JOY: AN EMOTIONAL CAUSE OF DISEASE?

It always seems strange that joy should be listed among the emotional causes of disease in Chinese medicine. And yet, it has always been mentioned as an emotional cause of disease since ancient times. Strangely, the Chinese character for “joy” [xi 喜] is the only one of the emotions that is not based on the ‘heart” radical. The character Xi is based on the radical for “drum” plus “mouth”, i.e. beating a drum and singing in happiness. Incidentally, two xi characters next to each other are called “double happiness” and are a symbol of a wedding.

It is interesting that, in the list of emotions as causes of disease, “joy” is always top of the list, followed by anger. For example, these are the emotions listed by Confucius: joy, anger, grief, fear, love, hatred, desire. These are the emotions listed by Lao Zi: joy, anger, worry, sadness, love, hatred, desire. It is interesting that both lists include “love” as an emotional cause of disease! Chen Wu Ze (1174) lists: joy, anger, pensiveness, worry, sadness, fear, shock. These became the widely accepted “7 emotions” of Chinese medicine. Zhang Jie Bin (1624) lists eight emotions: joy, anger, pensiveness, worry, sadness, fright, fear, shock.1

A normal state of joy is obviously not in itself a cause of disease; on the contrary, it is a beneficial mental state which promotes a smooth functioning of the Internal Organs and their mental faculties. The “Simple Questions” in chapter 39 says: “Joy makes the Shen peaceful and relaxed, it benefits the Ying and Wei Qi and it makes Qi relax and slow down.”2 On the other hand, in chapter 2 the “Simple Questions” says: “The Heart … controls joy, joy injures the Heart, fear counteracts joy.”3 Other passages in the Nei Jing clearly refer to joy as a cause of disease. For example, chapter 5 of the “Simple Questions” says: “Joy injures the Heart.”4 Chapter 8 of the “Spiritual Axis” says: “Joy scatters the Heart and deprives it of its residence.”5

Fei Bo Xiong (1800–1879) in “Medical Collection of Four Doctors from the Meng He Tradition” says: “Joy injures the Heart … [it causes] Yang Qi to float and the blood vessels to become too open and dilated …”6

I think that the best (and probably only) way to understand “joy” as an emotional cause of disease is in the light of the three main philosophies of China, i.e. Daoism, Confucianism and Buddhism. I think that “joy” is akin to “desire” and “craving” from the point of view of these three philosophies. Of the three philosophies, Daoism and Confucianism are the main ones because Buddhism was not widespread in China at the time when joy was already considered as a cause of disease, i.e. during the Warring States Period (476-221 BC).

All these three religions (or rather philosophies), for different reasons, advocated emotional restraint and avoidance of “craving” and “desire”. For example, the Daoists shunned social relations and advocated “following the Dao”, “absence of desire” (wu yu) and “non-action” (wu wei). They felt that joy would stop us from following the Dao as much as other emotions such as anger. The great Daoist Zhuang Zi (370-301 BC?) talks about wu qing, i.e. absence of feelings: “What I mean when I say that they [sages] are wu qing (without feelings) is that they do not injure their own persons with likes and dislikes and are always responsive to what is natural without trying to increase life.”7

The ancient Daoist text Nei Ye (Inner Training), older than the Dao De Jing, has this interesting passage on emotions:

The vitality of all people
Inevitably comes from their peace of mind
When anxious, you lose this guiding thread
When angry, you lose this basic point
When you are anxious or sad, pleased or angry,
The Dao has no place within you to settle
Love and desire: still them!
If you are tranquil, you will attain it (the Dao)
If you agitated, you will lose it.8

Indeed, to the Daoists, stimulation has a negative connotation. Zhuang Zi says concisely: “When desire is profound, the force of Heaven is superficial.” This means that desire turns us away from the vitality of Heaven stirring emotions within us that make us stray from the path of the Dao.

