As we continue this blog series on Yin Deficiency (with Heat), I want to make clear that the description of Heat hereby discussed is confined to the organic pattern of Heat and not the description of the external contraction of Heat in terms of communicable bacterial and viral diseases. This was developed by Ye Tian Xi (17th century) with the Four Levels of warm disease. There is a similarity between the two types of Heat but the greatest difference is that warm disease (Wen Bing) occurs as a result of an externally contracted pathogen while the category of Heat described here is one that develops from diet, stress and lifestyle.
Linear or goal-oriented thought processes are usually the basis of Western thought and medical science, but Traditional Chinese Medicine is much more complex. It is based on a circular understanding of the universe where everything returns to its source before manifesting once again.
Yin and Yang, a nutshell description of what Western physiology calls “homeostasis,” is the basis for all manifestation. Yin Deficiency is a progression were an excess leads to deficiency and deficiency leads to excess.
Yin Deficiency in the body can occur for years before giving rise to Empty Heat. In my experience, many of the strange symptoms people sometimes have that can’t be explained by any known pathology, such as a strange itch or rash on one part of the body, a sensitivity to smell, foods, allergies, are possible signs of Yin Deficiency. Some of these symptoms may be Empty Heat signs and not receptive to the same kind of Heat-clearing and/or anti-inflammatories as Full or Excess Heat.
In fact, they are impossible to fully resolve without addressing the underlying Yin Deficiency, which must be treated with Yin-nourishing and Deficient Heat-clearing herbs.
Before one can treat Yin Deficiency with herbs, it is first necessary to identify which herbs ‘nourish Yin.’ Unfortunately thinking in terms of Western herbalism where such concepts are foreign makes it more difficult to identify an herb that can be used as a Yin Tonic. However, considering that Yin tonics are lubricating and cooling (anti-inflammatory), oils such as fish liver oils, olive oil, borage seed or evening primrose oil could be considered a Yin tonic in a treatment protocol. Or one might prescribe aloe vera gel. Perhaps herbs such as comfrey, slippery elm and marshmallow root would have some cooling demulcent Yin tonic properties. These would be combined with certain mild Heat-clearing herbs including dandelion and/or burdock root – that is, herbs that clear Heat but add substance.
Concomitantly we also need to know which herbs deplete Yin. Obviously if the body is over-amped and in burnout mode, coffee, cayenne pepper and other stimulants would be contraindicated. Herbs that actively promote detoxification and elimination such as all the laxative herbs and strong liver-detoxifying cholagogues would also be contraindicated. However, milk thistle seed containing 70% silymarin has some nutritive and nourishing properties so that it could definitely be indicated for Yin Deficiency.
In Ayurveda we look to herbs such as aloe vera and shatavari (wild asparagus root), Amla fruit, possibly shilajit (although warm) as Yin tonics combined with Heat-clearing detoxifying herbs such as guduchi (Tinospora cordifolia).
The major Chinese formula for Yin Deficiency is Zhi Bai di Huang (Anemarrhena and Phellodendron Combination, see formula below), which is available in pill or other forms. To nourish the weakened organ and clear Deficient Heat requires herbs such as Moutan peony (mu dan pi), anemarrhena (zhi mu), phellodendron tree bark (huang bai), and others that may be used.
In the body, there is a pattern of Yin Deficiency without Empty Heat, and one with Empty Heat for every organ which in Traditional Chinese Medicine means the Heart, Spleen, Stomach, Lungs, Kidneys and Liver. Herbs for treating Yin Deficiency are sweet, cool and moist while those that clear Empty Heat, which in excess would be called Yin Fire, are bitter and cold such as coptis and goldenseal. As previously described many times Yin Tonic and Deficiency Heat-clearing herbs are combined.
This is not the time and space to go more thoroughly describing all the different manifestations of Heat in Traditional Chinese Medicine but following is a list from Maciocia’s book “Clinical Pearls”:
- Excess or Full Heat
- Heat from Qi stagnation
- Empty or Deficient Heat
- A distinction between Heat and Fire
- Latent Heat
- Yin Fire
The inspiration for this article was derived from Maciocia’s book and for those who want a more in depth discussion based on TCM principles I highly recommend the article in his book. He also offers a number of wonderful formulas corresponding to each of the above imbalances.
