Several decades ago, the concept of personality as a predictive factor in disease was formally

introduced to the West. Appreciation of the Type-A personality, with its hostility, its hurried mindset and
polyphasic thinking, drew widespread attention to emotion as a factor in the genesis of disease. Subsequently,
another illness-prone personality type-Type D-was recognized by its characteristic suppressing of negative
emotions. Western clinical researchers in recent years have scrutinized the relationship between emotion and
illness. Can negative thinking, they ask, make a person sick? More recently they have added, in counterpoint:
can positive thinking (generated by prayer and imagery) help a person heal? While these questions may pose
a fairly binary approach to the matter, binary it must be, since Western clinical studies cannot be conducted on
poetic or allegorical explanations of mind/matter such as we find in Traditional Chinese Medicine. For
authentic practitioners of Oriental Medicine, however, the interplay of organs/emotions/spirit is inescapable.
An ancient text, the "Huang Ti Nei Ching", compares the function and position of internal organs to
hierarchies found in an empire. It tells us: "The heart is like the minister of the monarch who excels through
insight and understanding; the lungs are the symbol of the interpretation and conduct of the official jurisdiction
and regulation; the liver has the functions of a military leader who excels in his strategic planning; the gall
bladder... excels through his decisions and judgment; the middle of the thorax is like the official of the center
who guides the subjects in their joys and pleasures...the kidneys are like the officials who do energetic work
and they excel through their abilities...." (1)
In her translation of the "Nei Ching", Ilza Veith explains that the heart, the spleen, the lungs, liver and
kidneys "determine the functions of all the other parts of the body, including the bowels, and also of the
spiritual resources and emotions"(2). Logically then, we should consider involvement of these five organs
when the issue of emotional problems is presented. Has the comparative weakness of certain organs, we
might ask, exposed a patient to illness or to prolonged recovery? Could the illness cause depletion of specific
organs, creating a self-defeating cycle? While the practitioner must be careful to leave psychology to the
psychologists, he or she will nevertheless recognize patterns of behavior/illness and opportunities for therapy
which have been described in ancient texts.

Emotional Concepts
What is the ancient concept of emotions and how does it relate to modern Western clinical practice? In
the book Emotions in Asian Thought, Chad Hansen contends the traditional Chinese concept of mind and
action does not center on "a mental/intellectual world populated by mental/intellectual objects set off against
an external world of physical objects or matter." Nor does this concept contain the Indo-European "distinction
between cognitive and affective states. A single faculty/organ, the xin (heart-mind), guides action rather than
separate faculties of heart and mind"(3).
Giovanni Maciocia, in his textbook The Fundamentals of Acupuncture, widens this premise for the
purpose of clinical practice. Maciocia notes the tradition of Five Emotions: anger, joy, sorrow, fear and
rumination, as well as others, and explains their significance to the practitioner. "The body-mind is not a
pyramid, but a circle of interaction between the Internal Organs and their emotional aspects. Whereas
Western Medicine tends to consider the influence of emotions on the organs as having a secondary or
excitatory role rather than being a primary causative factor of disease, Chinese Medicine sees the emotions as
an integral and inseparable part of the sphere of action of the Internal Organs.... Since the body and mind
form an integrated inseparable unit, the emotions can not only cause a disharmony, but they can also be
caused by it"(4). Anger, according to tradition, affects the liver; rumination taxes the spleen; sorrow depletes
the lungs; excessive joy affects the heart, and fear affects the kidneys.

Fear And Panic: A Case Study

"Extreme fear," says the "Huang Ti Nei Ching", "is injurious to the kidneys." An example of long felt fear
and its taxing effects on kidneys was presented to me in a phone call last year. "Can you help me?" came a
man's faint voice. "I'm agoraphobic; do you know what that means? Have you ever treated this condition?" I
told him I hadn't treated it but knew that it was a debilitating anxiety disorder marked by fear of public places
and situations that are associated with panic attacks. "That's it," he said. "I haven't been away from my house
in six years. Only, I get attacks even when I'm at home. Sometimes my heart starts beating like crazy, like I'm
going to have a heart attack or go nuts."
The man's symptoms conformed to the DSM (Diagnostic and Statistical Manual) requirements for panic
disorder. These requirements are four episodes in a four-week period, featuring four of these symptoms:
pounding heart, tightness in the chest, shortness of breath, feeling of choking, tingling, faintness, shakiness,
trembling, fear of losing control, hot flashes, a sense of unreality and a fear of going insane or dying. To
compound these troubles, comments Jerilyn Ross in her book, Triumph Over Fear, while "the fear during an

