Upbearing Clear Yang & Scattering Yin Fire

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal medicine, Li Dong-yuan, yin fire

Over the past 10 years I have come to be known as a proponent of Li Dong-yuan’s yin fire theory, and it is true that I find great clinical significance in the writings and formulas of Li Dong-yuan. However, I am not the only contemporary practitioner of Chinese medicine who finds great value in Li’s yin fire theory. Chinese authors in the People’s Republic of China regularly publish articles on their use of Li’s theories and formulas. As an example of these contemporary Chinese proponents of yin fire theory, I would like to present abstracts of three recently published case histories published by Wang Mao-song in issue #5, 2001 of Shan Xi Zhong Yi (Shanxi Chinese Medicine). The title of the article from which these cases are taken is, “An Examination of Li Dong-yuan’s Method of ‘Upbearing Clear Yang [&] Scattering Yin Fire,’” and it appeared on pages 60-61 of the afore-mentioned journal.

However, before presenting these three case histories, let me first say a few words about yin fire for those who are unfamiliar with this term. Yin fire refers to the pathological manifestations of ministerial or lifegate fire. According to Li, ministerial/lifegate fire is only healthy physiologically as long as it remains ping or level in its lower source. The lower source of ministerial fire is the lower burner, and the Chinese word ping or level has two meanings in this context. The first meaning is that it is calm, that it is not frenetically stirring or hyperactive. The second mean is that it is not counterflowing upward. If ministerial fire becomes hyperactive, frenetically stirs, and counterflows upward, it becomes pathological. Because it arises in the lower burner and because it is a pathological manifestation, Li calls it yin fire. This upward counterflow of ministerial fire may be provoked by a number of disease mechanisms, and I have written and spoken of the five basic mechanisms of yin fire in a number of other places. Here, let Li’s own words suffice as a precis of these mechanisms (from Chapter Two, Book Two, Pi Wei Lun [Treatise on the Spleen & Stomach]):

Dietary irregularity and immoderate [eating] of cold and warm [foods] may damage the spleen and stomach, [while] joy, Anger, worry, and fright may consume and cause detriment to the original qi [here meaning the central qi as the latter heaven origin. If] the spleen and stomach qi becomes decrepit and the original qi becomes insufficient, heart fire may become effulgent on its own. This heart fire is a yin fire. It starts [or rises up] from the lower burner and its ligation links to the heart. The heart does not reign [personally, Rather,] ministerial fire is its deputy. Ministerial fire is the fire of the pericardium developing from the lower burner. It is a foe to the original qi. [This yin] fire and the original qi are mutually irreconcilable. [If] one is victorious, the other must be the loser. [When] spleen and stomach qi becomes vacuous and [their qi] consequently runs down into the kidneys, yin fire is given a chance to overwhelm the earth phase.

Thus, in a nutshell, yin fire is due to spleen-stomach insufficiency with non-upbearing of the clear yang. This non-upbearing of clear yang results instead in a pathological flaming upward of yin fire. Because these type of heat evils are due to non-upbearing of clear yang, the method for clearing them is to “upbear clear yang [and] scatter yin fire.” These are the principles Wang Mao-song is applying in the following three cases.

1. Sjögren’s syndrome

The patient was a 56 year old female who was first examined on Aug. 21, 1997. The woman had suffered from dry mouth and dry eyes for 10 years. Two years ago, tears, saliva, and sweat had become even more scanty. This was accompanied by bodily fatigue, lack of strength, tidal heat, red cheeks, and hot flashes. when these hot flashes occurred, she felt a general malaise and had to eat or drink chilled things or apply cool compresses. For a number of years she had seen both Western and Chinese doctors for treatment and had been diagnosed as suffering from Sjögren’s syndrome. However, neither Chinese nor Western medicines had had any effect. These previous doctors had discriminated her pattern as yin vacuity with internal heat and had treated her with yin-nourishing, heat-clearing medicinals to no effect. Dr. Wang, however, thought the patient suffered from central qi insufficiency with yin fire flaming upward. Therefore, he prescribed the following medicinals based on the above-discussed principles for yin fire: Radix Pseudostellariae Heterophyllae (Tai Zi Shen), 15g, Tuber Ophiopogonis Japonici (Mai Men Dong), 10g, uncooked Radix Rehmanniae (Sheng Di), 20g, Radix Puerariae (Ge Gen), 10g, Rhizoma Cimicifugae (Sheng Ma), 8g, Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 10g, Cortex Phellodendri (Huang Bai), 10g, Radix Scrophulariae Ningpoensis (Xuan Shen), 10g, Herba Dendrobii (Shi Hu), 15g, and Radix Glycyrrhizae (Gan Cao), 5g. After taking 10 ji of these medicinals, the patient reported that she felt psychologically much better and that her dry mouth, eyes, sweating, and tidal heat were all improved. After another 30 ji of the above formula, all her symptoms had disappeared.

It is not that Dr. Wang did not nourish yin or did not clear heat as had the previous physicians. However, on top of those methods, Dr. Wang added fortifying the spleen and upbearing the clear. This upbearing of the clear and scattering of yin fire was accomplished not only by Sheng Ma but also by Ge Gen. By choosing medicinals that accomplish more than a single function, Dr. Wang was able to craft a very elegant and compact formula for this patient’s otherwise recalcitrant condition.

