Heart Series, Pt. 3: Two Hearts of Chinese Medicine

Circulation is more complicated than you thought! Between the Heart and the Pericardium, Chinese medicine has a lot to say about blood.

Running an empire can be a complex task! In Chinese medicine, the functions of the heart are divided between two separate organs, the Heart and the Pericardium. But, as with all of the organs in Chinese medicine, the functioning of the body is a springboard for a deeper discussion into mental health, spirituality, and more. Join Dr. James Mohebali as we look at trauma, PTSD, Game of Thrones, Varys, the emperor & the eunuch, and of course sex, drugs, and rock & roll, in order to understand the deeper meaning of the Heart organ, so that we understand what it really means when we have a broken heart. Touching on blood stasis, stillbirth, complex and chronic illnesses, birth trauma, the contributions of John Shen and Leon Hammer, Freudian views of children, and the difference between agape love and eros love, this episode tries to get to the heart of the issue.

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"Classic of Difficulties: Difficult Questions in Medicine, Acupuncture, and Beyond" is a new podcast and YouTube channel by Dr. James Mohebali, doctor of acupuncture and Chinese medicine.

We try to ask difficult questions from both a philosophical and a practical perspective about medicine, health, alternative medicine, and everything in between. We hope to deepen the conversation about medicine, taking it beyond the questions of "what's good" and "what's bad," instead trying to figure out what philosophies and assumptions underlie our approaches to medicine, so that we can begin to understand what's really at stake when we think about our health and wellness.

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Transcript

The heart is the ruler of the five organ networks. It commands the movements of the four extremities, it circulates the qi and the blood, it roams the realms of the material and the immaterial, and it is in tune with the gateways of every action. Therefore, coveting to govern the flow of energy on earth without possessing a heart would be like aspiring to tune gongs and drums without ears, or like trying to read a piece of fancy literature without eyes.

Greetings and welcome to “Classic of Difficulties: Difficult Questions in Medicine, Acupuncture, and Beyond”. I am your host, Dr. James Mohebali. I’m a doctor of acupuncture and Chinese medicine, and today we are going to be asking some difficult questions about medicine, health, alternative medicine, and maybe the meaning of life. Let’s do it!

This is episode 14: What does the Heart do, Pt. 3: Chinese Physiology

This is the long awaited third installment in the Heart series. In the past two episodes, we’ve spent a lot of time deconstructing what we formerly believed. But here, finally, in episode three we start to see the road forward, the road to a new understanding of what the heart might be. At this point, we can finally start to glimpse a new theory and a new approach to the heart. And, for me, the best approach is to look to our ancestors, to look to our traditional understanding of what the heart is. And, since I am a doctor of Chinese medicine, “returning to the source” means beginning with the Chinese classics.

Just so you know, this episode is going to be more on the serious side. We’re going to be talking about life, death, trauma, and serious existential pain, because we HAVE to talk about these things in order to understand the Heart. So this will not be easy listening, I don’t mean intellectually, but rather emotionally and spiritually. There could be some things in here that are very challenging. And because of these challenges, I can guarantee that listening will be deeply rewarding, because out of struggle comes beauty. So, let’s begin.

First, let’s be clear, nowhere in the Chinese medical classics does it say “the heart is not a pump.” Why would they even say something like that if they didn’t know about the theory that the heart WAS a pump? But, I would even hazard a guess that most Chinese medical doctors, both in the east and west, actually believe that the heart IS in fact a pump. This very interesting fact points to something very critical about modern life—the vast majority of people in the modern age are fully and completely steeped in the inherited knowledge from the Western, scientific worldview. Even when we try to abandon this worldview, even when we try to step into an ancient medicine, we inevitably carry some of our baggage with us. We often don’t even realize that we’re carrying it, because all of this baggage, all of these modern beliefs, have become so second-nature to us. This isn’t just a problem with practicing an ancient medicine, this is a problem any time we attempt interact with the past, whether that’s thinking about ancient history, encountering ancient religions, like Orthodox Christianity or Daoism, or whether that’s simply reading Plato or Aristotle.

So if we fail to completely inventory our beliefs and examine them and challenge them, then we inadvertently cross-contaminate, and develop an incomplete or inaccurate picture of the past. And if we end up judging the past by the standards of the present time, then the past always looks backwards, stupid, and misguided. It’s not that the people of the past weren’t smart enough or technologically advanced enough to have the enlightened worldview that we have, it’s the fact that they prioritized different things, and that they perfected and refined different types of wisdom, and that’s how they spent their time. In fact, if we held modern people up to THEIR standards of wisdom, WE would all look backwards, stupid, and misguided. So our goal in trying to adopt these ancient worldviews is to really see the world like they saw it, as much as is possible, and to glimpse a completely different vision of reality, a vision of reality that co-exists alongside our vision, and perhaps even encompasses our vision and extends far beyond it into realms that we as moderns have been woefully blind to.

