The Clinical User of Yin and Yang
In my previous article in Acupuncture Today, "A Brief Discussion of Yin and Yang," I introduced the concepts of Yin and Yang, and briefly touched on the idea of the Tai Qi Circle. Now that we have a basic understanding the concepts of Yin and Yang, we can move on to considering how the concepts of Yin and Yang are used clinically, in the practice of Chinese medicine.
Before we delve into this, we should realize that certain concepts are such a basic part of our thinking that we don't even realize they are concepts, but rather simply accept them as part of the fabric of reality. This pattern of thinking is only made conscious when we are confronted with ways of thinking about reality different from our own. Then, some sort of translation from one system of thinking to the other is necessary for understanding, because a person versed in only one of the systems of thinking simply cannot understand the other without it.
Two Different Concepts, One East & One West
[In Western scientific thought, which is basic to the Western medical model and to modern thought generally, these underlying concepts that are so basic to our outlook that we don't question them, are things such as that the body is composed of tissues that are composed of cells, or that substances are composed of compounds that are made up of elements, which are composed of atoms made of electrons, protons and neutrons, but which are mostly composed of empty space.]
Basic to this outlook is the idea that pathologies may be caused by bacteria and viruses. To a person who thinks this way, it would sound completely normal to say something like, stomach ulcers are caused by H. pylori bacteria, but it might sound like a flight of the imagination to say that a headache is caused by excess Yang in the Liver meridian. However, it is worth stopping for a moment to realize that in traditional Eastern thought, understanding reality in terms of Yin and Yang is as natural and basic as thinking in terms of acids and bases is in Western scientific thought.
While the idea of Yin and Yang in the body may sound crazy to a person versed only in Western thought, imagine how crazy it would sound to a person not trained in Western science to be told that a solid object is composed mostly of empty space! Keep this in mind as you try to understand Yin and Yang thinking in the clinical context.
Yin-Yang: A Single Whole
A practitioner of Chinese medicine might talk about a patient being "Yin deficient" or "Yang deficient" as general terms, or might say that a patient has an excess or deficiency of Yin or Yang in a particular organ system, such as "Kidney Yang deficiency" or "Kidney Yin deficiency." You might hear an acupuncturist say that a patient has "Liver Yang Rising," or "Heart Yin deficiency." We also talk of Yin organs and Yang organs.
For example, the Liver is a Yin organ, while the Gallbladder in a Yang organ. Why would an organ be classified as Yin or Yang? Remember from our conceptual discussion that Yang is associated with energy and movement, while Yin is associated with form and stillness. Thus, organs that are considered to have a more moving, active function, that of transportation and transformation, are seen as Yang organs, while those that are seen as more related to storage and structure are considered to be Yin organs.
Also remember that Yin and Yang are not separate, but are always understood to be in dynamic interplay, ideally balanced as a single whole, as represented by the Tai Qi circle surrounding them. This is one reason why every Yin organ is paired with a Yang organ. The two together make a balanced Yin/Yang system. The Yin/Yang organ pairs as seen in Chinese medicine are shown in table 1 below.
Table 1: The Yin and Yang Organ Pairs in Traditional Chinese Medicine | |
Yin organs (structure/storage) | Yang organs (transportation/transformation) |
| Liver | Gallbladder |
| Heart | Small Intestine |
| Spleen | Stomach |
| Lung | Large Intestine |
| Kidney | Urinary Bladder |
An organ system is seen in Chinese medicine as having a certain function, just as in Western medicine, but the functions attributed to it are not always the same in the two systems of thought. In Chinese medicine, the Liver, for example, is seen as responsible for the general movement of Qi throughout the body, among other functions. When the movement of Qi does not flow correctly in any part of the body (due to an injury, an external pathogenic factor, emotional upset, or for whatever reason), this can cause lack of movement of the Liver Qi.
This is called Liver Qi Stagnation. One primary cause of Liver Qi Stagnation is emotional stress. Holding back the movement of energy is metaphorically like compressing a gas in a small space. The action of compressing the gas causes the buildup of heat. It can also be likened to friction, which also produces heat. Heat is understood to be a form of Yang.
Additionally, a person may be generally Yin deficient. This can be thought of as something like a general lack of fluids in the body, which, when they are sufficient, would anchor/cool the Yang/heat. Heat rises, Yang rises. However, Yang has affinity for Yang, and Yin has affinity for Yin. The Liver is a Yin organ, so it does not have affinity for heat. Thus, it transfers it heat to its Yang organ partner, the Gallbladder.
Understanding Meridians
In Chinese medicine, each organ is understood to have an energetic channel or meridian that connects that organ to its Yin/Yang paired organ, and also travels along the surface of the body (the acupuncture points are found on these surface portions of the meridians). The Gallbladder meridian passes up through the upper back/top of the shoulders, into the back of the neck, and from there up the sides of the head, as can be seen in figure 1.
The Yang/heat of the Liver Qi Stagnation not anchored due to underlying general Yin deficiency can transfer to the Gallbladder meridian and can rise up through this channel, producing tension and pain. This might be called Liver Yang Rising. This is one way of understanding why emotional stress can result in tight, painful upper back and shoulder muscles, and a headache.
