Psychiatric and psychological conditions are a common experience in the daily clinical process. In this paper, we will discuss the normal shen as a method of understanding conditions such as depression, anxiety, bipolar disorders and addictions. We have been interested in the importance of shen harmony for some time and consider shen to be the capstone of human experience.
While the wisdom of working with human shen has been lost for some time, there is a new movement in contemporary times to recover the art of the shen. There are increasing publications and courses on shen as renewed interest and inquiry emerges. However, the complexities are limited to the conception of shen. The practical use of this discipline is far from clinical, in part because of the impact of a Newtonian physical conception of reality that has impacted the development of scientific approaches to medicine in the East and West. Further, the needs for physical pattern diagnosis, reports and other demands of contemporary practice limit the attention of the practitioner. There are other factors that have impacted the development of shen concepts in clinical practice, including superstitions and beliefs that can become confusing or easily dismissed on conventional cultural settings.
The ideal shen presents with a healthy, harmonious spiritedness. The loss of shen presents with spiritlessness and mental illness. This is the Chinese medical condition described as “shen disturbance” and includes mental and spiritual pathological conditions. The patient’s spiritedness may be evaluated by using the four examination methods of Chinese medical diagnosis: observation, olfaction, inquiry and palpation. Ever since the Chinese medical classic the Nei Jing emerged, many early practitioners have worked on the shen for various mental disorders, providing a clear view about healthy shen and shen harmony. Following Nei Jing theory and early practitioners, we know the practices of shen harmony and spiritedness include concepts such as shen unity, shen awareness, shen clarity, shen flexibility, shen stability, shen balancing, shen power, shen reactivity, shen initiation and shen processing. These discussions may be found in the Nei Jing Su Wen, chapters 1, 2, 13 and 25. The Ling Shu discussions of shen are in chapters 8 and 72.
A healthy mental state may be described as a harmonized shen. Similarly, the Su Wen (Shang Gu Tian Zhen Lun, chapter 1) states: “The Yellow Emperor of ancient times was bright and clever when he was born.” This description suggests that the Yellow Emperor had a harmonized shen. Since it was from birth, it implies that pre-heaven essence is involved. The Chinese medical conception of shen, however, is not assessed based only upon factors of spirit or mind. Observations may include hand or eye movements as expressions of shen . Further, observe the hair and nails for a deeper knowledge of the shen during clinical diagnosis. This provides a better understanding of the yin essence and blood which provide a root for the shen. We will now discuss the shen concepts individually.
Shen resides at the interior and fills the physical form. When shen is harmonized with the physical body, the physique and shen are harmonizing in oneness. The shen located in the heart is a singular concept called heart shen. The shen is also a plural concept and may reside in various organs. For example, the shen residing in the liver is called the hun; the shen residing in the lung is po; the shen residing in the spleen is yi; and the shen residing in the kidney is zhi. In a healthy state, these shen are united in a cooperative state. When the shen are harmonized together, creating the big shen, there is harmony throughout mind and body. Correspondingly, each organ system has its own shen pattern and activities, and must function cooperatively with other organ systems in order to perform the activities of the shen. Shen unity is an important component of healthy mental function so people move through life in contact with and using wisdom. Shen unity is an integral state of being that demonstrates congruency between the subpersonalities and can be observed by the practitioner via clinical signs.
If a single shen is hyper- or hypofunctioning, it also can affect other shen or systems. For example, heart fire may lead to heart shen irritability; the person who suffers from this condition may be easily startled or experience anxiety and insomnia. If the heart qi is weak, this may lead to a weakness of the heart shen and the patient may feel sad or have sluggish mental powers. A happy and enjoyable life requires attention not just to heart shen; there also must be cooperation from the hun, po, yi and zhi in a harmonious state.
Shen awareness extends from self into an individual’s social context. At the level of self, consciousness involves awareness of being, actions and location. Further, there is knowledge and awareness of orientation with complex social and life situations. For example, the patients know their family members, co-workers and relevant details about their lives. When the patients have good shen awareness, their shen situation will generally improve while they work with their doctor cooperatively and have good compliance.
