Hush (Buffy Season 4, Episode 10)

The amazing Silent Episode.  I must confess that even years later, this remains one of my favourite episodes, especially from a cinematic perspective.

The main plot line is simple enough:  the utterly refined ‘Gentlemen’ come to Sunnydale, cast a spell which prevents everyone from speaking or voicing any sound more than a gasp.  The Gentlemen then proceed to harvest hearts from select individuals, at least one of whom is a student at UC Sunnydale, naturally.

It would seem that voice loss or throat bi would be what needs to be treated.   The pathology isn’t quite so simple, however, and close attention to the episode provides us with a wealth of diagnostic information, all pointing in the same direction.  (Besides, throat bi was addressed previously in Buffy Season 3, Episode 11.)

Between orgasms and orgasm friends (provided by Anya’s current obsessive conversational topic and Giles’ visiting friend Olivia), disturbing dreams and interrupted sleep (experienced by Buffy), lost voices (affecting all Sunnydale), asylum escapees (who act as the Gentlemen’s henchmen), and monsters consumed by inordinate desire for refinement — not to mention their obsession with collecting actual, physical hearts — this is an episode full of Heart disorders.

Not all traditions in East Asia will treat the Heart channel directly for Heart disorders; often the Pericardium is the treated channel or organ.  The Ling Shu only seems to mention two points on the Heart Channel — the luo point (HT-5) and the source point (HT-7).  Everything else is referred back to the PC channel.

In Chinese, the Pericardium is the Xin Bao Luo, the ‘Heart Envelope Collateral’.  The character for ‘collateral’ is the same ‘luo’ that is used for ‘luo vessels’, so a reference to internal and blood related factors.  Taken as a JueYin organ, of course, the Pericardium is responsible, like the Liver, for the clarification of blood, especially at night, while one sleeps.  In this case, the Pericardium keeps wei qi (which circulates internally at night, while sleeping) from harming the Heart.  On another level, blood contains the emotions — and contains in the sense of constrains in a vessel — the three worms which crave lust, gluttony, and refinement .

Functionally, the Pericardium (PC) serves to protect the Heart by venting heat away from it.  Some practitioners emphasise the Pericardium’s role in protecting the Heart from emotional shocks (emotions being related to either the blood as already mentioned, and thus blood heat; or to internal causes of disease, and thus the Stomach channel, itself containing two points called Seas of Blood.  The ST channel is associated with internal, emotional causes of diseases partially because it is the first ‘internal’ channel of the primary channels, bringing pathogens to the interior at ST-12.  Like the blood heat mentioned above, its symptoms are also characterised by heat, notably the ‘four bigs’ .)

But what about the Heart itself?  A brief examination of the pathophysiology below should provide some insight into its role in the human person.

Anya and Giles

How are orgasms related to the Heart?  At climax, Heart fire (or Heart yang) descends to Kidney water (or Kidney yin; in other words, jing-essence), causing ejaculation.  While we often see cases of premature ejaculation or erectile dysfunction among men in the clinic, the other side of the physiology is difficult orgasm.  In such cases, JueYin may be shunting away too much heat from the Heart and not allowing fire to build up enough to descend to the Kidneys; alternately, Heart fire may be contained in the organ itself and herbs to address Heart bi may prove useful.  Secondarily I would address Kidney water, but through the use of warming (but not hot), lubricating herbs.  Cooling herbs might inadvertently cause the Heart to close up further, depending on the specifics of the case.  Of course, yang deficiency may be at the root, and a formula such as Zhi Shi Xie Bai Gui Zhi Tang might prove helpful in such cases.  (The other possibility is Fang Ji Fu Ling Tang, a formula which unblocks yang.)  Check the shu points around T4- T6; if redness or papules are present, this indicates heat.  If the tongue coating is white and greasy, this is phlegm from yang deficiency.  Treatment should follow accordingly.

A simple formula of Bai Shao (astringes JueYin), Xuan Fu Hua (which descends qi), and Shu Di (augments essence) might do the trick for a constrained heat presentation, but I have never tested this clinically.  Dai Zhe Shi might make an interesting addition (taking a cue from Xuan Fu Hua Dai Zhe Shi Tang), and it is said to ‘preserve the Liver’, so it may also have subsidiary effects on astringing the Pericardium.  I might be inclined to use Dai Zhe Shi if Dan Shen (goes to the PC) were used instead of Bai Shao.  Lian Zi Xin, which guides HT fire to the KD might make a better choice than Xuan Fu Hua.  Mai Men Dong could nourish the fluids and unblock clumping in the Heart (together with Shu Di, one then has two thirds of Nourish the Ye-fluids — associated with the SI, and thus also with the HT — Decoction).   As a side note, Luo Shi Teng also unblocks the luo channels, and is associated with the HT and LV; it may be particularly apt, given the trajectory of the LV’s luo channel, and the HT’s role in this particular pathomechanism.

