Heart

Heart Functions

The functions of the heart are governing the spirit and governing the blood and vessels.

The Heart Governs the Spirit (心主神 xīn zhǔ shén)

Also expressed as the heart stores the spirit (心藏神 xīn cáng shén), the heart governs the spirit means that consciousness, responsiveness to external and internal stimuli, and thinking are closely associated with the heart.

The Sù Wèn (Chapter 8) states, The heart holds the office of Sovereign; the bright spirit arises from it.

The Líng Shū (Chapter 71) states, The heart is the great governor of the five viscera and six bowels, the abode of essence-spirit (心为五脏六腑之大主, 精神之所舍 xīn wéi wǔ zàng liù fǔ zhī dà zhǔ, jīng shén zhī suǒ shè).

Although Chinese medicine associates specific emotions with the viscera, it also recognizes that we feel every emotion in our heart. So, the familiar Western idea of the heart as the seat of the emotions is comparable with the Chinese concept of spirit. However, Chinese medicine accords the heart the higher status of being the abode of the spirit (神 shén), that is, consciousness and intellectual faculties. In the Chinese conception, emotions are all felt in the heart, but they are each seated in a specific viscus. The heart is the seat of only one emotion, joy.

The word 神 shén, spirit, originally meant an unseen being, a god, a life-giving supernatural force. Gods universally are invisible and intangible beings possessing consciousness, intelligence, and powers that living humans do not share. Though existing outside our world, they have the power to influence and even control human affairs. Consciousness, intelligence, and power are all things associated with fire and the light it emits.

The Chinese posited the notion that humans possess an invisible, but powerful conscious, animating, and controlling yáng force within us, analogous to and hence referred to as a god, or 神 shén. We may speculate that this force was assumed to be located in the heart by the association of emotions with our desires, intentions, and our power to control our actions.

The connections between heart, spirit, and fire are obvious. The heart itself resembles fire physically in the radiation of blood vessels from it and functionally in its provision of warmth. Shén is the principle of consciousness, the seat of the emotions, the origin of desires and intentions, and the power of intellect. Its power over our actions gives it yáng qualities akin to fire. The heart is in the center of the body, and like the fire of a small human community as the hub of social life, it represents the central point of coordination of the individual’s physical movement, social behavior, and view of the world.

The importance of the spirit is highlighted by the fact that it is considered one of the Three Treasures (三宝 sān bǎo) or Three Mysteries (三奇 sān qí), the other two being essence and qì.

Most signs associated with illness of the heart in Chinese medicine are manifestations of disturbances of the spirit: heart vexation, insomnia, profuse dreaming, forgetfulness, clouded spirit, feeble-mindedness, and manic agitation. By contrast, few symptoms relating to the movement of blood are specifically related to the heart beyond specific tongue and pulse signs. This explains why the heart’s governance of the spirit is the focus of medical attention.

Consciousness: The spirit is that which enables the individual to be conscious of objects in the external world and of internal states of mind. The Líng Shū (Chapter 8) states, What responds to things is called the heart (所以任物者谓之心 suǒ yǐ rèn wù zhě wèi zhī xīn).

Partial or total loss of consciousness in externally contracted febrile disease, in epilepsy, or in wind stroke is described as clouded spirit.

Mental vitality: The health of the spirit is reflected in a person’s degree of mental vitality or energy. In Chinese medicine, this aspect of the spirit is often referred to as essence-spirit. Lassitude of spirit is the result of debilitation of the heart’s yáng qì.

Experiencing emotions: The seven affects are closely associated with the viscera―anger with the liver, thought with the spleen, joy with the heart, worry and sorrow with the lung, fear and fright with the kidney. However, all are consciously experienced by the heart.

The spirit is affected by excesses of the seven affects. Anger causes excitement of the heart spirit, while sorrow can cause lassitude of spirit. Fright and fear can cause heart palpitation.

The Lèi Jīng states, The heart is the great governor of the five viscera and six bowels. It controls the ethereal and corporeal souls and completes the mind and will. When worry stirs the heart, the lung responds; when thought stirs the heart, the spleen responds; when anger stirs the heart, the liver responds; when fear stirs the heart, the kidney responds. This is because the five minds are controlled by the heart (心为五脏六腑之大主, 而总统魂魄, 兼该志意, 故忧动于心则肺应, 思动于心则脾应, 怒动于心则肝应, 恐动于心则肾应, 此所以五为心所使也 xīn wéi wǔ zàng liù fǔ zhī dà zhǔ, ér zǒng tǒng hún pò, jiān gāi zhì yì, gù yōu dòng yú xīn zé fèi yìng, sī dòng yú xīn zé pí yìng, nù dòng yú xīn zé gān yìng, kǒng dòng yú xīn zé shèn yìng, cǐ suǒ yǐ wǔ zhì wéi xīn suǒ shǐ yě).

