The pattern of deficiency of both heart and spleen refers to a general term for a group of symptoms caused by the depletion of heart blood and damage to spleen qi, leading to the lack of nourishment of the heart spirit, weakness of spleen qi, and inability to control blood. It is often caused by excessive contemplation, improper diet, post-illness maladjustment, chronic bleeding, and so on.

The main clinical manifestations include: palpitation, forgetfulness, insomnia, dreamfulness, shallow yellow complexion, reduced appetite and fatigue, abdominal distension and fullness, loose stool, shortness of breath and timidity, or subcutaneous bleeding, women's menstrual irregularities, light-colored and excessive menstruation, menorrhagia and metrostaxis, or scanty menstruation and amenorrhea, pale and tender tongue texture, white coating, and thin and weak pulse.

The pattern of deficiency of both heart and spleen is commonly seen in various diseases such as "deficiency fatigue", "palpitation due to fright and severe palpitation", "insomnia", "forgetfulness", "vertigo", "bleeding", and so on.

This syndrome should be differentiated from "spleen qi deficiency pattern", "heart qi deficiency pattern", "pattern of heart-lung qi deficiency", and "spleen-lung qi deficiency pattern".

bubble_chart Differentiation and Treatment

The clinical manifestations and treatment methods of the pattern of deficiency of both heart and spleen vary across different diseases.

1. In "deficiency fatigue," the pattern of deficiency of both heart and spleen is characterized by the deficiency of zang-fu organs. Symptoms include palpitations, forgetfulness, insomnia, dreamfulness, dull complexion, poor appetite, fatigue, weak and thin pulse, pale tongue texture, and thin tongue coating. This is often caused by irregular diet, improper eating habits, and damage to the spleen and stomach qi, leading to the inability to generate and transform essential substances and produce qi and blood. Insufficient qi and blood fail to harmonize the five zang and six fu organs internally and nourish the nutrient-defense Jingmai externally. Spleen qi deficiency worsens, the source of transformation diminishes, heart blood becomes increasingly deficient, and the disease tendency deepens. Treatment should focus on tonifying and replenishing the heart and spleen, using Returning to Spleen Decoction (Jisheng Fang).
2. In "palpitation due to fright severe palpitation," the pattern of deficiency of both heart and spleen is characterized by palpitations, dull complexion, dizziness, blurred vision, pale red tongue, and weak and thin pulse. This is often caused by excessive thinking and overstrain, which injure the heart and spleen. Overthinking damages the spirit, depletes heart blood, and affects the spleen and stomach's ability to generate and transform, leading to deficiency of both qi and blood. This results in palpitations and a sense of discontinuity. Treatment should focus on tonifying the spleen and replenishing qi, tonifying blood, and nourishing the heart, using Four Ingredients Decoction (Hejiju Fang) combined with Celestial Emperor Heart-Tonifying Pill (Shiyi Dexiao Fang).
3. In "insomnia," the pattern of deficiency of both heart and spleen is characterized by dreamfulness, easy awakening, and restless sleep. This is often caused by overthinking and overstrain, which injure the heart and spleen, deplete yin blood, and lead to the failure of the mind to stay in its abode. The spleen's inability to generate and transform essential substances results in blood deficiency, leading to insomnia. Zhang Jing-yue said, "Excessive overthinking and overstrain will inevitably lead to blood depletion and loss of spirit, causing insomnia." Leizheng Zhicai also said, "Overthinking injures the spleen, damaging spleen blood, leading to chronic insomnia." Treatment should focus on tonifying and replenishing the heart and spleen, using Returning to Spleen Decoction or Heart-Nourishing Decoction (Zhengzhi Zhunsheng).
4. In "forgetfulness," the pattern of deficiency of both heart and spleen is characterized by forgetfulness accompanied by insomnia. This is often caused by excessive worry and overthinking, which injure the heart and spleen, leading to unclear mental abode. Sanyin Fang said, "The spleen governs intention and thought. Intention is the memory of past events, while thought involves the heart's activities. When the spleen is diseased, the intention abode becomes unclear, and the heart spirit becomes restless, leading to forgetfulness and the inability to recall things despite great mental effort." Treatment should focus on nourishing blood, tonifying qi, tranquilizing the mind, and calming the spirit, using the tonifying qi and calming spirit decoction (Zabing Yuanliu Xizhu).
5. In "vertigo," the pattern of deficiency of both heart and spleen is characterized by vertigo accompanied by pale complexion, dull lips and nails, mental fatigue, reduced appetite, and susceptibility to fatigue. This is often caused by internal damage from overstrain and deficiency of both heart and spleen. Heart deficiency leads to poor blood circulation, while spleen deficiency results in a weak source of generation and transformation. Treatment should focus on nourishing blood and regulating the nutrient system, using Ginseng Nourishing Pill (Hejiju Fang).
6. In "bleeding," such as epistaxis, bloody stool, hematuria, subcutaneous bleeding, and menorrhagia and metrostaxis in women, the pattern of deficiency of both heart and spleen is characterized by heavy bleeding, pale red blood, palpitations, shortness of breath, dull complexion, and pale lips and nails. This is often caused by heart and spleen deficiency, where the heart fails to control blood and the spleen fails to manage blood. Treatment should focus on tonifying the heart and spleen, replenishing qi, and controlling blood, using Returning to Spleen Decoction with modifications.

