Shen

Deconflating Shen and Heart

Definition

Shen is defined by it relation to the heart; it dwells within heart. Shen functionally relates to consciousness during wakefulness and unconsciousness during sleep. It also includes pathological states of unconsciousness. Presence of shen is evident in the brightness of the eyes, clarity of visage, and clear, upright bearing. Shen vitality is the index of overall health mentally and physically.

Pathology

Shen pathology is evident in palpitations, insomnia, heart vexation, wind stroke and “evil” invading the pericardium. Evil is any unfavorable condition affecting heart function, heart sensation, emotions and character. Since the shen dwells within heart, conditions affecting the heart also affect shen, and by extension, heart treatments include the shen. The heart-shen connection is reflected in the pulse. A depleted shen will be reflected in a weak, turgorless pulse. The “spirit” of pulse, as one would speak of a spirited pony, is also a sign of harmony between the three treasures, san bao, which include jing and qi. San bao, as esoteric as it may be construed, is a reminder that shen cannot be reduced to purely mechanical heart function. Blood and its concomitant aspects of production, storage, and content reflect shen. Shen pathology arises from pathogenic attacks to heart and blood. Pathology may also arise from deficiencies in the production of blood and cellular fluids.

Heat is a primary pathogenic factor affecting heart. It can scorch blood, causing blood and yin deficiency. These conditions leave no place for the shen to settle at night, according to the Internal Classic. Essentially, nighttime is yin. The body must be sufficiently comprised of yin in order for yin influences to rise in the evening and thus induce sleep. Insomnia can be treated by nourishing the blood with herbs like dang gui and rhemania. The spirit should also be settled with sinking herbs like mu li and dragon bone.

Cold is a pathogen that usually arises from deficiency when the body cannot ward off cold attacks. Naturally, those subject to environments that are comprised of constant or sudden cold risk greater outright cold invasion. Usually, however, cold heart symptoms usually arise from deficiency of yang. The yang should be warmed with herbs like fuzi, ren shen, and tu si zi. Pathogenically, cold can join forces with damp to “mist the heart,” causing muttering, profound confusion, and a rattling in the throat. The treatment principle is to transform damp and calm the shen. Fu ling and fu shen will be particularly useful herbs given their ability to drain damp and calm the shen. More powerful drainers like tian nan xing, cang zhu, and bai zhu can be used depending on the degree of individual deficiency.

Psychological symptoms may also be expressed from an attack of phlegm-heat. Mania, agitation, and violent demonstrations characterize this affliction. It should be treated with cooling, calming and phlegm-resolving herbs, such as dan shen, gua lou pi, chuan bei mu and lian zi. Dan shen in particular has the special ability to cool the blood, calm the shen, open the senses, and relieve pain caused by stagnation. The phlegmatic impertinence of this pathogenic combination must be moved while anchoring a fragile temperament. Use dragon bone, mu li, and suan zao ren to anchor.

Deficiency of qi and blood can cause pulse dysfunction. Heart qi deficiency expresses through excessive sweating and palpitations. Application of ren shen, gui zhi, gan cao, bai shao, and long yen rou in varying proportions depending upon the degree of deficiency heat can benefit heart qi by cooling and nourishing the blood.

Heart yang deficiency is a serious condition that resembles shock: cold clammy sweat, shortness of breath, and palpitations. Calming the shen with mother of pearl, he huan hua, and he zi, along with restoring the yang with fu zi, cinnamon, nutmeg, Korean red ginseng is in order.

Blood stagnation arising from heat can be treated with the formula Dan Shen Yin. Heart-blood stagnation is characterized by stabbing local pain, palpitations, and chest tightness. Acute manifestations are extremely serious requiring emergency care. Dispersion at the heart points would be necessary if in the unlikely event one experiences such an attack during treatment. Pericardium 6 and jing points located at the extremities should be considered in such cases. After the emergency, warming blood movers should be provided, such as persicae, safflower, licorice, dang gui and chuan xiong.

Heart yin deficiency causes difficulty staying asleep, night sweats, a deep central tongue crack, irritability, and heat. Tian wan bu xin dan is a spirit calming formula addressing kidney heart disharmony. Beyond the toxin cinnabar, this formula powerfully nourishes and cools the blood of the heart and upper jiao. Consider such herbs as asparagus root, mai men dong, and prepared rhemania.

