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The Heart resides at the head of the Five Zang Organs (Five Viscera), bearing the title of "Emperor," and stands in exterior-interior relationship with the Small Intestine; it is the abode of Shen (Spirit). It generates Blood, belongs to Fire in the Five Elements, and governs Summer. Its meridian is the Hand-Shaoyin (Hand-Taiyin) Meridian. In Summer, a normal pulse comes strong and goes weak, known as the "Hook" pulse; deviation from this indicates disease. If both the coming and going are strong, it is termed "Excess," indicating disease in the Exterior. If the coming is weak but the going is strong, it is termed "Deficiency," indicating disease in the Interior. Excess leads to fever and bone pain, mouth sores, scorched tongue, thirst that cannot be quenched immediately, resulting in irritability; upward it manifests as coughing and expectoration, downward as Qi leakage (e.g., incontinence or diarrhea). The pulse comes like connected pearls, smooth as touching jade—this is the Ping Pulse (Normal Pulse). If the pulse comes continuously linked but slightly curved within, it is a diseased pulse. If the pulse comes curved and goes rigid, like grasping a belt hook, it is a Dead Pulse.

Furthermore, excessive thinking and fright injure the Heart; Heart injury causes loss of Shen. Loss of Shen leads to fear. Additionally, if there is Heart pain and coldness extending more than five cun into the hands and feet, death occurs by evening if onset is in the morning, or by morning if onset is in the evening. Moreover, if Water-Qi accumulates in the Heart, the body swells, lying flat is impossible, and there is irritability. Wind invading the Heart causes fluttering heat, inability to control movement, hunger without desire to eat, and vomiting after eating. When Heart Qi is prosperous in Summer, the Left Cun (Inch) pulse should be Hong (Surging), Fu (Floating), Da (Large), and San (Scattered); deviation indicates disease. If the pulse is Chen (Deep) and Hua (Slippery), Water overcomes Fire, and ten cases result in nine deaths (untreatable). If the pulse is Xian (Wiry) and Chang (Long), Wood returns to nourish the child (Fire produces Earth, here implying generative cycle restoration), and the disease heals itself. If the pulse is Huan (Lax) and Da, Earth enters Fire (Fire generates Earth, implying slight conflict), minor pathogenic interference causes no harm.

Heart disease manifests as chest pain, fullness and distension in the four limbs, and pain in the shoulders, back, arms, and elbows. Deficiency leads to frequent palpitations, frightful insomnia, pulling pain in the chest, abdomen, waist, and back, propensity for sadness, and frequent fainting. Long-standing accumulation of Qi in the Heart causes worry and vexation, heart pain, incessant laughter, and dreams of fire. Prosperous Heart Qi leads to dreams of joy, laughter, and fear. Pathogenic Qi lodging in the Heart leads to dreams of smoke and fire. Heart distension causes shortness of breath, restless sleep at night, occasional feelings of regret/annoyance (Ao Nao), fluctuating swelling/Qi, abdominal heat, and drooling. Generally, Heart diseases improve at noon, worsen at midnight, and are calm at dawn. Additionally, a large Left Cun pulse indicates hot, red, and swollen hands; if excessive, it causes chest fullness and irritability, red face, and yellow eyes.

Generally, Heart disease begins with heart pain, followed by incessant cough, obstruction of Guan-Ge (cardiac diaphragm), unrelenting heaviness of the body, and death within three days. Heart Deficiency causes fear of people, desire to close eyes and sleep, lack of mental support, chaotic Hun and Po (Ethereal and Corporeal Souls), and a pulse that is Chen (Deep) and Xiao (Small) or Jin (Tight) or Fu (Floating), accompanied by asthma. If Qi under the Heart is firm and does not descend, with desire to swallow saliva, hot hands, vexation and fullness, forgetfulness, and frequent sighing, this results from excessive thinking. A very Ji (Rapid/Tense) pulse leads to convulsions; slightly Ji leads to heart pain radiating to the waist and back, inability to eat. Very Huan leads to manic laughter; slightly Huan leads to hematemesis. Very Da leads to throat closure; slightly Da leads to pain radiating to the back and excessive tearing. Very Xiao leads to hiccups; Xiao leads to Spleen consumption. Hua (Slippery) excessively leads to thirst; slightly Hua leads to Heart disease radiating to the umbilicus and abdomen with thirst. Severe Se (Choppy) leads to aphonia. Additionally, a Heart pulse that is Jian (Firm) and Chang (Long) causes a stiff tongue and inability to speak; Ruan (Soft) and San (Scattered) indicates fear, prostration, and anorexia. Ji (Rapid) leads to Xin Han (Heart Hernia) with pathological forms below the umbilicus, vexation, shortness of breath, and scorching heat rising.

Additionally, manic speech, sweating, irritability, and cold extremities in Heart disease indicate a pulse that should be Fu and Da; if it is instead Chen (Deep), Ru (Soggy), and Hua (Slippery), and the color should be Red but is Black, Water overcomes Fire, making it untreatable. Additionally, sinking Heart accumulation moves aimlessly up and down, causing chest fullness, palpitations, heat in the waist and abdomen, red cheeks, dry throat, and hot palms leading to vomiting; it improves in Spring and worsens in Winter, requiring urgent treatment. Additionally, excessive worry, joy, and thinking deplete Heart Qi internally; if the complexion appears harmonious and excessive, death occurs within ten days. Bian Que said: "Heart exhaustion leads to death in one day; ominous colors appear. Though the person may seem vigorous and agile, they are called a 'Walking Corpse.' Disaster will surely strike within a year."

Additionally, if speech starts broad but becomes rapid, subsequent words do not connect to previous ones, the voice is turbid and foul, the mouth is distorted, and there is inappropriate laughter, this is Wind entering the Heart. Additionally, Heart injury leads to Heart destruction, overcome by Water, causing paralysis of the body and limbs, relaxation of back joints, sluggish freedom of movement, continuous diarrhea, requiring urgent treatment; otherwise, death occurs in ten days. Additionally, laughing before grieving indicates Water overcoming Fire. Yin attaches to Yang; when Yin rises, Yang is suppressed. Suppression generates Heat, Heat generates Mania, confusion, chaos, erroneous speech, which cannot be trusted or questioned; the Heart is already damaged. Bian Que stated: "Red lips and mouth are treatable; blue-black indicates death."

Additionally, Heart Malaria causes irritability followed by thirst, fluttering heat, and a Fu (Floating), Jin (Tight), and Da (Large) pulse. Heart Qi Excess leads to difficult urination, abdominal fullness, heavy body heat, nausea without vomiting, rapid breathing, and inability to lie down; the Left Cun Kou pulse is Shi (Solid) and Da. Heart Deficiency leads to fear, frequent fright, sorrow, unhappiness, bitter pain in the chest and abdomen, trembling speech, aversion to cold, trance-like state, red face, yellow eyes, and epistaxis; the Cun Kou pulse is Liang Xu (Both Deficient) and Wei (Fine).