When treating shen disturbance, it is necessary to assist patients in the recovery of their shen awareness. The general status of shen harmony is an indicator for progress in the treatment of mental disorders. For example, some severe shen disharmony patients have significantly reduced or no shen awareness; they may refuse to see a doctor or deny their unbalanced behaviors. Consciousness is shen awareness; mild shen awareness troubles may be related to the reorganization of current situations, while severe shen awareness disorders may involve a complete loss of consciousness.
Shen clarity involves an aspect of consciousness that remains clear and unclouded. With shen clarity, the individual has clear thought processes and stable shen activities. The mind develops breadth and depth of consciousness. Thus, we can understand that great thinkers have developed shen clarity. The development of shen clarity usually requires a harmonized shen. The Su Wen (Mai Yao Jing Wei Lun, chapter 17) mentions, “The head is where the spirit located.” Here, “spirit” is translated into English from the Chinese word jing ming, where the head houses the jing essence and the ming is the clarity property of consciousness.
Many patients with mental disorders have disturbances of shen clarity. They complain of mental cloudiness and a lack of ability to maintain focus. Disturbed shen clarity may be described as a foggy feeling with poor thinking ability and loss of memory.
Shen activity is working in a balanced condition. According to the Ling Shu ( Tong Tian , chapter 72), a yin/yang constitution is the most balanced personality and is ideal. There are four additional forms with relative differences in the balance of yin and yang. The tai yin type has more yin and almost no yang, while the shao yin type has less yin and some yang. Tai yang is predominantly yang with very little yin, and shao yang is mostly yang with some yin. Here, we are using the yin/yang principle to explain the five types of personalities. When the person is more of a yin type, the shen energy is directed inward, similar to Jung’s concept of the introvert. The tai yang and shao yang types are outgoing personalities and the shen energy acts differently, extending outward.
The ideal type of shen is expressed in a yin and yang balanced manner. For example, we may have natural emotional responses to external stimuli or endogenously generated feelings and thoughts. In these situations, it is the shen harmony power that provides the capacity to control and recover relatively normal states. Thus, when crying or angry for some reason, we feel relief afterward. However, this recovery occurs when the emotions are within a tolerable range. The shen knows that to avoid the further damage from extreme emotional reactions, it must keep these extremes in balance, or a proper harmonious condition. Thus, if someone feels angry much of the time, experiences chronic sadness and depression, or otherwise has a flat affect with little emotional response range, we can call this situation a loss of shen balance. This situation is discussed in detail in the Ling Shu (Ben Shen, chapter 8), which mentions, “When liver qi is deficient, it feels fear, excess is anger; when heart qi is deficient, it feels sad, excess is over-joy.”
Shen energy expresses differently according to different types of personality and constitution. The qi transformation theory provides an opportunity and method for evaluating the shen power and clinical progress. Shen qi can be strong or weak, depending on the clinical condition.
Normal daily cycles require shen power and physical vitality, and are balanced with physical and mental rest at night. There are also social, economic and family needs that require the expression of shen. Such efforts require both mental and physical power. Some patients may be fatigued both mentally and physically; they tend to feel their energy leave quickly. Some patients feel mental exhaustion more than the physical. Clinical depression is a typical diagnosis associated with the pattern of shen qi weakness. Many forms of mental disorder have shen lassitude and sluggishness in the early stages that also correlate with weak physical energy. This is a type of shen disharmony. Conversely, the shen qi may be too strong and active, so patients feel more joyful and have an optimistic mood all the time, need little or no sleep, and have abundant mental and physical energy. This is the manic yang pattern of the shen disharmony condition. Such mood disorders may present either subtly or in the extreme, which could lead to a conventional diagnosis of a bipolar disorder. In either regard, there is a disturbance in the harmony range.
The shen and xing should harmonize. This is commonly known in Chinese medicine as “physique and shen harmonizing in oneness.” Thus, the shen power affects the physique, leading to a zang fu (viscera and bowel) system disharmony condition. This concept is discussed in the Ling Shu (Ben Shen, chapter 8): “I was told the human body is different in character: some are firm and some are soft in the personality; some are strong and some are weak in constitution.”