ORIGINAL ARTICLE CHINESE MEDICINE AND THE MIND Efrem Korngold, LAc, O MD1 and Harriet Beinfield, LAc1# HOW CHINESE MEDICINE VIEWS THE MIND tional processes that correspond to five organ systems referred to as Chinese medicine does not make absolute distinctions between the Five Organ Networks (Kidney, Liver, Heart, Spleen, Lung) that what we in the West classify as the mind, the activity of the central govern all internal events and outward expressions. That is to say, nervous system, and the physiology of the visceral organs. Within how the Qi moves in each of the Organ Networks and how they traditional Chinese medical thinking, a person represents a field of interact from moment to moment is what determines the nature of Qi, a continuum of dynamic structures, functions, processes, sen- our life experience (Table 1). sory perceptions, and cognitive faculties that range from the gross, substantial, and visible (fluids, blood, flesh, muscles, vessels, sense HOW THE FIVE ORGAN NETWORKS ORGANIZE OUR organs, nerves, and bone) to the subtle, insubstantial, and invisible MOTILE, SENSORY, AND COGNITIVE LIFE (sensations, perceptions, feelings, emotions, thoughts, images, and All activity is an expression of the movement of Qi occurring in dreams). Although flux and transformation are the fundament of various layers of the organism. At the level of sensations and per- the field, there is a coherence and unity that exists within this ceptions, Qi manifests as the qualities of movement associated with continuum, known as Shen-Jing. Shen refers to the psyche or the muscles, nerves, and sense organs. At the level of thoughts, ideas, intangible qualities of mind, and Jing refers to the soma or the and images, Qi manifests as intellectual activity of the mind, or tangible qualities of the material body. Shen-Jing implies the mutu- cognition. At the level of our response to sensations, perceptions, ally arising, interpenetrating nature of Shen and Jing, a microcosmic and thoughts, Qi assumes the form of feelings and emotions that manifestation of the interdependence and interaction of Yang and are experienced simultaneously as physical and mental events, ac- Yin. tions, or movements. Qi organizes that which moves, and all move- Both spheres are characterized by incessantly motile patterns of ment is a manifestation of Qi. Fundamentally, motility is Qi, and form and action. The structural parts of the organism have shape what is motile is alive. and move (with a distinct configuration and patterns of activity, When we consider the role of the central nervous system as it is fluids, blood, muscles, bones, and internal organs are in constant defined in Western terms, we think of the organism’s ability to motion). Similarly, the contents of the mind emerge, assume form, regulate and coordinate a myriad of complex and interrelated func- and shift from place to place in recognizable patterns (images and tions including locomotion, perception, cognition, circulation, di- ideas take shape, thoughts are shallow and deep, jump from one to gestion, elimination, detoxification, reproduction, regeneration, another, move in circles, and habits of mind develop). growth, maturation, and even degeneration and dying. All of these Human development is construed to be a seamless, formative processes involve patterned movement at the macroscopic level of process, an expression of embodied intelligence in space and time organs, muscles, nerves, and vessels as well as at the microscopic that involves the intermingling of creative imagination and innate level of cellular metabolism. In the Chinese view, it is the Organ constitution initiated and sustained by the organizing power of Qi. Networks that modulate and coordinate all these processes (Tables This enables a person to maintain life, cultivate an identity, and 2 and 3). make a future—fulfilling destiny (Ming). HOW CHINESE MEDICINE VIEWS DISTURBANCES OF THE THREE LEVELS AND FIVE ASPECTS OF MIND THE MIND AND NERVOUS SYSTEM Mental activities and experiences occur at three levels, again pro- Since the sensory, neuromuscular, emotional, and cognitive aspects ceeding from the more tangible to the more intangible: sensations of the nervous system and mind are linked to the movement of Qi and perceptions, thoughts and ideas, feelings and emotions. Sensa- and the functional activities of the Five Organ Networks, distur- tions and perceptions arise from specific parts of the soma: skin, bances of sensation, perception, mentation, and emotion are inter- muscle, viscera, ears, eyes, nose, mouth, and tongue. Thoughts and preted as being the consequence of disturbances of Qi, leading to ideas arise from the psyche: imagination, dreams, memory, atten- Organ Network dysfunctions. In particular, the faculties and func- tion, and