Wood: the Liver and Gall Bladder

The Su Wen, in chapter 8, states:

The Liver holds the office of General of the armed forces. Assessment of circumstances and conception of plans springs from it.

The General is for the defence of life; the nature of the Liver is an active springing up, a kind of assertive power. It is the capacity to make plans and put them into action, to exert one’s volition. This requires vision, always estimating and evaluating the current situation for the proper conduct of physical, emotional and social life. If the General acts the same in peace as in war, there will be disaster!

Thus we can see why the Liver governs the muscles and tendons in their function of contraction and extension. It is responsible for the voluntary movement of the muscles, tensing and relaxing them as appropriate. The muscular capacity to extend and contract does not refer to the substance of the muscles or tendons, but to the dynamic, functional connections between the flesh and the bones.

The Liver is also responsible for the voluntary movements of the social being, modulating engagement and self-restraint as appropriate to the circumstances.

The Liver is said to store the Blood, releasing it for use in movement, and gathering it back to itself when the body is at rest. This is the General deploying his forces, adjusting and regulating the activities of the army as appropriate in peace and at war, in activity and at rest.

The Liver houses the hun, the spirits which bestow on a person the quality of individuality. The hun represent the ‘giving of images’: they have everything to do with creativity, speculation, and vision. At death, they move upward from the body, following the natural movement of Wood, and persist in existence for some time.

The hun represent that aspect of the individual which is self-aware and concerned with boundaries between self and others, and with assessing situations so as to make possible harmonious and socially appropriate action..

The hun might be considered to be deputies to the shen, in the same way that the Lung is a deputy to the Heart. The hun are a sort of personalized expression of the shen in you as an individual.

The Ling Shu at chapter 8 tells us that the hun actually reside in the blood, and this is related both to the Liver’s function of storing the blood, and to the close relationship between the shen and the hun.

The Liver ensures the smooth flow of qi, being responsible for the harmonious movement of substances within the body and of the body as a whole, by removing obstacles so as to allow qi to penetrate easily and spread everywhere. Liver pathology manifests as obstruction or stagnation in the flow of qi, which may include uneven, irregular emotions and awkward social behaviour.

Just as the Liver regulates qi, it regulates the emotions in a general way. What is important is not which emotion is experienced — emotions are nothing more than expressions of qi, and there will be moments when anger, joy, fear, or grief are appropriate — but rather that the emotions should be in ‘free circulation’, and not blocked or repressed. The essence of the Liver is flexibility and the capacity to change and adapt.

The Liver rules the eyes, and the capacity for vision, both physical and imaginative — another aspect of the capacity to assess situations by accurate perception, and to create novelty through the destruction of fixed patterns and the imagination of possibilities. The Ling Shu at chapter 17 tells us that when the Liver is present “you can correctly grasp all the aspects presented on the outside of things”.

The emotion of the Liver is often translated as Anger, but might more appropriately be considered in a general way as the self-assertive, explosive impulse connected with beginnings, or with the defense of boundaries. If this impulse is blocked, it can easily turn to resentment or rage.

The Virtue of the Liver is Benevolence and Human Kindness. The biggest obstacle to Benevolence is Anger. It requires a higher quality of vision to be able to see both sides of a question and to set aside your instinct for individual self-preservation in favour of another person or the greater good. This quality of vision goes beyond the immediate moment and demands that you act from a place outside time and space, i.e. that you bring the shen into the picture.

You can have too much anger, or too little. An inability to get angry and defend yourself when it is appropriate is just as bad as wanting to have your own way all the time. One is a lack of kindness to self, the other a lack of kindness to others.

So the spiritual path of the Liver is to transcend selfishness and cultivate Benevolence toward everything and everyone, including yourself.

Psychospiritual Aspects of Traditional Chinese Medicine
Notes for a talk given by the British acupuncturist and herbalist at East West Seminar at Bore Farm, July, 1997

Francesca Diebschlag, BAc Bphil, MBAcC Mrchm

Ever since the 17th century, Western metaphysics has been informed by the Cartesian dualism, the notion that matter and mind or spirit occupy separate realms, and that only the material is the proper object of scientific study. As a result, great pains are taken in orthodox medical research to exclude subjective experience from the picture altogether.

