| pattern | Heart-liver Blood Deficiency |
The pattern of heart-liver blood deficiency is a general term for a series of symptoms caused by the depletion of nutrient-blood and insufficient transformation source, leading to the loss of what the heart and liver store, resulting in mental restlessness and the malnourishment of the organs and tissues they govern. Its disease cause is mostly due to internal damage from overstrain, prolonged illness depleting nutrient-blood, or long-term bleeding can also cause it.
The main clinical manifestations are: dizziness, blurred vision, palpitations, severe palpitations, insomnia, forgetfulness, restless sleep at night, women may experience hypomenorrhea or amenorrhea, or convulsions in the hands and feet, a dull complexion, a pale tongue with thin coating, and a fine string-like or fine choppy pulse.
The pattern of heart-liver blood deficiency is commonly seen in diseases such as "insomnia," "palpitation due to fright," "deficiency fatigue," "vertigo," "convulsive disease," and "menstrual disease."
This syndrome should be differentiated from "heart blood deficiency pattern," "liver blood deficiency pattern," "liver yin deficiency pattern," and "pattern of deficiency of both heart and spleen."
bubble_chart Differentiation and Treatment
The heart governs blood while the liver stores blood. Therefore, any condition that leads to a deficiency of yin blood may affect the functions of the heart and liver, leading to this syndrome. Generally, the formation of the pattern of heart-liver blood deficiency is mainly due to internal damage from overstrain, which depletes the heart's nutrient-blood. The heart belongs to fire and the liver to wood. Insufficiency of heart blood leads to a disorder of the child-organ affecting the mother-organ, causing the liver to lose its storage function. Alternatively, insufficient production or chronic loss of blood can prevent the liver from storing blood, leading to the heart not being nourished by blood. Prolonged illness that damages yin blood can also cause the heart to lose its nourishment and the liver to lose its storage function, forming this syndrome. The clinical manifestations of this syndrome mainly reflect in three aspects:
- First, the common manifestations of blood deficiency, such as dizziness, palpitations, a dull complexion, scanty menstruation or amenorrhea, a pale tongue, and a thin pulse;
- Second, mental aspects, as the heart stores the spirit and the liver stores the ethereal soul, blood deficiency leads to the inability of the spirit and soul to be stored peacefully, resulting in symptoms like insomnia, forgetfulness, and restless sleep;
- Third, symptoms of malnutrition in the tissues and organs governed by the heart and liver, such as blurred vision, tinnitus, convulsions in the hands and feet, pale lips and nails, and scanty menstruation or amenorrhea in women.
- For example, in "insomnia," the clinical manifestations are characterized by restless sleep and numerous dreams at night, accompanied by symptoms like vertigo and palpitations. Because insufficient nutrient-blood leads to internal disturbance by deficient fire, there are signs of restlessness and insomnia, as mentioned in Jingui Yaolue as "deficiency fatigue causing restless sleep." Insufficient liver blood leads to the ethereal soul not being stored peacefully, resulting in numerous dreams and restlessness at night. Treatment should focus on tonifying blood and nourishing the liver, tranquilizing the mind, and calming the spirit, with Sour Jujube Decoction(Jingui Yaolue) as the main prescription. In "palpitation due to fright," the characteristics are restlessness and timidity, accompanied by dizziness, blurred vision, a dull complexion, and a thin or choppy pulse, or even intermittent pulse. This is mainly because the depletion of heart blood causes the spirit to be restless, leading to palpitations, and insufficient liver blood results in "fright," along with other signs of blood deficiency. The pulse, being the house of blood, becomes thin and choppy due to insufficient blood flow. If there is also deficiency of heart qi, there may be an intermittent pulse. Treatment should focus on nourishing blood to calm the heart and tranquilizing the mind to settle fright, using Celestial Emperor Heart-Tonifying Pill(《Shiyi De Xiao Li》) combined with Four Ingredients Decoction(Hejiju Fang) with modifications.
