VITAL FACULTY: HEART AND CIRCULATION
Bringing Life to the Whole Body
The circulatory system is the central network of the Vital Faculty, and the heart is its core. Since all the body's organs and tissues need a fresh blood supply, the circulatory system pervades the whole organism.
The cardiovascular system consists of the heart (cardio) and its vascular network of blood vessels - the efferent arteries that carry blood away from the heart, and the afferent veins that return blood to it. The heart and its vascular network form one seamless, interconnected whole.
The circulatory system is a broader term, because it also includes the nodes and ducts of the lymphatic system. Greek Medicine calls this broader circulatory system the circulatory network, or Intermediate Channel, because it connects all parts of the organism, both superficial and deep, as its great central transportation network.
The Heart: King of Organs
In Greek Medicine, the heart is the most important organ in the body. Avicenna considered the heart to be supreme, and stated:
"There is one organ in the body which, if it is well, the whole body is well; and if it is ill, the whole body is ill. And that organ is the heart."
Being essentially a muscular organ and very active and dynamic, the heart is the hottest organ in the body. In Greek Medicine, the heart's left ventricle is the central, primary seat of the Innate Heat in the organism.
To cool down all this heat and protect and insulate the heart, which is constantly heaving and pulsating, from friction and wear and tear, the heart is encapsulated by the pericardium and bathed in an internal sea of pericardial fluid. This also keeps the heart from overheating.
Being so hot in temperament, the heart is very vulnerable to excesses and inuries of cold and cold, Phlegmatic vapors. As hot as it is, the heart is also vulnerable to fevers and excesses of heat, which agitate and disturb its Vital Spirits, causing restlessness, mania, insomnia, night sweats and delirium.
Modern medicine sees the heart as essentially nothing more than a very powerful, sophisticated pump. But Greek Medicine sees the heart as being much more; it's also closely allied to the brain and mind, in that it's the seat of sentiments, emotions and feelings, which are called the Vital Spirits.
The heart is also a furnace that combusts and infuses the Vital Force and Innate Heat into the blood with every heartbeat. It takes raw pneuma from the lungs and converts it into a very potent, concentrated form, the Vital Force, or Pneuma zoticon, which can actually be used by the body.
The nature and quality of one's feelings and emotions, or Vital Spirits, have a profound impact on the nature and quality of the Vital Force produced in the heart, which in turn combusts the Innate Heat and Thymos. The Vital Force and Innate Heat are then converted into the Natural Force and Metabolic Heat in the liver, which then generate the Four Humors.
And so, one's feelings and emotional life are central and important to one's heart, vital principles and overall health. Positive, noble, expansive, uplifting emotions expand and strengthen the heart and Vital Faculty, whereas negative, constrictive, ignoble or base emotions weaken them. In Greek Medicine, it's quite possible to die from a broken heart.
In regulating our mental, emotional and spiritual states, the lungs work closely with the heart; there's a great degree of mutual influence and interaction between our breathing and circulatory patterns. When we get fearful or anxious, not only does our breathing get shallow and rapid, but our heartbeat speeds up as well.
Because the heart is so exquisitely sensitive and responsive to our mental, emotional and spiritual states, Greek Medicine considers it to be the seat of the lower or sentimental mind. The higher mind, seated in the brain and Psychic Faculty, is cold, objective and rational; the lower mind, seated in the heart, is hot, subjective and passionate.
To live a truly satisfying, constructive and self-fulfilled life, there must be a harmonious balance, a working relationship between head and heart. Denying either one in favor of the other is negative and destructive.
The heart is like a great internal Sun, constantly radiating and sending out the lifegiving Vital Force and Innate Heat through the blood to every cell, organ and tissue in the body. But even as it sends this blood and its lifegiving forces out, its own need for them is considerable; the heart itself must be nourished by an abundant supply of fresh blood, with its Vital Force and Innate Heat. Any significant diminishment in either the quantity or quality of any of these vital factors will weaken the heart; a critical shortage or blackage of them could prove fatal.
The heart must constantly bathe itself in a rich sea of blood to keep functioning; and so, it's a very Sanguine organ. The main blood vessels that the heart uses to feed itself are the coronary arteries. A decrease of Vital Force and/or Innate Heat in the heart blood causes cyanosis; decreased circulation or stasis of heart blood is angina; and a total cessation of blood supply to the heart muscle is cardiac ischemia or a myocardial infarction.