attack is real, raw, crushing, and overwhelming...physicians tend to write off patients as neurotic or
hypochondriacal"(5). This may be a monumental oversight if one considers that 2.4 million Americans suffer
from panic disorder in any given year (National Institute of Mental Health).
The man on the phone drew a deep breath. "It means you'd have to come to my house," he said, "since
I can't go out." I drove to the upscale section of Los Angeles where he lived. His house, a sprawling mass of
glass walls and sharply angled stucco slabs, was a specimen of the atomic era. And like the atomic era, it was
a vision gone bad. Currently, the expansive yard was overrun with weeds and the many windows were
covered by torn, yellowed curtains and sagging, rusty blinds. Kicking aside an empty mayonnaise jar, I walked
a wide limestone path to his door.
The man who answered my knock was six feet tall, fifty years old and was clearly a frail version of his
former self. Noticeable also were deep brown circles under his eyes (kidney area of the face). While he
retained a full head of hair, it was unmanageably dry and had been corralled into a ponytail. "Come in," he
said, waving me into a musty hall. He handed me his dry, bony hand to shake. His name was Frank and for
many years he had been a successful stunt driver for television. The "King of Car Chases", they had called
him.
Unfortunately, he had experienced three mishaps in the course of six months, the last of which landed
him in a full body cast. Upon recovery from his most recent accident, he found himself unable to drive to work;
panic gripped him when he got behind the wheel. He had tried therapy without success (probably a poor
choice of therapist), had spent a fortune on therapeutic audiotapes and books and, because of his refusal to
take medication, was considered "a faker" by his family.
Based on query and observation, I formed a diagnosis and treatment plan. While many agoraphobics
cannot locate the specific cause of their disease (it may be the accumulation/magnification of perceived
dangers), Frank's crippling fear seemed traceable to his continued mishaps and their potential future
recurrence. "Kidney Qi energies," writes Leon Hammer, M.D., in Dragon Rises, Red Bird Flies, "help us to
anchor ourselves in the gestalt of the 'here and now'..."(6). Overall depletion of the kidneys was manifested in
a deep, weak kidney pulse (the proximal position on the radial artery), lower back pains, tinnitis, palpitations,
dizziness and dark pouches under his eyes. Chronic fear had taxed Frank's kidney Yin, as his dry hair, skin
and acquired boniness attested. He was the shriveled relic of a once-daring stunt driver. His depleted kidneys
failed, as the Nei Jing says, "to do energetic work and excel through...ability." Frank's abilities were being
wasted, although I wasn't certain the world would be improved by more car chases. Nevertheless, I decided
on a therapeutic principle and a "points strategy" as outlined in The Treatment of Disease in TCM.(7) I
determined to supplement the kidneys, fill the essence, and fortify the will. My formula would have been a
modified "Liu Wei Di Huang Wan", except that Frank was in terror of herbally-induced panic. Herbs were not
an option. Predictably, Frank was also in fear of needles. I therefore gave him a kidney-enhancing mix of
shiatsu and tuina, later convincing him to accept but four needles (L14 and LIV3 bilaterally) to "open the gates"
and allow Qi to flow.
When I returned to the office, the phone was ringing. Frank was in a panic. The unleashing of the Qi
prompted by my nominal needling had caused him alarm, triggering a panic attack. I reassured him and talked
him into a calm state of mind, agreeing to return the following day. In subsequent twice-weekly visits, I gave
him nothing but acupressure and tuina, always with the purpose of stoking kidney fire. Over the course of
several months, he reported gradual improvement and began venturing away from home, driving to the mall
with family and attending church. While there are occasional setbacks, his overall outlook is favorable. An
increasingly confident and robust Frank is now searching for a qualified therapist... and, at my urging, a desk
job.

Anger: A Case Study

"Sickness of the liver," the Nei Jing tells us, "causes...people... to have fits of anger." Anger causes Qiand tempers-to rise. Maciocia reminds us that anger can be considered to include irritability, frustration, rage,
indignation, animosity or bitterness. Anger, when expressed appropriately, may not cause harm; when chronic
or suppressed, it may become pathogenic. A study published in a recent issue of The Lancet found that the
"Type-D personality was a significant predictor of long-term mortality in patients with established CHD [chronic
heart disease].... Personality traits should be taken into account in the association between emotional distress
and mortality in CHD"(8). The American Journal of Cardiology concurs: "Anger is the effective state most
commonly associated with myocardial ischemia and life-threatening arrhythmias. The scope of the problem is
sizable-at least 36,000...heart attacks are precipitated annually in the United States by anger"(9).
When anger causes Qi to rise, symptoms are naturally expressed in the upper part of the body. A
patient will often exhibit dizziness, a flushed face, tinnitus and headaches (frequently parietal). His or her
tongue may be red due to liver fire, the result of prolonged liver Qi "stagnation" or "repression." Additionally,
rebellious liver Qi may flow sideways, invading the stomach and its paired organ, the spleen. This will result in
diarrhea and indigestion.
Liver Qi oppression and its consequences were embodied in a diminutive lady named Mrs. LeBeau.
While Mrs. LeBeau may have been petite, her repressed fury was not. She solicited my help with resolving
increasingly frequent parietal headaches and indigestion. It took little effort to discover the cause of her illness.
Removing her suede pearl-white gloves and placing them on my desk, Mrs. LeBeau marched to my
treatment table and lay down. She then said hello and held out her hand impatiently. Not knowing if she
expected me to shake it or kiss it, I took her pulse instead. She was, by her account, "fifty-something," yet I
noticed she had fewer wrinkles than the Chanel pant suit she had poured herself into. Her pulse was "wiry" in
the liver position, suggesting pain or repressed anger. Mrs. LeBeau spoke incessantly and admiringly of her
husband, a highly successful corporate motivational speaker. She was, she said, the luckiest woman in the
world. Her unstoppable eulogizing of Mr. LeBeau, however, was clearly practiced, as if she had delivered the
monologue many times previously. It was only as she relaxed that her pace slowed and, eventually, a frown
made her lips droop. In a sudden burst of tears she revealed her husband abused her, and she did not love

