Heart – Fire

From the Daoist classic, Contemplations by the Huainan Masters (Huainanzi, ca. 110 B.C.:

The heart is the ruler of the five organ networks. It commands the movements of the four extremities, it circulates the qi and the blood, it roams the realms of the material and the immaterial, and it is in tune with the gateways of every action. Therefore, coveting to govern the flow of energy on earth without possessing a heart would be like aspiring to tune gongs and drums without ears, or like trying to read a piece of fancy literature without eyes.

From the Daoist classic, Guanzi, prior to 200 B.C.:

The heart is the emperor of the human body. Its subordinate officers are in charge of the nine orifices and their related functions. As long as the heart remains on its rightful path, the nine orifices will follow along and function properly. If the heart’s desires become abundant, however, the eyes will lose their sense of color, and the ears will lose their sense of sound. Thus it is said: ‘Keep your heart empty-this is the art of the heart through which the orifices can be mastered.’

Deviation above will necessarily cause malfunction below. Do not race your heart like a horse, or you will exhaust its energy. Do not fly your heart like a bird, or you will injure its wings. Never frantically move things around just for the sake of seeing what will happen. If you move things around you dislocate them from their proper place. If you will be calm and patient, everything will come to you by itself.

The Dao is never far away, yet it may be hard to reach. It is within every one of us, yet it may be hard to grasp. If we stay clear of desires, the shen will enter its home. If we sweep away all impurities, the shen will stay with us. Human beings all crave intelligence and wisdom, but rarely do we try to understand what the source of their existence is. Alas, intelligence, intelligence-even if you jump over the ocean, it will not just sit there waiting for you! The seeker will be limping behind the one who is without desires. The sage does not seek anything, and thus naturally achieves the state of vacuous understanding [ultimate knowledge apart from fixed concepts].

From Li Ting, A Primer of Medicine (Yixue Rumen, 1575:

The heart is the master of the body and the emperor of the organ networks. There is the structural heart made from blood and flesh: it has the shape of a closed lotus flower and is situated underneath the lung and above the liver. And there is the luminous heart of spirit-shen-which generates qi and blood and thus is the root of life. It is the source of all our bodily parts and functions, yet it does not manifest in obvious signs and colors. Just when you want to define it and say ‘here it is,’ it is gone; whenever you forget about it, however, it comes closer to you than ever. This is why it is called the ‘vacuous spirit.’ Despite its elusive nature, shen commands our body’s every action and every part. Material form and luminous shen must therefore be looked upon as an interdependent pair, and we have to understand that diseases of the structural heart are always caused by unbalanced emotions such as depression, anxiety, obsession, or sadness, which open up a pathway through which noxious pathogens can enter.

From Li Yuheng, Unfolding the Mat with Enlightening Words (Tuipeng Wuyu, Ming dynasty, 1570:

The ancient book of definitions [Neijing] refers to the heart as the ruler of the human body, the seat of consciousness and intelligence. If we decide to nourish this crucial element in our daily practice, then our lives will be long, healthy, and secure. If the ruler’s vision becomes distracted and unclear, however, the path will become congested, and severe harm to the material body will result. If we lead lives that are centered around distracting thoughts and activities, harmful consequences will result.

The sage regards his/her body like a country: the heart is the ruler, and the jing and the qi are the citizens. If the heart does not abuse its superior position, if it remains centered and focused on the essential matters, the jing will flourish and the qi will be steady, noxious intruders will always be fought off, the dantian will be full with treasures, and every part of the body landscape will be light and at piece.

From Shen Jin’ao, Dr. Shen’s Compendium of Honoring Life (Shen Shi Zunsheng Shu, 1773:

All of the twelve channel networks obey the orders of the heart. The heart, therefore, is the ruler of the organ networks. Its position is south, its season is summer, and its nature is fire. The heart thus represents the principle that is referred to as the body’s imperial fire (jun huo). Its relationship to the other organs is hierarchical; not only do the twelve channel networks attune their respective qi [functions] to the directives of the heart, but they offer their entire jing [material essences] as tribute to nourish the heart.

The heart, therefore, is the root of life, the seat of shen, the master of blood, and the commander of the vessels. This elevated position is due to the omnipresence of shenshen resides within qi, and qi resides within jing. Only the heart’s jing is always abundant, enabling it to dispatch subordinate shens to the other four zang organs. Only the heart’s qi is always abundant, enabling it to draw the jing of the body into the six fu organs. These are the major functions of the heart.

The heart is connected to the kidney. The classic [Neijing] states: ‘The heart resides in the vessels. It rules the kidney network, not via a controlling position in the restraining circle of relationship between the organ networks [where the kidney actually restrains the heart], but simply because it is the general master of all organ networks. Before the heart fire can harmoniously blend with the kidney water, however, the kidney water must be sufficient. Otherwise the heart fire will flare out of control, and all kinds of heart and kidney ailments will arise.’

Due to this interdependent relationship between the heart and the kidney, there are two methods of nourishing and protecting the heart: First of all, there is the method of nourishing the heart qi directly, that is, via its own channel network. This means: do not burden yourself with depressing thoughts, do not get anxious about future events that may never happen, do not dwell on things that are well in the past-all of these emotions dissipate the brightness of shen. If we overextend our heart we will harm its qi. If this happens, the heart jing will also suffer damage, and the shen, consequently, will lose its abode. If we take a look at the doctrines of Confucius-do not will, do not strive, do not be inflexible, do not be egotistical-and his student Mencius-do not be self-righteous, do not expect things, do not force things-we see that the art of nourishing the heart had already been fully understood during the ancient times of Confucius and Mencius. Even though both masters never said much about medicine, they certainly understood how to nourish the heart.

