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The Tai Yang & Mental-emotional Disorders
by
Bob Flaws, Dipl. Ac. & C.H., FNAAOM
In 1990, Leon Hammer, a Western psychiatrist also trained as an acupuncturist, published a book titled, Dragon Rises, Red Bird Flies: Psychology & Chinese Medicine. In that book, Dr. Hammer presents certain theories he received from his teacher, John Shen, formerly of New York City, regarding the Chinese medical mechanisms of mental-emotional disorders as well as his own interpretations of those theories. John Shen was one of the great practitioners of Chinese medicine in the United States in the later half of the 20th century. As the son of a rich Shanghai family, he was allowed ample time to study Chinese medicine and perfect his skills without having to earn a living. Because of this unique opportunity, Dr. Shen developed exceptional skills as a diagnostician and therapist through his deep reading of the Chinese medical literature and his extensive clinical observations. Unfortunately, judging from his writing and lecturing, Dr. Hammer does not speak or read Chinese, and, having known Dr. Shen myself, Dr. Shen’s command of the English language, and especially of the technical terminology of Chinese medicine in English, was far from perfect. Therefore, Dr. Hammer’s book contains a great deal of information which, although intriguing, stands at odds with more standard Chinese medical information. Because the language Dr. Hammer uses is so nonstandard, it is frequently hard to make sense of some of his assertions. However, if one thinks about some of these assertions, one can often connect them with sound, well-known Chinese medical teachings. This suggests to me that Dr. Shen’s teachings were not so iconoclastic as they seem at first sight but rather that their apparent strangeness is mostly a function of poor translation.
The Tai Yang & the Nervous System
For instance, one such assertion that Dr. Hammer attributes to Dr. Shen and which seems strange at first sight is Dr. Shen’s supposed equation of the nervous system with the tai yang. Whether Dr. Shen said exactly this, I cannot say, but Dr. Hammer states this equivalence in unambiguous terms:
The Nervous System is simply another name for what is generally considered Taiyang; that is, the outermost energy of the body, which in some ways might also be equated with the “Wei Qi,” the defensive energy of the body. It is this outermost defensive layer of energy that is first affected by “pernicious influences.” In our time, pernicious influences might also include daily living habits. If the Taiyang, or Nervous System, is vulnerable, eating too fast will more easily affect the nerves of the Digestive System. Overexercising will affect the nerves related to the Circulatory System, and overwork the nerves of the Zang Organs. It is my personal impression that Dr. Shen’s association of the Nervous System with Taiyang, or the outermost, light, and most volatile of all energy (Qi), is partially an association with the relative rapidity of the Nervous system compared with the others. [1]
In standard professional Chinese medicine, the tai yang describes two, often conflated concepts. In terms of channel and network vessels theory, it describes the hand tai yang small intestine channel and the foot tai yang bladder channel seen as a single unit. According to Prof. Shuai Xue-zhong of the Hunan College of Chinese Medicine:
[There are] six classes of main channels. These are the tai yang channels, yang ming channels, shao yang channels. tai yin channels, jue yin channels, and shao yin channels. [2]
In Chinese herbal medicine, the term tai yang also describes the first or outermost of Zhang Zhong-jing’s six aspects or divisions of the body’s penetration by externally contracted cold evils. Again according to Prof. Shuai:
Tai yang disease refers to the initial stage external contraction disease. Its characteristics are that there is aversion to cold, emission of heat [or fever], headache, stiff neck, a floating pulse, and other such exterior symptoms. [3]
Although many Chinese medical practitioners consider these two uses of the term tai yang to be essentially the same, this is not necessarily so. Nevertheless, as far as I am aware, there is no correlation either in the premodern or contemporary Chinese language Chinese medical literature between the nervous system and either of these two meanings of the term tai yang. That being so, we can either dismiss Drs. Shen and Hammer’s assertions as merely flights of personal fancy, or we may posit that Dr. Shen, being the highly educated Chinese doctor he was, had something in mind which he was unable to perfectly convey in English.
