Internal Injury from the Seven Emotions has been documented since ancient times, but it was not until the Song Dynasty that Chen Wuze named the seven emotional changes of “joy, anger, worry, thought, sadness, fear, and shock” as the “Seven Emotions” in his book San Yin Ji Yi Bing Zheng Fang Lun, categorizing them as factors causing internal injury. In TCM literature, the terms “seven emotions” and “five desires” are commonly used. Here, “emotion” refers to feelings and moods, while “desire” encompasses not only emotions but also aspirations, will, memory, and more. “Thinking” refers to cognitive activities, which, although distinct from emotions, are traditionally included in the category of emotions and desires. The concepts of emotion and desire are not entirely the same, but both reflect human psychological and spiritual activities, hence they are often discussed together as “emotions and desires.” The “seven emotions” represent the emotional changes humans experience in response to external stimuli, reflecting the external manifestations of mental activities. The “five desires” categorize emotional changes according to the five elements, associating them with the five organs: heart, liver, spleen, lung, and kidney, to express the emotional activities of these organs. The seven emotions and five desires are closely related; when external stimuli act on the body, the heart and spirit respond, leading to emotional changes. Positive stimuli that satisfy human needs lead to affirmative emotional changes, categorized as joy, while negative stimuli that do not satisfy or contradict human needs lead to negative emotions such as anger, worry, sadness, and shock. Different stimuli can produce different emotional activities, and the same stimulus can elicit different emotional responses in different individuals. Therefore, the seven emotions are expressions of normal physiological activities and do not cause illness. For the seven emotions to become pathogenic factors, two conditions must be met: First, the external stimulus must exceed a certain threshold, exhibiting suddenness (such as violent anger or shock), intensity (such as extreme fear or excessive joy), or prolonged duration (such as prolonged happiness or sadness). Second, the body’s tolerance and regulatory functions must be impaired, leading to dysfunction in the organs’ qi and blood, and an imbalance of yin and yang, resulting in disease. Only under these conditions can the seven emotions become pathogenic factors. Differences between the six excesses and the seven emotions as pathogenic factors: a. The six excesses invade from the skin and mouth, while the seven emotions directly harm the internal organs, disrupting the qi and blood of the organs. The former injures the skin, while the latter damages the internal organs. b. The six excesses initially present with exterior symptoms; if not treated promptly or appropriately, the pathogenic factors can penetrate deeper and lead to severe symptoms. The seven emotions do not present with exterior symptoms but manifest directly as interior conditions. 1. The relationship between the seven emotions and the organs’ qi and blood The emotional activities of the human body are based on the essence, qi, and blood of the five organs, which are integral to the body’s functional activities. The production of essence, qi, and blood relies on the normal functioning of the organs, such as the spleen’s transformation of food into essence. The spleen’s upward movement sends the refined substances to the heart and lungs, where they are transformed into qi and blood and distributed throughout the body. Additionally, the essence of the kidneys and the blood of the liver can transform into one another. Therefore, normal emotional activities can only occur when the organs are harmonious, qi and blood are sufficient, and fluids are balanced. Since the essence and qi stored in the organs differ, the emotional expressions also vary, with each organ emphasizing different emotional activities: the heart corresponds to joy, the liver to anger, the spleen to thought, the lung to worry, and the kidney to fear. Thus, when the organs or their qi, blood, or essence undergo pathological changes or functional disturbances, corresponding emotional changes can occur. Generally, when the qi and blood of a specific organ are excessive, it often manifests as that organ’s emotional response. Conversely, when the qi and blood of an organ are deficient, it may manifest as emotional responses from the mother or son organs. As stated in Ling Shu: Ben Shen, “When the liver qi is deficient, there is fear; when it is excessive, there is anger… When the heart qi is deficient, there is sadness; when it is excessive, there is unending laughter.” Although fear is associated with the kidney, when the liver’s qi and blood are deficient, it can manifest as the emotional response of the mother organ—fear. Insufficient heart qi can lead to the lung metal attacking heart fire, resulting in the lung’s emotional response—sadness. Furthermore, excessive seven emotions can also damage corresponding internal organs, leading to emotional disorders. 2. Characteristics of diseases caused by the seven emotions Emotions are the external manifestations of organ function activities. The activities of the organs are governed by the heart, which is said to be the master of the spirit. The heart coordinates the functions of the five organs and governs the body’s physiological activities. At the same time, the heart can respond to various external stimuli, governing psychological activities, including emotional activities. Although emotional activities are associated with the five organs, they are realized under the regulation of the heart and spirit. Thus, it is clear that the heart plays a decisive role in the entire process of emotional activities; therefore, emotions arise from the heart and are expressed through the five organs. As stated in Lei Jing: Disease Category, “The heart is the great master of the five organs and six bowels, governing the soul and spirit, and encompassing will; thus, when worry arises in the heart, the lung responds; when thought arises in the heart, the spleen responds; when anger arises in the heart, the liver responds; when fear arises in the heart, the kidney responds; this is why the five desires are all governed by the heart.” 