Imbalance Between Yin and Yang
This phrase refers to an imbalance of wax and wane between yin and yang. It malt signify the pathological state of relative exuberance or deficiency of yin or yang, the inability of yin to restrain yang, the inability of yang to restrain yin, mutual impairment of yin and yang, depletion of yin and yang due to a loss of dynamic balance, or coordination between yin and yang caused by various pathological factors in the course of a disease.There are records of the pathological mechanisms of yin and yang in Chapters 5 and 36 in the Spirit Pivot, such as "imbalance between yin and yang," "disharmony between yin and yang," and so on. They show that an imbalance between yin and yang is important in the generalization of pathological mechanisms.
The etiology of TCM holds that "whenever the evil-qi accumulates, the genuine-qi
must be in deficiency. " However, the "six climatic evils," "endogenous seven emotions,"improper diet, and over-strain can result in disease by way of imbalance between yin and yang within the body. So, there is a generalization of various kinds of physiological contradictions and broken relationships of the organism, and the resulting imbalance is considered to be the primary factor in the occurrence and development of disease.
Yin and yang in TCM have the connotation of the unity of opposites in both sides of this contradiction. Yang-qi is the body's vital energy, and it motivates all physiological activities and thereby maintains the life processes. Yin-essence is the material counterpart to vital energy, and includes such substances as the essence, blood, and body fluids,which are important components constituting the viscera, tissues, and organs, which provide the material foundation for life. Thus, there is an inter-restraining and intertransforming relationship between yang-qi and yin-essence, as they maintain the unity of opposites to ensure the dynamic equilibrium, provide the basic condition for life.
Therefore, the theory of imbalance between yin and yang is a summarization of all kinds of functional and organic disorders relating to the loss of balance. Traditional Chinese medicine believes that no matter how complicated the changes of the pathological mechanisms of imbalance between yin and yang may appear, their basic pathological proeess consists of no more than the following aspects:
1. Relative Exuberance of Yin or Yang
This is manifested primarily in the pathological mechanisms and the syndrome of
"exuberance of the evil-qi resulting in excess. " The pathogenic evils tend to move in accordance with their categorical characteristics when they invade the human body, i. e.when yang-evil invades the body, it will cause relative exuberance of yang; and when the yin-evil enters the body, it will lead to relative exuberance of yin. Thus, Chapter 5 in Plain Questions states : "Exuberance of yang leads to heat syndrome, while exuberance of yin leads to cold syndrome. " This points out the pathological mechanism of relative exuberance of yin and yang, and its excess-cold and excess-heat characteristics in clinical manifestations.
Since yin and yang are inter-restraining, yang waxes while yin wanes, and vice versa.This means that exuberant yang must consume yin, leading to a relative deficiency of yin. Exuberant yin, on the other hand, must impair yang, resulting in a relative deficiency of yang. This is why Chapter 5 in Plain Questions states: "Predominance of yang leads to a disorder of yin, while predominance of yin leads to a disorder of yang. " This explains the inexorable consequence of the development of relative exuberance of yin or yang.
1) Exuberance of Yang
This refers to a physiological state in which yang-qi is exuberant, the human body is hyper-functioning, metabolism is accelerated, the individual is overly excitable, and the heat is excessive for the disease. Its pathological change generally is characterized by an excess-heat syndrome with unapparent deficiency of yin. This type of exuberant yang is often caused by the affect of warm-heat evil, or a transformation from infected yin-evil to yang-heat. It may also be the result of pathogenic fire that arises from persistent abnormal emotions and the over-action of five emotions, or from long-standing obstruction of qi, from blood stasis, or from the retention of food.
The so-called exuberance of yang leading to heat syndrome suggests that exuberant yang is likely to cause pathological changes of transforming into heat and fire, and is often manifested in excess-heat syndrome. This is because yang is characterized by heat, motion and dryness, so the symptoms that indicate the relative exuberance of yang are high fever, flushed face, and congestive eyes. Thus, Chapter 62 in Plain Questions states: "Exuberance of yang leads to the exterior heat," indicating that exogenous evil-qi attacks the exterior of the body, and meets with the opposition of defensive yang-qi, with the ensuing fight between these two forces being the essential characteristic of exterior heat syndrome.
