LING SHU

Nguyen Van Nghi Tran Viet Dzung Christine Recours-Nguyen

huangdi neijing LINGSHU Volume II Books IV and V

N.V.N. Edition Translated from the French by Edward S. Garbacz, MD With Additional Commentary by Sean Christiaan Marshall, D. Ac. © Jung Tao School of Classical Chinese Medicine - 2002

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“Understanding the meaning of the Dao of Acupuncture is like becoming liberated from doubt, like awakening from a drunken state, like coming clearly out of a sleep. In contrast, those who do not understand the Dao remain “mute” before their patient; and mistakenly understanding, sufficiently enough, the cause of the evolution of the disease, he gropes along “in the darkness” in order to attempt discovering a solution... .”

Ma Yuan Tai Tang dynasty (618-906 A.D.)

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no 8/9.

INTRODUCTION

We complete, finally, Volume II of the Lingshu which has demanded of us a sum of efforts and comprehension of several years. It was initially planned to split this work up into two volumes, but the abundance of commentaries has lead us to publish it in three works. This very old book, this cult book, has been subject over the centuries to numerous translations, transcriptions, discussions and analyses. There exists then inevitable archaisms and inherent linguistic difficulties in the evolution of the language, unrecognizable social and literary habits, customs/habits/type√, climate, the pathology and philosophy of this time. We must appreciate the exact measure, placing it constantly in the context of the era; we must nullify the traps of what is left unsaid, allusions, hierarchical terms, obscure analogies and maxim phrases√. In this manner, up to the present, none of the modern translations of the Lingshu, also deserving fut-elle, have statisfied us. One demands on the part of the translator to be an eminent historian and literary sinologist, and, above all, a grounded/grassroots/practical acupuncturist de terrain, rich in his own√ experience and an acupuncturist of culture/knowledge√ saturated with the great Chinese medical classics. Indeed, our work is not perfect; it presents/sets out again more or less, of uncertainties; most certainly we hope that physicians of the next generation will be able to improve it. But present-day physicians will be able to draw interesting teachings on the pathophysiology and therapeutics of Acupuncture/Moxabustion, to fill the gaps, to perfect the practice of acupuncture and to be urged to carry out research work according to the criteria of modern science, entirely respecting Daoist mind/ spirit/ thinking.

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This 2nd volume consists of Books IV and V. • Book IV consists of 7 chapters and develops various themes:

10.

_ Etiology, classification, therapeutics and prognostics of the extravagant and capricious syndromes of certain diseases of Yin and Yang nature (Yin Madnesses and Yang Madnesses). _ Diseases of Heat etiology and treatment: hemiplegia, quadriplegia, cutaneous pain, facial edema, limb spasms, ostealgia, deafness, bruxism, headaches, epistaxis, etc. _ Diseases of Afflux etiology and treatment: 9 types of cardialgia, 9 types of headache, deafness and buzzing, spinal pain, lumbalgias, gonalgias, nuchal pain, tonsillitis, epistaxis, disorders of behavior, disorders of diuresis, abdominal pains, limb flaccidity, etc. _ Erratic pain and cyclic pain and the therapeutic techniques of “Top-Bottom” and “Left/Right-Right/Left”. _ “Singular” diseases and treatment: yawning, hiccups, grief, trembling from cold, eructations, sneezing, muscular laxity, passage of tears, sialorrhea, sighing, tinnitus, biting the tongue ... .

• Book V consists of 20 chapters and concerns the following studies:

_ Attitudes of the sage: men of state and physicians. Favorable and unfavorable problems of Yin and Yang and problems of “attachment to life” and “fear of death”. _ Fundamental characteristics of the energy: “^6 Energies”, Jing (quintessence), Qi (energy), Xin (interstitial liquids), Ye (viscous liquids), Xue (blood) and Mai (vessels). _ Studies of the “4 Seas” and their transmittable points: Sea of “Cereal Water”, Sea of the Jingmai, Sea of Energy and Sea of Marrow. _ Five disorders of the energy and unfavorable phenomena of Yin and Yang. Method of conduction of the energy (Dao Qi). _ Etiology, classification, diagnosis and therapy of the intumescences. _ Five facial zones (Wu Guan) and the constant principles of examination of the complexions/colors. _ Treatment according to the build of the individual. _ Blood stasis and treatment. _ Properties of the pure and impure energy of the human organism. _ Solar and lunar movements in the determination of emptiness and fullness, growth and decline, of Yin and Yang. _ Acupuncture and the evolution of the disease according to the chains of production and destruction of the law of the 5 Movements. _ Analysis of the different types of dreams and treatment. _ Conformity of the energy of the body with that of the day divided into 4 seasonal periods and therapeutic principles of the Wu Shu (5 Shu antique points). _ Mechanism of triggering of disease as a function of the state of the musculoskeletal and epidermo-dermal systems. _ Favorable and unfavorable states of the 5 organs/6 bowels as a function of anatomic aspects (morphology, disposition ...). _ Basic principles of medical reasoning of Acupuncture and Moxabustion. 11.

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In this way, present-day acupuncture physicians saturated with scientific knowledge must work out of these ancient texts, knowing how with respect the archaic and magical aspects which saturate ipso facto Chinese thought of more than 3000 years beforehand and in drawing from new elements in order to, paradoxically, modernize the practice of their art. Scientific thinking and fundamental Chinese thinking are not contradictory. They are the perfect representation of the duality of the world. They are like Yin and Yang; they are at once opposed, indivisible and complementary. To possess these two modes of thought, these two types of medical knowledge, is to pose, more than every√ other, a serene, critical and universal look at medicine. The reading of the Lingshu remains one of the first acts to accomplish in order to reach there.

Marseille, November 5, 1995

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no 12/13.

Book IV Book IV consists of 7 chapters: Chapter 22: Yin Madness and Yang Madness (Dian Kuang) Chapter 23: Diseases of Heat (Re Bing) Chapter 24: Diseases of Afflux (Jue Bing) Chapter 25: Causes of Disease (Bing Ben) Chapter 26: Various Diseases (Za Bing) Chapter 27: Erratic and Cyclic Pains (Zhou Bi) Chapter 28: Oral Questions (Kou Wen)

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no 14/15.

CHAPTER XXII Yin Madnesses and Yang Madnesses (Dian Kuang)

Chapter 22 of the Lingshu is devoted to the study of the Yin-Madnesses and the Yang-Madnesses (Dian Kuang). Pathological approaches to these illnesses are grouped together in several phases from which the syndromes are classified and treated according to the principle of choice of the channels as a function of the “4 seasons”. The causes of Calm Madnesses and Agitated Madnesses are not beyond the scope of sadness, chagrin, fear, fright, worry, excessive joy, orientation of the essential energy toward insufficiency, digestive disturbance... and treatment must be based on deep analysis of the syndromes. This chapter of the Lingshu does not deal with mental disorders. The term Dian Kuang does not in any way signify manic-depressive psychoses, but “madnesses” in the sense of designating the excessive and capricious prodromes of some illnesses of Yin nature and Yang nature and, particularly, illnesses called Contrary Afflux (Jue Ni). This chapter consists of 22 paragraphs.

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PARAGRAPH 1 “The ocular angle split toward the external part of the cheekbone is Wai Zi (external canthus of the eye), and the angle directed toward the side of the nose, Wei Zi (internal canthus of the eye). The upper eyelid belongs to Wai Zi, and the lower eyelid, to Nei Zi. ” EXPLANATIONS AND COMMENTARIES

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I - Zhang Shi explains:

“The energy of Taiyin controls the maintenance of the canthii of the eyes, that of Taiyang involves the upper eyelid and that of the Yangming, the lower eyelid. Therefore, to speak of the upper eyelid belonging to Wai Zi and the lower eyelid belonging to Nei Zi is to speak of the energy of Taiyang and Yangming also controlling the canthii of the eye. The Hand Taiyin (Lu) responds to Heaven and Foot Taiyin (Bl), to Earth. Taiyang controls the opening (of the eye) and Yangming, the closing. The energy of Heaven and that of Earth lights the day and darkens the night. Such is the response of man to day and night, to the opening and closing, of Heaven and Earth. During one respiration, the opening and closing are intended to respond to the expiratory movement, inspiratory movement and the clepsydra. Is the energy of opening and that of closing are not evident, Yin energy and Yang energy are without distinction, Shen (mental) and Chi (will) lose their connection in growing dark, and transform into Dian Kuang (Yin Madnesses and Yang Madnesses). This is why treatment of these illnesses especially consists of needling the points of the Taiyang, Taiyin and Yangming channels of the foot and hand.”

II - Ma Shi clarifies:

“Paragraph 1 demonstrates the external energetic morphology of the eye because the eyes are the sites of manifestaion of the Jing Shen (pure energy and mental) of the organs and bowels and because examination of the Shen at the level of the eyes constitutes the first diagnostic action in the illnesses called Yin Madnesses/Yang Madnesses.”

III - N.V.N.: The external energetic morphology of the eye can be diagrammed in the following fashion: 17.

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Figure 1: Energetic morphology of the eye.

PARAGRAPH 2 “At its start, the Dian illness (Yin Madnesses) manifests by the following signs: _ sadness _ feeling of heaviness of the head and headaches _ gaze fixed toward the top and redness of the eyes. At a more advanced degree: _ anxiety, restlessness Examine well Tian Ding (1) and needle the points belonging to the Taiyang, Yangming and Taiyin; stop treatment as soon as the complexion changes.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The Dian illnesses (Yin Madnesses) and Kuang illnesses (Yang Madnesses) are due to an obstruction of the Yin and Yang energy of the bottom, causing an afflux toward the top. Shaoyin is a priori (innate) Water-Fire and Taiyin is a posteriori (acquired) Earth... . The “Water-Fire” energy of Heaven and Earth must be balanced above and down below; the opposite is synonymous with illness. 1. Frontal area (forehead).

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The Jing (quintessence) of Water is the Chi (will) and the Jing of Fire is the Shen 18. (mental). When the Shen and Chi are not at ease, they manifest as sadness. Fixed upward gaze and redness of the eyes are phenomena due to an afflux of the energy of the heart. Anxiety, restlessness is the result of the contrary flow (afflux- Jue Ni) of the energy encroaching on Taiyang and Yangming and also on Jueyin (XB). To examine Tian Ding is to observe the complexion (Heaven) located in the inter-eyebrow space. The upper half of the body is Yang and is controlled by the Hand Taiyin (Lu) and Hand Yangming (LI). This is why needling these two channels permits purifying the energy of this part of the body; and needling the Hand Taiyang (SI) permits cooling the Jueyin (XB) to suppress the anxiety. The heart controls the blood. As a result, during needling, the change in color of the blood (complexion) is a sign attesting that the Shen Qi (mental energy) is purified, the determining condition of cure of the Dian illnesses (Calm Madnesses).”

II - Ma Shi clarifies:

“From this paragraph to Paragraph 8, study is centered on the classification of the Dian illnesses whose beginning signs are demonstrated in Paragraphs 2, 3 and 4. The Hand Taiyang (SI), Hand Yangming (LI) and Hand Taiyin (Lu) are the 3 specific channels in the treatment of the beginning signs of the Dian illnesses (Yin Madnesses).”

III - N.V.N.: The points of these 3 channels recommended by Zhang Jing Yue (1563-1640 A.D.) are: 1 - Hand Taiyang (SI): _ Zhizheng (SI 7), Luo point (needle depth 0.3 cun, moxa 3 times) and Xiaohai (SI 8), He point (needle depth 0.2 cun, moxa 3 times) 2 - Hand Yangming (St): _ Pianli (LI 6), Luo point (needle depth 0.5 cun, moxa 3 times) and Wenliu (LI 7), Xi point (needle depth 0.3 cun, moxa 3 times). 3 - Hand Taiyin (Lu): _ Taiyuan (Lu 9), Luo point (needle depth 0.2 cun, moxa 3 times) and Lieque (Lu 7), Luo point (needle depth 0.2 cun, moxa 7 times).

PARAGRAPH 3 signs

19.

“At its start, the Dian illness (Yin madnesses) manifests by such as: _ deviation of the mouth and moaning _ dyspnea _ palpitations and fear.

Examine the Hand Yangming (LI) and Hand Taiyang (SI) and needle the left side if the right side is tense or the right side if the left is tense; stop treatment as soon as the complexion changes.”

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EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“With deviation of the mouth accompanied by moaning or dyspnea, palpitations and fear... one must needle the Hand Yanging (LI) and Hand Taiyang (SI). The tension is not pathologic if it is bilateral; it becomes so when it manifests on a single side. This is why one needles the side opposite the affected side and interrupts the needling upon change of the complexion.” II - Zhang Shi states:

“This paragraph demonstrates the mechanism of obstruction/afflux of the energy, causing disturbances of opening and closing , determinant factors of the Dian illnesses. Tears, cries and fear originate from disturbances of the energy of Taiyang. Dyspnea is due to the impurity of the energy of Yangming. Yet, the energy of Taiyang governs opening and that of Yangming, closing. This is why the above-cited pathologic signs originate from these two channels. Ma Men Zung states: “The Hand Taiyang (SI) constitutes the external system of the heart and the Hand Yangming (LI), the external system of the lung. As a result, “tears and fear” originate from the heart and “dyspnea”, from the lung. Tears, anxiety, dyspnea therefore result from the impurity of the energy of the opening and closing. In this case, the illness localizing at the exterior goes to reach the interior.” (2) III - N.V.N.: The notions of “closing-opening-hinge” have been many a time demonstrated and described in our works since 1965. Their complete assimilation permits the appreciation of the permanent mobility of the energy of the 3 Yang, Taiyang, Shaoyang, Yangming, from which all energetic pathology result.

PARAGRAPH 4

20.

“At its start, the Dian illness (Yin madnesses) manifest in the first place by stiffness of the body, then by spinal pain. Needle the Foot Taiyang (Bl), Foot Yangming (St), Foot Taiyin (Sp) and Hand Taiyang (SI); interrupt the needling as soon as the complexion changes.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Stiffness of the body results from the obstuction/afflux of the energy at the level of the Taiyang (Water-Cold). 2. The explanation of Ma Men Zung justifies treatment according to the technique called “SummitRoot”.

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Spinal pain comes from the encroachment of the “cold” energy on “Earth’. This is why one must needle the Foot Taiyang (Bl), Foot Yangming (St) and Foot Taiyin (Sp).” According to Liang Zhen: “The previous 3 paragraphs (2, 3, 4) only broach the starting phase of Jue Ni (Obstruction/Contrary Afflux) at the level of the Taiyin, Taiyang and Yangming channels, that is to say, at the level of the energetic layers and not the anatomic layers. The illnesses still within the energetic layers can easily be “purified” and “dispersed”. They become incurable from their penetration into the anatomic layers. As a result, the Dian illnesses localizing in the bones, muscles... are usually fatal. (3) The good physician treats the prodromes, while the poor physician waits until illnesses are declared before applying therapy.”

II - N.V.N.: a - Translations into Western language have completely changed the spirit of the text. Here, it concerns stiffness of the body with spinal pain due to an obstruction/afflux of the energy and not epilepsy (!). b - The points recommended by Zhang Jing Yue are: 1 - Foot Taiyang (Bl): Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61) and Jinmen (Bl 63). 2 - Foot Yangming (St): Sanli (St 36) and Jiexi (St 41). 3 - Foot Taiyin (Sp): Yinbai (Sp 1) and Gongsun (Sp 4). 4 - Hand Yangming (LI): Pianli (LI 6) and Wenliu (LI 7).

PARAGRAPH 5 “In the struggle against the Dian illnesses, the physician is advised to be at the bedside of the patient often in order to observe the evolution of the disease and determine the channel to needle. 21. During the crisis, one must carefully study the channel affected and practice bleeding. The blood conserved in a gourd will coagulate by the next crisis; if not, apply 20 moxas to the coccyx.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph shows the therapy of the Dian iillnesses according to the principle of distinction of the “water” energy and “fire’ energy, of the energy of Heaven and energy of Earth. The Fire of Taiyang is the Sun. The Water of Taiyin is the Earth. During bleeding to diagnostic and therapeutic ends, it is recommended to conserve the blood in a container made of the skin of gourd and observe the phenoenon of coagulation. Coagulation of blood comes from the passage of the energy of the afflux toward the Hand Taiyin (Lu) and Hand Taiyang (SI) conforming to the sensitivity of the energy of the Taiyang within the natural world. 3. This phrase corroborates our opinion on the misinterpretation of the old translation of the term “Dian Kuang”.

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In contrast, non-coagulation results from the deep penetration of the energy of the afflux into “Earth-Water”. This is why one must apply 20 moxas to Changqiang (GV 1). The Neijing said: “When the vessels are retained at the bottom, one must apply moxabustion”. In our case, the illness is maintained at the level of 2 channels, Foot Taiyang (Bl) and Foot Taiyin (Sp). One must then apply moxabustion at the level of the coccyx, site of reunion of the 3 vessels: Taiyang (Bl), Taiyin (Sp) and Dumai (GV),”

Figure 2: Changqiang (GV 1): reunion-meeting point of the 4 vessels (CV, GV, Taiyang, Taiyin).

PARAGRAPH 6

22.

“Dian of the bones (Gu Dian) is an ailment deeply reaching the bones and marrows. The clinical signs are: _ blockage and swelling of the Shu (kinetic) points and of the areas of distribution of the flesh, etc... _ weight loss _ sweating and anxiety _ frothy vomiting _ flowing out of the energy toward the bottom. The

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illness

is

incurable.”

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EXPLANATION AND COMMENTARIES Zhang Shi explains:

“Here, it concerns illness of the Foot Shaoyin (Ki) contaminating the Hand Shaoyin (He). Frothy vomiting is due to the ascent of the energy toward the top, rising up to the exterior. The kidney is the source organ of the production of the vital energy. The energy flowing out toward the bottom belongs to the Shaoyin. Therefore, one witnesses a phenomenon of concomitant escape of Yin and Yang, from the bottom and top. The illness is therefore incurable and the text does not propose treatment. This paragraph and the following two deal with material illnesses (having form: Xing), that is to say, illnesses at the level of the bones and muscles. This is why one does not speak of Yin and Yang of Tai (Yang) and of Shao (Yin).”

PARAGRAPH 7 “Dian of the muscles (Jin Dian) is an ailment which deeply reaches the muscles and is characterized by such signs as: _ asthenia _ spasm _ rapid and changing (Da) pulse. It is advised to needle Dazhu (Bl 11) belonging to the great vesselchannel of the neck. If these signs are accompanied by frothy vomiting and flowing out of the energy toward the bottom, the illness is incurable.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The pulse is always changing (Da) in Jin Dian. 23. The Foot Taiyang (Bl) maintains the muscles in “water”. This is why one needles Danzhu (Bl 11), located in the 1st intercostal space, 1.5 cun to the side of the 1st dorsal vertebral apophysis, to 0.5 cun depth and apply 7 moxas. “Vomiting and flowing out of the energy toward the bottom...” denotes that illnesses of the organs/bowels are material illnesses having escape of the energy as a consequence.” II - N.V.N.:

Danzhu (Bl 11), “reunion point of the bones” is not only specific on the treatment of bony ailments, but also in the treatment of neuro-psychiatric illnesses, particularly psychasthenia.

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Figure 3: Dazhu (Bl 11): reunion-meeting point of 3 vessels: Foot Taiyang, Hand Taiyang, Hand Shaoyang.

PARAGRAPH 8 “Dian of the vessels (Mai Dian) is characterized by a sudden fall. The vessels at the level of the 4 limbs are edematous and lax and the pulse is full. One must urgently practice bleeding by acupuncture. 24.

If the pulse is not full, one must perform moxabustion at the Taiyang located at the neck, at Daimai (GB 26), 3 cun from the lumbar vertebrae and at the dorsal Shu points of the region of the “distribution of the flesh”.

If these signs are accompanied by frothy vomiting and flowing out of the energy toward the bottom, the illness is curable.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The Jingmai play the role of softening the tendons and bones and insures joint movements. Therefore, the individual affected by Dian Illnesses falls down. The 12 Jingmai manifest at the Jing, Ying... points of the hands and feet. This is why, when they are affected by the Dian illness, they are swollen and slack. In this case, one must perform bleeding by acupuncture. If concerns the illness retained at the bottom, at the Foot Taiyang (Bl); it is advised to apply moxabustion at the point of the Foot Taiyang (Bl) of the cervical region. The Daimai (vessel of the belt) starts at Zhangmen (Li 13), at the level of the false ribs, arrives at the point of the same name, Daimai (GB 26), encircles the body and links the Jingmai of this region, among which is the Foot Taiyang (Bl). The point Daimai (GB 26) is located 3 cun below the tip of the 11th rib.” II - N.V.N.: a - We can cite Zhang Jing Yue: Treatment of this illness (Mai Dian), when the vessels are edematous and slack, consists of needling to bleed them. In the opposite case, one must apply moxas to the points Tianzhu (Bl 10) and Dazhu (Bl 11) of the Foot Taiyang (Bl), Daimai (GB 26) of the Foot Shaoyang (GB) and to the points located in the small valleys (Xi) and valleys (Gu) at the level of the swollen and slack regions. According to the book entitled “Classification, Diagnosis and Treatment”, the flowing out of the energy toward the bottom implies an escaping of the energy of the kidney. This EmptinessEscaping of the energy is fatal. b - The Daimai (belt channel), starting at Zhangmen (Li 13), is an important notion to retain. (Figure 4) 25.

Figure 4: Point of beginning of the Dumai (belt channel).

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PARAGRAPH 9 Kuang

“The rapid evolution of Dian (Yin madness) illness, like that of (Yang madness), is fatal, therefore incurable.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Fullness of Yin is the origin of the Dian illness, and that of Yang, the Kuang illness. The speed of the manifestation of Dian, like that of Kuang, originates from the concomitant disturbances of Yin and Yang; the illness is then grave. Clinically, one must always recall that Zhong Yin and Zhong Yang phenomena (concomitance or juxtaposition of Yin and Yang) are fatal.” II - N.V.N.: Since 1969, with Chamfrault, we had translated Dian and Kuang as Yin Madness and Yang Madness (conforming to the explanation of Zhang Shi). Recall that the term “manic-depressive psychosis” does not designate Dian and Kuang which are two distinct illnesses.

PARAGRAPH 10

26.

“Kuang (Yang madness) illness starts first with sadness, then forgetfulness, anger and fear. Everthing comes from preoccupation and hunger. Treatment consists of needling the Hand Taiyin (Lu) and Hand Yangming (LI) until the change of color of the blood and also the Foot Taiyin (Sp) and Foot Yangming (St).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“From this paragraph, the study is centered on Kuang illnesses organized into emptiness and fullness types. “... first with sadness” because the illness is secondary to the insufficiency of the kidney. “... then forgetfulness and fear” because the Shen-Chi (mental/will) is in emptiness. “... anger” comes from the emptiness of the liver with afflux of Yang (of the liver). Liver-Wood and Shen-Chi are created by the kidney. This Kuang illness always originates, on the one hand, from a state of mind in the grip of obsession qui anxiety or disturbance until moral suffering, and, other the hand, from a state of starvation. “Worries, sadness...” injure the lung and “hunger” slows the production of Cereal Jing (Gu Jing), hence insufficiency of the Jing of the Kidney. In this case, the insufficiency of Yin causes the fullness of Yang, determining factor of Kuang. One must needle in dispersion the Hand Taiyin (Lu) and Hand Yangming (LI) to combat

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blood stasis and exterminate the afflux phenomenon. The two channels, Foot Taiyin (Sp) and Foot Yangming (St), must be needled in tonification to augment the production of the Cereal Jing with the goal of maintaining the energy of the kidney. • In the majority of cases, the Dian illnesses are due to the fullness of Yin, and the Kuang illnesses, to the emptiness of Yin. Bian Que (alias Qin Yue Ren-500 A.D.) said: “The concomitance of Yin (Zhong Yin) manifests by Dian, and the comcomitance of Yang, by Kuang.” These phenomena of concomitance are due to the emptiness of Yin with fullness of Yang or from the emptiness of Yang with fullness of Yin.. This means to say that if Yin is in emptiness, Yang is in fullness; one then must disperse Yang and tonify Yin. In pratice, one must always recall that the Jing Qi (Yin Quintessence) is produced by the Yangming (St) and that the Yang Qi (Yang energy) has its source in Yin. Such is one of the aspects of the reciprocal relationship of Yin and Yang. Understanding the antagonistic and complementary aspects of these 2 phenomena (Yin and Yang) permits advancing onto the true path of medicine.” 27. II - N.V.N.: We recall again the teaching of Zhang Jing Yue: “The insufficiency of Shen (Mental) is the cause of anxiety; preoccupation and disturbance of the Hun (vegetative soul) cause immoderate ambitions. The Jing (quintessence) then is found in shortage. Chi (will) in a disturbed state is the cause of forgetfulness. Invasion of the energy of the liver on the spleen causes anger and fits of rage. The insufficiency of blood is the cause of fear. All these signs originate from anxiety and hunger, which injures the energy of the organs. It is then advised to needle: _ Taiyuan (Lu 9) and Lieque (Lu 7) of the Hand Taiyin (Lu) _ Pianli (LI 6) and Wenliu (LI 7) of the Hand Yangming (LI) _ Yinbai (Sp 1) and Gongsun (Sp 4) of the Foot Taiyin (Sp) _ Sanli (St 36) and Jiexi (St 41) of the Foot Yangming (St) and leave the needles in place until the change of the complexion.”

PARAGRAPH 11 “In the Kuang illness starting with such signs as _ insomnia and anorexia _ self-satisfaction and certainty noble _ screaming and insults _ agitation day and night,

of

being

skillful,

intelligent

and

one must needle the Hand Yangming (LI), Hand Taiyang (SI) and Hand Taiyin (Lu). Moreover, one must examine the “sublingual area” of the neck and the Hand Shaoyin (He) in order to perform needling in the event of fullness.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph shows the Kuang illness caused by fullness of the energy of the heart. Fullness of Yin energy causes hypersomnia, and fullness of Yang energy, insomnia. During penetration of cereal energy into the stomach, Jing Qi (quintessence) reaches the heart. When the energy is in fullness, the individual does not feel the sensation of hunger. The heart is sovereign organ. When the energy of the heart is in emptiness, the individual experiences the feeling of inferiority and thinks he is poverty-stricken, and, in the event of fullness of the energy of the heart, the individual is proud and arrogant and believes he is worthy and magnanimous. Screaming and insults originate from the fullness of Yangming. Fire-Heart in a state of fullness invades Fall-Metal. The lung is comparable to an umbrella covering the heart. When the fire rises up toward the top, the energy of Heaven becomes impure. This is why one must needle the Hand Taiyang (SI) to disperse the fullness of Fire-Heart and needle the Hand Yangming (LI) and Hand Taiyin (Lu) to cool and calm the illness, thereby reducing the invasive movement and revolt of the energy. This illness is of Shen Qi (mental) origin and not from Xue Mai (blood vessels) origin. One must examine well the “sublingual area of the neck” and bleed the Xue Mai of the heart in the event of fullness. In this way, therapeutically, in illnesses of the Shen Qi (psyche/mind), one must treat the bowel to purify the organ because the bowel is Yang responding to the energy. In contrast, if the illness of Shen Qi reaches the Xue Mai, one must treat the Luomai of the corresponding organ.” II - Ma Shi clarifies: “The previous paragraph demonstrates the precursor signs of Yang madnesses, and this one describes the beginning signs. III - N.V.N.: According to Zhang Jing Yue, 1 - The points used concerning the Hand Yangming, Hand Taiyang and Hand Taiyin channels are cited in the previous paragraphs. 2 - the “sublingual area of the neck” designates the point Lianquan (CV 23). (4) 3 - The points of the Hand Shaoyin are Shenmen (He 7) and Shaochong (He 9).

PARAGRAPH 12 “Kuang characterized by: _ logorrhea ( 5 ) _ fear _ groundless laughter _ obsession with music and singing _ erring ways, bad habits is due to fright. Hand

One must needle the Hand Yangming (LI), Hand Taiyang (SI) and Taiyin (Lu).”

4. This point has a vessel which goes to the base of the tongue. 5. Pathologically incoherent, repetitious speech; incessant or compulsive talkativeness.

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29.

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EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“Here, Kuang illness first manifests at the kidney, then reaches the heart, triggering fear. Yin in an empty state and Yang in a full state becomes indicated by logorrhea and panic. The classics stated: Fullness of the enery of the heart becomes characterized by logorrhea, and emptiness, by sadness. In the event of fullness, Xin-Chi (heart-will) is compressed. This is why the individual likes to sing and listen to music to become calm. The combined disturbances of Shen and Chi direct the individual to run aimlessly. Treatment consists of needling the Hand Taiyang (SI) to purify the heart in a state of fullness and the Hand Yangming (LI) and Hand Taiyin (Lu) to maintain the kidney in a state of emptiness.”

PARAGRAPH 13 “Kuang

characterized

_ visual and auditory _ and screaming

by hallucinations

is due to the loss of the energy. One must needle the Hand Taiyang (SI), Hand Yangming (LI), Hand Taiyin (Lu) and Foot Taiyin (Sp) and the “2 sides of the chin”.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Here, Kuang is due to the insufficiency of the energy of the kidney causing the emptiness of the energy of the heart. Above and down below, “Fire” (heart) energy and “Water” (kidney) energy support one another and become tempered. This is why the insufficiency of the kidney energy provokes the emptiness of the heart with appearance of the above-cited signs. It is recommended to needle the points of the Hand Taiyang (SI), Hand Taiyin (Lu) and Hand Yangming (LI) to “purify” hallucinations and to tonify Foot Taiyin (Sp) and Foot Yangming (St) to augment the production of the cereal energy (Gu Qi) because the 5 organs need the energy of Yangming to develop their functions. 30. The kidney is a water organ. It receives the Jing Qi (pure energy; quintessence) of the 5 organs (Figure 5). The energy (6) forms from Jing (quintessence). This classic has mentioned: “The energy of the stomach ascends toward the top and projects into the lung.” One part of this energy, via the pharyngeal route, rises up toward the head. On the one hand, it becomes exteriorized at the “orifices” (5 sense organs) and, on the other hand, it reaches the 2 sides of the chin up to the head. Here, our masters of old did not speak of the Foot Yangming (St), but mentioned the 2 sides of the chin to designate the facial portion of the Foot Yangming linked to the Shangjiao (UJ) and Zhongjiao (MJ).” 6. Here, this indicates “essential” or “vital” energy.

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II - N.V.N.: The explanation of Zhang Shi allows us to understand the important role of reception of the Jing of the 5 organs at the level of the kidney (Figure 5).

Figure 5: Kidney: receptor organ of the Jing of the organs.

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PARAGRAPH 14 “Kuang

manifesting

31.

by

such

signs

as:

_ bulimia _ visual hallucinations _ silent laughing come from elation. One must needle first the Foot Taiyin (Sp), Foot Taiyang (Bl) and Foot Yangming (St) and then secondly the Hand Taiyin (Lu), Hand Taiyang (SI) and Hand Yangming (LI).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“ 1 - Excessive joy injures the Xin (heart) and Chi (will) causing the “Xu Kuang” (Kuang in a state of emptiness). Bulimia is due to emptiness of the energy of the heart and visual hallucinations, to the emptiness of Shen Qi (mental energy). 2 - During penetration of nutritional energy into the stomach, the impure energy reaches the heart. This is why one must first tonify the Foot Taiyin (Sp) and Foot Yangming (St) to maintain the Jing (quintessence) of the heart and the Foot Taiyang (Bl) to activate the production of organic liquid in order to temper the Shen Qi; then secondly needle the Hand Taiyang (SI) and Hand Yangming (LI) to disseminate the Kuang syndrome. 3 - In illnesses caused by the Foot Shaoyin (Ki), one must first needle the channels of the foot, and in the illnesses caused by the Hand Shaoyin (He), one must do the opposite. This is a marvelously effective method to reestablish the exchange of the energy of the top and bottom.”

II - N.V.N.: We have also noted in the Nanjing: “During escaping of Yang, the individual perceives demons, and during escaping of Yin, vision is disturbed.”

PARAGRAPH 15 “If Kuang is not as serious as in the previous case, it is advised to needle the 2 Ququan (Li 8) (left and right) at the side of an artery. If they are in fullness, one must make them bleed by acupuncture and cure is virtually instantaneous. If this is not the case, one must apply 20 moxas to the coccyx.”

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EXPLANATIONS AND COMMENTARIES

32.

Zhang Shi explains:

“Here it concerns a general study of Kuang during its first manifestations, being able to be cured by needling the point Ququan (Li 8). In summary, the Kuang illness originates from emptiness or fullness of the energy of the heart. In contrast, if it is due to the emptiness or fullness of the energy of the kidney, Water reaches Wood then arrives at Fire. This is why, at the starting phase of the Kuang illness without signs of sadness, fear, anger, visual hallucinations... cure can be obtained on the field by needling the poing Ququan (Li 8) because the disturbance manifests at the level of the energy of the liver without touching the Shen Qi. If cure is slowed, the application of 20 moxas to the coccyx is recommended to eliminate the pathogenic energy of the liver by the lower route.”

PARAGRAPH 16 “In Feng Ni (contrary afflux of wind) manifesting by such signs as

_ sudden edema of the 4 limbs _ trembling with cold _ anxiety during hunger _ displeasure during satiety

one must needle the Hand Taiyin (Lu) and its external and internal relationships, the Foot Shaoyin (Ki) and Foot Yangming (St). If the individual feels cold in the muscles, one must needle the Y i n g - s t r e a m points, and if he feels cold in the bones, the Jing-well and Jingriver p o i n t s . ” EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“Jue (afflux) is a massive arrival of energy, triggering factor of the Dian illness. 1 - The kidney is a water organ and wind is a force susceptible to displace the mass of water in the form of waves. As a result, Feng Ni (contrary afflux of wind) implies a massive attack of wind provoking a contrary flow (afflux/Jue Ni) of the water energy of the Foot Shaoyin (Ki), hence sudden edema of the 4 limbs with shivers. 2 -Wind injures kidney water and causes emptiness of the heart energy (according ot he inhibitory law of the 5 movements). This is why the subject is anxious and annoyed when hungry. If perverse Wind-Wood injures the Center-Earth (spleen and stomach), the individual is usually agitated and angered when his appetite is satisfied. 33. 3 - To needle the system of “external-internal, Yin-Yang” relationship of the Hand Taiyin (Lu) is to liberate the perverse wind, and to needle the Foot Shaoyin (Ki) and Foot Yangming (St) is to harmonize the contrary afflux (Ni), thereby warming up the cooled energy.

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4 - To speak of “cold of the flesh” is to explain that the “cold” energy has reached the dermal system. Therefore, one must needle the Ying-Fire points in order to warm up the flesh and muscles conforming to the principle according to which Earth (spleen) governs heat and fire (heart) maintains Earth. The term “cold in the bones” implies that the perverse energy is still found within the water organ (kidney). One then must needle the Jing-well point to disperse (7) the perverse energy. 5 - Chu Ma Rong has said: “To needle the external and internal realationship of the Hand Taiyin (Lu) is to perform a provoked sweat, as is made by Herba Ephedrae (Ma Huang), with the purpose of aerating the sweat glands, associated with Semen Armeniaca amarae (Xingren) to maintain Lung-Metal, because the aeration permits the energy of the interior to diffuse to the exterior.”

PARAGRAPH 17 “In Jue Ni (contrary afflux) with such signs as: _ _ _ _ _

cold feet sensation of bursting of the thorax lancinating pain of the abdomen annoyance and anorexia large or small, steady or rapid pulse,

• if the body is hot, one must needle the Foot Shaoyin (Ki) • if the body is cool, one must needle the Foot Yangming (St). one

In the event of coolness, one must tonify, and in the event of heat, must disperse.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph explains contrary afflux (Jue Ni) of the energy of the Foot Shaoyin (Ki). 1 - The kidney organ sends out a large vessel which exteriorizes at the point Qijie (other name Qichong-St 30). This vessel descends, runs alongside the inner thigh, arrives at the knee, reaches the internal malleolus and penetrates into the sole of the foot. For this reason, at the time of the contrary afflux of the energy of the kidney, the soles of the feet are icy cold. 2 - “Sensation of bursting of the thorax...” is due to a gathering of the energy which, from the abdomen, affluxes toward the heart and thorax. 34. 3 - The basic substance of the blood vessels come from the kidney... . The large or small, regular or rapid pulse results from the engorgement of the Jingmai following an contrary afflux of the energy of the kidney.

7. According to the “Mother-Son” rules.

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4 - The kidney is the source organ of the vital energy. The body is warm because the phenomenon called “fullness-contrary afflux” intervenes; one must disperse Foot Shaoyin (Ki). In contrast, the body is cold because the phenomenon called “emptiness-contrary afflux” intervenes; one must tonify Foot Yangming (St) to maintain the Jing (quintessence) of the kidney organ. 5 - The previous Paragraph 16 demonstrated the syndrome of afflux of external origin (Jue); this one deals with the syndrome of afflux of internal origin. These affluxes are the primary causes of the Dian illnesses. This is why the treatment of the Jue syndromes (afflux) constitutes a preventive method of these illnesses called Yin Madnesses (Dian).”

II - N.V.N.: 1 - Regarding the choice of points, Zhang Jing Yue recommends: _ Yongquan (Ki 1) and Rangu (Ki 2) of the Foot Shaoyin (Ki) and _ Lidui (St 45) and Neiting (St 44) of the Foot Yangming (St). These points are specific in the treatment of Jue Ni (contrary afflux). 2 - The “large vessel” (cited above by Zhang Shi), which exteriorizes at the point Qichong (St 30) and reaches the inner thigh to the sole of the foot, is the descending branch of the Chongmai (Firgure 6).

Figure 6: Formation of the descending branch of the Chongmai.

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PARAGRAPH 18

35.

“In Jue Ni (contrary afflux) characterized by such signs as: _ _ _

swelling and abdominal fullness boborygmi thoracic fullness with respiratory

difficulty,

one must needle the sub-thoracic points, at the two hypochondria, at the place where the cough responds to pressure of the hand, and the dorsal Shu (Bei Shu) points at the place where the patient experiences relief with the pressure of the fingers.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi instructs:

“This paragrph explains the illness caused by Jue Ni at the level of Taiyin and Yangming. Swelling and abdominal fullness indicate Jue Ni at the level of the Foot Taiyin (Sp) and Foot Yangming (St). Boborygmi indicates the presence of Jue Ni at the level of the Hand Yangming (LI). Thoracic fullness with difficulty breathing explains the evolution of Jue Ni toward the Hand Taiyin (Lu). The points located at the two hypochondria are none other than Zhongfu (Lu 1) and Yunmen (Lu 2) of the Hand Taiyin (Lu).”

II - N.V.N.: The sub-thoracic points mentioned, at the two hypochondria, do not belong to the Hand Taiyin (Lu) but to the Foot Jueyin (Li). According to Zhang Jing Yue, it concerns Zhangmen (Li 13) and Qimen (Li 14). Ma Shi also had spoken of these.

Zhangmen (Li 13) is located below the tip of the 11th rib. This is the Mu point of the spleen and “reunion” point of the energy of the organs. The Nanjing states: The energy of the 5 organs reunites at Zhangmen (Li 13). Ailments of the organs are treated with this point. The Dacheng adds: “This point treats boborygmi, swelling/abdominal fullness... .” Qimen (Li 14) is located 3.5 cun to the side of Juque (CV 14), in the 6th intercostal space (Figure 7).

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36.

Figure 7: Localization of Zhangmen (Li 13), Qimen (Li 14), Dabao (Sp 21) and Riyue (GB 24).

PARAGRAPH 19 “When the interior is obstructed, the illness manifests by oligoanuria. One must needle the Foot Taiyang (Bl) and Foot Shaoyin (Ki), as well as the point at the coccyx, with long needles.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“In this paragraph, the energy of Jue Ni does not gather at the top, but at the bottom, hence oligo-anuria. One must needle the Foot Shaoyin (Ki) and Foot Taiyang (Bl) and the point located at the coccyx in order to disseminate the afflux, thereby favoring diuresis.”