Secondly, there is the option to foster the heart by nourishing its jing via the kidney network. This means: moderate your sex life and do not lust after women, otherwise your ministerial fire (xiang huo) will flare up and become unstable. If there is no protective maintenance of the kidney, the kidney jing will be harmed. If the kidney jing is harmed, then its qi will also suffer detrimental influences. Water, then, will be unable to restrain fire, yin will be unable to provide shelter to yang, and pathological water qi will enshroud the heart.

This is precisely what Master Xiangchuan meant when he said: ‘Jing can generate qi, and qi can generate shen; there is nothing greater than a healthy body brimming with ying [jing] and wei [qi]! A practitioner seeking to nourish life must first of all treasure his jing. If the jing is plentiful, there will be abundant qi; if qi is abundant, there will be abundant shen; and if shen is abundant, the body will be strong. Finally, if the body is strong, there will be no disease.’ The master physician Zhu Danxi (1282-1358), moreover, wrote once: ‘The kidney is in charge of bracing and storing, the liver is in charge of harmonizing the flow. Both organ systems contain ministerial fire, and at their upper end they are linked to the heart. The heart emperor represents fire-once aroused, it flares up. If the heart’s imperial fire flares up, the ministerial fire will also flare and the jing will naturally wander astray. This shows us that jing is braced by the kidney and activated by the liver, and that leakage of jing is usually initiated by the heart. If one of these networks loses its equilibrium, the other parts will be affected, too.’ What Xiangchuan and Danxi express so lucidly here represents the collective warning that the ancient masters of heart nourishment have issued since times immemorial. In sum, if the heart is not properly nourished, it will fall ill; if the kidney is not properly nourished, the heart will also fall ill.

The heart, moreover, is said to be in charge of blood; and blood is jing. Under normal circumstances there is a natural surplus of heart qi, but in the event that jing is harmed and blood is lost, the heart will become deficient. If blood is plentiful, therefore, our shen will be bright, but if the blood becomes exhausted our will power will become weak and muddled. Any situation of excess fire in the body involves a deficiency of blood; and blood deficiency, in turn, diminishes the beneficial functions of fire.

Is it then that these internal excess and deficiency conditions of the heart bear similarities to external imbalances such as fire stagnation or fire pathogens that saturate the atmosphere during certain times of the sixty year cycle of cosmic circulation? Indeed, both external and internal imbalances of this nature have to be counteracted by restraining one’s jing to sustain the qi, and by nourishing one’s yin to solidify the shen.

The Heart Network: Properties and Functions

1. The Heart contains shen

The term “shen,” frequently translated today as “spirit,” encompasses some of the most complex concepts of traditional Chinese medicine. In the Neijingshen is mentioned about 240 times. Traditionally, the term refers to the mechanism of change, the mystery of sudden and profound transformation, and the expression in a person’s face, particularly the eyes. When applied to the human body, the term describes a major part of what would be called physical vitality, mental activity, and spirit.

Three main functions are attributed to shen:

  1. mental activity (consciousness) as a manifestation of the central, albeit hidden, movement of shen. The ancient character shows a close affinity to the Big Dipper, which the Chinese viewed as the center of the universe. Shen, therefore, appears to be at the heart of all mental and physical activities, just as the Dipper appears to be the central pivot of the stars. As the Neijing puts it: “The heart is the emperor of the five zang and the six fu networks…; if the heart flares, then all of them will get out of line.” The heart, via the flame of shen that it harbors within, is therefore like a lantern in charge of illuminating the outside world; it is seen as the source of thought processes. Any thought or idea, the will to carry it out, mental focus, planning, and intelligence can thus be considered to be manifestations of shen;
  2. the seven emotional reactions (joy, anger, sadness, grief, fright, apprehension, worry) and their involuntary expressions (facial expressions, body movements, gestures, sighing, moaning, giggling, sobbing) are manifestations of shen; and
  3. the controlling and regulating effect of the heart over mental and physical properties that are classified as the five modes of operation (wushen): hunpoyizhi, and shen (this latter being the same term). Each of the modes is attributed to one of the five organ networks:
    hun refers to the self-awareness and self-control mechanism; associated with the liver;
    po refers to the body’s basic reactive instincts associated; with the lung;
    yi refers to the ability of thinking and remembering; associated with the spleen;
    zhi refers to the function of memory; associated with the kidney;
    shen refers to the function of processing all incoming sensory and intuitive information and supervising the body/mind reaction to it; associated with the heart.

When trying to comprehend the central aspects of Chinese medicine, it is extremely important to understand the dominant effect of the “immaterial shen” over the physical structure of the body. “If shen is strong,” one of the Neijing’s classic definitions reads, “the body will be strong; if we lose shen, the body will perish.” Just like the Dipper in the sky appears to regulate the movement of sun (yang) and moon (yin), shen commands the basic movement of bodily yin (blood) and yang (qi).

