Abstract
There is a need to differentiate old style yi (醫), healing work, from traditional Chinese medicine (TCM). The perspective on life, spirit, body, health and illness in yi are based on the principles of yinyang wuxing. In contrast, TCM tends to favour a modern biomedical view of the body, health and illness. The ancient herbal formulas and acupuncture methods were originally developed to correct disconnections of heaven, earth and people. When illness and healing methods are understood according to the old yi method, this provides reliable clinical results. There exist incongruences between TCM principles and practice, which interfere with the practitioner’s intention to achieve correct diagnoses and outcomes. This article gives a basic explanation of yinyang wuxing theory and how the practice of yi is different from modern TCM.
Keywords
Yinyang, wuxing, yi, TCM, Chinese medicine, acupuncture, Chinese herbal medicine
Introduction
Most people who have any knowledge of traditional Chinese medicine believe that it has a tradition of several thousand years. However, despite the ‘traditional’ trappings of acupuncture and herbal prescriptions, modern ‘TCM’ is not particularly traditional at all. A closer inspection of TCM reveals that its perspective of life, the body and illness are actually based on modern principles of biomedicine adopted over the past 60 years during the shaping of TCM. In this article I want to demonstrate the differences between TCM and ancient Chinese healing (yi, 醫).
Ancient Chinese healing applied the theory of yinyang wuxing when viewing the universe, life, the human body, spirit (神 shen) and illness. Because yinyang wuxing is the core theory that directs the practice of yi, I prefer to call this form of healing yinyang wuxing yi. The word yi means the work of treating illness. Another reason for using the term yinyang wuxing yi instead of ‘traditional Chinese medicine’ is to take the focus away from the ‘Chinese’ aspect and instead emphasise the unique approach to treating illness based on yinyang wuxing theory. The term Chinese tends to hide the fact that in many respects modern TCM is not a Chinese tradition at all.
Because most people are unclear about the yinyang wuxing explanation of the spirit and body, this article begins with an elaboration of the basic concepts of this perspective, and gives examples of how yinyang wuxing theory guides effective treatment of illness. At the same time, the shortcomings of clinical TCM are explained.
Yinyang wuxing cycle
People who have studied TCM are familiar with the terms yinyang and wuxing. Qualities such as hot, bright, floating, erect, loose and separating are the characteristics of yang, whereas cold, dark, grounding, flexible, sticky and gathering are characteristics of yin. It is often explained that hot (yang) and cold (yin) are opposite extremities of one thing. However, the theory of yinyang wuxing is not about the opposition and antagonism of yin and yang, but rather about how these opposite qualities work together to transform phenomena. If we look at a tree, we can see its upright nature. However when the wind blows the tree, if it is healthy, will bend with it. The uprightness is because of its yang nature, but the tree also has a yin nature, which gives it flexibility and the ability to bend. If there is insufficient yin the tree may be upright but becomes brittle and susceptible to damage from wind. If there is insufficient yang in the tree, the tree collapses and rots. Although the phase of the wuxing associated with trees – wood – is predominantly yang, in this example we see that a tree has and needs both yin and yang characteristics.
According to the Daodejing Chapter 40, ‘Under heaven everything is born out of existence. [And] existence is born out of non-existence.’ In other words things occur out of nothing. This is an essential point to understand in the practice of yi and the theory of yinyang wuxing. We may think of this as merely a construct but in nature things can appear out of nothing – wood and other forms of life can grow out of water.
Water is cold, coagulating and yin. When water receives yang heat, it moves. When wood receives yinyang qi from water it grows. Wood is by nature erect, expanding and yang. When wood receives yin water, it becomes flexible. When the yang of wood exhausts its yin – that is, when wood becomes extremely hot and dry – fire occurs. Fire is by nature floating, hot and yang. When fire is grounded by yin, it is strong and lasting. Fire is extreme yang, and when it exhausts its yin, it ceases and becomes soil. Soil is by nature sticky and yin. When soil receives yang warmth, it becomes permeable. The sticky yin quality of soil binds, whilst the permeable yang quality of soil sorts (the fine and coarse, hard and soft, etc. elements). The binding yin and sorting yang of soil together create metal. Metal has the nature of gathering and consolidating, so it is yin. When metal has yang warmth, it separates the moistness of soil into fresh water and waste. Thus, the cooperation of yin and yang creates a never-ending cycle – water creates wood, wood creates fire, fire creates soil, soil creates metal and metal creates water.
Wood, fire, soil, metal and water not only create each other, they also control one another. Wood creates fire and also controls soil, so there is no loss of soil. Fire creates soil, and also controls metal, so that metal is pure. Soil creates metal, but also controls water, so that there is no flooding. Metal creates water, but also stabilises wood, so that wood does not fall. Water creates wood, and also controls fire, so that fire is restrained. This is the theory of wuxing.