Responsiveness and mental activity: The spirit enables the individual to respond appropriately to external and internal stimuli (thoughts and emotions) and to think clearly.

Deranged spirit is any disturbance of the heart spirit that manifests in incoherent speech and abnormal behavior (e.g., as violent or destructive behavior or taciturnity and talking to self).

Rest and composure: The spirit is active and alert in the day, but rests at night. When it is healthy, the individual is relatively calm and focused and is able to rest when necessary during the day, as well as sleep easily at night without dreaming excessively.

Heart vexation (a feeling of unrest), insomnia, and profuse dreaming are considered as signs of disquieted heart spirit and the heart spirit failing to keep to its abode.

Memory: A good memory is dependent upon the clarity of the heart spirit. Forgetfulness can be a sign of heart disease. Note that memory is also closely related to the kidney.

Spirit and blood: The spirit is reliant on the blood for nourishment. Insufficiency of the blood can cause forgetfulness, heart vexation, and insomnia. Taxation of the spirit through excessive mental activity can damage spleen qì and heart blood. The Líng Shū (Chapter 18) states, The blood is spirit qì (血者, 神气也 xuè zhě shén qì yě).

Spirit and essence: The spirit is also dependent on essence for its health. Furthermore, essence and blood are interconvertible. Essence-spirit is a term often used to refer to the spirit, underlining its reliance on essence.

Spirit and yīn-yáng: The spirit can be affected by imbalances of yīn blood and yáng qì.

• When the heart’s yáng qì is relatively exuberant (arising from superabundance caused by heat or from insufficiency of yīn), the spirit becomes overexcited. Insufficiency of heart yīn gives rise to signs such as heart vexation, insomnia, and profuse dreaming, while repletion heat gives rise to the more severe signs of vexation and agitation or manic agitation.
• When the heart’s yáng qì is relatively debilitated, a patient evinces lassitude of spirit (lack of mental energy) and dull responses.

The Heart Governs the Blood and Vessels (心主血脉 xīn zhǔ xuè mài)

The movement of blood through the vessels around the body relies on the beating action of the heart, which is produced by heart qì with the help of ancestral qì.

When the heart’s function of governing the blood and vessels is disturbed, it may manifest in a bound pulse (a slow pulse missing a beat at irregular intervals) or an intermittent pulse (a pulse that regularly skips a beat).

The Sù Wèn (Chapter 5) states, The heart engenders blood (心生血 xīn shēng xuè). This is understood to mean that the heart turns fluid red to form blood.

The Heart’s Qì, Blood, Yīn and Yáng

These four aspects of the heart are closely interrelated.

Heart qì and heart blood form part of the blood and qì of the whole body and represent the basis for the physiological activity of the heart. They have complementary functions:

• Heart qì propels the blood; it also animates the heart spirit.
• Heart blood’s function is to nourish the heart spirit.

When heart qì and heart blood are abundant, the heartbeat is regular, the pulse is moderate and forceful, and the complexion is healthy and lustrous.

Heart yīn and heart yáng are opposing and complementary aspects of the heart's functions. Since qì belongs to yáng and blood belongs to yīn, heart qì and heart yáng form an inseparable entity, as do heart blood and heart yīn.

While heart qì refers to the propelling action of qì, heart yáng refers to the warming and animating action of yáng qì that ensures a strong heartbeat, smooth blood flow, and vigor of mental activity.

While heart blood refers to the action of nourishing, heart yīn refers to the quiescent principle that ensures a regular, moderate heartbeat, and calmness of mental activity.

Disturbances of the hearts qì, blood, yīn and yáng: When the heart’s qì and yáng are insufficient and fail to move adequately, there may be oppression in the chest. When they labor to move the blood, heart palpitation arises. Failing to animate the spirit, there may be lassitude of spirit. When heart yáng is insufficient, the heart qì vacuity signs are more pronounced and accompanied by cold signs.

When the heart’s blood and yīn are insufficient and fail to nourish the spirit, insomnia, profuse dreaming, and forgetfulness arise. When they fail to counterbalance yáng qì, there is, once again, heart palpitation. When heart yīn is insufficient, insomnia is more pronounced, and in addition there is heart vexation (unrest in the day as well as at night) and vacuity heat signs.

