Introduction
The nature of the relationship between the mind and the body has been debated since antiquity: Plato believed that the material world is a shadow of the world of Forms, and as the body is from the material world, the soul (i.e., mind) is from the world of Forms; the Buddha taught that the mind and body are interdependent and that both are impermanent manifestations of an ever-changing universe. Modern medicine is based on Cartesian dualism, which states that the mind and body are separate and distinct entities. Before its advent, the orthodox Church prohibited the study of human anatomy through dissection, obstructing the development of medical science, because it viewed the body and soul as one and believed that for the soul to ascend to heaven, the human body had to be preserved intact. René Descartes, through mind-body dualism, demythologized the body, allowing it to be studied, thereby, paving the way for “progress in medical science through the study of physiology and anatomy.” [1]. However, simultaneously, by isolating the mind, Cartesian dualism denied its relevance to disorders of the body, and vice versa. Still, clinically, the state of the mind is rarely considered when treating disorders of the body, and the condition of the body is rarely considered when treating disorders of the mind. This is in stark contrast to traditional Chinese medicine (TCM), which views the mind and body, and, therefore, their state of health, as inseparable. The purpose of this article is to elucidate the TCM understanding of the mind-body relationship and to illustrate how we apply this understanding in clinic.
The Inseparable Mind and Body
Before we delve into the TCM interpretation of the mind-body relationship, let us first examine how the mind and body are integrated from an anatomical perspective. The mechanistic view of the human body that arose from Cartesian dualism has separated the nervous system from the rest of the body. The nervous system is further divided into the central (CNS) and peripheral nervous systems (PNS). The CNS consists of the brain, which is considered to house the mind, and the spinal cord. The PNS contains all the nerves that lie outside of the CNS, merely serving to connect the organs, musculoskeletal system, and skin to the brain. However, this division of the nervous system is simply an analytical tool, a product of the reductionist mentality of modern medical science. In reality, the entire nervous system is a single unit, an extension of the brain that insinuates itself into every part of the body (Figure 1). Similarly, the separation of the nervous system from the rest of the body is also an analytically useful fantasy. In vivo, the nervous system is inextricable, both in form and in function, from the rest of the body. In this way, the brain, and, by extension, the mind, is entirely interwoven with all of the other systems in the body (e.g., vascular, connective tissue, etc.) (Figure 2). Whether the mind is merely the conscious product of brain activity, a phenomenon that uses the brain as a vessel to enact its will, or some combination of the two, it, at least in the living, is inseparable from the brain, and the brain is inseparable from the body.
Figure 1. The nervous system. [2]
Figure 2. The interwoven nervous system, vascular system, and connective tissue networks. [3]
The Mind-Body Relationship in TCM
The word “mind,” in Chinese, is 神 (Shen). Shen, however, can also be translated to “spirit” and “god.” In TCM, Shen is used in two ways: “First, in a narrow sense, Shen indicates the complex of mental faculties, which are said to ‘reside’ in the Heart. In this sense, the Shen corresponds to the Mind and is specifically related to the Heart. Secondly, in a broad sense, Shen is used to indicate the whole sphere of mental and spiritual aspects of a human being. In this sense, it is not only related to the Heart, but encompasses the mental and spiritual phenomena of all the other [Internal] Organs*, notably the Yin Organs — that is, the Ethereal Soul ([魂] Hun), Corporeal Soul ([魄] Po), Intellect ([意] Yi), Will-power ([志] Zhi) and the Mind ([神] Shen) itself.” [4]
* Note that the Internal Organs in TCM differ from the conventional understanding of internal organs; the Internal Organs each represent a complex of functions and physiological processes. For example, the Kidneys in TCM may include the functions of the kidneys, adrenal glands, and other organs, as well as a multitude of physiological processes that are involved in water regulation, genetics, bone health, etc. In this article, I will differentiate the TCM Internal Organs from conventional organs by capitalizing the TCM Internal Organs.
