Heart-kidney yáng vacuity

A disease pattern chiefly characterized by heart palpitation or fearful throbbing; puffy swelling; scant urine; vacuity cold signs.

Description: Fear of cold and cold limbs; heart palpitation or fearful throbbing; oppression in the chest; panting; puffy swelling of the limbs; inhibited urination; lassitude of spirit and lack of strength; cold aching lumbus and knees; green-blue or purple lips and nails; pale purple tongue; glossy white tongue fur; weak pulse.

Diseases: Water swelling; heart palpitation; fearful throbbing; chest impediment.

Pathogenesis: Insufficiency of the yáng qì affecting both the heart and the kidney.

The kidney is the root of the yīn and yáng of the whole body. Kidney yáng vacuity can easily affect, and be affected by, the yáng qì of other viscera. Heart-kidney yáng vacuity is a common instance of this. It usually arises in one of two ways:

• enduring illness affecting both heart yáng and kidney yáng;
• kidney yáng vacuity leading to qì transformation failure, which causes water to gather (giving rise to puffy swelling) and ascend to the heart. This is called yáng vacuity water flood or kidney vacuity water flood, which can affect the lung or the heart. The specific pathomechanism of water flooding into the heart region is called water qì intimidating the heart.

Analysis of signs

• Kidney yáng vacuity: Fear of cold and cold limbs; cold aching lumbus and knees.
• Kidney yáng water flood: Puffy swelling especially of the lower limbs and inhibited urination.
• Heart: Heart palpitation or fearful throbbing, arising when water qì causes an added burden to heart yáng.
• Blood stagnation: Green-blue or purple lips, nails attributable to the reduced propelling action of yáng qì.
• Tongue: Dull with a slightly green-blue or purple hue and a white and glossy fur.
• Pulse: Sunken and faint.

Treatment

Medicinal therapy: Warm and supplement the spleen and kidney using fù zǐ lǐ zhōng wán (附子理中丸 Aconite Center-Rectifying Pill) or shí pí sǎn (实脾散 Spleen-Firming Powder). For heart palpitation or fearful throbbing, warm yáng and disinhibit water, settle counterflow and stabilize palpitation, use líng guì zhú gān tāng (苓桂朮甘汤 Poria, Cinnamon Twig, White Atractylodes, and Licorice Decoction) combined with sì nì tāng (四逆汤 Counterflow Cold Decoction). For water swelling, warm and supplement the heart and kidney, disinhibit water and disperse swelling using zhēn wǔ tāng (真武汤 True Warrior Decoction).

Acumoxatherapy: Base treatment mainly on back transport points, HT, KI, and CV. Select BL-15 (Heart Transport, 心俞 xīn shù), BL-23 (Kidney Transport, 肾俞 shèn shù), CV-14 (Great Tower Gate, 巨阙 jù què), CV-17 (Chest Center, 膻中 shān zhōng), GV-4 (Life Gate, 命门 mìng mén), CV-4 (Pass Head, 关元 guān yuán), PC-6 (Inner Pass, 内关 nèi guān), HT-7 (Spirit Gate, 神门 shén mén), KI-3 (Great Ravine, 太溪 tài xī), and KI-7 (Recover Flow, 复溜 fù liū); needle with supplementation and amounts of moxa.

Comparison: Heart-kidney qì vacuity: Heart-kidney yáng vacuity is a development of heart-kidney qì vacuity. It shares the same signs and differs by being more severe and by the additional presence of yáng vacuity external cold.

See heart yáng vacuity and kidney yáng vacuity.