The Heart’s Associations

The Heart and Small Intestine Stand in Exterior-interior Relationship (心与小肠相为表里 xīn yǔ xiǎo cháng xiāng wéi biǎo lǐ)

The small intestine receives food passed down from the stomach. Its main function is to separate the clear and the turbid, useful and waste parts of food. The useful parts are sent to the spleen, while solid waste is passed on to the large intestine and liquid waste is sent to the kidney and bladder.

The heart and small intestine would appear to have little relationship. However, they are linked by channels, and the relationship between the two manifests in certain pathological relationships. In effulgent heart fire, heat can spread to the small intestine and disturb the small intestine’s function of separating the clear and turbid. When heart fire spreads heat to the small intestine, it manifests not only in signs of heart fire flaming upward such as mouth and tongue sores, but also in short voidings of reddish urine and scorching pain on urination.

The Heart Channel (心经 xīn jīng)

The channel associated with the heart is the hand lesser yīn (shào yīn) heart channel (HT).

The Heart Opens at the Tongue (心开窍于舌 xīn kāi qiào yú shé)

Chinese medicine states that the heart opens at the tongue, which is also expressed as the tongue is the sprout of the heart (舌为心之苗 shé wéi xīn zhī miáo). The tongue helps to move food in the mouth in the process of chewing and enables us to detect flavors. Probably just as prominent in the minds of ancient Chinese medical scholars would have been the tongue’s association with speech as the expression of the spirit. Thus, the tongue is a two-way orifice, detecting the taste of things entering the mouth and expressing the contents of the heart spirit to other individuals. Modern tongue diagnosis recognizes that the tongue can reflect the state of all the bowels and viscera, but much of this knowledge developed after the appearance of the Nèi Jīng. In modern clinical practice, the tongue reflects the state of the heart mainly in the following two ways:

• A stiff tongue that causes impeded speech or complete loss of speech, such as in wind stroke, is usually ascribed to a disturbance of the heart’s function of storing the spirit.
• A red-tipped tongue and sores on the tongue and in other parts of the mouth are understood to reflect heart fire flaming upward, which is a pattern of hyperactive heart fire with pronounced upper body heat signs.
• Mouth and tongue sore are most commonly the result of hyperactive heart fire.
• Disturbances of speech such as manic raving or muttering are associated with deranged spirit often resulting from heat or phlegm. Although such signs can be explained without reference to the tongue, as indeed they are in modern textbooks, this may not have been clear to physicians of the past.

The Heart Governs the Blood and Vessels

The Nèi Jīng says that the heart has its fullness (充 chōng) in the vessels. This is discussed above under functions.

The Heart has Its Bloom in the Face (心，其华在面 xīn, qí huá zài miàn)

The face reflects the spirit. Facial expressions convey what people are thinking and feeling. They help us to refine the meaning of their expression in language. They help us to judge how honest people are. They even provide hints about their emotional disposition. All the five minds and seven affects can be reflected in facial expressions. Joy, the mind of the heart, is the most positive. So, when a person’s facial expressions tell us of a positive attitude to life, we know that they have the best state of mind for the health of the body.

The health of the heart is reflected in a healthy, lustrous facial complexion.

• When heart qì is insufficient, this can manifest in a bright-white or dull stagnant looking complexion.
• Heart vessel obstruction can manifest in a green-blue or purple complexion.

While the face has a special relationship with the heart, it is important to understand that the facial complexion reflects the condition of all the bowels and viscera.

Sweat Is the Humor of the Heart (心, 在液为汗 xīn, zài yè wéi hàn)

Sweat is one of the five humors (sweat, snivel, tears, drool, and spittle) and is associated with the heart. It is the fluid that is discharged from the body through the sweat pores, which are often referred to as the mysterious mansions (玄府 xuán fǔ) or qì gates (气门 qì mén). In healthy individuals, sweating is associated with heat in the environment and with physical exertion. During physical exertion, the heart beats faster and sweating in the center of the chest occurs. Therefore, sweat is associated with the heart.

Relationship to blood and fluids: Sweat is derived from the fluids of the body, and hence it said, liquid and blood are of the same source. Since blood is a fluid substance, sweat is also related to the blood. Hence, it is also said that sweat and blood are of the same source.

Depletion of blood and fluids: When blood and fluids are depleted, the source of sweat is insufficient, so sweating is reduced.

• Excessive sweating easily damages liquid and blood. Since the heart governs the blood, excessive sweating can easily damage heart blood.
• Excessive sweating can also damage qì. It can damage heart qì and lead to yáng collapse.