If we consider that the exterior of a person consists of what can be observed and described without consulting that person, which is to say without requiring his active participation in the investigation, we have the types of data considered valid in ‘scientific’ medicine: size, shape, blood tests, x-rays — all those factors which can be quantified.

The interior of a person, however, is the realm of his own experience, his feelings, what things mean to him, what he values, his goals, his dreams, his destiny. In order to know about this realm, the object of investigation must become a subject, a co-researcher, an active participant in the investigation. You will never find out what things mean to a person, how he sees the world, unless you engage in a dialogue with him.

We are called upon to treat people at different levels of depth. Some people just need a remedy for a relatively minor acute illness. Some need strong and fast-acting treatment for life-threatening diseases. Others need long-term treatment for chronic or constitutional conditions.

But most of our patients need the Interior, as well as the Exterior realm addressed. Indeed, that is what they ask of us: that they be treated as Whole Persons.

The Chinese never suffered from the Cartesian dualism, and never developed the matter-spirit dichotomy which still plagues Western science. Traditional Chinese metaphysics divided the world not into Mind and Matter, but rather into yin and yang, and further into the wu xing, the ‘five phases’, which describe qualities applicable to phenomena from the most grossly material to the most subtle.

In the human body, there are five major organs (zang), one embodying each of the wu xing. The Chinese model of the zang-fu is more akin to a field model than to the mechanical Western model, in which organs are simply bits of specialized tissue with a specific location and particular biochemical functions. Rather, each of the zang represents a spectrum from physical structure, to physiological function, emotions, mental and social dispositions, and spiritual qualities.

A prevailing attitude throughout Chinese medical thought, and Chinese culture more broadly, is that the proper disposition of the spiritual and mental faculties is essential to physical health, and conversely, that a sound physical basis is required for the maintenance and furtherance of mental and spiritual life. But even to speak in terms of “mental” and “physical” in this way imposes on the Chinese model a dualism implicit in the English language.

Most modern Chinese texts either neglect the mental and spiritual aspects of the zang-fu, or offer an explanation based on Western psychology which distorts their original meaning. The traditional Chinese model of the human person images the individual, the kingdom, and the entire cosmos as organized along similar principles. The ancient medical texts, and particularly the Su Wen, compared the human person to society as a whole, and assigned a ‘social’ role to each organ.

So let’s now look at the psychospiritual aspects of each of the zang-fu in turn.

Fire: the Heart and Small Intestine

The Heart is literally the Emperor and Sovereign of the organism. The Su Wen chapter 8 states: “The Heart holds the office of Lord and Sovereign. The radiance of the spirits stems from it.”

The Heart has a double aspect, as did the Chinese sovereign. In traditional Chinese society, the Emperor was the embodiment of Heaven on Earth. He brought order and prosperity to his kingdom simply by being; it was his enlightenment, intelligence and personal harmony which radiated from his palace at the centre of the Forbidden City, which was considered to be at the centre of China, which was considered to be at the centre of the world.

But the Emperor was also a political leader, actively wielding power.

This double aspect is represented by two pairs of ideograms: xin jun and xin zhu. Jun denotes a ruler, the Heart as an entity which has authority by nature, whose presence alone is a guarantee of order. The command of the Heart over the body, as the Emperor’s over the kingdom, is accomplished not by action but by a radiation of order from the centre. The role of the sovereign is to preside; his virtue diffuses of its own accord throughout the population.

The Ling Shu chapter 8 says: “That which takes responsibility for the 10,000 beings is called the Heart”. And in the Su Wen chapter 8 it is said:

If the sovereign radiates (virtue), those under him will be at peace from generation to generation. And the empire will radiate with a great light.

The Heart is the residence of the shen. The shen are the messengers of Heaven, “the principle of life, that which transforms an assemblage of matter into a living being” (Larre and Rochat 1992). The shen are indestructible and immutable; they transcend Yin and Yang. Whereas other types of spirits are said to be three in number, or seven in number, the shen are innumerable, like drops of water in the ocean.

Another term reflecting the function of the Heart as the residence of the shen is xin zhong, the ‘heart as centre’. The shen radiate from the Heart not through an accumulation of energy, but from a void. The void of the Heart is a fundamental concept in Chinese thought, referring not to an absence, but to a space of potential which allows the possibility of creativity, communication and interaction. It is this void at the centre to which Chuang Tzu refers in the chapter entitled ‘The Fasting of the Heart’:

Look at this window; it is nothing but a hole in the wall,

but because of it the whole room is full of light.

