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INTERNET JOURNAL OF THE

INSTITUTE FOR TRADITIONAL MEDICINE


AND PREVENTIVE HEALTH CARE
Disease Prevention and Restoring Harmony:
Control the Emotions
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine,
Portland, Oregon

Web Posting Date: May 2002

Key medical terms: cancer, depression, anxiety, neuropeptides,


natural killer cells (NK), cytokines, cortisol, ACTH, DHEA
Key Chinese medical references: qi, shen, jing (three treasures),
seven emotions, zang/fu, spleen, heart, yin and yang
Chinese traditional texts: Great Compendium of Acupuncture and
Moxibustion; Canon of Medicine; Health-Preservation Skills
Developed by Taishang Laojun; Golden Mirror of Original Medicine
Modern Chinese sources: Journal of Traditional Chinese Medicine;
The Mystery of Longevity; Cancer Treatment with Fu Zheng Pei Ben
Principle; Experience in Treating Carcinomas with Traditional Chinese
Medicine
Traditional Chinese practices: tai ji, qi gong
SUMMARY: Emotional distress can contribute to the development
of diseases; this has been known since ancient times in China.
According to traditional texts, one can regulate the emotions and
reduce their adverse impacts on health by following basic advice
such as doing exercise, practicing temperance in eating and drinking,
keeping a regular schedule, and pursuing mind-calming activities.
Specialists in the field of calming the mind for health and longevity
caution about egoism and pursuing too many personal desires;
recommend finding constructive outlets for emotions--particularly
anger; and emphasize the importance of developing an interpretation
of one's life that focuses on becoming content, cheerful, and
compassionate. One of the diseases for which there is a great
concern about the adverse influence of emotions is cancer.
Mechanisms by which emotions can encourage the disease process
include raising stress hormones that lower immune functions and
altering the metabolism of hormones and other biochemicals into
carcinogenic compounds. Learning to control emotional distress is
seen as a means of preventing cancer and other life threatening
diseases and as a means of dealing with the diseases once they have
been diagnosed.

DISEASE PREVENTION AND


RESTORING HARMONY: CONTROL
THE EMOTIONS
essay by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine,
Portland, Oregon

Most people recognize that emotional distress can contribute to


disease. The emotions, or their immediate secondary effects--such as
digestive stress and disturbed sleep--may weaken the body and make
one susceptible to infection. The emotions may also trigger flare-ups
of chronic diseases; many patients with autoimmune disease mention
that this occurs after an emotionally stressful time. But, the question
is, how to regulate the emotions so that resistance to disease remains
strong?

This subject has been an important topic in the field of Chinese


medicine. Since ancient times, disease causation was understood to
fall into two major categories-external and internal. External causes
included extremes of weather and the influence of pathogens, while
internal causes were attributed to the emotions. Today, we recognize
that emotions don't directly cause disease, but they make it more
likely that a disease process will overcome the body's defenses and
homeostatic mechanisms.

There are specific means of attaining balance and harmony that


are incorporated into the Chinese culture, based on a long history of
seeking good health and longevity. For example, the ancient classics
suggest that one should:
Go by the laws of yin and yang, do body-building exercises
best suited to one's conditions, practice temperance in food
and drink, follow a regular schedule in daily life, avoid
overexertion, and keep calm and cheerful.

Such suggestions may seem quaint in the modern world, but they
are an integral part of the 2000-year-old culture that may have
something to offer today, at least for those who are concerned about
fragile health.

The Chinese descriptions of the effect of emotions on health rely


on some terms that are not familiar to most Westerners. The main
ones are:

• qi (pronounced "chee"), which describes a circulating


essence controlling body functions;
• shen, which describes the human spirit that is said to be
seated in the heart and is manifest as the mind and is part
of the trio of shen, qi, andjing, the latter being the
fundamental essence that nurtures the body;
• seven emotions, which is the group of emotions that are
traditionally listed and are said to each have differing
effects on the body; and
• primary internal organs or organ networks,
called zang and fu (these Chinese terms are not used in this
text, to avoid confusion). The internal organs defined in
traditional Chinese medicine have some differences with
those defined by modern medicine; most importantly, the
"spleen" refers here to an organ system that is defined to
incorporate a number of digestive system functions.

