The pattern of heart-kidney yang deficiency refers to the insufficiency of yang in the heart and kidneys, the decline of life gate fire, and the loss of warmth, leading to the internal excess of pudendal coldness, blood stasis, and water-dampness stagnation, resulting in symptoms and signs. It is often caused by prolonged illness or overstrain internal damage.

The main clinical manifestations include: cold body and limbs, palpitation and severe palpitation, scanty urine and body swelling, fatigue and desire to sleep, cyanotic lips and nails, pale or cyanotic tongue texture, white and slippery tongue coating, and deep and faint pulse.

The pattern of heart-kidney yang deficiency is commonly seen in diseases such as "edema," "palpitation," "severe palpitation," and "chest impediment."

This syndrome should typically be differentiated from "kidney-yang deficiency pattern," "heart yang deficiency pattern," and "spleen-kidney yang deficiency pattern."

bubble_chart Differentiation and Treatment

The pattern of heart-kidney yang deficiency,

1. seen in diseases with edema, manifests as "yin edema." The swelling is severe, with water pathogens spreading throughout the body, and when pressed, the indentation does not rebound. Symptoms include cold limbs, fear of cold, palpitations, shortness of breath, chest tightness, and heart pain. The heart is the monarch fire, and the kidneys store the ministerial fire. Insufficiency of heart yang can lead to kidney yang deficiency, and when both heart and kidney yang are deficient, the life gate fire declines, causing water dampness to linger. Treatment should focus on warming and tonifying the heart and kidneys, unblocking water, and dispersing edema. The recommended formulas are Original-Qi Preserving Decoction (Jingyue Quanshu) combined with True Warrior Decoction (Shanghan Lun) with modifications.
2. The pattern of heart-kidney yang deficiency seen in "palpitation due to fright severe palpitation" is characterized by palpitations, shortness of breath, cold limbs, and edema. The palpitations are marked by a feeling of emptiness in the heart, being easily startled, and restlessness, especially with movement. This is often caused by insufficient yang qi and upward rebellion of water retention. Shanghan Mingli Lun states: "The retention of water is due to water stagnating below the heart. The heart governs fire and dislikes water. When water stagnates internally, the heart becomes restless, leading to palpitations." Treatment should focus on warming yang and excreting water, calming rebellion, and stabilizing palpitations. The recommended formulas are Poria, Cinnamon Twig, Bighead Atractylodes, and Licorice Decoction (Shanghan Lun) combined with Cold-Extremities Decoction (Shanghan Lun) or Cinnamon Twig, Licorice, Fossil Bone, and Oyster Shell Decoction (Shanghan Lun) with modifications.
3. The pattern of heart-kidney yang deficiency seen in "chest impediment" is often caused by insufficiency of heart yang, leading to weak circulation and blood stasis. Symptoms include severe palpitations, chest tightness or pain, a dark purple tongue with possible stasis spots, and a choppy or irregular pulse. Treatment should focus on warming yang to diffuse impediment, unblocking collaterals, and transforming stasis. The recommended formula is Immature Orange Fruit, Longstamen Onion Bulb, and Cinnamon Twig Decoction (Jingui Yaolue) with Magnolia Bark and Immature Orange Fruit removed, and Dried Ginger and Asarum added.

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This syndrome is often seen in individuals with a constitution of yang deficiency, the elderly, or those with long-term heart yang deficiency and kidney yang insufficiency. Due to yang deficiency, external cold is prevalent, leading to cold limbs and a preference for warmth. Yin exuberance and yang weakness result in a quiet and less active state. Yin resides internally, and yang guards it. When yang deficiency is not consolidated, external pathogens easily invade, leading to frequent common colds. Improper treatment or excessive sweating during a common cold can deplete heart yang, exacerbating the condition.

The heart is the ruler of the five zang and six fu-organs. When the heart is clear, the lower organs are at peace; when the heart is unclear, the twelve officials are in danger. The kidneys are the innate foundation, the root of the twelve Jingmai, and the source of primordial yin and yang. Therefore, further progression of heart-kidney yang deficiency, with yang weakness and yin exuberance, can lead to symptoms such as great dripping sweating, cold and clear sweat, fear of cold, curling up, cold limbs, unconsciousness, and a faint pulse on the verge of collapse. Emergency treatment should focus on restoring yang to save from collapse.

bubble_chart Differentiation of Similar Patterns

1. Kidney-yang deficiency pattern and pattern of heart-kidney yang deficiency: Kidney-yang deficiency pattern is due to insufficient primordial yang, impaired qi transformation, inability to warm, and internal excess of pudendal coldness. It is characterized by fear of cold, pale complexion, shortness of breath, cold and soreness in the lower back and knees, clear and abundant urine, or enuresis or ischuria, edema particularly severe in the lower body, male impotence, spermatorrhea, infertility, female leukorrhea with cold discharge, uterine coldness, infertility, or diarrhea before dawn, pale tongue coating, and deep, thin or deep, slow pulse at the chi position. The pattern of heart-kidney yang deficiency, in addition to the manifestations of kidney yang deficiency, also includes features of heart yang deficiency, such as palpitation, severe palpitation, chest tightness and pain, sudden onset of heart pain, cyanosis of the lips, purplish-dark tongue texture, and choppy or intermittent pulse, which should be differentiated.
2. Heart yang deficiency pattern and pattern of heart-kidney yang deficiency: Heart yang deficiency pattern develops from heart qi deficiency. It is often caused by chronic illness in the elderly, congenital insufficiency, or excessive sweating damaging yang. Clinically, it must present with insufficiency of heart qi accompanied by yang deficiency symptoms such as fear of cold, and impaired blood circulation, such as chest stuffiness and fullness, heart pain radiating to the back, pale or purplish-dark tongue, or with ecchymosis and petechiae, and a thin, weak or intermittent pulse. However, its "cold manifestations" are not as prominent as in the pattern of heart-kidney yang deficiency, and it does not present with edema in the lower body due to water-dampness retention, which are manifestations of kidney yang deficiency. These can be used for differentiation.
3. Spleen-kidney yang deficiency pattern and pattern of heart-kidney yang deficiency: Spleen-kidney yang deficiency pattern is clinically characterized by cold limbs, pale complexion, soreness and weakness in the lower back and knees, cold pain in the lower abdomen, diarrhea with undigested food or diarrhea before dawn, facial and limb edema, difficulty in urination, and even tympanites, with a pale and tender tongue, white and slippery coating, and a thin, weak pulse. It is often caused by kidney yang deficiency, decline of life gate fire, inability to warm and nourish spleen yang; or chronic spleen yang deficiency affecting the kidney, eventually leading to deficiency of both spleen and kidney yang qi. Its symptoms of cold limbs, fear of cold, facial and body edema, and difficulty in urination are quite similar to those of the pattern of heart-kidney yang deficiency. However, spleen-kidney yang deficiency pattern, due to the spleen's failure to warm and transport, leads to water turning into dampness and food turning into stagnation, thus easily causing diarrhea with undigested food or diarrhea before dawn, and even tympanites. In contrast, the pattern of heart-kidney yang deficiency, due to heart yang deficiency, often presents with chest tightness and pain, and palpitation, which are different from the former.

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bubble_chart Documentation

1. Zhengzhi Huibu:"When there is stagnant water and dampness affecting the heart, there will be a gurgling sound in the chest, and the flow of deficient qi; as the water rises to affect the heart, the heart fire dislikes it, hence the heart beats rapidly, causing a feeling of discomfort, and the pulse is predominantly wiry."