Saturday, May 26, 2012

The Heart in Traditional Chinese Medicine

"The Heart is Like the Monarch and it Governs the Mind." --  Yellow Emperor's Inner Canon: Simple Questions, ca 475BCE-220CE

"The heart is the ruler of the five organ networks. It commands the movements of the four extremities, it circulates the qi and the blood, it roams the realms of the material and the immaterial, and it is in tune with the gateways of every action. Therefore, coveting to govern the flow of energy on earth without possessing a heart would be like aspiring to tune gongs and drums without ears, or like trying to read a piece of fancy literature without eyes." --  from the Daoist classic, Contemplations by the Huainan Masters (Huainanzi), ca110BCE

The external path of the Heart meridian runs
runs along the inner arm. Internally, the Heart
meridian passes through the major blood
vessels of the anatomical heart, down to the
small intestine (the paired organ of the Heart),
up through the Lungs, the throat, esophagus,
thyroid and the tissue surrounding the eye.
In Chinese five-element theory, the season of summer corresponds to the element fire. Fire corresponds, actually, to four "organs" of the body. The first two are the Heart and its paired "minor" organ, the Small Intestine. Fire also corresponds to two less commonly-known organs. First is the Pericardium, which the Chinese medical tradition views as the  protector of the Heart (playing a role also in the calmness of the mind). The final "organ" related to the fire element is a concept that does not exist in biomedical medicien. It is called the san jiao, translated as Triple Warmer, and is responsible for the movement of energy (Qi) throughout the entire body and plays an important role in water metabolism, as well as in protecting the body from disease from external pathogens.

Keep in mind that the "organs" in Chinese medicine correspond as much to areas of physiological function as to anatomical structure. Each "organ" in Chinese medicine is also tied to, and responsible for, an aspect of emotion, mind and spirit ---- physiological function and emotional/spiritual/mental well-being being inextricably linked Chinese medicine.

This blog is about the Heart as conceived in Traditional Chinese Medicine.

The Heart as Emperor:

The heart is considered the most important organ in Chinese medicine. Commonly referred to as the "sovereign" or "emperor," it is sometimes not even treated directly in acupuncture because of its preciousness The acupuncturist might treat points on the meridian of the Pericardium, or Heart Protector, as a way of influencing the Heart indirectly -- just as one would address a prime minister instead of directly addressing the emperor in an imperial court.

Blood -- the Heart's Precious Substance:

Similar to the biomedical perspective, the Heart in Chinese medicine is linked closely to the Blood, and is said, in fact, to govern Blood. It does this in two ways:

First, the final refinement/creation of Blood (from the refinement of the essence extracted from food) is said to take place in the Heart -- i.e. the Heart plays an ultimate role in the creation of Blood.

Second, as the circulator of Blood, the Heart is responsible for providing a proper supply of Blood to all organ systems and body tissues. It controls the blood vessels. So, one can gauge the health of the Heart by palpating the pulse in distal blood vessels.

The meaning of "Blood" in Chinese medicine is somewhat different from its meaning in biomedicine. It is, in fact, conceived of as a very dense, material manifestation of Qi, responsible for nourishing and moistening all parts of the body and providing the material foundation for the Mind/Spirit.

In some respects, Blood is the most precious substance in the body, and the quality of a person's blood is very important to their health (internal, structural, orthopedic and mental/emotional spiritual health). The strength of the Heart and the quality and circulation of the Blood, more than other factors, determine the fundamental constitutional strength of a person.

A line from the Yellow Emperor's Canon of Internal Medicine stated, "If the liver is supplied with blood, we can see; if the feet are supplied with blood, we can walk; if the hands are supplied with blood, we can grasp."

A practitioner of Chinese medicine can treat many aspects of a person's health by addressing the quality of blood (richness, circulatory flow, etc.) with acupuncture, herbs and dietary modifications. Because the Blood is formed from a refinement of food, the quality of Blood is directly affected by what we eat, as well as by medicinals, chemical toxins and other things that enter our body.

The Heart Manifests in the Complexion:

Because the Heart governs the circulation of Blood throughout the body, the state of the Heart and Blood is reflected in the complexion, particularly the complexion of the face. If Blood is abundant and the Heart strong, the complexion will be rosy and lustrous. A less perfect facial complexion (i.e. pale, dull, bluish, too red, etc.) indicates a specific imbalance of the Heart, the Blood or other related organs, which can be addressed with acupuncture, herbal medicine, dietary changes, etc.

Like the complexion, the appearance of the tongue is also an indicator of the health of the Heart. In fact, the tongue is considered to be the "offshoot" of the Heart. The Heart controls the color, form and appearance of the tongue. The tip of the tongue is particularly indicative of the state of the heart, whereas other regions of the tongue anatomy reflect the condition of other organs.

If the Heart has excessive Heat (relating to symptoms like insomnia or mania, etc.), the tongue may be dry or dark red and the tip swollen. Sores or ulcers on the tongue can be signs of extreme heat in the Heart. If the Heart is weak and the Blood deficient (which may also be related to insomnia, as well as poor memory, depressive symtoms, possible low cardiac function), the tongue may be pale and thin. A duskiness or bluish-purplish hue tongue-hue relates to sluggish circulation and/or cardiovascular pathology.

