Holistic concepts of health and disease
YIN-YANG, DUALITY, RELATIVITY
Thousands of years before the Bible spoke of Good and Evil, the Chinese developed the concepts of duality and relativity. To them, nothing was absolute, but was a mixture of opposing forces, Yin (the passive or negative force) and Yang (the active or positive force).
"Yin and Yang are the source of creation and the cause of destruction of all things": Chinese concepts of Yin and Yang were essential, fundamental parts of this world view. The Yin-Yang principle referred to opposites. Everything in creation has its opposite. Yin-Yang referred to female-male, below-above, earth-heaven, passive-active, front-back, dark-bright, etc.
The totally balanced system has equal amounts or Yin and Yang. Neither could exist in isolation, (i.e.) there is always some Yin in Yang and some Yang in Yin. Each was necessary for the other (interdependence) yet each opposed the other (inter-opposition). Balance or equilibrium was maintained by the mutual antagonism, yet mutual dependence of opposing forces. For example, for life to exist (as we know it on our planet) we need a balance of sunlight and darkness. If there was perpetual sunlight or perpetual darkness, life on the planet would cease. Similarly, in the family there must be Yin and Yang. If both husband and wife are Yang (active, bossy) there are family arguments, and if both are Yin (passive, inactive the marriage will be dull, apathetic and uncreative. Either way, the lack of balance (antagonism between Yin and Yang) leads to poor family life.
On the other hand, the male (Yang) may have some Yin characteristics (gentleness, laziness) and the female (Yin) may have some Yang characteristics (strong-mindedness, creativity). If the Yin-Yang balance is maintained, the marriage (unity) can be very stable.
This concept of Yin-Yang was applied to everything in Chinese life - art, politics, philosophy, medicine, architecture, etc. In medicine, Yin-Yang referred to hypo-hyper states, solid organs-hollow organs, female genitalia-male genitalia etc. Chronic dis-eases were Yin, acute dis-eases were Yang, etc. Table 1 shows some other examples of Yin-Yang.
Yin Water Ice Cold Female Passive Dark Material Solid
Yang Fire Steam Hot Male Active Bright Immaterial Gas
Yin Slow Centripetal Precipitation Winter Night Downwards Inner
Yang Fast Centrifugal Evaporation Summer Day Upwards Outer
Yin Solid organs LU SP HT KI PC LV CV Below waist Dorsal Medial lower
Yang Hollow organs LI ST SI BL TH GB GV Above waist Ventral Lateral upper
Yin Inhibition Relaxation Hypo- (deficient) Chronic Cold Moon
Yang Excitation Contraction Hyper- (excess) Acute Hot Sun
Yin Parasympathetic Diastole Flaccid
Yang Sympathetic Systole Erect
CHANGE, RHYTHMS, CYCLES
The concept of CHANGE is fundamental to Chinese thought. Everything in existence must change in a ceaseless cycle of anabolism (building up) and catabolism (breaking down). Nothing is permanent. All great civilizations were aware of the rhythms and cycles in nature:
a. the seasonal cycle
b. the lunar and tidal cycle
c. the mating-birth-growth-death cycle (d) the sexual (menstrual and male) cycles.
We have the activity-rest, the day-night cycles, sunspot cycles, political cycles. Internal (diurnal) cycles include the cardiac cycle (systole-diastole), respiratory cycle, hormone secretion cycle etc. All of life and nature follows cyclic patterns.
Yin-Yang concepts imply continuous transformation, change and movement. Nothing is static. Day must become night. Winter must become Summer, (i.e.) Yin reaches a limit and transforms into Yang. Yang reaches a limit and transforms into Yin. Substance (Yin) transforms into function (Yang) and function transforms into substance.
The Monad or wheel symbolises the cycle: endless and beginningless revolution. Within the Monad, we see the Yin-Yang symbol also. Yin changes to Yang and Yang changes to Yin in a changing, yet changeless cycle. Thus, mountains become flat land and flat land becomes mountains. Rock becomes sand and sand becomes rock. Thus, tears and laughter are opposite yet essential parts of the same whole.
RELATIVITY: Yin and Yang are seen as relative states. Summer is Yang relative to winter (Yin) but a cold, wet summer is Yin relative to a normal summer and a warm, dry winter is Yang relative to a normal winter. The head is Yang relative to the chest (Yin), but the chest is Yang relative to the feet (Yin). In the male (Yang) childhood, adulthood and old age are relatively Yin, Yang and Yin respectively. In the female (Yin) childhood, adulthood and old age are relatively Yang, Yin and Yang respectively.