Wuxing is a tightly bound chain; when it goes in the correct direction, life lasts, but should it go against the correct direction, life ceases. For example, if soil goes against its normal direction then fire is extinguished.
Figure 1: The wuxing cycles
Yinyang wuxing and life
Between heaven and earth, everything can be analysed through yinyang wuxing theory, and human life is no exception. Life is the joining of the spirit and body. The spirit is intangible, immaterial and yang. The human body is material and yin. The Neijing (Inner Canon) states:
Spirits in the heavens manifest in the [movement of the] wind, on earth through [the erectness of] wood. In the heavens [spirits] manifest through [flaming] heat, on earth through [floating] fire. In the heavens [spirits] manifest in [steaming] moisture, on earth through [the sorting ability of] soil. In the heavens [spirits] manifest through [absorbing] dryness, on earth through [the purity of] metal. In the heavens [spirits] manifest through [coagulating] cold, on earth through [flowing] water. Thus, the spirit is the qi of heaven that takes form on the earth. The interaction of qi and form transforms into everything.[1]
Thus, human life is the extension of the heavenly qi joined with the earthy body. The human spirit is part of the heavenly qi and thus connects with heaven and earth as well as other spirits and forms. Through the spirit, the human body is connected with heaven and earth. When any part of the body fails to connect with heaven and earth, or fails to freely breathe with heaven and earth, this causes physical pain/illness. As the Neijing states, when the body’s ‘qi is disconnected [from heaven and earth], pain occurs immediately.’[2] The breath is the essential connection of the human body to heaven and earth. This breath not only occurs through the nose, mouth and Lungs, but through all bodily openings. Therefore, sickness is a form of suffocation that is not confined to the Lungs. This is why the central aim of healing is to connect the body completely with heaven and earth.
When the yang spirit and yin body join at conception, their interaction creates a human wuxing cycle, which manifests as the wuxing organs.
Yinyang wuxing and organs
It is axiomatic that within yang there is yin, and within yin there is yang. The five organs have different yinyang qualities. The Lung is a yin-predominant metal organ. The yin of Lung metal gathers fluids and qi, which fills the body; the yang of Lung metal divides fluids and qi into clear and turbid. Lung metal thus gathers dampness, separates fluids into clear and turbid, and thereby creates Kidney water.
The Kidney is a yin-predominant water organ. The yin of Kidney water holds water and lubricates the body. The yang of Kidney water moves fluids and provides the body with strength. Kidney water yang supports the erectness of Liver wood, and Kidney water yin supports the flexibility of Liver wood. Thus, Kidney water yin and yang together create Liver wood.
The Liver is a yang-predominant wood organ. The yang of Liver wood provides the body with uprightness, so it can stand erect; the yin of Liver wood provides flexibility, so the body can bend. The erectness of Liver wood yang supports the floating/active yang of Heart fire, while the flexibility of Liver wood yin supports the calming/grounding yin of Heart fire. Therefore, Liver wood yin and yang together create Heart fire.
The Heart is a yang-predominant fire organ. Remember that the spirit is yang and the body is yin. The Heart is the abode of the spirit, and the spirit keeps a person alive. The yang of Heart fire impels the spirit outward to make the person active during the day. The yin of Heart fire holds or encloses the spirit and allows the body to rest during the night. The more a person becomes physically or mentally active, the more the body demands yinyang qi, which allows Spleen soil to transform food for the needs of the wuxing organs. When the body is at rest, the requirement of yinyang qi is less, which allows Spleen soil to store. So the yin and yang of Heart fire together create Spleen soil.
The Spleen is a yin-predominant soil organ. The yin of Spleen soil receives and stores food. The yang of Spleen soil transforms food to provide for the yinyang needs of the wuxing organs. The receiving and storing yin nature of Spleen soil allows Lung metal to gather and consolidate qi and fluid; the sorting and transforming nature of the Spleen soil allows Lung metal to separate fresh and waste qi and fluids. Thus the yin and yang of Spleen soil together create Lung metal.
While Lung metal creates Kidney water, it also controls Liver wood. Metal in the soil stabilises wood, so that wood does not fall. Lung metal fills the body with qi that binds Liver wood in place, so a person does not fall. While Kidney water creates Liver wood, it also controls Heart fire, so a person is grounded while active. While Liver wood creates Heart fire, it also controls Spleen soil. Wood holds soil, so there is no slipping of land. Spleen soil receives and distributes food. Liver wood holds Spleen soil, so a person can stop intake of food when the wuxing organs have sufficient yinyang qi. While Heart fire creates Spleen soil, it also controls Lung metal, so a person can breathe smoothly. While Spleen soil creates Lung metal, it also controls Kidney water, so a person is moist but not flooded (e.g. oedema).