So when the faculties are empty, the heart is full of light.

Being full of light it becomes an influence

by which others are secretly transformed…

The Tao gathers in emptiness alone.

Emptiness is the fasting of the heart.

The second aspect of the Heart is represented in the expression xin zhu; zhu also

means sovereign, but a sovereign in action, at work, in the process of actively excercising his power.

Since the true sovereign himself may not leave his central position of non-action, there must be system of connections, a means by which the authority of the Heart can radiate to the rest of the organism. Xin Zhu is sometimes translated as ‘Heart Governor’ or ‘Heart Master’, meaning the Heart as Master, not the Master of the Heart, which would be a nonsense. A translation suggested by Larre is “that through which the heart commands”.

Another term for this aspect of the Heart is xin bao luo. Bao conveys the idea of enveloping something precious in order to protect and maintain it, in the same way that a pregnant woman carries a foetus, or a bird sits on a nest. When combined with the ‘body part’ radical it takes on a meaning of a matrix, or more specifically, the uterus. When combined with xin, it refers to that which protects the heart, and is thus often translated as ‘Heart Protector’ or ‘Pericardium’.

When bao luo is linked to the Heart, it denotes that the void of the Heart needs not only protection, but also a network of relationships. The expression xin bao luo conveys both the enveloping of the heart in order to protect and maintain it, and a system through which the Heart may communicate its authority.

The xin bao luo has the function of protecting the Heart:

“The heart is the Grand Master (da zhu) of the five zang and the six fu, the residence of the jing shen. When this zang is solid and firm, the perversities cannot penetrate. If they penetrate, then the heart is injured, and if the heart is injured the shen leave, and if the shen leave, it is death. For this reason, when the perversities are in the heart, they are in the bao luo.” (Ling Shu chapter 17).

This does not mean there can be no pathology involving the Heart, only that extrinsic pathogens cannot intrude into the inner sanctum of the Heart itself. It is for this reason also, that the character xin does not contain the radical for ‘body part’, and is the only zang which does not.

The shen are said to actually reside in the Blood, which roots, embraces, and anchors them. The Heart’s function of housing the shen thus depends on adequate nourishment from the Blood.

The emotion of the Heart is, of course, Joy. The Virtue of the Heart is “Propriety and Rites”. Now why, if the shen are beyond Time and Space, is the Heart concerned with Propriety and Rites?

The answer lies in the role of the Heart as Emperor; the one and only role of the Emperor as a religious leader was to perform the appropriate rites which would invoke divine power. The Emperor served as a channel linking his people with the source of life.

On a personal level, I think this translates as Mindfulness. At a practical level, this may include making time and space for your spiritual practice, whatever it is. Often the first and hardest step in doing meditation — whether it be sitting meditation, tai qi, yoga, or whatever, is Making Time.

Small Intestine

The Heart is paired with the Small Intestine. “The Small Intestine is responsible for receiving and making things thrive. Transformed substances stem from it.” (Su Wen chapter 8). The function of the Small Intestine may be summed up as ‘separation of the pure and impure’. It is the primary point of choice between what is assimilated to the organism and what is rejected. In this way it may be seen to reflect the nature of the Heart, in that it determines what extrinsic influences are selected to constitute and reconstitute the organism.

Clinically, Small Intestine points are useful when a person is having trouble sorting out relevant and irrelevant, valid and spurious data, in order to come to a decision.

The san jiao

The xin zhu is paired with the san jiao, the ‘Triple Heater’, one of the most difficult concepts in Chinese medicine, not only because it has no equivalent in Western medicine, but also because even in China it has not been clearly and consistently defined.

The Su Wen chapter 8 says, “The san jiao is responsible for the opening up of passages and irrigation. The waterways (routing of water) stem from it.”

The san jiao does not describe a physical organ; indeed, it is the only fu whose character does not include the ‘body part’ radical. Like the Heart itself, it has “a name but no form” (Nan Jing chapter 25). It is rather the sum of the functions of transformation and interpenetration of various densities and qualities of substance within the organism, “the way and pathways of liquids and cereals, the beginning and ending of Qi” (Nan Jing).

