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'Excessive Use of the Eyes Injures the Heart.' Or, It’s All Nonsense Until its Suddenly Not!

A tierd and bloodshot eye

One of the things I love about Chinese Medicine is how often its theories, which at first sight seem bizarre or nonsensical, are suddenly found to be born out by the latest science. One example of such a seemingly bizarre theory the first of the Five Taxations which states that “Excessive use of the eyes injures the Blood (Heart)”. Why on earth would overworking the eyes have a detrimental impact on the heart is a question to which Chinese medicine provides a range of answers, some more esoteric than others. Conventional medicine has had no real way of explaining this, except perhaps in terms of lifestyle factors i.e. someone who spends large amounts of time reading or using a screen is more likely to have a sedentary lifestyle and so more likely to have heart problems. But recently I came across research that seemed not just to bear out the link between time spent staring at a screen and heart disease but found this effect didn’t diminish among more physically active people.

As a rule I think classical Chinese medicine should be taken on its own terms, but as someone who grew up and was educated within a materialist, rationalist paradigm its hard for me not to appreciate some ‘scientific’ validation of what I do. I actually think that these sorts of confirmatory findings are more important than that though. I think that rather than simply validating one small piece of theory what’s actually being validated is both a whole way of understanding the body and, by extension, the means by which that knowledge was acquired. I hope taking a look at the science and then the Classical theory behind the first taxation will illuminate this more.

In 2011 researchers from Department of Epidemiology and Public Health at the University College London looked at the health effects of spending too much time in-front of a screen. More specifically they looked at people spending more than four hours a day sitting in front of a television or computer and found that it more than doubled the risk of dying from or being hospitalized for heart disease. More surprisingly they found that that risk was the same for those exercising more than two hours a day as for those exercising less than two hours a day. The researchers suggested a number of mechanisms that may explain this; that those leading sedentary lifestyles may have other lifestyle factors that increase the risk of heart disease; that the body needs to move in order to break down sugars and triglycerides and lastly that being excessively sedentary leads to inflammation and an elevated level of C Reactive Protein, two things that correlate with higher rates of heart disease. However none of these mechanisms account for the fact that exercise doesn’t seem to reduce the risk of heart disease among those spending long hours in front of a screen because all of these mechanisms are positively affected by exercise.

More promising is research highlighted by Linda Stone, a speaker and consultant who spent more than twenty years as an executive for large technology companies, including Apple and Microsoft. In 2007 she was suffering from repeated chronic respiratory infections and her doctor suggested she study the Buteyko breathing technique. As soon as she began to become more aware of her breath she realised that often when working at a screen it became shallow with periods when she’d hold her breath completely. She began doing her own research and found that approximately 80% of those she tested were responding to working at a screen in exactly the same way and she coined the term email apnea to describe the phenomenon. She found that the 20% of people who didn’t respond in this way to staring at a screen all had some training which had elements of conscious breathwork. Fascinated she began looking to see what research there was on the subject.

In fact there’s not a huge amount work been done on this area, which is surprising given how much of our lives are now mediated by screens. In 2009 researchers found an increase in the activity of the sympathetic nervous system among students who were texting. The sympathetic nervous system readies the body for stress, at its most extreme its our ‘fight or flight’ response. There are physiological changes in the body associated with this state and prolonged arousal of the sympathetic nervous system is associated with a variety of physiological consequences, including hyperglycemia (high blood glucose levels), which can lead to type 2 diabetes mellitus, and hypertension (high blood pressure), which can lead to cardiovascular disease.

A 2008 paper by Anderson et al provides even better evidence that the email apnea that Stone had observed may be having a detrimental effect on the health of the heart. The researchers found that high variability in the rate and depth of the breath among subjects at rest was positively correlated with increased blood pressure measured over 24 hours and that this variability in breathing was inversely correlated with heart rate variability (higher heart rate variability is considered a measure of better heart health). When Linda Stone spoke to the researchers they were able to tell her much more about the effects email apnea may be having.

High variability in rate and depth of the breath when at rest was associated with changes in the body's balance of oxygen, CO2, and NO (Nitric oxide). The last of these is particularly interesting in this context because our immune system uses nitric oxide in fighting viral, bacterial and parasitic infections, as well as tumors. Nitric oxide is associated with the processes of learning, memory, sleeping, feeling pain, and, probably, depression and also transmits messages between nerve cells which provides a link between poor breathing patterns and the vagus nerve.

