It always seems strange that joy should be listed among the emotional causes of disease in Chinese medicine. And yet, it has always been mentioned as an emotional cause of disease since ancient times. Strangely, the Chinese character for “joy” [xi ?] is the only one of the emotions that is not based on the ‘heart” radical. The character Xi is based on the radical for “drum” plus “mouth”, i.e. beating a drum and singing in happiness. Incidentally, two xi characters next to each other are called “double happiness” and are a symbol of a wedding.

It is interesting that, in the list of emotions as causes of disease, “joy” is always top of the list, followed by anger. For example, these are the emotions listed by Confucius: joy, anger, grief, fear, love, hatred, desire. These are the emotions listed by Lao Zi: joy, anger, worry, sadness, love, hatred, desire. It is interesting that both lists include “love” as an emotional cause of disease! Chen Wu Ze (1174) lists: joy, anger, pensiveness, worry, sadness, fear, shock. These became the widely accepted “7 emotions” of Chinese medicine. Zhang Jie Bin (1624) lists eight emotions: joy, anger, pensiveness, worry, sadness, fright, fear, shock.1

A normal state of joy is obviously not in itself a cause of disease; on the contrary, it is a beneficial mental state which promotes a smooth functioning of the Internal Organs and their mental faculties. The “Simple Questions” in chapter 39 says: “Joy makes the Shen peaceful and relaxed, it benefits the Ying and Wei Qi and it makes Qi relax and slow down.”2 On the other hand, in chapter 2 the “Simple Questions” says: “The Heart … controls joy, joy injures the Heart, fear counteracts joy.”3 Other passages in the Nei Jing clearly refer to joy as a cause of disease. For example, chapter 5 of the “Simple Questions” says: “Joy injures the Heart.”4 Chapter 8 of the “Spiritual Axis” says: “Joy scatters the Heart and deprives it of its residence.”5

Fei Bo Xiong (1800–1879) in “Medical Collection of Four Doctors from the Meng He Tradition” says: “Joy injures the Heart … [it causes] Yang Qi to float and the blood vessels to become too open and dilated …”6

I think that the best (and probably only) way to understand “joy” as an emotional cause of disease is in the light of the three main philosophies of China, i.e. Daoism, Confucianism and Buddhism. I think that “joy” is akin to “desire” and “craving” from the point of view of these three philosophies. Of the three philosophies, Daoism and Confucianism are the main ones because Buddhism was not widespread in China at the time when joy was already considered as a cause of disease, i.e. during the Warring States Period (476-221 BC).

All these three religions (or rather philosophies), for different reasons, advocated emotional restraint and avoidance of “craving” and “desire”. For example, the Daoists shunned social relations and advocated “following the Dao”, “absence of desire” (wu yu) and “non-action” (wu wei). They felt that joy would stop us from following the Dao as much as other emotions such as anger. The great Daoist Zhuang Zi (370-301 BC?) talks about wu qing, i.e. absence of feelings: “What I mean when I say that they [sages] are wu qing (without feelings) is that they do not injure their own persons with likes and dislikes and are always responsive to what is natural without trying to increase life.”7

The ancient Daoist text Nei Ye (Inner Training), older than the Dao De Jing, has this interesting passage on emotions:

The vitality of all people
Inevitably comes from their peace of mind
When anxious, you lose this guiding thread
When angry, you lose this basic point
When you are anxious or sad, pleased or angry,
The Dao has no place within you to settle
Love and desire: still them!
If you are tranquil, you will attain it (the Dao)
If you agitated, you will lose it.8

Indeed, to the Daoists, stimulation has a negative connotation. Zhuang Zi says concisely: “When desire is profound, the force of Heaven is superficial.” This means that desire turns us away from the vitality of Heaven stirring emotions within us that make us stray from the path of the Dao.

