Archive for the ‘Chinese medicine’ Category

Ancient Chinese Medical Theory 101: Do I Need to Learn Chinese? (Part 2)

Roughly one year ago, I posted this blog in which I argued against the notion that the ability to read Chinese is a prerequisite to an understanding of the classics of Chinese medicine. The gist of my argument was that there are a number of great English translations of the medical classics currently available—in addition to some superb translations of other Chinese classics—and so English-speaking students should be encouraged to read them. I also suggested that those within the Chinese medicine community who can read classical Chinese should be cautious not to perpetuate the notion that the classics must be read in Chinese, or that any understanding of the classics gained from translations is superficial; statements like these only serve to discourage students. Further, I stressed the idea that a deeper study of the medical classics requires, at minimum, a basic familiarity with ancient Chinese history and philosophy (which can be gained through both English and Chinese sources). I still stand by these claims. What follows, then, is my experience of stepping into the world of Chinese language…

My interest in the Chinese language began midway through the master’s program at Five Branches University. I loved the medical classics of the Han dynasty, and I knew that one day, I wanted to read them in the original Chinese. After graduation, one of the reasons I chose to pursue a doctorate at the Pacific College of Oriental Medicine (PCOM) was because the program included Chinese medical language. I was exceptionally fortunate to have a brilliant teacher for the first two semesters of study. She could tell I was seriously interested in the language and was very helpful and encouraging—in fact, she later served as the chairperson of my DAOM committee! Over the course of those two semesters, she taught us the basics of Chinese language and grammar. She did more than that, though, because she also taught us how to use Wenlin for the purposes of translation. Knowing how to use Wenlin has saved me countless hours of looking up unfamiliar characters in a dictionary (though decent translation still requires the use of multiple dictionaries).  We worked with Paul Unschuld’s book, Learn to Read Chinese (Vol. 1), and we also discussed the often heated debates between notable translators in the field of East Asian medicine. With her as my guide, in two semesters, I had reached the outer gate of Chinese medical language. After that, she resigned from her post to focus on her PhD, and the remainder of my language training at PCOM consisted of learning characters that were especially relevant to Chinese medicine.

To be completely honest, other than my training at PCOM, I didn’t really spend much time with the Chinese language until last year. As a teacher, I still used Wenlin to add the Chinese characters (and Pinyin) of herb names—and the characters for key concepts like , yīnyáng, and xíng—to my class notes, but I never really went beyond that.

And then there were the scholars

ChineseScholarEnter the Scholars
Less than a year ago, I started a Facebook group, called Scholars of Chinese Medicine, to provide a place for practitioners, teachers, and students to discuss Chinese medicine on its own terms. A place where disputes were settled by citing sources, and where the classics were quoted frequently. To my great joy, there were others who shared this vision, and we have worked collectively to create a vibrant online community that currently has over 2,100 members. Whether due to divine providence, sheer dumb luck, or a fortuitous combination of both, some major scholars began participating in the group.

And with them came the Chinese characters.

On occasion, when some member of the community would ask a question, the response would come as a stream of Chinese characters. Thanks to my previous training, I began copying and pasting these characters into Wenlin in an attempt to decipher the different responses. After a while, I got better at it. I also noticed that many of the citations were coming from sites like The Chinese Text Project or The Qi, so I began familiarizing myself with the different texts available online. I recognized the names of the Huáng Dì Nèi Jīng (黃帝內經), Shāng Hán Lùn (傷寒論), and other classics, and I noticed that there were commentaries to these books available as well.

So I got curious, and I started looking at the Shāng Hán Lùn and Nèi Jīng, along with their different commentaries—nothing monumental, just a few key lines at a time. Depending on the author, time-period, and writing style, I was occasionally successful…and occasionally frustrated. With practice, my skills improved. To give a frame of reference: when I began, 1-2 lines of text would take about 15 minutes, and a larger paragraph could take up to 2 hours. Now it takes roughly 1/3 that time.

DAOM defenseTranslations in the Classroom
My newfound comfort with these resources was a big help in the classroom, and it enabled me to give the students something more than they would have gotten otherwise. Being an English-speaking teacher of the classics, who is teaching English-speaking students, there are limited resources available. These additional resources in Chinese were a great addition to the curriculum. Let me be clear: having one English translation of a medical classic is reasonable for a curious student or practitioner, but to teach the classics at the doctoral level, one needs to look at multiple source texts (even if they are all in English).

More to the point, sometimes the answers to ambiguities in the classics can only be elucidated by looking at commentaries—and not just one commentary, but multiple commentaries on the same line! These commentaries are in Chinese, and would otherwise be inaccessible, if not for my limited language skills. Thus, in addition to having multiple English translations and numerous articles on the classics, the ability to access over 1,000 years of commentary from Chinese authors was an invaluable resource. For a scholar of the medicine (or, in modern parlance: a total Chinese medicine nerd), I’ll admit there was a certain glee that came with knowing I was reading commentaries that few of my English-speaking colleagues had even seen! And, from a teacher’s perspective, it was incredibly rewarding to give students access to this material.

I still stand by the claims that I made in my original post on this topic: that post was directed at students and practitioners who were interested in, but intimidated by, the classics. As a matter of practicality, English-speaking students should first study the classics in English, but those who are interested should be encouraged to go further. Whenever possible, teachers should seek to incorporate Chinese characters into their lessons, so that the students will feel more comfortable with them in both their present and future endeavors. Those English-speaking teachers who have some familiarity with the Chinese language should do their best to incorporate bits and pieces from different commentators into their lessons, as a reminder to students—and, hopefully, as an inspiration to a few—that Chinese medicine is a world of diverse opinions.

In my next post, I will share some of the resources that have been helpful to me in my own journey, and show you how to utilize them.

© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.


Autism as Bai He Bing (百合病): A Chinese Medicine Perspective

Several months ago, I posted an article entitled, Autism as Shao Yang Disorder: A Chinese Medicine Perspectivein which I laid out a novel clinical approach to treating autism spectrum disorder (ASD) as a Shào Yáng (少阳) patternThat post inspired a fair bit of correspondence from other practitioners, so I thought it would be appropriate to follow-up with another classical disease (病) that might also be relevant to the treatment of ASD.

Autism Awareness ribbon

Before I begin, I’d like to clarify—as I always do with potentially “triggering” subjects—that I am NOT suggesting that Chinese medicine cures autism. I have witnessed both the lure of the “autism cure” that leads parents of autistic children/adults into a false sense of hope, and the subsequent disappointment when these therapies fail to meet expectations. In this article, I am offering a clinical theory rooted in the classics, and one that I hope will benefit your treatment of ASD. When treating autism with Chinese medicine, the goal should be the reduction of detrimental behaviors, the management of anxiety, and an increase in the quality of life for both the patients and their families. Ideally, Chinese medicine practitioners should try to work in tandem with the MD or specialist who handles the patient’s care from a biomedical perspective.

