Introduction
The idea of using psychedelic substances for healing and therapy has existed across cultures for thousands of years. There are cave paintings of psilocybe mushrooms dating back 6000 years, and numerous references from different societies to plants that induced altered states of consciousness. In the modern era – after a brief period of suppression – psychedelic medicines are seeing a resurgence in interest, and have been getting attention for their ability to treat mental health issues and addiction, as well as create permanent positive shifts in people’s attitudes and lifestyles.
The legal status of psychedelics is also changing rapidly. Cannabis, which for many people can act like a psychedelic, was the first ‘drug’ to go from being completely illegal to now legalized for recreational use in almost half of all states in the U.S. There are additional signs that legalization in some form is coming in the near future for psilocybin, and potentially MDMA. A recent Time article titled Psychedelics Could Revolutionize Couples Therapy discusses MDMA’s potential in a therapeutic setting, and briefly mentions psilocybin as well; other countries, such as Australia, have already taken steps to make psychedelics such as MDMA and psilocybin more available. In the U.S., Oregon has become the first state to make psilocybin legal as of January 1st, 2023, though mushrooms are not legal for recreational sale.
Of course, another consciousness altering substance is already legal, and is growing in popularity: ketamine. Though it remains a Schedule 3 substance and must therefore be prescribed by a licensed physician, the number of clinics offering ketamine-assisted therapy is growing, and mainstream publications have written about ketamine, such as the New Yorker in this article, Ketamine Therapy Is Going Mainstream. Are We Ready?
As a doctor practicing holistic, individualized medicine, I cannot deny the incredible transformations people have experienced through utilizing these substances. At the same time, anyone experienced in psychedelics knows that sometimes you have a “bad trip.” In clinical studies of psilocybin a significant minority of participants had negative experiences; LSD is known for increasing the risk of psychosis in people with certain risk factors; side-effects of ketamine are well characterized, as are side-effects of MDMA.
The question becomes, how to individualize treatment? Is a particular individual ready to take full advantage of psychedelic therapy? If not, what must be done to prepare them? Which substance (assuming an updated legal status) is the most appropriate? What about dosing? Are there other substances a person could take during the session to enhance the experience, or to protect them from negative side effects (for example, taking antioxidants, or specific vitamins)?
Though we may never have all the answers, other systems of medicine can provide insight into if, when, and how psychedelic therapy works and doesn’t work. Homeopathy is one of these systems. Chinese medicine is another, and examining these common substances through the lens of these alternative models will prove illuminating. But first, what happens when people take psychedelic substances?
Positive Effects of Psychedelics
Many psychedelic substances act by increasing, or changing, the degree of consciousness or awareness a person is experiencing. You start perceiving reality in a different way. People report seeing themselves, their environments, and even fundamental aspects of reality, from a whole new perspective, an often expanded perspective that goes beyond their habitual patterns of awareness. There can be experiences of unity, divine love, rapturous dissolution of the ego, and encounters with cosmic beings or deities. When this process goes well the person can have an immensely positive and transformative experience.
These positive long-term effects are well-known by those who use psychedelic medicine, and recent research is supporting these effects. A recent systematic review found that, in the 34 included studies, “Enduring changes in personality/attitudes, depression, spirituality, anxiety, wellbeing, substance misuse, meditative practices, and mindfulness were documented. Mystical experiences, connectedness, emotional breakthrough, and increased neural entropy were related to these long-term changes in psychological functioning. Finally, with proper screening, preparation, supervision, and integration, limited aversive side effects were noted by study participants.”
Another interesting mechanism of action proposed by Robin Carhart-Harris et. al. is that psychedelics increase entropy (chaos) in the brain. They suggest that negative mental states, such as depression, anxiety, addiction, and obsessive-compulsive thinking, are characterized by rigidity in brain activity. Of course, most of us go through our days with certain stable patterns of mental activity, even if they aren’t negative or labeled as mental health issues. From The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs, they write: “Specifically, it is proposed that psychedelics work by dismantling reinforced patterns of negative thought and behavior by breaking down the stable spatiotemporal patterns of brain activity upon which they rest.”