So how can we begin to understand the heart in a way that transcends cultural and temporal boundaries? Well, whoever you are, wherever you are, whenever you are, it’s impossible to talk about the heart without talking about blood. So what is blood anyways? For one, it’s obviously that stuff that’s in your arteries and veins, that squirts out whenever you cut yourself. But Chinese medicine and Western medicine have very different concepts of what blood is and what it does, just like they have very different concepts of what organs are and what they do. The common way out of this apparent contradiction is that we say that the Chinese conception is partially metaphorical, like “they didn’t REALLY think that the liver opened up to the eyes, since there’s obviously no connection between the liver and the eyes. They must have just thought it ENERGETICALLY opened up to the eyes.” Given what we were just discussing about immersing yourself completely in a foreign worldview, in order to obtain a deeper understanding of that worldview, we can see why this type of explanation has major shortcomings.

The Ancient Chinese absolutely, 100% believed that the Liver opened to the eyes. The only difference is that they had a concept of the Liver that, not only encompassed our modern understanding of the Liver , but extends far beyond it. And the same thing with blood.

So is Chinese medicine really talking about “Blood” when we talk about blood? YES. Of course! In fact, pricking vessels or points to release minute quantities of blood is ABSOLUTELY part of Chinese medicine and acupuncture. And it’s incredibly effective, especially for chronic, stubborn conditions. These conditions, by the way, are usually marked by some degree of BLOOD STASIS in Chinese medicine, and therefore they must be treated by moving blood (which, by the way, if you’re squeamish, can also be done using herbal medicine, without any bloodletting at all). But in order to understand why blood stasis is such a big deal, especially in serious conditions, we have to know about the functions of blood in Chinese medicine.

There are a lot of textbook functions of blood—nourishes the skin and sinews, nourishes the eyes, supporting reproduction and menstruation, and so on. But the most important function of blood, and the one that really completely separates the Chinese medical view from the Western medical view, is that the Blood is the residence of the Shen, of the Spirit or Soul. The Shen abides in the blood. That means that blood is responsible for SENSATION, whether or not you can feel things, like the literal sensation in your hands and feet; that means that blood is responsible for THOUGHTS, responsible for EMOTIONS, for DREAMS, and for our whole CONSCIOUS EXPERIENCE OF THE WORLD. Since the spirit is arguably the most important part of a living person, and spirit is fundamentally the thing that separates a living person from a dead one, that means that Blood and the vitality of your blood is THE defining feature of being alive. Because once the spirit has left the body, the body is nothing but inert, lifeless flesh, unable to achieve virtue, unable to achieve anything more in this world.

This highlights the central importance of blood stasis in Chinese medicine, which manifests particularly in diseases of aging and chronic illness, but can also be found in certain other situations, especially very serious ones. One example is in stillbirth, when a fetus dies in a mother’s womb. When the life of the fetus is gone, when its spirit has gone, the body that remains becomes blood stasis. What was once alive becomes dead blood. And, using the Chinese medical diagnostic signs, such as looking at the mother’s tongue and taking her pulse, this blood stasis is objectively detectable. We can see that change. We can see that the transition has been made from life to death. We can notice when the life has left the child’s body. And very quickly, what was normal and healthy proceeds to a serious medical situation requiring prompt action and strong intervention.

When we have blood stasis, more generally, it means that our mind, our emotions, our thoughts, our feelings are STUCK on something. The blood, the spirit, isn’t moving, it’s stuck. We can’t let go of something. There’s something that we’ve experienced that has tainted our worldview, and, now, after those experiences, we just can’t see the world in the same way anymore. We’ve been traumatized in some way, and we keep reliving that trauma. We tell ourselves stories about our trauma, and say that, the way we are now is because of that thing that happened to us. Our blood is stuck on that thing. Our spirit is stuck. That’s blood stasis. And when the blood is static, that’s not life anymore. When the blood is static, some part of us is dead. When we can’t let go of our anger for something that happened years ago, when we can’t forgive other people, or forgive ourselves, when we tell stories about how all of the difficulties in our lives have come together to prevent us from reaching our full potential, that means that some part of us is now dead, and without life.

Clearly, blood is absolutely essential to the practice of medicine. And, as I like to point out to my patients, Chinese medicine is not the only medicine that thinks that blood is extremely important, and therefore tries to treat the blood directly, that is by doing some degree of bloodletting. In fact, I would hazard a guess that every single traditional medicine the whole world over practices bloodletting in one way or another. There is only one form of medicine that I know of that does not practice therapeutic bloodletting—and that’s modern Western medicine. So really, Western medicine is the strange one, when we think about the significance of blood and bloodletting. Western medicine is the strange one when doctors, nurses, and patients think that it’s totally normal to remove pints of blood from one person and putting it into another. The SPIRIT is in the blood, after all. We’re not just talking about a blood transfusion, we’re talking about a spirit transfusion.

All of this is hugely important to understanding the Heart in Chinese medicine, because of the intimate relationship between the Heart and the blood. As I mentioned in our lovely introduction, quoted from the Huai Nan Zi and translated by Heiner Fruehauf, the heart is the ruler of the five organ networks. 

In the Nei Jing, it’s said that the heart is the taizhu, the grandmaster of all of the other organs. If the body is a kingdom, then the heart is the emperor, in charge of it all; and all of the other organs of the body exist to pay tribute to the emperor. The reason for this is that the Heart contains the Shen, it contains the Spirit, it contains the soul. The Heart is really the gateway to the transcendent, to higher realities, to deeper truth in Chinese medicine. All of life really exists because of the soul and its unquenchable desire to incarnate, to come and experience life.

