Disorders of the Heart and Small Intestine

By Dr (TCM) Attilio D'Alberto, drawing on the classical TCM literature

In Chinese medicine (TCM), the Heart governs blood and the vessels, houses the Shen (mind/spirit), opens into the tongue and manifests in the complexion. The Small Intestine receives the transformed food from the Stomach and carries out the critical “separation of pure and impure”. Together they form the Fire-element Sovereign pair (in contrast to the Minister Fire pair of Pericardium and Triple Burner). The Su Wen, Chapter 8, names the Heart “the Emperor from whom the spirit illuminates” (jun zhu zhi guan, shen ming chu yan) — the organ that determines the quality of consciousness, the durability of sleep, the depth of emotional life and the rhythm of the circulating blood. Disorders of the Heart and Small Intestine cover the cardiovascular, the cardiac-rhythm, the psychiatric-emotional, the insomnia spectrum, the chronic anxiety presentations and the cognitive disorders of late life. This article presents the classical pattern differentiation and herbal treatment strategies for Heart and Small Intestine disorders, drawing on the Nei Jing, Zhang Zhongjing’s Shang Han Lun and Jin Gui Yao Lue, the Heart-Spleen scholarship of Li Dong-Yuan and Yan Yong-He, the Heart-Kidney axis tradition of Zhu Dan-Xi and Ye Tian-Shi, and Wang Qing-Ren’s blood-stasis revolution.

Top Chinese herbs for the Heart

The most clinically important Chinese herbs for the Heart and Small Intestine are:

1. Suan Zao Ren (Sour Jujube seed) — the principal herb for nourishing Heart blood and calming the Shen; the emperor of the great insomnia formula Suan Zao Ren Tang
2. Dan Shen (Salvia root) — moves Heart blood, breaks blood stasis, calms the Shen; the central herb of TCM cardiology
3. Yuan Zhi (Polygala root) — reaches the Heart through the Kidney, calms the Shen, resolves phlegm, restores Heart-Kidney communication
4. Bai Zi Ren (Biota seed) — nourishes Heart blood, calms the Shen, moistens the intestines; pairs with Suan Zao Ren in many insomnia formulas
5. Long Gu (Dragon Bone, fossilised mineral) — powerfully calms the Shen and astringes; central to anxiety-with-palpitations protocols
6. Mu Li (Oyster shell) — pairs with Long Gu to calm the Shen, soften hardness, astringe
7. He Huan Pi (Mimosa tree bark) — the “happy-tree-bark”; soothes the Liver and calms the Shen; specific for low mood and constraint with poor sleep
8. Wu Wei Zi (Schisandra fruit) — calms the Shen, astringes Heart qi and yin, restores Heart-Lung axis
9. Mai Men Dong (Ophiopogon tuber) — nourishes Heart yin and Lung yin, generates fluids, gently calms the Shen
10. Huang Lian (Coptis rhizome) — drains Heart fire, the principal herb for excess heat with restlessness, insomnia, mouth ulcers
11. Sheng Di Huang (Raw Rehmannia) — nourishes Heart and Kidney yin, cools the blood, the principal yin herb for empty heat insomnia
12. Dang Gui (Angelica sinensis) — nourishes Heart blood, moves blood, the principal blood herb where Heart-blood deficiency dominates

These herbs are combined into the classical formulas Gui Pi Tang (Restore the Spleen Decoction) for Heart-Spleen blood deficiency, Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart) for Heart-Kidney yin deficiency with restless Shen, Suan Zao Ren Tang for Liver-Heart blood deficiency with insomnia, Zhi Gan Cao Tang (Honey-Fried Licorice Decoction, also called Fu Mai Tang “Restore the Pulse Decoction”) for Heart-yang and yin deficiency with arrhythmia, Sheng Mai San (Generate the Pulse Powder) for Heart-Lung qi and yin deficiency, Wen Dan Tang for phlegm-heat harassing the Heart and Gallbladder, and Xue Fu Zhu Yu Tang for Heart blood stasis with chest pain. A qualified Chinese herbalist selects and modifies these formulas based on each patient’s individual pattern.

Heart functions: the Sovereign organ

The Su Wen, Chapter 8, opens the great organ-personality chapter with the statement: “The Heart is the Sovereign from which the bright spirit emerges”. The Heart is the “Emperor” in the classical organ-government metaphor — the organ that does not work the fields but whose stable, illuminated presence allows the work to be done. When the Heart is at peace, the other organs can carry out their functions; when the Heart is disturbed, the disturbance spreads through every system. Three core functions define the Heart in TCM theory.

Governing the blood and the vessels

The Heart “governs the blood” (zhu xue) and “governs the vessels” (zhu mai). It is responsible for the propulsion of blood through the vascular network and for the quality and rhythmic regularity of that propulsion. The pulse, in TCM diagnosis, is a direct read-out of Heart function: a strong, regular, evenly-spaced pulse indicates a healthy Heart; an irregular, intermittent, or knotted pulse indicates Heart disturbance. The Heart shares the production of blood with the Spleen (which extracts the Gu Qi from food) and the Kidney (which provides the foundational essence), but it is the Heart that imparts the “red” (chi) colour to the blood and the regular propulsive force. When this function fails, the manifestations include palpitations, chest pain, irregular pulse, pale or purple complexion, cold extremities (failure of propulsion), and in severe cases the collapse of consciousness associated with cardiac arrest. The Ling Shu, Chapter 18, states that “the Heart, when its qi is in harmony, the pulse is moderate and the spirit is settled; when the qi is disordered, the pulse is rapid or knotted and the spirit is restless”.