Confucianists believed that the true “gentleman” (a mistranslation of the term jun zi that actually applies to both men and women) is not stirred by emotions because these cloud his or her true nature. They used the image of a pond with a muddy bottom. If the water is very still, it becomes clear: if we stir the bottom, the water becomes turbid. The pond is our human nature which is naturally “clear”; if we are stirred by emotions, these will cloud our human nature. Consider this passage from Xun Zi (a Confucianist philosopher, 312-230 BC): “It is ever so that the Heart-Mind [Xin] is naturally full, naturally born and naturally perfected. Should its function be impaired, it is certain to be due to sorrow and happiness, joy and anger, desire and profit-seeking. If we can rid ourselves of sorrow and happiness, joy and anger, desire and profit-seeking, the Heart-Mind [Xin] will revert to its flawless state.”9

The Buddhists considered desire and craving as the very root of human suffering. Greed (excessive desire), hatred and ignorance are at the centre of the Wheel of Life and greed is strangely symbolized by a rooster. According to them, our very existence begins out of the desire and craving of a mind in the Bardo state (the period after death and before the next reincarnation): the mind desires the warmth of a womb and it reincarnates. Later on in life, desire causes our mind to try to grasp objects like a monkey sways from tree to tree (that is why the Buddhist Wheel of Life has, among others, the image of a monkey on a tree).

So, what relevance has this view of “joy”, “desire” and “craving” to us in the 21st century? I think that these emotions are indeed causes of disease and I would call the modern equivalent of these emotions “overstimulation”. I think that this, rather than “joy”, would probably be the best translation of xi. Our society indeed bombards us with objects of craving and it artificially creates “desire” and “craving” through advertising; on the other hand, it provides and fosters substances that overstimulate us.

We are all “overstimulated” by entertainment, frenetic lifestyle, consumerism, coffee, tea, tobacco, alcohol, TV, video games, “recreational drugs”, medicinal drugs, and sexual stimulation.

The main stimulant drugs are:
• Caffeine
• Nicotine
• Cocaine
• Amphetamines
• Prescription drugs e.g. Ritalin® (Methylphenidate), Adderall® (amphetamine and dextroamphetamine), Dexedrine® (dextroamphetamine), Strattera® (atomoxetine), Focalin® (Dexmethylphenidate) etc.

Interestingly, antidepressants are not actually stimulants and do not usually lead to “joy”. My experience with depressed patients on anti-depressants is that these drugs “blunt” all emotions; they do somehow lift depression but at the expense of alertness and enthusiasm. Indeed, some anti-depressants are used for anxiety with some effect.

I think that the ‘blunting” effect of anti-depressants is reflected in the resulting pulse, i.e. a pulse that feels “stagnant” and does not have the healthy “wave” of the normal pulse. It is not Wiry, not Tight but I describe it as “stagnant” and “reluctant”. While most authors see anti-depressants as mood-elevating and stimulants, I do not share that view and the pulse qualities described above seem to confirm this.

Overstimulation, in the broad sense indicated above, makes the Heart larger. This leads to excessive stimulation of the Heart, which in time, may lead to Heart-related symptoms and signs. These may deviate somewhat from the classical Heart patterns. The main manifestations would be palpitations, over-excitability, insomnia, restlessness, talking a lot and a red tip of the tongue. The pulse would typically be slow, slightly Overflowing but Empty on the left Front position. It may seem strange that “joy” or overstimulation makes the pulse slow. This is because overstimulation makes the heart larger and therefore slows down circulation (shock, by contrast, makes the heart smaller).

The points I use for overstimulation are HE-7 Shenmen, P-7 Daling, Du-19 Houding, Ren-15 Jiuwei.

1. Zhang Jie Bin (also called Zhang Jing Yue) 1982 Classic of Categories (Lei Jing), People’s Health Publishing House, Beijing, p. 424. First published in 1624.

2. 1979 The Yellow Emperor’s Classic of Internal Medicine-Simple Questions, p. 221.