The Nei Jing also refers to the san jiao as ‘the pathways for the entry and exit of liquids and cereals’. ‘Entry and exit’ refers not only to the gross level of swallowing and excreting, but to everything that allows an organism to receive and introduce something into itself that is other than itself, and which gives it the ability to eliminate that which cannot be assimilated and integrated into itself. Between entry and exit are all the transformations of qi, and all take place within the scope of the san jiao, which ensures their coordination and unity. The details of digestion and metabolism may be governed by one organ or another, but the whole operation is orchestrated by the san jiao, which is responsible for not only the production of all types of post-natal qi, but also for its free circulation, from the deepest level to the most superficial.

A commentary by Sun Simiao in the 8th century emphasises the pivotal importance of the san jiao to the maintenance of life:

The san jiao through their reunion make the unity. They govern the tao of the shen, which come and go in the five zang and six fu….They know how to distribute life in the form of qi, they are connected to the origin, they make the blood and maintain life through the shen.

So we have here the idea that a sound physical basis is essential to spiritual life.

Metal: the Lung and Large Intestine

The Lung holds a privileged place in the body because it is found in the upper (yang) part of the body alongside the Heart. The beating of the Heart is intimately connected with and dependent upon respiration.

In the Su Wen chapter 8, it is said “The Lung holds the office of Minister and Chancellor. The regulation of the life-giving network stems from it”.

The Sovereign and his Minister form a couple, and inevitably this is a Yin/Yang pair. In relation to the Lung, the Heart is Yang, the leader, the more refined and immaterial; the Lung is Yin in relation to the Heart.

The Lung is associated with seven ‘spiritual’ entities, the po, which maintain and regulate bodily rhythms, respiration, metabolism, and homeostasis generally. The po are collectively responsible for maintaining the automatic rhythmic functions of the body, vital movements, sensations, reactions, and instinctive impulses. At the death of the organism, they return to the earth, following the natural downward movement of the Metal phase.

The Lung rules the exterior of the body, and its spiritual aspect, the po are the most ‘exterior’, material or outwardly observable, of all the spiritual aspects of the person.

The po experience things in the moment, on a reactive, unconscious basis; they are completely tied to Time and Space, and have no existence independent of the body. It is said that the po experience pain but not suffering, because pain is in the moment while suffering consists of one’s response to it.

The emotion associated with the Lungs is sadness, and this has something to do with the fact that the Metal element represents a withdrawal from life. The po are completely dependent on the body and, like all living things, will die. How do we make a spiritual path out of this?

The Virtue of the Lungs is Reverence. It is the ability to experience every moment as unique, as special and complete in itself. We get sad because we have embraced something, connected with its special quality, and then lost it. Reverence is sadness without the loss. It is what makes people cry when they are moved by great beauty.

If there is a lack of Reverence in your life, you won’t be nourished by ordinary everyday things. The virtue of the Lungs is to appreciate each moment in the Here and Now, as the only moment there is.

The Lung is paired with the Large Intestine (da chang), which receives the turbid (i.e. the unusable) portion of the products of food and fluids from the Small Intestine, absorbs the residue of useful fluids from it, and eventually eliminates it downward through the anus, the po men, ‘door of the po‘.

The Su Wen, in chapter 8, states:

The Liver holds the office of General of the armed forces. Assessment of circumstances and conception of plans springs from it.

The Liver is also responsible for the voluntary movements of the social being, modulating engagement and self-restraint as appropriate to the circumstances.

So the spiritual path of the Liver is to transcend selfishness and cultivate Benevolence toward everything and everyone, including yourself.