A deficiency of heart blood could be called cardiac anemia. In addition to the usual signs of anemia, such as pallor, dizziness, and low energy, there will be certain heart-specific signs, like anxiety, insomnia, palpitations, and restless, dream-disturbed sleep.
The heart, being the most important organ in the whole body, is a prime recipient of the Radical Moisture, which is the anchor that grounds and holds all its vital principles and functions in place, keeping thems from spending themselves prematurely. Residues from this Radical Moisture in the heart give a special richness, fulness and perfection to the blood as it's pumped out, enhancing its ability to nourish the organs and tissues. The Radical Moisture also gives the heart and its vital principles a certain functional reserve capacity. The symptoms of deficient Radical Moisture in the heart include palpitations, insomnia, night sweats, restlessness, and a tendency to be easily startled or excited.
Avicenna believed that the Vital Force in the heart was strongly attracted to aromas. Strongly aromatic substances like musk, camphor, saffron and aloeswood have a beneficial effect on the flow and distribution of the vital forces in and around the heart, and throughout the whole circulatory system. Many, if not most, of the natural cardiac drugs in Greek Medicine are strongly aromatic, and also exert a beneficial effect on the mind and consciousness.
The traditional Greek physician assesses heart function through a wide variety of different signs. Of these, the most important is the pulse, which is considered to be a direct extension of the heartbeat itself. As the heart beats, so beats the pulse, and abnormalities and irregularities of the pulse indicate similar dysfunctions of the heart.
Breathing patterns and aerobic capacity also tell us a lot about the heart, since the heart and lungs are so closely connected. The complexion of the skin tells a lot about the overall quality of the blood and its perfusion through the capillaries; the face and countenance tell a lot about the condition of the heart's Vital Spirits. The overall shape and movement of the chest during respiration also yield their clues, as does listening to the heart with a stethoscope.
Reflex Relationships of the Heart to Other Organs
The heart is linked to the vascular network as one seamless, interconnected whole, and hence to every other organ and tissue in the body. Therefore, pathologies and conditions of humor and temperament affecting the blood vessels also affect the heart, and vice-versa.
Although the vascular network connects the heart to every other organ and tissue in the body, some organs are much more closely linked to the heart than others. These are chiefly the four gateways or portals to the circulatory network, or Intermediate Channel: the lungs, liver, kidneys and skin.
The heart and lungs work closely together as partners in the operation of the Vital Faculty. The lungs supply the heart with the raw pneuma it needs to function and generate the vital principles. The lungs function like a bellows, fanning the flames of the heart furnace and sucking out the stale air as exhaust. The lungs are connected to the heart via the pulmonary artery and vein, two of the largest blood vessels in the body.
The heart and liver work closely together as the principal organs of the Vital and Natural faculties. Since the largest vein in the body, the Inferior Vena Cava, passes through the liver to pick up fresh humors before returning to the heart, the liver is associated more with the veins, whereas the heart, with its constant pulsation, expresses itself mainly through the arteries. The humors from the liver are activated by the vital principles in the heart, which makes them more usable by the organs and tissues. The liver also functions as a reservoir for surplus blood.
The Vital and Natural faculties are interdependent, and form a mutual feedback loop. The quantity and quality of the vital principles generated in the heart determine the quantity and quality of the Natural Force and Metabolic Heat generated by the liver, which then refine and generate the Four Humors. The quantity and quality of the Four Humors, as well as those of the Radical Moisture, the quintessence of all the humors, in turn nourish and vitalize the heart. Humoral imbalances like high blood cholesterol due to Choleric/bilious congestion of the liver, injure the heart and blood vessels.
The heart and kidneys have a close relationship, since the kidneys regulate the total volume of blood the heart has to pump through the excretion of urine. This regulation of blood fluid volume also has a profound influence on blood pressure.
The heart and kidneys are also very closely connected via the arterial circulation. After fresh blood is pumped out of the heart and into the abdominal aorta, one of the first places it goes is to the kidneys to be filtered and purified. Through a number of important hormonal feedback mechanisms, the kidneys have a profound influence on blood pressure and vascular dynamics. They also regulate the balance of several important minerals in the bloodstream, like sodium, potassium and calcium, which are necessary for proper heart function.
