The Seven Emotions as pathogens
The Seven Emotions (joy, anger, worry, pensiveness, sadness, fear, and fright) are internal pathogenic factors in TCM that cause disease when experienced excessively, abruptly, or for prolonged periods, directly affecting the organs and disrupting the flow of Qi and blood.
Key Properties
Body Layers
Qi
Qī Qíng
The Seven Emotions
Nature & Properties
Thermal Nature
Variable
Yin-Yang
Yang
Vulnerable Organs
Heart
The Heart is the supreme controller of all mental activities and houses the spirit (shen). All emotional disturbances ultimately affect the Heart, causing palpitations, insomnia, anxiety, and mental restlessness. Excessive joy and fright particularly damage the Heart.
Liver
The Liver governs the free flow of Qi and is most directly affected by anger, frustration, and resentment. Liver Qi stagnation is the most common pattern in emotional disorders, causing rib-side distension, sighing, and irritability.
Spleen
The Spleen is damaged by pensiveness and overthinking, which knot the Qi and impair digestive function. This leads to poor appetite, bloating, fatigue, and loose stools. The Spleen is also secondarily affected when Liver Qi stagnation attacks the digestive system.
Lungs
The Lungs are injured by sadness and grief, which consume Qi. This manifests as shortness of breath, weak voice, chest oppression, and susceptibility to catching colds. Prolonged grief can significantly weaken Lung function.
Kidneys
The Kidneys are damaged by fear and fright, which cause Qi to descend inappropriately. This results in weak knees and lower back, urinary symptoms, and in severe cases, loss of bladder or bowel control.
Educational content · Consult qualified TCM practitioners for diagnosis and treatment
Overview
The Seven Emotions (七情, Qī Qíng) represent one of the most important concepts in Traditional Chinese Medicine's understanding of internal causes of disease. Unlike external pathogens like wind or cold that invade from outside, the Seven Emotions arise from within as our natural psychological responses to life events. These emotions—joy (喜, xǐ), anger (怒, nù), worry (忧, yōu), pensiveness (思, sī), sadness (悲, bēi), fear (恐, kǒng), and fright (惊, jīng)—are perfectly normal and healthy when experienced in moderation.
The key TCM insight is that emotions only become pathogenic (disease-causing) when they are too sudden, too intense, or last too long. When emotional stimulation exceeds our body's ability to adapt, it disrupts the smooth flow of Qi and blood, throws off the balance of Yin and Yang, and damages the internal organs. This concept reflects TCM's holistic understanding that mind and body are inseparable—emotional distress doesn't just affect our mood, it creates real physical changes in our organs and energy systems.
Each emotion has a specific relationship with particular organs: joy relates to the Heart, anger to the Liver, pensiveness to the Spleen, sadness and worry to the Lungs, and fear and fright to the Kidneys. However, all emotional disturbances ultimately affect the Heart, which is considered the "monarch" that governs all mental and spiritual activities. In clinical practice, the Heart, Liver, and Spleen are most commonly affected by emotional factors.
Historical Context
The concept of the Seven Emotions as pathogenic factors has ancient origins in Chinese medicine, first systematically described in the Huangdi Neijing (Yellow Emperor's Classic of Internal Medicine), compiled approximately during the Han Dynasty (206 BCE – 220 CE). The Suwen (Basic Questions) section established the foundational relationship between emotions and organs, stating that the Heart governs joy, the Liver governs anger, the Spleen governs pensiveness, the Lungs govern grief, and the Kidneys govern fear.
The Lingshu (Spiritual Pivot) further elaborated on how excessive emotions damage the spirit (shen) and disrupt Qi flow. Classical texts described specific mechanisms: "Excessive joy scatters the spirit and it can no longer be stored," and "When one feels anxiety, the Qi is blocked and does not move." The Song dynasty physician Chen Yan formally classified the Seven Emotions as one of three categories of disease causation in his influential work San Yin Ji Yi Bing Zheng Fang Lun (Three Categories of Pathogenic Factors), establishing them as the primary internal cause of disease alongside external causes (Six Excesses) and miscellaneous causes.
Throughout Chinese medical history, physicians have developed sophisticated approaches to treating emotional disorders, including the famous "overcoming emotions" therapy based on Five Element theory—using one emotion to counteract another (for example, fear controls excessive joy, and anger controls excessive pensiveness).
Defining Characteristics
Directly injures internal organs
直接伤及脏腑Unlike external pathogens that must progress through defensive layers, the Seven Emotions bypass surface defenses and immediately affect the internal organs. Each emotion has an affinity for specific organs: anger injures the Liver, joy injures the Heart, pensiveness injures the Spleen, sadness injures the Lungs, and fear injures the Kidneys.
