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The Mind in the use of acupuncture

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The Mind in the use of acupuncture

How can we best help our patients to become- and remain healthy

By Alexandre Djukanovic

Supervised by: Marijke Fluitsma

December 2012

Academy for Chinese Medicine, Qing Bai

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Contents

Contents .................................................................................................................................................... 3

Conclusions ............................................................................................................................................... 4

Foreword ................................................................................................................................................... 6

Preface - Methods ..................................................................................................................................... 9

Introduction ............................................................................................................................................ 11

Choices related to our environment ................................................................................................... 11

Jing-Qi-Shen and wellbeing ................................................................................................................. 15

Health .................................................................................................................................................. 18

Disease ................................................................................................................................................ 21

Summary for health and disease ........................................................................................................ 26

Mind and emotions ................................................................................................................................. 27

Chapter outline ................................................................................................................................... 27

Mind .................................................................................................................................................... 28

Emotions ............................................................................................................................................. 29

The Heart ............................................................................................................................................ 29

Aspects of the five Shen ...................................................................................................................... 32

Description of Emotions, ..................................................................................................................... 38

Objective subjectivity .......................................................................................................................... 43

Examples of diseases and TCM diagnosis ........................................................................................... 46

Summary for Mind and emotions ....................................................................................................... 48

Mindfulness............................................................................................................................................. 49

Mind and emotions of the acupuncturist ........................................................................................... 50

Aspects for therapy ............................................................................................................................. 51

Summary for Mindfulness ................................................................................................................... 57

Discussion................................................................................................................................................ 58

Bibliography ................................................................................................................................................ 59

Appendix 1 .................................................................................................................................................. 61

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Conclusions The central question I attempt to answer is:

What do we need to consider when treating patients regarding their- and our own Minds?

This resulted in a discussion about the Mind, the relation with emotions and the body. Additional context was provided by relating these concepts to health and disease, Jing-Qi-Shen and Mindfulness. The mind and emotions play a central part in TCM (Traditional Chinese Medicine). The concept of Mind

or Shen comprises both cognition and emotions. Emotions are related to Qi and the Qi mechanism,

making a link with Blood and stagnation pattern. Furthermore the Mind in TCM is seen as the integrative

(and coherent) functioning of its 5 different aspects, Hun, Po, Yi, Zhi and Shen, with the Heart as their

conductor. Each of these is related to specific emotions and virtues. Their normal and appropriate

expression is seen as healthy with regards to cultivating your Shen and cultivating your personal virtues

(De). By looking at the three treasures Jing-Qi-Shen we see that emotions and the Qi mechanism

literally have a central role herein. Also Blood, as it is closely related to Jing-Qi-Shen, has a determining

role in disturbances of the Mind.

Normally emotions are not pathological. They are there to help us process and respond to everything

that happens in our environment. What make emotions harmful are their duration, intensity and

impaired expression. Meaning, expressed too little or too much, or expressed inappropriately with

regards to the context. What makes emotions unique in TCM is their interdependent role with their

corresponding organs. At the core of emotional imbalances lies a destructive relationship with these

(corresponding) organs: Emotions cause stagnation, this impairs organ function, leading to an emotional

response. There disruptive effect is not limited to their corresponding organ. But we can use the specific

symptoms for information about the organs involved. The impaired movement of Qi caused by emotions

(anger makes Qi rise, giving headaches and tinnitus etc.) and the behavioral aspect of the emotion

(observing Shen, listening etc.) both provide diagnostic insights. They provide additional information

next to the standard methods of interrogation with the Ba Gang.

Before becoming pathological emotions have positive effects as well. Or rather they have their root in a

positive aspect or Virtue. Paying attention to this in therapy can provide the practitioner with valuable

insights and a point on the horizon to work towards. Amongst others this is dependent on the

Mindfulness of the practitioner. Looking at the positive aspects of emotions, the quality that underlies

them, it is possible to try and use other emotions and behaviors to overcome a pathological one. This

can be done via the controlling cycle in the Wu Xing, or using opposing emotions to counteract an excess

one.

In treatment it is important to focus on the Shen aspect of a person and their illness. A focus on the

affliction or the body can lead to affirmation of that part and will hinder recovery. To become skilled in

such a feature you have to train yourself to be both sensitive and consequent in your subjective

interpretation. Examples of consequent practices are given, and at their core are objectifying your

interpretations by e.g. writing them down, checking them via motoric responses or to training yourself

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to go with the first (Shen) impression. Techniques like meditation, Qi Gong and concepts like Yang

Sheng are helpful in focusing your Mind and keeping your Heart empty to accommodate a state of

empathy and helping your patients. Awareness in these matters is important for awareness and

prevention of disease.

Because emotions are related to memory and intelligence it is important for practice to explain and

discuss about the emotions with your patients. It helps with gaining insight with their life and possibly

this aids or alleviates emotional blockages without administering acupuncture.

Health in general is reflected by a state of movement with requires continuous growth and adaptation.

This emphasizes the severity of stagnation in TCM. Mental health is thought to be maintained or

“acquired” via a moderate life style, free from desires and attachments and living in harmony with

nature. Whilst our society has become so complex harmony has become a relative notion compared to

the time when TCM classics were written. In therapy it is important to first help an individual within

their own environment and later put them (and their affliction) in the context of harmony with the

macrocosm as much as possible. The ability to recover from mental disturbances is dependent on the

constitution (Jing) of an individual, the duration and severity of the condition. What frequently comes

back in literature is the strong emphases on prevention of disease. Concluding it can be said that it is

helpful to explain to patients what this means to them, and give them tools directed towards this.

At the root of mental emotional disturbances lie behavioral aspects for the greater part. The question

then is why there is such a large occurrence of these afflictions, when you assume behavioral means

reversible. Part of it lies in the overwhelming and distracting effect of emotions. Another part is that we

pursue too much the ambitions of the Heart and are too little concerned with nourishing our life (Yang

Sheng). “Pursuing” Yang Sheng is about finding your true nature and Virtues. These Virtues are said to

lay at the foundation of longevity and health. Together with reduction of desire there is no room for

distractions that will lead to destructive and unhealthy behavior and choices. It is this notion that we

should take with us in therapy, to educate people about true health and prevention of disease. This

would, on my part, be a good point for further research. The true wonder seems to take in all this

ancient knowledge and apply it to this day and age.

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Foreword

My road towards TCM began with a fascination for Asian movies, martial arts, meditation and Yoga. One

of the most impressionable moments came at the age of 20. This was with the head teacher of the Wing

Chun – Kung Fu school at which I practiced at the time. The theme he enlivens and brings across to his

students is:

“Control your emotions, or they will control you”

Now the interesting thing with a theory is that you think you have got it, but really, you do not. And you

only learn this by virtue of the skills of your teacher. And in this particular case where the teacher is a

Kung Fu master, the point came across vividly, rapidly and painfully... Once you get scared, you tense up,

once you tense up your ability to move drastically decreases, i.e. in matters of speed and reach. That by

itself is not at all a good situation to be in. Especially in facing a skilled martial artist who then uses your

“would be weapons” (i.e. arms, legs or whatever) as levers that hurt yourself.

The interesting thing with martial arts is that philosophy and practicality are joined hand in hand. And

with many repeated cycles of learning, trying and evaluating it was a very fruitful builder of experience.

And if nothing else I learned that trough thought (philosophy) and experience you can create, construct,

build and survive. To me it proved that there was something very right with the “Asian” way of thinking.

For the larger part of the modern “Western” world we have created our own city like habitats, arguably

more distant from nature than before. But in any case we as a people generally do not have to worry

about dying from a cold, fighting with panthers, infections, lack of food etc. All thanks to how our society

has evolved in to its current state.

But with that evolution also came into existence a complex lifestyle that exerts a lot of strain on our

Minds. The components that cause this strain can of course be debated. But generally speaking the

complexity of social, financial and political structures, the haste that comes with the jobs we do, they all

lay a ground work for pathological developments. These factors are particularly unfavorable for a

healthy Mind and (emotional) life. Which can cause disease by itself but moreover this causes people to

act and make decisions that will harm them either directly or indirectly in the long term. Leading to what

are ironically called: “welfare diseases”. Here I’m referring to “modern” diseases like: diabetes, blood

vessel and heart disease, auto immune disorders, obesity etc. In this context people, or arguably their

emotions, have caused a restriction of movement and their capability to live their life in a satisfactory

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way. Please note that this comprises both a mental as well a physical restriction. At this point I

emphasize the importance in TCM and Chinese philosophy of free flow and unrestricted movement of

energy. As we will see later this is an important part in TCM in dealing with the Mind and the emotions.

Sly and deeply imprinted in our Minds it is not easy to discover the workings of our emotions, let alone

the workings of our Mind. Surely the latter is not the scope for this thesis. Though many philosophical

terms and theories will be reported and described in it. Being in an emotional state prevents you from

seeing things clearly, including these emotions! It’s is a mist or fog to your Mind, and a highly ironic

situation, which is hard to resolve. To quote the famous soccer player Johan Cruijf:

“Je gaat het pas zien als je het door hebt”

“You will see it when you figure it out”

To that end we need teachers and practitioners who can help us understand and cope with our

emotions, and their pathological manifestations. I think TCM, and acupuncture especially, is a very

appropriate tool to do so. On one end it is an integrated approach that does not distinguish between

Mind and body. And on the other hand it is stooled on an ancient tradition and framework that allows

us to communicate its essence to all to benefit from it. I especially hope that my work will contribute to

a bridging of worlds. And hopefully it will also contribute to healthcare in general as there is a need for

us all to look beyond what mystifies our Minds. In all the above I found the subject for my thesis: The

Mind in the use of acupuncture.

Now that communication is mentioned I plead that we as TCM practitioners are very careful with the

use of the words: Holistic and Alternative. As it is with Chinese words and concepts the perceived

meaning of a word can be something quite different than was originally intended. The term holistic has

many associations that go with it, and not all good. It is a term used by many and its original meaning is

lost due to inflation of use in the public debate. In my opinion this word does not do justice to the

profoundness of TCM. To that end it is better to use the word Integrated instead. The same line of

reasoning holds for the word alternative. Maybe it is even more illustrative, as it is a word often used for

something that is tried in second place. A ranking not suitable for a healthcare system that can prevent

people from becoming seriously ill, and prevent the large scale of invasive and expensive treatments

needed such as surgery, chemo, transplantation, immunotherapy transfusion, dialysis etc. Note that

these are great accomplishments of modern medical science, but the priority should be to prevent

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people from becoming this sick. For this to chime within the public domain a shift of thinking needs to

take place. For that to happen we need to facilitate trust, understanding and a pure and honest

dialogue. All of which can be nurtured through a properly functioning Mind and a peaceful heart.

To finalize, we need skillful teachers to help our patients and people develop and grow in their lives, for

them to become and stay healthy. In studying the intriguing and complex field of TCM I have found

myself lost many a time. Lost in translation, lost between two worlds lost within the scope of it all. Here

I am humbly reminded by a quote made by Bruce Lee in the movie: Enter the Dragon:

“It is like your finger pointing at the moon,

do not concentrate at your finger or you’ll miss all that heavenly glory”

Thus I hope my teachers will guide me in this process as I go along and help put the energy and focus in

proper use. I thank all of you who have helped shaping my thoughts in these, one way or the other. And

everyone who has given me the support in all of this, my sincere thanks.

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Preface - Methods In order to have a clear discussion we need to accurately define some key concepts. To that end the

TCM concepts of Mind, Disorder (i.e. disease), and Emotions are put into view. The emotions are added

here because of their close and intertwined relationship with the Mind. I aimed to be consequent with

the words: health, wellbeing, Mind and Spirit. To start with health and wellbeing, basically they have a

similar meaning. Health perhaps denotes a more physical state, whereas wellbeing hints more towards

the addition of a social and/or mental component. Mind and Spirit also have a close relation. Mind (with

capital, the TCM version) is a translation of Shen i.e. Spirit. Furthermore I use capitals for TCM words

and concepts.

There are several reasons for focusing on the Mind. Firstly, in TCM the Mind is a very interesting concept

by itself, its relation in Jing – Qi – Shen (Mind) is fascinating and will also be discussed to better

understand how it is defined in TCM. Secondly, in the west we tend to see the Mind as a control room,

when we know how to operate it, people can function properly and be healthy. But what do we really

know about operating the control room? (Please note that in the TCM concept of the Mind also

incorporates the intellectual properties.) Thirdly, in the TCM view of the Mind there is a strong

relationship with emotions. Rendering it very promising to cure and help people understand their own

problems and pathologies. Finally understanding the Mind and the emotions can help us understand our

own place within society and the universe as a whole.

