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The Daily Enlightenment
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Internal Medicine |
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Internal Medicine - Heart Disorders
Overview Of Heart Function
The heart governs
blood in two different ways. It is the area where food Qi (Gu Qi)
is transformed into blood. The heart Qi is the main organ
responsible for moving blood within the blood vessels in order to
transport blood to all tissues of the body. The heart houses the
bodys Shen. Shen indicates the mentality of an individual while it
also shows the emotional and spiritual aspects. So it not only
relates to the heart but it includes emotions, mentality and
spirituality of the bodies overall constitution. Disorders of the
heart include, excessive tiredness, angina, insomnia, depression,
manic psychosis and palpitations.
The Heart governs the blood and houses
the mind, therefore most problems of the Heart involve the blood and
mind.
The mind needs blood for nourishment
and vitality, and the blood needs emotional stability so as to not
be consumed.
Exterior pathogenic factors do not
directly affect the Heart, although Heat and Fire can reach the
Pericardium (i.e. infectious or epidemic febrile diseases showing
Heat in the Ying level with high fever, delirium, skin eruptions,
and possible coma).
Excessive joy can make the Heart Qi
slow and become deficient, but this rarely shows in patients so
great attention to this is not warranted.
Sadness makes Lung Qi
deficient, this dissolves all Qi in the body, and since the Heart
governs all emotions, its Qi is drastically affected.
Also, if anger is chronic and
causes stagnation and Fire in the Liver, it will transfer to the
Heart.
Signs & symptoms:
palpitations, mild physical activity causes shortness of breath
and/or feelings of oppression in the chest, spontaneous sweating,
fatigue, listless, pale complexion, lack warmth to connect with
people, trouble making conversation, trouble communicating ones
meaning or intentions (slow), absence of joy, amenorrhea, scanty
and/or late periods.
Tongue:
normal or pale colour with white coating, may have midline crack
(the deep crack when combined with a fold on the bridge of the nose
and a horizontal fold on the earlobe shows a predisposition to heart
disease).
Pulse:
may be empty, feeble, knotted, or intermittent
This pattern may be seen after blood loss, from emotional problems,
heart disease, arrhythmia, neurosis, and heart failure.
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Heart Yang
deficiency (& collapse)
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Signs & symptoms:
palpitations, mild physical activity causes shortness of breath
and/or feelings of oppression in the chest, spontaneous sweating,
fatigue, listless, bright-pale complexion, intolerance to cold (not
relieved by clothing or blankets), cold limbs, limb edema, cyanotic
lips, lack warmth to connect with people, trouble making
conversation, trouble communicating ones meaning or intentions
(slow), absence of joy, chest pain with cold limbs & sweat (heart
attack)
Collapse:
key symptoms are cyanotic lips, cold limbs and sweats, and a hidden
minute pulse.
Tongue:
pale swollen with a white moist coating
Pulse:
deep weak, thin feeble, or knotted pulse
This pattern may be seen indirectly from Kidney Yang deficiency
(chronic illness, excess sexual activity especially if exposed to
cold after intercourse, chronic retention of Dampness, old age),
after blood loss, from emotional problems, various physical heart
diseases, heart failure, or circulatory failure caused by various
acute or chronic diseases.
Signs & symptoms:
palpitations, dizziness, insomnia (trouble falling asleep), vivid
dreams that can make one feel like their sleep was not quality, poor
memory, numbness in the limbs, easily forget the words they wish to
use and simple routine things in life (i.e. keys), anxiety, easily
startled, easily fatigued, pale dull complexion, pale lips, may have
dry &/or itchy skin, shyness, sense of vulnerability, withdrawn,
amenorrhea, scanty periods, late menses.
This pattern could also lead to
Kidney and Heart disharmony (Kidney and Heart Yin deficiency leading
to Kidney Yin not nourishing the Heart Yin, hence, deficient Heart
Fire).
This pattern will be discussed under
the Kidney section.
Tongue:
pale thin, may be dry
Pulse:
thin, may be weak or choppy
This pattern is usually associated with a Spleen/pancreas Qi
deficiency (poor diet not creating enough blood or damaging the
Spleen/pancreas function), anemia, arrhythmia, hypertension,
hyperthyroidism, anxiety or worry, or blood loss.
