Recently I had an experience with someone that reminded me again about the major tenet of TCM ‘treat the person and not the condition.’ While to our students and TCM practitioners this may seem obvious, it’s also very easy to fall into a simplistic mode of ‘this for that,’ even when following energetic practices.
I was treating someone with a Yin Deficiency condition coupled with co-existing Phlegm, which can be quite a tricky situation, let me tell you! Yin Deficiency presents with signs of deficient Fluids and Empty Heat such as night sweats, malar flush (redness and burning heat along the cheeks and nose), burning sensation in the palms of the hands, soles of the feet and in the chest, afternoon fever or feelings of heat, restless sleep, dry throat or thirst at night, agitation, mental restlessness, dry cough, dry stools, and scanty dark urine.
Now how can someone with deficient Fluids also have Phlegm? One is a condition of lack of Fluids while the other is Excess Fluids. Can this occur simultaneously? Definitely.
In truth, this is not that unusual a combination, particularly today with so many dietary indiscretions and diet fads over time. It’s not just the excessive intake of cold drinks, milk out of the fridge and ice cream that cause Dampness, for instance, but also the excessive intake of raw foods, salads, juices and insufficient protein that can lead to the formation of Dampness. Then all it takes is insufficient activity, or excessive activity and insufficient rest, for Heat to congeal that Dampness into Phlegm.
Further, Dampness can co-exist with Phlegm. Hey, why not have a party with all these factors together? It’s never just one or the other; as conditions tend to arise from the development of several imbalances over time, they shift and change and invite more guests.
So back to how I was reminded once again to treat the person, not the disease.
Typically when one develops Yin Deficiency and Phlegm one needs to tonify Yin at the same time as clear Phlegm (and possibly Damp Cold or Damp Heat). So far so good. But what Phlegm-clearing herbs don’t injure the Yin? There’s fritillary, loquat and tricosanthes of course. But what about the Damp Cold? Pinellia is generally the herb of choice, but excessive amounts can injure the Yin. I had worked with all of these approaches and yet the balancing act was too fine a line to tread.
So I re-examined the tongue and yes, it was still a little swollen with no coat and some Liver-Heart Heat, cracks in the Lung and Stomach areas and Kidney Deficiency. Then I zoomed in on the cracks.
Of course! The Yin Deficiency was predominant and I suddenly knew the perfect herb: ophiopogon. This Stomach/Lung/Liver Yin tonic not only moistens Yin and clears fevers, but it also clears Heat. Taking just his single herb achieved the task of several others. Because it cleared Heat in the Phlegm, it loosened the Phlegm so it could be expectorated. At the same time, the depleted Yin energies were nourished. Voila! The result was not only less Dampness, but also the tongue was less swollen and the cracks were nearly gone.
Here the Yin Deficiency Empty Heat had dried the Fluids to help congeal the Damp to Phlegm. By clearing that Heat, the Phlegm could loosen, preventing further congealing of Dampness and nourishing the Yin at the same time.
What a great reminder to pay attention to the underlying condition and not forget the host of the party (the underlying Yin Deficiency) rather than just pay attention to all the guests (the Phlegm and Dampness). The art of herbalism is finding the perfect herb for each condition. If it can be done with a single herb, or even just two, that’s perfect.