So the heart is the emperor, and since the whole kingdom would collapse without the emperor, there are lots of safety measures in place. Like, if something starts to go wrong with the Heart, maybe the stomach and intestines will pick up the slack. Or maybe the Lungs. There’s lots of contingency plans to make sure that this blood stasis we were just talking about doesn’t damage the heart. Because that anger, that sadness, those traumatic things that happened to you, those things you can’t let go of, they could kill you.

How literal am I being right now? Totally literal. The Chinese medical idea of heart pain (aka heart attacks) encompasses all of this. Because Chinese medicine understands that everything in life is on this spectrum from physical to spiritual, and that every part of the spectrum affects every other part. So when you have chest pain and you show up at the ER, it’s because of the shock, trauma, and emotional pain that’s overwhelming your body.

And, guess what, 75% of the time, the doctors and nurses will dismiss you. Because 75% of the chest pain presenting in the ER is NOT an actual heart attack. And they’ll say, “oh it’s just a panic attack, you’re just having anxiety issues.” Which, by the way, feels terrible when someone says that to you. It feels like they’re telling you that you made it up. So what’s going on here from a Chinese medical perspective? And why does your chest hurt? Well, the chest pain is the sign that the emperor is being attacked, being insulted. It’s a sign that something has hurt you in a really deep way. Sometimes it’s acute—like a sudden, unexpected shock, like your best friend died—sometimes it’s chronic, and it’s just years and years of resentment and disappointment built up, finally getting pushed over the edge. But in this case, your body is strong enough to manage, because your other organs are strong enough to manage. The emperor calls in the other officials, and they take care of the problem. If this insult is being managed by the Kidneys, then you have lumbar pain alongside your chest pain. If it’s being managed by the Spleen, it feels like a dagger in your heart, and your four limbs feel weak—remember, according to Western medicine, quote “real” cardiac chest pain usually feels like HEAVINESS, not like sharp stabbing. If your Stomach comes in to save the day, then, in addition to your chest pain, you have sudden diarrhea, or a feeling of abdominal bloating and distension. All of these cases are TRUE HEART PAIN. They’re the real deal. You’re having a heart attack, but it’s not going all the way because your body can still use plan B or C or D. But because the other systems in your body are intact, the emperor doesn’t die, and the whole empire doesn’t collapse. And this can only happen if your systems are intact.

But that’s a big IF. There’s a lot of things that can cause blockage, both acutely and chronically. Chronically, that can be the many things we think of that “cause” heart disease from a western medical perspective—diet, genetics, lifestyle. Acutely, Maybe you were constipated for a week, maybe it’s from eating heavy and rich food, and as a result your Intestines can’t protect the Heart. Or maybe you develop a case of pneumonia, which blocks the diaphragm and therefore blocks the heart. Although the root cause is blood stasis, the triggers can be nearly anything. That is, although our sickness as human beings is fundamentally a spiritual sickness, there’s a lot of other things that can come in the way, physically, dietarily, genetically, mentally, and in terms of our lifestyle and our choices.

All of this makes it sound like we’re ticking time bombs, just rigged to explode. But fortunately, it’s not just a one way street of building up blood stasis, of building up trauma until finally all of the other organs can’t handle it any more, and the kingdom collapses. There is one official, one organ, that rectifies qi, that breaks up blood stasis and is capable of HARMONIZING the blood. There is one organ that can take that trauma and reincorporate back into your life. And that organ is the pericardium. See in Chinese medicine, there are really TWO hearts, there’s the emperor fire, the xin, the heart, and there’s the minister fire, the xinbao, xinzhu, or xinbaoluo, all of these terms being (somewhat poorly) translated as the pericardium.

How can we understand these two separate hearts in Chinese medicine? Well, both of them belong to the fire element in the Chinese five element paradigm. But the difference is the TYPE of fire. The true heart is referred to as the Sovereign Fire, the emperor, just like we were talking about before. On the other hand, the Pericardium is referred to as the Minister Fire, or ministerial fire. So the heart is emperor, and the pericardium is minister. Or the pericardium can also be thought of as the court eunuch.

The eunuch is a fascinating concept that can be a little difficult for us as moderns to grasp. Eunuchs, for those who don’t know, were men who were allowed to serve in a very, very close capacity to the emperor because they were castrated. Since they were castrated, the emperor could be sure that all of the offspring from the emperor’s concubines were from him, and not from the eunuchs. But the idea isn’t just difficult for our modern mind because we don’t have eunuchs anymore. It’s also difficult because of how we’re raised to think about ourselves, and our role as individuals in the world. In American culture in particular, we’re raised to believe that we’re all emperors. This belief is actually a presupposition of democracy, that your opinion as an individual is meaningful enough that it should affect the course of a nation. In fact, we’re told that if we don’t act like little emperors, for example, if we don’t cast our vote in elections, and we don’t participate in political causes, then we’re actually doing a disservice to the world and the people around us.

This idea that everyone ought to be an emperor is actually rather foreign to most cultures the world over, and is definitely absent from most of human history. It’s also a little foreign to Chinese medicine, because kingdoms really don’t function if everyone is an emperor, and the same could be said of the body. Both people & organs need to be willing to take subordinate roles, and different people, different organs are good at different things. Not everyone is really meant to be an emperor.