In clinical practice, sweating is often observed in heart patterns, e.g., intense heart heat, heart yīn vacuity, or heart yáng vacuity. However, it can occur in any other repletion heat, yīn vacuity, or yáng vacuity patterns.

The Heart Stores the Spirit (心藏神 xīn cáng shén)

See The Heart Governs the Spirit above.

Joy is the Mind of the Heart (心, 在志为喜 xīn, zài zhì wéi xǐ)

Joy is the mental state associated with the heart. Although all emotions are felt in the heart, joy (喜 xǐ) is the expression of the heart itself. Joy is the most positive of all the seven affects. It is associated with the yáng qualities of expansiveness, openness, enthusiasm, exuberance, and generosity. It manifests in an urge to spread the limbs, reach out, share positive emotion with others, and engage in positive action. It is felt throughout the body. Joy is the spirit of human communion, the conviviality of the campfire. In Chinese, words for happiness and joyfulness include 高兴 gāo xìng, literally high-exuberant and 开心 kāi xīn, open-heart, which underscore joy’s association with elevation and openness. In Chinese culture, joy is associated with red, the color of fire and blood. (Red’s association with danger in Western culture probably has to do with bleeding).

Joy does not simply mean happiness. It means a positive attitude to life, equanimity, absence of internal conflict, and spiritual peace.

Although joy is a positive emotion, excessive joy, as too much of anything good, can be damaging. Excessive joy causes heart qì to slacken and therefore lack in force.

The Heart Belongs to Fire (心属火 xīn shǔ huǒ)

In the five phases, fire is the flaming upward. It is associated with summer, fire (heat), south, red, and bitterness. Amongst the viscera, it is associated with the heart.

Why the heart is ascribed to fire: The heart’s pairing with fire rests on several counts.

Radiation of blood vessels: First, blood vessels attached to the heart grow thinner with distance away from it. This suggests that the heart is at the center of the vascular system. Thus, the vessels radiate from the heart as heat from a fire.

Heat and the heartbeat: the body gets hot when the heart beats strongly during physical exertion and turns cold when the heart stops beating. This may have suggested that the heart was a major source of heat in the body. In fact, the heart is said to be the abode of the sovereign fire for this reason.

Color of blood: Red is the color of the blood. In Chinese culture, it signifies happiness (joy), which is the mind associated with the heart. A red facial complexion and tongue appear when there is heat in the heart, but these are often signs of heat in general rather than heat in the heart.

Most yáng: Fire is the most yáng of the five phases and the heart is the most yáng of all the viscera. The yáng qì of the heart, which propels the blood around the body, is considered especially powerful because it can be felt subjectively and objectively in the throbbing of the heart.

Spirit: The spirit, which is stored by the heart, resonates with the notion of fire. In other cultures, fire is seen as a connection with the invisible spirit world. In China, money and other things are burned to carry them to the spirit world. The spirit is considered yáng because it is the formless, intangible aspect of the individual, in contrast to the physical body, which is yīn. It is sometimes referred to as the bright spirit (神明 shén míng), emphasizing its yáng quality. Because the heart stores the spirit, it is understood to play a role in the body like the ruler of a nation who embodies the yáng qualities of illumination, wisdom, authority, and power. More will be said about this under the heart holds the office of Sovereign below.

Summer: Heart qì corresponds with the qì of summer. The heart function is strongest in the summer.

Bitterness: Bitterness enters the heart. An example of this is huáng lián (Coptidis Rhizoma), which is bitter, enters the heart channel, and drains heart fire..

Cyclic relationships: As to cyclical relationships, heart-fire is engendered by liver-wood and engenders spleen-earth. Heart-fire is restrained by kidney-water and restrains lung-metal.

The Heart Holds the Office of Sovereign (心者君主之官也 xīn zhě jūn zhǔ zhī guān yě)

Sù Wèn (Chapter 8) states, The heart holds the office of Sovereign; the bright spirit arises from it (心者, 君主之官也, 神明出焉 xīn zhě jūn zhǔ zhī guān yě shén míng chū yān). This government metaphor is that of the ruler of a nation, who is expected to be aware of the needs of the people, have the intelligence to know how to meet them, and command the powers needed to ensure they are met. The sovereign is thus to the nation what the spirit stored in the heart is to the individual. The heart is like the ruler, who by his intelligence, wisdom, authority, and power (the spirit), leads the nation, keeping it united, in harmony, and joyful. The bright spirit refers to the heart spirit.