Housing the Shen

The Heart “houses the Shen” (cang shen). The Shen (神) is the most complex single concept in classical TCM — usually translated as “spirit” or “mind”, it covers the conscious awareness, the emotional life, the cognitive function, the quality of sleep, the sense of self-coherence, the social warmth in the eyes and voice. The Shen is the most refined of the five spiritual aspects (wu shen), and the only one based in a Yang organ rather than a Yin one (since the Heart, although a Zang, has Yang nature in the Fire element). The Shen rests in the Heart blood and Heart yin during sleep; if the Heart blood is insufficient, the Shen has nowhere to rest, and the patient cannot fall asleep or maintain sleep. If the Heart yin is depleted, an empty heat develops that further agitates the Shen, producing the chronic anxiety, vivid disturbing dreams and night-time hot palms and soles characteristic of advanced Heart yin deficiency.

Shen disturbance presents along a spectrum from mild (intermittent insomnia, transient anxiety, low mood) through moderate (chronic insomnia, persistent anxiety with palpitations, depression with palpitations and chest oppression) to severe (mania, psychotic agitation, dissociation, sustained mood-cycling, loss of contact with reality). Classical TCM recognised this spectrum and provided distinct treatment strategies for each level. The Ming-dynasty physician Zhang Jing-Yue, in Jing Yue Quan Shu, summarised the principle: “In all disorders of the Shen, first identify whether the substance (blood, yin) is deficient or whether a pathogen (fire, phlegm, blood stasis) is harassing; tonify what is empty and clear what is excess, and the Shen will settle”.

Opening into the tongue and manifesting in the complexion

The Heart “opens into the tongue” (kai qiao yu she) and “manifests in the complexion” (qi hua zai mian). The tongue, as the “sprout of the Heart”, reflects Heart function in its colour (red in Heart fire, pale in Heart blood deficiency, purple in Heart blood stasis), in its tip (the tip especially mirrors the Heart), in any sores or ulcers on the tongue body (Heart fire or Heart-Kidney disharmony), and in the clarity of speech (slurring speech and difficulty articulating thoughts can be Heart-Shen disturbance). The complexion, in particular the colour of the face, reflects Heart blood: a healthy rosy complexion indicates good Heart function; a pale complexion suggests Heart blood deficiency; a purple-tinged complexion (especially purple lips) suggests Heart blood stasis; a flushed red face suggests Heart fire or Heart yang rising.

Small Intestine functions: the Receiver of the Transformed

The Su Wen, Chapter 8, names the Small Intestine “the official who receives the transformed and brings about transformation”. The Small Intestine receives the partially digested food and fluid descended by the Stomach and carries out the most clinically important Small Intestine function: the “separation of pure and impure” (fen bie qing zhuo). The pure essence is sent up to the Spleen for transformation into Qi and Blood; the pure fluid is sent down to the Bladder (with Kidney transformation) for excretion as urine; the impure solid is sent on to the Large Intestine. This separation function gives the Small Intestine its unique clinical role: when it fails, urine and stool quality both change in characteristic ways (watery diarrhoea with scanty urine, or scanty hot dark urine with normal stool).

The Heart-Small Intestine couple

The Heart and Small Intestine are paired through an Interior-Exterior channel relationship and as the Sovereign Fire couple of the Five Elements. The pair is reciprocal: Heart Fire descends through the channel to support Small Intestine digestion; when Heart Fire is excessive (anxiety, alcohol, spicy food, sleep deprivation), it overflows into the Small Intestine through the channel pathway and presents as scanty, dark, burning urine (the classical Xin Yi Re Yu Xiao Chang — “Heart shifting heat to the Small Intestine”). Conversely, deficient Small Intestine cold can fail to anchor Heart Fire downward, producing irritability and insomnia. The classical TCM linkage between mouth ulcers (Heart Fire) and burning urination (Small Intestine Heat) is one of the most clinically useful and historically robust diagnostic pairings.

Heart Qi deficiency

Heart Qi deficiency (xin qi xu) is the foundational deficiency pattern of the Heart and is particularly common in the elderly, in convalescent patients, in chronic illness, in chronic Lung disease (Lung-Heart Qi deficiency), and in post-acute-illness states. Symptoms include palpitations — particularly on exertion, which is the cardinal sign; shortness of breath on exertion; spontaneous sweating, especially over the precordium; pale complexion; quiet voice; reluctance to speak; fatigue; tendency to feel apprehensive; and a soft, weak or empty pulse, particularly in the left cun (Heart) position. The tongue is pale and may be slightly enlarged.

Treatment strategy: Tonify the Heart Qi (bu xin qi). The foundational formula is Yang Xin Tang (Nourish the Heart Decoction) or, when Heart-Lung Qi deficiency dominates, Sheng Mai San (Generate the Pulse Powder) from Li Dong-Yuan’s tradition. Sheng Mai San uses just three herbs: Ren Shen (or Dang Shen as a daily substitute) to tonify the Lung-Heart Qi; Mai Men Dong (Ophiopogon) to nourish the Lung-Heart yin; Wu Wei Zi (Schisandra) to astringe the leaking Qi and yin. The formula is beautifully balanced and is used internationally in injectable form (Sheng Mai injection) as cardiac support in modern Chinese hospital practice for post-MI recovery, congestive heart failure and chemotherapy-induced cardiomyopathy. The acupuncture points HT 5 (Tongli), PC 6 (Neiguan), BL 15 (Xinshu, Heart Back-Shu), CV 17 (Shanzhong) and CV 4 (Guanyuan) tonify the Heart Qi through both the channel and the back-shu pathway.