Shen, Heart, and Characters

Sleep, heartbeat, and sweat are heart-shen indications. Given that shen symptoms appear with heart patterns, heart and shen appear to be virtually indistinguishable. Perhaps this is why Maciocia calls shen, “mind,” a state akin to cognition. If heart and shen were synonymous, however, they would not have different names. To some extent the distinction might be made by viewing heart as machine to shen’s ghost, as in ghost in the machine.

The difference between the characters, particularly the radicals further corroborates a shen-heart difference. Heart is a very basic element that is a radical unto itself. This radical literally undergirds nearly every emotional state, including some of the pathogens and virtues of the other four viscera. For example, thought (si), sorrow (bei), and anger (nu) are all elements of heart, not shen. These emotions invariablely affect shen but are not of it. The virtue “will” (zhi) demonstrates that characters supported by heart are not exclusively pathogenic. Nevertheless, illness arising from heart is clearly distinct from shen. The word psychology in Chinese is xin li xue, literally the study of heart order. It seems to suggest a meaning more closely related to Maciocia’s mind, not shen. Terms like ambition (literally, wild hearted, ye xin), open hearted (kai xin), and warm hearted (re xin) also show emotions attributed to heart but not shen.

Shen possesses a celestial radical. It dwells within the realm of the spooky kabuki. Shen also manifests in the viscera, but the characters sometimes receive the ghost radical, as in hun and po, the “ghosts” of liver and lung respectively. This means that shen is related to ghosts. There are ghost points on the body that address shen disorders. Two additional characters associated with the same radical as shen are li (ritual distinguish from principle) and ancestor (zu). These characters are related in that ritual is used in worship of ancestors. Formulated action becomes the principle medium for connecting with ancestors. Similarly, shen is a nonmaterial concept that bridges the gap between heaven and man by virtue of its celestial radical.

Mind and shen are clearly not synonymous. Some aphorisms further illustrate this difference. For example, “shen don’t know and ghosts haven’t an inkling,” refers to a stratagem about which most are kept in the dark. A “shen pen” refers to marvelous literary talent, and “shen qi ten feet,” is a way to remark upon one’s talents that stand head and shoulders above others.

Some shen idioms also include heart or characters possessing the heart radical, e.g., shen demeanor (shen qing, including the standing heart radical on the qing character). There is also “shen happy heart drunk,” which refers to great pleasure.[1] Finally, there is “shen will unclear,” which means total withdrawal, catatonia, or unconsciousness.

Conclusion

The following discussion has largely been expository, relating the views of shen within the context of Chinese medicine. Aside from describing shen patterns, treatment principles, and herbs, a culturo-linguistic flourish has been offered as a means of broadening the scope for understanding shen. In some ways this perspective allows us to wrest shen from a somewhat problematic conflation with mind, which more closely approximates heart. The difference between mind and shen radicals renders a reading of shen exclusively as mind as unsatisfactory, because shen also includes the miraculous, that which exceeds what is essentially a construct of mind in the form of mind pathogens and is an aspect of heart. This nuance almost unavoidably encourages associations with Buddhist typologies that draw distinctions between mind-self and the cultivated mind, and more likely, the Freudian id, ego, super-ego trinity. Such attempts have their limitations for reasons that go beyond the purview of this discussion. Suffice it to say that since Chinese Buddhism has evolved within the context of historical developments in the conceptions of heart and mind cultivation, associating shen with Buddhism is congruous and reasonable. The same cannot be said for Freudian psychology. The Dao De Jing begins with the admonition that the way that can be spoken is not the eternal way. Many shen aphorisms speak of the miraculous in a fashion that evokes the ineffable. Much talk of shen is confused and clouded by heart, but a clearer apprehension of its meaning can be gained by understanding its radical, which is associated with ghosts and dwells, confoundingly perhaps, in the nonreducible realm of the spooky kabuki.

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[1] Xian dai cheng yu ju dian (Gigantic Dictionary of Modern Idioms)(Da lian Publishers, 1993) includes a quotation from the Epic of the Sui and Tang Dynasties (sui tang yan yi), describing the emotional heights from listening to exquiste song and flute.

Tai Yang Conditions

In Chinese Meridian Theory, as in the law, certain tests or standards must be met in order for a syndrome to be diagnosed. In the case of Tai Yang conditions, a floating pulse and stiffness of the back of the neck mark the first two standards. The rub is numerous other distinctions must be made based upon the progression of the condition relative the body's strength. This includes preexisting conditions such as age and constitution.

