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Application of the theory of yin and yang in TCM

1. Explanation of the histological structure of the human body
TCM believes that the human body is an organic whole and that all the tissues and organs in the body depend on each other in function. Such an interdependence between these tissues and organs can also be explained according to the theory of yin and yang. That is why it is said in Huangdi Neijing that “man has a physical shape which is inseparable from yin and yang”. Generally speaking, the upper part of the body pertains to yang while the lower part to yin; the exterior pertains to yang while the interior to yin; the chest pertains to yang because it is located in the upper part of the body while the abdomen to yin because it is located in the lower part of the body; the lateral side of the four limbs pertain to yang while the medial side to yin. As to the zang-organs and the fu-organs, the five zang-organs pertain pertain to yin because they store essence, but never discharge it; the six fu-organs pertain to yang because they transport and transform food, but never store it. Among the five zang-organs, the heat and the lung are located in the chest, so they pertain to yang; but the liver, the spleen and the kidney are located in the abdomen, so they pertain to yin. Each organ itself can be further divided into yin and yang aspects, such as heart-yin and heart-yang, kidney-yin and kidney-yang, etc

2. Explanation of the relationship between structure and function
The theory of yin and yang holds that the normal activities of life result from the balance between yin and yang that the close relationship between histological structure and physiological functions signifies the opposition and the unity between yin and yang. The histological structure of the body, including the viscera, the meridians, qi, blood and body fluid. All pertains to yin because they are all substantial. However, their functions all pertain to yang. Thus there is an intrinsical relationship between substances that pertain to yin and functions that pertain to yang. I.E. the mutual opposition, interdependence, wane and wax as well as transformation of yin and yang. In terms of the interdependence between yin and yang, the human body relies on the viscera, the meridians, qi, blood and fluid to perform and maintain its physiological functions. On the other hand, the metabolism of qi, blood and body fluid depends on the functional activities of the related viscera. Similarly, the performance of various functional activities will inevitably consume qi, blood and body fluid. This process is marked by wax of yang and wane of yin. Besides, constant transformation and generation of nutrients must reply on the functional activities of the viscera and consume certain amount of energy. This process is characterized by wax of yin and wane of yang. This process of metabolism is also accompanied by mutual transformation of yin and yang between substances and functions. Only when the balance between yin and yang is ensured in this series of physiological process can normal state of life be maintained.

3. Explanation of pathogenesis
When the balance between yin and yang in the boy is damaged, it leads to various diseases known as “imbalance between yin and yang” changes generally fall into two categories; relative predominance of yin or yang and relative decline of yin or yang, according to the analysis of pathogenesis with the theory of yin and yang.

3.1 Relative predominance of yin or yang
Relative predominance of yin and yang, a pathological change due to excessive increase of yin and yang, includes two aspects: relative predominance of in and relative predominance of yang. Yin or yang that becomes predominant inevitably turns into a pathogenic factor. So predominant yin becomes a pathogenic factor of yin nature and predominant yang a pathogenic factor of yang nature.
Relative predominance of yang, usually caused by invasion of pathogenic factors of yang nature or exuberant heat transforming from the pathogenic factors of yin nature activated by yang, is a manifestation of excess-heat syndrome known as “predominance of yang leading to heat” in Huangdi Neijing. Pathogenic factors of different nature impair the corresponding healthy qi in the body. So pathogenic factors of yang nature tends to consumption of yin-fluid in the course of pathological changes. That is why it is said in Huangdi Neijing that “predominance of yang leading to disease of yin”. “Disease” here means impairment. For example, invasion of pathogenic heat into the body will make yang-qi in the body hyperactive, leading to high fever, sweating, reddish complexion and rapid pulse. With the progress of morbid condition, pathogenic factors of yang nature consume yin-fluid in the body, bring on thirst, scanty urine and constipation.
Relative predominance of yin is usually caused by invasion of pathogenic factors of yin nature into the body leading to exuberance of yin-cold and bringing on excess cold syndrome known as “predominance of yin leading to cold” in Huangdi Neijing. If pathogenic factors of yin nature further impair yang-qi in the body. A pathogenesis of “predominance of yin leading to disease of yang” will arise, as is recorded in Huangdi Neijing. Take pathogenic cold for example. When it invades the body, it leads to cold symptoms like aversion to cold, cold limbs and cold abdominal pain on the one hand, and symptoms due to yang-deficiency like floating whitish complexion, lassitude, frequent lying on bed, slow and weak pulse on the other hand.
Besides, when relative predominance of yin or yang develops to the extreme point, mutual transformation will occur under certain condition according to the principle of inter-transformation between yin and yang. That is to say that yin-cold syndrome will turn into yang-heat syndrome and vice versa.

3.2 Relative decline of yin or yang
Relative decline of yin or yang refers to pathological changes of yin or yang that declines below the normal level, including relative decline of yin and relative decline of yang. This morbid state mainly results from insufficiency oh healthy qi in the body. To be specific, relative decline of yin refers to insufficiency of yin-fluid and relative decline of yang to insufficiency of yang-qi in the body. Usually relative decline of yin or yang leads to the imbalance between yin and yang which brings on hypofunction of the viscera.
Relative decline or yang refers to deficiency-cold syndrome due to insufficiency of yang-qi that fails to restrain yin-cold and warm the viscera. The usual clinical symptoms are whitish complexion, aversion to cold, spontaneous sweating, slow and weak pulse. This morbid state was described as “deficiency of yang leading to cold” in Huangdi Neijing.
Relative decline of yin refers to deficiency-heat syndrome due to insufficiency of yin-fluid that fails to restrain yang-heat and nourish the viscera. The usual clinical symptoms are reddish complexion, tidal fever, night sweating, thin and rapid pulse. This morbid state was described as “deficiency of yin leading to heat” in Huangdi Neijing
Since yin and yang depend on each other and no one can exist without the other, relative decline of yin or yang may affect each other with the development of pathological changes. That is to say that prolonged deficiency of yin will lead to deficiency of yang and protracted deficiency of yang will bring on insufficiency of yin-fluid, eventually resulting in deficiency of both yin and yang.
When relative predominance of yin or yang and relative decline of yin or yang become extremely serious, it would lead to declination of healthy qi and bring on special changes of pathogenesis known as “loss of qi” and “loss of yang” which consequently cause death due to separation of yin and yang.