In early winter, I accepted a position teaching the Jīn Guì Yào Lüè (金匮要略)—a classic work on medical formulas from the second century CE—in the doctoral program at the Pacific College of Oriental Medicine. As I was preparing for a recent class, I was reminded of an obscure illness from that text called bǎihé bìng (百合病). Scholars have argued about the translation of bǎihé bìng, which either relates to Lilii Bulbus (the primary herb used to treat the disease), or a description of the syndrome (“Hundred Union Disease”). For the sake of brevity, I will avoid these semantic issues and leave the term untranslated.

Zhang Zhong-jing (Author of the Shang Han Lun and Jin Gui Yao Lue)

Here is the description of bǎihé bìng from the Jīn Guì Yào Lüè:

The classic says: bǎihé bìng, [the] hundred vessels [share] one ancestor, [so] all of them can cause disease. [The patient] desires food, but cannot eat; they are often quiet, and they desire to lie down, but cannot; they desire to walk, but are incapable of doing so; perhaps they desire food and drink at one time, but then the smell of food is offensive; they look like that are cold but without being cold, they look like they are hot without being hot; they have a bitter taste in the mouth; they have red urination; and no medicine can cure them. Even if the medicine causes intense vomiting, there is no benefit. They look like they are possessed by spirits or mischievous sprites, but the physical form seems harmonious; the pulse is faint and rapid. (Chapter 3, line 1)

As I began to contemplate this passage, my mind couldn’t help but zone in on the phrase, “they are often quiet.” Other (more experienced) translators have rendered this symptom as “frequent taciturnity” (Wiseman and Wilms, p. 69). The other statement that struck me was: “They look like they are possessed by spirits or mischievous sprites, but the physical form seems harmonious.” Having worked with individuals on both ends of the autism spectrum, I began to wonder if some forms of autism might be a type of bǎihé bìng. Interestingly, “bitter taste in the mouth” is a hallmark symptom of the Shào Yáng (少阳) stage disorders I described in the previous article on ASD, and “taciturnity” may manifest in certain Shào Yáng (少阳) stage disorders as well (Mitchell, Ye, & Wiseman, p. 410).

The treatment for bǎihé bìng is quite simple, and involves a decoction of only two herbs: the aforementioned bǎihé (Lilii Bulbus) and shēng dìhuáng (Rehmanniae Radix). Unfortunately, the original formula calls for the juice of shēng dìhuáng to be used, which is all but impossible to obtain. As such, my advice on dosages would be to follow the dosage ratio used in the research study below, or begin with the 2:1 ratio of shēng dìhuáng (生地黄) and bǎihé (百合) used in Bai He Gu Jin Tang and modify the dosages accordingly—up to 24g of bǎihé may be used (Bensky & Barolett, p. 161). Since the formula only involves two herbs, finding the proper dosage is crucial and may take several attempts, so it would be wise to inform the patient (or their family) ahead of time.

As I was preparing my lecture on bǎihé bìng for the students, I came across two additional pieces of information that support my theory. The first is from a book entitled, Understanding the Jin Gui Yao Lue, which states that: “this formula can be used in the treatment of a variety of neurological and mental disorders” (Sung, p. 74). The second was a recent study entitled, “Involvement of the Cerebral Monoamine Neurotransmitters System in Antidepressant-Like Effects of a Chinese Herbal Decoction, Baihe Dihuang Tang, in Mice Model” that was published in the journal Evidence-based Complementary and Alternative Medicine (Chen, et. al., 2012). This study concluded that “[Bai He Di Huang Tang] possess antidepressant-like effects…mediated, at least partially, via the central monoaminergic neurotransmitter system” (Chen, et. al., 2012). Since anti-depressant medications are often used in the treatment of ASD, this finding is significant. In fact, Temple Grandin, a professor at Colorado State University on the high functioning end of the autism spectrum, notes that: “My anxiety and panic attacks were 90% eliminated with a low dose of antidepressants” (

Taken as a whole, this modern research, and the description of bǎihé bìng from the Jīn Guì Yào Lüè, suggest that some forms of ASD may respond to treatment with Bai He Di Huang Tang—particularly in those patients who present with a faint and rapid pulse.


Chen, et. al. (2012) “Involvement of the Cerebral Monoamine Neurotransmitters System in Antidepressant-Like Effects of a Chinese Herbal Decoction, Baihe Dihuang Tang, in Mice ModelEvidence-based Complementary and Alternative Medicine.

“Frequently Asked Questions” (

Craig Mitchell, Feng Ye, and Nigel Wiseman, (1999). Shang Han Lun.

Sung Yuk-ming, (2010). Understanding the Jin Gui Yao Lue.

Nigel Wiseman and Sabine Wilms, (2000).  Jin Gui Yao Lue.

© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.

Autism as a Shao Yang Disorder: A Chinese Medicine Perspective

Before, during, and after receiving my master’s degree in Chinese medicine, I worked with the special needs community. For a good portion of that 10 year period, I was an aide for young adults with Autism Spectrum Disorder (ASD). The experiences I had during that time were profound and life-changing. It is with great humility, and with the deepest respect for the autistic individuals with whom I came into contact, that I offer this post.

Before I begin, I’d like to clarify—as I always do with potentially “triggering” subjects—that I am NOT suggesting that Chinese medicine cures autism. I have witnessed both the lure of the “autism cure” that leads parents of autistic children/adults into a false sense of hope, and the subsequent disappointment when these therapies fail to meet expectations. In this article, I am offering a clinical theory rooted in the classics, and one that I hope will benefit your treatment of ASD. When treating autism with Chinese medicine, the goal should be the reduction of detrimental behaviors, the management of anxiety, and an increase in the quality of life for both the patients and their families. Ideally, Chinese medicine practitioners should try to work in tandem with the MD or specialist who handles the patient’s care from a biomedical perspective.


Autism: A Brief Synopsis
Information about autism can be gleaned from a variety of internet sources, so I’m only going to give a very brief synopsis here. Autism Spectrum Disorder (ASD) is: “a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior” (NINDS). As suggested by the moniker, autism exists on a spectrum, with a wide range of presentations. The majority of individuals I worked with were non-verbal, but on the other end of the spectrum, you have someone like Temple Grandin, who teaches at Colorado State University and writes best-selling books. Grandin describes autism as “a behavioral profile,” as opposed to a precise diagnosis (

Current Chinese Medicine Thinking
The perspective I will put forth in this article is novel—novel in the sense that I have yet to see a similar theory presented in an English-language Chinese medicine journal, lecture, or blog. As I mentioned before, autistic individuals occupy a wide spectrum, and each person is unique. As such, the range of symptoms and diagnoses (from a Chinese medicine point of view), varies from person to person. I am not offering a definitive Chinese medicine diagnosis for ASD, I am merely offering a diagnostic alternative to the standard TCM thinking, for practitioners who may not be satisfied with the typical ways of approaching autism in the clinic.