Negative Effects of Psychedelics
However, it is well known that psychedelics can produce negative experiences, sometimes profoundly so. Common negative effects across various psychedelics are anxiety and fear, paranoia, dissociation, confusion and disorientation, various types of hallucinations (which of course can also be positive), emotional instability, along with physical effects such as nausea, vomiting, diarrhea, sweating, chills, headaches, and more. Physical purging is often considered a necessary part of psychedelic medicine, but at times this can go beyond a therapeutic effect and become excessive or even pathological.
Most of these effects are short-lived, and dissipate as the body metabolizes the psychedelic. More long-term effects can include what has been named Hallucinogen Persisting Perception Disorder, where people continue to experience visual disturbances and/or auditory hallucinations, though any shift in perception experienced during the “trip” can continue to be experienced afterwards. These types of symptoms also appear to be linked to anxiety and depression, though the correlation is not very strong. However, this disorder is extremely uncommon.
For a more detailed assessment of the risks of psychedelics see this excellent article by Bridget Huber, What do we know about the risks of psychedelics?
Chinese Medicine and Consciousness
Because we are discussing substances that are primarily taken to cause changes in consciousness, understanding consciousness from a Chinese medicine perspective is essential. The closest concept to consciousness in Chinese medicine is called 神 shén, also translated as spirit, deity, or mind. It is composed of two components, 礻on the left, and 申 on the right. The former means to show, to illuminate, to unveil; the latter means to stretch, or to declare. Taken together, the concept of consciousness is understood to be a quality of awareness, an understanding; the quality of stretching also pertains to the connection with Heaven or the Divine, and that consciousness is the divine aspect of a human being.
Shen is considered to be held, or stored, in the Heart, which is distinct from the physical heart, in that the Heart in Chinese medicine is the organ of consciousness and perception, and correlates most closely with the mind, and secondarily with the entirety of the cardiovascular system. The Blood, which is the “fluid” of the Heart, is what carries the shen to every part of the body; therefore the shen is also considered to be stored in the Blood (I capitalize Blood here to distinguish it from purely the physical fluid that we know as blood, as Blood has properties beyond that attributed to the physical blood). This connection to Blood is important for understanding issues coming from the Liver organ network, which helps keep the Blood flowing smoothly.
Shen is created from and supported by a process that begins with 精 jīng, typically translated as essence, referring to the essence of life: that which is most purified, most concentrated. The left side is the character 米, which means rice; the right side is 青, which is the color blue-green, associated with the season of spring and the phase-element of Wood. Taken together, jing is the substance that nourishes life, that gives birth to all of creation.
Jing is stored in and governed by the Kidney, which in Chinese medicine encompasses the physical kidneys and the adrenal glands, and functionally the creation of energy and water by mitochondria in every cell (in addition to multiple other functions of the body-mind). Jing is the storage form of life energy, the condensed energy of the universe that enables a person to be alive at all. It is said that the strength of one’s jing comes primarily from one’s parents, and once the jing is used up then the person dies.
Jing is then transformed into 氣 qì, which is the working energy of the body. Cosmologically, qi could be defined as change, or activity, as it is the product of the interaction of yin and yang, the cosmic duality. But within the body, qi in its many forms is responsible for everything that happens at a physiological level. Again the character 米 is present, underneath the character 气 which means air; qi is therefore the “air” or steam that rises up from cooked rice, a representation of nourishing energy.
Finally, qi is transformed into shen, the process starting with jing at the base of the spine and resulting in the light of spirit that shines out of the eyes. Consciousness, therefore, is dependent on the abundance of stored jing, the smooth and easy transformation of jing into qi, the natural and effortless flow of qi, and the capacity for generating shen as opposed to using qi for other purposes or body functions (such as reproduction, to give one example). In this model, consciousness is a spectrum, with increasing degrees of consciousness associated with transforming more jing into shen.
