Embracing Yin and Yang

The following are lecture notes from a recent talk I gave on 07-23-05 at the TriHealth (Cincinnati Good Samaritan and Bethesda Hospitals) Integrative Health and Medicine Center.

What is Yin and Yang

What is your first impression when you hear the terms yin and yang?  Are they jargons used in Asian study or Oriental philosophy?  Do they refer to female and male or woman and man?  Are we talking about Feng Shui here?  Whatever comes to your mind at this moment is probably correct.  Yin and Yang refer to a wide variety of objects, concepts or phenomena of opposite characteristics.  Yin and yang constitute two major pillars in traditional Chinese medicine.  One very important treatment principle is the yin/yang differentiation. I will illustrate that in this article.

Why do I want to talk about yin and yang?  Western medicine has never touched on this.  Yet, every day in my office, I see patients with a wide variety of disorders and symptoms secondary to yin and yang imbalance.  Not infrequently, just by balancing the yin/yang energy, they improve very quickly.  Once in a while, someone presents with extreme yin/yang imbalance and deficiency and he or she may have puzzling presentations to physicians trained in Western medicine only.  That being said, yin and yang medicine may be very useful to compliment conventional Western treatment. 

I frequently get asked the question, "If I would like to read more about traditional Chinese medicine, which book would you recommend?"  Unfortunately, there are quite a few textbooks written for medical professionals or traditional Chinese medical practitioners, but very few are written on a level intended for general readers.  Hopefully one day, I will write a book on this subject "Embracing Yin and Yang," to help introduce Traditional Chinese Medicine (TCM) to the general public.

Yang

As I mentioned earlier, yin and yang refer to a wide range of things.  Yang is symbolic of heaven, sun, fire, male or man, left hardness, anything that is moving, day brightness, spring or summer, exterior, heat excess, top convex, and last (if not least), it refers to Qi energy which is activity produced by the energy in the human body. 

Yin

To the contrary, yin is symbolic of the earth, moon, water, female or woman, right, being sedentary, night, darkness, autumn or winter, interior, cold, deficit, bottom, concave and in the human body it also refers to blood, body fluid (such as secretion) or simply put, it refers to substance including muscle or body mass.

The yang energy makes one feel warm and do like things.  The yin energy makes one feel cold and makes one feel like he or she would like to rest.  I have been searching for years for the equivalent of yin and yang in Western medicine, and the closest that I've come up with is the sympathetic and parasympathetic nervous system.  Just like the yin and yang, which are present in every organ, energy pathway or meridian according to traditional Chinese medicine, the sympathetic and parasympathetic nervous system are present in every part of the body. 

Yin/Yang and Sympathetic/parasympathetic nervous system

Through the secretion of adrenaline, the sympathetic nervous system prepares us for a "fight or flight."  Just to give a couple of simple examples, when the sympathetic nervous system is called to work, our heart rate speeds up, our blood sugar rises and the blood flow to the body is increased.  The parasympathetic nervous system, on the other hand, is for nurturing the body, preserving the energy, etc.  It contributes to digesting food, moving our bowels, emptying our bladder and when the parasympathetic nervous system is called to work, it slows down the heart rate and conserves the body energy.  I should note here, that I am only making an analogy between yin/yang and sympathetic/parasympathetic nervous system.  To me, they are not exactly the same things.

Next, I would like to talk about the relationships between yin and yang, just like the sympathetic and parasympathetic nervous system.  The yin and yang restrain and balance each other and an imbalance may give rise to illnesses, depending on which organ or energy meridian is predominantly affected.  What is unique in the traditional Chinese philosophy and medicine, is that the yang energy dominates during the day (yang phase of a day), and the yin energy prevails at night (the yin phase of a day).

Yin/Yang vs time of day

The yin and yang energy also exists in a constantly changing and evolving relationship.  For instance, at 12 p.m. or high noon, yang energy reaches its peak and yin energy begins to rise.  The yin energy reaches its peak at midnight, and at that time, the yin energy begins to rise.

It certainly makes sense that the yin energy should prevail at night, because yin energy refers to inactivity, and in order for us to have a good night's sleep, we should have abundant yin energy.  Interestingly, clinically, people with yin energy deficiency frequently have insomnia characterized by waking up early, for instance at 3 a.m. or 4 a.m. and have difficulty falling asleep again (just to give you a simple example of how the yin/yang imbalance affects the human body).

TCM eight principles

Traditional Chinese medicine is not just about yin and yang.  As a matter of fact, we talk about eight principles:  Yin and yang, deficiency and excess, cold versus heat and interior versus exterior.  Any clinical problems may be dissected according to those eight principles, or four pairs of opposing concepts or phenomena.

At this point, I would like to introduce concept and two principles, i.e., deficiency and excess.  By combining yin and yang with deficiency and excess, we now have four different patters, namely, yang energy excess, yang energy deficiency, yin energy excess and yin energy deficiency.  Needless to say, if I bring in cold/heat and interior/exterior, it will become even more complicated.

To help you relate to these energy imbalance patterns, I will use examples to help illustrate them.  For instance, a patient hospitalized in the intensive care unit because of pneumonia or meningitis, probably has the so called yang energy deficiency according to traditional Chinese medicine.  The clinical manifestations include high fever, rapid heart beat, perhaps altered sensorium/delirium, etc.  Another person may complain of chronic fatigue, feeling cold, having difficulty losing weight and/or feeling depressed, and this person may also have a yang energy deficiency.