Heart Yang deficiency

Heart Yang deficiency (xin yang xu) is the deeper form of Heart Qi deficiency — not merely deficient energy, but cold-deficient energy. It is particularly common in the elderly, in chronic congestive heart failure, in chronic ischaemic heart disease, and as a consequence of prolonged use of cooling and clearing herbs in patients whose constitution did not warrant them. Symptoms include palpitations on the slightest exertion, severe shortness of breath, cold extremities (particularly cold hands), aversion to cold, intermittent precordial pain or pressure, a tendency to chest oppression that worsens with cold weather, oedema (the failure of Heart Yang to move fluid), pale or purple lips and tongue, and a deep, slow, faint or knotted pulse. The tongue body is pale, swollen and may have a wet white coating.

Treatment strategy: Warm and tonify Heart Yang (wen bu xin yang). The defining formula is Gui Zhi Gan Cao Tang (Cinnamon Twig and Licorice Decoction) from Zhang Zhongjing’s Shang Han Lun — just two herbs in a 4:2 ratio that warms the Heart yang directly. For more substantial deficiency, expand to Bao Yuan Tang (Preserve the Source Decoction), which adds Ren Shen, Huang Qi and a small dose of Rou Gui. Where the cold features are severe with cold sweating and risk of yang collapse, the foundational rescue formula is Si Ni Tang (Frigid Extremities Decoction) from the Shang Han Lun — Fu Zi (Aconite) + Gan Jiang + Zhi Gan Cao — one of the great rescue formulas of classical TCM and routinely used in modern Chinese hospitals for circulatory collapse.

Heart Yang collapse

Heart Yang collapse (xin yang bao tuo) is the acute emergency state of the previous pattern. It is the TCM picture of cardiogenic shock, severe vasovagal syncope, acute decompensated heart failure, and the final stages of life-threatening illness. Symptoms include profuse cold sweating, gasping shallow breath, cyanosis of lips and extremities, marked extreme cold of the limbs, dramatically faint pulse (sometimes imperceptible at the wrist), and impaired consciousness up to coma. This is a medical emergency requiring conventional resuscitation; TCM treatment runs alongside, with the rescue formulas Shen Fu Tang (Ginseng and Aconite Decoction) and Si Ni Tang administered as fast as possible. Modern Chinese hospital practice routinely uses Sheng Mai Injection and Shen Fu Injection in cardiogenic shock and post-cardiac arrest, with controlled-trial evidence supporting their use as adjunctive measures.

Heart Blood deficiency

Heart Blood deficiency (xin xue xu) is the most common cause of insomnia, palpitations and anxiety in clinical TCM practice. It is particularly common in women (who lose blood with each menses), in patients with chronic illness, after surgery or significant blood loss, in vegan / vegetarian patients without adequate protein and iron support, and in chronic stress with poor sleep (which deplete the blood). Symptoms include palpitations (especially at rest in the evening), insomnia — particularly difficulty falling asleep with running thoughts, but also frequent waking through the night with vivid dreams; poor concentration, forgetfulness, dizziness on standing, pallor of face and conjunctiva, blurred vision, anxiety with a quality of insecurity rather than agitation, and the classical “dream of being chased” that signals an unsettled Shen on a depleted Blood base. The tongue is pale and thin; the pulse is thready and choppy, particularly in the left cun.

Treatment strategy: Nourish Heart Blood and calm the Shen (yang xue an shen). The classical foundational formula is Gui Pi Tang (Restore the Spleen Decoction) by the Song-dynasty physician Yan Yong-He, modified by Xue Ji in the Ming dynasty. The genius of Gui Pi Tang is that it does not directly tonify Heart blood — it tonifies the Spleen (the source of post-natal Blood production) plus adds the Shen-calming and Heart-nourishing herbs Suan Zao Ren + Yuan Zhi + Long Yan Rou + Dang Gui. This treats the root and the branch together: the Spleen as the source of Heart blood production, and the Heart-blood already depleted needing direct nourishment. Gui Pi Tang is one of the most clinically important formulas in TCM practice for insomnia with anxiety, post-natal depression, anaemia-related fatigue and the chronic-fatigue / functional-overload presentations.

Where the insomnia features dominate without significant Spleen Qi deficiency, the alternative formula is Suan Zao Ren Tang from Zhang Zhongjing’s Jin Gui Yao Lue. The original indication is “deficient agitation with inability to sleep” — the picture of the lying-awake-with-thoughts-spinning that anyone with chronic stress will recognise. Suan Zao Ren nourishes the Liver and Heart blood and calms the Shen; Zhi Mu (Anemarrhena) clears the mild empty heat that has developed; Chuan Xiong (Szechuan lovage) moves the qi and blood; Fu Ling calms the Shen via the Spleen; Gan Cao harmonises. This is a beautiful small formula and one of the most reliable insomnia prescriptions in classical Chinese medicine.

The acupuncture combination HT 7 (Shenmen, “Spirit Gate”), PC 6 (Neiguan), SP 6 (Sanyinjiao), BL 15 (Xinshu), BL 17 (Geshu, Influential Point of Blood), CV 17 (Shanzhong) and Yintang is the standard acupuncture combination for Heart blood deficiency. HT 7 is the “Spirit Gate” — the principal acupuncture point for calming a disturbed Shen and one of the most commonly needled points in TCM clinical practice worldwide.