The main goal a therapist has is to help people get well. In doing so you appeal to the body’s natural

capability to heal itself. For that reason and the reasons given above, in this work I will try and answer

this question:


To that end there is an emphasis on health and disease, what are they?, how are they related to- and

described in TCM? Then these descriptions lead to the discussion on the Mind and emotions, and again

the question is what is the Mind? What are emotions? Etc. To add additional context to this large subject

I chose to relate the above subjects to Jing-Qi-Shen, whenever possible or relevant. I hope this will

provide myself and the reader with an interesting and traditional framework. However please note that

that the Jing-Qi-Shen framework itself is not the main subject of investigation. I assume the reader has a

basic notion of this concept and so I have introduced this subject serving to clarify the Mind and

emotions.

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It is also good to mention what is not discussed or elaborated on. First of all this is not meant to be a

complete literary review. With such a large subject there will inherently be matters that are not

complete or unknown to me. Secondly I do not intend to explore the mechanisms of the Mind

technically. My aim is to have a complete feel of the mental and emotional aspects of TCM and

acupuncture. It is deliberately not called “the workings of the Mind” or something like that. This means

there is more emphases on Mindfulness and less on diseases, patterns and symptoms.

Thirdly this work should be seen as a presentation and selection of publications that are relevant to my

opinion. They are selected to work towards a constructive view on the topic at hand. In the end it is a

compromise between what I have learned so far and the selection of cited works. The aim is to write it

in such a way that there can be a thorough framework for myself and perhaps others to work on this

subject. And furthermore that it is written in such a way that leaves room for additional views and

comments.

Finally this work is written for my peers in the field of Chinese Medicine. However that does not mean

that it could not or should not be read by people that do not have this background. One of the aspects

why I love this study so much is that, though complicated by its depth and fastness, the essential ideas

are basic and fairly easy to understand. I sincerely hope that you will enjoy reading this thesis.

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Introduction

Choices related to our environment

What is intriguing about today is the vast amount of information and choices we have at our disposal. At

first thought may seem strange that “problems” in general still exist. Why, with so many smart people

and high end technology, solutions must be readily at hand for nearly any dilemma. Take for instance

the problem of people living in hunger. Worldwide we produce more than enough food, but for some

reason it does not get to all people. Let us relate this to the (emotional) health of an individual in this

example. There is enough energy (food) for healthy living and a properly functioning Mind, but

somehow it is compromised (not evenly distributed amongst people). Too much energy is used up by

disease or stagnation1, the organs get affected and the Mind suffers, see Figure 1:

Figure 1: The Shen (Mind) and the Zang Fu (organs) can influence each other. I.e. to function properly a harmonious relationship between the two is necessary. Stagnation can negatively influence this relationship.

From Yoga2 and the Qing Bai academy3 I was told that that the energy used up by disease, stagnation or

pathogens, burns people up, like a burnout. This basically comes down to a waste of energy, which we

can also represent by a traffic jam, Figure 24:

1 Meaning the actual energy it “costs” in terms of producing pathogens, as well as the bodies struggle against

disease. 2 Mr. Anil, yoga teacher, unlimitedhealth.nl

3 (Jie, 2012)

4 a) archief.carros.nl , b) dvhn.nl

Disruption of Shen

Disruption of Zang Fu

Stagnation of Qi/Blood

(Damp and Plegm)

http://www.unlimitedhealth.nl/

http://archief.carros.nl/autonieuws/extra-verkeersdrukte-op-5-december/

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a) b)

Figure 2, a) An event can cause a drastic increase in flow, when the flow is higher than the capacity a jam occurs. This way transport is very in-efficient. You could see at as an overstated investment to be somewhere. But do you need to be there? Right now you cannot know or investigate because you cannot move. A therapist can first alleviate the stagnation and ask the question, where do really want/need to be? Than perhaps one could ask, how to do that, and at what cost… b) pathogens like damp or phlegm can block your view on the road at hand, as such it is important for a therapist to address this early on in the treatment.

Now where to go with this information? Do we solve this problem by managing the traffic top down and

externally seen from the environment? Or do we look at the situation and motivation of the individual?

In other words do we look at the macrocosm or the microcosm?

The answer is most likely both. As practitioners of TCM we study and follow teachings from ancient

times. Passed on from people who had a thorough understanding of the various aspects of leading a

harmonious life. Meaning to rest, feed, clothe, move and behave appropriately and in accordance with

the changing seasons and thus nature.

In treatment you obviously look at your patient’s condition and symptoms, but his or her health

situation is always related to their personal environment. How well are you able to live your life and

function in it? A therapists always has to consider the patient in the context of their own lives. In the

ancient texts where the relation of man and his environment are discussed there was a more direct link

between the individual and their surroundings, mostly nature (macrocosm). Nowadays our personal

environments are most often artificial and much more hectic, this is an important difference.

Surroundings and environment both refer to the same principles, which are quite broad:

Surroundings

Macrocosm: nature, climatic factors, “events”, planetary movements, etc.

Personal environments: social interactions, city, home, etc.

Individual environments: Mind body and soul of an individual5

Basically our personal environment is put in between our microcosm and the macrocosm, perhaps like a

filter, or a wall if you will. See Figure 3:

5 Paradoxically the soul (Shen) of a person is a manifestation of the heavenly Yang energy “from” the macrocosm.

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Figure 3, our environment is more artificial and further from nature nowadays compared to when TCM text were written. Is the personal environment still in line with nature? Please note that the personal environment refers to the social interaction between people, as well a life style

The arrow in Figure 3 in some sense represents the Taoist notion of Dao (The Way), is your path

artificially tilted or blocked by your actions and choices and emotions? Are your actions in accordance

with the Dao? And what does that mean, in accordance with the Dao? In the Dao de Jing harmonizing

with the Dao comes back to conducting yourself in such a way that you can express your own nature,

strengths and personality, spontaneously6.

Modern life (artificial in the figure) can divert this line, by too much overstimulation, stress, artificial

living environment bad dietary habits etc. The next part from the Te-Tao Ching7 can add some

philosophical guidance to this:

“Act without acting,

Serve without concern for affairs,

Find flavor in what has no flavor”

As I interpret this quote, it does not mean you should not refrain from taking action, but be natural with

it. Do not let your concerns affect your activities. And look for the joy of simple matters. Act without

acting refers to the concept of Wuwei. Serve without concern, to me refers to a focus on what is right,

not to worry about the outcome of one’s actions. The last statement about finding flavor has a lot of

depth to in. More than I can comment on here, but it seems to speak for itself. As we will see later in the

6 (Rossi, 2007, p. 4)

7 (Henricks, 1989, p. 148)

Nature

(Macrocosm)

Personal / artificial

environment

Individual (Microcosm)

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chapter Mindfulness, cultivating such properties is facilitated by undertaking Mind clearing and relaxing

exercises and adopting to activities that will allow you to remember your heavenly virtues.

I do not think it is realistic to have the same standards for living in harmony with nature as thousands of

years ago. Times have changed, and so have our surroundings. For one we have developed a mostly

urban habitat. For a lot of people the choice is simply not there. In practice this means you need to look

at two different aspects of health concerning your patient. One is helping people to function in their

personal environment. And second is to compare their personal environment to the ways of the

macrocosm.

Though we never forget the macrocosm we have to be realistic about the world we live in, as therapists

we also need to look at the workings of the microcosm in ourselves and our patients. You could say: the

answer lies within ourselves. Addressing the internal problems (disharmony in emotions, stagnation etc.)

could result in making changes in our (personal) environment. In the end you do not focus either on

micro- or on macrocosm8. Rather in TCM we emphasize individuals to live in harmony with their

surroundings.

Emotionally this means we can help people go through blockages and they will learn more about

themselves, hopefully leading to a more healthy and constructive life and lifestyle. As therapists we can

help people with this by educating them about signs, symptoms and also healthy life style habits. And of

course by treatment of a disease, which quite possible is capable of disturbing this process.

Coming back to the decision making, when you are not in balance, you ask the questions to yourself, but

you have the wrong advisors. From a Western standpoint your emotions have to functionally guide your

behavior. For example when you are attacked, it is best not to try and have a theoretical debate with a

python or a lion, but to be scared and to either “fight or flight”. Though very much simplified it is the

crux of what emotions are to do. To guide you in appropriate behavior for a certain context. Not all of

the emotions correlate so nicely as the emotion of fear to the fight or flight behavior. The point to make

here is that in case of a pathology emotions can cloud your judgment and decision making. And because

of those combined properties emotions tend to reinforce their selves. Making it difficult to solve, thus

important for us to recognize and treat.

Summarizing so far the Mind and emotions are interesting to discuss because they are closely related to

physical wellbeing in TCM. As such these teachings provide a valuable insight to people in the West

because they can learn how their complaints are related to them. This makes for that people learn more

about their selves and can grow, physically, emotionally and spiritually. Furthermore emotions are a

pivot between people and their surroundings an health mental state makes for healthy choices.

8 I have used the term macrocosm rather loosely here. I’m aware that in ancient text this was likely to have a more

Daoistic meaning compared to the mundane matters to which I relate it. Nevertheless we still need to cope with life as it presents itself to us. Arguably we do not have the same choice of environment as the ancients did.

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By looking holistically at our patients, their welfare is always related to their surroundings. Those

surroundings are different compared to the time when the TCM classics were written. Therefore we

need to both create balance within the personal environment, and compare that to the ways of nature.

Resulting in a synergy, an happy and emotionally healthy person will make constructive and positive

decisions for him- or herself (and their surroundings). Or in Daoistic terms, living in harmony with the

Dao harbors traits and behaviors which support the effortless expression of yourself (talents, strengths,

etc.) which is the “ultimate” virtue, De.

In the next chapters the Mind and Emotions will be outlined in more detail and the subject of health and

disease will be put into more context starting with Jing-Qi-Shen and following up with a more general

discussion on these subjects.

Jing-Qi-Shen and wellbeing

In the previous chapter health is related to living in harmony with the Dao in such a way that one’s

virtues are effortlessly harvested and displayed. Jing-Qi-Shen provide an interesting framework to relate

health too. I am not stretching the imagination by stating that the contemporary notion of body-Mind-

soul are rooted in Jing-Qi-Shen. Their health is mainly determined by their preservation, and balanced

presence in the body.

Jing-Qi-Shen are also known as the three treasures, highlighting their importance. It reflects the position

of humans between heaven and earth. And in ourselves it links Mind and body to each other. A very

important distinction from Western medicine where body and Mind are considered more separately.

You can relate to this concept in many ways, and on many levels. Below is a simple overview to denote

its broad scope in Table 1:

Table 1, overview of various aspects of Jing Qi and Shen.

Level Cosmos Vital Substance Clinical Comment

Up Heaven Shen Keep empty Etherical/Mind9

Middle Man Qi Maintain flow

Down Earth Jing Prevent loss Material/body/basis10

Maciocia11 describes it as follows:

Essence is the material basis of Qi and Mind, forming the foundation for a happy and balanced metal

and emotional life

The fact that Jing-Qi-Shen are called the three treasures, reflects their importance in TCM and in health.

Of these three, Jing is the physical side, where Shen it the more etherical side. Qi is in between in

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Consciousness, pure connection to the macrocosm. (Saraswati, 2012) 10

Ding Li, unshakable basis, related to a feeling that you can’t go wrong and being in control. (Saraswati, 2012) 11

(Maciocia, The Foundations of Chinese Medicine, 2005, p. 242)

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density and function, you could say it facilitates the transformation from one to the other. In that sense

the Qi mechanism is crucial in a healthy emotional life, as emotions have an effect in Qi. This is also

referred to as: “the spiritual axis”12. It is also interesting to see that in humans correlate to Qi as well as

the Spleen, and Earth organ.

What is important to take from these relations is the notion that man stands between heaven and earth.