On top of the kidneys sit the adrenal glands, which secrete adrenaline, an important stimulator of the heartbeat and cardiac function. Adrenocortical hormones regulate the balance of vital nutrients and electrolytes in the bloodstream, which also impact heart health. Adrenaline is also involved in the sympathetic fight-or-flight response to stress, which places a considerable burden on the heart. And so, stress management is an important key to heart health and longevity.
The skin, which is fed by the capillaries at the peripheral end of the circulatory system, has an opposite yet complementary relationship to the heart, which is the circulatory system's center. The more blood diverted to the skin, capillaries and exterior, the less remains in the heart and interior, and vice-versa. Exuberance of the blood and the Vital Force radiating outwards from the heart to the periphery causes the skin to blush. If the organism wants to conserve heat, it shunts blood towards the heart and interior; if it wishes to disperse and release excess heat, it diverts blood towards the skin and periphery.
The Circulatory System, or Vascular Network
The circulatory system consists of the various attendant vessels that serve the heart. These are basically of four kinds, each with its own nature and temperament, and each performing a different function for the organism. These are the arteries, capillaries, veins and lymphatics.
The Arteries: Sanguine - Vital Faculty
The arteries serve the Vital Faculty, and are channels for its Vital Force, Innate Heat and Thymos. Arterial blood is bright red because it has been infused with these vital principles.
The Vital Force radiates blood outwards from the heart, and guides its circulation throughout the organism. The Innate Heat gives arterial blood the energy to drive cellular metabolism.
Because the arteries carry pneuma, or the Vital Force, they beat and pulsate, just like the heart. The speed and rhythm of the arterial pulse accurately reflects, in real time, the beating of the heart.
Rhythmic pulsation is a characteristic shared by all organs and vessels involved in the generation or transmission of pneuma. These include the lungs, heart and arteries.
The bright red arterial blood is warm, moist and Sanguine in temperament. Veinous blood, which has been drained of its vital energies, is cold in temperament.
The temperament of the arterial walls is quite different from that of the arterial blood they carry. Arterial blood is very warm, but the arterial walls much less so. And whereas arterial blood is quite moist, the arterial walls are moderately dry, which gives them firmness and palpability, and enables them to resist the pressure of arterial blood.
Arterial pressure and dynamics are mainly regulated by the heart and kidneys. The heart regulates arterial pressure by the volume and force of its contractions. The kidneys regulate arterial pressure by regulating blood fluid volume, and by several important hormonal feedback mechanisms.
The kidneys are a prime recipient of the arterial blood output of the heart. The more vigorous the circulation of arterial blood through the kidneys, the better they can function.
The arteries take fresh, oxygenated blood to the organs and tissues that need them. The only exception to this rule is the pulmonary artery, which takes spent veinous blood back to the lungs to be re-vitalized and re-oxygenated.
The Capillaries: Choleric - Fiery Exuberance
The terminal ends of the arteries are the capillaries. The capillary beds are where the actual exchange of vital energies and nutrients with the organs and tissues takes place.
Although capillaries can be found all throughout the body, the majority of them are found in the surface and periphery. This gives the capillaries a general affinity with the peripheral circulation to the head, hands, feet and extremities. If the peripheral circulation is strong and healthy, the capillary circulation will usually be as well.
To enable the blood to penetrate and circulate through the fine capillaries, residues of the Choleric humor are needed. And so, the capillary circulation in general has a fiery, Choleric character. The vitality and vigor with which the blood circulation penetrates and extends outwards into the peripheral arteries and capillaries is a good measure of the overall health and exuberance of the circulation.
Since a vast network of capillary beds underlies the skin and its pores, the peripheral capilaries are associated with sweating and the flushing of blood towards the body's extrerior to cool it off in hot weather. In cold weather, when body heat needs to be conserved, blood circulation is shunted away from the peripheral capillaries to warm the interior, or vital core of the organism.
Exercise and physical activity, which generate a lot of heat in the circulatory system, open up the capillary circulation, and can even create new capillaries. Regular aerobic exercise strengthens not only the heart and lungs, but also the arteries and capillaries.
The overall health of the peripheral and capillary circulation is especially important to the functioning of the brain, eyes and retina, lungs and kidneys, and feet and extremities. The aging process and certain chronic diseases like diabetes will produce degenerative changes in these organs and body parts.
