When the Gut Tenses, the Mind Tenses Too

When you get nervous your stomach hurts, and when your stomach is uneasy even your mind grows anxious. Often you cannot tell which came first. In these cases I do not look at the belly and the mind separately. I see it as a state in which the gut and the brain are connected in one line and shake each other.

The gut and the brain are a two-way road

The gut has its own dense network of nerves, so it is called "the second brain." These gut nerves exchange signals with the brain in real time through the vagus nerve. The road is not one-directional. Tension in the brain can travel down to the gut and clench the belly, and conversely the gut's discomfort and inflammation signals can travel up to the brain and heighten anxiety and sensitivity. It is a two-way road.

That is why symptoms come bundled together in these people. The stomach feels bloated, sleep is shallow, they are on edge over trivial things, and when nervous they urgently look for a toilet. At a glance the symptoms seem to run on their own, but they can sway together, because the gut and the brain share the same road.

That the gut's nervous system and the vagus nerve are connected to the brain in two directions, and that the state of the gut affects mood and arousal, is well documented.

I do not view such a person's anxiety as "a problem of the mind" alone, nor their indigestion as "a problem of the stomach" alone. I see it as one road blocked from both ends, and I look at which end to loosen first so that the whole road opens up. For some people, you must soothe the gut first for the mind to settle; for others, you must lower the tension first for the belly to ease.

I start from one end of the road

I look at which of the belly and the mind is shaking more strongly right now, and which one broke down first. I examine whether shallow, frequent breathing is carrying tension down to the gut, or whether the gut's discomfort is eating away at sleep and mood. On that basis, I loosen from one end of the road first. Helping to soothe both the gut's environment and the body's tension even during the hours away from the consulting room — this is where herbal medicine has its place. It is a way of not covering symptoms one by one, but of mending together the road that connects the two.

When you must go to the hospital first

That said, there are things that must be ruled out with abdominal symptoms. If weight loss, bloody stool, abdominal pain that wakes you at night, difficulty swallowing, or persistent fever are present together, the disease of the gut itself must be examined first. If anxiety and depression are severe enough to greatly disrupt daily life and sleep, it is good to also get help from a psychiatrist. I do not explain everything by the gut-brain axis. When necessary, I recommend testing first.

"It hurts because you are sensitive" is half true

The saying "you're sensitive, so your stomach hurts" is only half right. Because the stomach hurting can make you sensitive too. Whichever comes first, the two places are joined in one line. I will help loosen that line, gently, together.

References

• The gut's nerve network operates separately from the brain, which is why it is called the "second brain," and it holds some 500 million nerve cells — World Journal of Gastrointestinal Pharmacology and Therapeutics, 2025
• An explanation of how the vagus nerve travels between the abdominal viscera and the brain in both sensory and motor directions — Asan Medical Center Body Information
• A review finding that most of this line runs upward, from gut to brain — Neuron, 2022

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)