Thoughts on Yin-Yang

This article was previously published in the North American Journal of Oriental Medicine (NAJOM). It is reprinted here with the kind permission of NAJOM.

“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)

Lately I find myself thinking about yin-yang much of the time. I believe this is due to my recent study of the Sichuan Fire Spirit School of herbal prescribing and its emphasis on the restoration of the yang. In this article I will share some of my recent thoughts, including why I think this focus on the yang is important. 

Before I started my TCM training I had read Alan Watts’ book Tao The Watercourse Way. In it he explained that the polarity of yin-yang in East Asia was conceived of differently from our various polarities in the West. Here we can collectively hold the foolish notion of good overcoming evil in an ultimate sense, putting evil forever out of business. In East Asia the philosophy holds that yin and yang are like the poles of a bar magnet. If we attempt to remove the “evil” north pole of the magnet by cutting it off, we discover that along the edge of our cut a new north pole has been created. So it is with yin and yang , a dynamic dancing interplay of inextricably linked forces. 

I was profoundly disappointed in 1995 in the first semester of TCM theory when I discovered that the twenty minutes the teacher gave to presenting yin-yang was to be the sum total of the time we would devote to this foundational concept. I was flabbergasted and contemplated dropping out of the program. Heiner Fruehauf, Ph.D., L.Ac., in the same book from which the opening quote is drawn, tells the story of encountering an elderly, respected herbalist in Sichuan and asking him what he spent his time studying. In asking he was expecting the herbalist to say he had finally understood some arcane point in one of the classics; instead the gentleman said that he was trying to understand yin and yang. He was still working on it after more than sixty years of practice—my TCM theory teacher dispensed with it in a mere twenty minutes. We have a long way to go in our education mission.

In the Sichuan Fire Spirit philosophy the argument is NOT that yang is more important than yin, but simply that yang leads. As an example we can eat all the yin-nourishing foods we like, but without the yang of the digestion the food will just sit in our gut doing no good. So yang is seen as a mobilizer of sorts. Remember, the first hexagram in the Yi Jing has all six lines as yang. This is no accidental arrangement of the hexagrams; it expresses a key point of philosophy. In this style of herbalism aconite, cinnamon, and ginger formulas are often given (Sini tang, Fuzi lizhong tang, Zhenwu tang...), even in many instances when TCM-trained practitioners would prescribe yin-nourishing formulas. (See endnotes for ways to access Dr. Fruehauf’s scholarship on this philosophy.)

I have been assisted in my investigations of yin-yang by rereading Humans in Universe by R. Buckminster Fuller and Anwar Dil. The book is an edited transcript of a conversation between the two men with various appendices added. For those of you unfamiliar with Buckminster “Bucky” Fuller (1895-1983), let me simply say that I believe history will show him to be one of the most significant figures of the last century. Fuller made important contributions in philosophy, design, architecture, cartography, mathematics, and engineering. Even in our own field his work influenced Dr. Yoshio Manaka and helped him develop his unique ideas on the eight extraordinary meridians. This Fuller-Dil book covers all the essential points of Fuller’s work. Fuller explains in the book that he never set out to address problems in the various fields in which he worked; he sought instead something much broader—nature’s organizing and operating principles. Students of AOM will recognize this as essentially a Taoist stance. Now when I look at this Fuller-Dil book, years after I first read it, I see a yin-yang discussion in its many guises. Fuller points out that in nature tension and compression always and only co-exist, concavity and convexity always and only co-exist, radiation and gravity always and only co-exist and so on. It is no stretch to translate this as: Yin and yang always and only co-exist.

Lately I have been thinking about the Big Bang. If our astrophysicists are correct, what does the Big Bang have to say about yin-yang? My first thought was that the explosion was an instance of “pure yang”. However if there had been an initial burst of “pure yang” with no yin, there never would have been a yin at all. Yin and yang always and only coexist, to borrow Fuller’s language. In the Big Bang, however, clearly yang plays the lead role, just as in the Sichuan Fire Spirit philosophy. Also in this consideration of the Big Bang we can see illustrated another of Fuller’s teachings: Unity is always plural and at minimum two.

