# Hara Diagnosis Reflection in the Sea (2)

February 20, 2018 | Author: ShamimAcupuncture | Category: Medicine, Wellness, Philosophical Science, Science

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Descripción: Hara Dignosis...

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Rara Diagnosis: Reflections on the Sea -

by -

Kiiko Matsumoto &, Stephen Birch

, .:

Pa~

digm Publications -

Brookline, Massachusetts

1988 -

Published by

46 U.S.A.

ISBN 0-912111-13·5

CopyTight © 1988 Kllko

MalSUmCtO

and

Birch

of this publication may be reproduced. in a remeval system or cransmitled in any pr"tirtll'\'It' mechanical, photocopying, recording, or withom the prior wri([en penn is-

Cataloging in Publication Data:

l. Stephen, 1l IDNLM: 2. DiagnosIS } Medicine OrienUli Traditional, 1. Palpation.. methods WB 175 t.H3·H,! R602.MJ6 \988

616.07'54

88-17955

O·91211H3·)

Pubhsher: Robert L Fell ManhJ. Lte fleldlng Coller mU5ll"loon: VOShlO M:a!aka Texl llIust:r:triofl &. Cover Design: Herb Rich II! Fomurcing $upelVisor: T. Diane PuR i.:dIWl. Type;;enlng SoflWare: Texrware Im~madof1.31. Cambridge, Mus.achusw< Chinese Character Typesetting; Ungutstic Symms, MassachllStllS Addtnonal SoflWatel:;r World DistribuQon R~wlf\g proVld~ by Book Company. ilrooldine, M:1ssadiij$~115

Aad f !'Ce, archlvf-l"T~''''.,,,, It is probable duu selves were compiled rrom earlier [he meridian and less ~",~... ,,_

themtrealmtnt principles derived is documentary evidence thal descriptions of fewer While shrouded in prehistory. coundess preceded the theory and, practice or

the :lassical [eXIS, among [hem Wen and ling Shu, we numerous pas ages thal relate to palpation. Wen does not discuss palpation in d th; it was mostly a text of and prinCIples, discussions of classical neeIn the Ling Shu there are several pnnciples and techniques, as well as Point palpaoon frequently (rue of te-XIS through Ming On

YU"j,,"V.>U,-

me

as assumes some palv,,,.. ,,,,,,,,,,,!'. the luo meridians, me us to lOOK for signs of vacancy or repletion, around the luo acupoint. If one cannot above and below pOint, because each (LS 10:145).8 This makes ll''ltI'lTIYPf!Ulf1Yl

me

23

Palpation

When discussing the back shu points, the Ling Shu tells us abo t location and selection: If you want to get the points or examine them, you have to ru~ them. Inside [the point], there will be some reaction or pain this is the shu point (LS 51:381). This is an explicit description of point selection and diagnosis by pal lation. The points that are painful are the shu points. The Ling Shu also tel s us a little about the treatment of the back shu points when there is a path . genic invasion of the lungs. To treat the problem, "rub [the point] with one's hands. Then, if the patient feels comfortable, the needle can be ins rted" (LS 20:208). Here again, palpation is pan of the rreatment. More general palpatory diagnostic principles are derived fr01 and presented in the Ling Shu. These are important and panicularly usetul in modem practice. It is often stated that if palpation of a point or area licits pain, repletion is indicated. If palpation elicits a comfonable sens tion, vacancy is indicated. [After] researching and palpating the painful points on the left and right, the upper and lower parts, and diagnosing the temperature of the body, to see if it is uniform, [after thiS] one can diagnose the meridians that have the problems (LS 73:513). These principles of diagnosis are important and panicularly usef· I m modem practice. Pain or lack of pain on points, the comparison 0 left, right, upper, and lower relationships as pressure pain or temperature ariations, are the fundamental aspects of several important palpatory syste s. In discussing the use of needling techniques, the Ling Shu tells us: First, attentively observe and differentiate the repletion or vacancy of the meridians by pressing with the fingers, using sliding techniques, and also rubbing and Oicking the points. Then, very attentively, watch the response and reactiveness of the point (LS 75:544). In shon, observe, analyze, and treat to decrease the reactiveness, whate er it may be. Clearly then, palpation played a Significant role in the diagnostic ~nd treatment procedures of the Ling Shu. These procedures remain ope~~ to interpretation and further research. Throughout the progression of me ical history, many practitioners and authors have taken these vague ref ere ces and sketchy techniques as the staning point of their research. Two fUIlher passages from the Ling Shu point us to possible interpretations that ma~ be used to develop our understanding of palpation:

If there is abdominal pain, insen the needle to the moving [pulse] place at both sides of the umbilicus 9 After removing the needle, rub the place, it can immediately cure the problem. But, if it doesn't cure the problem, needle qichong [ST-301. Then rub the place when the needle has been removed. This can immediately cure the problem (LS 26:249).

24

Palpation

Understanding what i~ the "moving place at both sides of the umbilicus," and how to observe pulse is at once dear if one considers this passage a description of an ev m observed by abdominal palpation. Rarely in cbnical practice is a pulse 'sually observed in a simple case of abdominal pain. However. a pulse in th. iocation described is a frequent palpatory finding.

tlS

In the same mann r Chao Yu, one of the famed figures of the Ling Shu, diScusses different typ s of lumps In the intestines:

If the skin is t in and dry, the flesh not hard jelasticl. but muddy Iweak a d soft], this is a sign of bad intesones and stomach (LS 48:3'1 There are limes when ithe nesh will lose itS elasticity, becoming weak and sof t to such an extent [hat the condition will be vislbly obvious. However, this condition is more rasi\y confirmed with palpation. The Nan jing has vera1 comments nostic and treatment t hnique:

!O

make about palpation as a diag-

Palpation belo the stemum conveys the condition of hean!flre. Palpa ion around the umbilicus conveys the condition of spleen/e nh. Palpation below the umbilicus conveys (he condition 0 kicineys/wa[er Palpation on the right side below the ribs Cjnveys [he condition of lungs/metal. Palpation on the !ef t sid below the ribs conveys the condition of liver! wood (N) 16. NJ 56). There are severa! ways we may inlerpret these correspondences, and more possible imerpretation. will be discussed in a later chapter: the correspondences are obviously mportanl and have remained so in later developments of five-phase eory. The Nan jing also talks about palpating the skin of the (ore am a a way of confinning the quality one finds in the pulse (Nj lJ). In eHec , it recommends parallel qualities as confirmation. Thus, when one finds a pulse. the skin of the forearm should fed tight. For a slippery pll St, skin of the foreann should feel sUppery. As the major medi1al text that detailed and explained ideas introduced only randomly or discGrsively in oLher (extS. the Nan Jing is an essential resource. In regard to alpanon, the Nan jing mOSt inouiguingly details the importance of the abd men, correct breathing, and diagnosis and aea.tment or the source qi. eac a concept central co the understanding of an advanced use of palpa ion. ][ we compare, for example, the Su Wen discussion of needle tech iques with the Nan ling interpretation of the same concept. we can see ho the laler authors systematized the idea.. I

The earlier Su Wen pescribed the needling technique for conification: When the POintibS been chosen, rub it Iighlly, then harder. Then flick or ta the point with your finger to stimulate the point With you fingernail, press the point slighdy, then with lhe finger and [0 rob, pinch (he skin shgh[ly. All this serves to close the shen .. [Upon removing the needle] rub the point; this wi!! protect preserve the shen qi (SW 27: J70). 10

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25

Palration

The later Nan ling explanation demonstrates a systematic develop~ent of this concept:

I

When putting the needle into the yang [wei qi area], angle the needle and then insert. When putting the needle into the ying [qi area], use the left hand, rub the point to disperse the i [wei qiJ, then insert the needle (N) 76(4):19) The Nan ling contains further discussions of the treatment techniq?e that describe the importance of feeling the qi with the left hand while inserting and manipulating the needle with the right hand (N) 78(4):20-21). In effect, the Nan ling outlines a technique for the preparation of the acupoi that protects the various qi circulating throughout the body.ll The Ling Shu SUCCinctly states the most vital facet of needle techn que: The important part of tonification and dispersion technique] when using the nine needles lies in the subtle sensitivity of the fingers (IS 1:6).

Extrapolating from the Classical Texts Figure 2.1 Shao yan substernal tighmess

As is often the case in Oriental medicine, the discussions from t e earliest texts, the Su Wen, Ling Shu, and Nan ling, comprise the foundari n for further studies. This holds rrue for what has been said about palpatio . Expanding on the Ling Shu ideas, the lin Gui Yao Lue Fan Lun (Essential Prescriptions from the Golden Chest), one of the very earliest 'nternal medicine texts from approximately 200-300 B.C., states: When one palpates an abdomen that is swollen and full, and the patient does not feel pain, this indicates vacancy. If the patient feels pain, this indicates repletion. Therefore with replete patients, one must address and eliminate the repletion. 12 The author of this text was Zhang Zhong-Jing, who also wrote the :hang Han Lun (Treatise of InjUry by Cold), probably the earliest systematic t t of herbal medicine. In this text are other references to abdominal palp tion, including tension felt in the upper part of the abdomen below the rib and sternum. As a primary abdominal confirmation, tension in that area is usually indicative of a disease progression at the shao yang stage. Ho ever, the condition is also noted in regard to the yang ming state. When there is a lump or tighmess below the heart, the patient feels stagnation in this area, and the healer feels tightness when touching. 13 Medications are presCribed for this abdominal conformation.

Figure 2.2 Shao yang bcostal discomfort

The Shang Han Lun also describes a feeling of subcostal fullnes , in reference to a shao yang disease 14 The patient feels the presence of stagnation, and when one touches [in the subcostal region], it feels like a knot or is ctght. The patient feels uncomfortable or full in the subcostal region, and there is resistance or pressure pain when one touches. 1S

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Palpation an olhers from the Shang Han LuYl, have

stimulated

on abdominal palpation in herbal diagwhere abdominal diagnosis is the presCription of herbal of drug prescJipThe accompanying twO are m Kiran by lnaba an herbal [ext beginni g of the mneteenth cenrury. art of s achieved with use of "hl"ll'Ifflln in Ling Shu Su Wen can our research most directly. e imerestlng and perplexing from the Ling Shu. the Yellow basic blood, the are each slored in lwill cause iliem to] lose the jing; hun the zhi Iwilll and yi lnteUigence will

35

Aspects of Chinese What causes this? Is it a punishment from heaven or a mis e by the person? What are de ~, qi zhi;t, jing fpj, shen I , hun~, po ilt, and yi;t? (IS 8:84-85); (TS 70)4

*',

These are questions Oriental philosophers have attempted to anstr in all times. Today it is no more possible to give totally satisfactory ans ers than it has ever been. But in Qi Bo's answer there are important clu to the solutions the Chinese practitioners provided for themselves: I The heaven in one is de. The earth in one is qi. The Ide su-eams down and the qi reaches up to it, subsequently ther is life. Therefore, the coming of life is called jingo Both jing b at [meet] together; this is called shen. Following shen, going d returning, this is hun. Paralleling jing, going-out and coming in, this is called po (IS 8:85). I

The two jing beating together becoming shen refers to the physica expression of the male and female jing sperm and ovum - that unite du ·ng conception. Of the last two lines, the Tai Su comments: Hun is a different ling [spirit] of shen; therefore it folio s shen; going and returning, it is stored in the liver, it is cal 'ed hun. Po is also a different ling of shen, it parallels jing; go ng out and coming in, it is called po (TS 70-71) Of these same lines Xie Lin of the late Qing dynasty makes an: interesting comment: The liver stores the hun. The hun is the jing of the yang, e ling of qi. The qi of the person is yang, the blood is yin. he liver conu-ols the blood and inside it is the yang qi, this is cal~ed the hun. [On] researching the root of hun [we can say that] it is created at the one yang of == water. [Thus] we can infer tat the actions of the hun begin at and are the basic [fundamen I] qi of == metal. [The Ling Shu says] the hun follows the s en coming and going; this is ling's manifestation in the sen~es. The lung stores the po, the po is the jing of yin, the ling of the form. The liver conu-ols the blood, basically it is yin and stJ~es the yang hun, the yang is hidden in the yin. The lung contfls the qi, basically it is yang and stores the yin po; yin is created in the yang. After labor, the ears, eyes, heart/mind, the ha~ds and feet move, the baby's cries are the voice, all are the lin~ of po. [The Ling Shu says] that which parallels the jing and cotes out and goes in is the po. This is the capacity of movement. As is often the case with the circular logic of Chinese medicine, e ch basic

term is referenced to and defined by the other. To explain Qi Bo' answer, we need to enter the spiralling metaphor and attempt to define so e of the basic terminology. What are the jing, shen, hun, po, de, zhi, yi, xi , qi and ling? Such answers cannot, and will not, come quickly or simply. In each area of human energetics that we will explore in this text, we ill meet these essential terms. In each exploration greater detail will ap ,,:ar, and more will become clear about each idea. To begin, there are he basic

o

of Chinese Me~idne

cursor of matter, English brings to is a functionally modem quanrum It is involved in

and qi are general terms referring to various function, The jlng is akin to "vital energies," fun'up", involved In life itseU It is an energetic preof energy; defining it in pure" or "most vital." It as energy, Qi is in the sense of animate inanimate. It is in everythmg, all things and aU prol:esses It is the quality of phenomenae.

H""'\""'2\

specific energetic entities. Of all the Chinese is most life Christian of soul. It differs most expli'l"PI'V(,I,'''-'''' C ine5e scholars and practitioners made an explicit the ean and mind, or if. depending on COntext, they diff Tences It is probable that for them, the hean and of one necessarily involved some referenc [0 In an allegorical Story from the Lie 2i,6 the fa ed physician Sian name was by the author of the Nan Ji tg. bUI who acru.aUy lived several centuries Ihe Nan was Wntt n, was with two male He I"1P">1"1 a radical (rea ent for the two which illustrates these ,..,.".1""1,"". weak will and soong qi and the as he suggested to the two that the best therapy would from one [0 the other. The two agreed. Blan Que home.