Figure 2: The wuxing organs
All human physical functions are maintained by the wuxing organs. Lung metal governs the qi of the entire body. The yin of Lung metal gathers moisture and qi from heaven, earth and the wuxing organs to fill the body. Like metal that divides water and sludge, the yang of Lung metal separates to produce fresh qi and water, exhales waste qi through the mouth and nose, excretes body waste via the Large Intestine, and thus maintains the freshness and lightness of the body. Thus, all symptoms such as shortness of breath and fever indicate Lung metal yin damage. However, there are many reasons that can cause Lung metal yin damage. When Lung metal yang is damaged, qi and fluids are not separated into the fresh and turbid, which causes dampness and mucus to arise. This dampness and mucus will then ferment to create damp-heat. This damp-heat can then exhaust Lung metal yin and cause fever. When Kidney water yang is damaged, water is unable to rise, which can cause Lung metal yin damage (with symptoms of fever). On the other hand, symptoms such as bad body odour, mucus and tight chest would indicate Lung metal yang damage.
Kidney water governs the water of the entire body. The yin of Kidney water holds water and keeps the body moist. The yang of Kidney water moves fluids and keeps the body warm. The heat held by Kidney water is the power of the body. When Kidney water holds sufficient reserves of yang heat, a person can endure hard work. Water is the precondition for the reproduction of all life; Kidney water stores body fluids and heat, so it sustains the body’s ability to grow, reproduce and be strong. Therefore hot, yellow and short urination indicates Kidney water yin damage, whereas a lack of body heat, strength and growth/reproduction impediments indicates Kidney water yang damage.
Liver wood stores blood. Blood is the essence of the wuxing organs’ yinyang qi and instantly meets their yinyang needs. The erect nature of the Liver wood yang maintains the openness of the blood passages, so that blood flows freely without stagnation. The flexible nature of Liver wood yin allows the blood to flow smoothly, so a person is relaxed. Consequently, all symptoms of blood decay (血腐 xuefu) such as boils, ulcers, masses and lumps indicate obstruction of blood flow due to Liver wood yang damage. All blood heat-related wind symptoms, such as dizziness or wind-strike, are signs of Liver wood yin damage. Liver wood yin provides the body with flexibility, therefore all forms of body tightness and stiffness are indications of Liver wood yin damage. Liver wood yang makes the body erect; an inability to stand straight indicates Liver wood yang damage.
Heart fire is the home of the spirit. The yang of Heart fire impels the spirit outward from the Heart during the day when the Heart receives yang qi from heaven and earth; the yin of Heart fire holds or encloses the spirit during the night when the Heart fire yin receives the yin qi of heaven and earth. When the spirit comes out from the Heart, it communicates with other spirits between heaven and earth and makes a person active. When the spirit is enclosed, it is isolated from other spirits and allows a person to rest. Consequently, symptoms such as a lack of desire to do anything or feeling depressed and inactive during the day indicate Heart fire yang damage, while symptoms of restlessness at night indicate Heart fire yin damage.
Spleen soil provides the ‘food’ for the entire body. ‘Food’ in this sense is not just what we eat, but all sources of yinyang qi that enter the body from the external world through the mouth, skin, and nose, as well as ‘food’ produced within the body by the wuxing organs. The yin of Spleen soil is adhesive; it receives and holds food. The yang of Spleen soil is permeable; it transforms food for the yinyang needs of all the wuxing organs. Therefore, food intake problems such as lack of appetite and emaciation indicate Spleen soil yin damage, and food transformation disorders such as nausea, bloating and regurgitation indicate Spleen soil yang damage.
Yinyang wuxing and spirit
Just as the body is bound by yinyang wuxing regulation, so too is the spirit. When the yinyang of the spirit is out of balance it causes people to suffer emotional disorders. The existence of the spirit manifests through its zhi (誌 will). The spirit interacts with the wuxing organs to exercise its various zhi.
The wood aspect of the spirit is the striving zhi (鬥誌 douzhi). It is striving because wood is expansive and upwardly moving. The yang of the striving zhi is firm while the yin is flexible, so that the yang and yin qualities together make a person firm but not rigid.
The fire aspect of the spirit is the aspiring zhi (立誌 lizhi). It is aspiring because the nature of fire is active and floating. The yang of the aspiring zhi is ardent and passionate, while its yin is prudent. The yin grounds the ardour and passion so that they are not easily dissipated. The yin and yang of the aspiring zhi together make a person ambitious, yet able to remain realistic and down-to-earth.
The soil aspect of the spirit is the reasoning zhi (理誌 lizhi). It is the reasoning zhi because soil receives and processes. The yin of the reasoning zhi gathers messages, thoughts and ideas, while its yang enables a person to sort them out . Together the reasoning zhi takes in and sorts out ideas and makes a person able to think before acting.