Heart and Kidney Connection
Another aspect of Chinese medicine physiology that is essential to this exploration is the relationship between the Heart and the Kidney. These two organ systems must stay connected to each other, and must communicate back and forth. The Water of the Kidney must rise up to cool the Fire of the Heart, and the Fire of the Heart must go downwards to warm the Water of the Kidney. Without the cooling Water of the Kidney Heart Fire will rage out of control, producing excess in all dimensions and resulting in mania. Without the warming Fire of the Heart Kidney Water will become frozen, leading to fear, paranoia, and existential dread and despair. (For a lengthier exploration of this relationship see Dr. Leon Hammer, The Relationship of the Kidney and the Heart in Chinese Medicine). The Kidney, in addition to governing jing, also contains the zhi, or willpower. The shen and the zhi must stay connected; with only shen one becomes a wandering spirit, with no connection to human life; with only zhi there is no awareness, and life becomes solely about the struggle to survive at all costs.
The Role of Liver Qi
A note should be made as well about the role of the Liver in psychedelic experiences. The Liver’s job is to regulate the smooth flow of qi and Blood, and thus plays an integral role in the transformation of jing into shen. The movement of the Liver is upwards and outwards, and it assists the ascent of qi as it transforms into shen and consciousness. If Liver energy is too deficient it will be easier for the Heart and Kidney to separate, and for shen to become untethered. The Liver supports the energies of the Heart as physiology moves along the generating cycle of the five phase-elements, from the Wood of the Liver to the Fire of the Heart.
If there isn’t enough Wood then attempting to stimulate the Heart may lead to negative consequences. Since Liver qi is the energy of life it cannot be extinguished, but it can become too weak to be contained and “leak” out, causing uncontrolled movement – both physically, emotionally, and spiritually. This can look like spasms, or wild emotions, or hallucinations and “seeing ghosts.”
The Liver houses the hun spirit, commonly called the ethereal spirit, which is the aspect of one’s soul that continues on after death; during life the hun is responsible for dreaming, and potentially the capacity for astral projection. When the Liver qi becomes too weak the hun can become unanchored, leading to disturbing experiences as the person begins to perceive dimensions of reality beyond the human realm.
Chinese Medicine and Psychedelic Action
The main effect of psychedelic substances is to increase the process of transforming jing to shen, thus increasing and expanding consciousness during the experience. When the Kidney is strong, when there is adequate capacity of the Liver to support the smooth flow of qi and Blood, when the Spleen and digestion are solid, then this expansion of consciousness is well-tolerated and the person has a positive and potentially transformative experience. This is the case even in challenging experiences, as the expanded consciousness is fully anchored to the body and the Will, and the full resources of the person are available to meet difficulties as they arise.
Because Heart Fire is associated with awareness and shen, another way to understand psychedelic action is to point towards the ability of psychedelics to increase Fire. This provides a simple way to understand if a specific person will be able to tolerate psychedelic medicine: do they have signs of excessive Fire, whether from a true excess, or due to a relative deficiency? If so, using this kind of medicine may not be very advisable until Water or other yin influences are increased to balance the increase in shen and Fire stimulated by the psychedelic.
Excessive Fire, especially Heart Fire, generally looks like mania, which is characterized by “increased talkativeness, rapid speech, a decreased need for sleep, racing thoughts, distractibility, increase in goal-directed activity, and psychomotor agitation.*” People prone to mania, or manic episodes, such as those with bipolar disorder, should therefore be cautious using psychedelic medicine. This is consistent with recommendations coming from professionals experienced in the therapeutic use of these substances. Of course, there are also people experiencing bipolar symptoms who have benefited from psychedelics, which demonstrates a general principle of medicine, which is that substances can stimulate opposite types of responses depending on the person and the dose.
A relative excess of Fire is defined more by the lack of Water, or yin, particularly Kidney yin. According to Dr. Hammer in his book “Dragon Rises, Red Bird Flies”, Kidney yin provides the capacity to connect to something greater than oneself, to have perspective on one’s place in the universe. When someone has a deficiency of Kidney yin they will have difficulty relaxing into the unknown, and will therefore experience various levels of existential fear, with the ongoing attempt to dominate and control everything in order to achieve safety and survival. Without enough yin to finance the expansion of consciousness, use of psychedelics runs the risk of creating separation between the Heart and the Kidney.
