This is part 12 of a series about the use of the Yijing in clinical practice of Chinese medicine.
With this post we delve, at last, into clinical use of the Yijing.
What we’d like to be able to do is to speak with the Yi about clinical cases: who wouldn’t want the input of the Heavenly Sage while composing an herbal formula or deciding on a treatment plan?
But it’s important to acknowledge that if we simply ask the oracle ‘what’s the diagnosis’ or ‘what’s troubling this person?’, the oracle may not answer in a straightforward way. If we’re cutting corners, for example, we may get told off (Hexagram 4 being the classic put-you-in-your-place response.) It’s important to recognize that the Yi, a vital intelligence, has its own agenda.
It’s essential to listen to what it’s actually telling us, even if it’s not what we want to hear.
That’s the deal. We get access to wisdom, but that wisdom is double-edged. It demands that we conduct ourselves in certain ways, and if we’re not doing out work we can be sure the Yi will let us know.
That said, provided we’re doing our part, the oracle can and often will provide answers to the questions we mere mortals think to pose.
Say you’re in the clinic, stumped by a particular case.
Does the Liver qi stagnation or the blood stasis deserve more attention? Is there more excess or deficiency at play? You decide to ask the Yi what’s going on.
Suppose you get this response: Hexagram 28 —> Hexagram 29.
What is the oracle saying here? Briefly, Hexagram 28 Da Guo has the image of a roof beam bending under a heavy load. Da Guo’s all about excess. Sounds like Chinese Medicine speak to me.
Hexagram 29 Kan is composed of the trigram Kan doubled. So the hexagram’s meaning is essentially that of the trigram Kan. That means Water, and all the qualities that resonate with Water. North. Black. Cold. Winter. Salt.
The diagnosis, then, is that this person has excess in the water realm.
This could mean a number of things. Perhaps there’s strain on the kidney system from eating too much salt. Perhaps they’re constricted from fear (the emotion associated with water). Water here could also mean a bodily substance that’s congealed or hardened, turned to ‘ice,’ not flowing.
Whatever the case may be, we’ve narrowed things down to excess and the kidneys/north. We know we probably need to warm things up, melt stagnation and encourage flow. The broad-strokes treatment direction is established. The context will help us figure out the rest.
Another example: How about Hexagram 2 and Hexagram 9?
Hexagram 2 is Kun: pure yin, also earth, and also the triple warmer organ network. There’s almost too much to work with. Hexagram 9 is Xiao Xu, “minor force,” more or less the opposite of 28 above. Here the problem is not excess but insufficiency, or deficiency. So a reading of 2 – 19 might mean “yin deficiency,” “lack of grounding,” “insufficient triple warmer function” and so forth. As always, it depends on context.
Another example: Hexagrams 39 and 44
39 is about being stuck somewhere tough, ‘between a rock and a hard place’. Hexagram 44 is the tidal hexagram that corresponds to the Heart. So this combination could refer to a spiritual crisis, or to an obstruction in the Heart channel or zang. Phlegm misting the orifices, perhaps.
For practice, it’s well worth translating TCM and CCM patterns back into hexagram language as well. For example, how would you express “Liver yang rising” in hexagram form? Acupoints, herbs, formulas and diseases are all fair game, too.
Before we play this game, it helps to have the building blocks in view. We need to know individual hexagrams well enough just to get started.
First off, the 12 organ networks of Chinese Medicine correspond to the 12 ‘tidal’ hexagrams according to the ‘organ clock’ or ‘tidal flow chart’ (see classicalchinesemedicine.org for the map). This is a study in itself, and a deep one.
For reference, here are the correspondences:
- Lung: Hexagram 11 Tai
- Large Intestine: Hexagram 34 Da Zhuang
- Stomach: Hexagram 43 Guai
- Spleen: Hexagram 1 Qian
- Heart: Hexagram 44 Gou
- Small Intestine: Hexagram 33 Dun
- Bladder: Hexagram 12 Pi
- Kidney: Hexagram 20 Guan
- Pericardium: Hexagram 23 Bo
- Triple Warmer: Hexagram 2 Kun
- Gallbladder: Hexagram 24 Fu
- Liver: Hexagram 19 Lin
These are obviously key hexagrams for medical use
Beyond the tidal hexagrams, I have found that about half of the remaining hexagrams have direct or obvious medical relevance. What follows is a partial glossary, from Hexagram 1 to Hexagram 64.
