Treating closure of the Heart – Herbal formula Zhishi xiebai guizhi tang

In the previous two installments of this series we discussed the emotional and physical consequences of not having enough yin or yang in the heart and surrounding organs, particularly with reference to important Chinese medicine concepts and Chinese herbal formulas. You can read the first article here, and the second one here.

Today we’ll take a look at a slightly different cause of anxiety and depression: what happens when the heart is energetically closed.

A healthy heart is permeable. It opens to give and receive love and connection, and closes to protect itself from harm. This is mostly an energetic and psychological process, but the physical heart’s pumping mirrors it. The heart must beat even, pumping blood in and out in a rhythmic and equal way, in order to move blood to every part of the body.

When our hearts are healthy we able to reach for what nourishes us, and shrink away from that which does not serve our highest good. Life is full of both kinds of experiences, and if we are agile and responsive then our movement is similarly rhythmic; bringing close and letting go.

A wounded heart, however, can slip too far into either extreme.

heart opening depression chinese medicineIf too much injury is sustained, either in the moment or over time, the heart can lose its ability to open and reach out. It can forget how to receive care or how to feel tenderness. When this pattern becomes deeply entrenched, it can develop into a specific diagnosis that we call “heart closed”.

A closed energetic heart does have symptoms, both emotionally and physically. The up side of closing off one’s heart is that the risk of pain from loss is reduced. But pain of separation cannot be mended with anything other than connection, and this pain can become an overwhelming depressive state called anhedonic depression, or the inability to feel joy.

Transient moments of happiness may be possible, but transcendent joy remains out of reach. Anxiety can also result from this pattern, particularly the sort of low-level “I’m not sure what is wrong” anxiety, and this is usually also the result of lack of connection.

Such a person will often struggles to form or maintain close relationships, and will spend time alone reflexively.

The physical symptoms of such a situation are mostly local. People often experience tightness in the chest, a feeling that they cannot fully expand the chest, and even a visible sunken-ness over the heart. This is not generally frank chest pain per se, but certainly chest discomfort. This occurs because the heart is not fully able to circulate qi and blood to the surrounding organs and tissues.

This condition is not bad enough to cause overt disease, at least not in the short term, but it does cause the effected organs to perform below their full potential. The area above the heart is often tender to palpation in such cases.

The treatment for such cases is, as you may imagine, to open the heart. With acupuncture we would needle over the chest, and in the channels that pass through the chest, to do this and also nourish and move blood of the chest.

The herbal formula we might prescribe to this sort of patient is called Zhishi Xiebai Guizhi Tang (pronounced jir shir shea bi guay jir taang), or unripe bitter orange, Chinese chive and cinnamon twig formula. This formula contains several aromatic herbs that open the “orifices” of the body, meaning the sense organs, and thereby restore consciousness. It also has a great deal of cinnamon, which restores heart function and moves blood.

The transformation that can arise from this treatment is profound.

People find that they are able to connect with their inner feelings, and thereby connect to other people, in ways that they had almost forgotten were possible. Their depression improves dramatically, and they often feel like they are turning a corner in their lives. Also, their chest tightness goes away! Bonus!

This is a pattern that responds readily to correct treatment, but does not generally resolve on its own. It is obviously also very helpful to combine treatment with Chinese medicine with other therapies from qualified mental health professionals. If you resonated with this article, and want to see how Chinese medicine might help you in your quest to find balance – feel free to get on my schedule!

This article is not intended to help you diagnose yourself or your friends, but simply to shed light on how Chinese medicine understands and treats emotional distress. Your particular depression or chest tightness may or may not fit this Chinese medical pattern, which is why finding a qualified practitioner who can diagnose and treat your condition is important.

Written by Rowan Everard


I discovered Chinese medicine shortly after moving to Portland to complete my undergraduate studies. I began my journey as a patient, but after several years of being an increasingly curious patient I found myself drawn into the formal study of this medicine. In Chinese medicine, I found tools that helped me to transform myself, and which I have seen lead to dramatic positive shifts in patients.