2. Neurologic tinnitus

The patient was a 48 year old female who was first examined on May 14, 1998. The woman had had tinnitus for one year. This had started in one ear but had gradually gotten worse until it occurred in both ears and sounded like cicadas. In addition, her hearing had gotten worse. This was accompanied by dizziness, headache, chest oppression and discomfort. The patient had been diagnosed as suffering from neurologic tinnitus and was treated with a multivitamin, adenosine triphosphate, and blood vessel dilating medicines, however, without result. Initially, Dr. Wang tried treating the patient based on the principles of enriching the kidneys and boosting the essence, assisted by leveling (the liver) and subduing (yang), but this also failed to achieve any positive effect. Therefore, based on the line from the Nei Jing (Inner Classic), “Clear yang issues from the upper orifices,” Dr. Wang decided to try Li Dong-yuan’s method of upbearing yang and scattering fire. Therefore, he prescribed Yi Qi Cong Ming Tang Jia Jian (Boost the Qi & Brighten the Hearing Decoction with Additions & Subtractions). Unfortunately, Dr. Wang does not describe the specific medicinals he employed. However, Li Dong-yuan’s basic formula consists of: Radix Astragali Membranacei (Huang Qi), Radix Glycyrrhizae (Gan Cao), Radix Albus Paeoniae Lactiflorae (Bai Shao), Cortex Phellodendri (Huang Bai), Radix Panacis Ginseng (Ren Shen), Rhizoma Cimicifugae (Sheng Ma), Radix Puerariae (Ge Gen), and Flos Seu Herba Schizonepetae Tenuifoliae (Jing Jie Sui). After taking these medicinals, Dr. Wang says the patient’s tinnitus markedly decreased and that regulating therapy for a month was able to basically cure the woman.

3. Hypertension

The patient was a man of undisclosed age who was first seen on Sept. 22, 1998. The man had had hypertension for 30 years and commonly had headache, dizziness, chest oppression, heart palpitations, insomnia, and impaired memory. He had been treated with Western hypotensive medicines for a long time and his blood pressure had stabilized and would not go below 22-23/12kPa. At the time Dr. Wang examined this patient, all the above symptoms were worse and were accompanied by shortness of breath, chest noises, and nocturnal profuse urination. EKG showed myocardial damage. Physical examination revealed that the man was obese, his tongue tended towards red, the fur was thin and white, and both pulses were bowstring, small, and slippery. Based on these signs and symptoms, Dr. Wang concluded that the clear yang was not being upborne but that vacuity wind was harassing above. Based on that assessment, Dr. Wang prescribed the following medicinals: Radix Pseudostellariae Heterophyllae (Tai Zi Shen), 15g, Radix Astragali Membranacei (Huang Qi), 10g, Radix Puerariae (Ge Gen), 10g, Fructus Tribuli Terrestris (Bai Ji Li), 10g, Rhizoma Gastrodiae Elatae (Tian Ma), 10g, Ramulus Uncariae Cum Uncis (Gou Teng), 15g, Cornu Antelopis Saiga-tatarici (Ling Yang Jiao), 0.3g swallowed with the decoction, Radix Salviae Miltiorrhizae (Dan Shen), 12g, Sclerotium Poriae Cocos (Fu Ling), 10g, Flos Chrysanthemi Morifolii (Ju Hua), 10g, and Radix Albus Paeoniae Lactiflorae (Bai Shao), 10g. After 10 ji of these medicinals, the headache markedly decreased and the blood pressure went down to 20/11kPa. After another 10 ji, the man was able to reduce the dose of his Western hypotensive medicines. On follow-up after an unspecified period of time, his blood pressure was still 20/11kPa. On follow-up in 2001, the man’s blood pressure had still not risen. As Dr. Wang notes, based on yin fire theory, a person can have ascendant liver yang hyperactivity at the same time as clear yang not being upborne. In that case, simply leveling the liver and subduing yang will not result in lowering of the blood pressure.

 Discussion:

In case number one, yin vacuity had given rise to fire effulgence. In cases two and three, there appears to have been yin vacuity which had given rise to either ascendant liver yang hyperactivity or liver wind harassing above. However, there was also a central qi vacuity in all three of these cases with non-upbearing of clear yang. Clinically, when spleen qi vacuity complicates yin vacuity with heat or hyperactivity, we can describe that heat or hyperactivity as yin fire. In that case, not only is it necessary to fortify the spleen and boost the qi, it is also necessary to upbear the clear in order to scatter yin fire. In Chinese medicine, scattering is typically accomplished by acrid, windy natured medicinals, such as Radix Bupleuri (Chai Hu), Rhizoma Cimicifugae (Sheng Ma), Radix Puerariae (Ge Gen), and Radix Platycodi Grandiflori (Jie Geng). Such medicinals tend to come from either the exterior-resolving, qi-rectifying, or wind-treating categories. In reality, scattering yin fire is very similar to out-thrusting depression in the treatment of depressive heat. When these methods are indicated and when the medicinal formula is appropriately crafted with harmonizing agents, not only do they not result in aggravation of counterflow and hyperactivity, but are actually necessary in order to get the right therapeutic effect. I find it interesting that Dr. Wang used Ge Gen in all three cases. Ge Gen upbears clear yang and scatters yin fire. However, because it also engenders fluids, it does not plunder yin the way Chai Hu might. In my experience, Ge Gen is an all too often overlooked Chinese medicinal. It was a favorite of Li Dong-yuan and I believe it deserves to be used more frequently. Qi and yin dual vacuity complicated by liver depression and some sort of heat or hyperactivity are extremely common patterns in our Western patient population, and, as Dr. Wang asserts, for such complex yin fire scenarios, the treatment based on the principles of upbearing clear yang and scattering yin fire often makes the difference between success and failure.  

Copyright © Blue Poppy Press, 2002. All rights reserved.

For more information on the role of yin fire in diagnosis and treatment, see the Blue Poppy Herbs Product Guide or Blue Poppy Institute’s Distance Learning program, Complex Formulas for Complex Patients.