Disrupts Qi dynamics
影响脏腑气机Each emotion creates a characteristic disturbance in Qi flow: anger makes Qi rise, joy makes Qi slow down and scatter, sadness consumes Qi, fear makes Qi descend, fright scatters Qi chaotically, and pensiveness causes Qi to stagnate and knot. These Qi disruptions explain the diverse physical symptoms that accompany emotional disorders.
All emotions pass through the Heart
心为五脏六腑之大主While each emotion relates to a specific organ, the Heart is the supreme controller of all mental activities. All emotional injuries first affect the Heart and spirit (shen), then spread to influence other organs. This explains why palpitations, insomnia, and mental restlessness commonly accompany all types of emotional disorders.
Can transform into secondary pathologies
化火生痰Prolonged emotional disturbance can generate secondary pathological products. Qi stagnation from suppressed emotions often transforms into Fire (heat), which can consume Yin fluids. Stagnant Qi can also impair fluid metabolism, leading to Phlegm accumulation or Blood stasis, which then cause additional symptoms and complications.
Most commonly affects Heart, Liver, and Spleen
以心肝脾三脏为多见In clinical practice, these three organs are most vulnerable to emotional injury. The Heart governs the spirit; the Liver ensures smooth Qi flow and is easily disrupted by frustration and anger; the Spleen transforms and transports nutrients and is impaired by overthinking and worry.
Entry Routes
Unlike external pathogens that enter through the skin, nose, or mouth, the Seven Emotions are generated internally and do not have external entry routes. They arise directly from the mind and spirit (shen) in response to life circumstances and experiences. The pathogenic process begins when psychological stimulation exceeds the body's adaptive capacity, directly affecting the Heart (which governs all mental activities) and then spreading to influence the corresponding organs.
Progression Pattern
Body Layers Affected
QiEmotional pathology in TCM follows a predictable progression pattern. Initially, excessive emotions disturb the Heart spirit (shen), causing symptoms like restlessness, anxiety, or mental confusion. The disruption then affects Qi movement according to each emotion's characteristic pattern—anger causing Qi to rise, fear causing it to descend, pensiveness causing it to knot.
If the emotional stimulus continues, Qi stagnation becomes established, typically affecting the Liver first (as the Liver governs the free flow of Qi). Prolonged Qi stagnation may transform into Fire, causing symptoms of heat. The stagnation also impairs Blood circulation, potentially leading to Blood stasis with symptoms like fixed pain, masses, or menstrual disorders in women.
Over time, chronic emotional disturbance depletes Qi and Blood, leading to deficiency patterns. The Spleen's function weakens, reducing the production of Qi and Blood. The Heart loses its nourishment, worsening mental symptoms. Ultimately, Yin and Yang become imbalanced, and the pathology may affect multiple organ systems simultaneously.
Clinical Relevance
Understanding the Seven Emotions is essential for modern TCM practice, as emotional factors play a significant role in many conditions seen in clinic. Stress-related disorders, anxiety, depression, insomnia, digestive problems, menstrual irregularities, and chronic pain often have emotional components that must be addressed for successful treatment.
In clinical assessment, practitioners should always inquire about the patient's emotional state, stress levels, and any significant life events. The timing of symptom onset in relation to emotional experiences provides important diagnostic information. Physical symptoms that worsen with stress or improve with relaxation suggest emotional involvement.
Modern research increasingly supports the mind-body connection emphasized in TCM. Studies have demonstrated physiological changes in organ function, immune response, and hormonal balance associated with different emotional states. This validates the TCM understanding that emotions directly affect physical health. Integrating emotional support with acupuncture and herbal treatment significantly improves outcomes for many patients, particularly those with chronic or psychosomatic conditions.
Common Manifestations
Liver Qi Stagnation from Anger
Excessive anger causes Liver Qi to rise adversely, manifesting as red face and eyes, headache, dizziness, irritability, rib-side distension, and in severe cases, vomiting blood or sudden collapse.
Heart Spirit Disturbance from Excessive Joy
Over-excitement scatters the Heart Qi, causing palpitations, insomnia, mental confusion, forgetfulness, and in extreme cases, mania or inappropriate laughter.
Spleen Qi Stagnation from Pensiveness
Overthinking and worry knot the Spleen Qi, leading to poor appetite, abdominal distension, loose stools, fatigue, and digestive disorders.
Lung Qi Depletion from Sadness
Excessive grief consumes Lung Qi, causing shortness of breath, weak voice, chest oppression, depression, and susceptibility to respiratory issues.
Kidney Qi Sinking from Fear
Chronic fear causes Qi to descend inappropriately, resulting in weak knees, lower back pain, urinary incontinence, or nocturnal emission.
Heart Spirit Scattering from Fright
Sudden shock scatters the Heart Qi chaotically, causing palpitations, panic, disorientation, and inability to concentrate.
