Shen pathology is evident in palpitations, insomnia, heart vexation, wind stroke and “evil” invading the pericardium. Evil is any unfavorable condition affecting heart function, heart sensation, emotions and character.Since the shen dwells within heart, conditions affecting the heart also affect shen, and by extension, heart treatments include the shen. The heart-shen connection is reflected in the pulse. A depleted shen will be reflected in a weak, turgorless pulse. The “spirit” of pulse, as one would speak of a spirited pony, is also a sign of harmony between the three treasures, san bao, which include jing and qi. San bao, as esoteric as it may be construed, is a reminder that shen cannot be reduced to purely mechanical heart function. Blood and its concomitant aspects of production, storage, and content reflect shen. Shen pathology arises from pathogenic attacks to heart and blood. Pathology may also arise from deficiencies in the production of blood and cellular fluids.
Heat is a primary pathogenic factor affecting heart. It can scorch blood, causing blood and yin deficiency. These conditions leave no place for the shen to settle at night, according to the Internal Classic. Essentially, nighttime is yin. The body must be sufficiently comprised of yin in order for yin influences to rise in the evening and thus induce sleep. Insomnia can be treated by nourishing the blood with herbs like dang gui and rhemania. The spirit should also be settled with sinking herbs like mu li and dragon bone.
Cold is a pathogen that usually arises from deficiency when the body cannot ward off cold attacks. Naturally, those subject to environments that are comprised of constant or sudden cold risk greater outright cold invasion. Usually, however, cold heart symptoms usually arise from deficiency of yang. The yang should be warmed with herbs like fuzi, ren shen, and tu si zi. Pathogenically, cold can join forces with damp to “mist the heart,” causing muttering, profound confusion, and a rattling in the throat. The treatment principle is to transform damp and calm the shen. Fu ling and fu shen will be particularly useful herbs given their ability to drain damp and calm the shen. More powerful drainers like tian nan xing, cang zhu, and bai zhu can be used depending on the degree of individual deficiency.
Psychological symptoms may also be expressed from an attack of phlegm-heat. Mania, agitation, and violent demonstrations characterize this affliction. It should be treated with cooling, calming and phlegm-resolving herbs, such as dan shen, gua lou pi, chuan bei mu and lian zi. Dan shen in particular has the special ability to cool the blood, calm the shen, open the senses, and relieve pain caused by stagnation. The phlegmatic impertinence of this pathogenic combination must be moved while anchoring a fragile temperament. Use dragon bone, mu li, and suan zao ren to anchor.
Deficiency of qi and blood can cause pulse dysfunction. Heart qi deficiency expresses through excessive sweating and palpitations. Application of ren shen, gui zhi, gan cao, bai shao, and long yen rou in varying proportions depending upon the degree of deficiency heat can benefit heart qi by cooling and nourishing the blood.
Heart yang deficiency is a serious condition that resembles shock: cold clammy sweat, shortness of breath, and palpitations. Calming the shen with mother of pearl, he huan hua, and he zi, along with restoring the yang with fu zi, cinnamon, nutmeg, Korean red ginseng is in order.
Blood stagnation arising from heat can be treated with the formula Dan Shen Yin. Heart-blood stagnation is characterized by stabbing local pain, palpitations, and chest tightness. Acute manifestations are extremely serious requiring emergency care. Dispersion at the heart points would be necessary if in the unlikely event one experiences such an attack during treatment. Pericardium 6 and jing points located at the extremities should be considered in such cases. After the emergency, warming blood movers should be provided, such as persicae, safflower, licorice, dang gui and chuan xiong.
Heart yin deficiency causes difficulty staying asleep, night sweats, a deep central tongue crack, irritability, and heat. Tian wan bu xin dan is a spirit calming formula addressing kidney heart disharmony. Beyond the toxin cinnabar, this formula powerfully nourishes and cools the blood of the heart and upper jiao. Consider such herbs as asparagus root, mai men dong, and prepared rhemania.