Gall Bladder

As the Liver is the yin aspect of Wood, the Gall Bladder is the yang aspect. The Su Wen, chapter 8, tells us that “The Gall Bladder is responsible for what is just and exact. Determination and decision stem from it.” The phrase translated as ‘just and exact’ is zhong zheng, literally ‘centre’ (as in hitting the centre of a target), ‘correct’, or ‘as it should be’. The nature of the Gall Bladder is to be hard and exact, just and decisive. The Liver analyzes, assesses circumstances, conceives ideas, plans and strategies; the Gall Bladder has the firmness to bring fantasy and invention to a clearcut decision and see it through. The Su Wen chapter 11 says “The eleven organs come to the Gall Bladder for decisions”, and the Zhangshi leijing tells us that

The Gall Bladder is appended to the liver and they help one another. Even if the Liver qi is strong, without the Gall Bladder there is no decision. If the Liver and Gall Bladder mutually assist, bravery and courage are then created. (cited in Mann [1964:96)

As a manifestation of Wood, the Gall Bladder is related to beginnings, even more than the Liver. It gives one the initial push along one’s direction in life, and with its power of decisiveness maintains one in that direction. This ability not to be deviated or put off is said to protect one from influences such as sudden shocks; a strong Gall Bladder ensures a quick return to normal after physical or emotional shocks such as serious illness or bereavement.

Water: the Kidneys and Bladder

“The Kidneys are responsible for the creation of power. Skill and ability stem from them” (Su Wen chapter 8).

The Kidneys represent the origins of life in the depths of one’s being: the invisible beginnings, the seed. They are the original and permanent basis for life, like the foundations of a house. They are responsible for the deep inner power of a person: not the power of temporary exertion, but that which allows for duration.

This deep underpinning of life applies not only to the ongoing life of the individual, but to the human species as a whole. ‘Skill and ability’ refers not only to the ingenious skill of conducting one’s own life, but also the knowledge of how to create another life: the Kidneys house the jing, which govern reproduction and development.

The Kidneys are the only double organ, and have a double function. They are said to be the roots of yin and yang, of all the Fire and Water of the organism. “The Kidneys are the mansion of Fire and Water, the residence of yin and yang….the channel of life and death”. They link the past and the future.

The psychospiritual aspect of the Kidneys is the zhi. It represents the capacity for rootedness, for stability and endurance: the ability to initiate action (yang) and to see it through (yin).

The Kidneys are the door between life and death. They represent the withdrawal of life into the depths. The emotion of withdrawal is Fear.

The ultimate fear is the fear of extinction. Facing up to your mortality, and looking past it to discover and accept your destiny, is the transmutation of that fear into Wisdom. This is the virtue of the Kidneys.

Bladder

The yin aspect of the Kidneys is paired with the Bladder, which has a special place amongst the fu. The Su Wen (chapter 8) tells us that “The Bladder is responsible for regions and cities (zhou du). It stores the jin ye. The transformations of qi then give out their power.” The Bladder represents the last phase of metabolic transformation, the coming full circle from the original essence of the Kidneys to the manifest, explicate, workings of life. In a typically Chinese paradoxical twist of thought, the lowest of the fu has a significant influence in regulating the vitality of the entire organism. The power of the Bladder is reflected in its channel, which is the longest in the body, containing points which correspond to every significant physical structure and psychospiritual aspect of the organism.

Ming men and the dual nature of the Kidneys

As the only double zang in the organism, the Kidneys are a paradigm of the interpenetration of yin and yang.

The Nan Jing, at Difficulty 36, tells us:

“The zang are all single, the Kidneys alone are double. Why is this? The Kidneys are double: they are not both Kidneys. The one on the left is the Kidney; the one on the right is ming men, the door of individual destiny. Ming men is the residence of shen jing, Spirits/Essences; it is where the original Breaths, yuan qi, are attached. There man stores the Essences (jing, sperm) and woman attaches the reproductive organs (bao, uterus). Thus the Kidneys are unique.”

Ming is a term which expresses the power and virtue of Heaven in an organism, whether it be an individual person or the state. It implies that the destiny decreed by Heaven is nothing other than the unfolding of one’s true nature to its fullest expression. Men denotes a gate or door. Ming men, then, is the ‘Door of Destiny’, from whence one’s nature unfolds.

Commentaries on the Ling Shu chapters 2 and 47 say quite precisely that the right Kidney is paired with the san jiao and the left Kidney is paired with the Bladder. This is only understandable in the light of the Nan Jing Difficulty 36 where the left Kidney is correlated with Water; Ling Shu chapter 2 associates the Kidneys with the Bladder, and says that the Bladder is the “fu of the jin ye”.

The right Kidney, however, is equated with ming men, which is correlated with Fire, and is paired with the san jiao. Chapter 47 of the Ling Shu describes the san jiao as being like a messenger or servant of ming men for the distribution of yuan qi through the body.