The Tai Yang in Li-Zhu Medicine
Having referred more than a few patients to Dr. Shen over the years [4] , I have had numerous opportunities to examine Chinese medicinal formulas written by him, and, in analyzing the ingredients in these formulas, it is clear to me that Dr. Shen was no stranger to Li-Zhu medicine. [5] Li-Zhu medicine refers to the theories of Li Gao (a.k.a. Dong-yuan) and Zhu Zhen-heng (a.k.a. Dan-xi) and, by extension, to their yin fire theory. Li and Zhu were the last two and arguably the two greatest of the four great masters of the Jin-Yuan dynasties. Although Li is credited with founding the school of supplementing earth (bu tu pai) and Zhu is credited with founding the school of enriching yin (zi yin pai), anyone who has read these two doctors’ works knows that Zhu accepted Li’s theory of yin fire and then further expanded and supplemented that theory. I believe that it is Li and Zhu’s yin fire theory which helps explain what Dr. Shen was alluding to when he spoke about the tai yang in relationship to the psyche and/or nervous system.
Yin fire theory
According to Li Dong-yuan, the term yin fire refers to a pathological manifestation of ministerial or lifegate fire. Lifegate fire is the yang aspect of the moving qi between the kidneys and, as such, is the root of all yang in the human body. This fire is righteous or healthy as long as it remains calm or level in its lower source, i.e., the lower burner. However, if ministerial fire becomes hyperactive and stirs or counterflows upward, it transforms from a righteous yang into a species of heat evil. Because heat is yang, therefore it has an innate tendency to ascend, and the heart and lungs are the two viscera in the upper burner. This means that any heat evils engendered in the body have a natural tendency to accumulate in the heart and lungs no matter where they started from. This also means that yin fire counterflowing upward to the heart harasses the heart spirit causing it to become disquieted. This explains why patients with yin fire scenarios typically present with various degrees of mental-emotional disturbance.
The mechanisms of yin fire
Li describes four basic mechanisms that can cause upward stirring and hyperactivity of ministerial or yin fire. These are spleen vacuity, liver depression, blood vacuity, and damp heat. If, for any reason, the spleen becomes vacuous and weak, it may fail to perform any of three of its important functions. First, it may fail to upbear the clear. If the clear yang falls downward to accumulate in the lower burner, qi depression may give rise to depressive heat, thus mutually inflaming ministerial fire. Secondly, if spleen vacuity fails to engender and transform blood, blood vacuity may lead to yin vacuity, and yin may fail to control yang. In that case, yang may become hyperactive and ascend, thus also giving rise to yin fire. In addition, blood may be too vacuous and insufficient to nourish the liver. In that case, the liver will not perform its duty of controlling coursing and discharging. Instead, the qi will become stagnant and the liver depressed, possibly giving rise to depressive heat. And third, if spleen vacuity fails to move and transform water fluids, these may collect and accumulate, transforming into damp evils. Since dampness is a yin evil, it is heavy and turbid and tends to pour or percolate down into the lower burner. Being a yin evil, damp depression hinder and obstructs the free flow of yang qi, which, becoming depressed, may also transform heat. This gives rise to damp heat, and damp heat in the lower burner may also cause mutual flaming and hyperactivity of ministerial fire. Further, since the spleen is averse to dampness, damp evils damaging the spleen result in even worse spleen vacuity. Since damp evils obstruct the free flow of qi, damp depression also leads to qi stagnation and liver depression. And since dampness is transformed out of water fluids, damp depression leads to yin fluid insufficiency with concomitant loss of control of yang. Thus it is easy to see that spleen vacuity can not only cause upward stirring of ministerial fire all by itself but can also give rise to the other three mechanisms of yin fire.