These terms appear in descriptions of emotional excess and


emotion-caused symptoms and diseases, and of their remedies that act
by strengthening the body and calming the mind. As to strengthening
the body, there are many methods, including proper eating habits,
which will then help prevent emotional distress. Following is an
explanation from Yang Jizhou in The Great Compendium of
Acupuncture and Moxibustion (Zhenjiu Dacheng; ca. 1590), with a
quote from an older Taoist source Daoyin Benjing:
The spleen is situated at the center of the five organ
networks...It contains and fosters the five flavors, it brings
about the five mental faculties, and it moves the four
extremities....As soon as there is irregular intake of food and
drink or overexertion of any kind, the spleen qi will be
harmed....If we therefore force ourselves to eat when we are
not hungry, the spleen will suffer. If we force ourselves to
drink when we are not thirsty, the stomach will bloat. If we
eat beyond capacity, the vessels in which the qi circulates
will become obstructed, and the body's center (stomach
region) will become jammed and shut off. If we eat too little,
on the other hand, the body will become emaciated, the
stomach will grow anxious, and our thoughts will become
unsteady. If we eat contaminated food, the heart's ability to
differentiate will become blurred, and we will grow more
and more restless. If we eat things that we should not eat, the
four great upheavals will occur and bring along disease.
None of these types of behavior represents the way of good
health. Therefore, it is most important to consume our food
at the appropriate time, to drink our fluids in regular
intervals, and to avoid both overeating and hunger pains. If
we eat and drink according to these simple guidelines, then
not only the spleen/stomach network itself will remain
unspoiled and function perfectly, but also the organ networks
will all be in a harmonious state of health.

An example of the Chinese approach to having a healthy


emotional life is presented in The Mystery of Longevity by Liu
Zhengcai, who begins by referring to the main text of traditional
Chinese medicine, the Nei Jing:
The Canon of Medicine (Nei Jing) advises, in summing the
experiences of centenarians in remote times: 'Do not be
weighed down by perplexing thoughts; strive to be calm and
optimistic; be complacent [calm in the face of situations that
can cause anger]; keep sound in body and mind. This way,
one can live to the age of 100.' The Canon of
Medicinerecognizes that emotional and psychological
factors are important causes for illness. It indicates that
excessive emotion impairs the internal organs of the human
body. 'Anger hurts the liver, joy hurts the heart, brooding
hurts the spleen, and melancholy hurts the lungs.' Hence, it
proposes regulating the emotions by 'keeping the heart calm
and cheerful and the mind free of worries.' 'Where can
disease come from when the emotional state maintains inner
composure?' Scholars on the art of healthy living in
subsequent generations set forth many specific methods of
maintaining optimism in accordance with this principle.