From a TCM perspective, there are many potential etiologies for Autism Spectrum Disorder. When I did a basic Google search for “Autism and Chinese Medicine, ” or “Autism and Acupuncture,” many of the same diagnoses popped up. The most popular etiology seems to be “Phlegm Misting the Mind.” That diagnosis may sound unusual—I’m sure the Quackwatch guy would have a field-day with it—but it basically means “clouded thinking” or “blunted affect.” There are two types of “phlegm” in Chinese medicine, “substantial” and “non-substantial” phlegm. A diagnosis of Phlegm Misting the Mind refers to the latter type. In other words, we don’t think there is literally phlegm in the brain! Treatment for this diagnosis primarily focuses on clearing phlegm and supplementing the Spleen, a TCM “organ” that creates phlegm when imbalanced. Again, for those who don’t know Chinese medicine theory, the “Spleen” referred to here is a holographic metaphor for a specific series of structures and processes in the body. [Note: I am using “holographic” in the same way that Michael Talbot uses the term in The Holographic Universe.]

Treatments for autism that I found on PubMed included: scalp acupuncture, tongue acupuncture, and electro-acupuncture. Some practitioners like to treat the Heart, others like to treat the Kidney. A more research-based “integrative medicine” approach suggests treating autism as an inflammatory process using a specific Chinese herbal formula (Lee & Kong, 2012). As you can see, there are a lot of treatment options!

The one option that is curiously absent, however, is the possibility of treating ASD from a six-stage perspective (popularized by Zhang Zhong-jing in the Shang Han Za Bing Lun). It is my belief that many manifestations of ASD are disorders of the Shào Yáng (少阳).

The Shào Yáng and Autism
According to the Huang Di Nei Jing (Su Wen Chapter 6), the foundational classic of Chinese medicine:

“In the division and unity of the three yang [vessels], the major yang (Tai Yang) is the opening; the yang brilliance (Yang Ming) is the door leaf; the minor yang (Shào Yáng) is the pivot” (Unschuld, p. 131).

Thus, the Shào Yáng regulates opening and closing, and disorders of the Shào Yáng are often described as “half exterior half interior” (Mitchell, Ye, & Wiseman, p. 407). What is important about this idea? The modern classical scholar, Li-hong Liu, has this to say about the Shào Yáng:

“There are three organs which are most prone to opening and closing. The mouth opens and closes for Yang (talking) and for Yin (receiving and chewing food). The throat opens and closes for Yang (breathing) and for Yin (swallowing food, drinks and saliva). The eyes open and close for Yang (to catch daylight and vision) and for Yin (to allow Yin storage and tears). If the pivot or the hinge is obstructed, the opening and closing will suffer…The action needed is to harmonize” (Seidman, p. 8-9).

Zhang Zhong-jing (aka Zhang Ji) 150-219 CE

Liu based this statement on his understanding of the Shang Han Lun, an important medical text written several centuries after the Huang Di Nei Jing. According to the Shang Han Lun, bitter taste in the mouth, dry throat, dizzy vision, and red eyes are general symptoms of Shào Yáng disorder (Mitchell, Ye, & Wiseman, 1999). Thus, Liu describes the mouth, the throat, and the eyes as “most prone to opening and closing” (Seidman, p. 8).

The concept of the eyes opening and closing is particularly relevant to ASD. According to the available information, as well as my own experience, one of the chief signs of autism is an inability to maintain eye contact ( Using Liu’s description as a starting point, failure to maintain eye contact could be considered a yin-yang imbalance of the eyes: when they open and close, there is either too much qi coming in (hypersensitive individuals) or too little qi coming in (hyposensitive individuals). If the term qi is too esoteric, consider replacing it with either “stimulus” or “information,” which are two types of qi.

The mouth, according to Liu, “opens and closes for Yang (talking).” As mentioned above, many of the individuals I worked with were almost completely non-verbal, and communication difficulties often plague higher functioning autistics as well (Stevenson, et. al., 2013). The Shang Han Lun lists “taciturnity” or reluctance to speak as another potential symptom of Shào Yáng disorders (Mitchell, Ye, & Wiseman, p. 410). This symptom is caused by “depressed Liver-Galbladder qi,” causing the “Heart qi to become constrained, which in turn affects the Heart’s function of governing the spirit” (Mitchell, Ye, & Wiseman, p. 413).

The ears may also be affected in cases of Shào Yáng disorders (Mitchell, Ye, & Wiseman, p. 408). Implementing the same logic that Liu uses in his discussion of the eyes, we can say that the ears have an opening and closing function as well (hearing/listening). In modern terms, the brain is constantly filtering—choosing which sounds to focus on or to ignore; in Chinese medicine terms, we could describe this process as the ears’ ability to open and close. Auditory processing is affected in ASD (Porges, et. al., 2014): when the ears are too open (incapable of filtering/isolating sound), this condition causes hypersensitivity to sound; when the ears are too closed (no sound getting through), this condition causes hyposensitivity to sound.

The Autism Awareness Ribbon

Based on my interactions with autistic adults and children, I feel that Shào Yáng disorder is an accurate representation of many presentations that I’ve seen. I’ve heard several high-functioning autistic adults describe the world as “overstimulating” from a visual and auditory point of view. Several of the individuals I worked with wore either sunglasses or sound-blocking headphones to compensate for the sensorial overload created by the world around them. According to the DSM-V, one of the diagnostic criteria for ASD is, “Hyper- or hypo- reactivity to sensory input or unusual interests in sensory aspects of the environment” ( In other words, the pivot isn’t working, so the sensorial “door” (to use the Nei Jing analogy) is constantly open (hypersensitivity) or closed (hyposensitivity). Based on the descriptions from autistic individuals, on Li-hong Liu’s analysis of the Shang Han Lun, on modern research, and on my own experience, I believe that ASD can be approached clinically as a Shào Yáng disorder.

In my own practice, I have used Xiao Chai Hu Tang for the withdrawn and non-aggressive manifestations of autism, and Chai Hu Long Gu Mu Li Wan for the hyperactive and aggressive manifestations of autism. Both of these formulas originate from the Shào Yáng section of the Shang Han Lun. Of course, no Chinese medicine theory would be complete without a pulse: the Shào Yáng pulse is either “stringlike and fine,” or simply “stringlike” (Mitchell, Ye, and Wiseman, p. 409).

Finally, the Shang Han Lun specifically states that in Shào Yáng disorder, “only one sign [means that] this is [the pattern], they do not all have to be present” (Mitchell, Ye, & Wiseman, p. 420). I mention this line for its clinical relevance: you may not be able to discern whether a non-verbal autistic patient has certain symptoms (bitter taste, fullness under the ribs, dry throat, dizzy vision). If there are sensory processing issues, taciturnity, and a stringlike pulse, you can be confident using the Shào Yáng formulas to treat—if you are so inclined!

