The Separation of Yin and Yang - Part Two
In the previous article, the concept of the ‘separation of Yin and Yang’ was described in its varied forms. While this term has historically been employed to describe the ultimate separation of Yin and Yang that occurs at death, it is also possible to perceive the subtler manifestations of this process even in incipient stages. It is important to note these are long-term problems. As we shall see, having an understanding of the aetiology of the condition is vitally important.
Some of these processes begin as early as the intra-uterine environment. Under all circumstances, one must assess the balance between stability and chaos in the physiology, as well as the overall body condition of the patient, lifestyle influences that promote chaos, the vulnerabilities of the individual, and the degree of impact of any injurious stimuli. As chronic diseases become common place, it becomes increasingly important to bring the preventive aspects of Chinese Medicine to bear in ameliorating and preventing these conditions. Inherent in this process is the requirement that we recognize them early, and address the consequences immediately. In Contemporary Oriental Medicine® (COM) and Contemporary Chinese Pulse Diagnosis (CCPD), the pulse provides the key to success in this endeavour. What must never be overlooked is each individual's unique vulnerabilities and one's lifestyle, both before illness and after its onset (Hammer 1998, p2).
'Separation of Yin and Yang' in the Earth element, the source of post-natal Qi, will lead to significant malnourishment and eventual Qi depletion for the entire organism. We are all familiar with signs and symptoms of Spleen Qi and Yang deficiency, but with a 'separation of Yin and Yang' these symptoms take on a more urgent character with greater destabilizing effects. From a DRRBF point of view, the Earth phase has a function of moderating the other more dramatic psychological presentations from the other phases. With the healthy bonding established early in life, we become able to trust others and feel compassion. This is important for maintaining a balanced, even and stable emotional life. When Yin and Yang separate in the Earth phase, we find added instability and a tendency to be taken over more easily by one's emotions. It is not uncommon to see a history of anorexia nervosa and other eating disorders, a long history, or childhood history, of vegetarianism or raw food diets and other irregularities in nutrition or early life nutritional deprivation. Many patients had early life food allergies, including to their own mother's breast milk and/or infant formulas.
The qualities on the pulse are the (1) Empty quality; (2) Changing qualities; and (3) Changing Intensity (especially when 3+ or greater). In addition to these, one may also find a positive Spleen pulse in the ulnar aspect of the right middle position. While not indicative of a 'separation of Yin and Yang' it does reflect a constitutional deficiency of the Spleen and typically implicates the Kidneys as well.
Case 1: 26 year old female law clerk complaining of back and leg pain. Her past history is significant for birth trauma with a mother who fainted during the pregnancy, was born five weeks early with the use of forceps. Her mom had seizures a few days after the delivery and the patient was sent home with her dad and aunt for 3 weeks of her life without her mom. This was after spending time in the NICU for jaundice. She was placed in casts and special shoes due to her hips being turned from the delivery. She suffers from anxiety. She was very fearful as a child and describes herself as being future-oriented with a tendency to withdraw into herself. She has never felt like she has been in her own body; she feels she is all in her head. She suffered emotional turmoil with the separation of her parents. She has been anorexic since high school and in her recent family group therapy session her mother had a psychotic breakdown. During sessions of EMDR, the patient would assume foetal position, stomping, rocking, clapping and crying, break out with a heat rash all over her body, then suffer from an extreme occipital headache. She suffers from IBS. In addition to the Heart shock pattern she presents with and a Heart closed pattern (Muffled (4), there is also a yin-blood-essence deficiency in the Heart (Thin, Tight to Wiry) and phlegm misting the orifices (Slippery left distal position). The other most pressing concern, however, is her 'separation of Yin and Yang' in the right middle position, reflected in the Tight, Muffled (1+), Choppy, Changing Qualities to Reduced Substance. The right proximal position is also heading to a 'separation' as the blood depth is transiently Reduced Substance and the organ depth is Reduced Substance while the rest of the position is Tight and Choppy.
Perhaps one of the most important strengths of Contemporary Chinese Pulse Diagnosis is found in identifying with great specificity the aetiology of even the most complex conditions. Signs of the separation of Yin and Yang are often, as described above, implicated in serious conditions. Signs of physiological chaos are evident in individuals at increasingly young ages. Below we will discuss many of the causes.
