Fire and Emotional Illnesses
by Elisa Rossi
Translated by Giuliano Sacchi
Essentially the book was born from the desire to understand what the classics referred to about psychological aspects of illness. The quotations that could be found were scarce and frequently taken out of context. Quite often they seemed to simplify in a superficial way what was a very complex subject and I did not always find the translation convincing. The sinologist Laura Caretto, who has a profound knowledge of classical thought and has also graduated in traditional medicine in Beijing, has brought together the traces scattered throughout the huge existing medical literature and has translated them, checking sources and commentaries. Thanks to her painstaking work Shen is a good starting point towards a further, deeper understanding.
Many pictures and pathogenic processes that appear frequently in relation to emotions and the shen are in fact fundamental concepts of Chinese medicine as a whole and are also valuable elements of daily clinical practice. The use of terms such as yu-constraint, fire, phlegm, fanzao, help us to disentangle the collection of signs and symptoms presented by the patient.
This article tries to restore certain elements that are not always present in the clinic, so they may be used when the diagnostic picture is not immediately clear and we find ourselves at a loss.
'All methods of acupuncture must have their root in the shen.' (Huangfu Mi). Thus begins the first Chinese text specifically dedicated to acupuncture. Anyone who works with illness and, in particular, those who practise non-conventional medicine are well aware of the part played by psychological factors in the complaints brought by patients. Sometimes 'emotional illnesses' (see note 1), show themselves clearly, in other cases they insinuate themselves in more alarming ways, but in any case the psychological aspect pervades our daily clinical practice.
As we shall see, the classical Chinese texts describe the interactions between emotions, fire and illness in their various shades. This idea is also taken up by contemporary authors. To quote one example: 'It is easy for anger, excess euphoria and worry to give rise to fire and this fire produced by the emotions damages the organs. In particular it is a matter of fire of the heart and liver because the heart has the pre-eminent role in emotional activity and the qi of the liver has the propensity to be easily subject to constraint, knotting and rising upwards.' (Zhu 1987).
The heart is the sovereign and is in charge of the ten thousand things. 'The heart governs the shen and is fire, emotions act through the heart and so it is easy for fire to cause psychological as well as physical illnesses. The first thing that occurs [with the emotions] is an alteration in the movement of the qi, and when this reaches a peak what exceeds is fire.' (Wang 1988).
Let us remember that:
- Emotions are physiological movements of qi and they become pathological when 'excessive', that is when they agitate the heart and thus take us far from the possibility of acting in accordance with the spontaneity of the dao.
- Shen has no definition or limit and comes before yin and yang (see note 2). Thus it cannot be assessed in the normal terminology of full and empty since it refers to a world of existence different from that manifest in the immanent world, to which belong yin and yang and the ten thousand beings.
- The emotion linked to the heart and to fire is euphoria-xi, often translated as 'excessive joy'. The term xi corresponds to the feeling of euphoric happiness found at popular festivals, with much food, wine and music. So we are talking about a joyfulness close to the agitation of fire (see note 3).
Fire, shen, excess-shi and deficiency-xu - TCM classification
In cases where the shen is more involved, excess can consist of the simple and very common difficulty that the qi cannot flow freely, or in more serious pathologies caused by constraint, stagnation, stasis or chronic accumulation, to/till the extreme patterns of phlegm-fire of the diankuang madness, with its violent manifestations.
In the full syndromes we are in fact 'filling ourselves' excessively, not with upright qi-zhenqi, but with xieqi-pathogenic qi, usually of internal origin. Let us consider here the principal syndromes, paying attention to the aspects which link to fire.
Qi constraint-yu or stagnation-zhi
Stagnation of emotion and stagnation of qi mutually affect each other: all emotions that persist over a long period obstruct the physical movement of qi, and, conversely, qi that struggles to circulate does not allow the emotions to flow. It is the qi of the liver that suffers from this constraint particularly, given its key role in facilitating the flow of qi. Frustration, unrealised desires, suppressed anger and resentment are all feelings linked to anger and particularly affect the liver. If the qi does not circulate it produces stagnation, which manifests in tension, aches, swellings, mood swings, irritability. Any stasis that continues over time tends to produce fire (see note 4). In such cases irritability is transformed into irascibility. The qi-fire that rises and flares up can classically manifest in powerful outbursts of anger but can also produce a state of generalised restlessness, which causes impatience, anxiety, and a tendency to be bored as well as irritated (see note 5). The curled edges of the tongue are also red; the typical wiry-xian pulse can become also rapid-shuo.
