Digging the Well

Much of the elegance, beauty and profound truth of Chinese medicine derives from the foundation on which it rests – the interplay of yin and yang. These are principles that stand in dynamic tension, regulating and defining the expression of attributes, describing a process in motion. Essential to this is the understanding of qualities and properties in relation to something else. In the human body, yin and yang are ascribed to illustrate xu, vacuities and shi, repletions, which seek adaptation and reconciliation in the service of homeostasis. When movement in the body becomes insufficient, as in some motility and circulation disorders, activation may be required to resolve the natural balance of function and structure. Chinese medicine employs techniques to facilitate activation – acupuncture, herbs, exercise, bodywork – nudging the body back to balance. Restoration of harmony between yin and yang is the fundamental goal, reclaiming or re-establishing a new dynamic of balance.

Characteristics are assigned to identify yin and yang properties. Some yang properties include: activation, upward and outward movement, hot temperature, transformative action. Some yin properties include: quiescence, downward and inward movement, cold temperature, consolidation. Many of these properties describe a primary metaphor of yang energy/function in relation to yin structure. Each yin/yang metaphor requires the other for definition and meaning in dynamic relationship. All these properties are required for health, subject to the situational demands of a being in the world. Without quiescence and rest, activation would become unsustainable, without activation, structure could not be replenished. The dance of yin/yang is infinite in its possibilities.  Constitutionally, we are comprised of these yin/yang attributes, both temporary and some more sustained. These sustained propensities can reflect healthy patterns, as in our efforts to reduce lability and vulnerability by maintaining a balance of activation followed by rest and renewal, utilization of resources followed by nourishment and replenishment. Sustained patterns can also reflect stasis, lack of vitality and movement, accumulation and concretion. Our task in Chinese medicine is to evaluate these yin/yang relationships and determine if, when and how influence may be beneficial to restore harmony between these forces.

Symptoms provide opportunities for insight into the balance of yin and yang.  Symptoms may be significantly disruptive in and of themselves or may be early indicators of imbalances that may give rise to more serious problems as they skew further out of harmony. Restoration of yin/yang harmony is the more fundamental objective, with all the benefits that may accrue, not merely the eradication of symptoms. This constitutional approach engages the full benefit of our observation and experience. As we attend to evidence of balance or imbalance, we prepare ourselves for health and for the challenges to adaptation that we will surely experience. This reflection and preparation are foundational in the Chinese medical literature, with the admonition in the Yellow Emperor’s Classic (221 BCE) not to wait until one is thirsty before digging a well. Yang sheng nourishing life practices are one mechanism by which we utilize our yin/yang assessments and strategically apply ourselves to the restoration and maintenance of balance and harmony. Planning for and investing in true wellness is a means of focusing our attention and acting in accordance with our awareness.

Making Change - the Power of Add and Subtract

Central to the diagnostic system in Chinese medicine are the principles of shi repletion and xu vacuity. Our examination of the pulse and tongue and detailed questioning provide a comprehensive constitutional assessment of an individual at a specific moment of time, with all the strengths and challenges that have led to that moment. This snapshot of yin and yang is in continual flux, some aspects visible and apparent and others less so. Our task as practitioners – and as individuals monitoring our own health – is to deepen our awareness and sensitivity to this balance and to act decisively to influence our direction mindfully.

Most often this influence is a profoundly simple shaping of behaviors and choices. We add things which enhance our health and subtract things which diminish it. Simple and yet difficult, for all our common human reasons. When I think of myself and my patients, I think of adding fluids, stretching, more sleep, meditation, proactive food choices, exercise, herbs and other therapeutic interventions – a list limitless by our variety of experience. We subtract poor postural habits, muscular tension, excesses of devitalized food, alcohol, people and experience toxic to our spirits – perhaps our own critical and judgmental mindset that doesn’t advance our serenity and equanimity. We are an arithmetic of not enough and too much. While some of that equation may be mysterious, in my own experience much is apparent, often painfully so. Yang sheng, nourishing life, is about making a project of that equation – recognizing our fundamental ownership of it. This is the conscious crafting of our jing essence, both for this moment, but more importantly over the longer arc of our lifetimes. We can observe, monitor and influence these outcomes, by carefully defining issues and living in clarity about our goals.