It can be said that shen operates beyond the realm of physical form; it always relies, however, on the continuous supply of the more dense and less refined qi and jing which constitute the material foundation of the body. The inter-relationship is as follows: the workings of shen rely on both pre- and postnatal jing-qi, while the movement and transformation of physical jing and qi, in turn, are controlled by shen.

Blood is a type of “jing“-the latter being a term that always refers to sticky refined body substances which comprise the fundamental yin essence of the body (bone marrow, sperm, vaginal fluids, blood, saliva, etc.). Blood is regarded as a particularly important element of the material basis for shen activity. Further, the blood vessels are an important extension of the heart. In Neijing terms: “The heart network includes the blood vessels, and the blood vessels house shen.” Extensive blood loss has a devastating affect: the afflicted person will be without shen-unconscious.

2.  The Heart governs the blood vessels

As long as the heart is in motion, blood circulates through the vessels; and as long as this is the case, a person is alive. The blood vessels constitute one of the structural aspects of the heart network. From an evolutionary point of view, the physical heart is actually a local elaboration of the blood vessels. In a human embryo, it is a network of primitive blood vessels that appears first. Only later are parts of this network modified to form the physical heart.

From a Chinese perspective, blood is primarily produced in the process of extracting food essence in the middle burner. The definitive section in the Neijing states:

The middle burner is located underneath the upper burner and is closely associated with the stomach. It is in charge of extracting qi from food, of discarding the dregs, of assimilating the vital fluids, of transforming them into the body’s own jing, and then transporting this final product up to the lung and eventually transforming it into blood which nourishes the entire body; there is no substance within the body that is more precious than this.

In other words, fluids and nutritive qi derived from food enter the blood vessels where they are further transformed and refined. This process is usually referred to as “turning [the fluids into] red [blood].” Other organs involved in the process of manufacturing blood are the kidney (transforms jing into blood) and the spleen/stomach (produce food essence). The liver regulates blood flow and blood storage (amount retained in the body) and is considered to be the other major blood organ. The heart circulates the blood.

Blood moves through the body in an open-ended circle, providing the material basis for all aspects of mental activity and all organ networks and their associated body layers (skin, muscles, tendons, and bones). In the original terms of the Neijing : “If the liver is supplied with blood, we can see; if the feet are supplied with blood, we can walk; if the hands are supplied with blood, we can grasp.” The pumping action behind this central cycle of life giving movement is governed by the heart.

3.  The heart reflects in the face

If the quality of heart blood is unblemished, the myriad of fine vessels in the face will be well supplied, and the person will present with a rosy and lustrous complexion. Chinese medicine, therefore, has traditionally regarded the face as a mirror of the condition of the heart. Again, the Neijing points out: “If the qi of the shaoyin hand (heart) network becomes obstructed, the blood vessels will cease to function. If the vessels cease to function, the blood will not move. If the blood does not move, the skin and body hair will lack nourishment. Thus the face will turn grey like lacquer and the blood will perish.”

The essential “looking” aspect of the four-fold system of Chinese diagnosis refers primarily to the observation of the face. Since the conditions of both blood and shen reflect here, the face can tell much about the general state of a person’s physical and emotional state. The Neijing’s “superior doctor”-also called shen (different character)-thus knows about the condition of a patient by looking at the face alone.

4.  Sweat is the fluid of the heart

In general, it can be said that the occurrence of sweat is controlled by the opening of pores that are managed by the body’s protective qi (wei qi). Sweat production, however, relies on the process of distilling pale fluid from the blood by “steaming” transformation. As is observed in the Neijing: “A person who has lost large quantities of blood does not sweat anymore, and the one that has lost large quantities of sweat does not have any blood anymore.”

Comprising a transformed blood material, sweat is therefore considered to be quite a precious substance in the Chinese tradition, while it is generally ignored, or simply considered a bothersome part of life, in the Western cultures. Oriental physicians usually shake their heads when told about Western health rituals that entail the frequent and deliberate secretion of sweat, such as weekly saunas or intense daily exercise schedules. On the other hand, it could be argued that people living in industrial societies tend to have a much richer diet than those living in traditional rural societies; for them, failing to sweat enough could lead to accumulation.

5.  The heart is paired with the small intestine

The organs, classified as zang and fu, are paired. While the zang organ serves as a residence (the shen resides in the heart) and a major transporter (the heart moves the blood) the fu organ serves only as a transfer station, temporarily storing material that is to be discharged. The heart is paired with the small intestine, interconnected by the luo vessels. The small intestine receives partially digested food residue from the stomach and proceeds with the process of digestion by separating it into “pure” and “impure” substances, thus providing its transfer functions. Pure essence is being recirculated to the spleen, which is in charge of transporting it to the five organ networks where it can be stored. Fluids reabsorbed from the dregs are being passed on to the bladder, which stores and expels surplus liquid from the body. Solid waste matter is transmitted to and expelled via the large intestine.

Some cases of burning urination (particularly if accompanied by symptoms of dark or red urine) are treated by clearing heat in the heart: this heat, transferred from zang to fu (heart to small intestine) is then carried to the bladder with the fluid wastes.

6.  The heart opens into the tongue

An internal branch of the heart channel connects with the tongue. The Neijing states: “The heart qi communicates with the tongue. If the heart is in a state of harmony, the tongue can distinguish the five essential flavors.”