The following discussion on Tai Yang formulas allows for us to refine our diagnostic skills and raise deeper questions about common conditions. Central to any exploration of Tai Yang conditions is excess (yang) and deficiency (yin).

The formulas discussed are listed below:

Ge Gen Tang
Gui Zhi Jia Ge Gen
Gui Zhi Jia Ren Shen Tang
Gui Zhi Jia Hou Pu
Ma Huang Tang
Ge Gen Tang
Ge Gen Jia Ban Xia
Gui Zhi Jia Fu Zi
Da Qing Long
Xiao Qing Long

Excess versus deficient-- the initial stages

Quite simply the difference between a TY excess and deficient presentation is the presence of sweat. This axiomatically designates the condition as deficient. The rationale relates to a stagnation of yang qi that allows for the yin qi to seep through the pores. This is called "disharmony between wei and ying," which are more superficial aspects of the body. Sweat differentiates a TY deficient condition from bi syndrome, which can also present with neck stiffness and deficiencies but at deeper levels than wei and ying. Interestingly, however, most bi formulas contain gui zhi and many contain ma huang, both of which release the exterior/wei level. The chronicity of bi patterns is also a major differentiating factor from TY deficiency patterns. Beyond sweat, other TY deficiency symptoms include a moderate or weak pulse.

The sudden onset of neck stiffness without sweat indicates an excess pattern. In such cases, the body is considered strong enough for robust formulas. Ge Gen Tang is therefore appropriate. If, on the other hand, sweat is present then Gui Zhi Jia Ge Gen Tang is what the doctor should order.

Longstanding body aches that result from improper sweating call for Guizhi Jia Ren Shen Tang. This formula is often used in cases of fibromyalgia and even postpartum pain, so understanding the nature of the deficiency vis-a-vis the individual's constitution will determine the appropriateness of this formula. A practitioner will want to pay special attention to the state of blood, as pain cases are often the result of blood stagnation in combination with deficiency.

Asthmatic presentations follow the same logic. Sudden onset asthma with sweating is best addressed with Gui zhi Ho Pu Tang, whereas non-sweating asthma calls for Ma Huang Tang. There are numerous formulas for asthma and I have my doubts about the functionality of either of these formulas. This because by the time a patient feels the need for a doctor's visit, their condition has advanced beyond the the initial stages. For instance, phlegm indicates an advanced condition that would require some modification to more directly address phlegm, which is almost always present in asthma. In an instance of another asthmatic condition, coughing at night, an entirely different etiology is at play and the above formulas should be altogether avoided.

Just what in the world does "deficiency" mean in Chinese medicine? Just because a person develops really strong symptoms doesn't mean that they are deficient. In fact, it usually means the opposite because the body has more energy with which to mount its attack. This reasoning seems to characterize the formulas that allopathically treat the strong symptoms of diarrhea and vomiting, Ge Gen Tang and Ge Gen Jia Ban Xia respectively. These two patterns represent a combination of TY and Yang Ming conditions that exhibit no weakening of the body's response to the pathogen. The advance of the pathogen nevertheless proceeds afoot.

More insight into the differences between excess and deficiency is gained when considering treatment principles. Releasing exterior occurs in both deficiency and excess patterns, however, deficiency also requires harmonizing ying and wei. Deficiency may also require tonification of yang qi, as in Gui Zhi Jia Fu Zi Tang, for copious sweating, vomiting, and loss of fluids. Similarly, an aspect of yang is boosted in Gui Zhi Jia Ren Shen, which to reiterate is for body aches.

Excess presentations require no supplementation and may include more aggressive forms of clearing, such as in Da Qing Long Tang, a pattern also known as "fire wrapped by ice," characterized by the TY symptoms and the presence of irritability. Clearing is even appropriate in presentations that appear to possess deficiency components, as in the case of Xiao Qing Long Tang, which is often prescribed for cases of pneumonia. The excess in this case is the congested fluids that must be cleared from the lung.

It's important to note that vomiting is neither a sign of excess or deficiency. Ge Gen Jia Ban Xia and Gui Zhi Jia Fu Zi both do this. In the case of the latter, vomiting will not be the primary symptom.

In short, as with all syndromes of Chinese Meridian Theory symptoms may take different forms depending on the particulars of the patient. TY syndromes are early stage conditions that must be treated quickly to prevent the advance of the pathogen. In some cases, these formulas are used to treat conditions that have nothing to do with early onset, but are presumably appropriate because the pathogen has failed to advance beyond the very superficial levels of ying and wei.

