3. Syndrome of Heart-Qi deficiency
Manifestations
Main symptoms
Palpitations, restlessness, shortness of breath on exertion, mental tiredness.
Secondary symptoms
Insomnia, sweating easily, anxiety, depression.
Tongue
Pale or dull-pale with a white coating.
Pulse
Restless and weak in general; particularly weak in the Heart position. In some cases, the pulse in the Heart position is slightly forceful at the superficial level but weak at the second and third levels.
Associated disorders in western medicine
Different types of heart disease, such as rheumatic heart disease, arrhythmia; diseases of the circulatory and nervous systems, conditions where low blood pressure, anxiety and depression are present.
Analysis of the syndrome
The Heart-Qi has a close relationship with the Spleen-Qi as the Spleen-Qi is the source of the Qi in the different organs after one is born. The condition of the Heart-Qi is also directly influenced by the Heart-blood. Since an important function of the Heart is to govern the blood circulation, the relationship between Qi and blood in the Heart is very close from the start. It can be described as the Qi guides the blood and the blood carries the Qi. Thus the function of the Heart-Qi depends on sufficient blood. The Qi and the blood are generated by each other and they gain support from each other. Since the Heart houses the shen, a normal mental state and activities depend on sufficient Heart-Qi and Heart-blood.
Heart-Qi deficiency is often seen in conditions of Spleen-Qi deficiency and acute or chronic blood deficiency.
• If the Qi is too weak to promote blood circulation, palpitations start.
• If the Heart-Qi is not able to support the Lung-Qi in the Upper-Jiao, patients will have shortness of breath on exertion and will sweat easily.
• If the Heart-Qi is too weak to support the Heart-shen, patients may suffer from anxiety, restlessness, restless sleep and waking up frequently during the night, and may have a weak and restless pulse.
• When the Heart-Qi is too weak to stimulate the blood circulation, the color of the tongue turns to purple and the pulse does not flow freely.
(See Figure 5.3 on page 189 .)
Treatment principle: Tonify the Heart-Qi, nourish the Heart-blood, regulate the blood circulation and calm the mind
Herb selection principles and formula composition strategies
• First, herbs that are sweet, slightly warm and pungent, enter the Heart and Spleen meridians, and have a function of tonifying the Heart-Qi are selected.
• Second, herbs that are sweet and slightly warm, enter the Heart, Spleen and Liver meridians, are able to nourish the blood, calm the mind and improve sleep are often selected.
• Third, herbs that promote the Qi movement and blood circulation so as to maintain the proper function of the Heart are often used.
Structure of the formula and selection of herbs
Chief: Tonify the Heart-Qi directly
Ren Shen ( Ginseng radix) or Dang Shen ( Codonopsis radix)
Both Ren Shen and Dang Shen are sweet in nature and enter the Spleen and Lung meridians. They can directly tonify the Spleen-Qi and can therefore generate the Heart-Qi. They can tonify the Lung-Qi as well, which stimulates the blood circulation and influences the function of the Heart. They are often selected in the formula as chief to tonify the Heart-Qi. Compared with Dang Shen, Ren Shen is warm; as it also tonifies the Source-Qi, its function of tonifying the Heart-Qi is stronger than that of Dang Shen. However, some patients cannot bear its strong tonification and the symptoms of restlessness and insomnia can get worse. Dang Shen is sweet and neutral. It can gently tonify the Heart-Qi, does not have the side effects of Ren Shen, and is suitable for chronic conditions.
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is sweet and slightly warm, which are the principal properties of herbs that can tonify the Qi. It enters all the ordinary meridians, can tonify the Qi, moderate the speed of Qi and blood, and harmonize the functions of the internal organs. It is particularly selected in the formula with a large dosage as chief to calm the mind and relieve the palpitations and restlessness caused by Heart-Qi deficiency.
Long Yan Rou ( Longanae arillus)
Lou Yan Rou is a sweet and neutral fruit. It enters the Heart and Spleen meridians and can gently tonify the Spleen-Qi, the Heart-Qi and the blood. At the same time, it can calm the mind and treat restlessness, anxiety and insomnia. As this sweet fruit is neither cloying nor dry in property, it can be used in the diet for chronic conditions.
Deputy: Tonify the blood and generate the Heart-Qi
Wu Wei Zi ( Schisandrae fructus)
Wu Wei Zi is sour and warm, and enters the Lung, Heart and Kidney meridians. It has no function to tonify the Qi, but it can stabilize the Heart-Qi, especially when it is used with tonifying herbs. This herb is especially effective to treat palpitations, shortness of breath after exertion and sweating due to weakness of the Heart-Qi.
Fu Shen ( Poriae cocos pararadicis)
Fu Shen is neutral and bland, and enters the Heart and Spleen meridians. It is able to tonify the Heart-Qi and Spleen-Qi and calm the mind, thereby treating restlessness and insomnia. Since it is neutral and bland, and gentle in property and action, it is often used in the diet for chronic conditions of Heart-Qi deficiency.
Suan Zao Ren ( Ziziphi spinosae semen)
Suan Zao Ren is sweet, sour and neutral, and enters the Heart and Liver meridians. It nourishes the blood of the Heart and Liver and improves sleep. It is very useful in formulas to treat restlessness and insomnia caused by blood deficiency.
Mai Men Dong ( Ophiopogonis radix)
Mai Men Dong is sweet and cold, and enters the Heart, Lung and Stomach meridians. Although it is often used to nourish the Yin and reduce heat, it has a gentle function of tonifying the Qi of the Heart and Lung. It is a perfect choice in a formula when both the Qi and Yin are deficient.
Assistant: Calm the mind
Long Chi ( Mastodi fossilia dentis), Fu Shen ( Poriae cocos pararadicis) and Xiao Mai ( Tritici semen)
These three substances are all able to calm the mind. Of the three, Long Chi is the strongest and is used in acute conditions; Fu Shen can be used over a longer period of time and it can also gently tonify the Spleen-Qi; Xiao Mai is cold in temperature and it is principally used to treat restlessness with irritability when there is slight excess heat or empty-heat in the Heart.
Sheng Di Huang ( Rehmanniae radix) and Xuan Shen ( Scrophulariae radix)
The stable relationship between the Heart and Kidney is important in maintaining the normal mental state. It is described as the Heart-fire descends to the Lower-Jiao to warm the Kidney-water; and the Kidney-water ascends to the Upper-Jiao to calm the Heart-fire. Both herbs are cold in nature and enter the Heart and Kidney meridians. They are able to nourish the Heart-Yin and reduce the excess fire and empty-fire there. They are often chosen in formulas to treat restlessness and palpitation caused by Yin deficiency with heat in the Heart.
Chuan Xiong ( Chuanxiong rhizoma), Gui Zhi ( Cinnamomi cassiae ramulus) and alcohol
When the Heart-Qi is too weak to stimulate the blood, blood stagnation may appear, thus directly causing palpitations and restlessness.
Chuan Xiong is warm and pungent, and enters the Heart and Liver meridians. It is called a Qi moving herb in the blood.
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