Fire exhausts the yin, agitates and disperses the shen, just as flames that are too fierce quickly burn wood and become dangerous. Beyond the usual signs and symptoms of fire, we have above all agitation, which by day manifests as the need to be always moving, to be busy, to talk, and by night in a sleep that is agitated with many vivid dreams. This ceaseless physical and mental activity leads us back to the emotion related to the heart, excess euphoria-xi. An extreme psychiatric picture consists of manic episodes, which can be linked to the description of kuang in the Nanjing: 'Kuang, barely rests, knows no hunger, thinks himself holy, thinks himself wise, presents himself as noble, laughs crazily, wants to sing and play music, walks madly without rest.' (see note 6).
In conventional medical terms the patient suffers from psychomotor agitation, inflated self-esteem, excessive involvement in pleasurable activities that have a high potential for painful consequences and a decreased need for sleep. We can also describe a picture in which the patient thinks very highly of himself, does not sleep, talks unceasingly, buys Maseratis and listens to no one.
The process by which emotions, when they have become pathological, are able to transform into fire and damage the heart will be discussed in more detail later. But let us keep in mind that, given its yang nature, fire has a natural tendency to rise upwards, towards the upper jiao, and tends to disturb the heart and shen even in cases where it originates in the middle and lower jiao. It must be remembered that heart fire does not always manifest in such an obvious manner. Often there is constrained-yu fireor suppressed- fou fire, which may suggest itself in more subtle signs such as a red tongue tip or a rapid-shuo pulse. The patient’s gaze, that is the eyes - window of the shen, is an important diagnostic indicator.
The accumulation of phlegm obstructs the orifices of the heart and clouds consciousness. This is insubstantial phlegm, 'without form' - wuxing, but nonetheless it is a sluggish, sticky, heavy thickening characterised by great inertia and difficulty in elimination. Phlegm removes lucidity and clarity: it disturbs vision, equilibrium, concentration, memory, and thinking. In the clinic we see it as a sort of clouding: the patient himself reports a feeling of physical giddiness or mental exhaustion, or it may be the doctor who notices a kind of dullness in the patient’s movements and speech, or in the quality of the pulse.
In the case of phlegm-cold there is uncommunicativeness, unresponsiveness, apathy, emotional withdrawal to the point where we see a dian pattern. When phlegm is accompanied by fire there is instead the added element of agitation (see note 7). 'As a result of excessive worry heart qi becomes knotted and is unable to diffuse. Consequently phlegm too becomes thicker and knotted. If excessive anxiety is added, then the internal qi of the heart is consumed and hidden internal heat is born. The heat condenses phlegm, it grows even stickier and the phlegm traps the heat. Phlegm and fire cannot be eliminated and resolved and so build up and overflow, blocking all the orifices and the luo channels which connect heart and brain. This is the reason why the light of the shen is dimmed.' (Zhang Xichun).
In the most serious cases consciousness is so compromised as to give rise to delirious speech, altered perceptions and hallucinations and to behaviour characterised by confusion, violence and swiftness. These descriptions match the syndrome described classically as kuang (see note 8). The tongue shows certain typical signs such as a sticky, yellow coat (dark and dry, especially in the midline crack, if fire is clearly prevalent) and a swollen tip. The pulse is rapid-shuo, full-shi, and slippery-hua; in the most serious cases it may be hurried-cu (see note 9).
Stasis impedes the nourishment of heart and shen. This is a complex picture, that derives from other imbalances and produces symptoms which typically worsen at night (for example, palpitations). The patient reports a generalised restlessness, cries and sobs frequently for apparently trivial reasons, their moods are swinging, he is easily startled and absent-minded. Blood stasis readily generates heat, which increases restlessness and impatience, confuses the shen, gives rise to a feeling of internal heat, dries up fluids, agitates the blood making haemorrhages more likely, and frequently manifests on the skin.