- In "deficiency fatigue," the pattern of heart-liver blood deficiency has more clinical manifestations, characterized by obvious signs of systemic blood deficiency, palpitations, dizziness, insomnia, tinnitus, blurred vision, poor appetite, abdominal distension, shortness of breath, and fatigue. In women, there may be hypomenorrhea or amenorrhea, a pale complexion, and pale lips, nails, tongue, and pulse, all indicating blood deficiency, with a prolonged course of illness. Treatment should focus on tonifying and replenishing the blood of the heart and liver while also tonifying the spleen and replenishing qi to aid production. Returning to Spleen Decoction(Furen Liangfang) combined with Four Ingredients Decoction can be used with modifications.
- In "vertigo," the heart-liver blood deficiency is characterized by frequent vertigo, dizziness, and worsening with fatigue, accompanied by other symptoms, due to blood deficiency failing to nourish the brain marrow. Angelica Blood-Tonifying Decoction(Neiwaishang Bianhuo Lun) combined with Blackend Swallowwort Root Decoction(Benshi Fang) can be used with modifications.
- The pattern of heart-liver blood deficiency in "convulsive disease" often occurs in individuals with a constitutional blood deficiency, or after blood loss or postpartum. It is caused by the depletion of nutrient-blood and the failure of the tendons and vessels to receive nourishment, leading to what is known as "blood deficiency producing wind." As Zhang Jing-yue stated, "Those with yin deficiency and blood deficiency cannot nourish the tendons and vessels, resulting in convulsions and spasms." The characteristic symptoms include convulsions of the limbs or hands and feet, often subtle and accompanied by dizziness, blurred vision, palpitations, a pale or sallow complexion, a pale tongue with little coating, and a thin, weak pulse. The treatment should focus on nourishing blood, pacifying the liver, extinguishing wind, and stopping convulsions. For mild cases, Liver-Tonifying Decoction(Yizong Jinjian) or Eight Precious Ingredients Decoction(Zhengti Leiyao) with added wind-extinguishing ingredients can be used. For severe cases, Major Wind-Stabilizing Pearl(Wenbing Tiaobian) with modifications can be applied.
It should be noted that the pattern of heart-liver blood deficiency is an aspect of the blood deficiency pattern. Since the heart, liver, spleen, and kidneys are all involved in the generation and transformation of nutrient-blood—such as the heart governing blood, the liver storing blood, the spleen being the source of nutrient-blood production and also controlling the blood vessels, and kidney essence being able to transform into nutrient-blood, as the saying goes, "the vitality lies in the kidneys"—blood deficiency is reflected as pathological changes in multiple zang-fu organs. Although the pattern of heart-liver blood deficiency primarily involves the heart and liver, it may also include pathological changes in other organs, especially the spleen. This is because spleen deficiency can lead to a failure in the source of transformation, preventing the essence of food and water from being transformed into nutrient-blood, thereby causing blood deficiency. If the spleen fails to control blood, it is prone to blood loss, further exacerbating the deficiency of heart and liver blood. Therefore, in the pattern of heart-liver blood deficiency, symptoms of spleen qi deficiency are often seen, such as anorexia, abdominal distension and fullness, loss of appetite, fatigue, and lack of strength. In treatment, while nourishing the blood of the heart and liver, it is often combined with tonifying the spleen and replenishing qi to support the source of transformation.
