On the Scientific Character of 'The Heart Rules the Spirit-Bright'
Ever since Western medicine deepened its research on the brain, a current arose — among Western-trained doctors who had studied Chinese medicine, and within Chinese medicine itself — to doubt one of Chinese medicine's basic doctrines: the heart rules the spirit-bright. Many articles have appeared; some hold that this two-thousand-year-old "mistaken" doctrine should now be corrected.
Chinese medicine and Western medicine are two different theoretical systems. Western medicine is microscopic; Chinese medicine is macroscopic. Each has its strengths, and they supplement one another. One cannot say that only microscopic theory is science, and that whatever does not fit the microscopic is unscientific. As early as 1983 I published, in the Eighteenth Graduation Special of the Singapore College of Chinese Medicine, an essay titled "The Heart Rules the Spirit-Bright." Reading it twenty years later, I find its viewpoint correct. I quote it here:
Chinese-medical theory holds that the heart's function, beyond "governing blood and vessel," is also to "rule the spirit-bright" — beyond being the ruler of the circulatory system, also the ruler of the activities of the spirit. From the standpoint of Western anatomy and physiology this is unintelligible — and thus some have come to doubt the scientific character of Chinese medicine. In fact Chinese and Western medicine are two theoretical systems; one cannot say what accords with Western medicine is science and what does not is not.
> To understand "the heart rules the spirit-bright," one must first understand Chinese medicine's zàng-xiàng (storehouse-image) doctrine. The zàng-xiàng names the macroscopic phenomena of the five storehouses — heart, liver, spleen, lung, kidney — the body's five great systems. The five storehouses are the cores of these five great systems. This doctrine is the theoretical lift of millennia of Chinese-medicine observation in prevention and treatment. It came from practice and in turn guides practice. Practice is the criterion of truth — so the zàng-xiàng doctrine is science.
> That "the heart governs blood and vessel" and "the heart rules the spirit-bright" — Chinese medicine clearly groups the circulatory system and higher nervous activity together under "heart." Hence the saying "the heart is the office of the sovereign": the heart sits at the head of the five storehouses, the core within the core of the body's central system.
> Why does Chinese medicine unite the heart's governance of blood and vessel with its rule of the spirit-bright? Because the two have a tight, inseparable relation. In the clinic I often use the Wendan Decoction with modifications to treat coronary heart disease, and the same formula for insomnia and neurosis with equally definite effect — that is one proof. So in my view, the heart, this real organ, is not only a blood pump in mechanical role; it must produce secretions that act on the brain. This is not a fanciful supposition. For example, Western medicine has come to know that the lung, besides respiration, has "non-respiratory functions" — that it is the main site for the production, release, activation, and inactivation of many endocrine substances. This is a recent achievement of physiology. Yet Chinese-medical theory has long said that the lung, besides governing qi and ruling respiration, also "rules orderly regulation" — that the lung helps the "heart" regulate the whole. It is precisely by regulation of endocrine substances that the lung maintains the body's internal stability. Chinese medicine did not, of course, know these endocrine substances; but in clinical treatment, it knew to use lung-regulating medicines to maintain that stability.
> I believe that when the use of artificial hearts is widened, the existence of cardiac endocrine substances and their importance will be discovered — and the correctness of Chinese medicine's "heart rules the spirit-bright" will be borne out. The road is long. As early as 1937 the British physiologist G. Harris hypothesized that if the hypothalamus does not control the pituitary by nerves, it must be by chemical signals. Two research groups — Roger C. L. Guillemin's and Andrew V. Schally's — using the hypothalami of one million pigs and several million sheep, did arduous work to settle the question; Harris's hypothesis was vindicated in 1970. I believe "the heart rules the spirit-bright" will likewise be vindicated.