This pathological mechanism was described in Chapter 64 of Plain Questions: "The interstitial spaces between the skin and the flesh are blocked, the sweat pores are obstructed, and the defense-qi is unable to be dispersed, thus causing exterior heat syndrome. " This means that the failure of the defense-qi in controlling the opening and closing leads to obstruction of the sweat pores, and the sweat cannot be excreted, thus resulting in the ensuing fight between stagnated defense-qi and pathogenic evil. This produces excessive heat that is unable to discharge through the sweat pores, and instead causes an increase of body temperature.
In addition, long-standing stagnation of yang-heat must consume yin-fluid, so excess-heat syndrome will be prone to burn body fluids. For this reason, prolonged illness may contribute to an insufficiency of body fluids, and an impairment of yin-essence,which will then transform into excess-heat syndrome associated with insufficiency of yinfluid, or deficiency-heat syndrome. This is known as "predominance of yang leading to disorder of yin. "
2) Exuberance of Yin
This phrase denotes the pathological state of relative exuberant yin-qi, with a runetional inhibition or hypo-function of the internal organ, a disturbance of metabolism, and an insufficient generation of energy, as well as the accumulation of pathological products in the course of disease. In general, its pathological changes are usually characterized by an excess-cold syndrome due to exuberant yin, but with yang not being deficient. An exuberance of yin is usually the result of exogenous cold and dampness yin-evil, or overeating something raw and cold, which inhibits the middle-yang and exceeds the ability yang-qi to produce the necessary warmth. Or, it also may result from a prolonged deficiency of yang. In this case, yang is too insufficient to warm and transform yin-fluid leading to internal exuberance of yin-cold. The former is a case of excess syndrome; the latter is a complicated condition of both deficiency and excess.
Exuberance of yin leading to cold syndrome indicates that exuberant yin is likely to lead to a functional inhibition of the viscera and tissues, or a dysfunction of internal or gans and a failure of the warming and transformative function of qi. This results in pathological changes of endogenous cold, such as internal exuberance of yin-cold, retardation of circulation of blood, retention of phlegm, water-dampness, etc. Because yin is characterized by coldness, quietness, and dampness, exuberance of yin-cold is prone to symptoms of cold, such as cold trunk and limbs, light-colored tongue, abdominal pain,diarrhea, edema, and phlegm-retention. Chapter 64 in Plain Questions states: "Exuberant yin brings about endogenous cold," which explains the pathological mechanism of internal exuberance of yin-cold.
In addition, as long-standing exuberant yin must consume yang-qi, the syndrome of excess-cold with exuberant yin is usually accomplished by the syndrome of deficient yang,which is due to a general hypo-function or the decline of yang-qi.
2. Relative Deficiency of Yin or Yang
This refers to the pathological mechanism and syndrome characterized by loss of the essential qi. "Loss of the essential qi" refers to the insufficiency of such basic materials as the essence, qi, blood, and body fluids, or the hypo-function of these materials. At the same time, it also includes the viscera, meridians, and organs, as well as their physiological functions, all of which can be classified into yin and yang in nature. Under normal conditions, they are inter-restraining, inter-depending and inter-transforming to maintain a relative balance in the human body. If certain causative factors result in an insufficiency of the material or a hypofunctioning in the aspects of yin or yang, there is a resultant lack of restraint of the opposite, leading to a relative exuberance, and pathological changes of exuberant yin due to deficient yang, or hyperactivity of yang due to deficient yin. Thus,Chapter 64 in Plain Questions states: "Deficiency of yang leads to exogenous cold, while deficiency of yin causes endogenous heat. "
1) Deficiency of Yang
This suggests a pathological state characterized by insufficiency of yang, a decline in resp0nsiveness, metabolism, and the function of the viscera, and insufficient heat. Generally, its pathological change is characterized by deficiency-cold syndrome due to failure of yang to check yin, and relative exuberance of yin. A deficiency of yang usually stems from an innate insufficiency, from malnutrition, or from internal injury due to overstrain, and from an impairment of yang by a chronic illness.
In general, this condition refers to the deficiency of yang of both the spleen and kidney, and particularly to the decline of kidney-yang i. e. , an insufficiency of the vital gate fire, which occupies an extremely important position, as kidney-yang is the root of all yang-qi. In addition, as yang-qi is impaired, the warming and transformative functions of qi are weak, and blood and body fluids do not circulate smoothly. Water-fluids cannot be transformed and metabolized by yang-qi, and the failure of yang to check yin leads to an internal exuberance of yin-cold, and the syndrome of exuberant cold due to deficient yang occurs. A deficiency of yang produces cold syndrome, which is marked by pallor, an aversion to cold, cold limbs, light-colored tongue, slow pulse, lying in a "rolled" position, lassitude, clear urine with increased volume, diarrhea with undigested food, catching cold easily, and so on. Simultaneously, a dysfunction of water metabolism may result, giving rise to oliguria, edema, etc.