Shen, Heart, and Characters
Sleep, heartbeat, and sweat are heart-shen indications. Given that shen symptoms appear with heart patterns, heart and shen appear to be virtually indistinguishable. Perhaps this is why Maciocia calls shen, “mind,” a state akin to cognition. If heart and shen were synonymous, however, they would not have different names. To some extent the distinction might be made by viewing heart as machine to shen’s ghost, as in ghost in the machine.
The difference between the characters, particularly the radicals further corroborates a shen-heart difference. Heart is a very basic element that is a radical unto itself. This radical literally undergirds nearly every emotional state, including some of the pathogens and virtues of the other four viscera. For example, thought (si), sorrow (bei), and anger (nu) are all elements of heart, not shen. These emotions invariablely affect shenbut are not of it. The virtue “will” (zhi) demonstrates that characters supported by heart are not exclusively pathogenic. Nevertheless, illness arising from heart is clearly distinct from shen. The word psychology in Chinese is xin li xue, literally the study of heart order. It seems to suggest a meaning more closely related to Maciocia’s mind, not shen. Terms like ambition (literally, wild hearted, ye xin), open hearted (kai xin), and warm hearted (re xin) also show emotions attributed to heart but not shen.
Shen possesses a celestial radical. It dwells within the realm of the spooky kabuki. Shen also manifests in the viscera, but the characters sometimes receive the ghost radical, as in hun and po, the “ghosts” of liver and lung respectively. This means that shen is related to ghosts. There are ghost points on the body that address shen disorders. Two additional characters associated with the same radical as shen are li (ritual distinguish from principle) and ancestor (zu). These characters are related in that ritual is used in worship of ancestors. Formulated action becomes the principle medium for connecting with ancestors. Similarly, shen is a nonmaterial concept that bridges the gap between heaven and man by virtue of its celestial radical.
Mind and shen are clearly not synonymous. Some aphorisms further illustrate this difference. For example, “shen don’t know and ghosts haven’t an inkling,” refers to a stratagem about which most are kept in the dark.A “shen pen” refers to marvelous literary talent, and “shen qi ten feet,” is a way to remark upon one’s talents that stand head and shoulders above others.
Some shen idioms also include heart or characters possessing the heart radical, e.g., shen demeanor (shen qing, including the standing heart radical on the qing character). There is also “shen happy heart drunk,” which refers to great pleasure. Finally, there is “shen will unclear,” which means total withdrawal, catatonia, or unconsciousness.
The following discussion has largely been expository, relating the views of shen within the context of Chinese medicine. Aside from describing shen patterns, treatment principles, and herbs, a culturo-linguistic flourish has been offered as a means of broadening the scope for understanding shen. In some ways this perspective allows us to wrest shen from a somewhat problematic conflation with mind, which more closely approximates heart. The difference between mind and shen radicals renders a reading of shen exclusively as mind as unsatisfactory, because shen also includes the miraculous, that which exceeds what is essentially a construct of mind in the form of mind pathogens and is an aspect of heart. This nuance almost unavoidably encourages associations with Buddhist typologies that draw distinctions between mind-self and the cultivated mind, and more likely, the Freudian id, ego, super-ego trinity. Such attempts have their limitations for reasons that go beyond the purview of this discussion. Suffice it to say that since Chinese Buddhism has evolved within the context of historical developments in the conceptions of heart and mind cultivation, associating shen with Buddhism is congruous and reasonable. The same cannot be said for Freudian psychology. The Dao De Jing begins with the admonition that the way that can be spoken is not the eternal way. Many shen aphorisms speak of the miraculous in a fashion that evokes the ineffable. Much talk of shen is confused and clouded by heart, but a clearer apprehension of its meaning can be gained by understanding its radical, which is associated with ghosts and dwells, confoundingly perhaps, in the nonreducible realm of the spooky kabuki.
 Xian dai cheng yu ju dian (Gigantic Dictionary of Modern Idioms)(Da lian Publishers, 1993) includes a quotation from the Epic of the Sui and Tang Dynasties (sui tang yan yi), describing the emotional heights from listening to exquiste song and flute.