Specific to internal heat derived from blood stasis is the 'lantern disease', denglong bing, where the body is cool on the exterior but hot internally, giving rise to generalised impatience and irascibility in people of a tranquil nature. 'If the body is cool on the outside but inside the heart there is heat then it is known as denglong bing, there is blood stasis in the interior; impatience with the smallest thing, that is blood stasis; a normally tranquil person who after the onset of the disease becomes irascible, that is blood stasis.' (Wang 1830).
The descriptions of yin or blood deficiency are characterised by a shen that finds no rest and wanders without abode. The heart is in fact insufficiently nourished and lacks a 'material' foundation to preserve and root the shen. The profound lack of calm is evident both in the behaviour and speech of the patient who finds no peace, lives in a constant state of alert, or who is disturbed by every event and emotion. If the shen has nowhere to reside it becomes restless, producing the background restlessness, which by day is manifested in a state of anxiety, apprehension and forgetfulness and which, by night, does not permit sleep (see note 10).
Patients with empty fire report very various symptoms: there are those who speak of being in a constant state of anxiety about what may go wrong (to the point that they have the feeling they are going to die, characteristic of a panic attack). Others complain of poor concentration or memory (which is in fact a forgetfulness caused by lack of attention, an inability to follow arguments or events, since thoughts are unable to settle and are elsewhere). Yet others are at the mercy of such emotional liability that the slightest image, word or fact can destabilise them, arousing uncontrollable feelings (see note 11).
Fire and the emotions in the classics
The formulation of the theory wuzhi huare, “the five emotions produce heat”, goes back to Liu Wansu (1120-1200). This theory had a profound effect on subsequent medical thought and would be developed particularly during the Jin and Yuan dynasties by Zhang Ziye, Li Dongyuan and Zhu Danxi (whose works appeared respectively in 1228,1249 and 1347). Summarising greatly, what is dealt with is the pathological process by which an excess of emotions tends to produce heat and fire, the fire consumes yin and the organs and generates disease. 'The emotions-zhi of the five organs are anger, euphoria, sadness, thought and fear; if the five emotions are in excess there is exhaustion-lao, if there is exhaustion then the corresponding organ is affected, damage to the five organs is always caused by heat.' (see note 12)
Liu Wansu reads the forming of the pathology essentially as a consequence of the imbalance between yin and yang, between fire and water. Taking as a starting point the fact that yang is movement and yin is stillness, we can see how the movement of desires and emotions in excess agitates stillness and how their fire consumes the body (form-xing) and the shen. 'What we mean when we say that yang is movement and yin is stillness is that if form and shen are exhausted then there is agitation-zao and lack of calm, whereas with calm there is purity and tranquillity.'
If fire is in excess then the element which precedes it is unable to discharge its own excess into it and becomes calm: and so it is anger, the emotion of wood, which becomes full more readily and gives rise to madness. 'Anger is the emotion of the liver, if fire is full it attacks metal so that it cannot calm wood, and so if liver is full there is much anger which becomes kuang. That which arises from the five emotions is always heat, thus kuang manifests as a result of the five emotions, but above all with anger […] If the heat of the heart is excessive then the water of the kidney is exhausted, there is loss of zhi and madness' (see note 13). It is also interesting to note the importance given to the emotions when they are in excess they invade dreams and that heat increases further since during sleep the shen is obscured. 'When the seven emotions cannot be conquered whilst asleep, heat remains constrained in the interior and grows.' (Liu Wansu). The heart-kidney axis, fire-water, thus holds a fundamental importance within this perspective which links pathology of the emotions and heat: fire has the ability to agitate and upset the zhi which - like the jing - must be unified, concentrated, solid; if the root of life breaks up as do flames there can only be confusion and disorder; 'Doubt and confusion, disturbance and disorder, zhi is not one, it is as irregular as a flame, there is confusion and disorder. If fire is in excess water is weakened, zhi is lost and there is confusion and disorder. Zhi is the shen of the water-kidney.' (Zhang Yuansu).