The physician examines certain parts of the body where the capillaries are particularly visible to observe the condition of the peripheral and capillary circulation, and the overall health of the circulatory system. These areas include the conjunctiva, tip of the nose, earlobes, fingernails and fingertips.
Certain conditions will make the capillaries particularly visible on the skin and in these areas. Usually, this indicates a generalized excess, aggravation, or engorgement of blood in those of a Sanguine temperament or disposition. It can also be seen in cases of alcoholism, consumptive low grade fevers, and heart or circulatory disease.
The Veins: Melancholic - Natural Faculty
In Greek Medicine, the veins serve the liver and Natural Faculty. Their main function is nutrient transport.
The veins of the hepatic portal system take nutrient rich blood from the intestines to the liver for processing into the Four Humors. If the blood circulation in the hepatic portal system is stagnant or congested, a condition known as portal hypertension, the absorption of nutrients from the digestive tract will be compromised. Since the hepatic portal veins are afferent vessels supplying the liver, liver congestion can also produce backup or reflux portal hypertension, as well as hemorrhoids.
After the liver generates the humors, they are released into the general circulation via the Inferior Vena Cava, which passes through the liver on its way back to the heart. In the heart, the humors are activated by the vital principles, which increases their bioavailability.
Being rich in pneuma, the arteries pulsate; being depleted of pneuma, the veins don't. Since the blood pressure in the veins is much lower than in the arteries, veinous blood return to the heart is assisted by a network of one-way valves.
In all respects, the arteries and veins are complementary opposites. For the circulatory system to be healthy, its complementary arterial and veinous halves must be balanced, and work harmoniously together.
Of the peripheral veins, those supplying the extremities are the most important. Poor veinous return from the extremities is associated with the formation of clots, or embolisms, as well as swelling, edema, numbness or mortification of the extremities. If the veinous return from the extremities is poor, the arterial blood supply to them will be compromised by reflux action.
Being colder than arterial blood, veinous bood is cold, wet and Phlegmatic in temperament. Functionally, veinous circulation has an affinity with the circulation of lymph and interstitial fluids. Where veinous return is compromised, particularly in the extremities, there will also be lymphatic swelling, congestion and edema. Also, the lymphatic circulation drains back into the veinous system via the subclavian vein before reaching the heart; this strengthens the functional interdependence of the veinous and lymphatic systems, which both return vital fluids to the heart.
The walls of the veins themselves are cold and slightly to moderately dry, which makes them Melancholic in temperament. With veinous circulation being slower and more passive, clots and embolisms can form, particularly in the deep veins of the extremities, and especially when the blood is unduly thickened by excesses and aggravations of black bile. Portal hypertension is another veinous pathology that is often of a Melancholic nature.
The Lymphatics: Phlegmatic - Expulsive Virtue
The lymphatic system is cold, wet and Phlegmatic in temperament. So much of the Phlegmatic humor in our bodies is composed of lymph that it's sometimes called the Lymphatic humor.
The function of the lymphatic system is to recycle plasma and interstitial fluids that have escaped from the vascular portion of the circulatory system back into the blood vessels. Plasma and interstitial fluids become lymph as they're funneled back through the network of lymph vessels and nodes, which eventually return them back into the veinous circulation.
Since the lymph drains back into the veinous circulation, poor veinous return can lead to lymphatic congestion and stagnation. Since the lymph drains back into the subclavian vein via the thoracic duct located behind and between the lungs, phlegm congestion in the lungs leads to lymphatic congestion and stagnation and swelling and edema, particularly in the upper body.
The lymphatic system, being Phlegmatic in temperament, also has an Expulsive virtue and function. And so, one of the main functions of the lymphatic system is to cleanse and wash away impurities from all parts of the organism. Since the purification of the organism also has a beneficial effect on its immunity, this Expulsive function of the lymphatic system is closely related to its immune function.
To purify the lymph, there are several lymph nodes located throughout the body. Their concentration is particularly high in parts of the body that come into frequent contact with exogenous substances or impurities: the throat (tonsils), intestines (Peyer's patches and appendix), neck (submandibular, cervical and subclavian lymph nodes), chest and armpits (mammary and axillary lymph nodes) and groin (inguinal lymph nodes). If the physician suspects sepsis or infection, he palpates the surrounding lymph nodes to see if they're tender or enlarged.
These lymph nodes and lymphatic tissue also contain high concentrations of white blood cells, or leukocytes, which not only neutralize and consume debris and impurities, but also pathogenic microbes. And so, the lymphatic system also has an important immune function.
