yin deficiency may cause deficient heat, resulting in subsequent feverish sensations on the palms, soles and chest, tidal fever and night sweats. Ascending of deficient fire causes rosy cheeks. Failure of yin to ascend causes a dry throat. A red tongue with a scanty coating and a thready rapid pulse are typical signs of internal heat due to yin deficiency.

Differentiation

Other than palpitations and insomnia or dream-disturbed sleep, heart yin deficiency is distinctively characterized by a red tongue, a thready rapid pulse and/or night sweats; while heart blood deficiency is distinc- tively characterized by absence of redness (tongue and cheeks), heat or sweating but presence of a thready pulse, a pale tongue and a lusterless complexion.

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Distinctive notes

It is easy to identify heart yin deficiency or heart blood deficiency by the heart-related symptoms plus either yin deficiency or blood deficiency symptoms. The heart-related symptoms include mild or severe palpita- tions, insomnia or dream-disturbed sleep and abnormal mental activities. Chest tightness, chest pain, night sweats, profuse sweating and tongue changes may also be present; however, these symptoms can also be caused by dysfunctions of other zang–fu organs. There is an exception, though: owing to the close association between blood and heart–spirit, presence of palpitations and insomnia without other manifestations is often diagnosed as heart blood deficiency.

In addition, heart blood deficiency coupled with restlessness, tidal fever and night sweats can be identified as deficiency of heart yin and blood.

Hyperactivity of heart fire

Overview

Hyperactivity of heart fire manifests an internal exuberance of heart fire. The main contributing factors include internal fire heat, six external pathogens, qi stagnation transforming into fire and overingestion of hot, spicy or fatty food.

Clinical manifestations

A red face, thirst with a desire to drink water, restlessness, insomnia, dark- yellow urine, dry stools, ulcerations, swelling and pain of the tongue, redness on the tip of the tongue and a rapid pulse; alternatively, hematem- esis, bleeding from the nostrils, bloody urine, mania or skin sores may also be present.

Analysis

Ascending of exuberant fire causes a red face. Fire consuming fluids causes thirst with a desire to drink water. Internal exuberance of heart fire causes restlessness and insomnia. The heart opens into the tongue; ascending of fire heat along the meridian may cause redness on the tip of

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the tongue and subsequent ulcerations, swelling and pain. Dark-yellow urine, dry stools and a rapid pulse are typical signs of interior heat. Additionally, since the heart dominates blood and blood vessels, exuber- ant heart fire may accelerate the flow of blood, leading to hematemesis, bleeding from the nostrils or bloody urine. Heat disturbing the mind causes mania. Over time, internal toxic fire causes skin sores.

Differentiation

This pattern manifests as excessive fire and should be distinguished from heart yin deficiency which causes deficient fire. Combined fire and yin deficiency symptoms can be diagnosed as hyperactivity of fire due to (heart) yin deficiency.

Distinctive notes

The distinctive points of hyperactivity of heart fire include heart-related symptoms, especially involving the mental activities and tongue (redness, ulceration and pain), heat and excess.

Blockage of heart vessels

Overview

Blockage of heart vessels manifests obstructed circulation of heart blood. The main contributing factors include stasis, cold retention, phlegm, and

qi stagnation due to aging or chronic conditions. Clinical manifestations

Mild or severe palpitations, chest tightness with intermittent chest pain radiating to the shoulder, back and arms. Stasis causes a stabbing chest pain, a dark-purple tongue or a tongue with ecchymosis or petechiae, severe chest tightness, a white greasy tongue coating and a deep slippery pulse. Phlegm causes an oppressive chest pain, obesity, a general heavy sensation, a white greasy tongue coating and a deep slippery pulse. Cold retention causes a sudden intense chest pain that can be alleviated by warmth, cold intolerance, cold limbs, a pale tongue with a white coating

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and a deep slow or deep tight pulse. Qi stagnation causes a distending chest pain that is associated with emotions, a light red or dark-red tongue and a wiry pulse.

Analysis

Failure of heart yang (qi) to circulate blood to nourish the heart causes mild or severe palpitations and subsequent blood stasis and phlegm reten- tion. This may further cause chest pain that can radiate to the shoulder, back and arms along the meridian.

Clinically, blockage of heart vessels can be caused by one factor (of phlegm, stasis, qi stagnation and cold retention) alone or in combination.

Differentiation

This pattern is distinctively characterized by chest tightness and pain. In modern medicine, it can be seen in patients with coronary artery disease, angina or myocardial infarction. The chest tightness and pain can be caused by trauma, pulmonary or pleural conditions, or mental stress. In addition, this pattern is more commonly seen in elderly males, accom- panied by qi deficiency, yang deficiency, yin deficiency, blood deficiency, excessive cold or phlegm.

Distinctive notes

The distinctive points of this pattern include intermittent recurrent chest tightness and pain. Laboratory findings can help confirm the diagnosis and predict prognosis.

Phlegm misting the heart–mind

Overview

Phlegm misting the heart–mind manifests turbid phlegm disturbing the heart–mind. The main contributing factors include internal dampness transforming into phlegm and emotional disturbance.

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Clinical manifestations

Gastric fullness, nausea, phlegm sounds in the throat, mental confusion or unconsciousness, slurred speech, a white greasy tongue coating and a slip- pery pulse; alternatively, mental depression, apathy, dementia expression, muttering to oneself and abnormal behaviors may also be present. In some cases, a sudden collapse, unconsciousness, phlegm sounds in the throat, salivation, uncontrollable jerking movements of the arms and legs, and a staring spell can be present.

