OBSERVATION OF THE MIND, SPIRIT AND EMOTIONS

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Chapter 2

imageOBSERVATION OF THE MIND, SPIRIT AND EMOTIONS

INTRODUCTION

The Chinese character “Shen” has many different meanings in Chinese medicine, the main ones being, of course, Mind and Spirit. It should be remembered here that I translate as “Mind” the “Shen” pertaining to and residing in the Heart, while I translate as, “Spirit” the total of the Five Spiritual Aspects, i.e. the Ethereal Soul (Hun) residing in the Liver, the Corporeal Soul (Po) residing in the Lungs, the Intellect (Yi) residing in the Spleen, the Will-Power (Zhi) residing in the Kidneys and the Mind (Shen) itself residing in the Heart.

!Remember: I translate the Shen of the Heart as “Mind” and the complex of Hun, Po, Yi, Zhi and Shen itself as “Spirit”.

The Mind and Spirit are formed from the Prenatal Essences of the parents and are nourished by the Postnatal Essence of food and water taken in by the body. For example, Chapter 32 of the “Spiritual Axis” says: “The Mind and Spirit result from the transformation of the Essence of food and water.”1

Chapter 9 of the “Simple Questions” says:

The Essence, Qi and Blood are the material foundation of the Mind and Spirit and, conversely, the Mind and Spirit are the external manifestation of Essence, Qi and Blood. Chapter 18 of the “Spiritual Axis” says: “The Stomach is in the Middle Burner, it opens into the Upper Burner, it receives Qi, excretes the dregs, evaporates the fluids, transforming them into a refined essence. This pours upwards towards the Lungs and is transformed into Blood … Blood is the foundation of the Mind and Spirit.”3 All the above quotations highlight the relation between the Essence, Qi, Blood and the Mind/Spirit.

The “Great Dictionary of Chinese Medicine” says: “Human life originates from the Essence. It is maintained by Qi and manifested through the Mind and Spirit. Qi, Blood and Essence are the material foundation of the Mind and Spirit. Therefore, when Qi, Blood and Essence are sufficient, the Mind and Spirit are healthy. If there is deficiency of Qi, Blood and Essence, the Mind and Spirit suffer.”4

Our physical features reflect the state of the Mind and Spirit and therefore the state of the Mind and Spirit can be gauged through the observation of the physical features.

As we know, Qi is a subtle life force which is manifested simultaneously in the body in all its physiological activities and in the Mind and Spirit in its emotional and thinking activities (Fig. 2.1). For example, the pathological condition of Liver-Qi stagnation manifests with physical signs such as abdominal distension and simultaneously with emotional signs such as depression or mood swings.

Therefore, the Mind, Spirit and emotions reflect the state of the internal organs and of Qi, Blood and Essence and, vice versa, the state of Qi, Blood and Essence influences the Mind, Spirit and emotions. Observation of physical features such as the lustre of the complexion and hair, the vitality of the eyes, the tone of voice, the body movement, the pulse, the tongue, etc., help us to assess the state of the Mind, the vitality of the Spirit and the emotional state.

THE THREE ASPECTS OF THE SPIRIT

When observing and assessing the Spirit of a person, we should examine three separate aspects:

The embodiment of the Spirit

The vitality of the Spirit

Clinical significance

The vitality of the Spirit reflects the state of the Mind and Spirit and the relative strength of Qi and Blood of the internal organs and that of pathogenic factors. If the vitality of the Spirit of a person is vibrant, Qi and Blood are abundant, the internal organs are strong, pathogenic factors are weak and the disease is mild. If the vitality of the Spirit is dull, it indicates that Qi and Blood are deficient, the internal organs weak, pathogenic factors strong and the disease severe.

The chapter “Key to the Four Diagnostic Methods” of “The Golden Mirror of Medicine” says: “In the beginning of a disease, the state of the Spirit is important. The reason is that if the Spirit is strong at the beginning of a disease, it means that pathogenic factors cannot defeat the Upright Qi, as it is still strong. If the Spirit is dull, it shows that the Upright Qi cannot resist pathogenic factors as it is deficient.”5

The lustre of the Spirit

Observation

The lustre of the Spirit refers to the lustre of the complexion, hair and eyes; the Spirit is reflected in their lustre and observation of them is an essential part of the observation of the Spirit. If the lustre of the Spirit is bright, a person will have a normal, glowing complexion, clear sparkling eyes, shining hair, a lively expression and lustrous, supple skin. If the lustre of the Spirit is dull, a person will have a haggard complexion, withered, lifeless hair, dull eyes and a listless expression and dry, withered skin.

