I have an interesting case study. A 70-year-old woman has a deeply cracked, Yin deficient tongue. It's deep red, peeled, slightly swollen and short, and has many horizontal cracks throughout (no vertical Heart crack, though). She also suffers from insomnia (specifically trouble staying asleep at night). On the other hand, she suffered from a heart attack two years ago, leading to what has manifested as Heart Qi deficiency (cold extremeties, esp. hands and feet; she gets cold easily, and presents with a weak radial pulse in the Heart, Kidney Yang, and Spleen positions. She does not suffer heart palpitations. Pulse is slow, about 64 bpm. She also has varicose veins and fatigue, which indicates to me maybe a Spleen Qi vacuity. She also has high blood pressure. She has had surgery on her L5 region of her low back, and it now causes her a lot of pain when she sits and stands, but the weather does not seem to affect her pain.
How would one go about treating simultaneous Heart Qi deficiency and (presumably Kidney) Yin deficiency? (Both seem equally prominent) Treat the yin deficiency before qi deficiency? No moxa until Yin deficiency is resolved? I am a student of TCM who is interested in hearing what approach an acupuncturist would use. Thanks in advance for sharing your knowledge!