A good rendition of Chinese ideas of the dealing with emotions


by calming the mind was presented by Yuan Liren and Liu Xiaoming
of the Beijing College of Traditional Chinese Medicine as part of
their series of articles on health preservation published in the Journal
of Traditional Chinese Medicine. Their description of the nature of
emotions and their depiction of traditional methods for dealing with
the emotions is quoted here at length.
In traditional Chinese medicine, all such concepts as
consciousness, feeling, and thought are referred to as shen,
meaning mind, which is considered to be stored in the heart
and to govern all the activities of the organism. Regulation
by the mind is necessary in all physiological functions. In
fact, the so-called three treasures [shen, jing, qi] are: mind,
essence (which constitutes the material basis of the human
body), and qi (which is the motive force of all life activities).
A sound mind is considered the basis of health and
longevity; similarly, scarcity of essence, deficiency of qi, and
weakness of mind are the main causes of illness and aging.
Since mind plays the role of governing life and commanding
all the physiological functions of the primary internal organs
and those of the rest of the body as well, it is easily depleted
or impaired. Hence, taking good care of the mind is
particularly important.
The activities of the mind can be classified into two kinds:
emotional and mental. The former refers to changes of mood,
known in traditional Chinese medicine as the seven
emotions, i.e., joy, anger, melancholy, anxiety, grief, fear,
and terror; while mental activities refers to consciousness
and thinking. Since the activities of the mind are the general
responses of the organs in conforming with the outside
environment under the guidance of the heart, maintenance of
the mind is bound to involve many aspects, which include
roughly the following: preserving the tranquil mind, easing
the mind, and regulating emotions. A brief account of these
methods is given below.
Preserving a tranquil mind. Tranquil here refers to the
state of mind being peaceful, tranquil, free from excessive
desires and distracting thoughts, unaffected by outside
changes. Such a state of mind will harmonize the organs and
maintain a smooth circulation of qi and blood, benefiting the
health. This consists of the following aspects:
1. Minimize egoism and personal desires: Excessive egoism
and unbounded desires tend to deplete one's mentality,
causing disharmony between qi and blood, and with the
organs as well, inviting disease, whereas, less egoism and
desires helps remove unnecessary mental burdens,
enabling one to take a calm and nonchalant attitude toward
fame, wealth, and other desires, hence, the mental qi will
be preserved and health protected. Here are two points that
are essential. First, one should be aware of the harmful
effect of excessive egoism and desires so that the mind
may be rationally controlled in a tranquil state; second, one
should take a correct attitude toward personal gains and
losses. An ancient book entitled Health-Preservation
Skills Developed by Taishang Laojun points out: 'Those
who are expert at health preservation will always first try
to eliminate the six harmful elements, namely: fame and
profit, the desire for which should be suppressed; the
desire for sex, to which one should not abandon oneself;
wealth, for which one should not be greedy; rich food,
which one should not eat with abandon; unrealistic
fantasies, which should be got rid of, for they distract one's
thoughts from reality and are harmful to one's mind; and
jealousy, which should also be eliminated.' Eradication of
the above-mentioned six harmful factors has since ancient
times been considered essential for health preservation and
is therefore worthy of our attention.
2. Be broadminded in conducting oneself in society: When
faced with undesirable things and situations, one should be
broadminded and try to look on the bright side. In handling
various kinds of complicated problems and abrupt changes
in one's daily life, a stable state of mind and an optimistic
attitude toward one's life is very good for preserving a
sound mind. This includes the following aspects: first, set a
lofty goal in life-health preservation requires first and
foremost that one should cherish hopes, love life, and keep
a lofty goal, a noble ideal, and sound morality, all of which
guarantees for a sound mind; second, be content and be
happy, for it keeps one satisfied with what one has, caring
little about temporary setbacks and failures, and this, in
turn, will bring about both physical and mental health.
Easing the mind. Moods are the responses of people to their
surroundings, and everyone experiences the seven emotions
and six desires [six harmful elements, described above]. If
not properly regulated, the emotions will cause stagnation of
qi and blood, and disharmony between the organs, leading to
illness, even early death. Those who lived a long life,
according to historical records, are almost all people apt to
regulate their moods, the essence of which is to cultivate the
mind with virtuous and elevated ideas and mold the
temperament. Various methods have been developed and
described by people in the past, which can be boiled down to
the following: creating a happy mood by engaging in a great
variety of carefree, light, and lively activities in which spirit
is heightened, intelligence is increased, muscles and tendons
are exercised, and circulation of qi and blood is activated so
that health preservation is achieved in the midst of
amusement and sports, achieving the aim of nurturing the
mind, strengthening the body, and prolonging life. Some
traditional methods employed for this purpose include taking
up hobbies, such as playing the piano and chess; raising
flowers, plants, birds, or fish; sightseeing; and chatting with
friends.
Adjusting emotions. In one's daily life, the complicated
situation is bound to influence one's moods such as from joy
to anger, grief, etc. When one is in a bad or abnormal mood,
one should try to adjust and control it lest it go to an
extreme. As a mental means of health care, the following
methods are used:

1. Exercising self-control: Traditional Chinese medicine


holds that the seven emotions, i.e., joy, anger, melancholy,
anxiety, grief, fear, and terror, are, in the extreme, one of
the main causes of illness. Therefore, timely adjustment of
one's emotions with a view to preventing them from going
to the extreme is an effective method of health
preservation. Ever since ancient times, experts in health
preservation have believed that anger is the chief
pathogenic factor, for great anger may impair the liver and
also affect the heart, stomach, and brain. Hence, control of
anger is an important method of adjusting the emotions.
The essence is to control emotions by rational reasoning,
that is, to cultivate one's morality, train one's will,
consciously control one's mood, and overcome emotional
impulses with reason. As the ancients put it: 'When faced
with something exasperating, one should calmly consider
which is more important-anger or health?' This comparison
will enable one to gradually eliminate anger.
2. Providing outlets for anger. This is to help regain one's
psychological balance by finding proper outlets for
detrimental emotions accumulated in one's mind. This
method can be explained in three parts. First, direct
release: When one is in great sorrow, he should have a
good cry so that he may feel comfortable after his sorrow
has been fully given vent to. This is a measure beneficial to
health care; it helps regulate the circulation of qi and blood
and, consequently, prevent depression. Other measures are:
a loud cry when in great pain; a thorough pouring out of
one's heart when in great anger; a deep sigh or moan when
worried; or hearty singing when in great joy. Different
forms of expression are used for different emotions, all to
restore the mind to a peaceful and tranquil state. Second,
there is controlled release: in contrast to direct release, this
measure stresses a controlled and gradual release of pent-
up emotion in one's mind when in bad moods. For
instance, one may confide in relatives or good friends the
bitterness or grievance, or express feeling by saying poems
or writing articles. The advice and consolation of one's
relatives and friends and the release of emotion will enable
one to acquire psychological comfort and support, broaden
the mind, and finally become happy and at peace. This is a
good method for eliminating detrimental emotions. Third,
there is the method of diverting one's attention. This is also
known as diverting one's emotion, that is, changing the
focus of excitation, the principle of which is to free a
person from entangling emotions by taking certain
measures to separate oneself from harmful stimulating
factors....For instance, when in great distress or depression,
one may listen to a favorite piece of music or when one is
in great sorrow following some misfortune, one may stay
with relatives or good friends for a period of time; the
change of surroundings and atmosphere may divert bitter
emotions, allowing one to restore normal life after calming
the mind. Or when one is afflicted by troubling thoughts,
one may take a walk so that the surroundings of nature
may relax and refresh the mind, and thinking ability will be
restored.