Or in other words man is the representation of heaven on earth. The philosophical implications of this

trinity are many. But here I want to use this framework for two reasons. Firstly it gives a proper

reference to what we now label traditional in TCM. As such it is a good reminder to where we come

from in TCM. Secondly it is a framework for thought. An alchemic and more spiritual concept of Jing-Qi-

Shen is that life’s purpose is to transfer Jing in to Shen. How can you transform and cultivate your

physical or pre natal “self” in such a way you harvest all your talents. This goes from an earthy

acceptance of yourself (and your situation) to a profound wisdom. Where Jing recedes as we age, Shen

increases13 over time, see Figure 1:

Figure 4, As Jing (the sand) decreases over time the Shen (empty space) increases. A transition from shape to function. According to Daoist sources this is an important feat to try and accomplish during life.

How is the bodily Jing transformed into heavenly Shen14? Via Qi, which is nicely

positioned in the middle of Jing and Shen. What is clinically vital regarding Qi?

Maintaining a free flow. This is where emotions also come in to play. Emotions are

manifestations of Qi and they can cause blockages and hindrances in free flow of

energy.

In a different biological sense this is what happens when we regard the transformation from DNA (which

interestingly can be regarded as Jing15) into molecules (enzymes) that perform functions, which let you

live… Regarding DNA as a form of Jing gives it clinically similar properties in TCM as in Western Science.

In the latter one’s life span is determined by the slow degradation of DNA. And it is easy for us to

imagine that quality of your DNA relates to the quality of life (i.e. health). Hence it is important to

prevent damage to it. Like with Jing if you rest appropriately you can recover from damage done.

Harvesting Jing and preventing DNA damage in this sense are similar concepts to longevity and quality of

life.

In TCM we both diagnose and treat patients by looking at what their conditions of Jing-Qi-Shen are. Jing

set the background of a person’s health. Is it well preserved? What is the constitution? And what phase

of life is he or she in? Of the three, Qi and Shen pertain more to this thesis. In diagnosis it is these two

we are most concerned with, and as we will see later it is wise to be guided or directed toward a focus

on the Shen in treatment.

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(Maciocia, The Foundations of Chinese Medicine, 2005, p. 69) 13

Qing Bai 2012 (Saraswati, 2012) 14

Bodily and heavenly also refer to negative and positive habits like for example desire and compassion respectively. 15

Dr. Wang, course on channel palpitation, Dublin 2012

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To recapitulate, Jing-Qi-Shen gives a broad basis for the concept of (mental) health. It positions man

between heaven and earth and suggests a transformation from Jing to Shen under the influence of the

free flow of Qi. As a free flow of Qi is also under the influence of the emotions (and their relative

expression, this concept steers in the direction of emotions being an integral part in achieving your

lives’ goals and at the same time being healthy. The latter is a two way street, you need to be physically

healthy enough to be mobile and discover your virtues (De from the Dao de Jing).

From a treatment perspective Jing provides the starting point and quite literally the context of working

with your patient. Normally a TCM practitioner will be drawn toward the realm of Qi and Shen. As we

will see later, it is the Shen that should guide us for optimal results.

In the next chapter all of the above is related to the modern concept of mental health.

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Health

Health is a central theme in our modern life, and the healthcare industry is a major investment for

countries in the West. “We” find health important that much is clear. But our current understanding of it

is largely based on physical Newtonian thought. Leading to a pursuit of identifiable targets (enemies)

that are thought to diminish are life expectancies. Identifiable meaning, if you do not see it, it does not

exist. Unfortunately this leaves the public opinion in a state where faith (or “truth”) is determined by

either how well we are able to experiment or how well we are at marketing. It is true that it is difficult

opposing a time frame, or zeitgeist. I was told once that even Einstein’s theory of relativity was rejected

laughingly by his peers at first. The experiments (and mathematics) were sound, but they couldn’t

imagine it were true.

“Do not mistake the absence of evidence for the evidence of absence”

The definition for health coming from the WHO is as follows:

“Health is a state of complete physical, mental and social well-being and not merely the absence of

disease or infirmity16”

It is interesting to see that two out of three parameters are non-physical. That this is important is

reflected by the latter part: health is not just defined by the absence of a [diagnosable] disease. Even

more interesting is the relation that is made to social well-being. This opens the door to the definition as

we have learned in TCM.

Beautiful elaborations on ”health” can be found in the classics of TCM. A very nice quote on health and

wellbeing from the Neijing Suwen17 goes as follows:

“Health and well-being can be achieved only by remaining centered with one’s Spirit, guarding against

squandering one’s energy, maintaining constant flow of one’s Qi and Blood, adapting to the changing

seasonal and yearly macrocosmic influences, and nourishing one’s self preventively”

We can deduce from this passage that Spirit, energy conservation, absence of stasis (of Qi and Blood),

living in harmony with nature and nourishment are key elements in health preservation. A centered

Spirit is named firstly, probably with good reason. Though I must admit that this part remains illusive to

me. My guess would be a spirit that is focused, with meditative qualities to add to it. A healthy Spirit will

grant you the wisdom, not to squander your energy, to work on blockages, to adapt to the

circumstances at hand and to nourish yourself before your burn out. I will address the Spirit, but also the

stagnation of Qi and later.

In a way this has also to do with not losing energy, but I do not think it is quite the same as is meant in

the quote above. Squandering energy and nourishing oneself, will only come back in this thesis

indirectly, meaning as the product of a healthy Mind.

16

http://www.who.int/about/definition/en/print.html 17

(Ni, 1995, p. 265)

http://www.who.int/about/definition/en/print.html

19

An interesting perspective on life, based on the Su Wen chapter 17, comes from Elisabeth Rochat de la

Vallee18. It concerns more the view of the therapist:

“Life is not the constant regulation of something that is always the same. Life is always adaptation and

transformation”

To me it is quite interesting. I would not say that we do not know this idea, but because we are tended

to look at all the details19 there is a feel like we are talking about a status quo. Something that is or is

not, yes or no. In Western science there is a term that might give some insight here, it is called the

dynamic equilibrium. More readily available examples are the homeostasis of variables in the human

body like: pH, temperature, ion concentrations etc.

The next quote contains basically the same information as the previous one, but is more relevant for

diagnosis and treatment:

“ A normal pulse image is not the same in each season because the manifestation of life inside the body

through Qi and Blood is not the same “

Here we are reminded again that life is about change and adaptation (between birth, growth, decay and

death), this is reflected in the body as well, regarding both Blood and Qi. Finalizing this part with the

beautiful link between outer and inner.

Mental Health

In the previous chapter we already saw that mental health is incorporated already in the general and

broad definition of health. Let us elaborate on this.

Quiet peacefulness, absolute emptiness

the true Qi follows [these states]. When essence and spirit are guarded internally,

where could a disease come from? Hence,

The Mind is relaxed and one has few desires. The heart is at peace and one is not in fear.

The physical appearance is taxed, but is not tired20

The quote above nicely reflect several key aspects regarding mental Health. Coming back to the example

of the burnout and traffic jam (Figure 2) this poem tells us how to go about getting healthy: emptiness.

Getting rid of all that is unnecessary and thus (possibly) harmful.

18

(Larre & Rochat de la Vallée, The Seven Emotions, 2005, p. p. 51) 19

In the context of “Western” Newtonian thought and “Eastern” holistic thought. The first has a focus on particles and details. Whereas the latter emphasizes a more of a global form of understanding. 20

(Unchuld, 2011, p. 34)

20

Naturally there is no difference between health in general and mental health. Likely it is the unique

coupling of Mind and Body (discussed in Jing-Qi-Shen and wellbeing) that makes no difference in Mind

and Body, both can affect each other, reflected in the body by Xue, Qi and mental wellbeing, from the

Ling Shu21:

“When he Qi of the five Zang is peaceful and stable, the Xue and Qi in the channels are in harmony and

smooth, the Shen will be well remained”

At this point it is worthwhile to emphasize the Buddhist notion: “The Mind is relaxed and one has few

desires”. In Buddhism it is thought that all suffering has its root in desire. And freeing yourself from this

brings you to enlightenment. This is different way of interpreting the control of your emotions.

Finalizing remarks concerning health: Later we will see that desires come from a wrong pursuit of things

given in by the disturbing effect from our emotions. So it is not to say that we won’t have emotions or

desires, but the ones we do have will be a reflection of our true nature. This is why controlling our

emotions and/or your desires put you in a “direct” way (or Tao) towards your destiny (Virtue or De).

Which enables “proper” cultivation of Shen, or remembering your heavenly nature.

With regards to observing mental health it can be said that it is reflected by bright eyes, clear use of

words, a beautiful complexion and a regular breath. Vitality is to be seen in the Shen of their eyes22.

21

(Jie, 2012, p. 5) 22

(Rossi, 2007, p. 66)

21

Disease

The basic premise of disease in TCM is not to be in harmony with your surroundings. This can originate

from the outside described by the term Ji, “Qi attacking the person from outside” (environmental

factors), or can originate from the inside, described by the more commonly used term Bing:

“A more severe and complex disease, that is attached to a person’s righteous Qi inside the body23”

Fruehauf elaborates: “on the most literal level Bing means affliction of the heart” and summarizes to say

that:

“A situation where somebody has become physically ill due to mental, emotional, or spiritual causes”

And to relating disease to the three treasures, it is the scarcity of Jing, deficiency of Qi and weakness of Shen that causes disease24. To recapitulate here are the basic definitions causes of disease in TCM25,26:

- Internal causes of disease (emotions)

- External causes of disease (six environmental factors)

- Miscellaneous causes of disease

Obviously a disease caused by an external influence can transfer to the internal environment. The

effects of external (and miscellaneous) causes of disease are discussed indirectly. Meaning that any

disease can (and on some level will) affect the Mind. But the focus will be on the direction from the

mental and emotional side.

In this context the Mind is related to internal causes of disease. So the scope of this text is mostly about

“the internal”. This is not surprising since having shelter from the influences of the climate, rules this out

as a cause for most part.

The good and bad of emotions

To shortly go back to where we left of, normally emotions are not bad. They are there to perform a

function, from a Western scientific standpoint they are “reactions to the world” dependent on cognitive

interpretation, physiological activity and context. From a TCM perspective their function is subtly

described as organizational27.

Let’s consider the following statement:

“What actually makes an emotion harmful is either the long term presence, or their intensity28”

23

(Fruehauf, All Disease Comes from the Heart, June 2009) 24

(Liren & Xioming, 1993) 25

(Maciocia, The practice of Chinese Medicine, 2008), p. 241-267 26

(Deadman, The Causes of Disease (part one), May 1981) 27

(Larre & Rochat de la Vallée, The Seven Emotions, 2005, p. 26) 28

(Maciocia, The practice of Chinese Medicine, 2008, p. 278)

22

And their blinding or overwhelming character:

“When an emotion is present it is inclined to exaggerate something29”

To add to that we have the tendency to perpetuate our own mental afflictions, harboring social or

mental patterns that will reinforce the disease30. I emphasize once again the reason why understanding

emotions is so important. They can be overwhelming, intense and misleading. And it is because of this

help from someone objective is needed. A good example of this would be an drug or alcohol addict,

refusing to admit they are sick, or are having health issues, relating to their social and personal life. Or

how in our heads we can convince ourselves chocolate or French fries are healthy. Though the latter two

might not be all that bad (I’m sharing my pathology here with the reader) combined with a strong

memory and emotion things can be become destructive. It would probably take a very specialist

approach to treat someone with these mental patters. It is not the point to elaborate on this. It is just to

say that we all can be misled by our emotions one way or the other.

What is important for treatment is that there is a nature as well as a nurture component to emotions

and behavior31. Nurture implies that learning about your emotions can or should be an integral part in

treating their related pathologies. The nature component implies that there possibly is a limited to what

extent a person can be treated for their disease. This is mainly determined by their prenatal constitution

or Jing. Conditions you are born with are quite difficult to treat, if not impossible. If this is the case one

has to consider the relief of symptoms the best possible option for therapy. Most often we will be

concerned with the postnatal effects of the Minds and emotions. Treatment here is limited by the

duration and severity of the condition, both factors in the reversibility of an imbalanced state.

The aspect of context is also important in TCM when we discuss the appropriate expression of emotions.

Laughter is appropriate in situation of joy, but laughing continuously or when told someone has died can

denote a pathology related to Heart.

The main effect emotions have in pathology is that they drain Qi in general, exhaust and impair the

corresponding organ and can cause stagnation. More is discussed in the chapter: Effects of emotions on

the Qi Mechanism.