The metal aspect of the spirit is the lofty zhi (壯誌 zhuangzhi), lofty in the sense that it remains aloof to things that are not of its kind and therefore remains pure. The yin of the lofty zhi gathers spirits of all kinds; the yang of the lofty zhi separates out those spirits that are not akin to it. Together the yin and yang aspects of the lofty zhi make a person sociable but able to maintain their individuality.
The water aspect of the spirit is the enduring zhi (勵誌 lizhi), enduring in the sense that it has a desire to carry out difficult tasks. The yin of water is coagulating; the yang of water is surging. The yin of the enduring zhi is determined, while its yang is motivated. The yin and yang of enduring zhi together make a person steady and calm whilst being decisive and prompt.
Yinyang wuxing yi and illness
Illness occurs when the yinyang of a person’s wuxing organs do not respond to the yinyang transformations of heaven and earth. For example, at night, yin qi dominates a person’s surroundings. If a person’s yang qi is not grounded by yin qi, the yang qi will be assailed and exhausted by the stronger forces of the yin qi of heaven and earth, causing symptoms such as sleeplessness, lack of strength and irritability. Regardless of the illness, the symptoms are never anything other than a yinyang imbalance of the wuxing organs; that is, all illnesses are nothing more than the body’s lack of coherence with the yinyang transformations of heaven and earth. Therefore, all illnesses can be alleviated through regulating yinyang.
The spirit relies on the wuxing organs to realize its zhi. When the yinyang of the wuxing organs is damaged, the spirit cannot exercise its zhi, so there will be symptoms of spirit disorder. For example, when Liver wood yin is damaged, the yin of the striving zhi cannot be exercised and a person will have feelings of anger. Or if a person’s Kidney water heat is lost, the yang of the enduring zhi cannot be exercised and a person will have feelings of indecision.
Treating illness – understanding herbs
All things in nature have their particular yinyang wuxing characteristics. Yin is attracted to yang, and yang is attracted to yin. Therefore herbs that have yang characters like yin environments, and herbs that have yin characters like yang conditions. Ginseng grows in cold forests but has a strong warming yinyang nature. Aloe vera likes hot sunshine but is cold in nature. When the yinyang of a person is incoherent with the yinyang of heaven and earth, a person will suffer illness through being assailed by the yinyang qi of heaven and earth. The purpose of yinyang wuxing yi is to utilise the yinyang nature of things (such as herbs) around us to correct the body’s internal yinyang imbalance and reestablish the proper regulation of the yinyang qi of heaven and earth. This is the essential framework of treating illness. For example, a person with Heart fire yang damage may suffer a feeling of dispiritedness. This can be alleviated by administering strong yang herbs.
To practice yinyang wuxing yi successfully it is not the mastery of ancient herbal formulas that counts, but is the mastery of individual herbs. This mastery involves understanding the yinyang nature of herbs, not merely knowing which symptoms they might treat. The ancient texts may state that a herb can treat certain symptoms, but the reason that the herb treats such symptoms is because it has a particular yinyang nature. For example, aconite is a very drying and warming herb and can be used in any formula for treating cases of Kidney water yang deficiency or Heart fire yang deficiency, regardless of the symptoms. Therefore, all symptoms caused by the same yinyang disorder can be effectively treated by the same herb. Provided one understands the nature of aconite, then it can be safely used.
Another example of the understanding of herbs in yinyang wuxing yi can be seen in the lotus root. Li Shizhen’s Bencao Gangmu (Compendium of Materia Medica) describes this herb as follows: ‘Comes out of mud, but not dirtied by mud, lives in the water, but is not submerged by water. Its stem, flower and fruits are out of the ordinary. ’[3] Observing the lotus plant it is easy to see why it has an erect and damp-clearing nature. Liver wood yang erects the blood passages and maintains the freshness of the blood, and the lotus root goes into Liver channel to clear dampness and stop bleeding caused by dampness. Li Shizhen states the actions of lotus root as follows: ‘[It] clears cold dampness, stops Spleen [yang damage] loose stools and persistent diarrhoea, stops excessive vaginal discharge, heavy menstruation and other bleeding conditions.’[4] Symptoms of illness can change, but the causes of symptoms never go beyond the yinyang disorder of the wuxing organs. So long as one understands the root yinyang disorder of a symptom, one can freely use a herb that corrects this yinyang disorder without worrying whether or not others have used the herb for that particular symptom.
