Dual vacuity of the heart and spleen

Also heart-spleen qì and blood vacuity (心脾气血虚 xīn pí qì xuè xū)

Key signs: Heart palpitation; insomnia; reduced eating; sloppy stool; signs of qì and blood vacuity.

Description: Heart palpitation or fearful throbbing; dizzy head; insomnia and profuse dreaming; forgetfulness; reduced eating; abdominal distension; sloppy stool; lassitude of spirit and lack of strength; in some cases, purple macules under the skin; persistent dribbling pale scant menstrual flow; withered-yellow complexion; pale tender-soft tongue; weak pulse.

Diseases: Vacuity taxation; heart palpitation; fearful throbbing; sleeplessness; forgetfulness; dizziness; bleeding.

Biomedical correspondence: anemia; purpura; dysfunctional metrorrhagia.

Pathogenesis: Insufficiency of spleen qì reducing qì and blood production and depleting heart blood.

The spleen is the source of qì and blood production, while the heart governs the blood (that is, propels it). The heart spirit is particularly dependent upon the blood for nourishment. Hence spleen qì vacuity often develops with heart blood vacuity. The pathomechanisms that give rise to the combined pattern are as follows:

• Excessive thought and preoccupation, enduring illness, or dietary irregularities causing spleen qì vacuity with impaired movement and transformation and reduced production of qì and blood, depriving the heart of nourishment;
• chronic bleeding.

Analysis of signs

• Blood failing to nourish the heart: Palpitation or fearful throbbing, insomnia, profuse dreaming, dizziness, and forgetfulness.
• Spleen qì vacuity with movement and transformation failure: Poor appetite, reduced eating, abdominal distension, and sloppy stool.
• Spleen vacuity failing to contain blood: Scant but persistent pale menstrual flow and in some cases subcutaneous bleeding that manifests in purple macules under the skin.
• Dual vacuity of qì and blood: Withered-yellow facial complexion; fatigue and lack of strength.
• Tongue: Pale and tender-soft, reflecting qì and blood vacuity.
• Pulse: Weak, reflecting qì and blood vacuity.

Treatment

Medicinal therapy: Supplement the heart and spleen. Use Spleen-Returning Decoction (归脾汤 guī pí tāng).

Acumoxatherapy: Base treatment mainly on back transport points, HT, SP, and CV. Select BL-15 (Heart Transport, 心俞 xīn shù), BL-20 (Spleen Transport, 脾俞 pí shù), BL-17 (Diaphragm Transport, 膈俞 gé shù), CV-6 (Sea of Qì, 气海 qì hǎi), HT-7 (Spirit Gate, 神门 shén mén), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-10 (Sea of Blood, 血海 xuè hǎi), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo); needle with supplementation and add moxa.

Comparison:

Dual vacuity of the heart and spleen, heart-spleen blood vacuity, heart-spleen qì vacuity, and heart-spleen yáng vacuity are four distinct patterns involving the same two viscera. Heart palpitation occurs in all of them. Dual vacuity of the heart and spleen and heart-spleen blood vacuity are both marked by heart palpitation, insomnia, and profuse dreaming. Dual vacuity of the heart and spleen is a combination of heart blood vacuity and spleen qì vacuity and is marked by spleen qì vacuity signs such as abdominal distension and sloppy stool. It therefore differs from heart-spleen blood vacuity, which is a combination of heart blood vacuity and spleen blood vacuity (actually spleen qì vacuity and insufficient formation of qì and blood), in which abdominal signs are absent. Heart-spleen qì vacuity is characterized by heart palpitation, spontaneous sweating, shortness of breath, reduced eating, abdominal distension, pale enlarged tongue, and a vacuous pulse, whereas heart blood vacuity is marked by reduced sleep, vexation and agitation, profuse dreaming, pale lips, and a fine pulse. Heart-spleen yáng vacuity is similar to heart-spleen qì vacuity, but is more severe and characterized by pronounced exterior cold signs.