reflective contemplation. Feelings and emotions are the tions associated with the Liver and Heart Networks are considered outcome of our responses to sensations and perceptions, those that to have a predominant influence over the tone, tempo, and clarity arise inwardly, and those from the outside world that enter our field of behavior and consciousness. of awareness. Furthermore, whether we deem our experiences to be The Liver is the abode of the Hun, and the Heart is the abode of physical or mental, somatic or psychic, our capacity to recognize the Shen: Hun represents the active, seeking, goal-directed, reactive, their influence is rooted in the physiological structure and func- executive aspects of the mind and nervous system and Shen the receptive, globally aware, intuitive, insightful, and integrative as- pects. There is a saying that the Heart receives and understands, 1 Chinese Medicine Works, San Francisco, CA whereas the Liver feels and acts. In other words, whereas the Liver # Corresponding author. Address: perceives what the mind and body experience (sensation), the Heart 1201 Noe Street, San Francisco, CA 94114. gives it meaning in reference to a person’s true nature or self (in- e-mail: hbeinfi[email protected] sight). The Liver acts in accord with the dictates of the self (produc- © 2006 by Elsevier Inc. Printed in the United States. All Rights Reserved EXPLORE July/August 2006, Vol. 2, No. 4 321 ISSN 1550-8307/06/$32.00 doi:10.1016/j.explore.2006.04.003 Table 1. The Organ Networka Organ Network What It Governs Emotional Responses It Enables Kidney Imagination Capacity to experience fear Reflection Response to life-threatening events/conditions Memory Liver Clarity Capacity to experience anger Judgment Response to frustrating events/conditions Decision making Heart Receptivity Capacity to experience pleasure Intuition Response to attaining goals and fulfilling desires Recognition Spleen Attention Capacity to experience contentment/self-esteem Orientation Response to appreciating accomplishments Intention Lung Sorting Capacity to experience sadness Analysis Response to impermanence, separation, and loss Evaluation aEach Organ Network governs, and in a sense produces, specific mental faculties and characteristic emotional response patterns. ing feelings and reactions), and the Heart interprets the feelings and to the mix that, from a Western perspective, we understand as the reactions in relation to their congruence with the self and its ideol- neuropsychological basis of consciousness, integration, coordina- ogy and purposes (integration). In its role as feeler and actor, the tion, and adaptation. Disorganization of any or some of these Net- Liver gives the tone and temperament to one’s inner life, the effort works or functional terrains has a profound impact on the integrity and ease, confidence, and tenderness with which one responds to of both cognitive faculties and neurological competencies. experience. In its role as receiver and integrator, the Heart gives breadth and depth, meaning and coherence to one’s inner life. When the Heart is well, the Mind is tranquil, the senses are clear, HOW CHINESE MEDICINE VIEWS DEPRESSION and the body is comfortable. When the Liver is well, the Mind is Webster’s dictionary defines depression as, “a state. or disorder flexible, the disposition cheerful, and the structure supple. marked by sadness, inactivity, difficulty in thinking and concentra- The hallmarks of dysfunction are the unnatural distortions of tion, increase or decrease in appetite and time sleeping, feelings of healthy function. With disturbances of the Heart Network, the dejection and hopelessness, and sometimes suicidal tendencies; a capacity to witness, understand, and integrate can transform into lowering of vitality or functional activity.” The last phrase, “a low- obliviousness, confusion, and incoherence. Because the Heart also ering of vitality or functional activity,” goes to the center of Chinese governs the perfusion of blood throughout the body, disorders of medicine’s understanding of the root causes of depression: that the Heart may also manifest as flushing and chilling, labile hyper- emotional and behavioral symptoms are manifestations of an un- tension or hypotension, and localized ischemia or insufficiency. derlying constraint, collapse, or dissolution of Qi that weakens and With disturbances of the Liver Network, the capacity for good destabilizes the core identity or self (Shen-Jing). judgment and an even temper can transform into impulsivity and All diagnoses in Chinese medicine conform to the Yin Yang— volatility. Because the Liver also governs the muscles and nerves as Five Phase paradigm regardless of whether the illness at hand well as the volume of circulating blood, disorders