Signs & symptoms:
palpitations, irritability, dream disturbed sleep, easily startled,
insomnia (falls asleep with only slight difficulty but sleeps
shallow or wake often during the night), vivid dreams sometimes to
the point of disturbing the sleep, five center heat sensation,
anxiety, jumpy, chatty, fidgety, restless, flighty, malar flush
(rosy cheeks), night sweats, tidal fevers, dry mouth, throat, and
lips, cankers of the tongue, trouble with public speaking, tendency
to quick and hasty words, poor memory for people or place names,
amenorrhea, scanty periods.
In menopausal women this
pattern shows hot flashes, irritability, and dryness of the vagina.
It should be noted that Heart Yin deficiency includes that of Heart
Blood deficiency because Blood is a part of Yin.
Yin deficiency seems to happen
more in mid-to-old aged peoples, where Blood deficiency is more
common in younger peoples (especially women). May show chest pain.
Tongue:
red with dry scanty or dry with no coating (peeled), red tip with
redder spots, midline crack that may reach the tip and be quite deep
depending on the severity of disease and constitutional weakness
(the deep crack when combined with a fold on the bridge of the nose
and a horizontal fold on the earlobe shows a predisposition to heart
disease).
Pulse:
thin or thready and rapid, if severe may show floating and empty.
This pattern is often seen with
chronic anxiety and a very busy or hectic lifestyle like that of the
West.
May also be seen in more in hot
climates, tachycardia, arrhythmia, anemia, neurasthenia,
hypertension, hyperthyroidism, and generalized anxiety disorders.
Signs & symptoms:
palpitations, thirst, irritability, insomnia and dream disturbed
sleep (dreams of fire are common), cankers of the tongue (more red
and painful), agitation, anxiety, mental restlessness, impulsive,
whole face red, dark urine that may contain blood and/or
be painful (this is a result of
Heart Fire transmission to the Small Intestine, i.e. Mu Tong),
constipation with dry stool (possible hematemesis), epistaxis,
delerium, manic episodes, bitter taste, Fire can make blood reckless
resulting in heavy periods or flooding and trickling. May show chest
pain.
Tongue:
deep red with red tip and red spots, yellow coating, midline crack
that may reach the tip and be quite deep depending on the severity
of disease and constitutional weakness (the deep crack when combined
with a fold on the bridge of the nose and a horizontal fold on the
earlobe shows a predisposition to heart disease).
Pulse:
full rapid, may be intermittent.
This pattern is seen in emotional disturbances (chronic generalized
anxiety, anger, worry, most notably depression), external
pathogenic Fire, Liver Fire, neurosis, chronic mouth ulcers, urinary
tract infections, overeating of spicy pungent deep fried foods, and
over-consumption of alcohol.
Signs & symptoms:
palpitations, stabbing pain, constriction, or oppression in the
heart region that may radiate to the left shoulder, medial (inner)
aspect of left arm, or through to the back, this pain becomes
more severe at night, shortness of breath, fatigue, cyanotic lips
and nails, cold hands (lack of circulation to the limbs), feeling of
impending doom.
This may be caused by or complicated
with Phlegm (overweight, expectoration of sputum, greasy tongue
coating, nausea), or Yin type Cold obstruction (Heart Yang
deficiency cant move the blood in the chest which shows sudden
attacks of severe pain, cold limbs, intolerance to cold, pale
tongue, deep slow pulse, brought on by physical exertion or cold
weather), Heart blood deficiency, or Heart Fire.
This pattern also typically
causes irregular menstruation and dysmenorrhea.
Tongue:
purple (may show purple spots)
Pulse:
uneven, knotted, or intermittent
This pattern is seen in patients suffering from angina pectoris,
pericarditis, coronary artery disease, myocardial infarction.
Causes are most commonly old
age, chronic Yang deficiency, cold weather, Phlegm, and emotional
problems (grief, anxiety, and anger not properly dealt with will
stagnate in the chest impeding circulation of Qi and Blood.
Smooth flow of Qi and Blood is
needed for the proper functioning of the mind, and a smoothly
functioning mind is needed for proper circulation of Qi and Blood).
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Phlegm covering the Heart-Mind orifices |
▲ |
Signs & symptoms:
mental confusion, palpitations, dementia, unconsciousness, fatigue
(heavy feeling), cloudy thinking, apathy, haziness, abnormal
behavior, soliloquy, nausea, fullness in the chest and epigastrium,
Phlegm rattling sound in the throat, aphasia, dull complexion,
copious expectoration of sputum, mental diseases (depression,
bipolar, mentally handicapped, introverted, talking to oneself,
delusional, blackouts, staring), these people are usually not
dangerous to others (possibly to themselves), coldness, passive,
slacker behavior, not logical thinking.