2) Deficiency of Yin
This phrase refers to a pathological state which is manifested in a relative over-abundance of yang. The failure of yin to check yang results in a false hyperfunctioning, eaused by impairment of the essence, blood, and body fluids. In general, it is characterized by deficiency-heat syndrome manifested in insufficiency of yin-fluid and attenuation of the nourishing function. This condition occurs most commonly in cases where there is an impairment of body fluids due to heat diseases, prolonged illness, or the pathogenic fire that arises from persistent five abnormal emotions.
A deficiency of yin-fluid points to a yin deficiency of lung, liver and kidney. Deficient kidney-yin, in particular, occupies an extremely important position in the pathological mechanism of deficient yin, as it is the source of myriads of yin. Since the yin-fluid is too weak to check yang-qi, various syndromes may appear, such as interior heat due to yin deficiency, flaring of fire due to yin deficiency, or hyperactivity of yang due to yin deficiency. Symptoms of interior heat due to yin deficiency include a feverish sensation in the five centers, tidal fever, accompanied by emaciation, night sweats, dry mouth, red tongue, or a thready, rapid, and feeble pulse. Symptoms and signs of tidal fever, night sweat, feverish sensation in the five centers, malar flush, hemoptysis, emaciation, insomnia, seminal emission, excess libido, dry mouth and throat, red and dry tongue thready and rapid pulse, vertigo, agitation, or irritability may be seen in the syndrome of flaring of fire due to yin deficiency, and hyperactivity of yang due to yin deficiency.
3. Mutual Impairment of Yin and Yang
This phrase indicates that over-consumption of either yin or yang can lead to insufficiency of its opposite, with the result of a deficiency of both yin and yang. This is called impaired yin affecting yang when deficient yang forms on the basis of deficient yin; and is termed impaired yang affecting yin when deficient yin forms on the basis of deficient yang. It is necessary to point out that the kidney stores the essential qi and contains genuine yin and genuine yang, and is the root of yang-qi and yin-fluid. In general, regard less of whether yang or yin is deficient, only when yin and yang of the kidney are impaired, or the yin and yang of the kidney itself are disharmonious, will it be likely to produce the pathological change of impaired yang affecting yin and vice versa.
1) Impaired Yin Affecting Yang
This implies that impairment of yin-essence can lead to insufficient growth of yang-qi, or the exhaustion of yang-qi without attachment. The result is a deficiency of yang,and eventually, the pathological state of deficiency of both yin and yang occurs, but with yin deficiency dominating. For example, the syndrome of ascendant hyperactivity of liver-yang is most commonly seen in clinic, and its pathological mechanism results from a syndrome of ascendant hyperactivity of yang due to yin deficiency, namely "failure of water to nourish wood. " But the development of disease may further consume the essential qi of the kidney and impair kidney-yang, leading to the syndrome of deficient yang, with such symptoms as aversion to cold, cold limbs, pallor, and feeble pulse. Such a condition shows that impaired yin affecting yang eventually transforms itself into a deficiency of both yin and yang.
2) Impaired Yang Affecting Yin
This denotes that persistent impairment of yang-qi leads to impaired generation of yin-fluid. Insufficient yin, in turn, leads eventually to a deficiency of both yin and yang,with a domination by deficient yang. For example, the main pathological mechanism of edema most commonly seen in clinical practice is that the deficiency of yang-qi fails to perform the transformative function of qi. The body fluids of metabolism are blocked, and water-dampness accumulates internally and overflows the tissues of the surface. However, as the condition continues, consumption of yin increases, and emaciation, restlessness, or even chronic convulsion may result. Such a condition suggests that impaired yang affecting yin develops itself into a syndrome of deficiency of both yin and yang.
4. Repellency Between Yin and Yang
This is a special pathological mechanism in the imbalance between yin and yang,
which includes excessive yin repelling yang and excessive yang repelling yin. Its pathological mechanism is characterized by a state in which either yin or yang is extremely excessive. This is caused by certain causative factors, which trap and choke inside the body,and cause yin and yang to repel their opposite side to the outside. As a result, yin and yang are forced to be disconnected, thus leading to a real cold syndrome manifested by pseudo-heat symptoms and a real heat syndrome manifested by pseudo-cold symptoms.