3. Tian Dai Hua 2005 The Yellow Emperor’s Classic of Internal Medicine - Simple Questions p. 38.

4. Ibid., p. 38.

5. Spiritual Axis, p. 25.

6. Medical Collection of Four Doctors from the Meng He Tradition, p. 40.

7. Ames RT and Hall DL A Philosophical Translation of the Dao De Jing, Ballantine Books, New York, 2003, p. 47.

8. Roth H Original Tao, Columbia University Press, New York, 1999, p. 94.

9. Lee J Xunzi and Early Chinese Naturalism, State University of New York Press, Albany, 2004, p. 35.

Petition to save herbal medicine in Europe

To European practitioners and public: please sign this petition from the Alliance for Natural Health to save herbal medicine in Europe. Bring the battle to your elected representatives: they, not the so-called regulatory agencies, are ultimately responsible to reverse this gross infringement of our freedoms.

An EU directive has banned many herbal medicines, denying us safe remedies and feeding the profits of big pharma. Let's raise a massive outcry to push the Commission to reverse the Directive. Let's get to 1 million voices to save herbal medicine. Add your name here:

https://secure.avaaz.org/en/eu_herbal_medicine_ban/?utm_source=The+Alliance+for+Natural+Health&utm_campaign=95058cff75-110602_ANH_Intl_eAlert_No_576_2_2011&utm_medium=email

European Union

This is particularly for UK practitioners (who are of course also UK taxpayers). If you want to get an idea of the madness and lack of accountability of the European Union, watch this:

http://www.bbc.co.uk/news/uk-politics-13438712

Ah yes, and in the middle of this financial, economic and banking crisis, what is the European Union concerned with? Why, of course, the marketing of herbal remedies..

A BLACK DAY FOR FREEDOM IN EUROPE, A SHAMEFUL DAY FOR THE EUROPEAN UNION

On 1 May 2011, the European Directive on Traditional Herbal Medicinal Products 2004/24/EC will come into force. This Directive has far-reaching (negative) consequences for acupuncturists, herbalists, the herbal medicine industry and consumers of herbal medicine. Quite simply, this is a draconian Directive that limits our freedom to use herbal medicines as practitioner and consumers. Make no mistake, contrary to what our bureaucrats are telling us, this Directive has nothing to do with the protection of the consumer: it has everything to do with the desire and need of Eurocrats to regulate and control.

In this age of the Internet when high-quality information is readily available, the consumer is perfectly able to satisfy him- or herself about the standard of quality controls and efficacy of a particular herbal remedy. For example, hundreds of clinical studies on herbal medicines are available online.

The main motivation for this draconian European Directive is the European political and administrative class’s pathological need to regulate. In the European mindset, anything that is not “regulated” is assimilated to “illegal”. The European bureaucracy needs to regulate to justify their existence and paradoxically, we, the victims of this legislation, are even paying their salaries through taxation. Have you heard that the European Commission has asked for an increase of 5% in their annual budget? At a time when all over Europe (and especially in Ireland, Greece and Portugal) populations are suffering under a regime of economic “austerity” and drastic cuts!

The second reason for the ban is, sadly the lobbying by the powerful drug companies. Hannan says: “Whenever an apparently absurd law of this kind emanates from the EU, ask yourself cui bono — whose interest does it serve? In this case, there is no mystery: the directive was openly lobbied for by large pharmaceutical companies, which saw an opportunity to put their smaller rivals out of business. Not for the first time, big corporations have used the EU to push through rules which national assemblies would never have countenanced. MPs were left in no doubt about how their constituents viewed the proposal. But Brussels fonctionnaires are invulnerable to the ballot box: the EU was designed, in the aftermath of the second world war, precisely to shield them from public opinion”.1

When asked why we need this Directive, regulators churn out always the same trite things: some Chinese herbal remedies contain undeclared medicinal drugs, some have high levels of heavy metals, etc. This is true (although the percentage of above remedies is a tiny proportion of the total), but there are already existing laws against such practices. Such practices could easily be stamped out using existing legislation without this draconian European legislation. In fact, the result of this legislation will be the exact opposite of what it purports to do. A tiny minority of companies will probably continue selling remedies that are already illegal while many reputable herbal companies who do not, and never have, used such practices will be driven out of business. Moreover, as in usual European style, each country will do what they want, we will have the absurd situation that consumers in one country will be able to buy unlicensed herbal remedies online from another European country: hardly a desirable outcome.