29


(Saraswati, 2012) 31

(Linden, 2006, pp. 62, 151-155)

23

Etiology

My impression is that there is a fairly common understanding of contemporary causes for mental-

emotional problems. A helpful summery is given by Maciocia32:

- Constitution

- Diet

- Overwork

- Excessive sexual activity33

- Drugs

I would like to complete this list with sleep as it is very important for mental health and wellbeing and

cognitive functioning34,35.

If you look at the list above, four out of the five are behavioral factors. Though with drugs you could

argue it can be a choice, but your constitution can also make you susceptible to addiction. In an article

by Deadman he relates overwork to the emotions: greed, ambition, guilt and insecurity36, in part these

are further discussed in the chapter of emotions.

Lee emphasizes the importance of the digestive system in mental disorders, when the energy of the

Spleen and Stomach system is unbalanced, Shen disorders will follow, amongst others problems with

sleep. Qi stagnation in the Stomach and Large Intestine will block the ascendance of clear Yang Qi,

causing forgetfulness37. In reference to Jing-Qi-Shen, humans are related to Qi, and the corresponding

organ is the Spleen.

At this point it is good to mention that diet won’t be discussed beyond this point. To me it is subordinate

in the discussion on the Mind and emotions. Pathologies in diet are to extent related to emotions

(craving, or so called emotional eaters) and choice, which lead me to focus on the Mind and emotions

instead of diet itself.

In the West we have many complicated theories on the workings of the Minds, disease and pathology.

How adapt can a theory be that you would be able to summarize it in a single sentence:

”Pathology is just an excess or lack of something at the level of the five Zang38”

32

(Maciocia, The practice of Chinese Medicine, 2008, p. 312) 33

It is said that with this Essence is lost. There are those who say that for this reason abstinence is beneficial to health. Such remarks should be seen in the context of that believe or religion. In TCM this is said to cause emptiness, which prevents you from pursuing the [true] ambitions of one’s Heart ( (Larre & Rochat de la Vallée, The Seven Emotions, 2005, p. 119) 34

(Linden, 2006, p. 136) 35

(Unchuld, 2011, p. 33) 36

(Deadman, The Causes of Disease (part 2), September 1981) 37

(Jie, 2012, p. 5) 38

(Larre & Rochat de la Vallée, The Seven Emotions, 2005, p. 30)

24

Susceptibility

Very briefly we can describe (Western medical) risk factors in the prevalence of mental disorders39:

- Familial history (Jing, genetic)

- Recent stressful event

- Prior episode of depression

- Presence of another mental disorder

To me these factors appear vague. Meaning from a medical standpoint what would you do with this

information? Though TCM can be illusive, in my opinion it provides a better, broader framework to put

around mental disorders.

Like with diet, these points are depicted here to have a more complete overview and I would like to

leave it at that for now.

Biomedical factors

Also a brief description in order to be complete40:

- Thyroid disease

- Degenerative (neurological) disease

- Infectious disease

- CFS

- Drug use

- Hematologic disease

Like the previous paragraph, it is good to be aware of these factors, but clinically it is difficult to extract

information of it, so I will leave it like this.

39

(Saraswati, 2012, p. 23) 40

Ibid, p. 24

25

Diagnosis

Diagnosis in TCM is based on four pillars41:

Diagnosis by:

- Observation, seeing

- Hearing and smelling

- Touch (pulse, channel palpitation)

- Interrogation (asking)

As we are now working within the domain of the Mind, the diagnostics involved (and discussed) are

mainly seeing and asking. With seeing here it is meant the true Shen observation of a person and their

condition. With asking I mean asking about the intricacies of Mind and emotion, so in that sense, in this

work we are outside of the scope of the Ba Gang.

The tricky thing with the Mind and emotions is that they can deceive us, and cloud our judgment.

Further on we will see how why this is, and even later how you can train yourself for addressing this

appropriately.

41


26

Summary for health and disease

Health is governed by moderation in general, and of desires and ambitions especially. Health and wellbeing are determined by both physical and mental-emotional factors. Furthermore a subjective feeling of welfare is part of this as well. If live is movement and change, health is the capacity to act (respond or adapt) accordingly. In this sense health is not a static state but rather a dynamic between people and their environment. In TCM this is recognized and has led up to an emphasis on a free flow of Qi and blood and mentally by an effortless expression of oneself. Mental disturbances are determined by an imbalance and or inappropriate expression of emotions that

are either very intense or long lasting. Leading to impaired function on a physical (Qi and Blood

stagnation, draining of Qi) and mental level, and on a larger scale failure to fulfill one’s life ambitions

and goals (virtues or De). The road (Tao) towards discovering these virtues is different for each. What

helps is participating in rituals that help you become Mindful, i.e. to “remember your heavenly nature”.

The success of treating mental and emotional afflictions is determined by constitution (Jing), the severity

and the duration of the condition. Since emotions are related to our memory and created in part by

learning, it is advisable to facilitate an intellectual understanding of the occurring pathological emotions

during therapy. From this it can be concluded that talking and getting to know your patient is important.

From this perspective the Mind and emotions will be described in the next chapter.

27

Internal

Emotions

External

Mind and emotions Writing this chapter I do not seem to be able to describing one without the other, perhaps it makes it

somewhat confusing to read, however this fits very well with the TCM idea of how related the two are.

Figure 5, the emotions, let us call them effectors of the Mind, and help us deal with our environment in the broadest sense. As such they are the interplay (overlap in the figure) between external and internal.

The Mind is the soul, cognition, memory and emotions all integrated and working well together. In TCM

it is said that this coordination is done by virtue of the Heart. The etymology for Mind is memory, in TCM

also related to the Heart. And in the West we have the saying: ”learning by heart”, what also seems to

be the line of thought from TCM point of view. You learn by Virtue of Yi (Spleen), but you truly

memorize with the virtue of your heart. Making this small circle complete. Furthermore the Mind is

thought to be consisting of five different parts, displaying different virtues and pathologies, one of which

just named here.

Chapter outline

All the above matters will be discussed in this chapter, starting with the Mind and emotions, and

continuing with the Heart, because of its special role regarding TCM and Mind and emotions. After this

the five Emotions and virtues will be discussed in more detail, followed by an more general description

of emotions in TCM.

With the chapter Objective subjectivity I aim to bridge the knowledge gathered so far towards the next

chapter of Mindfulness. The chapter explains the importance for practitioners to train their Minds, and

the chapter Mindfulness will elaborate on this.

The chapter is finished with a short overview of disease and diagnosis in TCM, and a summary.

28

Mind

In Chinese medicine a very distinct and profound definition of the Mind is given:

“That which is subtle and invisible, yet commands everything” Or:

“The highest point where life brightly expresses itself is the spirits42”

This means we have the following “order” in TCM:

Shen Qi Body (vessel), or:

Mind Emotion Body.

So we see that the Mind is foremost in TCM, and it is the ruling entity of a person.

Maciocia provides us with this beautiful quote:

“The Mind is a transformation of Essence and Qi: both [pre-heaven and post-heaven] essences contribute

to forming the Mind”

Furthermore he gives a helpful notion on why emotions pertain to certain organs. As he states it the

energy of an emotion is innately present in the organ, and dependent on the stimulus it will resonate

with the psychic energy of a particular organ. In the case. Thus it is emphasized that emotions are not

something that “attack” us from the outside43. Another expression of the relationship between the

micro- and the macrocosm.

The definition of Mind thus is very broad and philosophical. To add to that the Mind is also the faculty of

cognition, thinking and feeling. A narrower description puts the Mind into two parts, cognition and

emotion44. Cognition is not discussed in this thesis separately from the Mind. You could argue that

cognition (true knowledge and learning) is also dependent on the emotions (and the five Shen). In this

sense maybe the division in cognition and emotion relates more to our western thoughts about the

Mind than to the TCM ideas.

42



(Liren & Xioming, 1993)

29

Emotions

The Western term for emotions is based on the Latin etymology and means “that which moves”. It is

interesting to relate this to the pathological effects that emotions can have on the Qi dynamic (see

Table 5). In Buddhism there are two mechanisms known that can “move” the Mind. The first is more

cognitive, where you logically think of what to do next (based on proof). This form is suitable for

learning about your emotions and how to deal with them. The second one is a more spontaneous way of

thinking, and it relates to your “first impression”. There is a small component of reasoning present, but

not so much. It is in the second group that Buddhism foresees problems with. This distinction brings

forth a term called destructive emotions. A very adapt description, it comes back in a similar form in the

paragraph Emotions and expression. It just is to say that when considering aspects of the Mind,

Mindfulness and meditation play a big role as well (see the respective chapters). The etymology of Mind

stems from memory45. The combination of a spontaneous occurrence of an emotion and memorizing it,

gives a hint of the complexity of this process. It is a worthwhile aspect to remember in treating

behavioral aspects of a disease, and therefore relevant to the Mind and emotions.

Emotions in Chinese medicine are better translated as passions. This word stems from the Latin partire

which means to suffer. And this relates better to the destructive effect emotions have as a cause of

disease, corresponding to the Chinese Qing46.

The Heart

It is said the Heart is the residence of the Mind, it resonates with all the different aspects of the five

Shen and furthermore it orchestrates and regulates emotions. Besides its “own” emotion Joy it is also

related to having a purpose and applying yourself. The Chinese do not make/have a difference between

Heart and Mind. Because of this a lot of emotional symptoms we normally perhaps would discard (in

Western medicine), to Chinese are full of intellectual insights47.

Having a Heart and being human means that we dynamically balance between the earthly (bodily)

desires and the virtue of your heavenly nature. We are the only animals to walk on the earth with two

legs, bound to the earth, but upright directed to heaven to find it on earth48. Humans as a vessel for Qi

(earth) and Shen (heaven) we can choose their own direction, they meander between the downward

movement of earth and the upward movement represented by heaven.49 Remembering your heavenly

nature is what creates room from the earthy problems, and will facilitate development of your true self.

“The Heart is the root of life and the origin of the Mind”50, and its importance in mental/emotional

afflictions is great, all emotions affect the Heart. With this is stressed the importance of the Heart as a

concept to health. To be open, understanding and connecting.

45

http://en.wikipedia.org/wiki/Mind#Etymology 46




(Maimon, 2012) 50


http://en.wikipedia.org/wiki/Mind#Etymology

30

In contemporary TCM the Heart is generally regarded to pertain to Fire. In ancient texts though it was

ascribed to Earth. To quote:

“The human condition, therefore, is metaphorically described as the state of having an earthen heart, which in its healthy state is capable of containing the fire of spirit, including the emotions and their

potentially troublesome ramifications” When regarding the Hearth as an empty container, a place where the Shen can reside, it makes sense that is an Earth organ51, as a physical chamber to hold the Fire of the Spirit. This supports the Chinese philosophy of how man is created by clay (earth) and the fire of Heaven. The reactiveness, movement and “fickleness” of the Heart is balanced by its earthy groundness. Without this there is room for the seven emotions to create disturbances52. Larre and Rochat describe Yi (intellect or purpose) as a raw material, like clay, becomes fixed by the warmth of fire (Heart) giving form. When purpose remains, there is Zhi, will. Supposedly an earth organ, the Heart comes back in the center of Jing-Qi-Shen, as being the body’s emperor as well as the central earth bound place to balance the fickleness of the Shen which resides there.

Heart and blood

We know that the Shen resides in the Heart, and Heart governs blood. Shen, and thus Heart, governs all

mental activities. An important relation between Shen and Blood is:

“Blood anchors the Shen”

Meaning Blood embraces and anchors it, creating a peaceful and happy Mind. And simply stated

emptiness of (Heart) blood, will result in mental restlessness, depression, anxiety, and insomnia. Which

can in turn lead to a deficiency of blood. Symptoms reflecting this are pale complexion palpitations and

a weak or irregular pulse.

Emotionally speaking the Heart stands for the capacity to have meaningful relationships. A healthy Heart

and Mind will contribute in our ability to relate to other people. This is what makes an “open” Heart so

important. It also shows that opening up to others is what is leading in health, happiness and mental

wellbeing. Subtly supported by the Buddhist thought that all suffering is generated by attachment (i.e.

to self/ego). Another theorem that adds to this thought is that:

“All disease comes from the Heart53”

It is another way of saying that the Mind is the most important, highest and noble faculty of man. If

there is an unbalance, unhappiness etc. they are prone to manifest as an disease.