Sù Wèn (Chapter 8) explains further:

Therefore, when the ruler is enlightened, there is peace below, and life-nurturing will result in long life and avoid danger throughout life... If the ruler is not enlightened, then the pathways become blocked, the body is greatly damaged, and life-nurturing will end in disaster.

In other words, just as the stability of a nation is dependent on the skill and wisdom of the ruler, so the health of the body is dependent upon the health of the heart and the heart spirit. For this reason, the Líng Shū (Chapter 71) states, The heart is the great governor of the five viscera and six bowels. (心为五脏六腑之大主 xīn wéi wǔ zàng liù fǔ zhī dà zhǔ). It is the ruler of the entire body. The heart is considered the most important organ of the body. The other four viscera, though performing essential functions, are all subordinate to it. Just as the enlightened ruler has full control over the nation, so the heart exerts control over the whole domain of the body. The spirit stored in the heart represents the intelligence required to ensure the integrated functioning of the entire body.

The ideal sovereign embodies the qualities of fire. He (rarely she) is the outstanding natural leader who rises above the masses, as flames from the fire rise high in the air. He holds the highest position in society, as the sun occupies the highest position in the heavens. His power ensures the safety and protection of his people. His intelligence is its guiding light. His beneficence ensures social cohesion and harmony. The opulence and splendor that surround him represent the people’s affirmation of the ideal ruler, as well as the glory and spirit of the nation. In keeping with these associations, the yáng qì of the heart is often referred to as the sovereign fire, which stands in complementary opposition to the ministerial fire (which is said to inhabit the life gate, liver, gallbladder, and triple burner).

Rulers in many cultures are assumed to have divine powers or connections with the divine. In China, the emperor was believed to receive his power to rule the country from Heaven (天命 tiān mìng, the Heavenly Mandate) and was referred to as the Son of Heaven (天子 tiān zǐ). The ruler is all-powerful, wise, and beneficent as a god or 神 shén. He resides in a palace located in the capital city, to which all roads lead as all vessels lead to the heart.

One condition identified according to the theory of warm disease is called heat entering the pericardium, which is characterized by clouded spirit and delirious speech, which are normally symptoms of heart disease. It has been proposed that the pericardium is the locus of the condition rather than the heart itself because the suggestion that an external evil could threaten the sovereign might be construed as a politically subversive message. In a strong, well-ordered society, ill-doers may reach the palace walls but are unable to get into the palace itself to threaten the sovereign.

Joy is associated with the sovereign. Just as joy is felt throughout the body, so a good sovereign ensures the welfare and happiness of the nation. He is mentally balanced and untrammeled by negative emotions. Similarly, a person who maintains a positive attitude to life and knows contentment is likely to suffer less from illness. A joyful spirit is the root of health.

The Heart Is Averse to Heat (心恶热 xīn wù rè)

This phrase is from the discussion in the Sù Wèn, Chapter 23, about the five aversions. The heart belongs to fire, whose nature is heat, so excess heat is dangerous for the heart. As discussed in the following subsection, the heart is susceptible to vacuity heat and repletion heat (heart yīn vacuity and hyperactive heart fire). However, while the heart may be susceptible to vacuity cold (heart yáng vacuity), there is no heart repletion cold pattern.

Heart Disease Signs

Signs of heart disease fall into three categories:

• Chest: Chest pain and oppression in the chest are the result of yáng qì failing to move or to obstructive evils such as cold, phlegm, and static blood. Heart palpitation stems from yīn-yáng imbalance or the presence of evil qì.
• Spirit: Forgetfulness, insomnia, profuse dreaming, and heart vexation are the result of insufficiency of heart blood or heart yīn. Vexation and agitation or manic agitation is traceable to repletion heat. Clouded spirit and deranged spirit in heart disease are mostly caused by heat or phlegm.
• Tongue: The tip of the tongue reflection heat in the heart. Tongue sores are mostly attributable to hyperactive heart fire flaming upward.

Chest pain (胸痛 xiōng tòng); oppression in the chest (胸闷 xiōng mèn): These signs are caused by insufficiency of the heart’s yáng qì failing to warm and move the blood and/or to blood stasis and phlegm turbidity obstructing blood flow.

Heart palpitation (心悸 xīn jì): Episodic strong and rapid beating of the heart that patient can feel. It can occur when yáng qì of the heart is weak and labors to propel the blood, when insufficiency of the heart’s yīn blood fails to keep yáng qì in check, or when phlegm or stasis obstructs the flow of blood. Episodes are usually triggered by emotional stimulus (shock, fright).

Forgetfulness (健忘 jiàn wàng): Poor memory. It is often attributable to insufficiency of heart blood depriving the spirit of nourishment but may also be a sign of insufficiency of kidney essence or phlegm turbidity.

