The instability of the heart described in Donguibogam shares many links with the neurological and physiological mechanisms of anxiety disorder and obsessive-compulsive disorder in modern medicine. Behind repetitive thoughts and actions, various neurotransmitters and brain regions interact in complex ways.
First, imbalances in neurotransmitters closely tied to anxiety, such as serotonin, dopamine, and norepinephrine, are known to influence obsessive-compulsive symptoms. Serotonin in particular plays a vital role in mood regulation and anxiety relief. When its function declines, feelings of anxiety amplify, and repetitive thoughts easily cascade. Dopamine is also closely involved in the reward circuit that drives compulsive actions.
Specific brain regions also play significant roles. The frontal lobe oversees higher cognitive functions such as planning, judgment, and impulse control, and dysfunction or hyperactivation of the frontal lobe is sometimes observed in patients with obsessive-compulsive disorder. In particular, excessive activation of the orbitofrontal cortex can lead to disproportionate fixation on specific stimuli or repetitive checking compulsions. In addition, dysfunction of the cortico-striato-thalamo-cortical circuit, which includes the basal ganglia and thalamus, is identified as a primary cause behind recurring obsessive thoughts and compulsive actions. When this circuit fails to work properly, unnecessary thoughts are not filtered out and continue to stimulate the brain.
An unsettled heart in Korean medicine can also be understood as the body's overall vulnerability to stress, reflecting a disruption in autonomic nervous system balance or hyperactivation of the hypothalamic-pituitary-adrenal axis, the brain's stress response system. Chronic stress worsens anxiety and obsessive-compulsive symptoms, creating a vicious cycle that deepens these neurological imbalances. Ultimately, when the central governing system of our body becomes unstable, much like the heart in Donguibogam, dysfunctions also arise in brain functions that regulate thought and behavior, giving rise to obsessive-compulsive symptoms.