The pathological changes of this syndrome primarily involve the heart and spleen, often manifesting as deficiency of both qi and blood. If qi deficiency is predominant, it tends to lean toward spleen deficiency; if blood deficiency is predominant, it tends to lean toward heart deficiency. In the evolution of the disease mechanism, blood deficiency may progress to involve yin, leading to deficiency of both qi and yin in the heart and spleen. In addition to palpitations, severe palpitations, mental fatigue, and lack of strength, symptoms such as dry mouth, sore throat, afternoon tidal fever, flushed face, and feverish sensation in the palms and soles may appear. Severe cases may result in qi deficiency and blood collapse, presenting with severe palpitations, pale complexion, profuse sweating, and a faint, almost imperceptible pulse, requiring urgent attention.

bubble_chart Differentiation of Similar Patterns

1. Spleen qi deficiency pattern and pattern of deficiency of both heart and spleen: Spleen qi deficiency pattern is often caused by dietary irregularities, overstrain leading to internal damage, or excessive vomiting and diarrhea. It can also result from the influence of other diseases, such as liver qi overacting on the spleen. Clinically, it is characterized by impaired spleen function, insufficient production of qi and blood, and lack of nourishment to the muscles of the limbs. Symptoms include anorexia, abdominal distension and fullness after eating, loose stools, shortness of qi, reluctance to speak, emaciation, fatigue in the limbs, shallow yellow complexion, pale tongue with white coating, and weak pulse. Treatment should focus on tonifying qi and strengthening the spleen. On the other hand, the pattern of deficiency of both heart and spleen, while showing symptoms of spleen qi deficiency, differs in that the former is located in the spleen and emphasizes qi deficiency, while the latter involves both the heart and spleen. Therefore, it not only exhibits signs of spleen qi deficiency but also includes manifestations of heart qi and blood deficiency, such as palpitations, forgetfulness, insomnia, and dreamfulness. Treatment should focus on nourishing the heart and spleen qi and blood.
2. Heart qi deficiency pattern and pattern of deficiency of both heart and spleen: Heart qi deficiency pattern is often caused by prolonged illness leading to physical weakness, sudden illness damaging yang and depleting qi, aging with weakened organ qi, or congenital deficiency. Clinically, it is characterized by palpitations, shortness of breath that worsens with activity, spontaneous sweating, mental fatigue, pale tongue with white coating, and irregular or weak pulse. The pattern of deficiency of both heart and spleen, however, is caused by excessive worry and overstrain. Clinically, it is characterized by symptoms of heart blood insufficiency and spleen qi deficiency. Although both syndromes involve palpitations, the pattern of deficiency of both heart and spleen, due to the accompanying heart blood insufficiency, often includes forgetfulness, insomnia, and dreamfulness, which are different from the palpitations and shortness of breath that worsen with activity seen in heart qi deficiency pattern. Additionally, the pattern of deficiency of both heart and spleen must include symptoms of spleen qi deficiency, such as reduced appetite, fatigue, abdominal distension and fullness, and loose stools; or symptoms of spleen failing to control blood, such as nosebleeds, bloody stools, hematuria, subcutaneous bleeding, menstrual irregularities, and menorrhagia and metrostaxis. The former should be treated by tonifying qi and nourishing the heart, while the latter should focus on nourishing both the heart and spleen.
3. Pattern of heart-lung qi deficiency and pattern of deficiency of both heart and spleen: The lungs govern qi, the heart governs blood, qi commands blood, and blood nourishes qi. The pattern of heart-lung qi deficiency is often caused by excessive overstrain or prolonged illness with coughing and wheezing, which depletes the qi of the heart and lungs. Clinically, it is characterized by lung qi deficiency and impaired heart blood circulation, leading to palpitations, shortness of breath, coughing, wheezing, chest tightness, spontaneous sweating, lack of strength, worsening with activity, pale or dull complexion, even cyanosis of the lips, dull tongue texture or with ecchymosis, and weak pulse. Treatment should focus on tonifying and replenishing the heart and lungs. This is easily distinguishable from the pattern of deficiency of both heart and spleen, which is characterized by heart blood depletion and spleen qi deficiency.
4. Spleen-lung qi deficiency pattern and pattern of deficiency of both heart and spleen: Although both syndromes exhibit symptoms of spleen qi deficiency, such as fatigue, reduced appetite, abdominal distension and fullness, and loose stools, the spleen governs transformation and transportation, while the lungs govern regulation and management. When both spleen and lung qi are deficient, food cannot be transformed into essence, and water metabolism is impaired, leading to internal phlegm-dampness. Therefore, the former must include symptoms such as coughing, wheezing, excessive thin white phlegm, facial and foot swelling, fear of cold, and timidity, while the latter, due to heart blood insufficiency, must include palpitations, forgetfulness, insomnia, and dreamfulness, making them easy to distinguish.

AD

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

bubble_chart Documentation

1. Danxi Xinfa‧Palpitation due to fright severe palpitation》: "Zheng Zhong is due to blood deficiency, severe palpitation occurs without any specific time, mostly seen in those with less blood. It can be triggered by overthinking, belonging to deficiency. When it occurs intermittently, it is due to phlegm stirred by fire."