3.3 Diagnosis and syndrome differentiation
To occurrence, development and changes of disease, according to the theory of yin and yang, lie in the imbalance between yin and yang. Clinically all kinds of diseases, including pathological changes of complexion, voice and pulse condition as well as the nature of diseases, can be generalized and analyzed with the theory of yin and yang.
Diagnostically, the theory of yin and yang can be used to analyze the data collected with four diagnostic methods and differentiate the nature of disease, which is an important method for making correct diagnosis. That is why it is said in Huangdi Neijing that one should “observe complexion and take pulse, differentiating yin and yang first” take complexion, voice, disposition, nature of disease and pulse for example. Bright complexion pertains to yang while grayish complexion to yin; sonorous voice pertains to yang while low and weak voice to yin; preference for cold and aversion to heat pertain to yang while preference for heat and aversion to cold to yin; floating, slippery, rapid and full pulse states pertain to yang while deep, unsmooth, slow and thin pulse condition to yin.
In syndrome differentiation, syndromes are usually differentiated from the aspects of yin and yang, external and internal, deficiency and excess, cold and heat which are the general principle for differentiating disease and syndrome, known as “syndrome differentiation with eight principles”. Among these eight principles, yin and yang are regarded as the general ones. According to such a gradation, external syndrome, excess syndrome and heat syndrome are yang syndromes while internal syndrome, deficiency syndrome and cold syndrome are yin syndromes. The theory of yin and yang are also used to differentiate visceral syndromes. Take visceral deficiency syndrome for example. It can be divided into heat-yin deficiency, heat-yang deficiency, kidney-yin deficiency, kidney-yang deficiency, spleen-yang deficiency and liver-yin deficiency. Clinically the basic principle for differentiating syndrome is to differentiate yin syndrome and yang syndrome.

3.4 Guiding clinical treatment

3.4.1 Deciding the therapeutic principles
(1) Therapeutic principles for relative predominance of yin and yang: since the basic pathogenesis of relative predominance of yin and yang is the exuberance of pathogenic factors, the treatment must follow the therapeutic principle that “excess should be reduced”. To be specific, excess-heat syndrome due to the exuberance of pathogenic factors of yang nature should ebe treated by clearing away heat while excess-cold syndrome due to the exuberance of pathogenic factors of yin nature should be treated by eliminating cold. Further development of relative predominance of yin and yang may lead to consumption of yin-fluid by yang-heat or impairment of yang-qi by yin-cold, which should be treated by elimination of pathogenic factors in combination with deficiency-supplementing therapy, i.e. combination of the therapy for clearing away heat with the therapy for nourishing yin combination of the therapy for eliminating cold with the therapy for tonifying yang.
(2)Therapeutic principle for relative decline of yin and yang: since the basic pathogenesis of relative decline of yin and yang is insufficiency of the healthy qi, the treatment must follow the principle that “deficiency should be supplemented”. To be specific, deficiency-cold syndrome due to insufficiency of yang-qi should be treated by nourishing yang while deficiency-heat syndrome due to deficiency of yin-fluid should be treated by nourishing yin. Further development of relative decline of yin and yang may lead to deficiency of yin due to protracted deficiency of yin, bringing on deficiency of both yin and yang which should be treated by nourishing both yin and yang or mainly nourishing yang with the consideration of yin or mainly nourishing yin with the consideration of yang.

3.4.2 Generalization of the properties of drugs.
TCM believes that all drugs possess four properties, five flavors and four acting tendencies (namely ascending, descending, sinking and floating) which are generalized according to the theory of yin and yang.
The four properties refer to cold, hot, warm and cool nature of drugs. Drugs of hot and warm nature pertain to yang while drugs of cold and cool nature belong to yin, the former are usually used to treat cold syndrome while the latter to treat heat syndrome.
The five flavors refer to acrid, sweet, sour, bitter and salty tastes of drugs. There is another flavor known as bland which is not as distinct as any of the five flavors. Drugs of different flavors bear different effects and are categorized differently in terms of yin and yang. For example, acrid flavor disperses, sweet flavor nourishes and bland flavor oozes. So the acrid, sweet and bland flavors pertain to yang. Sour flavor astringes, bitter flavor purges and salty flavor moistens. So the sour, bitter and salaty flavors pertain to yin.
The concept of ascending, descending, sinking and floating is a generalization of the acting tendencies of drugs. Drugs tending to ascend and disperse pertain to yang while drugs tending to descend and tranquilize pertain to yin.
To generalize the properties and acting tendencies of drugs with the theory of yin and yang is guide clinic differentiation of syndrome. Clinically only when relative predominance or decline of yin and yang is clearly differentiated, correct therapeutic principles are decided and proper drugs are selected according to their properties, flavors and effects can satisfactory curative effect be obtained and therapeutic aim be realized.

Dr Wang
Next Artical: Cardiovascular Diseases in TCM
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