“Autism Fact Sheet” (

“DSM-V Diagnostic Criteria” (

“Frequently Asked Questions” (

David Lee & Xuejun Kong, (2012). “Potential Treatment of Autism with Traditional Chinese Medicine“. North American Journal of Medicine and Science, Vol. 5(3): 189-192.

Craig Mitchell, Feng Ye, and Nigel Wiseman, (1999). Shang Han Lun.

SW Porges, et. al. (2014). “Reducing Auditory Hypersensitivities in Autistic Spectrum Disorder“. Frontiers in Pediatrics.

Yaron Seidman. Three Yin and Three Yang: Clarifying Zhang Zhongjing’s Diagnostic Approach.

Ryan Stevenson, et. al. (2014). “Multisensory Temporal Integration in Autism Spectrum Disorders“. The Journal of Neuroscience, vol. 34(3): 691-697.

Paul Unschuld, (2011). Huang Di Nei Jing Su Wen.

© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.

Ancient Chinese Medical Theory 101: Do I Need to Learn Chinese?

Several of my recent posts have focused on ancient Chinese medical literature, so I thought now would be an appropriate time to share my thoughts on the use of English translations in the classroom. There is a notion within the East Asian medicine community that in order to truly understand the ancient medical literature, it must be read in the original classical Chinese. This notion is perpetuated by some who feel that the literature is otherwise inaccessible to the English-speaking student. Unfortunately, it deters students from reading these ancient texts, and should therefore be abandoned. This article will focus on the specific ways that English-speaking students and teachers of East Asian medicine can utilize existing English translations of ancient Chinese medical literature (and other ancient Chinese literature) to gain a better understanding of the medicine. *Note: for the purposes of readability, I will simply refer to the Chinese language as a whole, instead of writing “modern Chinese and/or classical Chinese” each time. Astute scholars will recognize that the ancient medical texts were originally written in classical Chinese, but have since been transliterated into modern Chinese.*

DAOM defense

Doctoral Research Presentation and Defense

I do not read Chinese, yet I did my doctoral research on the Huáng Dì Nèi Jīng, the foundational text of Chinese medicine. More specifically, I created a consensus-based curriculum for this ancient medical text. To some in the field, it is inappropriate—even blasphemous—for an American who cannot recognize more than 100 Chinese characters to undertake research on the Chinese medical classics. In fact, I have heard tales of native Chinese teachers telling their American students that they will only be able to understand <50% of the Nèi Jīng without being able to read it in Chinese. Even American practitioners perpetuate this nonsense, and make statements suggesting that one can only get “the ‘impression’ of information, rather than the information itself,” when reading English translations of the ancient texts. Statements like these are disrespectful not only to students, but also to the translators of these great works.

Professor Yanzhong “Kevin” Zhu (Five Branches University)

Dr. Dong Ji, PhD (Pacific College of Oriental Medicine)


Barry Xin (Pacific College of Oriental Medicine)

Thankfully, my classics teachers, Yanzhong “Kevin” Zhu, Barry Xin, and Dong Ji, did not subscribe to this divisive viewpoint, and supported my enthusiasm for the classics, despite what others might have perceived as linguistic inadequacies. After graduation, I considered enrolling in a master’s program for classical Chinese, but I ultimately discarded the idea for practical reasons. It is unreasonable to think that every English-speaking student and practitioner of East Asian medicine needs to learn Chinese in order to gain an understanding of the classics. As a community, we must reject this idea that the ancient medical literature can only be accessed by those who read Chinese, because:

  1. It discourages English-speaking students from approaching the ancient medical texts.
  2. It leads to the implication that the classics are reserved only for those who can read Chinese.
  3. It is impractical and fundamentally flawed.

In many ways, classical Chinese is to modern Chinese as Middle English is to modern English. Take a look at this passage from Geoffrey Chaucer’s The Canterbury Tales:

Whilom, as olde stories tellen us,
Ther was a duc that highte theseus;
Of atthenes he was lord and governour,
And in his tyme swich a conquerour,
That gretter was ther noon under the sonne.

—The Canterbury Tales

Though it was originally written in Middle English, which ultimately developed into the form of English we speak today, it reads almost like a foreign language. Based on my limited understanding of the Chinese language, classical Chinese would likely appear as foreign to the modern Chinese reader as Middle English does to the modern English reader. So, the ability to read the ancient texts in the original classical Chinese is the privilege of a select few—even amongst native Chinese speakers! Luckily, there are Western scholars and academics who have already published stacks of research on the ancient medical literature. The ability to read Chinese is therefore just one potential way of approaching the classics; an understanding of ancient Chinese history, philosophy, and culture can be equally effective. The idea that simply reading the text in classical Chinese will give one a profound understanding of it is a fallacy!

Let me return to my example of The Canterbury Tales. Here is the modern English equivalent of the same passage quoted above:

Once on a time, as old tales tell to us,
There was a duke whose name was Theseus:
Of Athens he was lord and governor,
And in his time was such a conqueror
That greater was there not beneath the sun.

—The Canterbury Tales

Look back at the original. As a native English speaker, do you feel that something is lost in the translation to modern English? In my opinion, it would be far more beneficial to have some background on Theseus, or to have some understanding of the socio-political factors surrounding the time at which The Canterbury Tales was written.

Now let’s take a look at a passage from the Nèi Jīng Sù Wèn (Chapter 5):

Heaven is not sufficiently present in the North-West.
Hence the North-West is yin,
and the ears and the eyes of man on the right are not as clear as on the left.
The earth is incomplete in the South-East.
Hence the South-East is yang,
and the hands and feet of man on the left are not as strong as on the right.
—Unschuld, 2011, p. 116

Here’s the same passage translated by Elisabeth Rochat de la Vallee:

Heaven is deficient in the north-west, therefore the western and northern quarters are yin, and in man the ear and eye are not as clear on the right as on the left.

Earth is not full in the south-east, therefore the eastern and southern quarters are yang, and in man the hand and foot are not as strong on the left as on the right.

—Rochat de la Vallee, 2011, p. 122

…And the same passage translated by Ilza Veith:

Heaven is not complete with only the West and the North; the West and North are the regions of Yin.  Man’s hearing and eyesight are not so clear on his right side as they are on his left side.

The Earth is not complete with only the East and the South; the East and the South are the regions of Yang. Man’s left hand and foot are not so strong as are his right hand and foot.