This summation by Yuan and Liu shows that one should respond
promptly and effectively to emotional distress and should cultivate
habits and thought patterns that help one avoid frequent experience of
emotional excess. In the traditional Chinese medical view, the
emotion-based causes of disease, like the external-based causes, are
assumed to fade out as circumstances change. For example, for
someone who is exposed to severe cold, which causes or contributes
to some diseases, the weather in the summer will eventually turn hot
and the initial cause will be removed, at least for a while. Similarly, if
one experiences severe anger, fright, or fear, one will certainly
experience something else later. Rather than waiting for
circumstances to change gradually, one can more immediately
respond to the situation, for example, by warming up the body after
exposure to extreme cold or relaxing anger after a threatening
encounter.

There can be circumstances where causative factors remain


prevalent, but this is usually because of failure of the person to accept
and follow the basic rules that have been developed over the
centuries. If one lives in a region of the country where the weather is
cold most of the time, then one is expected to adapt to this
circumstance by dressing warmly, eating warming foods, and staying
physically active. If one experiences anger or other emotion
repeatedly, one is expected to adapt to the circumstance by altering
behavior and changing attitudes. For the Chinese, the changes are
made in accordance with one or more of the traditionally provided
means of accomplishing the task: Confucianism, Taoism, and
Buddhism. These philosophical and religious systems (often referred
to as the three pillars of Chinese society) instruct people in living
properly. In the West, many people turn to Eastern philosophy for
assistance in this realm. Still, people often feel most comfortable
discussing the issue in terms of health and not in relation to the
religious and cultural peculiarities of the East.

Shi Tianji, a scholar on the art of healthy living in the Ming


Dynasty, proposed 'Six Always' for maintaining a calm and cheerful
state of mind, summarized here:

1. Always be peaceful in mind. Remain peaceful in mind


without vain hopes. Do not covet, do not indulge in vain
wishes, do not worry about personal gains and losses.
Hence, Shi Tianji said, 'If one has few desires, his mind
will naturally be peaceful. Just look at secluded hills and
remote valleys! Most people there enjoy long life spans
because they have few desires and always remain peaceful
in mind.'
2. Always be kind-hearted. A kind-hearted person often takes
pleasure in helping others and has no desire to harm others.
Whenever he conceives an idea, makes a remark, or does a
deed, he always ponders whether it is beneficial or harmful
to others. 'When others are evil, I remain upright; when
others are vicious, I remain kind-hearted; when others stir
up troubles, I strive to alleviate troubles; when others harm
people, I serve people. If I act in this way, I shall have a
clear conscience and naturally feel calm and tranquil in
mind.'
3. Always uphold justice. Distinguish between evil and virtue
and between right and wrong. Virtue and evil are
antagonistic, and right and wrong are not to be confused. If
one maintains his awareness, upholds integrity, and
remains clear-headed and sharp-eyed, he will naturally be
free from worries and troubles. Hence, Shi Tianji said,
'When the sun shines in the sky, obscurity is naturally
cleared away. When one grasps this miraculous concept, he
will be cured of disease and attain longevity as well.'
4. Always be cheerful. Adapt to different circumstances; feel
complacent at all times; avoid overdoing anything and do
not hurt anyone's feelings. As Bai Juyi says in a poem: 'Be
cheerful, whether rich or poor; he who does not laugh can
only be a fool.' One should often have hearty laughs. A
folk saying goes, 'A good laugh makes one ten years
younger; worry turns the hair gray.'
5. Always be pleasant. Harmony is paramount in human
relations. Be amiable, modest and prudent, broad-minded
and magnanimous; do not be calculating and do not worry
about trifles. To be amiable in dealing with others will
bring happiness to both the others and oneself.
6. Always be contented: it is a rare person who avoids all
adversity. One should remain cheerful despite adversities.
Yan Feitai had a wise epigram on caring for life. 'Just step
back to think everything will naturally be all right.'
'Contentment is happiness.' Whenever this is adversity,
compare it with a worse circumstance and one will feel
calm and cheerful.

