3.1 Zang Organ Patterns I: Heart and Lung

3.1 Zang Organ Patterns I: Heart and Lung

In Traditional Chinese Medicine (TCM) diagnostic theory, the five Zang viscera—Heart (Xin), Lung (Fei), Spleen (Pi), Liver (Gan), and Kidney (Shen)—constitute the solid internal Yin organs. As defined in Chapter 11 of the Su Wen (Plain Questions), the primary physiological nature of the Zang organs is to manufacture, transform, and store pure essential substances (Jing, Qi, Blood, Body Fluids, and Shen) without discharging them. Because they store pure essence rather than coarse, turbid waste, the Zang organs are characterized by physiological fullness without repletion (Cang Er Bu Xie—storing without draining).

Understanding the individual physiology, tissue correspondences, directional movement of Qi, and pattern differentiations of each Zang organ is fundamental for the Foundations of Oriental Medicine (FOM) module. This section covers the Heart and Lung; Section 3.2 covers the Spleen, Liver, and Kidney.

---

1. Heart (Xin) - The Sovereign Ruler

The Heart is designated the Monarch or Sovereign Ruler (Jun Zhu Zhi Guan) in Chapter 8 of the Su Wen. It oversees all other organs and hosts the supreme spiritual consciousness.

Primary Physiological Functions

• Governs Blood (Zhu Xue) and Controls the Blood Vessels (Zhu Xue Mai): The Heart transforms Food-Qi (Gu Qi) into Blood and provides the propulsive kinetic force that circulates Blood throughout the vascular network. The state of Heart Qi directly dictates vascular tone and arterial pulse strength.
• Houses the Mind / Spirit (Cang Shen): The Heart anchors the Shen, which encompasses consciousness, cognitive processing, emotional integration, memory, and sleep architecture. When Heart Blood and Yin are abundant, the Shen is anchored peacefully at night; when deficient or agitated by Heat, sleep disturbance and mental restlessness occur.
• Opens into the Tongue (Kai Qiao Yu She): The tongue is described as the "sprout of the Heart" (Xin Zhi Miao). Heart Qi and Blood supply the tongue, governing speech articulation, taste perception, and the physical coloration of the tongue body, particularly the tip.
• Manifests in the Complexion (Rong Zai Mian): Because the face has a rich vascular supply directly dependent on Heart circulation, a healthy Heart produces a rosy, lustrous, radiant facial complexion. Heart Blood deficiency yields a dull, pale, or sallow face; Heart Blood stasis causes a purplish, dusky hue; and Heart Heat causes flushed redness.
• Controls Sweat (Han Wei Xin Zhi Ye): Sweat is recognized as the fluid of the Heart (Xin Zhi Ye). Because Sweat and Blood share a common origin in Body Fluids (Jinye), excessive diaphoresis depletes Heart Blood and Qi, while profuse hemorrhage leads to fluid dryness.

Heart Pattern Differentiations

A. Heart Qi Deficiency

• Etiology: Chronic illness, constitutional weakness, prolonged grief, or severe blood loss.
• Core Manifestations: Palpitations (Xin Ji) provoked or aggravated by physical exertion, shortness of breath on exertion, spontaneous daytime sweating (Zi Han), fatigue, listlessness, and a pale complexion.
• Tongue: Pale body or normal color, thin white coating.
• Pulse: Weak (Ruo) or Empty (Xu), particularly in the left Cun position.
• Treatment Principle: Tonify Heart Qi.

B. Heart Yang Deficiency and Heart Yang Collapse

• Etiology: Progression of Heart Qi deficiency, severe Kidney Yang deficiency failing to warm Heart Fire, or cold environmental exposure.
• Core Manifestations (Yang Deficiency): Heart Qi deficiency symptoms plus pronounced chills, cold extremities (Si Zhi Jue Leng), dull chest discomfort, cyanosis of lips and nails, and physical aversion to cold.
• Tongue: Pale, swollen, wet body with a white coating.
• Pulse: Deep (Chen), weak (Ruo), and slow (Chi), or knotted (Jie).
• Heart Yang Collapse (Heart Yang Tuo): Critical emergency. Profuse, cold, oil-like sweat beads on the forehead, severe cyanosis of lips and face, cold limbs up to the elbows and knees, coma or severe lethargy, and an extremely faint, imperceptible, minute pulse (Wei Xi Yu Jue).