Wej

37

Aspects oj Chinese Mjicine

The patients returned complainmg that their wives and fanrlly no longer recognized them. Bian Que found that the men had retured to what they considered home, but no one recognized their PhYSical~ppear­ ance, because each had taken on the physical appearance of the oth r. The personality associated with a panicular family now had the hysical appearance of the other. This allegorical tale demonstrates dra atically that the conceptual associations of what we call the "mind" and "h~art" are far more intimate than we would suppose by thinking only that tht "heart stores the shen," as if it were some prized jewel packed away in a reasure trove. In the context of the Ling Shu passage, the Yellow Emperor s question about xin does seem to refer more to the concept we call "mi d," but we should not forget the reference to the heart. Both zhi and yi are also related to xin, "mind." This can be see in the characters themselves, both have the xin radical Ie.". This connectio is also stated in the Ling Shu: The controller of the body is xin [the mind]. The unexpress d thoughts [of the mind] are called yi [ideas]. The place at whi h the ideas exist is zhi [the will] (LS 8:85). Ideas and will are seen in direct relationship to the mind, xin. The Shuo Wen Jie Zi says of yi, ideas: "The yi is the same as the zhi, will" (Mor). EtymolOgically, The character yi is comprised of two ba. ic component parts, ~ which means "verbally expressed thoughts," and.c..', which means heart-mind (Fuj). The yi itself seems to refer to putting the mind into the verbally expressed thoughts. Hence the common trtnSlation as thoughts, ideas. . The character zhi $which means "will" approximates this me ing: ± refers to a foot; Ie." refers to the heart/mind (Fuj). The mind controls the feet to bring about movement and u timately action. This capacity for instigating actions with what we cal will is expressive of the mind's fixed purpose. I The yi, "ideas," relates to the intention someone expresses wi~h words or sounds. Zhi are the actions that express the mind, the verbal expressions of the mind. The Ling Shu concept is thus more simply sel n as an expression of the interrelation of the mind and ideas, that manifes through both thought and action. The energetic and medical implications are also found in the LTg Shu: Zhi and yi [will and ideas] are therefore the controller !harm~n­ izer] o[ jing and shen, the secure place of the hun and po, jhe regulator of the temperature. They harmonize joy and anger .. When the will and ideas are harmonized, the jing and s~en become straight [flUid]. The hun and po don't disperse. 9ne doesn't become too regretful or too angry. The five yin organs don't accept evil qi (LS 47349); (TS 76), 'I When thought, expression, and action are in harmony, everyth+~ works well and the body remains healthy. D I 38 Aspects of Chinese Me4cLl1e F:-oblems of tOO not enough. toO or tOO strong of will. This particular passage is very we examine the concept of counterflow qi in so In metaphoric it is perhaps discussions [rom which the Shu comment of needle The aspect of For the practitioners these ideas had for how we should approach our and or from 1601 A.D. dISCUSSes a "shen [ech- Shu techniques: should be no patient movements of the Place the of il warm. With the lef l one: insert the needle. When rubbing, carer ul, as though one were holding a right hand, insert and rotate the needle.. Do not be tense, keep hand relaxed. 7 that we never idea rerrtains 10 the tip warm the nee- Important are This passage scresses the both [or the and menta!, or attitudinal states were seen as barriers belween one individual's mental of another individual were experienced as (ar are in the Wesc Not only were touch and patients' vital energies, but as importandy a necessary and impOrtant Lltde emphasis on the development of discussion or needle (echyin organs, concerning energetics: The. blood siores hun. When When liver imubilicy The heart SlOTes the SlOre the shen. When heart qi becomes When heart qi becomes replete, is spleen StOres the ying. ying spleen qi becomes vacant, the four at motion and the yin organs become qi replete, body bec,,, ........;:, in dlsordered qi With the oUlside is overcome by the sweat" ing and the inside by character we transl..ate as "thoughts" is si ~" another very much like and yi. It refers mote to the interior verbally nor actively Shuo We is capacity, it is me words of {he more !O the mental with brain, what we now We can yi and si rhus: Vi to Zhi refers to 51 refers (0 thoug ts that me interaction between thoughts. thoughts. in the process mind and brain. terms describe racets of the functions work in and OUt of halT11ony. ences on overall health. All The yi and zhi. the hun and po, such as regret or Vi and zhi help cause problems the mind. It of o harmonize the jing and shen, secure and prevent excessive emotions carnes a slighdy differem connotation. rrom the quO(e above, seems to narure. Mental thought, is a focal poim of for shen [0 rerum to. causing Stagthus stagnation of qi in It is Aspects of Chinese Me~icine 43 whether this is nue of all thought, but it is rather a startling idea. Too much mentation causes stagnation of qi. Perhaps this is pan of the reason for the aphOrism "thinking with the hara." Mental and emotional states are at once the result of energetic limbalances and the cause of energetic imbalances. It is easiest to see IT)any of these disorders as a parallel to the condition of counterflow qi. Tlile qi is not rooted at its source; it is too actively engaged elsewhere in th body, causing problems in the organs and meridians, and manifesting as mental and emotional disturbances. Treating the conditions when they manifest as tension, tight ess, or pressure pain at specifically reflective areas found by palpation is articularly advantageous. Not only will such treatments address the un erlying problems, they will do so prior to the obvious manif estation of the mental or emotional symptoms or the simultaneous physical correlates. mentioned, some therapists see mental problems as coming from vac ncy of the dantian. Dantian functions to store the jing and shen. If it is w ak, the jing and shen are not well retained. Since the yi and zhi hannonrze and balance the jing and shen, it is not unreasonable to suspect that imbrlanced thinking (which may cause or result from dishannony of the yi a~d zhi), also causes this dispersion of jing and shen. Since the yi is storeq by the spleen and the zhi by the kidney, dishannonies of the spleen and kidney may be the root of this problem. [ 1 That dantian should show vacancy in mental or emotional Pjoblems correlates to its palpatory description as the area on the abdomen wrere the spleen and kidney reflex positions overlap. Is dantian's ability to store the jing and shen related to mental and emotional stability and the ba~ance of the spleen and kidney? Certainly underlying and resulting vacancie~can be seen in emotional disorders. This is indicated in several passages f om the Su Wen. Very commonly, the five emotions are seen to cause va ncy of the corresponding yin organs by injuring shang ~, the yin orga~s. This injury is usually described as something that weakens function. Anger injures the liver ... joy injures the heart ... depressi ,n injures the lung ... fear, shock injures the kidney ... thinki g injures the spleen (SW 5:37-42) Here the emotions injure the organs. Whatever the cause of a cert 'n emotion, expressing the emotion too much (or possibly even at all) can weaken an organ. One cause of the emotional expression can be a wea ness or vacancy of the organs. It is almost a spiral, a vicious circle. In the lassical descriptions of the relationship of emotions to organ weakness, the one gives rise to the other, which in tum can give rise to the first again. English language and cultural conditioning do not express well the simul eity of these manifestations; rather our tendency to assume one-way, cal sal relationships is emphasized. The Su Wen discussions of organ weakness and emotional ~tates is quite complex. It involves the reverse process of the "controllin~ cycle" among the five yin organs. When there is weakness or vacancy of the organ that should transmit jing qi to any of the five yin organs, the result is that the jing qi will unite with the transmitting organ, producing:ertain correspondent emotional state. o Aspects of Chinese 44 never distinguished body. were viewed as a continuum. the psyche-soma relationship was in thai dwelling mentally or emotionally on has caused problems makes tilde sense at all "problem." Contrary to modern the emotive [he basls of a ronn may be its creadon development canof Oriental spiril-affecr concepts. "''''" ...'''''' never implied. their cuhure do nOl toward such issues are more likely to even of a psychol .cal counselor. Even today, Orientals rend to express their emotional oncems in terms of family, or social environment rath r man in Indeed, much of what is the real of the counselor m Western are issues societies as familial or social processes. One anthropology [0 understand that means, Zen Buddhism for example, for methods have been uniquely their We cannl't assume from our cultural they do is similar to wha we do in the West From the medical p rspective. very act of on mental or emotional stales is a 10 c [hat a framework. Looking for an Lmderlying emolidnal trauma assumption mat me emotion really is frdm body and symptoms. For the Oriental is reallf approaching the problem backward, since the itself is been nor acceptable. The tmderlying trauma and symptoms are [wo e~ds of the same stick, there is no to or recall thuma, the symptOms are so already. We have seen taL emo[ional, relationships between menphysiological function. These are all expressions of [he same this, the Oriental practitioner states, but perceives these as more inpUt (0 diagn snc For example. in the !:radition, were the pracctctone [0 hear a statement such as, "he problem," what wo \d come immediately to the "'''''I''''''''''''''TC would be the tighmess 0 me patient'S shoulders and patient's structure was i balanced of of Oriental medicine mal students of before progressing to Certainly. a review of it supplies ample ,,, . ,,..' .......... r thought to be the are located the are the H is internal trajecmeridians. The superwere seen as the a in energetics of me body. there are xceptions to rule - the hem, swmach, and bladder The main informaooo to derived from this idea is [hat (he more imponamienergelic and interactions occur wiUlio the . e superficial extensions of the meridians describe through the rest of the body. It is alsD interesting dy's most including those that Again, we are learn ng by inference more of what the idea of "main meridians" means. Th overall importance of understanding the internal is context, is two-fold. a detailed underand knowledg of the internal pathways plainly demonsrrate.s the and mportance of the Second, a close scrutiny of on these particularly those are on main p:uh working knowledge of acuand or are extremely useful in internal rraJectories, we sources. These sources Shisi Jing Fa Hui (Elu,idatiolJ oj r"/n"cnr in 1341 A.D .. ! The author, Hua Shou, includes the merna! of the meridians, and also gives detailed descriptions 0 [he earlier Ling 5hu information. From modem the Neijing)ie P Sheng Li Xue (Anatomy alld Physiology of the Yellow Internal Clas i.e), a useful compilation of theoretical materials of us wiUl significant lof or-.,'>1'1.,-",,-, in Ni Tsuilt (Pathways internal meridian and detailed research of anatomy and physlology, the basic informaexplanations and diagrams Generally, the yin meridiyang meridians, reOec(ing Internal Trajectories of 12 Meri ians 51 Internal Trajectories of the Lung Meridian The Ling Shu describes the internal trajectories of the lung meridian th s: l The vessel ~ of the lungs, hand tai yin, starts at the middle warmer. It comes down and then spirally wraps the large intes'! tine. It then returns to and circles the entrance of the stomach1 coming up, and permeates the lungs, then going to and coming out at the sides (LS 10). , • CV-13 CV-12 • CV-13 V CV-1O CV-9 • CV-9 ~ Figure 4.1 - 4.5 Lung meridian trajectory We may interpret this desCription in the following manner: llhe starting place is seen as CV -12 (middle of the stomach); from here it ~asses to CV-IO (exit of the stomach), then up to CV-13 (entrance of the s~omaCh)' then down to CV-9 (dividing place of water) (Shisi). Next it tray rses the lower part of the large intestine, by way of the greater omentum or possibly the mesenterial folds, following the length of the large intestine an spirally wrapping it until it reaches the rectum (Ima). From here it returns t~ CV -13, o 52 It then follows the pass oUt co (hna). to first stages of [he meridian as a spiral from a o Internal Trajectories of 12 Meri ians 53 Internal Trajectories of the Large Intestine Meridian .. Figure U 1 - 4.13 Large intestine meridian The Ling Shu describes the main internal trajectory o[ the large in estine meridian thus: [It] comes into ST-12, down to and spirally wrapping the lung I' then down to the diaphragm, and then permeates the large intestine (IS 10). We may interpret this description in the following manner: Fr m 5T12 the trajectory passes to and spirally wraps the lungs; then, follow ng the aorta. it passes downward through the diaphragm. Here it splits 0 permeate the large intestine (Shisi). Several commentators, including Hu . 5huo. think that this trajectory involves 5T-25 (Li Xue). I Internal Trajectories of the Stomach Meridibn The Ling Shu tells us that at 5T -12. the "main" meridian passesi down along the chest and abdomen to 5T-30. while the branch: , , , passes down to the diaphragm ([rom 5T -12). permeates th stomach. and spirally wraps the spleen. Another branch sta ing at the exit of the stomach passes down through the linin of the abdomen to ST -30 (LS J0). Figure 4.B meridian trajectory Most commentaries agree with this simple trajectory. the one totable exception being the Lei jing (The Classic of Categories). which tells s that the branch that comes down through the lining of the abdomen to 5T -30. comes down slightly lateral to the kidney meridian. starting at th same level as Kl-16 (Li Xue) , o Internal 54 Meridians Internal Trajecf0ries of the Spleen Meridian The spleen spleen, and diaphragm. contaG meridian rises up the (0 CV-4, to SP-14, 10 cv-n. There is to CV-lO from here, which however, [he internal trajectory to and permeates the then comes e (Shlsj). There it comes up through or base of me longue (lmll) From a (5h(si) Meridian Internal Trajectpries of The hean. hand yin StartS 31 the center or the hem, comes out pe eates the supponer of the hem, goes down [0 and spirally w s the small intestine. A branch following the supporter of ( heart surrounds the throat and up 1O and makes con ct with (he supponer the The main following supponer of the [0 the dow armpit, startS al HT-l (LSJO). The heaT! meridian as itS in heart itSelf, but does not meate (he hean. rather it "supporter of the hean," probably Ihe aona and mher blood vessels entering and exiting me (lma). Following the abdominal aona, the descending part of lhe "supponer of " t passes down [0 mesenteric and to the small spirally w pping the small (lma). The branch that surroun ing me throat, and going (0 me "supporter of the (the optic nerve), p obably [ollows the blood head. Le., the carotid (lma). main "supporter of the hearl," robably me pulmonary the.nce to the of at HT -1 (Ima). A the Su Wen [ells us how t ,f and uterus are related: doesn't come, it is stagnant The [meridianJ, , qi . nean ql canno[ not come (SW 33'197). o that the blood of the uterus, the inside of the lungs from down smoothly, 55 Internal Trajectories of 12 Meridi ns There are several important distinctions regarding the heart meri ian trajectory. The heart meridian does not permeate the heart itself, ra~r it permeates the "supporter of the heart," which becomes the descen ing abdominal aorta. This vessel is palpable as the moving qi berween the kidneys. The energetic consequences of this distinction are enonn usly importaiH. We feel that this is making a very direct statement abou the energetic nature of the heart, especially about the relation of the heart t, the blood and to the shen. As we shall see later in this text, this has a ajor influence on how we understand the nature of the source Ll1!, the sour e qi JJlt~, the moving qi berween the kidneys ~rf3jJJJ~, and ultimately the way in which the authors of the Ling Shu understood the origins of life. The relationship berween the heart and the uterus is very significant. orne authors see the uterus as the place where the moving qi berween th kidneys resides. This tends to reinforce the energetic connections th t the heart has to this source. Further, it is the superficial trajectory of the supporter of the heart that is the main meridian. This is possibly one r as on why many great practitioners have consistendy refused to treat the heart meridian directly. Internal Trajectories of the Small Intestine Meridian After rising up the arm from 51-1, a trajectory passes to ST -12: Figure 4.17 Heart m ridian trajectory ... then it enters ST -12, [passes down to 1 and spirally wraps the heart. It circles down and around the throat [and esophagus], passes through the diaphragm to the stomach, then permeates the small intestine (LS 10). This trajectory is generally accepted and uncomplicated. The L i ling author comments that CV-lO is the "place of the small intestine" ( i Xue). Thus, it may be reflective of the small intestine. Figure 4.18 - 4.19 Small intestine meridian traj ectory o I 56 2 Meiidians lnternal Trajedones \ I ories of the Bladder Meridian Internal Iraj cier, foot lai startS at and passes over The is the first line on the back, me shu points head. The main m line. Ir then: line [0 the lumbar area and goes into rhe kidneys, (hen passes down 10 and fW'>r' f1 b quotarion is the kidneys, the bladder, to penneate the lumbar area to l' (LS J0) understood to mean mal after wrap(hrough or with ureter [0 It is that in passing from wrap the kidneys it through rhe rena! I trajectory Internal Trajectpries of the Kidney Meridian kidney foat to the "hear! the kidney below the small toe, then comes across the (near K1-\), then 10 and rhe leg pathway. A[ (he it goes interior: penneates the kidneys, spirally wraps According (Q most trajeCtories Once the spine at Ihen up spine and out to KI·ll 1(1-16. o kidney has a complex series of internal at the thigh, it passes to spine (an indefinite distance), down KI-1] it superficially passes up to Internal Trajectories of 12 Meri ians 57 At Kl-16 an internal trajectory circles backward between the ski the peritoneum (Ima), almost following the dai mai trajectory. The m then enters arid permeates the kidneys (Shisi). Then, passing dow through the ureter (Ima) to the bladder, it spirally wraps the bladder path also passes out to 01-3 and 01-4 (Li Xue). and 'dian ward This Q KI-16 c::::::::> o =:!:Jr;!' KI-16 Figure 4.22 Beginnings of the kidney meridian. Figure 4.24 - 4.25 (Peritoneal) kidney meridian trajectory. Figure 4.26 Kidney meridian trajectory passing to the bladder. Figure 4.23 Spin kidney meridian From KI-16 the external meridian passes up to KI-21. Here, nother trajectory goes internally to and through the liver and up thro]gh the diaphragm into the lungs (Shisi) There are two main interpretation' of the traj~ct?ry after it reaches the lungs. The first posits that from the 1 ngs the mendlan passes along the pulmonary vem to the heart and spirall) wraps o I 58 Internal Trajectories of 12 Meridiaru the ~ ieart. It [urmer LrfvelS [0 me "insIde of the chest," usually seen as 0/-17. CV -17 is me re ex poim of the "inside of lhe chest" and may be a synonym for upper qi at (lnta). A second tnlerpreLation proposes thai the internal rrajecwry ends [the lungs and iliat from Kl~21 the external meridian passes up to 5 From this point a rrajwory passes inward to spirally wrap the. heart' nd reach [Q the "inslde of the chest," CV -17 (lma). poim, or mu pomt, fa second imerprel.arion w tation, il is interesting [ spirally wraps the hea coupled yin-yang meri usual relationships hay 's research suggesc.s mat Kl-25 is a better reflex the heart d'\an the traditional pOlm, CV-14,1 the thus be better justified. Regardless of interprenote (hat the kidney meridian has a trajectory thaI ,an energetic connection usually reserved (or the These kldney meridian deviations from the major energetic consequences and ramifications. (Y·17' . 1 Kl·2! Figure ... 17 Kidney mcridj~n !JJI:C!ory pa.ss~ through the liver and lun!l$ to the hare Figure ·U.S· 4.29 Alle.malive l~lerpre[;!Uon of Ihe kidney m~ridLln rrnjeclory.