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II - N.V.N.: 37. The points favoring diuresis recommended by Zhang Jing Yue are: _ Yongquan (Ki 1) and Jiaoxin (Ki 8) of the Foot Shaoyin (Ki) and _ Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61), Jinmen (Bl 63) of Foot Taiyang (Bl). The “point located at the coccyx” is Changqiang (GV 1). (8)

PARAGRAPH 20 “In the Jue Ni syndromes, one must needle the Taiyin and Jueyin. In serious cases, it is advised to add the Shaoyin and Yangming.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph justifies the treatment of the Jue Ni syndromes. Because, when the energy of the afflux of the energy of the Foot Shaoyin (Ki) arrives in abundance at the heart to trigger the Dian Kuang (Yin Madnesses and Yang Madnesses), one must needle the Jueyin because the “water” energy maintains Liver-Wood and, from there, it reaches Heart-Fire. This is why, at the start of the illness, one must needle Ququan (Li 8) (9). If the case is serious, one must disperse the Foot Shaoyin (Ki).” II - Ma Shi states:

“In the Jue Ni syndromes, it is advised to needle Foot Taiyin (Sp) and Foot Jueyin (Li). In serious cases, add Foot Shaoyin (Ki) and Foot Yangming (St) (Ex: Fuliu- Ki 7, Jiexi- St 41, etc.).”

PARAGRAPH 21 “In syndromes of such signs as:

insufficiency of

the

energy characterized by

_ chills _ shortness of breath and cracked voice _ arthralgia _ sensation of heaviness of the body _ fatigue of the limbs with trouble moving, one must tonify the Foot Shaoyin (Ki).”

8. All of these points are described in MTC- NVN Edition. 9. Ququan (Li 8) is the He point of the Foot Jueyin (Li) which responds to water.

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EXPLANATIONS AND COMMENTARIES

38.

I - Zhang Shi explains: “This paragraph concerns the insufficiency syndrome of the energy of the Foot Shaoyin (Ki), determining factor of the triggering of the illness called Xu Ni (Emptiness-Contrary Afflux). The heart governs speech and the lung, the voice. But they become manifest due to the “active” energy (Dong Qi) (10) of the kidney. As a result, in the insufficiency of the energy of the kidney, speech is no longer possesses its connected nature (11). In this case, it is advised to urgently tonify the Foot Shaoyin (Ki), that is to say, the “root energy” (source energy).” II - N.V.N.: According to Zhang Jing Yue, this illness is due to emptiness of the Jing (quintessence) of the kidney, causing a contrary flow (Jue Ni), hence the necessity to tonify the Foot Shaoyin (Ki).

PARAGRAPH 22 “Short respiration is synonymous with a more or less prolonged suspension of respiration (apnea). It is gasping for breath with poorer effort. One must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo (blood capillaries).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph justifies the reascent of the energy in a state of “loss”, susceptible to triggering the syndrome called Emptiness-Yang Madnesses (Xu Kuang), while the previous one demonstrates the syndrome of “loss” of the energy of the Foot Shaoyin (Ki), that is to say, the syndrome of insufficiency of the energy located down below. Short respiration originates from the energy in a state of insufficiency down below with encroachment on the top. Thus, one must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo.”

II - N.V.N.: Paragraph 22 and the previous one concern the emptiness of the energy. One does not tonify the Hand Taiyin (Lu) (mother of energy) but the Foot Shaoyin (Ki) (“source” of the energy) because “Yang has its origin in Yin” and “energy is created from Jing (quintessence).” Therefore, the search for the root of the illness represents a primary phase in Oriental medicine, necessary before any therapy.

10. The “active” energy is a very mobile, very dynamic energy which, at every moment, changes direction. 11. Difficulty forming sentences.

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39.

CHAPTER XXIII Diseases of Heat (Re Bing) (1)

Chapter 23 is devoted to the diseases of heat: classification and description of diseases, therapy and prognosis. The methods of needling of the different forms of the diseases of heat and their contraindications are clearly set forth. The description of the diseases of heat at the level of the different anatomic layers (skin, flesh, muscles, blood and vessels, tendons and bones) is based on the principles of the 5 Movements at the level of the channels (liver, heart, spleen, lung and kidney) in order to determine the therapeutic rules by acupuncture, The 59 energetic “anti-heat” points are mentioned. This chapter consists of 28 paragraphs.

PARAGRAPH 1 “In the syndrome Tian Ku (hemiplegia) ( 1 ) , characterized by a painful paralysis of half of the body, without change in language and without disturbance of will (Chi), the disease is localized in the “demarcation of the flesh” (epidermo-dermal system); one must employ “great needling” in order to tonify the essential energy in a state of insufficiency and to disperse the perverse energy in a state of excess.” 1. In any event, Re Bing cannot be translated as “febrile diseases”.

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EXPLANATIONS AND COMMENTARIES

40.

I - Zhang Shi explains:

“Chapter 23 studies the diseases of heat of three different etiologies: _ exogenous etiology, caused by an infiltration of Wind-Cold _ endogenous etiology, following a syndrome of heat at the level of the 5 organs _ mixed etiology, resulting from simultaneous disequilibrium of the interior and exterior, of Yin and Yang, of the essential energy and perverse energy. Paragraph 1 concerns the disease of heat of external origin. Here, perverse Wind-Cold infiltrates into half of the body. Ying (nutritive) energy and Wei (defensive) energy grow weak, the source energy escapes and the perverse energy inserts itself alone, triggering Tian Ku (hemiplegia), with disturbance of motility and pain. The heart governs speech, and the kidney, Chi (will). Therefore, “absence of change in language and disturbance of will” indicates that the interior is intact and that the perverse energy is localized only at the exterior. One must then use the “great needling” method (Ju Zhen) to tonify the essential energy and disperse the perverse energy.”

II - N.V.N.: _ Regarding Tian Ku (hemiplegia), complementary studies are developed in the Suwen (Chapters 3 (“Relationship of the Vital Energy with that of Heaven”), 7 (“Special Study on Yin and Yang”), 42 (“Dissertation on Wind”), 48 (“Dissertation on the Great Singularities”), 75 (“Discourse on the Illustrious Teaching”) and 77 (“Analysis of the 5 Errors”) - N.V.N. Edition). _ “Great Needling” cannot be translated as “a large needle” because it concerns here an acupuncture technique opposite to that called “needling in opposition” (Mu Zhen) (see Suwen, Ch. 63 (“Disocurse on Needling on the Opposite Side”). One can therefore not correctly translate Oriental medical classics like the Neijing without being an acupuncturist. The Great Needling used in the treatment of hemiplegia of external origin consists of needling points of the side affected to reestablish the circulation of the Jingluo and harmonize the blood and energy.

PARAGRAPH 2 “In Fei (quadriplegia), the paralysis of the 4 limbs is not painful. If the Chi (will) is not totally altered and if the voice is not very 41. weak, the disease is curable. In contrast, it is incurable if there is anarthria. This disease first starts at Yang, then it reaches Yin. One must first treat Yang and secondly, Yin. The needling done on Yang must be superficial.”

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EXPLANATONS AND COMMENTARIES I - Zhang Shi explains:

“The Fei disease (quadriplegia) belongs to the Feng-Re (Wind-Heat) group. The non-painful nature of the paralysis indicates that perverse energy has not yet reached the interior. Wind-Wood deteriorates the “Center-Earth”; the spleen maintains the Zi (intelligence) and governs the 4 limbs. As a result, the integrity of the Zi in the paralysis of the 4 limbs denotes that the perverse energy becomes localized only in the “mid-external, mid-internal” area and that the source energy is not yet altered. Weakness of the voice announces that the perverse energy disturbs the essential energy. The disease, which is still found at the energetic level, is curable. In contrast, the presence of anarthria is a sign revealing the disease located at the level of the organ, therefore difficult to treat. The exterior is Yang, the interior is Yin. The disease manifests in the first place in the area of “demarcation of the flesh” (Yang), and in the second place, in the interior (Yin). One must consequently first needle Yang then Yin. Superficial needling permits evacuation of the perverse energy localizing at the exterior.”

II - Ma Shi teaches:

“This paragraph demonstrates the needling method against Fei disease (quadriplegia). The previous paragraph concerns painful paralysis and this one, non-painful paralysis. The previous paragraph speaks of paralysis of the hemi-body, and this one, of paralysis of the 4 limbs. Tian Ku (hemiplegia) and Fei (quadriplegia) therefore are two different diseases. Non-aggravation of the disturbance of the Shen (mental) and Chi (will), weakness of voice and perceptiveness of mind are indicators of the curability of the disease. In contrast, in the case of aggravation of the disturbance of the Shen and Chi with anarthria, the disease is incurable. One must clearly specify the level of attack of the peverse energy in order to perform appropriate treatment. Because, if the disease starts in the first place by the Yang channels and in the second place by the Yin channels, one must needle first the Yang channels, then the Yin channels. The needling must be superficial because Yang is found at the exterior. 42. The text mentions neither the disease starting via the Yin channels then evolving toward the Yang channels nor the needling done at the Yin channels before the Yang channels nor deeper needling, probably because the disease starting via the Yin channels is incurable.”

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PARAGRAPH 3 “In the heat disease evolving for 3 days, where the Qi Kou pulse (right radial pulse) is calm and Renying (left radial pulse) is agitated, one must needle the points of the Yang channels, choosing among the “59 (anti-heat) Points” to evacuate the perverse heat and favor perspiration, all in respecting the principle “render the Yin channels full to tonify the insufficiency”. are

In the case of too high a fever where the Yin pulse and Yang pulse calm, needling is expressly advised against.

If acupuncture is still judged possible, the needling must be immediate because, even without provoked sweating, the perverse energy can be eliminated to the exterior. To say not to needle is it evoke a fatal syndrome.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“In the heat disease evolving over 3 days, the perverse energy comes to cross the 3 Yang channels and goes to reach the 3 Yin channels. The expression “Qi Kou is calm and Renying is agitated” indicates that perverse energy lodges in Yang and still has not reached Yin. One must then needle the Yang channels. The 59 Points (anti-heat) possess at one time the power to evacuate and to sudorificate. The principle to render full the Yin channels to tonify insufficiency implies not letting the perverse energy insert itself into the Yin channels in a state of insufficiency. In the case of too high a fever where the Yin and Yang pulses are calm, the essential energy of the 3 Yang channels and 3 Yin channels are in a state of emptiness; therefore, the prognosis is fatal and acupuncture is useless. In contrast, in the case where acupuncture is judged still to be possible, needling must be immediate to evacuate the perverse energy by the sweat gland route when it is found in the Yang part (of the body) or in order to excrete it via the low route. Such is the therapeutic principle of serious disease caused by perverse heat without alteration of the essential energy. 43. Zhang Yai Chi has said: “The heat diseases are of the Shanghan type (evolutive diseases of cold). In effect, they evolve following the 6 channels, and, on the 7th day, they return to their point of departure. The disease is specifically energetic; this is why diagnosis is performed at Qi Kou and Renying.” “Without sweating, one must excrete it by the low route” has the same meaning as that of the phrase drawn from the Suwen: In the disease of heat of less than 3 days, only sudorification is advised. When it exceeds 3 days, only purgation is indicated.” (2)

2. Also see “Evolutive Diseases of the 3 Yin and 3 Yang” (According to the Shanghan Lun) N.V.N. Edition.

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II - Ma Shi teaches:

“The theme of Paragraphs 3 to 21 is devoted to the diseases of heat. In this paragraph, the signs and pulses are in aggreement; it is advised to needle to provoke sweating so as to expel the perverse energy. If the pulse and signs are not in aggreement, acupuncture is useless. In the heat disease of more than 3 days, Qi Kou is calm and Renying is agitated because the Yang channels are affected. In the case where the signs and pulses are in aggreement, one must needle the Yang channels to disperse the perverse energy. In contrast, in slightly elevated fever, if the Qi Kou pulse is calm and Renying is agitated and if Yin channels and Yang channels are simultaneously calm, the signs and pulses are not in aggreement; the prognosis is fatal and needling is without purpose. Because the perverse energy is in fullness, the pulse is agitated. The fullness of perverse energy with very high fever is the indicator of the insufficiency of the essential energy; a pulse which is no longer agitated is a fatal sign”

PARAGRAPH 4 “In the disease of heat greater than 7-8 days with Mai Kou (radial pulse) agitated, dyspnea and short respiration, it is advised to urgently needle; sweating is spontaneous. The needling is performed at the level of the thumb.”

EXPLANATIONS AND COMMENTARIES

44.

I - Ma Shi explains: “In this paragraph, the signs and pulse of the disease of heat are clearly emphasized. It is advised to needle the Hand Taiyin (Lu). Because, in the disease of heat exceeding 7-8 days with Mai Kou agitated, dyspnea and short respiration, one must employ the technique of sudorification by needling the point Shaoshang (Lu 11), clearly most indicated.” II - Zhang Shi clarifies: “Here, although the heat disease lasts for 7-8 days, the perverse energy is still located at the exterior; one must needle urgently to evacuate it because its non-liberation by the 8th day marks its imminent progression toward the Yin channels, the serious phase of the disease. Agitation of Mai Kou associated with dyspnea and short respiration are warning signs of the persistence of the peverse energy within the external energetic layers. As a result, it is advised to disperse Shaoshang (Lu 11) to excrete the perverse energy by the sweat gland route.” III - N.V.N.: According to You Ba Rong, needling the point Shaoshang (Lu 11) has the same sudorific effect as Herba Ephedra (Mahuang). (3)

3. See Wording 35 of the Shanghan Lun of Zhang Zhongjing, translated under the title “Evolutive Diseases of the 3 Yin and 3 Yang” - N.V.N. Edition.

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PARAGRAPH 5 signs

“In the disease of heat greater than 7-8 days, revealed by such as: _ galloping√ and small pulse _ hematuria _ and dryness of the mouth,

death follows in 1 day and a half. If the pulse is changing (Da), death follows in 1 day.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph demonstrates the case of non-liberation of the disease of heat evolving toward the Shaoyin (He), therefore of fatal prognosis. On the 7th day, the disease ends its progression at the level of the 6 channels (3 Yin and 3 Yang) and returns to its point of departure. On the 8th day, the non-liberation of perverse heat marks a new evolutive cycle of the disease. The small and galloping√ pulse of the Shaoyin (He) (4) responds to Ministerial Fire. 45. Hematuria indicates the localization of the disease at the level of the Water Organ responding to the Foot Shaoyin (Ki). Dryness of the mouth indicates the localization of the heat disease at the level of Imperial Fire responding to the Hand Shaoyin (He). Evaluation of death at 1 day and a half expresses the fatal occurrence in the period of time occurring between 1 and 2 days, moment of the disappearance of Yin energy and of Yang energy, of water and fire. The pulse starts at the kidney, but it is controlled by the heart. The changing (Da) pulse signals the exhaustion of the energy of the lower part of the body, hence death in 1 day”.

II - N.V.N.: The Da pulse (5) cannot be translated as “large” pulse but as “changing” pulse because this pulse assumes an intermittent nature (a more or less long stop between several beats). Generally, the changing (Da) pulse is the indicator of the evolution of the disease toward worsening or improvement of the disease.

4. Here it must mean Hand Jueyin (XB). 5. See explanation in the Maijing (“Classic of Pulses”) of Wang Shu He - N.V.N. Edition, and also in Chapter 29 (“Teachings Transmitted by the Masters”) of this classic (Volume II).

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PARAGRAPH 6 as:

“After sweating, if the heat disease still presents with such signs _ agitated pulse _ dyspnea _ and fever, needling the cutaneous areas is advised against. If the dyspnea worsens, it is death.”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“After sweating, the pulse is still agitated because the too virulent Yang-Heat is not eliminated via the sweat gland route. Dyspnea and fever are the signs revealing the evolution of the disease toward the interior. Acupuncture performed at the skin is useless, therefore advised against. The aggravation of the dyspnea reveals the state of fullness of the perverse energy lodged in the interior, provoking disturbances of the Yin energy and Yang energy, hence the lethal prognosis.” 46.

PARAGRAPH 7 “In the disease of heat exceeding 7-8 days and manifesting by a non-agitated or agitated pulse but without diffuse and rapid nature, sweating is spontaneously produced at the end of 3 days. If sweating does not appear at the end of 3 days, death follow on the 4th day. During the period of absence of sweating, needling the sweat gland area is not advised.”

EXPLANATION AND COMMENTARIES Zhang Shi explains: “The absence of agitated pulse indicates the liberation of the exterior. The agitated pulse without diffuse and rapid nature signals the incomplete evacuation of perverse heat and the normal state of the essential energy. Three days later, that is, on the 11th day (8+3), the perverse heat progresses again toward Li-Yin (Interior-Yin) where it encounters the Xin-Ye (organic liquid) which expels it via the sweat gland route, factor of cure. As a result, during the waiting period of 3 days, it is useless to needle the sweat gland areas.

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In contrast, the absence of sweating after 3 days of waiting... is due to the fullness of the Yang-Heat (perverse) and to the exhaustion of the Yang energy (of the body). This is why death follows on the 4th day... . If the previous paragraph studies the heat disease localizing at the exterior which, in spite of sweating, progresses toward the interior, this one has for its object the localization of the perverse energy in the Yin part, determining factor of spontaneous sweating. Therefore, sweating provoked there is useless. This study allows comprehension that Yang can penetrate within Yin and that Yin can exit from Yang.”

PARAGRAPH 8 “In the disease of heat manifesting by such signs as: _ cutaneous pain _ nasal obstruction _ edema of the face, one must use Chan type needles (No. 1) ( 6 ) and needles according to the technique of the “59 points’ (anti-heat). 47.

In the event of nasal ulceration, one must treat the lung and needle the skin. In the absence of a result, one must treat Fire, that is to say, the heart.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph concerns the case of fixation of perverse energy at the level of the skin, hence the necessity of needling this area. In the absence of results, the heart must be tonified to accentuate its triumphant action over the lung. The lung responds to Metal and links with the skin. The disease of heat starts at the skin with nasal obstruction and heavy sensation of the eyelids, evoking facial edema; one must then needle the skin to expel the perverse heat. To needle the skin implies inevitably “to needle the skin without injuring the flesh”. Nasal ulceration is an ailment of the skin and to needle the skin consists of acting on the energy of the lung (because it unites with the skin). If that proves ineffective, one must act on Fire, that is to say the heart, because tonifying the heart amounts to augmenting the potential of Fire and diminishing that of Metal. To act thusly is to repel the perverse heat lodged in the lung.”

II - Zhang Shi instructs:

“Paragraph 8 and the following ones deals with heat diseases localized in the interior (organs).

6. See Chapter 1 (“9 Needles” and “12 Yuan”) of this classic.

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From the fact that the diseases are located at the level of the organs, one must always examine the skin, vessels, flesh, muscles and bones, that is to say, the corresponding anatomic and energetic layers. If the diseases persist, it is recommended to apply the “inhibitory method”. Cutaneous pain and nasal obstruction are signs revealing the presence of heat at the level of the lung and the needles are of the Chan (No. 1) type in aggreement with the method of the “59 points” (anti-heat). In the more serious forms, in particular nasal ulcerations, one must always look for the cause at the level of the lung. If the treatment proves ineffective, the cause is looked for again at the level of Fire-Heart because the heart can triumph over Metal (Figure 8) because, in the interior, the 5 organs unite with the energy of the 5 organs, and at the exterior, they respond to the 5 anatomic layers. In short, in disturbances of the energy at the level of the corresponding anatomic areas, One must first treat the exterior, then, in the event of failure, utilze the Inhibitory Method of the 5 Movements, conforming to the principle according to which “One must first treat the summit, then the root.” 48.

Figure 8: Treatment of the heat disease at the level of the anatomic layer belonging to the lung by the inhibitory method.

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PARAGRAPH 9 “In the diseases of heat manifesting by such signs as: _ _ _ _

skin rough to the touch asthenia and fever sadness dryness of the lips and throat,

one must needle the Mai ( 7 ) with the No. 1 (Chan type) needle according to the method of the “59 (anti-heat) points” . In the event of swelling of the skin, dryness of the mouth and cold sweat, one must treat the heart. If the disease does not regress, one must treat at the level of water, that is to say, the kidney.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph shows the case of localization of perverse heat within the Luo following an primary attack of the Mai (vessels). Treatment consists of needling these latter. If the disease does not regress, one must tonify the kidney to triumph over the heart. 49. Because the vessels (blood) being the seat of the disease, one must treat them in evacuating the perverse heat, respecting the principle which stipulates “During the needling the vessels, do not injure the flesh. In this case, No. 1 needles are recommended to needle the points among the group of “59 points” (anti-heat). In the presence of other accompanying signs, such as swelling of the skin, dryness of the mouth, cold sweat..., the disease is always seated at the level of the Mai and the organ to treat is only the heart. If the disease does not regress, one must treat at the level of water, that is to say, kidney, because tonification of the kidney permits augmentation of the potential of Water, thereby reducing that of Fire, that is to say, the syndrome of heat.” (Figure 9) II - Zhang Shi specifies:

“This paragraph demonstrates the case of localization of heat at the level of the Xin Bao Luo (XB), with clinical manifestations at the level of the Xue Mai (blood vessels). The Jing (channels) and Mai (blood vessels) are the circulatory routes of Ying (nutritive energy) and blood, sites of development of Yin and Yang. When Fire is in fullness, the heart is perturbed, and when Fire rises up toward the top, the lips and mouth become dry. The treatment consists of using Chan (No. 1) type needles to disperse the heat at the level of the vessels according to the method of the “59 (anti-heat) points.”

7. It must mean Jingmai (channel system).

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Figure 9: Treatment of the heat disease at the level of the anatomic layer responding to Xin Bao (XB).

PARAGRAPH 10

50.

“In the diseases of heat with such signs as: _ dryness of the throat _ abundant drinking _ fright _ difficulty rising out of bed, the affliction is seated at the dermal (flesh) system. of

One must utilize needle No. 6 (“Yuan Li”) according to the method “59 points” (anti-heat).

If a blue vessel appears at the internal canthus of the eye, one must aim for the spleen to treat the flesh. If the disease does not regress, one must treat Wood, that is to say, the liver.”

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EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “The spleen responds to Earth and governs the flesh (dermal system). In the heat diseases with dryness of the throat, abundant swallowing of drinks, fatigue of the limbs, difficulty getting up from bed, the flesh is affected. It is advised to needle the flesh to disperse the heat according ot the method of “needling the flesh without injuring the muscles”. “The appearance of a blue vessel at the internal canthus of the eyes” reveals the inhibitory action of the Wood-Liver on Earth-Spleen. In this case, the disease is always located in the “flesh” system. This is why one must aim for the spleen to treat the flesh. If, despite treatment, the disease does not regress, one must tonify Wood (liver) to reduce the energetic potential of the spleen (Earth), thereby favoring cure of the heat disease at the level of the spleen.” (Figure 10)

II - Zhang Shi clarifies: “The laryngo-pharyngeal apparatus (throat) responds to the energy of Heaven, and the stomach, to that of Earth. During the course of the heat disease, the individual feels the need the constantly drink. This phenomenon is due to a rising up of the heat of the spleen (Earth) toward the stomach, also provoking the sudden arrival of a state of fright. The spleen governs the dermal system (flesh) and the 4 limbs. As a result, during the heat disease, there is a difficulty standing up. It is therefore advised to needle the energy belonging to the flesh according to the method of the “59 points” (anti-heat) with the No. 6 (Yuan Li) type of needle to disperse the heat.” 51.

Figure 10: Treatment of the heat disease at the level of the anatomic layers responding to the spleen.

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PARAGRAPH 11 “In the diseases of heat characterized by such signs as: _ pale greenish facies _ encephalgia _ agitation of the limbs, one must needle the osteo-tendinous insertions of Si Ni (4 limbs) with No. 4 (Feng type) needles. If the muscles are paralyzed and accompanied by shedding unmastered tears, one must needle the liver to treat the muscles. If the disease does not regress, treatment at the level of Metal, that is to say, the lung, is imposed.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“The liver responds to Wood and governs the muscles and tendons. Pale and greenish facies is the color of the liver. Encephalgia comes from attack of the liver by perverse heat which infiltrates into the Dumai (GV) at the level of the brain. Agitation of the 4 limbs indicates excess of heat of the liver which reaches the spleen, organ governing the 4 limbs. 52. In the majority of cases, ailments of Wood ( liver) manifest at the level of the muscles of the 4 limbs. It is then advised to needle the muscles and tendons with a No. 4 (Feng) type needle to evacuate the perverse heat in accordance with the principle according to which “do not injure the bones in needling the muscles”. Paralysis of the muscles and the unstoppable outflowing of tears denotes that the disease is found in the liver. This is why one must aim for the liver in order to treat the muscles. If the disease does not regress, one must treat at the level of Metal, that is to say, the lung. Because, tonifying the lung consists of increasing the potential of the energy of the lung, thereby diminishing that of the liver (by inhibitory action according to the law of the 5 Movements), hence regression of the perverse heat (located at the level of the liver)” (Figure 11).

II - Zhang Shi clarifies:

“The greenish complexion is the pathologic color of the liver. A vessel from the liver reaches the top of the cranium and penetrates into the brain. The attack of this vessel by perverse heat is the cause of encephalgia. The energy of the muscles and tendons starts at the Jing-well point (Jing: spring-woodliver-muscle), located at the tip of the fingers and toes and, following the channels, reaches the 4 limbs. This is why, when the muscels are affected by heat, the 4 limbs are agitated.”

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Figure 11: Treatment of the heat disease at the level of the anatomic layers responding to the liver.

PARAGRAPH 12

53....

“In the heat diseases characterized by such signs as: _ frequent shudders _ spasm and laxity of the muscles _ Kuang (Yang Madnesses), one must needle the Mai (vessels) with the No. 4 needle to urgently disperse the excess. In contrast, in Dian (Yin Madnesses) with falling out of hair, one must aim for the heart to treat the blood. In the event of failure, one must treat at the level of water, that is to say, the kidney.”

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EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“This paragraph concerns the heat disease located in the heart. The heart responds to Fire and governs the blood vessels (Xue Mai). In heat disease, frequent shudders denotes excess of the pathogenic energy of the heart. Spasm and laxity of the limbs indicates the production of wind by maximal heat. Kuang (Yang Madness) results from a strong virulence of perverse energy. This is why it is advised to utilize No. 4 (Feng type) needles to disperse the perverse energy in a state of excess at the level of the blood vessels. When the Xue Mai (blood vessels) are affected, the affected blood has as a consequence “Dian (Yin Madness) and falling out of the hair”. As a result, one must aim for the heart to treat the madness and falling of hair. If the treatment proves ineffective, one must then treat at the level of Kidney-Water because tonifying the kidney amounts to augmenting the potential of Water to suppress Fire.” (Figure 12) 54.

Figure 12:

Treatment of heat disease at the level of the anatomic layers belonging to the heart.

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PARAGRAPH 13

53...

“In the heat disease revealed by the following signs: _ sensation of heaviness of the body _ bones pains _ diminished auditive ability _ obscuring of vision with tendency to close the eyes, one must needle the bones with No. 4 needles according to the method of the “59 Points” (anti-heat). In _ _ _

the presence of accompanying signs such as: anorexia bruxomania (bruxism) blue venules on the ear,

one must aim for the kidney to treat the bones. If the treatment proves ineffective, one must resort to Earth, that is to say, to the spleen.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Here, the disease of heat is located at the kidney. The kidney governs Water and unites with the bones. In the heat disease, sensation of heaviness of the body, bone pains, weakness of hearing, obscuring of vision with tendency to close the eyes are the signs revealing disease located in the bones. Treatment consists of utilizing Feng (No. 4) type needles to needle the points chosen among the “59 (anti-heat) Points” and tonifying the bones. If the subject furthermore presents anorexia and bruxism associated with appearance of a little blue vessel on the ears, the disease always is located at the bones, and one must treat the kidney. If the disease does not improve, one must aim for the spleen because tonifying the spleen permits the acceleration of the production of Earth to repress Water. Cure is, thus, obtained”. (Figure 13) 55. II - Zhang Shi clarifies: “The kidney is the source-producer of the energy. The sensation of heaviness of the body denotes attack of the energy by heat. The kidney governs the bones. Consequently, attack of the energy of the kidney manifests by bone pains. The kidney governs the ears. Deafness is caused by a contrary afflux (Jue Ni) of the energy of the kidney. The disease localizing at the Shaoyin (Ki), the subject has the tendency to close his eyes (somnolence). Anorexia is a sign of fullness of the energy of the kidney. The Neijing said: “The internal perturbation of the kidney causes hunger, but the individual refuses to eat.” Heat in a state of fullness is a triggering factor of bruxism. The teeth are surplus parts of the bones, and the ears are the sites of exteriorization of the energy of the kidney. This is why in

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Figure 13: Treatment of disease of heat at the level of the anatomic layers belonging to the kidney.

the event of bruxism and the appearance of little vessels on the ear, one must treat the kidney. In the absence of results, one must always have recourse to Earth, that is to say, to the spleen, because needling Spleen-Earth has the objective of triumphing over Water. The 5 organs represent the material, anatomic forms and their 5 Movements the immaterial, energetic aspects. When the energy is affected, the disease always reaches the exterior at the level of the skin, flesh, muscles and bones. The first therapeutic act is therefore the treatment of the exterior; nevertheless, in the event of inefficacy, treatment must be oriented toward the interior, at the level of the 5 organs, that is to say, at the level of the energy of the 5 Movements.” 56.

PARAGRAPH 14 “In the heat diseases characterized by such signs as: _ inability to localize the pain _ deafness _ dryness of the mouth, the fever is elevated at the time of the orientation of Yang toward victory, and trembling from cold (chills) appears at the time of the orientation of Yin toward victory. In this case, heat is located in the marrow; the disease is fatal, therefore incurable.”

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EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “Paragraph 1 of this chapter studies heat of external origin and Paragraph 13, heat of internal origin. From this Paragraph 14, the study is at once devoted to heat of external origin and heat of internal origin. In the heat disease, inability to localize the pain indicates the penetration of external heat into the organ (interior); deafness, paralysis of the limbs and dryness of the mouth gives evidence of the exteriorization of the energy of the kidney. To speak of strong fever and chills is to speak of internal heat which confronts the external heat, and to speak of heat localized in the marrow is to speak of external heat which confronts the internal heat. The exteriorization of the disease is favorable and its interiorization to the marrow is unfavorable.”

PARAGRAPH 15 “The heat disease characterized by such signs as: _ headaches _ painful tension extending from Neokong (GB 19) to eyes and mouth _ epistaxis is due to the afflux of heat (Jue Re). One must use No. 3 (Ti) type needles and needle as a function of emptiness and fullness. This disease can be responsible for syndromes of Cold-Heat and hemorrhoids.”

57.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Here, it is a matter of external heat which enters into battle against the heat of the liver at the summit of the cranium, hence headaches of the vortex. Painful tension at the level of the eyes and mouth is due to the afflux of heat of the liver toward Naokong (GB 19), where a vessel leaves from toward the face (Figure 14). Frequent epistaxis denotes an overheating of the vessel of the liver at the level of the face and nose (Figure 14). The non-liberation of “wind” heat and that of the heat of digestive origin are the principal causes of ulcerations and hemorrhoids. Recall that the struggle between the external heat and internal heat can be located either at the energetic layers (without disturbance of the channels) or at the level of the channels (without disturbance of the energetic layers). But, at every moment, disturbance of the channels can affect the energetic layers and vice versa; such is the case of ulcerations and hemorrhoids cited in this paragraph.”

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II - N.V.N.: The explanation of Zhang Shi has enriched the understanding of the energetic physiology of the liver and gallbladder at the level of the face (Fig. 14).

Figure 14: Cranio-facial vessels of the Foot Jueyin (Li) and Foot Shaoyang (GB).

58.

PARAGRAPH 16 “In the heat disease characterized by such signs as: _ sensation of heaviness of the body _ sensation of heat in the intestines, one must utilize No. 4 (Feng type) needles and needle the Shustream point, located in the space of the toes, and the Luo point of the stomach. Cure is, as a result, obtained.”

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EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“The spleen governs the “flesh” (dermal) system of the 4 limbs. This is why, during the infiltration of perverse energy into the spleen, the limbs are heavy. The large intestine and small intestine belong to the stomach. During the penetration of perverse heat into the stomach, the intestines are affected (overheated). In this case, one must use the needles of the Feng (No. 4) type and needle the Shu-stream point of the stomach, which is Xiangu (St 43), the point located in the space of the toe, Neiting (St 44), and the Luo point of the stomach, Fenlong (St 40). Such is the method of going in search of the energy of the Jing (channel) and of the Luo (Longitudinal Luo) of the stomach in the goal of excreting the perverse energy.” II - Zhang Shi clarifies: “The sensation of heaviness of the body denotes the infiltration of heat into Stomach-Earth (Spleen) with sensation of heat in the intestines. Needles of the Feng (No. 4) type are used to needle the Shu point of the stomach channel, Xiangu (St 43 - needle depth 0.5 cun, left in during 7 expirations, moxa 3 times) and the points Lidui (St 45) and Neiting (St 44). This procedure aims for the evacuation of perverse heat via the energy of the stomach.” III - N.V.N.: The points recommended by Zhang and Ma are different, but their action on the perverse heat is evident. In this manner, therapeutic formulae in acupuncture are not rigid; they vary according to the reasoning of the practitioner.

PARAGRAPH 17 “In the heat disease characterized by such signs as: _ _

intense umbilical pain sensation of thoracic and

hypochondrial

fullness,

59.

one must needle Yongquan (Ki 1) and Yinlingquan (Sp 9) with No. 4 needles and also the point of the throat.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Intense umbilical pain with thoraco-hypochondrial fullness denotes attack of the Foot Taiyin (Sp) and Foot Yangming (St) by perverse heat. Teament consists of dispersing Yongquan (Ki 1) and Yinlingquan (Sp 9) and also Lianquan (CV 23), located at the middle of the neck below the larynx” II - Zhang Shi specifies: “Here, it concerns a case of struggle of the heat of the external part of the body against that of the heart.

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The Neijing said: “When the umbilical region is painful, the disease bears the name “Fuliang” (8). In other words, when umbilical pains are of “heat” etiology, the “active” energy (Dong Qi) of the heart accumulates in the subcardiac region and transforms into Fuliang. The afflux of the heat of the heart taking place in the interior is the cause of thoracohypochondrial fullness. It is then advised to needle Yongquan (Ki 1) and Yinlingquan (Sp 9). To needle Yongquan (Ki 1) is to utilize the “Water” energy of the kidney in order to temper the Fire of the heart, and to needle Yinlingquan (Sp 9) is to utilize the “Center-Earth” energy (Spleen) to dissolve the energetic mass (Fuliang) concealed in the supraumbilical region. Moreover, it is advised to use the No. 4 needle and puncture the point of the throat to disperse the heat from the subcardiac region. This point is none other than Lianquan (CV 23).”

III - N.V.N.: 1. The explanation of Zhang Jing Yue is quite simple: “When the heat affluxes toward the route of the Foot Shaoyin (Ki), it is the origin of umbilical pains, and when it affluxes toward the route of the Foot Taiyin (Sp), it is the cause of thoraco-hypochondrial fullness. This is why it is advised to utilize No. 4 needles and puncture Yongquan (Ki 1) and Yinlingquan (Sp 9). As for the point of the throat, this designates Lianquan (CV 23).” 2. Lianquan (CV 23) is the “meeting-reunion” point (9) of the two vessels, Renmai (CV) and Yinwei. According to the Da Cheng, “This point is located at the middle of the neck below the pharynx. Lift up the head to locate this point; moxa 3 times, needling to a depth of 0.3 cun; disperse as soon as the energy arrives (10).” 60. And according to the Lingshu, “Lingquan (CV 23) and Rugen (St 18) form the route of delivery/transporting of the organic liquid... . Lingquan (CV 23) gives off a vessel at the base of the tongue; as a result, it is specific in the treatment of thirst.” (Figure 15)

8. It concerns an accumulation of the “active” energy (Dong Qi) of the heart concealed in the supra-umbilical region (see “Difficulty 16” of the Nanjing de Bian Que). 9. See this group of points in M.T.C. - N.V.N. Edition. 10. See “Art and Practice of Acupuncture and Moxabustion” According to the Zhen Jiu Da Cheng N.V.N. Edition.

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Figure 15: Lianquan (CV 23), point of dispersion of the afflux of heat of the Foot Shaoyin (Ki).

PARAGRAPH 18 “In the disease of heat characterized by sweating or the presence of a pulse favorable to sweating, dispersion of the points Yuji (Lu 10), Taiyuan (Lu 9), Dadun (Sp 2) and Yinbai (Sp 1) favor the regression of the heat, and their tonification facilitates perspiration. If the sweating is excessive, one must stop it by needling the points located at Huan Mai (transversal vessels), above the internal malleolus.”

61.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Here, it concerns a case of confrontation of the external heat and the heat of the lung, resolved by sudorification. The heat disease with sweating or pulse favorable to sweating indicates that the ailment is located at the exterior, caused by the presence of external heat and internal heat. It is then advised to needle Yuji (Lu 10) and Taiyuan (Lu 9) of the Hand Taiyin (Lu) and tonify Dadun (Sp 2) and Yinbai (Sp 1) because:

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_ dispersion of the Hand Taiyin (Lu) acts in favor of the regression of the heat _ tonification of the Foot Taiyin (Sp) favors production of organic liquid, hence sweating. The point located at Huan Mai designates Sanyinjiao (Sp 6). From this point, the energy is secreted to the exterior, bringing with it sweating. As a result, needling this point is intended to direct the energy toward the depths (to the interior), therefore to curb sweating.”

II - N.V.N.: Clinically, the treatment of excessive sweating is extremely dificult. Zhang Shi furnishes the means of combatting this illness.

PARAGRAPH 19 “In the disease of the heat, sweating associated with a full and agitated pulse results from an excessive weakness of the Yin vessels; this is death. life.”

In contrast, if the sweating is associated with a calm pulse, this is

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The recapitulation of the above-cited paragraphs ends with the following conclusion: Sudorification is a therapy for all diseases of heat localizing at the exterior or in the interior. Sweating associated with an agitated and full pulse indicates the progression of the heat toward the interior. Despite sweating, this heat remains confined at the level of the channels which are overheated to the extreme. The prognosis is then fatal. Sweating associated with a calm pulse indicates that the heat is “purified” (liberated). The prognosis is then favorable.” 62. II - N.V.N.: The axioms applied in this paragraph, highly prized in Oriental medicine, are the following: 1. 2. 3. 4. 5.

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The maximal emptiness of Yin and the isolation of Yang are fatal. Evacuation of perverse energy via the sweat gland route is favorable. Yang is responsible for the “full” and “non-full” state of the pulse. Yin is responsible for sweating and non-sweating. Physiologic, pathologic, diagnostic and therapeutic problems are always posed as a function of the presence or absence of Yin because: _ Yin is the source-producer of the vital energy _ and the escape of the energy always originates from insufficiency of the source.

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PARAGRAPH 20 “In the diseases of heat, acupuncture is contraindicated in the following 9 syndromes: 1. 2. 3. 4. 5. 6.

Absence of sweating, red cheekbones, hiccups and nausea. Diarrhea and excessive fullness of the abdomen. Dimming of vision and persistence of fever. In the elderly and children: fever and abdominal fullness. Absence of sweating, vomiting, melena and hematuria. Ulceration and necrosis of the base of the tongue and persistence of fever. 7. Cough, epitaxis and absence of sweating, or else sweating but respecting the feet. 8. Latent heat in the marrow. 9. Fever, body stiffness, ophisthotonus, spasmodic cramps of the limbs. These 9 syndromes are fatal, thus prohibited from acupuncture.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1. Absence of sweating explains the non-exteriorization of perverse heat via the sweat gland route. Red cheekbones indicates the excess of heat at the level of the 5 organs (11). 63. Nausea comes from the confrontation of 2 energies, external heat and internal heat, in the area of the center (12), causing the insufficiency of the energy of the stomach. 2. Diarrhea and abdominal fullness denote a strong evacuation of the essential energy and organic liquid and the presence of an accumulation of perverse heat in the area of the center. 3. Dimming of vision and persistence of fever are the results of the presence of an excessive mass of heat injuring the interior just as well as the exterior. 4. In the elderly and children affected by heat disease, the main signs are fever and abdominal fullness resulting from the state of exhaustion of the blood and energy in the elderly and from the state of incomplete formation of Yin and Yang in children. In them, abdominal fullness is due to the afflux of the heat toward the “center” (Spleen/Stomach) without possibility of being exteriorized. 5. Absence of sweating, melena and hematuria indicate the non-liberation of heat to the exterior and attack of the Yin channels in the interior. 11. In Chapter 32 (“Acupuncture and the Diseases of Heat”) of the Suwen, we read: _ In the heat disease of the liver, the left cheek turns red first. _ In the heat disease of the heart, the forehead turns red first. _ In the heat disease of the spleen, the nose turns red first. _ In the heat disease of the lung, the right cheek turns red first. _ In the heat disease of the kidney, the 2 cheeks turn red first. 12. Designates the Zhongjiao (Middle Jiao).

