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Clarity and Confusion

May 8, 2017
dewdrop on a leaf
Clear as a dewdrop

Clarity of Mind

Clarity of mind, of spirit, even a clear-and-lightness of our bodies, is a necessary prerequisite for peace, for joy, for committed and effective engagement with others, with the world, and especially with our own lives.


In the tradition of medicine I study, one of the principle pathogenic factors is translated as “Dampness.” In many cases, this can be understood as bodily fluids that no longer serve healthy physiological function – think of edema, painful swellings, over-production of mucus, and even the accumulation of adipose tissue. In East Asian medical terms, these could all be examples of “Dampness.” The mechanism is reasonably straightforward in many cases, though of course extraordinarily complex in others. A broad outline of one type of Dampness is as follows: Heat in the form of inflammation occurs somewhere in the body; this is not a problem as such, there are many benefits to inflammation in normal circumstances, as the environment produced by inflammation (higher temperatures, increased number of WBCs in the area, etc) is not an easy one for bacteria and other small invaders to live in, and as such, a traumatized area can be protected. The body of course sends fluids to a traumatized area as well, a “yin” function to protect and nourish a traumatized area, especially to balance the “yang” function of the physiological heat being produced at a site. However, in many cases inflammation becomes chronic. The source of the Heat does not abate – some underlying or hidden factor continues to exacerbate an existing problem, or recreate the same problem repeatedly, such that the inflammation-Heat complex never really subsides. The body continues, quite naturally, to send fluids to the area to try to balance this. Unfortunately however, local and capillary bed circulation have often been damaged by whatever trauma occurred, or have been occluded to some degree by the swelling, Heat, and waste products of metabolizing local infections. The local circulation is not able to pull the fluids back out of the tissues, and the fluid is no longer available to be pulled back into the capillary beds by osmotic pressures – there is too much fluid and nowhere for it to go. This leads to a cyclic production, where the stagnant fluid combined with the initial cause of the inflammation lead to further heat, further inflammation, and more fluid. It can be difficult to get this kind of swelling under control without intervention.

Phlegm Misting

Lately, however, I have begun to think about what this might mean from a psycho-emotional perspective. East Asian medical thought describes a phenomena called “Phlegm Misting the Orifices of the Heart.” Phlegm, for the purposes of this brief essay, can be understood on a spectrum with Dampness, albeit more severe and more pathological. The Heart, in this construct, is taken to be related to the Shen, or the clear-minded spirit of awareness. In effect, this pattern describes a clouding of one’s mental clarity by a kind of confused, almost slippery irregularity of thinking and behaving. There are many different manifestations of this pattern, but I have been attempting to understand how this pathodynamic might occur in the first place. While this does not hold for all expressions of “Phlegm-Misting”, I have begun to consider, and operate with as a working hypothesis in my clinic, that for some kinds of anxiety, anger, and confusion, there is a similar emotional patho-mechanism at work as described above for inflammation.

Many forms of anxiety, and certainly of anger, can be understood as Heat out of place. An agitated mind, the inability for thoughts to rest but instead rushing about, driving one to distraction, always catching at the next thing, or unable to let go of the last, spun up and unrelenting – just a few ways to describe this kind of anxiety as a form of Heat. According to an Eight Principle Pattern diagnosis, this kind of Heat is more often from a Yin deficiency (an inability to rest) and so is not a true, excess, robust Heat, it nevertheless can be severely agitating, distressing, and even incapacitating. Anger is a more common expression of excess Heat, in an emotional sense – overflowing, burning, intense, with the threat of flashing out of control.

Regardless of its excess or deficient nature, the body/mind, if it has the resources available, will attempt to cool this kind of Heat by sending a Yin substance to this emotional expression – it will attempt to send emotional calm, stillness, peace, rest. This is a natural reaction, and a healthy one. The difficulty arises when the source of the agitation is not able to be resolved, whether an external stressor or an interior psychological or behavioral pattern. The Heat continues to come, despite the coolness of the calm that the body/mind attempt to reorient themselves to. In effect, the normal “fluids” of emotional calm become pathological Damp, in a psycho-emotional sense, as the “emotional inflammation” of anxiety-or-anger-Heat continues to build. This Dampness begins to cloud thinking. Rather than putting out the Heat and soothing the frazzled nerves, instead it becomes a kind of confusion, a clouding of clarity. It begins to be like murky, stagnant water, where we are unable to determine what is real from what is not. The calm that should quiet the anger or anxiety simply dampens our ability to connect with our real experience of our emotions, ultimately spreading beyond dampening just the anger or anxiety, to becoming a clouding and muting of our whole emotional life.


While of course each case is different, the dual strategies of Clearing Damp and Heat (whether one must Dry, Drain, or Transform Damp tends to be specific to the patient) form the foundation of any chance of a successful treatment. To find our way back to clarity we must find a way to remove Heat, while simultaneously removing the Damp, without doing either one too drastically. The subtly powerful aspect of this medicine is to recognize at every moment, with every patient, that they are working toward some kind of homeostasis. However pathological, there is a reason that they present as they do. If we simply clear away the Heat, the Damp will overwhelm – this could lead to a deep depression, even some kinds of markedly dissociative behavior, as their clarity becomes completely overwhelmed. Similarly though, if we strip away the barriers of Damp that have been accumulated, the raw Heat that they have been dealing with could burn right through them. Consider that anger is often a meaningful and normal response to trauma, especially in terms of emotional, physical, and sexual abuse, or other situations of marked and even radical injustice. To approach that hurt, and the Heat it generates, without the emotional “yin” of calm and peace – even if mildly pathological as Damp from time to time – could be so destabilizing that we actually cause far more harm than help. As such, we work in the clinic to approach both of these simultaneously, while also working with the patient to help them find emotional tools, relationship tools, and even breathing techniques that will help them work both toward their own clarity, and toward being able to look directly at some kinds of particularly difficult hurt.

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