- In general, Hexagrams 1 Qian and 2 Kun represent yang and yin, respectively, as well as heaven and earth. This is in addition to their specialized correspondences to Spleen and Triple Warmer.
- Hexagram 3 Zhun: conception. The very beginning of any process, including the inception of a given treatment.
- Hexagram 6 Song hands us ‘counterflow’ on a silver platter. A very medically relevant hexagram.
- Hexagram 9 easily suggests insufficiency or deficiency (xu).
- Hexagram 11: not just the Lung, but a state of harmony and balance more generally. A symbol of good health (see also Hexagram 63). Can simply mean “yes” or favorable.
- Hexagram 12 Pi: not only the Bladder, but also means blockage or obstruction more generally. Can simply mean “no” or unfavorable.
- Hexagram 18 Gu. This one’s a can of worms—literally. See Heiner Fruehauf’s original Gu article and print interview on classicalchinesemedicine.org for an introduction.
- Hexagram 21 Shihe. Strong medicine, drastic measures. Shock therapy.
- Hexagram 27 Yi is a picture of a mouth or jaws. Its purview includes matters of nutrition and diet, as well as speech. In other words, it covers what goes in our mouths and what comes out of them.
- Hexagram 28 Daguo. A state of excess or strain.
- Hexagram 40 Jie has the sense of ‘releasing’ or ‘untying’ and is a nice image for what often happens in a successful treatment. Softening, easing Baishao might be the representative herb for Jie.
- Hexagram 41 Yi means ‘increase’ or ‘more.’ A very straightforward, useful symbol.
- Hexagram 42 Sun means ‘decrease’ or ‘less.’ It can also refer to an offering (a pouring out or emptying). In traditional context the Yi would have been prescribing offerings constantly.
- Hexagram 47 Kun means ‘oppression,’ ‘entrapment’ or ‘constraint.’ Lack of free flow. Stasis and stagnation (of qi or blood) go here. (Very severe stasis might be represented by Hexagram 12 Pi.)
- Hexagram 36 Mingyi is a beautiful portrait of the digestive fire or spleen yang: fire within the earth. This hexagram was explored in depth in an earlier post.
- Hexagram 57 Xun: Wind/Wood. Subtle processes. Yin wood.
- Hexagram 60 Jie: structure, limitations, ends. Extremities, joints.
- Hexagram 61 Zhongfu: the middle, as in middle burner. Also marrow or essence (see Jing, below)
- Hexagram 63 Jiji: completion, harmonization, state of integration. Health.
- Hexagram 64 Weiji: non-completion, disintegration, disorder.
- As you can see, the Yi is a natural fit with Chinese medicine, and this is of course no accident. Actually, I’d argue the Yi is more than just a good fit: its 64 symbols hold the keys to the medicine.
Nevertheless, there may be some medically important concepts that don’t have obvious one-to-one hexagram correspondences
Blood, for example, or phlegm. These things can be expressed, but there’s no one hexagram that rings the bell (at least for me, in my experience so far). These make good exercises, then.
How might you express the following CM terms, in as few hexagrams as possible? (Possible answers coming next time.)
- Guizhi Tang
- The point Spleen 2
- Mahuang Tang
- Banxia Houpo Tang
- Wind-Damp Bi Syndrome
A trick: when you get stumped, you can always ask the Yi how it would describe a given substance, or disease, or whatever.
In other words, the Yijing itself can tutor you in Yijing. For example, I once asked for a description of coffee’s effects. The answer was just one hexagram: Hexagram 21, Shihe, Thunder below Fire. Fire represents shen, the mind or spirit; while Thunder represents a vigorous, stimulating influence. Thunder in the mind sounds about right!
I’ve presented a great deal here, so don’t be discouraged if it seems overwhelming.
This is not material to be memorized; rather these are intended as examples of how to think about and work with the Yi, how to get on the oracle’s wavelength so some interesting conversations can unfold.
When in doubt, go back to the basics. Above all, don’t by shy about flipping some coins and asking the Yi itself to help get you unstuck.