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Pathological changes of the heart mainly result from its failure in circulating blood and mental activities. Therefore, heart diseases are usually manifested by palpitation, fearful throbbing, heart pain*, restlessness, insomnia*, profuse dreaming, amnesia*, loss of consciousness, derangement*, and bound or intermittent or skipping pulse. Besides, since the heart opens at the tongue, some tongue disorders, such as tongue pain and tongue sore, are also ascribed to* the heart.

Deficiency heart patterns, such as heart yin, heart yang, heart qi and heart blood deficiency, and heart yang collapse usually result from mental exertion, innate deficiency, visceral qi deficiency, or prolonged illness. Excess heart patterns, such as hyperactive heart fire, heart vessel obstruction, phlegm clouding the heart spirit, phlegm fire harassing the heart, and blood stasis obstructing the brain collateral usually result from phlegm obstruction, fire harassment, cold congelation, qi stagnation, and blood stasis.

Deficiency Patterns
虚证类

There are many kinds of deficiency patterns in heart diseases and the commonly observed ones are shown in Fig. 11-1.

Fig. 11-1 Common deficiency patterns of heart diseases

Heart qi deficiency pattern arises when the heart qi is deficient, failing to sufficiently* provide power for blood circulation* and housing spirit, resulting in hypo-function of the heart. This is manifested by palpitations, pallor*, pale tongue, and weak or irregular pulse. In addition, there are symptoms caused by qi deficiency of the whole body, marked by shortness of breath, listlessness, and spontaneous sweating*.

Heart blood deficiency pattern results from deficiency of the blood to nourish the heart spirit and the whole body, manifested by palpitations, dizziness, dream-disturbed sleep, forgetfulness, pale or sallow complexion, pale lips and tongue, and fine pulse.*

Heart yin deficiency pattern is caused by deficiency of yin fluid failing to nourish the heart spirit and giving rise to deficiency heat. This is manifested by mental irritability, palpitation, insomnia, low fever, night sweating, malar flush, thirst, and rapid fine pulse.

Heart yang deficiency pattern arises when deficient yang fails to warm the body and deficient heart yang qi fails to provide power for maintaining the normal functions of the heart. This failure affects the whole body because heart yang is a part of the whole body yang, usually manifested by palpitation, dyspnea, a feeling of pressure in the chest, aversion to cold with cold limbs, bright pale complexion, dark lips and tongue with white coating, and weak or irregular pulse.

Heart yang collapse pattern is usually the further worsening of heart yang deficiency, marked by sudden profuse sweating and cold skin, reversal cold of the limbs, feeble breathing, palpitation, clouding or loss of consciousness, pale complexion and hardly perceptible pulse.

Excess Patterns
实证类

The common excess patterns of heart disease are shown in Fig. 11-2.

Fig. 11-2 Common excess patterns of heart diseases

Intense heart fire pattern* arises when exuberant fire causes body fluid shortage and disturbs the heart spirit. This condition is marked by fever, thirst, vexation, insomnia, and in severe cases, manic* agitation, and delirious speech, reddened tongue tip and yellow coating, and rapid slippery pulse.

Heart vessel obstruction pattern* arises when the heart vessels are impeded, marked by paroxysms* of palpitations with fearful throbbing, pain and a feeling of pressure in the heart and chest referring to* the shoulder or upper arm.

Pattern of phlegm clouding the heart spirit* arises when phlegm clouds the heart spirit. This causes mental disorder, marked by impairment of consciousness, psychotic depression, or even coma, accompanied by phlegmatic sound in the throat*.

Pattern of phlegm-fire harassing the heart* is usually caused by phlegm-fire harassing the heart spirit, marked by restlessness, insomnia or even raving madness, reddened tongue tip, yellow dense and slimy tongue coating, and rapid slippery pulse. There may also be more symptoms caused by the phlegm-fire, such as fever, thirst, and chest depression.

Pattern of (blood) stasis obstructing the brain collateral* arises when a brain collateral is obstructed by static blood. This is marked by dizziness, headache with fixed location, or forgetfulness, insomnia, or loss of consciousness, dull lusterless complexion, purple tongue or tongue with purple spots, and fine choppy pulse.