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6. Ulceration of the base of the tongue and persistence of fever gives evidence of the presence of heat in the Yin channels. 7. Cough, epistaxis... denotes the presence of heat at the level of the lung with compression of the vessels. Because the lung, governing skin and hairs, is the site d’assistance of all the vessels; perverse heat must be evacuated via the route of sweating controlled by the lung. Thus, absence of sweating is due to exhaustion of the energy of the top part of the body, or else sweating not affecting the feet, because of the exhaustion of the energy of the lower part of the body. 8. Heat in the marrow indicates that the kidney is in peril. 9. Fever, body stiffness, ophisthotonus, spasmodic cramps... are signs revealing the localization of perverse heat in Taiyang with exhaustion of kidney energy. This is the fatal phase. The Taiyang (Bl) and Shaoyin (Ki) are the productive sources of Yin energy and Yang energy. As a result, therapy is aimed at treating the energy, that is to say, at augmenting its potential mass and at establishing its equilibrium in order to eliminate the perverse energy. But in the 9 syndromes cited above, the perverse heat is extremely virulent and the essential energy is near total exhaustion. This is why acupuncture is in vain.” II - N.V.N.: 64. The pathologic process of these 9 fatal syndromes studied by Zhang Jing Yue (1563-1640 A.D.) is the following: 1. Absence of sweating is due to the weakness of Yin characterized by reddness of the cheeks.

Hiccups and nausea indicate the penetration of heat into the Yangming, causing great emptiness of the stomach. As a result, the “root” is in maximal emptiness; life is impossible. 2. Diarrhea and maximal fullness of the abdomen comes from the defeat of the energy of the spleen during its confrontation with the perverse heat. Death is inevitable. 3. The Jing (quintessence) energy of the 5 organs and 6 bowels reaches the top and maintains the brain and, particularly, the ocular system. As a result, the depletion of Jing is the cause of dimming of vision and death. 4. In elderly and children, the energy of the spleen is the source of life. When perverse heat reaches the spleen organ, death is certain. 5. Absence of sweating is due to the emptiness of Yin. It is associated with nausea and hemorrhages... . When Yin is seriously affected by perverse heat, death is inescapable. 6, The liver, heart and spleen have their vessels linked to the root of the tongue (Figure 16). “Necrosis” of the tongue muscles, following an overheating of the perverse heat, indicates the destruction of the 3 Yin; death is inevitable. 65. 7. The localization of perverse heat within the lung channel is one of the determining conditions of “disruptions” of Yin-Blood. “If sweating is absent or if sweating does not reach the lower limbs, it denotes the depletion of the Source-Yin. Death ensues. 8. The marrow originates from the materialization of the Jing Qi of the Zhi Yin (arrival at Yin). Deep infiltration of the perverse heat overheats the marow and provokes the exhaustion of the kidney energy. Death results.

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9. Stiffness of the spine, ophisthotonus, spasmodic cramps... are due to the transformation of maximal heat into wind which destorys Yin-Blood. Death is incontestable.

Figure 16: Energetic morphology of the “root” of the tongue.

PARAGRAPH 21 “The “59 Points” cited in the previous paragraphs are: _ at the external and internal ungual angles of the fingers: 3 points, that is, (3 + 3) X 2 = 12 points for the 2 hands. _ in the interdigital spaces of the hand; 4 points, that is, 4 X 2 = 8 points for the 3 hands. _ in the interdigital spaces of the foot: 4 points, that is, 4 X 2 = 8 points for the the 2 feet. _ 1 cun inside the anterior root of the hair and outside the anteroposterior midline of the cranium: 3 points, that is, 6 points for 2 sides. _ still 3 cun more inside the boundary of the hair: 5 points, that is, 10 points for the 2 sides. _ in front of and behind the ear: 2 points, that is, 4 points for the 2 ears. On the head: • 1 point on the summit • 1 point, Xinhui (GV 22) • 1 point below the mouth • 1 point on the nucha

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• 1 point in front of and behind the implantation of the hair, that is, 2 points • 1 point, Lingquan (CV 23) • 2 points, Fengchi (GB 20) • 2 points, Tianzhu (Bl 10).” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph studies the locations of the “59 Points”. a - The 6 points located at the ungual angles of the fingers are: Shaoshang (Lu 11) Shangyang (LI 1) Guanchong (SJ 1) Zhongchong (XB 9) Shaoze (SI 1) Shaochong (He 9) that is, 6 X 2 = 12 Jing points of the bilateral channels of the 2 hands.

66.

b - In each interdigital space: 1 point, that is, 4 X 2 = 8 points for the 2 hands and 8 points for the 2 feet, totalling 16 points. (13) c - The 6 points located 1 cun inside the root of the hair and outside the antero-posterior midine of the cranium are: 2 points, Wuchu (Bl 5) 2 points, Chengguang (Bl 6) 2 points, Tongtian (Bl 7). d - The 10 points located 3 cun beyond the root of the hair are: 2 points, Linqi (GB 15) 2 points, Muchuang (B 16) 2 points, Zhengying (GB 17) 2 points, Chengling (GB 18) 2 points, Naokong (GB 19). e - The 4 points located in front of and behind the ear are: 2 points, Tinghui (GB 2) 2 points, Wangu (GB 12). f - The 11 points located on the head, neck and nucha are: 1 point, Baihui (GV 20) 1 point, Shangxing (GV 23) 1 point, Xinhui (GV 22) 1 point, Chengting (GV 24) 1 point, Yamen (GV 15) 1 point, Lianquan (CV 23) 1 point, Fengfu (GV 16) 2 points, Fengchi (GB 20) 2 points, Tianzhu (Bl 10).” 13. The author does not mention the name of the points. See explanation below.

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II - N.V.N.: 1. The interdigital points cited in this paragraph were the object of numerous controversies over the centuries. According to Zhang Jing Yue, the interdigital points used would not be the Curious Points (outside-channels), Baxie (Eight Demons- PC 167) and Bafeng (Eight Winds- PC 137) (14), but the kinetic (Shu) points of the channels. These points are all located behind the metacarpo-phalangeal joints. These points are: _ Houzi (SI 3), Zhongzhu (SJ 3), Sanjian (LI 3) and Shaofu (He 8) for the hand _ Shugu (Bl 65), Linqi (GB 41), Xiangu (St 43) and Taibai (Sp 3) for the foot. 67. We lean toward this thesis of Zhang Jing Yue. 2. Recall that in the Suwen Chapter 61(“Study on the Water-Heat Points”) (Volume IIIN.V.N. Edition), the “59 Points” are specific in the treatment of the diseases of water and that those cited in this chapter are intended to treat the diseases of heat. These diseases are not the same, therefore the technique of needling is different (15).

PARAGRAPH 22 “In the fullness of the energy in the thorax with dyspnea, one must needle the Foot Taiyin (Sp) at the tip of the great toe, one “He” leaf width from the internal ungual angle. In the event of cold, leave the needle in place a long time, and in the event of heat rapidly remove it.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The previous paragraphs concern: _ first the diseases of heat of external origin and internal origin _ then those caused by the confrontation of the perverse heat and essential heat. These diseases take place in the energetic layers and not in the channels. In contrast, this Paragraph 22 describes the disease of heat of external (perverse) origin at the level of the 3 Yin channels and 3 Yang channels. This is why it is advised to needle the Jing points of the hands and feet and the Xue Luo (blood capillaries). The Taiyin is “Center-Earth” (Sp). The energy of afflux reaches the top as easily as the bottom. The Foot Taiyin (Sp) circulates from the bottom upward and is directed toward the heart.

14. See “Chapter of the Curious Points” in M.T.C.-N.V.N. edition. 15. Also read Chapters 31 (“Diseases of Heat”), 32 (“Acupuncture and the Heat Diseases”) and 33 (“Commentaries on Heat Diseases”) of the Suwen (Book IX, Volume III).

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The fullness of the energy within the thorax with dyspnea originates from the aflux of the energy of the spleen channel toward the top. One must needle Yinbai (Sp 1) in order to bring the spleen energy back toward the bottom. Relief is immediate.”

II - Ma Shi clarifies:

“This Paragraph 22 and the following ones deal with various diseases unrelated to the diseases of heat. This paragraph shows the therapeutic technique of the syndromes belonging to the energy. In the fullness of the energy with dyspnea, the disease is located at the top part of the body; one must treat the bottom, that is to say needle Yinbai (Sp 1). 68. If this disease is of cold etiology, it is advised to leave the needle in place a long time in order to make the heat of the body return to combat the perverse cold. In contrast, if it is a question of the disease of heat origin, one must remove the needle rapidly to make the organic cold return; stop needling as soon as the energy descends.”

III - N.V.N.: The teaching of Zhang Jing Yue is the following: “In internal cold, the energy arrives slowly and the needles are left in place a long time, and in internal heat, the energy arrives rapidly and the needles are promptly removed.”

PARAGRAPH 23 “In Xin Shan (compression/blockage of the heart energy) with intense pains, one must needle the Foot Taiyin (Sp) and the Foot Jueyin (Li) and bleed the Xue Luo (blood capillaries).”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “Shan designates the disease localizing at the lower abdomen and genital organs. Xin Shan is a painful syndrome of the bottom which pulls at the top. In other words, this disease is primarily located at the lower abdomen and is characterized by painful swelling on palpation and is secondarily located at the heart.

The Foot Taiyin (Sp) of the lower abdomen projects into the heart; the Foot Jueyin (Li) links up to the genitals, arrives at the lower abdomen, crosses the diaphragm and flows down into the lung... . Xin Shan therefore originates from the disturbances of the energy of the Foot Taiyin (Sp) and Foot Jueyin (Li) which affluxes toward the heart... . This is why it is advised to needle the Foot Taiyin (Sp) and Foot Jueyin (Li) located at the bottom (of the feet) and to eliminate the perverse energy by bleeding the Xue Luo. This technique assures cure of the painful syndrome of the heart (cardialgia).”

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PARAGRAPH 24 “In Hou Bi (algoparesthesias) characterized by such signs as:

of

the

laryngo-pharyngeal

organs

_ tongue retraction 69. _ mouth dryness _ anxiousness and cardialgia _ pain of the innner arm with inability to lift the hand to head, one must needle the tip of the ring finger, one “He” leaf width from the internal ungual angle.” ( 1 6 ) EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“The Xin Bao Luo (XB) starts in the thorax. Above, it communicates with the heart, and down below, with the Sanjiao (SJ). This is why: _ in disturbances of the Xin Bao (XB), the heart is “anxious” and “painful” _ and at the time of rising up of Ministerial Fire toward the top, the laryngo-pharyngeal system is blocked and painful, the tongue is retracted and the mouth is dry. One must needle the Jing point located at the tip of the 4th finger, Guanchong (SJ 1), to eliminate the Ministerial Fire. In this way, cure is assured.”

PARAGRAPH 25 “In reddness and pain of the eyes starting at the internal canthus of the eye, one must needle the Yinqiao.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“The internal canthus of the eye belongs to Jingming (Bl 1). “One must needle the Yinqiao: implies the sense of needling its point of departure which is Zhaohai (Ki 6), conforming to the principle according to which the disease being at the top, one must needle the bottom; and in tonifying Yin, Yang will move back... .” II - Zhang Shi clarifies:

“Here, it is a matter of a clinical example explaining that, at the time of infiltration of perverse energy into the 3 Yang channels, the disease can locate either at the upper or lower part of the body or at the middle part. 70. 16. Energetic description.

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When the eyes are red and painful and the internal canthus of the eye is affected first, the disease belongs to the Foot Taiyang (Bl) and is seated at the upper part of the body. The Foot Taiyang (Bl) starts at the internal canthus of the eye, where it unites with the Yinqiao and Yangqiao, at the point Jingming (Bl 1). This is why one needle the Yinqiao, that is to say, the point Zhaohai (Ki 6), in order to purify Yang-Heat.”

PARAGRAPH 26 “In Feng Jing (cramps of “wind” origin), the body is in ophisthotonus; one must needle the Foot Taiyang (Bl) at the middle of the popliteal crease and bled the Xue Luo (blood capillaries). In the event of cold in the interior, one must needle Sanli (St 36). ”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“In diseases belonging to the Yang, the body cannot be flexed forward (orthotonus), and in the diseases belonging to the Yin, the body cannot be bent backwards (ophisthotonus). The Foot Taiyang (Bl) runs along the side of the spine. When it is affected by wind, the muscles and vessels become retracted and the body is in ophisthotonus. This is why one must needle Weizhong (Bl 40) and bleed the Xue Luo (blood capillaries) at the level of the popliteal crease; it is also advised to needle Sanli (St 36) because the Jingmai, blood and energy are produced by the Yangming. This point has a therapeutic action on Feng Han (Wind-Cold).”

PARAGRAPH 27 “In the Bi Long syndrome (urinary retention by obstruction), it is advised to needle the Yinqiao and the region of the “3 Hairs” and bleed the Xue Luo (blood capillaries).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 71. “Here, the disease is located at the lower portion of the Foot Taiyang (Bl), at the site where the lower He point of the Sanjiao (SJ), Weizhong (Bl 40), is found. From this point, a vessel leaves which follows the principal channel of the Taiyang (Bl), reaches the bladder and solidly clasps the Xiajiao (LJ). Fullnes of this vessel is the origin of oligo-anuria, whose treatment consists of needling the Yinqiao (linked to the Yangqiao, at the point Jingming (Bl 1) in order to provoke the phenomenon known as To enter at Yang to unite with Yang and exit from Yin to unite with Yang”. To act in this way amounts to evacuating the perverse energy via the route of the Qiao. Basically, this disease is of “liver” origin. This is why one needles the region of the “3 Hairs”, called Dadun (Li 1), as well as the Xue Luo, making them bleed.”

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II - Ma Shi clarifies: “The bladder and kidney constituting the “Yin-Yang, Internal-External” system, it is advised to needle Zhaohai (Ki 6), point of departure of the Yinqiao, and Dadun (Li 1) because the kidney attends to the aeration of the organs and the liver controls the free circulaton of the energy.”

PARAGRAPH 28 “If men, affected by a large abdomen ( 1 7 ) , and women affected by nausea and vomiting like the beginning of pregnancy, feel a sensation of laxity of the lumbars and break of the spine with anorexia... one must first bleed Yongquan (Ki 1) by acupuncture, then examine well the top of the foot and also practice bleeding at the vessels in a state of fullness.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph shows the treatment of diseases of swelling/compression. Sensation of laxity of the lumbars and break of the spine... denotes the upper localization of the disease. It is then advised to needle the lower part of the body; first bleed Yongquan (Ki 1) by acupuncture, then carefully examine the top of the foot belonging to the Foot Yangming (St). In the event of the presence of Xue Luo (blood capillaries), one must also make them bleed.” II - Zhang Shi concludes:

“The totality of this chapter deals with diseases of internal etiology with external manifestations. This paragraph is the conclusion of the chapter. It is centered on the essential energy of the exterior and interior because diseases located in the interior or at the exterior always perturb Yin and Yang, blood and energy. Yin and Yang, blood and energy originating from a posteriori Jing Gu (cereal or acquired energy) have for their root a priori Jing Qi (innate or ancestral energy). 72. The circulatory route in the interior and at the exterior of the a priori Jing Qi is controlled by the kidney, and that of the a posteriori Jing Qi, by the stomach. At the subumbilical region, Dandian (18) designates Qihai (CV 6- Sea of Energy) and Bao Zhong (19), Guanyuan (CV 4- Barrier of the Source). The first corresponds to the boy and the second, to the girl. This is why large abdomen in men originates from energetic stasis, and nausea and vomiting in women originates from blood stasis. The body is controlled by the spleen and stomach. The lumbar vertebrae constitute the “palace” of the kidney. Anorexia is the result of the afflux of the energy of the stomach. In this case, it is a matter of a perturbation of the essential energy of the interior and exterior caused by the presence of perverse energy localizing at the same time in the interior and at the exterior. It is then advised to bleed Yongquan (Ki 1) and the Xue Luo (blood capillaries) of the top of the foot 17. As in beri-beri and scurvy. 18. Rice field. 19. “Uterus”.

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(belonging to Yangming) by acupuncture in order to aerate the blood and energy in the interior as well as at the exterior. In this manner, understanding the circulatory routes of entering and exiting of the essential energy is critical in acupuncture practice with the prupose of assuring equilibrium of blood and energy, thereby cure of the disease.”

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73.

CHAPTER XXIV Diseases of Afflux (Jue Bing)

Jue designates the afflux of the energy towards the top. Chapter 24 of the Lingshu concerns the Jue diseases and presents numerous clinical examples to illustrate the classification and description of diseases, therapy and prognosis. The diseases of afflux explained are: _ _ _ _ _ _

headaches (9 types) cardialgia (9 types) parasitosis (ascariasis) deafness and tinnitus coxalgia (difficulty raising the thigh) Feng Bi (algoparesthesias caused by wind).

This chapter is basically centered on the study of the afflux of cold (Han Jue). As a result, it differs slightly from Chapter 45 (“Essay on Affluxess”) of the Suwen. It consists of 22 paragraphs.

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PARAGRAPH 1 signs

“In the headaches caused by afflux (Jue) characterized by such as: _ facial edema _ “anxiety” of the heart (agitation), it is advised to needle Foot Yangming (St) and Foot Taiyin (Sp).”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: 74. “ 1. This chapter is devoted to the phenomena of afflux of the energy of the 5 organs, determining factors of numerous illnesses, hence the title of this chapter: “Diseases of Afflux”. 2. In this paragraph, the energy of Yangming reaches the face and flows to the head to trigger headache and facial edema. The perturbation of Yangming causes that of the heart, hence anxiety. This is why, in this type of headache, one should needle the Foot Yangming (St). But as the change in the energy of Yangming depends on that of the Taiyin, one must also needle the Foot Taiyin (Sp). (Figure 17) Here, the afflux occurs in the energetic zone and not in the channels.

Figure 17: Headache of the origin of “afflux” of the Yangming (St).

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PARAGRAPH 2

75.

“In the headaches caused by afflux (Jue) characterized by the following signs: _ pain at the level of the cranial vessels, _ sadness and crying (with tears), examine these vessels and, in the event of fullness, make them bleed by acupuncture, then balance the Foot Jueyin (Li).”

EXPLANATIONS AND COMMENATRIES Zhang Shi explains: “This paragraph concerns afflux of energy of the Jueyin (Li) toward the cephalic region and the channels to trigger headache. (Figure 18). Sometimes, the afflux occurs only at the level of the energetic layer without reaching the channels (such is the case of the afflux of the energy of Yangming (St); see Paragraph 1); sometimes it occurs first in the energetic layers, then in the channel (such is the case of the afflux of the energy of Jueyin). In other words, the energy located outside the channels and that located within the channels communicate; but at any moment, they can become separate. In Paragraph 2, the afflux of the energy of Jueyin occurs within the cranial vessels (hence headaches) and within the energetic layers causing a perturbation of the energy of the heart (hence anxiety, saddness and tears). It then is advised first to examine well the cranial vessels and bleed them in the event of fullness (sensations of swelling) via acupuncture to disperse the energy of the afflux lodged within these vessels, and second, to balance and tonify the Foot Jueyin (Li) to harmonize the energy in a state of afflux.”

Figure 18 Headaches of origin of the afflux of the energy of Foot Jueyin (Li).

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PARAGRAPH 3

76.

“In headaches caused by afflux (Jue) characterized by intense pains of fixed location ( 1 ) , it is advised to disperse the 5 lines above the head, that is to say, the 5 points of each line. In the first place, needle the Hand Shaoyin (He), and in the second place, the Foot Shaoyin (Ki).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Paragraph 3 demonstrates the case of afflux of the energy of the Foot Shaoyin (Ki) toward the cranium, then from there into the Foot Taiyang (Bl) to trigger headache (Figure 19). The 5 cranial lines designate: 1. The midline and its 5 points: Shangxing (GV 23) Xinhui (GV 22) Qianding (GV 21) Baihui (GV 20) Houding (GV 19). 2. The 2nd (lateral) line and its 5 points (that is, 10 points for the 2 sides): Wuchu (Bl 5) Chengguang (Bl 6) Tongtian (Bl 7) Luoque (Bl 8) Yuzhen (Bl 9). 3. The 3rd (lateral) line and its 5 points (that is, 10 points for the 2 sides): Linqi (GB 15) Muchuang (GB 16) Zhengying (GB 17) Chengling (GB 18) Naoking (GB 19). The Shaoyin and Taiyang govern the “Water-Fire” system. Top and bottom, summit and root unite...; this is why it is advised, in the first place, to disperse the Foot Taiyang (Bl) (that is to say, the points indicated above), then, in the second place, to needle the Hand Shaoyin (He) before the Foot Shaoyin (Ki).” II - N.V.N.: The points of the 5 cranial lines cited above make up part of the group of “59 Points” already mentioned in the previous chapter. These points are specific in the treatment of afflux of heat at the level of the cranium. 1. According to later ancient editions: vertigo and sensation of heaviness of the head.

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According to Zhang Jing Yue: To needle first the Hand Shaoyin (He) is to evacuate the heat (Fire) in a state of afflux located to the South, and to needle the Foot Shaoyin (Ki) is to activate the production of Water located to the North to equilibrate water and fire, Yin and Yang of the cephalic region. 77.

Figure 19 Headache of origin of the afflux of the energy of the Foot Shaoyin (Ki).

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PARAGRAPH 4 “In headaches caused by afflux (Jue) characterized by such signs as:

_ frequent forgetfulness _ pains not detectable upon pressure of the fingers,

it is advised to needle first the artery located to the right and left of the face, then the Foot Taiyin (Sp).” EXPLANATIONS AND COMMENTARIES

78.

I - Zhang Shi explains:

“This paragraph demonstrates the case of afflux of the energy of the Foot Taiyin (Sp) affecting first the cephalic region, then the vessels of the head and face, which induces headache (Figure 20). The spleen governs thought (Yi). When the energy of this organ affluxes toward the top, the Shen (mental) and Chi (will) become unclear, and Yi loses its power of memorization, hence frequent forgetfulness. The head governs the energy of Heaven, and the spleen, that of Earth. “Pains not detectable upon pressure of the fingers” denotes that the energy of the spleen affluxes toward the top and invades that of Heaven. It is then advised to first disperse the “artery” at the left and right of the head and face to evacuate the energy of afflux, then needle and harmonize the Foot Taiyin (Sp).”

II - N.V.N.: Interpretation of the commentaries of Zhang Jing Yue furnishes us with interesting clarifications: “The spleen governs thought and disturbances of thought are the cause of forgetfulness. “Pain undetectable by finger pressure” implies that they are not of fixed localization. “The arteries of the face” designate the Yangming (St). “After bleeding these arteries” one must needle the Foot Taiyin (Sp) to tonify the energy of the spleen.”

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Figure 20 Headache of origin of the afflux of the energy of the spleen.

PARAGRAPH 5

79.

“In headaches caused by afflux (Jue) manifest first by nuchalgia and secondly by lumbalgia, one must needle first Tianzhu (Bl 10) , then the other points of the Foot Taiyang (Bl).”

EXPLANATIONS AND COMMENTARIES

80.

Zhang Shi explains:

“Here, it is a matter of headache due to afflux of the energy of Foot Taiyang (Bl). The bladder channel circulates from the head to the nucha, then to the lumbars. This is why this type of headache is followed by nuchalgia and lumbalgia (Figure 21). This afflux occurs originally within the energetic layer and secondarily in the channels. It is then advised to first needle Tianzhu (Bl 10)to eliminate the afflux phenomenon, then the points of the Foot Taiyang (Bl) in the goal of regulation.”

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Figure 21 Headaches of origin of the afflux of the energy of the Bladder.

PARAGRAPH 6 as: ear,

“In headaches due to afflux (Jue) manifesting by the such signs _ intense ache of the head 81. _ heating up and tension of anterior and posterior vessels of the

one must first bleed these vessels by acupuncture, then needle the points of the Foot Shaoyang (GB).”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “This paragraph describes headache caused by the afflux of the energy of the Foot Shaoyang (GB) toward the cephalic, nuchal and cervical regions (Figure 22).

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The Shaoyang governs Ministerial Fire. This fire affluxes to the head (hence intense pains) and warms up the Luomai of the anterior and posterior parts of the ear (hence tension of these Luo). It is then advised to evacuate the contaminated blood in these Luomai before balancing the energy of Foot Shaoyang (GB). This paragraph and the previous 5 demonstrate the phenomenon of afflux of the energy of the the 3 Yin and 3 Yang, determining factors of headaches of endogenous etiology and not of exogenous etiology caused by perverse energy.”

Figure 22 Headaches of afflux origin of the Foot Shaoyang (GB).

PARAGRAPH 7 “The “true headache”, characterized by extremely intense pains invading the entire brain with cold feet and hands reaching the joints, is incurable, therefore, fatal.” EXPLANATONS AND CMMENTARIES I - Zhang Shi explains: “True headaches” are not headaches due to the afflux of the energy of the 3 Yin and 3 Yang (endogenous origin), but headaches caused by perverse energy at the level of the brain.

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The head is the site of reunion of all Yang channels, and the brain is the “sea” of the Jing (2) of the marrow. The arms and legs are icy cold to the joints (elbows and knees) because the source energy is seriously affected by perverse cold. The disease is fatal, therefore, incurable.” II - N.V.N.: a) According to Zhang Jing Yue, there exists two types of headaches: 1. Headaches caused by the afflux of the energy which are curable. 82. 2. Headaches caused by the deep infiltration of cold-wind at the level of the brain (encephalgias) which are incurable and fatal. According to this author, the head is the site of gathering of all the Yang channels, and the hands and feet are the “roots” of the Yang channels. violent pains of the head reveal destruction of the Yang energy by perverse energy at the level of the brain. b) In the Nanjing, Bianque adds: “During the course of its infiltration, cold-wind, at the level of the 3 Yang of the hand, is the origin of the afflux responsible for headaches. When it penetrates into the brain, it provokes “true headaches”. (Figure 23)

Figure 23 The “true headaches” (encephalgias).

2. The term “Jing” designates pure energy (quintessence) which maintains the brain and marrow.

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PARAGRAPH 8 “Headaches of traumatic origin are not treated by kinetic (Shu) points because the viscous blood is in a state of stagnation in the interior. In contrast, if the muscles are not seriously affected, local needling can be done at the painful sites. But in these cases, needling the points at a distance is strictly advised against.” EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“This paragraph concerns headaches secondary to trauma. The Shu (kinetic) points (3) are contraindicated because the headache is of anatomic and non-energetic origin. In a general way, against the pains of the head, one needles the points of the bottom (hands and feet) because the afflux of the energy reaches the top. This technique is founded on the theories of the “Top-Bottom, Bottom-Top” circulation of the energy. In post-traumatic headaches, the pain does not come from the energy, but from the blood. Therefore, in these cases, treatment consists of only needling local painful points and not the distal points (points of the Wu Shu or Shu Antique group).”

PARAGRAPH 9 “In certain headaches, acupuncture is advised against. In this way, in Dai Bi syndromes (great obstructions), the pain is permanent and needling is aimed only at easing and not curing.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Dai Bi is an ailment due to concomitant infiltration of 3 perverse energies: wind, cold and humidity. If the pain is permanent, it is advised to perform the technique of oblique (subcutaneous) needling at the level of the cranial muscles and bones in the goal of relieving and not curing because of the penetration and too deep fixation of these 3 perverse energies. Therefore, the kinetic (Shu) points at a distance are not effective in obtaining a total cure.” II - N.V.N.: In practice, the cure of some types of headaches treated by acupuncture proves to be incomplete because they are secondary to a serious syndrome called “Dai Bi” (great obstruction). But, if the cure is, in effect, incomplete, relief of the pain is the rule. In this blatant case, the anti-pain effect of acupuncture, more than any other medicine, cannot lay claim to such a success. 3. Here, the term “Shu” does not designate the “Shu antique” (or “Wu Shu”) points, but the energetic points, in endless movement (kinetic), belonging to the channels.

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PARAGRAPH 10

84.

“In hemicrania caused by cold, it is advised to first needle the points of the Hand Shaoyang (SJ) and Hand Yangming (LI), then those of the Foot Shaoyang (GB) and Foot Yangming (St).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph concerns the layer of attack of the Jingmai (principal channels), origin of hemicrania. Cold injures the Ying (nutritive energy). The text speaks of pain caused by cold. The vessels of the 3 Yang channels of the hand and foot reunite at the head; those of the left reach the left side, and those of the right, the right side. When the right is affected by cold, the pain is on the right side, and when the left is affected, the pain is on the left side. Shaoyang and Yangming of the hand and foot are distributed to the 2 sides of the head. It is advised to needle first points of the channel of the hand because the hand channels, at the cephalic region, unite with those of the foot. The text does not mention Taiyang because it occurs in the medial region of the cranium.” II - N.V.N.: Zhang Jing Yue clarifies: “Needle first points of the hand channels to treat the summit, then needle points of the foot channel to treat the root.”

PARAGRAPH 11 signs

“Pains of the heart caused by afflux (Jue) characterized by such as: _ pain radiating toward the back _ frequent spasmodic movements _ a feeling of being stabbed in the back to the heart _ stooped back and inability stand upright, bear the name cardialgia of renal afflux origin.

Needle Jinggu (Bl 64) and Kunlun (Bl 60) ; in absence of amelioration, add Rangu (Ki 2).”

EXPLANATIONS AND COMMENTARIES

85.

I - Zhang Shi explains:

“From Paragraph 11 to Paragraph 17, study is centered on the phenomenon of afflux of the energy of the organs, origin of cardialgias. The energy source of the organs is linked to the heart, and the heart receives the energy of the blood vessels (Xue Mai). The afflux of the energy of the other 4 organs follows this route to reach the heart and trigger cardialgia. The back is Yang. The heart is Taiyang in Yang. As a result, the pain radiates from the

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heart toward the back and from the back toward the heart. The back and heart are therefore in relationship; when the pulse of the heart is too rapid, the individual has “the feeling of being stabbed in the back to the heart”. The kidney has a vessel which links up to the spine and from the spine to the heart. By this spinal route, the energy of the kidney flows down into the heart. Because of the heart pains, the individual stoops forward with inability to extend backwards. This pain is due to the afflux of the energy of the kidney toward the heart. Needling the points Jinggu (Bl 64) and Kunlun (Bl 60) constitutes the method of utilization of Fu-Yang (Yang of the bowel) to battle against the afflux of Yin-Zang (Yin of the organ). As soon as the needle is removed, if the patient is not relieved, one must add Rangu (Ki 2). This study is centered only on the afflux of the energy of the organ encroaching on the Jingmai, without relation to the 6 energies (4). This is why the words “Taiyang and Shaoyin are not evoked but only their points.”

II. N.V.N.: 1. All the channels (Jingmai) are linked to the heart. An attack on one of these channels is enough so that the circulation of the channel becomes chaotic in flowing to the heart. The encroachment of this energy of afflux on the heart provokes pain of this organ called “cardialgia of afflux”. This paragraph and the following ones (12 through 15) deal with cardialgias of afflux origin. 2. Zhang Jing Yue describes: “... From the inner thigh, the Foot Shaoyin (Ki) penetrates into the perineum, reaches the anterior side of the lumbar spine and arrives at the kidney. Another vertical vessel leaves the kidney, crosses the liver and diaphragm and penetrates into the lung. Stooping of the back is a stance provoked by pains of the stabbing type, piercing the heart by way of the back. This painful phenomenon is due to the encroachment of the energy of the kidney upon the heart, hence the name cardialgia of renal afflux. (Figure 24) The kidney and bladder constitute the system of relation “internal-external, Yin-Yang”. For this reason, treatment consists of needling Jinggu (Bl 64) and Kunlun (Bl 60), and if the pain persists, adding Rangu (Ki 2)”. 86. 3. The energetic relations of the kidney and heart, explained by Zhang Shi and Zhang Jing Yue, can be synthesized in the diagram below:

4. “6 energies” designates the 6 channels: Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin.

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Figure 24: Cardialgia of renal afflux

PARAGRAPH 12 as:

“Pains of the heart due to afflux (Jue) characterized by such signs _ abdominal swelling _ thoracic fullness _ aggravation of the pain (during the bout) are cardialgia of gastric origin. It is advised to needle Dadu (Sp 2) and Taibai (Sp 3).”

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87...

EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains: “Abdominal swelling and thoracic fullness originate from the afflux of the energy of the stomach. The rising up of the energy of this afflux toward the heart worsens the cardiac pains.

The spleen and stomach are linked by the Yin-Yang system. The spleen aids the stomach in metabolizing the food products and distributing the energy of the organism. This is why it is advised to needle Dadu (Sp 2) and Taibai (Sp 3) of the Foot Taiyin (Sp) to disseminate the energy of the afflux of the stomach. 88... Chen Yu Gong has written: “In the preceding paragraph, the bowel is used to disperse the organ, while in this paragraph, it is the organ which is used to disperse the bowel. The exploitation of this energetic relation is, therefor,e a marvelous method. On the other hand, the energy and blood are products of the stomach; this is why the texts emphasizes the role of the stomach among the 5 organs.”

II. N.V.N.: According to Zhang Jing Yue, in cardialgia of gastric origin, one needles the points of the spleen because the Foot Taiyin (Sp) has a relationship with the Foot Yangming (St). His explanation is the following: “The Foot Yangming (St) descends from the supra-clavicular fossa (Quepen) toward the stomach and divides into two branches: one reaches the spleen and the other, the inner abdominal wall. This is the reason for which one needles Dadu (Sp 2) and Taibai (Sp 3) in order to evacuate the energy of the afflux of the stomach at the level of the heart, thereby combatting cardialgia due to gastric afflux.” (Figure 25)

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87...

Figure 25: Cardialgia of gastric origin and its treatment: Sp 2 and Sp 3

88...

PARAGRAPH 13 “Pain of the heart caused by afflux (Jue), pain like the sting of a needle, characterized by its intensity, bears the name cardialgia of splenic origin. It is advised to needle Rangu (Ki 2) and Taixi (Ki 3). ”

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EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains: “The spleen possesses a vessel linked to the heart. By this route, its afflux flows down into the heart, hence cardialgia of the sting-of-a-needle type. The point Rangu (Ki 2) must be changed to Lougu (Sp 7), and the point Taixi (Ki 3), to Tianxi (Sp 18), because the translation of the ideograms into modern script is often wrong.”

II. N.V.N.: The validity of Taixi (Ki 3) and Rangu (Ki 2) in cardialgia of “splenic” origin has provoked numerous controversies, hence that given by Zhang Shi. But confirmation of the use of these points in the treatment of this ailment is indisputable. Zhang Jing Yue demonstrates it in this manner: “A vessel of the spleen reaches the heart. When the function of metabolization and distribution of the energy of the spleen is found in a state of breakdown, this energy affluxes towards the heart to trigger a cardialgia of the needle-sting type. Therapeutically, the text advocates Rangu (Ki 2) and Taixi (Ki 3) of the Foot Shaoyin (Ki). For what reasons? Because, upon meeting the “cold” energy, the “humid” energy stagnates. This humid energy is then associated with the cold and affluxes to the heart. One must therefore needle the points of the kidney to disperse the cold of the heart, thereby combatting the afflux of the energy of the spleen, causal condition of cardialgia of “spleen” origin. (Figure 26) Clinically, in cardialgias of the needle-sting type, needling Rangu (Ki 2) and Taixi (Ki 3) always gives very good results.

Figure 26: Cardialgia of Splenic origin and its treatment: Ki 2 and Ki 3.

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PARAGRAPH 14 signs

“Pain of the heart caused by afflux (Jue) characterized by such as: _ cadaveric color, greyish facies _ difficulty breathing deeply during the day bears the name hepatic cardialgia. One must needle Xingjian (Li 2) and Taichong (Li 3).”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“The liver governs the complexion and belongs to the energy of spring/birth. Because the energy of the liver surges back toward the top, the complexion is greyish, calling to mind a cadaver. 90. When the liver is affected, the energy of the gallbladder is also found in a state of afflux. This is why, during the day, deep breathing is impossible. The afflux of the energy of the liver towards the heart is the cause of cardialgia of hepatic origin. it is advised to needle Xingjian (Li 2) and Taichong (Li 3) in order to disseminate the energy in a state of afflux.” (Figure 27)

Figure 27: Cardialgia of hepatic origin and its treatment: Li 2 and Li 3.

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PARAGRAPH 15 signs

“Pain of the heart caused by afflux (Jue) characterized by such as: _ sensation of the body suspended in air while stretching in bed _ worsening of the pain during physical activity _ absence of color in the face bears the name cardialgia of pulmonary origin. One must needle Yuji (Lu 10) and Taiyuan (Lu 9).”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“The lung governs the totality of the energy of the body. Sensation of suspension of the body... denotes the presence of afflux blocked and swollen in the interior (in the thorax) with possibility of exteriorizing to the external part of the body. Because the afflux occurs in the interior, the pain worsens during physical activity. 91. The heart unites with the vessels and manifests at the exterior through the complexion. The lung is the “umbrella protector” of the heart. This ailment is therefore due to an afflux which descends from the top. that is to say, from the lung toward the heart, preventing the energy of the heart from reaching the exterior, hence absence of change of the color of the facies. (Figure 28) It is advised to needle Yuji (Lu 10) and Taiyuan (Lu 9) in order to eliminate the afflux phenomenon toward the heart.”

Figure 28: Pulmonary cardialgia and its treatment: Lu 10 and Lu 9.

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PARAGRAPH 16 “In true pain of the heart, characterized by greenish color ( 5 ) of the limbs up to the joints, if the bout is triggered in the morning, death follows in the evening, and if it is triggered in the evening, death follows in the morning.” EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains: “The heart is sovereign organ; the Shen Ming (mental clarity) comes from there. For this reason, the heart is rarely attacked by perverse energy. If the source energy of the organ is affected, death is immediate. 92. Cold and heat are energies of Heaven; green and red are the colors of the 5 Movements (Wu Xing). In “true pains” of the head, cold of the limbs reaches the joints, and in “true pains” of the heart, the greenish color of the limbs reaches the joints; these two cases are fatal.” II. N.V.N.: According to Zhang Jing Yue, the true cardialgias result from a massive infiltration of perverse energy into the sovereign heart. Death is therefore instantaneous; the word greenish implies the sense of “cold”.

PARAGRAPH 17 “Pains of the heart not within the scope of acupuncture are those that are characterized by the massive presence of stagnated energy in the interior. The Shu (kinetic) points are not indicated.” EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains: “This paragraph demonstrates cardialgia via afflux of the energy of the 5 organs abundantly concentrated in the interior and not by afflux of the energy at the level of the channels. In other words, it is a matter of afflux following an excessive fullness of the energy of the 5 organs accumulated in the form of a mass in the interior and not of afflux of the energy via the routes of the channels. The afflux of the energy coming from the channels and the afflux of the energy coming from the mass (tumor) toward the heart to provoke cardialgia are of different natures. This is why the choice of points (kinetic-shu) is not indicated.” II. N.V.N.: According to Zhang Jing Yue, the type of cardialgia cited in this paragraph is an ailment originating from an energetic gathering-accumulation (stasis) or blood stagnation located in the interior. Consequently, this cardialgia cannot be cured by acupuncture. 5. “Greenish color” had been changed to “cooling/chilled” in later editions. See explanation of Zhang Jing Yue.

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PARAGRAPH 18 “In parasitosis (Zhong Jia, Jiao Hui) ( 6 ) , the little needles are advised against.

93.