Without enough yin or jing, the body cannot handle the demand that the medicine places on the Kidney. This can lead to the Heart and Kidney separating as pressure is placed on the Heart to expand but the Kidney cannot stay in contact. Like a hot air balloon that is stretching its mooring lines, the shen pushes upwards, and yin and yang begin to separate. Heart Fire can spiral out of control, leading to mania, or delusions of grandeur, thinking of oneself as god, or the return of christ. Kidney Water can become frozen, leading to intense anxiety, fear, and paranoia. Sometimes these states can even co-exist. This separation of Heart and Kidney explains the occasional psychosis that occurs with use of psychedelic medicines.
Psychedelics can also increase the connection between Heart and Kidney. One interpretation of this idea of psychedelics introducing more chaos into the brain – proposed by Carhart-Harris – is that psychedelics bring more Fire into the realm of Water. According to Dr. Leon Hammer, Kidney yin correlates with the substance of the nervous system, particularly the central nervous system. When the Kidney Water becomes too cold, anxiety, depression, OCD, and similar types of mental imbalances characterized by rigid thought patterns are more likely. Fire, due to its capacity to ‘melt’ rigid structures, is conceptually similar to the idea of introducing chaos into a system. By increasing Fire and shen, psychedelics can ‘thaw’ these frozen mental patterns and create transformation.
Chinese Medicine and Ketamine
Because ketamine is currently the only legal psychedelic medicine being used therapeutically, gaining more understanding of its use and action is incredibly important. Ketamine is characterized as a “dissociative anesthetic,” with initial test subjects describing the feeling of floating in outer space and being unable to feel their extremities. Browsing through the ketamine experiences section of erowid (erowid is a nonprofit organization founded in 1995 that provides information about psychoactive substances), people experience weightlessness, a detachment from both physical and mental/emotional sensation, a release from feelings of stress, distortions in time, auditory and conceptual hallucinations, and at times a complete detachment from even a sense of self. For some, this was experienced as blissful or peaceful; and for others, frightening and traumatic.
In the first experiment on humans, one in three suffered adverse effects (roughly matching the ratio of negative experiences in later experiments with psilocybin). A more modern list of adverse effects from Medscape includes: high and low blood pressure, increased and decreased heart rate, arrhythmias, hallucinations, vivid dreams, tonic-clonic movements, painful urination with increased frequency and urging, nausea, vomiting, bile duct dysfunction.
Many of these effects – both positive and negative – are consistent with the separation of Heart and Kidney, leading to intensifying Heart Fire or issues with the Kidney and urinary system. In the positive experiences the person is able to reconnect their Heart and Kidney as the ketamine wears off, bringing their experiences of “beingness” back into the physical form. However, the experience itself is a state of separation, and the effects on heart rhythm are consistent with the Heart becoming untethered from the grounding influence of the Kidney.
For the negative experiences this separation often leads to fear, even terror. This maps to issues concerning the Kidney. Ketamine is known for causing inflammation of the bladder, particularly in regular users, which indicates a degeneration of Kidney qi as it is unable to properly maintain bladder function. This degeneration is likely due to the lack of Heart Fire descending to generate warmth.
Chinese Medicine and Cannabis
Cannabis is arguably the most popular psychedelic-like substance used in the United States today, though it is not strictly a psychedelic, but is classified variably as an intoxicant, entheogen, depressant, or simply as psychoactive. Due to its history of use even in this country the effects are better understood than some of the other psychedelics. From a Chinese medicine perspective cannabis works somewhat differently when compared with classic psychedelics like psilocybe mushrooms or LSD. In particular, cannabis acts more on the Liver, and has less impact on the Heart-Kidney axis.