So for us moderns, in order to understand the eunuch, we have to step a little outside of our modern world, into the past. One possible bridge into the past is fantasy novels and fantasy television. Perhaps the token example from modern culture would be the eunuch from Game of Thrones, Varys. I’m a little embarrassed to say that I’ve watched more Game of Thrones than I’d care to admit. But, for those of you who have seen it, Varys is an excellent example of a Pericardium that is totally and completely dysfunctional. So this Varys fellow, these court Eunuchs; what is their main personality trait? Manipulative, conniving, always up to something. They can use their powers for good – and that would be how things are in a properly functioning empire, but it just so happens that in both medicine and cinema we really don’t see a whole lot of properly functioning empires. In medicine, we don’t see these because it’s usually sick people that come to see you, not healthy people. And in cinema, we don’t see these because it’s not dynamic and gripping when everything in the world works really well. Especially nowadays, we don’t really watch cinema, or even watch the news, or even look at social media to see all of the nice and positive things that have happened in the world. Positive things aren’t interesting to us in a lasting way. Not only does Hollywood know that, Facebook knows that, Google knows that. So you could say that cinema, the media, social media, even some of your friends are always intentionally depicting a diseased form of humanity, because disease is interesting to us.

So what is a properly functioning eunuch, a properly functioning Pericardium? Well, as a rule, the emperor really shouldn’t have direct, unfettered contact with the world. He couldn’t handle it. From his birth, the emperor has been protected, shielded, guarded, just like you guard a precious flame from the wind and the elements. It’s not just that he’s dainty and spoiled and doesn’t have a concept of reality as a result of his privilege and his upbringing, that kind of thinking would be importing our modern bias into an understanding of the past, which we’re trying to avoid. The idea here, just like guarding the fire, is that the emperor, the spirit, the soul is really TOO GOOD for the world. It’s too precious for the world. If we really just let our souls fully encounter the world directly, to fully encounter truth directly, it would be too much for us to handle. It would extinguish us.

So we need to have a mediated relationship with the world. And that’s where the minister comes in, where the pericardium comes in. He takes messages for the emperor. If something tragic and horrible happens in the kingdom, the minister doesn’t just tell the emperor right away. He waits, he deliberates, he picks the right time to let the emperor know, he does it in the right way so that he can appropriately process it and manage it. This is how our pericardium, in our body, helps us deal with reality, helps us deal with trauma. You don’t experience the sudden death of a loved one all at once. Your pericardium first puts you into shock. All information pathways get shut down. The emperor is on lockdown. Then your pericardium gradually loosens, gradually feeds information in piece by piece, once things are safe again, and once you can handle it properly.

The minister completely sculpts the emperor’s vision of reality so that the emperor’s skills and tendencies can be most effectively applied. It’s only through the pericardium and its manipulation of reality that the true personality of the emperor, his best qualities, can really be put on display. So the choice of minister is extremely important—if you have a bad minister, a bad pericardium, it will corrupt the kingdom, and the emperor, the heart, the soul, won’t even know it. The way we perceive our life, tell stories about our life, and report back to ourselves, back to the emperor, about our life, could either help us, and lead to a beautiful and rich life full of meaning and purpose, or it could corrupt us and inadvertently start to extinguish our precious light.

So in classical acupuncture, in the old days especially, but also in some schools of thought now, you don’t treat the emperor directly. You don’t needle the Heart channel. You don’t talk directly to him, you don’t look directly at him, you certainly don’t touch him, you don’t do anything like that. Any interaction you have with the emperor goes through his ministers. So when you want to treat the Heart, because we respect the absolute sovereignty of the emperor, the sovereignty of the soul in the body, we treat the pericardium. We treat the minister. When somebody has a Heart problem, which could be physical, like congestive heart failure, or it could be mental, like insomnia or depression or even schizophrenia is often a heart problem, what do you do? Instead of going at it directly, you try to change things around how a person perceives their world, you try to encourage them to see things in a different light. You can’t just tell someone to stop being depressed. You can’t just tell someone to forgive the people that abused them. It’s not that simple. It’s not just that it’s ineffective, it’s also not paying attention to how complex the human spirit is. Or how complex forgiveness is.

All of this discussion on the Heart inevitably gets into the idea of mental illness, and spiritual illness. We have to ask ourselves: What is mental illness, really? What’s wrong with a person when they’re depressed and they can’t see out of their funk? What’s wrong with a person when they see themselves as a failure and nothing anyone says or does can change their mind? Or what’s wrong with someone when they’re schizophrenic, and their perception of the world is very different than your average person, and it’s overwhelming to them? Is their soul somehow diseased? Were they just born with a defective soul? And is it curable? Is it treatable?

This is a big topic, and I hope to get into it in a full episode soon. But for now, suffice to say that a true Heart issue is traditionally thought to be the purview of religion rather than medicine. I’m not talking about an issue with the other roles in the kingdom, and remember, everyone in the kingdom is working for the heart. So when someone is depressed, there’s often something amiss with their liver, something amiss with their spleen, those other organs are ultimately preventing your heart from functioning properly. That stuff is easy, there’s plenty of good Chinese herbal formulas and acupuncture treatments for that.

But when the kingdom is working fine, and still the emperor doesn’t want to get out of bed in the morning. That’s a spiritual problem. When you are lost in life and you want to die, you don’t go to the doctor, necessarily. You go to your priest. You go burn some incense, say some prayers, and try to connect with something greater than yourself. 