—Veith, 1965, p. 122

We have now looked at three different translations of the same passage. Despite different word and grammatical choices, each of these passages conveys the same basic idea—with the exception of the specific directions. Is it North and West or Northwest? Is it South and East or Southeast? We could consult Maoshing Ni’s translation as well, where we would find “Northwest” and “Southeast,” but that still leaves the translators equally divided. Seemingly this is a question that could only be answered by an in-depth knowledge of Chinese language. But just as we could learn something about The Canterbury Tales through historical research, so too could we learn more about this passage through similar means. We could consult English translations of other ancient Chinese texts for the answer. I happened upon the answer in my readings of the Huái Nán Zǐ, a text that was written at roughly the same time as the Nèi Jīng:

Anciently Gong Gong and Zhuan Xu fought, each seeking to become the Thearch. Enraged they crashed against Mount Buzhou; Heaven’s pillars broke, the cords of the Earth snapped. Heaven tilted in the northwest, and thus the sun and moon, stars and planets shifted in that direction. Earth became unfull in the southeast, and thus watery floods and mounding soils subsided in that direction.

—Major, 1993, p. 62

This ancient legend, found in an English translation of the Huái Nán Zǐ, not only solves the directional ambiguity in the Nèi Jīng passage above, it gives us more to think about. The mythical conflict between Gong Gong and Zhuan Xu was probably so well known to the intended audience of the Nèi Jīng that the authors did not need to explain it further. Why did the ancient Chinese create this myth? Where is Mount Buzhou? I could answer those questions for you, but I’d rather inspire you to look them up yourself. I’ll even tell you where to look: John Major’s 2010 translation of the Huái Nán Zǐ (Chapter 3.1, p. 115; and the introduction to Chapter 4, p. 150). There you will find a description of Gong Gong, and the significance of Mount Buzhou: the mountain at the center of the Universe. You will learn that Mount Buzhou is the central peak on Mount Kunlun—a mountain that occupies the center of a 3×3 topographical grid in a cosmological theory that was popularized by Zou Yan, who is also famous for his role in the development of Five Phase theory. Mount Buzhou is the pivot around which the Universe turns. Why? Because, based the Earth’s orbit, the stars appear to move in a westerly direction around the celestial pole (Schafer, 2005). Mount Buzhou was the earthly counterpart to this celestial pole. In addition, due to the topography of China, the major rivers flow in an easterly direction toward the ocean. Simply put, this ancient myth was a way for the ancient Chinese to explain the celestial mechanics they observed from Earth, and to explain the directional flow of their rivers as well.

Did I lose you? Good. I want you to be lost. I want you to search for answers. I don’t want you to wait any longer to approach these ancient texts, and I certainly don’t want you to listen to the myopic views of those who would discourage you from doing so. Since I discovered the origin of this passage on my own, two additional Nèi Jīng books have been published that explain this particular chapter of the Sù Wèn (Kong, 2010; Rochat de la Vallee 2011). Every few months, more books and research papers are published in English that can help us to better understand East Asian medicine. The medical anthropologist, Paul Unschuld, has devoted his career to studying and translating the ancient Chinese medical texts—surely his translations of the Nèi Jīng and Nán Jīng should be suitable for all but the most erudite and discriminating scholar. Nigel Wiseman has produced outstanding translations of the Shāng Hán Lùn (with Craig Mitchell and Feng Ye) and Jīn Guì Yào Lüè (with Sabine Wilms) that contain excellent commentary. John Major has produced a detailed translation of the Huái Nán Zǐ. There are multiple English translations of the Yì Jīng, Dào Dé Jīng, and Zhuāng Zǐ—and the list goes on…

Long Hu Shan (Daoist Monastery)

Long Hu Shan
(Daoist Monastery)

Translation of the classics is just one piece of a much larger puzzle: one that also involves an understanding of the political and cultural factors that surrounded the creation of these texts. In fact, I chose the Nèi Jīng passage above precisely because it would still be ambiguous if you understood the Chinese language but lacked an understanding of Chinese mythology. You would still have to read the Huái Nán Zǐ, and though you could do so in the original Chinese, you would ultimately arrive at the same conclusion about this Nèi Jīng passage that could have been reached by utilizing existing English translations! By examining the work of Western scholars on topics like Chinese history and philosophy, we can gain a deeper understanding of the classics without ever learning Chinese. Let me be clear: I am not saying the work of translators is over—far from it—I am simply suggesting that students and practitioners not put limits on their ability to access the ancient medical texts. The field of East Asian medicine in America will always benefit from more English translations of the medical classics and their associated commentaries, but unless you are intent on pursuing a degree in classical Chinese, why not read the information available in English first? Then, if you are still driven to learn Chinese, I am sure you will be an amazing asset to our profession; for the rest of us, English translations can still be used to unlock the secrets of the classics.

As part of my doctoral research, I employed the method outlined here in the creation of a master’s level Nèi Jīng curriculum; I utilized multiple English translations of the Nèi Jīng for each passage, and then explained these passages with research from other disciplines. This method is, in my opinion, the best way to approach the ancient medical texts in the classroom—especially because the majority of American students are dependent upon English translations (Pritzker, 2014). Access to multiple English versions of each passage enables students to get a foundational understanding of the material, while research from scholars in complementary disciplines reinforces the concepts and theories described therein. I would like to see more teachers adopt this method in their classrooms. It undoubtedly takes more work, but the benefits to the students and to the profession are many.

Click to read part 2…


Geoffrey Chaucer, (14th Century). The Canterbury Tales. Available online.

Y.C. Kong, (2010). Huangdi Neijing: A Synopsis with Commentaries

John Major, (1993). Heaven and Earth in Early Han Thought

John Major, (2010). The Huainanzi

Maoshing Ni, (1995). The Yellow Emperor’s Classic of Medicine

Pritzker, S., Hui, K.K., & Zhang, H, (2014). Considerations in the Translation of Chinese Medicine

Elisabeth Rochat de la Vallee, (2011). The Rhythm at the Heart of the World

Edward Schafer, (2005). Pacing the Void

Paul Unschuld, (2011). Huang Di Nei Jing Su Wen

Ilza Veith, (1965). The Yellow Emperor’s Classic of Internal Medicine

© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.

Ancient Chinese Medical Theory 101: Why Study Ancient Chinese Medical Literature?

My doctoral research focused on the Huáng Dì Nèi Jīng—the foundational text of East Asian medicine—so students and colleagues frequently ask me why the ancient medical literature is important. I have been thinking about this subject for some time now, and I am looking forward to sharing my own answers to this question over the coming weeks. Special thanks to the students, colleagues, and friends who have challenged me to think and rethink my position on what I believe to be a vital issue in our field.


Why Study Ancient Chinese Medical Literature?

The Yellow Emperor as depicted in a tomb from the mid second century AD.

This is a question I get asked frequently, but it is also one of the most difficult to answer. As a result, I have given much thought to an appropriate response, because I recognize that people want more than, “Ancient Chinese medical literature is the foundation of East Asian medicine.” These days, practitioners want to know precisely how the classics will make them more effective in the clinic, or how it will directly benefit their patients. I have never studied the ancient literature to achieve any practical clinical goal, so it is hard for me to answer from this perspective. My own journey into ancient Chinese medical theory was based purely out of curiosity and a desire to understand the roots of the medicine I was studying. As I mentioned above, I have given this question a lot of thought, and despite my own biases, the best answer I can presently give is, “Whatever you want to achieve in East Asian medicine, the ancient literature will take you there.”