_ The fullness and pain are sometimes at the upper part, sometimes at the lower part, of the abdomen, or sometimes the absence of pain, _ the sensation of intra-abdominal heat, _ thirst and sialorrhea are the signs revealing parasitosis. With the hand, firmly support the painful mass without displacing it and needle with large needle, then leave the needle in place. Removal of the needle is only executed upon the total disappearance of the movements of intra-abdominal displacement. Persistent fullness and abdominal pain indicate the formation of the mass of the lines which is directed from the bottom upward.”

EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains:

“This paragraph defines Zhong Jia (parasitic mass) and Jia Hui (reunion of lines) and thier potential to trigger cardialgia. Jiao Hui designates the reunion of lines in the interior of the intestines and stomach. It is responsible for cardialgia because the energy of the bowels communicates with that of the heart. Zhong Jia is a mobile mass, parasitic, formed at the exterior of the intestines and stomach. It is also the origin of cardialgia because the heart governs the Shen Ming and possesses its palace of protection against attacks coming from the exterior. The little needles are ineffective because the lines neither pass by the routes of the Luomai nor by the routes of the channels (Jingmai). These types of lines gather in the intraabdominal spaces. Their morbidity is the origin of the pain and abdominal fullness, and their pause produces a remission period of calm. Pains of parasitic origin are therefore intermittent. These lines develop in the milieu “Humidity-Heat”, hence sensation of intra-abdominal heat. Because the site of development of these lines is heated up, the individual is thirsty. During mobility of the lines, the point Lianquan (CV 24) opens, hence sialorrhea. In presence of the classification cited above, one must think of Jiao Hui (accumulation of the lines) and treat it according to recommended techniques.”

II. N.V.N.: In the treatment of parasitosis, needling is oblique, that is to say, subdermal.

6. Numerous Chinese and Vietnamese texts, translated by Zhong Xia, translated it as an immoblie mass of blood and energy. One must read “Zhong Jia” (false mass or mobile mass) to be loyal to the text.

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PARAGRAPH 19

94.

“In deafness, one must needle the point which responds inside the ear, ( 7 ) and in buzzing of the ear, the artery in front of the ear ( 8 ) . In otalgias of pyogenic etiology, needling is advised against. If the ear is locked by cerumen, a dimunition in auditory ability is generally observed. In the event of deafness, first needle the ungual angle of the ring finger, and, secondly, the point of the hand and that of the foot. In the event of buzzing, needle the tip of the middle finger. If the buzzing is on the right, needle the left side; if it is on the left, needle the right side. First needle the hands, then the feet.”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“This paragraph demonstrates the case of afflux of the energy of the channel. From the foot, it passes to the hand, and from the hand, it reaches the head. 1. When the afflux occurs at the top part (from the hand toward the head) causing deafness and buzzing, one must first needle the Luomai located around the ear. (Figure 29) In contrast, during the afflux coming from the bottom, one should needle, in the first place, the Jing-well points of the hand, and, in the second place, those of the feet because the phenomenon of afflux originally has a site at the bottom (feet), secondarily at the top (hands) and definitely at the head (ears). In other words, for the afflux of the energy of the bottom (feet) to be able to trigger deafness and ringing in the ears, it is necessary that it pass first to the channels of the hand, then to those of the head, before reaching the ear. (Figure 29) Otalgia of pyogenic etiology and the dimunition of auditory acuity by cerumen do not have any relation to the energy of the Jingmai. This is why needling is not indicated. 2. The point at the tip of the ring finger is Guanchong (SJ 1), the point at the tip of the middle finger is Zhongchong (XB 9) and that of the tip of the great toe is Dadun (Li 1). The vessels of the 3 Yin channels of the foot and hand do not get to the head and neither pass from right to left nor left to right. Here, it concerns only the afflux of the energy toward the top to trigger deafness and ringing in the ear. 3. The ear is the orifice of the kidney. Jueyin governs spring, and Shaoyang is the “birth” energy. 95.... Jueyin and Shaoyang are created by the water of the kidney organ. When this energy, in forming, is in a state of afflux, the orifice of the mother organ (kidney) is obstructed. This is why one must needle the Jing-well points of the hand, sites of manifestation of the energy of the channels. 7. Tinggong (SI 19). 8. Ermen (SJ 21).

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4. The previous paragraphs study headaches caused by the afflux of the energy, contaminating the channels (Jingmai), and cardialgias provoked by the afflux of the energy at the level of the organs, contaminating the vessels (Mai), following the routes of intercommunication of “organs/bowels-channels/energies”. 96.... In contrast, this paragraph studies the afflux of the energy at the level of the Jingluo (principal and secondary channels) and at the level of the energetic layers. In the 1st case, one must needle the points from which the Luo (vessels of ramification) emanate, and in the 2nd case, the Jing-well points of the foot and hand... so as to favor the circulation of the energy. Such are the rules called “Union-Separation” of the channels and energies”. Yin and Yang enter and exit; cold and heat go and come. These energies all originate from Earth; therefore, from the foot, they reach the top. Needle first Yang, then Yin, because the energy goes from the bottom upward, and needle first the hand, then the foot, because the energy goes from the foot to the hand.” (Figure 29) 95....

Figure 29 Processes triggering deafness and ringing of the ear and their treatment _ afflux of the energy from the hand toward the head: Ermen (SJ 21) and Tinggong (SI 19), from where leave the Luo toward the interior of the ear. _ afflux of the energy from the foot toward the hand, then toward the head: Guanchong (SJ 1), Zhongchong (XB 9), Dadun (Li 1), activator points of the circulation of the energy of the channel.

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PARAGRAPH 20

96...

“In the case of difficulty raising the thigh, it is advised that the patient go into the lateral decubitus position in order to needle the middle of the hip joint with the Yuan Li type needle, the large needle being advised against.” EXPLANATIONS AND COMMENTAIRES I. Ma Shi explains: “The word thigh designates the coxo-femoral (hip) joint. The patient being in the lateral decubitus position, the effected limb held in flexion and the sound limb stretched out, needle, with the Yuan Li-type needle, the point Huantiao (GB 30), belonging to the Foot Shaoyang (GB), 2 cun deep, during one expiration and apply 3 moxas. The large needle is prohibited.” (Figure 30)

II. Zhang Shi clarifies: 97. “The thigh cannot be lifted because the energy of Shaoyang is in afflux down below. In priciple, the needling of Huantiao (GB 30) must be deep (2-3 cun). But here, the afflux occurs in the energetic layer and not in the channel; this is why the needling is superficial, epidermo-dermal, in order to activate the circulation of the energy. Deep needling up to the channel is not necessary.”

PARAGRAPH 21 “In intestinal hemorrhages, it is advised to needle Ququan (Li 8) . ”

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “Hemorrhages during defecation are due to the breaking down of the energy of the liver which cannot return the blood. This is why one must tonify Ququan (Li 8), belonging to the liver channel.”

II. Zhang Shi clarifies: “1. Jueyin (Li) governs the blood. Hemorrhages are due to the energy of Jueyin in a state of afflux circulating in the channels. Ququan (Li 8), belonging to the Foot Jueyin (Li), has an obvious anti-hemorrhagic action. 2. The energy belongs to Yang, and blood, to Yin. The top responds to Yang, bottom to Yin. When the energy circulating toward the top affluxes toward the Jingluo, it is the origin of the obstruction of the energy (Bi), of deafness and ringing in the ears. In contrast, when it circulates toward the bottom and affluxes toward the Jingluo, it causes intestinal bleeding.”

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PARAGRAPH 22 “Feng Bi (algoparesthesia of “wind” origin) is characterized by such signs as: _ latent and chronic pains _ feet alternately frozen as during a walk on ice or hot as during a bath in hot water _ massive infiltration of perverse energy at the level of the thighs and legs 98. _ anxiety and headache _ sometimes, vomiting _ sometimes, anguish and sensation of oppression _ vertigo following sweating. In the chronic state: _ dizziness and vertigo _ mental instabilty: successive states of sadness, joy, fear, _ short breathing (apnea) and melancholy, death follows in 3 years.”

EXPLANATIONS AND COMENTARIES I. Zhang Shi explains: “1. Feng Bi is the expression designating obstruction and afflux of wind characterized by lancinating pains localizing within the entire body, as easily at the top as at the bottom. Feng Bi is therefore a syndrome of wind (perverse) origin of changing and very mobile nature.

2. Following the law of Yin-Yang, Yin and Yang gather together into 3 Yin and 3 Yang responding to the Jingmai of the foot and hand. Water and Fire represent Yin and Yang. The heart and kidney are the organs responding to Water and Fire. When the afflux of the wind floods the top and bottom and reaches the organs, the disease is incurable. In this case, the application of the method of purification (9) damages the fire of the Xin Bao (XB), and the applicaton of the method of calorification (10) injures the Yin of the kidney organ (Kidney Yin). This is why Feng Bi is a difficult disease to treat. When the afflux of the wind reaches the lower part of the body, the feet are ice cold because they are affected by the “Cold-Water” energy. And when it reaches the upper part of the body, the feet are hot because they are affected by the “Heat-Fire” energy”. When the afflux of the wind goes from the top downward, the thigh and legs are affected, and when it goes from the bottom upward, the head is affected. The fickle, inconstant signs of “vomiting, anguish...” indicate that sometimes the afflux of the wind takes place at the center (Spleen-Stomach). 9. Method consisting of using the medicines of refridgerating or refreshing nature or the energetic “anti-heat” points. 10. Method consisting of using medicines of calorific or warming nature or the energetic “anti-cold” points. See MTC- NVN Edition.

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All vessels gather together at the eyes. Dizziness and amblyopia indicate, therefore, the overflowing of the afflux of the wind at the level of the blood zone of the Jingmai. Sweating is due to the afflux of the wind toward the energetic zone of the skin-sweat gland system. 99. The Jing (quintessence) of Water is Chi (will), and the Jing of Fire, Shen (mental). These two psychologic energies afflux toward the eyes, hence dizziness. Joy belongs to the heart, and fear, to the kidney. These inconstant signs of sadness, joy, fear... indicate the instability of the Shen of the heart and Chi of the Kidney. Short breathing also originates from the disturbance of the energy of the kidney, and sadness (without joy), from disturbance of the heart.”

II. Ma Shi describes:

“The disease localizing at Yang bears the name Feng (Wind), and that localizing at Yin, the name Bi (obstruction and pain). When Yin and Yang are disturbed together, the disease bears the name Feng Bi. In Feng Bi, perverse energy overflows and diffuses everywhere: _ below, it affects the feet, hence sometimes icy, sometimes hot feet _ above, it arrives at the head and eyes, hence headache, dizziness _ at the exterior, it reaches the skin and sweat glands, hence sweating _ in the interior, it is the origin of short breathing (apnea) and instability of the Shen. Feng Bi is therefore a syndrome due to the dysharmony of Yin and Yang, to circulatory disturbances of the energy of the 5 organs, to the loss of connection of Ying (nutritive energy) and Wei (defensive energy) and to the the simultaneous defeat of the blood and energy. This is why death follows in 3 years.”

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no 100/101.

CHAPTER XXV Causes of Disease (Bing Ben)

Chapter 25 of the Lingshu demonstrates the therapeutic rules following the principles of Summit-Root (Jiao Ben). These methods have the basic objective of adapting the treatment to the characteristics of the disease: _ to its etiology (Root) or to its symptomatology (Summit) _ to its seriousness or to its benignness _ to its acute, subacute or chronic nature. These two words, Summit (Jiao) and Root (Ben), must be taken in the larger sense. They can, in effect, have different acceptances, according to the point of view considered: _ in the development of the disease, the word Root corresponds to cause, and the word Summit, to symptoms; _ in a disease association, Root designates the disease which originally appears, and Summit, that which follows secondarily; _ in the determination of the location of the disease, Root applies to deep attack (attack of the interior), and Summit corresponds to superficial attack (attack of the exterior). In practice, faced with the diversity of clinical forms, we must apply these two therapeutic principles with flexibility and discernment because experience has demonstrated the existence of cases which necessitate treatment of the Root (etiologic treatment) or treatment of the Summit (symptomatic treatment). Ma Shi has said: “This Chapter 25 of the Lingshu is like Chapter 73 (“Study on the Origin of Disease”) of the Suwen. Generally, treatment must be, before all, etiologic because that is the logic of all therapy. In the Lingshu, “Summit-Root” and the “evolution of the disease” constitute two different chapters, while in the Suwen, they make up only

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one.”

This chapter consists of 4 paragraphs.

PARAGRAPH 1

102.

“In disease prior to afflux (Jue), one must treat, in the first place, the root ( B e n ). root.

In afflux prior to disease, one must treat, in the first place, the

In the attack of cold prior to disease, one must treat, in the first place, the root. root. the

In the disease prior to cold, one must treat, in the first place, the

In attack of heat prior to disease, one must treat, in the first place, root.”

EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains:

“This paragraph define the words Jiao and Ben (Summit and Root), Biao and Li (exterior and interior) and their use therapeutically. 1. “... prior to the afflux; ... prior to cold; .. prior to heat” implies the effect on the organism before attack of the 6 perverse energies. Disease prior to afflux designates the pathologic state (disease) of the individual preceding the triggering of the phenomenon of afflux. As a result, one must treat, as a matter of priority, the “root-disease”. Afflux prior to disease implies the primary attack of the 6 perverse (cosmic) energies with perturbation of Yin and Yang of the body, responsible for the phenomena of the afflux, triggering factor of the disease. As a result, one must treat first the “perverse root-energy”. Cold prior to disease implies attack by an infiltration of perverse (cosmic) cold before the appearance of the syndromes of the 6 channels. As a result, one must treat, in the first place, the “perverse root-cold”. Disease prior to the cold implies the attack of the body before the appearance of the cold syndrome. As a result, one must treat in the first place the “root-disease”. Heat prior to the disease implies attack by an infiltration of perverse (cosmic) heat before the appearance of other syndromes. As a result, one must treat first the “perverse root-heat.” 2. The 6 energies of Heaven are cold, wind, heat, humidity, dryness and fire. The 6 energies of Heaven designate the 6 channels, that is to say, the 3 Yin and 3 Yang: Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin. 103. Yin and Yang of the human being unite with the 6 energies of Heaven. As a result, the “root” disease can contaminate the “summit” disease and vice versa. In this paragraph, root designates the primary disease, and the summit, the secondary

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disease.” II. N.V.N.: This paragraph stresses that treatment must basically be etiologic. We take some general examples: 1. In disease preceding the appearance of disturbances of blood and energy, the disease is considered the root, therefore to be treated beforehand. 2. In the event of disturbances of blood and energy preceding the onset of the disease, blood and energy are considered as two original causal factors (root) which must be treated first and foremost. 3. In the event of influenza preceding the appearance of the disease of cold, the influenzal virus (perverse cold) is considered as the root to be combatted first. 4. In the disease of cold preceding influenza, the disease is the root that must, as a result, be treated first.

PARAGRAPH 2 “In diarrhea prior to another disease, one must treat and harmonize the root (Ben) before taking an interest in the ailment itself. In disease prior to bloating/abdominal fullness, one must urgently treat the summit (Jiao). In disease prior to diarrhea, one must treat the root ( B e n ) . In bloating/abdominal fullness prior to anxiety, one must treat the root ( B e n ) . ”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“1. “Diarrhea” is an ailment belonging to the spleen and stomach. The spleen governs the 4 limbs and the dermal system (flesh). “... another disease” designates that of the spleen, with disturbances at the 4 limbs and other parts of the body. This is why one must, in the first place, treat the root and harmonize the “Spleen-Stomach” system before becoming preoccupied with other diseases. 2. “Bloating/abdominal fullness” (Zhong Man) originates from disturbances of the spleen and stomach. “In disease prior to the bloating/abdominal fullness”, one must treat in the first place, the summit (Jiao) which is the Zhong Man, then secondly, the root of the disease. 104. 3. “In disease prior to the diarrhea”, one must first treat the root; the diarrhea stops spontaneously. 4. Zhong Man (bloating/abdominal fullness) prior to disturbances of the heart (anxiety) is due to afflux of the energy of the spleen toward the heart. This is why one must, in the first place,

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treat the root of the disease. • In man, the organs and bowels, energy and blood, Jing and Luo all have their root at the level of the spleen and stomach. The previous paragraph demonstrates the exogenous pathologic factors at the time of the meeting of the guest energies (perverse energies) of Heaven and of Yin and Yang of man, while this one studies the endogenous pathologic factors due to the perturbation of the essential energy of man. This is why, in diarrhea of internal origin, one must base one’s judgment on the spleen and stomach to therapeutic ends.”

PARAGRAPH 3 “Sometimes, because of the presence of the energy-guest (Ke Qi ) or because of the presence of customary active energy (Dong Qi ) , the disease is characterized by signs of dysuria of difficult defecation; one must urgently treat the summit ( J i a o ) . In contrast, in case of absence of these signs, one must treat the root( B e n ) . ” EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains:

“The energy-guest (Ke Qi) designates the group of 6 irregular energies of Heaven, and the customary active energy (Dong Qi), the group of 6 regular energies of Heaven. Diseases can be caused either by guest perverse energy (Ke Qi) or by active customary perverse energy (Dong Qi). Therefore, these perverse energies are harmful to the essential energy of the body. Disturbances of metabolism of the essential energy are the causes of dysuria and difficult defecation; one must treat urgently the summit (Jiao). If diuresis and defecation are normal, one must treat the root (Ben).”

II. N.V.N.: The words Ke Qi (energy-guest) and Dong Qi (customary active energy) merit more precise definition: 105. 1. Ke Qi designates an intrusive type of energy of man which infiltrates into the organism in inconstant fashion. This is a disordered energy of the 4 seasons. Ex: cold in summer, heat in spring... . 2. Dong Qi designates, in a general way, the normal climatic energy of the 4 seasons like: _ the warmth of spring (Chuan Wen) _ the heat of summer (Xia Re) _ the freashness, coolness of autumn (Zu Liang) _ the cold of winter (Dong Han). The variation of these seasonal energies is cyclic and constant.

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PARAGRAPH 4 “In the state of excess (fullness), the disease progresses from root toward summit; one must treat first the root, and secondly, the summit. In the state of insufficiency (emptiness), the disease evolves from summit to root; one must treat first the summit, and secondly, the root. One must meticulously evaluate the benignity and seriousness of the disease in order to harmonize them. In the benign case, one must treat at one time the perverse energy and essential energy, and in the serious case, one must treat them separately. Dysuria and difficult defecation being prior to another disease, one must treat the root.”

EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains:

“This paragraph studies Jiao (summit) and Ben (root) of Yin and Yang and the 6 energies. Chapter 68 (“Great Presentation on the Secret of Six”) of the Suwen states: “_ The top of Shaoyang belongs to the “fire” energy _ The top of Yangming belongs to the “dryness” energy _ The top of Taiyang belongs to the “cold” energy _ The top of Jueyin belongs to the “wind” energy _ The top of Shaoyin belongs to the “heat” energy _ The top of Taiyin belongs to the “humidity” energy. 106. These energies are the roots below which are found the summits. In other words, wind, cold, heat, humidity, dryness and fire are the 6 energies responding to the roots, and the 6 energies of the 3 Yin and 3 Yang (Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin) respond to the summits.

1. “In states of excess...” designates the perverse energy in a state of fullness. “In states of emptiness” designates the state of emptiness of the essential energy. The disease in a state of fullness progresses from the root to the summit, and the treatment must be carried out, in the first place, at the level of the energy of the root, that is to say, at the level of “wind, cold, heat, dryness, humidity, fire”; then, in the second place, at the level of the summit, that is to say, at the level of the 3 Yin and 3 Yang (Taiyang, Shaoyang,... Taiyin, Jueyin...). In other words, one must first dipserse the perverse energy and only later tonify the essential energy. In contrast, the disease in a state of emptiness progresses from summit toward root. One must, as a matter of priority, harmonize Yin and Yang, then secondly, the energy of the root. Such are the fundamental rules of therapy according to root and summit, perverse energy and essential energy, emptiness and fullness. 2. “... treat at one time the perverse energy and essential energy” means that the

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dispersion of perverse energy must be associated with the tonification of essential energy. 3. “... treat separately” implies to treat the case of perverse energy only in a state of fullness or the case of the essential energy only in emptiness. Treatment is aimed then only at the state of fullness of the perverse energy or at the state of emptiness of the essential energy. 4. In the case of “dysuria and difficult defecation” prior to another disease, one must treat only the root, that is to say, the dysuria and difficult defecation.”

II. N.V.N.: In general practice, the physician is often confronted by concrete pathological situations which can be extremely complex and of infinite diversity. Faced with all these situations, it is important to discern the Summit and Root before assuming a therapeutic decision. Deep knowledge of the notions of Root and Summit permit differentiating the essential from the secondary, establishing a hierarchy of morbid symptoms, detecting the mechanism which drives the cause of the symptoms and applying, as a result, a rational therapy. 107. In this regard, Qi Bo clarifies: “_ If disturbances of the energy are secondary to a disease, one must first treat the Root. _ If a disease is secondary to disturbances of the energy, one must first treat the Root. _ If signs of cold are secondary to a disease, one must first treat the Root. _ If a disease is secondary to that of heat, one must first treat the Root. _ If a disease is the result of diarrhea, one must treat the Root, beginning first to reestablish liquid equilibrium, then treat the disease.

_ If abdominal flatulence is the result of a disease, one must first treat the Summit. _ If diarrhea is the reult of a disease, one must first treat the Summit. _ If upset stomach is the result of abdominal flatulence, one must first treat the Summit. _ Faced with a disease with disturbances of evacuation of matter and urine, one must urgently treat the Summit. _ Faced with a disease of fullness, with signs of attack of the Root evolving toward signs of attack of the Summit, one must first treat the Root, then the Summit. _ Faced with a disease of emptiness, with signs of attack of of the Summit evolving toward the Root, one must first treat the Summit, then the Root, taking into account the benignity or seriousness of the ailment in order to apply a treatment of harmonization: _ If the disease is benign, treat Summit and Root together. _ If the disease is serious, treat Summit and Root together. _ Faced with a secondary disease from distrubances of evacuation of matter and urine, one must treat, as a matter of urgence, the Root. This assertion means to say that treatment must be etiologic as much as possible. Nevertheless, there are diseases of acute pace necessitating urgent symptomatic treatment. This illustrates the second general principle according to which: “One must treat the Summit at once in acute cases, and the Root in subacute and chronic cases”. In summary, the method of Summit and Root is basically founded on the differentiation of acute, subacute and chronic states on the one hand, and on the seriousness or benignness of the disease on the other hand. If the Summit is more acute than the Root, one must first treat the

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Summit. If the Root is more acute than the Summit, one must first treat the Root. The discernment of Summit and Root is therefore of prime importance in therapeutic management. This importance has been stressed in the Suwen: “To know the notions of Summit and Root is to have the power to cure all diseases. To misjudge these notions is to introduce regrettable errors”.

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no 108/109.

CHAPTER XXVI Various Diseases (Za Bing)

Chapter 26 of the Lingshu studies various sydromes of afflux etiology (Jue): _ spinal pain, facial edema, dysphasia, boborygmi, salivation, gonadal pain, tonsillitis, “Fever-Chills”, odontalgia, deafness, epistaxis, lumbalgia, dyspnea, behavioral disturbances (anger, joy,...), lower maxillary pains, nuchalgia, disturbances of diuresis, cardialgias, abdominal pains, limb flaccidity, hiccups... . The classification and description of the disease, diagnosis and therapy are shown explicitly. Because the scope of study is heterogenous, this chapter is entitled: “Various Diseases” (Za Bing). This chapter contains 28 paragraphs.

PARAGRAPH 1 “In the Jue (afflux) syndrome causing spinal pain radiating up to the top of the cranium, with sweating and heaviness of the head, diminished visual acuity and lumbar stiffness, it is advised to needle the Xue Luo (blood vessels) located at the popliteal crease, belonging to the Taiyang (Bl).”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The energy of the Taiyang channel controls the external layer of the body. The perverse energy attacks the Taiyang, causing a opposite flow of the energy of this channel characterized by the signs noted above. One must needle the Xue Luo (blood capillaries) of the popliteal crease to evacuate the perverse energy. 110. II - N.V.N.: Among the 6 channels (3 Yin, 3 Yang), the Taiyang is the most exposed to the exterior. As a result, the attack of perverse energy at the level of the epidermo-dermal layer always perturbs the energy of Taiyang whose afflux is the origin of spinal pain, headache of the vertex, sensation of heaviness of the head, dizziness of the eyes, lumbar stiffness... . It is the reason for which Qi Bo in the first place presents the disturbances of the Taiyang, always characterized by the presence of Xue Luo (blood capillaries) at the popliteal crease which one must bleed.

PARAGRAPH 2 “In the Jue (afflux) syndrome characterized by thoracic fullness with edema of the face, puffiness of the lips and severe dysphasia, or aphasia in the serious case, one must needle the Foot Yangming (St).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The Foot Yangming (St) vessel starts at the side of the nasal ala, _ ascends toward the forehead in passing the internal canthus of the eye, _ redescends and encircles the lips, _ penetrates into the laryngo-phayrngeal apparatus, _ arrives at the point Quepen (St 12), _ reaches the diaphragm... . The text also stipulates: “When perverse energy attacks the face, it descends by the route of the Yangming.” During attack of the perverse energy at the level of the epidermo-dermal layer of the facial region, it expresses by face swelling. “It descends by the route of the Yangming” also implies the creation of thoracic fullness and puffiness of the lips. The laryngeal system is the path of ascent and descent of the energy, and the Yangming vessel follows this route. This is why, in the event of afllux, the energetic system of this region is disturbed, hence severe dysphasia or aphasia in the serious case. It is then advised to needle the Foot Yangming (St) in view of dispersing the perverse energy.” II - N.V.N.:

111.

According to Ma Shi and Zhang Jing Yue, this pufiness of the lips is always accompanied by salivation. Here, the dysphasia is due to disturbances of the circulation of the energy of the Yangming

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at the level of the laryngo-pharyngeal organs. This is why one must choose the points of the Foot Yangming. According to the Dacheng (1), in facial edema with disturbance of speech, one must needle Jiexi (St 41) and Neiting (St 44).

PARAGRAPH 3 “In the case of afflux of the energy toward the laryngopharyngeal system with dysphasia, accompanied by cold hands and feet and dysuria, one must needle the Foot Shaoyin (Ki).”

EXPLANATIONS AND COMMENTAIRES I - Zhang Shi explains:

“The Foot Shaoyin (Ki) vessel ascends toward the laryngo-pharyngeal system and attaches to the base of the tongue. As a result, afflux of the energy toward the throat is the cause of the dysphasia. The kidney is the source organ of the production of the energy. When this energy affluxes toward the top, the feet and hands are cold. The kidney exteriorizes at anterior Yin (genitals) and at posterior Yin (anus). Its disturbances always cause dysuria and difficult defecation. One must needle the Foot Shaoyin (Ki) to normalize the circulation of the energy in a state of aflux.” II - N.V.N.: Here, it is a question of another type of dysphasia, accompanied by coolness of the feet and hands with dysuria and difficult defecation. As for treatment, the Dacheng proposes needling the Jing-river point (Fuliu-Ki 7).

PARAGRAPH 4 “In the syndrome of afflux (Jue) characterized by boborygmi, with stagnation of “cold” energy causing gurglings and constipation, one must needle the Foot Taiyin (Sp).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The abdomen enters into the “Spleen-Stomach” sphere. Boborygmi originates from the afflux of the energy occuring in the abdomen. Taiyin responding to Humidity-Earth is Zhi Yin (arrival of Yin) in Yin. Therefore, gurglings are provoked by “Water-Humidity” movements.

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112.

1. See “Art and Practice of Acupuncture/Moxabustion According to Dacheng” - N.V.N. Edition, Vol. II.

The energy of Earth (Spleen) does not ascend and that of Heaven (Stomach) does not descend, hence difficult defecation. As a result, one must needle the Taiyin to eliminate the phenomenon of contrary afflux.” II - N.V.N.: The Dacheng proposes the Jing-well point (Yinbai- Sp 1) and Yuan point (Taibai- Sp 3).

PARAGRAPH 5 “In dryness of the laryngo-pharyngeal system (throat) with the sensation of heat in the mouth and thick salivation, one must needle the Foot Shaoyin (Ki).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Here, perverse energy offends the energy of Shaoyin, provoking an afflux at the lower part of the body. The “water’ energy of the kidney and “fire” energy of the heart communicate. When the kidney is disturbed by perverse energy, the energy of Shaoyin (Ki) affluxes toward the bottom and cannot be directed to the top to enter in relationship with that the heart, hence fullness of fire with dryness of throat, hot mouth and thick and sticky salivation. It is advised to needle the Foot Shaoyin (Ki) to suppress the phenomenon of aflux in order to accelerate the movements of ascent of water toward fire.” (Figure 31) II - N.V.N.: The Dacheng proposes the Jing-well point (Yongquan-Ki 1) of the Foot Shaoyin. 113.

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Figure 31: Process of triggering dryness of the tongue and its treatment (Yongquan- Ki 1 and Taixi- Ki 3)

PARAGRAPH 6 “In gonalgia, one must needle Dubi (St 35) with the type 6 needle (Yuan Li) every 2 days. This large needle, resembling a long hair of the tail of the buffalo, is well adapted to needling the knee, without any doubt.”

EXPLANATIONS AND COMENTARIES I - Zhang Shi explains:

“Here, perverse energy infiltrates into the Foot Yangming (St) channel and provokes gonalgia. It is then advised to use a large and long needle of the Yuan Li (No. 6) type, resembling a hair of buffalo’s tail. “... without any doubt” also implies that one must needle the point of the energy when the perverse energy is found in the energetic layer to create a state of flow, and the point of the

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channel when the perverse energy is found within the Jingmai.” II - N.V.N.: 1 - The “point of the energy” described by Zhang Shi is the A Shi (painful) point or the curious point, site of concentration of the Jing energy (Quintessence) of the corresponding organ/bowel. Ex: Yingtang (PC 3) is the site of concentration of the Jing of the lung. 114. 2 - The “point of the channel” is the point of the channel itself, site of concentration of Ying (nutritive) energy. Ex: Taiyuan (Lu 9) is one of the points of concentration of Ying energy, belonging to the channel of the lung.

PARAGRAPH 7 “In tonsillitis with aphonia, one must needle the Foot Yangming (St), and in tonsillitis without aphonia, the Hand Yangming (LI).”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“Tonsillitis is an ailment caused by perverse energy at the level of the throat and is characterized by inflammation with edema. The Foot Yangming (St) circulates in this region. As a result, perverse energy prevents circulation, hence tonsilltitis with aphonia. The Hand Yangming (LI) circulates a small distance from this region. In its attack, the voice remains normal. This is why, in case of tonsillitis without aphonia, one must needle the Hand Yangming (LI)” (Figure 32)

Figure 32:

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Circulation of the Hand and Foot Yangming (LI and St) at the level of the laryngo-pharynx.

PARAGRAPH 8

“In the disease of “Fever-Chills” with absence of thirst, characterized by a bout every 2 days, one must needle the Foot Yangming (St). 115.

In contrast, in the disease of “Fever and chills” with thirst, characterized by a daily bout, one must needle Hand Yangming (LI).” EXPLANATIONS AND COMMENTARIES

I - Zhang Shi explains: “ Perverse energy (of fever-chills) follows the Jingmai and penetrates deeply within the interior of the body. As it infiltrates into the Yin part, it cannot get back to the exterior, hence a bout every 2 days. The Foot Yangming (St) vessel arrives at the stomach and passes to the spleen to respond to the terrestrial energy of the lower region of the body. Its circulatory route is distant, hence a bout every 2 days. Since Earth responds to Yin, thirst is absent. In this case, one must needle the Foot Yangming (St). The Hand Yangming (LI) vessel originates from the large intestine, links to the lung and responds to the celestial energy of the upper region of the body. Its circulatory route is therefore nearby, hence a daily bout. Since Heaven responds to Yang, thirst is present. In that case, one must needle the Hand Yangming (LI).” (Figure 33) II - N.V.N.: The Dacheng proposes the Shu-stream point (Sanjian- LI 3) of the Hand Yangming (LI).

Figure 33:

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PARAGRAPH 9

Circulation of the Hand and Foot Yangming (LI and St) 116.

“If in odontalgia, cold drinks are not feared, needle the Foot Yangming (St). In contrast, if in odontalgia, cold drinks are rejected, needle the Hand Yangming (LI).”

EXPLANATIONS AND COMMENTAIRES I - Zhang Shi explains: “The Hand and Foot Yangming (LI and St) have their branches to the maxillae. The Foot Yangming (St) governs heat; therefore it does not fear the cold. In contrast, the Hand Yangming (LI) governs coolness; for this reason, it fears the cold.

II - N.V.N.: Dental pains without fear of cold drinks are generally due to Fullness-Heat of the Foot Yangming (St).Dispersion of this channel is therefore indicated. In contrast, dental pains with fear of cold drinks are generally due to Emptiness-Cold. As a result, tonification of this channel of Hand Yangming (LI) is necessary.

PARAGRAPH 10 “In dimunition of auditory acuity without otalgia, one must needle the Foot Shaoyang (GB), and in dimunition of auditory acuity with otalgia, one must needle the Hand Yangming (LI).”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “The Hand and Foot Shaoyang (GB and SJ) vessels have pre- and post-auricular branches and branches penetrating into the ear. When the Shaoyang receives the Ministerial Fire of the Sanjiao (SJ), temporary deafness is always accompanied by otalgia.”

PARAGRAPH 11 “In continous epistaxis with blood clot, one must needle the Foot Taiyang (Bl), and in epistaxis without blood clot, needle the Hand Taiyang (SI). 117. If the epistaxis persists, one must needle Wangu (SI 4) ; without result, needle Weizhong (Bl 40) . ”

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EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“The Foot Taiyang (Bl) responds to water (cold). As a result, epistaxis forms a blood clot. The Hand Taiyang (SI) responds to fire (heat). As a result, epistaxis is without blood clot. Here, it is a question of a case of infiltration of perverse energy within the energetic layer causing an anarchic circulation of the Yang Luo (Superficial Luo of the nasal mucosa). This is why it is advised to needle the Hand and Foot Taiyang (SI and Bl) to activate the energetic circulation, thereby stopping the epistaxis; without result, one must needle Wangu (SI 4) and bleed Weizhong (Bl 40).” (Figure 34)

Figure 34: Treatment of epistaxis

PARAGRAPH 12 “In lumbalgia with sensation of cold at the lumbar area, one must needle the Foot Taiyang (Bl) and the Foot Yangming (St). In lumbalgia without sensation of cold at the lumbar area, one must needle the Foot Jueyin (Li).” 118. Foot

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In lumbalgia with inability to flex and extend, one must needle the Shaoyang (GB).”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Taiyang and Yangming govern, respectively, “Cold-Water” and “Coolness-Metal” energies. As a result, in lumbalgia with cold sensation, one must needle the Foot Taiyang (Bl) and Foot Yangming (St). Jueyin/Wind-Wood governs the energy and unites with the “transformed fire” (Ministerial Fire) of Shaoyang; this is why in lumbalgia with sensation of heat, one must needle Jueyin (Li). Lumbalgia preventing flexion and extension of the body originates from the rupture of the “hinge” of the Shaoyang; this is why one must needle the Foot Shaoyang (GB).” II - N.V.N.: The explanation of Zhang Jing Yue is more practical: “In lumbalgia with sensation of cold at the lumbars, one must needle the Yangming in order to drive the perverse Yin out into the Yang layer of the body. In lumbalgia with sensation of heat at the lumbars, one must needle the Jueyin to drive out the Wind-Heat infiltrating within the Yin. The Shaoyang vessel circulates the length of the two lateral sides of the body; this is why, in inability of extension and flexion of the body, one must needle the Foot Shaoyang.”

PARAGRAPH 13 “In sensation of heat in the abdomen with dyspnea, one must needle the Foot Shaoyin (Ki) and bleed Weizhong (Bl 40) . ” EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“The Foot Shaoyin (Ki) vessel is directed toward the top, crosses the diaphragm, projects into the thorax, penetrates within the lung and attaches to the heart. The syndrome of abdominal heat is due to an opposite flow (afflux- Jue Ni) of the Shaooyin that cannot communicate with the heart. Therefore, one must needle the Foot Shaoyin (Ki) and bleed Weizhong (Bl 40).”

PARAGRAPH 14

119.

“In the case of excessive joy and anger with anorexia and weak voice, one must needle the Foot Shaoyin (Ki), and in the case of anger with logorrhea (2), needle the Foot Shaoyang (GB).”

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2.

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“Too much joy harms the heart, and too much anger harms the liver. Under the action of the stomach, foods are transformed into Jing Qi (pure energy) which diffuses toward the heart and liver. As a result, disordered digestion can provoke a contrary afflux of the energy of the heart and liver, responsible for anorexia. The number 5 responds to Yin (voice) and Yin governs the end of summer; when the energy of the liver and that of the heart are in a state of contrary afflux, the energy of the center (Zhong Qi: spleen) is disturbed and the voice gradually grows weaker. One must needle the Foot Taiyin (Sp) to ventilate the circulation of the energy of the spleen in order to activate food metabolism and acentuate the tone of the voice. The liver governs speech (therefore also the voice). Anger with logorrhea is due to a strong ascent of the energy of Jueyin. As a result, one must needle the Shaoyang (GB) to ventilate the energy of the liver.”

PARAGRAPH 15 “In pains of the lower maxilla, one must needle the Hand Yangming (LI) and bleed the vessels in a state of fullness.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“A vessel of the Hand Yangming (LI) leaves Quepen (St 12), reaches the neck and arrives at the cheekbone... . The Foot Yangming (St) reaches the ocular system, redescends to the cheekbone, penetrates into the gums, reaches Daying (St 5), where it divides into two branches: _ one branch descends toward Renying (St 9) _ another branch rejoins Jiache (St 6), passes in front of the ear, arrives at the temporal region, where Xiaguan (GB 3) occurs, and terminates at Touwei (St 8). As a result, during lower maxillary pain, one must needle the Hand Yangming (LI) and the vessel in a state of fullness.” II - Ma Shi states:

120.

“Here, the words lower maxillary includes the cheekbone and temporal region, that is to say, the region of passage of the Foot Yangming (St). To needle the Hand Yangming (LI), that is to say, the point Shangyang (LI 1), and bleed the vessel in a state of fullness, that is to say, needle and bleed Jiache (St 6), located above and in front of the lower angle, on the masseter.” (Figure 35)

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Figure 35: Treatment of lower maxillary pain.

PARAGRAPH 16 “In nuchalgia with stiffness preventing flexion and extension of the neck, one must needle the Foot Taiyang (Bl); if the head can neither turn to the right nor left, one must needle the Hand Taiyang (SI).” EXPLANATIONS AND COMENTARIES I - Zhang Shi explains:

“From the nucha, the Foot Taiyang (Bl) follows a trajectory parallel to the spine to the lumbar vertebrae. Therefore, in case of disturbances preventing flexion and extension of the neck, one must needle the Foot Taiyang (Bl). Once reaching to the posterior part of the shoulder joint, the Hand Taiyang (SI) projects

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into Dazhui (GV 14), then redescends to Quepen (St 12) in the supraclavicular fossa... . As a result, in case of disturbance preventing movements of rotation of the head, one must needle the Hand Taiyang (SI).” II - N.V.N.: 121. According to the Dacheng (3), in cervicalgia with torticollis, _ “To needle the Foot Taiyang (Bl)” is to needle the Shu and Ying points of the bladder channel: • Shugu (Bl 65), responding to the “Wind-Wood” movement • Tinggu (Bl 66), responding to the “Cold-Water” movement _ and “To needle the Hand Taiyang (SI)” is to needle the Jing-well and Xi points of the small intestine channel: • Shaoze (SI 1), responding to the “Metal-Lung” movement • Yanglao (SI 6), point of unblocking.

