Unhappiness is identified as the etiology of many important disease states in the Nei Jing. Chapter 44 of the Su Wen says that "Wei Atrophy" Syndrome can come about when a person is disappointed or mentally distracted.When there is "pondering without limits" or when a person can't deal with not getting what they want, the Zang (visceral) organs can "become hot." Internal heat burns the organs, damaging their yin-form and yang-function, potentially creating severe physical problems.
Wei Atrophy is sometimes translated as "withering" or "limpness." The symptoms associated with Wei Atrophy in the Su Wen resemble what we know modernly as degenerative and autoimmune conditions such as Systemic Lupus, Pulmonary Tuberculosis, Parkinson's Disease and Osteoporosis. Interestingly, the treatment suggested by the Su Wen for the treatment of Wei Atrophy Syndrome is similar to that suggested by the Ling Shu for depression: use of the Shu-Stream and Ying-Spring points.
The Ling Shu emphasizes the importance of one's mental health. It contains the famous quotation from Chapter 8 saying all acupuncture treatment must be "rooted in the spirit." In Chapter 54 the theme of the "spirit" is discussed as being about a sense of "completion" and "harmonization." Completion suggests a feeling that everything is as it should be - acceptance without regret; harmonization means the ability to get along with elements of the surrounding world and all the aspects of the self. Lack of harmonization results in rebellion and resistance: both which can create internal heat: the precursor to degeneration. Chapter 36 discusses "Rebellious Qi" and its role in creating blockage (Bi obstruction) in the body: another precursor to Wei Atrophy Syndrome and psychological states like depression.
Another classical disease state said to begin with unhappiness is Dian Kuang. Giovanni Maciocia associates Dian Kuang with the modern psychological condition bipolar disorder. Common translations of Dian Kuang is yin and yang "madness" characterized by psychosis and acting out, or "dullness and mania" as Maciocia translates it. The yin state of Dian is characterized by disengagement from the world, while the yang state of Kuang is characterized by manic "acting out." In his book, The Psyche in Chinese Medicine, Maciocia also associates Dian Kuang with forms of epilepsy.
Chapter 22 of the Ling Shu describes Dian Kuang as beginning around the sensory orifices of the face, mainly the eyes and mouth. Dian begins with sadness, reddening of the eyes, and the physical sensation of a heavy head. When it becomes more advanced, it manifests in constant worry, anxiety and preoccupation. Kuang also begins with sadness, then progressively generates forgetfulness, anger and fear. Kuang is also said to come from preoccupation and worry. Deviation of the mouth is also associated with Dian Kuang, showing up as an early sign of the disease.
The Su Wen famously states in Chapter 3 that "wind" is the cause of all disease. Dian Kuang is no exception. Dian Kuang is often associated with the pathological combinations of wind-phlegm and phlegm-fire. Like all wind pathology, Dian Kuang has a progression that is described by the Ling Shu. The text describes it somatically and emotionally. Dian begins at the eyes or the mouth. In his published lecture on the Ling Shu from the New England School of Acupuncture, Jeffrey Yuen says that the image of redness of the eyes, in addition to being a somatic sign, is also a metaphor for a person who is upset: "crying" about disappointment or loss of something. The wryness of the mouth is associated with fear, generating neurological wind. This can also manifest as facial tics, or other wind-associated symptoms affecting the face. The progression of Dian can then move into the cheekbones, jaw and teeth where it will generate sweating, the tendency to fidget and anxiety. If the Dian moves into the muscles, this can create spams or seizures: further wind symptoms associated with epilepsy. If Dian moves into the acupuncture channels, it can create swelling of the limbs and the sensation of having been "beaten." Dian can also create states of rebellious qi (acting out, aggression and destructive behavior) accompanied by spinal symptoms such as stiffness, spinal curvature and misalignment.
How do the Chinese medical classics see unhappiness in terms of health? The notion of wind is very important in the discussion of all disease states, including that which affects the mind and emotions. Chapter 58 of the Ling Shu presents the concept of "thieving wind." Contained within this concept is that we become vulnerable to external pathology only when our own internal mental energy is deficient or not adequately engaged. In other words, when our mind is distracted and not present, "perversity" or "xie qi" can makes us sick. In the Ling Shu, there is much discussion on the importance of harmonization between Wei "defensive" and Ying "nourishing" qi in the body. We can see this as our ability to harmonize our minds with that which is occurring external to us in the world. Emphasis on the sensory orifices when discussing Dian Kuang suggests mental illness is predicated on perception. Chapter 54 says "spirit" is a state of completion and harmonization: we feel full, content and at peace. We neither feel we need to fight with the world, nor do we feel impoverished and lacking for what we do not have. To the Nei Jing, this state of being is what protects our health.
It's interesting to note that for the treatment of Dian Kuang, commentators to the Ling Shu say that Luo points are the primary focus. The theory of the Luo Vessels help describe the ideas presented in Chapter 54. Nguyen Van Nghi's commentary to Chapter 54 discusses the concept of "latent" perversity in the form of "humidity" or dampness and its effect on a person's health and behavior. When the body is holding onto something that is unresolved, says Van Nghi, the person is more vulnerable to becoming sick when confronted by external forces. There's the image of resonance between that which is occurring outside the body and that which is being held unresolved within. The meeting of these factors can cause a person to become sick suddenly, seemingly without cause.