Liver Invading Spleen Pattern
Anger damaging the Liver often causes it to "attack" the Spleen, resulting in alternating irritability with digestive symptoms like abdominal pain relieved by bowel movement, bloating, and appetite changes.
Qi Stagnation Transforming to Fire
Prolonged emotional constraint generates internal heat, manifesting as bitter taste, dry throat, red eyes, irritability, constipation, and dark urine.
Tongue Manifestations
Tongue signs vary according to which emotion predominates and how long the condition has persisted. In Liver Qi stagnation from anger, the tongue edges (representing the Liver) may appear red or slightly purple, with the body showing a normal or slightly dusky color. As Qi stagnation transforms to Fire, the tongue becomes red with yellow coating.
Pensiveness damaging the Spleen may show a pale, swollen tongue with teeth marks along the edges and a thin white coating. Heart disturbance from excessive joy or fright typically presents with a red tip (the Heart area) and the tongue may quiver slightly. Chronic emotional depletion leads to a pale, thin tongue indicating Qi and Blood deficiency. Blood stasis from long-standing Qi stagnation produces a purple or dusky tongue, sometimes with visible sublingual veins.
Pulse Manifestations
Pulse diagnosis reveals characteristic changes with different emotional patterns. Liver Qi stagnation from anger typically produces a wiry (xián) pulse, feeling like a taut guitar string under the fingers—tight and spring-like. This reflects the constrained nature of stagnant Liver Qi.
When Qi stagnation transforms to Fire, the pulse becomes wiry and rapid (shuò). Heart disturbance from fright or excessive joy often shows an irregular or intermittent pulse, reflecting the scattered Heart Qi. Pensiveness damaging the Spleen may produce a moderate, slightly weak pulse, while profound sadness depleting Lung Qi creates a weak, thin pulse. Fear damaging the Kidneys typically manifests as a deep (chén) and weak pulse, reflecting the sinking of Qi to the lower body. In chronic cases with Blood stasis, the pulse may feel choppy (sè) or hesitant.
Common Pathogen Combinations
Qi Stagnation with Phlegm Accumulation
Combined with Cold as a pathogenWhen emotional Qi stagnation impairs fluid metabolism, Phlegm accumulates. This combination creates the classic "plum pit throat" (globus sensation) where patients feel something stuck in the throat that cannot be swallowed or expelled. Other manifestations include chest stuffiness, dizziness, and a greasy tongue coating. In severe cases, Phlegm may mist the Heart orifices, causing mental confusion or even manic behavior.
Qi Stagnation with Blood Stasis
Prolonged Qi stagnation impedes Blood circulation, leading to Blood stasis. This combination manifests as fixed, stabbing pain (especially in the chest or rib-sides), masses or lumps, and in women, painful menstruation, dark clotted menstrual blood, or amenorrhea. The tongue becomes purple or shows purple spots, and the pulse feels wiry and choppy.
Emotional Fire
Constrained emotions, particularly anger, commonly transform into Fire. This internal heat manifests as irritability, red face and eyes, bitter taste, thirst, headache, insomnia with vivid dreams, and constipation. The tongue is red with yellow coating, and the pulse is wiry and rapid. This pattern is especially common in Liver Fire rising from suppressed anger.
Differentiation from Similar Pathogens
The Seven Emotions must be distinguished from external pathogenic factors that may produce similar symptoms. While external Wind can cause headache and dizziness (similar to Liver Qi rising from anger), emotional headache typically has a clear relationship to stress or frustration, occurs with rib-side discomfort, and is accompanied by emotional symptoms like irritability. External Wind headache has a more sudden onset with symptoms like neck stiffness and aversion to wind.
Heart Fire from emotional causes must be differentiated from Heart Fire due to Yin deficiency or external heat. Emotional Heart Fire has a clear connection to excitement or shock, while deficiency-type Heart Fire typically develops gradually with signs of Yin depletion (night sweats, afternoon fever). Spleen deficiency from pensiveness should be distinguished from Spleen damage due to dietary irregularity—both cause digestive symptoms, but emotional Spleen damage is accompanied by mental symptoms like difficulty concentrating and excessive worrying.
It's also important to recognize that emotional factors often combine with external pathogens or dietary causes—a patient may develop Liver Qi stagnation from stress, which then makes them more susceptible to external Wind invasion or digestive problems from food stagnation.
Treatment Principles
Treatment of Seven Emotions disorders follows several key principles. First, address the Qi dynamic disturbance—if Qi is stagnated, move it; if Qi has risen adversely, direct it downward; if Qi has scattered, consolidate it. The Liver plays a central role in Qi movement, so "soothing the Liver and regulating Qi" (疏肝理气) is a fundamental approach for many emotional disorders.