Heart vexation (心烦 xīn fán); insomnia (失眠 shī mián); profuse dreaming (多梦 duō mèng): Heart vexation refers to mental unrest. These signs are the expression of disquieted heart spirit, which reflects exuberance of the heart’s yáng qì, due either to insufficiency of yīn blood or to repletion fire.

Vexation and agitation (烦躁 fán zào); manic agitation (狂躁 kuáng zào): Vexation and agitation is heart vexation (mental unrest) with agitation (pronounced physical fidgetiness). Manic agitation is severe agitation, as marked by flailing of the arms and legs. These signs indicate severe repletion, as in hyperactive heart fire.

Clouded spirit (神昏 shén hūn): Partial or total loss of consciousness. It is mostly attributable to heat and/or phlegm and is seen in externally contracted febrile disease, epilepsy, and wind stroke. It also occurs in severe vacuity patterns. The term includes clouding collapse, which occurs in epilepsy when a person suddenly loses consciousness during the normal waking state and falls to the ground.

Deranged spirit (神乱 shén luàn): Any abnormal state of the spirit, temporary or lasting, manifesting in abnormal thinking and speech. It can occur with manic agitation and delirious speech occurring in febrile disease. It characterizes the mental abnormalities occurring in mania and withdrawal (manic and taciturn mental diseases) and in feeble-mindedness.

Mouth and tongue sores (口舌生疮 koǔ she2 sheng1 chuang1): These are most commonly the result of hyperactive heart fire.

Bound and intermittent pulses (结代脉 jie2 daì maì): A bound pulse is a slow irregularly interrupted pulse; an intermittent pulse is a regularly interrupted pulse. Both reflect either insufficiency of its yáng qì or blood stasis.

Heart Patterns

For fuller information than is given below, follow the pattern links. See heart pattern identification.

The heart is susceptible to insufficiencies of its yáng qì and yīn blood. It is also vulnerable to heat, phlegm, and blood stasis.

Insufficiency of the Heart’s Yáng Qì

Insufficiency of the heart’s yáng qì is attributable to constitutional weakness, enduring illness, or decline of visceral qì in advancing years. It manifests in decreased activity of the heart.

In diagnosis and treatment, a distinction is made between heart qì vacuity and heart yáng vacuity. However, since heart qì forms a part of heart yáng, considerable overlap exists.

Heart qì vacuity (心气虚 xīn qì xū): When heart qì labors to move the blood, heart palpitation and interrupted pulses (bound or intermittent pulses) appear with general qì vacuity signs such as shortness of breath, spontaneous sweating, and lack of strength.

Heart qì vacuity can lead to heart yáng vacuity and heart vessel obstruction.

Heart yáng vacuity (心阳虚 xīn yáng xū): This pattern is similar to heart qì vacuity, but the manifestations are more severe and include cold signs.

When heart yáng labors to move the blood, there may be heart palpitation, and oppression in the chest, and in some cases sudden bouts of chest pain. When it fails to animate the spirit, there is lassitude of spirit.

General yáng vacuity signs also appear: spontaneous sweating, panting, puffy swelling of the face and limbs, cold body and limbs, a bright-white facial complexion, moist tongue fur, and a pulse that is slow and weak.

Insufficiency of the Heart’s Yīn Blood

Insufficiency of yīn blood manifests in lack of nourishment for the heart spirit and failure to counterbalance the activity of the heart’s yáng qì.

In diagnosis and treatment, a distinction is made between heart blood vacuity and heart yīn vacuity. However, since heart blood forms part of heart yīn, the two overlap to a considerable extent.

Heart blood vacuity (心血虚 xīn xuè xū): Heart blood failing to nourish the heart spirit gives rise to forgetfulness and insomnia. When heart blood fails to counterbalance qì, heart palpitation appears. General blood vacuity signs are also observed: dizziness, a withered-yellow facial complexion, a pale tongue, and a fine pulse.

Heart yīn vacuity (心阴虚 xīn yīn xū): When heart yīn is insufficient, it fails to counterbalance yáng, making the heart spirit overexcited and thereby giving rise to heart palpitation, heart vexation, insomnia, and profuse dreaming. General yīn vacuity signs also appear: heat in the hearts of the palms and soles, tidal heat effusion, reddening of the cheeks, night sweating, dry pharynx and mouth, emaciation, a red tongue with little fur, and a pulse that is fine and rapid.

Fire, Stasis, and Phlegm

These occur in various combinations in heart disease.