Thanks to the availability of translated books, Westerners have


relatively easy access to these Oriental traditional systems of dealing
with emotions; additionally, they have other means of dealing with
emotions, including their own religious heritage and established
psychological aids.

SUMMARY: THE CHINESE METHODS FOR DEALING WITH


EXCESSIVE EMOTIONS
Chinese literature describes two basic means of dealing with
excessive emotions:

• Since excessive emotions arise because of derangements in


the functions of the internal organs and disorders of the
circulation of qi and blood, one can deal with the effects of
the emotions by making efforts to correct these internal
imbalances. Aside from receiving acupuncture and herbs
from practitioners, the individual is expected to regulate
daily life: arise early, eat nutritious food, carry out one's
work in an effective manner, avoid excesses in sexual
activity, dress according to the weather, be kind and
compassionate to those one encounters, go to sleep at a
reasonable hour, etc.
• Since excessive emotions lead to diseases, one must
cultivate a mental condition that is calm. This is done
through following the rules set down by and practices of
the individual's religion and by following the advice of
those who have attained a state of equanimity.

APPENDIX: How Emotions May Contribute to Cancer


The traditional Chinese medical view of cancer etiology holds that
there are several possible contributing factors, and that one of the
principal causes is internal factors, namely emotions. For example,
Sun Binyan writes in his bookCancer Treatment and
Prevention (1):
According to our understanding of the tumor patient, most
have suppression of the emotions. They tend to hold in their
anger. Although some patients have good results after
treatment, emotional stimulation may cause them to decline
again and then the previous treatment would have been in
vain. Some people have a severe phobia about cancer. Before
they know the real disease, they have a lot of suspicion.
Once they know they have the cancer, their whole spirit
breaks down. This kind of spiritual state is very bad for the
treatment.

In the book Prevention and Treatment of Carcinoma in


Traditional Chinese Medicine (2) Jia Kun gives 10
recommendations for prevention. In addition to good environment
and personal hygiene, proper levels of work (exercise) and rest, good
eating habits and proper food, avoiding smoking, and timely
treatment of all ailments, he states that:
Emotional changes, such as worry, fear, hesitation, anger,
irritation, and nervousness should be prevented. Mental
exhaustion is harmful and life should be enriched with
entertainment.

Shi Lanling and Shi Peiquan mention the etiology of various


cancers in their book about Experience in Treating Carcinomas
with Traditional Chinese Medicine (3), as regards the effect of
emotions:
The etiologic factors of the disease involve chiefly the
disturbance of the seven emotions, especially melancholy,
anxiety, and anger, which are liable to impair the spleen and
the liver. Impaired by melancholy and anxiety, qi will be
stagnated and the spleen will lose the function of
transformation and transportation, leading to disturbance of
water metabolism and the subsequent accumulation of
phlegm-dampness, while, impaired by anger, the liver qi will
be stagnated. The stagnated liver qi, as qi is the commander
of blood, may give rise to blood stasis if not relieved in time.
Thus, emotional disturbance, in-coordination between the
ascending-descending movement of qi of the internal organs,
sluggish flow of qi and blood, and the ensuing obstruction of
dampness, phlegm, and blood stasis are the fundamental
pathogenesis of the disease.

The authors go on to mention other contributors, such as


consumption of food that is "rough, hot, or hard," indulgence in
smoking, alcoholism, traumatic injuries, and chronic ulceration. In
their section on treatment of breast cancer, the authors refer to a
discussion in a Ming Dynasty text by the surgeon Chen Shigong
(1555-1636 A.D.) indicating that breast cancer "results from anxiety,
emotional depression, and overthinking which impairs the liver,
spleen, and heart and causes the obstruction of the channels." This
text is also mentioned in The Treatment of Cancer by Integrated
Chinese-Western Medicine (4), translated this way:
Breast cancer is due to worry and melancholy. Lots of ideas
hanging around make one feel dissatisfied. Perverse flow of
liver qi to the spleen leads to the obstruction of the channels
and collaterals and congealations due to excessive
accumulation.

Pan Mingji, in his book Cancer Treatment with Fu Zheng Pei


Ben Principle (5), presents a section on etiology of cancer, listing 5
contributing factors. The first item mentioned is emotional
disturbance:
TCM embodies changes of spirit and sentiment as the seven
emotions: pleasure, anger, grief, fear, yearning, sorrow,
surprise, all of which are emotional, physiological reactions
of an organism towards external changes in its environment.
Emotional disturbance refers to reactions, either excessive
(excitation) or insufficient (inhibition) which will ultimately
lead to disturbances in the flowing of qi and blood and the
visceral functions, with subsequent illness. TCM claims rage
harms the liver, excessive stimulation harms the heart, grief
harms the spleen, great sorrow harms the lungs, and fear
harms the kidneys. Though not necessarily precise, this
belief definitely points out that emotional injury will effect
the physiological functions of the qi, blood, viscera, and
channels, and lower the body resistance, resulting in disease.
The human body is susceptible to cancer when under
emotional stress or disturbance. This is mentioned early in
Chinese medical classics, such asYellow Emperor's Canon
of Internal Medicine and Golden Mirror of Original
Medicine.