51

Please note the previous reference on earth versus heaven, where earth is associated with craving. 52

As opposed to animals who are generally free from the pathological influences of emotions 53

(Fruehauf, All Disease Comes from the Heart, June 2009)

31

The relation with Blood, and blood flow is crucial to the Heart and Shen. A stated before Shen resides in

the Heart, and is anchored by Blood. The three treasures are important in healthy Blood household, see

the following:

Figure 6, Jing-Qi and Shen are all closely related to Blood.

In TCM the Mind is closely related to the body. If essence (Jing) is flourishing, and Qi vital, the Mind will

be peaceful and happy. The reverse is also true, when Jing and Qi are weak/deficient the Mind will

suffer54.

As Figure 6 depicts Shen resides in the Heart, and Heart controls the vessels, by extension Shen resides

in the vessels55. I’m wondering if this relates to the biological effect that where you focus your Mind on,

will generate an increase in blood flow to the corresponding organ/ body structure.

A concluding remark: Blood (yin) anchors the Mind (yang). And thus for a healthy Mind we need a good

production and flow of Blood. In the previous chapter the Heart was introduced as both an Earth and

Fire organ, earth provides room and also anchors the Mind. I’m not sure how these two aspects relate

to each other. Perhaps it is by the function of the earthy organs (Spleen and Stomach) to convert Jing,

into blood. Where its formation is completed by the spark of fire (and Shen?) of the Heart.

When it is said the Heart should be empty, an “empty vessel”, it refers to being free from harmful

emotions and obviously not empty in relation to Blood, an interesting contrast.

54


(Al-Khafaji, 1995, p. 32)

Xue

(Blood)

Jing

Qi

Shen

•Transforms into blood and vice versa

•forms blood

•Is nourished by blood Jing

•Commander of blood/ blood is the mother of Qi (nourishes)

•Holds, moves, generates blood Qi

•Anchored by blood

•Heart controls the vessels

•Resides in the Heart Shen

32

Aspects of the five Shen

So far we have discussed the Mind (in general), emotions and the Heart. Actually the Mind in TCM is

composed of five different aspects, Wu Shen. We already highlighted on the fact that an empty Heart

has room to accommodate the view and presence of other people. Coming back again to health, it can

be thought of as the absence of destructive emotions and correlated behavior. If all disease comes from

the Heart, an healthy Heart should not generate diseases. A tough statement to make I guess, with deep

implications. In part we will address this in this paragraph by looking at the virtues of the five Shen. Later

(in the chapter Mindfulness) we will see that health is determined both by absence of destructive

emotions and expression of true or virtuous emotions, there to express your true self.

The Heart is the emperor of the five Zang and the place where the Shen resides. The Heart Shen

determines the other four Shen56. In each respective organ the Shen embodies a different aspect:

“In the liver it is Hun, in the heart it is Shen, in the spleen it is Yi, in the lung it is Po, in the kidney it is Zhi”

As stated before, the Mind is a transformation of essence and Qi. The relationship with the five Shen

and Jing-Qi-Shen is depicted below in Figure 757:

Figure 7, as Jing is transformed into Shen, it takes the Zhi (will power) and Yi (intellect or memory related to the heart).

From this relation it is said that Hun is close to essence but it comes and goes and Po is close to Shen,

but it comes and goes58. Related to this Hun has the ability to imagine (yang) and Po has the sensitivity,

touch of the surrounding (yin)59.

Now let us first look in more detail to five different aspects of the Mind and how they each pertain to

specific emotions and correlating Yin organs in Table 2 below60:

56

(Jie, 2012) 57


(Larre & Rochat de la Vallée, The Heart, Ling Shu chapter 8, 2004, p. 70) 59

(Maimon, 2012) 60


Jing

Hun

Qi

Po

Shen

Zhi and Yi

33

Table 2, components of the TCM concept of Mind, related to organs and corresponding emotions. Sometimes emotions are described as 5, or 7 (qiqing). In the latter case You and Jing are added to the list of five.

Spirit Organ Virtue Emotion61 Emotion

Shen (Spirit) Heart Ecstasy Xi (euphoria) Joy

Hun (Etherical soul) Liver Vigor Nu (rage) Anger

Po (Corporal soul) Lung Nostalgia Bei (sadness) Grief

Yi (Intellect) Spleen Contemplation Si (thought) Worry

Zhi (Will power) Kidney Awe Kong (fear) Fear

You (anguish)

Jing (fright)

Emotions are numerous62, 63, however in TCM they are often described in a sets of five or seven, due to

the philosophical implications in Chinese numerology64. In another arrangement the emotions are

categorized as six, related to the six climate factors. A very suitable metaphor for the unpredictability,

intensity and vastness of emotions themselves “the weather of the micro cosmos”65. Or to quote from

Larre & Rochat de la Vallee66:

“Heaven possesses wind and rain, man possesses elation and anger”

Nicely followed up by the statement that it is natural to have perturbations, but it is not normal to

always be in a storm or hurricane. The number five represents our virtues, they can be under attack by

attachments or over indulging in things. This in turn can lead to a more noticeable imbalance in the

seven emotions, which all together can lead in diminished health. An overview is given below.

Figure 8, the 5 psychic aspects here refer to the traits and characteristics of a person. Going through life it is the balanced expression of these virtues that will guide you towards cultivation of your Shen. Emotions are also related to the 5 Shen, but their long term or strong effect negatively influences health. Note that the 5 Shen (virtues in this case) can also create imbalance themselves by selfish attachments or overindulgence

67.

61

(Rossi, 2007, p. 14) 62

In Buddhism it is said there are 84.000, denoting the complexity of the Mind, but also the number of ways to start your path to “enlightenment”. Arguably this relates to the previously discussed concept of Jing-Qi-Shen. 63

(Coleman, 2007, pp. 116-117) 64

(Larre & Rochat de la Vallée, The Seven Emotions, 2005) 65



(Fruehauf, All Disease Comes from the Heart, June 2009, p. 29)

5 psychic aspects

Influenced by "7" emotions

effect towards health and

Shen

Indulgence, attachment etc.

34

The grouping of five relates more to the innate mental aspects, meaning we are all born with the traits

and characteristics relating to, Shen, Hun, Po and Yi. We have our own landscape of emotions, likes and

dislikes, which is normal. The seven emotions are considered to be the pathological counterpart of the

five virtues or five Shen. Ju-Yi calls it: “Postnatal manifestations of the interaction of the individual with

the world68”. Meaning that as a person with certain traits, as you undergo life you are subject to the

influence of emotions. The relation between the five Shen and the (seven) emotions can be described as

follows: E.g. it is the Yi that accounts for once intelligence and focus and it is the excess emotion worry

(or thought) that can affect it negatively. For the others it is vigor that turns to anger, ecstasy to

hysteria, nostalgia to grief, awe to fear. Possibly leading to fire pathologies, excess, deficiency or

stagnation69.

Being exposed to life and its hurdles, interactions etc. influences your wellbeing. With influence I mean

imbalance or disease. The long term or profound effect of these influences eventually influences Shen

and the overall sense of wellbeing and happiness. In the next chapter the virtues of the five Shen will be

discussed. Focusing on these positive aspects can be an positive outlook in therapy.

68

(Ju-Yi & Robertson, 2008, p. 76) 69


35

Virtues of the 5 Shen

As stated in the previous paragraph, the five aspects of Shen relate to the innate state of an healthy

human being. In TCM they are also called the Wu Chang (five virtues) The balanced ability to express or

perform these traits is what determines health. In therapy, by talking and observing you can get a feel

for what is going well for someone, or where they could be lacking. Knowing about the five virtues can

help with a compassionate understanding for your patient and so enhance the effectiveness of

treatment.

The table below summarizes the five psychic aspects, with some typical characteristics one can look out

for:

Table 3, five psychic aspects and their characteristics.

Mind Organ Characteristic70

Corporeal soul (po) Lung Tenacity, physical appearance

Intent, reflection (yi) Spleen Organized logical thought

Spirit (Shen) Heart Spark of intelligence, recognition

Essence (jing) / Will (zhi) Kidney Ability to finalize intended action

Ethereal soul Liver Balanced courage

Another overview is given by Fruehauf71, in it are more mental aspects compared to the previous table:

Table 4, different positives aspects of the 5 Shen.

Wood Fire Earth Metal Water

Organ Liver Heart Spleen Lung Kidney

Virtue Compassion Propriety Integrity Selflessness Wisdom

Positive quality

Sense of direction and strategy

Understanding, sacred connection

Trust and reliability

Radiance of sound and light

Soft and harmonious

Powers Containment Respect Commitment Discernment Awareness

It is remarkable to see the difference in these two tables, coming from different references. Table 3 to

me has a more basic quality to the properties it depicts. Table 4 depicts more of the qualities in life, and

to my opinion reflects the idea of virtues (De) the best because it can provide an outlook on personal

development and growth.

70

(Ju-Yi & Robertson, 2008, p. 77) 71

(Fruehauf, All Disease Comes from the Heart, June 2009)

36

Foreseeing the chapter on Mindfulness the water element in both tables is interesting to highlight. In

the tables it is related to following through with your actions and wisdom. Larre and Rochat describe Zhi

as:

I am both confused and intrigued by the fact that the wood element is related to compassion. In

Buddhism and contemporary ideas of Mindfulness compassion is related to the Heart. Maybe it has to

do with the relation (and control of) anger. Perhaps it is though that controlling your anger towards

others has to do with being compassionate towards them.

There are also helpful traits to be found with regard to the elements themselves72:

- Water, fear. But also the flexibility to withstand and go through difficult situations

- Wood, anger. But also patience (like a slowly growing tree), or the drive to push through

- Fire, joy. The negative emotion could be madness, a form of isolation perhaps. But fire also

stands for the ability to connect.

- Earth, worry. But also the ability to plan and think ahead and provide means for growth

- Metal, grief. But also the capacity to embody and resist

The list below elaborates on positive traits of emotions, before they become pathological73. The arrow

represents the positive transformation, and below that is given a practice and associations to facilitate

the transformation:

Fire: Joy (and madness) love

Politeness, humbleness, deference (sacrifice time for rituals and remembering your heavenly nature.

Earth: Focus (or intent). Makes us real. Trustworthy, integrity (with ourselves, others and the universe)

Metal: Sadness reflection

Righteousness (acceptance/selflessness), seeing the beauty in things. See the ruby “metal” in the earth,

“yes it happened, and it is all right”

Water: Fear Awe

Wisdom, making yourself lower, you can learn from anyone. (water seeks the lowest point, and

minimum resistance)

Wood: Anger compassion

Wishing well and benevolence.

To finalize this paragraph we end with another positive note. Before it was said that emotions are there

to guide us in our behavior. When people get stuck in a certain emotion it is possible to address their

situation with an counteracting emotion, from the controlling cycle of five element theory we get74:

- Anger counteracts pensiveness

- Joy counteracts sadness

72

Largely my own interpretations, inspired the references above and by Maciocia’s comment on this about Water. 73

(Saraswati, 2012) 74


37

- Pensiveness counteracts fear

- Sadness counteracts anger

- Fear counteracts joy

38

Description of Emotions75,76

Although in TCM it is thought that emotions pertain to a specific organ, their effect is not limited to that

organ. To that end in describing the emotions emphases is made on the effect they have on different

organs. Furthermore I tried to relate all the emotions to the effect they have on the Heart. The effects of

expression and suppression are named, but not elaborated on. This will be discussed in the paragraph

Emotions and expression. I did not stick to any of the typical numbers describing the emotions. They are

a selection of the most common ones described in literature.

Anger Liver, Lung, Spleen/intestines and Heart All emotions are difficult to control, but from this quote77 Anger especially:

“Of the seven emotions, anger is the hardest to control”. Li Yi-ru, Qing dynasty.

