The Separation of Yin and Yang - Part One
A Word About Stability and Separation of Yin and Yang Systemically: 'Qi Wild'
In terms of CCPD, the most important determinants of an organism’s stability are the rhythm of the pulse, followed by its rate (Hammer 2005b, p113). While arrhythmias in and of themselves do not signify 'separation of Yin and Yang' or 'Qi wild,’ the integrity of these two factors is crucial to the smooth workings of the organ functions. The terms “Circulation out of Control” and “Erratic” are used to describe these arrhythmic qualities (Hammer 2005b, p100). Some combinations of pulse qualities with the arrhythmias do suggest however, some of the most profound 'qi wild' diagnoses, (see below). Another important consideration is that rhythm and stability have a close association to the mind, 'nervous system' and one's emotional state, with the Heart regulating issues of pulse rhythm and the spirit-mind (Hammer 2005a, p 113 and 127). In fact, all of the qualities that we associate with 'qi wild' would also suggest (and is clinically verified) that the patient experiences anxiety, confusion, emotional fragility, a tendency to become easily fatigued and a life marked by chaos (Hammer 2005b, p127). The pulse qualities associated with the 'Qi wild' pattern include: Empty, Empty Thread-like, Leather, Scattered, Minute, Yielding Hollow Full-Overflowing, Change in Qualities, Empty Interrupted, Interrupted Yielding Hollow and Intermittent Yielding Hollow. Typically, the rate will be Slow (see note 1).
When we speak of a 'Qi wild' pattern, we speak of a systemic issue; "a chronic issue that has risen to the level of an extreme functional weakness wherein the yin and yang have separated and have become unable to support one another" (Hammer 2005b, p128). By the time a patient has reached this late stage, the immune system has become severely compromised and the patient has little ability to resist significant illness and disease (Hammer 2005b, p128). As Dr. Hammer describes it, the Yin represents the material aspect of the universe exerting a gravitational force that holds and grasps the effervescent Yang energies. If depleted, this ability becomes compromised and the lighter Yang energies aimlessly wander with an inability to function without the Yin's organizing force, resulting in physiological disarray (Hammer 2005b, p128). When this happens systemically one is vulnerable to significant and imminent severe and potentially life-threatening illness, including cancers, degenerative central nervous system diseases, auto-immune diseases, severe mental illness, and other chronic conditions. (Hammer 2005b, p128). (The aetiologies giving rise to ‘separation of Yin and Yang’ will be discussed in part two).
Within this discussion of 'separation of Yin and Yang' and 'Qi wild' representing a severe level of deficiency, it is necessary to distinguish deficiency wherein Yin and Yang remain intact and deficiency wherein this contact is compromised or lost. As an example, the Deep or Feeble-Absent pulses whether present in one position or over the entire pulse evidences significant deficiency of Qi and blood and suggest serious illness within three to five years in whichever organ system it is found or if it is found systemically. The Empty pulse represents a 'separation of Yin and Yang' in any given organ in which it is found (i.e. Yin and Yang have lost contact) and this extreme dysfunction if not addressed or corrected presently eventually leads to chaos throughout the organism. If found over the entire pulse, it evidences a Yin and Yang separation systemically and a 'Qi wild' pattern with significant and immediate risk of severe debilitating and life-threatening illness. (Hammer 2005a, p135).
At this point of diagnosis, however, the organ(s) in which this separation is found are in dire need of immediate intervention (Hammer 2005a, p140). To recognize this process is of profound importance and potentially life-saving. To prevent repetition with some of the pulse qualities that suggest 'separation of Yin and Yang' we will confine our discussion of this process in terms of the signs, symptoms and pulse qualities to three of the organ systems (see note 2).
Separation of Yin and Yang in the Organ Systems
As the Heart is the Emperor, 'separation of Yin and Yang' in this organ can have far-reaching physiological and psychological effects. The Heart has a close association to the mind, 'nervous system' and one's emotional state, and instability here can cause an emotional roller coaster, including significant depression (lack of joy-type), anxiety and panic disorders, manic states, depersonalization and dissociation. On a physical level, as the Heart governs the circulation of blood and nutrients to the entire body-mind, a wide array of symptoms can present, including arthritis and other circulatory disorders, gynaecological disorders with signs of Blood stagnation in the Lower Burner, including pre-menstrual syndrome, endometriosis, infertility (a very common occurrence in the author’s experience, see case history below), chest pain, palpitations and cardiac disease, insomnia and sleep apnoea, as well as an apparent Blood deficiency wherein sufficient blood is not adequately circulated.