When combined with Wind, this
pattern can manifest post-stroke (coma, paralysis, aphasia). This
pattern more relates to Dian Zheng.
Dian Zheng:
this resembles a more
depressive side to mental disorder.
From TCM point of view this is
characterized by Phlegm covering the Heart and mind, it is the
passive stage.
Quiet, do not do much, talk to
themselves quietly, sleep a lot, may not eat or sleep much.
The Fire is now small but still
there and covered by Phlegm.
It will slowly build because of
the Phlegm stagnation and lead to Fire Kuang (mania) once again.
The Spleen is also a major
producer of Phlegm so it must be strengthened.
An underlying Yin deficiency
may also be contributing to the build up of Heat and the coagulating
of the Damp from the Spleen into Phlegm, therefore the Yin must be
nourished.
Tongue:
swollen with thick sticky slippery whitish coating, may have midline
crack
with prickles in it (a deep crack when
combined with a fold on the bridge of the nose and a horizontal fold
on the earlobe shows a predisposition to heart disease).
Pulse:
slippery
This pattern is seen in constitutionally weak children.
This results in mental
retardation and/or speech difficulties.
It can also be seen in adults
who eat too much greasy-cold-raw (Phlegm forming) foods and have or
are currently experiencing severe emotional difficulties.
Epilepsy, hysteria,
depression, neurosis, after effects of Wind-stroke, and coma,
all may also show this pattern.
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Phlegm-Fire disturbing the Heart-Mind |
▲ |
Signs & symptoms:
mental restlessness, palpitations, manic episodes, fidgety,
insomnia, vivid dreams that disturb sleep, easily frightened, bitter
taste, delerium, strange speech, confusion, harsh behavior, violent,
aggressive, uncontrollable laughter, singing, shouting, or crying,
talking to oneself, depression, aphasia, flushed red face, dark
urine (may see blood), constipation with dry stool, hallucinations,
if severe enough patient may fall into a coma.
This is a major pattern of
Kuang Zheng.
Kuang
Zheng: is
a Fire (Yang) pattern that is usually complicated with Phlegm
covering the Heart, mind, spirit, Hun (ethereal) and Po (physical)
soul (Dian Zheng).
This manifests as blockage
accumulating and causing Heat until the point of bursting resulting
in Fire surging upwards.
Tongue:
red with greasy yellow coating, tip may be deep red and swollen with
red spots, may have midline crack
with prickles in it (a deep
crack when combined with a fold on the bridge of the nose and a
horizontal fold on the earlobe shows a predisposition to heart
disease).
Pulse:
full, slippery or wiry, and rapid.
This pattern is often seen in Schizophrenia, Bipolar
manic-depression, neurosis, hysteria, menopausal syndrome,
gram-negative sepsis, encephalitits, apoplexy, or epilepsy.
It may be caused by severe
emotional problems that cause stagnation and turn to Fire, a diet of
rich spicy hot and greasy foods, and external pathogenic invasion
(epidemic febrile diseases).
The patient can
sleep anywhere or anytime no matter how much sleep they have
received. They may wake up in the morning and keep on sleeping
through out the day, fatigue is so bad that patient will be unable
to work. Is usually caused by Yang Qi Deficiency.
Western Medicine
-
Chronic fatigue, Bi polar or
Narcolepsy
Causes
Syndromes
Angina is a
cramping pain in the chest which can radiate to the shoulder blade,
down the left arm and up the throat to the teeth. Heart pain can
also be accompanied by palpitations, shortness of breath and a
distended or fullness feeling behind chest.
Western Medicine
Angina is a lack of
oxygen supply to the heart itself causing pain. This is often
caused by coronary Heart disease causing Heart Attacks or
inflammatory heart diseases.
Causes
External Pathogen
Invasions
Emotion
-
over thinking, worry, anger,
joy, sad, fear
Diet
Phlegm which blocks
Heart meridian Qi.
Deficiency
Differential
Diagnosis:
ST Ache
-
lower pain which does not
radiate into the chest and down the left arm. Accompanied by
belching, flatulence, acid regurgitation
Hypochondriac
-
Chest Pain
- related with cough and
febrile disease history, accompanied by liver Qi stagnation
symptoms.
