The Effect of Sadness and Other Emotions on the Body
Dear Dr. Jiang:
I see a lot of sadness in many of my patients recently. Although I was taught that sadness comes from the lung, I find that many of these patients have no other lung symptoms, such as coughing or wheezing. Should I still treat the lung, even if there are no other lung symptoms?
"Hopeful"
St. Paul, Minnesota
Dear Hopeful:
The short answer to your question is no; sadness alone is not a sufficient reason to treat the lung. If sadness has truly caused a lung disorder, additional lung signs will be evident. More importantly, though, sadness does not actually "come from" the lung at all. Your question raises an issue that has become greatly confused among Western acupuncturists, so please allow me to try to clarify the traditional Chinese concept of emotions. To begin with, the Seven Emotions (qi qing) are not pathological in and of themselves, since even normal people feel some degree of anger; fear; joy; etc., from time to time. Emotions only cause pathology if they are extreme, or if the patient holds on to them for long periods of time.
If we are trying to determine which organ an emotion comes from, the answer will always be the same: all emotions originate in the heart. Chapter eight of the Su Wen states, "The heart holds the office of monarch, whence the spirit light (shen ming) originates." If we think of this "spirit light" as consciousness, we can say that all of our emotions originate from within our consciousness. This consciousness is "monarch" of the body in the same sense that a king is monarch of a kingdom. So long as the heart and its consciousness are functioning normally, the emotions will remain peaceful, like a well-governed country. But if the heart and the consciousness are disordered, any emotion can surface; not just joy, but anger; sadness; pensiveness; fear; and so on, just like a country at war.
Chapter 71 of the Ling Shu states, "The heart is the monarch of the five zang and six fu, and houses the essential spirit (jing shen)." In the Ming Dynasty classic Lei Jing, the physician Zhang Jie Bin interpreted this to mean that while different emotions can gravitate to different organs and damage them, all emotions originate in the heart and ultimately cause some damage to it. According to this theory, the heart not only gives rise to anger, but will be injured by anger; it can give rise to sadness and be injured by sadness. The same can be said about fear, pensiveness and the rest of the Seven Emotions. Because they all originate with the heart, the heart is ultimately damaged by them. For this reason, treatment of emotional problems must always include the heart.
According to chapter eight of the Ling Shu, the liver often works with the heart to generate emotions because "that which goes hither and thither with the spirit is called the soul (hun)." Since the soul is stored in the liver and the spirit is stored in the heart, these two organs work together in the process of creating disordered emotional states. "When the liver qi is deficient, fear will occur; when excess, one will become angry · When the heart qi is deficient, sorrow will occur; when excess, unceasing laughter will occur." This is the only reference in the entire Nei Jing to emotions "coming from" organs. As far as the Nei Jing is concerned, only the liver and heart are capable of generating emotions.
Therefore, if an emotional problem is just beginning, or if it is not too strong, one can simply treat the heart, perhaps including the liver, if this later organ is also involved. In other words, in uncomplicated emotional disturbances, you simply treat the emotion at its source: the heart and liver. Only if the emotion lingers for a long time or becomes very severe will it gravitate to additional organs and cause damage to them. The specific organ targeted by each emotion is listed in chapter five of the Su Wen, which states, "Excess anger damages the liver; excess joy damages the heart; excessive pensiveness damages the spleen; excess sorrow damages the lung; excess fear damages the kidneys." The Nei Jing does not specify target organs for anxiety (you) and fright (jing), but these emotions are generally believed to affect the lungs and kidneys, respectively.
Let me emphasize once again: sorrow damages the lung, but does not originate in the lung; pensiveness damages the spleen but does not originate in the spleen; and so on. Clinically, this means that we cannot infer that a patient's lung is disordered just because he is sorrowful, or that a patient's spleen is disordered just because she is pensive. Emotions such as sorrow and pensiveness are merely causative factors as far as lung and spleen pathology are concerned; they are not in themselves evidence that pathology in these organs has actually occurred.
Chapter 39 of the Su Wen details the specific types of damage each emotion can cause in its target organ. To determine that an emotion has truly caused an organ pattern, we must find evidence of this specific damage. Anger causes the qi to "ascend" (shang); this refers to the tendency of anger to cause liver fire or ascending liver yang. Joy causes the qi to "scatter" (huan). In this case, "joy" (xi) is really a reference to manic hysteria (kuang), as evidenced by the "unceasing laughter" referred to above. The Su Wen's clinical picture of "excess joy," therefore, is one of a patient who has gone mad with extreme excitement, which fits the description of the pattern of heart fire. Sorrow causes the qi to "disperse" or "break up" (xiao). The Su Wen referred to the weakening effect sorrow has on lung qi and yin, causing it to break up or disperse from the body.
Fear (kong) causes the energy to descend (xia). This refers to the downward draining effect fear can have on the kidneys, as well as to the urinary incontinence extreme fear can cause. Pensiveness causes the qi to "bind" or become "knotted" (jie), a description of the stagnation that can form as a result of the spleen's transporting and transforming functions becoming injured. Fright (jing) differs from fear in that fear arises from thoughts within one's own mind, while fright comes from being suddenly shocked by something from the outside, as in the case of a large animal lurching out unexpectedly in the dark. This type of fright is said to cause "derangement" or "abnormality" (luan) in the qi, a self-explanatory reference to how one might react in the above scenario. No specific damage is attributed to anxiety, but this emotion is usually assumed to have similar effects to sorrow.
If an emotion has indeed caused damage to its target organ, it will come back and cause damage to the heart and liver as well, which can then give rise to new emotions. The whole process is therefore cyclical: the heart and liver generate the emotion; the emotion damages specific organs; then it damages the heart and liver (see the illustration).
Let's take a look at some specific treatments. Anger tends to cause excess in the body, even when it occurs in a patient with underlying deficiency. It originates in the heart and liver and causes damage to the heart and liver. The treatment principle, therefore, is to calm the heart and drain liver fire. Typical formulas include long dan xie gan tang, zhu sha an shen wan and sheng tie luo yin.
Joy - really manic hysteria - also tends to manifest in excess patterns. It originates in, and damages, the heart. The treatment principle is to drain heart fire. Important formulas include zhu sha an shen wan, sheng tie luo and dao chi san. Incidentally, dao chi san was originally intended for nightmares in children caused by heart fire, and was only much later adopted to treat urinary disorders caused by heart fire sinking into the small intestine.
Pensiveness comes from the heart, damages the spleen and then comes back to damage the heart. Although pensiveness can theoretically lead to excess as well as deficiency patterns, the historical emphasis has been placed on pensiveness causing deficiency, in which case the most appropriate formula is gui pi tang, which tonifies the heart and spleen and calms the spirit.
Fear or fright comes from the heart, liver and gall bladder, and damages the heart and kidney. These emotions tend to cause deficiency patterns, so the treatment principle is to tonify the heart, liver and kidney. Typical formulas include ding zhi wan and suan zao ren tang. If the fear has caused incontinence or enuresis, you can use sang piao xiao san.
Finally, we come to the emotion you are concerned about. Although sadness usually causes deficiency in the body, the specific treatment will vary according to the organs involved. In some cases, sadness comes from the heart; damages the lung; then comes back to damage the heart. If the lung is truly damaged, however, you really need to see other signs of lung qi or yin deficiency, such as coughing, shortness of breath, etc. If such is the case, a good formula to start with is sheng mai san, which can be modified according to need. In some cases, sadness is really the result of depression of liver qi, in which case the best treatment is usually xiao yao wan. Here again, though, look for other signs of depression of liver qi, such as rib-side pain and a wiry pulse, and not just sadness alone.
If your patients are sad and distressed, and show no obvious physical symptoms, a safe general formula is gan mai da zao tang. According to the Jin Gui Yao Lue, this formula is indicated for such signs as yawning and crying with no reason. It gently calms the spirit and nourishes the heart, liver and spleen.
I hope this information keeps you "hopeful" in the months to come.
Edited with the assistance of John Pirog, MSOM.
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