Heart Yang Deficiency

Understanding Heart Yang Deficiency

Heart Yang is described as the warmth that drives the Blood through the vessels. When it is low, the beat feels weak or irregular, the extremities become cold, and the chest feels uncomfortable rather than painful.

Palpitations are the central symptom, often with a sense of the heart fluttering or pausing. The limbs are cold and the face is bright pale. Breathlessness on exertion is common.

The chest may feel stuffy or uncomfortable, and the person frequently presses or holds it. The tongue is pale, puffy and tender with teeth marks and a white slippery coat; the pulse is weak, deep and slow, or irregular.

It develops from long-standing Heart Qi deficiency, from Kidney Yang deficiency that fails to warm the Heart, from excessive sweating, or from prolonged grief.

Treatment warms and tonifies Heart Yang and settles the spirit. Any chest pain or a new irregular heartbeat is medically assessed first, because the symptoms overlap with cardiac conditions.

Signs and symptoms

Key signs

• Palpitations
• Feeling of cold with cold limbs
• Chest stuffiness or discomfort
• Bright pale face

Also seen

• Breathlessness on exertion
• Fatigue
• A tendency to hold the chest
• Cold hands
• A weak voice
• Swelling of the ankles in more advanced cases

Variations

• An irregular or skipping heartbeat
• A sense of dread with the palpitations
• Cold sweat on exertion

Timing

• Palpitations are worse with exertion and in cold weather.
• It is chronic and slowly progressive.

Practitioner notes

• The tongue is pale, puffy and tender with teeth marks and a white slippery coat.
• The pulse is weak, deep and slow, or irregular. An irregular pulse is a medical finding and needs assessment.
• The distinction from Heart Qi deficiency is the coldness: cold limbs and a pale face with a cold feeling.
• The distinction from Heart Blood stasis is the absence of fixed stabbing pain and a purple tongue.

Causes

Common causes

• Progression from Heart Qi deficiency
• Kidney Yang deficiency weakening the Heart
• Excessive sweating or incorrect treatment
• Prolonged grief and sadness

How it develops

• It develops slowly from long-standing deficiency.
• If it deepens, fluid can accumulate, producing swelling and breathlessness.

Diagnosis

Diagnosis rests on palpitations with coldness and a pale wet tongue, alongside medical assessment.

Tongue

• Body: Pale, puffy and tender with teeth marks.
• Coating: White and slippery.
• Note: A red tongue would suggest Heat instead.

Pulse

Weak, Deep, Slow or irregular

An irregular pulse needs medical assessment.

Observation

• Bright pale face
• Cold hands
• A hand resting on the chest

Listening

• A weak voice
• A report of the heart fluttering

Palpation

• Abdomen: Cool and soft.
• Channels: BL-15 and PC-6 may feel empty; the limbs are cool to the touch.

Questions that separate it from look-alikes

• How do the palpitations feel, and when do they come?
• How cold do the hands and feet feel?
• Any breathlessness or chest discomfort?
• Has this been medically assessed?

Treatment

Principles

• Warm and tonify Heart Yang
• Settle the spirit and slow the palpitations
• Support the Kidney Yang where it is the root
• Assess any chest pain or irregular rhythm medically first

Herbs

Formulas

• Zhi Gan Cao Tang - The reference formula for palpitations from Heart Qi and Yang deficiency.
• Gui Zhi Jia Long Gu Mu Li Tang - For palpitations with anxiety and restlessness, settling and warming together.
• Ling Gui Zhu Gan Tang - For fluid retention with palpitations and dizziness from Yang weakness.
• Shen Fu Tang - For severe Yang deficiency with a very weak pulse; requires professional prescribing.
• Bao Yuan Tang - A warming Qi tonic for exhaustion with coldness.
• Zhen Wu Tang - For Yang deficiency with fluid accumulation and swelling.

Acupoints

• BL-15 (Xinshu) - The Heart back-shu point, used to strengthen Heart Yang.
• REN-6 (Qihai) - Warms and strengthens the lower abdomen; moxibustion is often used.
• PC-6 (Neiguan) - Opens the chest and settles the heart rhythm.
• HT-7 (Shenmen) - The Heart source point, used for palpitations and anxiety.
• DU-14 (Dazhui) - Warms Yang and supports the surface.

Personalising the plan

• If the pulse is very weak, strong Qi support is added.
• If coldness dominates, warming is increased.
• If anxiety dominates, spirit-settling herbs are added.
• If swelling develops, herbs that move fluids are added and medical review is arranged.

Self-care

Diet

• Warm cooked food; small amounts of ginger and cinnamon
• Avoid cold and raw food and iced drinks
• Reduce salt if swelling is present

Lifestyle

• Keep warm, especially the chest and hands
• Rest and avoid overexertion
• Gentle exercise as advised by a doctor
• Have palpitations and chest symptoms medically assessed

Qigong and movement

• Very gentle practice with slow breathing, stopping before fatigue.

How it differs from look-alikes

Patterns that can be mistaken for heart yang deficiency, and the contrast that separates them.

Where it appears

Skin conditions in which this pattern is commonly seen.

Safety and when to get help

For anything severe, sudden or spreading quickly, read when a skin problem needs urgent care.

This page describes a TCM pattern, not a diagnosis, and a pattern can accompany more than one skin condition. Get urgent medical help for a rash with fever, confusion or feeling very unwell; skin that is blistering, peeling or spreading quickly; swelling of the face, lips or throat, or difficulty breathing; or a lesion with increasing pain, warmth, red streaks or pus. For anything persistent, severe or changing, have it assessed by a clinician before treating it yourself.

Read the skin condition pages for the red flags that belong to a specific presentation.

Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.

Evidence note

No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.

Related patterns