The color of the tongue body reflects the condition of heart blood. A deep red or scarlet tongue, for instance, usually indicates the presence of toxic heat in the blood. At a severe stage, toxic heat may adversely affect shen and eventually cause loss of consciousness (as in the case of encephalitis or other febrile diseases). A pale tongue usually indicates blood deficiency.

Just as important in the context of heart-tongue relation is the second meaning of the Chinese term “xin” (heart), namely, center. In Chinese medical terminology, “xin” often refers to or at least implicates the stomach, since the epigastric region constitutes the structural center of the torso. We know that diseases of the structural heart often manifest as symptoms of stomach pain. Vice versa, stomach problems, such as ulcers, can both cause and be exacerbated by mental symptoms that in Chinese terms would be classified as a heart disorder. In clinical diagnosis, the physical tongue body serves as an indicator of the condition of the organs (especially the circulation through the organs), while the tongue coating serves as an indicator of the situation of the digestive system. Clinicians primarily seek information about the heart’s condition from the tip of the tongue where imbalances of the upper burner organs, lung and heart, may reflect.

7.  The pericardium is the protective screen of the heart

The pericardium or “heart protector” is said to be a shielding layer enveloping the heart. Just as an emperor is surrounded by a dense circle of intermediaries, the pericardium forms a network of finely meshed pathways around the heart through which both the heart’s qi and blood have to pass on their way to and from the far reaches of the body landscape. The pericardium is categorized as a separate organ, yet, as the heart’s last line of defense against invading pathogens, it clearly is an integral part of the extended heart network. The Neijing emphasizes: “If we talk about pathogens [evil] entering the heart, we always mean that the pathogens have advanced to the pericardium.” If pathogens would indeed advance to the actual innermost, where all mental and physical functions are conceived and coordinated, the result would be like that of foreign rebels advancing to the throne room of the imperial palace: demise of the country results.

The Heart Network: Pathogenesis

Obstruction of the Heart Orifice: At an advanced stage of pathology, heat pathogens may obstruct the pericardium and thus cause the orifice to the heart-the crucial opening through which the flame of consciousness illuminates the outside world-to become blocked. Typical symptoms are unrelenting high fever, loss of consciousness, and delirious talk. If the orifice of the heart becomes obscured by phlegm fire, epileptic seizures or outbreaks of madness may occur. It is important to note that the term “obstructed heart orifice” is not a label for common emotional disorders, but indicates an acute situation where all mental faculties are seriously impeded.

Lack of Nourishment to the Heart Shen: If heart yin, that is the basic material substance of the heart (heart blood), is deficient, a person’s shen will become deprived of the nourishment it requires and will be unable to rest. Symptoms of insomnia, confusion, memory loss, and other mental symptoms are possible results of this condition.

Obstruction by Phlegm-Rheum: If the heart yang, the flame of life, is deficient, water accumulates in the upper part of the torso and gives rise to a frequently occurring symptom complex that is referred to as “water qi intimidating the heart” (shui qi ling xin). Palpitations, edema, asthmatic breathing, pulmonary heart disease, and related conditions are typical manifestations of this situation.

Frenetic Blood Movement Due to Blood Heat: Exuberant heat in the internal “blood layer” can cause the blood to deviate from its proper course in the vessels, resulting in various kinds of hemorrhaging. If the yang vessels are harmed, bleeding occurs in the upper part of the body (nosebleed, vomiting of blood, expectoration of blood); if the yin vessels are harmed, bleeding occurs in the lower part of the body (blood in stool, urine, metrorrhagia). This type of pathology (heat, hyperactivity, affecting the blood) is also associated with the other blood network: the liver.

Blood Stasis: If blood stasis occurs in the vessels for prolonged periods of time, pathological or “dead” blood will form and severely impact both mental and physical aspects of the heart network. Prolonged or recurrent bleeding is also a major cause of blood stasis, which in turn may bring about further hemorrhaging. Blood stasis is also associated with the other blood network, namely the liver: inhibited flow of liver qi is most often responsible for blood stasis.

Blood stasis in the pericardium is a common cause of angina pectoris. Ancient texts frequently describe a heart attack (sudden chest pain, loss of voice, lips and face turn blue, hands and feet turn cold and blue) as a syndrome of “polluted blood attacking the heart.”

Heart Heat Manifesting in the Small Intestine: Imbalances of zang organs frequently manifest as symptoms in their associated fu network. Thus, heart heat may manifest as burning diarrhea with intestinal cramping or burning urination (often with dark or red urine) that represents transfer of heat from small intestine to bladder. Conversely, small intestine heat can result in heart symptoms such as restlessness or mouth ulcers.

Heart Disorder Affecting the Tongue: Deficiency of heart blood usually causes the tongue to take on a pale color. Mouth ulcers frequently arise from heart or small intestine heat. Stasis of heart blood often reflects in the form of purple spots in the tongue body or in the discoloration/malformation of the veins underneath the tongue. If heat toxins have invaded the pericardium, or if phlegm obscures the orifice to the heart, patients may lose control over their tongue. Stroke victims, for instance, often experience stiffness of the tongue resulting in the common post-stroke phenomenon of slurred speech.

Deficiency of Heart Yin (Blood): Besides the mental symptoms indicating a malnourished shen, there may be physical symptoms such as palpitations, dizziness, a pale face, dry skin and body hair, and a fine, weak, and often rapid pulse. Since the liver network is in charge of storing the blood, blood deficiency most commonly involves the liver.