Dryness Formulas

A central tenet of Chinese meridian theory is that pathogens track with a predictable progression through the body. Different seasons bring varying influences into the body. Autumn is the season of dryness. Below is a discussion of the "dryness" pathogen and its progression as articulated by Wu Ju-tong (1757-1841), one of the most highly regarded herbalists of the Qing Dynasty, heralding from the Warm Disease school, which specialized in seasonal affective disorders.

The purpose of the following article is to acquaint readers who have a passion for Chinese herbalism with Warm Disease perspectives on dryness by discussion the common formula prescriptions.

Formulas:
Sang Xing Tang
Sang Ju Yin
Sha Shen Mai Men Dong
Qiao He Tang
Qing Zao Jiu Fei Tang

Discussion
Sang xing tang and Sang ju yin are both for initial stage dryness. The condition is in the lung and wei levels. Use acrid, cool, clearing, and moistening herbs.

Sha shen mai men dong tang is for dryness that has damaged "yin aspects of the lung and stomach, [presenting] with fever or cough. This is a deeper level of damage than above, therefore the addition of sweet is needed to assist in the production of jin and ye.

Qiao he tang treats dryness transforming into fire and Qing zao jiu fei tang treats pent-up (fen yu) qi.

The interesting thing is that all these formulas treat dryness, specifically heat dryness. Dryness patterns range from conditions resembling wind-heat to yin deficiency, so the texts are adamant about doing proper differentiation. The problem is that differentiation is much easier said than done because constitutional patterns often must be considered in addition to the acute presentation.

The formulas above are characterized by their treating the lung primarily and stomach secondarily. It is interesting to note that the text's commentators place considerable emphasis on the role of earth as mother to metal. Fascinatingly, this also leads to their stunningly obvious but daring conclusion that autumn dryness is actually born from summer dampness. Be that as it may, aromatic damp transformers, so central to all dampness formulas, do not find their way into any of the above formulas.

Since these formulas track the progression of heat through the meridians of the lung, differentiation turns on duration and severity of the condition. By far the most severe presentation belongs to "dryness transformed into fire." In contrast to clear repletion fire formulas however, heavy bitter herbs are not appropriate. Toxicity is cleared through the bitter, slight sweet, and bland of he ye (lotus leaf) and the anti-toxicity of lian qiao (forcythia), an herb that must rank among the lightest of the category. Hallmark signs are tinnitus and red eyes, but accompanying upper jiao symptoms, such has weakness, wheezing, and vomiting, can also be present. Herbs that can be used are fresh ju hua, ku ding cha, xia ku cao, niu bang zi, and huang qin.

Dryness that progresses beyond the initial stage, that which damages the lung and stomach yin calls for Sha shen mai men dong tang. The first two formulas Sang xing tang and sang ju yin are for the initial stages. The latter of these two would be used for initial stage dryness that also presents with a cough.

Initial stage conditions are characterized by lung and wei presentations, whereas deeper stages do not have wei symptoms. This means when differentiating between whether to administer first stage or second stage (so to speak) formulas, it is important to determine whether wei syndromes are still present. Constitutionally speaking, deficient patients-- individuals with lung deficiency, pre-existing dampness, or yin deficiency-- may never present in the clinic with wei patterns because their wei qi, and by extension zheng qi, is already on the deficient side.

We conclude this discussion on dryness with Qing zao jiu fei tang. I have personally found this formula helpful for yin deficiency cough. A strong reminder is served to practitioners about using cold and bitter herbs for dryness for diminishing heat symptoms in the case of lung dryness. This formula focuses on stomach earth as mother of lung metal. Though it is easy to note the spleen lung relationship, this text reminds us that the yang aspect of earth is the focus of dryness conditions. Herbs that clear and moisten (run) are consequently called for.

All of the above formulas are discussed in Bensky with the exception of Qiao he tang, so its ingredients are provided below:

Bo he 1 qian 5 fen
Lian qiao 1 qian 5 fen
Sheng gan cao 1 qian
Black zhi zi 1 qian 5 fen
Jie Geng 3 qian
Lu dou yi 2 qian

Source text: Wen Bing Xue. Meng Shu-jiang ed., Ren min wei sheng chu ban she, 1989 1st edition 1997 3rd printing.