Under normal circumstances, the heart and kidney primarily maintain a relationship of mutual interaction and balance, akin to the interplay of water and fire. If due to innate deficiencies, prolonged illness leading to deficiency fatigue, or excessive sexual activity, the kidney water becomes deficient below and fails to nourish the heart fire above, the heart fire becomes hyperactive above and cannot descend to interact with the kidney. Alternatively, excessive mental strain or overactivity of the five minds may lead to the hidden depletion of heart yin and the hyperactivity of heart yang, preventing the heart fire from descending to interact with the kidney. This results in the heart fire not descending and the kidney water not ascending, leading to a failure of the heart and kidney to maintain their water-fire balance, thus forming a pathological condition clinically referred to as "heart-kidney non-interaction pattern."

The main clinical manifestations include: irritability, insomnia, dreamfulness, seminal emission, soreness and weakness in the lower back and legs, tidal fever with night sweats, dizziness, blurred vision, tinnitus, or palpitations, or dry throat, or frequent urination at night, a red tongue texture, little or no tongue coating, and a thin, rapid pulse.

This symptom and sign are commonly seen in conditions such as "palpitation due to fright or severe palpitation," "insomnia," "seminal emission," and "forgetfulness."

In clinical diagnosis, it should be differentiated from "heart fire hyperactivity pattern," "heart yin deficiency pattern," "pattern of deficiency of both heart and spleen," "pattern of qi deficiency in heart and gallbladder," and "liver-kidney yin deficiency pattern."

The symptoms of heart-kidney non-interaction pattern vary across different diseases.

1. In cases of palpitation due to fright and severe palpitation, the main symptoms include restless palpitation triggered or worsened by fright, insomnia due to irritability, a red tongue with scant coating, and a thin, rapid pulse. Associated symptoms may include vexing heat in the chest, palms, and soles, soreness and weakness in the lower back and knees, dizziness, blurred vision, and tinnitus. This is caused by a deficiency of kidney essence, leading to an inability of water to nourish fire, resulting in internal stirring of heart fire. Treatment should focus on nourishing yin and blood, clearing the heart, and tranquilizing the spirit. The recommended formulas are Celestial Emperor Heart-Tonifying Pill(Shiyi Dexiao Fang) combined with Cinnabar Sedative Pill(Dongyuan Shishu‧Differentiation of Internal and External Injuries);
2. if vexing heat in the chest, palms, and soles, and soreness and weakness in the lower back and knees are prominent, Six-Ingredient Rehmannia Pill(Xiao'er Yaozheng Zhijue) combined with Cinnabar Sedative Pill may also be used.
3. In cases of seminal emission, the characteristic symptom is nocturnal emission during dreams, accompanied by dizziness, blurred vision, lack of energy, fatigue, palpitation, or short, yellow, and hot urine; the tongue is red, and the pulse is thin and rapid. This is often caused by excessive desires, unfulfilled wishes, restlessness of the heart spirit, hyperactivity of monarch fire, hidden consumption of heart yin, and frenetic stirring of ministerial fire, disturbing the semen chamber and mingmen. This results from excessive heart fire and deficient kidney water, leading to non-interaction between the heart and kidney, and a failure of water and fire to nourish each other. Treatment should focus on enriching yin and draining fire (nourishing kidney yin and draining monarch and ministerial fire). The recommended formulas are Anemarrhena, Phelloendron and Rehmannia Pill(Yifangkao) or Heaven, Human, and Earth Marrow-Retaining Pill(Weisheng Baojian) with modifications. However, for such conditions, relying solely on medication is insufficient; attention must also be paid to mental cultivation and clearing the heart of desires. Zhang Jing-yue said: "The onset of seminal emission is always rooted in the heart... When seeking treatment after the disease has developed, it is especially important to prioritize mental discipline, followed by syndrome-based regulation, which will inevitably lead to recovery. Those who do not understand the principle of addressing the root cause and rely entirely on medication will rarely achieve success."
4. In cases of insomnia, the main symptoms include restless insomnia, dreamfulness, vexing heat in the chest, palms, and soles, dry mouth with scant saliva, accompanied by dizziness, tinnitus, and palpitation; the tongue is red, and the pulse is thin and rapid. This is caused by overstrain and internal damage, leading to insufficient kidney water and excessive heart fire. Treatment should focus on strengthening water to control fire, enriching yin, and clearing heat. The recommended formula is Coptis and Ass Hide Glue Decoction(《Treatise on Cold Damage》) combined with Cinnabar Sedative Pill with modifications; if symptoms of exuberant heart fire are prominent, Harmonic Interacting Pill(Hanshi Yitong) may be used; if yin deficiency is present without excessive fire, Celestial Emperor Heart-Tonifying Pill may be used.
5. In cases of forgetfulness, the main symptoms include forgetfulness, insomnia, palpitation, vexing heat, a red tongue, and a thin, rapid pulse, accompanied by soreness in the lower back, lack of strength, nocturnal emission, and tinnitus. This is caused by depletion of kidney essence and malnourishment of the heart spirit. Treatment should focus on enriching and tonifying kidney essence, nourishing the heart, and tranquilizing the mind. The recommended formula is Six-Ingredient Rehmannia Pill(Xiao'er Yaozheng Zhijue) with additions such as Sour Jujube, Schisandra Fruit, Milkwort Root, and Acorus.