A Chinese medicine practitioner might help this patient by needling acupuncture points which have the function of moving the Liver QI and Gallbladder Qi, clearing heat, nourishing the Yin, thus balancing the Yin and the Yang of this system. An herbal formula might also be recommended that has a similar function.
As stated above, Yin has an affinity to Yin, and Yang to Yang. This is true in terms of time of day as well. Daytime is Yang time (more light, more heat, more movement). Nighttime is Yin time (more darkness, more cold, less movement). A case of insomnia is an example of how this might come into play in the clinic. A patient might complain of waking up often at night, of vivid dreams, and of feeling tired even after a night of sleep when he doesn't wake during the night, or wakes relatively few times.
His acupuncturist determines that he has "Heart Yin deficiency," and treats the patient with points and herbs that strengthen the Heart Yin. First, how does Heart Yin deficiency relate to insomnia, and second, how did the acupuncturist arrive at this diagnosis? First, we return to the idea that, conceptually, Yang relates more to energy and movement, and Yin more to form and stillness.
The Spirit
In Chinese medicine, consciousness, which we experience when we are awake, is awareness of the spirit or mind, or Shen. Consciousness is not a graspable physical entity. It barely exists in physical reality, which is why it can be called spirit. The mind/spirit/Shen has very little form and is energetic, constantly on the move, from thought to thought and idea to idea. Thus, the nature of the Shen is Yang. In Chinese medicine the Heart is considered to be the house of the Shen. In this context, the Heart has clear physical form and is quite still, relative to the Shen. Thus, the nature of the Heart is Yin. When the body is in Ying-Yang balance, the Yang of the body should be dominant during Yang time (the day), and a person should be awake, that is, conscious.
The Yin of the body should be dominant during Yin time (the night), and a person should be asleep. This means that at night, the Heart, a Yin organ, should securely house, or anchor, the Shen, a Yang entity. Because this patient's Heart Yin is relatively weaker than it should be, his Heart Yin has less ability to anchor the Yang Shen at night time, when the Yin should be dominant. Because Yang is akin to heat, and "heat rises," the Shen, failing to be sufficiently anchored by the Heart Yin, "floats up," or is active when it should be dormant, and some level of consciousness occurs when there should be sleep.
If full consciousness does not occur, there are vivid dreams, which is a lower level of consciousness than full wakefulness. When full consciousness occurs, the patient wakes up when he should be asleep, which we call insomnia. Through acupuncture and herbal treatment, the Chinese medicine practitioner can help the patient's Yin and Yang to balance, strengthening the Heart Yin relative to the Yang of the Shen. Thus, once the patient's "Yin and Yang are balanced," the patient no longer wakes at night, but achieves full nights of restful sleep.
That a patient simply presents in clinic with a chief complaint of insomnia does not automatically mean that the Chinese medicine practitioner will diagnose him with Heart Yin deficiency specifically, or Yin deficiency at all, however, as other conditions may also produce insomnia. Similarly, not all cases of shoulder tension with headaches are due to Liver Qi Stagnation combined with Yin deficiency causing Yang to rise.
The specific diagnosis depends on the presence of other signs and symptoms. In the case of Heart Yin deficiency, we would also expect to see general Yin deficiency symptoms like malar flush and night sweats, a feeling of heat in the palms of the hand and souls of the feet, dry mouth and/or thirst, with red tongue with little coat and a thin radial pulse that might be rapid; and more specific Heart Yin deficiency symptoms like palpitations, anxiety, restlessness, forgetfulness. If the case of the shoulder tension with headache is due to Liver Yang Rising, we would expect this patient to also feel hot and irritable, experience ringing in the ears, and have a dry mouth, red tongue, thirst, and a rapid, tight radial pulse.
While an article of this length cannot provide the same ability to understand the body in terms of Yin and Yang that growing up/studying in a culture in which understanding the world in terms of Yin and Yang is basic to thought, my hope is that this article, along with its previous partner article discussing the conceptual basis of Yin and Yang, will be helpful for those versed only in Western scientific thought in understanding how practitioners of TCM might apply the concepts of Yin and Yang in a clinical setting.
Resources
Governor Gavin Newsom has retracted the proposed budget cuts to the Medi-Cal acupuncture program for low-income Californians for the 2024-2025 budget year. This decision marks a significant victory for health care providers and advocates who have long championed acupuncture as a vital component of comprehensive medical care.
There’s no doubt that many of your patients visit your practice because they are in pain. And there’s certainly no doubt that curcumin from turmeric (Curcuma longa) can be incredibly effective in stopping that pain, whether due to chronic conditions like arthritis or acute pain from intensive workouts. But your patients may also benefit from curcumin for other reasons.
| Digital Exclusive
Fair and appropriate wages in health care are typically based on economic evaluations. A simple literature review illuminates that acupuncture is missing economic evaluations; which implies you are either underpaid or overpaid. The complexity of services provided by most American acupuncturists, which they are trained and certified to provide, must be reimbursed fairly.