However, not all yin fire scenarios necessarily start with spleen vacuity. If for any reason, the liver becomes depressed, enduring or extreme depression may transform heat. If there is liver depression, the qi is stagnant. Since it is qi which moves and transforms water fluids in the body, qi stagnation may fail to move water. In that case, water fluids may collect and transform into damp evils. If liver depression transforms heat and damp evils are present, this makes it all the more likely that these damp evils will transform into heat. Further, enduring depressive heat damages and consumes blood and fluids, thus leading to yin vacuity with vacuity heat, yang hyperactivity, or fire effulgence. And finally, if the liver becomes depressed, the spleen typically becomes vacuous. This is based on the five phase control cycle where replete wood counterflows horizontally to attack and damage the spleen. This tendency of liver depression and spleen vacuity to go hand in hand is so common, the Nei Jing (Inner Classic) says, “[If] the liver is diseased, first treat the spleen.” Hence liver depression may give rise to any of the three other mechanisms of yin fire.
Damp heat may be either externally contracted or internally engendered. For instance, external contraction of summerheat is a species of externally contracted damp heat, while damp heat due to overeating greasy, oily, fried foods and drinking too much alcohol is an example of internally engendered damp heat. Since the spleen is averse to dampness and fire eats the qi, damp heat leads to or aggravates spleen qi vacuity. Likewise, as we’ve seen above, dampness and, therefore, damp heat, can lead to liver depression and yin-blood vacuity. No matter what its cause, if damp heat pours into the lower burner, it may cause mutual inflammation and hyperactivity of ministerial fire.
It is also possible for ministerial fire to stir frenetically simply due to too much stirring. This means mental-emotional, verbal, and/or physical stirring. All stirring or movement is the expression of the activity of yang qi, and all the yang qi of the body is rooted in the lifegate fire. Stirring consumes yang qi at the same time as it transforms and consumes yin essence. In particular, stirring of heart and/or liver fire due to emotional stress, excitement and anger or the stirring of excessive sexual desire and activity may stir ministerial fire to flame upward and become hyperactive above. Last but not least, many so-called recreational drugs which are acrid, warm, upbearing, out-thrusting, and scattering may also cause upward stirring of ministerial fire. [6]
According to Li Dong-yuan, upward stirring ministerial fire and the original qi (here referring to the latter heaven origin of the engenderment and transformation of the qi and blood, i.e., the spleen qi) are mutual enemies. As he says, “Both cannot exist in the same place.” If ministerial fire, as pathological yin fire, ascends to the middle burner, this will damage the spleen. Conversely, a healthy spleen can keep the ministerial fire from stirring upward. Thus, the more vacuous the spleen, the more likely it is that ministerial or yin fire may stir upward.
Since any one of these five mechanisms may cause any of the other four, it is very common to have certain multipattern presentations in patients who are chronically ill. In real-life, one does not typically have just spleen vacuity or just liver depression. If one has liver depression, they probably have spleen vacuity, and especially if they are a female in whom “blood is the main [thing].” Likewise, if one has a liver-spleen disharmony, then one probably also has some kind of heat, whether depressive, vacuity, or damp heat, and, if the spleen is vacuous and weak, then it is likely that ministerial fire will stir upward, flaming and ascending hyperactively. If heat evils ascend and harass the heart spirit, the spirit will be disquieted and one will experience all sorts of mental-emotional complaints.
The exteriorization of heat evils from heart to tai yang
As stated above, all heat evils in the body tend to ascend due to their inherent yang nature, and, once ascending to the upper burner, they will also tend to harass the heart spirit. The heart is a yin viscus which has no innate affinity to yang heat. In fact, it is a statement of fact that, “The heart is averse to heat.” Therefore, the heart may, and often does, shunt yang heat evils to its paired yang bowel, the small intestine, or, even better, to its paired yang bowel’s channel. Since hand and foot tai yang are a single unit, these heat evils are not simply passed to the hand tai yang channel but to the hand and foot tai yang as a whole. Li and Zhu give varying descriptions of how this may occur. In the following famous passage from the Pi Wei Lun (Treatise on the Spleen & Stomach), Li describes how heat evils in the heart may be passed from heart to chong mai, from chong mai to du mai, and thence to the hand and foot tai yang.