Heart Yin deficiency

Heart Yin deficiency (xin yin xu) is the deeper substance deficiency — not merely insufficient blood, but depleted yin (the cool, moistening, anchoring substance). It is particularly common in perimenopausal and post-menopausal women, in chronic sleep deprivation, in chronic stress with sustained sympathetic over-drive, after febrile illness, and in patients on long-term stimulant medications. Symptoms include palpitations (particularly at night), insomnia with restless turning and vivid disturbing dreams, easy waking with difficulty returning to sleep, sweating during sleep (the classical night sweats of yin deficiency), hot palms and soles and a flushed sternum, dry mouth at night, dry red tongue particularly at the tip, sometimes ulceration of the tongue tip, mood swings with predominant anxiety, restless agitation, and chronic feeling of being “wound up” without obvious cause. The tongue is red, thin, dry; the tip may be redder than the body; the coating is scanty or peeled. The pulse is thready, rapid and may be irregular.

Treatment strategy: Nourish Heart yin and calm the Shen (zi yin an shen). The defining formula is Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart). The classical authorship is attributed to the Ming-dynasty physician Hong Ji (in some sources, to Sun Si-Miao of the Tang); the formula is a careful combination that addresses Heart yin deficiency from multiple directions. Sheng Di Huang (Rehmannia) is the emperor herb, nourishing Heart and Kidney yin; Xuan Shen (Scrophularia) supports the cooling of the empty heat; Tian Men Dong and Mai Men Dong nourish Lung and Heart yin; Dang Gui nourishes blood; Dan Shen moves Heart blood; Ren Shen tonifies Heart qi; Wu Wei Zi astringes the leaking yin; Yuan Zhi + Bai Zi Ren + Suan Zao Ren calm the Shen; Jie Geng guides the formula upward to the chest and Heart. The original formula contains cinnabar (Zhu Sha) for its Shen-calming action; modern practice (including my clinic) omits this on heavy-metal toxicity and welfare grounds, substituting Zhen Zhu Mu (Mother of Pearl) or He Huan Hua.

The acupuncture combination HT 6 (Yinxi, Xi-Cleft point for Heart yin), HT 7 (Shenmen), KD 3 (Taixi), KD 6 (Zhaohai), SP 6, CV 4 and Yintang nourishes the Heart-Kidney yin axis. Moxibustion is contraindicated. The Tang-dynasty physician Sun Si-Miao, in Qian Jin Yao Fang, wrote: “In chronic Shen disturbance, do not exhaust the patient with cold draining herbs — the empty heat is from emptiness; fill the emptiness and the heat will subside.”

Heart Fire blazing upwards

Heart Fire blazing (xin huo shang yan) is the excess heat pattern of the Heart. It is particularly common in alcohol-heavy, spicy-food-heavy, sleep-deprived and stress-driven patients. Symptoms include severe insomnia with restless agitation, vivid dreams sometimes with frank nightmares, marked irritability and rapid temper, palpitations, dry mouth with bitter or sweet taste, thirst for cold drinks, mouth and tongue ulcers (especially on the tongue tip), scanty dark hot painful urination (Heart Fire descending to the Small Intestine), constipation with dry stools, possibly skin manifestations (the classical “Heart fire to the skin” eruption: red painful eruptions like cystic acne, sometimes urticaria), and in severe cases manic agitation, racing thoughts and the loss of normal sleep entirely. The tongue is red, sometimes ulcerated at the tip; the pulse is rapid and full.

Treatment strategy: Drain Heart Fire (qing xin xie huo). The classical formula for Heart Fire descending to the Small Intestine is Dao Chi San (Guide Out the Red Powder) by Qian Yi (recorded in his paediatric text but used in adults universally): Sheng Di Huang nourishes the heart yin while cooling; Mu Tong (or its safer modern substitute Tong Cao) guides the heat down and out through urination; Sheng Gan Cao Shao (raw Licorice tips, with their channel affinity to the small intestine) reinforces the diuretic descent; Dan Zhu Ye (Lophatherum) clears Heart fire. The formula brilliantly treats both the Heart fire (insomnia, mouth ulcers, irritability) and its descent to the Small Intestine (hot painful urination) in a single elegant prescription.

For more severe Heart Fire with marked Shen disturbance, the classical formula is Xie Xin Tang (Drain the Epigastrium Decoction) which uses Da Huang, Huang Lian and Huang Qin in equal doses to drain heat from Heart and Stomach together. For Heart Fire causing severe anxiety and insomnia, the alternative is Zhu Sha An Shen Wan (Cinnabar Pill to Calm the Spirit) by Li Dong-Yuan — though again, my practice substitutes plant-only Shen-calming herbs (Zhen Zhu Mu, Long Gu, Mu Li) for the cinnabar component. The acupuncture combination HT 8 (Shaofu, Fire point of the Heart, drains Heart fire), HT 9 (Shaochong, the well point for emergency clearance), SP 6 and KD 3 drains Heart fire while protecting the Kidney yin underneath.

Heart and Kidney not communicating

The Heart-Kidney axis is one of the most clinically important concepts in TCM theory. The Heart (Fire above) and the Kidney (Water below) maintain a dynamic balance: the Heart Fire descends to warm the Kidney; the Kidney Water ascends to cool and anchor the Heart. When this circulation fails — whether from Heart Yin deficiency, Kidney Yin deficiency, severe sleep deprivation, chronic stress, prolonged febrile illness, sexual over-strain, prolonged use of stimulants, or the combination of stress and ageing — the result is “Heart and Kidney not communicating” (xin shen bu jiao). The Heart Yang is unrestrained above, producing flushing, hot face, severe insomnia, restless agitation, irritability, palpitations; the Kidney is unwarmed below, producing low back ache, urinary frequency, nocturia, cold lower body, low libido. The tongue is red at the tip but may have a pale base; the pulse is rapid in the cun positions but empty in the chi.