1) Excessive Yin Repelling Yang or Upward Floating of Yang
Excessive yin repelling yang refers to the repellency between yin on the interior and yang on the exterior within the body. It points to a pathological state in which the excessive yin-cold traps and chokes within the body, then repels yang, and the two become disconnected. Since the essence of the disease pertains to the internal exuberance of yinco1d, it has characteristic of pseudo-heat phenomena along with symptoms such as fever,flushed face, thirst, and a surge pulse. This condition is thus described as real cold syndrome manifested by pseudo-heat symptoms.
Closely related to this condition is the syndrome known as upward floating of yang.It refers to the repellency between yin on the lower and yang on the upper, and it points to a pathological state in which primordial yin falls into decline, and primordial yang is separated from yin and floats upward in the body. This condition occurs most commonly in syndrome of cold in the lower with pseudo-heat symptoms in the upper.
2) Excessive Yang Repelling Yin
This is refers to the repeUency between yang in the interior and yin in the exterior.It points to a pathological state in which the exuberance of internal heat is trapped and choked within the body, and yang is unable to be released to reach the limbs, so that yin and yang are separated from each other. Yin in the exterior of the body becomes disconnected from the exuberance of yang in the interior. As it is the essence of disease that yang is excessive internally, and is chocked within the body, its clinical manifestations are cold clammy limbs, and a sunken pulse. It is called real heat syndrome manifested with pseudo-cold symptoms, and also known as "cold limbs due to yang," or "cold limbs due to heat. " Thus, the chapter of Cold-Attack Comprehended in Verse in the Gold Mirror of Medicine states: "As yang-qi is exuberant, yin and yang are not inter-nourishing,which means they are unable to mutually embrace. So yin is hindered to the exterior of the body, and it is thus termed excessive yang repelling yin".
5. Depletion of Yin and Yang
This suggests a morbid state in which yin-fluid or yang-qi of the body is suddenly depleted, and exhaustion of function appears.
1) Yang Depletion
The depleting of yang is a serious pathological state in which yang-qi is suddenlylost, thus causing severe failure of the body's function. In general, it occurs in case of exuberance of the evil-qi that goes beyond the capacity of the genuine-qi to resist. It may becaused by an insufficiency of genuine-qi due to a constitution of deficient yang, togetherwith an inducing cause of overstrain. It may also be caused by the escape of yang along with the excretion of body fluids in the condition of excessive perspiration due to overuse of diaphoretic therapy. Finally, it also may appear in an advanced stage of chronic consumptive disease when deficient yang floats due to severe consumption of yang-qi.
This condition belongs to a critical syndrome, which points to the stage at which
both yin-essence and yang-qi are about to divorce. The symptoms that indicate the depleting of yang are profuse sweating, cold clammy skin and limbs, lying in a rolled position, lassitude, a fading pulse.
Since yang-qi and yin-fluid have a mutual relationship, the depleting of yang leads to a failure in the production of yin-fluid, which also becomes exhausted. The depleting of yang is thus usually followed by the exhaustion of yin. Once yin becomes divorced from yang life comes to an end.
2) Yin Depletion
Yin is said to deplete when there is a severe consumption or sudden loss of yin-fluid, which leads to a pathological state of serious declination of systematic function in the entire body. The most common cause usually is excessive heat or prolonged retention of evilheat, which scorches the body fluids. Other causes include massive hemorrhage, vomiting, diarrhea, or other disorders that quickly consume yin-fluid. This is a critical syndrome of a disease. It is marked by short of breath, thirsty, restless, warm hands and feet with greasy sweating, and even delirium and coma.
Similarly, the loss of yin-fluid reduces the concentration of yang-qi. Since the two are interdependent, yang-qi disperses and floats to the body surface. If this situation is not remedied timely, yang also depletes soon afterward, and the body system collapses. As yin and yang are not inter-connected, eventually, there will be a "divorce of yin and yang leading to non-existence of essential qi," and life is endangered.
As mentioned above, it is clear that the pathological mechanism of imbalance between yin and yang is based on the theory of nature of yin and yang. There are inter-restraining, inter-consuming, inter-depending, and inter-transforming relationships of yin and yang. Therefore, close connections exist between the relative exuberance of yin and yang and relative deficiency of yin and yang, between yin depletion and yang depletion. In other words, the various pathological mechanisms are not fixed, but are constantly changing along with the prosperity and decline of the genuine-qi and the evil-qi, and the development and improvement of the state of disease. Only by observing and mastering their changes at all times, can one understand and grasp the essence of occurrence and development of a disease.