By far, the largest lymphatic organ is the spleen, which is the central hub of the lymphatic system. The spleen consumes, neutralizes and digests the most obstinate debris and particulate matter out of the blood and lymph, using the chelating action of its black bile. Like the liver, the spleen also functions as a reservoir of surplus blood, to be drawn upon when needed.
The health of the lymphatic system depends on regular exercise to stimulate its circulation. Since both the lymphatic and veinous circulations are passive, both are dependent upon adequate exercise and physical activity to keep them healthy. Massage, especially with medicated oils, is also very beneficial.
Circulatory System Health
The greatest enemy of healthy circulation is stagnation, or stasis. Stagnation is usually the result of sedentary habits and lifestyle.
Conversely, adequate exercise is the greatest friend and ally to circulatory system health, since activity and movement stimulate circulation. Besides increasing the aerobic activity of the heart and lungs and the vigor of the arterial and capillary circulation, exercise is crucial in stimulating veinous and lymphatic return, since the circulation in both these systems is passive.
Massage is a form of passive movement that enhances and stimulates veinous and lymphatic return. Massage with medicated oils is doubly beneficial, since the aromatic essences they contain stimulate circulation and help purify the lymph.
Diet is also important in maintaining and enhancing circulatory system health. Adequate fiber intake keeps the portal circulation healthy, and keeps the veinous blood there from getting too thick and congested with excessively dense concentrations of nutrients to flow smoothly and efficiently to the liver for processing.
Probably the worst dietary abuse you can give your circulatory system is to eat rancid or toxic fats. The worst offenders are fried foods, rancid oils, hydrogenated or trans- fats, and saturated animal fats. According to Greek Medicine, rancid, toxic fats lead to the formation of morbid, toxic forms of yellow and black bile produced by charring, or excessive oxidation. In modern medical terms, they lead to pathogenic oxidative processes and the creation of harmful free radicals, which injure and harden the arteries and lead to the formation of arterial plaque.
There are Four Temperaments, each with its own characteristic predispositions towards certain circulatory system pathologies:
Choleric types tend to suffer from bilious pathologies producing high cholesterol and arterial plaque, as well as disorders of excessive exuberance, heat, pressure and/or inflammation in the blood and blood vessels. These include arterial hypertension, or high blood pressure; hemorrhaging and excessive or easy bleeding; arterial aneurysms and ruptured blood vessels; and phlebitis, or inflammation of the veins.
Sanguine types usually suffer from a generalized congestion or engorgement of excessive blood in their blood vessels and capillaries. Some pathologies like diabetes can have negative, degenerative repercussions on the circulatory system, such as high cholesterol and hyperlipidemia, and especially capillary degeneration. Gout and uremia often cause inflammatory changes in the capillaries and blood vessels. Circulation in general can become sluggish.
Those of a Phlegmatic temperament are predisposed to excesses and aggravations of the lymphatic system, and lympohatic stagnation, toxicity, congestion or obstruction, which is generally called lymphatism. Poor veinous return and a generally lax blood vessel tone tend to make their overall circulation sluggish. These conditions are usually aggravated by their preferred dietary abuses: excessive consumption of sweets, dairy products and starchy or glutinous foods.
Melancholic types tend to suffer from thick blood that is excessively prone to embolisms and clotting, due to a generalized excess of black bile in the bloodstream. This predisposes them to veinous pathologies and varicose veins; deep vein thrombosis; and cerebro- and cardio- vascular accidents caused by clots and embolisms, as well as the apoplexy that often accompanies these conditions. Arterial plaque and hardening of the arteries caused by toxic, oxidated forms of yellow and black bile is a general predisposition that Melancholics share with Cholerics. A generalized hardening or sclerosis of the circulatory system as they age can also aggravate their predisposition towards stiff joints, arthritis and rheumatism.
Since the circulatory system pervades the whole organism, putting your circulatory system back in order means putting all aspects of your diet, hygiene and daily regimen back into balance. This means following the necessary dietary, hygienic, and lifestyle guidelines for your constitutional nature and temperament.
The quotation of Avicenna about the heart is courtesy of The Traditional Healer's Handbook by Hakim G. M. Chishti, page 238. Copyright 1988 by Hakim G. M. Chishti. Published by Healing Arts Press, Rochester, Vermont