TCM
While yinyang terminology is used in modern TCM, within the TCM texts wuxing is given virtually no clinical relevance. One of the most renowned developers of modern TCM, Deng Tietao, stated that ‘Chinese medicine must connect with all kinds of the most advanced natural sciences and social sciences’ and that in order to do this ‘the original treasure must first go through a complete sorting out, so the theory of Chinese medicine can be more systematic and standardised.’ [6] This meant that the concepts of yi had to be rearranged to fit scientific medicine. One of the major sorting tasks for Deng was to eliminate wuxing theoretical perspectives from Chinese medicine, as he further states:
Superficially, Chinese medicine ‘wuxing theory’ is the same as the ancient philosophy of ‘wuxing theory’, but it is fundamentally different in content. It is possible to say that within Chinese medicine wuxing is merely a pronoun for the five organs and the relationship of mutual facilitation and mutual-restriction between tissues and apparatus, people and environment that centres on the five organs.[7]
Once Deng declared that TCM wuxing was merely ‘a pronoun’, he was able to change its meaning to the more scientifically acceptable name of organs – Liver, Kidney, Lung, Spleen and Heart. Thus, wuxing became wuzang– five organs[8] in order to build a foundation for the ‘five organs correlation theory.’ The ultimate aim was, as Deng explained, to ‘strip off the philosophical coat … and return to the true scientific contents of “five organs correlation theory.”’ [9] As a result TCM practitioners may learn wuxing theory, but in terms of the body they understand wuzang. Therefore, practitioners cannot find the relevance of wuxing theory in their clinical practice
Moreover, in TCM texts there is invariably scant discussion and explanation of spirit. In the Dictionary of Chinese Medicine Terminology, spirit is explained as ‘an important part of human life activity. It has the closest relationship with the “Heart” in the five internal organs.’ Although the dictionary refers to the Heart as the house of spirit, it does not explicitly provide a definition of spirit. In another government sponsored text, Chinese Medical Culture Expo, there is a chapter on essence (精 jing), qi and spirit. It briefly states that the spirit is responsible for ‘various activities, change and internal regulation.’ The text goes on to quote from the Suwen (Basic Questions): ‘The Heart is the most important organ of the human body, and is where the brightness of the spirit originates.’[12] The text interprets this statement so that ‘the spirit governs the human body’s physiological and mental activities, such as spiritual awareness and thinking.’[13] These modern, new-age-sounding statement miss what the spirit is precisely, including its relationship to heaven and earth.
The clinical impact of different ways of thinking
If TCM did not achieve any clinical results, it would not have spread all over the world. In fact, many TCM practitioners achieve surprising healing results. Why then is it so important to understand the theory of yinyang wuxing? The answer is that yinyang wuxing theory can provide practitioners with a flexible approach to treatment that does not rely on old formulas, and at the same time provides reliable clinical results.
I once met a 40 year-old woman who asked my opinion on the prescription given to her by her TCM doctor. The patient had suffered symptoms of anxiety, cold and fatigue for two years since giving birth to her child. Six months later, she also began to have persistent headaches. The headaches became worse day after day, and sometimes woke her from early morning sleep. Then she started to feel nauseated by the pain, and even lost part of her vision. She was diagnosed with brain cancer. Consequently, she had surgery and chemotherapy, but the cancer cells did not clear. She went to see a TCM practitioner, who diagnosed her with a pattern of ‘damp-heat poison in the blood’, which is essentially another way of saying cancer in modern TCM language. The formulas contained a large amount of heat- and dampness-clearing herbs as well as ‘anti-cancer’ herbs. In fact, there are no herbs that have been confirmed by scientific research or ancient texts to be anti-cancer medicines. Rather they were so called by the modern developers of TCM who looked through the ancient texts and felt that some of the cases were similar to modern descriptions of cancer. As well as these problems with the clinical reasoning behind herb selection, the TCM diagnosis of this case did not explain the root cause of the damp-heat poison in the blood. Because the root cause of the sickness remained unclear, the treatment was only able to deal with symptoms. The Neijing states: ‘In treating illness the root cause must be traced. ’ Without knowing the root cause or having a coherent theoretical framework, it is very difficult to work out alternative treatments or approaches when the initial treatment does not achieve the desired result.
At the time when I met the patient, she was suffering from body aches, was unable to manage daily housework, and felt cold in her bones. At the onset of the condition, as well as feeling cold, the patient suffered from anxiety, which indicated Kidney water heat loss. After giving birth a woman’s joints are loosened, and at this time wind and cold easily invade the body and drain the its yang heat. Kidney water stores the yang heat that keeps the body warm and gives it strength. When Kidney yang heat is lost, a person feels cold and has no strength. The yang of the enduring zhi of the spirit relies on Kidney water yang to exercise its will, which makes a person confident. When Kidney water heat is lost, the spirit is unable to exercise its enduring yang zhi, so the patient feels anxious.
Early morning is the time when heaven and earth pass through the body’s Liver wood yinyang passage. Having headaches at this particular time indicates that the Liver wood yinyang passage has obstructions, which are then struck by the yinyang qi of heaven and earth, causing pain. The eyes are the openings of Liver wood to heaven and earth. When Liver wood is not open to heaven and earth, the vision is unclear.
