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by Charles Yarborough L.Ac.

Several decades ago, the concept of personality as a predictive factor in disease was formally introduced to the West. Appreciation of the Type-A personality, with its hostility, its hurried mindset and polyphasic thinking, drew widespread attention to emotion as a factor in the genesis of disease. Subsequently, another illness-prone personality type-Type D-was recognized by its characteristic suppressing of negative emotions. Western clinical researchers in recent years have scrutinized the relationship between emotion and illness. Can negative thinking, they ask, make a person sick? More recently they have added, in counterpoint: can positive thinking (generated by prayer and imagery) help a person heal? While these questions may pose a fairly binary approach to the matter, binary it must be, since Western clinical studies cannot be conducted on poetic or allegorical explanations of mind/matter such as we find in Traditional Chinese Medicine. For authentic practitioners of Oriental Medicine, however, the interplay of organs/emotions/spirit is inescapable. Smile

An ancient text, the "Huang Ti Nei Ching", compares the function and position of internal organs to hierarchies found in an empire. It tells us: "The heart is like the minister of the monarch who excels through insight and understanding; the lungs are the symbol of the interpretation and conduct of the official jurisdiction and regulation; the liver has the functions of a military leader who excels in his strategic planning; the gall bladder... excels through his decisions and judgment; the middle of the thorax is like the official of the center who guides the subjects in their joys and pleasures...the kidneys are like the officials who do energetic work and they excel through their abilities...." (1)

In her translation of the "Nei Ching", Ilza Veith explains that the heart, the spleen, the lungs, liver and kidneys "determine the functions of all the other parts of the body, including the bowels, and also of the spiritual resources and emotions"(2). Logically then, we should consider involvement of these five organs when the issue of emotional problems is presented. Has the comparative weakness of certain organs, we might ask, exposed a patient to illness or to prolonged recovery? Could the illness cause depletion of specific organs, creating a self-defeating cycle? While the practitioner must be careful to leave psychology to the psychologists, he or she will nevertheless recognize patterns of behavior/illness and opportunities for therapy which have been described in ancient texts.

Emotional Concepts

What is the ancient concept of emotions and how does it relate to modern Western clinical practice? In the book Emotions in Asian Thought, Chad Hansen contends the traditional Chinese concept of mind and action does not center on "a mental/intellectual world populated by mental/intellectual objects set off against an external world of physical objects or matter." Nor does this concept contain the Indo-European "distinction between cognitive and affective states. A single faculty/organ, the xin (heart-mind), guides action rather than separate faculties of heart and mind"(3). Suspicion

Giovanni Maciocia, in his textbook The Fundamentals of Acupuncture, widens this premise for the purpose of clinical practice. Maciocia notes the tradition of Five Emotions: anger, joy, sorrow, fear and rumination, as well as others, and explains their significance to the practitioner. "The body-mind is not a pyramid, but a circle of interaction between the Internal Organs and their emotional aspects. Whereas Western Medicine tends to consider the influence of emotions on the organs as having a secondary or excitatory role rather than being a primary causative factor of disease, Chinese Medicine sees the emotions as an integral and inseparable part of the sphere of action of the Internal Organs.... Since the body and mind form an integrated inseparable unit, the emotions can not only cause a disharmony, but they can also be caused by it"(4). Anger, according to tradition, affects the liver; rumination taxes the spleen; sorrow depletes the lungs; excessive joy affects the heart, and fear affects the kidneys.

Fear And Panic: A Case Study

Fear

"Extreme fear," says the "Huang Ti Nei Ching", "is injurious to the kidneys." An example of long felt fear and its taxing effects on kidneys was presented to me in a phone call last year. "Can you help me?" came a man's faint voice. "I'm agoraphobic; do you know what that means? Have you ever treated this condition?" I told him I hadn't treated it but knew that it was a debilitating anxiety disorder marked by fear of public places and situations that are associated with panic attacks. "That's it," he said. "I haven't been away from my house in six years. Only, I get attacks even when I'm at home. Sometimes my heart starts beating like crazy, like I'm going to have a heart attack or go nuts."

The man's symptoms conformed to the DSM (Diagnostic and Statistical Manual) requirements for panic disorder. These requirements are four episodes in a four-week period, featuring four of these symptoms: pounding heart, tightness in the chest, shortness of breath, feeling of choking, tingling, faintness, shakiness, trembling, fear of losing control, hot flashes, a sense of unreality and a fear of going insane or dying. To compound these troubles, comments Jerilyn Ross in her book, Triumph Over Fear, while "the fear during an attack is real, raw, crushing, and overwhelming...physicians tend to write off patients as neurotic or hypochondriacal"(5). This may be a monumental oversight if one considers that 2.4 million Americans suffer from panic disorder in any given year (National Institute of Mental Health).