The consideration of the role of emotional stimuli in the aetiology of fire is developed by Li Dongyuan, who analyses the consequences of heat at the level of consumption of yuanqi. ‘Euphoria-xi, and anger-nu, grief-you, and fear-kong damage and consume yuanqi and feed fire in the heart. Fire and yuanqi cannot coexist, if fire dominates and invades the position of earth.' And 'Anger, rage, sadness, thought, fear, dread all damage yuanqi. The powerful burning of yin fire beginning in the heart generates condensation and stagnation and the reason for this is that the seven emotions are not calm.' (Li). Li Dongyuan's elaboration of the relationship between emotions and fire is taken up by Zhu Danxi who reflects particularly on desires and emotions, the power and inevitability of which he recognises as elements of human nature. But fire is easily generated by the yang movement of emotions and desires and goes on to consume yin, 'so difficult to produce and so easily exhausted', a condition in which the minister fire flares up and jing flows away. Going back to the thought of the neo-Confucians Mengzi and Xunzi, Zhu Danxi describes thus the pleasure of the senses: 'The desire of man is limitless […] warmth and softness fill the body, sounds and voices fill the ear, colours and images fill the eyes, perfumes and fragrances fill the nose, only in a man of iron could the heart not be moved.'.
The chapter on the minister fire reminds us how yin and yang are born out of stillness and movement, underlines the connection between movement and fire, and describes the distinction between sovereign fire and minister fire and their characteristics. But the ease with which the minister fire rises up has ominous consequences and leads to the consumption of yin. Master Zhu says 'One must ensure that the heart of the dao constantly governs the whole body and that the heart of man always obeys its orders.' This a good way to meet with fire, in such a way the heart of man is subject to the orders of the heart of the dao and is governed by calm, the movement of the five fires is under control, the minister fire can help and integrate generation and transformation and give rise to life.' (Zhu). With regard to treatment Zhu Danxi's indications are interesting. According to him there are cases where it is possible to make fire descend and others where in order to eliminate it one can only follow its nature, using its upward movement: 'Gentle fire can be made to descend, strong fire must be drawn upwards following its nature. Full fire is drained, […] empty fire is tonified.'
Constraint-yu and phlegm-tan
The concept of constraint-yu, fire and the generation of phlegm that results from it, wasintroduced by Zhu Danxi as a central factor in the aetiology of emotional illnesses. Constrained qi is blocked and becomes knotted, tends to produce heat, consumes liquids and gives rise to phlegm. ‘Constraint of the seven emotions, then phlegm is produced and fire moves.' During the Ming and Qing dynasties the concept of constraint-yu is definitively consolidated and the emotional aspects assume an ever greater relevance. Zhang Jiebin recognises for example that fullness derives from the knotting caused by thinking too much or from the accumulation of anger, producing fire and the rising of qi counterflowing, with possible symptoms of madness: 'In all kuang illnesses the cause is for the most part fire. This comes from planning too much, which causes loss of zhi or from constraint and knotting of thoughts, which turn in on themselves and do not expand, and anger is not drained. This leads to fire and wood pathogens, liver and gall-bladder qi which flow upwards in the wrong direction, and these pathogens become a pattern of fullness in the East.' (Zhang Jiebin).
Zhang Jiebin reminds us that emotional and sexual excesses, consumption of alcohol and over activity at first exhaust the qi and then manage to consume the yin. 'All losses and deficiencies are due to alcohol, sexual activity, fatigue and the seven emotions. These can first strike the qi and then reach the jing. Or if the jing is first stricken, then this reaches the qi. In man qi and jing is referred to as the yin aspect. Yin is the root of the unity of the heavens. In all illnesses if they are powerful higher up, then there must be great exhaustion below. The damage done by the arrival of pathogens caused by a deficiency falls on the yin, the damage of the five organs reaches the kidney.' (see note 14). The movement of the emotions is powerful and its fire agitates the shen, a dynamic which in the Qing dynasty begins to be described in the first person: 'When they stir, all emotions qiqing e wuzhi are fire, and all are capable of disturbing the peace of my heart.' (He 1751).
