Editor's Note: Part one of this article appeared in the November 2006 issue.
This article examines the mechanisms of addiction and how they relate to traditional Oriental medicine theory and treatment. In part one, I stated that an addiction is a complicated disharmony that has involvement in every phase of the Chinese Five Elements. Making use of this model, it broke the sequence down into manageable parts, yet simultaneously honored the fact that an addiction depends upon the whole cycle to continuously feed off itself.
This article will continue to explore the etiology of an addiction by employing the Eight Principle Theory. In addition, it will compare traditional Oriental medicine's internal devil of fright to the modern psychological concept of psychiatric trauma and how this all relates to what addicts commonly call "the void."
To begin, the traditional Eight Principle Theory is a great way to introduce traditional Oriental medicine philosophy to addicts because it illustrates through absolute simplicity. The three yin/yang pairings of cold/hot, inside/outside and too little/too much have been used for millennium to help people understand the nature of health versus illness and can be just as easily applied to addictions.
As a fellow practitioner of Oriental medicine, I encourage you to explain this simple set of pairings to a group of addicts. Once they understand the basic notions of how this theory works, ask them their opinion upon whether an addiction is a yin or yang disease based upon the two prominent divisions of the yin "too little on the inside" and the yang "too much from the outside." Leave out the hot/cold pairing to keep things simple, and I guarantee you will be treated to a lively discussion.
The yang segment of the population will put forth the argument that their addiction is too much pressure from the outside and that everything would be just fine if only these hassles would stop being imposed upon them. Unfair scenarios like the ones presented in the form of the intense demands of a job, the guilt-laden expectations from parents, the social pressure of peers and the ever expanding, role-fulfilling requirements as a spouse and a parent, are a few of the commonly mentioned stressors that appear as "too much from the outside," which easily can trigger an addict into using.
The yin part of the group will agree that all of the above-mentioned factors are indeed real and will put added pressure upon an addict to use; but the deeper motives of this unhealthy habit still lie within. These people will recognize that it's the too little on the inside, which looks like devastated self-esteem, broken ability to forgive oneself, a black hole of unworthiness and a complete lack of self confidence, to name a few, which are the instruments of attraction that act as a magnet to their drug of choice.
So, which one is correct? To use the traditional Oriental medicine point of view, it's generally agreed that the deficiency on the inside is the cause for an individual to manifest disease into one's being. Giving the example of a common Wind/Cold attack, traditional Oriental medicine states that if the wei qi is not deficient and strong, there is no place for the invading pathogen to enter or it's expelled immediately. On the other hand, if a person's wei qi is weak, the Wind/Cold gets into the body and can even penetrate to deeper levels of the qi, ying and xue levels, if they are also deficient. It's the internal deficiency that determines how deeply the invading pathogen will affect the body. At this point in the yin/yang explanation of addiction, the yin crowd usually feels "right," as it's plain for all to see that it's the too little on the inside that was there first, which then creates the pull toward the too much on the outside.
To further solidify this viewpoint, addicts are very familiar with the term "the void," which also is referred to as "the hole in the soul." This concept is characterized by the power that manifests as the gluttonous need to fill it up with everything it can get its hands on, and especially one's particular drug of choice. This term, "the" is easily equated by the addict with the Eight Principle yin concept of too little on the inside. This insatiable force also is given more description when compared with the Buddhist version of the "hungry ghost." When told of this spirit's bottomless belly, which it's forever trying to fill through the inadequate vehicle of a pinhole mouth, the addict can more fully relate their addiction with the language of yin and yang.
But then someone from the "losing" yang "too much from the outside" group always inevitably asks, "But wait a minute, I wasn't born with this too little on the inside, this hole in the soul, this hungry ghost, so where does the void come from?" And the discussion is going once again. Indeed, where does this void come from? How does something like this happen and what can be done about it? The void, taking the form of all of the reasons why there is too little on the inside, is created through the infliction of pain. To put it most succinctly, it's trauma that causes the void.
Psychiatric trauma is defined as "an experience that is emotionally painful, distressful, or shocking and which may result in lasting mental and physical effects."1 This experience can be singular or repetitive in nature and it's caused by an immediate and direct confrontation with the threat of "death, extreme human suffering, severe bodily harm or injury, coercive exploitation or harassment, sexual violation, violence motivated by ethno-cultural prejudice, or politically based violence."2 To a lesser degree, it also can be attributed to verbal abuse, emotional neglect and/or abuse, and being witness to any of the above-mentioned events.
The experience of trauma causes what is known in psychology as dissociation. This is the term given to what happens when an individual's psyche "leaves the scene of the crime." When the trauma occurs, there is a part of an individual that will split off and become dissociated from the whole. It's a natural defense mechanism to preserve the ego that is employed in times of extreme pressure. This paradigm does have traditional Oriental medicine equivalents and the best way that I've found of expressing it would be to say that trauma is translated as the internal devil of fright and dissociation is seen as a fractured shen.
When the internal devil of fright appears and breeches the defenses of the pericardium, it makes its way into the imperial gardens of the heart and delivers its brand of pathological destruction. Specifically, the damage is imposed upon the shen. A fractured shen is the term used to describe this type of injury and it's an applicable name for what occurs as a result of this type of trauma.
The fractured shen is like a window; it's meant to be clear, transparent and able to let light shine in and out, but when it's hit by a small stone, all types of cracks will run out from the point of impact. The shen does the same thing when hit by the "stone" of fright. Like in psychology, when the natural phenomenon of dissociation occurs to protect the ego, aspects of the spirit escape the trauma/fright by traveling out along the cracks of shock. This preserves the most important pieces of the shen when the fright is inflicted upon the vulnerable heart. From this fracture, the ramifications of injury, as well as the answers to health's questions, lie hidden within these trails of wounds, and they must be followed if one wishes to find the dissociated aspects of the shen.
For the affected individual, life goes on, but the window is never the same; the spirit is never quite the same. It's this aspect of the dissociated shen, which leaves behind in its wake the vacuity that we see in the patient's eyes. This vacuum becomes the force that is the voracious craving from inside of the hungry ghost's belly - this is the qi of the void.
At this point, the yang side, representing the too much from the outside, has the feeling that they've finally trumped the yin too little on the inside troop. For it has become obvious that the reason why there is all of those factors for the void to form is because it has been inflicted from the trauma, which is by definition too much from the outside.
But like the never-ceasing cycle of yin and yang, the answer to the original question, of whether an addiction is either a yin or yang disease, is not stagnant in one definition. It's constantly evolving, ebbing and flowing, and like Lao Tzu says of the 10,000 things, it has provided us a starting point and given us something to talk about, which hopefully leads to a deeper understanding of the mysteries. Because in this scenario, there are only more questions, such as, "But why didn't I have protection from that outside fright that caused my void in the first place? Isn't it because I didn't have enough on the inside?" Yes, the seeds of yin are in the yang, the wheel keeps on turning, and as a wise teacher once told me, "It's like an onion, son; there is only layer after layer and the deeper down you go, the more it stinks and the more it makes you cry."
References
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In the past five years of my clinical practice, I have seen an astonishing upsurge in the chronic use of proton-pump inhibitor (PPI) medications for the gastrointestinal issue diagnosed by allopathic medicine as GERD. It is not uncommon to encounter patients taking these prescriptions for five-plus years.
Working with chronically ill patients entails acknowledging the reality that not all patients will survive their diagnosis. Chinese medicine and acupuncture play a crucial role in palliative and end-of-life care, addressing medication and disease side effects, alleviating pain associated with death, reducing anxiety and stress, and helping patients find peace during the dying process.
