Nurturing life through the body, heart, and spirit with the wisdom of Chinese medicine


A collection of notes on the topics of classical Chinese, medicine, and traditional culture.

This blog is a collection of ruminations, translations, and personal opinions by Sabine and some guest authors. Reflecting my own personality, some posts are academic, some clinical, and some personal, some are excerpts from existing books and some may become part of future books. Please leave comments with feedback, questions, constructive criticism, and differences of opinion as long as you argue your reasons for disagreement logically. Any personal attacks, uncivil remarks, or self-promoting comments will be deleted.

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The Synchronicities of an early fall morning inspired by Suwen 5

On the wonderful synchronicities of life, here is an early-morning commentary on Sùwèn chapter five (陰陽應象大論篇第五, “The Great Treatise on Yin-Yang Resonating in the Manifest World”), inspired by my walk with the dogs this morning in the first foggy rainy soupy Oregon fall day. Every year, I get to revisit this chapter, which I currently consider perhaps the single most important treatise in Chinese medicine in general, in the course of teaching three Neijing Seminars in the Classical Texts curriculum at the university. We start off with Suwen 5, and invariably some eager students will voice a bit of disappointment, after a quick look at the syllabus, that we are only going to cover a single chapter. Don’t we want to read the entire Néijīng (黃帝內經 “Yellow Emperor’s Inner Classic”)? And equally predictably, we run out of time long by the end of the term, long before the end of this chapter. So here are some ruminations on just the first couple of lines.

Such is life. It is all part of the ebb and flow, the yīn and the yáng, the give and take, the living and dying, the biàn 變  and huà 化. As the Yellow Emperor states so succinctly in the very first line of the chapter:

“Yīn and yáng are the Dào of Heaven and Earth, the lead rope and connecting strands of the myriad things, the father and mother of biàn and huà change, the foundation and beginning of giving life and of taking it, and the palace of shén míng.”

Relating this wisdom directly to medicine in the second line, he continues, “To treat disease, you must seek it in [this] foundation.” 「治病必求於本。」So what is this foundation? How are we to understand CHANGE, which to me is really at the core of what ancient Chinese texts have to teach us? In English, we do have a host of terms available (transform, transmute, alter, metamorphize, fluctuate, convert, transfigure…) but often use them casually and interchangeably. To be sure, Chinese authors sometimes do the same, but this particular passage, in my mind, invites us to slow down and contemplate this interaction of yīn and yáng, in the macrocosm as well as in the microcosm of the body. Without this necessary interaction, yáng ascends upwards indefinitely, yīn descends downwards, their healthy physiological tendency turning into pathology, and the body, or the cosmos, dies as the cycle of change stops. “When clear qì is located below, it engenders diarrhea with undigested food particles; when turbid qì is located above, it engenders swelling and distention. These are the contrary actions of yīn and yáng, and the manifestations of disease that go against the proper course of things.” 「清氣在下,則生飧泄;濁氣在上,則生䐜脹。此陰陽反作,病之逆從也。」 So simple in one way, and yet so complex. 

Before turning to the manifestations of yin-yang change in nature as a way to wrap our heads around this difficult subject, here are a few thoughts on change: Biàn huà 變化 is a reference to two types of change, namely huà-type sudden irreversible substantive and often generative change, such as from the pupa to the butterfly, or from non-being to being; and biàn-style gradual, slow alterations, such as between yīn and yáng, day and night, water and ice and steam, or seasonal changes. In the Chinese classics, these two types are explained along these lines: “Gradual [change] of things is called biàn, the extreme state of things is called huà.”「物之漸,謂之變;物之極,謂之化。」  Another way to render these two types of change in English may be as “permutations and transmutations,” or as “alterations and metamorphoses.” In this context, it is ironic that biàn is often translated in clinical literature as “to transform,” when it is really huà-type change that “transcends the form,” as opposed to just altering it. I myself am guilty of this mistake and have sworn to not repeat it, but it makes sense when we consider how casually we tend to use “transform” in spoken English to refer more to a biàn-type change of gradual fluctuations, such as “water transforms into snow” or the “transformation of a child into a teenager.”