Anxiety, restlessness and agitation – fanzao
Anxiety is a continuous state of worry, agitation and restlessness and thus is a manifestation of fire-heart. In the background there is apprehensiveness, a persistent and pervasive feeling of generalised dread, that is the root is fear- kidney. The fire-water axis is involved, the yin and yang which is the origin of everything. Chinese texts, both ancient and modern, speak of ‘restlessness and agitation’. The term fanzao refers essentially to a symptom. It is a combination of interior restlessness and outward agitation. Fan corresponds to feeling irritated, bothered, troubled, impatient. It contains the radical for 'fire' and 'head’. Zao refers more to a physical agitation. It contains the radical ‘foot’ and thus the idea of movement (see note 15). Fanzao is essentially linked to heat and internal fire, which trouble the heart and disturb the shen. The symptom of fanzao manifests in many cases of chronic deficiency in which heat and fire develop through a range of pathogenic processes:
· Residual heat that is not entirely resolved
· Yin deficiency with fire agitating and confusing
· Consumption of fluids with empty heat
· Extreme fatigue with exhaustion of qi and excess fire
· Accumulation of yin-cold and internal heat
The term already makes its appearance in chapters 69 and 74 of the Suwenfanzao accompanies other more physical signs when the balance of seasonal qi changes. But in the description of the pathology of the kidney channel in chapter 10 of the Lingshu it appears as vexation to the heart (fanxin) as well as other manifestations of anxiety such as 'hunger with no desire to eat, one cannot see clearly, his heart is hanging – like when one is hungry, since the qi is insufficient fear arises easily, the heart is alarmed and feels as when it is about to be captured'. Zhang Zhongjing picks out the symptom of fanzao in different pathologies amongst which: 'In exhaustion from deficiency there is fanzao from deficiency and inability to sleep.'
Sun Simiao develops the idea of yin agitation (yinzao), in which anxiety, though a sign of heat, derives from yang deficiency. This deficiency in fact creates the conditions for the arising of a great fullness of yin: the remaining yang floats on the surface and disturbs the heart. The yin pulse is not rough-se, whilst on the contrary the body is cold and there is fan in the interior.' (see note 16). The picture is thus of false heat and true cold. Li Dongyuan takes up Sun Simiao's reflections on yin agitation, yinzao. Symptoms are similar to those of external heat diseases, but in reality are due to heat which attacks from the inside (neishan rezhong), for example in cases where the person 'desires to sit down in mud, here it is the yang which is first exhausted, we have a case of yinzao, due to true cold and false heat'. According to Li Dongyuan: 'When fire enters the heart there is fan; if it enters the kidney there is zao, in both cases it is in the kidney since its paths communicate with the mother lung, but on the whole fanzao is more a disease of heart fire. The heart is the sovereign fire, if the fire is excessive metal is melted, water is consumed, fire alone excels, lung and kidney together produce fanzao'.
The theories from the Jin and Yuan dynasties that place a crucial importance on the role of heat underline underlining particularly the relationship between fanzao and fire, both external and internal, so that all cases with 'agitation, fanzao, vexation with a feeling of heat, restlessness, these are all due to pathogenic fire which takes over, permeating interior and exterior' and 'if heat is in excess on the exterior then movements are restless, if heat is excessive in the interior then shen and zhi are agitated' (Li Wansu). The consumption of fluids also leads easily to fanzao: 'Following perspiration, diarrhoea, cholera, vomiting, since there is a significant loss of fluids, the organs become dry and there is empty fan. This is because yin is insufficient to balance the yang, yangqi is relatively in excess, and thus there is empty heat and fan ' (Dai Sigong).
In clinical practice reference to fanzao can frequently be of use in patients whom the signs of empty fire manifest themselves as a generalised restlessness and a lack of calm which leads them to be anxious, agitated and fearful of normal everyday events. Mental and emotional strain, working too hard, external pressures, relationship problems consume the qi which supports them, the yin which provides the necessary rest and the fluids which allow things to flow easily. Recognising this picture helps to break the vicious circle in which fire continues to burn the yin without it being restored.
Elisa Rossi is author of the book ‘Shen’, from which this article is taken.
First published in the European Journal of Oriental Medicine, vol.4, n.6.
1. Illnesses which have a predominant psychological component – which we define variously as mental disturbance, psychiatric pathologies, emotional upset, etc. – are known as ‘emotional illnesses’ qingzhi jibing or qingzhi bing, an expression from the classics which is still commonly used.