Analysis

This pattern is often seen in a critical stage of depression, epilepsy or other chronic conditions, such as stroke.

Depression causes dementia expression and abnormal behaviors. It often results from emotional disturbance and subsequent liver qi stagna- tion. Epilepsy causes a sudden collapse with uncontrollable jerking move- ments of the arms and legs. It is often congenital or linked to a sudden fright. Since the liver dominates tendons and opens into the eyes, internal stirring of liver wind may cause a staring spell. Ascending of liver qi causes phlegm sounds in the throat.

External or internal turbid dampness may obstruct the ascending of clean yang and descending of stomach qi, resulting in gastric fullness and nausea. Over time, the turbid dampness may transform into phlegm to disturb the mind, leading to mental confusion, slurred speech or even loss of consciousness. A white greasy tongue coating and a slippery pulse are typical signs of internal phlegm turbidity.

Differentiation

This pattern should be distinguished from hyperactivity of heart fire. Both may cause abnormal mental activities. However, hyperactivity of heart fire mainly causes excessive heat symptoms, while phlegm misting the heart– mind mainly causes phlegm symptoms, including phlegm sounds in the throat, a white greasy tongue coating, gastric fullness, nausea and salivation.

If coupled with fire heat symptoms, the new pattern can be diagnosed as phlegm fire disturbing the mind.

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Distinctive notes

The distinctive points of this pattern include abnormal mental activities (due to phlegm disturbing the mind), gastric discomfort and nausea (due to ascending of phlegm turbidity) and recurrent attacks.

Phlegm fire disturbing the mind

Overview

Phlegm fire disturbing the mind manifests phlegm fire affecting the heart– mind. The main contributing factors include internal phlegm fire trans- formed from qi stagnation and heat phlegm disturbing the mind following an external contraction of heat.

Clinical manifestations

Red face and eyes, fever, restlessness, manic delirium, yellow sticky spu- tum, a red tongue with a yellow greasy coating and a slippery rapid pulse; alternatively, insomnia, restlessness, dizziness, blurred vision, profuse sputum and chest tightness may be present. In some cases, illogical speech, crying or laughing with no apparent reason and manic behaviors may be present.

Analysis

Qi stagnation transforming into fire may consume fluid and form

phlegm, which then ascend to disturb the mind, leading to red face and eyes, fever and restlessness. Exuberant heat also causes yellow sticky sputum. Phlegm fire disturbing the heart–mind causes mental confusion and subsequent manic delirium. Internal exuberance of phlegm fire causes a red tongue with a yellow greasy coating and a slippery rapid pulse.

Differentiation

This pattern should be distinguished from hyperactivity of heart fire and phlegm misting the heart–mind. Hyperactivity of heart fire is marked by

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restlessness, insomnia and dark-yellow urine. Phlegm misting the heart– mind is marked by dementia expression, mental confusion and a white greasy tongue coating. This pattern is marked by mania, mental confusion and phlegm sounds in the throat.

Distinctive notes

The distinctive points of this pattern include excessive phlegm, exuberant heat and mental confusion.

Excessive heat in the small intestine

Overview

Excessive heat in the small intestine manifests exuberant interior heat in the small intestine. It is mainly caused by downward transmission of heart fire to the small intestine.

Clinical manifestations

Restlessness, thirst, mouth or tongue ulcerations, painful urination with a burning sensation in the urethra, bloody urine, a red tongue with a yellow coating and a rapid pulse.

Analysis

Internal heart fire can disturb the mind and cause restlessness. Fire consuming fluids causes thirst. Ascending of heart fire causes mouth or tongue ulcera- tions. Since the heart is internally–externally connected with the small intes- tine, heart fire can be transmitted down to the small intestine, leading to painful urination with a burning sensation. Exuberant heat damaging yang collaterals causes bloody urine. A red tongue with a yellow coating and a rapid pulse are typical signs of heat.

Differentiation

This pattern, also known as downward transmission of heart fire to the small intestine, should be distinguished from damp–heat in the urinary

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bladder. Common symptoms of the two include dark-yellow urine with a burning sensation in the urethra. However, this pattern also causes symptoms due to hyperactivity of heart fire, while damp–heat in the urinary bladder mainly causes low back pain and lower abdominal distension.

Distinctive notes

The distinctive points of this pattern include symptoms of hyperactivity of heart fire, scanty painful urination with a burning sensation and an absence of low back pain.

Summary

The patterns and diagnosis points for the heart and small intestine:

Patterns Distinctive Diagnosis Points

Heart qi deficiency Palpitations, shortness of breath, mental fatigue

and general hypofunction

Heart yang deficiency Heart qi deficiency + deficiency cold symptoms

Sudden collapse of heart yang Heart yang deficiency + yang depletion symptoms

Heart yin deficiency Palpitations etc. + yin deficiency symptoms

Heart blood deficiency Palpitations etc. + blood deficiency symptoms Hyperactivity of heart fire Heart-related symptoms + heat + excess syndrome Blockage of the heart vessels Chest tightness + recurrent attacks + lab tests Phlegm misting the mind Abnormal mental activities + ascending turbid

phlegm

Phlegm fire disturbing the mind Phlegm + heat + mental confusion

Excessive heat in the small intestine Hyperactive heart fire + scanty painful urination + an absence of low back pain

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