The yin of Spleen soil receives food, whilst its yang transforms food. When Spleen soil yang is damaged, food cannot be transformed, so there are symptoms of nausea.
In the wuxing cycle, Kidney water nurtures Liver wood. When Kidney water heat is lost, Liver wood loses its support and is weakened. At this time, a person can easily be attacked by external abnormal yinyang qi, which causes Liver wood yinyang disorder. Kidney water heat loss also causes water stagnation in Spleen soil, which damages Spleen soil yang qi, so food is not transformed. Therefore, this case should be treated by warming Kidney water as the main approach, assisted by clearing Liver wood, refreshing blood and loosening Spleen soil. Because Kidney water heat loss was the source of the whole condition, and many Liver wood clearing herbs tend to have strong cold yinyang natures, such as Zi Hua Di Ding (Violae Herba), Pu Gong Ying ( Dandelion ) and Lu Hui (Aloe), these cold clearing herbs should be avoided as much as possible. Instead, herbs such as Chi Shao (Paeoniae Radix rubra), Da Huang (Rhei Radix et Rhizoma) and Ru Xiang (Olibanum) should be used as they clear blood dampness and support Liver wood yang while being less cold for Kidney water.
There are many ways to warm Kidney water whilst clearing blood decay to support Liver wood regeneration and loosening Spleen soil; if this is done appropriately there is no way that the body will not respond to such treatment, just as there is no way that a body will not respond to a hotbath. If the water is not hot enough to warm the body, find herbs that give the right level of warmth to the body. Thus, according to the response of the patient, a physician can work out appropriate treatment methods. Therefore yinyang wuxing theory guides the train of thought for a physician to actively search and create methods to deal with any symptoms. With the guidance of yinyang wuxing theory, even though a physician may not have been able to deal with a yinyang disorder, she surely has means to look for a way to deal with it.
Yinyang wuxing yi and secret/experiential formulas
There are many TCM practitioners today who boast that they have secret ancient formulas. In an article: ‘Bianzheng Lunzhi Is the Soul of Clinical Chinese Medicine’ Deng Tietao gives an example of himself treating women with retained dead foetuses that were unable to be delivered where after the first ancient formula does not work, he tried a second then a third that still did not work. When he used a fourth ancient formula, the dead foetus finally came out. Perhaps this case might make practitioners envious that Deng knew so many formulas which he could substitute one after another. But why the first three formulas did not work is something that he does not explain. What if the fourth formula did not work, would there be a fifth and a sixth and so on? This is exactly the puzzle that many TCM practitioners face. These so-called experiential methods that are taught sometimes work, but often do not. When old formulas work it is a nice surprise, but without a proper theoretical guide, when they do not work one is lost. There are hundreds of formulas for treating specific symptoms but from different causes; without understanding the original purpose of the individual herbs, it is difficult not to make mistakes when choosing ancient formulas.
A young man came to see me to help cure pimples on his face. The patient had been seeing TCM practitioners and taking their herbs on and off for many years. In the beginning he found the herbs were helpful, but after a while they stopped being effective, and the condition got even worse. Sometimes after taking herbs he would feel lower back pain. The formulas that the patient had been taking contained mostly cold herbs such as Pu Gong Ying (Taraxaci Herba), Zi Hua Di Ding (Violae Herba), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma) and Huang Bai (Phellodroni Cortex). Pimples are a sign of blood decay or damp poison in the blood, which are caused by Liver wood yang damage. The above herbs all clear heat and dampness and cool the blood, but in this case they made the condition worse rather than better.
During the first consultation I found that the patient regularly drank soft drinks. The white sugar in these soft drinks drains Kidney water heat. If one were to dissolve a cup of white sugar in water and drink it, within a short time, you would feel the need to urinate; there would be little water and the urine would be warmer than usual. There are also many chemical ingredients in soft drinks such as colourings and preservatives which obstruct normal yinyang wuxing transformation. If they are not quickly expelled from the body, they block the yinyang passages of the wuxing organs and encourage dampness to flourish. In this case the soft drinks damaged Liver wood yang and caused blood damp poison to grow. The previous TCM practitioners’ disregard of the patient’s diet meant they failed to find the cause of his illness.
In the wuxing cycle, Kidney water nurtures Liver wood. Kidney water heat loss causes Liver wood to be undernourished; therefore the cooling herbs further damaged both Kidney water and Liver wood. Cold Kidney water then caused lower back pain. This case required Kidney warming herbs such as Ba Ji Tian (Morindae officinalis Radix), Xian Mao (Curculiginis Rhizoma) and Dang Gui (Angelicae sinensis Radix), and herbs that remove blood dampness to support Liver wood yang such as Chi Shao (Paeoniae Radix rubra), Da Huang (Rhei Radix et Rhizoma) and Ru Xiang (Olibanum). At the same time, the patient had to stop drinking soft drinks and even eating fruit, because sweet things would encourage the damp poison in the blood to flourish and impede the regeneration of Liver wood yang. Through a change of diet and taking Kidney-warming herbs, the patient’s symptoms subsequently showed quick and sustained improvement.