2. That which is beyond yin and yang is called shen,' states the Yijing (Great Appendix, 5.9) and similarly the Suwen (chapter 66): 'The birth of things is called transformation, the limit of things is called change, the yin and yang which cannot be measured is called shen.'
3. The other character which is used in the classics – le – is well rendered by the term 'joy' when it expresses a more interior feeling, linked to rituals and ceremonies, to mean a peaceful and harmonious state. The pre-Han classics already made this distinction: 'le sings and dances [the rites], xi receives alms [at festivals]', in Zuozhuan, chapter Zhaogong ershiwu nian. In the case of si, often translated as 'excessive thought', we have chosen to keep the literal translation, that is, simply ‘'thought'. Whilst the graeco-judaic tradition describes thinking per se in an extremely positive way and hence pathogenesis resides only in its excess, in the Taoist conception thinking is less positive since it is a substitute for an immediate response, it is a mediation which lacks the harmony of the spontaneous response to that which is presented.
4. ‘constraints which persist release heat and heat over time generate fire.' In: Danxi xinfa, chapter Liuyu (The six constraints).
5. 'Because when the emotions are not resolved there is constraint and illnesses occur. […] If there is constraint then the qi stagnates and if the qi stagnates over time heat is produced. If there is heat fluids are consumed and do not flow and the upward and downward movements of qi are not regulated. In the first phase the qi level is affected, but with time of necessity the blood level is affected too. If this continues it leads to chronic consumptive disease. […] Yu of the emotions derives from concealed feelings, from frustrated and unexpressed aims-yi, which cause the mechanism of rising and descending of qi, of opening and closing not to function.' Ye Tianshi, Lingzhen zhinan yian (Guide to cases in the clinic, 1766).
6. Nanjing, chapter 59. The description is attributed to Hua Tuo in which kuang is found 'to sing and laugh, or to be sad and weep, to run everywhere, to consider themselves holy, to stay awake and be unable to sleep, to eat but not expel urine or faeces'. In: Huashi zhongcangjing' (Classic of the central organ), chapter15 (Text attributed to Hua Tuo but probably a work dating from the time of the Five Dynasties, 906-960).
7. 'The fire of the five emotions-zhi originates because of the seven passions-qing and becomes phlegm' In: Danxi xinfa (Secrets of Danxi, 1347). Before this Zhang Zihe stated: 'Phlegm obstructs the orifices of the heart', in Rumen shiqin, 1228. Dai Sigong (1324-1405) takes up the same concept saying, 'diankuang arises from the constraint of the seven emotions', in: Zhengzhi yaojue (Essential elements of diagnosis and therapy).
8. 'The outbreak of kuang is for the most part a heat disease. The person climbs up high and sings, removes his clothes and walks about, on seeing water wants to throw himself in; he utters oaths and swears, shouts threats of death, his words are unrestrainable; the tongue is as if covered in bristles, he drinks without cease, the phlegm is clear, the face is as if swollen with fire. At times he takes a knife and kills people, or when he sees an official he loads him with insults; he does not recognise his relatives, does not know his sons and daughters; rejoices at the sight of water, grows furious at the sight of food; he is crazy as though he had seen spectres.' In Chen Shiduo, Shishi milu (Secret notes of the stone room, 1751), chapter Lihun (hun that wanders).
9. 'A cu pulse comes and goes quickly, from time to time it stops and then returns as if stumbling, its speed is not constant.' In: Binghu maixue (Binghu’s science of the pulse).
10. We cite a passage by the great Zhang Jiebin which is concise and clear: 'Sleeplessness can be present in many diseases, nevertheless only two things need be understood: sleep has its roots in yin and the shen is its master. If the shen is at peace, then there is sleep, if the shen is not at peace, then there is sleeplessness. The reason it is not at peace is because the pathogenic qi troubles it or because yin is insufficient.' In: Jingyue quanshu (Prescriptions of the golden room), chapter Bumei. In Ming times 'pathogenic qi' refers to a state we would now describe as full.