It is well understood that entrenched patterns of any kind – physical, mental, spiritual – give rise to complications which snag, tangle and accumulate into enduring injury. When these become intractable lesions, they become the province of the most dramatic interventions in our culture: hospitalization, surgery, polypharmacy. Subtraction is taken to its furthest extreme and largely removed from our own power. These are vital and necessary resources, but out of scale by having been applied after much damage has been done. Yang sheng is the slow march of minute choices, incrementally implemented. The benefits can be decidedly undramatic, at times indiscernible. Yang sheng requires a greater attunement by ourselves to our own condition and a faith that our discipline matters over the long haul.  It requires recalculation as our circumstances change acutely or evolve slowly; even previously successful solutions may require recalibration. The shaping of our behavior may become distorted by our fear or desperation about health issues and we may over-react or grasp wildly about for interventions. The enduring center of a successful  meeting of this equation is the locating of attentiveness and power within ourselves. Evaluating our condition mindfully and responding decisively to our challenges yields immeasurable riches, optimizing our possibilities for vitality and graceful aging. Addition and subtraction are simple and elegant ordering strategies for the management of yin and yang; applied rigorously, they are deceptively powerful agents in our efforts to identify and to act.

What additions and subtractions have provided the most meaningful benefit on your journey? Which call to you as having the greatest potential for positive change? I look forward to your comments.

'cause that's where the money is...

Why do you rob banks? The response, attributed to the bank robber Willie Sutton, is a lesson in focusing on direct and high yield avenues to success. It’s a maxim that enjoys a high degree of applicability in many domains, perhaps uniquely so in healthcare. The behaviors we engage in regularly, over an extended period of time, have implications for the shaping of our condition – physically, mentally and spiritually. Identifying the flaws in those behaviors and adapting ourselves to those realities can lead to fundamental change in the quality of life and our experience.

Yang sheng, nourishing life principles, reflects a commitment to assessing ourselves candidly to reveal the unique complexity of our constitutional condition. In view of that knowledge and awareness, we implement changes likely to lead to more successful outcomes. This is, fundamentally, a life affirming strategy. It is not blaming ourselves for our symptoms, it is more simply, living in clarity about what is now required to engage those symptoms.

In my fifties, I began to experience what my wife sympathetically described as a pot belly, despite the fact that I had maintained my identical weight since high school. While I examined dietary contributions, it soon became clear that it was a conditioning issue that required targeted physical exercise. I researched and dutifully engaged in a variety of these strategies, week after week, with no apparent impact. I was outraged and dismayed. While I did not dare to imagine a lean physique, I had labored genuinely, I had earned a marginally flatter belly by my measure. There was absolutely no evidence of the level of my commitment.

I observed and copied others and, finally, tripled the number of repetitions in a session. Slowly, over the course of weeks - evidence of progress. I experienced results, but it was three times as hard as I’d expected to work for them. Good news on a lot of levels, but it cost me much more than I had anticipated. The upshot being, of course, that is exactly how much it cost, at my age and level of conditioning, however much I would have wished otherwise. So I can decide how important that is to me (and it may be more important than I might choose to admit).

This is a simple example, perhaps more about vanity than the life challenging conditions presented by many of my patients. Clearly, everything is not about willpower. For those things that are – and there are many of them for me - this is meant as an illustration of how our expectations and commitments, however legitimate, may not go near enough to where the money is. The sacrifices we endure, in time, expense, effort, pain, monotony – countless categories of commitment and loss, have to touch the center of injury.  Medicine, at its best, is not about judgement and critique. It is about validating our efforts to be mindful and informed and investing in fruitful avenues to improve our condition. Faith leaps towards it, fueled by our resilience and courage to change. It is woven deeply into the DNA of Chinese medicine, in practices that refine and advance our best selves. Good treatment, in any discipline, is about that authentic dialogue. We are vitalized by those efforts, whatever the outcome.

How have your own expectations and commitments been challenged by your circumstances?  I look forward to your comments.

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