The man on the phone drew a deep breath. "It means you'd have to come to my house," he said, "since I can't go out." I drove to the upscale section of Los Angeles where he lived. His house, a sprawling mass of glass walls and sharply angled stucco slabs, was a specimen of the atomic era. And like the atomic era, it was a vision gone bad. Currently, the expansive yard was overrun with weeds and the many windows were covered by torn, yellowed curtains and sagging, rusty blinds. Kicking aside an empty mayonnaise jar, I walked a wide limestone path to his door.

The man who answered my knock was six feet tall, fifty years old and was clearly a frail version of his former self. Noticeable also were deep brown circles under his eyes (kidney area of the face). While he retained a full head of hair, it was unmanageably dry and had been corralled into a ponytail. "Come in," he said, waving me into a musty hall. He handed me his dry, bony hand to shake. His name was Frank and for many years he had been a successful stunt driver for television. The "King of Car Chases", they had called him.

Unfortunately, he had experienced three mishaps in the course of six months, the last of which landed him in a full body cast. Upon recovery from his most recent accident, he found himself unable to drive to work; panic gripped him when he got behind the wheel. He had tried therapy without success (probably a poor choice of therapist), had spent a fortune on therapeutic audiotapes and books and, because of his refusal to take medication, was considered "a faker" by his family.

Based on query and observation, I formed a diagnosis and treatment plan. While many agoraphobics cannot locate the specific cause of their disease (it may be the accumulation/magnification of perceived dangers), Frank's crippling fear seemed traceable to his continued mishaps and their potential future recurrence. "Kidney Qi energies," writes Leon Hammer, M.D., in Dragon Rises, Red Bird Flies, "help us to anchor ourselves in the gestalt of the 'here and now'..."(6). Overall depletion of the kidneys was manifested in a deep, weak kidney pulse (the proximal position on the radial artery), lower back pains, tinnitis, palpitations, dizziness and dark pouches under his eyes. Chronic fear had taxed Frank's kidney Yin, as his dry hair, skin and acquired boniness attested. He was the shriveled relic of a once-daring stunt driver. His depleted kidneys failed, as the Nei Jing says, "to do energetic work and excel through...ability." Frank's abilities were being wasted, although I wasn't certain the world would be improved by more car chases. Nevertheless, I decided on a therapeutic principle and a "points strategy" as outlined in The Treatment of Disease in TCM.(7) I determined to supplement the kidneys, fill the essence, and fortify the will. My formula would have been a modified "Liu Wei Di Huang Wan", except that Frank was in terror of herbally-induced panic. Herbs were not an option. Predictably, Frank was also in fear of needles. I therefore gave him a kidney-enhancing mix of shiatsu and tuina, later convincing him to accept but four needles (L14 and LIV3 bilaterally) to "open the gates" and allow Qi to flow.

When I returned to the office, the phone was ringing. Frank was in a panic. The unleashing of the Qi prompted by my nominal needling had caused him alarm, triggering a panic attack. I reassured him and talked him into a calm state of mind, agreeing to return the following day. In subsequent twice-weekly visits, I gave him nothing but acupressure and tuina, always with the purpose of stoking kidney fire. Over the course of several months, he reported gradual improvement and began venturing away from home, driving to the mall with family and attending church. While there are occasional setbacks, his overall outlook is favorable. An increasingly confident and robust Frank is now searching for a qualified therapist... and, at my urging, a desk job.

Anger: A Case Study

"Sickness of the liver," the Nei Jing tells us, "causes...people... to have fits of anger." Anger causes Qi-and tempers-to rise. Maciocia reminds us that anger can be considered to include irritability, frustration, rage, indignation, animosity or bitterness. Anger, when expressed appropriately, may not cause harm; when chronic or suppressed, it may become pathogenic. A study published in a recent issue of The Lancet found that the "Type-D personality was a significant predictor of long-term mortality in patients with established CHD [chronic heart disease].... Personality traits should be taken into account in the association between emotional distress and mortality in CHD"(8). The American Journal of Cardiology concurs: "Anger is the effective state most commonly associated with myocardial ischemia and life-threatening arrhythmias. The scope of the problem is sizable-at least 36,000...heart attacks are precipitated annually in the United States by anger"(9). Anger

When anger causes Qi to rise, symptoms are naturally expressed in the upper part of the body. A patient will often exhibit dizziness, a flushed face, tinnitus and headaches (frequently parietal). His or her tongue may be red due to liver fire, the result of prolonged liver Qi "stagnation" or "repression." Additionally, rebellious liver Qi may flow sideways, invading the stomach and its paired organ, the spleen. This will result in diarrhea and indigestion.