Here it might help us to associate huà with a yáng-type change and biàn with a yīn-type change, as in Line Four of Sùwèn 5: “Yang generatively changes into qì, yīn completes the outer form.”「陽化氣,陰成形。」Trying to translate this chapter, by the way, is truly a humbling experience, because I am constantly being reminded of the limitations of the English language, and the impossibility of using a single English word to convey a concept in Chinese that reflects a completely different way of looking at the world. But rather than giving up, let us follow the lead of the ancient Chinese writings and persevere in our effort to understand the perpetual interactions between yīn and yáng by looking at the “resonances [of this process] in the manifest world” (as the title of this chapter suggests).

Of course no discussion of change would be complete without mentioning my favorite author, Zhuāngzi 莊子, the unchallenged master of playfully engaging with this subject with his heart and soul, rather than his brain. The most commonly cited examples by Chinese authors of huà-type change are found in this Daoist treasure trove. First, there is the famous metamorphosis from the giant fish Kūn to the bird Péng: 

“In the Northern Darkness there exists a fish with the name Kūn. Kūn’s size is I don't know how many thousands of miles. It suddenly/substantively changes (huà!) into a bird with the name Péng. Péng's back is I don't know how many thousands of miles. Arousing itself and and taking off in flight, its wings are like the clouds hanging from the sky. When the oceans churn, this bird migrates to the Southern Darkness. The Southern Darkness is the Pond of Heaven.”
北冥有魚、其名爲鯤。鯤之大、不知其幾千里也。化而爲鳥、其名爲鵬。鵬之背、不知其幾千里也。怒而飛、其翼若垂天之雲。是鳥也、海運 3 則將徙於南冥。南冥者、天池也。

Then of course there is Zhuāngzi’s famous butterfly dream:

“In the past, Zhuāng Zhōu dreamed that he was a butterfly, a happily fluttering butterfly who considered itself to be utterly satisfied, not knowing [about being] Zhōu. Suddenly, it woke up and was pleasantly surprised to be Zhōu. Who knows whether it was Zhōu dreaming of being a butterfly or the butterfly dreaming of being Zhōu! Zhōu and the butterfly, now there must be a distinction between them! This is what is called “substantive change (huà!) of things.”
昔者莊周夢爲胡蝶,栩栩然胡蝶也,自喩適志與。不知周也。俄然覺 則蘧蘧然周也。不知周之夢爲胡蝶與胡蝶之夢爲周與。周與胡蝶則必有分矣。此之謂物化。

In contrast to huà change, biàn is a slow gradual change or fluctuation, as in weather cycles, seasonal changes, or the gradual aging of the human body. In Chinese dictionaries, the difference is explained as biàn being a change where the two states can be present simultaneously, like the alterations or variations between yīn and yáng or between day and night or winter and summer, while huà is a complete and irreversible substantive change from one thing into something else, like the caterpillar into the butterfly, where the two states cannot be present simultaneously. In the context of cosmology, huà change is the origin of creation, while biàn are the innumerable and never-ending cyclical alterations that are the defining characteristic of the material realm in the cycles of the Five Phases and yīn and yáng. Am I making sense yet? Or have I started making less and less sense, following my hero Zhuāngzi? 

Oscillating between sense and non-sense, let me return to my lovely foggy-soggy walk this morning:

“Clear yáng constitutes Heaven; turbid yīn constitutes Earth. Earth qì, rising up, becomes clouds; Heaven qì, coming down, becomes rain. Rain emanates from Earth qi; clouds emanate from Heaven qì.”

This morning, the day after the autumn equinox, was a beautiful reminder of what struck me as a momentary perfect balance between yin and yang ascending and descending, moving the Earth qì up and bringing Heaven’s qì down in a typical autumn stew of rain and clouds as perhaps only the Oregon rain forest can provide.