That’s a problem that requires a priest. And I’m not just using a priest as a stand-in, here. I’m using it and emphasizing it because you really need someone else to help. You can’t just figure it out on your own. The emperor can’t just think his way out of it, or read his way out of it; the heart really needs to reach out and seek connection and meaning from other people.

The function of the heart, the function of the soul is to reach out. To extend. The Chinese character for Shen involves the radical that means “to extend.” This naturally leads into the idea of blood flow, and the different types of blood flow associated with the heart and pericardium. The heart, in Chinese medicine, is associated with the expansive blood flow, the blood flow leaving the heart and going to the surface. The arterial blood flow. Rich, red, oxygen filled, excited blood. Flowing in quick sudden, spontaneous bursts. The emperor is excited to encounter the world. He’s passionate about seeing things, experiencing things, meeting people, tasting exotic foods from the far-reaches of the kingdom, having exotic and interesting experiences. And he’s not just passionate about food—after all, emperors usually have quite a few concubines and courtesans. By the way, we do have an episode on sex coming up soon, and all of this heart/pericardium discussion will be very important, and will definitely come up again.

Now looking at the pericardium, it’s characterized by constrictive blood flow. It’s the blood returning back to the heart. The venous blood flow. The minister is all about closing the doors, managing access, preventing things from getting into the throne room. Again, it’s not just a negative thing, he’s also involved in processing experiences. When the emperor goes out into the kingdom, he’s going to encounter a lot of things that he doesn’t understand, and the minister has to make sense of them, and explain them to the emperor. Specifically, he has to explain them in a way that the emperor DOES understand—even if that explanation is partially untrue. The noble lie.

We really cannot comprehend the whole of the world around us. In order for us to maintain our integrity and our sanity, our perceptions, our sensations, and our understanding of the world is limited. For example, many people believe that angels and demons and ghosts and all these strange spiritual things don’t exist because your average person can’t see them. And then, throughout history there’s all these very cool and interesting spiritual people that could see them. And these people seemed to be well-liked and well-respected by their peers and colleagues, and they seem to have had a net positive impact on the world around them. So what’s going on here? Well, it’s often said by spiritual seekers and saints of the Orthodox church and energy workers that it’s really a great blessing that we can’t see all of these things—if we could, we would be completely unable to function, at best, and at worst, live in a state of constant terror. It’s not just the demons and ghosts that are scary—angels are terrifying too.

In any case, the pericardium limits our reality, it lies to us. But sometimes the lies that are supposed to protect us actually start to harm us. Sometimes we tell ourselves a story about how we should’ve been something greater than what we are. That we did everything we could, but that the world was too cruel, and it derailed us, and now we can’t be who we were really meant to be. We keep telling ourselves that, and all of our new experiences just get sorted into that narrative. The original blood stasis, the original blockage, just keeps accumulating and accumulating more blood stasis, like a dam in a river. And when we die, we’ll be bitter, we’ll be resentful, we’ll go out saying, “I told you so. I knew this world was cruel, and I knew I would never be able to be happy.” That’s an unhealthy pericardium.

Sometimes it’s dramatic, like I was just describing. But sometimes, when the heart gets snuffed out, it’s just a gradual, slow process. Sometimes that blood stasis starts to cause yang deficiency, cold, in the heart. You’re getting older, you feel like you’ve seen the world. You’re retired now. Every day when you wake up, your life is more or less the same. You’re not excited to see your wife anymore. You’re not really excited for much. You have your hobbies, and they keep you busy, and give you some joy, but nothing is terribly meaningful anymore. Your kids didn’t turn out the way you thought they would, and now even your grandchildren are grown, and they didn’t turn out how you expected either. So, what happens? Your heart rate slows down. Your blood isn’t getting to the surface as easily. Your blood isn’t rushing out to meet the world anymore. Congestive heart failure. You’re cold all the time. Your hands and feet especially. You just want to curl up and stay in bed.

Contrast that slowed heart rate and weary attitude with children, with my daughter, for example. She wakes up before she’s even fully rested. She’s so excited to see the new day, and every morning when I wake up, or rather, when she wakes me up, she’s beaming at me. So excited to see her dad. That’s how children are. And their heart rate reflects that—fast heart rate, rushing that blood to the surface as much as possible, to take in as much of the world as possible. We don’t just see it in the heart rate. In Chinese medicine, the heart channel opens to the eyes. The spirit can be seen and measured in the eye. With children, their eyes are bright, their hearts are open, they love freely. Children are often held up as the ideal of the spiritual path. And, in fact, clinically, pediatrics is one of the few occasions where, even classically, you see the use of points on the Heart channel, rather than the pericardium channel. This is because, not only is their heart more open, but that openness is reflected in their body, it’s reflected in their physiology. The way their bodies run is different, and this difference is clinically detectable—you can see it. If you pay attention and you know what you’re looking for, you can tell when someone’s heart is open.

Sometimes you see older people with the same light in their eyes that children have. This kind of thing is common among saints, among the kind of people who, despite having long and complex lives like the rest of us, or sometimes even more complex, they have managed to actually open their heart further, instead of closing it down. They’ve managed to become like little children again—pure, loving, full of joy.