Cannabis essentially draws on Liver yang energy, stimulating the engagement and release of Liver yang, which then goes on to impact the other systems of the body, particularly the Heart. Increased Heart energy is felt in the expansion of creativity, thoughts, and ideas, in the tendency towards laughter, and in the redness of the eyes (which also reflects the Liver). Liver yang impacting the Stomach is responsible for increased appetite/munchies. And the rising of Liver yang can push the hun spirit out of the body, allowing the person to see ghosts and spirits. In the oldest book on medicinal herbs, the Shen Nong Bencao Jing, the entry on cannabis states “eaten in large quantities, it causes you to see ghosts and run around manically.”
Due to this expending of Liver yang, chronic use of cannabis causes Liver qi and yang deficiency. Because the Liver is responsible for all movement, both mental, emotional, and physical, this leads to the “couch potato stoner” stereotype, endlessly theorizing but unable to put plans into action. The inability to manage Liver yang also leads to this movement becoming chaotic and uncontrolled, which in the extreme manifests physically in cannabis hyperemesis syndrome where the person suffers regular bouts of nausea and vomiting; and manifests emotionally as anxiety and paranoia.
This suggests that cannabis, like all strong psychoactive medicines, should be used carefully and sparingly, and with additional caution in those with weak or compromised Liver qi.
Chinese Medicine and Psilocybin
Psilocybe mushrooms – also known as magic mushrooms – are the source of psilocybin, one of the more well-studied psychedelic compounds in recent years. Looking through the large number of user experiences on erowid, as well as examining the more clinical studies that have been done, reveals classic psychedelic effects, both positive and negative.
In addition to these typical experiences mushrooms are known to induce nausea. This reflects the involvement of the Spleen/Stomach organ network in Chinese medicine and the importance of assessing the strength of digestion before using psychedelic medicine, and mushrooms in particular. Despite inducing nausea, psilocybin is not known as a strong purgative, compared to other purgative psychedelics, such as ayahuasca. Thus the nausea in some cases may be an indication of weakness of the Spleen/Stomach, and the need to support digestion before and during the experience. If the body doesn’t have enough digestive strength to support the process of increasing consciousness, instead of generating a flow upwards in the body to expand the shen, a person can have this upward movement in the digestion instead.
I am reminded of a patient who was undergoing psilocybin-assisted therapy, and their first several sessions were consumed by lingering nausea, with very little shift in conscious perception. I found out that the therapist had been telling them to fast before the session, and it was only after I suggested eating a small meal beforehand that the nausea subsided and they experienced an expansion in consciousness.
Chinese Medicine and MDMA
MDMA, as a substance gaining recognition for treatment of PTSD, eating disorders, and anxiety, and on track for approval from the FDA for breakthrough treatment for PTSD, should be characterized and understood from a Chinese medicine perspective. MDMA is known as an empathogen or entactogen and creates feelings of closeness to others, increased empathy, sociability, well-being, and emotional openness. This distinguishes it from more traditional psychedelics as it impacts the emotional and relational dimensions instead of shifting the perception of self and reality; put another way, MDMA changes the emotional relationship to self and other, whereas psychedelics like psilocybin change consciousness. This matches a different system of physiology in Chinese medicine: the Pericardium.
From a Chinese medicine perspective MDMA can be considered to impact the Pericardium, instead of the Heart and shen. The Pericardium, or Heart protector, assists the Heart by protecting it from pain and suffering, allowing self-expression, and mediating Heart connections with others (humans and non-humans). It is responsible for intimate bonding, as well as the ability to present oneself in an authentic way, at the right time, in the right place, and to the right people. It is therefore closely involved with emotional intelligence, something greatly impacted by MDMA.
MDMA has a softening and opening effect on the Pericardium, which is often tight or closed due to pain and trauma. This allows greater emotional clarity, empathy, and better interpersonal communication. Instead of drawing on Kidney essence to finance the expansion of consciousness, MDMA draws on Liver qi and Blood to finance the expansion of the Pericardium. This explains common adverse effects of MDMA, such as grinding the teeth, muscle tension, anxiety, insomnia, headaches, and dizziness. As the Liver is responsible for smooth movement of muscles, of blood flow, and within the nervous system, all these symptoms represent an over-activation of this system. Therefore, MDMA should be used with caution in people who already have symptoms of Liver qi or Blood deficiency, as they may experience increased side effects.