The pattern of center heat disease at the onset arises because the fire of the chong mai attaches to that inside the two yin and is transmitted to the governing vessel. What is known as the governing vessel [begins at] Chang Jiang under the twenty-first vertebra and is a channel that mutually attaches with the foot tai yang urinary bladder cold qi. The governing vessel, when exuberant, runs like a great river or like a rapidly galloping horse with an uncheckable tremendous momentum. [But] tai yang cold qi is a as thin as a thread. When [fire] travels upward against the current of the tai yang cold qi, [it] surges into the top of the head, turns down the tip of the nose, and enters the hand tai yang in the chest. The hand tai yang is bing which is hot qi. The foot urinary bladder [channel] is ren which is cold qi. Ren is able to overwhelm bing. But as cold and heat counterflow in the chest, the pulse becomes large and exuberant. Since the hot qi of the hand tai yang small intestine [channel] cannot join and enter the urinary bladder channel, the qi of the other 11 channels [becomes] exuberant and gathers in the chest. Therefore, the pulse is large and exuberant. [7]
Zhu Dan-xi took Li’s basic premises concerning yin fire and applied them to chronic upper back, neck, and shoulder pain, describing a more direct route of exteriorization from the heart to the tai yang:
A male suddenly had a thread of pain in the medial border of his scapula which spread over the shoulder and obliquely through the chest, ending in the flank. This unbearable pain continued day and night without a break. His pulse was bowstring and rapid, but when pressure was applied, it was greatly hollow. [It was also] larger on the left hand than the right. The scapula [is associated with] the small intestine channel, while the chest and flank [are associated with] the gallbladder [channel]. This [condition] must be due to the heart being injured by thought and worry. Before the heart contracts disease, the bowel [i.e., the small intestine] becomes diseased. Therefore, the pain started from the scapula on the back. Furthermore, as worry had not been resolved, it went to the gallbladder. Hence, the pain ascended onto the chest and ended in the flank. This was small intestine fire overwhelming gallbladder wood, the child overwhelming the mother, a repletion evil. After inquiry, it proved true that the disease was a result of failure in a project. [8]
Although the exact routes of exteriorization differ in detail between these two descriptions, the fact remains that both Li and Zhu believed that heat evils in the heart can be transported to the hand and foot tai yang as a way of the heart protecting itself from the ill effects of psychological stress. In that case, one will experience various somatic complaints due to the chaos and counterflow of yang qi in these channels. [9] This may result in upper back, shoulder, and neck pain along the course of the du mai-tai yang, headache along the du mai-tai yang, facial pain, as in TMJ, associated with the tai yang, and chest and breast pain. If these somatic complaints are, in fact, the result of the exteriorization of yin fire heat evils from heart to du mai-tai yang, there will always be psychoemotional complaints as well, such as excessive thinking and worry, irritability, insomnia, profuse dreams, vexation and agitation, impaired memory, restlessness, and confused, chaotic thinking.
The Clinical Implications of Yin Fire-Tai Yang Theory in Chinese Medical Psychiatry
In terms of Chinese medical psychiatry, I believe that the most important clinical implication of Li and Zhu’s teachings on yin fire and the tai yang is the clear-cut, reciprocal relationship between psychological stress and somatic complaints. Psychological stress results in somatic complaints having to do with upward counterflow of yin fire and, therefore, non-free flow of the tai yang. Conversely, counterflow of the tai yang results in chaos in the flow of qi of the chest within which the heart and its spirit reside, remembering that the word spirit is just another way of speaking of the heart qi. Therefore, if psychological stress has resulted in somatic symptoms of pain and tension in the tai yang, it is extremely important to free the flow of that qi and disperse heat evils if one wants to eliminate all the ramifications of that psychological stress. In terms of physical therapies, this may mean gua-shaing the tai yang, cupping the tai yang, seven star hammering the tai yang, and/or needling all a shi points on the tai yang, since a shi points are, ipso facto, the sites at which the qi is not freely flowing. For instance, as a Chinese medical gynecologist, I have treated many women with fibrocystic breast disease complicated by irritability, anxiety, insomnia, heart palpitations, fatigue, and chronic upper back, shoulder, neck, and/or jaw pain by clearing excessive yang qi from the tai yang and then needling all a shi points on the tai yang. Not only does this typically result in elimination or marked reduction of somatic pain and tension, it also results in improved mood and better sleep. [10]