The chapter “On compulsory observation of the Spirit while observing a disease” in the book “Origin of Medicine” (Yi Yuan, 1861) says:

Clinical significance

The lustre of the Spirit reflects the state of the Internal Organs and the strength of Qi and Blood. If the lustre of the Spirit is rich, it indicates that the Internal Organs are functioning normally and Qi and Blood are abundant. When diseases occur, they are mild and the prognosis is good. If the lustre of the Spirit is lacking, this denotes that Qi and Blood are deficient, the Internal Organs are weak, pathogenic factors are strong and the prognosis is poor.

Box 2.1 summarizes the three aspects of the Spirit.

BOX 2.1   THE THREE ASPECTS OF THE SPIRIT

THE THREE CONDITIONS OF THE SPIRIT

When examining the state of the Mind and Spirit, there are three basic conditions:

Weak Spirit

Observation

The signs of a weak Spirit are listlessness, lack of enthusiasm, dull eyes without sparkle, complexion without lustre, shallow breathing, a weak voice, slow body movements, confused thinking, tongue without “spirit” (Shen), and possibly with a Heart crack, and a pulse without a wave. Such people will suffer from apathy, depression, lack of will-power, confusion about their path in life and a slow intellect.

Chapter 17 of the “Simple Questions” describes the manifestation of a weak Spirit by observation of the head and eyes: “The five Yin organs house the Spirit; they are essential for the body to be strong. The head is the residence of the Spirit: if the head droops and the eyes are deep-socketed and dull, it means that the Spirit is exhausted.”7

The chapter “Keys to the Four Diagnostic Methods” of “The Golden Mirror of Medicine” also discusses the manifestations of lack of Spirit by observing the eyes, speech and mental condition of the patient and it says:

False Spirit

The condition of “False Spirit” usually appears only during the course of a severe, chronic disease. This occurs when a severely ill patient suddenly appears revitalized and in high spirits: this is called “False Spirit” and it is usually a poor prognostic sign. The key factor in determining that this is a false appearance of the Spirit is the suddenness of the improvement; however, if the Spirit of a chronically ill patient improves slowly and gradually over several days, that is a good sign.

Observation

The typical manifestations of the False Spirit appear in the course of a severe chronic disease and they are as follows: the patient suddenly seems to be vigorous with a clear look in the eyes, talks incessantly and wants to meet family members, the appetite improves suddenly and the complexion suddenly becomes bright red almost as if the patient were wearing make-up. There is a precise description of the False Spirit in the book “Chinese Medicine Diagnosis”:

The False Spirit indicates the momentary improvement in energy of a patient during a severe, chronic disease: it is not a good sign but an omen of death. The manifestations of the False Spirit are as follows: in a patient suffering from a severe, chronic disease and previously suffering from a weak Spirit, suddenly the energy seems better, the eyes become bright, the patient suddenly talks a lot and wants to meet family members, the voice, previously feeble, suddenly becomes clear and loud, the complexion, previously dark, suddenly becomes bright red and the appetite suddenly comes back. These manifestations are due to the extreme exhaustion of the Essence and Qi. In such a circumstance, Yin fails to restrain Yang so that Yang floats outwards and upwards, causing the false appearance of an improvement. In ancient times, people compared it to the last flicker of a fading oil lamp or the last radiance of the setting sun. It is a dangerous sign indicating the separation of Yin and Yang.9

THE SPIRIT AND CONSTITUTION

When observing the mental and emotional state of a person, it is important first of all to assess the relative strength of the Spirit compared with that of the constitution, both the prenatal and postnatal as described above. The Spirit and the constitution are both reflections of the Essence and Qi of the body, the former in the mental—spiritual sphere and the latter in the physical sphere. Because of the close connection between the Spirit and the constitution of a person, generally a strong pre- and postnatal constitution is accompanied by a strong Spirit; conversely, a weak pre- and postnatal constitution is generally accompanied by a weak Spirit. However, there may be cases when there is a divergence between these two aspects, that is, the person has a strong pre- and postnatal constitution but a weak Spirit, or vice versa.