• Fire results from various internal causes or to externally contracted evils entering the interior. It can affect the heart spirit causing vexation and agitation, or even mania (highly excited behavior with mental disturbance).
• Phlegm is often caused by yáng qì vacuity failing to move the fluids or fire condensing fluids. It can affect both the heart’s governance of the spirit and governance of the blood and vessels.
• Blood stasis commonly develops when insufficient yáng qì fails to propel the blood. It often combines with phlegm to produce heart vessel obstruction.

Hyperactive heart fire (心火亢盛 xīn huo3 kàng shèng) is a repletion heat pattern caused by fire-heat of external or internal origin. Fire-heat harasses the spirit, causing heart vexation, manic agitation, insomnia, and in severe cases clouded spirit and delirious speech; it also flames upward to cause tongue sores and a red-tipped tongue. There are also general repletion heat signs: a red or crimson tongue with yellow fur; a pulse that is rapid and forceful.

Heart vessel obstruction (心脉痹阻 xīn maì bì zǔ) is essentially blockage of the heart vessels resulting from blood stasis, phlegm, congealing cold, or stagnant qì, all of which obstruct blood flow, causing oppression and pain in the heart and chest, with pain stretching into the shoulder and medial aspect of the arm, heart palpitation or fearful throbbing, a purple or green-blue tongue sometimes with purple stasis speckles, and a pulse that is stringlike.

Phlegm clouding the heart spirit (痰蒙心神 tán meng2 xīn shén) is a repletion pattern characterized by mental abnormalities with signs of exuberant internal phlegm turbidity. It occurs in withdrawal patterns, feeblemindedness, and epilepsy. General phlegm signs are observed: a dull, stagnant-looking complexion; a slimy white tongue fur; a slippery pulse.

Phlegm-fire harassing the spirit (痰火扰心 tán huo3 rao3 xīn) is a repletion pattern that results from external contraction or internal damage resulting from excesses among the seven affects. It is characterized by deranged spirit, phlegm signs, and fire (heat) signs: heat effusion, clouded spirit or heart vexation and insomnia, copious phlegm, and oppression in the chest. The facial complexion is red. The tongue is red with a slimy yellow tongue fur. The pulse is slippery and rapid.

The Heart’s Relationships

Heart and Lung

The heart governs the blood, while the lung governs qì; the heart moves the blood, while the lung governs respiration. In these functions, both viscera rely on the help of ancestral qì. Hence, the relationship between the heart and the lung is closely linked to the relationship between qì and blood.

Lung affecting the heart: The lung’s function of governing qì and controlling respiration is complementary to the heart’s action of moving the blood. Lung qì vacuity or impaired diffusion and depuration can influence the heart’s function of moving the blood, causing blood stasis that manifests in oppression in the chest, changes in the heart rate, green-blue lips, and a purple tongue.

Heart affecting the lung: The heart’s function of moving the blood helps to maintain the lung’s function of controlling respiration. Insufficiency of heart qì or heart yáng can cause heart vessel stasis obstruction, which can affect the lung’s functions of governing diffusion and depurative downbearing, giving rise to counterflow ascent of lung qì, which manifests in cough and rapid breathing.

Heart and Spleen

The heart governs the blood; it moves the blood around the body. The spleen is the source of qì and blood formation; it is the main viscus responsible for producing blood. The spleen also controls the blood, that is, prevents extravasation.

The relationship between the heart and spleen concerns (a) the production of blood; (b) the movement of blood; and (c) the connections between blood, spirit, and movement and transformation.

Production of blood: The spleen governs movement and transformation of grain and water and is the source of qì and blood formation. When spleen qì is exuberant, blood production is normal, the heart has blood to govern. Conversely, the health of the spleen is in some measure reliant on the health of the yáng qì of the heart for its warming action.

In pathology, the heart and spleen can influence each other in several ways. Excessive thought and preoccupation can wear the heart blood. When the yáng qì of the heart is insufficient, this can deprive the spleen of warmth and nourishment, thereby affecting blood production. In any event, the result is dual vacuity of the heart and spleen, which manifests in heart palpitation, insomnia, reduced eating, and fatigue.

Movement of blood: The heart governs the blood, while the spleen controls the blood. When the heart and spleen are healthy and coordinated, blood production and flow are normal.

When heart qì is insufficient and fails to move the blood adequately, blood stasis and stagnation can develop. When insufficiency of heart yáng deprives the spleen of warmth and nourishment, this can impair the spleen’s ability to control the blood, causing bloody stool, bloody urine, or flooding and spotting.