The principle for acupuncture treatment is the same as herbal treatment, only the methods differ. As for the above case, it would be to empty (虛) Zulinqi GB-41, consolidate (實) Ququan LIV-8, Yingu KID-10 and Zutonggu BL-66. Each channel has wood, fire, soil, metal and water wuxing points. Zulinqi GB-41 is the Gall Bladder channel’s wood point, and the Gall Bladder is the yang aspect of Liver wood. Because pimples are Liver wood yang damage with blood stagnation, emptying this point can clear blood stagnation and support Liver wood yang regeneration. Ququan LIV-8 is the water point of the Liver wood channel; consolidating this point supports water in order to regenerate wood. Yingu KID-10 is the water point of the Kidney channel which is used to consolidate water and thus generate wood. Zutonggu BL-66 is the water point of the Bladder channel; the Bladder channel is the yang aspect of the Kidney water organ, so Zutonggu BL-66 is used to support Kidney water yang. In addition to the above four points, Qiuxu GB-40 can be added (the yuan point [原穴] of the Gall Bladder channel). Zhang Jingyue states: ‘The qi of the five zang and the six fu are interconnected. The six fu are the surface of the five zang, and the twelve yuan are the surface of the six fu. The twelve yuan connect with the outside of the body at the four main joinings. The four main joinings are the two elbows and two knees, which are the major bone joints.’ So yuan points are the main points where the internal organs connect with heaven and earth. The Neijing states that ‘illnesses of the wuxing organs should be expelled from the twelve yuan points.’[18] Because the pimples in this case involved Liver wood yang damage causing blood stagnation, emptying Qiuxu GB-40 connected the Liver wood yang qi with heaven and earth to thus expel the blood stagnation.
This is an example of how to choose acupuncture points to treat illness according to the theory of yinyang wuxing, rather than using ‘experiential’ point protocols. Pimples are a symptom of Liver wood yang damage, but creating a treatment for Liver wood yang damage is not limited to clearing blood stagnation to support Liver wood yang; warming Kidney water can support the regeneration of Liver wood. Fire is above soil, water is below, loosening Spleen soil permits Heart fire yang heat to get through the soil and down to Kidney water, then to support Liver wood regeneration, and so on. That said, so long as we understand the nature of yinyang wuxing, we are able to find methods to deal with any kind of illness. This is why yi scholars always emphasised yinyang wuxing theory in their case discussions rather than simply saying which herbs or acupuncture points treat which symptoms.
To suit the present day socio-political situation that privileges science, the developers of TCM cast off the theory of the yinyang wuxing of heaven, earth and people, only retaining some of the methods of herbs and acupuncture to treat symptoms or biomedical diseases. Although TCM is sometimes effective, when it does not deliver the desired effect there is no coherent reasoning system to search for different clinical approaches. For example, the Shanghai Chinese Medicine University Teaching Hospital TCM clinic reported their experience in treating pimple cases according to the modern TCM approach of bianzheng lunzhi. First, they searched the ancient texts, and concluded that there are four types of pimples: the Lung channel wind and heat type, the intestine and Stomach damp-heat type, the qi and blood stagnation type, and the chong and ren vessel disorder type. They decided all types would be treated with Yintang M-HN-3, Yingxiang LI-20, Dicang ST-4, Hegu LI-4, LI-11 Quchi, Zusanli ST-36 and Ah Shi (阿是穴). Then if it was the Lung channel wind and heat type they would add Fengchi GB-20, Feishu BL-13, Dazhui DU-14 and Chize LU-5. If it was the intestine and Stomach damp-heat type, they would add Shangjuxu ST-37, Yinlingquang SP-9 and Fenglong ST-40. If it was the qi and blood stagnation type, they would add Geshu BL-17, Ganshu BL-18, Xuehai SP-10 and Shang Ju Xu. If it was a Chong and Ren vessel disorder, they would add Xuehai SP-10, Sanyinjiao SP-6 and Shenshu BL-23.
It is possible that the pimple cases reported in this article did conform to these four patterns, but for clinical success the appropriate causes still have to be traced. These patterns can still be understood as yinyang wuxing disorders. For example, in the case of Lung channel wind heat, is it because of Lung metal yin weakness that qi and moisture are not gathered? And how does that cause pimples? Does the Lung channel wind damage Liver wood yang? From the perspective of yinyang wuxing, Liver wood yang keeps the blood passages erect and open to keep blood flow free and circulating; when Liver wood yang is damaged, blood flow becomes unsmooth, which leads to blood stagnation. Stagnated blood ferments to create heat and dampness, which shows as pimples. So pimples always involve Liver wood yang damage. If the root cause of the symptoms remains unclear, rigidly applying ancient methods to treat symptoms is likely to produce unsuccessful results.