By the way, do you know that the long delay (7 years) in the implementation of this Directive was deliberate? Hannan says: “The ban was voted through the European Parliament seven years ago but, as so often, Eurocrats built in a delay, knowing that national ministers were far more likely to agree to an unpopular measure that would blow up in the laps of their successors”. Indeed, in the UK, the Directive was approved by the Blair Labour Government and it has now blown up in the face of Cameron’s Coalition Government.

Why do we need such Directive?
• Six million people in Britain have visited a herbalist at some point in the past two years
• Two million regularly use alternative treatments as a first resort
• Herbal remedies account for just 0.4% of reported adverse reactions.

In theory, the EU Directive sounds reasonable. It is not “banning” herbal medicines: it is “merely” establishing rules for their “licensing”. In practice however, the licensing requirements are such that no remedy with multiple ingredients (such as Chinese or Ayurvedic medicines) can get a licence because it is impossible to meet the criteria for registration.

Secondly, cost. The licensing of each remedy would cost about between € 50,000 and € 100,000 Euro ($ 74,000-148,000) which is therefore impossible to bear for the overwhelming majority of herbal suppliers. Therefore, the practical effect of this legislation is indeed to ban herbal remedies (and, by the way, increase unemployment).

The result of this Directive is that:
• A third-party dispensary service (Product Supplier) can no longer make up individualised raw and powdered prescriptions, batches of pills or capsules
• Patent herbs will no longer be available to any practitioners, whether state regulated or not and will disappear from the UK/ European market. Over-the-counter herbal remedies also will not be available to consumers
• Only health professionals who are statutorily regulated can prescribe or sell “finished” unlicensed medicines and even that is up in the air in the UK

It is ironic that such restrictions on the use of herbal medicines are being introduced at the same time as more and more powerful and dangerous previously prescription medicinal drugs are being de-regulated and sold over the counter without prescription. Such drugs cause a 100 times more side effects and adverse reaction than herbal remedies. This proves that the European Directive has nothing to do with protection of the consumer.

In my opinion, we should fight this European Directive tooth and nail on political rather than medical grounds because that is what this Directive is inspired by. We can argue for the next 10 years that herbal remedies are intrinsically safe but the regulatory authorities will always come back with the same old excuses: undeclared drug ingredients, heavy metals, the one patient who got liver failure years ago, St John's Wort induces cytochrome P450, etc.

It is also a losing battle to argue the medical case with regulatory authorities (although necessary and we should continue doing that) because they are not elected and have a vested interest in “regulating” and “licensing”. By contrast, politicians are elected and all they are interested in is being re-elected. They are therefore more sensitive to the political case: we should tell them en mass that we are not going to vote for them if they do not scrap this Directive.

Why should Eurocrats decide what I can and cannot take for my health? It is a fundamental issue of freedom and we should demand our freedom!

It is ironic that this freedom-killing European Directive is coming into force on 1 May, the day when traditionally the peoples of Europe celebrate freedom and workers’ rights…

1. Daniel Hannan: www.spectator.co.uk Allergic to Freedom Why is Europe taking up arms against herbal remedies? (12.03.2011)

2. Daniel Hannan: www.spectator.co.uk Allergic to Freedom Why is Europe taking up arms against herbal remedies? (12.03.2011)

GIOVANNI ON TWITTER

Giovanni has a new Twitter account which will be dedicated to short messages on all aspects of Chinese medicine, some with links. @gmaciocia.

ON SHAME

Since the previous Clinical Tip was about guilt as an emotional cause of disease, it makes sense to discuss now shame as an emotional cause of disease. I think that shame is as common as guilt in Western patients while it could be argued that Eastern societies are more prone to shame than guilt.

Shame may be caused by a feeling of shame about one's behaviour in breaking society’s rules or customs; more commonly, it is an in-born feeling of shame due to one's upbringing. It is a feeling of blame which often makes one feels “dirty”; with shame, one feels that one has to hide from the frowning look of society. One feels observed all the time.

According to Solomon, in small doses, shame is an affirmation of one's autonomy, a confirmation that one will live by one's standards and accept responsibility. In small doses, shame is conducive to self-esteem. However, in larger doses, shame is overwhelming and it is self-demeaning, making one extremely defensive and impotent.