The above was written on January 17, 1982. On March 24, 1983, foreign news reported that the first patient implanted with an artificial heart had died the previous day. The surgeon who had implanted the heart in Clark, DeVries, was quoted: "Although the plastic heart continuously pumped blood, Clark's vessels became flaccid, swelling outward; his circulatory system could not sustain the pressure needed to push oxygenated blood to his organs. His colon function was lost; then his kidney function; then his brain function." My estimate is that once the heart was replaced, the secretion of cardiac hormones stopped. When the lung's substitute support exceeded a limit, and the stored cardiac hormones in the body were exhausted, life ended. The Clark case shows: for an artificial heart to last and work well, one must seek out cardiac endocrine substances — and so confirm and lift "the heart rules the spirit-bright." (April 10, 1983)
Does the heart secrete a hormone? A year after the above was written — in 1984 — the question had a first answer. By report, the Lebanese researcher Dr. Inagami found that the heart secretes a hormone directly into the blood that reduces arterial pressure; it was named ANF. I believe the cardiac hormone that acts on the cerebral cortex will one day be found. A hypothesis is not a reality. But a Chinese-medical theory built up from macroscopic observation cannot be casually denied with microscopic theory. Practice is the sole criterion of truth. The September 6, 2002 Guangming Daily reported "Liu Haoruo Recovers Rapidly," noting that "in waking her and in her rehabilitation, Chinese herbal medicine, acupuncture, and TCM massage showed unique strengths." If Chinese medicine's "the heart rules the spirit-bright" doctrine is wrong, how does one explain the unique strength of TCM treatment in waking Liu Haoruo — whom the British doctors had pronounced brain-dead?
Theory guides practice. I do not know what high methods — what li, fa, fang, yao — those who promote "the brain rules the spirit-bright" in place of "the heart rules the spirit-bright" have put forward to lift clinical level; or whether they have proposed a complete system that fuses "the brain rules the spirit-bright" with Chinese-medical theory and so substantially raises Chinese medicine's theoretical level, lifting it by a tier. Unfortunately, in their articles I have seen nothing constructive on either count.
Is replacing "the heart rules the spirit-bright" with "the brain rules the spirit-bright" an innovation in Chinese medicine? Western medicine has already attained admirable results in brain rules the spirit-bright; one need not exert oneself for that — researchers will not surpass Western scholars there. The proponents are doing nothing other than reshaping Chinese medicine with Western medicine. By what means is "the heart rules the spirit-bright" to be reshaped? With what blueprint? With what method to fuse the brain-rules-the-spirit-bright with Chinese medicine's systemic theory? It all looks like somebody else's job. Writing such articles is easy. But it is like prying out the load-bearing beam of the temple of Chinese medicine and laying a sheet of asbestos board, or a colored plastic prop — and calling it a modern Chinese medicine. That is too dangerous. The hall is about to lean; Chinese medicine is in danger.
Looking back: in the Han, Zhang Zhongjing studied infectious diseases and wrote the Shanghan Lun. In Jin-Yuan, Liu Hejian emphasized fire; Zhu Danxi nourished yin. In Ming, Wu Youke wrote the Wenyi Lun. Across over a thousand years to the Qing, Ye Tianshi, Wu Jutong and many famous physicians took it deeper, and the Wenbing school appeared, supplementing what the Shanghan Lun lacked — but the Wenbing school did not replace the Shanghan. Combining the Shanghan and Wenbing schools to treat infectious disease, in the first half of the 20th century, before antibiotics were invented — outcomes far exceeded those of Western medicine, which already had a deep knowledge of cerebral nerves. To this day in treating Japanese encephalitis B, Chinese medicine still leads. And today those who want to take Chinese medicine over to "the brain rules the spirit-bright" hold no mature method and no result — and propose to replace or "reform" "the heart rules the spirit-bright." Replacement is no simple matter of a few words. Pray, what is the content of the reform? I support unceasing innovation in Chinese-medical theory — but I oppose using innovation as a slogan to discard the essence of Chinese medicine.
For over two thousand years Chinese medicine has been in continuous development. Some doctrines that look backward are in fact forward. Yet undeniably, for over two thousand years Chinese medicine has developed only by quantitative change; no qualitative leap has occurred. The 20th century was a half-century in which Chinese medicine was doubted, slighted, discriminated against, and excluded; the natural sciences of the time were unable to be of great help. I estimate that the 21st-century revolution in new technologies will be of immense help to Chinese medicine. Joined with new technologies, Chinese medicine will undergo a qualitative leap. That leap, of course, will follow Chinese medicine's own developmental law — not be a "development" of using Western theory to reshape Chinese-medical theory.
Mid-autumn evening, September 20, 2002