him anymore. Leaving him was a moral impossibility since he had recently been diagnosed with cancer. "And
besides," she sobbed, "it simply isn't done! Are you or are you not going to offer me a tissue?" It was
interesting to note that Mrs. LeBeau's cosmetic surgeon had removed all facial evidence of intense liver Qi,
lines which extend vertically from the inward tips of the eyebrows. Resigned she was to a duplicitous life,
attending social functions and televised events wearing a smile that was not her own. Meanwhile, her
headaches had become frequent and nearly intolerable. Food, she complained, caused her to bloat and belch
and she experienced a continual bitter taste.
While there was little I could do to improve the circumstances of her life, I was able to address, on an
energetic level, Mrs. LeBeau's liver symptoms. Her long-repressed anger forced rebellious liver Qi to flow
upward, causing headaches and bitter taste, and to flow "sideways," toward the stomach/ spleen. The result
was indigestion and bloating. If left unchecked, suppressed liver Qi could turn into liver fire, with its attendant
violent, unpredictable behavior. My treatment plan was to soften the liver and descend rebellious liver Qi.
Modified Xiao Yao was the herbal remedy.

Statistical Proof
My concern for Mrs. LeBeau was further fueled by statistics recently published in Nursing Research. In
an article, "Women's Anger: Relationship of Suppression to Blood Pressure," we find a 12-year Michigan study
of middle-aged men and women which "showed that suppressed anger significantly interacted with elevated
blood pressure to produce the highest mortality"(10). It appeared that people with elevated blood pressure
who scored higher on anger suppression were five times as likely to die than hypertensive people who
expressed it. On reading this, I directed Mrs. LeBeau to a qualified therapist whom she now sees regularly in
addition to receiving her acupuncture treatments.
As these case studies show, the management of emotion-associated illness may be slow, requiring
great patience and the scrupulous application of ancient Oriental principles to modern dilemmas.
Nevertheless, such concepts of emotion, illness, and the expression of character are as pertinent today as
they were more than a thousand years ago when Laotse wrote:
"Those who are disturbed by their senses and minds cannot preserve their own character. How much
less can they follow the Tao!" (11)
Names and circumstances have been changed to protect patients' privacy. Charles Yarborough, L. AC.,
NCCA, practices acupuncture in the Los Angeles, CA area.
References:
1. Veith, Ilza. The Yellow Emperor's Classic of Internal Medicine. Berkeley: University of California Press,
1972, p. 28.
2. Veith, p. 25.
3. Marks, Joel, and Ames, Roger R., eds. Emotions in Asian Thought: A Dialogue in Comparative Philosophy.
Albany: State University of New York Press, 1995, p. 183.
4. Maciocia, Giovanni. The Foundations of Chinese Medicine. New York: Churchill Livingstone,Inc. 1989, p.
129.
5. Ross, Jerilyn. Triumph Over Fear. New York: Bantam Books, 1994, p. 19.
6. Hammer, Leon I. Dragon Rises, Red Bird Flies. New York: Station Hill Press, 1990, p. 111.
7. Soinneau, Philippe, and Gang, Lu. The Treatment of Disease in TCM, Vol 1. Boulder: Blue Poppy Press,
1996, p. 250.
8. Denollet, J., Sys SU, Stroobant, N., Rombouts, H., Gillebert, TC & Brutsaert, DL. "Personality as
independent predictor of long-term mortality in patients with coronary heart disease." The Lancet, 1996;
347:417-21.
9. Jain D, Burg M. & Zaret BL. "Prognostic implications of stress-induced silent left ventricular dysfunction in
patients with stable angina pectoris." Am. J. Cardiol, 1995; 76:31-5.
10. Thomas, Sandra P. "Women's anger: relationship of suppression to blood pressure." Nursing Research,
1997; 46:324-30.
11. Yutang, Lin, ed. The Wisdom of Laotse. New York; Random House, Inc., 1976, p. 85.
The following books referenced by this article are available from our Online Qi Catalog at or 1-800-787-2600.
The Yellow Emperor's Classic of Internal Medicine: #B271
The Foundations of Chinese Medicine: #B436
Dragon Rises, Red Bird Flies: #B178
The Treatment of Disease in TCM, Vol. 1: #B079