BALANCE AND TRANSFORMATION: Yin or Yang can not exist in isolation. They need each other and they change into each other. The circle is complete, without beginning, middle or end.
If there is no day, there is no night. If there is no excitation, there is no inhibition. The balance of Yin-Yang is a dynamic, changing state. There is seldom exact balance, with equal amounts of Yin and Yang. For instance in Summer, daylight exceeds darkness (Yang is predominant) but in Winter, darkness exceeds daylight (Yin is predominant). Equal amounts of Yin and Yang (night and day) occurs only at the equinoxes (March 2lst and September 23rd). The limits of Yin and Yang are seen, for example at the Winter solstice (December 2lst) when Yin is maximal (relative to Yang) and Summer solstice (June 2lst) when Yang is maximal. This transformation of Yin to Yang and Yang to Yin is a natural, universal phenomenon. It is natural for Yin to predominate at certain times and Yang to predominate at other times, in dynamic cycles.
WESTERN EXAMPLES OF DUALITY: In modern medical and scientific concepts, the idea of duality and relativity is accepted easily. We know that homeostasis in the body is maintained by mutually antagonistic yet mutually dependent systems. For instance, health requires the balance (harmony) of Yin-Yang : sleep-wakefulness; flexor muscles-extensor muscles; parasympathetic-sympathetic systems; feedback-feedforward systems; inhibitor-activator; relaxation-contraction; sensory-motor systems; corpus luteum-follicle; calcitonin-parathyroid hormone; receptor-ligand etc. We also know that an excess or deficiency of any one of these can lead to imbalance in the system. In time, this may lead to dis-ease.
Thus, the Chinese concept of Yin-Yang is not as incomprehensible as it may seem at first glance. It is similar to western ideas of duality-relativity. But it preceded our concept and use of binary theory (the idea of on-off, as used in modern computers) by thousands of years. Indeed, those who appreciate the beautiful symmetry of Chinese Yin-Yang philosophy have no difficulty in accepting the probability of advanced concepts in physics and astronomy etc such as ; gravity-antigravity; matter-antimatter; expanding space-black holes; time-negative time.
INTERDEPENDENCE, INTERACTIONS IN THE BODY
There was a story about the relative importance of the organs. They were arguing among themselves: "I am the most important", said the brain. "I do all the thinking, make all the decisions and control the lot of you!". "Not at all", said theheart. "I am more important because I keep you alive by pumping blood, oxygen and glucose up to you and I take away all your waste for disposal!". "Hold on!" said the liver. "I am the most important. I am responsible for glucogenesis and detoxification. Without me, both of you would be in trouble!". "Bull-shit!", growled the stomach. "Without me, you three would starve to death!". The argument grew fierce. The spleen, lungs, gallbladder, bones, muscles et al all had their spake.
Meanwhile, the anus (which had not said a word) got fed up with all the arguing and ballyhoo. Muttering "I'll show them who is boss!", it seized up tight and said nothing (kept its mouth shut). After a few days of severe constipation, colic and toxaemia set in. The stomach lost its appetite, the liver was unable to cope with the toxins, the heart went into failure and the brain began to grow faint. At the last moment, the brain screamed to the anus: "All right, you win!". The anus relaxed and all was well3 .
Although moral of the original joke was: "Don't underestimate an Ass-Hole!", there is an obvious moral for clinicians also. There isinterdependence and interaction between the organs, functions, and emotions of the body.
We saw earlier that the Chinese regarded man as a unity of Yin-Yang in body-spirit. Psychosomatic medicine also sees man as a unity of mind (spirit) and soma. Thus, interactions between these components of the organism influence the health (balance) of the organism. Psyche influences Soma and Soma influences Psyche. Those who ignore this reality have a very incomplete view of factors influencing health. In vet medicine, it would appear that the animal psyche plays a less important role in dis-ease than the psyche in human medicine. Nevertheless, the animal psyche is important and can be harnessed in many practical ways, as any experienced animal handler knows. The psyche (and psychic energy) of the therapist can (and should) be focused to help/love and beam compassion into the psyche of the willing patient, animal or human.
The Chinese were aware of the unity of the psyche-soma and of the interdependence of the organs and emotions. Disorders of the heart may influence the kidneys and lungs, and vice-versa. Disorder of the liver-gallbladder may influence the stomach. Chinese medical philosophy developed a complete schema of interdependence between the organs in the Five Phase Cycle. The Five Phase Theory and its uses in medicine are discussed in another paper, to which the reader is referred.