1. Trauma. As discussed in our previous articles, trauma is one of the most ubiquitous and overlooked aetiologies of complex conditions. In the words of Fei Boxiong, "the seven emotions injure the five yin organs selectively, but they all effect the heart" (Maciocia, quoted in Scheid 2007). We have examined the role of shock and trauma in a number of cases both above and in previous articles. Its action lies in introducing chaos into the functioning of the Heart, and a lack of functional contact between the Yin and Yang of the heart has far-reaching effects for the whole person. To some degree every shock effects the circulation, and these effects create conditions that are ultimately even more draining to the heart. As we have seen, unresolved deficits and stresses are precisely the agents that progress through deepening states of deficiency, until functional contact is lost. Trauma is identified as a "block," and its resolution is of paramount importance. Rough Vibration, as a first impression, together with an elevated rate are reliable pulse signs that suggest shock to the heart. We must entertain a heightened sensitivity to the stresses of our age in searching the patient’s history for a traumatic experience that is significant enough to introduce chaos into the Heart. Traumas include abuse, violence, combat experience, unsuccessful surgeries, or those conducted under inadequate anaesthesia, and motor vehicle accidents, even at moderate speed. We must also consider sources of emotional shock such as divorce, the loss of a parent or loved one unexpectedly, or any other experience that overwhelms the patient’s capability to cope.
2. Birthing practices represent another considerable challenge to many individuals when they are in the most vulnerable state. Throughout his many years of practice as a child psychiatrist, Dr. Hammer has observed the "soft" deficits present in children and later in adults, who were birthed in modern facilities with such practices as the use of forceps, vacuum suction, and so on (Hammer 2005, p320). The evidence of these practices can be observed in the pulse many years later in life. The principle Organ systems affected include the Heart, due to the traumatic nature of these methods. The Kidneys are affected due to their role in determining the basic constitution of the individual. These vulnerabilities are manifested in deficits associated with Essence, and in particular the Yang aspect of the Essence (Yang-Jing). As such, they are evidenced by the effect this bears on the functioning of the central nervous system, and the "sea of marrow" in conventional TCM. Dr. Shen's term Nervous System Weak addresses these conditions. It is defined as a heightened degree of physical and mental vulnerability, with instability, and constantly fluctuating symptoms that are typically worsened with even slight stress. In later adulthood, signs of the separation of Yin and Yang appear in the pulse as Change of Qualities and Change in Intensity in the proximal positions (Hammer 2005, p577). A concomitant effect is a lifelong tendency toward endogenous depression, also evidenced by a Deep quality in the proximal positions. In addition, the lack of natural force exerted on the lungs during a typical vaginal delivery, which is absent in birth by caesarean section, also influences the lungs as well as the Kidneys. Pulse signs include those demonstrating birth trauma, such as Deep in the proximal positions, and Absent or Flat qualities in the right distal position and Flat, Narrow or Restricted in the Special Lung Position. Asthma is one typical condition that may result. Generally speaking, insults during gestation, at or around birth and in the early years are reflected in vulnerability and poor constitution. Another deleterious influence on the constitution, long recognized in Chinese medicine, is the advanced age of parents at conception.
3. As we have seen, the process leading to the 'separation of Yin and Yang' is a gradual and lifelong one that begins with the depletion of an organ system, and worsens to encompass multiple organ systems if left unchecked. In earlier times, and still today, this process may begin with cold damage that is never properly addressed. Zhang Zhong Jing's masterwork documents this process in rich detail, including the effect of iatrogenic errors. In most cases encountered clinically today, iatrogenic factors are quite significant. But it is especially in the context, as discussed in this and our previous article, of a significantly depleted and vulnerable person, that these potent medicines could produce so tragic an end. More insidious effects are related to suppressive treatments of pathogenic factors, such as Exterior Cold and Heat, which are never properly resolved from a Chinese medicine perspective, and continue to exert their deleterious effects. The degree to which these processes occur in vulnerable individuals, and in those rendered vulnerable by lifestyle and inadequate recovery or remedial practices, increases the likelihood of their becoming chronic conditions that are characterized by increasing degrees of depletion and ultimately chaos.