Syndromes
Depression (Dian)
is the emotional state of being sad or extreme feelings of
dejection, lack of worth and emptiness. Signs of depression (Dian)
range from lack of motivation, failure to concentrate, lack of
expression on ones face, quiet, and in severe conditions body
functions can be effected. Manic Psychosis or Mania (Kuang) is a
mood disorder where there is excess excitement, nervousness, excess
talking, loud talking, and possible violent destructive or
self-destructive behaviour.
Causes
Qi Stagnation
Phlegm
Fire
Blood Stasis
Depression - Dian
Syndromes
-
Phlegm Stagnation
- Lack of expression,
retarded mental activity, paranoid, talk to themselves,
suicidal, poor appetite
- T white/greasy coat P
wiry, slippery, deep
- Treatment: Soothe
liver Qi and eliminate phlegm to clear mind
- Formula Xiao
Yao San & Di Tan Tang or Er Chen Tang
- Qi Deficiency With Phlegm
Stagnation
- Very quiet, dull yellow
complexion, soft stools, lack of expression, retarded mental
activity, paranoid, talk to themselves, suicidal, poor
appetite
- T pale, swollen,
white/greasy coat P weak, soft, slip.
- Treatment:
Strengthen spleen Qi and eliminate phlegm to clear
mind
- Formula Si Jun
Zi Tang + Di Tang Tang
- Qi & Blood Deficiency
- Pale, fatigued, lack of
concentration, easily shocked, palpitations, easily sad,
easily cry, no courage, disturbed sleeping patter, HT/SP
deficient patterns
- T pale, teeth marks,
thin/greasy coat P weak, thin
- Treatment: Nourish
Qi/Blood/Heart & spleen to clear mind
- Formula Yang
Xin Tang
Manic Psychosis - Kuang
Syndromes
-
Phlegm Fire
- Acute onset, insomnia,
H/A, irritable, red complexion, red eyes, angry eyes Severe
case violent, sweating, shouting
- red, yellow/greasy coat P
slippery, rapid
- Treatment: Induce
vomit then Purge bowel movement to eliminate phlegm
- Formula San
Sheng Tang = induce vomit
Xie Xin Tang + Gun Tan Wan = purge
phlegm
- Yin Deficiency With
Hyperactive Fire
- Fatigued with
irritability, anxious, insomnia, easily shocked, red
complexion, emaciation
- T red, thin coat P
thin, rapid
- Treatment: Nourish
yin and descend fire to calm the mind
- Formula Er yin
Jian + Din g Zhi Wan
- Qi & Blood Stagnation
- May occur after traumatic
injury or related to menses, H/A, heavy menses with clots,
severe PMS, abdominal pain, irritability, insomnia, red
complexion
- T purple, thin/yellow
coat P thin, wiry, rapid
- Treatment: Promote
blood circulation and regulate Qi to relieve stagnation
- Formula Dian
Kuang Meng Xing Tang + Tao Hong Si Wu Tang (mild)
Or + Da Huang Zhi Cong Wan (severe)
Insomnia is the
chronic inability to sleep not being able to achieve deep sleep.
Most people who suffer insomnia will be unable to sleep through out
the night with ought waking frequently. The primary organ affecting
sleep is the heart, which is usually accompanied by a secondary
organ which is dysfunctional.
May Be Caused By:
-
Emotions:
- All 7 emotions may cause
dysfunctionJoy (HT)has most impact on sleep
- HT Joy shen/spirit
doesnt calm at night HT looses control
- LR Anger cant store
blood liver turns to fire attacking HT
- SP Worry/Sad SP Qi
stagnates and cant T&T Blood to nourish HT
- Spleen Deficiency:
- Caused by diet/poor
digestion or over working cant produce blood to nourish
HT
- Heart & Kidney Disharmony:
- Causes a disharmony
between kidney water and heart fire
- Liver Blood Deficiency:
- Liver cant store ethereal
soul soul becomes active and eyes will not shut
- Heart & Gall Bladder Qi
Deficiency:
- Impairs heart function
GB cant ascend or disperse timid person
- Phlegm Heat in the Liver /
Heart:
- Phlegm heat entraps heart
and mind
- Disharmony of Stomach Qi:
- Follows divergent meridian
impairing heart
Syndromes
Palpitations are
the pounding or racing of the heart and may be accompanied by
shortness of breath, fatigue and an irregular pulse which may be
short and fast or rapid. Palpitations are usually due to lack of
support from another organ creating a Heart deficiency or an
external pathogenic factor blocking the Heart meridian.