Internal Iraj Meridian

es of the Pericardium

The vessel o( t master of the hem, hand jue yin. hearlwrapping luo [p ricardium], Starts al the inside of lhe chest, comes OUl and p rmeate.5 hean-wrapping luo, passes down through [he diap ragm, then timelessly spirals down through the triple WaITne (LS 10)

me

The "inside of {h~Ches[" is commonly viewed as 0/-17 (5hui). The imemal trajectory SLan al 0/-17, {hen passes (0 the pericardium. From here it passes downwa ds, probably along the aona or the esophagus (Ima), through the diaphragm. [hen "timelessly" spirally wraps the ITiple warmers.

o

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59

Internal Trajectories of 12 Memdians

The idea of timelessness offers faSCinating insightS inco the na re of me niple wanners. The character we translate as "timeless," is Ii I!ftThiS character has a number of different meanings, including "to pass th ough" and "successively." Our selection of "timeless" is based on me N, n ling and Zhuang Zi. We propose mat mis interpretation ameliorates c0:rl~ only misinterpreted ideas about me nip Ie wanner and the master of me hfart by emphasizing me absolute energetic nature of these concepts. In a iscussion relating to me reasons why there are five yin organs and si yang organs, me NanJing comments:

CV-17

The rriple wanner has me function of dividing the source i l*~ and controlling each of these qi. This has a name but ha no form (N] 38:3,3). Anomer passage discusses me same problem:

meridian trajectory

The master of the heart with me triple warmer are the outsid and lining of me body. They have a name but they have np fonn (N] 25:2,12). I This idea of "no form," in mis context, is usually seen to refe to the absence of a phYSical organ in me body for the set of functions w ich we identify as me triple wanner. It actually has much deeper implicatio s than me absence of physical substance. The tenn "no fonn," 1!\IiM, wu xing, is used by Zhuang Zi. We feel that me Nan Jing references me idea of no fonn from Zhuang Zi. ~I Absolute jing ~~ has no fonn. The jing is tinier man me sm II [me concept of smallness]. Rough jing has fonn. No fo means mat it cannot be divided further. 5 The idea of no form does not simply refer to absence of matefal substance. It refers to me essential change of state between matter and energy, to me basic underlying substrate of material substance. Much like t: e concept of me atom in pre-relativistic physics, or quarks and me multi dinous sub-atomic particles of current phYSics, it is me theoretical smallest particle of matter. The "absolute jing" is the precursor of matter or fonn. hile it is always delightful to find an idea of such sophistication in an ancient medical text which Western scientific prejudice has overlooked, th s is not such a rare idea. Omer classical texts have referred to the conce t of no fonn in similar tenns and we will meet mis idea again in our stud es. For now, however, me essential information that we must relate to the interior energetics from classical desCription is me sense that rather than th. attachments of so many imaginary wires, the connections indicated are fluence of quintessential forces. What occurs at mis intersectio ' is not completely described by a terminology that allows us to think of , e connection of simple elecrrical currents. It is more like the opposed c its of a generator or transfonner where the currents create a change of s cyclotron where matter becomes energy. I

While admitting that me "passing through" translation of the c aracter Ii I!f is sufficient for me description of the body's interior "wiring d gram," and certainly less subject to the criticism of orthodox translation, i( lacks

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12 Meridians

Internal

relativism of the classical idea of II """,if'''','''"'' of the pencardium imersecLS the triple warmer. warmer imenwine become identical. It Is pericardium have no material environment that is not limited by matter, and time are not descriptions that are the dimensions of nor the

suit the "tiny boundaries of

Am. of Qi Be/wooD (RelaliXllQ Small Hearl alld

(

to

o

60

indicate that this a boundary become the more

Internal Trajectories of 12 M IridianS

61

Regardless of our reader's willingness to accept our feelings tha there is a tremendous relativism in the ideas, the fact remains that the mast r of the heart, the heart-wrapping luo (pericardium) is intimately connect d to the triple warmer. It carries out similar functions. There are eff ectiv ly three distinct aspects of this meridian. The first is the branch, arm jue yin, which emerges at PC-l and passes down the arms to PC-9. The second is the heart-wrapping luo which is a trajectory that passes only arqund the heart, in normal usage, the pericardium. The third is the masteT of the heart. There are many places (for instance Ling Shu, chapter 1 ) where these three names are used in reference to the one meridian. Diagrammatically these three aspects can be seen as follows: ~he master of the heart most logically relates to the aorta. It is an extensi n of the heart; branching from this is the heart-wrapping luo and the arm ue yin6 That arm jue yin branches from the master of the heart is some ing we can derive by inference from an understanding of how the other eridians branch from their main pathways, and from the text of the Ling Sh : The heart-wrapping luo is the vessel of the master of the he rt (LS 71:494).

The master of the heart is likely the main pathway, with both a and the heart-wrapping luo as branches.

jue yin

The master of the heart carries out the functions of the shen; 7 he heart stores the shen (SW 23:153). The pericardium, heart-wrapping luo, f· nctions to protect the heart from all types of disturbance (LS 71:494). If the, heart is injured, the shen will be disturbed and this will result in death or af incurable disease (SW 14:87); (LS 71:494). The master of the heart functio s energetically as a communicative pathway for the shen between the h art and the moving qi between the kidneys 8 In conceptualizing these p thways and functions, it is even possible to see this pathway as the meridi In of the "small heart" or ming men: The Su Wen says, "At the sides of the seventh vertebra on the inside, is the small heart." Mr. Yang, the writer of the Tai ~u, says, "There are twenty-one vertebrae in the person. Countipg upwards from the lower parts, to the sides of the seventh ver~e­ bra, on the left is the kidney, on the right is ming men. Mi~g men is the small heart." The Nan jing says, "The source of t e heart comes out at PC-7; thus PC-7 belongs to arm jue yi . Wrapping luo, helping fire, this is the meridian of the sm 11 heart."9 This particular passage from Liu Wan Su gives us a significant deSCription of the pericardium meridian, as it is commonly called, and its vario~s internal trajectories. This Significance will become clearer in later chaptlrs. For now, however, we may expand our diagrammatic representatio of the internal trajectories to the kidney (see last figure).

o

TripLe Warmer

Internal Meridian

or

Having passed up niple warmer meridian

Pt] comes in at

arm (rom the ring finger,

me

2. !.hen passes down to do\\'I1 into the .wrc,r-Jlm

linto {he passes down

a pervasive picrure is one of through. Notice down"

il is like

"dispersion into me once inside [he lungs warmer pathway which (0 pericardium. Fro warmers. This downwa means by

rhe relationship of [he rriple warmer [0 relationship [0 breath and the movement umbilicus is rehued to me action of imo the lungs upon inhalation; ir then mingles with the triple Then. it do\\'I1 [here it may circle downward the triple d movement through the rriple warmers may well (he qi of bre.aming aJ1ives below the umbilicus in the formation source qi

Figure -t.33 . 4.3+ Tnple warmer

o

tr.;jwory.

Internal Trajectories of 12 M ridians

63 .

Internal Trajectories of the GaUbladder

Meridian Having come down from the head, a trajectory passes to ST -12 1

[Thence] it passes to the inside of the chest and then down; lt passes through the diaphragm, spirally wraps the liver and p rmeates the gallbladder. Then it circles round the inside of e lining of the ribs and the side of the body, and comes down 0 ST-30 (LS 10).

Figure i .35 - i.37 Gallbladder meridian trajectory. Figure i .38 Side view of me gallbladder meridian trajeclOry to 51-30.

D

64

Interna! Trajectories

n OIlS case, "the of the chest" is seen as the sides of the chest, around PC-l (SnLsij. we should be aware that the inside of the chest has a wider which depends on context It can be inside (he chest, CV -l7, the the chest, as well as some other less common referents. In comIng own through the diaphragm it probably passes through the esophagu and then the stomach, before it passes to and spirally wraps [he Hver rna). AI ter this, it permeates the gallbladder. In circling around on in ide of the lining of !.he ribs and the sides of the body it passes out co L ·13, and then to 5T-30 (Shisi).

Internal Traje~tOries of the Liver Meridian The liver meridian rises up [he medial sides of the legs from the big toes.

\It the;l ,comes iryto the yin o.rgans \se~ual organs] and circles aroune li1e I'm 01Sans. Then It passes mrough the. small abdomen; then up co: surrounding the stomach; then it permea[es the liver.!l1d spirally wraps the gallbladder. 11 comes up and passes th ugh the diaphragm, up !.he sides of the ribs, up behind the IT chea, to behind the throal Then it rises up the cheeks, com into the eyes, passes up the forehead and mem the du m i at (he tOP of me head. . . . A branch separates from th~ passes up through !.he diaphragm, and I goes lO the lungs Af ter circling aroun the sexual organs it passes into [he small abdomen, the kidney renex rea, and an area below the umbilicus described by, or including CV-2, cvl CV-4 (Snisl) Then it passes up to and surrounds the stOmach, permeates [the liver, and spirally wraps the gallbladder. When it passes up and OUt to :the sides, II surfaces at LV-13 and re-enters internally at LV -14 (Shisi). .

Figure -4.39 llvcr mend12n trajectory

(f'

The trajectory that asses up [0 and meets the du mai joins at GV-20 (Silisi). The branch pass s up to the lungs, then comes down to the middle warmer and "surround CV-12" (Shisi). Once at eV-D, the cycle of the twelve meridians is rea y to stan again, as the lung meridian has its origin at CV-12 This interpr lanon of the meridians beginning at CV-l2 and ending at CV -12 so [\"I they make a complete circuit is one that comes from the ShLSi}ing Fa HUt.

figure 4. mf'll'" mansions, are centered around the fixed points relative [Q the and meas-

We understand th se mansions as a system of star VV""'""", by which the I relative movements as the means by which rwelve branches are delineated. In fact, the temporal of the ms. the twelve branches and the four directions, were all seen :n to lwemy-eight lunar mansions and the pole SLar (5&C 3:248). The twelve-year year cycle of Jupher bihourly periods is of tanh around teo stems are stems at

of [he branches is 3.402) The daily (0 [he division of

to the nearly rwelvtbranches in rwelve da), and thus the roradon scholars propose that the around the star, with fifth pole star itseU.12 stems are lhus to 13 around the sun The six!:}' years of the stembe 10 the conjunction of Jupiter from of the rwelve branches (LS 10; NJ 1), ten stems to the five-phase NJ 33) were imporrant in medical theory for rhythmic occurrences In the body, such as the qi (1..5 15. 1..5 76; Nj J)

lar is cyclic rhythms en (or through [he stem-branch cycles as time, or within the norrh pole scar as the

the uses of the stems and as phenomena lhey produce in the geomagnetic field di:-eccly such it is possible to see lhe within space and using the regular and

me

75

Origins & Energetios

repeated movements of other celestial bodies, the Sun, Moon, and Jupiter, as further reference points. At any particular time within this geometrical system, specific changes and phenomena were described as occurring in the body. If the geomagnetic field is seen as the main medium for these phenomena, we can find much support in modem literature.14 The north pole star, as the central coordinate in this geometrical system, was thus extremely significant. Indeed, many of the important systems or ideas that influenced much of Chinese life and medicine are centered around or based on the pole star. It is probably because of these relationships that the emperor, who was symbolically the center of Chinese culture, was compared to the pole star (5&C 3:240). We feel that the deliberate selection of names for acupoints or areas of the body from the voca:bulary of astronomy, and the particular symbolism of the pole star, was designed to create symbolic analOgies. This is especially true in the relatioFl of tian shu and the pivotal nature of the pole star to the moving qi between the kidneys. This, the central energetic focus of the body, has a pivotal role as the yin-yang, water-fire poles are centered here. We can also think of this as being the "great one." These relationships are more Significant as they are neither partial, nor occasional, but consistent and complete. Several of the big dipper stars are significant as they complete the pole star analogy found in the names of important points in the hara. In particular the second and third stars, (tian~ xuan and (tian) ji are important. ls Xuan ji is the name of an astronomical sighting tube used by classical Chinese astronomers. It was pointed at th~ pole star, then observations and measurements were made. 16 Also, xuan ji is used to refer to the second and third stars of the big dipper, and is thus a synonym for the big dipper itself (Mor). Xuan ji is also the name of the acupoint CV-21. The relationship of CV-21 to zhongji, CV-3, for example, is speculative, but fascinating. One practitioner in Japan, Naoichi Kuzomel notes that tension of the rectus abdominis muscles (on which lie ST-25 anc\ 5T-23, and between which lies CV-3) stresses the rib cage, resulting in a palpable pain around CV-21. Thus, pain found around CV-21 is indicative of tension in these areas and a particular shiatsu technique that relieves this tension. The fourth and fifth stars of the big dipper are also important. If we examine the etymology of the name of the fif th star, yu heng, we note that heng {tj refers to an astronomical machine used to calibrate the movemen~ of the starsY Heng is associated with another important concept, chuan heng, pivot. Chuan is part of the name of the fourth star of the big dipper, tian chuan. The Su Wen explains, The qi goes back to chuan heng [the pivot]. If the pivot is normal, the pulse will be normal (5W 21:139). The characters we translate as "pivot" are the same characters used to refer to the fourth and fifth stars of the big dipper. Chuan also refers to the weight on a bar scale; heng also refers to the bar of a bar scale (Fuj). The pivot refers to the kidneys or the moving qi between the kidneys 18 At the least, this concept pertains to a balance of fundamental energies. The relative balance (healthiness) of the qihai dantian area of the hara is the pivot, the relative balance of water-fire, yin-yang in the moving qi betwe('o the kidneys.