AD

TCM's treatment of atopic dermatitis is more comprehensive, fundamental, non-toxic and effective than Western medicine's symptomatic treatment

In summary, heart-kidney non-interaction pattern manifests differently in various diseases, with distinct disease causes, mechanisms, and main symptoms. However, since it involves non-interaction between the heart and kidney, it must always include abnormal manifestations resulting from the failure of these two organs to nourish each other, which is the commonality.

bubble_chart Differentiation of Similar Patterns

1. Heart fire hyperactivity pattern and heart-kidney non-interaction pattern: Although both may present symptoms such as vexation, palpitation, and dreamfulness, heart fire hyperactivity pattern is often caused by emotional stagnation transforming into fire, internal stagnation of six excesses transforming into fire, excessive consumption of spicy foods, or overuse of warm and drying medications. The intense heart fire disturbs the mind, flares up to the mouth, and moves down to the small intestine. The manifestations are mainly dominated by excess fire, such as vexation with heat, bitter taste in the mouth, thirst, ulceration and pain of the tongue or aphtha, scanty and dark urine, or burning and painful urination, red tongue tip, and rapid pulse. On the other hand, non-interaction between heart and kidney is caused by overstrain, overacting of five minds, "yin deficiency below and fire excess above," which is "deficient fire." Symptoms include vexing heat in the chest, palms, and soles, tidal fever, night sweats, red tongue with little moisture, scant or absent tongue coating, thin and rapid pulse; or nocturnal emission, soreness and weakness of the waist and knees. The "fire" manifestations seen in these two syndromes are one of excess and one of deficiency, which is their fundamental difference.
2. Heart yin deficiency pattern and heart-kidney non-interaction pattern: Both exhibit signs of yin deficiency (such as dry mouth and throat, vexing heat in the chest, palms, and soles, tidal fever, night sweats, red tongue with little moisture, scant or absent tongue coating, thin and rapid pulse) and mental restlessness (such as palpitation, insomnia, and dreamfulness). However, their disease causes, locations, and symptoms also differ. Heart yin deficiency pattern is caused by constitutional weakness, post-illness debility, blood loss, or emotional stress depleting heart blood and heart yin. The disease location is in the heart, with insomnia not being very severe, characterized by dreamfulness, easy waking, and vexing heat in the chest, all due to yin failing to restrain yang. Heart-kidney non-interaction pattern is caused by overexertion or excessive fatigue. Insomnia is severe, with tossing and turning, even sleeplessness throughout the night; accompanied by lumbago, soreness and weakness of the waist and knees, seminal emission, dizziness, tinnitus, and other signs of kidney yin deficiency. Therefore, by combining disease causes and carefully examining the symptoms, distinguishing between the two is not difficult.
3. Pattern of qi deficiency in heart and gallbladder and heart-kidney non-interaction pattern: Pattern of qi deficiency in heart and gallbladder is caused by constitutional weakness, timidity of the heart and gallbladder, or sudden fright, emotional tension, damaging the heart and gallbladder. The vital qi of the liver and gallbladder is weak, wood failing to generate fire, leading to heart qi deficiency. The heart governs mental activity, and the gallbladder dominates decision-making. If the qi of the heart and gallbladder is deficient, one is easily startled by events, has nightmares and fears, and may even be unable to sleep alone; or wakes up startled from sleep, as if someone is about to capture them, with a pale tongue and wiry, thin pulse. As stated in "Shen's Book of Life Preservation": "Timidity of the heart and gallbladder, easily startled by events, chaotic dreams, and vexing insomnia." Although pattern of qi deficiency in heart and gallbladder also shares symptoms such as palpitation and vexing insomnia with heart-kidney non-interaction pattern, it is characterized by fear and unease, being easily startled by events, or a constant sense of apprehension, as if someone is about to capture them. Additionally, pattern of qi deficiency in heart and gallbladder often involves phlegm-heat, presenting with chest fullness, nausea, profuse phlegm, and greasy tongue coating, which are not seen in heart-kidney non-interaction pattern.
4. Pattern of deficiency of both heart and spleen and heart-kidney non-interaction pattern: The heart stores the spirit, and the spleen governs thought. Pattern of deficiency of both heart and spleen involves both the heart and spleen. It is often caused by excessive thinking and mental strain. Spleen deficiency fails to transform and generate essence, and blood deficiency is difficult to replenish; heart blood deficiency leads to fire failing to generate earth, causing spleen qi deficiency and decline, with no source for generation and transformation, further depleting the heart's qi and blood, thus forming deficiency of both heart and spleen. The key to differentiation lies in the simultaneous presence of symptoms of heart qi and blood deficiency and spleen deficiency with poor transportation. Although both pattern of deficiency of both heart and spleen and heart-kidney non-interaction pattern may present with palpitation, insomnia, and dreamfulness, pattern of deficiency of both heart and spleen includes symptoms of poor spleen transportation such as reduced appetite, abdominal distension and fullness, loose stools, fatigue, and lack of strength, which are generally not seen in heart-kidney non-interaction pattern. On the other hand, heart-kidney non-interaction pattern includes symptoms of kidney yin deficiency and exuberance of heart fire such as vexation, vertigo, tinnitus, soreness and weakness of the waist and knees, and seminal emission, which are not present in pattern of deficiency of both heart and spleen. Additionally, pattern of deficiency of both heart and spleen presents with a pale tongue, white coating, and thin, weak pulse, which differs from the red tongue with scant coating and thin, rapid pulse seen in heart-kidney non-interaction pattern. Therefore, distinguishing between the two is relatively easy.
5. Liver-kidney yin deficiency pattern and heart-kidney non-interaction pattern: The liver and kidney both reside in the lower energizer. The liver corresponds to Yi water, and the kidney corresponds to Gui water. Yi (liver) and Gui (kidney) originate from the same source. Kidney yin is the root of the body's yin essence. "The kidney governs water and receives the essence of the five zang-organs to store it." Kidney yin nourishes liver yin. If there is an inherent deficiency of kidney yin or excessive strain that damages true yin, water fails to nourish wood, and yin fails to restrain yang, leading to ascendant hyperactivity of liver yang. The main manifestations of liver-kidney yin deficiency pattern are: lumbago, soreness and weakness in the waist and legs, vexing heat in the chest, palms, and soles, tidal fever, night sweats, dizziness, blurred vision, tinnitus, irritability, discomfort in the chest and hypochondrium, a red tongue with scant coating, and a thin, wiry, and rapid pulse. The key points for differentiation are: in addition to symptoms of liver and kidney deficiency, there are symptoms of ascendant hyperactivity of liver yang such as dizziness, blurred vision, tinnitus, irritability, and discomfort in the chest and hypochondrium. Although the manifestations of kidney yin deficiency in heart-kidney non-interaction pattern share many similarities with liver-kidney yin deficiency pattern, symptoms of exuberance of heart fire such as vexation, palpitations, insomnia, and dreamfulness are unique to it. Additionally, heart-kidney non-interaction pattern does not exhibit obvious symptoms of ascendant hyperactivity of liver yang, which distinguishes it from the other.