On the other end of the spectrum, sometimes you can see young people who are broken and damaged by their lives. They have a dead look in their eyes, without light and without luster. And they might sometimes feel like they’re a little dead inside. They don’t have the bright, shining look that characterizes human eyes. Their eyes are dull, they look kind of like the eyes of a cat or a dog, or worse, the eyes of a snake, they look like animal eyes—they just don’t have that unique sparkle, that unique openness that makes us human. Sometimes this dullness can come and go. Like when people are angry, for example, it might go away. They might become less human and more animal. Or it might go away if someone is being intentionally manipulative. The pericardium snatches that light away from the eyes, it hides it away. It keeps people from accessing the emperor. It keeps people from seeing your soul.

In discussions of disease and health, it can be easy to fall into ideas of good and bad, healthy and unhealthy, evil and upright. But it’s important to remember that there are still two sides to this issue, and we’ll get into both a little bit. Focusing on the importance of the idea of morality in medicine, we see that, to some extent, the ideas of good and evil are always part of medicine. The practice of medicine always involves an implicit discussion of morality, because it prioritizes a state that we call health. Health is good and sickness is bad, right? You wouldn’t seek medical treatment if you didn’t think something about your life wasn’t going well, if you didn’t think something about your life was bad. But the body also has an innate sense of morality. It’s built into the organs and built into the channel system. It’s built in that you can’t breathe air full of smoke and poison, because it will cause disease. You can’t just eat unclean foods and drink unclean water, because it will cause disease. And you can’t just have sex all the time with everyone you want, because it will cause disease. So it’s important to remember that morality is part of medicine. When it comes to the body, it’s simply not true that anything goes, and that morality is relative, or that morality is a social construct.

All of this gets into the discussion of what happens the emperor goes awry. Of course, the shen, the spirit, is a gift from the greater spirit; we often call this greater spirit “the big shen” in modern Chinese medical textbooks. Our heart holds the little shen, which is borrowed from, and really belongs to, the big shen. But even though we have borrowed this shen, there’s a bit of an issue: as the Chinese tradition and the Orthodox Christian tradition are both well aware of, man has perfect free will. We can do whatever we want; the emperor can do whatever he wants. And, in China, when the emperor goes way off the rails, and he disregards the health of the empire in pursuit of worldly pleasure, like sex, drugs, rock and roll, and alchemical elixirs made out of mercury and arsenic, he is really asking for the empire to fall apart. And people start muttering amongst themselves—I think the emperor has lost the mandate of heaven. I think that the big shen doesn’t approve of him being emperor anymore. So the whole dynasty falls, and a new dynasty replaces it—which, is, by the way, proof that the mandate of heaven has been lost. If the emperor had successfully squashed the rebellion, on the other hand, it would be proof that he still had the mandate of heaven.

So the emperor, just like the minister, can go off the rails too. Excessive joy in Chinese medicine scatters the qi. So when you have too much joy, when you’ve done a lot of cocaine, or ecstasy, or mushrooms, or anything like that, which can produce tremendous amounts of joy and excitement at the time, you might find that, years later, your heartbeat is irregular, your moods are all over the place, you can’t think straight anymore. It’s because the heart qi was depleted from all that joy. It’s because the emperor was given free reign, to fulfill his whims. And now, the emperor doesn’t know how to beat anymore, it doesn’t know how to rule the body anymore. And chaos results in the empire.

And, looking again at children, which are, as I mentioned before, one form of the ideal of the spiritual path, there’s a very different, but also very true perspective on them that we have to consider. It’s a little Freudian. According to Freud, children are ultimately just selfish, jealous, and completely driven by pleasure. If you gave a kid a giant bag of candy, and told them to do whatever they wanted and left the room, most kids would just eat the whole bag, with no regard for the consequences. Kids aren’t inherently well-behaved. They need to be taught how to interact with others. They need to be socialized. They need to be taught how to share. They need to be taught how to be considerate to other people. It’s not an inborn characteristic.

So if the human heart was just left to its own devices, with no training, with no conditioning, with no pericardium, then the whole system would fall apart. Just like we see most clearly in the example of children, the sovereign fire seeks control. It wants to be in charge of life. But when you become in total control of your world, when you become in total control of your experience of pleasure, like happens with drugs, pornography, sex, all these things that bring joy and are increasingly placed at the cornerstone of our modern world, our Brave New World, it results in an unhealthy heart. There’s nothing wrong with seeking pleasure. It’s natural. There’s no problem with seeking love. The problem is pleasure out of control.

The ministerial fire is meant to bring the sovereign fire into balance. The ministerial fire seeks redemption, justice, right and wrong. The ministerial fire takes a moral code and uses it to shape the emperor’s actions. Only through the merging of these two fires, the constant dynamic interplay between them, can we access the Big Shen. The real Shen. The love that belongs to our body’s sovereign fire isn’t perfect. Imagine if you asked your mom how much she loved you and she said, “I love you as much as I love cocaine.” It’s a different kind of love, the love we have for cocaine—the Greeks often talked about it as Eros. Erotic love.

It’s only through the ministerial fire merging with the sovereign fire that we can access the love that we’re really looking for. Unconditional love. Love that is beyond matter. Love that transcends reality, love that goes beyond this lifetime. Love that doesn’t require us to take cocaine, have a bunch of sex, or eat too much mac and cheese to experience pleasure. For the Greeks, this other kind of love would be agape love. The love of a parent for their child. Unconditional. Never-ending. Always present. Even after they die.