PARAGRAPH 17 “In fullness/swelling of the lower abdomen with surging of the energy toward the stomach and heart, sometimes sensation of fever, sometimes sensation of chill, and disturbance of diuresis, one must needle the Foot Jueyin (Li). In abdominal fullness with constipation, surging of the energy toward the thorax and laryngo-pharyngeal system, dyspnea and loud breathing, one must needle the Foot Shaoyin (Ki). In abdominal fullness with dyspepsia, boborygmi and difficult defecation, one must needle the Foot Taiyin (Sp).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph describes the phenomenon of afflux of the energy of the 3 Yin (Jueyin, Shaoyin, Taiyin) manifesting at the lower part of the body, triggering factor of the syndrome of abdominal fullness.

a - The Foot Jueyin (Li) reaches the lower abdomen, arrives at the stomach, crosses the diaphragm... . As a result, the afflux of the energy of this channel is at the origin of fullness/ swelling of the lower abdomen. Because this afflux is directed toward the top, it arrives at the stomach and heart. Jueyin makes up part of maximal Yin in which is born first Yang, hence sensation of fever and chills. The liver governs all phenomena of secretion of the organism. Therefore, disturbances of diuresis originate from the afflux of the energy of Jueyin. b - The kidney is the “door” of the stomach. It becomes exteriorized at the level of the 2 Yin (anterior Yin- urethra; posterior Yin- anus). The fullness/swelling of the lower abdomen is due to the closure of this door at the time of the contrary afflux of the energy of the kidney. The kidney has a vessel which crosses the diaphragm, penetrates into the lung and arrives at the laryngo-pharyngeal organs... . This is why the afflux of the kidney energy at the level of

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this region causes loud respiration.

122.

3. See “Art and Practice of Acupuncture and Moxabustion According to the Dacheng” - NVN Edition.

c - The Foot Taiyin (Sp) governs the movements and transformations of the cereal water. Because the energy is in a state of afflux, the abdomen is in fullness. Boborygmi, dysuria and constipation must be treated at the level of the points of the 3 Yin of the foot to combat this afflux.” II - N.V.N.: _ In fullness of the lower abdomen with dysuria, the Dacheng proposes needling Taichong (Li 3), Yuan point corresponding to the “Earth-Spleen” movement. _ In abdominal fullness with constipation, the Dacheng advises needling Taixi (Ki 3), Yuan point of the kidney channel. _ In abdominal fullness with dyspepsia, the Dacheng proposes the point Taibai (Sp 3), Yuan point of the spleen channel.

PARAGRAPH 18 “In heart pains radiating toward the lumbar region with nausea, one must needle the Foot Shaoyin (Ki).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The lumbar region is the external “palace” of the kidney organ. The kidney and stomach have a relationship of “union-transformation” between Wu (Vth Celestial Trunk-Hill/Earth) and Qui (Xth Celestal Trunk-Stream/Water). Pains of the heart radiating to the lumbar region with sensations of nausea are due to the ascent (afflux) of the energy of the kidney toward the heart. One must treat at the level of the Foot Shaoyin (Ki).” II - Ma Shi states:

“Here, it is a question of the afflux of perverse energy of the kidney toward the heart.” III - N.V.N.: To stop this afflux, the Dacheng proposes Yuanquan (Ki 1), Jing-well point of the kidney, responding to the movement “Wood-Liver”.

PARAGRAPH 19 109

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“In pains of the heart with abdominal bloating, cutaneous chill and difficult defecation, one must needle the Foot Taiyin (Sp).” EXPLANATIONS AND COMMENTARIES

123.

I - Zhang Shi explains: “The Taiyin is Zhiyin (extreme Yin) in Yin. Yin designates cold. The non-metabolization of this energy by that of the spleen (Earth) is at the origin of abdominal bloating with sensation of cold and diffcult defecation. Here, it is a question of a syndrome of Obstruction/Cold of the spleen energy causing the heart pains. This is why one must needle the channel affected (spleen) to eliminate the afflux phenomenon.”

II - N.V.N.: The Dacheng proposes Yinbai (Sp 1), Jing-well point of the spleen channel, corresponding to the movement Wood-Liver”, to combat the phenomenon of afflux of the energy of the spleen (Earth).

PARAGRAPH 20 “ In pains of the heart with dorsal radiation and respiratory difficulty, it is advised to needle the Foot Shaoyin (Ki); without result, one must add the Hand Shaoyang (SJ).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “A vessel leaves from the kidney organ, crosses the diaphragm, penetrates into the lung and links with the heart. As a result, pains of the heart with dorsal radiation and respiratory difficulty are due to an afflux of the energy of Shaoyin which occurs at this upper part of the body (thorax). This is why one must needle the Foot Shaoyin (Ki). Treatment proves to be ineffective when this afflux starts at the level of the kidney organ which is the source organ of the Shaoyang (SJ).The energy of Sanjiao (SJ) diffuses into the thorax. For this reason, one must needle also the Hand Shaoyang (SJ) to combat the aflux of the energy of the kidney.” II - N.V.N.: Here, treatment consists of first needling Rongquan (Ki 1). If it gives no result, add Guanchong (SJ 1), Jing-well point, responding to the movement “Metal-Lung”.

PARAGRAPH 21 “In pains of the heart, sometimes radiating toward the lower abdomen with pelvic fullness, dysuria and dificult defecation, sometimes

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regaining the top, one must needle the Foot Jueyin (Li).” EXPLANATIONS AND COMMENTARIES

124.

Zhang Shi explains: “Pains of the heart radiating toward the lower abdomen with pelvic fullness are due to the afflux of the energy of the Jing (channel) of Jueyin (Li). In contrast, pains declaring sometimes at the top, sometimes at the bottom, with dysuria and difficult defecation, originate from the afflux of the energy of the Luo (secondary vessels, energetic branches) of the Jueyin (Li). As a result, the phenomenon of afflux of Jueyin simultaneously involve the Jing and Luo of the Jueyin (Li). This is why one must needle the channel of the Jueyin (Li) to reestablish the circulation of its energy.”

PARAGRAPH 22 “ In pains of the heart with short respiration (hypopnea), one must needle the Hand Taiyin (Lu).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The lung governs the energy. This is the organ of respiration where energetic (gaseous) exchanges are made. It is linked to the cardiac system. Pains of the heart with short and difficult respiration are due to the afflux of the energy of the lung toward the heart. This is why one must needle the Hand Taiyin (Lu) to reestablish normal circulation of the lung organ.” II - N.V.N.: In cardialgia with hypopnea, the Dacheng proposes Taiyuan (Lu 9), Shu-Yuan point of the lung channel, responding to the movement “Earth-Spleen”.

PARAGRAPH 23 “In pains of the heart, one must look for the point located to the side of the 9th dorsal vertbrae that one massages (with the finger) before needling. After removal of the needle, perform the same acts of massage and the pains disappear immediately. If there is no amelioration, massage and needle the points located above and below the point needled; as soon as the Deqi (obtaining the energy) arrives, the pains disappear, as if by magic.”

EXPLANATIONS AND COMMENTAIRES I - Zhang Shi explains:

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125...

“This paragraph concludes the previous 5 concerning the 5 types of cardialgias provoked by the reascent of the energy of the 5 organs. “The point located to the side of the 9th dorsal vertebrae” designates Hunmen (Bl 47), 1.5 cun outside of Ganshu (Bl 18). The Hun (vegetative soul) of the liver organ and Shen (mental) of the heart organ follow one another and execute the movements of entry and exit. This is why it is advised to needle Hunmen (Bl 47) to aerate the energy of the heart. “Massage before needling and massage again after needling” are the acts of conduction and aeration of the energy permitting cure of pains of the heart. “The point located above the needled point (Bl 47)” is Geguan (Bl 46), 1.5 cun to the side of Geshu (Bl 17), and the “point located below the point needled” is Yanggang (Bl 48), 1.5 cun to the side of Ganshu (Bl 19). The energy of the heart and that of the liver are propelled toward the exterior by the diaphragmatic movements. This is why, in the event of non-cure, one must massage and needle these two points, Geguan (Bl 46) and Yanggang (Bl 48) to aerate the Xin-Shen (mental of the heart) and Liver-Hun (vegetative soul of the liver).” II - Ma Shi adds: In pains of the heart, it is also advised to choose the point located below the spinal process of the 9th dorsal vertebra, that is to say Jinsuo (GV 8), belonging to the Dumai (GV). To obtain cure, one must massage before needling. If this technique does not give a result, one must again massage and needle below the spinous process of the 8th dorsal vertebrae (absence of energetic point) or below the spinal process of the 10th dorsal vertebrae (absence of energetic point); cure is immediate.” (Figure 36) 126...

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Figure 36: Treatment of cardialgias due to the reascent of the energy of the organs. _ Treatment of Zhang Shi : Bl 47 or 46 and 48. _ Treatment of Ma Shi : GV 8 or the Ashi point located above or below GV 8.

PARAGRAPH 24

125...

“In maxillary pain, one must needle and bleed Q u y e (other name Jiache- St 6) of the Foot Yangming (St); the pains cease immediately. If they do not disappear, one must add Renying (St 9); cure is immediate.” EXPLANATIONS AND COMMENTARIES

126...

Ma Shi explains: “The point Jiache (St 6), located at the inferior maxillary angle, is sourrounded by capillaries, hence the name Quye (section of passage of capillaries). If one succeeds in bleding it, the pains cease immediately. If not, needling Renying (St 9) assures cure. Recall that the left radial pulse also carries the name Renying.” (Figure 37)

Figure 37: Specific points of treatment of maxillary pain.

PARAGRAPH 25 “When the contrary afflux is triggered toward the top, one must needle the point located in the intercostal space and the arterial point at the bottom of the thorax.”

EXPLANATIONS AND COMMENTARIES 127. I - Zheng Shi explains: “The contrary afflux is triggered toward the top” means a massive arrival in the wrong

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direction toward the top. “Intercostal spaces of the thorax” are the sites of passage of the Foot Yangming (St). Therefore, needling the energetic points located in these sites permits reestablishing the normal circulation of this channel toward the top.” II - Ma shi comments: “In the contrary flow toward the top, one must needle the point located in the intercostal space, Yingchuang (St 16), belonging to the Yangming (St), and the “arterial” point of the thorax, Tanzhong (CV 17), belonging to Renmai (CV).” III - N.V.N.: But according to Zhang Jing Yue: “The point located in the intercostal space is designated Wuyi (St 15) and the arterial point is none other than Zhongfu (Lu 1).” The energetic points proposed by Ma Shi and Zhang Jing Yue to treat contrary afflux toward the top do not result from the same reasoning. Dan Pa Yuan Jian gives evidence that the commentaries of these two authors are incorrect and this was transmitted by the following remark: “Tanzhong (CV 17) is not located by an artery and Zhongfu (Lu 1) is not located at the bottom of the thorax... . This is truly strange... .” These words were related to qualification of documentation and research. Note, however, that the intercostal spaces and thorax are highy vascularized by numerous vessels and capillaries originating particularly from the mammary artery; all the energetic points of this region are therefore surounded by capillaries.

PARAGRAPH 26

128.

“In abdominal pains, one must first needle pressure) the artery located to the left and right is often immediate. If the pains do not cease, one massage Qijie (other name Qichong-St 30 ); cure is

then massage (by of the umbilicus; cure must needle and then instantaneous.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“ The Foot Yangming (St) descends vertically to the breast, then redirects inside and passes to the side of the umbilicus to penetrate into the groin at the point Qijie (Qichong) St 30, point of entry/exit of the energy. Abdominal pains come from the afflux/obstruction of the energy of Yangming. This is why one must needle and massage the “arterial” point, Tianshu (St 25). If the pains do not disappear, one must stick and massage Qijie (St 30) in the goal of bringing the energy toward the exterior (to the skin). At Qijie (St 30), the energy of the Yangming becomes exteriorized to the skin; then after having irrigated the epidermo-dermal system, it returns to this point to complete its circulatory cycle.”

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II - N.V.N.: According to Zhang Jing Yue (1563-1640 A.D.), Huangshu (Ki 16), located 1 cun to the side of the umbilicus, also plays an important role in the treatment of abdominal pains (Figure 38)

Figure 38 : Treatent of abdominal pains.

PARAGRAPH 27

129.

“In Wei-Jue (limb flaccidity). it is advised to tie up the 4 limbs of the patient and liberate them upon the appearance of a sensation of irritation. This method must be performed 2 times per day; the sensation gradually returns at the end of 10 days. Repeat the process until definitive cure.” EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“The preceding paragraphs demonstrate the case of stoppage of the movements of descent of the energy of the Yangming caused by the phenomenon of contrary afflux, while this one studies the case of non-distribution of the energy of Yangming at the level of the 4 limbs, repsonsible for

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the disease “Wei-Jue”. _ “Wei” implies the sense of flacidity of the limbs without force. _ “Jue” cold, icy limbs. The method of tying, hand and foot, the limbs is based on the conduction of the energy.”

PARAGRAPH 28

“To stop hiccups, one scratches the nostrils of the patient with the aid of a straw with the purpose of provoking sneezing; or else one plugs up the nostrils of the patient with the aid of fingers so as to prevent respiration; or also one provokes a great fright in the patient. The result is immediate.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The Yangming (St) receives the energy of the cereals and, via the route of the Taiyin (Sp), it conducts it toward the lung which, in turn, spreads it toward the epidermo-dermal system. The lung, disturbed by energetic afflux, redirects this “cereal” energy toward the stomach which provokes a concommitant afflux at the level of these organs. The energy of Yangming is restrained from becoming exteriorized by the laryngo-pharyngeal route, hence hiccups.”

II - N.V.N.: In conclusion, Chapter 26 demonstrates the causes of “various diseases” brought on by the afflux of the energy, by the afflux of the channel or also by concommitant afflux of the energy and channel. The study begins with the Taiyin and ends with the Yangming because: _ the Taiyin governs Yang Qi (Yang energies) _ and the Yangming is the production source of Xue-Qi (blood-energy).

130.

Diseases do not leave the etiologic sphere “endogenous-exogenous” and are all able to provoke contrary afflux phenomena (Jue Ni) of the blood and of the energy. Since the majority of diseases are of “obstruction/afflux” origin, the causes and syndromes cited in this chapter and the previous ones constitute a base of clinical research of energetic medicine to diagnostic and therapeutic purpose.

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131.

CHAPTER XXVII Erratic and Cyclic Pains

(Zhu Bi)

“Zhu” signifies cycle, implying the cyclic circulation of the 12 Jingmai. “Bi” signifies pain and paresthesia (algoparesthesia)/obstruction. Chapter 27 of the Lingshu demonstrates the etio-pathologic process of Bi, in particular, of Zhu Bi (pain and paresthesia of the cyclic circulation of the Jingmai) and of Zong Bi (pain and paresthesia of the Dai Luo = great secondary vessels). Zhu Bi is always preceded by a phenomenon of Jue Ni (contrary afflux), and Zong Bi, by a phenomenon of blockage. In the first case, the therapeutic technique called Top-Bottom/Bottom-Top is is expressly advised, and in the second case, the therapeutic technique called Left-Right/Right-Left (needling on the opposite side) is indicated. Ma Shi writes: “This Chapter 27 studies the progression of pain following the Jing and the Luo, hence the name Zhu Bi. It is advised to consult Chapter 43 (“Discourse on Obstructions”) of the Suwen to complete our knowledge.” This chapter comprises 6 paragraphs.

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PARAGRAPH 1 Huangdi questions Qi Bo: “Within the organism, Zhu Bi follows the path of the vessels (channels) and reaches the top or bottom, the left or right of the body. Are these pains located within the vessels or the flesh? Why do they move? Sometimes the shifting of these pains is so rapid that one hasn’t time to put the needle in; sometimes the treatment isn’t yet performed then these pains have already disappeared... . Why?” 132.

Qi Bo replies: “It is a matter of the Bi Syndrome (pain/obstruction) and not of the Zhu Bi Syndrome (pain/obstruction of the cyclic circulation).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This chapter shows the entanglement of the Jingmai (principal channels) and Luomai (secondary vessels). The Jingmai are the 12 channels belonging to the organs and bowels traveling the top and bottom of the body, while the Luomai are the large vessels leaving from Yin toward Yang. from Yang toward Yin, from left toward right and from right toward left. Bi (pain/obstruction) is an ailment caused by the fusion of 3 perverse energies (wind, cold, dampness) which gather in the cutaneo-dermal spaces and flow out into the Dai Luo (Great Luos), hence the name Zong Bi (Bi of the extended space). When these perverse energies become directed into the Jingmai (principal channels) the phenomenon called Jue Ni (contrary afflux) arises, causing Zhu Bi (Bi of the cyclic circulation). The cyclic and erratic nature of the pain brought up by Huangdi is based on Yin and Yang, on blood and energy, on superficial and deep, on skin and flesh and on Jingmai and Luomai. This is why, to reply to the question posed by Huangdi, Qi Bo distinguishes two types of Bi: Zong Bi and Zhu Bi.”

II - N.V.N.: The word Bi designates a sensation of joint and muscular pain, heaviness and numbness. It is a question, therefore, of an algoparestheia. The Suwen, Chapter 15 (“Important Theory Inscribed on Jade”), states: “The energy which the human being receives originates from the cereals. The place where the cereals arrive is the stomach. The stomach is then the “sea” of the Cereal Water, of the Blood and Energy. The paths by which the stomach releases these nutritive substances has the name

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Jing Sui (deep paths) which constitute the system of Dai Luo”. In other words, the blood and energy released by the stomach spreads into the epidermodermal system via the paths of the Dai Luo. Therefore, when perverse energy becomes seated in the skin and flesh, it infiltrates into the Dai Luo to activate Zong Bi. 133.

Figure 39: “Top-Bottom/Bottom-Top” and “Left-Right/Right-Left” circulatory systems.

PARAGRAPH 2 Huangdi: “How does Zong Bi m a i n f e s t ? ” Qi Bo:

“ Zong Bi manifests successively in different areas. Cured at one place, it passes to another place, from left to right, right to left... its presence is therefore not felt everywhere at the same time.” Huangdi: “Good!

How do you needle it?”

Qi Bo:

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“Although the pain has disappeared due to acupuncture, one must repeat the same procedure at the original place affected to avoid relapse.” EXPLANATIONS AND COMMENTARIES

134.

I - Zhang Shi explains: “ ... successively in different areas” implies the overflowing of perverse energy toward the Dai Luo. The pain changes place constantly; it is therefore not a generalized pain. In Zong Bi (pain/obstruction of the Dai Luo), the pain always manifests in the area opposite to that of the illness. The illness being at the left, the pain localizes at the right and vice versa. This is why, therapeutically, one must needle not only the painful point, but also the site where the illness originally localized.” II - N.V.N.: In practice, it is necessary to reinforce the energy of the body. Therefore, the treatment of Zong Bi consists not only of dispersing painful points (A Shi), but also tonifying the Yangming.

PARAGRAPH 3 Huangdi: “How does Zhu Bi m a n i f e s t ? ” Qi Bo:

“ Zhu Bi takes place within the vessels-channels. It evolves toward the top or bottom, following the direction of these vessels, without going through the left or the right, at successive, specific spots.” Huangdi: “How do you needle it?” Qi Bo:

“If the vessel affected goes from above downward, it is necessary, in the first place, to needle the bottom in to curb the progression of the illness, and in the second place, the top, to evacuate it toward the exterior. Similarly, if the vessel affected is directed from below upward, it is necessary, in the first place, to needle the top to curb the evolution of the illness, and, in the second place, the bottom, to evacuate it toward the exterior.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

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“This paragraph concerns the therapeutic technique of Zhu Bi. As indicated by its name, this ailment occurs within the vessels-channels (Jingmai) to evolve toward the top or the bottom according to the direction of these vessels-channels. Zhu Bi differs, therefore, from Zong Bi. Therapeutically, if the illness belongs to the descending vessel, it is advised to needle first the painful spot located down below to stop its progression, then the painful point located above to eliminate the “source” of the illness, thereby preventing it again reaching the bottom. The same treatment, but reversed, is reserved for the ascending vessel. For this reason, technique called Top-Bottom or Bottom-Top is expressly advised in the treatment of Zhu Bi. As for the technique called Left-Right or Right-Left, it is reserved for the treatment of the Zong Bi Syndrome.” 135. II - N.V.N.: It is also recommended to consult Chapter 63 (“Discourse on Needling on the Opposite Side”) of the Suwen, concerning “needling of the opposite side” (Mu Ci) and “great needling” (Ju Ci), to better understand this subtlety of acupuncture practice.

PARAGRAPH 4 Huangdi: “Good! name?”

What are the causes of these pains and what justifies their

Qi Bo” “Once lodged within the dermis, the 3 perverse energies “WindCold-Damp” force the organic liquid to be transformed into scum (Bo). Upon encountering the cold, these scums become concentrated and provoke the breaking up of the flesh fibers, hence pain. Then the XinShen (Heart-Mental) gathers at this spot (painful), bringing heat there which eases the pain. The phenomenon of afflux (Jue) appears during relief of the pain which is revealed by Bi whose manifestations come to be added” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“Shen designates the Qi (energy) of the body. Qi brings heat and the heat relieves the pain, but it does not cure it, hence the appearance of the phenomenon of Jue Ni (contrary afflux). The 3 perverse energies, Wind-Cold-Damp, then follow the blood and energetic (channels) vessels and progress toward the top or bottom. It is, therefore, a matter of the pains of the Zhu Bi type.”

II - Zhang Shi states:

“This paragraph explains the etiopathological process of the Zhu Bi syndrome. The 3 perverse energies, Wind-Cold-Damp, infiltrate into the carnal spaces and flow toward the

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vessels-channels to trigger the phenomenon of Jue Ni (afflux), responsible for Zhu Bi. The scums (Bo) are the viscous substances released during the confrontation of WindCold-Damp and the organic liquid.”

PARAGRAPH 5

136.

Huangdi: “Right! Summarizing, the syndrome of Zhu Bi is not located at the organs, but at the exterior, within the distribution of the flesh, preventing the source energy (Zhen Qi) from following its cycle, hence the name Zhu Bi. This is why, to treat the Zhu Bi syndromes, it is necessary to examine the state of emptiness or fullness of the channels of the bottom (foot) and the state of blood stagnation at the level of the Dai Luo or the state of their weakening caused by emptiness, then circulate the blood and energy by acupuncture or by the application of poultices and activate their circulation in the event of spasm.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“ a - Generally, when perverse energy infiltrates within the organism, it lodges in the skin and body hair. If it doesn’t go away, it provokes the opening of the pores and penetrates into the dermis. If one doesn’t drive it out, it flows out into the Jingmai which link to the organs. But here, it is a matter of a concomitant penetration of 3 perverse energies, Wind-ColdDamp, into the dermis. These energies flow down into the Jingmai to provoke there the phenomenon of Jue Ni (contrary afflux) and trigger the syndrome Zhu Bi (blockage of the cyclic circulation). It is why Huangdi stresses: “This syndrome does not become seated in the organs... “. b - When perverse energy becomes located within the dermis, the dermis goes into fullness, and the Jingmai are empty. Similarly, when Jue Ni occurs in the Jingmai, these are in fullness, and the dermal part is in emptiness. Therefore, it is necessary to examine well the emptiness and fullness in order to tonify or disperse. Such is the therapeutic conduct of the syndrome Zhu Bi (Figures 40 and 41). c - “ ...blood stasis within the Dai Luo” implies the presence of perverse energy in these vessels. “ ...weakening caused by emptiness” indicates that the energy of the Luo in a state of emptiness is retained in the interior (channel). d - “Poultices” are medicinal preparations applied onto the skin to combat pains or inflammations. They have the power to evacuate perverse energy held in the interior. In the presence of spasm or laxity, massage therapy is strongly advised to activate the circulation of energy and blood. It is well urilized in this type of illness.”

II - N.V.N.: The thesis of Zhang Shi can be diagrammed in the following manner:

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137.

Figure 40: Etiopatholgic process of Zhu Bi.

Treament of the syndrome of Zong Bi:

------>> Disperse painful (A Shi) points and the opposite points (technique of needling on the opposite side) ------>> Tonify the corresponding Jingmai

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Figure 41: Syndrome of Zong Bi and treatment. 138.

Treatment of the syndrome of Zhu Bi

--------->> Disperse the affected channel (Technique of needling “Top-Bottom” and “Bottom-Top”) --------->> Tonify blood and energy of the body at the level of Yangming

Figure 42: Syndrome of Zhu Bi and treatment.

PARAGRAPH 6 Huangdi: “Good. I have grasped the meaning of the term Zhu Bi and the l o c a l i z a t i o n of this illness. The rules of the 9 Needles are explicit and easy to apply; they shed light on the syndromes of the 12 Jingmai and of Yin-Yang.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Huangdi underscores that the “9 Needles” is an easy and rational method which instructs on Yin and Yang, blood and energy of the organism. But how to determine front and back, entry and

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exit, according to the Great Dao of Heaven and Earth? The scholar judges them after the actions of acupuncture. Only in this way do we not commit ungratefulness regarding our learned ones of long ago.” 139.

CHAPTER XXVIII Oral Questions (Kou Wen)

This chapter of the Lingshu demonstrates the etiology, classification and descriptions and therapy of the 12 diseases at the level of the “orifices” (eyes, nose, ears, mouth) caused by the 12 perverse energies called singular (Jie Xi). Called singular perverse energies, these perverse energies differ from the usual perverse energies (6 cosmic energies, 7 psycho-affective components, food intoxication...). These singular diseases (Ji Bing) (1) are not well developed in the ancient books (before the period of Huangdi). Their understanding originates from an oral transmission from the master teaching of Qi Bo. This is why this chapter is entitled: “Oral Questions” (Kou Wen). Chapter 28 consists of 15 paragraphs.

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1. See also Chapter 28 of the Suwen: “Essay on the Singular Diseases”.

PARAGRAPH 1 Free from all imperial obligations, Huangdi dismissed his advisors and posed this question to Qi Bo: “I have heard you speak of the Classic of 9 Needles and study in extensive fashion the favorable and unfavorable problems of Yin and Yang and of the 6 channels (3 Yin and 3 Yang). Now, I want you instruct me on the Oral Questions (Kou Wen).” Qi Bo moved, bowed his head respectfully and, hands crossed, replied: “Your request is most pertinent! It is a matter here of oral transmissions handed down by our ancestors”.

140.

Huangdi: “I would like to be enlightened on this subject.” Qi Bo: “100 Diseases” all have for origin wind or rain, cold or heat, Yin or Yang, joy or anger, diet or psycho-affective behavior, great fear or sudden fright... . In these cases, _ _ _ _ _ _ _

blood and energy separate Yin and Yang grow weaker Jing and Luo become exhausted the circulatory routes are blocked Wei (defensive) energy stagnates the Jingmai are in emptiness energy and blood are in disequilibrium... .

These phenomena, not conforming to the general rules, are wellknown to you. But there exists diseases called singular not occuring at the level of the channels; permit me, therefore, to submit them to you.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “The Classic of 9 Needles” (Zhen Jing) is a book of acupuncture of the ancient epoch. In this paragraph, in addition to written transmission, Huangdi desires to be informed of oral transmissions, besides Yin and Yang and the 6 channels, of other energetic routes which are still unknown to him, besides internal and external causes, of other singular causes still undefined. Generally, diseases are only known to have two causes, exogenous and endogenous. The

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external causes are wind, cold, heat... and the internal causes are anger, fear... . These components injure Ying (nutritive energy) and Wei (defensive energy), Qi (energy) and Xue (blood), Yin and Yang and the Jingmai (principal channels). But there are singular diseases (Ji Bing) which are neither due to one nor the other of these two causes.”

PARAGRAPH 2 Huangdi: “Which

energy

is

responsible

for

yawning?” 141.

Qi Bo:

“Wei energy circulates in the Yang part of the body during the day, and during the night, in the Yin part. Yin

govern

night,

and

night,

sleep.

Yang governs the movements of ascent, and Yin, the movements of descent. This is why, when and the Yang energy is Yin toward the top, but double attraction is at

the not Yin the

Yin energy is still conserved at the bottom yet completely exhausted, Yang attracts the redirects it back toward the bottom. This origin of repetitive yawning.

When the Yang energy is at its end, the Yin energy is in fullness, hence closure of the eyes (sleepiness), and when the Yin energy is at its end, the Yang energy is in fullness, hence opening of the eyes (wakefulness). One must disperse the Foot Shaoyin (Ki) and tonify Foot Taiyang (Bl).”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph explains the cause of yawning and its treatment. Yawning originates from the non-concordance of the circulation of Wei (defensive) energy in the Yang zone (where the 3 Yang of the foot and hand occur) during the day and in the Yin zone (where the 3 Yin of the foot and hand occur) during the night. Yin channels are devoted to the nocturnal circulation, and night obviously causes closure of the eyes (sleepiness). Wei energy responds to Yang and governs the ascending movements, and Ying energy responds to Yin and governs the descending movements. These two words, Yin and Yang, designate therefore Ying and Wei. In the case where Yin energy gathers only down below and where Yang energy is also found at the bottom, this latter pushes the Yin toward the top, but Yin immediately attracts it toward the bottom. These simultaneous movements of attraction of Yin and Yang are at the origin of yawning. (Figure 43) At midnight, everyone is asleep, hence the name Hui Yin (reunion of Yin). During these times, Wei energy ends its cycle and Ying energy is found in a state of maximum plethora, hence closure of the eyes (sleepiness). From midnight, Yin energy grows weaker and Yang energy increases, hence opening of the eyes (wakefulness). As a result, in the individual who sleeps little, yawning is frequent because

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the Foot Shaoyin (Ki) is attacked by the perverse energy called singular (Ji Xie); this is why, one must disperse Zhaohai (Ki 6) of the Yinqiao. Similarly, because the Yangqiao is in emptiness, yawning is also frequent; one must tonify Shenmai (Bl 62). II - N.V.N.: 142. Zhong Jing Yue (1563-1640 A.D.) concludes: “Excess of Yin (Ying) and insufficiency of Yang (Wei) cause yawning. It is recommended to disperse Zhaohai (Ki 6), site of departure of the Yinqiao, and tonify Shenmai (Bl 62), site of departure of the Yangqiao.”

Figure 43: Phenomena of attraction of Yin (Ying) and Yang (Wei): yawning.

PARAGRAPH 3 Huangdi: “In man,

which

energy

is

responsible

for

hiccups

(Yue)?”

Qi Bo:

“Foods penetrate into the stomach and the energy of the stomach flows into the lung. When latent “cold” energy localized in the stomach mixes together with the “cereal” energy, the essential energy and perverse energy confront one another and provoke phenomena of contrary flow (affluxJue Ni), exteriorizing and emitting a noise by the gastric route, the hiccup.

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One must tonify the Hand Taiyin (Lu) and disperse the Foot Shaoyin (Ki).” EXPLANATIONS AND COMMENTARIES

143.

I -Ma Shi explains:

“This paragraph explains the etiopathologic mechanism of hiccups and its treatment. Under the action of the stomach, the “cereal” energy is transformed into extremely fluid energy which flows into the lungs; then from the lungs it reaches the 5 organs and 6 bowels. The meeting of the “cold” energy in a latent state in the stomach and of the “cereal” energy is the cause of the confrontation of the essential and perverse energies. The essential energy designates the energy of the stomach, and the perverse energy the cold coming from the kidney. These two energies become concentrated and afflux toward the top, hence hiccups. It is advised to tonity the Hand Taiyin (Lu) and disperse the Foot Shaoyin (Ki).” II - Zhang Shi states:

“ a - The stomach is the sea of the cereal energy. The lung responds to Heaven and governs the pilo-cutaneous system. The cereal energy penetrates first into the stomach, then it reaches the lung. The lung controls the vessles and directs the Jing Qi (energetic quintessence) toward the skin and body hair. In this way, the vessels and the pilo-cutaneous system receive the Jing Qi and bring it toward the bowels . (Figure 44) b - The lung is primarily affected by cold which is found there in the latent state. This cold perverse is awakened by the cereal energy which bring it toward the stomach. The confrontation of the essential (gastric) energy and perverse energy induces a contrary flow (afflux/Jue Ni) which is ejected to the exterior because the stomach cannot tolerate this type of attack, hence repetitive hiccup. c - The kidney responding to Zhi Yin (extreme Yin) is rich in “water”. The lung responds to the Taiyin (Lu). The Shaoyin (Ki) responding to the pulse of winter has its root (Ben) at the kidney organ and its peak (Jiao) at the lung organ. As a result, the kidney and lung play the role of conserving the “water’ component. In other words, the “Cold-Water” route of the bottom (kidney) communicates with that of Heaven (lung). This is why it is advised: _ to needle in tonification the Hand Taiyin (Lu) to maintain the Yang energy of Heaven _ and to needle in dispersion the Foot Shaoyin (Ki) to attract the cold perverse toward the bottom. The cold perverse and cold originate from the kidney. 144. d - This paragraph establishes an analogy between the organic functions (of the human being) and that of the phenomena of the exterior (Heaven-Earth, Yin-Yang). In this chapter, the perverse energy designates a type of auto-productive energy called singular and non-perverse originating from the exterior (wind, cold, heat...).”

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III - N.V.N.: The pathophysiology and treatment of hiccups described in this chapter is most instructive. The conclusion of Zhang Jing Yue summarizes them perfectly: 1 - The Hand Taiyin is the energetic route of the lung. The Foot Shaoyin is the energetic route of the kidney. The afflux of cold from the bottom toward the top is at the origin of hiccups. For this reason, at the top, one must tonify the lung to increase its potential, and at the bottom, disperse the kidney so that the cold can follow the Water movement to be metabolized. 2 - The peak (Jiao) of the hiccup is located in the stomach, but its root (Ben) is found in the kidney. Generally, one distinguishes two types of hiccup: hiccup-fullness and hiccup-emptiness (or hiccup-cold and hiccup-heat). This paragraph concerns hiccup of the “Emptiness-Cold” type.

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Figure 44: Formation and circulation of the Jing of the lung (according to Zhang Shi). 145.

Figure 45: Etiopathologic mechanism of the hiccup During digestion, the “cereal” energy attracts the cold located in the lung toward the stomach according to the “Mother-Son” system, triggering Hiccup.

PARAGRAPH 4 Huangdi: “Which

is

the

energy

responsible

for

sorrow?”

Qi Bo:

“The fullness of Yin energy and emptiness of Yang energy, the rapidity of Yin energy and slowness of Yang energy, the excess of Yin energy and insufficiency of Yang energy are the principal causes of sorrow. One must tonify Foot Taiyang (Bl) and disperse Foot Shaoyin (Ki).”

EXPLANATIONS AND COMMENTARIES

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I - Ma Shi explains: “This paragraph explains the pathologic process of sorrow and its treatment. Compassion without tears has the name “sorrow”. Clinically, during sorrow, the Yin energy is in fullness and its movements are rapid, while the Yang energy is in emptiness and its movements are slow. Treatment consists of tonifying Yang and dispersing Yin. Tonification of Yang is done at the point of exit of the Yangqiao, that is to say Shenmai (Bl 62), and dispersion of Yin, at the point of exit of the Yinqiao, Zhaohai (Ki 6).” 146. II - N.V.N.: The energy which perturbs the psycho-affective components belongs to Yin. Here, it is a matter of a syndrome of fullness of Yin/emptiness of Yang.

Figure 46 : Etiopathogenic mechanism of sorrow.

PARAGRAPH 5 Huangdi: “Which

is

the

energy

responsible

for

trembling

from

cold?”

Qi Bo:

“When perverse “cold” energy is localized within the skin, the Yin energy is in fullness and Yang energy, in emptiness, hence trembling from of cold. One must needle the Yang channels in tonification.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Trembling from cold is due to the fixation of perverse cold in the pilo-cutaneous system. In this case, one must tonify the Yang channels to restore heat to the skin. In other words, one must aid Yang (heat) to combat Yin (cold).” II - N.V.N.:

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According to Zhang Jing Yue, to tonify the Yang channels corresponds to needling the Yuan and He points of these channels and the point of exit of the Yangqiao (Shenmai- Bl 62). (2) 2. The action of these points is described in MTC - N.V.N. Edition.

PARAGRAPH 6 Huangdi: “Which

is

147.

the

energy

responsible

for

eructations?”

Qi Bo:

“Perverse “cold” energy located in the stomach causes a contrary flow (afflux- Jue Ni) which diffuses from the bottom upward and exteriorizes via the gastric route, hence eructations. One must tonify the Foot Taiyin (Sp) and Foot Yangming (St). Another theory proposes tonification of Mei Ban (named Zanzhu - Bl 2) . ” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“Because perverse cold is located in the stomach, a contrary flow spreads from the bottom upward. Exteriorization of this afflux takes place from the stomach, hence eructations. One must tonify Foot Taiyin (Sp) and Foot Yangming (St) to heat them up. It is also advised to needle the Foot Taiyang (Bl) at the point Mei Ban (Bl 2), also called Zanzhu (Bl 2).”

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Figure 47 : Etiopathogenic processes of eructation. II - Zhang Shi comment: 148. “The kidney is a water-organ and the cold is found above the Taiyang. Hiccup is due to the presence of “cold” energy in the latent state in the lung (coming from the kidney), while eructation also originates from cold “energy” (coming from the kidney), but lodged within the stomach. Dispersion of the “cold” energy at the level of Shaoyin (Ki) and tonification of the Yang energy of Taiyang are different, but have the same meaning.”

III - N.V.N.: This paragraph (concerning eructation) and Paragraph 3 (concerning hiccups) raise the same problem of the presence of cold in the stomach. In the first case (eructations), the perverse cold comes directly from the kidney. According to Zhang Jing Yue, this singular perverse energy is compared to a guest who comes to arrive. Its location is found at the stomach. In the second case (hiccups), the “cold” energy also comes from the kidney, but it remains in the latent state in the lung (see Paragraph 3). Its location is therefore deep. The choice of points and channels cited in the text is justified by the mechanism of activation of the illness.

PARAGRAPH 7 Huangdi: “Which

is

energy

responsible

for

sneeze?”

Qi Bo:

“In harmony, the Yang energy fills the heart, invades the nose and comes back out via the nostrils, hence sneeze. One must tonify the Foot Taiyang (Bl) at the point Mei Ban (ZanzhuBl 2). Another theory proposes the point Mei Shang (Meichong-Bl 3). ” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Yang energy, when it is peaceful and favorable, fills the heart and gathers at the nose, hence sneeze. Mei Shang designates Meichong (Bl 3), having the same action as Zanzhu (Bl 2), point to needle to 0.3 cun depth; leave the needle in during 6 expirations and apply 3 moxas.” II - N.V.N.: 1 - According to Zhang Jing Yue, sneezing can also be due to the presence of Wind-Cold at the level of the pilo-cutaneous system preventing the Yang energy from reaching the exterior. It is obliged to follow the nasal route. As a result, sneezing originates from the noisy manifestation of the Yang energy of the body.

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149. 2 - The presence of cold in the abdomen causing the emptiness of Yang can prevent some individuals from sneezing, despite their desire. As a result, in the chronic emptiness of Yang, sneezing is a good sign of recuperation of the Yang energy. 3 - In emptiness of Yang of the bottom with sneezing, tonification of Zanzhu (Bl 2) or Meichong (Bl 3) is advised because the Taiyang (Bl) and kidney constitute the “Yin-Yang, Interior-Exterior” system. This technique constitutes what one calls “Tonification of Yang in Yin” (See Chapter 23 (“Discourse on the Five Energies”) of the Suwen).

Figure 48: Etiopathologic process of the sneeze.

PARAGRAPH 8 Huangdi: “Which energy is responsible for “Qi Tuo” (energetic relaxation; muscular laxity.” Qi Bo:

“Emptiness of the stomach causes that of the vessels, responsible for muscular atony. In individuals affected by this illness who indulge in sexual relations, the Yuan Qi (energy source) can not be recuperated, hence muscular laxity. Look for the location of the illness and tonify the interdermal spaces locally.” 150. EXPLANATIONS AND COMMENTARIES

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I- Ma Shi explains: “Qi Tuo designates a diminution of tonicity or elasticity of the muscles and tendons of the neck, back and limbs, hence head tilted to one side and curved back.” II - Zhang Shi states: “The muscles and vessels take their source from the stomach bowel and are maintained by Water-Cereal. This is why the deterioration of the energy of Yangming is the principal cause of muscular laxity. The Yangming humidifies Tongjin (system of reunion of the muscles making up the genital muscles). In the event of muscular laxity, one must tonify the intramuscular spaces of the affected area, the Yangming.”