The Oriental view that emotions contribute to cancer formation


differs from that adopted by Western scientists, who regard cancer as
a change in DNA that is induced by a chemical agent, radiation
exposure, or insertion of viral genes (in a few cases, the abnormal
DNA may already be present in the genetic heritage of the
individual). In order for the induced DNA change to lead to cancer, it
is first not properly repaired by certain DNA repair proteins and then
the abnormal cell is not destroyed by a natural cell death process
(apoptosis). Cancer initiating factors act within the environment of the
individual-which includes the person's genetic background and
nutritional status-to trigger the development of cancer. Thus, lung
cancer is often caused by breathing carcinogens such as those
contained in cigarette smoke; stomach and colon cancer are often
caused by carcinogens in the food supply; skin cancer may be induced
by excessive exposure to the ultraviolet light of the sun; and leukemia
may be induced by exposure to industrial chemicals, to radiation, or
to a virus that resides in the bone marrow. Traditional Chinese doctors
were aware of this type of external causation. For example, they
recognized that cancer occurred more often in certain places and was
attributed to something in the drinking water, or that cancer could be
induced by rotted food and, in modern times, by smoking. Yet, it was
the emotions that were often regarded as the most significant factor.
At the least, the excessive and/or suppressed emotions would disrupt
the functions of the internal organs and the flow of qi and blood, and
then the external factors would more easily induce further damage.
Pan goes on to say:
There are a lot of factors which affect the anticancer ability
of the organism, but the leading one has to do with whether
the spirit, nervous system, and various defenses of the
organism are perfect. A lot of evidence proves that those
who are optimistic and undertake exercises [in China, this
refers mainly to taiji and qigong, along with similar types of
practices, as well as hiking in the woods] tend to have
healthy and sound function of the nervous system, strong
physiques, and naturally great anticancer ability and
immunity. Even if those people come into contact with
outside carcinogens, they will not develop cancer. On the
contrary, those who have mental injury, who are
disheartened, or often have a fear of cancer, and who do not
undertake exercises at all or are overtired, whose daily life is
irregular and unsanitary, whose spirit and nerve function is
disorganized, tend to reduce their defensive ability. As a
result, the rate of cancer occurrence among those people is
higher.

Western researchers have not undertaken detailed study of the


possibility that persistent or repeated experience or suppression of
emotions contributes to the risk of cancer for several reasons. Aside
from a low motivation to undertake the study because other factors
are considered more important, such research is extremely difficult to
perform properly. One would have to recruit a very large number of
people into the study, have some reliable method of measuring
emotional status over a long period of time, and then find some way
to quantitate the emotional condition (as it varied over time) so as to
compare with the actual incidence of cancer among individuals under
study. Still, the fledgling field of psychoneuroimmunology (the study
of how psychological states and nervous system manifestations of the
emotions impact the immune system) has developed some data
supporting the concept that emotional stress increases a person's
susceptibility to cancer (12).

In China, a study (7) involving a huge population (750,000


people in Beijing) attempted to find out if psycho-social factors
contributed to the incidence of primary lung cancer. They reported
that their study showed three factors positively associated with
occurrence of lung cancer:

1. Burst of emotion that could not be controlled.


2. Poor working circumstances, including poor relationship
with coworkers
3. Depressive feeling for a long time.

Poor relationship with coworkers would generally suggest that


there is emotional tension during the work day, so all of these could
indicate emotional disorders associated with higher incidence of
cancer. When "depressive feeling for a long time" was analyzed
further, it was found that this was a significantly stronger risk factor
for women than men. This study supports the traditional Chinese
contention that emotions can contribute to cancer incidence, but it
would need to be verified by a tightly controlled trial in order to
convince Western researchers that the results could have important
implications for understanding the etiology of cancer.

The emotional status of patients after receiving a diagnosis of


cancer has been studied, but the difficulty in monitoring emotional
status was perhaps the only thing clearly revealed. In a study
conducted in Denmark (6), women who had just been diagnosed with
breast cancer that was considered to have a low risk of recurrence
(easily treated, not metastasized) were compared with women from
the general population. The results conflicted with the expectation
that the patients would have a higher level of stress and anxiety, but
this may simply reveal the difficulty of designing the monitor of
emotional status, since other studies have found that anxiety and
depression in cancer patients tends to be a significant problem.