In terms of Chinese herbal medicine, it means using acrid, windy natured, exterior-resolving medicinals which enter the tai yang as well as out-thrust depressive heat, such as Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Ledebouriellae Divaricatae (Fang Feng), and Ramulus Cinnamomi Cassiae (Gui Zhi). For instance, I have had several practitioners tell me that, when they have prescribed Gong Ding-xian’s Shi Liu Wei Liu Qi Yin (Sixteen Flavors Flow the Qi Drink) to patients with fibrocystic breast disease and emotional depression due to a liver-spleen disharmony and yin fire, not only did their patients’ breast pain disappear but their depression also disappeared or markedly improved as well. Although Shi Liu Wei Liu Qi Yin does not include any specifically bitter, cold, heat-clearing ingredients, it does include Fang Feng and Gui Zhi which both enter the tai yang, freeing the flow within that channel as well as freeing the flow of yang qi in the chest. In addition, Gui Zhi, especially when combined with Radix Linderae Strychnifoliae (Wu Yao), Semen Arecae Catechu (Bin Lang), and Folium Perillae Frutescentis (Zi Su Ye), guides upwardly counterflowing ministerial fire back down to its lower source. [11]
Representative case history
The following case history exemplifies how yin fire theory is applied, at least by some doctors in China, to the treatment of yin fire scenarios resulting in psychoemotional disorders. [12] The patient was a 39 year old female who had had chronic gastritis for 20 years. In 1993, the woman began to sleep poorly at night with difficulty falling asleep. When this was severe, she would not be able to sleep the whole night. For a long time, she had been administered various types of Western sedatives, such as Valium. Her insomnia was accompanied by heart vexation and restlessness, dizziness, impaired memory, low-grade fever in the afternoon, burning skin on the palms of her hands, devitalized eating and drinking, and lassitude of the spirit. Her tongue was pale with teeth-marks on its edges and white fur, while her pulse was fine.
Based on the above, the patient’s pattern was categorized as middle burner vacuity and dispiritedness with yin fire internally harassing the heart spirit. For this, the formula used was Sheng Yang San Huo Tang (Upbear Yang & Scatter Fire Decoction): Radix Puerariae (Ge Gen), Radix Codonopsitis Pilosulae (Dang Shen), and Cortex Albizziae Julibrissinis (He Huan Pi), 10g each, mix-fried Rhizoma Cimicifugae (Sheng Ma) and Radix Ledebouriellae Divaricatae (Fang Feng), 6g each, Radix Bupleuri (Chai Hu), Radix Et Rhizoma Notopterygii (Qiang Huo), and Radix Angelicae Pubescentis (Du Huo), 5g each, Radix Albus Paeoniae Lactiflorae (Bai Shao), 12g, Caulis Polygoni Multiflori (Ye Jiao Teng), 15g, and mix-fried Radix Glycyrrhizae (Gan Cao), 3g. After a half month of administration of these medicinals, the patient’s sleep was markedly improved and she did not have to use sedatives to go to sleep. The above formula was continued for another month to consolidate the treatment effects, the insomnia was completely eliminated, and the woman was considered cured.
The reader should note the inclusion of at least two medicinals in the above formula which are acrid and windy natured, enter the tai yang, and upbear and out-thrust depressive heat – Fang Feng and Qiang Huo. Based on my own clinical experience, I would be very surprised if this patient did not also suffer from upper back, shoulder, and neck tension and pain. Unfortunately, the authors of this case were more interested in the patient’s psychological as opposed to somatic complaints. Within standard professional Chinese medicine, there is no metaphysical dichotomy between psyche and soma. Psyche and soma are unitary, with the spirit merely being the manifestation of the function of the viscera and bowels. Thus it is said, “The essence is the root; the spirit is its function.”