11. Li Dongyuanss direct master, Zhang Yuansu, takes up the discussion on excess fire which weakens water and the mental disorder that results from it: 'Madness-wang caused by deficiency: fire is yang and so is pure and clear on the exterior and turbid and dark in the interior; it governs movement and disorder, thus if fire is excessive the water of the kidney is weakened andthe zhi is not concentrated; there will be visual and aural hallucinations; they ask questions and answer them. It is an alteration of shen and zhi and it is as if they saw spirits and ghosts.' In: Zhang Yuansu, 1151-1234, yixue qiyuan (The Origin of medical science).
12. Liu Wansu (1120-1200), Suwen xuanji yuanbing shi (Examination of the arcane mechanisms and of the origin of diseases in the Suwen), chapter Relei (Heat category). Liu Wansu, founder of the system of cool and cold therapy, describes the same seven emotions that appear in the Liji and the six desires of the Buddhist tradition, which relate to the five organs and to thinking-yi.
13. Liu Wansu, Suwen xuanji yuanbingshi, (Examination of the arcane mechanisms and of the origin of diseases in the Suwen), chapter Kuangyue (Madness). 'Madness' in this case translates kuangyue, in which yue signifies 'to go beyond'. See also the chapters on heat and fanzao for a discussion on the relationship between emotions, heat, consumption of yin and the organs, imbalance in the water-fire axis and related manifestations of confusion and disorder.
14. Zhang jiebin, Jingyue quanshu chapter Xusun (Damage from emptiness). 'Alcohol and sexual activity' translate jiuse, in which jiu is an alcoholic drink and se, which literally means 'colour' is a euphemistic metaphor for the sexual sphere.
15. Zao appears too in zangzao and is a homophone of zao, 'dry', which however contains the radical ‘'fire'.
16. Sun Simiao, Qianjin yaofang (Thousand gold piece remedies for emergencies, 625). Tao Hua, in the Ming dynasty, continues the discussionon yinzao, in which are present signs of interior yin such as abdominal pain or a deep pulse, and at the same time there is fan: 'On the surface and in the interior there is no heat, but only fan; usually they do not like the light, there is abdominal pain, the pulse is deep and weak.'
Dai Sigong (1324-1405), Zhengzhi yaojue (Essential elements of diagnostics and therapy).
He mengyao, Yibian (Foundations of medicine), 1751.
Huangfu Mi,. Zhenjiu jiayijing (The classic of acupuncture and moxibustion, 259 AD), chapter 1. These words take up the first sentence of chapter 8 of the Lingshu.
Jingui yaolue (Prescriptions from the golden room), chapter 6, ca. 220 AD.
Li Dongyuan, Piweilun (Treatise on the stomach and spleen, 1249), chapter Piwei xushi zhuanbianlun (Transformation of fullness and emptiness in the stomach and spleen).
Li Dongyuan, Piweilun, chap. Anyang xinshen tiaozhi piwelun (Calm and nourish the and shen to regulate the stomach and spleen).
Liu Wansu (1120-1200), Suwen xuanji yuanbings hi (Examination of the arcane mechanisms and of the origin of diseases in the Suwen), 1182.
Wang Miqu, Zhongguo gudai yixue xinlixue (Ancient Chinese medical psychology), 1988, p.238.
Wang Qingren, Yilin gaicuo (Correction of errors in medical texts), 1830.
Zhang jiebin, Jingyue quanshu (Complete works of Jingyue, 1640), chapter Diankuang chidai (Insanity and madness).
Zhang Xichun, Yixue zhongzhong canxil (Notes on medicine based on tradition which consider the West, 1918-1934), Chapter Zhidianfan.
Zhang Yuansu (1151-1234), Yixue qiyuan, chapter Huo (Confusion). Zhang Yuansu - the originator of the first diagnostic systemisation of the five organs, with the descriptions of full and empty – was the direct master of Li Dongyuan and the promoter of yishui therapy, 'change water'.
Zhu Danxi, 'Gezhi yulun', chap. Xianghuolun (Minister fire). Master Zhu is Zhu Xi (1130-
Zhu Wenfeng. Zhongyi xinlixue yuanzhi (Psychological principles of Chinese medicine), 1987, p.91.