AD

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

bubble_chart Documentation

1. 《清代名醫醫案精華‧王九峰醫案》："Five kinds of fluid deficiency, two fires blazing, water failing to nourish fire, yin failing to match yang. Due to excessive consumption of harsh medications in the past, kidney yin was injured, leading to symptoms such as severe palpitation and fright palpitations. Taking heart-nourishing medications is reasonable. However, treating the upper must seek the lower, and nourishing the sprout must water the root. The heart is the manifestation of the disease, while the kidney is the root of the illness. It is unnecessary to treat the heart; instead, focus on tonifying the kidney. Prepared Rehmannia Root, Chinese Yam, Cornus, Angelica Sinensis, Schisandra Fruit, and Cervi Deer-Horn Glue are made into pills. The heart is the abode of the monarch, and the kidney is the organ that stores water. Fire nature rises, while water nature moistens and purges. Water desires to ascend, and fire desires to descend. If water cannot rise, how can fire descend? When water and fire fail to interact, there is non-interaction between heart and kidney, resulting in mental confusion, floating pectoral qi, and pulsations in the virtual region. The pulse is soft, rapid, and spiritless, indicating palpitation due to fright and forgetfulness. The treatment should focus on strengthening water to subdue yang. American Ginseng, Poria, Angelica Sinensis, Cornus, Schisandra Fruit, Dodder Seed, Lycium Berry, and Platycladi Seed Chinese Yam are ground into powder, mixed with Unprocessed Rehmannia Root, Ophiopogon, and Atractylodes soft extract, and then combined with turtle and deer glue. Once dissolved, the mixture is formed into pills."
2. Gezhi Yulun ："In human life, the heart is fire, residing above; the kidney is water, residing below. Water can rise, and fire can descend. This continuous rise and fall never cease, thus life is sustained."
3. 《慎齋遺書》："Heart-kidney interaction relies entirely on the ascending and descending movements. The descent of heart qi depends on the ascent of kidney qi, and the ascent of kidney qi is due to the descent of heart qi. ... The ascending and descending movements are water and fire, and what drives these movements are the true yin and true yang within water and fire. True yin and true yang are the vital qi within the heart and kidney. Therefore, the kidney's postnatal aspect is the heart's prenatal aspect, and the heart's postnatal aspect is the kidney's prenatal aspect. To tonify the heart, one must strengthen the kidney to allow the kidney to ascend. To tonify the kidney, one must calm the heart to allow the heart to descend. ... This is the method of harmonizing the heart and kidney."