On the pulse, we see a number of configurations that signify instability in the progression to a 'separation of Yin and Yang.'
(1) Arrhythmias `Circulation Out of Control’
- Rate measurable without missed beat
- Change in Rate at Rest (Constant, Occasional, Small, Large)
The Changing Rate at Rest pulse speeds up and slows down and is often associated with mental instability; often the patient reports feeling as if they are on an emotional roller coaster. It is what Dr. Shen called 'Heart Nervous' or what Dr. Hammer refers to as 'Heart Qi Agitation.' This instability in the Heart affects the nervous system that results in a lack of stability. As we move from occasional to constant and from small to large we are progressing through a continuum of mild to a more moderate instability and increasing deficiency, wherein the frequency and intensity of symptoms increase (Hammer 2005a, p114-18).
- Rate measurable with missed beats
- Intermittent, Interrupted
Whilst being two different pulse qualities, both reflect Heart qi or Yang deficiency. The Intermittent quality also illustrates a blood and Yang deficiency with an aetiology beginning before the ages of 5 to ten years and in the words of Dr. Hammer, "includes Heart Qi deficiency (often congenital or rheumatic in origin), collapse of all Yin organs, pregnancy with toxaemia, and severe childhood malnutrition" (Hammer 2005a, p119). It signifies a serious disharmony.
- Rate not measurable
- Interrupted, Yielding Hollow Intermittent
The Constantly Interrupted pulse is one of the most severe forms of Heart Qi-Yang deficiency and should be considered as urgent, unless otherwise proven (Hammer 2005a, p121). The Yielding Hollow Intermittent is considered the most severe form of Heart Qi-Yang deficiency and would constitute true Heart disease (Hammer 2005a, p121).
(2) Unstable: the sensation is of total chaos, where the impulse moves constantly from one part of the position to another as a quick, pulsating point. The message is that the Qi, blood and Yang of whichever Yin organ it is found in, and especially the parenchymal tissue, has been affected. It denotes a very serious condition (Hammer 2005a, p140).
(3) Nonhomogenous: the sensation lacks consistency in substance and a smooth, uneven shape. It signifies extreme stagnation involving all the substances of a given organ and physiological disarray (Hammer 2005a, p140).
(4) Change of Intensity (3+ and higher) in left distal position and entire pulse reflects the Emperor's inability to maintain stability and homeostasis. It is a more serious sign of the 'separation of Yin and Yang' when found exclusively in the Left Distal position.
(5) Change of Qualities: A 'Change of Qualities' in the left distal position is one of the most significant signs of a 'separation of Yin and Yang.' While 'separation of yin and yang' is significant wherever it is found, it is especially destabilizing when it affects the Emperor.
An example of extreme instability in the Left Distal Position is a patient who presents with Dissociative Identity Disorder. In addition to other signs that suggest extreme emotional and physical trauma beginning in the remote past, the Left Distal exhibits an Unstable quality and a constant Change of Qualities.
A case history involving infertility with 'separation of Yin and Yang' is presented as an example.
31 year old female with secondary infertility. She has one child (daughter age 3) who was conceived with the help of western technology. She has never used birth control and never conceived naturally. As a 31 year old with 'separation of Yin and Yang' we must look to early life history for the explanation. Here we find an emergency C-section born with congestive heart failure due to a hepatic AV fistula that blocked the heart causing it to expand to three times its normal size. She was placed in an incubator and given a transfusion due to a significant loss of blood during her delivery. Other symptoms are fatigue, cold hands and feet, insomnia with frequent waking after 2-4 hours of sleep with anxiety and trouble returning to sleep. She is stressed very easily and describes herself as a major hypochondriac. She has asthma (with frequent use of steroids as a child), palpitations, and a heart murmur. Her abdomen shows loss of tone below her umbilicus with a diastasis. While outwardly an attractive woman, internally, she shows significant signs of depletion with a Leather pulse on Uniform Impressions reflecting a significant Yin-blood-Essence deficiency, Heart shock, toxicity and significant Liver blood engorgement/stagnation, and severe blood deficiency. Signs of chaos show up in the distal positions, namely the Heart wherein the left distal position changes qualities from Thin, Rough Vibration, Tense-Tight, Muffled (3+-4) and Changing Intensity (3) to completely Absent. There is also a Change in Rate at Rest. Prioritizing all the above, the most immediate threat to her health (and consequently for the realization of her goal of becoming pregnant (in a way that doesn't negatively impact her health or the health of her future baby) is the Heart. Therefore, the Heart must become the first point of entry for her treatment.