C. Heart Blood Deficiency

• Etiology: Blood loss, Spleen Qi deficiency failing to manufacture Blood, or chronic emotional anxiety and overthinking.
• Core Manifestations: Palpitations, insomnia characterized primarily by difficulty falling asleep, excessive vivid dreaming, dizziness, poor memory, dull pale facial complexion, and pale lips.
• Tongue: Pale, thin, relatively dry body with a thin white coat.
• Pulse: Thready (Xi) and weak (Ruo), or choppy (Se).
• Treatment Principle: Nourish Blood and tonify the Heart, calm the Shen.

D. Heart Yin Deficiency

• Etiology: Prolonged emotional stress, chronic febrile disease injuring Yin fluids, or Kidney Yin deficiency failing to ascend.
• Core Manifestations: Palpitations, insomnia with frequent waking throughout the night, dream-disturbed sleep, mental agitation and fidgetiness (Xin Fan), afternoon or evening low-grade tidal fever, night sweats (Dao Han), five-palm heat (soles, palms, chest), dry mouth and throat without desire to drink, and malar flush.
• Tongue: Red body, peeled or absent coating (Guang Bo She), deep red tip with elevated red prickles (Mang Ci), and a midline crack extending toward the tip.
• Pulse: Thready (Xi) and rapid (Shu), or floating-empty (Fu Xu).
• Treatment Principle: Nourish Heart Yin, clear Empty Heat, anchor the Shen.

E. Heart Fire Blazing (Full Heat)

• Etiology: Severe emotional depression transforming into fire, excessive consumption of spicy/heating foods, alcohol, or external pathogen entering the interior.
• Core Manifestations: Severe palpitations, intense mental agitation, mania, delirium, insomnia with racing thoughts, feeling of intense heat, thirst with desire for cold liquids, red face, aphthous ulcers on the tongue and oral mucosa with severe pain, and dark, burning, concentrated urine.
• Tongue: Red or deep red body, darker red tip with painful ulcerations and swollen red prickles, dry yellow coating.
• Pulse: Rapid (Shu), full (Shi), and overflowing (Hong).
• Treatment Principle: Clear Heart Fire, drain Fire toxins, calm the Shen.

F. Phlegm Misting the Heart (Mind) vs. Phlegm-Fire Harassing the Heart

• Phlegm Misting the Heart (Cold/Damp Phlegm): Characterized by mental confusion, stupor, lethargy, incoherent mumbled speech, rattling sound of phlegm in the throat, dull eyes, blank stare, and in severe cases, sudden coma or loss of consciousness. Tongue is pale or normal with a thick, sticky, greasy white coating; pulse is slippery (Hua).
• Phlegm-Fire Harassing the Heart (Hot Phlegm): Characterized by manic-depressive psychosis (Dian Kuang), aggressive behavior, shouting, uncontrolled laughing or crying, violent outbursts, biting, tearing clothes, insomnia, flushed red face, and dark urine. Tongue is red with a thick, sticky, greasy yellow coating; pulse is rapid, slippery, and wiry (Hua Shu Xian).

---

2. Lung (Fei) - The Prime Minister

The Lung is designated the Prime Minister (Xiang Fu Zhi Guan) in the Su Wen, assisting the Heart by regulating rhythm, circulation, and the distribution of vital energy. It is also known as the Canopy (Hua Gai) and the Delicate Organ (Jiao Zang) because it occupies the highest anatomical position in the thoracic cavity and connects directly to the external environment via the respiratory tract, making it exceptionally vulnerable to external pathogens.