A POSSIBLE MECHANISM INVOLVING SHORT-TERM


EMOTIONAL STRESS
The Chinese physicians who comment about the role of emotions in
cancer formation point to the fact that the internal viscera become
weakened, thus increasing the opportunity for pathologies of all types,
including cancer. Western research has already supported the idea that
depression can impair immune system functions (perhaps indirectly,
such as by repeatedly impairing a good night of sleep, with sleep
contributing to maintenance of the immune system). It has been
shown that tumor-relevant lymphocyte subpopulations, such as
natural killer cells (NK cells; these can directly attack cancer cells),
have receptors for various neuropeptides, including those released
during stress. This finding indicates how NK cell activity might be
modulated by a person's emotional responses. The level of NK cell
activity has been found to be a reasonably good predictor of outcome
for women with breast cancer. Further, a portion of the loss of this
immune cell activity in cancer patients was shown to be correlated
with psycho-social measures such as patient "adjustment" (avoiding
showing distress at the cancer diagnosis/treatment), lack of social
support, and symptoms of fatigue/depression (14).

Along these lines, the immune system may regulate the activities
of enzymes, such as aromatase, that converts estrogens to estradiol in
breast tissue (17, 18), where estradiol is thought to contribute to
breast cancer. Cytokine changes (as occur with infection and
inflammation) have been observed in cases of major depression, and
have been suggested to be a potential cause of depression (19, 20). In
fact, some antidepressant drugs are tumor necrosis factor (TNF)
inhibitors; this being one of the cytokines that causes considerable
adverse effects in cancer patients. It is also possible that depression,
and other emotional disorders, will affect the cytokines.

In the book Why We Get Sick (10), which is based on the


premise that most of our body (and mental) functions have been
determined by evolutionary factors, the author explains how a
potentially helpful feeling (anxiety) can have harmful physiological
effects:
Everyone must realize that anxiety can be useful. We know
what happens to the berry picker who does not flee a grizzly
bear, the fisherman who sails off alone into a winter storm,
or the student who does not shift into high gear as a term-
paper deadline approaches. In the face of threat, anxiety
alters our thinking, behavior, and physiology in
advantageous ways....Because anxiety can be useful, it might
seem optimal to adjust the mechanism so that we are always
anxious. This would be distressing, but natural selection
cares only about our fitness, not our comfort. The reason we
are sometimes calm is not because discomfort is
maladaptive, but because anxiety uses extra calories, makes
us less fit for many everyday activities, and damages tissues.
Why does stress damage tissues? Imagine a host of bodily
responses that offer protection against danger. Those that are
"inexpensive" and safe can be expressed continually, but
those that are "expensive" or dangerous cannot. Instead, they
are bundled into an emergency kit that is opened only when
the benefits of using the tools are likely to exceed the costs.
Some components are kept sealed in the emergency kit
precisely because they cause bodily damage. Thus, the
damage associated with chronic stress should be no cause for
surprise....In fact, recent work has suggested that the "stress
hormone" cortisol may not defend against outside dangers at
all, but instead may mainly protect the body from the effects
of other parts of the stress response.

Thus, if the "emergency kit" that is intended to respond to


specific immediate dangers is left open for an extended period of
time, for example, by living in a situation that the body and mind
deems unsafe, then progressive damage to the tissues can occur. This
damage may then cause or exacerbate chronic disease or a life-
threatening event (e.g., stroke, heart attack, incurable cancer).
Cortisol, which may act as a protector for the body, when elevated for
long periods of time, can impair immune functions, eventually
leading to damage.

Chinese researchers have attempted to quantify physical


responses to emotional distress. In one study (21), rats that became
angered and fought with one another were tested after this change
compared to others that remained in a calm condition. The study
results suggested that the stress condition induced release of extra
adrenocorticotropin hormone (ACTH), raising cortisol levels, which
had a secondary effect of reducing the output of hydrogen peroxide
from macrophages (a type of white blood cell). It was thus proposed
that the defensive function of the immune system could be slowed or
impaired as a result of the emotional stress. In an Algerian study of
women under stress (22), it was shown that heightened cortisol levels
often occurred, and that this was sometimes counteracted by
production of another hormone, dehydroepiandrosterone (DHEA),
which was suggested to be a potential therapeutic substance to
counter the adverse effects or raised cortisol.

