Heart
The Heart is the supreme Zang organ in TCM, known as the 'Monarch' or 'Emperor' of the body. It governs blood circulation through the vessels and houses the Shen (spirit/mind), controlling consciousness, mental activity, and emotional well-being.
Five Element Correspondences
Season
Summer
Climate
Heat (暑 - Shǔ)
Emotion
Joy (喜 - Xǐ)
Color
Red (赤 - Chì)
Taste
Bitter (苦 - Kǔ)
Sound
Laughing (笑 - Xiào)
Direction
South
Sense Organ
Tongue (Heart opens to the tongue - 心开窍于舌)
Body Tissue
Blood Vessels (Heart governs the vessels - 心主脉)
Body Fluid
Sweat (汗为心之液 - Sweat is the fluid of the Heart)
Peak Hours
11-13
Meridian
Heart Meridian
Educational content · Consult qualified TCM practitioners for diagnosis and treatment
Overview
In Traditional Chinese Medicine, the Heart (Xīn, 心) holds the most exalted position among all the internal organs, earning it the title of 'Monarch' or 'Emperor' of the body. Unlike the Western medical understanding which focuses solely on the physical pump, the TCM Heart encompasses both physical and psychological dimensions – ancient texts distinguish between the 'blood and flesh heart' (xuèròu zhī xīn) and the 'spirit-brightness heart' (shénmíng zhī xīn).
The Heart's two primary functions are governing blood and vessels (主血脉, zhǔ xuèmài) and housing the Spirit (藏神, cáng shén). As the central organ of the circulatory system, the Heart propels blood through the vessels to nourish all tissues. Equally important, it serves as the residence of the Shen – consciousness, cognition, emotions, and mental clarity. When Heart function is balanced, a person exhibits clear thinking, emotional stability, good memory, and peaceful sleep.
The Heart's supreme status is reflected in the classical statement: "The Heart holds the office of lord and sovereign; the radiance of the spirits stems from it." This means when the Heart is healthy, all other organs function harmoniously. Conversely, Heart imbalances affect the entire system, potentially causing not just cardiovascular symptoms but also mental-emotional disturbances, sleep disorders, and cognitive difficulties.
Historical Context
The Heart's theoretical foundations were established in the Huangdi Neijing (Yellow Emperor's Classic of Internal Medicine), compiled during the Han Dynasty (206 BCE – 220 CE). The Suwen chapter 'Linglan Midian Lun' famously declares: "The Heart is the monarch official, from which spirit-brightness emerges" (心者君主之官，神明出焉). This text established the Heart's dual role in governing blood circulation and mental activities.
Early Chinese scholars debated the Heart's elemental correspondence – the Shuo Wen Jie Zi dictionary (121 CE) noted some scholars associated the Heart with Earth (due to its central position), while others assigned it to Fire. The Fire association ultimately prevailed in standard TCM theory. Throughout history, the concept evolved from purely anatomical descriptions to emphasize functional relationships, especially following Yun Tieqiao's introduction of Zangxiang (visceral manifestation) theory in the 1920s, which clarified that TCM organs represent functional systems rather than anatomical structures alone.
Physiological Functions
Governing Blood and Vessels
主血脉 (Zhǔ Xuè Mài)The Heart is responsible for propelling blood throughout the body via the vessel network. Heart Qi provides the motive force for blood circulation, much like a pump. When Heart Qi is abundant and Heart Blood is sufficient, the pulse is strong and regular, the complexion is rosy, and all tissues receive adequate nourishment. This function requires three conditions: sufficient Heart Qi, adequate Blood volume, and unobstructed vessels.
Housing the Spirit
藏神 (Cáng Shén)The Heart is the residence of the Shen (神), which encompasses consciousness, cognition, memory, thinking, sleep, and emotional responses. When Heart Blood and Yin are abundant, the Shen is properly nourished, resulting in clear thinking, good memory, emotional balance, and restful sleep. The Heart's role as 'master of the five Zang and six Fu organs' means it coordinates all physiological and psychological activities.