The Luo Vessels are considered part of the collateral system of the body. They are vessels of latency, holding unresolved pathogens in a dormant state, using Ying qi (blood and fluids) to keep pathology hidden and relatively quiet and controlled. However, according to Van Nghi, latent pathology can become activated when it comes in contact with a similar external catalyst. This is perhaps the notion of "fullness" and "emptiness" of the Luo as described in Chapter 10 of the Ling Shu. The Luo vessels fill with pathology until they become saturated, whereby they will empty back into primary circulation and become symptomatic once again. We can see these two theories as similar to that of the notion of emotional re-traumatization. When a person experiences a trauma, there is a tendency for the body to repress it. However the trauma can become reactivated when the person comes in contact with a situation that resembles the original trauma. The Ling Shu suggests this can occur on both a physical as well as mental level.
The notion of wind is not just external weather that disturbs the body, but anything that challenges the homeostasis or sense of stability of the self. In the case of Dian Kuang, wind seems to describe the reaction of the body to the challenge. Wind is the state of "dizziness" chaos, unpredictability or uneasiness the body experiences. Wind is a metaphor. Wind also describes the way in which pathology moves around the body: from the eyes and mouth to the cheeks and muscles and channels as in the case of Dian Kuang. We can also look at wind in relation to fear. What do we do when we are afraid? We shake - a symptom commonly associated with fear. We commonly fear what we don't understand, or that which we feel disempowered by. A common response to fear is to retreat from the situation or to fight. One of the most dramatic descriptions of the somatic manifestation of fear in the medical classics is "Running Piglet Qi": a situation where a surge of energy rises from the lower part of the body into the chest, disturbing the heart. Running Piglet qi can feel like a panic attack, making a person feel as if they are going to die. It is attributed to a disharmony between the Kidneys and the Heart, which can be interpreted as latent fear being released from the lower part of the body to overwhelm the heart, the seat of the spirit.
Within the discussion of latency, phlegm is an important element to consider. The theory of phlegm is not discussed in the Nei Jing. It was introduced later in history, most likely by Sun Si Miao during the Tang Dynasty (7th-9th Centuries CE). Phlegm is the factor that keeps things latent in the body. It is that which makes conditions chronic, insidious, hidden and lurking. It also clouds perception and disturbs normal physiological function. It has become the factor that is most commonly associated with psychosis and mental illness. Philosophically, phlegm is often associated with confusion or delusion.
Fullness of the Luo Vessels is most commonly associated with blood stasis states, manifesting as visible spider veins that appear on the surface of the skin. Emptiness of the Luo Vessels can create swellings, lipomas and cysts: phlegmatic accumulations.
The classical advice for using Luo vessels in the Ling Shu is to blood-let them. This follows the strategy that to expel wind, one must move the blood. When a Luo Vessel has begun to empty, manifesting as swellings and cysts, moxibustion commonly follows the bleeding. Philosophically, to bleed a Luo point can be seen as breaking through the stagnation in the mind: freeing the Shen from its stubborn, fixed perception. Whereas, bleeding followed with moxibustion provides a person with the empowerment of yang qi so they may dissipate and transform the confusion and/or delusion creating their problem.
According to Chapter 22 of the Ling Shu, the major channels suggested for the treatment of Dian are the Small Intestine, Large Intestine and the Lung. The chapter advises treating these points until the blood changes, which seems to suggest treating the Luo of these channels. When there are symptoms of rebellious qi (Kuang-"acting out"), the chapter advises treating the Bladder, Stomach and Spleen channels. When there are wind issues, BL-11 is suggested to move the blood. BL-11 is the Shu-transport point for the "Sea of Blood," as stated in Chapter 33 of the Ling Shu. When there are swellings and the person feels "beaten," BL-10 is suggested. If none of this helps, moxibustion is suggested for GV-1.
Van Nghi states that Kuang "always involves both obsession that has a hold on the spirit, which is troubling or bothersome to the point of psychological suffering and a state of famine." Therefore, treatment of Kuang must focus on breaking the obsessiveness, which suggests working with the phlegm aspect of the condition.
The idea of using the intestine channels as the initial treatment for Dian Kuang resonates with a statement made later in the Ling Shu in Chapter 26. Before one can open and release the upper portals of the body, the lower portals must be opened first. Dian Kuang is described in the Ling Shu as a condition characterized by a fullness and stagnation in the lower part of the body and an emptiness in the upper body. To treat the depression of qi in the heart, lungs and pericardium in the chest, the intestines in the lower body must first be rectified. Primary to the treatment of mental health is the health of the intestines.
It's my contention that to be able to treat degenerative and autoimmune conditions, one must understand how to treat mental illness. Chapter 44 says Wei Atrophy syndrome is the result of mental distress: the inability to deal with disappointment and worry. Therefore, if one wishes to treat the root of the problem, one must help to desensitize the patient in their overreaction to the realities of life. The core strategy employed in treating Dian Kuang for example is opening the intestines: helping the person find a way to let go of what they are holding onto or obsessing about. The other strategy employed after the lower portals have been opened is the opening of the upper portals. The focus of treatment is working on perception. Helping the patient to let go of seeing the world as a scary, disappointing place. To help them reach the goal of their spirit: to more fully realize a state of completion and harmonization.
It is interesting to note that the Divergent Channels, as presented in Chapter 11 of the Ling Shu also utilize the strategy associated with Dian Kuang as presented in Chapter 22. The Divergent Channels are commonly treated by stimulating a pair of opening "confluent" points. One set of these points are located on the lower body, often affecting the bowels; the other set are located on the head and neck, exerting an opening effect on the upper portals - the sense orifices. The Divergent Channels have become some of the most popular channels to treat degenerative and autoimmune conditions associated with latency. Based on the strategies suggested by their trajectories, they are also potentially strong channels to work with Dian Kuang and mental illness.
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