Look for my review of Afterglow: Ministerial Fire and Chinese Ecological Medicine, by author Zev Rosenberg, in the current issue of the Journal of Chinese Medicine.

Z’ev Rosenberg’s Afterglow: Ministerial Fire and Chinese Ecological Medicine is his third book in a series of texts designed to distill foundational concepts embedded within classical Chinese medical texts. Readers familiar with his first two entries in the series will recognise similar themes of ecological holism, ministerial fire and vessel dynamics. Afterglow expands upon Ripples in the Flow Chapter 7, entitled Mìngmén Dynamics and Severance of the Vessels, to provide a comprehensive overview of yang qi dynamics (陽氣機 yáng qì jī) and the movement of heat qi (熱氣 rè qì) through the six divisions of the three yin and three yang channel system (三陰三陽 sān yīn sān yáng). Rosenberg discusses the idea of ministerial fire (相火 xiāng huǒ) in various historical periods and why it is critical to understanding immunity in terms of classical Chinese medicine. Drawing upon the model of the body as an ecosystem, a central theme in his second text entitled Returning to the Source, Rosenberg further describes how the circulation of heat and water in the environment mirrors that of defense qi (衛氣 wèi qì) and construction qi (營氣 yíng qì) in the human body. I found his writing style refreshingly accessible, and his discussion on the movement of ministerial fire through the sān yīn sān yáng is exacting and clinically coherent. I also particularly enjoyed his emphasis on ecological holism and its relationship to xiāng 相 (each other/minister), wherein he reveals what it means to be ministerial and how mutual interdependence is a core concept in Chinese philosophy and medicine.

Afterglow is a book of essential principles designed to serve clinicians of Chinese medicine by clarifying the nature of yang qi dynamics and when to enrich yin, supplement yang and clear heat. Rosenberg differentiates between the physiological functions of sovereign fire (君火 jūn huǒ) and ministerial fire, then outlines how the latter relates to qi transformation theory (氣化學說 qì huà xuéshuō) and sustaining wèi qì and yíng qì that ‘serve as the main functional qi responsible for maintaining immunity’ (p.26). In addition, he devotes a chapter to the nature of source qi (元氣 yuán qì) that underlies all other substances and functions in the human organism, including articulating its relationship to ministerial fire and channel qi (經氣 jīng qì), blood (血 xuè) and essence (精 jīng). Rosenberg’s succinct style brings coherence to this otherwise extensive subject, helping readers recognize and implement these thermodynamic principles in a clinical setting.

Chapter 1 begins with the subject of ecological-medical holism, one of the two principal models of the body in the Huang Di nei jing, as exemplified in Ling shu Chapter 71, Evil Visitors (邪客 Xié kè). In this model, humans and their environment are conceived as holographic projections of one another: the human body mirrors the timing and structures of heaven and earth (天地 tiān dì), and vice versa; the earth is conscious and composed of systems that parallel the components of a human body, such as mountains as bones and aquifers as veins. The author describes how humans and the natural world are complex systems that operate according to the same principles of yin-yang and the five phases and six qi (陰陽, 五運六氣 yīn yáng, wǔ yùn liù qì). He states that ‘human life resonates with earth qi’ (p. 30), and as a result, whatever affects the health of one also affects the other. Rosenberg outlines in Chinese philosophical and medical terms how environmental upheaval and climate change impact human health and create pandemics, providing a clear outline of how and why physicians of Chinese medicine are obliged to apply the principles of yin-yang and the five phases to the whole of human existence, including its ecological, social, and medical needs.

Chapter 2 moves from the macrocosmic focus of the first chapter to the microcosmic, circular progression of yang qi through the human body’s three-yin three-yang channel system. This circular movement in the body mirrors the sun rising and setting, moving from the exterior at dawn to the interior at dusk, circulating fifty times daily. Here, timing is ‘essential to understanding immunity in terms of classical Chinese medical thought’ (p. 40). Chapter 2 is my favourite chapter of Afterglow, wherein Rosenberg skillfully employs the model of the body as an ecosystem in his detailed descriptions of the changing nature and function of ministerial fire as it moves through the six paired channels. For example, in the section on lesser yang (少陽 shǎo yáng) mechanics, he describes how the movement and metabolism of water in the triple burner system (三焦 sān jiāo) mirrors that of rivers, channels, and waterways. Both systems must be ‘replenished, maintained, and kept clean’ (p. 44), lest we suffer a polluted, ill watershed that cannot support life. A malfunctioning sān jiāo will invariably develop stagnation, chaotic movement of fire, a loss of effective qi transformation and damaged water metabolism.