On the surface, this new answer may appear just as vague as the original that I was trying to improve, but allow me to explain further; whether you practice TCM, Worsley-style Five Element Acupuncture, Japanese Meridian Therapy, Qigong, “integrative medicine,” or “functional medicine,” studying the ancient medical literature will benefit you. A few weeks ago, I published an article entitled, The Crisis of American TCM, in which I laid forth a number of my concerns about the overall state of academia in our field. One of my primary concerns is the lack of higher-order learning objectives being taught in many TCM and OM programs. Without going into too much detail, I feel that many of these programs are only giving students a surface understanding of foundational concepts like yīn-yáng theory and Five Phase theory. As a result, many students feel frustrated and/or confused by what seems to be an incomplete theoretical foundation on which to rely. The teachers in these programs do not bear sole responsibility, however, because the majority of them were trained within the TCM educational model—which only scratches the surface of what East Asian medicine truly has to offer. My concerns were validated by an outpouring of support and correspondence from former and current students of the medicine.

My Experience with Ancient Chinese Medical Literature

I was introduced to the Huáng Dì Nèi Jīng early in my Chinese medicine education, and for that, I am extremely grateful. Up until the point that I discovered the medical classics, TCM felt like a vapid shell comprised of disparate and often conflicting theories. Thanks to my teacher, Yanzhong Zhu, the classics became an adventure. He challenged my colleagues and me to cast aside the logical rationalism that has come to define our culture, and enter an ancient world of sages and immortals. In many ways, the divide between modern TCM and the ancient medical texts is as wide as the divide between modern biomedicine and the Hippocatic writings. Ironically, having read the Hippocratic writings, they seem to bear far more resemblance to ancient Chinese medicine then they do to modern biomedicine! But I digress…

The ancient Chinese medical texts helped to fill in the holes created by my education in modern TCM. Even more than that, they caused me to rethink my relationship to the world around me. Yīn-yáng theory is not as simple as we are taught in school. From the perspective of our universe, the interplay between yīn and yáng creates vortices, toroids, and wormholes. From the perspective of physics, yīn is potential energy and yáng is kinetic energy. In general, the nature of of yáng is to expand outwardly, and the nature of yīn is to contract inwardly.

Professor Yanzhong “Kevin” Zhu

I remember a specific time when Professor Zhu led me to a deeper understanding of yīn and yáng. I was traveling with a good friend of mine—who was also in the same TCM master’s program, and a scholar of the classics in her own right—to Hawaii for winter break. Before we left, Yanzhong, or Kevin as he is known to Five Branches University students, challenged us to: “Think about yīn and yáng in Hawaii. How are they different than here (Santa Cruz, CA)? How are they the same?” This challenge inspired a discussion on the beach several days later. My friend and I were contemplating the relative yīn-yáng dynamics of the landscape around us, which led to the question, “Which is more yáng, the beach, or the ocean?” The knee jerk TCM reaction would be: the ocean. After all, one of the primary manifestations of yīn—after Earth—is Water. On the other hand, while the beach may be warmer (yáng), the ocean is in constant motion (also yáng). Ultimately, we determined that the ocean, despite being Water (yīn), was more yáng than the beach, due to its unceasing motion. Whether this answer is definitive or not is of no concern. What matters is that we were challenged to think beyond the simple and basic associations that had been taught in our TCM Foundations class. I share this story with the hope that my experience may benefit others and inspire them to contemplate yīn and yáng.

As I continued through the master’s program, I became the teaching assistant for Professor Zhu’s Nèi Jīng class, and I did my best to share my passion for the classics with the students. I also realized that “the truth” about yīn and yáng or the Five Phases cannot be taught—it can only be understood through our interactions with the world around us. Yanzhong Zhu never told me what to think, he simply taught me how to think, using the mind of the ancients as a guide. For that, I will be forever grateful, since it lead me to where I am today. From the initial spark that was Professor Zhu’s class, I began reading not just the medical classics, but the philosophical classics of Chinese culture that were written at roughly the same time. I have now amassed a vast library of Chinese literature: with multiple translations of the Yì Jīng, Dào Dé Jīng, Zhuāng Zǐ, and Huáng Dì Nèi Jīng. My wife often jokes that the one thing we will always need more of is bookshelves!

I recognize that I have not yet given any specifics as to how the classics benefited my own practice of Chinese medicine, because the more I think about it, the more I realize that the value of the classics is beyond articulation. By reading the classics—even in the form of translations—we begin to see certain similarities with the descriptions of a particular concept across multiple texts. We begin to have an almost intangible understanding of this ancient wisdom, almost as though a portal has opened in the space-time continuum. There is something inherently mysterious or spiritual about this type of transmission that spans thousands of years. Having grown up on the East Coast, I recognize how un-academic and New Age-y that may sound, but it is my experience, nonetheless. Every time I read the Nèi Jīng, I find something new, or see something I hadn’t noticed before. Indeed, in my experience, the ancient texts seem to evolve as we do. This is my relationship with the classics, however: I don’t know what effect they will have on you. As I mentioned above, I never had any particular goal in mind when reading these ancient texts—I did it solely out of curiosity and a desire to better understand Chinese medicine. I cannot definitively tell you: “After reading the ancient literature, my practice volume increased by 10%, I used 27% fewer needles, and my patient retention rate improved by 7.3%.” For all I know, the ancient literature won’t have any effect on your practice—it may instead make you a better parent, or a better mountain biker, or a better person.

How Ancient Chinese Medical Literature Can Benefit You


Image from Wikipedia

Despite my apparent inability to articulate the relevance of the classics outside of my own experience, I can say with some certainty that a familiarity with this ancient literature will deepen your understanding of the medicine. As both a student and a practitioner, I have observed the crucial role that intention plays in the clinic. In fact, scientists recognize the role of intention as well: it is the primary reason that the “gold standard” of scientific research is the double-blind placebo controlled study. Scientists recognize that if the researchers or the research subjects know who is in the control group or in the experimental group, the results of the study will be unreliable. What reason, other than intention, could account for this type of interference? A deeper understanding of yīn-yáng theory and Five Phase theory—or simply a better historical understanding of why we use certain points, herbs, or formulas in the clinic—will add more weight to our intention and, by extension, our clinical result. We will embody this knowledge during our verbal and non-verbal interactions with patients: effectively harnessing the same intention that scientists try to avoid in their research! Further, for those who practice “integrative medicine” or “functional medicine,” an understanding of the roots of Chinese medicine will enable you to more accurately integrate the theories of East Asian medicine and biomedicine. In order to create a functional model of integrative medicine, a knowledge of the ancient literature is essential; otherwise, the model will be built on the relatively weak theoretical foundations of “brand-name” TCM. According to the medical anthropologist Paul Unschuld:

The efforts…for a…legitimation of certain practices (i.e., acupuncture, application of drugs, and various other techniques)…may, in the long run, have provided more harm to the interests of traditional practitioners than benefit.  The elimination of the theoretical background of systematic correspondence threatened the existence of traditional Chinese medicine as a conceptually independent alternative, thereby contributing to a further, and potentially final, stagnation of this ancient knowledge (Unschuld, 1985, p. 261).