Controlling Mental Activities
主神明 (Zhǔ Shén Míng)Beyond housing the spirit, the Heart actively governs mental and emotional functions. It processes sensory information, enables rational thought, and maintains appropriate emotional responses. This function explains why Heart disorders often manifest with psychological symptoms such as anxiety, insomnia, poor concentration, or in severe cases, confusion and delirium.
Manifesting in the Complexion
其华在面 (Qí Huá Zài Miàn)The Heart's condition is reflected in the facial complexion due to the rich blood vessel network in the face. Healthy Heart function produces a rosy, lustrous complexion. Heart Blood deficiency shows as a pale, dull face; Heart Yang deficiency as a bright-pale face; and Heart Blood stasis as a purple or bluish complexion.
Opening to the Tongue
开窍于舌 (Kāi Qiào Yú Shé)The tongue is called 'the sprout of the Heart' because it directly reflects Heart conditions. The Heart meridian connects to the tongue, and Heart Blood flows abundantly to this organ. Heart pathology manifests in tongue changes: pale tongue indicates Heart Blood deficiency; red tip suggests Heart Fire; purple tongue shows Blood stasis; and tongue stiffness or speech difficulties may indicate severe Heart imbalance.
Relationships with Other Organs
Other
The Heart and Small Intestine share an interior-exterior (biao-li) relationship connected by their respective meridians. Heart Fire can transmit to the Small Intestine, causing symptoms like burning urination, blood in urine, or intestinal heat. Conversely, Small Intestine heat can affect the Heart, disturbing the Shen. This relationship is clinically important when treating urinary symptoms related to Heart Fire.
Other
The Heart-Kidney relationship represents the fundamental Yin-Yang, Fire-Water axis in the body. Heart Fire (Yang) must descend to warm the Kidneys, while Kidney Water (Yin) must ascend to nourish and cool the Heart. This mutual communication maintains balance. When disrupted, 'Heart and Kidney not communicating' occurs, causing insomnia, anxiety, palpitations, and night sweats. The Kidneys also provide the foundation of Yang for all organs, so Kidney Yang deficiency can lead to Heart Yang deficiency.
Generating
In the Five Element generating cycle, Wood (Liver) generates Fire (Heart). The Liver stores Blood and ensures its smooth flow, directly supporting Heart function. Liver Blood nourishes Heart Blood, and the Liver's role in emotional regulation complements the Heart's governance of the Shen. Liver Qi stagnation can generate Fire that rises to disturb the Heart, causing irritability, insomnia, and palpitations.
Other
The Spleen produces Blood from food essence, directly supplying the Heart. Spleen Qi deficiency leading to Blood deficiency commonly causes Heart Blood deficiency. Additionally, overthinking (a Spleen emotion) can consume Heart Blood and disturb the Shen. In the generating cycle, Fire (Heart) generates Earth (Spleen), so Heart Yang warms and supports Spleen function.
Other
Heart and Lungs both reside in the Upper Jiao (upper body cavity) and work closely together. The Lungs govern Qi and assist blood circulation through Qi movement, while the Heart propels Blood that carries Qi throughout the body. Grief and sadness (Lung emotions) can weaken Lung Qi and subsequently deplete Heart Qi. Both organs must function harmoniously for proper circulation of Qi and Blood.
Controlling
In the controlling cycle, Water (Kidney) controls Fire (Heart). This represents the necessary balance between Kidney Yin cooling the Heart Fire to prevent it from flaring excessively. When Kidney Yin is deficient, it fails to control Heart Fire, leading to empty Heat symptoms like night sweats, palpitations, and mental restlessness.