Second, treat the affected organs according to their specific pathology. For Liver Qi stagnation, course the Liver and resolve depression. For Heart spirit disturbance, calm the Heart and settle the spirit. For Spleen damage from overthinking, strengthen the Spleen and nourish Qi. For Lung grief, regulate Lung Qi and resolve melancholy. For Kidney fear, tonify the Kidneys and secure Qi.
Third, address secondary pathologies that have developed—clear Fire if Qi has transformed into heat, transform Phlegm if fluids have accumulated, or invigorate Blood if stasis has formed.
Beyond herbs and acupuncture, emotional therapy using Five Element relationships is classical treatment: anger can treat excessive pensiveness (Wood controls Earth), joy can treat excessive grief (Fire controls Metal), pensiveness can treat excessive fear (Earth controls Water), grief can treat excessive anger (Metal controls Wood), and fear can treat excessive joy (Water controls Fire). Counseling, lifestyle modification, and stress reduction are essential components of complete treatment.
Representative Formulas
Xiao Yao San
The classic formula for Liver Qi stagnation with Spleen deficiency, used for emotional constraint with irritability, rib-side discomfort, fatigue, and digestive symptoms.
Chai Hu Shu Gan San
Strongly courses Liver Qi and resolves depression, used for more pronounced Liver Qi stagnation with pain and distension in the rib-sides and abdomen.
Gan Mai Da Zao Tang
A gentle formula for Heart and Spleen deficiency with emotional symptoms, particularly for women with depression, crying spells, and restless spirit.
Gui Pi Tang
Tonifies Heart and Spleen, nourishes Blood, used for anxiety, insomnia, poor memory, and fatigue from overthinking damaging both organs.
Ban Xia Hou Pu Tang
Moves Qi and transforms Phlegm, specifically for plum pit throat (globus sensation) from Qi stagnation with Phlegm accumulation.
Representative Points
Taichong
The source point of the Liver, essential for coursing Liver Qi, calming Liver Yang, and treating anger-related symptoms. Combines with LI-4 ("Four Gates") for moving Qi throughout the body.
Shenmen
The source point of the Heart, calms the spirit, treats insomnia, anxiety, palpitations, and all Heart-related emotional disorders.
Neiguan
Opens the chest, calms the Heart, and settles the spirit. Excellent for anxiety, chest tightness, and palpitations from emotional causes.
Yintang
Located between the eyebrows, this extra point strongly calms the mind and is used for anxiety, insomnia, and frontal headache from stress.
Baihui
At the vertex of the head, lifts Qi and clears the mind. Used for depression, poor concentration, and sinking of clear Yang.
Qimen
The Front-Mu point of the Liver, used for rib-side pain, chest oppression, and emotional constraint affecting the Liver.
Classical Sources
Huangdi Neijing Suwen (Yellow Emperor's Classic - Basic Questions)
Chapter 5 - Yin Yang Ying Xiang Da Lun怒伤肝，悲胜怒；喜伤心，恐胜喜；思伤脾，怒胜思；忧伤肺，喜胜忧；恐伤肾，思胜恐
Anger injures the Liver, sadness overcomes anger; joy injures the Heart, fear overcomes joy; pensiveness injures the Spleen, anger overcomes pensiveness; worry injures the Lungs, joy overcomes worry; fear injures the Kidneys, pensiveness overcomes fear.
Huangdi Neijing Suwen
Chapter 39 - Ju Tong Lun (On Pain)百病生于气也。怒则气上，喜则气缓，悲则气消，恐则气下，惊则气乱，思则气结
All diseases arise from Qi. Anger makes Qi rise, joy makes Qi slacken, sadness makes Qi dissolve, fear makes Qi descend, fright makes Qi scatter, pensiveness makes Qi knot.
Huangdi Neijing Lingshu (Spiritual Pivot)
Chapter 8 - Ben Shen (Root Spirit)喜乐者，神惮散而不藏；愁忧者，气闭塞而不行
Those with excessive joy and elation will have their spirit scattered and unable to be stored; those with worry and anxiety will have their Qi blocked and unable to flow.
San Yin Ji Yi Bing Zheng Fang Lun (Three Categories of Pathogenic Factors)
By Chen Yan, Song Dynasty七情，人之常性，动之则先自脏腑郁发，外形于肢体
The Seven Emotions are the normal nature of humans; when disturbed they first arise from depression in the organs, then manifest externally in the limbs and body.
Modern References
The Foundations of Chinese Medicine
Comprehensive textbook with detailed chapters on emotional causes of disease and their treatment with acupuncture and herbs.
The Seven Emotions: Psychology and Health in Ancient China
In-depth study of the classical Chinese concept of emotions from the Neijing and Taoist perspectives.
Chinese Medicine Psychology
Modern textbook bridging TCM emotional theory with contemporary psychological understanding.
Huangdi Neijing: A Synopsis with Commentaries
Annotated translation of the Neijing with focus on theoretical foundations including emotional pathology.