1. Directly injuring the internal organs Emotional activities are closely related to the organs (especially the five organs). On one hand, emotional activities are based on the essence and qi of the five organs. On the other hand, emotions, as inner feelings, are subjective experiences of the functional activities of the organs expressed outwardly. Long-term practice has shown that certain organs correspond to specific emotional activities. Due to the different functional activities of the organs, the emotional changes expressed outwardly naturally differ. Conversely, when external stimuli act on the organs, emotional injuries can selectively affect the organs. Excessive seven emotions can directly impact the corresponding organs, leading to qi and blood dysfunction and disease. For example, the heart corresponds to joy; excessive joy can harm the heart. The liver corresponds to anger; excessive anger can harm the liver. The spleen corresponds to thought; excessive thought can harm the spleen. The lung corresponds to worry; excessive worry can harm the lung. The kidney corresponds to fear; excessive fear can harm the kidney. Emotional activities that directly harm the internal organs have the following characteristics: a. Excessive seven emotions primarily harm the heart and spirit. The heart governs the spirit, and in the onset of diseases caused by excessive emotions, the heart is primarily affected, followed by other organs. In fact, any abnormal emotional change can impact the functional activities of the heart to varying degrees. As stated in Ling Shu: Kou Wen, “Thus, sorrow, grief, and worry cause the heart to move; when the heart moves, all five organs and six bowels tremble.” b. Diseases caused by the seven emotions are most commonly seen in the heart, liver, and spleen. The heart governs the blood vessels and promotes blood circulation. The spleen governs transformation and is the source of qi and blood generation. The liver governs the smooth flow of qi and stores blood, affecting the regulation of qi and blood circulation. The heart, liver, and spleen are closely related to the generation, movement, and distribution of qi, blood, and essence, directly influencing the material basis of emotional activities. Therefore, when the seven emotions cause disease, the heart, liver, and spleen are most commonly affected. Clinical observations indicate that in emotional activities, the most common issues are shock and joy harming the heart, leading to mental disorders. Depression and anger harm the liver, causing qi stagnation. Overthinking harms the spleen, leading to insufficient qi and blood, manifesting as palpitations, insomnia, restlessness, anger, depression, dizziness, tinnitus, coma, dementia, mania, and delirium, which are symptoms of heart, liver, and spleen disorders. c. Emotional injuries to the internal organs are complex and variable. Although emotional effects on the organs exhibit clear selectivity, since humans are an organic whole and emotional activities are diverse, diseases caused by the seven emotions do not necessarily damage the corresponding organs. One emotion can harm multiple organs; for instance, excessive thinking can harm both the spleen and the heart and liver. Multiple emotions can also harm a single organ; for example, sadness and worry harm the lung, and any excess in the seven emotions can harm the heart. 2. Affecting the qi mechanism of the organs The diseases caused by the seven emotions primarily occur through their impact on the qi mechanism of the organs, leading to disordered qi and blood circulation. a. Anger causes qi to rise: Anger is an emotional activity characterized by agitation and indignation. Mild anger can release pent-up feelings, allowing liver qi to flow normally and qi and blood to circulate smoothly. However, excessive anger can harm the liver, causing liver qi to rise and leading to various symptoms. Su Wen: Ju Tong Lun states, “Anger causes qi to reverse; if severe, it can lead to vomiting blood and diarrhea.” b. Joy causes qi to relax: Excessive joy primarily harms the heart and spirit, causing heart qi to disperse and the spirit to become unsettled. Mild cases may present as palpitations, insomnia, and inability to concentrate, while severe cases may lead to excessive laughter, nonsensical speech, and chaotic mental states. Ling Shu: Ben Shen states, “Joyful people have spirits that scatter and do not remain contained.” c. Sadness causes qi to deplete: Excessive sadness can deplete lung qi and reduce organ function. In a state of sadness, the heart’s vessels become congested, and the lung’s function of dispersing qi is impaired, leading to stagnation of qi and blood. Prolonged stagnation can generate internal heat, depleting qi and causing organ function to decline. Stagnant lung qi can lead to feelings of heaviness and fullness in the chest. Depleted lung qi can result in a pale complexion, shortness of breath, low voice, and fatigue. d. Fear causes qi to descend: In a state of excessive fear, the upper qi mechanism may become obstructed, forcing qi downward and damaging kidney qi. Kidney deficiency leads to symptoms of essence depletion. If kidney qi is insufficient, it can result in lower back and knee weakness, bone atrophy, and if kidney qi is unstable, it can lead to incontinence, nocturnal emissions in men, and menstrual irregularities or increased vaginal discharge in women. e. Thought causes qi to stagnate: Thought refers to contemplation, a cognitive activity focused on problem-solving. Normal contemplation can enhance responsiveness; however, excessive thinking can lead to stagnation of the qi mechanism in the organs, primarily causing spleen qi stagnation. Spleen dysfunction can lead to symptoms such as reduced appetite, abdominal distension, and loose stools. Insufficient qi and blood can lead to dizziness, fatigue, and muscle wasting. Additionally, prolonged qi stagnation can affect the heart, leading to heart and spleen qi stagnation, with mild cases presenting as palpitations, insomnia, and vivid dreams, and severe cases leading to mental confusion. Su Wen: Ju Tong Lun states, “Thinking leads to the heart holding onto something, the spirit having a place to return, and the righteous qi remaining stagnant, thus causing qi stagnation.” 3. Commonly manifesting as emotional disorders Emotional stimuli easily lead to disruptions in the body’s qi mechanism, causing qi and blood abnormalities, injuring the internal organs, and resulting in the formation of dampness, phlegm, and blood stasis, which can lead to various diseases. However, in clinical practice, diseases triggered by emotional factors primarily manifest as emotional disorders. This is because emotional stimuli first affect the function of the heart and then impact related organs, leading to disease; thus, emotional imbalances frequently manifest as emotional disorders, such as dementia, mania, palpitations, organ agitation, forgetfulness, insomnia, and coma. 4. The relationship between disease progression and emotions is close Abnormal fluctuations in emotions can not only lead to or trigger diseases but can also rapidly worsen or exacerbate existing conditions. For example, patients with pre-existing liver yang hyperactivity may experience dizziness, fainting, or hemiplegia and facial drooping due to excessive anger, which causes uncontrolled yang to rise and blood and qi to reverse. Therefore, regulating emotions is of great significance for health maintenance, disease prevention, and health promotion.END
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