The Mind of the Heart
According to TCM, mental activity and consciousness “reside” in the Heart. This means that the mental activities, including the emotional state, consciousness, memory, thinking, and sleep, are related to the state of the Heart. If the Heart is strong, mental activity will be normal: emotions will be balanced; consciousness will be clear; memory will be good; thinking will be sharp; sleep will be restful. If the Heart is weak, there may be “mental-emotional problems (such as depression), poor memory, dull thinking, insomnia or somnolence and, in extreme cases, unconsciousness.” [4] The Heart also functions to govern Blood. There is a relationship of mutual dependence between the function of housing the Mind and governing the Blood: “The Heart's function of housing the Mind depends on an adequate nourishment from the Blood and conversely, the Heart's job of governing Blood depends on the Mind.” [4] A deficiency of Heart-Blood will result in mental restlessness, depression, anxiety, and insomnia. Conversely, mental restlessness, emotional problems, and sadness can “induce a deficiency of Blood of the Heart, causing palpitations, a pale complexion and a weak or irregular pulse.” [4] In this way, the health of the Heart and that of the Mind are inextricably linked.
While modern medicine views the heart as simply the muscular organ that pumps blood to the rest of the body and only recognizes a neurological and biochemical relationship between the heart and brain, the intimate heart-mind relationship is universally evident in the human experience. This is exemplified in phrases like “broken heart,” “follow your heart,” and “heart of gold.” Such phrases exist in every language. The literary and cultural expressions of the heart-mind relationship may exist because emotions are largely felt in the heart. Lauri Nummenmaa, et al. “used a topographical self-report tool to reveal that different emotional states are associated with topographically distinct and culturally universal bodily sensations.” [5] A map of these associations can be seen in Figure 3. Notice that nearly all of the emotions are felt in the chest.
Figure 3. “Bodily topography of basic (Upper) and nonbasic (Lower) emotions associated with words. The body maps show regions whose activation increased (warm colors) or decreased (cool colors) when feeling each emotion. (P < 0.05 FDR corrected; t > 1.94). The colorbar indicates the t-statistic range.” [5]
The heart-mind relationship is also evidenced by many reported cases of personality changes following heart transplantation, which include “accounts of recipients acquiring the personality characteristics of their donor,” such as “changes in preferences, alterations in emotions/temperament, modifications of identity, and memories from the donor’s life.” [6] For example, Claire Sylvia, who received a heart and lung transplant, acquired her donor’s taste for beer, green peppers, Snicker’s chocolate bars, and McDonald’s Chicken Nuggets, foods that she had never liked before. She also reported experiencing strange dreams, in which she would see a thin, young man called “Tim L.” “By searching through local obituaries of the days leading up to the day of her transplant, she came across Timothy Lamirande,” an 18-year-old who “died in a motorcycle accident on the same day as Claire’s transplant.” [7] Claire tracked down Tim’s family, and “they confirmed to her that the cravings she was having were indeed all for foods that Tim had enjoyed.” [7][8] Mitchell B. Liester, a psychiatry specialist and an Assistant Clinical Professor in the Department of Psychiatry at the University of Colorado School of Medicine, hypothesized “the acquisition of donor personality characteristics by recipients following heart transplantation” occurs via the transfer of four types of cellular memory, “(1) epigenetic memory, (2) DNA memory, (3) RNA memory, and (4) protein memory,” as well as other possibilities, such as the “transfer of memory via intracardiac neurological memory and energetic memory.” [6]
The intimate relationship between the heart and the mind is rather intuitive; however, TCM holds that the mind is also related to the other Internal Organs.
The Five Spiritual Aspects of Shen
As stated earlier in this article, Shen also indicates “the whole sphere of mental and spiritual aspects of a human being. In this sense, it is not only related to the Heart, but encompasses the mental and spiritual phenomena of all the other [Internal] Organs, notably the Yin Organs.” [4] Each of the five Yin Organs is related to a specific mental-spiritual aspect: the Liver pertains to the Ethereal Soul (魂 Hun); the Lungs pertain to the Corporeal Soul (魄 Po); the Spleen pertains to the Intellect (意 Yi); the Kidneys pertain to the Will-power (志 Zhi); the Heart pertains to the Mind (神 Shen). The complex of these five mental-spiritual aspects represents the TCM view of body, mind, and spirit.