I have read Dr. Kobayashi’s book on his Shaku-jyu therapy as well as the many NAJOM articles detailing this style of acupuncture. In his work I find a sort of acupuncture correlate to the Sichuan Fire Spirit school of thought. It is clear that in his thinking preservation of yang is paramount. Above I mentioned the first hexagram in the Yi Jing, and it is interesting to me that Dr. Kobayashi is a noted Yi Jing scholar. When someone of his experience thinks and practices in this way, it tends to lend me philosophical support in my studies in this yang-focused herbal approach. 

I had an initial hurdle to overcome when considering the emphasis on preservation of the yang. This focus on yang’s leading role bumped up into a sort of Libran dream of perfect balance and symmetry between yin and yang. It is a feminist perspective almost. In me was a desire to have a system where yang can lead some of the time, and yin some of the time. When Fuller discusses radiation and gravity, he provides the clarity and perspective I sought. He explains that they are absolutely equal forces but that gravity is twice as efficient as radiation. Without this being the case we would not have the physical universe as we know it. If we are to overlay gravity and radiation on yin and yang, gravity will be yin and radiation yang. Gravity is a coherent force, which is a yin function. Although tangential to our discussion here, I want to point out that Fuller said love is metaphysical gravity, i.e., the force that holds all together. He felt every physical law had a metaphysical correlate. 

It occurred to me that if gravity (yin) is more “efficient”, then radiation (yang), in a sense, needs more therapeutic support (since on its own, like radiation, it is relatively inefficient). This is a bit tricky, I will admit, trying to jump from cosmological organizing principle to clinical strategy, but it works for me to make sense of why focus on the preservation and restoration of the yang is important. Another way of looking at it is that yin is form and yang is energy. The nature of energy/radiation is dissipative while form maintains its “pattern integrity,” to steal a key phrase from Fuller. Dissipation is clearly inefficient relative to maintenance of form. 

Moxibustion warrants at least a brief mention since we are discussing the clinical importance of yang. Moxibustion is the perfect adjunctive treatment to go with the focus of the Sichuan Fire Spirit School. We all know the character for acupuncture contains the character for moxibustion, i.e., they were seen in ancient times as inseparable. Although the modern Japanese and Chinese have different styles and ideas about moxa, if one stays with the simple image of fire being used on the body, then one recognizes this is yang being mobilized in healing. 

As I have attempted to bring this focus into my acupuncture practice, it is primarily through an increased reliance on moxa that I have done so. I also made a replacement for shiunko with aconite and ginger instead of the typical angelica and lithospermum; I use a thin layer of this salve under my moxa cones when I want a decided warming action. Because the focus of the Sichuan Spirit School is actually on using aconite, ginger, and cinnamon to restore Earth’s ability to “contain” (deficient heat can flare up in the body because this “containment of the earth” is weak), I have also started using more earth points in my treatments. This fits nicely with a comment made by Baba Sensei in the summer of 2007 in Tokyo; he told us that when we have a cold patient we should needle earth points. Using these earth-yuan source points (we are on the yin meridians in this discussion), according to the theory, links to ministerial fire. It is the San Jiao function to facilitate the movement of yuan qi into all the organ-networks. This occurs through the source points, and using these same points connects us back into the ministerial fire we need to warm up the cold.

To summarize, through my readings of Fuller I have arrived at a place of philosophical peace with this idea of clinical focus on the yang. I offer my thoughts in this article. I do not suffer under the delusion that I am a philosopher or scholar, or even a practitioner of any note. At best I am a committed student. I realize it is entirely possible that I will look back on this article in five years and cringe with a strong dose of embarrassment; still I am inclined to put it out there with the hope it will trigger some thoughts in readers. I invite all comments and criticisms.