Liver Qi oppression and its consequences were embodied in a diminutive lady named Mrs. LeBeau. While Mrs. LeBeau may have been petite, her repressed fury was not. She solicited my help with resolving increasingly frequent parietal headaches and indigestion. It took little effort to discover the cause of her illness. Fright

Removing her suede pearl-white gloves and placing them on my desk, Mrs. LeBeau marched to my treatment table and lay down. She then said hello and held out her hand impatiently. Not knowing if she expected me to shake it or kiss it, I took her pulse instead. She was, by her account, "fifty-something," yet I noticed she had fewer wrinkles than the Chanel pant suit she had poured herself into. Her pulse was "wiry" in the liver position, suggesting pain or repressed anger. Mrs. LeBeau spoke incessantly and admiringly of her husband, a highly successful corporate motivational speaker. She was, she said, the luckiest woman in the world. Her unstoppable eulogizing of Mr. LeBeau, however, was clearly practiced, as if she had delivered the monologue many times previously. It was only as she relaxed that her pace slowed and, eventually, a frown made her lips droop. In a sudden burst of tears she revealed her husband abused her, and she did not love him anymore. Leaving him was a moral impossibility since he had recently been diagnosed with cancer. "And besides," she sobbed, "it simply isn't done! Are you or are you not going to offer me a tissue?" It was interesting to note that Mrs. LeBeau's cosmetic surgeon had removed all facial evidence of intense liver Qi, lines which extend vertically from the inward tips of the eyebrows. Resigned she was to a duplicitous life, attending social functions and televised events wearing a smile that was not her own. Meanwhile, her headaches had become frequent and nearly intolerable. Food, she complained, caused her to bloat and belch and she experienced a continual bitter taste.

While there was little I could do to improve the circumstances of her life, I was able to address, on an energetic level, Mrs. LeBeau's liver symptoms. Her long-repressed anger forced rebellious liver Qi to flow upward, causing headaches and bitter taste, and to flow "sideways," toward the stomach/ spleen. The result was indigestion and bloating. If left unchecked, suppressed liver Qi could turn into liver fire, with its attendant violent, unpredictable behavior. My treatment plan was to soften the liver and descend rebellious liver Qi. Modified Xiao Yao was the herbal remedy.

Statistical Proof

My concern for Mrs. LeBeau was further fueled by statistics recently published in Nursing Research. In an article, "Women's Anger: Relationship of Suppression to Blood Pressure," we find a 12-year Michigan study of middle-aged men and women which "showed that suppressed anger significantly interacted with elevated blood pressure to produce the highest mortality"(10). It appeared that people with elevated blood pressure who scored higher on anger suppression were five times as likely to die than hypertensive people who expressed it. On reading this, I directed Mrs. LeBeau to a qualified therapist whom she now sees regularly in addition to receiving her acupuncture treatments.

As these case studies show, the management of emotion-associated illness may be slow, requiring great patience and the scrupulous application of ancient Oriental principles to modern dilemmas. Nevertheless, such concepts of emotion, illness, and the expression of character are as pertinent today as they were more than a thousand years ago when Laotse wrote:

"Those who are disturbed by their senses and minds cannot preserve their own character. How much less can they follow the Tao!" (11)

Names and circumstances have been changed to protect patients' privacy. Charles Yarborough, L. Ac., NCCA, practices acupuncture in the Los Angeles, CA area.

References:
1. Veith, Ilza. The Yellow Emperor's Classic of Internal Medicine. Berkeley: University of California Press, 1972, p. 28.
2. Veith, p. 25.
3. Marks, Joel, and Ames, Roger R., eds. Emotions in Asian Thought: A Dialogue in Comparative Philosophy. Albany: State University of New York Press, 1995, p. 183.
4. Maciocia, Giovanni. The Foundations of Chinese Medicine. New York: Churchill Livingstone,Inc. 1989, p. 129.
5. Ross, Jerilyn. Triumph Over Fear. New York: Bantam Books, 1994, p. 19.
6. Hammer, Leon I. Dragon Rises, Red Bird Flies. New York: Station Hill Press, 1990, p. 111.
7. Soinneau, Philippe, and Gang, Lu. The Treatment of Disease in TCM, Vol 1. Boulder: Blue Poppy Press, 1996, p. 250.
8. Denollet, J., Sys SU, Stroobant, N., Rombouts, H., Gillebert, TC & Brutsaert, DL. "Personality as independent predictor of long-term mortality in patients with coronary heart disease." The Lancet, 1996; 347:417-21.
9. Jain D, Burg M. & Zaret BL. "Prognostic implications of stress-induced silent left ventricular dysfunction in patients with stable angina pectoris." Am. J. Cardiol, 1995; 76:31-5.
10. Thomas, Sandra P. "Women's anger: relationship of suppression to blood pressure." Nursing Research, 1997; 46:324-30.
11. Yutang, Lin, ed. The Wisdom of Laotse. New York; Random House, Inc., 1976, p. 85.
The following books referenced by this article are available from our Online Qi Catalog at or 1-800-787-2600.
The Yellow Emperor's Classic of Internal Medicine: #B271
The Foundations of Chinese Medicine: #B436
Dragon Rises, Red Bird Flies: #B178
The Treatment of Disease in TCM, Vol. 1: #B079

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