PARAGRAPH 9 Huangdi: “What is the energy responsible for outflowing of tears during sorrow?” Qi Bo:

“The heart is the sovereign organ of the 5 organs and 6 bowels. The face is the site of gathering of the Sun Mai (little energetico-blood capillaries) and of the Shang Ye (upper liquid routes). During compassion, sadness, sorrow,... the heart is agitated and s h a k e s the 5 organs and 6 bowels which, in their turn, influence the Sun Mai. Agitation of these latter open the Shang Ye and tears flow out freely. The organic liquid (Ye) is an aqueous substance humidifying the Jing Qi (quintessence of the energy) of the orifices. The unremitting outflow of tears is one of the causes of depletion of the organic liquid, hence diminution of visual acuity (amblyopia). This phenomenon bears the name Duo Jing (abduction of Jing energy). One must tonify the point Tianzhu (Bl 10) located at the neck.”

151.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Crying with tears has its root at the heart. The heart governs the 5 organs and 6 bowels. The face is the site of reunion of the Sun Mai and Ye Qi (energetic-liquid routes). The mouth and nose are the doors and windows of Qi (energy). This is why, during psycho-affective disturbances (sorrow, sadness...), agitation of the heart causes a series of agitations of the 5 organs and 6 bowels which, in their turn, have repercussions on the Sun Mai and provoke the opening of the liquid routes located at the level of the face, hence tears, rhinorrhea, sialorrhea... . The Ye (organic liquid) of the face has the function of humidifying the Jing (quintessence) of the “orifices”. As a result, an incessant outflow of tears is one of the causes of amblyopia. This

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ailment is due to the phenomenon called Duo Jing (usurpation of Jing). One must tonify Tianzhu (Bl 10) located 0.5 cun above the edge of the hairline of the nucha and 1.3 cun to the side of Yamen (GV 15); needle depth 0.2 cun; left in during 6 expirations; apply 7 moxas.” II - N.V.N.: The mechanism of the production of tears during sorrow can be diagrammed in the following fashion:

Figure 49: Mechanism of outflowing of tears.

PARAGRAPH 10 Huangdi: “What

energy

152.

is

responsible

for

sighing?”

Qi Bo:

“During anxiety, the cardiac system retracts and provokes contraction of the energetic routes with circulatory hindrance. result, sighs are respiratory movements intended to reestablish circulation of the energy. It is advised to tonify the Hand Shaoyin (He), Xin Bao (XB) Shaoyang (GB) and leave the needles in place.”

a As a the and Foot

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph concerns the respiratory movements simultaneously controlled by Tong Qi (thoracic energy or a priori energy) located in the Shangjiao (Upper Jiao- UJ) and by Sheng Qi (birth energy) located in the Xiajiao (Lower Jiao- LJ). (Figure 50)

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Tong Qi is conserved within the thorax, reaches the laryngo-pharyngeal system and is directed toward the vessels of the heart to accomplish respiratory function. During anxiety, the cardiovascular system retracts and causes depletion of the energetic and blood routes. Sighs then are respiratory movements necessary for the reactivation of the energetic circulation. Sheng Qi is constantly in liason with Tong Qi via the action of the Sanjiao (SJ). Treatment consists of tonifying the Hand Shaoyin (He), Xin Bao (XB) and Foot Shaoyang (GB). In other words, this therapeutic is aimed at tonifying the energy created by the kidney (that is to say, that of the Shaoyang (GB), according to the “mother-son” law) and at reestablishing the liason of this energy (GB) with that of the heart and Xin Bao (XB). Moreover, to tonify the Hand Shaoyin (He) and Xin Bao (XB) is to aerate the Shangjiao (UJ); and to tonify the Foot Shaoyang (GB) and leave the needle in permanently is to activate the reascent of Sheng Qi from the Xiajiao (LJ) toward the Shangjiao (UJ) to reestablish their liason, thereby combatting sighs.” II - N.V.N.: The explanation of Zhang Shi can be diagrammed in the following fashion: 153.

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Figure 50: Control of cardio-pulmonary movements by Tong Qi and Sheng Qi.

PARAGRAPH 11 Huangdi: “What

is

the

energy

responsible

for

sialorrhea?”

Qi Bo:

“During food absorption, if the stomach is affected by heat, it awakens the lines (intestinal) causing the movements of descent of the energy of the stomach. Above, the point Lianquan (CV 23: source of saliva) opens, hence sialorrhea. One must tonify the Foot Shaoyin (Ki).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The energy of the Foot Shaoyin (Ki) is directed toward the top to unite with the stomach to aid it in metabolizing the water-cereal (food). 154. The intestinal lines are of the Yin type. The awakening of these Yin spaces prevents the energy of the kidney from linking up with the Yangming (St). Since the energy of the kidney is no longer directed toward the top (stomach), the dietary water carries out movements following the route of the Renmai (CV) to reach the point Lingquan (CV 23), hence sialorrhea. It is recommended to tonify the Foot Shaoyin (Ki) to favor the ascent of the energy of the Xiajiao (LJ). When this energy reaches the top, the perverse water automatically carries out movements of descent.” II - N.V.N.: Sialorrhea, due to a rupture of the “Kidney-Stomach” liason, can be diagrammed in the following fashion:

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Figure 51: Process of triggering sialorrhea.

PARAGRAPH 12 Huangdi: “What

energy

is

responsible

for

tinnitus?”

Qi Bo:

“The interior of the ear is the site of reunion of numerous Sun Mai (energetic-blood capillaries) coming from the 12 Jingmai (principal channels). When the stomach is in emptiness, these capillary vessels are also in emptiness and cause a depletion of blood and energy at the level of the ear, hence tinnitus. 155. One must tonify Ge Zhu Ren (Shangguan-GB 3) and the point located at the tip of the thumb, at the place where the flesh is close to the nail.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph concerns the production of blood and energy at the level of SpleenStomach under the propulsion of the energy of the kidney. The lung is the site where all the Jingmai of the organism intervene; it also controls all the Sun Mai (little energetic-blood capillaries) of the “orifices”. The ear is one of the sites of gathering of all these Sun Mai, whose blood and energy originate from the Water-Cereal (Shui Gu: foods). Consequently, when the stomach is in emptiness, it automatically causes emptiness at the level of the Sun Mai with outflowing of the energy toward the bottom, hence depletion of blood and energy at the level of the ear responsible for tinnitus. It is advised to tonify Ge Zhu Ren (GB 3) to provoke reascent of the energy which flows out toward the bottom.” II - Ma Shi comments;

“This paragraph explains the etiopathologic process of tinnitus and its treatment. The ear is the site of reunion of the Sun Mai, maintained by the energy of the stomach. This is why, when the stomach is in emptiness, the Sun Mai of the ear are deprived of blood and energy, hence tinnitus. It is advised to tonify Ge Zhu Ren (GB 3), also called Shangguan (GB 3), point located in front of the ear on the upper edge of the zygomatic arch, in a crease which is formed by opening the mouth; needle depth 0.1 cun (do not exceed), left in permanently during 7 expirations, moxa 3 times. It is also advised to tonify the point located at the external ungual angle of the thumb (energetic description), at a distance from the nail equal to the thickness of a Gao (chive) leaf; needle depth 0.1 cun, left in during 3 expirations, moxabustion advised against.” (3) III - N.V.N.: 1 - Ge Zhu Ren (GB 3) is the point of reunion-meeting of the Foot Shaoyang (GB) and Hand

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Shaoyang (SJ). (4) 3. It is a matter of the point Shaoshang (Lu 11). 4. See the explanation in M.T.C. - N.V.N. Edition.

This point can be chosen in the event of disturbances of the energy of the channels of the Sanjiao (SJ), gallbladder and stomach, causing tinnitus or temporary deafness. Tonification and dispersion of this point must be performed according to the emptiness and fullness of the illness. Ge Zhu Ren (GB 3) is located on the upper edge of the zygomatic arch, just above Xianquan (St 7). 2 - Ying (nutritive energy) and Wei (defensive energy) have their root at the level of the acquired energy (“Water-Cereal”); their activity and their relationship are controlled by the innate (ancestral) energy located at the level of the Xiajiao (LJ= Kidney-Liver). For this reason, _ in Paragraph 10, the energy of Shaoyin (Ki) reaches the top to unite with the Tong Qi (innate or thoracic energy) in order to control the respiratory movements. _ in Paragraph 11, the energy of Shaoyin (Ki) reaches the top to unite with the Yangming (St) in order to control food metabolism. _ in Paragraph 12, the energy of Shaoyin (Ki) reaches the top (at the face) to unite with the Sun Mai in order to control the auditory system. In short, the energy of the kidney controls: _ cardiopulmonary movements, _ digestive movements _ and auditory movements. (Figure 52)

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Figure 52: Systems of control of the kidney (after Paragraphs 10, 11 and 12).

PARAGRAPH 13

157.

Huangdi: “What energy is responsible for biting of the tongue?” Qi Bo:

“An opposite flow (afflux- Jue Ni) of the energy, together with the ascent of the energy of Zhongjiao (MJ), can be at the origin of this affliction. When it concerns the energy of Shaoyin (Ki), biting occurs at the level of the tongue; when it concerns the energy of Shaoyang (GB), the biting occurs at the level of the cheek; when it concerns the energy of Yangming (St), biting occurs at the level of the lips. One must observe the site of biting and tonify the corresponding channel.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“ 1 - The cereal energy, distilled at the level of the Zhongjiao (MJ), is an a posteriori energy having its source at the Xiajiao (LJ), belonging to a priori Yin-Yang . The energy of the Zhongjaio (MJ) and that of the Xiajiao (LJ) reunited to perform their circulatory movements. 2 - The teeth are created by the energy of the kidney. The Shaoyin (Ki) possesses vessels which branch to the base of the tongue. The Shaoyang (GB) possesses vessels which distribute to the cheek. The Yangming (St) possesses vessels which encircle the lips. 3 - When the kidney energy contracts and affluxes toward the top following that of the Zhongjiao (MJ), the tongue goes outside the teeth, the lips press against the teeth, the cheeks become stuck between the teeth... . In summary, this paragraph has taken for an example biting the tongue in order to explain the dependence of the a priori energy on the circulation of blood and energy of the Yangming (St).”

II - N.V.N.: According to Zhang Jing Yue, _ the contrary afflux (Jue Ni) of the energy toward the top always causes an overflowing of blood and energy to create the diseases called singular (Ji Bing) whose location is very specific; _ the base of the tongue is the site of branching of the energy of Shaoyin (Ki) 158. _ the ear and cheeks are the sites where the energy of the Shaoyang (GB) circulates _ the mouth and lips are the sites encircled by branches of the energy of Yangming (St) The afflux of each of these energies passes therefore into a specific zone; one assists then

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in the bites of various types. Besides these bites, other ailments, like inflammations and itching sensations, are also distinguished.

Figure 53: Afflux of the energy and different types of biting.

PARAGRAPH 14 The 12 illnesses cited above are caused by an ascent of perverse energy called singular (Ji Xie) toward the “orifices”. This is why an insufficiency always manifests at the place where the illness is seated. Therefore, _ the insufficiency of the energy of the top part of the body is a sign of a malnutrition of the brain, hence buzzing in the ears, head tilted toward the shoulder, diminution of visual acuity... . _ the insufficiency of the energy of the center (Zhongjiao- MJ) is characterized by a change in stool (diarrhea or constipation) with boborygmi... . _ the insufficiency of the energy of Xiajiao (LJ) is manifest by atrophic impotence (Wei) (5) with cold limbs, anxiety... . 159. One must tonify underneath and behind the external malleolus and leave the needle in place.”

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5. Do not confuse the defensive Wei energy with the Wei disease (atrophic impotence) which has the same pronounciation but different ideograms.

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

This paragraph shows the general conclusion of the 12 illnesses cited in this chapter, illnesses caused by a defect in maintainance of the “orifices” (ears, nose, mouth, eyes) by the organic liquid. Perverse energy is referred to as singular when it comes neither from the exterior (wind, cold, heat...) nor from the interior (psychoaffective components). It is a question of phenomena of non-irrigation of organic liquid at the level of the “orifices”. This is why the place where the singular illness is seated always is indicated by an organic liquid deficiency. This information clearly explains that inactivity of the essential energy is the at origin of the production of the “singular” perverse energy. Therefore, _ the insufficiency of cerebral energy (cerebral Jing), with ear buzzing, encephalgia, amblyopia, etc., originates from the deficiency of essential energy at the top part of the body. _ disorders of defecation (diarrhea or constipation) are a consequence of the deficiency of “central” energy (Zhong Qi= energy of Zhongjiao- MJ). _ atrophic impotences with cold limbs (Wei Jue) result from the deficiency of the energy of the Xiajiao (LJ), and anxieties originate from rupture of the “Top-Bottom” (Heart-Kidney) connection. It is recommended to tonify the point located below and behind the external malleolus, Kunlun (Bl 60), and allow the needle to remain in place up to the arrival of the Deqi because: _ the Taiyang (Bl) belongs to the 3 Yang which responds to Heaven (cephalic part) _ Kunlun (Bl 60) is the point of departure of the organic liquid toward the top.”

PARAGRAPH 15 Huangdi: “How must one treat these singular diseases?” Qi Bo:

Foot

160.

“The kidney governs yawning; one must needle Foot Shaoyin (Ki). The lung governs hiccups; one must needle Hand Taiyin (Lu) and Shaoyin (Ki).

Sorrow (with or without tears) results from the exhaustion of Yin and Yang; one must tonify Foot Taiyang (Bl), disperse Foot Shaoyin (Ki) and tonify the Yang channels. In eructations, tonify the Foot Taiyin (Sp) and Foot Yangming (St). In sneezing, tonify the Foot Taiyang (Bl) at Mei Ban (Zanzhu- Bl 2).

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In joint laxity, one must tonify the spot where the illness is located. In tearing and rhinorrhea, tonify Tianzhu (Bl 10), located outside the trapezius tendon, above the edge of the hairline. In sighing, tonify Hand Shaoyin (He), Xin Bao Luo (XB) and Foot Shaoyang (GB) and leave the needle in place. In ptyalism ( 6 ) , tonify the Foot Shaoyin (Ki). In the tinnituses, tonify Ge Zhu Ren (Shangguan- GB 3) and the point located at the external ungual angle (7) of the thumb. In tongue biting, look for the location of the illness and tonify the corresponding channel. In dizziness of the eyes with head tilted to the side, tonify under the external malleolus and leave the needle in place. In the atrophic impotences (Wei) with cold limbs (Wei Jue) and anxiety, needle the point located 2 cun from the tip of the great toe. Another theory proposes the point located below the external malleolus and leave the needle in place.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The previous paragraphs analyze the deficiency of moistening of the “orifices” by the organic liquid metabolized at the level of the bladder, causing an insufficiency of the energy of Shangjiao (UJ), Zhongjiao (MJ) and Xiajiao (LJ). 1 - This paragraph studies the illnesses caused by the 12 perverse energies called singular (Ji Xie) treated by the methods of tonification and dispersion of Yin and Yang. 161. The bladder receives the liquid substances coming from the organs and bowels in order to transform them into organic liquid. These will be conducted toward the stomach and spleen whose role is to redistribute this same organic liquid necessary to their functioning. Such is the role of reciprocal exchanges of the bladder. This is why, in the above-cited ailments, treatment must be performed as a function of the location of the singular perverse energy. 2 - The point located 2 cun from the tip of the great toe designates Taibai (Sp 3), “Earth” point of the spleen organ. 3 - This paragraph studies the liquid substance of the Taiyang (Bl) whose energy circulates not only toward the exterior (skin, flesh) but also toward the heart by the route of the Zhongjiao (MJ) and Shangjiao (UJ). For this reason, in the event of insuficiency of the energy of the top part of the body, one must tonify Kunlun (Bl 60), and in the event of the insufficiency of the bottom part of the body, causing rupture of the connection of Zhongjiao (MJ) with the heart, one must needle Taibai (Sp 3) to activate the circulation of the “Earth” energy. In all cases, the “Water” energy of Taiyang (Bl) always constitutes the source of control, hence the theory of utilization of “the point behind and below the external malleolus”.”

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6. Excessive secretion of saliva (sialorrhea). 7. Energetic description. It concerns the point Shaoshang (Lu 11).

II - N.V.N.: This paragraph recapitulates the causes and treatments of the 12 singular illnesses cited in this Chapter 28. We conclude the following: Ying (nutritive energy) and Wei (defensive energy) have their root at the level of the acquired energy (a posteriori: “Water-Cereal”); their activity and their relationship are managed by the innate energy (a priori: ancestral energy) located at the level of the Xiajiao (LJ) (Ki-Li). For this reason, _ in Paragraph 10, the energy of the Shaoyin (Ki) reaches the top to unite with the Tongqi in order to optimize the control of respiratory and cardiac movements. _ in Paragraph 11, the energy of the Shaoyin (Ki) is directed toward the top to unite with the Yangming (St) to optimize the control of the metabolic modifications of Water-Cereal (foods). _ in Paragraph 12, the energy of the Shaoyin (Ki) is transported toward the top to unite with the Sun Mai (little energetic-blood capillaries) in order to go in relation with the “100 Vessels”. _ in Paragraph 13, the energy of the Shaoyin (Ki) can afflux toward the top to provoke tongue biting... . Perturbations of the energy of the Xiajiao (LJ), that is to say, of the kidney, therefore play an important role in the activation of the diseases called singular. In acupuncture and moxabustion, etiopathologic data of the energy of the kidney are fundamental in the choice of points and channels. We present below a summary table of diseases caused by the singular perverse energies:

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Table: Recapitualtion of etiopathologies and treatments of diseases caused by

the 12 singular perverse energies.

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Syndromes

Etiopathology

Treatment

Yawning

Attraction of Yin (Ying) and Yang (Wei) Disperse Foot Shaoyin (Ki) and tonify Foot Taiyang (Bl)

Hiccup

Confrontation of latent cold energy and cereal energy in the stomach

Tonify Hand Taiyin (Lu) and disperse Foot Shaoyin (Ki)

Sorrow

Fullness and rapidity of Yin energy; emptiness and slowness of Yang energy

Tonify Foot Taiyang (Bl) and disperse Foot Saoyin (Ki)

Chills/Shivers Fullness of Yin and Yang in the (trembling from cold) pilo-cutaneous system

Tonify the Yang channels

Eructations

Presence of cold energy in the stomach

Joint Laxity

Emptiness of stomach energy and Jingmai Locally tonify region affected

Sneezing

Gathering of Yang energy at the nose

Tonify Foot Taiyang (Bl) at the point Zanzhu - Bl 2

Overflowing of tears Opening of Shang Ye (upper liquid during sorrow; routes) during agitation of the heart rhinorrhea

Tonify Foot Taiyang (Bl) at the point Tianzhu - Bl 10

Sighing

Tonify Hand Shaoyin (He), Xin Bao Luo (XB), Hand Shaoyang (GB); leave the needle in place

Sialorrhea

Retraction of cardiac system and shrinkage of the energetic routes

Tonify of Foot Taiyin (Sp) and Foot Yangming (St); other theory: Tonify Meichong - Bl 3

Rupture of relation of Foot Shaoyin (Ki) Tonify Foot Shaoyin (Ki) and stomach

Tinnitus

Depletion of blood and energy of Sun Mai Tonify Ge Zhu Ren (GB 3) and of the ears Shaoshang - Lu 11

Biting of tongue, cheek and lips

• Afflux of energy of Shaoyin (Ki): biting of tongue • Afflux of energy of Shaoyang (GB): Tonify the corresponding channel biting of cheek • Afflux of energy of Yangming (St): biting of lips

Dizziness of eyes with head tilted to side

Insufficiency of the energy of the cephalic region

Weakness of limbs, Insufficiency of the energy of the lower cold limbs or region thoracic oppression

Tonify Kunlun - Bl 60

Tonify point located 2 cun from the tip of the great toe (Taibai-Sp 3)

163.

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Book V Book V consists of 18 chapters:

Chapter 29: Teaching Transmitted by the Masters (Si Chuang) Chapter 30: Fundamental Characteristics of the Energy (Jue Qi) Chapter 31: Intestines and Stomach (Chang Wei) Chapter 32: Normal Man Faced with a Shortage of Cereals (Bing Ben Ju Gu) Chapter 33: Study of the Seas (Hai Lun) Chapter 34: The Five Disturbances (Wu Luan) Chapter 35: Study on Intumescences (Zhang Lun) Chapter 36: Distinction of the Five Types of Liquid Retention (Wu Lung Xin Ye Bie) Chapter 37

164.

Five Approvals and Five Emissaries (Wu Zue Wu Chu) Chapter 38: Contrary and Favorable

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Fat and Thin (Ni Sun Fi Xu) Chapter 39: Study on Blood Stasis at the Level of the Blood Luo (Xue Luo Lun) Chapter 40: Of Yin and Yang, Of Pure and Impure (Yin Yang Qing Zhuo) Chapter 41: Correlation Between Yin-Yang and the “Sun-Moon” System (Days and Months) (Yin Yang He Yua Ye) Chapter 42: Evolution of the Illness (Bing Chuang) Chapter 43: Overflowing of Perverse Energy and Manifestation of Dreams (Zan Xie Fa Meng) Chapter 44: Conformity of Human Energy with that of the Day Divided Into Four Seasonal Periods (Shun Qi Ye Si She) Chapter 45: Evaluation of the Exterior (Wai Zui) Chapter 46: The Five Transformations (Wu Bian) Chapter 47: Constitutional Characteristics of the Organs (Ban Zang) Chapter 48: Prohibition and Submission (Gan Fu)

165.

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CHAPTER XXIX Teaching Transmitted by the Masters (Si Chuang)

The term Si Chuang implies the sense of transmission of knowledge of the past to future generations, according to the Dao of “High Morality” and of “Modern Social Awareness” in order to administer the country, govern the people and direct the family. Chapter 29 of the Lingshu is therefore exceptional because it brings together the attitude of man in regard to perfection, organization of the family and administration of the country with that of the Oriental physician vis a vis his patient. This chapter is composed of 3 parts: 1 - Attitude of the sages: men of state and medicine 2 - “Favorable” and “Unfavorable” problems of the pathologic process of cold and heat, of Yin and Yang and problems of “attachment to life” and “fear of death”. 3 - Relationships between the bodily form (Xing) and the Di Qi (energy of the Earth = where man lives). These relationships manifest at the exterior at the level of Xing (form) and Qi (energy). This chapter consists of 6 paragraphs.

PARAGRAPH 1 151

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Huangdi: “I have heard it said that you have in your possession mnemonics never described in the books. I would like to hear you on this subject in order to inspire me to _ _ _ _ _ _

Govern the country Treat the body Preserve the “Hundred Families” of diseases Harmonize the top and bottom Permeate myself with charity Spare future generations from preoccupations

in

perpetuating

166.

them.”

Qi Bo:

“Your request is most sagacious! Because to guide the people or look after the body, manage a great enterprise or direct a little affair, to govern the entire country or lead a family is to not follow the contrary process (Ni) but uniquely the favorable process (Shun). The favorable process applies not only to Yin and Yang, to the Jing (channels) and to the Mai (vessels), but also to the people who like to live as they please... .” Huangdi: “When one penetrates into a country, one must wonder about the customs; when one is accepted into a family, one must wonder about the rituals; when one examines a patient, one must wonder about adequate therapeutic methods.”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“This paragraph shows the fundamental principles of governing the country, running the family and leading the people. By these principles, great physicians model their therapeutic methods. _ “Favorable” implies the sense of harmony. _ “Favorable and unfavorable of the energy” applies to the midifications of Yin and Yang, cold and heat. _”When one penetrates into a country, one must wonder about the customs, etc...” represents the rules of the principles of governing the country and guiding the people. _ “To govern the country” can only be entrusted to men whose conduct conforms to the laws of moral and duty. It is the same in the choice of the physician in order to treat the patient.”

PARAGRAPH 2

152

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Huangdi: “What are the most adequate therapeutic principles applied to diseases?” Qi Bo:

“The appropriate treatment of the disease of heat localizing in the interior with polydipsia (Jiao Dan) is cold, and the appropriate treatment for the disease of cold localizing in the interior is heat. Heat localizing in the stomach accelerates digestion and activates hunger with sensation of cutaneous heat of the supraumbilical area. Heat localizing in the intestines causes liquid stools evoking the appearance of watery yellow-colored rice with sensation of cold in the infraumbilical area. Cold localizing in the stomach provokes abdominal bloating. Cold localizing in the intestines causes boborygmi with postprandial diarrhea. Cold localizing in the stomach associated with heat localized in the intestines causes simultaneous abdominal bloating and diarrhea. Heat localizing in the stomach associated with cold localized in the intestines causes simultaneous hunger and abdominal pains.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “_ Heat localizing in the interior (Re Zhong) and cold localizing in the interior (Han Zhong)” designates cold energy and heat energy of internal origin manifesting from the interior toward the exterior. “_ Sensation of cutaneous heat of the supraumbilical area and sensation of cold of the infraumbilical area” are phenomena of interactions of cold and heat, of interior and exterior.” II - N.V.N.: Zhang Jing Yue develops certain points: 168. 1 - In the disease of heat of internal origin, treatment consists of prescribing medicines of refridgerating property or using acupuncture points responding to cold. In disease of cold of internal origin, one must prescribe medicines of calorific property or choose acupuncture points responding to heat.

2 - Heat localizing in the stomach” warms up the upper part of the body, in particular Heart-Blood (Xin-Xue), giving the impression of having the “Suspended Heart” with feeling of hunger. 3 - The area located above the umbilicus belongs to the stomach and small intestine. As a result, the warming up of the cutaneous zone located above the umbilicus is an indicator of the attack of the small intestine by heat. 4 - “Yellow-colored soft stools” signals the presence of Humidity-Heat within the stomach

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which progresses toward the intestines. Observe, however, that in the attack of the other organs by heat, one also notes corresponding cutaneous warming. Therefore: _ when the liver and gallbladder are affected by heat, the individual feels a sensation of heat in the subcostal region to the hip. _ when the lung is affected by heat, the iindividual has the impression of having a warm lumbar region. Diagnosis of the attack of the organs/bowels by heat is therefore very precise. Zhang Jing Yue continues: “The infraumbilical area is cold” implies an attack of the intestines and stomach by cold with disturbance of digestion, hence bloating. When the intestines are affected by cold, the Yin energy stagnates and does not fulfill the function of distinction of “pure” and “impure”, hence boborygmi and post-prandial diarrhea. Appropriate treatment of these syndromes is heat.

PARAGRAPH 3 Huangdi: “Heat within the stomach causes desire to drink cold beverages, and cold in the intestines, desire to drink warm beverages. As a function of these two phenomena of opposite nature, how do you determine an appropriate treatment? No one dares contradict arrogant and shameless princes and dukes, given over to licentiousness and debauchery, inclined to look down on others, indulging in feasting, incapable of curbing themselves. 169. Restrictions go against their will; if one allows them to satisfy their excesses, their illnesses worsen. In this case, what is the appropriate solution and what is the treatment priority?” Qi Bo:

“These men have fear of death and wish to profit from the joys of life. It is sufficient to explain to them the disastrous consequences of the illness and the significance of supressing the excess. Although the Dao (principle) is unknown to them, they willingly accept to think things over.” Huangdi: “How do you treat them?” Qi Bo:

“In spring and summer, one must first treat the summit (Jiao) and secondly, the root (Ben). In fall and winter, one must first treat the root (Ben), then the summit (Jiao).” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

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“In spring and summer, the Yang energy is found at the exterior and the illness is also found at the exterior. One must first treat the summit (Jiao), then secondly, the root (Ben). In fall and winter, the Yang energy is found in the interior; the illness is also found in the interior. One must first treat the root (Ben), then the summit (Jiao). It is a question of therapeutic method according to the primary and secondary manifestations of the iillness.” II - Zhang Shi states: “Here, root (Ben) implies the sense of interior (Li), and summit, exterior (Biao). The energy of spring and that of summer rises up from the interior (Li) toward the exterior (Biao). This is why one must first treat the summit (Jiao), and secondly, the root (Ben). The energy of fall and that of winter gathers in the interior. This is why one must first treat the root (Ben), then the summit (Jiao). To know the root and summit it to know how to apply a therapy to that which manifests before and that which manifests after in the goal of harmonizing the energy. This method can be taken as a model to govern the people because, in this case, it conforms to the Dao of Heaven and Earth.” 170.

PARAGRAPH 4 Huangdi: “What is the appropriate solution to apply in diseases which do not conform to the indications of the physician?” Qi Bo:

“The appropriate solution is diet and dress which must be adapted to the cold and heat. The cold must not be freezing and the heat must not make the patient perspire; drinks and foods must neither be burning hot nor excessively cold. Average adaptation of the cold and heat conserves the equilibrium of the energy (essential), key factor against the intrusion of perverse energy.” EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“Dress and diet, which are used daily, must be harmonized to conserve the equilibrium of Yin-Yang of the body, therefore preventing the infiltration of perverse energy into the organism. In this paragraph, cold and heat are of external origin. Therefore, foods and drinks must not be burning hot or ice cold in order to favor the equilibrium of cold and heat of the interior. The energy of the four seasons designates the cold and heat of internal origin. Therefore, upon encountering the cold, one must not undress, and upon encountering heat, one must not wait for perspiration to get cooler. To act in this manner is to balance the Yin energy and Yang energy of the interior with that of the exterior. This chapter is centered on the study of the regulation of Yin and Yang of the interior (body) and of that of the exterior (surroundings) and not that of the Yin and Yang of the Xue Mai (blood vessels). The favorable and contrary phenomena are therefore specially presented. This is why Qi Bo emphasizes counterbalanced adaptation to the cold and heat in the maintenance of

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equilibrium of the essential energy, critical factor against the intrusion of perverse energy within the organism. Heaven has its cold and its heat; man possesses his Yin and his Yang. As a result, the equilibrium of Yin-Yang of the human being can prevent the penetration of excessive cold and excessive heat of Heaven and Earth.”

PARAGRAPH 5

171.

Huangdi: “In the chapter Ben Zang (Constitutional Characteristics of the O r g a n s ) (1), the volume of the 5 organs and 6 bowels can be appreciated by examination of the body and form, joints and muscular prominences . But dukes and princes, who dares examine them by palpation?” Qi Bo:

“The body and joints are the sites of exteriorization of the energy of the 5 organs; but their examination is not so easy as that of the face.” Huangdi: “Examination of the face can determine the state of the energy of the 5 organs. I know that. I would like to know how one can evaluate the state of the organs by examination of the joints.” Qi Bo:

“Among the 5 organs and 6 bowels, the lung is comparable to a protective umbrella. To determine its external aspect, it is proper to evaluate the size of the shoulder and thickness of the neck.” Huangdi: “Good.” Qi Bo:

“The heart is sovereign organ. Quepen (supraclavicular fossa) is its route of conduction. To determine its size, it suffices to observe the width of the clavicles and the xiphoid appendix.” Huangdi: “Good.” Qi Bo:

“The liver fulfills the function of general. It prevents external aggressions. To determine its firmness, it suffices to observe the size of the eyes.”

1. Name of Chapter 47 of this classic. See further on.

Huangdi: “Good.”

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Qi Bo:

“The spleen controls the distribution of “cereal” energy into the entire body. To determine its state, it suffices to discern the favorable and unfavorable flavor perceived at the level of the tongue and lips.” 172.

Huangdi: “Good.” Qi Bo:

“The kidney governs hearing. To determine its state, it suffices to distinguish the favorable and unfavorable noise perceived at the level of the ears.” Huandi: “Good.”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “Ben Zang (“Constitutional Characteristics of the Organs”) is the title of Chapter 47 of the Lingshu.

According to the classics, 1 - Man is born on Earth and his destiny is dependent on Heaven. The union of the energy of Heaven and that of Earth procreates man. Heaven governs the energy (Qi), and Earth, the form (Xing). Here, it is a question of the creation of life, site of foundation of the form and of determination of the energy. The energy of the 5 organs manifests at the complexion and their substance responds to the form. In observing the complexion, one can evaluate the energetic state of the 5 organs, and in examining the form (bodily), one can specify their volume. The notion of Energy (Qi) and Form (Xing) is therefore necessary in order to establish the a good diagnosis and suitable therapy. 2 - Palpation of the different parts of the body and joints is usually not necessary to evaluate the size, firmness and correct or incorrect placement of the organs and bowels. It suffices to observe, for example: _ the width of the shoulder and depth of the crease at the base of the sternum to evaluate the morphology and energetic state of the lung, protective umbrella of the organs. _ the size of the ends of the clavicles and width of the supraclacicular fossa, sites of ascent and descent of the energy, to appreciate firmness or softness, top or bottom location of the heart, sovereign organ of the 5 organs and 6 bowels. It is the same for the liver, spleen and kidney. Palpation of these organs is therefore not necessary except in pathologic cases.”

PARAGRAPH 6 157

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Huangdi: “And for the 6 bowels?” Qi Bo:

“Among the 6 bowels, the stomach represents the “sea”. Its contents in “5 cereals” (Wu Gu) can be determined by the width of the maxillae, the thickness of the neck and development of the thorax. The prominence and length of the nose allows appreciation of the size of the large intestine. The thickness of the lips and length of Renzhong (nasolabial groove) allows evaluation of the size of the small intestine. The extent of the suborbital area allows estimating the size of the gallbladder. The exteriorization of the energy at the level of the nostrils (expiration) allows exploration of the ease of outflow of the energy of the bladder. The prominence of the bridge of the nose allows estimating the firmness of the Sanjiao (SJ). Such are the methods of observation of the 6 bowels at the level of the face. The harmonization of Top/Bottom, divided into three levels, allows explaining the good functioning of the 5 organs and 6 bowels.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph is devoted to inspection by which one can determine the morphology and functioning of the 6 bowels. The energy of the 5 organs Appears at the complexion and their morphology is reflected in the bodily form (Xing). As a result, examination of the facies allows the evaluation of the functioning of the 5 organs, and examination of the bodily form can determine their pathologic state. The nose is the orifice of the lung whose bowel is the large intestine. This is why the nose is used to judge the form and energetic state of the large intestine. The mouth is the orifice of the spleen and impure substances coming from SpleenStomach are contained in the small intestine. This is why the lips and Renzhong (nasolabial groove) are used to estimate the form and functioning of the small intestine. The eyes are the orifices of the liver. This is why the subocular area is used to appreciate the firmness of the gallbladder. 174. The bladder is the receiver organ of the organic liquid. Energetic transformation comes from there. The nostrils are the sites of exteriorization of the energy thanks to which the energy of the bladder can flow out toward the bottom. In other words, aeration of the upper orifices causes the opening of the lower orifices. The Sanjiao (SJ) is responsible for the general irrigation of the organism. The liquid

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routes are issued from there. When the circulation of the energy is congested and obstructed, the Sanjiao becomes engorged, and when the circulation of the energy is released, the liquid routes freely flow out. The uprising movement of the nostrils explains the movement of exteriorization of the energy (inspiration) whose role is to activate the functioning of the Zhongjiao (MJ) because inspiration causes the phenomenon of grasping or engagement the Zhongjiao (MJ), and expiration, the phenomenon of disengagement. These phenomena translate the mechanism of “closing/ opening” of the top and bottom. In summary, this paragraph studies the form (Xing) and functioning of the organs and bowels under the action of the energy, going from the interior toward the exterior and vice versa. The top and bottom of the face are divided according to 3 levels which are none other than the 3 areas responding to Heaven, Earth and Man.” (Figure 54)

II - N.V.N.: 1. According to Zhang Jing Yue: “The 5 organs are located in the interior, but their energetic aspect becomes manifest at the exterior. Our classic masters looked to examine the complexions/colors or bodily form (Xing) to evaluate the energetic state of the 5 organs and 6 bowels. Despite that, in practice, one must always base one’s judgment on the harmonious aspect of the “3 levels” of the face to appreciate the good functioning of the 5 organs and 6 bowels.” 2. The “harmony of the “3 levels” or “3 palaces” (San Ding) of the face guarantees the good health of the individual. The area which extends from the frontal hairline to Yintang (PC 3) belongs to Shang Ding (upper palace). The area which extends from Shangan (PC 4) to the tip of the nose (PC 16- Biliu) belongs to Zhong Ding (middle palace). The area which extends from Renzhong (GV 26- nasolabial groove) to the tip of the chin (PC 19- Dihe) belongs to Xia Ding (lower palace) (Figure 54). The human body also consists of “3 Palaces” (Figure 55).

175.

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Figure 54: The “3 Palaces” of the face. 176.

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Figure 55: The “3 Palaces” of the body. 177.

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CHAPTER

XXX

Fundamental Characteristics of the Energy (Jue Qi)

Chapter 30 of the Lingshu is directed at determining the “6 energies”, Jing (quintessence), Qi (energy), Xin (interstitial fluid), Ye (viscous substance), Xue (blood) and Mai (vessel), all which arise from “Cereal Jing” (foods). These six acquired a posteriori energies originate therefore from the same a priori source energy (Heaven-Earth). They do not designate the structural composition of the energy divided into 6 different types. Here, the word Jue implies the sense of characterization. Because this chapter analyzes the “6 energies” originating from the same source in order to understand their physiologic and pathophysiologic relationships, it is entitled: “Fundamental Characteristics of the Energy” (Jue Qi).

PARAGRAPH 1 Huangdi: “I have heard it said that the living being is endowed with Jing and Qi, Xin and Ye, Xue and M a i . But according to me, all these energies make up only one; I do not understand the reason why one gives them six different names.” EXPLANATIONS AND COMMENTARIES

178.

Zhang Shi explains: “Jing and Qi, Xin and Ye, Xue and Mai are acquired substances circulating within the

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organism originating from the source energy of “dietary” origin called “cereal”. Once in the stomach, and under the action of the Zhongjiao (Middle Jiao), this source energy becomes transformed into 6 substances indispensible to the maintainece of life, hence Huangdi’s question to demonstrate the process of this transformation.”

PARAGRAPH 2 Qi Bo:

“The union of 2 Shen (mental) (1) creates form (Xing) ( 2 ). The necessary element to create Xing (form) is Jing (sexual) ( 3 ) . ” Huangdi: “What does one call Qi ( e n e r g y ) ? ” Qi Bo:

“The Shangjiao (Upper Jiao) has the function of spreading the quintessence of the “5 cereals” (Wu Gu) toward the skin in order to warm it up and toward the body hair in order to humidify them like mist and rain watering the plants and herbs. This quintessence is called Q i . ” Huangdi: “What does one call Xin (interstitial

liquid)?”

Qi Bo:

“When the tissue fibers open, sweat is excreted. This interstitial substance carries the name X i n . ” Huangdi: “What does one call Ye (viscous

substance)?”

Qi Bo:

“Once in the stomach, foods become transformed into energy, which spreads within the entire body, and into substance, which, on the one hand, infiltrates into the osseous system to facilitate joint movements, and on the other hand, maintains the marrow and brain and gives a glowing appearance to the skin. This viscous substance carries the name Y e . ”

1. It is neceassary to understand the union of 2 beings (woman and man). 2. Here, the word “Xing” designates embryo (fetus). 3. It is a matter of sexual Jing: ovules and spermatozoa.

Huangdi: “What does one call Xue ( b l o o d ) ? ” 178.

Qi Bo:

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“The Zhongjiao (Middle Jiao) receives the energy and draws up the liquid substance which becomes transformed into thick liquid of red color called X u e .” Huangdi: “What does one call Mai ( v e s s e l ) ? ” Qi Bo:

“The tubular organ which protects the Ying energy and requires it to circulate following a determined direction within the entire organism is called M a i . ”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph defines Jing and Qi, Xin and Ye, Xue and Mai, 6 essential components of the organism. The collection of these components has the name Qi. This is why in Paragraph 1 Huangdi emphasizes the notion of “Source Energy”, and in this paragraph, Qi Bo defines the notion of “6 energies”. 1. Jing (sexual) is an essential element in fertilization and transformation. According to Yi Jing (I Jing: Classic of Changes): “Girls and boys possess their Jing; procreation and development occur and mature thanks to the Jing”.