A quote provided by Maciocia also reveals this nature:

“Anger causes loss of self-control” Anger is, amongst others, related to resentment, repressed anger, irritation, rage and bitterness. It can cover a deeper laying emotion like guilt and feelings of insecurity. The long term or intense presence of these can injure the liver, leading to stagnation of Liver Qi, stasis of Liver Blood, Liver Yang rising, Liver fire, etc. Because anger raises Qi symptoms can include headaches, tinnitus, dizziness, red eyes, etc. The involvement of Blood and the Hun make it also prone to forgetfulness78. If the Stomach/Spleen is attacked also diarrhea can occur. As an emotion it is generally directed outwards, to others. Like the earth element is wood element is also involved in making plans and pursuing them. Anger is related to the Liver but also the Gall-Bladder. The latter is known as the rectifier, associated with correctness. And it is also associated with courage and timidity. Joy Heart (also related to madness, Kuang and Dian) Joy in itself in not a pathological emotion, in moderate amounts it actually is very beneficial. What is meant here is the overabundance in expecting or seeking joy, like partying all the time etc. It is this craving for joy that is thought to be the root of emotional problems by Confucianism, Buddhism and Taoism! In the Qi dynamic Joy slows down Qi and stirs up the ministerial fire, which disturbs the Heart79,80 (imperial fire).81

75

(Maciocia, The practice of Chinese Medicine, 2008, pp. 282-298), for the general descriptions 76

(Larre & Rochat de la Vallée, The Seven Emotions, 2005) 77

(Deadman, How to be Healthy, June 2005) 78

Good memory is made by communication of Spleen, Kidney and Heart 79

(Saraswati, 2012, p. 19) 80 The difference of sovereign and ministerial fire also reflects pure and bodily (lust etc.) sensations. 81

This balance of fires and the balance of water and fire is very interesting, but outside the scope of the Mind and emotions for now.

39

On the other hand there is the condition of having a permanent lack of Joy in once life. This does not refer to the undertaking of fun activities. What is implied is a lowering of standards for happiness and Joy, unconditionally. Not: “I will be happy if…” But just simply the contentment of being alive82.

Worry/Pensiveness (overthinking) Lung, Spleen and Heart Thinking is about the correct perception of the senses and integrating information with memory by the Heart. Normally this would be a balance between brain and heart, and the ability to plan further ahead. The latter can also be pathological, always planning but not seeing the plans though. Worry is a common emotion in our modern society, also called overthinking in TCM. It is said to knots/stagnate Qi. Because of this it has an effect on the Lungs and Spleen. Leading to loss of concentration and digestive symptoms (Spleen) and shallow breath and “chest” symptoms (Lungs). Knotting of Qi means there comes a new focus for the Mind, making for an unbalanced Mind and a perpetuating nature of this emotion, like the element earth has the nature to attract. Compared to worrying pensiveness has a more nostalgic note to it and is related to an excess of think for example by studying, without worry. Sadness and grief Lungs and Heart (and the Liver, Liver yin) (also regret) These emotions have a relation to regret, loss and breakups. They can be from the past, and the tendency can be to mentally go back to that time. They can dissolve Qi causing deficiency and tiredness, weak voice etc. If the deficiency last for a long time it can lead to stagnation. Sadness can also affect the Liver yin. The impairment of this organ, and the Hun can lead to mental confusion, depression, no sense of direction in life and no capacity to plan one’s life. Sadness is related to the Heart and the Pericard, giving pressure on the Heart, its muscles and the connections there. Because Heart is linked with Fire, there is a special relationship with Water. If there is an imbalance between the two, water can flow from the Hearts orifice the eye, and there is crying. Fear/Shock Kidney and Heart (also fright and agitation) Besides the relationship with the Kidneys, fear can also be related to the Liver and Gallbladder and an impairment of the Hun. The effect of fear in generally said to make Qi descend (effecting the Kidney), giving symptoms like incontinence. But Maciocia adds that it blocks the upper burner Qi, Therefore unblocking the Qi should be considered in treatment of fear (e.g. by the points He-5 and Lu-7). Fear can also make Qi rise, in which case it will affect the Heart. In this case it can cause insomnia and palpitations. Shock also pertains to the Kidneys and is said to scatter Qi, making it chaotic. It creates an inability of the to balance yin and yang in a person, facilitating a dissociation between spirit and essence, leading to for example convulsions and epilepsy. However these convulsions and fright can also be related to a lack of Blood (related to Liver and Gallbladder above). Love Heart

82


40

Like the other emotions we are concerned here not with normal affection but with the over indulgence or inappropriate expression. Meaning persisting in loving someone who hurts you (mentally or physically). It is also related to severe jealousy. It quickens Qi, affects the Heart and symptoms are: insomnia, mental restlessness and palpitations. Guilt Lung, Heart, Liver and Kidney Guilt is very common in the West. It has deep foundation in our Christian culture. In TCM it is less known and not so much described. Probably because the notion of guilt is not common to the three big religions of the east. Guilt incorporates the feeling of responsibility of negative situations, a feeling of regret for misdeeds (true or imagined), feeling of responsibility for negative of things happening to others. The effect of the emotion is directed inwards, towards the self. In a sense it is similar to shame, but guilt has more of a sense of inadequacy to it and much more darkness. The effects of guilt are diverse, it can lead to Qi stagnation like all other emotions and it is closely related to Blood stasis. It can also cause a sinking of Qi. Shame Spleen, Kidney (and Heart) Shame resembles guilt and is also very common to the west. What is interesting is the notion brought up

by Maciocia that guilt is helpful for growth. It is argued that by knowing right from wrong and admitting

your mistakes contributes to wisdom. As such it is regarded as a positive emotion, because it aids to

self-esteem. The key again is moderation. If shame is pathological it is overwhelming and self-

demeaning and it makes you defensive and impotent.

Shame is more related to what people think compared to guilt, and it brings forth a feeling of wanting to

hide. Guilt you would still feel even if no one is watching you. Both are inwardly directed, leading to

stagnation and sinking of Qi. Often accompanied by Dampness, reflecting the feeling of “dirtiness”. With

a heavy sexual moral from Christianity and Protestantism in the West, it is interesting to see this

reflected by symptoms in the bodily areas of reproduction: vaginal discharge, excessive menstrual

bleeding, and also incontinence, prolapse of organs.

41

Emotion

Qi/Blood stagnation

Organ disfunction

Effects of emotions on the Qi Mechanism

Let us resume the general process by which emotions are disruptive83 with regard to Qi, Blood and other

pathological factors:

Figure 9, Emotions are an expression of Qi, and have a disturbing effect in the Qi dynamic. Ultimately this will lead to Qi stagnation. Because of the close relation to Blood, this can also lead to Blood stagnation. Both Qi and blood stagnation can lead to Damp or Phlegm formation. And all of these factors in turn can lead to an emotional response. See also Figure 10.

All of the above emotions described in the previous chapter, and many more, can cause a disease. They

can interrupt the working of their corresponding organ, or stagnate Qi and blood flow.

We start from the point that an emotion can affect a related organ, but the reverse is also true. Looking

at an example of emptiness of Liver Blood, can cause Liver Yang rising with headaches, anger and

irritability. The other way around anger and headaches can have an effect on Liver Blood (facilitates

deficiency) and Qi (facilitates stagnation). See the below figure as a general illustration.

Figure 10, the dysfunctional relationship between the (Yin) organs and emotions in case of a pathology.

Because emotions cause stagnation, organs more involved in the Qi mechanism are likely to suffer i.e.

the Liver and the Lungs, besides the corresponding organs from five element theory.

83


Emotion Qi

Rising

Descending

Knotting

Dissolving

Qi / Blood stagnation

Damp

Phlegm

42

A more detailed description of the effects also on the Qi mechanism as it is commonly known in TCM is

shown in the table below:

Table 5, emotions and the effect on the Qi mechanism84

.

Emotion Effect on Qi Transformation Organ often affected

Joy, elation (xi) Causes Qi to slacken, moderates excessive emotions Heart

Anger (nu) Causes Qi to rise; moves to the head; blood follows Qi in counter flow

Liver

Thought, thinking (si)

Causes Qi to knot and bind; Qi dynamic does not move Heart, Spleen, Stomach

Sorrow (bei) Dispels Qi; prevents free flow in the upper burner by depressing the lung

Heart, Lung

Melancholy, worry (you)

Effects not described in Inner Classic; often combined with sorrow

Lung, Spleen

Fear (kong) Causes Qi to descend; kidney fails to hold urine, feces, or even essence

Kidney

Fright (jing) Causes disorder of Qi; affects the clarity of the heart; one cannot think

Heart

The features described in the table above that make TCM so unique. Emotions (our interactions with

others) are related to our own appearance and health, giving way for objective interpretation and

diagnosis and treatment. Again this gives a feel for what is happening with your patient, but it also

provides a hint towards which organs systems might be involved.

Emotions and expression

In the previous part it was stated that key elements of life and health embody continuous change and

adaptation to change. This also counts for mental health. But what is more important for mental health

is the relationship with our emotions. When we relate health with emotions there are two very

important aspects in case of a pathology, from the patients’ perspective:

1. Emotions are expressed to little

2. Emotions are expressed to much

It is very important to express your emotions. Not doing so can lead to depression and a desire to be

alone. Arguably this could be a reason why women live longer than men, because they cry and express

their emotions more compared to men.

Not expressing anger for a long period of time can be a cause for depression. Furthermore it is stressed

that anger is quite often used as a mask for other deeper lying emotions like guilt fear or shame. It is

important to be aware of this and to act accordingly in therapy.

84

(Ju-Yi & Robertson, 2008, p. 77)

43

The idea that in pathology of the Mind is related to emotional expression is widespread. In Table 6 are

some examples described by Josef Müller85.

Table 6, emotional expression is key to health. Basically emotions can be over- or under expressed. Knowing either characteristic can aid in diagnosis and therapy.

Organ emotion Under expressed Over expressed

Liver86 Anger No expression Loud, intrusive, much anger87

Heart Joy Lack of inspiration, mentally closed when hurt

To open: “I broke my arm. Haha”

Spleen Worry Too much consideration for external issues. Empty center

Too much sympathy for yourself (narcissist)

Lung Grief Unresolved hurts Cutting away from grief

Kidney Shock88 “Life is boring”, adrenalin junkies. Paralyses.

The examples in the table above give some practical insight into whereas emotions are over- or under

expressed. Especially talking with your patients these references can readily come up. It is convenient to

have an easy reference as the table above, to help steer your thoughts in the right direction. Note that

not all emotions will give a distinguishing profile. But even this can be of help. E.g. in the case of anger,

someone does not have to show signs. But if during the intake you find out that some great injustice has

been done to that person, and you do not see anger signs, you know that this is significant as well.

Furthermore he emphasizes to throw away your white doctors’ coat, to get in contact with your

patients. It is easy to imagine why this is important when you look at the behavioral symptoms

described above. Their meaning is subjectively interpreted by the therapist. Being in a Mindful and

compassionate state helps to come to the right diagnostic conclusion. Do you hear someone nagging

and going on and on about “nothing” or do you hear someone suffering from grief and/or shock? The

eye is in the beholder! Ideally you would not need a table or some reference like it, but for students it

provides some help.

Objective subjectivity89

We can deduce from the previous chapter is that subjectivity is a challenge to overcome. Obviously this

is an inherent compromise that is fundamental to TCM, as it thrives on this subjective notion. You need

your subjective skills to come to a true perception of your patient. But you should not be misled by your

emotions… It was interesting to learn that a number of experienced practitioners seem to have found

one way or another to deal with the “flaws” of this subjectivity. For example Josef Müller uses a

technique based on muscle reflexes in combination with asking the patient what direction treatment

85

Internship at the Qing Bai academy, Amersfoort, 6 May 2012 86

Maciocia describes: for repression: stagnation of liver Qi and for expression: Liver yang rising with symptoms above. 87

Statement not from Müller, it is my own interpretation 88

Ask for traumas. Shock cuts axis Ht-Kid 89

The description of the discussed practitioners and techniques is far too short to do them justice. Furthermore it is my own interpretation of their work, it may not be accurate.

44

should go90. Dr. Wang has specialized himself in relating the internal disharmonies to manifestations on

the surface of the body. And he stresses the importance of making notes of every treatment you

perform, so you can afterwards objectify your choices at that time91,92. Yair Maimon uses a principle of

“one minute diagnoses” which should allow your basic TCM instinct to take over, avoiding complicated

theories and artificial strategies93. Robin Saraswati has an approach where a Mindful approach is central

in her practice, therapy is “guided” by discussing the questions of life, to go to the root of the problem,

see Appendix 1.

In the framework of TCM for a single diagnosis there can be many possible treatment strategies. And

even the diagnostic principles can differ according to the particular tradition. To add to that the

variability from person to person, gives a lot of room for uncertainty. To have a method or principle that

helps you with structuring and objectifying can be greatly beneficial. See Figure 11 for a graphical

representation.