It seems entirely possible that a single period of intense stress


lasting months, such as occurs with a divorce, death of a family
member, loss of job, or other life-changing event, rather than decades
of habitual emotional distress, might lead to serious damage to the
tissues which could trigger or allow the development of cancer. The
stress hormones might themselves stimulate latent cancer cells into
reproduction; the hormones or their metabolites might transform a
normal cell to a cancer cell; or the damage to the tissues may lead to
failure of normal cancer-control mechanisms. In this way, a diagnosis
of cancer may be encountered a year or two after such an event (it
takes that long for the cancer to develop enough to yield evident
symptoms or a diagnosable lump). Such a correlation-between
stressful events and subsequent cancer diagnosis (13) or recurrence of
previously treated breast cancer (15)-has been supported by early
studies that still require replication. If severe emotional stress (of the
type that is likely to be mentioned during questioning) does
sometimes give rise to cancer soon after the stress is experienced, this
would certainly explain the observation made by traditional
practitioners: that emotions are a cause of cancer.
REFERENCES TO APPENDIX

1. Sun Binyan, Cancer Treatment and Prevention, 1991


Offete Enterprises, San Mateo, CA.
2. Jia Kun, Prevention and Treatment of Carcinoma in
Traditional Chinese Medicine, 1985 The Commercial
Press, Hong Kong.
3. Shi Lanling and Shi Peiquan, Experience in Treating
Carcinomas with Traditional Chinese Medicine, 1992
Shandong Science and Technology Press, Shandong.
4. Zhang Daizhao, The Treatment of Cancer by Integrated
Chinese-Western Medicine, 1989 Blue Poppy Press,
Boulder, CO.
5. Pan Mingji, Cancer Treatment with Fu Zheng Pei Ben
Principle, 1992 Fujian Science and Technology Publishing
House, Fujian.
6. Groenvold M, et al., Anxiety and depression in breast
cancer patients at low risk of recurrence compared with
the general population: a valid comparison? Journal of
Clinical Epidemiology 1999; 52(6): 523-530.
7. Fan RL, Zheng SH, and Wu ZS, Study on the relationship
between lung cancer at preclinic stage and psycho-social
factors: a case control study, Chinese Journal of Blood
Diseases 1997; 18(5): 289-292.
8. Cavaljeri EL, et al., Molecular origin of cancer,
Proceedings National Academy of Sciences 1997; 94:
10,937-10,942.
9. Pan Mingji, How to Discover Cancer Through Self-
Examination, 1992 Fujian Science and Technology
Publishing house, Fujian, China.
10. Nesse RM and Williams GC, Why We Get Sick, 1994
Times Books, Random House, New York.
11. Guzman RC, et al., Hormonal prevention of breast cancer:
mimicking the protective effect of pregnancy, Proceedings
of the National Academy of Sciences USA, 1999; 96(5):
2520-2525.
12. Ader R (editor), Psychoneuroimmunology, 1981
Academic Press, New York.
13. The Burton Goldberg Group, Alternative Medicine: The
Definitive Guide, 1993 Future Medicine Publishing
Group, Puyallup, WA.
14. Levy S., et al., Correlation of stress factors with sustained
depression of natural killer cell activity and predicted
prognosis in patients with breast cancer, Journal of
Clinical Oncology, 1987; 5(3): 348-353.
15. Ramirez AJ, et al., Stress and relapse of breast cancer,
British Medical Journal, 1989; 298: 291-293.
16. Wright JV, Schliesman B, and Robinson L, Comparative
measurements of serum estriol, estradiol, and estrone in
non-pregnant, premenopausal women: a preliminary
investigation, Alternative Medicine Review 1999; 4(4):
266-270.
17. Reed MJ, et al., The role of cytokines and sulphatase
inhibitors in regulating estrogen synthesis in breast
tumors, Journal of Steroid Biochemistry and Molecular
Biology 1995; 53 (1-6): 413-420.
18. Purohlt A, Singh A, and Reed MJ, Regulation of steroid
sulphatase and estradiol 17 beta-hydroxysteroid
dehydrogenase in breast cancer, Biochemical Society
Transactions 1991; 27(2): 523-532.
19. Dantzer R, et al., Cytokines and depression: fortuitous or
causative association? Molecular Psychiatry 1999; 4(4):
328-332.
20. Licinio J and Wong ML, The role of inflammatory
mediators in the biology of major depression, Molecular
Psychiatry 1999; 4(4): 317-327.
21. Yan Can, et al., Study on pathogenic mechanism of
emotions in traditional Chinese medicine, Journal of
Traditional Chinese Medicine 1999; 19(2): 132-134.
22. Boudarene M and Legros JJ, Study of the stress response:
role of anxiety, cortisol, and DHEAs, Encephale 2002;
28(2): 139-146.

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