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76

Origins & Energetics bei lou qi xing (MOT).

and at The Huai Nan ZI says

has female and male female to the righl 1n med\calliieramre. and the right side of ably based in pan on

side of the body was seen as more (male) mOTe yin, Uem ale) (SW 5). idea is probfrom the Hl.lai Nan Zi.

areas of me abdomen, below and named after highly significant Stars and connalure or the body was in the relationships are nor rill"""''' and non-medical cosmo!oglca! focus [or the body star acupoims on the

a cenrra\ also north pole as well as other important philosophical names of acupoims. Yun-]i

(Mer).

is LU-9) kun lun is BL-60. Te shu probably refers to the five mansions on the top of Zi says: "On the [OP of the kun lun mountains, In Daoist mythology. Kun Lun mountain or moumain range was imagined to be at the end of This was the origin of [he Yellow River and center of early Chinese civiliza[lon. It is now iii (erraln (0 be a specific mountain but are no ancient maps tha[ show any particular Morohashi is of ten thought of as kunrun; the panly because their pronuncia[ion is considerations. In Daoisl mUlrlV,lflOU

of

as a !>' ..'_Vl.>Vl

baslc qi

are

of the child of a chicken isl dark yellow; lit hasj no no vOlce, no beginning,19 no roots. land) deep inside, there is jing. This the great threads ithere isj no longer slow and At center! of thisl (Mor).

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Origins & Energetics

This is an extremely difficult passage. It is helpful to know that in Daoist mythology the earth was seen as suspended and cocooned within a vast network or web of threads hanging down from heaven that controlled terrestrial events. If we cry to analyze this passage completely, we become lost in speculation. However, it is clear that the idea of kuntun and thus kunlun is, like the idea of the pole star, an idea of the origin of everything. Kunlun is the earthly equivalent of the pole star. The Huai Nan Zi supports the interpretation of kunlun as kuntun. Everything is madly, hurriedly created; subsequently, there is no origin. The river has nine curves and streams to the ocean. Subsequently (it) streams without end, because of the transportation of kun lun (HNZ 6:3-4). This is a strong parallel to the idea of kun run. Kun lun. as the mythical mountain range on which the Daoist immonals dwelled, has tai yuan as a synonym. Morohashi describes tai yuan as the place where the realizetn non of

breathmg,

y'Uall pu.ls.e palpation and me encrgeti(";.'; kidneys, and !he SOUTa qi

of

lower damian, or qihai danlian - has a role in the body. It is as imponam to body as kunlun is to fonnali n of qi on earth and as the or dan shu. or tal y • is to the creation of yin and yang in

me

_

._. " O J

This can al 0 be seen in references to damian. there were three damian in the body_ n The lower damian, "qihai """'Y"'". is situated below the umbi-kus near CY·6 and CV·4. Middle is related to Ihe hean and is in from of, or near to heart Upper is eyebrows. The dantian are energetic cemers 3l w are. Interact. and transform. They 3re imp the breath is directed andlhrough whkh it is cm:ulai[~ con,lerrlpladve brealhlng practices. n

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Origins & Energetics

Dantian is important in Chinese alchemy, both in external alchemy or early chemistry and in internal alchemy, the process of self-transformation through the pursuit of specific developmental techniques and practices. The areas in the body more specifically related to the internal practices of alchemy are also symbolic of some of the external alchemies. The difference is not uniquely defined. Dan A- refers to cinnabar (HgS, Mercuric Sulphide).24 This is a red-colored ore that has some peculiar properties. It was mined for early alchemical practices. In fact this must have been a widespread practice. The Shuo Wen lie Zi defines dan thus: A red stone from Ba Yue [an area to the north and east of ancient China], it symbolizes digging holes [mining] (Mor). The origin of the character dan A- refers to a mine B in which one finds cinnabar, the' inside the character dan (Fuj; Mor). The Shuo Wen jie Zi tells us that an alternate form of the character refers to the actual vessel or kiln in which the cinnabar was placed by the alchemists for purification to a more potent form (Mor). Tian 83 refers to a field, specifically a field tilled to grow food (Fuj). This is how the the common translation of the term dantian, "red fields" or "cinnabar fields" comes to be. Dan is a substance that was seen to symbolize life itself. There are a number of reasons for this. Partly because of its transformative and mutable qualities, partly because the color of dan in its natural state is bright red, the substance had powerful magical qualities. At certain times in the early hiStory of China, in particular the Zhou dynasty, red was a symbolically important color, the imperial colors (5&C 5:5). Joseph Needham notes that the practice of alchemy seems to date from before five hundred B.C. (5&C 5:4). The earliest recorded reference to dan comes from the Yu Gong chapter of the Shu ling (5&C 5:5) where it was given symbolic significance since the emperor in China during the Zhou dynasty was the heavenly child, tian zi, and held a special position in the religious practices of the people. Needham also comments that the use of red things or painting things red was a "natural piece of sympathetic magic," as red was the "colour of blood, and its ceaseless movement" (5&C 5:3) In the five phases, red symbolizes the phase of fire and fire rules transformation. 25 Most importantly for our study, jing ~ (or at least the jing qi) is stored at dantian and is distributed to the rest of the body from there. The Huang Ting WaiJingjing says: In the dantian is jing qi; the jing qi disperses [to the whole body] (Mor). The modem character for jing, ~, has the moon radical in the lower right comer; however, the classical character for jing, ~, had the dan character in that place (Mor), This has important connotations for the nature of jing as well as dantian: is the rice radical, a general term for food. t refers to newly germinated young grasses growing in spring. :R symbolizes life and living energies. The whole character refers to vital energies in living things, possibly those derived from food (Fuj).

"*

o

& Energetics

82

Shuo WenJie

this idea. and explains [he of this about righl part of the jing character

five phases. In which means

(0

(cyan), it

the east direction. creates dan. this is obvious (Mar).

creation of dan from to qing, the cOlor ion. was created in [he east. symbolically the sun rises [rom the east). This symbolism is r creates at the left side" (SW 52:275). uner the Nan as the reOex area of the liver (1'1) 16; 1'1) Jing associates the east, h east (wood) narurally fro over to jing. Needham comments:

it can hardly be mat bright red substance, used in an ient times as what might called a srrong magic of resurrecti . n, should have turned out to give rise [0 the most hving of the silver, metallic mercury. ll. but a life itself (S&C 5"3). three dam[an take on an imponam the qi and jingo By damian art cemers in the same area,

exact loc.aoon lower damian. It umbilicus,26 near the acupoim CV+ is three divisions below umbilicus, extending [\Vo divisions eimer of from H nn Maspero also suppon the Vlew that lower division below the umbihrus. 28 Yang's on the Nan jing concurs 19 However. name damian" as: ghuy dtUerem locaDon is ;:'U)i~t:::,~t::u is the name of the acup int CV-6 and is one and a hair divisions below {he umbiiicus, [he' dantian is located there, Since dal)tian is more an area CV-6 around CV-4, this location lOO is conslsteTIL ail pomt [0 an energetic center of symbolic t contemplative and inner s are suggested. Henri summarizes the The human body is rior world, that of cosm). And it toO with (qt).

CXle-

as the Chinese say (macrowith di\>inities. Life enters into it breath descending into the belly through the essence (jing) enclosed in rhe union produces the spirit (shen) which

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Origins & Energetics is the master principle of man, causing him to act well or badly, giving him his personality. This spirit, unlike what we caU the soul, is temporary: formed by the Union of breath which has come from the outside and essence which is contained within each man, it is destroyed when these separate at the moment of death; it is reinforced by increasing breath and essence through appropriate practices 30

This centrality is further demonstrated by the symbolism of the names of acupoints near dantian in the hara. Qihai, CV-6, is known as L~e "ocean of qi," implying an energetic reservoir. The ShuQ Wen Jie Zi supports this interpretation, stating that qihai is "heaven's pond, to which all rivers come" (Mor). Qi flows in the body just as rivers flow on the earth's surface. Qihai is the place to which all rivers flow. More than just a center of energies, qihai dantian is the center from which the energies emanate. This can be seen, for example, in the triple warmer function of carrying source qi from the center to the extremities, the source points of the twelve meridians (N] 66). It is also the center from which healers derive their energy used for healing. Two of Japan's most famous acupuncturists, Sorei Yanagiya and Keiri Inoue, used non-insertion needle techniques, utilizing qi alone to stimulate the acupoints. 3l There am many more examples of qi gong masters, martial artists, and healers who attribute their abilities to the cultivation of this center. Dantian is focussed around guan yuan, "the gate of basic," eVA. The name guan yuan also has considerable significance. Bunshi Shiroda, a modem scholar and practitioner, tells us that CV -4 was seen as the "lower regulator": The upper regulator is wei wan [CV -12]. The lower regulator is guan yuan [CV_4]32 He also notes that OJ -4 is called dantian and quotes Kisei Matsui as saying "dantian is the secure place of the master of the heart.,,33 The most significant aspect of the name is the relationship of yuan 5I:. (basic) to the basic qi, the original or fundamental qi, one of the most fundamental energies of the body, indeed of the universe itself. According to the Zhou Yi, basic qi precedes the division or separation of heaven and earth: The great ultimate, tai ji, is where the basic qi is still blending or swirling before heaven and earth are divided. 34 The Shuo Wen says of the basic qi: The basic qi divides. The light, clear, yang part becomes heaven. The heavy, unclear, yin part becomes earth 35 Heaven and earth arise from the division of the cosmic or basic qi. There are many ideas about basic qi. It has been seen to arise from several sources and bring about a number of different effects:

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source, tai

qi is a broad The grea[ rrans[ordivision of yin and me primordial quote IS one of many the of basic qi In Daoism. Interestingly, we are told [he void, space, bm is rIOr limicless. ln this sense qi, the division of which produces oilier forms of i( was related [0 me process of birth and cycles of bn:m, death, and rebirth:

die. This is nature.

basic qi the body the root, remming [0 the

to

39

source, is also revealing. The Chun the roOl or basic pan.'IO Basic qi is source qi is more active in the bask qi is a somewhat more of Dr e As Sugiyama says, iO moving qi source QuotKi No tell us,

The

qi are explained in me following passage practitioner of anma,

quoted from Shinsai lJ"adinonal Japanese

will resulL If the death. How we basic qil h is Crom of overwork of from overworking (psychological or a lot of self-serving desires, the basic qi tOO much alcohol, [00 much sexual toO wind. cold. heat, dampness or physical cause the qi to scagnare. When the basic qt its freshness. causes diShalny yin and six the blood and vessels ecom!: stagnant; the joints muscles becom tense; the skin becomes dry or tous:B it means

Virtually all 'Ii This passage form of the basic

seen as stemming from stagnation of the basic quite dearly the underlying, undifferentiated

That there is a point oh the abdomen yuan, imphes for this poiot a very SIgnificant or symbolic function. with dantian 'liMi, may sy boUze life These points and areas ail lie at cenler or (he ody at the moving 'Ii between kidneys

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Through their names and associated symbolism, they may be seen symbolically as belonging to the center where the source is located. There are also a number of points on the back at the same level as these points on the abdomen. Qihai shu, BL-24, and guan yuan shu, BL-26, are probably related to 01-6 and CV-4. Often, these points are checked for reactions when 0/-6 or 0/-4 are reactive on palpation. It is possible that these two points treat the problems that create the reactiveness on CV-6 or 0/-4. Ming men, GV-4, is also related to these points and this area in the abdomen. It too shares a relation to the energetic center and the origin of life: The person is created on the earth, the ;IS; [thread that hangs down to hook onto the] ming, in heaven. Heaven and earth meet the qi; it is called the person (5W 25: 159). This is a difficult passage. The character ;IS; is the modem form of~, which commonly means to "hang" or "suspend." Thus, the passage refers to the creation of the person and the suspension of personal life (ming) from heaven. The character ~ specifically refers to a thread that hangs down to hook onto something (Fuj). This usage recalls the Daoist creation story that explains the relation of heaven, person, and earth. In this story, ji t\ "heaven's loom," weaves the threads, the jing (vertical threads, meridians) of the fabric of the universe (Kad).44 This may be related to the other Chinese concepts of meridian cycles controlled by the cycles of the stars and constellations. 45 The term ji, in other Daoist contexts, refers to the idea of a "germ." Here, germ implies the sense of "germ cell" or "germination," the source of life. The Zhuang Zi contains an interesting discussion that appears to be a theory of evolution. All things start at the ji, the germ, changing into larger creatures, ultimately producing man. Needham offers an excellent translation of this passage (5&C 2:78-79). Similar articles may also be found in the Lie Zi: "All things come out from the germ and return to the germ.,,46 These ideas at least hint at the microscopic origins of life. Both these ideas of ji may well be the same. The threads may be thought of as a germ too, producing the same effects in living things. A passage from the Huai Nan Zi raises more questions about our understanding of this term. The realized man [the sage 1is able to attach or connect to tian ji [heaven's loom, heaven's germ] inside the body (HNZ 1:74). This may be referring to a cultivated ability to connect with the threads from heaven, or the Ling Shu concept of mingo Thus, we should not think of the threads as literal threads, but as some kind of energetic connection. This is important in this context because there are two points on the back which relate specifically to this idea. Ming men, GV-4, lies below the point xuan shu, GV-S. If we take the Su Wen idea of the thread suspending ming from heaven, we can see this in these two points. The thread suspends the ming, life, at ming men from xuan shu. As we will see in the next chapters, ming men is intimately tied to the ideas of the water-fire interaction as the "small heart," the active aspect of water, the source, and the moving qi

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be(We':n the kidneys. W~ile this toO is inte~rer.ive, we see once again me implication 01 :{ very sign~[ Icane and symbollc funcllon In rIllS area of the body below the umbillcusj [he hara.

Transformation· The classical concept r a source is like a puz.zle, each piece joins and supportS [he o[hers. We see the hara as me place where many essential energetic functions occur \t is me residence of basic qi. mat energy that precedes yin and yang, fi e and water. It is the meditative center, the driving force 01 the pulse. e center of meridian circulation, and it plays a powerf ul role in classical ucrilion theory. The hara is associated with jing, shen. qi. the essemial ene it is reJated to major philosophical concepts: middle palace, purple heavenly child, trigrams, branches. stems, and the dantian Some of most important acupoints - CV-3. CV-4. CV-6, CV-12, CV-l?, CV-19, ST-23, 5T-25, LU-9. BL-60, are eimer named as part of the phll sophieal concepts related to the hara, to its funcllons, or to both. As, we ave seen, the imenor branches of the meridians imerweave the abdomen i a fine tapestry.