Treatment strategy: Re-establish communication between Heart and Kidney (jiao tong xin shen). The defining formula is Jiao Tai Wan (Grand Communication Pill), credited to the Ming dynasty: just two herbs in a 10:1 ratio of Huang Lian (Coptis) and Rou Gui (Cinnamon bark). The Huang Lian clears the unrestrained Heart fire; the small dose of Rou Gui warms the Kidney yang and draws the Heart fire back down to its proper home. The simplicity of the formula belies its mechanism — one of the most elegant in classical TCM pharmacology. For more substantial Heart-Kidney yin deficiency presentations, the formula expands to Tian Wang Bu Xin Dan as discussed above. The original classical formula for Heart-Kidney disharmony is Huang Lian E Jiao Tang from the Shang Han Lun, but modern practice (including my clinic) substitutes plant-based blood-nourishing herbs — Shu Di Huang, Dang Gui, He Shou Wu — for the E Jiao (donkey-hide gelatin), on conservation and animal-welfare grounds.

Heart Blood stasis

Heart Blood stasis (xin xue yu zu) is the Heart pattern that maps most directly onto Western cardiology, particularly to coronary artery disease, angina pectoris, post-MI states, congestive heart failure with ischaemic origin, and chronic ischaemic heart disease. The pattern is characterised by physical chest pain (the cardinal sign) — classically described as fixed in location, sharp or stabbing in quality, with possible radiation to the left arm, shoulder, jaw or back; the pain typically worsens with exertion or emotional stress and may be triggered by cold; palpitations, particularly with chest discomfort; cold extremities; cyanosis (purple lips, purple tongue, purple nail beds); shortness of breath on exertion; and the sense of chest oppression and pressure. The tongue is purple or has purple spots, especially at the tip; the sublingual veins are distended (the “clinical purple tongue” sign); the pulse is choppy, knotted, or intermittent.

Treatment strategy: Move Heart blood and resolve stasis (huo xue hua yu). The historical milestone in Heart blood stasis treatment was Wang Qing-Ren’s Yi Lin Gai Cuo (Correction of Errors in the Forest of Medicine, 1830). Wang Qing-Ren, in possibly the most important contribution to Qing-dynasty TCM, systematically observed clinical correlations between symptom patterns and post-mortem anatomical findings, deriving from this his series of region-specific blood-stasis formulas. Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) treats Heart and Lung blood stasis in the chest. The formula combines Tao Ren (Peach kernel) + Hong Hua (Safflower) + Dang Gui + Chuan Xiong + Chi Shao + Sheng Di Huang (the blood-moving and blood-nourishing core) with Chai Hu + Jie Geng + Zhi Ke + Niu Xi + Gan Cao to regulate the qi (since qi commands blood and the chest is where the qi most readily stagnates).

Modern Chinese cardiology has developed Wang Qing-Ren’s approach into a substantial evidence-base for angina and coronary heart disease. The injectable formulations Dan Shen Injection and Compound Dan Shen Injection (containing Dan Shen, Jiang Xiang, Sanqi) are routinely used in Chinese hospitals as adjunctive therapy for acute coronary syndrome, with multiple controlled trials showing benefit on symptom relief, ECG changes and short-term outcomes. The herbal formula Tong Xin Luo, developed in the 1990s, has been the subject of large-scale Chinese controlled trials in stable angina and acute MI. None of these substitute for conventional cardiology management (antiplatelet, statin, beta-blocker, intervention as required), but they have a clear adjunctive role in symptom control and recovery.

The acupuncture combination PC 6 (Neiguan), HT 7 (Shenmen), BL 17 (Geshu), CV 17 (Shanzhong), BL 15 (Xinshu) and SP 10 (Xuehai) moves Heart blood and treats angina-type chest discomfort. PC 6 is the principal point and is used internationally in stable angina as adjunctive therapy alongside conventional management.

Phlegm misting the Heart orifices

Phlegm misting the Heart orifices (tan mi xin qiao) is the classical TCM pattern for impaired consciousness, mental confusion, dementia, post-stroke cognitive impairment, schizophrenia, severe depression with cognitive dulling, and the catastrophic loss of mental clarity. The classical mechanism is that Phlegm-Damp, generated by Spleen failure or by chronic Liver Qi stagnation, has risen to the head and obstructed the “orifices” (the channels of consciousness) so that the Shen can no longer illuminate clearly. Symptoms include mental dullness, slow or confused thinking, blunted affect, sometimes paradoxical agitation, drooling, vivid disturbing dreams or hallucinations, rambling speech, gurgling sound in the throat, and in severe cases coma or persistent vegetative state. The tongue has a thick greasy white or yellow coating; the pulse is slippery and wiry.

Treatment strategy: Open the orifices and dissolve phlegm (kai qiao hua tan). The classical formula for cold phlegm misting (the dementia, stroke aftermath, comatose patient with cold features) is Su He Xiang Wan (Liquid Styrax Pill); the classical formula for hot phlegm (acute severe febrile delirium, severe psychiatric agitation with heat features) is An Gong Niu Huang Wan (Calm the Palace Pill with Cattle Bezoar). Both formulas in their classical forms contain ingredients that modern practice cannot use: Su He Xiang Wan contains She Xiang (musk from CITES-protected musk deer) and traditional cinnabar (mercury); An Gong Niu Huang Wan contains Niu Huang from cattle gallstones and originally Xi Jiao (rhinoceros horn, now universally substituted with Shui Niu Jiao, water buffalo horn). My clinic uses only plant-based equivalents and does not stock either classical formula for the She Xiang and traditional cinnabar reasons explained on the relevant herb pages. The plant-based equivalent is Wen Dan Tang for the less severe presentation; for more severe phlegm-obstruction with confusion, modified versions of Di Tan Tang (Wash Away Phlegm Decoction) using only plant-based herbs.

