Yin and Yang in diagnosis

To pick up on some of the ideas we were discussing.  In the traditional Chinese view, the energy we have comes from three sources:  our natural inherited constitution which gives us our essence, from food and from exercise (especially breathing).  In practice, it is very difficult to improve upon your inherent energy, but by careful eating and exercise one can slowly raise it.  In the view of TCM, exercise is designed to capture energy from the earth-heaven connection while in the western view exercise is about expending energy in order to get fit.  There may be a temporary gain in hard training but it is very easy to lose the fitness one gains (this is a big clue), and the body suffers in the end with injuries and pain.  It's a fact that most athletes stop their sports when the pains and injuries become too much. The TCM object is to live long and prosper without suffering from pain and damage on the way.  One captures energy from the earth and sky through things like Qi Gong, T'ai Chi and also yoga, and the principal quality to these is slowness of movement and slowness of breathing.  Most of Qi Gong should be done at the rest breathing rate which is definitely pretty slow and hard to maintain.  My view is that the slowness acts on both the tendons and muscles: lengthening the tendons and increasing their capacity, warming the muscles without any of the stress byproducts that usually accompany hard exercise. There is also the question of yin and yang elements in the exercise.  Too much stressed exercise raises yang levels at the expense of yin, leading to shrinking and tightening of organs and loss of fluids - including nourishing essence.  The body manages for a while on raised yang but eventually the system has to relax and with generally bad results. 

To talk about yin / yang in the diagnosis.

Yin and yang are two principles of energy and matter that co-exist in the world and in all processes of life.  As change happens, yin becomes yang and vice-versa.  In any process there are harmonious levels of each, and the level of either is related to the other but is also independent of the other.  In the organs of the body, for example, there can be harmony between yin and yang (i.e. the appropriate level of each); an excess of yang with normal levels of yin; debil yang with normal levels of yin; debil yin with normal or excess yang; or general debility.  The levels of each are generally dictated by the three origins of energy mentioned above, and by illness.  There are basically two origins of illness: damaging invasions from the outside by excesses of one of the five elements (like too much heat) or from external pathogens, and damaging energies from inside the body which come from disturbances in one or other of the seven emotions.

To illustrate how we might use these ideas to diagnose someone.  An inflated balloon has yang in the tension of the skin, while its capacity say, is yin.  When the neck of the balloon is open, the yang expels the air.  The tighter the balloon, the more yang there is in the skin's tension, but, at a given energy of inflation, it also inflates less and therefore holds less.  Thinking of the human bladder then, someone with an excess of yang is likely to urinate more often, while someone who has less yang or who is dominated by yin - say someone who tends towards passivity, stillness or who eats yin-stimulating foods - will urinate less often.  Temporary higher levels of yang in the body can have many causes, but long term elevated levels of yang are likely to be the result of disease that has invaded and gained a foothold in the interior of the body or by lesions in the emotions.  The bladder is the yang component of the water element in the body (the yin component are the kidneys.  Sounds contradictory since the kidneys do lots of work, but the action of the kidneys is to gather and supply the interior of the body whereas the bladder's job is to expel, hence relative to each other, the bladder is more yang than the kidneys), and the water element governs the emotions of fear. Hence if someone was very fearful say, that might also cause a rise in bladder yang. 

Of course, the elements in the body all act on each other in several ways, so a rise in bladder yang could be caused by a failure of the earth element to control the water element.  Each element is made up of yin and yang, and the 'earth' organs are the stomach (yang) and the pancreas/spleen (yin).  In this case, the yin organs may not be supplying enough yin to soften the bladder yang and to improve it's capacity.  Foods like sugar while seeming to give energy actually reduce the nourishing capacity of the pancreas/spleen and tend to induce more urination.  Urinating often may well indicate a problem with the pancreas.  If the yin component of the earth element is weak, then the stomach may not digest properly and acid may rise. Since earth nourishes metal and metal controls the action of the large intestine and hence the absorption of water, in the absence of signs of pathogens, loose bowels and frequent urination may indicate a problem with the pancreas, or inappropriate diet and incorrect exercise. If someone who is passive suddenly starts to urinate frequently, then that would suggest the invasion of illness. Someone who urinated frequently but now urinates normally is probably a lot happier than they were or has changed their diet.

The diagnosis looks at many signs in the body as well as the declared symptoms, to find the root cause of the disharmony.  A person, however, exists in a milieu.  An illness within may cause behaviour that results in external effects that return to further damage  the individual.  A disturbance in the liver, for example, may cause anger, with subsequent reactions from those with whom the person deals, increasing the stress on the heart and other fire organs.  A person lives in an environment, and stress like wind and damp can readily invade the body and produce not just physical symptoms but psychological ones as well, and which have to be taken into account.

Thus, there can be several reasons, internal and external, for an illness or problem. The essence of shiatsu is the diagnosis.  Once the correct diagnosis has been made, the practitioner is relatively free to plan his treatment of the disharmonies, looking for the long lasting correction of the problem.