2. Tong Qi (4) designates a great energy (innate, ancestral, a priori energy) conserved within the Shangjiao (UJ- thorax) whose role is to control the respiratory and cardiac movements and distribute the quintessence of the “5 cereals” within the entire body. For this reason, due to the action of the lung, this quintessence saturates the skin and humidifies the body hair and head hair like mist and rain permeate the thousand beings. This quintessence, activated by Tong Qi, has the name Qi (energy). 3. The viscous substance produced at the level of the interstitium of the tissue fibers and excreted to the exterior by the sweat glands in the form of sweat is called Xin (interstitial liquid). 4. At the level of the stomach, foods become transformed into energy which permeates the entire body and into viscous substance which infiltrates into the bones and muscles, marrow and brain, skin and body hair. This viscous substance is called Ye (viscous liquid). 5. Chapter 18 (“Production and Reunion of Ying and Wei”) of this classic specifies: “The Zhongjiao (MJ) is endowed with the power of decantation and transformation (food metabolism). The viscous substance thus obtained flows down to the lung and heart and, under the action of this latter, becomes red and has the name Xue (blood).” 6. Tong Qi has the property of inducing the Xue and Ying to circulate within the vessels of conduction called Mai (vessels) which spread throughout the entire body.” 180. 4. Also written “Dong Qi”.

II - N.V.N.: 1. Here, 2 Shen designates Yin (woman) and Yang (man). The union of Yin and Yang creates form (Xing); but this creation cannot take place without Jing (sexual: ovum and sperm). In this

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manner, the text states: “The necessary element to create Xing (form) is Jing (sexual).” Chapter 8 (“Origin of the Mental”) of this classic states: “The union of the 2 Jings has the name Shen”, and Chapter 30, this chapter, states: “The union of 2 Shen creates Xing”. At first sight, these two citations can seem different; in reality, they bring out the extreme intimacy of relationship of Yin and Yang, two opposed but complementary components; it is what which one calls Dao of Union. 2. Here, Shangjiao (UJ) designates the thorax in which is stored the great energy called Tong Qi (a priori energy) or also called Chen Qi (original energy). Chapter 71 (“Perverse Guest”) of this same classic clarifies: “Chen Qi is retained within the thorax, reaches the larynx, crosses the vessels of the heart and activates the respiratory routes. Chapter 75 (“Effects of Needling on the Source Energy and Perverse Energy”) of the same classic stresses: “Chen Qi (original energy) is an a priori energy (Heaven, innate) associated with that of the cereals (a posteriori, acquired), intended to develop the corporeal structure. Chapter 18 (“Production and Reunion of Wei”) of this classic specifies: “Man receives the cereal energy. This penetrates into the stomach, reaches the lung, then from there the 5 organs and 6 bowels. Therefore, it is intended for the development of the body, for warming the skin and moistening the body and head hair like the mist and the moistening dew watering and saturating the thousand beings. This force is called Qi (energy). 3. According to Zhang Jing Yue: “Xin (interstitial liquid) is Yang; sweat is an excretory substance originating from Xin, and the pores are miniscule orifices of the skin whose dilation favor sweating. Ye is a viscous, thick substance; it infiltrates into the bony system to facilitate joint movements in order to activate the circulation of the Jingmai. In the interior, this substance maintains the marrow and brain, and at the exterior, it moistens the pilo-cutaneous system.” In summary, Xin and Ye have the same origin, but are divided into Yin and Yang because Xin is the clarified part and Ye is the opaque part of Xin. 181. Xin becomes exteriorized to the exterior via the path of the sweat glands in the form of sweat; for this reason, it is Yang. As for Ye, it saturates the bones and tonifies the brain and marrow; it is, therefore, Yin. Chapter 36 (“Distinction of the Five Types of Liquid Retention”) of this classic specifies: The Sanjiao (SJ) brings the energy to the exterior in order to warm up the flesh and muscles and maintain the skin and body hair. This excretory substance has the name Xin (interstitial liquids) and the remaining non-excretory substance is called Ye (viscous liquid). The meaning of this assertion is the same as that cited above. 4. Zhang Jing Yue adds: “The Zhongjiao (MJ) receives the cereal liquids (drink, food) and passes it to the Xiajiao (LJ), then from there to the intestines and kidneys where it is subjected to numerous decantations before it is conducted to the spleen. lung and heart. At the spleen, this liquid is viscous and yellow; at the lung, it is white, then at the heart it becomes red and has the name Xue (blood). (Figure 56) 5. When at the Mai (vessel), Zhang Jing Yue compares it to the pavement or embankment of a canal requiring the Ying energy to flow out following a specific direction. Naturally, Mai designates neither Qi nor Xue; the collection of Mai constitutes the paths of conduction of Ying Qi (nutritive energy) and blood.

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Figure 56:

PARAGRAPH 3

Different phases of decantation of food liquid and the process of blood formation. 182.

Huangdi:

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“These 6 energies can be in excess or insufficiency. Qi can be in abundance or scarcity; marrow and brain can be in emptiness or fullness; blood can be clear or disordered ... . How can one know it?” Qi Bo:

“The

emptiness

of

Jing

(quintessence)

causes

deafness;

That of Qi, amblyopia; That of Xin, dilation of the pores with abundant sweating; That of Ye, problems of joint motility with dry and withered complexion; That of marrow and brain, lancinating pain in the interior with tinnitus; That of blood, pale and dry complexion with emptiness of pulse... Such are the signs indicating emptiness of each of the 6 energies.”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“Ying is the Jing Qi (energetic essence), and Xue (blood) is Shen Qi (mental energy); Jing and Xue, Xin and Ye are the metabolized substances of energy; this is why they are called the “6 energies”. The words clear and disordered designate the qualitative state of Ying (nutritive energy) and Wei (defensive energy). The kidney conserves the Jing and exteriorizes at the ears. The loss of Jing of the ear causes deafness. The 5 flamboyant colors perceived by the eyes are the “flower substances” of the energy; this is why the loss of the “flower energy” is the cause of amblyopia (dim vision). The pores are the orifices of the skin. Their opening favors escape of Xin signaled by abundant sweating. 183. Ye saturate the osseous system, tonify marrow and brain and humidify the pilo-cutaneous system. This is why its escape is the origin of disorders of joint motility with dryness of the hair system. The kidney governs the osteo-medullary-cerebral system. Undernourishment of the marrow and brain is the cause of ostealgia with tinnitus . The heart governs Xue and Mai. These exteriorize in the form of the complexion. For this reason, escape of blood is indicated by pale complexion and emptiness at the level of the pulses.”

PARAGRAPH 4 Huangdi: “How are the favorable and unfavorable moments of these

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“6

energies”

during

periods

of

predominance?”

Qi Bo:

“These “6 energies” each have their own region. Their favorable and unfavorable moments depend on their period of predominance. But they are especially the “5 cereals” and stomach, which constitute the “Great Sea” (source).” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: This paragraph concerns the “regions” (Bu) belonging to the 6 energies among which the stomach plays the role of “Great Sea”. Huangdi questions on the favorable and unfavorable times of the 6 energies. According to Qi Bo, all regions of the body are equipped with 6 energies of potential and variable nature such that: _ the region of Yangming consists of an abundance of energy and blood, and that of the Taiyang, an abundance of blood but shortage of energy. _ the “5 Ye” (Wu Ye): tears, rhinorrhea, sweat, urine and saliva; and the “5 Jing” (quintessence of the 5 organs). Among these regions, that which respond to the period of predominance is qualified as favorable, and that which does not respond there, as unfavorable. The “6 energies” are the substances originating from the “5 cereals” (Wu Gu) metabolized under the action of the stomach. Thus, the stomach is the “great source” (Great Sea) of the energy.” 184. II - N.V.N.: This paragraph merits clarification because different translations into Oriental language are not loyal to the text.

鬼 蚺: easy/convenient path) designates the period of

1. Here, the words Gui Tian (

predominance, therefore the favorable moment. Ex: spring and summer are the periods of predominance of Liver-Wood and Heart-Fire; autumn and winter are the periods of predominance of the Lung-Metal and Kidney-Water. Otherwise is unfavorable. The words Zian Ya (

齾: good and bad) designates the normal and abnormal nature of

the energy. Ex: The fullness of perverse energy and emptiness of essential energy are abnormal aspects; the excess and insufficiency of the vital energy are also abnormal aspects. 2. The “6 energies” each have their specific region of distribution. Examples: _ Qi governs the skin and body hair. _ Xin manifests at the level of the pores. _ Ye permeates the osseous system and maintains the marrow and brain. _ Mai conducts the blood and energy and circulates throughout the entire body.

3. The “5 organs” each possess a specific “master function”. Examples: _ The kidney conserves the Jing (quintessence) of the 5 organs. It is therefore the “master” of Jing. _ The lung controls the energy. it is therefore the “master” of Qi.

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_ The spleen distributes the organic liquid. It is therefore the “master” of Xin-Ye. _ The liver conserves the blood. It is therefore the “master” of Mai Xue. _ The heart regulates the circulation of blood. It is therefore the “master” of Mai. 4. The interpretation of this paragraph is the following: _ Question: “What are the criteria for determining the emptiness and fullness of the “6 energies”? _ Answer: “The zones of distribution of the “6 energies” are different. Each of these zones is maintained by a specific energy of the organ responding to a specific season. The emptiness and fullness of these zones serves as diagnostic and therapeutic criteria. But these “6 energies” are formed during metabolic transformation at the level of the stomach. Therefore, the stomach is the “Sea of Cereals”, “Source of Energy”.”

185.

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CHAPTER XXXI Intestines and Stomach (Chang Wei)

Chapter 10 of the Lingshu is devoted to the morphologic study of the energetic organs of the digestive tract concerning the mouth, lips, teeth, tongue, pharynx, esophagus, stomach, small intestine and large intestine. The length and diameter, weight and capacity of these organs are meticulously demonstrated. In antiquity, the intestines and stomach were considered cornerstones of the organism. This is why this chapter is saved and entitled: “Intestines and Stomach” (Chang Wei). This chapter consists of a single paragraph.

Huangdi: “I ask you to acquaint me with the digestive route of the 6 bowels, in particular the length, diameter and contents of the intestines and stomach.”

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Bagao: “Allow me to demonstrate to you in detail the length, diameter, circumferance and capacity of the digestive tube beginning via the path of penetration of the “cereals” and ending via the path of evacuation of feces. 1 The The The cun.

The distance from the lips to the teeth is 9 fen. width of the mouth is 2 1/2 cun. 186. capacity of the mouth is 9 he. tongue weighs 10 liang; it length is 7 cun and width 2 1/2 cun.

2 - The door of the pharynx weighs 10 liang; its diameter is 2 1/2

The distance between the phayrnx and stomach (esophagus) is 1 chi 6 cun. 3 - The curvature of the stomach stretches out along a length of 2 chi 6 cun; its circumference is 1 chi 5 cun; its diameter is 5 cun and its capacity is 3 dou 5 sheng. 4 - The small intestine relies on support from behind by the left side of the vertebral column and follows flexuosities which are superimposed on itself. It contains digestive products which are directed into Hui Chang (large intestine). In front, it is supported by the area located above the umbilicus and forms 16 loops each of 2 1/2 cun in circumference, 8 1/2 fen in diameter and 3 zhang 3 chi in length. 5 - Hui Chang (large intestine) arises from the left side of the umbilicus, coils up and describes 16 loops each of 4 cun circumference, 1 1/3 cun diameter and 2 zhang 1 chi length. 6 - Guang Chang (sigmoid colon and rectum) is supported by the sacral region and constitute the continuation of Hui Chang. Its circumference is 8 cun, its diameter is 2 3/4 cun and its length is 8 cun. In total, from the place of reception of the cereals to the passage of secretion of feces, the intestine and stomach measures 2 zhang 4 chi 4 fen long and forms 32 loops.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This chapter demonstrates the “numbers” of the intestines and stomach, counting from the place of reception to the place of excretion.

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a - The superior mouth of the small intestine is the inferior mouth of the stomach. The small intestine is attached in back at the vertebral column, and in front it is held at the area above the umbilicus; it contains food wastes which fall into the Hui Chang (large intestine) and form 16 loops each of 2 1/2 cun circumference, 8 1/2 fen diameter and 3 zhang 3 chi length. b - Hui Chang designates the large intestine. Its superior mouth is the inferior mouth of the small intestine. It coils up and forms 16 loops each of 4 cun circumference, 1 1/2 cun diameter and 2 zhang 1 chi length. 187. c - Guang Chang designates the sigmoid colon and rectum. It measures 8 cun circumference, 2 1/2 cun diameter and 2 chi 8 cun in length.” II - N.V.N.: Here are the remarks of Zhang Jing Yue: “The stomach can hold 2 dou of cereal and 1 dou 5 sheng of drink. The inferior mouth of the small intestine falls into Hui Chang (large intestine). The small intestine is supported above by the umbilicus, the area responding to the point Shuifen (CV 9). Hui Chang designates the large intestine whose superior mouth responds to the inferior mouth of the small intestine. In the Jia Yi Jing de Huang Fu Mi (214-282 A.D.), the length of the digestive tube is calculated from the stomach, while in this chapter of the Lingshu, the calculation is made from the mouth, hence the difference of the “numbers” between the two texts.”

Figure 57: Esophagus, stomach and intestines as seen in the era of Huangdi. no 188/189.

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CHAPTER XXXII Normal Man Faced with a Shortage of Cereals (Bing Ren Jue Gu)

Bing Ren signifies man in good health, normal man, and Jue Gu, the shortage of cereals (deprivation of nourishment, inanition). Chapter 32 of the Lingshu is devoted to the study of digestion and the function of food reception of the stomach and intestines, fundamental basis of nutrition and safeguarding of life. In the man in good health, the intestines and stomach function normally. The normal state of these viscera is maintained due to well-regulated dietary hygiene. In contrast, in the case of exhaustion by shortage of nourishment, progressive diminution of the quality of contents of the intestines and stomach has the great emptiness of these viscera as a corollary; Jing Qi quintessence of the energy) and Xin-Ye (organic liquid) become progressively exhausted, hence the disappearance of nutritive phenomena ending in death. Because Chapter 32 of the Lingshu is basically directed at analyzing the causes of death in the originally healthy individual in a state of inanition during 7 days, it is entitled: “Normal Man Faced with a Shortage of Cereals” (Bing Ren Jue Gu). Chapter 32 consists of a single paragraph.

Huangdi: “I want you to explain to me why, if he is deprived of eating and drinking, man dies at the end of 7 days?”

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Bagao: “Allow me to explain the cause _ the radius of the stomach is 1 its length is 2 chi 6 cun. It can hold 2 dou of “cereal” and 1 dou 5 sheng

to you in detail: chi 5 1/2 cun; its diameter is 5 cun; 3 dou 5 sheng of “cereal”; generally of water suffice to fill it.

_ the Shangjiao (UJ) assures the secretion and diffusion of the Cereal Jing (pure energy originating from foods) which is light, fluid and rapid. The Xiajiao (LJ) assures the energetic decantation at the level of the intestines. 190.

_ the circumference of the small intestine is 2 1/2 cun; its diameter is 8 1/2 fen; its length is 3 zhang 3 chi; it contains 2 to 4 sheng of cereals and 6 sheng 3 1/2 he of liquid. _ the circumference of Hui Chang (large intestine) is 4 cun; its length is 2 zhang 1 chi; it contains 1 dou of cereals and 7 1/2 sheng of liquid. _ the circumference of Guang Chang (sigmoid colon and rectum) is 8 cun; its diameter is 2 3/4 cun and its length is 8 cun; it contains 9 sheng 3 1/2 he of cereals. In total, the length of the intestines and stomach is 5 zhang 8 chi 4 cun It can contain 9 dou 2 sheng 1 1/8 he of Shui Gu (Water-Cereals). Such is the “number” of contents of the stomach and intestines. But the process of the sequence of digestion in normal man does not take place in this fashion because, in him, filling up of the stomach is accompanied by the continuous emptiness of the intestines and the filling up of the intestines is associated with the continuous emptiness of the stomach. This succession of emptiness and fullness favors the movements of ascent and descent of Qi (energy), harmonizes the 5 organs, balances blood circulation and consolidates the Jing Shen (quintessence and mental) originating from Shui Gu (Water-Cereals). This is why the intestines and stomach continuously conserve 2 dou of cereals and 1 dou 5 sheng of water. The normal individual evacuates 2 times per day 2 1/2 sheng of feces; in one day, he eliminates 5 sheng, and in 7 days, 35 sheng, that is to say, 3 dou 5 sheng, the “number” indicating the exhaustion of Shui Gu retained in the intestines and stomach. As a result, the death of normal man abstaining from eating and drinking for 7 days is due to the exhaustion of water and “cereals”, of Jing (energetic quintessence) and Xin-Ye (organic liquid).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The 5 organs and 6 bowels, the form and the body, Jing and Shen, Qi (energy) and Xue

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(blood) are maintained by Shui Gu (Water-Cereals). Therefore, the depletion of this latter is the cause of destruction of the Xing (form) and Qi (energy).” II - N.V.N: Some diseases do not kill at the end of 7 days of deprivation of eating and drinking because the Shui Gu retained within the stomach and intestines is not completely eliminated.

191.

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CHAPTER XXXIII Study of the “Seas” (Hai Lun)

Hai means Sea, site of reunion of “100 rivers”. In Oriental language, all movements of gathering or reunion bear the name “Hai”. For example: Ren Hai (human sea). Chapter 33 defines 4 words, Stomach, Chongmai, Tanzhong (CV 17) and Brain, which are not only the source sites of Jing Shen (quintessence-mental) and Qi Xue (energy-blood), but also the sites of reunion/gathering of Ying ( nutritive energy) and Wei (defensive energy), Qi (energy) and Xue (blood) and the 12 Jingmai (channels-vessels). The “reunion” of the 4 vital substances, marrows, blood, energy, Water-Cereals (Shui Gu), bears the name “4 human seas”. These 4 human seas respond to the “4 cosmic seas” which are the 4 cardinal points: East, West, North and South. The classification and description of diseases and therapy of the excess and insufficiency of these 4 seas are explicitly developed. Because these 4 seas of man are taken as the object of this study, this chapter is entitled: “Study of the Seas” (Hai Lun). This chapter consists of 7 paragraphs.

PARAGRAPH 1 Huangdi: “I have understood in the rules of acupuncture that one must

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never separate Ying (nutritive energy), W e i (blood) and Qi (energy). In the interior, the organs and bowels, and at the exterior, they system. Yet, now you link them to the 4 Seas for me.”

(defensive energy), X u e 12 Jingmai unite with the link up with the articular (Si Hai). Please clarify this

Qi Bo:

“Man also has at his disposal 4 Seas and 12 Jing Shui (waterways, rivers). The Jing Shui flow down into the seas responding to the 4 cardinal points, East, West, North, South, hence the name 4 Seas. ”

192.

Huangdi: “How does man respond to the “4 Seas”?” Qi Bo:

“Man possesses a Sea of Marrow, Sea of Blood, Sea of Energy and Sea of Water-Cereals to respond to the 4 Seas of Heaven and Earth.” Huangdi: “Your explanation is very significant. In short, you have united Man with Heaven and Earth. Do you want to inform me of their realtionships?” Qi Bo:

“One must first go very deeply into the notions of Yin and Y a n g (channels), Biao and Li (exterior, interior) of the 5 organs and 6 bowels and the localization of the Ying-Shu points ( 1 ) to be able to determine the 4 Seas.” Huangdi: “How does one determine them?” Qi Bo:

“The stomach is the Sea of Shui Gu (Water-Cereals). Its Shu point (2) of the top is Qi Jie (other name Qichong-St 30) and that of the bottom is Sanli (St 36). The Chongmai is the Sea of Blood of the 12 channels. Its Shu point of the top is Dazhu (Bl 11) and those of the bottom are the points Shanglian (St 37) and Xialian (St 39).

1. Here, the term “Ying-Shu” represents the group of points called “Wu Shu” (5 Shu antique points). 2. Here the word “Shu” designates the energetic or transmittable point.

Tanzhong (CV 17) is the Sea of Energy. Its Shu point of the top is found above and below Zhu Gu (cervical vertebra) (3) and that of the bottom is Renying (St 9). The brain is the Sea of Marrow. Its Shu point of the top is

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Baihui (GV 20) and that of the bottom is Fengfu (GV 16).” EXPLANATIONS AND COMMENTARIES

193.

I - Ma Shi explains: “This paragraph gives dissertation on the existence of “4 Seas” in human beings. The Earth has at its disposal 12 great routes of water called “12 Jing Shui” (rivers), all flowing out toward the sea, responding to those of Heaven, divided into West, East, North and South (4 cardinal points). This is why on does not speak of 12 seas, but only 4 seas.

1. The stomach is the “Sea of Shui Gu (Water-Cereals)”. Its Shu (kinetic or transmittable) point of the top is Qijie (Qichong- St 30), located 5 cun below Tianshu (St 25); needle depth 0.3 cun, left in place during 7 expirations, dispersed immediately upon the arrival of the energy (De Qi), apply 3 moxas. Its Shu point of the bottom is Zu Sanli (St 36): needle depth 0.3 cun, left in place during 7 expirations, dipserse immediately upon the arrival of the energy, apply numerous moxas (sometimes up to 100). 2. The Chongmai is the “Sea of Blood of the 12 Jingmai”. Its Shu point of the top is Dazhu (Bl 11); needle depth 0.3 cun, left in place during 7 expirations, moxabustion prohibited. Its Shu points of the bottom are Shangjuxu (other name Shanglian-St 37) and Xiajuxu (other name Xialian-St 39). For the first, needle to a depth of 0.3 cun and apply 7 moxas; for the second, needle to a depth of 0.3 cun and apply 48 moxas. 3. Tanzhong (CV 17) is the “Sea of the Energy”. Its posterior Shu points above and below the cervical spine (Zhu Gu) designate Yamen (GV 15) and Dazhui (GV 14); needle to a depth of 0.3 cun, left in place during 6 expirations, apply 7 moxas. It anterior Shu point is Renying (St 9); needling and moxabustion prohibited. 4. The brain is the “Sea of Marrow”. Its Shu point at the top is Baihui (GV 20); needle to 0.2 cun depth, apply 7 moxas. Its Shu point of the bottom is Fengfu (GV 16); needle to 0.3 cun depth, moxa prohibited. To localize this point, have the patient speak quickly and stongly; the point swells; it is located 1 cun above the edge of the hairline, in a crease.” II - Zhang Shi clarifies:

“Heaven governs fertilization and Earth determines form (Xing). As a result, the bodily form of the human being responds to the “4 Seas” and the “12 Jing Shui” (rivers) of Earth. The energy of Heaven and that of Earth communicate with each other thanks to the presence of the Qi Jie (energetic routes), located at the summit of the cranium, at the middle of the thorax, abdomen and lower limbs. Via these routes, the energy of the channels ascends and descends, enters and exits. 3. According to Ma Shi, the top and bottom of the cervical spine designate the points

194. 1. The stomach is the “Sea of Shu Gu” (Water-Cereals). Its Shu point of the top is Qichong (Qijie-St 30); its energy reaches the abdomen and stops at the back Shu point (Weishu Bl 21), then it redescends to Zu Sanli (St 36). In summary, the “Sea of Water-Cereals” (Shui Gu) extends toward the top to go into relationship with the Tian Qi (energy of Heaven) and toward the bottom to communicate with the Yamen (GV 15) and Dazhui (GV 14).

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Jing Shui (rivers) of the Earth. 2. The Chongmai is the “Sea of Shui” of the 12 channels. From its Shu point, its energy goes up to the point Dazhu (Bl 11), then from there it descends to the points Juxu Shanglian (St 37) and Juxu Xialian (St 39) in order to follow the energetic route (Jie) of the leg. Such is the energetic route of the Chongmai which, at the exterior, communicates with Heaven and in the interior goes into relation with the Jing Shui (routes of water/?waterways) of the Earth. 3. Tanzhong (CV 17) represents the thoracic region in which is located the Tong Qi (a priori energy). Its posterior Shu points are found above and below Zhu Gu (cervical spine), that is to say, at the points Yamen (GV 15) and Dazhui (GV 14), and its anterior Shu point is Renying (St 9). 4. The bones have their marrow and the brain is the site of reunion of the marrows. This is why the marrows belong to the brain and the brain is the “Sea of Marrow.” The “Sea of Marrow” extends from the summit of the cranium toward the occipital region, that is to say, from the point Baihui (GV 20) to the point Fengfu (GV 16), belonging to the Dumai (GV), which form the “upper/lower, “anterior/posterior” routes, control the movements of rotation of the body and constitute a type of cap of protection.”

III - N.V.N.: Summarizing, the human being is endowed with “4 Seas”: 1 - The “Sea of Water-Cereals” is controlled by the stomach. From Qichong (St 30), it extends toward the dorsal region to the point Weishu (Bl 21), then toward the lower limbs, to the point Sanli (St 36) (Figure 58). 2 - The “Sea of the 12 Jingmai” is controlled by the Chongmai. It extends from the dorsal region, from the point Dazhu (Bl 11), toward the lower limbs, to the points Shanglian (St 37) and Xialian (St 39) (Figure 59). 3 - The “Sea of Energy” is controlled by Tanzhong (CV 17). It extends from the area of the cervical spine from the points Yamen (GV 15) and Dazhui (GV 14) toward the anterior area of the neck to the point Renying (St 9) (Figure 60). 4 - The “Sea of Marrows” is controlled by Xuanzhong (GB 39) and Jugu (LI 16). It extends from the top of the cranium toward the occipital base, that is to say, from the point Baihui (GV 20) to the point Fengfu (GV 16) (Figure 61).

195.

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Figure 58: Extent of the “Sea of Water-Cereals” and its transmittable points. 196.

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Figure 59: Extent of the “Sea of the 12 Jingmai” and its transmittable points. Note: The Chongmai is intrathoraco-abdominal. 197.

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Figure 60: Extent of the “Sea of Energy” and its transmittable points. 198.

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PARAGRAPH 2

Figure 61: Extent of the “Sea of Marrows” and its transmittable points. 199.

Huangdi: “The “4 Seas” each have a benefit and a detriment, a blossoming and a decline. How is that?”

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Qi Bo:

“In the favorable state, the “4 Seas” bloom, and in the unfavorable state, they decline. To know how to balance them is to favor them; ignoring the regulation is to injure them.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“In man, to maintain the “4 Seas” in the normal state is to maintain life. Therefore, one must understand clearly that the Dao of Regulation is salutory to the maintenance of the body.”

PARAGRAPH 3 Huangdi: “How are the favorable and unfavorable states of the “4 Seas”?” Qi Bo:

“When the “Sea of Energy” is in excess, the thorax is filled with Qi (energy), respiration is rapid and the face suddenly becomes red. voice

In contrast, when it is in insufficiency, the thorax loses Qi and the grows weaker.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph braoches the notions of “favorable” and “unfavorable” of the “4 Seas”. The word excess implies the presence of perverse energy in a state of excess and fullness, and the word insufficiency, the presence of the essential energy in a state of insufficiency and emptiness. These two words employed in the following three paragraphs have the same meaning.” II - Ma Shi states: 200. “The thorax is the region belonging to Tong Qi (a priori energy). It exteriorizes at the level of the trachea and controls the respiratory movements. This is why, when the “Sea of Energy” is excessive, the thorax is filled with Qi with afflux toward the top causing redness of the face.” III - N.V.N.: According the Zhang Jing Yue, the voice originates from the manifestation of Qi. When the energy is insufficient, the voice grows weaker.

PARAGRAPH 4

“When the “Sea of Blood” is in excess, the subject has the feeling of having a large body, without thinking of a disease.”

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In contrast, when it is in insufficiency, the subject has the sensation having a small body, without ability to localize the disease.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The Chongmai possesses two large vessels: _ a vessel leaving the interior of the uterus to reach the back. It concerns a vessel called “Sea of 12 Jingmai” (Figure 61) _ and a vessel emerging at the exterior to reach the thorax where it diffuses toward the skin. It concerns the principal trajectory of the curious channel Chongmai (Figure 62). This is why, in the event of stagnation or fullness of blood of the Chongmai, the subject has the feeling of having a large body, and in the event of emptiness, having a small body.” II - N.V.N.: Recall however that the Chongmai possesses another vessel descending toward the internal surface of the lower limb (Figure 62). Zhang Jing Yue clarifies: The bodily form is maintained by the blood. As a result, the excess of blood expresses as a sensation of heaviness of the body with slow motion of walking, and its insufficiency, by a sensation of weight loss with thoracic compression. These two syndromes make up part of the group of diseases caused by a dysharmony of the Sea of Blood. Diseases of the blood are of slow evolution; this is why the subject ignores that he is ill.

PARAGRAPH 5

202...

“When the “Sea of Water-Cereals” (Shui Gu) is in excess, the abdomen is in fullness, and when it is in insufficiency, the subject feels a sensation of hunger but refuses to eat.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“Excess of the energy of the stomach expresses as bloating/abdominal fullness (4) and its insufficiency by a sensation of hunger with anorexia.”

4. There also exists “bloating/emptiness” of splenic origin.

201.

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Figure 62: The Chongmai and its two vessels: postero-internal and antero-external.

PARAGRAPH 6

202...

“When the “Sea of Marrows” is in excess, the body is light and is carried well; the force of work is above normal. In contrast, when it is in insufficiency, the subject complains of

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headache, buzzings of the ear. dull pain within the bones of the leg, dizziness of the eyes and bodily asthenia.” EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“Sufficiency of the Sea of Marrows expresses by the solidness of the body... and longevity. In contrast, its insufficiency causes vertigo and buzzings, lancinating pains of the calves, headaches and diziness, panic and amblyopia, limb weakness and desire to go to sleep... signs, among others, of brevity of life.”

PARAGRAPH 7 Huangdi: “ I have faithfully heard the words on excess (of the 4 Seas). How does one balance them?”

and

insufficiency 203.

Qi Bo:

“One must thoroughly examine the Shu (kinetic or transmittable) points in order to harmonize the emptiness and fullness; one must avoid what is harmful and follow that which is favorable because the opposite worsens the disease.” Huangdi: “Good.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Thorough examination of the Shu points cited above permits knowing the existence of the routes of communication of the “4 Seas” united to the channels and that of the channels to the energy of the exterior. When one achieves harmonization of emptiness and fullness, excess and insuficiency immediately go into regulation. The word harmful designates unfavorable phenomena causing worsening of the disturbances of the energy of the channels, and the word favorable implies the sense of improvement of these disturbances.” II - Ma Shi clarifies:

“In the method of harmonization, exact localization of the Shu (kinetic or transmittable points) of the 4 Seas is always profitable and never harmful; it is always favorable and never contrary. The harmonization of the 4 Seas consists of utilizing the method of tonification or

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dispersion. In the event of emptiness, it is necessary to tonify, and in the event of fullness, one should disperse. These methods are always beneficial and never injurous; they are always favorable and never unfavorable.”

III - N.V.N.: In conclusion, in the treatment of disturbances of the 4 Seas (marrow, blood, energy, Water-Cereals), the classification and description of signs and symptoms and localization of kinetic and transmittable Shu points located above and below are necessary to determine the emptiness and fullness in order to apply the method of tonification in the event of emptiness and dispersion in the event of fullness. In practice, one must always avoid the creation of “Emptiness-emptiness/Fullnessfullness” phenomena to not bring about deliterious, serious diseases. In this manner, Zhang Jing Yue says: One must carefully examine the Shu points cited in this chapter. In the event of emptiness, do not accentuate the emptiness, and in the event of fullness, do not accentuate the fullness to avoid worsening the disease.

204. TABLE: CLASSIFICATON, DESCRIPTION AND TREATMENT OF DISTURBANCES OF THE “4 SEAS”

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205.

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CHAPTER XXXIV The Five Disturbances (Wu Luan)

Chapter 34 of the Lingshu is devoted to the study and treatment of The 5 disturbances: _ _ _ _ _

Disturbances Disturbances Disturbances Disturbances Disturbances

of of of of of

the the the the the

energy energy energy energy energy

at the level of the heart at the level of the lung at the level of the stomach and intestines at the level of the limbs at the level of the head.

These disturbances are caused by: _ a perturbation of the energy of the organs/bowels and that of the Jingmai _ unfavorable phenomena of the circulation at the level of Yin and Yang _ circulatory dysharmony of Ying (nutritive energy) and Wei (defensive energy). Zhang Jing Yue (1563-1640 A.D.) clarifies: “The disturbances cited in this Chapter 34 are recent disturbances and not chronic disturbances of the blood and energy. The energy manifests according to the law of the “5 Movements”, hence the title “The Five Disturbances”. This chapter consists of 3 paragraphs.

PARAGRAPH 1 Huangdi: “The 12 Jingmai are distinguished into 5 Movements and divided into 4 Seasons. What are their disturbances and how does one treat them?”

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Qi Bo:

“The “5 Movements” follow a very specific order; the “4 Seasons” have their divisions (climatic). To be in conformity with these movements and seasons creates peace; the opposite create disturbances.” Huangdi: “What do you mean by conformity? ”

206.

Qi Bo:

“The 12 Jingmai respond to the 12 months. The 12 months are divided into 4 seasons. The 4 seasons are spring, summer, fall and winter. Each of these seasons has a different Qi (different climate). Ying (nutritive energy) and Wei (defensive energy) follow them; Yin and Yang are in harmony; pure and impure do not mix... . As a result, they are in conformity with the 5 Movements and the 4 Seasons. ” Huangdi: “The pure energy responds to Yang; instead of rising toward the top, it is attracted toward the bottom which is Yin. The impure energy responds to Yin; instead of falling toward the bottom, it is attracted toward the top which is Yang. Ying (nutritive) energy belongs to Yin; instead of circulating in conformity with the Jingmai, it is found within the Yang part. Wei (defensive) energy belongs to Yang; instead of following the normal rules of circulation, it is found within Yin. These abnormal placements of the energy cause disturbances at the level of the thorax which are none other than the Great Inconveniences. This is why: _ at the level of the heart, the energetic disturbances are: sadness, closed mouth (deep silence), lowered head and agitation of the tongue, _ at the level of the lung, the energetic disturbances are: difficult respiration, unexpected shaking of the head, hands pressed against the thorax, _ at the level of the stomach and intestines, the energetic disturbances are: diarrhea and vomiting, limbs

_ at the level of the leg, the energetic disturbances are: ice cold

_ at the level of the head, the energetic disturbances are: contrary afflux (Jue Ni) with sensation of heaviness of the head, dizzy spells and syncope.” EXPLANATIONS AND COMMENTARIES

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207.

Ma Shi explains:

“Man has his 5 disturbances which manifest by different signs. His Jingmai unite to with the 4 seasons; they are then in conformity with the laws of the natural world. The pure energy must rise up toward the top and reach the Yang part even thought it is found at the Yin part. The impure energy must be attracted toward the bottom and reach the Yin part even though it is found at the Yang part. Ying energy is of Yin nature; it is the source-substance for the production of Jing (quintessence) and must follow the Tong Qi (a priori energy) in order to circulate correctly within the Jingmai. Wei energy is of Yang nature; it is nimble in its movements and must circulate within the fleshly spaces (epidermis, dermis and muscles). In the event of disturbance of the circulation of Ying and Wei, Pure and Impure fuse and cause disturbances in thorax. Therefore, the phenomena of non-conformity to the “5 Movements” and to the “4 Seasons” are factors of disturbance, responsible for numerous displeasures, such as: _ disturbances at the level of the heart _ disturbances at the level of the lung _ disturbances at the level of the stomach and intestines _ disturbances at the level of the arms and legs _ disturbances at the level of the head whose specific signs are explicitly presented.”

PARAGRAPH 2 Huangdi: “What are the specific methods of treating these 5 disturbances?” Qi Bo” “Since there exist routes of entry (of the perverse energy), there are surely routes of exit. To know these routes is to be able to acquire the precise method of maintaining the body.” Huangdi: “Good. I would like you to inform me about these routes.” Qi Bo:

“In disturbances of the energy at the Shu point of the Hand Shaoyin (He) (XB). In disturbances of the energy at Ying point of the Hand Taiyin (Lu) and

the level of the heart, needle and Shu point of the Hand Jueyin 208.

the level of the lung, needle the Shu point of the Foot Shaoyin(Ki).

In disturbances of the energy at the level of the intestines and stomach, needle the Shu point of the Foot Taiyin (Sp) and Shu point of the Foot Yangming (St). In the absence of results, add Zu Sanli (St 36).

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In disturbances at the level of the head, needle Tianzhu (Bl 10) and Dazhu (Bl 11) of the Foot Taiyang (Bl); in absence of results, add the Ying and Shu points of the Foot Taiyang (Bl). In disturbances at the level of the arm and leg, first bleed the Xue Luo (blood capillaries), then needle the Ying and Shu points of Yangming (LI and St) and Shaoyang (SJ and GB).” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph presents acupuncture techniques against the 5 disturbances. The word routes designates the trajectories of the Jingmai. A route of arrival certainly has its route of departure. Knowledge of these routes is therefore invaluable to the method of evacuation of perverse energy and to that of the conservation of the body. In practice, all physicians, acupuncturists or herbalists, must know the Summit (Jiao) and Root (Ben) of the disease, use the corresponding Jingmai with precision and especially discern in precise fashion the essential energy and perverse energy. Such is the key method of therapy. This is why: 1 - In disturbances of the energy at the level of the heart, one should needle: _ the Shu point of the Hand Shaoyin (He), Shenmen (He 7): needle depth 0.3 cun, left in place during 7 expirations and 7 moxas, _ and the Shu point of the Hand Jueyin (XB), Daling (XB 7): needle depth 0.5 cun, left in place during 7 expirations and 3 moxas. 2 - In disturbances of the energy at the level of the lung, one should needle: _ the Ying point of the Hand Taiyin (Lu), Yuji (Lu 10): needle depth 0.1 cun, left in place during 3 expirations and 3 moxas, _ and the Shu point of the Foot Shaoyin (Ki), Taixi (Ki 3): needle depth 0.3 cun, left in place during 7 expirations and 3 moxas. 209. 3 - In disturbances of the energy at the level of stomach and intestines, one should needle: _ the Shu point of the Foot Taiyin (Sp), Taibai (Sp 3): needle depth 0.1 cun, left in during 3 expirations and 3 moxas, _ and the Shu point of the Foot Yangming (St), Xiangu (St 43): needle depth 0.5 cun, left in place during 7 expirations and 3 moxas. In the absence of results, add Zu Sanli (St 36). 4 - In disturbances of the energy at the level of the head, one must needle: _ the point Tianzhu (Bl 10) of the Foot Taiyang (Bl): needle depth 0.2 cun, left in during 3 expirations, disperse during 5 inspirations and 7 moxas, _ and the point Dazhu (Bl 11) of the same channel. In the absence of results, add: a - the Ying point of this channel, Tonggu (Bl 66): needle depth 0.2 cun, left in place during 5 expirations and 3 moxas, b - and the Shu point, Shugu (Bl 65): needle depth 0.3 cun, left in during 2 expirations and 3 moxas.