It makes sense that observation of the tongue and facial complexion are central to diagnosis in Chinese medicine. The health and function of all organs, especially the Heart, and the general vitality of the body can be gauged by aspects the tongue and the complexion including colors, shades, casts, luster, form, moisture, dryness, ulceration, etc.

In pediatric medicine, we learn a lot about our little patients by looking at their faces. This is important because it is generally hard or impossible to palpate the pulse or observe the tongue of very small children. Also, since children are so new, they have had less time to develop complex pathologies and subtle forms of guarding themselves as adults have. Their young faces are a very clear lens into their physiological and emotional health. Relatedly, Chinese medicine pediatricians are always taught to look to the eyes of a child for prognosis as the eyes are a lens into the Shen (mind, emotions, spirit -- see below) -- as the Heart meridian enters the tissues surrounding the eyes. Even if a child is very ill, but still has bright, sparkly eyes, this means that his spirit is strong and the prognosis for his recovery is good.

The Heart Houses the Mind (......and the Emotions & the Spirit):

Chinese medicine perceives the Heart to be the residence of the Shen. Shen is sometimes narrowly translated as "Mind," but in a broad sense, Shen is used to indicated the whole sphere of mental and spiritual aspects of a human being.

Each Chinese medicine "organ" plays a role in a specific aspect and quality of emotional/spiritual/mental life, but the Heart's role is paramount.

The state of the Heart and Blood affect all mental activities as well as the emotional state. The Heart and its Blood are said to be the root of the Mind, embracing and anchoring the Mind so that it will be peaceful and happy. If the Heart is strong and Blood rich and abundant, there will be normal mental activity, emotional balance, a clear consiousness, good memory, keen thinking and good sleep. If the Heart is weak and Blood deficient, there may be mental-emotional problems (depression, anxiety), poor memory, dull thinking, restlessness, anxiety, insomnia or somnolence. An agitated and overheated Heart or one affected by excess phlegm in the body will manifest in symptoms of mania, poor social judgement, antisocial behavior, etc.. So, improving and regulating the quality of Heart and Blood is very important in the clinical treatment of mental or emotional issues. In fact, the Heart and the Blood are as commonly treated with acupuncture and herbal medicine to address mental-emotional issues in patients, as they are treated in addressing anatomical-physiological cardiovascular/circulatory issues.

The Heart plays a critical role in sleep. If the Heart-Blood is strong, a person will fall asleep and sleep soundly. If the Heart-Blood is weak, the Mind has no residence. It will "float" at night causing inability to calm down and go to sleep, disturbed sleep or excessive dreaming.

On an interpersonal level, the state of the Heart determines a person's capacity to form meaningful relationships.

The Heart and Pathology:

In assessing the health of the Heart, the Chinese medicine physician must discriminate between patterns involving the Qi, Blood, Yang and Yin of the Heart. Deficiency of any of these aspects can be related to weakness of the circulatory and cardiovascular systems or mental-emotional depression, and have ripple affects in other aspects of physiological function. Excess Heart conditions must also be considered. These include Heart-Fire blazing, Phlegm-Fire Harassing the Heart, Phlegm Misting the Mind, Heart Qi Stagnation, Heart Vessel Obstructed, and Blood Stasis of the Heart. Excess Heart conditions can manifest as emotional/mental problems (like restlessness, mania, agitation) or, again, circulatory and cardiovascular pathologies.

It's important to note that any disease label (say, insomnia, anxiety, depression, hypertension, coronary artery disease, etc.) does not relate solely to one organ. From the holistic perspective of Chinese medicine, multiple organ, tissue and energetic systems may be involved in or affected by a pathological process. The role of the Chinese medicine practitioner is like detective work -- sleuthing out complex patterns -- and, then, restoring balance through appropriate treatment.

The Heart is may be centrally related to the following symptoms and diseases. Other organs, especially Heart, Spleen, Lung and Kidney function in close relation with the Heart and will likely be secondarily involved in these pathologies as well.

Physical Imbalances:
The Heart Meridian
pallor or bluish complexion or lips
shortness of breath
cold hands
chest pains
profuse sweating
night sweats
tongue ulcers
dark urine, blood in urine
coronary artery disease
cardiac infarction

Mental-Emotional Imbalances:
poor memory
excessive dreaming
mental restlessness and uneasiness
mania/ manic-depression
violent or antisocial behavior

Please stay tuned to my blog for more essays and articles on specific modern diseases and their treatment through Traditional Chinese Medicine.

More colorful and inspiring perspectives on the heart can be found:

The Heart in Classical Chinese Medicine, summarized by Subhuti Dharmananda, PhD, of The Institute for Traditional Medicine and Preventive Health Care, Inc. (ITM)


The Heart in Relation to Spirit, summarized by Lorie Eve Dechar, author of Five Spirits: Alchemical Acupuncture for Physiological and Spiritual Healing.


Giovanni Maciocia. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists.