“When diagnosing and treating disease, we must first of all differentiate between yin and yang. This is simply the most important principle of medicine.If the physician correctly differentiates yin and yang, the treatment will never be accompanied by side effects. All of the myriad ways of practicing medicine, therefore, can be summed up in two words: yin and yang, and that is all there is to it! There is the yin-yang of symptoms, there is the yin-yang of pulses, and there is the yin-yang of herbs.”
Zhang Jingyue, noted Ming dynasty physician (Fruehauf, 2007, p.52)
Chinese Medicine is described as a tradition in which the original insights came from observation of nature. Yin-yang, the foundational polar pairing of Chinese medicine, has many expressions in our environment: cold-hot, shade-sunlight, moon-sun, night-day, moist-dry, contraction-expansion, and so on. In this article I take a closer look at yin-yang and discuss how insights from a modern scientist, the late R. Buckminster Fuller (1895-1983), and a Chinese medical tradition newly presented in the West, the Sichuan Fire Spirit School (Huo Shen Pai), clarify the proper relationship between yin and yang. In reflecting the views of Fuller I will rely on his own writings; in describing the tenets of the Fire Spirit School I will draw on the work of Heiner Fruehauf, Ph.D., L.Ac., a noted sinologist, clinician, and scholar of Chinese herbal medicine, as well as on the work of his colleague, Liu Lihong, Ph.D., himself a well-regarded scholar of Chinese medicine. Liu Lihong’s book, Contemplating Chinese Medicine, has sold many printings in China and has broken out of the narrow confines of the professional community to become popular with the general Chinese public as well.
The Sichuan Fire Spirit School was founded by Zheng Qing-an in the late nineteenth century. The key conceptual basis for this style of prescribing is found in the image of yang as leader. The Yijing, proponents of this approach point out, begins with a hexagram in which all six lines are yang. This is taken as a clear statement of yang’s appropriate role as initiator and leader. The Shanghan Lun also maintains a clear focus on preservation of the yang. It is, after all, sometimes called “The Book of Cinnamon”. The Fire Spirit approach accomplishes its treatment goals through a strong reliance on formulas containing aconite, cinnamon, and ginger. For safety’s sake I hasten to add that Fire Spirit herbalists do not prescribe these formulas for all patients irrespective of complaint. The dose of aconite in their formulas can reach levels that, from a TCM perspective, seem dangerous. Practitioners in this style use the core aconite formulas—Sini tang, Fuzi lizhong tang, Zhenwu tang, Wenpi tang, Qianyang dan (this one, which might be seen as a modification of Fuzi lizhong tang with sharen added and baizhu deleted, is unique to the Fire Spirit School)—with a frequency that surprises TCM-trained herbalists, whose education leads them to these formulas only occasionally, and then the key warming herbs are employed in low or moderate dosages. Newcomers to this prescribing style are surprised to discover that even in situations in which the typical TCM strategy would call for yin-nourishing substances, often aconite formulas are given. It is possible the formula would also contain a smaller measure of yin tonics as a sort of balance, but warming would be the main therapeutic thrust. An example of this might be prescribing Suanzaoren tang together with Fuzi lizhong tang for anxiety with insomnia.
My initial response upon hearing about the Fire Spirit approach was a dubious one. In Chinese medical history we see various treatment styles in herb prescribing, including, not surprisingly, one that focuses on nourishing yin. The Fire Spirit School seemed simply the to-be-expected counterpoint to the Yin Nourishing School of the Jin-Yuan period. Because of my studies with Heiner Fruehauf, Ph.D., though, I decided to give it a closer look and to try it in my practice. If he saw something of value in this philosophy, I reasoned, it was at least worth a closer look. I was surprised when the clinical results from the yang-supporting strategies turned out often to be dramatically better than what I had anticipated, certainly an improvement on what I had been achieving in my practice.
Before we go further in this discussion, let me introduce R. Buckminster Fuller, because his insights provide key clarifications when one is grappling with the relationship between yin and yang. Fuller was referred to by many as “the last Renaissance man” or as a “modern Leonardo”. An architect, poet, inventor, engineer, cartographer, educator, designer, mathematician, and author of some 28 books, Fuller referred to himself simply as a “comprehensivist”. Alex Gerber, Jr., Ph.D., a scholar of Fuller’s work, defines a comprehensivist in his book, On Buckminster Fuller Education and the Tao, as someone “who values the whole and has an all-encompassing, holistic perception of reality.” Fuller’s quest was to learn “how Nature solved problems,” and in this search his sights were set on discovering her unvarying principles. This focus on the ways of nature should be immediately recognized as a Taoist perspective. It is no surprise then that healers have found valuable insights in his writings since these same principles of nature will necessarily be at play in medicine.
Manaka Yoshio, MD, the brilliant Japanese medical doctor, researcher, acupuncturist, artist, scholar and author of over thirty books was inspired by Fuller’s work in geometry and used it to develop his own octahedral view of the body that modeled how one might use acupuncture’s eight extraordinary meridians to remedy postural distortions, as well as to treat a host of other maladies. In the November 2009 issue of the North American Journal of Oriental Medicine (NAJOM) dedicated to the memory of Dr. Manaka and marking the 20th anniversary of his death, Stephen Brown described Dr. Manaka, one of his early mentors, as being a Buckminster Fuller-like figure in the Japanese acupuncture community. What he meant is that, like Fuller, Manaka’s ideas were far ahead of his time and poorly understood by his contemporaries.
Without referring explicitly to yin and yang Fuller often identified crucial relationships in nature that speak of this polar dynamic. In Fuller’s 1983 poem “At Minimum Two” we find numerous yin-yang pairings: radiation-gravity, observer-observed, positive numbers-negative numbers, convex-concave, insideness-outsideness, diffusion-concentration, and so on. In this poem Fuller comes back repeatedly to the point that unity—and life—is at minimum two, i.e., there can be no yin without yang, no yang without yin.
To imagine we can speak of yin without yang or vice versa is to contemplate a bar magnet with only a positive or only a negative pole. If we try to cut the negative pole off, so as to have only positive, we discover that along the line of our cut a new negative pole has been formed. It is clear we cannot create a unipolar bar magnet; we know that from our practical experience. Our culture in the West though, especially in the last U.S. administration, sought much the same outcome with its stated mission to rid the world of “evil doers,” as if a world with good and no evil were possible. As Alan Watts, the late philosopher and early popularizer of Zen, repeatedly pointed out in his talks and writings, it is impossible to talk of light without begetting dark in the same breath. Good is identified as good only in contradistinction to evil. This has always been understood in SE Asia but sadly not here in the West.
Efficiency is a new concept to be brought into the discussion of yin-yang, and it can add something valuable to our understanding. We can thank Buckminster Fuller for this. He explains that when comparing radiation and gravity (one yin-yang pair), we discover that gravity is more efficient, i.e., conserving, than radiation. If this were not so, we would not have the universe we now have. When we look at convexity and concavity we discover the same principle: the yin (gravity and concavity) conserves more efficiently than its yang counter pole. In building a solar cooker we choose a concave surface, because it is relatively difficult to concentrate the heat of a convex surface when compared to a concave one. In fact he claimed that a definite ratio could be determined. Gravity is twice as efficient as radiation. Radiation is by its very nature dissipative; gravity is conserving. The same ratio holds for convexity and concavity. To restate this in the language of Chinese medicine, yin is more efficient than yang.
When I recently reread Humans in Universe by Buckminster Fuller and Anwar Dil and realized this key point, it deepened my understanding of yin-yang. Yang’s very nature is dissipative. It makes perfect sense then that our therapeutic focus needs to be aimed in that direction. Without this therapeutic support our patients’ yang easily becomes depleted, more so than the yin. This is not some obscure point to be made in herbal medicine or philosophy; it is instead, according to Fuller’s work, entirely consistent with the organizing principles of the universe.
Let me back up a step. I have long held a perspective that was essentially feminist; I wanted yin and yang to be interchangeable in every way. The balance and symmetry of the taiji symbol seems to support this view. Half the lines in the Yijing are solid (yang) and half are broken (yin); that seems to bespeak an evenhandedness that argues against the Fire Spirit approach. Female CEOs had been proven to be as capable as their male counterparts; even in the military women have excelled as officers. Why then should the cosmological principle be that yang leads? Why not yin leading some of the time and yang leading some of the time? And yet, there are differences between men and women, and to pretend otherwise is folly; and so too are there differences between yin and yang.
Please note this is an entirely different slant on the earlier discussion from the Sichuan Fire Spirit philosophy, wherein we saw a leadership role for yang that was based in Chinese cosmology. Instead of focusing on yang in our formulas because yang in a cosmological sense is the natural leader, I am now, based on Fuller’s work, saying our focus is there because yang’s nature is to be relatively inefficient and dissipative. That is a truly radical shift, and those feminists reading this article can take some measure of comfort in that perspective. I am not saying that it is inaccurate to conceive as yang as the initiator and leader; instead, I am saying that Fuller’s point on the relative efficiency of yin and yang fleshes out the picture. Think of the leader of the pack in a cycling race. (S)he has so much more work to do because of being in the front and breaking the wind for all those following. The other riders behind draft off of his/her efforts. This is a good image to hold in mind when considering the nature of yang. As leader it is called upon to exert so much energy that it naturally becomes exhausted.
What does this have to add to our discussion about yin and yang and the strategy of the Fire Spirit School? If yang is seen as dissipative by its very nature (consider the Second Law of Thermodynamics), then it makes perfect sense that we as practitioners need more of our focus to be on the preservation and replenishment of the yang. Yin, in this way of thinking, can be counted on to be lost less rapidly than the yang. So this focus on formulas with cinnamon, ginger and aconite is intuitively in line with Fuller’s insights into the relative efficiency of yin and yang.
So far in this article I have focused on herbal practice, but most of us also work primarily as acupuncturists. How do these principles of yin and yang express themselves in acupuncture? With our needles is it possible to promote the yang, to help bring the yang back into storage? Is it only by using moxa that we can bring a yang-supporting element into our acupuncture work?
One needling technique I learned in the summer of 2007 in Japan is worth mentioning. It was a teacher from Hiroshima, Kohno Sensei, who shared a powerful opening move that her teacher had passed on to her. Her teacher had been a direct student of Yanagiya Sorei, one of the elders of the modern Japanese meridian therapy movement, and he claimed that this was one of Yanagiya’s techniques. Kohno Sensei herself was an impressive practitioner who seemed to generate a field of gentleness around her as she treated patients. She started her treatments at CV 12, which the reader will recall is the influential point for fu organ-networks, and it was at the point that she performed this technique. The location then already is alerting us to a focus on the yang aspect. Her insertion at CV 12 was very superficial, no more than a millimeter. Because yang is the surface and yin the depth, we can recognize that treating in this superficial layer is the realm of the yang. As the patient’s abdomen rose with the inhalation, her thumb would glide over the handle in a slow, upward stroking manner. This was very gentle and did not alter the depth of the needle. Then when the patient exhaled and the abdomen fell, she stroked downward over the needle handle. A minute or two were spent on this technique stroking up and down on the handle in synchronization with the patient’s breath. The technique itself can be seen as a harmonizing of yin and yang, but with the location at CV 12 we see the emphasis on yang. Its effects are profoundly centering and calming. It is amazing how a cold abdomen with this one technique for one or two minutes can be warmed.
There is another side to this technique worthy of brief discussion. CV 12 is the ST mu point and thus has a strong connection to the earth phase. Another teaching of the Fire Spirit School that Heiner Fruehauf, Ph.D. presents is that earth has a “containment” function. When I first heard this phrase, it had an immediate intuitive appeal. When the “KD Yang battery”, as Fruehauf refers to it, weakens and can no longer secure the yang below, heat rises in the body to harass the ST and PC. If the earth retains its appropriate integrity, it will “contain”, the rising heat so that it ascends no farther. Kohno Sensei’s technique seems to be one that can support Fire Spirit strategies with regard to strengthening earth’s ability to contain.
In moxibustion we see an obvious alignment with Fire Spirit treatment priorities and philosophy. Moxa is readily identified as a therapy on the yang end of the spectrum. It is, after all, the burning of herbal material, and what could be more obviously yang than actual fire. And yet conditions that seem clearly to cry out for a yin-based approach (e.g., treating burn lesions) can benefit from moxa. In her 2007 NAJOM article Sharon Weizenbaum describes the use of moxa to treat radiation burns. Burns involve clear damage to the yin (substance), and yet in order for the yin to be mobilized in the service of healing, yang must be brought into the picture to lead. This is what the direct moxibustion surrounding the burn lesion does: It activates (“yang-izes” we might say) the yin potential, and healthy new tissue (yin) is generated to replace what was damaged by the radiation therapy. It should be pointed out that she is referring to the Japanese style of direct moxibustion in which tiny pieces of highly refined moxa (this type of moxa burns about twenty degrees cooler than the less expensive green moxa commonly used in China) are burned either directly on the skin or on a thin layer of herbal cream. This is analogous to Fire Spirit herbalists prescribing warming formulas for patients who would in the standard TCM approach receive yin-nourishing formulas. Here we are using moxa even in situations in which it would seem to be contraindicated.
In this article I have shared my understanding of yin and yang and the way that Fuller’s unique views and the Fire Spirit philosophy have come together in my thought. I have given ancient cosmological as well as modern scientific rationales for focusing our therapeutic efforts on supporting the yang. The development of my understanding is still very much a work in progress, and I fully expect to continue contemplating yin and yang for whatever time I have left to me. If Zhang Jingyue is correct is his assessment outlined in the opening quote of this article that yin-yang is the most important principle in our medicine, then it is entirely appropriate for my focus to be here. I thank the readers for their kind attention and invite all comments and criticisms.
Bob Quinn, L.Ac., DAOM practices Japanese Meridian Therapy style of acupuncture, herbal medicine, Sotai, and Thai massage in Portland, OR. He also teaches and supervises at Oregon College of Oriental Medicine and the National College of Natural Medicine. He can be reached at bquinn88@yahoo.com
Endnotes
Fruehauf, Heiner (2007). Classical Chinese Medicine: An Introduction to the Foundational Concepts and Political Circumstance of an Ancient Science. Portland, OR: self-published—this is a gem of a book and should be required reading for everyone studying TCM.
Heiner Fruehauf’s work on the Sichuan Fire Spirit School and that of Liu Lihong can be found on www.classicalchinesemedicine.org. There are also interesting interviews this writer conducted with him on the same topic to be found at www.classicalpearls.org
Fuller, B., Dil, A. (1983). Humans in Universe. New York: Mouton—This book and Tetrascroll are my two favorite books from Fuller. Reading them you encounter the immense scope of his thought and emerge with a strong personal sense of the man.
Manaka, Y., Itaya, K., Birch, S. (1995). Chasing the Dragon’s Tail. Brookline, MA: Paradigm Publications—I wish I had an extra lifetime to spend studying just this one book. What a genius Manaka was!
Weizenbaum, Sharon NAJOM v14 n41, p36-37, 2007 Using direct moxibustion for patients with yin deficiency