Chapters 3 and 4 cover the interactions between ministerial fire, source qi, and defense qi. Rosenberg discusses the nature of source qi as the wellspring of qi transformation that underlies all substances and functions in the human organism. The Nan jing describes yuán qì as that which ‘contains the influences’ of the sān jiāo and carries out the orders of the ministerial fire (see Unschuld’s translation, p.547). Rosenberg’s primary focus is on the clinical engagement and ‘gentle awakening’ (p. 59) of source qi to spontaneously heal patients without interfering with their intrinsic natural functioning. His selection of acupuncture points revolves around restoring ministerial fire’s ability to heat, move and transform. Rosenberg homes in on the need to root ministerial fire in the lower burner, centre its circulation in the shǎo yáng, and restore yuán qì to promote the integrity of body and mind.

In Chapter 4, the author discusses the systems approach of Chinese medicine and its ability to engage the complexity of the human immune system, which he characterises as a cognitive system with processes akin to memory, learning and self-recognition. Central to this discussion is the need to adopt seasonal observances that preserve yang qi and condition the skin against environmental forces of heat, cold, dampness and humidity. Theories of yīn yáng, sān yīn sān yáng, and wǔ yùn liù qì provide a comprehensible foundation to interrelate the numerous vectors that impact human immune function, such as seasonal qi, climate, human activity, emotions, age, constitution and immune history.

Rosenberg reflects on nourishing life (養生 yǎng sheng) practices in Chapter 5 that are important for preserving yang qi, an ample supply of which is essential for those wishing to live their optimum lifespan. It is worth noting that while following the natural order is a normative principle of Chinese medicine, there are exceptions. Regarding longevity, one must move counter to the decay of yang that begins in autumn, both seasonally and in the ‘autumn of one’s life’ (p. 70). In this regard, one of the keys to safeguarding health is preserving one’s warmth and storing ministerial fire.

Chapters 6 and 7 cover Chinese medical thermodynamics and the clinical management of autoimmunity and menopause. These chapters aim to simplify diagnosis and organise clinical information coherently. Here we find autoimmunity described in terms of ministerial fire disharmony and the dynamic relationship between sovereign fire, the shǎo yáng and ministerial fire. Chapter 6 is arguably the core of Afterglow, detailing the pathomechanics involved in immune dysfunction and how a breakdown in xiāng huǒ, jūn huǒ, and wèi qì functions can result in autoimmune conditions. Rosenberg answers some essential questions regarding ministerial fire and autoimmunity, which includes views from both the Nan jing and the Spleen Stomach Treatise (脾胃論 Pi wei lun) by Li Dongyuan 李東垣and covers various causative factors that can contribute to complex autoimmune disorders. Again, we see the bidirectional relationship between ecology and human health and why Chinese medicine can be considered a manual of ecological and medical correspondences. Rosenberg discusses menopause in Chapter 7, wherein he details the pathomechanisms involved and why it is a common mistake in modern clinical practice to diagnose menopausal hot flashes and night sweats as arising from yīn vacuity of the Kidney.

Chapter 8 contains an interesting (and new to me) discussion on transmutation and steaming (變蒸 biàn zhēng) that occur at various stages of childhood development, detailed in Sun Simiao’s Essential Formulas Worth a Thousand in Gold for Emergencies (備急千金要方 Bei ji qian jin yao feng). The structure of this section is a dialogue between Rosenberg and his colleague, paediatrician Stephen Cowan. Cowan and Rosenberg discuss how to differentiate between pathomechanisms that arise from exterior evils versus heat symptoms that can express during childhood growth stages wherein a child’s exuberant heat qi can ‘spill over.’ Cowan states that the ‘physiologic warmth in young children is objective evidence of ministerial fire’s action, facilitating yuán qì’s function of supporting growth and development through the sān jiāo’ (p. 97) and follows that we must take care to avoid the excessive use of bitter and cold medications, such as antibiotics and steroids, in paediatric practice.

Rosenberg wraps up his text by including several case studies that illustrate the role of yang qi dynamics and a reflection on the ecological, socioeconomic, and climatic factors that compose the broader picture of pestilence qi (疫氣 yì qì – experienced recently with COVID-19). Also included is a valuable discussion on one of my favourite formulas, Dìng zhì wán 定志丸, that the author employs to exemplify further the functions of ministerial fire, sovereign fire, and the role of the shǎo yáng in governing the movement and circulation of ministerial fire.

Afterglow is an accessible, engaging read with direct macro and microcosmic clinical relevance. I would especially refer my colleagues to the sections on yang qi dynamics as they evolve in the sān yīn sān yáng system and their role in regulating immunity. These principles are necessary for the effective dispensation of Chinese medicine. ‘Everything is revealed as fire and water, at its core,’ writes Rosenberg (p. 17). Indeed, what are we but the circulation of hot water and vapour? Ministerial fire represents ‘the warm relations’ that bring forth life as it flows within us, in our community, and between ourselves and our environment (p.97). It speaks of the mutual interdependence of polar opposites that dwell at the heart of classical Chinese philosophy and its political, ecological, and medical holism system.

Justin Penoyer