Supporting the New Generation of American Scholar-Practitioners

Unschuld wrote those words almost 30 years ago about the TCM model that America inherited from China. Traditional Chinese Medicine is the primary source of information for the boards and thus, American master’s programs. I still have hope that the stagnation brought about by the TCM model is not, as Unschuld posits, final. My hope lies in the students, who I believe are ready and eager to assimilate this ancient literature into a more complete system of East Asian medicine. This generation of students is currently being underserved, and while I am not advocating for a drastic overall of the entire American TCM juggernaut, I do hope that our schools can nurture this eagerness and enthusiasm before it is lost. Previous generations of practitioners have made significant progress toward greater pubic awareness of acupuncture and East Asian medicine as legitimate healthcare modalities; I believe that today’s students and practitioners must work to gain the same level of acceptance in both the biomedical and greater academic communities. This goal can be achieved through the creation of a new generation of scholar-practitioners, who deeply understand the theoretical underpinnings of the medicine. Only then can a high level of integrative medicine come about, in which East Asian medicine practitioners do not have to sacrifice the theoretical foundations on which our medicine rests. Further, by fostering a higher standard of academia within our own community, we will be better equipped to interface with other scholars—Anthropologists, Sinologists, Historians, and Linguists—who have been studying East Asian medical literature for decades and who may provide new insights into the history and practice of this great healing art. Ancient Chinese medical literature can play an important role in this process by inspiring future generations of students to gain a more in-depth understanding of Chinese medical theory than most master’s programs currently provide: thereby facilitating a renaissance of East Asian medicine in America. To quote Zhongjia Deng, a highly esteemed modern Chinese practitioner and educator:

The true nature of Chinese medicine comes…from a time that is a time of synthesis…the only way to do this justice is to find a type of educational model where you read the classics of this medicine that were written at the time when this synthesis occurred (Deng, 2005).

As I mentioned at the outset, this article is just the beginning discussion of a much larger topic. In the coming weeks and months, I will be detailing the specific texts and chapters for a number of topics, including: yīn-yáng theory, Five Phase theory, and herbal medicine. I am also considering a monthly group forum—an ancient Chinese literature book club, if you will—for those who would like a more interactive discussion of these topics. If you are interested, please sign up for my email list, and I will provide you with additional details when they become available. For those of you who would like to see how the ancient literature can be useful in your practice, I invite you to explore the texts and chapters associated with the following topics:

  • Chinese medicine as preventative medicine: Huáng Dì Nèi Jīng Sù Wèn Chapter 1
  • Yīn-yáng theory: Huáng Dì Nèi Jīng Sù Wèn Chapters 2, 3, 4, 5, & 6
  • Five Phase theory: Huáng Dì Nèi Jīng Sù Wèn Chapters 2, 3, 4, & 5
  • Herbal theory: Huáng Dì Nèi Jīng Sù Wèn Chapters 3, 4, 5, 9, 10, 14, 22, 23, 67, 70, 71, & 74.
  • Worsley-style Five Element Acupuncture: Huáng Dì Nèi Jīng Sù Wèn Chapters 2, 3, 4, 5, & 8; Huáng Dì Nèi Jīng Líng Shū Chapters 1 & 64; Nán Jīng Chapters 64 & 69


Zhongjia Deng, (2005). Chinese Medicine Past and Present: Problems and Solutions. [Video file]. Retrieved from

Paul Unschuld, (1985). Medicine in China: A History of Ideas

© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.

Ancient Chinese Medical Theory 101: Which Nèi Jīng Translation Should I Buy?

Ever since I completed my doctoral research on the Huáng Dì Nèi Jīng, students and colleagues have been asking me which translation of this medical classic they should buy. I always preface my answer with: “That depends on what you are looking for…” Rather than describe the individual merits of each translation, I created a practical flowchart, complete with hyperlinks to where they can be purchased. I would like to thank everyone who has shown interest in my research, in the Huáng Dì Nèi Jīng, and in ancient Chinese medicine. The images below are a sampling of the translations available in English. Consult this flowchart to determine which one is right for you!

Complete translations:

Affordable translations:

Expensive, well-researched translations in multiple volume sets:


Depression and the Death of Robin Williams: A Chinese Medicine Perspective

Robin Williams

Robin Williams

Despite my personal fears that it is somehow gauche to add my own commentary about Robin Williams’ death to the vast dialogue that has recently taken place, I have been unable to shake the following Huáng Dì Nèi Jīng (黄帝内经) passages from my mind:

Double yáng reverts to yīn; double yīn reverts to yáng.”

“Extreme joy damages yáng.”

“If joy causes harm, it damages the heart.”

–all from Huáng Dì Nèi Jīng Sù Wèn, Ch. 5


Do a basic search for Robin Williams, and—amidst “beloved”—you are likely to find descriptors like “high energy,” “manic,” and “genius.” Watching any of Mr. Williams’ improvisations or comedic performances, one can literally feel the energy he was capable of generating through his art. His high energy public persona, juxtaposed with his fatal private battle with depression, underscores the wisdom in the above passages.

Double yáng reverts to yīn; double yīn reverts to yáng
This passage highlights the relationship between yīn () and yáng ()—two concepts that are foundational to both Chinese philosophy and Chinese medicine. The ancient Chinese recognized that nothing can grow indefinitely, and that life exists on a continuum between the two poles of yīn and yáng. In the Wenzi, a Daoist text that existed at the beginning of the Han dynasty, it is stated: “The way of Heaven is to revert after reaching a climax, to diminish upon reaching fullness; this is illustrated by the sun and the moon…when things reach full flourishing, then they begin to decline; when the sun reaches midsky, it starts to set; when the moon waxes full, it starts to wane; when happiness ends, one is sad” (Cleary, p. 186-187).

The inter-relationship of yīn and yáng echoes the first law of thermodynamics: matter is neither created nor destroyed, it only changes forms. As related to the Nèi Jīng passage above, a strong burst of yáng energy will ultimately transform into yīn. Elsewhere in the same chapter, we find, “yīn is tranquil, yáng is restless.” The powerful creative flourishes Mr. Williams demonstrates in his improvisations and performances are palpable examples of the explosive and restless power of yáng. These same flourishes, however, must ultimately revert to a more yīn state. I suspect this was the case for him: each brilliant creative outburst was likely followed by a period of rest and quiet (at best) or depression and suicidal thoughts (at worst).