The Jia Yi Jing recommends LU-10 for treating Heart bi, especially when manifesting with sorrow, irritability, or counterflow qi.


I’m pretty sure I’ve covered in previous posts the interrelationship between dreams, blood, sleep, and the heart.  Dreams emerge from the wanderings of the hun-ethereal souls, which are housed in the blood.  Heat in the blood can disturb the sleep and make the hun agitated, while a deficiency of Heart blood means the hun have no place in which to rest.  One of the best insomnia-treating formulae, Suan Zao Ren Tang, is named after the chief herb, Suan Zao Ren, which nourishes the Heart and Heart blood.


Saying that HT-5 (or the herb Pang Da Hai) is good for loss of voice seems too easy.  So for lost voices, I am going to use instead a more complex diagnosis which focuses on opening the orifices, either the orifices of the Heart or the Sensory orifices.

Closed disorders also affect the Pericardium.  Both Heart and Pericardium have a relationship with blood; the Pericardium through its association with the JueYin channel system (which clarifies the blood); the Heart through being the motile force of blood and through its role in sealing the blood with the red colour.

What are closed disorders?  Bensky’s Formulas and Strategies gives a succinct definition:  “Loss of consciousness may be due either to excess or deficiency.  When the problem is one of excess, it is known has a ‘closed disorder’ in which pathogens obstruct and veil the sensory orifices,” and may be due either to heat sinking into the Pericardium and affecting Heart or cold.  Cold can constrain the qi and lead to the formation of phlegm, which in turn veils the Heart’s orifices.  Symptoms include rigid limbs, clenched jaw and fists, but NOT delirious speech, which is more characteristic of the ‘raving’ mentioned under Yang Ming heat disorders.

The treatment strategy is to use formulas which open the orifices.  Herbs such as camphor, musk, acorus, and cattle bezoar are often administered as the chief ingredients in such formulas.

I might consider choosing the very simple formula Tong Guan San for our characters in this episode, a powder made from zhu ya zao and xi xin.  A small amount of the powder is blown into the nose to generate a sneeze, which will open the jaw and disperse some of the phlegm blocking the orifices.  She Xiang (musk) can be added to increase the orifice-opening abilities of the formula.  Given that the Gentlemen were destroyed by very violent sneezing at the end of the episode (their heads exploded), I think this is an excellent formula to try — but then, this is a diagnosis based on knowing the end result, rather than one drawn from etiology.  (Tong Guan San is used in cases of collapse occurring after overwork or dietary excess.  I seem to recall Anya overindulging in some snack at the start of the show… )

Asylum Escapees

As noted above, the orifices of the Heart, which provide clarity of consciousness to humans, can become blocked with phlegm.  This sort of blockage causes a veiling of perception.  If the phlegm becomes combined with heat or fire, however, insanity and incoherence is the result.  The Asylum Henchmen may very well have been sufferers of phlegm-fire harassing the Heart (assuming they still have hearts, and the Gentlemen don’t resurrect their victims to act as henchmen…)  We will have a chance to revisit treatment options for insanity in a future episode; for now, I would simply ask what happened to these henchmen after their masters were taken care of?

The Gentlemen

The three worms which eat away at the body are associated with desire, greed, and ignorance or refinement (depending on whether one sues a more Buddhist or more Daoist oriented paradigm).  Refinement is associated with the Heart because of its role in promoting li, propriety, among the five virtues.  Refinement is li taken to an extreme, such that it ceases to be de-power or virtue, and instead becomes decadent.  A modified Zhu Che Wan could be helpful in this case; I would add some Bing Lang or other ghost  or gu-parasite removing herb, such as Tian Men Dong, if the Gentlemen seemed overly hot. (The Gentlemen do explode at the end after all, and I associate explosiveness with hot disorders, at least, more so than with cold disorders, since cold contracts…)

The acupoint prescription in this case would be PC-7 (for gu — its alternate name is ‘ghost heart’), HT-5 (for speech), and LU-7  (the command point for the head and neck).

As always, these posts are for entertainment purposes only.  If you feel you could benefit from Chinese medicine, please see a qualified practitioner.  Happy Slayage!


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