This picture shows the fields in the process of being harvested, both by humans, and by the resident elk herd, as evidenced by their tracks. A few minutes later I actually surprised a gorgeous elk cow down the road, another gift of this special morning. The apparent contradiction in the line quoted above can be explained as follows: In general, yáng rises up to Heaven while yīn descends down to Earth. As such, it is the logical result that accumulated yáng is associated with Heaven and accumulated yīn with Earth. Nevertheless, any separation between yīn and yáng, whether in the body or in nature will lead to pathology and eventually to death. The present line hence describes the healthy ideal state of continuous interaction and connection between yīn and yáng, which results from the fact that the process reverses direction as soon as it has reached its peak. When yáng qì has thus ascended to its extreme in the form of clouds, it has to come down as rain, connecting back down to yīn, and when yīn qì has descended to its lowest state in the form of rain, it has to turn around to rise from the Earth as clouds, connecting back up with yáng. In other words, clouds rise up and up and up in a yáng process until they reach a layer of cold that forces them to precipitate down as yīn rain, starting the process anew. We can thus interpret the term “emanate from” here in the sense of “is rooted in.” As the Qīng-period commentator Zhāng Zhìcōng 張志聰 explains, “the interchange between yīn and yáng qì and up and down [and Heaven and Earth] is how the ten thousand things are engendered”「陰陽之氣,上下相交,然後雲行雨施,而化生萬物也。」.

In addition, the picture above reflects a little bit of the bleakness of metal to me, the ruthless harvest in the fall, the season for doling out punishment, engaging in warfare, letting the cutting edgy glare and sharpness of metal shine forth also in the light and service of truth. The season to eliminate extra commitments, issue judgments, and set affairs in order, taking advantage of the pivoting energy before the long cold darkness of winter when we need all our qì to turn inwards and downwards. Continuing on my walk, before encountering the elk cow, I received another reminder of seasonal change:

The geese are flying south, heading out to kinder climates. Perhaps they are smarter than us humans and our fellow permanent plant and animal residents here, who need to get ready for the season of feasting, of putting on fat to make it through ice storms and snow piles by hunkering down, wrapping up, “going into storage” 藏 in the words of the Néijīng, after we have completed “sprouting” 生, “growth” 長, and “harvest” 收. But not for a few more weeks, first there are apples to harvest and cider to make!

The last sign of seasonal change I encountered on my walk were two slugs having intercourse and making babies with lots of foam. Being no great friend of slugs, I spare you the picture. It was a reminder though to arrange for a buck to come visit and breed my goats, at just the perfect time, because I want them to give birth not in the cold of winter, risking a kid freezing to death if I happen to not be there, but when spring pasture is at its juiciest, most verdant and vital and energetic best, so that my ladies can produce the most nutritious milk possible. 

This takes me back to our discussion of change in its various manifestations. I just dropped my only daughter off at college, which to me felt very much like a substantive, irreversible change of the huà variety. Changing from a school girl to a university student is, after all, a gigantic step from which there is no turning back. To both of us, this event clearly belonged to the magnitude of a Kūn fish and Péng bird. From a larger perspective, however, and one that Zhuāngzi would happily endorse, the changes of human life from parents’ intercourse to newborn baby to child to teenager to adult and on to wise old age, decrepitude, and eventual death are all just alterations, fluctuations even, momentary glimpses in the never-ending cycle of life and death and life again. And for this reason, he celebrated the death of his beloved wife not by mourning but by drumming happily, much to the concern of a friend and perhaps, one can imagine, offending the sensibilities of neighbors and relatives. But as he explained to this person, who was he to know whether this change was a good or a bad thing for her? Why would we celebrate entry into this world and body at birth but mourn the departure from here instead of the other way around? Change just is, and most of the time our understanding of it is like that of the frog in the well, lecturing the tadpoles on how advanced his knowledge is. 

And here we can return to Sùwèn 5: “Yáng changes into qì, yīn completes the outer form.” There are so many ways to read such a seemingly simple line and to contemplate the actions and manifestations and resonances of yáng and yīn in the body and the cosmos! I would not have encountered the passing elk cow had I not stopped to admire the geese, which I would not have noticed had I not slowed my walk to take the picture of the rainy foggy Oregon fall stew, which again I would have perhaps not enjoyed so much had I not been working on Sùwèn 5 late the night before. I feel quite fortunate indeed…