F-21.

While it is uue that e must speculate to understand much in the c1assicalliceramre, the philos phical centrality of the hara is hard to deny. Yet, if we c:!refully consider e work of the dassic:!l authors, we may also see that there is anomer cons stem theme: transformation. The area below the umbilicus, qihai damian, as well as the other danrian in front o[ the hean and between the eyebTOXS' are areas particularly associated with mmsf Ofmarion. In regards [0 n [ritlon, energetic anawmy, and qi function, the abdomen is where esse tial transformations occur. This idea, though requiring some in(erpreta~ion, is particularly reinforced by Daoist alchemical practices . Transformation is a ifficul[ cause to champion. The misconceptions and misrepresentations that have plagued me ideas of alchemy and rransmucation have color d the word with derision. For many, the idea is superstitiOUS nonsense. owever, there are ways we can think of uansf ormJllOn that are wonh ou investigation It is possible, for example, to think of transformation as si ply the processes of digestion and respiration where elementS of the enronmem are ualized by the body. it is also possible to mink of transmu arion as the resuh of the processes of nuclear fission and fusion where cmical elements are crans formed by the emission of subatomic panicles ' owever, it does no! always take nuclear reactions, as we currently know the . to cause rransformation. Scientists in the IaSl w decades have demonstrated beyond reasonable doubt !.hat life can trans orm chemical elements according [0 need. Much of (he research work do e has centered on plants; however, animals and humans also demonstra e thiS abilil:)" Louis Kervran. a well-known and respected French scient I, has led [he fIeld in this research 47 He conducted much of his ow research and compiled the results from a large number of other studies These range from [he geophysical to the microorganismk and i!1IUde on industria] accidents, agri cui rure , plant developmenl. and one mending. His conclusions provide a stariling challenge to our lay un erslanding, demonsuating mal the old chemical theories of Lavoisier are. uOTIoded and do nOl apply in biolOgical systems.

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Scientists have, until quite recently, assumed that chemical elements are immutable; that is, in a chemical reaction, nothing is lost, nothing created . Instead, all the elements of the reaction are changed from one state to another, retaining the integrity and structure of the basic building blocks, the atoms. This assumption is based on the idea that atomic interaction occurs only by the exchange of electrons from the outer orbits of the atom. Kervran has shown that in biological systems, there are other fundamental reactions involving the exchange of protons from the core or nucleus of the atom . One chemical element, for instance Sodium, can be· transmuted to another element, Potassium. These changes are mediated by biological reactions and catalysts, such as enzymes, and do not require the enormous power involved in nuclear fission and fusion. Kervran postulates that this function is essential to the continued survival of living things, an essential part of life's adaptability. Most biological transmutations occur within the first tvienty elements of the periodic table and to a lesser degree with the next ten. 48 Some examples he cites are the abilities of man's phYSiology to transmute Nitrogen to Carbon and Oxygen, Sodium to Potassium, Sodium to MagneSium, Iron to Manganese and vice versa. Animals such as chickens are able to transmute Potassium to Calcium, and rats Calcium to Magnesium. In plants, Phosphorus to Magnesium, and Manganese to Iron transmutations occur 49 The list of examples is large. What it evidences is that the basic building blocks of matter are not immutable and are constantly changing. As Kervran says: Most of the reactions studied can occur with the movement of an atom of Hydrogen or an atom of Oxygen, thus with the addition or subtraction of H or addition or subtraction of 0. 50 The greatest source of Hydrogen and Oxygen is water. Thus it would follow that water is a substance essential in these transmutations. This mirrors the nature of water in Chinese thought. The Dao De Jing states: Under heaven, nothing is more soft and yielding than water Yet for attacking the solid and strong, nothing is better. It has no equaL The weak can overcome the strong5 1 At times the Daoist literature expresses the mutability of water obscurely. An interesting and potentially important passage from the Huai Nan Zi compares the nature of heaven and earth, brightness and darkness, fire and water: The dao of heaven is round. The dao of earth is square. The square controls the darkness. The round controls the brightness. Brightness is like blowing qi. Therefore, fire is the outer shadow. Darkness is absorbing (containing) qi. Therefore, water is the internal shadow. The blowing qi is nourishing. The absorbing (containing) qi alchemically transforms. Therefore yang is giving, and yin is transforming (HNZ 3: 133).

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The partS of me assage we want to focus on are me fir ili through eighth lines. Various c mmemators comend that the "ourer shadow" refers :0 ',he shadow chat is ast by a light source, such as a fire. The energy or light [rom the fire e anJtes outwards. "blows out," casting its shadow extemaUy, These com entatOrs note chat the "internal shadow" refers co me shadow that can e seen in water, a reflection. The light is reflected from the waler and I e shadow appears internally, as if floating in the water Not only does [ is important reference express me classical conceplion of the inherent c!i ference between the symbols waeer and fire, it also expresses the mutabilll of water,

If we can recall au own youthful playing in ponds we wiil remember that when different 0 jects are placed by the waler me reflection will change. If me water iSt,dlsrurbed' the shadow or image in the water will change. Water has, in is sense, the abiliry {O transform the image. Thus, in terms of the passage 'the absorbing qi alchemically transforms," and the nature of yin is "lransf rmative," we see Ihe classical idea of cransf ormation described through the melaphor of the subtle, moving changes o( a renection. The changink image, the interior shadow, slands for the process or transmuration, There are passages i! the medica.llirerarure thal state similar principles: "Water can alchemically transform everyming."s2 The relationship between the great symbols fire a d water and their associated functions - the kidneys, hearl. master of t e hean and triple warmer" the interaction of the jing, qi, and shen - ar the relationships of transmutation. The Daoist alchemists utilized these elements in their techniques of imernal alchemy. This concept of transm talion was the one that the medical authors most probably presupposed i their theoretical discussions. We are thus able to understand thal me Chi ese concept of transmutation, the result sought through their alchemies, ames none of the gross misperceptions thal have come to be associated wi h the word. Instead, they understood !.hat subtle processes of transforma on occurred \vithin the human body, that these processes were importan to human life. and were pan of the general nutritive, yin, category of eve While we cannOl sa . nor expect, L.~a( [he ancient Chinese medical authors were aware of iological rransmutation in the sense of modem language and principles science, we can say that their observations and theoretical principles \ead~hem [0 suppose and ~memp( to describe in their own symbols the ability a HVlng beings to rransform. Perhaps, in the light of the accomplishments f Kervran and his associates, we can re.alize that the ideas of alchemical raccices and rransformations are nOl so bizarre. Kervran suggestS that his ideas and findings challenge modem relativistic and quanrum theory, by owing that i[ cannot be applied LO living things or blOlogica! processes. he.se basic transformations al low energy levels differ from the exchange studied in high energy physics. 53 It is nO! that the general laws of nUdea~PhYSiCS cznnO[ be applied to biolOgical systems, more maE mese laws are ot the exclusive explanation o[ transfonnarive eventS, There are definite y similarities in these processes, though fundamentally of different ener tic orders.