Excessive Joy Injuring the Heart: Under normal circumstances, joy can relieve tension, stimulate the flow of qi and blood, and harmonize the (nutritive) ying and (protective) wei layers. If this particular emotion is exaggerated, however, the qi will disperse and shen will scatter. Intense and prolonged emphasis on joy, in other words, can impair a person’s focus and concentration. A person who has been giggling/laughing for a long time and now has a hard time stopping and regaining control, is, at least during this particular moment, without shen (that is unable to focus). In cases where the shen becomes so severely dispersed that it cannot find its way back to its physical “home,” madness may result. Shock causes the heart shen to become dispersed and all subordinated shen to deteriorate into a state of disarray. Typical manifestations of this problem are loss of consciousness, epilepsy, or dementia that have been induced by a shock (a frightful experience). Vice versa, a deficiency of heart qi can cause a person to be easily startled.

Represetative Substances for the Treatment of Heart Disorders

Nourish blood (bu xue): tang-kuei (danggui), salvia (danshen), rehmannia (dihuang), millettia (jixueteng).

Nourish the heart and pacify shen (yang xin an shen yang ): fushen (fushen), zizyphus (suanzaoren), biota (baiziren), succinum (hupo).

Tonify qi (bu xin yi qi): ginseng (renshen), polygala (yuanzhi), longan (longyanrou), baked licorice (zhi gancao).

Warm yang (wen yang yi qi): cinnamon bark (rougui), cinnamon twig (guizhi), aconite (fuzi), alpinia (yizhiren), (zishiying).

Astringe and tonify yin (lian yin): schizandra (wuweizi), cornus (shanzhuyu), peony (baishao), mume (wumei).

Purge fire (xie huo): coptis (huanglian), gardenia (zhizi).

Clear heart heat (qing xin): rhino horn (xijiao) or water buffalo horn (shuiniujiao), forsythia (lianqiao), and the “heart” portions of bamboo leaves (zhuye) and lotus (lianzi xin; lotus embryo).

Sedate the heart and settle shen (zhen xin an shen): cinnabar (zhusha), dragon bone (longgu), oyster shell (muli), magnetite (cishi), rust (sheng tieluo).

Open the orifice of the heart (kai qiao): borneol (bingpian), musk (shexiang), acorus (shichangpu), styrax (suhexiang).

Open the orifice by dispelling heat phlegm (huo tan): bamboo sap (zhuli), ox gallstone (niuhuang), bamboo resin (tianzhuhuang), bile treated arisaema (dan nanxing), fritillaria (beimu), pinellia (banxia).

Transform water rheum to calm the heart (hua yin ning xin): hoelen (fuling), atractylodes (baizhu), cinnamon twig (guizhi), akebia (mutong).

Move the blood (huo xue): persica (taoren), carthamus (honghua), cnidium (chuanxiong), achyranthes (niuxi).

Drive out blood stasis (zhu yu): leech (shuizhi), tabanus (mengchong), eupolyphaga (tubiechong), pteropus (wulingzhi).

Soften and dissipate masses (ruan jian): zedoaria (ezhu), sparganium (sanleng), anteater scales (chuanshanjia), turtle shell (biejia).

Stop bleeding (zhi xue): notoginseng (sanqi), bulrush (puhuang), bletilla (baiji), sanguisorba (diyu), cephanoplos (xiaoji), lotus nodes (oujie).

Cool the blood: red peony (chishao), raw rehmannia (sheng dihuang), moutan (mudanpi), lithospermum (zicao).

The Heart Network: Basic Guildelines for the Treatment of Heart Disorders

Although many blood disorders are treated via the liver, it is the heart that is officially considered to be the master of the vessels and their content. Blood disorders, therefore, are often associated with the heart. If blood heat causes eruptions or bleeding, the blood needs to be cooled. If blood cold causes stagnation and pain, the channels need to be warmed. In cases of bleeding, additional hemostatic measures can be applied, but it is imperative to first clearly differentiate the cause for the condition; blood heat, spleen qi deficiency, and blood stasis can all be potential causes.

Since the heart stores the shen, the label “heart disorder” often stands for situations where the shen cannot be properly stored. This primarily manifests in symptoms of mental agitation, such as insomnia, vivid dreaming, irritability, or hysteria. If the shen is agitated due to the presence of excess pathogens, the removal of the pathogens (heat, phlegm, stagnant blood) is often sufficient to settle an agitated shen. Often, however, it is a deficiency of heart blood-the material (yin) pool that keeps the volatile (yang) shen grounded-which is at the root of this condition. In this case, the blood must be nourished to restore the material basis of shen and give it a residence that it feels enticed to return to. To achieve a more immediate effect, it is advisable in both cases to include herbs that have a sedative action on the heart and thus directly settle the shen. Usually, substances with a settling affect are heavy in nature, such as cinnabar (zhusha), magnetite (cishi), oyster shell (muli), or dragon bone (longgu). A subdued heart can also cause a dispersal of shen focus, and a slow beating pulse can cause the blood to stagnate in the vessels; in such cases, it is necessary to invigorate the heart and vitalize the blood circulation.

Just like a bright fire burns pure and is not obscured by smoke, the heart and its light of consciousness remain pure unless pathogenic influences, such as impure qi or phlegm, block the heart orifice. If impure qi veils the flame of consciousness, herbs that expel impurity and open the orifice should be used. If blood stasis clogs the heart collaterals (vessels), then measures that drive out stasis and unblock the collaterals should be employed.