In the preceding case, the presentation is chaos in the Heart. This root problem can be seen as contributing to the multitude of signs and symptoms by an overall destabilization of function systemically. Without the regular, stable and systematic circulation of Heart blood, one's ability to perform even the most basic of functions will eventually become impacted.
We can see 'separation of Yin and Yang' with a significant Liver Qi-Yang deficiency. The three major pulse qualities we see with this diagnosis are: is the (1) Empty quality; (2) Changing qualities; and (3) Changing Intensity (especially when 3+ or greater).
(1) Empty quality: from a CCPD and COM perspective this is an indication of significant instability and chaos in the Liver with a threat of severe physical illness, including lymphomas and tumours. The Empty quality results from the chronic use of cooling drugs such as marijuana, chronic sub clinical lingering hepatitis and mononucleosis and Epstein-barr like infections, chronic parasites, and less often where an individual has worked beyond their energy for a significant period of time.
(2) Changing Qualities: a very serious 'separation' sign wherein the qualities in the left middle position will change from one combination to another, such as from Tense Robust Pounding --> Reduced Substance and/or Feeble. Strong intervention is warranted with this pulse picture.
(3) Changing Intensity: When the 'Changing Intensity' is greater than a (3) to (3+) in an individual position, it begins to reflect an early sign of the yin and yang separating in a given organ. While this is an early sign, and less serious than the others, it bears mention as this is a key opportunity to intervene and prevent potentially devastating illness.
(4) The 'Split' pulse, wherein the radial artery actually bifurcates in an individual position (or entire side) is commonly encountered clinically in the left middle position in recent years. This finding is often associated with a near death experience and obsessive thoughts relating to, or a pre-occupation with death.
From a Dragon Rises, Red Bird Flies (DRRBF) perspective, the Liver is responsible for advance and retreat and the containing of emotion and actions, and gives the body the ability for restraint, the ecology of which helps us to preserve our energies and contain pathogens that the body is unable to eradicate. With a separation of Yin and Yang, the individual loses this capacity to create stagnation, i.e., contain pathology, and the effervescent Yang wanders aimlessly causing pathology to spread throughout the system. Thus, as most TCM practitioners make the ubiquitous diagnosis of Liver Qi stagnation, Dr. Hammer argues that often in Liver disease (deficiency), there is too little stagnation rather than too much. The containment functions of the Liver break down, resulting in a rapid 'metastasis' and the spread of far-reaching pathology.
34 year old female suffering from glioblastoma multi-form brain cancer. She had two major brain surgeries, partially removing her left frontal lobe, over twenty rounds of chemotherapy, multiple homeopathic treatments all with little or no effect on the cancer located, at the time I saw her, on the left parietal lobe. She suffered from extreme fatigue, poor sleep, high stress levels and mood swings (patient had an Interrupted pulse), poor appetite with nausea, poor memory and loss of peripheral vision, allergies and seizures (despite anti-seizure medications). Her pulse, which showed pathology in multiple areas, was most significant in the left and right middle positions which were Changing Qualities to absent from Tense-Tight Choppy. The left middle position was also Full-Overflowing and the entire left side tending towards Empty. The patient’s mother was 37 years old at conception and drank alcohol during the pregnancy.
In part two, we will continue the discussion of ‘separation of Yin and Yang’ with a look at the Spleen and Stomach, then discuss the aetiologies of this condition, always keeping in mind that this is a chronic process, the early recognition of which can prevent significant disease.
Note 1: The reader is referred to Chinese Pulse Diagnosis, A Contemporary Approach for a full detailed description of the pulse qualities mentioned here and throughout this article as some terms will be unknown to those unfamiliar with CCPD and others will have broadened meanings and associations.
Note 2: Qi Wild has been explored in a very thorough paper by Dr. Hammer (1998) cited below. For our purposes, we have merely defined the terms and hope that readers will pursue Dr. Hammer’s article.
Hammer, L. (1998). The Unified Field Theory of Chronic Disease With Regard to the Separation of Yin and Yang and 'The Qi is Wild,'Oriental Medical Journal, Vol. 6, No. 2 & 3.
Hammer, L. (2005a), Chinese Pulse Diagnosis, A Contemporary Approach, Rev. Ed., Seattle: Eastland Press.
Hammer, L. (2005b). Dragon Rises, Red Bird Flies, Rev. Ed., Seattle: Eastland Press.