One of the major cranial nerves, the vagus nerve mediates the autonomic nervous system, which includes the sympathetic -- "fight or flight," and parasympathetic -- "rest and digest" nervous systems. As noted above over activation of the sympathetic nervous system is associated with a number of negative health effects and its activation also leads the liver to dump glucose and cholesterol into our blood stream, neither of which is good for the heart.

Somewhat annoyingly I’ve not been able to find any research looking at whether these effects are found with other activities that require prolonged staring (reading for instance) or whether these effects are particular to staring at screens. As I’ve already said given how much of our lives are mediated by screens I’m surprised there’s not more research in this area. But what I have turned up seems to suggest that ‘Too Much Staring really does Injure the Blood (Heart)’. So how does Traditional East Asian Medicine explain this?

In Chinese Medicine the organ associated with the eyes is the Liver and the Liver is also said to ‘store the Blood’. The Heart however is associated with the tongue but is said to ‘generate the Blood’ and Blood is seen as the material basis for the shen (consciousness) which resides in the Heart. Its interesting to note that some of the mental processes in which nitric oxide plays a role (learning, memory, sleeping, and some forms of depression) would in Chinese Medicine be understood as being under the influence of the Heart Blood. However this still doesn’t explain why over use of the eyes would result in damage to the Heart. For that we need to look at 5 Phase theory.

Five element chart

In 5 Phase theory the Liver is associated with the Wood phase and the Wood phase is the ‘mother’ of the Fire phase which is associated with the Heart. So over taxation of the Liver (mother) would, according to the theory, lead to vacuity or deficiency in the Heart (child). A simple, practical example of this might be reading on a screen before bed leading to poor sleep – which could be understood as overuse of the eyes taxes the Liver which then fails to nourish the Heart, which in a deficient state can’t properly house the shen and so one’s mind wanders and you’re unable to get to sleep. Like much of Chinese medicine the theory is simple but describes what is observed in practice. More that this, in keeping with the holistic nature of Chinese Medicine its application can be ever more subtle and sophisticated.

So far I’ve used the term ‘Too much staring’ but the original Chinese has a wider range of meanings. One of these is something like ‘to look but not see’ and this describes a state of desire or yearning after something we haven’t got (from a Daoist or Buddhist perspective this would describe a state of attachment, itself a form of suffering). Here the theory gets more subtle. I’ve already said that the Heart generates the Blood and that the Blood roots the Shen but these relationships are somewhat circular and mutually dependent because the Heart’s ability to generate the Blood is also dependent on the Mind. So both the idea of yearning after something we haven’t got and, on a physical level, ‘too much staring’ are suggestive of a mind turned away from our centre.

Monk meditating under the moon

There’s a Chinese saying; 'Diseases of the Heart must be treated in the Heart [i.e. not with acupuncture or herbs]’. This isn’t to say that acupuncture and herbs can’t play a part but it does perhaps point to something deeper. As a holistic system of medicine Chinese Medicine sees Heart, Blood, Shen (consciousness) both as three different things and as three manifestations of the same energetic. Within Daoist and Buddhist thought consciousness is understood to be the primary basis of reality and so in this instance treatment would need to primarily be at that level. In practice this would suggest that meditative practices, Qigong, Neigong etc, practices that turn the attention of the Heart-mind away from the exterior and toward the interior world would be the primary means of addressing the effects of ‘too much staring….’ Interestingly this is exactly the approach that Linda Stone is proposing, with practicing conscious awareness of one’s body being her primary piece of advice as to how to reduce one’s susceptibility to and experience of email apnea. As I said at the start it’s my opinion that the research Linda Stone refers to not just validates this particular bit of theory but also a whole way of understanding the body and, by extension, the means by which that knowledge is acquired. But just how the ancient Chinese may (or may not) have acquired such knowledge is probably a subject for another time.

* The Five Taxations are outlined in the Classics of Chinese Medicine thus:

Excessive use of the eyes injures the Blood (the Heart) Excessive lying down injures Qi (the Lungs) Excessive sitting injures the muscles (the Spleen) Excessive standing injures the bones (the Kidneys) Excessive exercise injures the sinews (the Liver)


Bruce Bell is a 5 Element acupuncturist practicing from clinics in Midsomer Norton, Bath and Keynsham

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