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That biological rransmutation or transformation is a concept and phenomenon seen in Chinese thought, complements those parts of Chinese theory that parallel the modern ideas of quanrum physics. Detailed examination of Daoist and medical concepts reveal ideas quite similar to concepts and ideas that are basic to our modern conception of the physical world. In the Chinese model, bian, change ~; hua, alchemical transf ormation 1t; xing, form M; wu xing, no form 1!\I;M; shen, spirit ii\$; qi, ~ each exemplify aspects that suppose a far more sophisticated understanding of physical nature than we might expect Translations of most of Oriental energetic terminology into simple English equivalents is usually fruitless, an almost impossible task. Simple renditions of qi as "energy" did work to facilitate communication of the earliest understandings, and basic concepts, of a complex symbol, but should not be taken too literally. The connotations attached to the English words are sometimes subtly, sometimes grossly different than those of the concept as it was used traditionally. The idea of "no form" is, for example, a very complex term that is not clearly understood if we think of it as a simple absence of substance. In the Nan ling the triple warmer and master of the hean are said to have a "name but no form" (NJ 25; NJ 38). From this comes a pervasive idea of the triple warmer and master of the heart as "insubstantial organs." This, although "correct" and "properly translated," is far too incomplete to stimulate an appropriately profound understanding of the idea; an idea we must explore in detail if we are to gain a reasonable understanding of how the Chinese saw the processes of change and transmutation. Zhuang Zhou conceived of no form as absolute jing, the tiniest nondivisible, underlyingjing, the underlying substrate of material things. 54 This concept ascribes to the triple warmer some important properties and implications. In addition, the concept of no form has been discussed by a number of classical authors. There have therefore been a number of different ideas about the nature of no form. Although slightly different in their detail, all refer to the same concept: the pure energetic, immaterial precursor of both animate and inanimate matter. Some of these discussions remind the reader so much of the modern relativistic model that it is impossible not to think of no form in those terms. To reiterate what Zhuang Zhou said: Absolute jing has no form. The jing is tinier than [the concept ofl smallness. Rough jing has form. No form means that it cannot be divided futher. 55 Zhuang Zhou, one of the earliest and most famous Daoist masters, seems to be talking about the non-divisible components of matter. The idea of "absolute jing" is almost atomic in nature, perhaps even sub-atomic. Modern physicists tell us that matter and energy are hard to distinguish. We cannot really say that atoms or subatomic particles are material or energetic; they are both and in some sense neither. How they are perceived is dependent on the model, measurements, and techniques used to study them. Yet it is from these basic building blocks that material things are constructed. Thus, in the terminology of Zhuang Zhou, form is compused of something that is insubstantial: no form. o 90 Origins & Energetics aboul no fonn The Shi Ji, the book of hiStory, TLere are other tells us: The DaoislS cause the person's iing and shen to become one, to move and unite WHf no form (Mor). Here the term no form i~ seen in a DaOlst context, relative to some Daoisl pracuce. Another Daois!t~ text, the Huai Nan Zi from 122 B C, makes numerous references to the concept of no fOITIl. From these we gain greater mSlght into [he na Ife of no form: I No fonn is the grea ancestor of manerNo sound is the gre I ancestor of the voice The child [of no fo J is light The grandchild [of 0 form I is water. All are created ffOjno fonn (HNZ 2.59-60). Because of the gram mati a1 structure of these lines we can see this passage as refemng to no [onn, he parent, glVlng birth to light, the child, and in rum to water, grande ild. This passage is desc.1 ing the materiallzation of no form, the precursor of material things, from ~re point at which it cannot be perceived, to a perceived Stale, light. h [h~ evolves to a materiallzed State, water. This is remarkably to Ej1stein's idea about the interchange of energy and matter. In this conceptl as energy is slowed down it becomes morc material. As matter speids up, it becomes more energetic. Maner and energy are seen as being ttmerchangeable, undergOing changes or transformations back and fOl1h. IIhe same passage from me Huai Nan Zi continues: light can be seen; it cannot be grasped. Water can be molded; it cannot be desnhed. Therefore, of aU things mat have maller, nothing is ~ore respectable than water (HNZ 2.59-60). i Water IS again seen as th highest, firs!, or most respectable material manif e.5t3nOn This was so c early unders tood mat it was ref erred to as bvious: "No form thus creaL form. mis is obvious" (HNZ 105). Form and and rebinh: nO f form ,-ere found ° In the Daois[ concepts of life, deam, l The f onn is the e of life. The qi is the fuHne.s IplemtudeJ of life. The shen is the con roller of hf e (HNZ 77). The manife.stalio ,the fonn, the body, is the dwelling place of Ufe filled with qi and cOt1IJo.led by shen. No {onn, on the other hand, was seen in relation to the on said to be of the one. It is said thaI the one with anything below heaven (HNZ 61). The "one" is the great 0 e, the origin of change and transfonnation, yin and yang and all things. fonn was seen (0 derive from, or be related to, the great one: o 91 Origins & Energetics All the myriad things, all of them, can be placed in one category. The roots of all material things come out from one gate; its movement is no form; its hua [alchemical transformations 1and bian [changes] are like shen (HNZ 2:62-63). No form is the great ancestor of matter, it is that part of the great one which gives rise to matter and all things. The shen is the other part of the great one, which governs and controls the transformations and changes of no form. The interaction of shen with no form, or the derivatives of no form, was seen to be the constant recycling of life and death. The form, the material things that are derived from no form, also revert to no form: Therefore, when the form declines, the shen which [itself] is never alchemically transformed, responds by alchemically transforming [the form]. [Even with] a thousand changes and ten thousand transmissions, it has not yet begun to polarize. [The form that is] alchemically transformed returns again to no form. [The shen that is] never alchemically transformed dwells together with heaven and earth (HNZ 338). Shen as the eternal unchanging prinCiple constantly transforms no form to form at conception and birth and form to no form at death. The passage continues: Upon the death of a tree, [the one that made the tree] green leaves the tree. [The one that made] the tree alive is not the tree itself. [The one that makes] the form fuU is not the form itself. Therefore, [the one that] creates life never dies. [The one that] was created will die. [The one that] alchemically transforms things has [itself] never been alchemically transformed. [The one that] has been alchemically transformed, can be alchemically transformed [is mortal] (HNZ 338). This idea is described again in another passage from the Huai Nan Zi: [The one that] creates life, never dies, and [the one that] alchemically transforms things, is not [itself] alchemically transformed (HNZ 120). Life and death were seen as transformations back and forth. The shen, which catalyzes or controls the transformations, remains unchanged. The Lie Zi supports the Huai Nan Zi interpretation of the cycling of no form between life and death: "Having form" [life] is created by no form. [The state of] "having form" returns to no form upon death 56 Zhuang Zhou says similar things about life and death. For him, change, bian, rather than alchemical transformation, hua, characterizes the changing or transformative process of life and death: If one thinks about the beginnings [of everything], then they basically have no life. Not only no life, but baSically no form. Not only no form, but basically no qi The beginnings are o 92 and mere is qi. and there dea[h. S7 Chall);es and alchemical enres berween transformation, hua, is i porum for un(ler;itarldlflg different but ideas from Zhuan Zhou and the in na(Ure, almost n the way one season into or how yang at the exrre'11 changes into yin. Hua is a radical a l1ansformalion of one thIng to another, more in the alchemical sense of transforming or rransmut ng one substance to another. lions described by Kervra ,or me transformation of a seed at germiTiation, more describe hua. . polar When transformed. changed. Yin and shen (SW 66361). 58 to be akhemical1y its Umh it is to are [rom This can be seen In rdalio Hua! Nan Zi: Bian and hua, me yin and y og aspects of change, are Yang alchemically lra sfonns qi; yin becomes form (5W 5:32), For instance, the comments: alclherllic;~Uy COllr~aCts, m.ere'lore il beccimes mmsforms form 59 Li Zhang Zi comments: Yang has no it alctlemlcally cr:anslornns qi. Yin has subslance, '11'>a.};,L,!l!\ refers 10 the of body flames (Mot) rl"lllnn,,,,,.,,',, [0 a to me names of a Thus, the nsing from me names of a One shows three phoenixes rising from thac there are three wanners 1 The or as one direction, itself there are " "burning," or "warming." The best body's essential capability of warmer is the medium through which the within the human body. Ie has concept in Daoisl of or in lhe juslificatlon for ideas. According (Q the Ihe system of fasciae and body. in panicular the OkamOlo specificaUy men (BL-46); from whole body cia in rhe o wanner is the Ippo nip!e warmer qi exited al huang the huang, the fascia, to the are the various systems of fasciae mat connecl ihe organs 4XA U4#I44¥ Classical Energetic Anatomy & Physiology 141 I The Mo and Luo Other concepts referred to in [he classical literature are worth~ of note and further investigation: the mo ~, the mu ~, of the mu polms, the diaphragm~, the concept of the lining of the body, the Ii ~ and tre lUG ~ of the luo vessels and points. Careful and detailed examinations o~ each of these imponant concepts further reveals the imponance of the a~dominal and bodily fasciae. . Descriptions in classical texts of the internal trajectories of th~ twelve meridians note how a meridian "belongs to" or "penneates" its o~n organ and "spirally wraps" its coupled organ. The character trans~ated as "spirally wrap" is luo (Fuj). Luo is a difficult character to translate, having a number of pifferent meanings in different contexts. There are the lUG mai *frPffi, or luq vessels, often translated as the IUD meridians or as blood vessels. There ar¢ the jing IUD '@l\fr, or system of vertical ~ and horizontal ~ meridians that traverse the body. There are the luo xue ~A, or luo pOints, one of whic~ lies on each meridian. There is the luo wrapping of coupled organs by th~ meridians. In several contexts the luo is seen to be an energetic pathway or trajectory, and as such it refers to fascial or connective tissue membrane~. The luo is a branch from the main or vertical meridian. The tLing Shu teUs us: The jing mai ~Pffi [meridian] is Ii ~ [the lining]. The horizo~tal branch of the meridian is the luo. The divergent branches are the grandchild luo I*~ (1.5 17: 190). Here, the luo are described as the horizontal branches of the ~~ridians. From the luo spring other smaller branches, the "grandchild lu~." This image is similar to vascular system branches. The blood passes thrbugh the arteries to the arterioles and thence to the capillaries. The branchi~g trajectories can be seen in a similar manner. The pivotal concept in theidescription of the the luo and grandchild luo is that of li, the lining. I In modern times, the character of li has been simplified to m., 'meaning inside or interior. In the Han dynasty, Ii ~ referred to the lini~g of the body. It was generally seen in opposition to biaD ~, surface. Silke biao, the surface, is usually understood to refer to the skin and body ~air, the lining is thus something that covers and lines the body, yet is notlthe skin itself. We suggest that this distinction is perfectly reasonable find evidences the Chinese understanding of the superficial fascia of the ~ody. In this, we are not alone. In a brief discussion of the yin and yang r-vei mai, Xie Un of the Qing dynasty stated: The yin wei controls the qi of the greasy membranes ~~~ I it goes to the lining of the body24 Here "lining" refers to the superficial fascia and probably the mor~ internal systems of fasciae as well. This has fundamental implications. Since the "meridian is li, the lining," the meridians themselves are seen as[ flowing through the superficial fascia of the body. The luo vessels, as thr horizontal branches, would also flow through the superficial fascia. o Classical Energetic Al1atom~ & Physiology 142 ! Diagrammatically we can see\it thus: jmg (vertical). luo (horlZo!ltal) TIllS system of branch from the mendian is usually understood as rraversing the whole body j [as the superficial fascia does. When these branches "spirally wrap" th coupled organs they are traversing the fascia! envelopes that encapsulate the organs, AnalOmiatUy !.his makes good sense. The various fascia! s, stems of the body are functionally one large imerconnecred system Fascfl conneClions from inside the body surround and connect the organs to tly~ surface of the body through the. superficial rascia where the meridians and luo meridims lie, This concept has many ipraclical implications when one needles the acupointS_ The acupoims a~~ meridians lie only a few millimeters below the surf ace of the skin, an in~'ponanl consideration when treating with needles and moxa Further, it i~ nOl a speculative concept It is described in the SI.< Wen ie. the context ol the origins and transformations of disease: The Yellow Emperorlsaid. "This IS [he origin of disease. II is the tiny, absolute jing. It always comes flTst into and knotS at the skin" (5W J'i;87). The concept of "tiny, absqlute Jmg is slighdy dirferem from Zhuang Zi's idea of "no !It%fi?, as "tiny, absolute. jing" ~::e:til. or that whkh cannot be further However, [he conceptS are closely parallel. As we have seen. the warmer has a name but no form," This implies some mple warmer to the tiny absolute jing. In o Classical Energetic Anatomy & P'hysiology 143 I this context, the tiny absolute jing of the Su Wen discussion mig9t well follow the same idea. Diseases have tiny origins, like the tiny, ab~olute jingo In coming first to the skin, disease is the smallest perturbation of !qi flow in the meridians. This disturbance may be seen to come from with~n the person and not just from the outside. The Su Wen says further: ' This is the origin of all diseases. Evil always attacks first a~ the skin and hair and then comes into the area between the Iskin and the flesh. It comes in and stays at the luo vessels. [If it does not leave, it transmits to and enters the meridians. If it does not leave, it transmits to and enters the fu fff and then gathers at the intestines and stomach (SW 56:290). I This passage describes disease as originating very superficial~y, coming in a little deeper to the area between the skin and the flesh, whdre lies the superficial fascia of the body. From here it is transmitted to the l~o, thence to the meridians, thence to the fu and then to the intestines anQ stomach. In this context, it is very unlikely, as several commentators have said, that "fu" refers to the yang organs Ml The term "fu" has been used in a variety of ways over the ~ears. It is generally seen to mean a place of gathering or storing. Fu also refers to the chest, the area around CV_17 25 This last reference to the area ar;ound ev17 may be construed to great significance. The etymological r06ts of tanzhong (CV-l?) refer to a cooking pot with a lid on it (Kad) and ~lso to fat, greasy, smelly tissues (Fuj). Since eV-17 is said to be the "pal~ce of the master of the heart" (LS 35:288) and the master of the heart seen)s to refer anatomically, at least in part, to the major blood vessels exiting anp entering the heart, then it may refer to the thymus gland which lies underneath the sternum, roughly level with ev -17. This gland lies over the p~ricardium and aortic arch. "Fu" further refers to the tendons and the site~ at which they attach muscles to bones: Yanglingquan [GB-34] is the shu point of the knees. The knees are the fu of the great muscles. Theref ore, this allows stretching and bend ing [to occur]. 26 Again: Many old people wear waist bands [hara warmers]. Thi~ is because the lumbar vertebrae are the fu of the kidneys27 The Nan ling distinguishes the triple warmer as the sixth f~ (N) 38:3). This has been interpreted as ref erring to jU M1, a yang organ. Acqording to some commentaries, the use of the term jU ,rf,f in this passage ' refers to something other than the character used to reference a yang org1n. In his commentary on this passage, Wang Shu He actually refers to the 'I fu of the yang organs," clearly distinguishing fu from the yang organs. F&rther, he describes each pair of yin and yang organs as having a fu, the triple warmer having or being an "external fu" In the Nan jing Du Ben Mu Lu, Wang Yi Ren felt that this \1se of fu referred to the systems of lymph nodes in the body. o l44 Classica! Energetic six fu. What is the single ru? wanner is arm shao yang. of the kid- warmer there are vein. In the lower warmer nodes 28 Again we find a relation to is related to the area then the possible lakes on great oons. These source 'Ii and the niple warmer. Also. if fu CV -17, and CV -17 is related to [he thymus of fU [0 the systems of lymph nodes as both have immunological {unc.m 1813 by K Mitsutane in Kailai wanner is related to the lymphatic sysupper warmer to the thymus gland. (he lower warmer to the systems of the 29 To be internally consistent it warmer in re.lation to the spleen, is important in these The involve- Extending the the various extensions of the lymph system, the lie In superficial fascia. saw how the was seen in relation (0 in the water (tS 12;]51-]55) We the flow now have a UVO'''' ...H_ ",,,,I"""9tl of this fluid now, and its to the triple wanner to systems that are an upper warmer (IS 18). usage of the te.rm [u in This interpretation fits whe.n one s~eaks of me warmer (u, it exists at (N) J1:20). There are and Qi dose proximiry to One last and totally Nan Zi. The six [u were Bl-B7, B2-B8) Each o in the body, in me. head. name for ST-30, qi lymph nodes.)O of me term fu comes from the Huai six pairs or opposire earrhly branches rh>f'I as a (HNZ J:112). 145 dassical Energetic Anatomy & P~ysiology Given the considerable use and reinterpretation of the charact~r "f u," it is not impossible and is in fact quite likely that the fu referenc~d in this context is the lymph nodes. Since fu is generally used to mean ~ place of gathering or storing, this interpretation is justified. In referenFe to the movement of the evil from the meridians in the superficial fascia to the fu, it also makes sense to see fu as the lymph nodes. These are pIa es where fluids gather as they stream back towards the interior body. T, e lymph nodes are also related to the superficial fascia, since the surf at e lymph vessels that drain into the nodes lie in the superficial fascia. In !hiS 1888 Qing dynasty commentary on the Su Wen, the Huang Di Nei jing fU Wen ji Gua, Zhang Yin An said: It [pathogeniC qi] does not gather at the intestines and stom~ch , it gathers between the intestines and stomach 3l . He proposed that the mesenteric membranes between the intes ~ines and stomach were the site of the third stage of disease transmission. Ir) context, this passage can be seen to describe the penetration and transm:ission of I pathogenic qi from the skin to the superficial fascia and through t~e fascial system to the mesenterium. In a similar passage, the Su Wen describes the penetration 9f pathogenic qi into the yin organs: I Therefore evil qi comes slightly to the inside of the five yin organs, hOrizontally connecting to the mu yuan ~1Jii.: (SW 35:402). This brief and seemingly innocuous passage from the Su Wen has been richly commented upon. Essentially, it describes the penetration pathogenic qi to the fascia that encapsulates the yin organs. This is only obvious by examining the meanings of the tenns, rnu and rnu yuan. In ~is Tang dynasty commentary Wang Bing says that the mu yuan is "the so~rce connection 1Jii.:* of the diaphragm mu." This refers to. the mesentertc membranes of the abdomen. It references the ideas of the Ling Sh~ source theory that describe the falcifonn ligament, at the upper end of y.,hich is the gao source.~. It is attached to the lower edge of the diap~ragm, at the lower end of which is the huang source ~ ~. . df Yao Zhi An, in his Qing dynasty commentary on the SU Wen, ~itled the Su Wen ling Zhu lie jie, explains that mu yuan is "the source of t ie rna J¥;; [diaphragm membranesj."32 Quoting the Quan Yuan Qi Ben, he also explains the rnu JJ: "mu creates the membranes." This passage is Icited by the modem commentators of the Tai SU as part of their commentary on the e~planation of mu yuan (TS p.448). In describing rno yu~n ~JJli: , which is seen as the same as mu yuan, since the mu creates th~ mo or membranes, the Tai Su says: Each of the five yin organs has a membrane source ~JJli: . If eyil qi comes into the five yin organs , it will be hOrizontally co~­ nected to the transporter fm of the five yin organs' membrame source. o 146 Classical Energetic Anawnty & Physiology In Olher words, each ~n organ has a membrane related to it This membrane has a source, a ~Iaee of attachment in the body. If pathogenic qi comes into a yin organ, • will be transmitted through !.he rransponer to this source, This is a diffi4ult passage to imerpret, but In thIS context the imphcatiOn thaI m IthlS case pathogenic qi, transmits through the membranes, is inesca.pal:lle. The commentaries of b~th Wang Bing and Yao Zhi An present !.he mu yuan in relation to the diaphragm. In the lale Han dynasty, the Shi Ming described the diaphragm ~n\'~s a block ~ rha! separaled the upper and lower pans (Mor). In the eleven~ century Song dynasty, the )i Yun, a massive encyclopedic dictionary, defcribed the diaphragm as "huang Fl " or "being like leather" (Mor). As previously postulat huang refers to certain of the fascia and mesenteric membranes in e abdomen, The diaphragm was also seen to relale [0 certain fasda! tissu " The comment from the Quan Yuan Qi Ben, "mu creates the membranes" indicates that the mu is related lO the various membranes of the body. though nor stated as clearly in the earliest ClasslCal textS, this understa ding of the mu existed much earlier, probably as early as the Han dynasty,. A mort recent etymolo~cal srudy, the Shuo Wen Tong Xun Ding Sheng (Explanation Book of the Shuq Wen), wnnen circa 1848 in the Qing dynasry, attempted to the m~ character: "Mu was used to substitute for mo ~" (Mor) aUthor felt tha( the rerrn mu, in itS earlier uses, was synonymous mo, (he I'embranes, and was at times used in place of [he mo, The Shi Ming f the late Han dynasty saw mo as "like a curLain, spiraUy wrapping ~ (lu ) [he body" (Mor). The mo thus described the superficial fascia of the bo y. Modem scholars generally agree with this definition of the rno as the uperficlal fascia, thin membrane between [he skm and the flesh (Mor). , me This understanding of in relation to the mu and especiaJJy the mu yuan can also be found in texts. For inS12nce Zhang Yin An's Qing dynas!y commentary on the Su Wen, the Huang Di Nci )mg Su Wen)i Gua, comments on [he use of the mu yuan in chapler 35 of the Su Wen: 11'lzOnlal connection Ithat is part of!33the The mll yuan is the gao mo Igreasy memb neJ of the yin and yangorgans. Mu yuan here is seen as pol of the mesenterium or abdominal fascia with a honzontal feature connect~ng the yin and yang organs to each other and to the abdommal walis, the Aeriloneal fascia, in anoLher passage Zhang Yin An makes funher commem The mu yuan is a gre~' y membrane. It also has the narure of con nectmg [!.h ings J. T lerefore, il is the narure of. the skin and the yin and yang organ .54 The mu yuan has [he narurelor connecting t,l,ings in the body. specificaJJy [he yin and yang organs and the This Slates the same relationship o( the superficial fascia and the imerna! rascia. the meridians and !.heir organs, that classical authors pro osed, me o j Ed . 