The Mind of the Liver
The Liver houses the Ethereal Soul, which approximates the Western concept of “soul.” The Ethereal Soul is Yang in nature and survives the body after death. It is thought to influence one’s sense of direction in life. A lack of direction in life and mental confusion could be the result of an unrooted Ethereal Soul. Thus, if the Liver (particularly Liver-Blood) is healthy, the Ethereal Soul is firmly rooted and enables one to plan one’s life with wisdom and foresight. If Liver-Blood is deficient, the Ethereal Soul is unrooted, and one will become aimless. The Ethereal Soul is also the source of life dreams, aims, vision, creativity, and inspiration. Without these, the Mind would be sterile and one would suffer from depression. Conversely, the Mind must also keep the Ethereal Soul in check. The Ethereal Soul contains a limitless supply of ideas, dreams, projects, and inspiration. If the Mind is unable to control and integrate all of these ideas, one’s behavior would become chaotic and, in some cases, even manic. [4] The Liver-Mind relationship is also reflected in cases of personality changes following liver transplants. For example, Dr. Michael Hagan, an emergency room physician who contracted Hepatitis C and received a liver transplant, reported increased emotionality and odd cravings for avocados and barbeque, traits that were shared by the liver donor, Shamika Jones. [7]
Each of the Yin Organs is also associated with an emotion. The Organ and its associated emotion are mutually related in that the emotion may negatively impact the health of the Organ, and the health of the Organ may provoke the emotion. The Liver’s associated emotion is anger, which includes irritation, frustration, resentment, repressed anger, and rage. A state of anger can cause a variety of Liver pathologies, like Liver-Qi stagnation, especially when it is repressed, manifesting as a feeling of distension of hypochondrium, chest, epigastrium, and sighing; anger that is vented often causes Liver-Fire, causing symptoms, such as temporal headache, red face and eyes, thirst, constipation, dark-yellow urine, and epistaxis. Conversely, Liver pathology may also cause one to become irritable.
The Mind of the Lungs
The Lungs house the Corporeal Soul, which is the Yin and physical counterpart of the Ethereal Soul (Hun); it is the part of the Soul that is “indissolubly attached to the body and goes down to [the] Earth with it at death.” [4] As such, it can be thought of as the “somatic manifestation of the soul;” [4] it gives us the abilities of sensation, feeling, hearing, and sight. The Corporeal Soul is also closely related to Essence (精 Jing), one of the “Three Treasures” along with Qi and Shen (i.e., the Mind), and can be thought of as a “manifestation of Essence in the sphere of sensations and feelings.” [4] Furthermore, since it is related to the Lungs and, therefore, breathing, the Corporeal Soul affects all physiological processes. The aforementioned story of Claire Sylvia may exemplify this Lung-Mind relationship.
The emotions associated with the Lungs are sadness, grief, and worry. Such emotions have a powerful and direct effect on breathing. Sadness and grief deplete Lung-Qi and cause short and shallow breathing. Worry tends to cause Lung-Qi stagnation, which manifests as breathlessness and shoulder and chest tension of those who are chronically anxious. Conversely, Lung pathology may also cause symptoms of depression and anxiety.
The Mind of the Spleen
The Spleen houses the Intellect, which is responsible for “applied thinking, studying, memorizing, focusing, concentrating, and generating ideas.” [4] Therefore, if the Spleen is healthy, then thinking will be clear and memory, focus, and concentration will be good. If the Spleen is deficient, the Intellect will be dull and slow-thinking, and memory, focus and concentration will be impaired. Conversely, excessive studying, concentration, and mentally-demanding work for sustained periods can cause the Spleen to become deficient. In TCM, the Spleen, along with the Stomach, functions to transport and transform food and water into usable energy. In physiology, this can be correlated to the digestion, absorption, and metabolism of water and nutrients in order to produce adenosine triphosphate (ATP), the primary carrier of energy in the body. The Spleen-Mind relationship is evidenced by the brain’s enormous energy expenditure: “For the average adult in a resting state, the brain consumes about 20 percent of the body’s energy.” [9] Additionally, a study by Fei Du, et al. found that cerebral ATP metabolic rate is tightly coupled with brain activity. [10]
The emotion associated with the Spleen is pensiveness (i.e., overthinking, brooding). Pensiveness can be thought of as the “dark side” of the Intellect’s capacity for focus and concentration. Pensiveness causes Spleen pathologies, such as Spleen-Qi deficiency, which manifests as fatigue and indigestion, and Spleen-Qi stagnation, which manifests as indigestion with a feeling of epigastric distension. Conversely, Spleen pathology may also cause one to become pensive.