Primary Physiological Functions

• Governs Qi (Zhu Qi) and Controls Respiration (Si Hu Xi): Inhales Clean Qi (Da Qi) from the heavens and exhales dirty, turbid Qi. It combines Da Qi with Gu Qi (from the Spleen) in the chest to form Gathering Qi (Zong Qi), which drives respiration and blood circulation.
• Controls Dispersing (Xuan Fa) and Descending (Su Jiang):
  • Dispersing: Diffuses Defensive Qi (Wei Qi) and Body Fluids upward and outward to the skin, pores, and body hair to warm the exterior and resist pathogenic invasion.
  • Descending: Directs inhaled Clear Qi downward to the Kidneys and channels fluids downward to the Kidneys and Urinary Bladder.
• Regulates Water Passages (Tong Diao Shui Dao): Termed the Upper Source of Water (Shui Zhi Shang Yuan). It sprays fluids like a fine mist across the skin surface and descends condensed fluids to the lower burners. Impairment results in facial edema or urinary retention.
• Controls Skin and Body Hair (Zhu Pi Mao): The Lung nourishes the skin, pores (Qi Men—sweat pores), and body hair through Wei Qi and fluid dissemination, governing the opening and closing of sweat pores.
• Opens into the Nose (Kai Qiao Yu Bi) and Controls Voice: Clear nasal passages and acute olfaction depend on Lung Qi. The strength, resonance, and clarity of the voice reflect Lung capacity.

Lung Pattern Differentiations

A. Lung Qi Deficiency

• Etiology: Chronic respiratory illness, constitutional weakness, excessive speaking, or prolonged grief.
• Core Manifestations: Weak, feeble cough (Ke Sou Wu Li), shortness of breath, clear dilute watery sputum, low voice with dislike of speaking (Shao Qi Lan Yan), aversion to cold drafts, spontaneous sweating, daytime fatigue, and a pale complexion.
• Tongue: Pale body, thin white coating.
• Pulse: Weak (Ruo) or Empty (Xu), particularly at the right Cun position.
• Treatment Principle: Tonify Lung Qi and reinforce Defensive Qi.

B. Lung Yin Deficiency

• Etiology: Unresolved exterior Wind-Heat drying fluids, chronic smoking, voice overuse, or constitutional Yin deficiency.
• Core Manifestations: Dry unproductive hacking cough, or cough with scanty, thick, sticky sputum that is difficult to expectorate; blood-tinged or blood-streaked sputum (Ke Xue); dry mouth and throat; hoarse voice or aphonia; afternoon tidal fever; night sweats; malar flush; and heat in the palms and soles.
• Tongue: Red, dry body with scanty coating or entirely peeled (Guang Bo), fine cracks in the anterior third (Lung zone).
• Pulse: Thready (Xi) and rapid (Shu), or floating-empty (Fu Xu).
• Treatment Principle: Nourish Lung Yin, moisten dryness, and clear Empty Heat.

C. Exterior Invasions: Wind-Cold vs. Wind-Heat Invading Lung

• Wind-Cold Invading Lung: Exterior Wind-Cold impairs the Lung dispersing function. Severe aversion to cold, mild fever, absence of sweat, occipital headache, sneezing, runny nose with clear watery discharge, cough with thin watery white sputum. Tongue shows thin white moist coating; pulse is floating and tight (Fu Jin).
• Wind-Heat Invading Lung: Exterior Wind-Heat damages fluids and disrupts Lung descending. Higher fever than chills, mild sweating, sore swollen throat, cough with thick yellow sputum, blocked nose with thick yellow mucus, thirst. Tongue has red tip and edges with a thin yellow coating; pulse is floating and rapid (Fu Shu).

D. Interior Excess: Phlegm-Damp vs. Phlegm-Heat Obstructing Lung

• Phlegm-Damp Obstructing Lung: Chronic, heavy cough with copious, easy-to-expectorate white, sticky, or foamy sputum; fullness and oppression in the chest; shortness of breath aggravated by lying flat (orthopnea); nausea; and absence of thirst. Tongue is pale, swollen, with a thick greasy white coating; pulse is slippery (Hua) or soggy (Ru).
• Phlegm-Heat Obstructing Lung: Barking, resonant cough with copious, thick, sticky, foul-smelling yellow or green sputum; chest pain provoked by coughing; wheezing, asthma, or flaring of the nostrils; fever; thirst for cold water; and constipation. Tongue is red with a thick, sticky, greasy yellow coating; pulse is slippery and rapid (Hua Shu) or full (Shi).

---