Figure 11, To pin point your therapy in such a way that you get the maximum effect from your own interpretation within the classical framework of TCM experience and objectivity are needed.

In the above figure we can see key factors in diagnosis and treatment. If we regards the classical

framework of TCM as “fixed”, the other two factors become determining in therapeutic efficacy. To

both of these experience is a key element. But besides that working in such a way so that you can collect

feedback (e.g. from your notes) and structuring your methods (as described above), can enhance

accuracy and effectiveness.

90

Internship at the Qing Bai academy, Amersfoort, 6 May 2012 91

(Ju-Yi & Robertson, 2008) 92

Course: introduction to channel theory and palpation, Dublin, June 2012 93

(Maimon, 2012)

Experience

Structured method

feedback

Classical framework

Subjective interpretation

Chosen therapeutical

strategy

45

Having elaborated on the matters of diagnosis and emotions we now look at some examples of mental

disturbances and their “traditional” diagnosis in the next paragraph.

46

Examples of diseases and TCM diagnosis

This chapter is just a short summary of generally seen patterns in mental en emotional diseases. Like

stated in the preface this part will not be elaborately discussed because the emphasis is on the Mind and

the emotions themselves. To be accurate I do want to spend a few words on this subject, please see

them as a point for further reference.

Mental disturbances are many, to give an example here are a few which fit this description:

- Excessive fear, Overthinking, Extreme sadness, over worrying, Depression (Yi Yu), Chronic

fatigue syndrome (CFS), Insomnia

- Saraswati names a couple of additional conditions: Withdrawal (Dian), agitation (Zang/Fan Zao),

easily awakened (Yi Xing)94

Withdrawal is defined here as a numb effect, depression with no desire to communicate and a desire to

be alone.

CFS and depression can be thought of as general mental disorders. Meaning that most mental emotional

disease will likely have aspects of CFS or depression. The etiology given by Lee for CFS is also a broad

one:

1. Physical overwork

2. Mental exhaustion

3. Disharmony of life rhythm

It cannot be clearer, from this again we conclude that a moderate lifestyle is paramount. Related to

points three above, following the changes of the universal Qi95 is essential. This literally comes back in

several references. But also in the first two points above a large component attributed to lifestyle

factors. Exhaustion can also be thought of as the lack of rest or sleep and good quality of sleep is

beneficial for mental health. But often also our going-to-sleep-behavior is prone for improvements.

Sleep is an interesting phenomenon related to the Mind. All or mental activities (seeing hearing thinking

etc.) consume Yang Qi, and when we are out of stock we lose the capacity to have a clear Mind and to

have contact with the outside world. At night the Blood and Yin replenish and nourish the Yang Qi. Sleep

is related to the Hun and Shen, and thus is related to blood. If there is sufficient Blood Hun and Shen will

be healthy and sleep will be good96.

A number of TCM diagnosis is correlated to mental disturbances97, likely having a root in being unhappy

and being in an emotionally unbalanced state. The most important ones being98:

- Qi Stagnation (Heart, Liver)

94

(Saraswati, 2012, p. 20) 95

(Jie, 2012, pp. 1-5) 96

(Marsman, 2012, p. 2) 97

Please note that these are prominent examples, not a complete list 98


47

- Blood Stasis (Heart, Liver)

- Heat or Fire (possible due to long term Qi stagnation)

- Damp or Phlegm (associated with Spleen function) clouded Mind

- Heat toxicity (from long term EPF, traumatic experience, bad life style: diet and time)

- Kidney deficiency (yin vacuity fire)

- Spleen deficiency (yin vacuity fire)

The patterns can be described more specifically, Qi stagnation often has to do with the Liver, and Damp

and Phlegm can be related to Spleen function.

Each of these factors can contribute to the formation of the next: Qi stagnation can lead to Blood stasis,

both of them can cause Heat or Fire, and the combination of stagnation and Heat can lead to Dampness

of Phlegm. Al of them hinder the function of the Qi mechanism and Damp and Phlegm add to that a

barrier, possibly isolating the Mind and or Heart.

48

Summary for Mind and emotions

It can be said that the concept of health embodies the capability to react, change an respond according

to the circumstances at hand. These can be social or psychological events as well as the changing

environment as it normally occurs in nature.

Emotions disrupt the Qi mechanism leading to stagnation. Although they are correlated to specific

organs their disruptive effect is not limited to a single organ. Specific symptoms can be deduced from

organ relations, Qi movement impairment by the emotions (anger makes Qi rise, giving headaches and

tinnitus etc.) and the behavioral aspect of the emotion. Qi stagnation can lead to stagnation and

deficiency of Blood, making that the Shen cannot reside there and mental emotional problems can arise.

In the end all emotions will affect the Heart, when the Heart is disturbed it loses its ability to orchestrate

all the different aspects of the Mind (Wu Shen, five spirits) coherently and this lead to mental emotional

disturbance as well.

Emotions have a bad PR so to say, but they do have a function, both from a western perspective as in

TCM. Looking at the five virtues (aspects of the five Shen) can help guide a negative emotion into a

positive trait. And these virtues can provide a guides of where we need to go to in therapy and life as

well.

It is crucial to be compassionate and Mindful for the patient you are working with, interpreting their

emotions can also interfere with yours. Are you merely observing or also projecting and reflecting? To

this end it can be helpful to incorporate techniques and manners which will allow you to objective your

own (subjective) practice. That is of course besides knowing about the different aspects and emotions as

they are described in TCM, knowing these will also help finding out what is going in with your patient on

a Shen level.

In this chapter, Mind refers both to memory (in the West) and an integration of the five psyches in TCM.

It is natural to express emotions and this should be done so in a balanced fashion, not too little, not too

much. When however you are working with your patient on an emotional level you should always take

into consideration the fact that they cannot directly understand and/or control their emotions. An

intellectual understanding of how the Mind works, and techniques (meditation) to redirect emotional

“routes” in their brains can help the person and their treatment. Thus it is important to know emotions

diagnostically (and correlate them accordingly to therapy).

In treatment it is important that you adopt to a method that allows you to objectify the subjective

interpretations you make. This can be by means of a journal, first impression (not overthinking), by an

understanding of emotional expression patterns and many other possible techniques.

49

Mindfulness Mindfulness is a modern term that relates to what Sun Simiao was thought to introduce first in TCM,

namely Yang Shen, or nurturing life. He did so by integrating cosmology with the ethical ideas of

Confucianism and Buddhism, leading to a new means to spiritual, personal and social cultivation. He

emphasized greatly the importance for the physician to have a sound moral99:

“In one’s daily practice, one must have an attitude of self-possession and concentration; have a dignified

appearance; treat all patients equally with no regard to wealth, gender, status, nature of ailment or

potential rewards ... while abstaining from luxuries and from criticizing one’s fellow physicians”

Mindfulness is the modern term that basically denotes a moderate and compassionate lifestyle. It

involves a healthy moderate diet, exercising, resting well, self-massage, sunshine (going out) and a quiet

Mind100. But also includes respecting the products you use and the food that you eat and having a

positive attitude towards life (just because...). The quotes below referred to by Peter Deadman101

illustrate to all this very well:

“The reason why the virtuous live long is that they are not greedy for outward gains and are able to keep inward peace”

Dong Zhongshu 179 BCE-104BCE

“The less one eats, the broader his Mind and the longer his life span; the more one eats the narrower his Mind and the shorter

his life span” Zhang Hua, Jin dynasty 265-420

“Be cheerful whether rich or poor, He who does not laugh can only be a fool” Bai Juyi

“A treasured friendship can replace regret and hatred and heal the old wounds of the Mind. Such a friendship can provide

sincere help, consolation and encouragement. These can be magic weapons for elimination of grief and anxiety. When your life is free from anxiety and grief, you will find food tasty, sleep

restful and recreation enjoyable” Xu Xiangcai

We can take from these quotes, the basic premise of Mindfulness, moderating, avoiding or minimizing

craving and passions (in the negative sense), to be joyful and to share your life and happiness with

others. This is the reason why people of ancient times aged well:

99

(Wilms, 2012, p. 6) 100

(Saraswati, 2012, p. 12) 101

(Deadman, How to be Healthy, June 2005)

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“Reached one hundred years of age without decline in their activities102”

Moderation is a key aspect to prevention of mental emotional disturbance according to Maciocia. He

summarizes to avoid: excessive thinking and craving, and distracting thoughts.

Mindfulness in therapy means being there for you patient, with full attention and compassion. But also

means heaving great respect for a healthy and balanced state, and being sure that you do not disturb

this if and when encountered.

There are many practices which will help to cultivate a Mindful state of Mind. Rituals are important

therein, as this helps you remember and focus on your virtues or heavenly nature. So this is the

foundation of a Mindful lifestyle to create and harbor activities that will allow you to remember your

heavenly nature. This is the same for everyone, including therapist and patients. Examples of practices

are given in the paragraph, Aspects for therapy.

Mind and emotions of the acupuncturist

In the Suwen several paragraphs are dedicated to the skill of the healer. For instance in this passage

where it asked why physicians who know TCM and know the patient still can prevent illness from

manifesting103:

“A good healer cannot depend on skill alone. He must also have the correct attitude sincerity

compassion, and sense of responsibility”

With this we are again reminded that it is both what and how are important.

This sincerity and compassion ultimately is put to use to become a “top level physician”, one who sees

what the average practitioner cannot see. Of course if you cannot “perceive” you ask and feel for the

discomfort, you go with what you have got. To reach this level you do not just go with what is told by

your patient, rather it is Shen that guides you. Again a beautiful and insightful quote from Fruehauf104:

“Your eyes see the invisible, your Heart is open, and your intuitive sensing is front and center. All of a

sudden then, the subtle truth will reveal itself to you, without being able to put your experience into

words, seeing while everybody else does not; as if the night turns bright for you alone while everybody

else remains in the dark, like the invisible hand of the wind moving the clouds. That is why it is called

Shen, mysterious”

Even more insightful is the conclusion drawn from this, that in “grasping” Qi, by not focusing on the

Shen and the subtle aspects, you actually contribute to the manifestation of the disease and thus the

decline of the body.

102


(Ni, 1995, p. 54) 104


51

As a healer, or patient, we all benefit from cultivating our Minds. It is important to try and make it a

daily ritual, which suits you personally. Besides that other activities you can adopt as often as required

(or possible, like a retreat). Examples are:

Writing, journaling, fasting, retreat, chanting, contemplation, meditation, sauna, exercise, yoga, tai chi,

Qi Gong, going to a religious place, etc. But it can be also as simple as a candle and a table. Prayers or

mantra’s (Mind projections) are very helpful as well. The importance is that you put your Mind to it, do

it daily (so it becomes a habit for when you need it).

Qi Gong105

To highlight one of these Qi Gong is found to stop mental processes while consciousness and awareness

are maintained. Because the brain is temporarily relieved from external stimuli the brain function

achieves a high degree of coherence. Furthermore it is found that general energy consumption is

lowered, the bodily rhythm is improved, and the Qi flow is in the correct direction and in the right

meridians.

It is to be expected that with these properties, positive effect are to be expected for (mental) health.

Indeed Qi Gong is found to be effective in a wide range of diseases. Related the Mind it was found to

regulate hormones and emotions, improves mental agility, short term memory and increase the

attention span. Furthermore there was an increases sense of inspiration and creativity.

In TCM there is a group practitioners who use medical Qi Gong to treat people, this is also done in

combination with acupuncture.

Aspects for therapy

Describing this perfect state of Mind in the previous paragraph, the obvious question is how. What can I

do to become better? It starts with remembering your heavenly nature, and adopting activities that

encourage that (walking, meditation, retreats etc.) like described before.

Then we can incorporate rituals106,107 to adopt in treatment specifically. To follow the tenets of ancient

times and to experience their magic in the present. To keep the inner eye on the subtle and mysterious /

the unlimited.108,109:

105

(Guo, 1994, p. 2) 106

Rituals or methods are also discussed in Objective subjectivity 107

Rituals are also important in ancient China, they are deeply embedded in the culture, to help people adapt though with appropriate regard to emotions and social circumstances (Fruehauf, All Disease Comes from the Heart, June 2009). 108

(Ni, 1995, p. 101), Su Wen Chapter 25 109

From a standpoint of an acupuncturist the list could also be reversed. But it is safe to assume that the Spirit is first and foremost in this classic.