147 :; U 4 ;. . _4.4 . -...' ~ .' '" "~.'. Classical Energetic Anatomy & Physiology I Another possible interpretation of mu yuan is to see it as the{'root of the mesentery," which extends from the left side of the secon lumbar vertebra to the right sacroiliac symphysis. 35 This is the site of attac, mem of the mesentery to the dorsal abdominal wall, and holds possible sigljlificance since this would place the "root" at the crossing of the lumbar veJebrae at the inferior level of the kidneys, and thus in the region between lthe kidneys, related to the moving qi between the kidneys. We recall ~ie Lin's Qing commentary on the Nan ling: The strand of fatty membrane, passing through the spinal bones ... [is 1 called the kidney connector. It passes down to the net-like membrane ... [and] extends to dantian, the soutce of the lower wanner. 36 The "net-like membrane" is reasonably seen as the mesenteriurq and its root as being related to the mu yuan. Another modem Chinese commentary on the Su Wen by Guo ¥\i Chun defines mu yuan as "the source of the transporting membrane, b~low the I umbilicus. ,,37 Again, the membranes are seen as having the cagacity or function of transportation; they are said to lie below the umbilicu~, fitting reasonably with the Ling Shu discussions of the source of hua~g, Chen Yan's statement about the triple wanner, and Xie Lin's discussion of how the membranes extend down to dantian in the lower wanner. Zl:1ang Yin An makes a further relevant comment about huang 1l Huang is the greasy membrane that spirally wraps (luo) ~ the small intestine 38 . This is a direct reminder of the relationship of huang to Ling Sh\i source I theory. This passage also makes a relatively clear statement about ;the possible relationship of the small intestine to this theory. ' The relationship of the mu points to the fascia is something thJr can be seen practically in the work of Yoshio Manaka. 39 He has found tHat often in the prone position the mu points are not reactive when a patidm has a problem of the organs and meridians that the mu points are said t~ reflect. However, by stretching the meridian through rotating, flexing, or dtending the foot or hand, the points immediately become reactive. For in~[anCe, a patient with a problem of the small intestine as diagnosed by s;' ptoms and point palpation evidenced no soreness at CV -4. After stretc ing the small intestine meridian, CV-4 became very reactive. Manaka re inds us of the importance of the wrists and ankles in tai ji movements. Gilven this context, it is quite likely that the mu points are points of specifiq attachment of the fasciae through which the meridians run. By specifi~ movements of the wrists and ankles, the stretched fasciae acquire a cer~ain tension and changed conductivity. The energy thus freed and the fasicial tension induced by stretching establishes a tension at the mu point lllaking it more reactive on palpation. Detailed anatomical studies will !help to demonstrate this hypothesis, yet it certainly fits the overall picture In his text, Qian lin Yaa Fang, Sun Si-Mo provides an idea rdaung [0 this picture. Discussing the location or the extra point huang m1I K ~, or "fascial mu," he describes its location as follows: o . .-,,' Classical Energetic Anato~y mu Physiology fo nd by to t e center of me umbilicus llNlth a piece of thread in the distance below [he nip le. 4o [IS Sun 5i-Mo look as the ba is of hIs idea me Ling Shu "source of gao" and "so ree of huang" (KJ-16); the NanJing refere ce to the meridians; and the Zhen Ji Jia Yi description of the the concept of a (0 detennine occurs with the nrn,n"TTlP" flexion, or as occurs in tai ji, gr of ,change~ other oL attachment and eension shape of the imerconneceed fascial field relates to the bloelecmcal or specifically its treatment eft eces. there will Shu..d.is.cuss the different tisare by-the five yin organs. Some For instance. both the'Su Wtn the Shu say: r'n: The lung comrols the The heart controls the vessels; The liver controls the uscles; The controls th nesh; The kidne>' comrols (SW 23:154; LS 78:586). tlte A parallel and pJsage m the Su Wen notes: ~in The lung me and body hair of the body, The hean controls the blood vessels of the body. The liver controls uscular The spleen controls !.hI! flesh of kidney the marrows of 44.2i6). nWlfll1F%ln,." the Su Wen says. stores the o of muscular membranes (SW J8:1I0} -.=. . -=....=.j,.,.,..,-~.~""...:. +.-,..".",.,..,..= .. Classical Energetic Anatomy & PhYriology 149 The liver was described as the controller of the muscular membra1es. We now call the muscular membranes the deep fascia. For the liver to Ibe seen in relation to the deep fascia, the classical authors must have co~sidered the fascia to be fundamentally important. Some modem commenpries of Su Wen chapter 44 also give this passage from the Quan Yuan Qi Bey): Mo~, the muscular membranes M~, are in the person, beldw the skin and above the flesh (SW 44:246). Kazunori Shibata, a specialist in Japanese foot reflexology, has made a detailed study of the correspondence of the muscular membran~ to the liver. 4l In his desCription, he differentiates between the muscles land the membranes. To his mind, the term "muscle membrane" does not refer to just the muscles and myofascia, but to both. Based on his rese4rch and clinical experience, he distinguishes between the muscles, the longitudinal and vertical fibers in the body, and the membranes, the horizont~l fibers. In the context of Chinese medicine he identifies the term "musdfe" with the nerves, tendons, and blood vessels as well as the muscle tissyes. The term "membrane" he considers to refer to the pleura, peritoneum! mesenterium, myofascia, and superficial fascia. Thus, the term "musc\e membrane" refers to all the fibers and membranes in the body. Since ~hese are controlled by the liver, if the liver becomes vacant, all the fibers arid membranes can be affected. The liver functions to keep all the fibers aJd membranes loose and flexible. Using massage of the hands and feet, particularly certain toes, Shibata treats problems that lie in these fibers arid membranes. I Another instructive passage from the Ling Shu discusses the Irelationship of gao to digestion and the triple warmer: All water and grains enter through the mouth. There are ~he five tastes; each of them streams to the ocean. The jin i* apd ye '{({ run their own individual way. Therefore, the qi cornes out from the triple warmer. It keeps the skin and flesh warlm. The jin nourishes the skin. The stream that does not mov1 is the yeo The jin and ye of the five grains harmoniously u9ite and become gao [the membranes.] It is absorbed inside i?to the holes in the bones, it supplies and nourishes the brain 1nd marrow. Subsequently, it streams downward to the groin (LS 36:295-296). The jin and ye are the two vital fluids. They flow throughout the ~ody and nourish the tissues. As these two move, the niple warmer qi mo~es. The jin and ye also create the gao. Aside from the connection of thelfluids to the triple warmer and the mesenteric membranes, the gao, this pa sage has important implications for an examination of the modem anato+ical and phYSiological structures and functions of the various membrane~, fasciae, and connective tissues. These water relationships and functioqs of the connective tissues are an interesting key to modem scientific wor~, particularly that of Albert Szent Gyorgyi. Modem data also may help understand the passage from the Ling Shu describing the movement of the twelve meridians of the surface in relation to the movement of fluid th~ough the "water meridians" (see page 2 of this chapter). Both the movem~nt of qi, which the ancient anatomists measured [or "fullness and insuf.flciency" and the triple warmer qi which moves with the jin and ye, becbme ys to Classical Anato~y & Physiology the movement and intersnrial Ian important role is SzeDi Gyorgyi's model of This puzzle has ia(ed several hypotheses. rury commentary on the atrracted the attention of -scholars- and in hiswonderlul Jillg chapler 42 the muscles and vessels and them grow. body.~2 seems to be in chapler 47 lOO refers to an area between the commentary refers [0 cou Ii as me skin and the inside. The rhrough here:B discusses the the skin and The wei qi gives the skin a the skm and Desh wam the segments of the flesh, nounshesthe tissues The LtiJing of is Thus, it the skin, hair, is the wei qi Here [he wei qi is the superricial and these The wei qi IS the ra qUick-Witted, sharp, Therd flesh. The o seen as passing between the skin- and in passage from Su Wen states is probably the 'ei qi through the membranes: id qi of [he waler nd slippery re, wei me wei 151 Classical Energetic Anatomy & P1ysiology ! We have already discussed the relationship of the wei qi to tlhe lower warmer, where it is produced, and to the triple warmer. The wei \qi passes through the tissues between the skin and flesh, the fasciae, and ~eeps the huang mo, the peritoneum, warm. Thus, both the idea of the movement of qi through the fasciae and the hypothesis that the the triple wa~er structure is these fasciae, are further supported. While examples of these relationships are abundant, even t1is collection of information cannot define the gao, huang, and triple wa:nler definitively. Among the various classical and modem sources, there ha~e been a variety of slightly different interpretations as to what each of t~ese functional entities may be. However, there is no disagreement as to t~e importance of the membranes and the fasciae. Generally, the Nanling s6urce and triple warmer theories were seen in relationship to the earlier Ling Shu source theory. Writers who comment on these relationships see lthe triple warmer as either a system of fascial membranes or as a functiona~ relationship to the system of fascial membranes described in the Ling Shu. That the fasciae are important as transporters of qi is clear in all th~ classical references to transference, connection, and source. The relevaqce of the fasciae to huang, gao, fu, mu, mo, jin and ye, luo, li, and the meri~ians evidences a centrality to the energetic anatomy of man that cannot b~ denied. One remaining facet of what appears to be a triple warme~ function has a notable anatomical basis. Essentially, this function relates t~ passage of the stomach qi to certain brain structures and seasonal vario I of temperature, and thus to bodily thermoregulation. The stomach qi iSlnot often mentioned in classical literature, but existing references seem to Isuggest a coherent theory. Both the Su Wen (5W 18) and Nan ling (N) 15) describe the stomach qi with reference to the quality of the radial pulse. ThJ Nan ling deSCription explains the normal seasonal pulses and their patholo~cal variations with reference to the stomach qi. 45 . The Ling Shu also makes reference to the stomach qi and pulse diagnosis at the carotid artery (5T -9). This passage describes the s~omach qi pathway as an explanation for carotid pulse diagnosis: . The Yellow Emperor asked, "What causes the pulsing at leg yang ming [carotid pulse at 5T -917" Qi Bo replied, "The stomach qi rises up to the lungs, the rapid qi ascends qUickly into the head, encircling the throat ~nd flowing to the orifices. [A branch I encircles the supportet of . the eyes, passes into and spirally wraps [luo] the brain. It tpen passes out to the temples [around TW-23 and 5T-7], circl to the teeth wheel [ST-6] where it meets leg yang ming, t en passes down [to 5T-9]. Thus, the stomach qi divides and ns from leg yang ming" (LS 62:288). ' t Most authors agree that the "rapid qi" is the wei qi and shou~d be distinguished from the ying qi that flows through the meridian circ~it sta ting at the lung meridian. Thus Qi Bo's reply could read, o Classical Energetic AnaLomt & Physwwgy 152 Tht stomach qi rises ~o the lungs Here it divides. one part passIng do\lVT', the lun meridian, the other part, the rapid qi, ascending quickly into he head ... The onfices are the seven oflces - eyes, ears, etc. The supporter of lhe eyes is probably the optic rYe. When it passes inco and spirally wraps Ible brain, it is possible to nslate this as "passes into and spirally wraps (some part of) the brain," i plying a connecdon to only a particular strucrure within the brain and no the whole brain. The same passage dlscut:s the Circulation of the ying and wei qi retative (0 (he invasion of cold dr wind. Since we know om the ying qi flows through the twelve meridian~ and that the wei qi emerges from the eyes co circulate around t.he body, wt may again interpret the rapid qi as !.he wei qi. Also, since {he triple warm~ begins in !.he stomach, and the ying ql and wei ql are seen as the qi of e middle and lower warmers (LS 18) we can see (he references in this passa e as describing some aspect of mplc warmer function. . Further, since the h qi is seen w:~h reference 10 seasonal pulse variations, it is f unct10nally r lated to temperature conrrol in the body. The major variant faclor during e progression of the seasons is !.he temperature. This interpretanon is f nher supported by me discussion of ying and wei qi circulation and melf iSlurbance by cold or wind invasion, where circulation to the rour limbs iis impaired (IS 62). This is, of course, rypical of the body's response to The ClTculauon of blood to the surface and extremities is decreased. Thi passage describes the thermoregulatory functions of the stomach qi relat ve to the ying and wei qi, and indirectly !he triple warmer control of bod I temperature. COJ. There is cons~derable pbIYsiological significance m the rapid qi of the stomach rising to encircle ~e throat. and passing from the eyes into the brain. The thyroid glan', which essentially regulates metabolism throughout !he body, lS i [he throat. A significant Slrucrure, !.he hypothalamus, is found wh re the supporter of lhe eyes crosses in the brain, at !.he optic chiasm major functlon of the hypothalamus is !.hermoreguianon. There would seem to be no coincidence !hat twO of lhe body's most important the oregulawry strucrures, the hypothalamus and !.hyroid gland, lie on the pat.h ay of me stomach qi. The regulalion of temperature begins with the co ITo\ of blood flow to the surface and four limbs of the body. When [h environment IS hot this circulation increases, when it is cold me circularton decreases.'I6 According to ling Shu meory, when cold invades the body,\ circulation of ying and wei qi is impaired in !.he limbs. Why these functions aredescnbed wi!.h reference to the stomach and stomach qi is another quest on of imereSL When food is ingested and passes inro the digestive sySl m, the circulation of blood to the surface of the body is diverted to!.he igesrive system (0 help absorb the nutrientS and fluids of digestion Sine normal !.hermoregulation varies through the increase or decrease of blood flow to the surface of d\c body, we can posit that the circulatory responses\ of d.igestion may create a functional tension between the conaol of blood 1I10w arising from hypothalamic function and o 153 Gassical Energetic Anatomy & P;hysiology the control arising as a digestive response. If this is correct, stomach qi describes the body's thermoregulatory functions and secondJrily helps explain the temperature-regulating properties of the triple warme~47 Embryological Development The concept of gao from Ling Shu source theory relates the 'gao to the first month of embryological development as described by the H4ai Nan Zi. From approximately 400 or 300 B.C to the seventh century A.D, series of similar embryological theories developed in China. Although thejr anatOmical descriptions are simple, compared to the microanatomical ~tudies of today, their descriptions are neither essentially inaccurate nor without provocative permutations. r That the Chinese were interested in embryology is very na~ural; they were fascinated with ideas of "beginning," "root," or "origin'i' and the "basic" or "source" parts. Many characters in Chinese imply rooG or origin, not the least common of which is the idea of the "source" 1Jll:, the ibasic idea of both the Ling Shu and Nan Jing theories. With their desire to urderstand where things came from, the source or origin of life, it is natura~ that they would see embryology as an essential study. Looking at em~ryological development, the fascia and connective tissues, it is possible to uhderstand many of the classical medical ideas about life, health, and disease. As the most complete and accessible theory, the Huai Nan ~i deSCription of the stages of embryological development are a reference to which we may compare several other systems. However, the oldest discrsions of embryology can be found in the Guan Zi (The Book of Master Guan), from the late founh century B.C The person is [composed of] water. The jing ~ of the man and woman unite. Subsequently lthe water streams and then makes the form. At three months it is like masticated food [it has an un~if­ ferentiated form]. What are these? What are the five tastes? What are the Ifive yin organs? I Acidic controls the spleen Salty controls the lungs. S~icy controls the kidney. Bitter controls the liver. Sweet cont~ols the heart. The five yin organs are now formed, then the fles~ is created. The spleen creates the diaphragm. The lung creftes the bones. The kidney creates the brain. The liver creates [the skin. The heart creates the flesh. I The five flesh are already created, then the nine Orif~ces occur. The spleen occurs at the nose, the liver at the eyes, Ithe kidneys at the ears, the lungs at the [other] orifices. At five months it is already completed. At ten months i't is already bom. 48 These early five-phase correspondences differ from the c~rrespon­ dences generally associated with the phases. It is curious t0a[ such correspondences are discussed in relation to a developing emb~'o The Huai Nan Zi also has a brief discussion of other, again slightly ~ifferent D' ""I>v,"'nr 154 Anato1Y & Physiology correspondenceS\. In later phases were consikiered • 1 fJ""''''5''';!' from the cenrury, to embryological develop' menc no m nuon is of mesemeric or fascial memo Huai Nan I in 122 B.c., these tissues, specifically the branes, month of are memioned in ment, 300 has Zi it makes an further has no dear no "\After] the person's conception, Then the jing composes the brain become the srem Ithe spinal become the ying InounshmemJ, flesh becomes llike aJ and body hair This passage Introduces' imply [hat the qi and birth, In a medical comexl The of the second month, zhi in the Guang Ya Zhi uterus, This passage was because the pathways, h seems [0 begin circulating after is extremely important, month of pregnancy in Qin" Ya (Mor) is the same as Huai Nan Zi the " The description the fourth month, !!I!! are somewhat dif- mpmr\r~l"l of 7J. . 1.3 The first two months of de'Vl:loprnem (after Ishm Po). Chao Yuan HUGi Nan Zi and Guang Va, One of the earlier works on the taller. of the momer {O the developa posslb!e mechanism by which the problems, strengths, and wealmesses If J. \ 155 Classical Energetic Anatomy & PhYfiology the mother has a weakness in a meridian, this would lead to proble~s during the related stage of development. Although this is not a specific claim made by Chao Yuan Fang, it is a tempting interpretation. In the following quote, note how Chao Yuan Fang perceived t7e entry of the five-phase jing into the developing fetus and the development of dantian by the tenth month. The accompanying illustrations ar~ in the style of Tamba no Yasuyori's Ishin Po, an important tenth-century J~panese medical treatise. 49 In the first month it is called the beginning of fonn~. L~g jue yin nourishes this. Leg jue yin is the vessel of the liver, tThe liver controls the blood. At this time the blood flow sto~s [the menses stop]; therefore, leg jue yin nourishes this. The second month is called the beginning of gao 1f, t~e mesenteric membranes. Leg shao yang nourishes this, leg shao I yang is the vessel of the gallbladder. The gallbladder contr9ls the jing m. The jing of the fetus 7t. is composed.in the lining pf the wrapping [of the fetus, the lining of the uterus, possibly tlile placenta]. I The third month is called the beginning of tai ~r;, the pregnant uterus. The ann master of the heart controls this, the aryu master of the heart is the jing and shen in the vessels, the inside is connected with the heart, it is able to cleanse the shen. *:m The fourth month is when the water jing is beginning ;to be accepted. With this the blood vessels are composed. AJn shao yang controls this, ann shao yang is the vessel of the tri8le wanner, inside it is connected with the fu Jf.f [here, probably tbe yang organs]. I *:m The fifth month is when the fire jing is beginning to ~e accepted. With this, the qi is composed, leg tai yin nourish:es this, leg tai yin is the vessel of the spleen. Leg tai yin controls the four seasons. In this month the four limbs are completed. .&:m The sixth month is when the metal jing is beginningf'to be accepted. With this the muscles are composed, leg ya g ming nourishes this . Leg yang ming is the vessel of t, e stomach. This altogether controls the mouth and eyes. i *:m The seventh month is when the wood jing is beginnihg to be accepted. With this, the bones are composed, hand ~i yin nourishes this. Hand tai yin is the vessel of the lung a~d controls the skin and body hair. The eighth month is when the earth jing ±rrJ is beginning Ito be accepted. With this the skin is composed, it hannonizes the I heart (or mind) and quiets the breathing, ann yang ming nOl.jrishes this. Arm yang ming is the vessel of the large intestide. The large intestine controls the nine orifices. o dassical Energetic Anatomy & Physiology 156 when [he stone jing is beginning to ,he skm and body hair are composed, leg shao yin nOlmsh~s thIs. Leg shao yin is the vessel of the kidney. The controls the. conne.cting thre.ad Iumbilicus), !n the tenth mont~ all the [ive yin organs are compleled. the six yang organs and 1C umbilicus are connected. Heaven and Earth qi emer at dam an, t ' The most criticai impH lion in this description is that the narure and origin of disease is prenata'. II does represent one of the dearest anempr.s by a Chinese physician to demonstrate how prenatal problems can influence our health after we re born. Sun Si-Mo, in his Qial1 Jin Yao Fang (Priceless Prescriptions) fro 652 AD, describes an embryological development essemially identlcal 0 Chao Yuan Fang's from fony years earlier. The one slmple difference ere is [hat Sun Si-Mo refers to the first momh as the "beglnning of [he em ryo," ramer than the "beginning of form."50 For each month of de~.elopmem, Sun$i·Mo prescribes cenain herbs. He also comments that one should not needle or moxa points on the meridian during the month a ericiian is in active control of fetal developmem. S1 This is perhaps m dical pracrice m its most superb and sophisticated aspect. Treating pre&naru mothers to ensure healthy children may represent the mOSt advanced form of preventive medical practice possible.

