Archive for the ‘Yellow Emperor’s Inner Classic’ Category

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: 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.

DAOM Research: Huang Di Nei Jing (Yellow Emperor’s Inner Classic)


The Huáng Dì Nèi Jīng has long been regarded as the seminal classic of East Asian medicine, but only 51% of accredited East Asian medicine programs in the United States currently teach the Huáng Dì Nèi Jīng as part of their curriculum. The study sought to clarify this problem through the development of a practical, consensus-based curriculum for the Huáng Dì Nèi Jīng. To create this curriculum, a modified Delphi method was utilized to survey current classroom teachers in the United States that teach the text: each was asked to identify what they believed to be the 10 most important chapters for master’s level students. Twenty-five potential schools were identified and contacted, and 19 provided contact information for the appropriate teacher. Of the 19 teachers surveyed, 8 provided a full response, 3 abstained because they objected to the wording of the question, and 1 abstained because they were a new teacher and felt unqualified to answer: yielding a total response rate of 64%.  More than 80% of the chapters picked were from the Su Wen portion of the text, and 10 of these chapters generated 3 or more responses.  The present curriculum examines these 10 chapters–in addition to supplementary information from classical and modern sources–to provide teachers with a practical way of approaching the Huáng Dì Nèi Jīng within one semester’s time.

Here’s a video of my doctoral research presentation:


© 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.

Yin-Yang in the Nei Jing Su Wen (Chapter 5)

The following passage is found at the the beginning of the Huangdi Nei Jing Su Wen (Chapter 5):

The Yellow Emperor said, “Yinyang is the dao of Heaven and Earth, the fundamental principle of everything, the progenitor of myriad variation, the root of life and death, and the palace of spirit brightness.”

Creative Commons License
This translation by Yanzhong Zhu and Philip Garrison is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Tai Ji (yin-yang) symbol at Long Hu Shan Daoist monastery

Tai Ji (yin-yang) symbol at Long Hu Shan Daoist monastery

This elegantly simple passage contains a wealth of information relevant to chinese medical theory and practice.  Everything in the world, from the most complex to the most simple, can be expressed in terms of yin and yang.  Of course, yin and yang are not static, they are always in motion, as indicated by the taiji symbol.  In the simplest terms, yin and yang are polar opposites of a spectrum.  Life is the product of this dipole movement and interaction.  When yin and yang separate, life ceases to exist.

Yin and yang are also representative of force vectors.  Yang represents an outward and upward force, while yin represents an inward and downward force.  Yang expands and yin contracts.

Based on his observations of nature, Viktor Schauberger, the Austrian naturalist, developed terminology to explain toroidal motion that could also be applied to yin and yang.  In axial -> radial motion, the toroidal force moves away from the center (yang), and in radial -> axial motion, the toroidal force moves toward the center (yin) (Coats, 59).

Of course, China’s early natural philosophers were also in tune with nature, and thus yin and yang apply to all sorts of natural phenomena.  The sun is considered yang, while the moon is considered yin.  Daytime is yang, and nighttime is yin. Spring and summer are yang, fall and winter are yin. Male is yang, and female is yin.  Thus, it is through these interactions that life exists.  Without the interaction of male and female, there would be no life.  Similarly, without the passage of the seasons, and the alternation of the sun and moon, planting and harvest seasons would be unclear.

Of course, one could go on-and-on relating the associations of yin and yang and their applicability to both life and medicine.  As one ponders the universal applicability of this theory, its elegant simplicity begins to unfold.

Huáng Dì Nèi Jīng 黄帝内经

Callum Coats, Living Energies

© 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 Wisdom

The study of Chinese medicine is, more specifically, the study of life.  While the historical date of the origin of Chinese medicine is up for debate, its recorded history dates back approximately 2000 years.  Chinese medicine is inextricably bound to ancient Chinese philosophy and, in particular, the philosophies of yinyang and the five elements.  Initially, these concepts may appear archaic to modern minds, but they are actually quite deep.  This site explores the depth of this ancient wisdom as elucidated in the Nei Jing and other classical texts.

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