If the material basis of the heart, the heart yin and heart blood, are deficient, nourishing of yin and/or blood is indicated. If the force of the heart-the heart yang and heart qi-are deficient, yang should be warmed and qi should be tonified. In case that a heart yang deficiency has already caused pathological water and phlegm to accumulate, measures that support heart yang need to be accompanied by herbs that drive out water rheum and phlegm.

In case there are obvious signs of dispersed heart qi (palpitations, shortness of breath), deficient heart yin (sweating), or disturbed heart shen (inability to concentrate), sour flavors can be used to astringe the various substances of the heart. The famous turn of the century physician Zhang Xichun, for instance, often decocted large amounts of the sour fruit cornus (shanzhuyu) and gave it to patients in emergency situations to keep their shen qi from leaving the body. Most commonly, today, schizandra is used to astringe both heart yin and heart qi.

Bitter is the flavor with a direct affinity to the heart network, and thus should be used, but sparingly, in patients with heart problems. Bitter flavors have a drying effect, and, when used in large amounts, can have a potentially damaging affect on heart yin.

In a situation where the heart has transferred pathological heat to the small intestine, treatment should clear heart heat, descend fire, and guide out the heat via the lower burner.

In the treatment of all heart disorders, the network’s relationship to other systems needs to be taken into consideration. In deficiency situations, for instance, the “tonify the mother” rule applies; heart yin/blood deficiencies are thus primarily addressed by tonifying the liver yin/blood. Also of particular importance is the heart’s relationship to its upper burner neighbor, the lung. Since the heart is the lung’s controlling organ, heart pathology occasionally manifests in bloody (heart colored) phlegm. On the other hand, prolonged phlegm accumulation in the lung will eventually affect the heart, causing palpitations, chest pain, and pulmonary heart disease. In this situation, it is primarily the pathological water in the lung that needs to be addressed. Furthermore, the heart forms the shaoyin network along with the kidney. Since the heart is above and the kidney below, it is one of the critical physiological tasks to connect and mingle the energies of the heart and the kidney despite the natural tendency of water to flow down and fire to flare up. If the body’s polar water and fire networks fail to link up properly, symptoms of restlessness, insomnia, and other signs of the water organ failing to control the fire organ occur. In this case, the heart and the kidney need to be “reconnected” by clearing heart fire (descending heart fire) and steaming kidney water (ascending kidney water); an example is using a small amount of bitter coptis to reduce the heart fire with a small amount of hot spicy cinnamon to steam the kidney water.

The Heart Network: Typical Disease Patterns

HEART BLOOD DEFICIENCY (xin xue xu): primary symptoms are palpitations; pale and lusterless complexion. Secondary symptoms include insomnia; vivid dreaming; forgetfulness; tendency to easily get startled; dizziness; pale lips and nails. The tongue is typically pale; the pulse tends to be fine.

Representative Herbs: tang-kuei (danggui), cooked rehmannia (shu dihuang), salvia (danshen), peony (baishao), gelatin (ejiao), longan (longyanrou), zizyphus (suanzaoren), biota (baiziren), fushen (fushen), millettia (jixueteng).

Representative Formula: Tang-kuei Four Combination (Siwu Tang).

HEART YIN DEFICIENCY (xin yin xu): primary symptoms are palpitations; panic sensations; insomnia; vivid dreaming; dry mouth and throat; heat sensation in palms and soles. Secondary symptoms include forgetfulness; restlessness; tendency to easily get startled; flushed cheeks; dark urination; dry stools; tidal heat sensations; night sweats. The tongue is typically red with little coating; the pulse tends to be fine and rapid.

Representative Herbs: raw rehmannia (sheng dihuang), tang-kuei (danggui), ophiopogon (maimendong), salvia (danshen), lily (baihe), zizyphus (suanzaoren), biota (baiziren), polygonatum (yuzhu), polygonatum root (huangjing), (hehuanpi), fushen (fushen).

Representative Formulas: Ginseng and Zizyphus Combination (Tianwang Buxin Dan); Cinnabar Sedative Pills (Zhusha Anshen Wan).

UPFLARING HEART FIRE (xin huo shang yan): primary symptoms are restlessness; mouth ulcers; palpitations; insomnia. Secondary symptoms include heat sensation in the chest; flushed face; thirst; dark or red urine; constipation; and in serious cases, outbreaks of madness. The tongue typically presents with a red body or a bright red tip; the pulse tends to be forceful and rapid.

Representative Herbs: gardenia (zhizi), coptis (huanglian), ox gallstone (niuhuang), rhinoceros horn (xijiao), antelope horn (lingyangjiao), (lianzixin), scrophularia (xuanshen), raw rehmannia (sheng dihuang), forsythia (lianqiao), ophiopogon (maimendong), phragmites (lugen), lithospermum (zicao).

Representative Formulas: Purge the Heart Decoction (Xiexin Tang); Rehmannia and Akebia Formula (Daochi San).

HEART QI DEFICIENCY (xin qi xu): primary symptoms are palpitations accompanied by shortness of breath that get aggravated by physical activity; mental and physical fatigue; sensitivity to wind and drafts; spontaneous sweating. Secondary symptoms include stuffy sensation or dull pain in the chest; pale face color; shallow breathing; low voice and disinclination to talk. The tongue is typically pale; the pulse tends to be fine and weak or irregular.