Figure 7.8 . 7,9 The sevemh and eighth months of devdopm~m (aher Ishin Po).

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Figure 7.1 0 . 7.11 The \as! ueve\opme.nl (a(1.f.r l.!hin Po),

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Chapter -8-

Modern Anatomy &: Physiology

of the Fasciae &: Connective Tissues

Modem Anatomy and Physiology of the Fasciae and the Connective Tissue\$ The human body is an intricate set of systems that interact wjth each other as a functional whole. The nervous, muscular, skeletal, dIgestive, respiratory, reproductive, excretory, hormonal, and vascular systerhs each have distinct characteristics and properties. Yet none of these systbms are separate entities. When working synchronously they constitute 1hat we call, in a gross sense, "life." Several systems exercise mediation or control of functional interactions. The nervous and vascular systems re, for example, largely concerned with regulation. All parts of the bod I are to some degree innervated and vascularized. These systems provide a medium that connects the parts through a series of complex inte~aCtions and feedback mechanisms. Incorporated within the nervous and vascular systems are various sub-systems such as the hormonal messenger~. Each sub-system is itself a categorization that represents another set of ~pecific interactions. Within the body one system is amazingly pervasive and versa~ile: the connective tissue. In effect, the connective tissue is a system thao totally interconnects all parts of the body at each level from the anatomical to the microscopic. Connective tissues can be found within every single organelle, within every cell, and within every tissue of the body. Mbst significant for Oriental medical theory and practice are the properties ~uch as energy generation and conduction that these tissues demonstrate. The various membranes and fasciae discussed in Oriental rpedical literature are composed of connective tissues. Although modem a~atomi­ cal, physiological, and embryolOgical knowledge is much more cjetailed than the discussions in early Chinese medical texts, the essential ana~omical details are the same. More noteworthy are the many parallels b~tween Oriental medical concepts, in particular qi movement, and the ~odem understanding of the properties of the fascia. While there are intiIfations that the Chinese medical authors were discussing energetic concel1ts and concurrently utilizing physical knowledge, it is the mass of data co~piled by modem physical sciences that compels us to consider these e*rgetic concepts in the light of what we now know of the body's physiologital and electrical functions. It is thus possible and intriguing, and in fact necpsary, to propose and examine models by which we may explain dassical Chinese medical concepts using the data of Western science.

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160

Usi'\g aU the lnrormalon at hand, what can be demonstrated is the possIble means by wlllch at some organ relationships described by classical medical theory nay function. For instance, me five phase, ten stem and yin-yang corres ondences and functlons can be undersrood as analogs of biophysical rela~ionships among fascial tissues, The relationship of certain acupoims to cerrin areas in the body and the probable mechan ism by which the lines ofl energy movement, the meridians, develop and funCtion may also be undbstood as bioelectrical functions of the fascial planes. The poims of Co~nWion, the unifying factor of ffi3:1Y energetic concep(S, may be seen as r lated to the the systems of membranes and fascia and their connective tis ue SlJUcrure. p

The Fascial Syste In gross anatomical te s chere are [VJO basic systems of fasciae: the subcmaneou5 and the sub erous systems. We can delineate quile dearly whole systems of tlssues, ccurate1), ddinmg their anatomy and function. I Although chese are cominu us systems !.ha[ merge wilh each other, they are The subcutaneou system is the system that connects the skin, muscles, and skeletal Struc res. The subserous system lines the body cavities. Both systems have co nected layers. I

The subcutaneous SYSI'm has tWO distinct layers thal form a continuous sheet over [he whole a ea of the body. Properly, we speak of the subcutaneous raseta as havin two layers, one more superficial, the other deeper. The superficial fa I Lal layer of the subcutaneous system is itself a double layer thar is fusediand continuous. Essentially. i[ is a membrane that varies in depth accordi g to location and individual differences. It also has varying amounts of fa tissues The deeper level con tams the nerves, the blood. and the lymph essels that nounsh and help maintain the skin. This layer also functions 0 maintam body temperature and protect the body from trauma The superficial

to be thinner in males !han in females. It is the abdomen and thinnest over the dorsal aspects of the hands and ct, the sides of the neck, the face, around the anus, and over the peniS 3 d scrotum 2 The areas where it is thinner are aU areas traditionally c\assif led as yang or relatively yang. The areas where it IS deeper, in particular the ab omen, were classified as yin areas. Thus, the yang areas of (he body, 0 the more yang nature of those areas and the meridians located there, ha e a clear relarionshlp to !he depth of the superficial fascia and the amoun of fatty tissue

quile distinctly deeper

J

Since the superficla\ f cia is contjnuous with the dennis, it lies just below the epidermal and layers of the skin. GeneraUy this 1S JUSl over one to just over two m\lllmcters beneath the skin surface.)

1nna!

Beneath [hIS doubled s9perficiallayer is the deep fascia. This includes the fascia that covers all th1 muscles of the body, excluding the superficial muscles of the head, neck. tnd palmar brevis, aU the large blood vessels, all the large nerves, the deep I mphatic vessels and nodes, as well as certain glands. The deep s)'stem f the subcutaneous fascia is the system that passes from the superficial pans of the body to the interior. In the limbs. this layer connectS as deep as the periosteum, the connective tissue

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Modem Anatomy & Physiology of fasciae

161

membranes of the bones. In the trunk, it runs as deep as the interifr walls of the thoracic and abdominal cavities. In both these places it enve ops the muscles and bones, providing surfaces that form attachments . nd aid movement. This system is an imponant part of the musculo-skel9tal support structure. By lining the interior walls of the abdominal and ~horacic cavities, it becomes continuous with the subserous fascia. The subserous fascia of the thoracic cavity is called the pleural In the abdominal cavity, the subserous fascia is the peritoneum. Each (Dr these fascia is layered. One layer lies next to the deep fascia that lines tHe inside of the cavity, the parietal pleura and parietal peritoneum. The la~ers that are more related to the different organs in each of the cavities arel~he visceral pleura and the visceral peritoneum. The visceral layers envel~pe and connect the various organs. For example, in the abdomen the visceral layer is called the peritoneum proper. Its invaginations and folds fbrm the mesenterium that envelopes, connects, and covers the digestive orgJns. The subserous layers of the thorax and abdomen are almost siparated by the diaphragm, which stretches between the two. But the pariet~llayers of -each cavity are continuous, since the fascia enveloping the aoha as it passes through the diaphragm merges with the parietal fasciae of ~e cavities above and below the diaphragm.

I - diaphragm 2 - endothoracic fascia 3 - aorta 4 - transversalis fascia Figure 8.1 The fascial sheath of the aorta is continuous with both the endothoracic fasCia and the transversalis fascia on the superior and inferior surface of the diaphragm

Not only are there fascial continua by which the surface of the body is connected to the interior, but there are also fascial continua that conne~t all the organs inside the body.

Fascial Connections By following these various connections or continua of fascia,. we can trace pathways from anyone part of the body to any other, runnirg up to down, down to up, inside to outside and outside to inside. The E1xamples provided by James Oschman trace these connections quite clearly: In principle it would be possible to trace the fascial connections between any point within the body and any other. flor our purposes we shall begin by tracing the larger planes of cia upward from the feet to the top of the head and then bah

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oJ Fasciae

Anatomy

be viscera, the pericardium, the pmpmlT\O from [he heart (and thence network of the circulatory system), of the rhYTOid gland, hyoid bone\ temand Ihe fascia ensheathing the layers be traced and thence the perineural ' ' ',. ...''',

in !Urn, is conrmuous with !he that suppon the abdominal thai the walls traCt it associated organs jom the Extending u ward, [he fascia ensheathing major and quadratus lumborum blends with covering the right a d left crus of the crus, in rum, attach to In bodIes of lumbar vertebrae which are siles of auachmen of ligaments, tendons, and myofascia, a! tendon the diaphragm is contiguous with the roOtS of the great blood {he aorta, the pulmo ary artery and vein, and vena cava, fascia a e contiguous with ennre an~ venous (rees, The [he blood vessels ar also assocIated with cia, which in !Urn e vclope the thyroid sheath, and faslen s curely 10 bone. bone is connected to S1 laid of the temporal bone by a

how is of ten believed.

a large nUl ber of experiments shOWing how rissues and respond to lwncal and He discusses ha\'!! much influence than

research in Ihe United field. Using the adult salamander eVIdence snongly suggesting thaI the e nervous system 48 He distinguished £wo or in body. The first is !he more evolutionarily advanced s stem, the nervous is a or primitive syste to communicate information in the e1ecmcal curren as "injury pou;mial" and the abiliry w defect chan environmental elecoical and magnelic fIelds are processed by!h more system. He condudes thai the nervous system at leas! dererm nes the of the field. but Ihal there are many electrical wi hm thIS do no! originate with nervous and [hal serve s information channels for the whole He posits rom the most ancient life 49

Roben O. Becker SUHes on ,he nature of Ihe as his experimenLaI animal. field pattern correlates

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Modem Anatomy & Physiology of Fasciae

The existence of these systems and fields is beyond doubt. They have been measured in the lowest and highest fonns of life, in living~things with and without a nervous system. From the perspective of Orien~l medicine, the most significant property of this field is that in a living beipg the core or center of this field will lie at the center of gravity, just as in non-living systems. This core will lie somewhere on the polar axis as the polar axis itself will pass through the center of gravity. The center of gravity of a person lies somewhere in the abdomen below the umbilicus. It is sometimes seen as being located roughly two inches in front of the se Phy~o!ogy oj Fasciae

become the left and right *ides o[ the embryo. Further divisions also produce near mirror Images. :However, with the development of the internal organs, the rotations, migr 'tions, and the singu\ariry of many of the organs, the mitial symmelry beco es less dominant. The origina!, nearly perfect symmetry is SttU reflected In the bilateral ears, eyes, legs, arms, and other body pans EvenruaHy, th body becomes Imperfectly symmerrical, retaining its only real symmetry n the surface,

Manaka views Lhese sr,nmetries as impon.ant in the naNre of the excraordinary vessels. HeJ~O reels they are important strucrurally and energeticaBy, He propos that topological geometry, the geometry of three-dimensional objem, ill provide greater inSights inw the significance of the body's relative sym wies. Simply stated, his idea is thal the body rer.ains a memory of {he s mc(ry lost through embryological development and that its state of i m rf eel symmerry expresses many of these memories. With any disto 'on of ilie body, either physically or energetically induced, the body wi respond in some manner thac will symroerrically rellcc[ chat diSWrUon or example, problems of the left leg can often relleet on {he righl arm Pr blems of ilie lower right abdominal quadrant can reflect on the upper Ie abdominal quadrant; problems of the lower abdomen on the m'idline ma reflect on the midline of the upper back. Manaka proposes iliat ese symmetries and the body's natural abiliry to compensate symmetricali for distortion are mathematically precise. Ii such mathemaric.al relations ips exist, it is very likely thal there are some componeolS of Lhe body at are able to rransmit or communicate the in [ormation by which chese ompensations are directed. The e.xO

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