Extreme joy damages yáng
This statement is specific to the emotion of “extreme joy.” Williams’ was beloved because he shared his own extreme joy with us. Unfortunately, such a high-energy state requires a large expenditure of yáng to sustain, which ultimately results in the depletion of yáng. When the yáng becomes exhausted, the yīn takes over while the yáng regenerates. As stated above, these yīn states can simply be periods of rest and repose, or they can degenerate into feelings of depression and suicide.

If joy causes harm, it damages the Heart
In Chinese medicine, a common cause of depression is Heart and Spleen deficiency (Shi, p. 159-160). According to Sù Wèn Chapter 23, the Heart houses the Spirit (shén), which relates to consciousness and our ability to think, feel, and respond (Wiseman, p. 550). The state of the Spirit is an important diagnostic indicator of health—it manifests in the patient’s face (particularly the eyes) and demeanor. Bright eyes, articulate speech, and vitality are positive indicators; dull eyes, incoherent speech, and blunted affect are negative indicators (Wiseman, p. 551).

The Heart is associated with the phase of Fire, the South, and the season of the Summer. Let me take a brief moment to address the Chinese medicine detractors who typically use such statements to attack our field as “mystical nonsense” or “pseudoscience”: we don’t actually think there is a literal fire in the Heart. It is a description we use to explain the nature of the heart—sort of a holographic image that describes the role of the heart in the body.

Bernini's Ecstacy of St. Teresa

Bernini’s Ecstasy of St. Teresa

In Judeo-Christian terms, the notion of a spiritual fire in the heart is a common descriptor of mystical experience. In fact, it is one of the most common descriptions of the presence of the Holy Spirit. St. Teresa of Avila (1515-1582) described her experience in these terms: “I saw in [the angel’s] hand a long spear of gold, and at the iron’s point there seemed to be a little fire. He appeared to me to be thrusting it at times into my heart, and to pierce my very entrails; when he drew it out, he seemed to draw them out also, and to leave me all on fire with a great love of God” (Teresa of Avila). 

The Heart as Emperor
The Heart, as described in the Huáng Dì Nèi Jīng Sù Wèn Chapter 8, is the Emperor of the body. This metaphor of the body as a kingdom with the Heart as the Emperor underscores the importance of the Heart in Chinese medical physiology and psychology. According to the same chapter, “When the Emperor is peaceful, the subjects (other organs and biological processes) are orderly…when the Emperor is not peaceful, the subjects (other organs and biological processes) are harmed.” Thus, great care should be taken to keep the Heart peaceful, because when it becomes agitated, chaos ensues on a systemic level.

When the Heart is harmed, there is likely concurrent damage to the blood and the Spirit. The state of the blood in Chinese medicine is closely linked to the peacefulness of the Spirit—to cite but one example, a potential cause of insomnia (from a Chinese medicine point of view) is blood heat and/or blood vacuity. In the case of blood heat, a person cannot sleep because the heat disturbs the Spirit, while in the case of blood vacuity, a person cannot sleep because the Spirit lacks proper nourishment from the blood.

The Role of the Spleen (pí) in Depression
Going back to Sù Wèn Chapter 5: “The Heart generates the blood, the blood generates the Spleen.” This relates to a complex Five Phase (wǔ-xíng 五行) association that I don’t have time to explain here. What I will say is that, just as the Heart is associated with Summer, the Spleen is associated with the transitional period between the Seasons (Nèi Jīng Sù Wèn Chapter 29). I find this association particularly interesting with regard to the subject of depression: it is as though one gets stuck in a particular “emotional season,” and lacks the ability to assimilate and transform that emotion.

When the Spleen is deficient—from a Chinese medicine point of view—a common result is the generation of phlegm, which manifests in certain patterns of depression. Again, let me take a moment to address the TCM-haters and internet trolls out there—we do not believe that the Spleen literally produces phlegm, the “Spleen” (pí) in Chinese medicine is a holographic metaphor for a particular process in the body. We also don’t think that depression can be cured by simply blowing one’s nose or hacking up more phlegm! In fact, even the term phlegm is a bit of a misnomer in this context: it is more a descriptor of the kind of blunted affect or clouded thinking that typically results from depression.

Etymology of the Character Diān ()
The character for depression is diān (), which is particularly interesting when broken down into its components. On the left side of the character is the radical nì (), meaning “disease” or “sickness.” The other component of the character is diān (), meaning “summit” or “top of the head.” My reading of this character—which I preface with the caveat that I am not a Chinese linguist—is “disease of the top of the head.” My Chinese language teacher and colleague, Dr. Sonya Pritzker, cautioned against extrapolating on the characters without a linguistic background, so I freely admit that I may be incorrect in my interpretation of the character, and that my reading of it is likely influenced by my own cultural perspective. I am intrigued and encouraged by the etymology, however, which suggests that the phonetic component of the character, diān (), is part of the same word family as tiān (), which means “Heaven” or “sky” (Schuessler, p. 211). With this in mind, it suggests that depression may be symbolically understood as a disease of the top of the head which results in losing our heavenly connection. In fact, the acupuncture point at the top of the head, Hundred Meetings (bǎi huì 百會), is alternatively called Mountain of Heaven (tiān shān 天山), and it is through this point that one can access the heavenly yáng energies (Deadman, p. 552-553)!

If my interpretation does have validity, it is truly humbling to recognize the depth to which the ancient Chinese understood depression, as encoded in this one character. It seems to suggest the same isolation and lack of connectedness that plague so many individuals who live with depression, including Leo Tolstoy, who said: “I say that the search for God was not reasoning, but a feeling, because that search proceeded not from the course of my thoughts – it was even directly contrary to them – but proceeded from the heart. It was a feeling of fear, orphanage, isolation in a strange land, and a hope of help from someone” (Tolstoy).

Closing Thoughts
With all this in mind, I can only imagine the struggle Robin Williams faced. To the public, he was an explosion of yáng, but in private, I imagine he spent much of his time in a yīn state. One positive thing to come out of his tragic death has been a renewed dialogue and public acceptance of depression. I offer this Chinese medicine perspective to my colleagues and former students, in the hope that it will inspire you to better serve depressed patients and all patients suffering from mental illness. If you or someone you know is suffering from depression, please seek help: Chinese medicine is a wonderful potential adjunct therapy to counseling and/or psychiatric treatment.

Huáng Dì Nèi Jīng 黄帝内经

Thomas Cleary, The Taoist Classics: Vol. 1

Anshen Shi, Internal Medicine

Teresa of Avila

Axel Schuessler, ABC Etymological Dictionary of Old Chinese

Peter Deadman & Mazin Al-Khafaji (with Kevin Baker), A Manual of Acupuncture

Leo Tolstoy, A Confession

Nigel Wiseman and Feng Ye, A Practical Dictionary of Chinese Medicine

© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.

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