Representative Herbs: ginseng (renshen), codonopsis (dangshen), astragalus (huangqi), cinnamon twig (guizhi), fushen (fushen), polygala (yuanzhi), baked licorice (zhi gancao).

Representative Formula: Nourish the Heart Decoction; Astragalus and Zizyphus Combination (Yangxin Tang).

HEART YANG DEFICIENCY (xin yang xu): primary symptoms are palpitations; shortness of breath that gets aggravated by physical activity; cold extremities; and general sensation of physical coldness. Secondary symptoms include sensation of stuffiness or pain in the chest; pale or ashen face color; shallow breathing; disinclination to talk; aversion to wind and drafts; spontaneous sweating; colorless urination; loose stools. The tongue typically presents with a pale body and a thin, white and moist coating; the pulse tends to be deep, forceless and slow, or fine and weak, or irregular.

Representative Herbs: cinnamon twig (guizhi), aconite (fuzi), dry ginger (ganjiang), polygala (yuanzhi), bakeri (xiebai), fushen (fushen), astragalus (huangqi), baked licorice (zhi gancao).

Representative Formulas: Cinnamon and Licorice Combination (Guizhi Gancao Tang); Protect the Source Decoction (Baoyuan Tang).

HEART QI AND BLOOD DEFICIENCY (xin qi xue liang xu): primary symptoms are palpitations; shortness of breath; insomnia; vivid dreaming; dizziness; pale or ashen face color. Secondary symptoms include mental and physical fatigue; spontaneous sweating; shallow breathing; disinclination to talk; pale lips and nails; dry and brittle hair. The tongue is typically pale and tender; the pulse tends to be fine and weak.

Representative Herbs: astragalus (huangqi), ginseng (renshen), codonopsis (dangshen), cinnamon twig (guizhi), fushen (fushen), baked licorice (zhi gancao), tang-kuei (danggui), cooked rehmannia (shu dihuang), peony (baishao), gelatin (ejiao), salvia (danshen), longan (longyanrou), millettia (jixueteng).

Representative Formulas: Tang-kuei and Ginseng Eight Combination (Bazhen Tang); Ginseng and Longan Combination (Guipi Tang).

HEART QI AND YIN DEFICIENCY (xin qi yin liang xu): primary symptoms are palpitations and shortness of breath that get aggravated by physical activity; insomnia; vivid dreaming; mental and physical fatigue; heat sensations in the palms and soles; pale face with flushed cheeks. Secondary symptoms include forgetfulness; spontaneous sweating or night sweats; low voice; dry mouth and throat; low-grade fever or heat sensation. The tongue typically presents with a red and tender body with little moisture and a thin white coating or little coating; the pulse tends to be fine or fine and rapid.

Representative Herbs: ginseng (renshen), pseudostellaria (taizishen), glehnia (bei shashen), polygonatum root (huangjing), astragalus (huangqi), baked licorice (zhi gancao), fushen (fushen), ophiopogon (maimendong), raw rehmannia (sheng dihuang), dendrobium (shihu), schizandra (wuweizi).

Representative Formulas: Baked Licorice Combination (Zhi Gancao Tang); Generate the Pulse Powder; Ginseng and Ophiopogon Formula (Shengmai San).

HEART BLOOD STAGNATION (xin xue yu zu): primary symptoms are palpitations and sensations of stuffiness and pain in the chest (pain is piercing or stabbing, comes and goes, or comes on suddenly; it may reflect into the left arm, shoulder, or upper back); in serious cases this condition may cause loss of consciousness, as may happen during a heart attack. Secondary symptoms include purplish discolorations on the face, lips, or nails; cold extremities; spontaneous sweating. The tongue typically presents with a purplish body or with purple spots on the sides or on top, the pulse tends to be hesitating or irregular, or in acute emergency cases may seem to be “on its way out.”

Representative Herbs: persica (taoren), carthamus (honghua), salvia (danshen), tang-kuei (danggui), cnidium (chuanxiong), red peony (chishao), curcuma (yujin), pteropus (wulingzhi), bulrush (puhuang), cinnamon twig (guizhi), chih-shih (zhishi), bakeri (xiebai), trichosanthes fruit (gualou), aquilaria (jiangxiang).

Representative Formulas: Persica and Achyranthes Combination (Xuefu Zhuyu Tang); Coronary Number II (Guanxin Er Hao); Pteropus and Bulrush Formula (Shixiao San) plus Chih-shih, Bakeri, and Cinnamon Combination (Zhishi Xiebai Guizhi Tang); for loss of consciousness, may have to include Ginseng and Aconite Combination (Shen Fu Tang).

WATER QI ENCROACHING ON THE HEART (shui qi ling xin): primary symptoms are palpitations; shortness of breath; coughing or asthmatic panting with clear phlegm; pale or ashen complexion; puffiness or edema. Secondary symptoms include dizziness; sensation of fullness in the epigastric region; panicky disposition; aversion to cold; cold extremities; mental and physical fatigue; sensation of upwards rushing qi; small amounts of clear urination. The tongue typically presents with a fat and pale body, toothmarks, and a slippery white coating. The pulse tends to be deep and fine, but often soft or slippery in the first (cun) positions.