Common Pathological Patterns
Key Manifestations
Key Manifestations
Key Manifestations
Key Manifestations
Key Manifestations
Key Manifestations
Key Manifestations
Tongue Manifestations
The Heart has a particularly strong relationship with the tongue, which is called 'the sprout of the Heart.' The tip of the tongue specifically corresponds to Heart conditions in tongue diagnosis. Key tongue signs include:
- Pale tongue: Indicates Heart Blood or Qi deficiency – the blood cannot fill the tongue adequately
- Red tip: Suggests Heart Fire or Heat in the Heart – excess heat rises to the tongue tip
- Deep red tongue: Indicates severe Heart Heat or Yin deficiency with empty Heat
- Purple tongue or purple spots: Shows Heart Blood stasis – blood circulation is impaired
- Midline crack extending to tip: Constitutional Heart weakness or chronic Heart Qi/Yin deficiency
- Tongue ulcers: Heart Fire flaring upward, especially when on the tip
- Stiff tongue or speech difficulties: May indicate Heart pathology affecting the Shen, or Heat invading the Pericardium
Pulse Manifestations
The Heart position is traditionally felt at the left distal (cun) position on the radial artery. Pulse qualities reflecting Heart conditions include:
- Weak/Empty pulse: Heart Qi deficiency – insufficient force to circulate blood
- Deep and weak: Heart Yang deficiency – Yang cannot push blood to the surface
- Thin/Fine pulse: Heart Blood or Yin deficiency – insufficient blood volume
- Choppy pulse: Heart Blood stasis or severe Blood deficiency
- Rapid pulse: Heart Fire or Heat, or Yin deficiency with empty Heat
- Knotted pulse (irregular with long pauses): Heart Yang deficiency with stagnation
- Intermittent pulse (irregular with short pauses): Severe Heart Qi exhaustion
- Overflowing/Full pulse: Heart Fire blazing
Clinical Relevance
The Heart's clinical significance extends beyond cardiovascular issues to encompass mental health, sleep disorders, and emotional well-being. Practitioners commonly treat Heart patterns for conditions including insomnia, anxiety, depression, palpitations, poor memory, and chest discomfort. Because the Heart houses the Shen, any mental-emotional complaint warrants assessment of Heart function.
In diagnosis, the tongue tip and left distal pulse position provide direct information about Heart status. Facial complexion reveals Heart Blood circulation quality. Treatment approaches vary by pattern: deficiency patterns require tonification (building up resources) while excess patterns need clearing or moving strategies. The Heart's status as 'Emperor' means that addressing Heart imbalances often resolves seemingly unrelated symptoms in other organ systems.
Modern integrative applications include using Heart-calming points and herbs alongside conventional treatment for anxiety disorders, using Blood-invigorating formulas for cardiovascular support, and employing Shen-anchoring strategies for sleep disorders. The Heart-Kidney communication axis is particularly relevant for menopausal symptoms, chronic anxiety, and stress-related conditions.
Classical Sources
Huangdi Neijing Suwen
Linglan Midian Lun (Chapter 8)心者，君主之官也，神明出焉
The Heart holds the office of lord and sovereign; the radiance of the spirits (spirit-brightness) stems from it.
Huangdi Neijing Suwen
Wuzang Shengcheng (Chapter 10)诸血者，皆属于心
All blood pertains to the Heart.
Huangdi Neijing Suwen
Weilun (Chapter 44)心主身之血脉
The Heart governs the blood and vessels of the body.
Huangdi Neijing Lingshu
Xieke (Chapter 71)心者，五藏六府之大主，精神之所舍也
The Heart is the great master of the five Zang and six Fu organs; it is the residence of essence-spirit.
Modern References
The Foundations of Chinese Medicine
Comprehensive modern textbook with detailed coverage of Heart physiology, pathology, and pattern differentiation in clinical practice.
Chinese Acupuncture and Moxibustion
Standard reference text covering Heart meridian points and their clinical applications in treating Heart patterns.
The Practice of Chinese Medicine
Clinical reference focusing on treatment strategies for Heart patterns including anxiety, insomnia, and palpitations.
Chinese Medical Herbology and Pharmacology
Detailed reference on herbs that affect the Heart, including those that calm the Shen, invigorate Blood, and clear Heart Fire.