A lot of us don’t have a good foundation in that kind of love. A lot of us have never experienced that kind of love, from our parents, or from anywhere else. And, since we’ve never had it before, we might not even recognize it if we finally saw it. At least, we wouldn’t recognize it if we weren’t paying attention. I personally think that everyone has the ability to recognize it built in somewhere, everyone knows what real love is supposed to feel like. What truth is supposed to feel like. But we have to be willing to be open to this truth, to this love, and in order to be open to it we have to be willing to break down some of what we think, some of our preconceived notions. Our notions about what love is like, what truth is like. We’re going to have to leave what we were taught, leave what’s socially acceptable, leave what’s comfortable, because what’s comfortable is what’s killing us. Only by leaving all this can we open ourselves up to finally experience real love.

For most of us modern people, between our heart and our pericardium, something’s off, and we have a lot of trouble feeling safe, at home, and loved. Up until the 20th century, there has really been no school of thought in Chinese medicine that focused exclusively on diseases of the heart. There’s been a school that claims that the Liver is the root cause of all disease. There’s been a school that says that it’s the Spleen. There’s been a Lung school. There’s even two separate schools for the left and the right kidney. But there’s no heart school. Like I said before, heart issues have been treated by working with other organs. It would be hubristic to treat the emperor directly. But finally, in the 20th century, many notable formulas were written specifically for the heart, particularly by John Shen, a modern master, whose unique style, unique pulse diagnosis, and lineage are best captured in the writings of Leon Hammer. The reason I mention this is that there seems to be a growing recognition, even among modern practitioners of an ancient medicine, that we are now living in unparalleled times. One could argue that the fact that we finally had to make a “heart school” after 2000 years of medical history is a testament to the fact that the soul of our society, the spirit of our society is sick. It’s crying out for help. Something’s wrong. The way we think about love is wrong, the way we connect with others is wrong. People are depressed, mental illness is rampant. Disease of the physical heart is rampant, too. Our hearts are sick. We’ve lost contact with the Big Shen, with the universe, with God. And this disconnect is making us sick.

One of the most interesting aspects of the Shen-Hammer lineage and pulse system is the emphasis it has on trauma. Shock and trauma affects the heart. And I’m not just talking about trauma like from war, or from an abusive upbringing, I also mean things like physical trauma, like repeated concussions, or like birth trauma, where something didn’t go smoothly for the baby in the birthing process. And there’s also more gradual trauma, like the effects of repeated over-exercising, like we see with high intensity interval training or long distance running. All of these affect the heart. All of these traumatize the heart.

Shock and trauma is a very complex issue in Chinese medicine. In fact, there’s a whole book that has recently been written about it, that I love, called Heart Shock by Ross Rosen. It’s a great book for practitioners, but would be a little too much for patients and laypeople. That’s linked in the description below. But there are some general things we can say about the physiology of shock and trauma, and the pathology that can happen when it’s not processed properly. When we’re in shock, when we’re traumatized, the pericardium takes over. He shuts all the doors, brings all the blood in to the heart, and holds it for safe keeping. He closes the orifices and says, “it’s not safe to go outside. Stay in the throne room.”

It's a good response. If you didn’t have that response, your world would fall apart. Imagine experiencing the horrors of war, and needing to process them while you’re still on the battlefield. You’d freeze, you’d cry, you’d fall down sobbing, and you’d ultimately get killed. Or coming from an emotionally abusive home. Your priority number one is to get out alive.

The pericardium channel in acupuncture is the master channel for emergencies. It treats pain, bleeding, serious febrile illness, including seizures and loss of consciousness. Points on the pericardium channel are known to release endogenous opioids—the channel helps you cope with the fact that life is really too painful to keep living.

The pericardium helps us deal with trauma. And it has a lot of tools, a lot of lenses to do so. To understand some of these tools, let’s look at the channel anatomy. The external pathway of pericardium channel runs between two tendons, between two muscles, between two tight places. On the upper arm, it runs between the two heads of the biceps. It’s a tight space, full of tender spots, that most people don’t even realize is there. On the forearm, it runs on the inside, the yin side, between the two prominent tendons all the way up to the wrist. The tendon of palmaris longus and flexor carpi ulnaris. It’s a tight little gap. It’s perfectly straight. And it’s right down the middle.

The pericardium channel is the middle path. Just like the middle path of Buddhists, or Aristotle’s doctrine of the mean, or the moderation that characterizes many religious paths, the middle path takes the extremes of passion of the emperor and tames it using religion, morality, judgement, and identity. A lot of these words have become bad words lately. But I like to point out that Rudolf Steiner, a frank esotericist and occultist, believed that moral development is the foundation of spiritual development. We need to start with a sense of right and wrong, we need to start with these foundations and judgments in order to begin to rein in and manage the heart.

The pericardium is the stories that we tell ourselves in order to live. Like I was saying before, the pericardium lies to us. It protects us. It tells us a neat story about how things are, so that we can understand our place in the world and understand ourselves in simple terms. It might tell us that the original two humans were fashioned out of ground up corn, and imbued with life from the Gods, and that all people are descended from these. That’s the Mayan creation myth. Or maybe it’s that all modern people are descended from billions of years of evolution, and a kink in the chain that separated monkeys from people. That’s the Darwinian creation myth. Whatever understanding we come to, we are always working with a partial truth.

