The 6 conformations model describes the dynamics necessary for the healthy physiological function of our body. Each conformation represents a different dynamic, responsible for a wide array of roles.
The core of the 6 conformations model, is embedded in the title of the text, Shang Han Lun – Treatise of Cold Damage. This book is a clinical text, which deals with the different patterns involved in pathological conditions of the body. The title implies, that the cause for the damage is寒hán , translated as “cold”. It is therefore essential to grasp the full scope of the term 寒hán. In the article on the Yang conformations, I discussed the difficulty in translating the term han, since it is a representation of much more than cold. This term is actually a symbolic term representing both pathogenic factors of various natures that damage the body, as well as the damage to the body’s own essential forces:
- “Han” as a symbol of all pathogenic factors, able to disrupt the normal mechanisms of the body. As explained in my article discussing the Yang conformations, “cold” shouldn’t be understood just in the narrow sense of damage caused by cold pathogens, but rather as a representer of all potentially harmful pathogens, including heat and fire.
This meaning of the term relates mainly to pathogenic factors of various nature, affecting the function of the 3 Yang conformations. When there is harm to a Yang conformation, the pathogenic factor (Xie Qi) has caused harm to the dynamics of the conformation but has not weakened the body’s vital Qi (Zheng Qi).
- “Han” as a description of diminished or deficient Zheng Yang, or body vitality and force, making it incapable of performing its normal duties. The body’s vital forces are usually grouped under the general term ‘Yang’ or ‘Zheng Yang’. Zheng Yang is the power, vitality, and potential for building, conserving, protecting and rehabilitating in our body. When the Zheng Yang is hurt, “cold” takes over the body, meaning we have less strength, less vitality, less capability of motion. When the body dies, it is the Yang qualities that leave it completely. It is overcome by Yin qualities, manifesting in complete stillness and cold.
This meaning of the term mainly relates to damage of the 3 Yin conformations. When there is damage in the Yin conformations, there is true weakness and deficiency of vital Qi.
The qualities of Yin conformations
The Tai Yin conformation acts with the strength of the spleen’s organ and channel. It affects the metabolism of nutrients and fluids, the ability to revitalize and replenish our post natal Jing. The Yang of the Tai Yin has the capacity to absorb and build. In order to function properly, it has to have the dynamic mechanism to open towards the more exterior Yang conformations. It opens to the Yang Ming conformation, from which it receives nutrients necessary for production. It opens to all the Yang conformations, to which it supplies the vital substances necessary for each conformation’s function: the Tai Yin conformation continuously replenishes the Wei Qi and Ying Qi needed for the function of the Tai Yang conformation, the bodily fluids necessary for the function of the Yang Ming conformation, and the Qi necessary for the smooth pivot dynamics of the Shao Yang conformation.
According to the Shang Han Lun line 275, the Tai Yin peaks between 9pm and 3am. In this time, the sun has already set, and the world changes from a state of alertness and activity to a state of renewal and regrowth. Interestingly, we can compare these hours to the hours when the growth hormone is secreted. Growth hormone maintains a significant role in repairing damage and restoring health to the body. The secretion of growth hormone reaches its peak between 10pm and 2am. Sleep during those hours is very important, to allow the body to regenerate fully.
In Tai Yin hours, the sun has already set, and the world isn’t affected directly by its warmth or light, but the heat is still felt in the depths, and so the Yang quality of the Yang Ming conformation continues to affect inwardly on the Tai Yin, supplying it with the Yang needed to transform, build and transport the nutrients necessary for maintaining or restoring health.
The general framework of Tai Yin pathology is described in line 273 of the Shang Han Lun:
“In disease of greater Yin, (there is) abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain, and if precipitation is used, there will be a hard bind below the chest”
(tr. Feng Ye, et al)
This line describes a spleen Qi or spleen Yang deficiency, with damage to transformation and transportation function, damage to the regulation of the up-down flow in the middle Jiao, and accumulation of cold and dampness internally.
Spleen deficiency with damage to the transformation and transportation function presents as abdominal distention, lack of appetite, and diarrhea. This can lead to cold and dampness accumulation, blocking the flow of Qi, and to sensations of heaviness and stagnation in the stomach, alternating stomach ache, with a need for heat and touch.
Line 277 clarifies further the deficient cold diagnosis:
“when (there is) spontaneous diarrhea and thirst is absent, this belongs to greater Yin disease, because (there is) cold in the storehouse, one should use a warming (treatment)”
(tr. Feng Ye, et al)
When a Tai Yin pathology is present, the body loses the ability to absorb nutrients internally. This is usually related to digestive and metabolic functions. However, the Tai Yin conformation has an “opening” quality, whose importance goes far beyond digestive functions. It allows a healthy appetite for both the physical and the emotional abundance of the world. Stemming from this opening quality, is the ability to gain knowledge, to be inspired, to appreciate and enjoy the experiences of life through our senses and our intellect. When it is damaged, we will see a tendency to close down, a rejection of physical and mental stimuli, accompanied by an increasing weakness.
The Shao Yin acts with the strength of the heart and kidney organs and channels. These are the organs responsible for the deepest functionality, related to our potential and the genetic expression embedded in the Jing, and to the relationship between body and spirit, which is at the core of basic functions of the body.
The name – Shao Yin – little Yin, describes the quality of the conformation. While the Tai Yin (large Yin) deals with the raw material used as the building blocks of the body, providing for its daily needs, the Shao Yin deals with the delicate substances, and most basic processes needed for our existence. The Shao Yin functions in the deep and hidden realms of the body. In order for Shao Yin to function properly, it needs to be protected from the ongoing changes of the external world, that might easily throw these delicate processes out of balance.