As a cause of disease, we consider the shame that is overwhelming, that is due to one's upbringing and that is not related to one's actions or to have done anything wrong. A person suffering from this shame will always feel as if they had done something wrong and will want to hide.

It is often said that Western societies are “guilt-based” and Eastern ones “shame-based”, so it is useful to explore the differences between shame and guilt. Shame is related more to one's place in society, what people think of us, the feeling that one has to hide because one has done something wrong, something that society frowns upon, something “dirty”.

In other words, as long as we do not do anything that society disapproves of or, most importantly, we are not seen, not found out to be doing something “wrong”, we do not feel shame. By contrast, in such situations we would feel guilty even if nobody sees us doing something “wrong”.

It is certainly true that Eastern societies are shame-based probably due to the strong Confucian influence. As the Confucian ethics is all about social relationships, and about one's “place” in society and conforming to strict rules of conduct and social hierarchy, it is natural that shame ensues from contravening the established rules of society. Thus, people are worried about not being seen to be doing anything that society would frown upon.

What is paramount in shame, is how one appears to the other members of the community, not how one feels inside. Guilt, is a “darker” emotion, more inner-directed, an emotion from which there is no escape, the judgement is there, whether anyone sees us or not. The big difference between guilt and shame is that guilt has no redemption, it “eats” one inside for ever; shame has redemption and repair.

With shame, we have a feeling of being seen doing something wrong (by implication, if we are not seen, we do not feel shame). With guilt, we hear an inner voice condemning us and we cannot escape it.

Wollheim explores the differences between shame and guilt and I have summrized them in this Table.

The term “guilt” (zui) occurs very infrequently in the Analects of Confucius. By contrast, shame (chi) is mentioned in many passages. It is always used with reference to a lapse of responsibility, often accompanied by insult, estrangement and humiliation at the hands of others.

Shame is very ingrained in Confucianist ethics. It is even something that is considered a beneficial “tool” to keep people in line. Consider this passage from the Analects of Confucius:

“The Master said: ‘Lead the people with administrative injunctions and keep them orderly with penal law, and they will avoid punishments but will be without a sense of shame. Lead them with morality (de) and keep them orderly through observing ritual propriety (li) and they will develop a sense of shame; and, moreover, will order themselves”.

This passage is an attack on the Legalists who advocated keeping people in order with strict laws and harsh punishments. In other words, Confucius is saying that laws and punishments may keep social order, but even better is to lead by example so that people will regulate themselves due to the sense of shame from not following the social order.

The importance of shame in Chinese society is also apparent from a study of the penal system and amnesties in ancient China: there is evidence that the ancient courts acted harshly in cases of serious crimes but relied on shame entailed in the process of litigation to discipline the more minor offenders and restore their commitment to social responsibility.

In terms of the effects on Qi by shame, I think that this emotion makes Qi stagnate but also possibly in some cases, sink. Indeed, sinking of Qi is, in my experience, a common result of shame; Dampness also frequently accompanies shame.

When one feels shame, one feels “dirty” and “dirty” is characteristic of Dampness. Thus, shame often manifests with sinking of Qi and Dampness: for example, prolapses, very chronic and stubborn vaginal discharge, excessive menstrual bleeding from sinking of Spleen- and Kidney-Qi, slight urinary incontinence.

1. Solomon R The Passions, Hackett Publishing Company, Indianapolis, 1993, p. 245. 2. R Wollheim, On the Emotions, Yale University Press, 1999, pp. 155-6.

APPEAL TO EUROPEAN HERBAL PRACTITIONERS AND PUBLIC

The draconian European Directive on herbal medicines is coming into force very soon (at the end of April). This will stop the sale of herbal remedies. We must all make our voice heard to stop this infringement of our freedoms that is being pushed by the European Union under the influence of pharmaceutical multinationals. Please support the Alliance for Natural Health, the Benefyt Foundation and the European Herbal Practitioners Alliance. Please watch the video http://www.savenaturalhealth.eu/ and sign the petition.