Blood, spirit, and movement and transformation: The heart governs the blood; blood provides the spleen with nourishment. At the same time, the heart governs the spirit; a normal heart spirit helps to ensure normal splenic movement and transformation. Splenic movement and transformation are necessary to produce heart blood and to nourish the spirit. Hence, a close relationship exists between heart blood, heart spirit, and splenic movement and transformation.

When spleen qì is weak and movement and transformation fails, or when the spleen fails to control the blood, this can cause insufficiency of heart blood or disquieted heart spirit. The dual condition, called dual vacuity of the heart and spleen, manifests in reduced eating, sloppy stool, chronic bleeding, together with lusterless facial complexion, heart palpitation, insomnia, and profuse dreaming.

Heart and Liver

The relationship between the heart and liver mainly concerns the blood and spirit-mind.

Blood: The heart governs the blood, whereas the liver stores the blood. Only when heart blood is abundant and heart qì is exuberant can blood flow be normal and the liver have blood to store. Conversely, only when the liver has plentiful amounts of blood to store and can meet the varying demand for blood needed for physical activity is the heart able to perform its function of propelling the blood. Hence, heart blood and liver blood are mutually reliant.

Insufficiency of heart blood can cause insufficiency of liver blood, and vice versa. In both cases, the result is heart-liver blood vacuity characterized by a lusterless complexion, heart palpitation, dizzy head or vision, and scant menstruation.

Spirit-mind: The heart governs the spirit, while the liver governs free coursing and regulation of the spirit-mind. A normal heart spirit is beneficial to the liver’s free coursing. Likewise, normal free coursing is beneficial to the heart spirit.

Disquieted heart spirit can affect the liver’s free coursing and emotional balance. Conversely, impaired free coursing can cause disquieted heart spirit. In both cases, the result is effulgent heart-liver fire characterized by heart vexation, insomnia, and impatience, agitation, and irascibility.

Heart and Kidney

The physiological relationship between the heart and kidney concerns (a) the interdependence between heart fire and kidney water and (b) the interdependence between heart blood and kidney essence.

Interaction of the heart and kidney (心肾相交 xīn shén xiang1 jiaō): The heart belongs to fire in the five phases and is located in the upper burner; the kidney belongs to water and is located in the lower burner. In the five phases, water restrains fire. In yīn-yáng theory, fire and water and upper and lower are yīn-yáng pairs; they are rooted in each other and mutually restraining. What is in the lower body should ascend, while what is in the upper body should descend. Therefore, heart fire, that is, heart yáng, is expected to descend to the kidney, while kidney water, that is, kidney yīn, is expected to ascend to the heart. If the kidney is deprived of heart fire, water becomes cold; when the heart is deprived of kidney yīn, fire becomes intense. The heart needs the moistening and enriching influences of kidney yīn, and the kidney needs the warmth of heart fire. Therefore, we say that the heart and kidney interact. This is also expressed in five-phase terms as fire and water interact (水火相交 shuǐ huo3 xiang1 jiaō) or the heart and kidney help each other (水火相济 shuǐ huo3 xiang1 jì).

A breakdown of this relationship, called noninteraction of the heart and kidney, most commonly arises when kidney yīn is insufficient and fails to nourish heart yīn, allowing heart fire to grow intense. For this reason, it is also called water failing to help fire. It can also arise when heart fire stirs and saps, that is, damages kidney yīn. In either case, noninteraction of the heart and kidney manifests in kidney signs such as tinnitus and limp aching lumbus and knees, together with heart signs such as heart vexation and insomnia.

Water qì intimidating the heart: When kidney yáng is depleted, it can fail to perform its function of governing water. This most commonly takes the form of weakness of the steaming function that manifests in long voidings of clear urine. However, in some cases, the kidney’s qì transformation function and opening and closing action is impaired, so that waste fluid is not properly discharged in the form of urine but tends to accumulate and seep out into the skin to cause puffy swelling most pronounced in the lower body, together with short voidings of scant urine. This is called yáng vacuity water flood or kidney vacuity water flood. In this event, water accumulating within the body can affect the heart, overburdening heart yáng, causing heart palpitation and shortness of breath. This is called water qì intimidating the heart.

Blood and essence: The heart governs blood; the kidney stores essence. Blood and essence are mutually convertible.

Insufficiency of heart blood can cause insufficiency of kidney essence; insufficiency of kidney essence can cause insufficiency of heart blood. In both cases there are heart signs such as lusterless complexion and heart palpitation, together with kidney signs such as tinnitus and limp aching lumbus and knees.