Sometimes we tell ourselves that we are the way we are because of a specific traumatic event that happened in high school. It makes for a good story. It helps us understand our world and our tendencies. But then, ultimately that story has to crumble. Because you’re more complex than something that happened to you in high school. You and your soul are infinitely more complex than any story that can be written into a high budget motion picture, or even a best-selling novel.

So the basic format of the circulation in Chinese medicine—we go out into the world. Without self-consciousness, we go out, trying to experience the joy and the beauty of what the world has to offer. We go out looking for love and connection and life and beauty and everything in between. And then something happens. We don’t get what we wanted. Life’s not that easy. It didn’t turn out the way you thought. Your girlfriend suddenly breaks up with you. It seems like out of the blue, for you, but for her it’s been a long time coming. You thought you were both in love, you thought you were connected. You thought you were feeling the same thing. But you weren’t. And she lets you know that the way that you were perceiving your reality is wrong. She lets you know that she wasn’t feeling the same thing as you. It hurts. It breaks your heart. You don’t know what to do.

When we experience trauma, when we experience adversity, when we experience things that we don’t know how to deal with, the pericardium gets activated. That’s fine, like I said, before. Maybe you weren’t perceiving things accurately, maybe you were being naïve. Your emperor needs that feedback from your minister, so that he can reach towards truth, instead of his personal whims. But then we have an option. There are two ways of responding to trauma. We could stay clamped down, and let our trauma prevent us from living out our lives fully. The pericardium could strangle out the heart, and tell us “it’s never safe to go outside again, it’s never safe to date again, because she broke up with you.” And, inevitably, when we act in that way, when we act exclusively with our pericardium, we are manipulative, conniving, petty. We are like the eunuch. In Chinese medicine, the pericardium is the beginning of personality disorders, of narcissism, of borderline personality disorder, of all of these patterns that people have where they try to inflict suffering on other people because THEY are suffering. They don’t know what to do with their trauma, so they just keep traumatizing others, the people around them, the ones that they’re supposed to love, the one’s they’re supposed to be sharing their heart with.

The other way we can deal with trauma is by letting go. By harmonizing. By using the pain and the suffering to guide us back to the middle path, and to help refine our heart. There’s a beautiful line from the Psalms that I always think of when thinking about the heart and the pericardium, “A sacrifice unto God is a broken spirit, a heart that is broken and humbled God will not despise.” It’s only through the adversity, the trauma, the hardship that we can really reach towards truth, towards heaven, towards God. But only if we process it properly.

I promised earlier that we would talk about medicine that is beyond good and evil. That we would look at the heart and pericardium, and look at this dynamic of pain and suffering, harmonizing and managing, without thinking of the organs and their innate tendencies as either good or bad. This last point is the springboard to that discussion. The fact of the matter is, the things that we tend to call “bad” are really the things that perfect our heart. The things that are heartbreaking, that are impossible for us to deal with, they are the things that transform the heart into something more beautiful, richer, and more harmonious.

And with the pericardium, we have a lot of tools that we can use to help us process it properly. We have religion and spirituality, we have stories, we have things that we can do to harmonize the blood, to help us make sense of the pain. That’s the pericardium at its best. The pericardium channel connects to its paired channel, the liver, and through the liver is able to ascend to the vertex of the head. It’s able to ascend into the heavens. Without these stories, we are completely unable to make sense of the heartbreak. But it’s very important that our stories about the heartbreak do not ultimately become a cage for us, and don’t ultimately prevent us from living our lives, and seeking out new and beautiful experiences.

The pericardium has another role, another job in the empire, this one discussed explicitly in Huang Di Nei Jing Su Wen chapter 8. According to the Su Wen, the pericardium is the court jester. The pericardium is in charge of making the king laugh, bringing forth joy, of making light of the tragedies in the empire. This is the healthy role of the pericardium, this is the healthy role of spirituality, this is the healthy role of story-telling. To free us from our tragedies, and bring us closer to a truth. When a child’s toy is broken, it seems like the end of the world. When we experience pain, loss, and trauma, it feels like the world has completely fallen apart. Our emperor cannot handle it. But then the pericardium, the jester, reminds the emperor that the world has not fallen apart. Not by gaiety and brightness necessarily, not by slapstick humor. Sometimes it’s dark humor. In my experience, I find that it’s a common occurrence that grieving and funerals tend to bring out very deep, profound laughter in people. Sometimes the jester tells a different story, in order to move the blood, in order to enliven the king once more. Because how can the king wake up and live another day after the tragedy? How can we keep living when we’ve lost everything that we thought life was about?

The pericardium is not the enemy. However, just like any organ, it can be in harmony with our lives, or it can be out of harmony. It can be a massive help, or a massive stumbling block. There was a lot more basic physiology I hoped to cover in this episode, but that will have to wait until our next episode on the heart, when we talk about the brass tacks of alternative theories of circulation. For now, I hope that you have a new perspective on everything that’s going on in your chest and circulation, and I hope that you tune in next time on “Classic of Difficulties.” As always, keep asking questions, and stay difficult.