Many want to lose weight and most weight loss programs are successful to begin with, and the challenge is how to sustain it, as most people gain their weight back within a year.  As I see it from the yin/yang standpoint, many people with a weight problem have a yang energy deficiency; as a result, they have a slower metabolic rate, they do not have the energy to exercise and it is difficult for them to lose weight.  A more reasonable and healthier approach is to try to boost their yang energy through an herbal program and exercise.  Of course, what I refer to as an herbal program does not include stimulants such as Ephedra, which was banned by the FDA recently.

Yin deficiency

People with yin energy deficiency, a frequent clinical occurrence, would experience dry mouth (dry eyes and dry skin, etc.), restlessness, insomnia characterized by early awakening and difficulty falling asleep again, sometimes night sweats or hot flashes at night, but not during the day.  People with extreme yin energy deficiency may also lose weight (not in a favorable way, as yin deficiency gives you a very uncomfortable feeling).  In its extreme form, people with yin energy deficiency may also have fever, which is more pronounced in the late afternoon, evening or early morning.

So far, the yin and yang seem to be relatively simple, at least to some of you.  In clinical practice, it may be difficult at times.  Having said that patients with yang energy excess may have high fever, I have also seen patients with extreme yin energy deficiency present as ongoing significant temperature elevation. 

Fever of unknown origin

As a matter of fact, as a medical oncologist, one of my specialties, I treated a patient earlier this year with so called "fever of unknown origin".  This is a 41 year old gentleman with extensive lymphoma, undergoing chemotherapy.  His body condition deteriorated rapidly during chemotherapy and his complaints included restlessness, dry mouth, insomnia and significant weight loss.  The mentioned symptoms progressed, and he developed a high fever.  Needless to say, the first thing that came to my mind was that he had developed some sort of infection.  He was hospitalized for nine days.  Extensive workups (including many blood cultures and repeat CAT scans) failed to show any source of infection.

Unfortunately, modern Western treatment had probably made him more ill, as antibiotics and some of the anti-inflammatory medications cause nausea and stomach pain.  I discharged him from the hospital and started him on traditional Chinese herbal remedy to boost and balance his yin energy.  His fever subsided within days, and other clinical manifestations also improved very quickly.  The point I am trying to make here, is that high fever is not only seen in people with yin energy excess, it may also be seen in individuals with yang energy deficiency.  If an incorrect diagnosis is made, treatment not only is ineffective, it may make things a lot worse.

Migraine headache

I will share with you another case example:  A 23 year old female nurse came to me for a severe and disabling migraine headache.  She had missed a lot of work in recent months because of her headache.  Along with her headache, she has also experienced dry mouth, irritability, insomnia, night sweats, etc.  Her headache is located over the right temporal area, extending to above the right eyebrow and also radiating down her neck to the right shoulder.

She has tried many Western medications with marginal benefits and significant side effects.  With acupuncture and herbal treatment, she improved very quickly and her yin deficiency symptoms subsided rapidly.  Her diagnosis, according to traditional Chinese medicine, is liver yin deficiency leading to uprise of liver yang energy.  Stated in a different way, the root of her problem is deficiency of yin energy in the liver channel, and the lack of yin energy is not able to balance or subdue the yang energy.  The yang energy rises up, causing her headache and along with that, a feeling of vertigo or dizziness at times. 

As you can see, our treatment in traditional Chinese medicine does attempt to get to the root of the problem, i.e., what is the underlying energy imbalance?  Let me ask you now, are your yin and yang energies imbalanced?

Other examples of Yin/Yang

One may bring the yin/yang concept into just about every symptom we see clinically.  For example, patients with chronic obstructive pulmonary disease or emphysema may be divided into the yin and yang type.  Those who are thin or emaciated are most likely the yin deficiency type.  They have lost weight and they complain of an intense thirst sensation and when one checks their tongues, they are usually very red and without coating (tongue diagnosis is an important part of traditional Chinese medicine in differentiating yin and yang balance). 

Another type referred to as the "blue bloater" in Western medicine, are overweight and they tend to have yang energy deficiency and have dampness or phlegm obstructing their lungs.  Likewise, people with diarrhea may be subdivided into yin type of diarrhea and yang type of diarrhea. People with stomach upset may be further differentiated into yin energy deficiency or yang energy excess, just to give a few examples.  All of a sudden, clinical practice becomes a lot more complicated and a lot more interesting.

TCM and Western medicine

Having practiced Western conventional therapy for 20 years as an internist, hematologist and medical oncologist, I feel very strongly that the strength of Western medicine is standardization of care based on our understanding of basic science, such as virology and microbiology, metabolism, experiments, repeated analysis and results from clinical trials.  However, what conventional Western medicine is missing is the internal variation.  In traditional Chinese medicine, no two individuals are treated exactly the same, as we are all different, and that is the main reason why response to any treatment in Western therapy is not 100%.

It makes a lot of sense to me to integrate the traditional Chinese medicine into conventional Western therapies, in order to benefit more patients.  You are welcome to visit us if you think you have some kind of imbalance and no other physician understands your problem.

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