4. In our times, we must also consider the similarly injurious influence of toxic chemicals. An ongoing Centres for Disease Control study tracks chemicals in blood and urine samples for 116 contaminants. Of these chemicals 89 had never been systematically tested in the US population. Many of the substances were found in at least half of the people tested (Science News 2003). Pulse signs associated with toxicity are Choppy felt as a first impression on the entire pulse, or at the Left Middle position, a Slow rate, and the Blood Unclear quality, the latter depending on the type of toxin. Conditions associated with toxicity have been identified in those exposed to small amounts of chemicals over a long period of time, or large exposures of even short duration. Wandering joint pains, skin conditions such as eczema and psoriasis, and especially fatigue are commonly related to toxicity. The development of multiple chemical sensitivities, representing an increasingly vulnerable state, can be recognized as an omen of the advancing depletion that indicates a 'separation of Yin and Yang.' We might also consider the burden of chemicals and preservatives in food, and the endocrine disruptions attributed to them as pertaining to many chronic disorders.
5. Other factors that can develop into the type of serious chronic disease typical of the 'separation of yin and yang' include: (a) severe early environmental deprivation: without adequate food and shelter, the vital substances of the Yin Organs cannot be sustained, and the resulting damage, especially that incurred early in life, bodes ill for the physical and mental health and longevity of the individual; (b) overwork during childhood has similar effects to environmental deprivation.
6. Exercise beyond one's energy early in life: over-exercise is a form of overwork, and it has a disorganizing effect on the circulatory system, and the Heart (Hammer 2005a, Ch6). Symptoms include reduced attention and concentration, anxiety, excitability, restlessness, and exhaustion (Hammer 1998). Also related to exercise as a form of overwork is sudden cessation of intense prolonged exercise. Exercise causes increases in plasma and blood volumes and decreases in baroreceptor sensitivity (Mtnangi and Haiworth 1999, p121). Blood vessels also adapt to accommodate this increase, and when exercise is stopped suddenly the balance of Yin and Yang within the vessel itself is disrupted. As we have seen, instability is the result. Often students will cease a lifetime of excessive exercise after failing to meet the higher demands of competitive collegiate athletics. The disorganization of the personality that is associated with a breakdown of contact between Yin and Yang can provoke severe depersonalization, explosive anger, fatigue, labile emotions, and anxiety amongst other symptoms. The Yielding Hollow Full-Overflowing pulse is associated with this condition.
7. Protracted menorrhagia in girls is more significant depending on the vulnerability of the patient. Currently, largely due to the presence of estrogenic toxicity, and the prevalence of hormones in the food supply, menstrual disruptions occur frequently at younger and younger ages. Excessive menstrual bleeding exerts a burden on young women conventionally associated with Blood deficiency, including pain, depression, and fatigue. Insofar as menstruation has been recognized as predisposing women to Blood deficiency, the effect of excessive bleeding is understood as even more depleting, and sets the stage for more serious conditions if left unresolved.
8. Sudden extraordinary episode of lifting: also evidenced by a Yielding Hollow Full-Overflowing pulse is an instance of lifting beyond one's energy as might occur in an emergency. In addition, such circumstances might elicit signs and symptoms associated with trauma.
9. Substance abuse: in a manner similar to the case of toxicity, and other circumstances which contribute to disorganization of the sensorium, substance abuse can set the separation of yin and yang in motion. The depleting effects of recreational drugs, most commonly marijuana, contribute to the progression from gradual depletion to loss of contact between yin and yang. Excessive marijuana use is often revealed by the Empty quality, itself a Qi Wild indicator, in the Left Middle position.
Often in complex cases, the simplest strategy is the most useful: treat what one sees. Our purpose in this article has been to demonstrate a number of ways to refine our perception of Yin/Yang, aetiologies, signs, and symptoms, in the interest of preventing disease. The separation of Yin and Yang is a lifelong process, and the recognition of this condition is necessary in the prevention of chronic and degenerative diseases that are on the rise, with cancer slated to overcome even heart disease as a prominent killer. A major theme of this article is the understanding that we can identify chronic and debilitating conditions very early in the process. It behoves us, then, to recognize these conditions and their precursors in their incipient stages, to prevent them when possible and treat them when necessary.
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.
Maciocia, G. (2005). The Practice of Chinese Medicine, Edinburgh: Churchill Livingstone.
Mtnangi and Haiworth, (1999). Effects of moderate exercise training on plasma volume, baroreceptor sensitivity and orthostatic tolerance in healthy subjects, Experimental Physiology (1999), 84: 121-130.
Scheid, V. (2007). Currents of Tradition in Chinese Medicine 1626-2006, Seattle: Eastland Press.
Science News, (2003) February 22, Volume 163.