Representative Herbs: cinnamon twig (guizhi), hoelen (fuling), atractylodes (baizhu), aconite (fuzi), dry ginger (ganjiang), alisma (zexie), polyporus (zhuling), akebia (mutong), astragalus (huangqi), codonopsis (dangshen).

Representative Formulas: Atractylodes and Hoelen Combination (Ling Gui Zhu Gan Tang); Vitality Combination (Zhenwu Tang); Hoelen Five Herb Formula (Wuling San).

ACUTE COLLAPSE OF HEART YANG (xin yang xu tuo): primary symptoms are acutely compromised mental faculties, and sudden onset of cold sweats and ice cold extremities. Secondary symptoms include palpitations; stuffy sensation in chest; blue lips; ashen face color; barely detectable voice; weak and shallow breathing. The tongue is typically pale or purplish; the pulse tends to feel as if being “on its way out.”

Representative Herbs: ginseng (renshen), aconite (fuzi), dry ginger (ganjiang), baked licorice (zhi gancao), bakeri (xiebai), cinnamon twig (guizhi).

Representative Formulas: Ginseng and Aconite Combination (Shen Fu Tang); Ginseng, Aconite, Dragon Bone, and Oyster Shell Combination (Shen Fu Long Mu Tang).

PHLEGM FIRE DISTURBING THE HEART (tan huo rao xin): primary symptoms are palpitations; restlessness; disturbed mental faculties; insomnia; vivid dreaming; red face; heavy breathing. Secondary symptoms include constipation; dark urination; mad or violent behavior; uncontrolled movements; hysterical crying or laughter; incoherent screaming or swearing. The tongue typically presents with a red body and a thick yellow and greasy coating; the pulse tends to be wiry, slippery, and rapid.

Representative Herbs: bamboo skin (zhuru), rhubarb (dahuang), coptis (huanglian), gardenia (zhizi), bile treated arisaema (dan nanxing), trichosanthes (gualou), ox gallstone (niuhuang), acorus (shichangpu), curcuma (yujin).

Representative Formulas: for less serious conditions, use Harmonize the Gallbladder Decoction with Coptis (Huanglian Wendan Tang); for more serious conditions, use Lapis Drive Out the Phlegm Pill; Lapis and Scute Formula (Mengshi Guntan Wan); for violent conditions, use Rusty Iron Shavings Formula (Sheng Tieluo Yin).

PHLEGM OBSCURING THE ORIFICE OF THE HEART (tan meng xin qiao): primary symptoms are acutely disturbed mental faculties or loss of consciousness. Secondary symptoms include fever; inability to speak; seizures; stuffy sensation in chest; body pain; sudden deafness; sounds of rattling phlegm or drooling sputum; thirst but no desire to drink. The tongue usually presents with a thick yellow and greasy coating; the pulse tends to be soft or slippery and rapid.

Representative Herbs: curcuma (yujin), acorus (shichangpu), polygala (yuanzhi), bamboo sap (zhuli), fritillaria (beimu), rhino horn (xijiao), gardenia (zhizi), coptis (huanglian), forsythia (lianqiao), bamboo leaf (zhuye), moutan (mudanpi), talc (huashi).

Representative Formulas: Acorus and Curcuma Decoction (Changpu Yujin Tang); Guide Out the Phlegm Decoction (Daotan Tang) plus orifice opening substances (acorus, curcuma, polygala); Great Treasure Pill; Rhinoceros and Amber Formula (Zhibao Dan).

HEAT INVADING THE PERICARDIUM (re xian xinbao): primary symptoms are high fever; clouded consciousness; delirious talk. Secondary symptoms include cold extremities; restlessness; fever blisters; eruption of macules; seizures; nausea. The tongue is typically scarlet red with a dry surface or a yellow coating; the pulse tends to be rapid or slippery and rapid.

Representative Herbs: ox gallstone (niuhuang), rhino horn (xijiao), curcuma (yujin), acorus (shichangpu), bamboo leaf (zhuye), (lianzixin), scrophularia (xuanshen), ophiopogon (maimendong).

Representative Formulas: Clear Heat in the Ying Layer Decoction (Qing Ying Tang); Ox Gallstone Pacify the Palace Pill; Bezoar and Curcuma Formula (Angong Niuhuang Wan); Purple Snow Pellet (Zi Xue Dan); Ox Gallstone Rectify the Qi Pill (Niuhuang Chengqi Wan).

HEART AND KIDNEY FAILING TO LINK (xin shen bu jiao): primary symptoms are restlessness; insomnia; vivid dreaming; palpitations; forgetfulness; spermatorrhea or premature ejaculation. Secondary symptoms include dizziness; tendency to easily get startled; ringing in the ears; tidal heat sensations; night sweats; sore and weak lower back and knees; dry throat; flushed cheeks; dark and scanty urination or nocturia; constipation. The tongue typically presents with a red body and little or no coating; the pulse tends to be fine and rapid.

Representative Herbs: raw rehmannia (sheng dihuang), asparagus root (tianmendong), ophiopogon (maimendong), scrophularia (xuanshen), salvia (danshen), schizandra (wuweizi), fushen (fushen), lotus seed (lianzi), anemarrhena (zhimu), coptis (huanglian), phellodendron (huangbai), cinnamon bark (rougui).

Representative Formulas: Coptis and Gelatin Combination (Huanglian Ejiao Tang); Connecting Pill (Jiaotai Wan).

Credit to: Heiner Fruehauf Ph. D



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