The acupuncture combination PC 5 (Jianshi), PC 6 (Neiguan), GV 26 (Renzhong, for acute revival), GV 20 (Baihui), ST 40 (Fenglong) and the “13 ghost points” described by Sun Si-Miao are used. GV 26 is the principal emergency revival point in TCM and is sometimes the first point needled in acute loss of consciousness, in syncope, and in severe seizure.

Phlegm-Fire harassing the Heart

Phlegm-Fire harassing the Heart (tan huo rao xin) is the more developed pattern where Phlegm has accumulated and is generating Heat from its long obstruction. It is the classical TCM picture of acute manic episodes, bipolar mania, severe psychotic agitation, post-traumatic acute psychotic reactions, severe anxiety with paranoid features, and the agitated dementia presentation. Symptoms include severe insomnia or no sleep at all, marked agitation and restlessness, rapid loud speech, grandiose or paranoid thinking, severe irritability with outbursts, sometimes violence, vivid hallucinations, manic energy alternating with crashes, dark red tongue with thick yellow greasy coating, and a rapid slippery wiry pulse.

Treatment strategy: Drain fire, dissolve phlegm, calm the Shen. The classical formula is Wen Dan Tang with Huang Lian added (called Huang Lian Wen Dan Tang) for milder presentations, or Sheng Tie Luo Yin (Iron Filings Decoction) for more severe presentations with frank mania. Sheng Tie Luo Yin uses Sheng Tie Luo (iron filings) as the imperial herb — its weight and ability to anchor descending energy makes it the principal mineral for severe psychiatric agitation in TCM. Modern Chinese inpatient psychiatry uses Sheng Tie Luo Yin alongside conventional antipsychotics in acute manic and psychotic states.

Small Intestine patterns

The Small Intestine has fewer distinct disease patterns than the Heart but several clinically important presentations:

Small Intestine Heat: The most clinically common Small Intestine pattern, almost always arising from Heart Fire descending. Symptoms include scanty dark hot painful urination, possibly haematuria, possibly mouth ulcers (the Heart Fire component), thirst, irritability, restless sleep. Treatment uses Dao Chi San as discussed above. Modern Chinese practice uses Dao Chi San for paediatric UTIs and for adult UTI with the Heart Fire pattern.

Small Intestine Qi pain (Shao Fu pain): Lower abdominal griping pain, possibly radiating to the testicle or the lower back, in some cases the picture of intestinal colic, hernial pain or testicular pain. Treatment uses Tian Tai Wu Yao San (Tian Tai Mountain Wu Yao Powder) or Dao Qi Tang to warm and regulate the qi in the Small Intestine channel.

Small Intestine Cold: Chronic lower abdominal cold pain better with warmth and pressure, watery diarrhoea with audible borborygmus, clear copious urine; from constitutional Spleen-Kidney yang deficiency. Treatment warms the Small Intestine via Spleen and Kidney yang tonification (Si Shen Wan, Li Zhong Tang plus Fu Zi).

Small Intestine failing to separate fluids: Watery diarrhoea with scanty urine; the “wrong output” pattern. Treatment uses Wu Ling San (Five Ingredient Powder with Poria) from the Shang Han Lun, which redirects fluid through the proper channel.

Small Intestine channel obstruction: Pain along the posterior arm, the lateral shoulder blade (the famous SI channel referred pain pattern that any acupuncturist recognises in chronic shoulder pain), the side of the neck and the angle of the jaw. The most common clinical presentation is frozen shoulder, scapular pain and TMJ pain. Treatment uses the SI channel points SI 3 (Houxi), SI 9 (Jianzhen), SI 11 (Tianzong), SI 15 (Jianzhongshu) and channel-distal points.

Heart and Spleen disharmony

Heart-Spleen disharmony (xin pi liang xu) is one of the most common compound patterns in modern TCM practice. The Spleen produces Blood from food; the Heart governs the Blood. When the Spleen fails to produce sufficient Blood, the Heart Blood becomes deficient; when the Heart Shen is chronically disturbed (by chronic worry, overthinking, stress), the Spleen Qi is depleted (since worry is the Spleen’s emotional pathology, and overthinking damages Spleen Qi). The two disharmonies feed each other in a self-perpetuating loop that classical TCM recognised and named.

Symptoms combine those of Spleen Qi deficiency (fatigue, poor appetite, post-prandial bloating, loose stools, sallow complexion, pale lips) with those of Heart Blood deficiency (palpitations, insomnia with difficulty falling asleep, vivid dreams, poor concentration and memory, anxiety, dizziness). The tongue is pale, thin, often with teeth marks at the edges; the pulse is thready and weak, especially in left cun (Heart) and right guan (Spleen).