The Mind of the Kidneys
The Kidneys house the Will-power. If the Kidneys are strong, the Mind will be driven to accomplish goals. Conversely, if the Kidneys are weak, the Mind will be easily discouraged and led astray. Lack of Will-power and motivation are commonly seen in cases of mental depression; in these cases, the Kidneys must be tonified. In addition to “Will-power,” Zhi can also be translated as “memory;” the Kidney's housing of Zhi, therefore, also implies that the Kidneys influence memory and recall. In TCM, the Kidneys function to store Essence and nourish the brain, thereby influencing short-term memory. This is exemplified in the elderly; Kidney-Essence declines with old age and fails to nourish the brain. As a result, many elders often have poor short-term memory and forget recent events, but may have no trouble remembering long-past events (which is related to the Heart). The Kidney-Mind relationship is also evident in chronic kidney disease patients: “Neuropsychiatric conditions including depression, anxiety disorders, and cognitive impairment are prevalent in patients with chronic kidney disease (CKD).” [11]
The emotion associated with the Kidneys is fear. Fear and chronic anxiety deplete Kidney-Qi and causes Qi to descend, which can manifest as nocturnal enuresis in children and urinary incontinence or diarrhea in adults. It can also cause a pattern of Kidney-Yin deficiency, resulting in a sensation of “heat in the face, night sweating, palpitations, and a dry mouth and throat.” [4] The effect of fear on the Kidneys can be seen in the prevalence of certain neuropsychiatric conditions, including anxiety, in patients with CKD. Additionally, the Kidneys in TCM include the function of the adrenal glands, which produce cortisol and norepinephrine in response to stress and threatening situations; these stress hormones elevate heart rate and blood pressure and can cause symptoms similar to those of Kidney-Yin deficiency. Conversely, Kidney pathology may also cause one to become fearful and anxious.
The Mind of the Heart
The mental-spiritual aspect of the Heart (i.e., the Mind, Shen) was already discussed earlier in this article. However, we have not yet explained its associated emotion, joy. Of course, a state of joy that is characterized by a state of healthy contentment is not a source of disease but a beneficial mental state that promotes the smooth-functioning of the Internal Organs and their associated mental faculties. However, a state of joy that occurs suddenly (e.g., when receiving good news unexpectedly) and/or is characterized by excessive excitement and craving can be harmful to the Heart, manifesting as “palpitations, overexcitability, insomnia, restlessness, talking a lot, and a red tip to the tongue.” [4] Conversely, heart pathology may also cause overexcitability.
The Mind-Body Connection in Clinic
While the relationship between the mind and body and the mechanism by which they are integrated are not fully understood in terms of biomedicine, the existence of this indissoluble relationship is undeniable. Therefore, in clinic, we treat the mind and body as one; the state of the mind is considered when treating disorders of the body, and vice versa. The mental functions and emotions attributed to the various Internal Organs are assessed and treated with equal importance to physical symptoms. Let us illustrate this with a case study.
Case Study
A 34-year-old female attorney presented with fatigue, lassitude, indigestion, loose stools, and brain fog. Her radial pulse was thin and weak, particularly on the right side; her tongue was pale and slightly scalloped. Her symptoms began two weeks after she began working on a particularly challenging case and about one month prior to her initial consultation at Rise. She exercised regularly, consumed a balanced diet, and slept well. This patient had also consulted her primary care physician, who conducted a physical exam and ordered bloodwork, including a complete blood count (CBC), a complete metabolic panel, and a broad thyroid panel. The physical exam revealed no significant findings, and all vital signs and laboratory results were within normal ranges. Assessment of this patient at our clinic revealed a pattern of Spleen-Qi deficiency. As her lifestyle habits were healthy, the origin of the pathology was determined to be excess mental activity due to her work (the Spleen houses the Intellect and is affected by pensiveness and overthinking). She was treated with the treatment principle of tonifying Spleen-Qi, using a combination of acupuncture, manual therapy, herbal medicine, meditative exercises, and lifestyle modifications. Acupuncture, herbal medicine, and meditative exercises, such as mindful breathing and Qi-Gong, were employed to increase her body’s ability to produce energy. Manual therapy to the scalp and forehead was primarily applied to reduce stress and improve the quality of her sleep. Although her lifestyle was generally healthy, some adjustments were made to her diet, exercise routine, and sleep schedule to optimize her energy levels.
