Psychospiritual Aspects of Traditional Chinese Medicine

Ever since the 17th century, Western metaphysics has been informed by the Cartesian dualism, the notion that matter and mind or spirit occupy separate realms, and that only the material is the proper object of scientific study. As a result, great pains are taken in orthodox medical research to exclude subjective experience from the picture altogether.

If we consider that the exterior of a person consists of what can be observed and described without consulting that person, which is to say without requiring his active participation in the investigation, we have the types of data considered valid in 'scientific' medicine: size, shape, blood tests, x-rays -- all those factors which can be quantified.

The interior of a person, however, is the realm of his own experience, his feelings, what things mean to him, what he values, his goals, his dreams, his destiny. In order to know about this realm, the object of investigation must become a subject, a co-researcher, an active participant in the investigation. You will never find out what things mean to a person, how he sees the world, unless you engage in a dialogue with him.

We are called upon to treat people at different levels of depth. Some people just need a remedy for a relatively minor acute illness. Some need strong and fast-acting treatment for life-threatening diseases. Others need long-term treatment for chronic or constitutional conditions.

But most of our patients need the Interior, as well as the Exterior realm addressed. Indeed, that is what they ask of us: that they be treated as Whole Persons.

The Chinese never suffered from the Cartesian dualism, and never developed the matter-spirit dichotomy which still plagues Western science. Traditional Chinese metaphysics divided the world not into Mind and Matter, but rather into yin and yang, and further into the wu xing, the 'five phases', which describe qualities applicable to phenomena from the most grossly material to the most subtle.

In the human body, there are five major organs (zang), one embodying each of the wu xing. The Chinese model of the zang-fu is more akin to a field model than to the mechanical Western model, in which organs are simply bits of specialized tissue with a specific location and particular biochemical functions. Rather, each of the zang represents a spectrum from physical structure, to physiological function, emotions, mental and social dispositions, and spiritual qualities.

A prevailing attitude throughout Chinese medical thought, and Chinese culture more broadly, is that the proper disposition of the spiritual and mental faculties is essential to physical health, and conversely, that a sound physical basis is required for the maintenance and furtherance of mental and spiritual life. But even to speak in terms of "mental" and "physical" in this way imposes on the Chinese model a dualism implicit in the English language.

Most modern Chinese texts either neglect the mental and spiritual aspects of the zang-fu, or offer an explanation based on Western psychology which distorts their original meaning. The traditional Chinese model of the human person images the individual, the kingdom, and the entire cosmos as organized along similar principles. The ancient medical texts, and particularly the Su Wen, compared the human person to society as a whole, and assigned a 'social' role to each organ.

So let's now look at the psychospiritual aspects of each of the zang-fu in turn.

Fire: the Heart and Small Intestine

The Heart is literally the Emperor and Sovereign of the organism. The Su Wen chapter 8 states: "The Heart holds the office of Lord and Sovereign. The radiance of the spirits stems from it."

The Heart has a double aspect, as did the Chinese sovereign. In traditional Chinese society, the Emperor was the embodiment of Heaven on Earth. He brought order and prosperity to his kingdom simply by being; it was his enlightenment, intelligence and personal harmony which radiated from his palace at the centre of the Forbidden City, which was considered to be at the centre of China, which was considered to be at the centre of the world.

But the Emperor was also a political leader, actively wielding power.

This double aspect is represented by two pairs of ideograms: xin jun and xin zhu. Jun denotes a ruler, the Heart as an entity which has authority by nature, whose presence alone is a guarantee of order. The command of the Heart over the body, as the Emperor's over the kingdom, is accomplished not by action but by a radiation of order from the centre. The role of the sovereign is to preside; his virtue diffuses of its own accord throughout the population.

The Ling Shu chapter 8 says: "That which takes responsibility for the 10,000 beings is called the Heart". And in the Su Wen chapter 8 it is said:

If the sovereign radiates (virtue), those under him will be at peace from generation to generation. And the empire will radiate with a great light.

The Heart is the residence of the shen. The shen are the messengers of Heaven, "the principle of life, that which transforms an assemblage of matter into a living being" (Larre and Rochat 1992). The shen are indestructible and immutable; they transcend Yin and Yang. Whereas other types of spirits are said to be three in number, or seven in number, the shen are innumerable, like drops of water in the ocean.

Another term reflecting the function of the Heart as the residence of the shen is xin zhong, the 'heart as centre'. The shen radiate from the Heart not through an accumulation of energy, but from a void. The void of the Heart is a fundamental concept in Chinese thought, referring not to an absence, but to a space of potential which allows the possibility of creativity, communication and interaction. It is this void at the centre to which Chuang Tzu refers in the chapter entitled 'The Fasting of the Heart':

Look at this window; it is nothing but a hole in the wall,

but because of it the whole room is full of light.

So when the faculties are empty, the heart is full of light.

Being full of light it becomes an influence

by which others are secretly transformed...

The Tao gathers in emptiness alone.

Emptiness is the fasting of the heart.

The second aspect of the Heart is represented in the expression xin zhu; zhu also

means sovereign, but a sovereign in action, at work, in the process of actively excercising his power.

Since the true sovereign himself may not leave his central position of non-action, there must be system of connections, a means by which the authority of the Heart can radiate to the rest of the organism. Xin Zhu is sometimes translated as 'Heart Governor' or 'Heart Master', meaning the Heart as Master, not the Master of the Heart, which would be a nonsense. A translation suggested by Larre is "that through which the heart commands".

Another term for this aspect of the Heart is xin bao luo. Bao conveys the idea of enveloping something precious in order to protect and maintain it, in the same way that a pregnant woman carries a foetus, or a bird sits on a nest. When combined with the 'body part' radical it takes on a meaning of a matrix, or more specifically, the uterus. When combined with xin, it refers to that which protects the heart, and is thus often translated as 'Heart Protector' or 'Pericardium'.

When bao luo is linked to the Heart, it denotes that the void of the Heart needs not only protection, but also a network of relationships. The expression xin bao luo conveys both the enveloping of the heart in order to protect and maintain it, and a system through which the Heart may communicate its authority.

The xin bao luo has the function of protecting the Heart:

"The heart is the Grand Master (da zhu) of the five zang and the six fu, the residence of the jing shen. When this zang is solid and firm, the perversities cannot penetrate. If they penetrate, then the heart is injured, and if the heart is injured the shen leave, and if the shen leave, it is death. For this reason, when the perversities are in the heart, they are in the bao luo." (Ling Shu chapter 17).

This does not mean there can be no pathology involving the Heart, only that extrinsic pathogens cannot intrude into the inner sanctum of the Heart itself. It is for this reason also, that the character xin does not contain the radical for 'body part', and is the only zang which does not.

The shen are said to actually reside in the Blood, which roots, embraces, and anchors them. The Heart's function of housing the shen thus depends on adequate nourishment from the Blood.

The emotion of the Heart is, of course, Joy. The Virtue of the Heart is "Propriety and Rites". Now why, if the shen are beyond Time and Space, is the Heart concerned with Propriety and Rites?

The answer lies in the role of the Heart as Emperor; the one and only role of the Emperor as a religious leader was to perform the appropriate rites which would invoke divine power. The Emperor served as a channel linking his people with the source of life.

On a personal level, I think this translates as Mindfulness. At a practical level, this may include making time and space for your spiritual practice, whatever it is. Often the first and hardest step in doing meditation -- whether it be sitting meditation, tai qi, yoga, or whatever, is Making Time.

Small Intestine

The Heart is paired with the Small Intestine. "The Small Intestine is responsible for receiving and making things thrive. Transformed substances stem from it." (Su Wen chapter . The function of the Small Intestine may be summed up as 'separation of the pure and impure'. It is the primary point of choice between what is assimilated to the organism and what is rejected. In this way it may be seen to reflect the nature of the Heart, in that it determines what extrinsic influences are selected to constitute and reconstitute the organism.

Clinically, Small Intestine points are useful when a person is having trouble sorting out relevant and irrelevant, valid and spurious data, in order to come to a decision.

The san jiao

The xin zhu is paired with the san jiao, the 'Triple Heater', one of the most difficult concepts in Chinese medicine, not only because it has no equivalent in Western medicine, but also because even in China it has not been clearly and consistently defined.

The Su Wen chapter 8 says, "The san jiao is responsible for the opening up of passages and irrigation. The waterways (routing of water) stem from it."

The san jiao does not describe a physical organ; indeed, it is the only fu whose character does not include the 'body part' radical. Like the Heart itself, it has "a name but no form" (Nan Jing chapter 25). It is rather the sum of the functions of transformation and interpenetration of various densities and qualities of substance within the organism, "the way and pathways of liquids and cereals, the beginning and ending of Qi" (Nan Jing).

The Nei Jing also refers to the san jiao as 'the pathways for the entry and exit of liquids and cereals'. 'Entry and exit' refers not only to the gross level of swallowing and excreting, but to everything that allows an organism to receive and introduce something into itself that is other than itself, and which gives it the ability to eliminate that which cannot be assimilated and integrated into itself. Between entry and exit are all the transformations of qi, and all take place within the scope of the san jiao, which ensures their coordination and unity. The details of digestion and metabolism may be governed by one organ or another, but the whole operation is orchestrated by the san jiao, which is responsible for not only the production of all types of post-natal qi, but also for its free circulation, from the deepest level to the most superficial.

A commentary by Sun Simiao in the 8th century emphasises the pivotal importance of the san jiao to the maintenance of life:

The san jiao through their reunion make the unity. They govern the tao of the shen, which come and go in the five zang and six fu....They know how to distribute life in the form of qi, they are connected to the origin, they make the blood and maintain life through the shen.

So we have here the idea that a sound physical basis is essential to spiritual life.
(To be continued)

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miraculous hands
Posted: Thu Jan 27, 2005 4:42 am