In modern Chinese medicine, 神 shen, often translated as spirit, is a key concept. Due to the many and varied meanings of the word spirit in English, this term often leads to confusion, both among patients and professionals. Here we would like to explain the understanding of this concept within the Chinese culture.
Bob Flaws, who coauthored Chinese Medical Psychiatry, points out that there are three different connotations of the term 神 shen. The non-medical usage describes a universal consciousness or pervasive animating force and has been compared to the Native American idea of the Great Spirit.
Within a medical context, however, spirit has different implications. The standard medical usages can be categorized into the broader and more narrow meanings. Many Western practitioners of Chinese medicine have been taught that 神 shen mainly describes the general vitality of a patient. This is the broader usage and, in practice in China, is largely employed to determine the prognosis of a critically ill patient. This form of spirit is most apparent in the eyes.
Far more important in the daily practice of Chinese—especially in the West where most clients remain ambulatory—is the narrow meaning of spirit. This application roughly equates to consciousness and is the central subject of the study and practice of Chinese medical psychiatry. For many patients who have been diagnosed with a behavioral health disorder by Western medicine, the Chinese practitioner will examine spirit as it is understood in its narrow sense.
Chinese medicine offers a number of statements describing the anatomical and physiological nature of the spirit. The spirit resides in the heart. It is an accumulation of qi and blood. When healthy, the spirit remains level in its abode. During the day, the spirit extends through the orifices of the heart and connects to the phenomenological world outside, withdrawing to the inner sanctum of the heart at night where it is enfolded by blood and yin.
There are three fundamental pathologies that affect the heart spirit. First, heat may harass the spirit leading to mania, agitation, or insomnia. Second, a lack of qi and blood may result in malnourishment and nonconstruction of the heart spirit. Finally, the orifices of the heart may be blocked, preventing the heart spirit from communicating with the outside world.
A person in a manic state with a predisposition towards heat, a red tongue, and a rapid pulse is an example of the first case. A fragile, fatigued, elderly person with palpitations, forgetfulness, and difficulty sleeping exemplifies the second pathocondition. Finally, the third pathology might be seen in a case of schizophrenia where the patient is trapped in an individual reality, disconnected from our common reality, and presents with a thick, slimy tongue fur and a slippery pulse.
As with other translated concepts in Chinese medicine, there is no simple English equivalent that fully describes 神 shen spirit. Only by taking the time to explore the numerous uses within the native culture is one able to get a sense of the true Chinese medical meaning of the term. Beyond being a stimulating semantic exercise, taking the time to learn more about the Chinese perception of spirit allows us to better utilize, or receive, Chinese medical treatments designed to address disorders of the spirit. In many cases, a nuanced understanding of the Chinese concept of spirit may make the difference between success and failure in clinical practice.