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Dr. Leon Hammer, M.D. - Joy, Sadness, Anger, Reflection, Fear - COMAccording to Chinese medicine, the aetiology of disease is systematized according to internal agents and external agents. It is the internal causes that are relevant to our discourse. While many texts list these inner agents of disease as being seven in number, some reduce the inner causes to just five - joy, anger, reflection, sadness and fear- to fit the Five Phase Theory.


With regard to the traditional organ system, there is overall agreement within Chinese medicine that, when excessive, anger injures the Liver, joy injures the Heart, reflection injures the Spleen, sadness injures the Lungs, and fear injures the Kidneys.

Allusion to these vital organs is to be interpreted only in energy terms, where conceptually the Heart, Liver, Spleen, Kidneys, and Lungs are clearly distinguished from the material organs. In reality, they are in a continuous dynamic exchange, and, at the point where ‘energy’ solidifies into ‘mass’, these concepts merge and the distinction is clinically obscure. While Chinese medicine is equipped to address both energy and mass, it clearly speaks most eloquently to the former.


Joy affects the Heart, which is said to be the home of the spirit. The joy is equated with energy on the ‘mental’ plane; thus, the Heart controls the mind. Excessive joy (shock) injures the mind by creating too much fire, causing excitement or overtaxing of mental energy. This may lead to palpitations, anxiety, insomnia, irritability, and/or shortness of breath, depending on whether the deficiency is one of qi (kinetic energy), blood, or yin (water). This is known as a disturbance of the shen, or spirit. Conversely, an energetically weak Heart can make one vulnerable to shock.


Unreleased anger damages the Liver, and a diseased Liver gives rise to easy anger. The classics say that the Liver corresponds to the phase Wood. In Wood, the sap must flow. Anything that inhibits the flow of this material (yin) aspect of the energy will cause a greater output by the functional (yang) energy. The result is a nonproductive ‘heat of friction’, known in Chinese medicine as heat from deficiency (emptiness, weakness). As the heat from deficiency increases, the entire organism undergoes a subtle rise in temperature, experienced as tension and ultimately pain. The Liver stores the blood, which becomes hot as the heat from deficiency accumulates in the Liver. The increased Liver heat has many manifestations on a physical level, and on an emotional level this ‘slow burn’ or ‘fast burn’ is expressed, respectively, as smoldering or as explosive irritability and anger. One might say that the person has become “hot-blooded”, an expression corresponding exactly to the heating process occurring in the stagnant, stored blood in the Liver.


Reflection (thinking) is the process of attention and concentration in the service of problem solving. The Spleen, which controls the process of digestion, separation, absorption, and elimination, as well as distribution of metabolites, is primarily affected by excessive rumination, which slows the digestive process. Symptoms of anorexia, fullness, diarrhea, and weakness may result. Any injury to the Spleen system will lead to a disorder in thought process.


Sadness concerns an unresolved, and most often unconscious, early experience of grief. Because grief is usually expressed by crying and sobbing, the breathing apparatus at the physiological level is heavily involved in the reaction of sadness. To control the outward expression of sadness, one has to suppress the breathing mechanism. For this reason, sadness at first affects the Lungs. Likewise, Lung disease can lead to unexplained sadness.


Since fear descends to the lower part of the body, it affects the Kidney system, which controls this terrain. The Kidney system in Chinese medicine includes the hormonal function of the adrenal glands, which are the endocrine organs most intimately associated with stress. Prolonged, fearful stress or 'frozen panic' affects the Kidney system, whereas sudden fear most often affects the Heart.


Concerning their effect on overall energy, it is said that anger makes the energy climb to the top of the body; joy renders it harmonious; sadness disperses it; reflection concentrates it (in the brain); fear makes it descend; and apprehension troubles the energy. In some instances, emotion will first affect one organ and later affect the entire balance of energy as that organ deteriorates. In other situations, emotion will have a more general effect on the entire organism; to a lesser extent, or later, it may affect the specific organ systems.


Traditionally, the emotions are regarded as dangerous only when they are extreme. The other factor is the relative integrity of the organ system. Emotional distress originating from organ system dysfunction may produce distinctly different emotional states, depending on whether the organ system is in a state of excess (strong-active) or deficiency (weak-passive). Syndromes of excess (hot, yang, strong) tend to produce conditions of excitement; syndromes of deficiency (cold, yin, weak) result in conditions of a more muted description, such as depression.


This article has been adapted from Dr. Hammer’s book Dragon Rises, Red Bird Flies (Eastland Press, 2005). To learn more about any of the concepts discussed above, please refer directly to the source text.



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Originally appeared 10 June, 2015

The Five Internal Agents of Disease
Dr. Leon Hammer, M.D.