Heart-kidney disharmony is the pattern name for the picture in which the fire of the heart above and the water of the kidney below are described as no longer meeting - the heart fire is said to blaze because the kidney water does not rise to cool it.
The recorded features are: difficulty falling asleep, or waking and being unable to get back to sleep; a mind that will not settle and a feeling of inner restlessness; palpitations; poor memory and difficulty concentrating; dizziness and tinnitus; a dry mouth and throat, worse at night; night sweating; a sore and weak lower back and knees; a red tongue with a thin coating, or with little coating at all, and a fine, rapid pulse. The classical texts also mention nocturnal emission and a sense of heat in the chest, palms and soles.
The heart and kidney here are functional roles. No anatomical connection between them has been demonstrated, and nothing in this pattern name corresponds to a finding on an electrocardiogram or a kidney function test.
What shares the list: chronic insomnia and anxiety; obstructive sleep apnoea - snoring, witnessed pauses in breathing, morning headache and sleepiness in the day; restless legs; reflux on lying down; caffeine, alcohol and shift work; medicines including beta blockers, some antidepressants, corticosteroids and decongestants; an overactive thyroid; the menopause; and depression, which is present in a large share of people with chronic insomnia.
Where description has to stop: insomnia together with thoughts of ending one's life needs a person, not a pattern name, and in many countries a helpline exists; a reduced need for sleep together with elation, rapid speech and risk-taking is not insomnia and is assessed urgently; loud snoring with witnessed pauses needs a sleep study rather than an explanation; chest pain, breathlessness at rest or on lying flat, and blackouts are not part of this pattern; tinnitus on one side, or pulsing in time with the heartbeat, or with neurological signs, is assessed; and a new severe headache is not covered by this framework. For chronic insomnia, cognitive behavioural therapy for insomnia is recommended as first-line in most clinical guidelines, ahead of medicines.
Whether the approaches described as restoring the meeting of heart and kidney change sleep outcomes is not established.
心肾不交是古典术语：位居上的心火与位居下的肾水被描述为不再相交——心火偏亢，是因为肾水不能上济以制之。
记载中的表现包括：难以入睡，或醒后不能再睡；心烦不安、静不下来；心悸；健忘、注意力难集中；头晕耳鸣；口干咽燥，入夜尤甚；盗汗；腰膝酸软；舌红少苔或薄苔，脉细数。古典文献还提到梦遗，以及五心烦热。
这里的心与肾是功能角色。两者之间没有任何被证明的解剖联系，这个证名也不对应心电图或肾功能检查上的任何一项所见。
共享这份清单的有：慢性失眠与焦虑；阻塞性睡眠呼吸暂停——打鼾、被目击的呼吸暂停、晨起头痛与白天嗜睡；不宁腿；平卧后的反流；咖啡因、酒精与轮班；药物包括 β 受体阻滞剂、部分抗抑郁药、糖皮质激素与减充血剂；甲状腺功能亢进；绝经；以及抑郁——慢性失眠者中有相当比例同时存在抑郁。
描述必须停下的地方：失眠若同时带有结束自己生命的念头，需要的是一个活人，不是一个证名，许多国家设有求助热线；睡眠需要减少却伴随情绪高涨、语速加快、行为冒险，那不是失眠，需要尽快评估；大声打鼾伴被目击的呼吸暂停应做睡眠监测而不是解释；胸痛、静息或平卧时气短、晕厥不属于本证；单侧耳鸣、与心跳同步的搏动性耳鸣，或伴神经体征，都要评估；新发的剧烈头痛不在这个框架的覆盖范围内。慢性失眠在多数临床指南中把失眠认知行为治疗列为一线，先于药物。
所谓交通心肾之法是否改变睡眠结局，未被证实。
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