Treatment strategy: Tonify Spleen Qi and nourish Heart Blood (bu pi yang xin). The defining formula is Gui Pi Tang (Restore the Spleen Decoction) by Yan Yong-He. The formula tonifies the Spleen as the source of Blood (Ren Shen + Huang Qi + Bai Zhu + Fu Ling + Gan Cao + Sheng Jiang + Da Zao — essentially Si Jun Zi Tang plus warming additions) and adds the Heart-Shen-calming herbs (Suan Zao Ren + Yuan Zhi + Long Yan Rou + Dang Gui + Mu Xiang to move the qi gently). It is the single most prescribed formula in TCM clinical practice for the combined fatigue / insomnia / anxiety / mild depression presentation, particularly in women, and is one of the most reliable treatments in TCM for post-natal depression. Effective treatment typically takes 6–12 weeks of daily herbs plus weekly acupuncture. Li Dong-Yuan, in Pi Wei Lun, wrote: “In disorders of the Shen with fatigue, the practitioner who treats only the Shen and not the Spleen will find his patient returns unchanged”.

Differentiating yin and yang patterns of the Heart

The Heart, despite being a Yang organ in the Fire element, contains both yin and yang components. The Heart Yang is the warming, propulsive, illuminating function; the Heart Yin is the cooling, anchoring, substantial function. Heart disorders almost universally have a yin/yang component to their differentiation:

Heart Yang excess (Fire blazing): covered above. Characterised by upward and outward heat — insomnia, agitation, mouth ulcers, hot dark urine. Treatment uses bitter cold herbs.

Heart Yang deficiency / Heart Yang collapse: covered above. Characterised by cold and weakness — cold limbs, faint pulse, oedema. Treatment uses warming pungent herbs and Si Ni Tang in emergency.

Heart Yin deficiency / empty heat: covered above. Characterised by night sweats, hot palms, tongue tip ulceration without significant inflammation. Treatment uses cool moist yin-nourishing herbs.

Heart Blood deficiency: covered above. The combined yin/blood deficiency producing pallor, palpitations, insomnia of difficulty-falling-asleep type. Treatment uses Gui Pi Tang or Suan Zao Ren Tang.

Heart Blood stasis: covered above. The terminal yin pattern, the TCM picture of coronary disease. Treatment uses blood-moving formulas.

Differentiating hot and cold patterns of the Heart

Pure Heart cold patterns are uncommon — the Heart, as the Sovereign Fire, tends toward heat. The hot/cold differentiation usually concerns:

Heart Fire (excess heat): covered above. The most common heat pattern.

Heart yin deficiency with empty heat: covered above. The most common heat pattern in chronic cases.

Heart Yang deficiency (cold): covered above. The clinical picture of cardiac insufficiency with cold features.

Heart fire descended to Small Intestine: covered above. The Dao Chi San pattern.

Heart-Kidney not communicating (heat above, cold below): covered above. The Jiao Tai Wan pattern.

Differentiating excess and deficiency

The Heart, like the Liver, expresses both excess and deficiency patterns. The clinical clue is the pulse and tongue:

Heart excess patterns (Heart Fire, Phlegm-Fire harassing, Heart Blood stasis with strong pulse): tongue is red, often with thick coating or marked purple; pulse is rapid, full, slippery, wiry or knotted. Treatment uses clearing, draining and moving methods.

Heart deficiency patterns (Heart Qi, Heart Yang, Heart Blood, Heart Yin deficiency): tongue is pale or red but thin; pulse is thready, weak, faint or knotted. Treatment uses tonifying methods.

Combined excess-deficiency patterns (the more common): an underlying Heart deficiency (typically blood or yin) with an overlay of fire, blood stasis or phlegm. Treatment must address both, with the emphasis depending on the predominant feature. The classical example is Heart Yin deficiency with empty heat (treated with Tian Wang Bu Xin Dan): the formula is two-thirds yin-nourishing, with smaller doses of mild cooling herbs (Xuan Shen, Mai Men Dong) rather than aggressive draining.

Frequently asked questions about Heart and Small Intestine disorders

What does Chinese medicine consider the most common cause of insomnia?

By a substantial margin, Heart Blood deficiency — particularly the Heart-Spleen Blood deficiency variant that produces difficulty falling asleep with anxious thinking. It is the classical TCM picture in chronically stressed working women, in post-natal mothers, in vegan / low-protein patients with marginal iron status, and in chronic-illness convalescence. Treatment uses Gui Pi Tang or Suan Zao Ren Tang as the foundational formula, plus weekly acupuncture at HT 7 (Shenmen), PC 6 (Neiguan), SP 6 (Sanyinjiao), Yintang and Anmian. Most patients achieve meaningful sleep improvement within 4–8 weeks.

How does Chinese medicine treat anxiety and panic attacks?

Anxiety in TCM is approached through the Shen and the underlying organ-system disturbance, not as a standalone diagnosis. Three patterns predominate: Heart-Gallbladder Qi deficiency (timidity, easy startling, decision difficulty, dreams of pursuit — treated with Wen Dan Tang or An Shen Ding Zhi Wan); Heart Blood / Heart-Spleen Blood deficiency (chronic anxiety with insomnia, palpitations, fatigue — treated with Gui Pi Tang); and Liver Qi stagnation transforming into Heart Fire (irritable anxiety with red face, hot palms, dreams — treated with Dan Zhi Xiao Yao San or Long Dan Xie Gan Tang). Acute panic with palpitations responds dramatically to acupuncture at HT 7 and PC 6; chronic anxiety requires several months of consistent treatment.

Are heart palpitations always serious in Chinese medicine?

No — in TCM theory, palpitations (xin ji and zheng chong) are extremely common and most are functional rather than structural. Most palpitations seen in clinical practice are Heart Blood or Heart Yin deficiency (palpitations at rest in the evening, with anxiety and insomnia), or Heart Qi deficiency (palpitations on exertion), neither of which represents structural heart disease. However, palpitations with chest pain, with cold extremities, with shortness of breath at rest, with cyanosis, with syncope or with an unusual irregular pulse may indicate underlying cardiac disease and warrant conventional cardiac assessment. TCM and Western cardiology should run in parallel: get the conventional cardiac assessment, get the TCM treatment for the symptom and the underlying pattern. The combination produces the best clinical outcome.