Post-treatment evaluation of this patient revealed a 40% improvement in energy levels after the first treatment and 95% improvement after twelve treatments. She completed her work on the case just before her eighth treatment. Naturally, her condition improved more quickly from this point. After twelve treatments, the patient returned monthly for reassessment and maintenance treatments. She maintained a 90-100% improvement of fatigue symptoms, depending on her workload and level of compliance with lifestyle modifications.
Strengthening the Mind and Body
An important component of treatment at Rise is improving the general constitution of our patients. While the various treatment modalities, including acupuncture, manual therapy, herbal medicine, and lifestyle modifications (e.g., dietary therapy, physical exercise, sleep habits, etc.) that we employ, are certainly effective, we also train our patients in a variety of methods to strengthen the mind and body, as well as their relationship. These methods include meditative exercises that combine mental and physical training, such as mindful breathing, yoga, and Qi-Gong, which build neural pathways, cultivate awareness of the mind and body, and reinforce the mind-body connection. Additionally, these exercises help our patients to center their emotions, making them less susceptible to emotional fluctuation and its accompanying effects on health. Patients are encouraged to practice these methods at certain times of the day; some methods, such as mindful breathing, are also practiced during acupuncture and manual therapy treatment. The value of these methods’ ability to strengthen both the mind and body cannot be overstated.
Our Mission
Our mission at Rise is to provide our patients with a holistic and effective approach to healing, as well as the knowledge to proactively prevent illness and injury. We work tirelessly to ensure that our patients receive the care, tools, and knowledge to restore balance to their lives. We take pride in going above and beyond for those who choose us as their healthcare providers. We are committed to serving our community with integrity, professionalism, respect, compassion, and love. In doing so, we hope to improve the overall health and well-being of our entire community by promoting healthy lifestyle choices, as well as mental and emotional health. To this end, we regularly host free seminars and workshops on topics ranging from nutrition to therapeutic meditative exercises. If you are interested in attending these events, subscribe to our mailing list at the bottom of this page and/or follow us on social media.
References
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[2] Grey, Alex. Nervous system: Alex Grey. https://www.alexgrey.com/art/paintings/sacred-mirrors/alex_grey_03_nervous_system. Accessed October 27, 2021.
[3] Myers, Thomas W. (2011). Anatomy Trains. London: Urban & Fischer.
[4] Maciocia, Giovanni. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Edinburgh: Churchill Livingstone, 1989. Print.
[5] Nummenmaa L, Glerean E, Hari R, Hietanen JK. Bodily maps of emotions. Proc Natl Acad Sci U S A. 2014;111(2):646-651. doi:10.1073/pnas.1321664111
[6] Liester MB. Personality changes following heart transplantation: The role of cellular memory. Med Hypotheses. 2020;135:109468. doi:10.1016/j.mehy.2019.109468
[7] Lowth, M. 10 Organ Recipients Who Took on the Traits of Their Donors. Listverse. https://listverse.com/2016/05/14/10-organ-recipients-who-took-on-the-traits-of-their-donors/. Accessed 28 October 2021.
[8] Sylvia C, Novak W. A Change of Heart: A Memoir. New York: Warner Books; 1998.
[9] Richardson MW. How much energy does the brain use? BrainFacts.org. https://www.brainfacts.org/brain-anatomy-and-function/anatomy/2019/how-much-energy-does-the-brain-use-020119. Accessed October 31, 2021.
[10] Fei Du, Xiao-Hong Zhu, Yi Zhang, Michael Friedman, Nanyin Zhang, Kâmil Uğurbil, Wei Chen. Tightly coupled brain activity and cerebral ATP metabolic rate. Proceedings of the National Academy of Sciences Apr 2008, 105 (17) 6409-6414; DOI: 10.1073/pnas.0710766105
[11] Simões E Silva AC, Miranda AS, Rocha NP, Teixeira AL. Neuropsychiatric Disorders in Chronic Kidney Disease. Front Pharmacol. 2019;10:932. Published 2019 Aug 16. doi:10.3389/fphar.2019.00932