bubble_chart Differentiation of Similar Patterns- Heart blood deficiency, liver blood deficiency, and the pattern of heart-liver blood deficiency: All three syndromes are pathological changes caused by blood deficiency, involving the heart and liver. The heart governs blood while the liver stores blood, and there is a mother-child relationship between the two. The heart governs blood and houses the spirit, its brilliance is reflected in the face; the liver stores blood and houses the ethereal soul, its vitality is reflected in the nails. Both heart and liver blood deficiency can cause symptoms of restless spirit and insufficient nourishment of blood, such as palpitations, insomnia, forgetfulness, easy fright, blurred vision, dull complexion, stiffness of tendons, and pale nails, making it difficult to distinguish clinically. The difference lies only in the sequence of the disease course and the emphasis of the disease mechanism. For example, in heart blood deficiency pattern, the disease mechanism mainly affects the heart's function of governing mental activity, causing symptoms like palpitations and insomnia; while in liver blood deficiency, the focus is on a series of symptoms caused by insufficient nourishment of liver blood, especially the pathological changes in menstruation due to the emptiness of the Sea of Blood and the failure of the Chong and Ren meridians to nourish. The pattern of heart-liver blood deficiency includes both, with symptoms of restless spirit such as insomnia, dreaminess, and easy fright, as well as symptoms of insufficient liver blood nourishment like dizziness, blurred vision, pale lips and nails, limb convulsions, and menstrual disorders. The three are causally related, influencing each other closely. Either heart deficiency comes first, with the disorder of the child-organ affecting the mother-organ leading to liver blood deficiency, or liver deficiency is primary, with the disorder of the mother-organ affecting the child-organ causing insufficiency of heart blood. Ultimately, both can lead to deficiency of both the heart and liver. Clinically, attention should be paid to identifying the main symptoms, analyzing the disease development process to find the disease mechanism for treatment, adhering to the principle of treating the root cause of the disease.
- Liver yin deficiency pattern and the pattern of heart-liver blood deficiency: Liver yin deficiency pattern can also present symptoms like vertigo, dizziness, excessive dreaming at night, tinnitus, blurred vision, or limb stiffness and numbness, so it should be differentiated from the latter. In terms of disease cause and mechanism, both involve blood deficiency. However, heart-liver blood deficiency is mostly caused by overthinking and overstrain depleting nutrient-blood, while liver yin deficiency pattern is often due to insufficient kidney yin, failing to transform essence into blood and blood failing to nourish yin. Clinically, both have symptoms of liver blood deficiency. But liver yin deficiency pattern, besides the general symptoms of insufficient yin and blood nourishment, also has signs of deficiency heat due to yin deficiency leading to internal heat, such as dry mouth and throat, facial heat, afternoon cheek redness, red and dry tongue texture, and thin and rapid pulse. Especially, changes in the tongue and pulse are important markers to distinguish blood deficiency from yin deficiency.
- Pattern of deficiency of both heart and spleen and the pattern of heart-liver blood deficiency: Both syndromes can present symptoms of heart blood deficiency and restless spirit, such as palpitations, insomnia, dull complexion, and pale thin tongue, but their disease mechanisms differ. The former is caused by overthinking and overstrain depleting the heart and spleen, with spleen deficiency leading to poor transportation and transformation, resulting in insufficient source; the latter is caused by depletion of nutrient-blood, leading to insufficient nourishment of the heart and liver. Therefore, the key points for differentiation are: the pattern of deficiency of both heart and spleen has symptoms of spleen deficiency, such as anorexia, abdominal distension and fullness, loose stools, and lack of strength due to spleen deficiency failing to transport, or spleen failing to control blood may also cause bleeding symptoms; while the pattern of heart-liver blood deficiency has symptoms of insufficient liver blood, such as vertigo, blurred vision, restlessness, and easy fright due to insufficient liver blood nourishment, and may also present with hypomenorrhea or amenorrhea, and symptoms of blood deficiency producing wind like limb stiffness and convulsions. Of course, as previously mentioned, the pattern of heart-liver blood deficiency, like other blood deficiency syndromes, generally includes changes of spleen deficiency, so treatment should include tonifying the spleen and replenishing qi to support the source of transformation. However, it is different from the pattern of deficiency of both heart and spleen, which mainly focuses on tonifying and replenishing the heart and spleen.
- Zabing Guangyao‧Palpitation due to fright》: "There are cases where anger damages the liver, and cases where fright enters the gallbladder. The mother can cause the child to become deficient, leading to insufficiency of heart blood. Additionally, excessive desires and endless thoughts can deplete the heart spirit and unsettle the heart ruler. This is why treatment may originate from the liver and gallbladder."