Causes
Primary Causes
General
Body Qi Def - giving rise to HT deficiency
Emotional Stress - causes LV Qi Stag impairs HT
function
- causing LV Qi
Stag blood stag. blocks HT meridian impairs HT function
-dysfunction of SP
damp/phlegm blocks meridian SP cant produce blood to nourish HT
Chronic
Illness -consumes HT Qi & Yin
Secondary Causes
Chronic
Bi Syndrome - pathogens follows meridian and enters HT
Acute/Chronic Bleeding - blood Def. HT isnt
nourished
Epidemic Febrile Disease - Toxic heat attacks HT
Chronic
Cough/Asthma -LU Qi/Yang Def. with Phlegm creates HT Qi
Def.
Differentiate
Between:
Running
Piglet Syndrome feeling starts in L. Jiao and goes up to
throat
- Kidney
Disorder
Syndromes
-
Heart Qi Deficiency
- Heart cant push blood and
cant nourish itself. Palpitations with shortness of
breath, dizziness, fatigue, spontaneous sweat, agg. by
activity and amel. By rest.
- T pale P thin, weak
- Treatment: Nourish
heart Qi and nourish Yin
- Formula Wu Wei
Zi Tang
- Heart Yang Deficiency
- Palpitations, aversion to
cold, scanty urine, edema, cold symptoms, shortness of
breath, dizziness, fatigue, spontaneous sweat
- T - P deep
- Treatment: Warm and
Strengthen Heart Yang
- Formula Bao
Yuan Tang
Ling Gui Zhu Gan Tang induce
diresis if edema
- Heart Yin Deficiency
- Palpitations induced by
fear with insomnia, dysphoria, 5-centre heat sensation,
fever, night sweat, yin def. symptoms
- T red, scanty dry coat
P thin, rapid
- Treatment: Nourish
heart Yin and calm heart to relieve palpitations
- Formula Tian
Wang Bu Xin Dan
- Heart and Spleen Deficiency
- Palpitations with
shortness of breath, dizziness, insomnia, poor appetite,
soft stools, pale face
- T pale, puffy P weak
- Treatment: Nourish
heart & spleen
- Formula Gui Pi
Tang
- Heart Qi / Blood Deficiency
- Palpitations, shortness of
breath, dizziness, short of breath, pale
- Treatment: Nourish
heart Qi & Blood
- Formula Zhi Gan
Cao Tang
- Liver and Kidney Yin
Deficiency
- Palpitations with
insomnia, 5-centre heat sensation, back/knee ache/weakness,
dizziness, tinnitus, blurred vision, reproductive disorders,
LV/KD Yin Def. Symptoms.
- T red, thin coat P
thin, rapid
- Treatment: Nourish
Liver Kidney & Heart to calm the mind
- Formula Yi Guan
Jian - nourish liver & kidney
+ Suan Zao Ren Tang - nourish
heart
- Spleen and Kidney Yang
Deficiency
- Palpitations with fatigue,
tired, aversion to cold, cold limbs, cold body, poor
appetite, soft stool, scanty urine
- T swollen, pale, white
coat P deep, thin, retarded
- Treatment: Warm
Spleen and Kidney and Induce diresis to calm heart
- Formula Li
Zhong Tang + Zhen Wu Tang (induce diresis)
- Heart and Gall Bladder Qi
Deficiency
- Palpitations with fear,
timid person, lots of dreams, fearful of lights and sounds,
poor appetite
- T - pale P thin, wiry
- Treatment: Nourish
Heart and Gall Bladder Qi to calm the mind
- Formula Ping Bu
Zhen Xin Dan
Wen Dan Tang
- Turbid Phlegm Stagnation
- Palpitations due to poor
diet or over thinking causing dysfunction of spleen,
shortness of breath, fullness/distended chest, easily
nausea, bloated, poor appetite, heavy feeling
- T teeth marks,
slippery/greasy coat P wiry, slippery
- Treatment: regulate
Qi to transform phlegm
- Formula Dao Tan
Tang
Wen Dan Tang (phlegm heat)
- Blood Stasis
- Palpitations with
shortness of breath, dysphoria, fullness in chest, slight
pain in head
- T purple veins under
tongue P irregular
- Treatment: promote
blood circulation, remove blood stasis
- Formula Xue Fu
Zhu Yu Tang
Links -
Heart:
: Fire Energy Yin Organ
(Bioenergetics)
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