The report of the results in this research stated that of the 45 cases treated with these methods, 16 of them recovered. There was no further mention of the 29 uncured cases and of any alternative treatment methods that could have been used. In everyday clinical encounters, TCM practitioners in such a situation often look into the archives of ancient yi texts to look for experiential methods, or ask other senior practitioners for their methods. Instead of this, I suggest practitioners get a proper grounding in yinyang wuxing theory to gain the ability to fundamentally understand the causes of illness and create their own formulations for treatments, rather than mistakenly believing that there are ancient formulas that can be used to remedy illnesses described and understood in biomedical terms. It is essential that practitioners creatively think through yinyang wuxing theory when diagnosing and treating illness rather than hoping that someone a thousand years ago had a solution and left it in a message for them.
Conclusion
Yinyang wuxing theory provides practitioners with the flexibility to create effective treatment methods to deal with the myriad of everyday clinical encounters. Currently one has to follow some form of recognised education and qualification in order to practice TCM. To my knowledge there are no institutions that provide a deep education in yinyang wuxing. Whilst some practitioners understand the concept of yinyang and the creative and controlling aspects of wuxing, the real difficulty is putting these concepts together in a way which allows them to be used as a theoretical tool to treat illness. The failure I believe lies in an inadequate understanding of the yin and yang aspects of the wuxing organs. If practitioners study and obtain a deep understanding of yinyang wuxing, they will never need to inefficiently rummage around old or new texts looking for formulas, but instead they will have the ability to adeptly develop their own prescriptions.
Although I do not have the unrealistic expectation that all readers will begin pursuing yinyang wuxing yi, I hope that this paper will let more people know that yinyang wuxing yi is a coherent system and an invaluable source of clinical knowledge.
[1] Huangdi Neijing Suwen (Yellow Emperor’s Basic Questions), chapter 19: ‘神在天為風，在地為木；在天為熱，在地為火；在天為濕，在地為土；在天為燥，在地為金；在天為寒，在地為水；故在天為氣，在地成形；形氣相感而化生萬物矣。’
[2] Huangdi Neijing Suwen, chapter 11: ‘…氣不通，故猝然而痛。’
[3] Li Shizhen, Bencao Gangmu, Fruits section, chapter 33, number 6, Lotus, 果部第三十三卷\果之六 <篇名>蓮藕 ‘蓮產於淤泥而不為泥染；居於水中而不為水沒。根莖花實，凡品難同。’
[4] Ibid. ‘除寒濕，止脾泄久痢，赤白濁，女人帶下崩中諸血病。’
[5] Deng Tietao, (1988). Brief Discussion on Five Organs Correlation Replacing Wǔxíng Theory略論五臟相關取代五行學說, Guangzhou Chinese Medicine College Bulletin, 5.2, 65-68, p. 65
[6] Ibid., p. 65
[7] Ibid., p. 66
[8] Ibid.
[9] Ibid..
[10] China Ministry of Health, 2016 Dictionary of Chinese Medicine Terminology《中醫名詞詞典》retrieved from http://www.zysj.com.cn/lilunshuji/mingcicidian/109-3-4.html#hi-5363. “自然界种种运动变化及其内在规律” Cited on 17th August 2018
[11] Editor in charge Zhong Wen 鐘文(2010). Chinese Medical Culture Expo. 中國醫學文化博覽Foreign Language Press 外文出版社: Beijing, pp.4-5
[12] Ibid. p.5
[13] Ibid. p.5
[14] Neijing Basic Questions Ch. 5 : “ 治病必求于本.”
[15] Bianzheng lunzhi辨證論治 (treatment based on syndrome differentiation) is the system of the modern Chinese medicine, for more discussion on bianzheng lunzhi see Chang, R. (2015). Chinese Medicine Masquerading as Yi. Maninriver Press: Bretti, Australia
[16] Deng Tietao (2002). Bianzheng Lunzhi Is the Soul of Clinical Chinese Medicine, Chinese Archives of Traditional Chinese Medicine, 20.4, 394-395, p. 394.
[17] Zhang Jingyue (1624). Lei Jing 類經, The Categorised Inner Canon, chapter 8: ‘Twelve Yuan’ ‘臟腑之氣，表裏相通，故五臟之表有六腑，六腑之外有十二原，十二原出於四關。四關者，即兩肘兩膝，乃周身骨節之大關也。’
[18] Yellow Emperor, Lingshu, 靈樞Divine Pivot. Chapter 1, section 1 : ‘五臟有疾也，應出十二原。’
Published on Journal of Chinese Medicine Number 118 October 2018
Rhonda Chang 
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