Earth: the Spleen and Stomach

The Earth phase of the wu xing belongs not to one direction or season but to the central region and the transformation of the seasons, and the Spleen holds the same position within the organism:

The Spleen doesn’t govern a season, can you explain this to me?

Qi Bo replies:

The Spleen is the Earth, tu, it governs the central region,

and continually through the four seasons it allows the development

of the four zang.

All of the zang are paired with a corresponding fu, but the Stomach and Spleen are virtually one unit. In chapter 8 of the Su wen, which delineates the functions of the zang-fu, they are dealt with together, in the central section of the chapter, reflecting their central position in anatomy and physiology, and they are the only zang-fu pair considered in this way.

The Su wen at chapter 8 says “The Spleen and Stomach are responsible for the storehouses and granaries. The five tastes stem from them”.

The Spleen is not only the central pivot of the four types of Qi, it is the pivot between yourself and the world outside. Its function is to transform substances that are not-you (food and drink) into the substance of you. This function is expressed in the word hua, which actually has alchemical connotations. There is really something magical about turning rice and carrots into a human being.

The result of transformation is stability. “The Spleen corresponds to the Earth. It regulates the centre, that which is constant.” (Nei Jing, chapter 29).

Kidney Jing is like the hand of cards dealt to you by fate; the Kidneys are the ‘root of pre-natal Qi”. The Spleen, on the other hand, is the way you play that hand; it is the “root of post-natal Qi”. The best constitution in the world will fail you if you don’t feed it well.

Just as the Earth phase describes a central pivot, or the pivot between each of the four directions, the spiritual aspect of the Spleen is not an entity, but rather a quality of mind, a central channel of expression, yi. Yi is variously and ambiguously translated as purpose, intention, engagement, ideas, or thought; it corresponds to the Taoist notion of ‘spontaneity’ — that action to which one is spontaneously moved by one’s grasp of one’s situation. Yi is said to dwell in the ying qi, the ‘nutritive’ qi of the channels; the capacity to engage with the world requires sufficient qi to reach out and connect. A deficiency of ying qi generally manifests on a physical level as fatigue, and on a psychological level as a lack of presence, interest and engagement.

It is the Spleen which ensures the passage from one quality of qi to another, and from one zang to another. Its particular power is to master passages, transmissions, and transformations.

The ability to translate experience — whether it be of food (the biological level) or data (the cognitive level) — into something life-enhancing for oneself belongs to the Earth phase.

The ’emotion’ associated with the Spleen is not really an emotion. It’s si, which means thought, but in the sense of coherence — when various perceptions and ideas come together in a coherent, meaningful way. In Ling Shu chapter 8 it says “When yi remains we speak of zhi”, that is, when purpose is held, there is will, a continuity that allows accomplishment.

The Virtue of the Spleen is thus Faithfulness and Reliability. It’s the holding to a commitment or relationship, but by constantly creating and re-creating it, rather than just going through the motions of some past decision or habit pattern. It’s like waking up every morning and saying “Do I still want to do this? Yes!”.

Qi and Blood

Qi is what allows you to engage and become involved with the world. One of the core Qi tonic formulas is said to be indicated “When you can’t tell it’s a nice day outside, or that the food tastes good”.

This is a description of boredom, of lack of engagement. People with Qi deficiency tend to complain a lot because they cannot reach out and engage the world, so it’s all happening to them.

Qi forms a yin/yang pair with Blood. The concept of Blood in TCM is quite different from the Western concept of Blood. In TCM, blood is the yin aspect of Qi; it is the aspect of Qi responsible for responsiveness and receptivity, as contrasted with engagement and transformation.

Whereas Qi is active and creative, Blood gives you the capacity to embrace and be comfortable with what has already been created.

Qi gives you the ability to be active; Blood gives you the ability to be comfortable about being still. People who are constantly fidgeting are lacking this quality; they don’t feel comfortable in themselves.

People with low self-esteem tend to be deficient in Blood; they can’t acknowledge and embrace and feel good about what they are and what they have done. Memory depends upon Blood; memory is being able to hold onto and reconnect with what Qi originally connected us with in the outside world.