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1. Have unity of Mind and spirit (do not be scattered)

2. Understand and practice the Tao of self-preservation and cultivation

3. Be familiar with the true properties and actions of each herb

4. Be proficient in the art of acupuncture

5. Know the art of diagnosis

Fruehauf110 interprets it similarly, but slightly different:

1. Treat the spirit

2. Know how to nourish the physical body

3. Know the true transmission of herbal medicine

4. Work with large and small needles

5. Know how to diagnose the state of qi and blood in the Fu and Zang organs

They are very similar however I appreciate the interpretation given for point number two, it makes it

somewhat easier to understand.

A lot of the quotes used so far have to do with Mindfulness and how important it is. So I will not repeat

the effort here. We can use this part in concluding that it is very important to focus your Mind,

illustrated here:

“The clinician should cultivate the ways of heaven and earth, understand the dynamics of the human

spirit, and ponder the depts. Of nature. One will then grasp the Dao”

Again these are very high end ambitions to go for. The practicality in it is to have an open Heart and to

be objectively critical of yourself. So this means keeping a personal journal to observe them, but also to

record your findings with patients. In treatment then it is also important to allow all your emotions (also

negative ones) and to let a situation be uncomfortable. This way you can record it and learn about it

later. If you do not allow it, it will never surface and you are blocked.

This Mindful state allows you to ask the proper questions in treatment and prevents you from

sidestepping from the moment/experience at hand. Adapting to a structure to get your Mind in the right

state is very helpful for this. To that end I already described possibilities in the chapter Objective

subjectivity.

In the end we can reduce al the complexities to say that, you need to simply observe what is out of

balance, and bring it back in to balance111. As difficult and complicated TCM can be, the basics remain

simple.

110

(Fruehauf, All Disease Comes from the Heart, June 2009), ref: Chapter 25 of the Suwen 111

(Maimon, 2012)

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Talking and other aspects of therapy

As we know there is a psycho- emotional aspect about knowing the Mind and recognizing it with your

patients. It that way you can use this to facilitate an intellectual understanding that helps and aids

treatment, especially since emotions are so connected to memory and per definition behavior. They can

become a sort of conditioned (bad) ritual.

There also is the notion of controlling your emotions by also rational reasoning. This entails a cultivation

of morality and will, the conscious control over ones mood and overcoming emotional impulses with

reasoning112,113. The (first) authors continue with practical notes; to consider that is important when you

get angry, your emotion or your health? Than from that statement they aim to overrule the emotions

and thoughts in the patient by giving powerful examples of healing done before and other reasoning.

Furthermore the awareness of the harmful effect of egoism and desires is stressed. And reference is

made to the six harmful influences114, which should be diminished:

- Fame and profit desire should be suppressed

- The desire for sex to which one should not abandon oneself

- Wealth for which one should not be greedy

- Rich food be moderate with

- Unrealistic fantasies get rid of, they distract thought from reality and are harmful to the

Mind

- Jealousy should also be eliminated

In a way they resemble the negative aspects from the emotions discussed earlier, but most of these

points have more of a social context to them.

It is stressed that a broadminded and positive attitude toward life, and having lofty and respectably

ambitions, a sound moral, are a the foundation to “attack” these harmful influences. They form the

basis for further progression. Also relating to the five Shen and corresponding five virtues.

Now when we want to decipher which emotions are relevant to our patients when talking to them,

these are some questions from Saraswati to help115:

112

(Liren & Xioming, 1993) 113

(Fruehauf, All Disease Comes from the Heart, June 2009) 114 Fruehauf also describes six emotions should be warded off like one does with dogs, dears, fish,

monkeys, birds and snakes114. I assume we shouldn’t take this to literally and that there are thought to

be behavioral traits associated with these animals. Furthermore he concludes to say that where there is

an absence of desire and emotions, and the Zang are purified, then there is ample room for “the light of

Spirit”.

115 (Saraswati, 2012)

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Wood: How feel do you feel right now?

Fire: How much are you willing to love yourself, rather than have the world love you?

Earth: How well are you able to maintain boundaries in your life? (Spleen no energy, but still helping

others)

Metal: How much are you willing to let go?

Water: Can you reach the part of your being that is unshakable?

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With this the “what” is defined relatively clearly, now what about the “how”? It is important to reduce

the temperament and ease the Mind, and seeking activities that help to this end. For example carefree,

lively and light exercise is thought to activate Qi and Blood, spirits are raised, intelligence increases and

the muscles and tendons are exercised. These activities are thought to prevent illness and increase

longevity. This means for practitioner as well as patient, again.

When faced with complex situations and emotions, one angle of treatment is to counteract and control

them actively. This can be done with reasoning, providing an outlet for the emotion (as a friend, family

member or TCM therapist you can facilitate this)116, diverting attention (playing music, going for a walk

etc.). Writing down your thought patterns can be insightful and help to create distance from that

negative emotion or thought pattern. Finally we can try counteracting with opposing emotions. For the

latter see the table below:

Table 7, the psychotherapy method of Zhu Dan Xi is based on the below interactions of emotions.

Emotion Diversion Mitigation

Anger Diverted by Sorrow Fear

Ecstasy Restricted by Horror Alleviated by Anger

Anxiety (and Sorrow) Restricted by Joy Alleviated by Anger

Sorrow Restricted by Contemplation Alleviated by Anxiety

Fright Curbed by Anxiety Relieved by Horror

It is interesting to see that anger even though it is toxic as an emotion it can be used in tempering both

Anxiety and Ecstasy. To me this is a new approach and it seems worthwhile. I can imagine someone

partying too much or lacking joy in life can benefit from horror in the sense that connecting them with

an angst will confront them. In both cases, I think, it could confront them with what they will miss out

on, if they keep up their current behavior. Anger next can provide the necessary impulse to get up and

do something about it. At this point it would be too much too elaborate on all of the individual aspects.

The basic idea is there, and right now it is not the goal to cover all the possible implications.

All the examples above are there to help relate your patient. To help them reach where there are

emotional problems in Appendix 1 there is a list with important life questions. These can provoke

emotional responses and provide insight in the condition of the Mind.

Mindset for therapy

All these various aspects of Mind and emotions are, like TCM, quite complex and you can get easily

confused or derailed by all the different aspects to consider. That is why focus and the right Mind set are

so important. A reference on how to do that comes from Sun Si Mao who stated that for treatment the

doctor:

1. Calm your Mind (breathe)

116

The latter can be done spontaneously or controlled. The latter is supported by friends and family members and are supported by e.g. writing and poetry.

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2. Take your Zhi (wisdom from the Kidneys, will power and determination)

3. Let go of your ego (do not focus on results, or have thought like “I’m the best doctor” etc.

4. Hold nothing back (connecting with your patient “bring yourself to the table”)

5. Initiate your kindness

Saraswati has this related manner of preparing yourself for practice:

1. Set intention (think and feel in the body

2. Relax (belly breathing 3x (3 seconds inhaling 9 seconds exhaling)

3. Feel safe, mentally bring in teachers, loved ones, pets, divine beings

4. Cultivate feelings of wellbeing (loving kindness or anything positive), for yourself and for all

sentient beings

5. Soak it up, like a sponge (3 breaths closing)

To add to letting go of the ego, it is not important, or even required to cure immediately and expect

such results. Healing, like life, is a process, you aim it to be better in the future117.

Then with full focus and attention on the tip of the needle you are ready to start your acupuncture

treatment.

117


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Summary for Mindfulness

Mindfulness describes a variety of concepts related to the concept of Yang Sheng, which in turn is about

finding or discovering your true virtues (or positive traits / heavenly nature). Being involved with

activities that harbor this is beneficial for health and longevity, for both patient and therapist. From the

perspective of a therapist is helps accommodate compassion and focus on your patient, and it helps

deflecting the restricting effects of the ego. Sun Simiao who was at the foundation of the concept of

Yang Sheng stressed the importance to self-cultivation and a sound morale in practice, this includes

practicing TCM with the upmost compassion and selflessness. His notion at that time was to redefine

the definition of life, leading to new insight into spiritual, personal and social cultivation.

So cultivation of your Mind is key in practice and therapy, and adopting a ritual to perform these is very

beneficial.

I will close with this beautiful quote which applies very well to our modern times, if we change

alchemical preparations for medicine (or instant fixes)118:

“The Perfected Person said: “Even if you constantly ingest alchemical preparations but do not know the art

of nurturing life, it will still be difficult to extend your lifespan. The way of nurturing life is to constantly strive

for minor exertion but never become greatly fatigued and force what you cannot endure. Moreover, running water does not grow stale, the pivot of the door does not get bug-infested. The reason for this is that they move””

118

(Wilms, 2012)

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Discussion I have tried the give answers to this central question:


And from that specific conclusions are made. What is not answered is why mostly behavioral related

afflictions keep throwing us of balance. Reflecting on this it must have to do with the artificial context

we are living in. The following quote from the Suwen119 provides insight, it starts with describing the

various aspects of modern life that are off balance. And then this is stated :

“They make every effort to please their hearts, [but] they oppose the [true] happiness of life”

By just looking at this I would deduce that pleasing their hearts means indulging in the five emotions and

their related aspects. I would not be able to hold this up to the “right” reference. Luckily in the

commentary by Unschuld a useful reference is made to nourishing life (Yang Sheng):

“To find pleasure in realizing one’s heart’s desires is to counteract the happiness that can be obtained by

nourishing one’s life”

From that statement I conclude that there should be more awareness of the notion of Yang Sheng. It is a

different frame to hold your life’s standards to. Or more roughly stated, it puts a social and moral frame

to our own desires and ambitions. Without going into its particular aspects, I think it would be a valuable

reference to our modern western life style.

Directly or indirectly a lot of the aspects of health and disease are related to a balanced and harmonious

life, free from desire, resting and eating appropriately. Ultimately health is directed to the discovery

(and road towards) your Virtues. Rituals can provide help and structure to that end, for both

practitioners and patients.

I think this is the most profound conclusion to be made. Besides that I argue that there is an artificial

environment that we need to consider when we look at harmonious living these days compared to the

original time frame where TCM originated from. To that end we need to consider the limitations of a

true harmonious lifestyle, whilst still participating in society.

With this broad subject of the Mind there are matters which could not be discussed in thesis and could

be at the basis of future research. For example the concept of Yang Sheng and activities that go with it

like Qi Gong. They have been described in the context of an healthy Mind, but were not the main

subject as such. Also the five Shen could easily be the sole subject of a thesis. I came across very

interesting references of the Hun in relation to mental health, or the role of ministerial versus imperial

fire. I judged it to be too technical for this thesis, and relating to the preface, it also out of scope because

I wanted to focus on the practicalities of working and discussing the Mind and emotion. A good point for

further research.

119

(Unchuld, 2011, p. 33)

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Appendix 1

Question to refer to in your conversations, to help them reach their true nature and meet up to life’s

ambitions120. Please note that it can be that some matters can only be discussed when it is the right time

for the patient and can also depends on the relationship between patient and therapist.

1) How is the current relationship to the significant people in your life?

a. How has it been in the past?

b. How would you like it to change?

2) What are the significant events of your childhood?

a. Of your adulthood

b. What is incomplete in your life?

c. What has been completed?

3) What is the history of- and relation to your job?

a. Does it give you support?

b. Is it a burden?

c. Is it what you want to be doing?

4) What changes has your health problems brought in your life?

a. Job/work

b. Family/friend

c. Self-esteem/self-worth

d. Have there been any benefits? How does your health situation benefit you?

5) Has the health problem confirmed or changed your ideas about who you are?

a. Has the problem a special meaning or lesson for you?

6) How do you care for yourself? And how do you care for others? And has your health condition

changed that?

a. How do you abuse or neglect yourself?

b. What do you value most in yourself?

c. And has it changed since the illness?

7) What do you consider the major disappointments in your life?

a. What are your major successes?

b. What are your major learning experiences?

8) What are the sources of pleasure in your life? (can be guilty pleasures Shame)

a. Where do you recognize sadness in yourself?

b. How do you deal with the pain?

9) What are your most recurrent feelings (e.g. lonely, anxiety, inertia), thoughts, expectations,

fantasies, dreams, plans, fears, memories, obsessions?

10) For the practitioner: What response does the patient evoke from you? (you are a mirror (versus

projection) try and create resonance, to see and to be seen)

120

(Saraswati, 2012), reference to Ted Kapcuks 10 question.

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