Conclusion
While it may be impossible to know exactly what Dr. Shen had in mind when he spoke to Dr. Hammer about the tai yang and the nervous system, I do not think it unlikely that he was thinking about Li Dong-yuan and Zhu Dan-xi’s ideas about yin fire, the tai yang, and mental-emotional disorders. If so, this explanation turns a highly peculiar and idiosyncratic teaching into a contemporary expression of a well-known 800 year old Chinese medical theory. Not only does this help explain and “repatriate” some of the ideas in Dragon Rises, Red Bird Flies, it also underscores the importance of using a standard translational terminology. If Drs. Shen and Hammer had had access to such a standard Chinese medical terminology, Dr. Shen could have expressed himself more precisely, and, therefore, more Western practitioners could have benefitted from his teachings. [13] If I am correct in my identification of the Chinese literary antecedents of Dr. Shen’s ideas, they are important ideas that more practitioners need to know about, and it is a pity these ideas were not expressed more clearly.
Copyright © Blue Poppy Press, 2001. All rights reserved.
[1] Hammer, Leon, Dragon Rises, Red Bird Flies, Station Hill Press, Barrytown, NY, 1990, p. 319-320
[2] Shuai Xue-zhong, Chang Yong Zhong Yi Ming Ci Zhu Yu (Commonly Used Chinese Medical Names, Words & Technical Terminology), Hunan Science & Technology Press, Changsha, 1983, p. 115
[3] Ibid., p. 316
[4] As of this writing and as far as the author knows, Dr. Shen has returned to China to prepare for his eventual death and burial in his mother soil.
[5] Li-Zhu formulas are typically comprised of certain core categories of Chinese medicinals, such as qi supplements, qi-rectifiers, yang-upbearers, and heat-clearers, and then, within those categories, certain preferred medicinals and combinations.
[6] This includes marijuana, cocaine, amphetamines, opiods, and hallucinogens. It also includes coffee, alcohol, and tobacco.
[7] Li Dong-yuan, Pi Wei Lun (Treatise on the Spleen & Stomach), trans. by Yang Shou-zhong & Li Jian-yong, Blue Poppy Press, Boulder, CO, 1993, p. 82-83
[8] Zhu Dan-xi, The Heart & Essence of Dan-xi’s Methods of Treatment, translated by Yang Shou-zhong, Blue Poppy Press, Boulder, CO, 1993, p. 189-190
[9] It is the Chinese word luan chaos, wich helped tip me off to the fact that, when Dr. Shen was talking about the tai yang and its relationship to the nervous system or psyche, he had yin fire theory in mind. Li often talks about yin scenarios causing counterflow and chaos of the qi, and Dr. Hammer frequently quotes Dr. Shen’s use of the term “qi is wild,” a nonstandard rendition of qi luan, qi chaos. Outside the writings of Li and his followers, this term is not that commonly used.
[10] For more information on the specific acupuncture protocol I use, please see my and James Lake’s Chinese Medical Psychiatry, Blue Poppy Press, Boulder, CO, 2000
[11] The other ingredients of Shi Liu Wei Liu Qi Yin are: Radix Panacis Ginseng (Ren Shen), Radix Astragali Membranacei (Huang Qi), Radix Angelicae Sinensis (Dang Gui), Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix Angelicae Dahuricae (Bai Zhi), Radix Auklandiae Lappae (Mu Xiang), Radix Platycodi Grandiflori (Jie Geng), Cortex Magnoliae Officinalis (Hou Po), Radix Ligustici Wallichii (Chuan Xiong), and Radix Glycyrrhizae (Gan Cao).
[12] Zhang Qi & Long Jia-jun, “Observations on the Clinical Use of Yin Fire Theory,” Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), #11, 2000, p. 488-489
[13] The terminology used in this essay as in all Blue Poppy Press publications is based on that found in Nigel Wiseman and Feng Ye’s A Practical Dictionary of Chinese Medicine, Paradigm Publications, Brookline, MA, 1998.
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Post time: 2009-04-27 17:10:00
Post time: 2009-04-27 17:10:14