What does it mean to “calm the Shen” in Chinese medicine?

Calming the Shen (an shen) is the TCM treatment principle that addresses any disturbance of the spirit, mind, sleep or emotional state. It does not refer to sedation in the Western pharmaceutical sense (i.e. drug-induced unconsciousness) but to the restoration of the Shen to its “settled” state in the Heart blood. This is achieved through several mechanisms depending on the underlying pattern: nourishing the substance in which the Shen rests (Heart blood, Heart yin), with herbs such as Suan Zao Ren and Bai Zi Ren; weighting the Shen with mineral herbs that anchor a scattered Shen (Long Gu, Mu Li, Zhen Zhu Mu); clearing the heat or phlegm that is harassing the Shen (Huang Lian, Zhu Ru); and addressing the underlying organ disharmony (Spleen for blood production, Kidney for yin foundation, Liver for qi smoothing) so that the Shen can rest. Acupuncture at the Spirit-named points (Shenmen, Shendao, Shenzang, Shenting) is the corresponding channel intervention.

Can acupuncture and Chinese herbs help with angina or coronary heart disease?

As adjunctive therapy alongside conventional cardiology, yes. The TCM picture in coronary heart disease is Heart Blood stasis (often with underlying Heart Qi deficiency); the treatment moves Heart blood and tonifies Heart Qi. The herbal formula Xue Fu Zhu Yu Tang is the foundational prescription, modified for the individual presentation. Acupuncture at PC 6, HT 7, CV 17 and BL 15 reduces anginal frequency and improves exercise tolerance in controlled trials. Modern Chinese cardiology has developed Dan Shen injection and Compound Dan Shen tablets as routine adjuncts. None of this substitutes for antiplatelet therapy, statin, beta-blocker or revascularisation as indicated — but combined with conventional management, patients consistently report reduced anginal frequency, better exercise tolerance and improved overall quality of life.

Why do mouth ulcers and urinary tract infections sometimes occur together?

This is one of the most clinically beautiful classical TCM observations. The mouth ulcers are Heart Fire (the tongue is the “sprout” of the Heart). The hot painful urination is the same Heart Fire descending through the Heart-Small Intestine channel pair to the lower jiao. The single classical formula Dao Chi San (Guide Out the Red Powder) treats both presentations in a single elegant prescription. Western medicine treats the mouth ulcers and the UTI as completely separate entities; TCM correctly recognises them as the same pathological mechanism manifesting at different points along the meridian system. The clinical observation underpinning this connection — that patients with recurrent UTIs frequently also report recurrent oral ulceration — is a robust empirical finding sustained across two millennia of Chinese medical practice.

Conclusion

The Heart and Small Intestine pair, the Sovereign Fire couple, is the seat of consciousness and the propulsion of life. The Heart governs the blood and houses the Shen; the Small Intestine separates the pure from the impure and shares the Heart’s Sovereign Fire. Disorders of this pair cover the most clinically important and socially common conditions in TCM practice: insomnia, anxiety, depression, palpitations, cardiac disease, dementia, the “burnout” presentations of modern overstrain, and the recurrent UTI / mouth ulcer Heart-Small Intestine axis. The key clinical principles, distilled from classical sources and contemporary practice, are:

1. In all Shen disturbance, identify whether the disturbance is from emptiness (deficiency of Heart blood, yin, qi) or from harassment (fire, phlegm, blood stasis); the treatment strategy is opposite and must be precisely targeted
2. The Spleen is the source of Heart blood production — in chronic Heart-Shen disturbance, the Spleen must be supported (the principle expressed in Gui Pi Tang)
3. The Kidney is the foundation of Heart yin — in chronic insomnia or anxiety with night sweats and dry tongue, the Kidney yin must be nourished alongside the Heart
4. Heart Fire descends to the Small Intestine through the channel pair — mouth ulcers and burning urination are the same disorder and the same treatment
5. Heart Blood stasis is the most direct TCM correlate of structural coronary disease — the treatment is adjunctive to conventional cardiology, not a replacement, but the adjunctive benefit is real and well-documented
6. The Shen rests in the substance (blood, yin); the practitioner who only sedates with mineral herbs but does not nourish the substance will find the patient returns unchanged when the herbs are stopped

The Heart, the Emperor organ, has been the subject of the deepest and most refined classical TCM scholarship from the Su Wen through Zhang Zhongjing’s Shao Yin chapters in the Shang Han Lun, through Sun Si-Miao’s Tang-dynasty work on the Shen, through Yan Yong-He’s Song-dynasty formulation of Gui Pi Tang, through Zhu Dan-Xi’s Yuan-dynasty contributions on Heart Yin deficiency, to Wang Qing-Ren’s Qing-dynasty blood-stasis revolution. The classical patterns remain valid; the modern clinician’s task is to apply them correctly to the patient sitting in the consultation room.

Further reading on this site

Return to the Zang-Fu organ overview. Read the related organ hub pages for the Heart and Small Intestine. See also the companion deep-dive articles on Disorders of the Spleen and Stomach (Earth) and Disorders of the Liver and Gallbladder (Wood). For specific conditions discussed in this article, see insomnia, anxiety, urinary tract infections and the deficiency-pattern blog posts Spleen Qi deficiency, Yin deficiency and Yang deficiency.