An assessment of the relative strength of the two is helpful in forming a prognosis, which will be discussed below. There are four possible situations:

Strong Spirit and strong constitution

Clinical significance

The above physical and mental characteristics indicate both a good constitution and a strong Spirit; the internal organs of such a person are strong and function normally, Qi and Blood are abundant and the Mind and Spirit are healthy. The body will not be easily invaded by pathogenic factors. Even if diseases occur, they can be easily cured. Chapter 19 of the “Simple Questions” says: “If the Upright Qi and the body build of a patient are both strong, any disease will be easy to treat. If the complexion is lustrous and bright, the patient will recover soon.”10 Chapter 20 of the same book says: “If the body build and the Upright Qi are both strong, the patient will survive.”11

Weak Spirit and weak constitution

Weak Spirit and strong constitution

Strong Spirit and weak constitution

THE SPIRIT AND THE EMOTIONS

The emotional state of the patient is gauged primarily from observation of the eyes, the complexion and the tongue. The observation of these features must of course be closely integrated with the interrogation, listening to the voice and palpation of the pulse.

Eyes

Observation of the eyes to gauge the emotional state of the patient is based primarily on observation of the lustre and control of the eyes.

Lustre of the eyes refers to the brilliance, sparkle, glitter and vitality of the normal eye. Eyes with lustre indicate a normal state of the Mind and Spirit and, generally speaking, the absence of serious emotional problems. Eyes without lustre are dull, lack vitality and sparkle and look as if they were covered by a mist; this always indicates emotional problems of some nature. The extent to which the eyes lack lustre is directly related to the duration and intensity of the emotional problems: the duller the eyes, the deeper and more long standing are the emotional problems.

Control of the eyes refers to the gaze and movement of the eyes. If a person is able to fix the gaze and the eyes do not move but neither are they too fixed, the eyes have “control”. If a person has a shifty gaze, if the eyes move too much or if they are fixed in a stare, they are “uncontrolled”. Eyes without control indicate a relatively serious disturbance of the Mind and Spirit.

Tongue

One of the main features to look for in the tongue to determine whether the patient is affected by emotional problems or not, is the presence of absence of a Heart crack (see Fig. 25.8, p. 217).

A Heart crack on the tongue is relatively narrow and it extends throughout the whole length of the tongue to the border of the tip. Such a crack indicates the tendency to emotional problems; the deeper the crack, the more intense the emotional problems.

A second pathological sign to look for on the tongue in emotional problems is a Red tip. Emotional stress generally leads to Qi stagnation and with time this leads to some Heat. As all emotions affect the Heart, emotional stress frequently manifests with a Red tip of the tongue, which reflects a certain degree of Heart-Heat. The redder the tip the more intense are the emotional problems, and a swelling and red points on the tip indicate an even more severe emotional problem.

The observation of these three features, eyes, complexion and tongue, should be closely integrated and each sign should be checked against the other two to give us an idea of the intensity and duration of the emotional problems.

In terms of time scale, when a person is subject to emotional stress, the lustre of the eyes will be the first of these three to change, the complexion the second and the tongue the last (although this is just a general rule and there may be variations in practice). Therefore, for example, if the eyes lack lustre but the complexion has lustre and the tip of the tongue is not Red, this indicates that the emotional problems are of a relatively short duration; if, on the contrary, the eyes and complexion lack lustre and the tongue has a Red tip and a deep Heart crack, this indicates that the emotional problems suffered by the patient are very deep and long standing.

As indicated above, when diagnosing the emotional state of the patient, interrogation and observation must also be integrated with palpation of the pulse. In terms of time scale, the pulse will actually be the first to change. To summarize, therefore, the time scale of the changes observed in emotional problems is as follows:

The observation of the lustre of the eyes is discussed also in Chapter 6, while that of the complexion is discussed in Chapter 3.

NOTES

1. Spiritual Axis (Ling Shu Jing image). People’s Health Publishing House: Beijing, 1981:72 First published c. 100BC

2. The Yellow Emperor’s Classic of Internal Medicine – Simple Questions (Huang Di Nei Jing Su Wen image). People’s Health Publishing House: Beijing, 1979:67 First published c. 100BC

3. Spiritual Axis, p. 52

4. Cited in Sheng, Zhang Shu. Great Treatise of Diagnosis by Observation in Chinese Medicine (image). Taiyuan: Shanxi Science Publishing House, 1995; 65.

5. Cited in Sheng, Zhang Shu. Great Treatise of Diagnosis by Observation in Chinese Medicine (image). Taiyuan: Shanxi Science Publishing House, 1995; 69.

6. Cited in Sheng, Zhang Shu. Great Treatise of Diagnosis by Observation in Chinese Medicine (image). Taiyuan: Shanxi Science Publishing House, 1995; 69.

7. Simple Questions, p. 100.

8. Cited in Great Treatise of Diagnosis by Observation in Chinese Medicine, p. 71

9. Cited in Great Treatise of Diagnosis by Observation in Chinese Medicine, p. 72

10. Simple Questions, p. 128.

11. Simple Questions, p. 136.

12. Simple Questions, p. 128.

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