The Causes of Heat
Excess or Full Heat is the same as “Wind Heat,” as opposed to Deficient or Empty Heat.
Yin Deficiency Heat
As stated, the major cause of Yin Deficiency is overwork without adequate rest. This burns out Yin and causes Yin Deficiency with symptoms of Dryness and Heat. This in turn gives rise to symptoms of Empty (or False) Heat.
Full or Wind Heat
All emotions lead to Heat. Thus a red-tipped tongue is the most reliable indicator of emotional stress.
Emotions, Stress and Qi Stagnation
Traditional Chinese Medicine posits seven emotions and each of these relates to one or more of the internal organs outlined in the Five Elements. Different exponents might describe these differently but the most important thing is to understand each emotion in excess can cause Qi Stagnation leading to Excess Heat and when this becomes more than our body can deal with, Yin Deficiency with Empty Heat symptoms occur.
Diet and Drinks
Excessive consumption of alcohol is a major source of Heat and the higher the alcohol content the more Heat it can cause. All kinds of meat are hot (or warm) but especially lamb and beef. All wild game with the exception of fish is hot. Finally, most spices are hot, including peppers, ginger, cumin, cloves, cinnamon, etc.
Environmental and Dietary Toxins
Toxins taken from food, drink and the environment which the body is unable to neutralize and discharge are a major cause of Heat. Symptoms corresponding to the internal organs leads us to what herbs to use to discharge or eliminate this Heat.
External Pathogenic factors penetrating to the Interior
Any external factor that is not expelled at the external stage and penetrates to the interior can change to Heat. Thus even Wind-Cold conditions not expelled from the surface through diaphoresis will change to Heat.
For example, a cold or flu not discharged via sweating can penetrate to the bronchioles or lungs causing bronchitis or pneumonia. This will happen if the symptoms are suppressed with fever-reducing drugs or antibiotics, for instance. We also might consider the phenomenon of Lyme disease or any feverish condition which starts out on the surface and penetrates and becomes internal Heat with a variety of debilitating symptoms manifesting in the joints and internal organs causing chronic fatigue and joint pains to be another example of this process.
The point to understand here is that pathogenic Heat, which in Western and Ayurvedic herbal medicine is largely considered a form of toxicity, is seen by Chinese medical theory as being caused by Qi Stagnation.
Yin Deficiency generates Heat caused by weakness and over taxation. Yin Deficiency gives rise to “empty or false” Heat (true Heat being Excess Heat).
Following are two representative TCM formulas for Yin Deficiency and Yin Deficiency with Empty Heat:
Liu Wei Di Huang Wan – Rehmannia Six For Kidney Yin Deficiency
Prepared Rehmannia glutinosa (Shu di huang) – 20-25g
Cornus berries (Shan Zhu Yu) – 10-15g
Dioscorea batata (Shan Yao) 10-15g
Alisma (Zi Xie) – 9-12g
Moutan peony (Mu dan pi) – 6-9g
Poria mushroom (Fu ling) - 9-12g
Prepared Rehmannia nourishes Yin, Jing and Blood
Cornus Berries nourish Liver and Kidney
Dioscorea tonifies the Spleen and Kidney
Alisma sedates the Kidney and causes turbidity to descend (diuretic)
Moutan sedates deficiency fire of the Liver
Fu Ling strengthens the Spleen and resolves dampness
The formula for Yin Deficiency with Heat (Zhi Bai Di Huang Wan) is the same with the addition of the Deficient Heat Clearing herbs
Anemarrhena (Zhi mu) – 6-9g
Phellodendron tree bark (Huang Bai) 6-9g
Both of these clear deficient Heat.
Portions or this article were inspired, extracted and paraphrased from Clinical Pearls by Giovanni Maciocia, one of the most highly respected practitioners of acupuncture and Chinese herbal medicine in Europe. Any errors uncovered in the text would be my own. Giovanni has an online education program here.