The conformation peaks between 11pm and 5am (stated in line 291 of the text). These are the dark, quiet hours of the day, when all sensory stimuli are brought to a minimum. As this conformation deals with the basic functions of life and existence, pathology in the Shao Yin conformation is usually related to irreparable damage to tissues or functions, to incurable diseases, and to the terminal stage of illness.
The general framework of Shao Yin pathology appears in line 281:
“in disease of the lesser Yin, the pulse is faint and fine, and there is a desire only to sleep”
(tr. Feng Ye, et al)
Faint and fine (weak and thin) pulse points to Yin, blood, and Yang deficiency. Thin pulse relates to Yin and blood, and weak to Yang deficiency. Since faint is mentioned first, many believe that Yang deficiency is described here as the major aspect of the pathology.
Desire only to sleep describes both a physical and an emotional state where there is no interest in anything happening outside the body. This can also mean damage to consciousness. This can be an indication of severe deficiency in the nourishment of the spirit (Shen). This line outlines a general description of a condition with great deficiency, leading to diminishing Yang – the flame is burning out.
The Jue Yin acts with the strength of the liver and pericardium organs and channels. It is mostly connected with the nature of the liver organ, responsible for keeping the balance between holding and releasing, storing and distributing. It deals with the functions of blood and the kidney fire – Xiang Huo. The conformation’s dynamics have the quality of change between two poles, between the Yin of converging inwards, accumulating, and renewal, and the Yang of acting, moving, and spreading outwards.
The meaning of Jue (厥 jué) is extreme, suggesting the Yin energy has reached its extreme state, where Yang can now begin to grow from it. The conformation peaks between 1am and 7am (line 328 in the text). These hours illustrate well the dynamic quality of Jue Yin – starting at 1am, when Yang is fully immersed in Yin, the world is at peace and dark, but ending at 7am when Yang emerges with sunrise. This image of Yang emerging out of Yin is prevalent in western culture as well (e.g. always darkest before dawn, the quiet before the storm, etc.).
The Jue Yin conformation is the driving force behind the cyclic movement in our body. If after the exhale we don’t inhale, it means we’re dead. It is Jue Yin that gives us the initial drive for the inhale after the exhale, just as it brings the spring after the winter and the sunrise out of the night. There are numerous cycles in the body, examples include the cyclic flow of Qi, the circulation of blood, the daily and monthly biological cycles. These cycles in the body are of great importance to maintaining health, adaption abilities, and rehabilitation processes.
A Jue Yin pathology will manifest as extreme changes between the two polarities – hot and cold, excess and deficiency, Yin and Yang. The main characteristic of the pathology is the lack of balance and regulation, the lack of the normal cyclic rhythm of the body. This is a dynamic where the forces of Yin and Yang no longer cooperate, but rather fight each other, throwing the control from one pole to another. As a result, in Jue Yin pathology, there isn’t a single clear symptom, no specific syndrome, and no single treatment strategy. When there is heat, we cool; when there is cold, we heat; when there is deficiency, we tonify; and when there is excess we disperse. Often, all treatments are needed simultaneously.
There is a tendency to think that all Jue Yin pathologies are fatal. Jue Yin pathology can indeed lead to a terminal disease, but only if the struggle between Yin and Yang leads to a Shao Yin conformation deficiency. In fact, many Jue Yin pathologies are long-term chronic conditions, significantly affecting the quality of life, but not necessarily the patient’s lifespan.
The general framework of the pathology is described in line 326:
“in disease of the reverting Yin, there is dispersion thirst, Qi surging upward to the heart, pain and heat in the heart, hunger with no desire to eat, vomiting of mud-worms after eating, and if precipitation is used (there will be) incessant diarrhea”
(tr. Feng Ye, et al)
This line does not describe the exhaustion of Yin or Yang, but rather sever stagnation, prohibiting any smooth flow or normal body cycles. We see a condition of chaos and no control over the bodily systems, with unregulated physiological manifestations. In this specific case a syndrome of heat above and cold below is described. Vomiting mud-worms signifies the existence of both heat and cold in the body: since worms seek heat and avoid cold, when heat is above and cold is below, the worms escape upwards, causing the vomiting. Mud-worms are not crucial to the diagnosis, they are an illustration of the effect of a hot/cold struggle in the body.
The Jue Yin chapter describes many additional types of Jue Yin pathologies, illustrating a wide diversity of clinical manifestations. The characteristic common to all of them is the disconnection and struggle between Yin and Yang forces in the body. This is summed best in line 337:
“in all reversal (Jue) (patterns), Yin and Yang are not connected smoothly, which means reversal (Jue)”
(tr. Feng Ye, et al)
The combination of the 3 Yin conformations
The relationship between the 3 Yin conformations is illustrated through their peak hours:
Tai Yin: 21:00 to 3:00
Shao Yin: 23:00 to 5:00
Jue Yin: 1:00 to 7:00
There is an overlap:
Both Tai Yin and Shao Yin are at their peak between the hours of 23:00 to 3:00
Both Shao Yin and Jue Yin are at their peak between the hours of 1:00 to 5:00
All 3 Yin conformations are at their peak between the hours of 1:00 to 3:00
This overlap does not exist with the Yang conformations.
In my opinion, this overlap is significant in the understanding of diagnosis and treatment of the Yin conformations. Once there is true deficiency, it is often difficult to reach a definitive diagnosis, as deficiency in one conformation is bound to have an effect on another conformation. In addition, each conformation is dependent on the others, so while treating one conformation, we will need to consider how we can engage the other two for the benefit of the overall function of the Yin conformations.
In the words of the Nei Jing, Su Wen ch. 6:
“These three Yin cannot lose each other. If they beat, but not in the depth, this is called one Yin”
(Translated by Paul U. Unschuld and Hermann Tessenow)
— Translated from Hebrew by Ariel Levental —