Confucianists believed that the true “gentleman” (a mistranslation of the term jun zi that actually applies to both men and women) is not stirred by emotions because these cloud his or her true nature. They used the image of a pond with a muddy bottom. If the water is very still, it becomes clear: if we stir the bottom, the water becomes turbid. The pond is our human nature which is naturally “clear”; if we are stirred by emotions, these will cloud our human nature. Consider this passage from Xun Zi (a Confucianist philosopher, 312-230 BC): “It is ever so that the Heart-Mind [Xin] is naturally full, naturally born and naturally perfected. Should its function be impaired, it is certain to be due to sorrow and happiness, joy and anger, desire and profit-seeking. If we can rid ourselves of sorrow and happiness, joy and anger, desire and profit-seeking, the Heart-Mind [Xin] will revert to its flawless state.”9

The Buddhists considered desire and craving as the very root of human suffering. Greed (excessive desire), hatred and ignorance are at the centre of the Wheel of Life and greed is strangely symbolized by a rooster. According to them, our very existence begins out of the desire and craving of a mind in the Bardo state (the period after death and before the next reincarnation): the mind desires the warmth of a womb and it reincarnates. Later on in life, desire causes our mind to try to grasp objects like a monkey sways from tree to tree (that is why the Buddhist Wheel of Life has, among others, the image of a monkey on a tree).

So, what relevance has this view of “joy”, “desire” and “craving” to us in the 21st century? I think that these emotions are indeed causes of disease and I would call the modern equivalent of these emotions “overstimulation”. I think that this, rather than “joy”, would probably be the best translation of xi. Our society indeed bombards us with objects of craving and it artificially creates “desire” and “craving” through advertising; on the other hand, it provides and fosters substances that overstimulate us.

We are all “overstimulated” by entertainment, frenetic lifestyle, consumerism, coffee, tea, tobacco, alcohol, TV, video games, “recreational drugs”, medicinal drugs, and sexual stimulation.

The main stimulant drugs are:
• Caffeine
• Nicotine
• Cocaine
• Amphetamines
• Prescription drugs e.g. Ritalin® (Methylphenidate), Adderall® (amphetamine and dextroamphetamine), Dexedrine® (dextroamphetamine), Strattera® (atomoxetine), Focalin® (Dexmethylphenidate) etc.

Interestingly, antidepressants are not actually stimulants and do not usually lead to “joy”. My experience with depressed patients on anti-depressants is that these drugs “blunt” all emotions; they do somehow lift depression but at the expense of alertness and enthusiasm. Indeed, some anti-depressants are used for anxiety with some effect.

I think that the ‘blunting” effect of anti-depressants is reflected in the resulting pulse, i.e. a pulse that feels “stagnant” and does not have the healthy “wave” of the normal pulse. It is not Wiry, not Tight but I describe it as “stagnant” and “reluctant”. While most authors see anti-depressants as mood-elevating and stimulants, I do not share that view and the pulse qualities described above seem to confirm this.

Overstimulation, in the broad sense indicated above, makes the Heart larger. This leads to excessive stimulation of the Heart, which in time, may lead to Heart-related symptoms and signs. These may deviate somewhat from the classical Heart patterns. The main manifestations would be palpitations, over-excitability, insomnia, restlessness, talking a lot and a red tip of the tongue. The pulse would typically be slow, slightly Overflowing but Empty on the left Front position. It may seem strange that “joy” or overstimulation makes the pulse slow. This is because overstimulation makes the heart larger and therefore slows down circulation (shock, by contrast, makes the heart smaller).

Giovanni Maciocia

The points I use for overstimulation are HE-7 Shenmen, P-7 Daling, Du-19 Houding, Ren-15 Jiuwei.

1. Zhang Jie Bin (also called Zhang Jing Yue) 1982 Classic of Categories (Lei Jing), People’s Health Publishing House, Beijing, p. 424. First published in 1624.

2. 1979 The Yellow Emperor’s Classic of Internal Medicine-Simple Questions, p. 221.

3. Tian Dai Hua 2005 The Yellow Emperor’s Classic of Internal Medicine - Simple Questions p. 38.

4. Ibid., p. 38.

5. Spiritual Axis, p. 25.

6. Medical Collection of Four Doctors from the Meng He Tradition, p. 40.

7. Ames RT and Hall DL A Philosophical Translation of the Dao De Jing, Ballantine Books, New York, 2003, p. 47.

8. Roth H Original Tao, Columbia University Press, New York, 1999, p. 94.

9. Lee J Xunzi and Early Chinese Naturalism, State University of New York Press, Albany, 2004, p. 35.