The domain of Blood is your inner self; the domain of Qi is from yourself outward into the world.

One of the basic clinical assumptions in TCM is that women tend to have problems with Blood, while men have problems with Qi, or Yang. There has been much speculation about why this is so. Some say it is because women lose blood every month through menstruation, and even more through pregnancy, childbirth and lactation. Some modern scholars say that Chinese culture was so sexist it created an imbalance by making women feel worthless.

But try this one on: The movement of Qi is linear, from A to B. It’s about creating new things, mastering new skills, conquering new territory. The movement of Blood is cyclic. It covers the same ground again and again, around and around on the same path, supporting and nourishing.

In a traditional society, the men go out and do new and challenging things, while the women stay home and look after the household, which requires a lot of repetitive work. Maybe women get Blood deficient because this excessive repetitiveness depletes Blood, just as excessive challenge and activity depletes Qi. Just a thought.

The importance of the psychospiritual dimension

In Chapter 8 of the Ling Shu, we find a strong call for the stability of the shen to be central to every medical treatment:

Huangdi asked Qi Bo this question:

When needling, one must not miss the rooting in the spirits. Blood and mai, ying and qi, jing and shen, are stored by the five zang. If, following a situation of overflowing and complete invasion, they leave the zang, then the essences are lost. Both hun and po are carried away in an uncontrollable agitation, will and purpose become confused and disordered, know-how and reflection abandon us. Where does this state come from? Should one accuse heaven? Is it the fault of man? And what is the meaning of virtue, qi, life, jing, shen, hun, po, heart, purpose, will, thought, know-how and reflection?

Qi Bo replied:

Heaven in me is virtue.

Earth in me is Qi.

Virtue flows, Qi spreads out, and there is Life.

That living beings arise denotes jing.

That the jing embrace denotes the shen.

That which faithfully follows the shen in their coming and going denotes the hun.

That which associates with the jing in their exits and entries denotes the po.

For that which takes charge of the beings, one speaks of the Heart.

When the Heart is applied, one speaks of Purpose (yi).

When Purpose is permanent, one speaks of Will (zhi).

When Will, which is maintained, changes, one speaks of Thought (si).

When Thought spreads far and powerfully, one speak of Reflection (lu).

When Reflection is available to all beings, one speaks of Know-how (zhi).

Thus Know-how is what maintains your life.

This text takes us from the Universals of Heaven and Earth right through the entire subjective structure of a human person, telling us how to maintain life. There is no mention of diet, exercise, or specific reference to conformance with the seasons. Instead, it speaks of process through the interiority of the individual, in such a way that life can be maintained.

Su Wen chapter 54 says “Through the purpose of the heart (xin yi) man is in resonance with the eight winds”. The eight winds represent all the variations of external influences — from the most subtle psychosocial conditions to the most physical manifestations of climate — which can touch and have an effect upon our internal organization. If the heart is not stable, one can be thrown into disorder by external circumstances.

This passage tells us also that the Heart is a centre where unity is maintained in the midst of the flux of qi and shen. The dual nature of the Heart represents the meeting of the changeless and the changing, the inevitable and the contingent, the implicate and the manifest. It stands for absolute autonomy and at the same time, responsiveness to, and resonance with, universal forces, trends, and patterns. As Hsun-tsu put it:

“How does man know the Way? By the heart. How does the heart know? By being empty, unified, and still. The heart never ceases to store, yet something in it is to be called empty; to be multiple, yet something in it is to be called unified; to move, yet something in it is to be called still. From birth man has knowledge, and in knowledge there is memory; ‘memory’ is storing, yet something in it is to be called empty — not letting the already-stored interfere with the about-to-be-received is called being empty. From birth the heart has knowledge, and in knowledge there is difference; of the different it knows each at the same time, and if it knows each at the same time is multiple, yet something it is to be called unified — not letting one of them interfere with another is called being unified. The heart when sleeping dreams, when idling takes it own course, when employed makes plans, so never ceases to move, yet something in it is to be called still — not letting dream and play disorder knowledge is called being still.” (Hs 21/34-39)

Thus, if we can get the psychospiritual disposition right — and this is a continuous process, not a discrete once-and-for-all event, we stand a far better chance of helping our clients ‘maintain life’, which is to say, being more fully alive. For what other reason do we practice?