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5 - In disturbances of the energy at the level of the arms and legs, one must: _ first bleed the blood capillaries (Xue Luo) of these regions _ then at the forearm, needle: a - the Ying point of the Hand Yangming (LI), Erjian (LI 2): needle depth 0.3 cun, left in place during 6 expirations and 3 moxas, b - the Ying point of the Hand Shaoyang (SJ), Yemen (SJ 2): needle depth 0.2 cun, left in place during 3 expirations and 3 moxas, c - the Shu point of the same channel, Zhongzhu (SJ 3): needle depth 0.2 cun, left in place during 3 expirations and 3 moxas, _ and finally, at the foot, needle: a - the Ying point of the Foot Yangming (St), Neiting (St 44): needle depth 0.3 cun, left in place during 10 expirations and 3 moxas, b - the Shu point of the same channel, Xiangu (St 43): needle depth 0.5 cun, left in place during 7 expirations and 3 moxas. c - the Ying point of the Foot Shaoyang (GB), Xiaxi (GB 43): needle depth 0.3 cun, left in place during 3 expirations and 3 moxas, d - and the Shu point of this channel, Lingqi (GB 41)√: needle depth 0.2 cun, left in place during 5 expirations and 3 moxas.” 210. III - N.V.N.: This paragraph gives information on the method of utilization of the Wu Shu (5 Shu antique) points in the treatment of the 5 disturbances, in particular the Ying and Shu points of the Yin and Yang channels as a function of the 5 Movements and 4 Seasons. The disturbances cited in this chapter are of endogenous origin (energetic perturbations). 1 - In disturbances of the energy of the heart (Fire-Heat), one must needle the Shu-Yuan points (Shu-Yuan= Humidity-Earth) of the Hand Shaoyin (He) and Hand Jueyin (XB) (to temper them), that is to say, the points Shemen (He 7) and Daling (XB 7). 2 - In disturbances of the energy of the lung (Metal-Dryness), one must needle the Ying point (Ying= Fire-Heat) of the Hand Taiyin (Lu) and Shu-Yuan point (Shu-Yuan= Earth-Humidity) of the Foot Taiyin (Sp) to reestablish the equilibrium of “Water-Fire” so as to maintain the coolness of this organ, that is to say, the points Yuji (Lu 10) and Taixi (Ki 3). 3 - In disturbances of the energy of the stomach and intestines (Dryness), one must needle the Shu-Yuan point (Shu-Yuan=Earth-Humidity) of the Foot Taiyin (Sp) and the Shu point (Shu= Spring-cool Wind) of the Foot Yangming (St) to reestablish the “Yin-Yang” equilibrium in order to maintain the coolness at the level of these viscera, that is to say, the points Taibai (Sp 3) and Xiangu (St 43). In the absence of results, add the He point (He= Humidity-Earth) of the Foot Yangming (St), that is to say, Zu Sanli (St 36). 4 - In disturbances of the energy of the head (site of gathering of the 3 Yang channels of the body: Taiyang, Shaoyang and Yangming, channels which bring water toward the cranium), one must reestablish the Yin-Yang circulation of this region via Tianzhu (Bl 10) and Dazhu (Bl 11). In the absence of results, one must needle the distal points located on the foot, that is to say, the Ying points (Ying= Winter-Water) and the Shu point (Shu= Spring-Wood-Wind) of the Foot Taiyang (Bl) to activate the “Water” movement toward the cranium, that is to say, the points Tonggu (Bl 66) and Shugu (Bl 65).

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5 - In the disturbances of the energy at the level of the arm, one must needle the Ying (Ying= Winter-Water) and Shu (Shu= Spring-Wood-Wind) points of the Hand Shaoyang (SJ) to which one adds the Ying of the Hand Yangming (LI), that is to say, the points Erjian (LI 2), Yemen (SJ 2) and Zhongzhu (SJ 3). In disturbances of the energy of the leg, one must needle the Ying (Ying= Winter-Water) and Shu (Shu= Spring-Wood-Wind) of the Foot Shaoyang (GB) to which one adds the Ying point of the Foot Yangming (St), that is to say, the points Neiting (St 44), Xiangu (St 43) and Linqi (GB 41).

PARAGRAPH 3

211.

Huangdi: “How are tonification and dispersion applied in these cases?” Qi Bo:

“Slow movements of progession and slow movements of retreat transmitted to the needle constitute Dao Qi (method of conduction of the energy). To tonify is to conduct the essential energy, and to disperse is to conduct the perverse energy. Tonification and dispersion are not based on content and form, but their essential goal is to conserve and maintain the Jing Qi (quintessence of the energy). This therapeutic method bears the name Dong Jing (synchronization of the energy). It does not concern a treatment of excess or of insufficiency of the “Water-Cereal” energy (Shui Gu), but only a method of conduction of the “rebel” energy.” Huangdi: “That the Dao (of medicine) is clearly worthy! Your dissertation is most explicit. I wish that it be transcribed onto the table of jade with the title Treatment of the Disturbances.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph demonstrates the treatment of the Five Disturbances which consists only of channeling the energy in the favorable direction to reestablish its equilibrium; this is entirely different from the method of tonification and dispersion applied in the case of excess or insufficiency. In the 5 Disturbances, one must transmit to the needle slow movements of progression and retreat with the purpose of redirecting the energy toward its normal route without needing to follow the priciples of tonification or dispersion.”

II - N.V.N.:

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Dao Qi (method of conduction of the energy) is fundamental in the daily practice of acupuncture. This chapter seeks to resolve the problem of circulatory disturbances of the energy (non-conforming circulation, therefore contrary). It sets aside the case of emptiness or fullness, excess or insufficiency.

212. Table: Use of the Wu-Shu points (5 Shu Antique points) in the treatment of the “5 Disturbances” of endogenous origin.

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213.

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CHAPTER XXXV Study on Intumescence (Zhang Lun)

`Chapter 35 of the Lingshu analyzes the causes, syndromes, etiopathologic process, diagnosis and therapy of the intumescences. The intumescences (swellings) are grouped together as: _ _ _ _ _ _

pulsologic intumescence pulmonary intumescence hepatic intumescence splenic intumescence gastric imtumescence vesicular intumscence, etc... .

Because this chapter seeks to resolve the problem of turgescence, it is entitled: “ Study on Intumescence” (Zhang Lun). Chapter 35 consists of 8 paragraphs.

PARAGRAPH 1 Huangdi: “The pulse responds to Cun Kou (radial pulse). How does it reflect the diseases of intumescence?”

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Qi Bo:

“The large, hard and rough pulse belongs to the disease of intumescence.” Huangdi: “How do you know if the intumescence is situated at the level of the organs and bowels?” Qi Bo:

“Yin responds to the organ and Yang, to the bowel.”

214.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the perceptabilty of swelling of the organ or bowel at the level of the pulse: _ the large (full) pulse of Cun Kou is indicator of the presence of perverse energy in a state of excess. _ the hard (firm) pulse of Cun Kou signals the non-dissolution of perverse energy. _ the rough pulse of Cun Kou reveals stagnation of the energy and blood. But the large/full and hard/firm pulse responds to Yang and the swelling is located at the bowel. The rough and hard pulse responds to Yin and the swelling is located at the organ.” II - N.V.N.: Another version states: If the pathologic pulse is at Yin, intumescence occurs at the organs, and if the pathologic pulse is at Yang, intumescence is found at the bowels. This is also instructive.

PARAGRAPH 2 Huangdi: “Is Qi (energy) responsible for the intumescence found within the interior of the Xue Mai (blood vessels) or within the interior of the organs and bowels?” Qi Bo:

“All three (blood vessels, organs and bowels) are affected by it, but are not the principal sites of intumescence.” Huangdi: “I would like you to inform me about the principal sites of intumescence.” Qi Bo: “Intumescence manifests outside the organs and bowels. It widens the thorax and hypochondria and provokes distention at the level of the skin, hence the name i n t u m e s c e n c e . ”

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EXPLANATIONS AND COMMENTARIES

215. “In this paragraph, the disease is purely energetic. It hampers anatomic components like the blood vessels, organs and bowels, hence the phrase “All three are affected by it”. These anatomic components are not the sites where intumescence is located. In the interior, it seeps its way into the “inter-visceral” sites, and at the exterior, into the epidermodermal spaces, hence the name intumescence-- that is to say, swelling associated with the energy without anatomic lesion.”

PARAGRAPH 3 Huangdi: “The organs and bowels located in the interior of the thorax and abdomen are like precious objects conserved in a box. They each have a name and different location and dwell in the same place. But within the same area, the energy manifests by different syndromes. I would like to know the cause.” (Qi Bo”s response has been lost). EXPLANATIONS AND COMMENTARIES Ma Shi emphasizes: “Huangdi’s question should have been accompanied by Qi Bo’s response. What a shame it was lost!”

PARAGRAPH 4 Huangdi: “I have still not completely understood. Explain it to me again.” Qi Bo: and

“The thorax and abdomen are the protective walls of the organs bowels.

Luo

Tanzhong (middle of the thorax- CV 17) is the palace of the Xin Bao (XB). The stomach is the granary.

216.

The pharynx and small intestine are routes of dietary conduction. The “5 openings” of the stomach call to mind the 5 doors of the house of the people of long ago.

Lianquan (honest, upright door- CV 23) and Yu Ying (other name Yutang-CV 18) are the routes of organic liquid.

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area

This is why the 5 organs and 6 bowels each have a well-delineated and their pathologic manifestations are different.

Ying Qi (nutritive energy) follows the Mai (vessels) and Wei (defensive energy), circulating in the opposite direction, causes swelling of the vessels (Mai Zhang). Wei Qi circulating following the Mai (vessels) becomes directed toward the “carnal spaces” and provokes swelling of the skin (Fu Zhang). It is advised to disperse Sanli (St 36) . In the case of acute intumescence, disperse once, and in the chronic case, disperse 3 times. The skillfulness of the practitioner consists of dispersing on the field without being concerned about emptiness and fullness.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “a - This paragraph concerns the principal localization of the disease of intumescence. This disease is the result of a circulation in the opposite direction of Wei Qi (defensive energy). Faced with such a case, one must immediately disperse Sanli (St 36).

b - Diseases of intumescence are localized neither in the interior of the vessels (Mai) nor in the interior of the organs and bowels (Zang-Fu). First, they occur outside the organs and bowels, that is to say, in the inter-visceral spaces, then they move away from there to reach the interior of the thorax. It is as a result of this that the skin becomes swollen. In other words, the skin is the principal site of turgescence (swelling). c - The organs and bowels are located in the same places, in the interior of the thorax and abdomen. But their pathologic manifestations are different because of their different delimitation or marked boundaries Therefore: _ the thorax and abdomen are considered protective walls of the organs and bowels, _ Tanzhong (CV 17), as the “palace” of the Xin Bao Luo (XB), _ the stomach, as granary, _ the pharynx and small intestine, as routes of food conduction/expulsion, _ the “5 doors” of the stomach, as 5 doors of the house of people of long ago, _ Lianquan (CV 23) and Yutang (CV 18), as the routes of the Xin-Ye (interstitial liquid). d - The delimitation of the areas belonging to the 5 organs and 6 bowels is therefore clearly stated. It allows explanation of the difference between the pathologic manifestations of the organs and bowels. 217. e - Diseases of intumescence are not caused by Ying Qi (nutritive energy) but only by Wei Qi (defensive energy) because Ying Qi, endowed with Yin nature specialized in the conduction of Jing Qi (energetic quintessence), is permanently guided by Tong Qi (innate, a priori energy). As a result, Ying Qi can never be responsible for intumescence. But Wei Qi, circulating in the opposite direction, follows the Mai (vessels) and infiltrates into the “carnel spaces” to trigger first turgescence of the vessels (Mai Zhang), then progressively cutaneous turgescence (Fu Zhang). f - The stomach is the “sea” (of food) of the organs and bowels, and Sanli (St 36) is its He

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point. This is why one must disperse Sanli (St 36) one time in the acute case and three times in the chronic case without concern for emptiness and fullness. The dispersion must be performed on the field as soon as the disease appears. Yang Yuan Re put forward: “The contrary circulation of the energy always causes the disappearance of the system of production/growth. In chronic cases, it is certain that the disease is found in the state of emptiness and the disappearance can only be performed in the presence of the obstruction of the energetic routes. If the “doors” are obstructed, one must open them; if the “windows” are sealed shut, one must release them; if the essential energy is insufficient, one must tonify it. To tonify, disperse and release at once is the right method of treating intumescence. In recent diseases, the energy is not yet in the state of emptiness; a single battle suffices in order to defeat, a single stick suffices to cure. Zhu Ying Nian concludes: “One must admit that numerous practitioners only know the method of dispersion in the treatment of intumescence and totally ignore the routes of communication and doors of “Entry/Exit” of the energy. And yet, once the knowledge of these “doors/windows” and routes of communication are mastered, nothing appears difficult. As a result, to attain the “root” (of energetic medicine), one must very attentively read the texts of the Neijing.”

II - N.V.N.: The term “5 doors of the stomach” designates the 5 routes of access which are: Yi Hou (throat), Bi Men (cardia), Wou Men (fundus), Lan Men (pylorus) and Po Men (door of the soul). In other words, the stomach profits from 5 routes of communication: _ laryngo-pharyngeal route _ cardiac route _ intestinal route _ hepato-renal route _ pulmonary route. 218. Zhang Ying Yue summarizes: “The pure energy responds to Ying Qi (nutritive energy) . Ying circulates within the Jingmai. This energy is subtle and specific; it cannot cause the syndrome of intumescence. The impure energy responds to Wei Qi (defensive energy). Wei circulates outside the channels; this energy is nimble and volatile; it circulates within the flesh spaces. As a result, turgescence is primarily due to disturbances of the circulation of Wei. First, it circulates within the channels to provoke Mai Zhang (swelling of the vessels), then it penetrates into the flesh spaces to trigger Fu Zhang (swelling of the skin). Sanli (St 36) belongs to the Foot Yangming (St). Yangming is the “sea” of the 5 organs and 6 bowels; it governs the flesh system. This is why in diseases of intumescence, Sanli (St 36) is used in dispersion, and the number of punctures depends on the chronicity of the disease.”

PARAGRAPH 5 Huangdi: “Please inform me about the disease of intumescence.” Qi Bo:

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“Intumescence of the heart manifests by anxiety with short respiration and agitation during sleep. Intumescence of the lung is characterized by flatulence with dyspnea and cough. Intumescence of the liver is indicated by hypochondrial fullness with pain radiating toward the lower abdomen. Intumescence of the spleen is characterized by frequent vomiting with fatiguability of the limbs and a feeling of heaviness of the body, inability to dress oneself and agitation during sleep. Intumescence of the kidney manifests by abdominal bloating/ oppression radiating toward the back with dull pain at the level of the lumbar region and thighs. • As for intumescence of the 6 bowels, the clinical signs are: _ swelling of the s t o m a c h : abdominal fullness, gastralgia, perception of a burnt odor, anorexia and difficulty defecating. _ swelling of the large intestine : boborygmi and abdominal pain. In winter, secondary attack of cold triggers diarrhea with undigested food. _ swelling of the small intestine : fullness/oppression of the lower abdomen and pain radiating toward the lumbar region. _ swelling of the b l a d d e r : lower abdominal fullness and difficult micturition. carnal

_ swelling of the Sanjiao (SJ) : fullness of the energy within the spaces with sensation of “softening” on palpation. 219.

_ swelling of the g a l l b l a d d e r : hypochondralgia, bitter mouth and frequent sighing.”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“1 - This paragraph demonstrates the contrary circulation of Wei Qi in the interior of the “walls” (thorax and abdomen) at the level of the 5 organs and 6 bowels, responsible for intumescence whose symptomatology always starts as functional signs (energetic, therefore immaterial), slowly evolving toward anatomic signs (organic, therefore material). Treatment of diseases of swelling (intumescence) consists of clarifying the notion of “favorable/contrary” because to disperse emptiness and tonifying fullness is to separate the Shen of the body; to aid the perverse energy and forget the essential energy is to disturb the “source” (energetic). In this way, little workers commit serious errors in the practice of medicine and attribute their fault to the “celestial order (destiny). As for skillful workers, they tonify the emptiness and disperse the fullness, that is to say, they make the Shen return and fill the

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emptiness. 2 - Regarding the circulation, the term “favorable/contrary” is applied to the Ying energy circulating in the interior of the Jingmai and to the Wei energy circulating at the exterior (of the Jingmai). The former circulates in one direction and the latter in another direction, hence the notion of favorable/contrary. To fill the emptiness implies that, at the exterior, one must not allow the Jingmai, skin and pores enter a state of emptiness, and in the interior, one must augment the potential of the Shen Qi (mental energy) of the 5 organs and 6 bowels. This method is invaluable for great workers. 3 - The phrase “...without concern for emptiness and fullness, one must disperse on the field” cited in the previous paragraph and the phrase “...tonify emptiness and disperse fullness” mentioned in this paragraph denote that one must clearly discern the perverse energy and essential energy in order to carry out tonification or dispersion. Sages of long ago went to much trouble for future generations. Such is the profound meaning of the text.”

PARAGRAPH 6 Huangdi: “How is intumescence produced? And what is its cause?” 220.

Qi Bo:

“In the organism, the Wei energy circulates with Ying energy within the carnal spaces. This circulation is in the same direction or opposite direction, Yin and Yang follow each other. Celestial harmony is therefore obtained; the 5 organs succeed one another following the rhythm of the 4 seasons; Wu Gu (5 cereals) are then assimilated. If Jue Qi (afflux of the energy) takes place down below, Ying and Wei stagnate, the “cold” energy flows counter-current toward the top and confronts the original energy (Yuan Qi or source energy) and they become indissociable, hence the formation of stasis responsible for intumescence.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph demonstrates the process of occurrence of the disease of intumescence. In the organism, Wei energy circulates during the day within the zones belonging to the Yang channels, and at night, in the zones belonging to the Yin channels. Like the vessels (Mai), it circulates within the carnal (flesh) spaces; it enters there, it leaves from there, always in the same direction or opposite direction, all in responding to Yin and Yang (night and day). The circulatory movements of the Wei energy are, therefore, in harmony with the energy of Heaven and Earth, a harmony which favors the potentialization of the energy of the 5 organs following the order of the 4 seasons and facilitating the assimilation of the 5 cereals (Wu Gu). If Jue Qi (afflux of the energy) occurs at the bottom, Ying and Wei no longer obey the normal rules of circulation; perverse cold rises from below upward. The original energy and perverse energy confront one another and provoke stagnation which becomes transformed into the

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disease of intumescence.”

II - N.V.N.: Here, the term “4 seasons” designates the period determined by the movements of insufficiency and excess during the day comparable to the 4 seasons: morning = spring noon = summer evening = autumn night = winter In this way, in one day (24 hours), Ying and Wei, energy and blood obey the rules of progressive activity.

PARAGRAPH 7

221.

Huangdi: “Correct. But by what criteria does one base one’s judgment in order not to triumph?” Qi Bo:

“It is sufficient to reunite Ying and Wei to Chen Qi (original or innate energy, also called “Yuan Qi”: energy source, or “Tong Qi: a priori energy). These 3 reunions permit clear comprehension of the cause of Jue Ni.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Chen Qi is innate energy which, associated with the cereal energy (acquired energy), maintains the body. Chen Qi, located at the Xiajiao (LJ), is therefore ancestral. It reaches the top to aid the Yangming in metabolizing the Wu Gu (5 cereals) and in producing two types of energy, Ying and Wei. This is why the text stresses: “The two energies, Ying and Wei, unite with Chen Qi... The reunion of these three energies permit the clear understanding of the cause of Jue Ni (contrary afflux).” In this way, for example, when the energy source (Yuan Qi, also called Chen Qi or Tong Qi) is blocked at the bottom and is subjected to the influence of a contrary afflux, the two other energies (Ying and Wei) are returned to the top and the “Cold-Water” energy of the Xiajiao (LJ) reascends upstream/counter-current. In this case, the energy source and perverse energy (designated “Cold-Water”) confront one another, and the Ying and Wei can no longer divide/separate hence stagnation and formation of the disease of intumescence.” II - N.V.N.: Translation without commentary of this paragraph appears incomprehensible, without any medical or scientific value.

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The phrase “

三合茈?薘?

“ (San He Zi Da = to obtain the 3 reunions) (1) is

modelled on the context according to which diseases of intumescence can localize at the level of the Jingmai, organs and bowels. Here is the explanation of Zhang Jing Yue: “Despite its origin at the level of the Wei Qi, the disease of swelling can localize at the Xue Mai (blood vessels) to trigger disease at the level of the Jingmai (channels), at the organs to trigger disease at the Yin part and at the bowels to trigger disease at the Yang part. To understand these three pathologic processes is to assure the Chen Qi (original or innate energy).

PARAGRAPH 8

222.

Huangdi: “The pathophysiologic study of intumescence being set down, therapy consists of dispersing on the field without concern for emptiness and fullness. In recent disease, one must needle one time, and in “distant” (chronic) disease, three times. But in the event of absence of results after 3 punctures, where does the error come from?” Qi Bo:

“Needling must reach Ru Huang (carnal layer; dermis) and Qi Xue (energetic point). Not attaining the energetic point, the perverse energy returns to the interior; needling not arriving up to Ru Huang , the perverse energy is not eliminated; attack of the muscles can cause disturbances of Wei energy with accumulation of Yin and Yang to trigger the disease of intumescence. In the event of obligatory dispersion not performed, the perverse energy does not become eliminated. After having needled 3 times, if the disease does not regress, one must repeat the needlings until the elimination of the perverse energy. These new punctures can end in cure, without any risk. Furthermore, in the examination of the pulses fullness in order to apply rapid as the resonance of

treatment of diseases of intumescence, the is necessary to discern the emptiness and tonification or dispersion whose efficacy is as beats of drumsticks.”

1. This phrase has been very poorly translated into Western language. “3 reunions” designates the union of the 3 energies: Ying, Wei and Chen Qi.

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“Cure or non-cure of the disease of intumescence depends on the accuracy of the

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application of needling on the energetic point. “After the 3rd needling, the disease does not regress” when the needling does not fall exactly on the energetic point and the perverse energy is again found trapped in Ru Huang (carnal layer). From the moment that the needling is not precise, the perverse energy remains in the interior. If the needling exceeds Ru Huang and involves the muscles, the perverse energy also cannot be expelled and the Wei energy is disturbed with accumulation of Yin and Yang, hence the disease of intumescence. The 3 needlings proposed above are then utilized. In this case, one must carefully observe the emptiness and fullness in order to tonify or disperse, and the needling must fall exactly on the point. Cure is in this way assured.”

223.

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CHAPTER XXXVI Distinction of the 5 Types of Liquid Retention (Wu Lung Xin Ye Bie)

Chapter 36 of the Lingshu demonstrates the 5 types of water retention. The word Xin designates interstitial liquid, and the word Ye, viscous liquid. But these two words are often used together and we translate imperfectly the composite name Xin-Ye as organic liquid. The substance which spreads within the entire body to heat up and humidify the “flesh” (dermal) system and maintain the skin is called Xin, and that which divides uniquely within the joints and marrow bears the name Ye. Xin and Ye, like Qi (energy) and Xue (blood), Ying (or Rong, nutrtitive energy) and Wei (defensive energy) are substances originating from food metabolism directed by the Zhongjiao (Middle Jiao- MJ). These substances can be excreted to the exterior under the influence of psychologic or climatic factors in the form of 5 types of excretion: sweat, tears, urine, saliva and mucus. For this reason, this chapter is entitled: “Distinction of the 5 Types of Liquid Retention”. It consists of 7 paragraphs.

PARAGRAPH 1 Huangdi questions Qi Bo: “Shui Gu (Water-Cereals), once in the mouth, are transported to

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the stomach and intestines where they are transformed into metabolic substances among which Ye (viscous substance) is differentiated into 5 types able to be excreted to the exterior via various factors. In

this

manner,

for

example:

224.

_ If in cold weather one wears light clothing, a part of the Ye can become transformed into urine and Qi (energy). _ If in hot weather one wears thick clothing, a part of the Ye can become transformd into sweat. _ During sorrow the energy rises up; a part of the Ye can become transformed into tears. _ Heat in the Zhongjiao (MJ) can impede the functions of the stomach and a part of the Ye transforms into saliva. _ Disturbances in excretory function caused by perverse energy can prevent the “Water” (Shui Qi) energy from circulatng causing liquid retention... . These phenomena are known, but I am unaware of their cause. Please explain it to me.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “1- According to Wu Shu, this chapter is devoted to the study of the Xin substance and Ye substance. These substances, originating from metabolism of Shui Gu (Water-Cereal: foods) and following the energetic routes, are 5 in number. The words Wu Bie (5 distinctions) designate sweat, urine, saliva, tears and mucus. The words Wu Lung (5 retentions) implies the sense of obstruction. Because, when Ye permeates the marrow and brain and a part of this Ye flows out toward the bottom and clogs and obstructs the energetic routes of Yin and Yang, the “4 Seas” are obstructed and the “Water-Cereals (Shui Gu) is returned to the Xiajiao (Lower Jiao- LJ) without passing to the bladder. As a result, water overflows and is transformed into the illness called liquid retention. The previous Chapter 35 (“Study on Intumescence”) studied the causes of energetic retention, while this one addresses the causes of liquid retention. Knowledge of these two causes determines the therapeutic method to apply in these two illnesses.

2 - The bladder is like a frontier post where the Xin-Ye gather. This is the site where the last phase of liquid decantation takes place. In this manner, the energy obtained becomes the energy of the Taiyang (Bl) and the remaining water is rejected to the exterior in the form of urine. Sweat, urine, blood, energy, marrow are all metabolized components from Shui Gu (WaterCereals) and from Xin-Ye (nutritive liquid). To answer Haungdi’s question, Qi Bo divides these metabolites into Xin-Ye (interstitial liquid and energy), into cold and heat, which are always elements in motion, responding to the movements of the “4 seasons”. This is why one must dress according to the cold and heat. That the translators of the classic texts do not betray the spirit of the text!” 225.

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II - Ma Shi states: “In cold weather, closure of the pores prevents the energy and internal humidity from circulating. In this case, water is no longer returned by the energy and it flows out toward the bladder and is transformed into urine and into energy.”

III - N.V.N.: Chapter 36 (“Distinction of the 5 Types of Liquid Retention”) of the Lingshu tackles the problem of liquid excretion. It establishes a connection with Chapter 23 (“Discourse on the 5 Energies”) of the Suwen which defines the “5 Transformations” of Ye at the level of the 5 organs: _ the heart transforms Ye into sweat _ the lung, into mucus _ the liver, into tears _ the spleen, into saliva _ the kidney, into drool.

PARAGRAPH 2 Qi Bo answers: “At the mouth, Shui Gu (Water-Cereals) are distinguished into 5 flavors each flowing out toward its own “sea”. The substance Xin-Ye also possesses its own route; this is why the Sanjiao (SJ) transforms a part of this substance into Qi (energy) intended to heat the flesh and muscles and maintain the skin; this part has the name Xin (interstitial l i q u i d ) . As for the remaining part, it gathers in the interior in very specific places without spreading to the exterior and has the name Ye (viscous liquid) ( 1 ) ” . EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph defines the process of triggering of sweat by the Xin substance. This substance follows the energy of the Sanjiao (SJ) (2) to permeate the tissue spaces at the level of the pores; it exteriorizes in the form of sweat; at this level, cold can infiltrate into the dermis and provoke tissue rents with pain.”

1. It concerns synovial fluid and cerebrospinal fluid.

II - N.V.N: 1 - This paragraph is devoted to distinguishing Xin (interstitial liquid) and Ye (viscous substance). Xin is Yang; it follows the Wei (defensive) energy and circulates within the Yang part

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(skin, flesh, muscle) of the body. Ye is Yin; it follows the Ying energy (nutritive energy) and reaches the Yin part of the body to lodge in the joints and spinal canal. In this way, despite their same origin, they have distinct names. 2 - According to Chapter 33 (“Study of the Seas”) of this classic, man possesses “4 seas”: _ the brain is the sea of marrows _ the Chongmai, the sea of blood _ the Tanzhong the sea of energy _ the stomach, the sea of Water-Cereals (Shui Gu). The 5 organs and 4 Seas receive the “Sapor-Energies” of the cereals via the route of the channels. This is why the texts states: “The Xin-Ye become transformed into energy and follows its own route.”

PARAGRAPH 3 “Hot weather and thick clothing favor opening the pores and the outflowing of sweat. This opening facilitates the infiltration of perverse cold; it is retained in the spaces of flesh demarcation and provokes stagnation of the Xin-Ye which bcome transformed into froth (Bo) responsible for pain. Cold weather favors closure of the pores and prevents circulation of the “humidity” energy; water accumulates in the bladder and becomes transformed into urine with escaping of Qi.” ( 2 )

EXPLANATIONS AND COMMENTARIES N.V.N.: The “pain” concerned in this paragraph evokes Zhou Bi, painful phenomenon localizing at the level of the channels, necessitating a treatment called “Top-Bottom,Bottom-Top”. (See Chapter 27: “Erratic and Cyclic Pain”).

2. Here the word “Qi” must be translated as “gas” (intestinal).

PARAGRAPH

4

227.

“Among the 5 organs and 6 bowels, the heart is the principal guide.

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The The The The The The

ears are devoted to h e a r i n g . eyes are devoted to vision. lung plays the role of advisor. liver plays the role of general. spleen plays the role of bodyguard. kidney plays the role of controller of external affairs.

This is why the Xin-Ye substances of the 5 organs and 6 bowels all gather at the eyes. If the ailment reaches the heart, the energy is compressed and the “heart” system is contracted. The “heart” system being contracted, the lung is distended. The distention of the lung causes overflowing of the Xin-Ye substance toward the top. The “heart” system must not therefore be contracted, and must not therefore be distended because they no longer assure movements of ascent and descent of their energy. This is why, Shui Ye (Water-Viscous Liquid) follows the energy in order to toward the top, it provokes cough and tears.”

the lung the when the overflow

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph explains the process of triggering of tears. Tears are provoked by an afflux of the Xin-Ye of the 5 organs and 6 bowels during distention of the lung following a compression of the energy of the heart (in the course of an ailment). The heart is the sovereign organ, that is to say, the organ which commands the entire system of 5 organs/6 bowels. The ears and eyes are the “orifices” of the upper part of the body and the sites of flowing down of the Xin-Ye. The words “advisor, general, bodyguard...” designate the ministers of the sovereign. The expression “the kidney controls external affairs” implies that the kidney conserves the Xin-Ye with which it permeates the “orifices” (eyes, ears). The phrase “the ailment reaches the heart and provokes compression of the energy” means to say: when the heart is hit with sorrow, the energy of the 5 organs/6 bowels gathers at the heart to await the order of the sovereign, and during this time, the energy of the “heart” system is contracted and the lungs are distended. 228. The distention of the lung causes the overflowing of Xin-Ye toward the top because the lung is “master” of the energy and water carries out these movements thanks to the energy. But the “heart” system and “lung” are not always distended in this way. Their energy sometimes carries out the movement of ascent, sometimes the movement of descent. When the Xin-Ye follow the movement of descent of the energy, it provokes cough, and when it follows the movement of ascent of the energy, it overflows the eyes, hence tears (3).” II - N.V.N.:

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The explanation of the process of triggering of tears by Zhang Shi is clear. The heart is sovereign organ. Under it aegis, the 5 organs/6 bowels and their energetic system assert their physiologic activity. The functions of the 5 organs are the following: _ the lung directs the regulation of the energy within the entire organism, like the minister of the interior who administers the affairs of the country. _ the liver, site of the final phase of formation of Wei (defensive) energy, plays the vital role in the struggle against intrusion from the exterior, like the general who defends his country. _ the spleen controls food metabolism and the movements of the Cereal Jing within the entire organism. Its role is to maintain the “flesh-muscle” system, like the minister charged with feeding the people. _ the kidney controls the production of Jing (energetic quintessence) which permeates the “external orifices” (ears, eyes...) and fills the internal “reservoirs” (spinal canal and cranial box), like the minister of the exterior. Among these sites, the eyes are the orifices of gathering of numerous Jingluo (principal channels and secondary vessels). This is why the movements of the Xin-Ye are all directed toward the eyes. During sorrow (one of the psychoaffective elements directed by the Shen-Heart), the Luomai (4) of the heart are hurried and tense and cause distention at the level of the lung which abolishes the movements of ascent and descent of the energy. As a result, when the Shui Ye (viscous liquid) follows the energy, it overflows the top and produces cough, tears and mucus.

PARAGRAPH 5 “Heat lodged in the Zhongjiao (MJ) activates the digestive function of the stomach and facilitates the movements of ascent and descent of parasites responsible for gastrointestinal disorders. It is in this manner that the dilation of the stomach and intestines is a factor triggering afflux of the energy toward the top with flowing out of drool.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph explains the formation of drool from the Ye substance (viscous liquid). According to Chapter 28 (“Oral Questions”) of this classic: “the dilation of the stomach causes the opening of the point Lingquan (CV 23) with flowing out of saliva (sialorrhea); it is advised to tonify the Foot Shaoyin (Ki).” The Renmai (CV) starts at Huiyin (CV 1) and links up with the Foot Shaoyin (Ki) at the level of the neck at the point Lianquan (CV 23). As a result, when the stomach is dilated, the energy of the Foot Shaoyin (Ki), in its inability to unite with that of the Foot Yangming (St) (5), affluxes toward the top, to the point Lianquan (CV 23), bringing along with it Ye (viscous substance), hence outflowing of drool.” 3. Here, cough and tears are of psychologic origin. 4. The original text designates them by the name “heart-system”. 5. The kidney controls the “Spleen-Stomach” and “cardiopulmonary” systems. See prior chapters.

II - N.V.N.: It is interesting to compare Chapter 28 (“Oral Questions”), which shows the process of triggering sialorrhea, with this Chapter 36, devoted to the mechanism of outflow of drool. These two phenomena have one same “Kidney-Stomach” origin. The first case is provoked by the presence of Humidity-Heat, factor responsible for the production of the intestinal lines.

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The second case is due to the presence of heat within the Zhongjiao (MJ) with, as a corollary, the dilatation of the stomach. In these two cases, the energy of the Foot Shaoyin (Ki) cannot control the Yangming (St); water directed by the Shaoyin (Ki) returns to the kidney organ and follows the path of the Chongmai to reach Lingquan (CV 23) (Figure 63). 230.

Figure 63 Route of the Foot Shaoyin (Ki) toward the point Lianquan (CV 23).

PARAGRAPH 6

229...

“Xin-Ye originating from Wu Gu (5 cereals) can be transformed into fatty substance (Gao) which, in the interior, permeates the bony cavities and maintains the marrows and brain; then it flows out toward the bottom, into the internal part of the thigh.”

EXPLANATIONS AND COMMENTARIES

230...

I - Zhang Shi explains: “This paragraph explains the formation of the marrow from Xin-Ye. The kidney is receptor organ of the Jing (quintessence) and governs the bones. This Jing of the kidney, associated with the Ye of the “5 cereals”, is transformed into Gao (fatty substance) which permeates the cavities of the bones and maintains the marrow; then, by the spinal route, it redescends and reaches the internal part of the thighs.” (Figure 64)

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Figure 64 Formation of the marrow.

PARAGRAPH 7

231.

Disequilibrium of Yin and Yang provokes overflowing of Ye (viscous liquid) which flows out toward the “Yin orifices”; Ye and marrow become reduced and accumulate at the bottom. If the accumulation (at the bottom) is too abundant, it produces phenomena of emptiness (at the level of the marrow) indicated by lumbo-dorsalgia or ostealgia of the lower limbs. During this time, _ the energetic routes of Yin and Yang are obstructed and the “4 Seas”, blocked. _ the Sanjiao (SJ) no longer assures the functions of “release” (de-obstruction). _ Xin-Ye are no longer metabolized. _ cereal liquid accumulates in the stomach and intestines and food wastes do not arrive at the lagre intestine. _ liquid retained in the Xiajiao (LJ) no longer permeates the bladder and provokes the syndrome called retention of the Xiajiao (LJ), and its overflowing causes the syndrome called retention of water (edema) . Such is the distinction of the 5 types of retention of Xin-Ye. EXPLANATIONS AND COMMENTARIES Ma Shi explains:

This paragraph explains the process of triggering of water retention (edema).

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Jing (quintessence) unites with Ye (viscous liquid) of the 5 cereals to be transformed into Gao (fatty substance) in order to permeate the bony cavities. At the top, this substance is very useful for the marrow and brain, and at the bottom, it gathers within the internal part of the thigh. During the disequilibrium of Yin and Yang, this Ye substance descends and overflows the Yin energy and and leaves behind it a state of malnutrition at the level of the marrow. If the descent of Ye is too abundant, it causes a state of emptiness of the bony marrow, hence lumbo-dorsalgia and ostealgia of the lower limbs. Moreover, this descent of Ye favors deleterious phenomena such as: _ obstruction of the energetic routes _ accumulation of cereal liquid in the stomach and intestines _ liquid retention at the level of the Xiajiao (LJ) and _ overflowing of water to trigger the retention of water or edema.”

no 232/233.

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CHAPTER XXXVII Five Approvals and Five Emissaries (Wu Zue Wu Chu)

The term Wu Zue (5 Approvals) designates the accord between pathological modifications located in the interior and those observed at the exterior, and the term Wu Chu (5 Emissaries or 5 Ambassadors), the appearance of different colors originating from the organs located in the interior. Ma Shi clarifies: “Wu Zue determine the 5 Energies (5 colors), and the 5 Energies are the ambassadors of the 5 organs.” In brief, Chapter 37 of the Lingshu gives dissertation on Wu Zang (5 organs: liver, heart, spleen, lung and kidney) and Wu Guan (5 facial zones of observation), in particular, the importance of Wu Shuo (5 colors: green, red, yellow, white and black). The 5 colors of the 5 organs reflected at the exterior are diagnostic elements of the pathologic state of the 5 organs located in the interior. Diseases of the 5 organs/ 6 bowels are always expressed by a change in color at the level of the “external orifices” which correspond to them, in particular, at the level of Ming Tang (nose). As the essence of Chapter 37 is to define the 5 colors of the 5 organs with the purpose of determining the diseases of the 5 organs, it is entitled: “Five Approvals and Five Emissaries” (Wu Zue Wu Chu). Chapter 37 consists of 6 paragraphs.

PARAGRAPH 1 Huangdi questions Qi Bo: “I have heard something about a method of diagnosis called “Wu Guan Wu Zue” (five areas of observation and five approvals) to

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determine the Wu Qi (five energies) ( 1 ) , which are the emissaries of the 5 organs responding to the “5 seasons”. I would like you to inform me about these emissaries.” Qi Bo responds: “ Wu Guan (5 facial areas of observation) are the sites of external appearance of the energy of Wu Zang (5 organs).” Huangdi: “Pleese tell me about the sites of manifestation of energy of the 5 organs in order to establish the constant principle of examination.” Qi Bo:

“The pulse manifests at Cun Kou (radial pulse) and the colors appear at Wu Guan in order to respond to the “4 seasons” and to the pathologic state of the 5 organs. When perverse energy, located at the level of the channels, infiltrates into the organ, one must treat the interior.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns Wu Guan (5 facial areas), sites of examination of the exterior of the 5 organs. But in order to determine Wu Shuo (5 colors), Ming Tang (nose) is the area most often examined. The five facial areas make up part of the method of diagnosis because, at the level of Wu Guan, one can observe the 5 colors of the energy: green, red, yellow, white and black. Because these 5 energies (5 colors) belong to the 5 organs, _ green responds to the liver _ red, to the heart _ yellow, to the spleen _ white, to the lung _ black, to the kidney. As for the distinction of the 5 seasons, _ spring corresponds to the liver _ summer, to the heart _ end of summer (2), to the spleen _ fall, to the lung _ winter, to the kidney. These 5 energies always manifest in accord with those of the 5 organs at the level of Cun Kou (radial pulse) and at the level of Ming Tang (nose). When perverse energy, located at the level of the channels, infiltrates into the organ, one must treat the interior.”

1. Here, “Wu Qi” designates the 5 colors of the energy. 2. The original text uses the term “Zhi Yin” (enter into Yin) to designate end of summer.

II - N.V.N.:

235.

Zhang Jing Yue teaches: “In clinical practice, one must define the energy of the 5 organs. At the exterior, this energy manifests at the level of Wu Guan (5 facial zones of observations).

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Here, the term Wu Guan designates, for example, the nose which is the Guan (examination zone) of the lung. As for the word Zue (approval), it implies the manifestations of the energy of the organ which can be perceived and examined. Wu Zang (5 organs) is located in the interior, but their energy manifests at the exterior at the level of Wu Guan (5 zones of observation) in such a way that interior and exterior communicate. The color of the Qi (energy) responds to Heaven, the Jing Mai respond to Earth and the 5 Movements govern the 5 organs of man. The color of the Qi appears on the face and the Qi of the 5 Movements responds to Heaven. The path which goes from the interior to the exterior, that is to say from the organ toward the Jing Mai and pilo-cutaneous system, responds to the path of the energy of Earth which rises up toward Heaven. The path which goes from the exterior toward the interior, that is to say, from the epidermo-dermal system and system of Jing Mai toward the organs, responds to the path of the celestial energy which descends toward Earth. In total, the path of entry/exit and ascent/descent of the energy is carried out following a circle without end. Such is the meaning of the phrase “when perverse energy infiltrates into the channel, it reaches the organ; one must treat the interior.” Zhang Jing Yue’s assertion is based on the movements of the energy, fundamental notions of the practice of acupuncture, and, in the event of disturbance, one must treat at the level of the organ.

PARAGRAPH 2 Huangdi: “Good. Are the colors only determined at Ming

Tang (nose) ? ”

Qi Bo:

“After having discerned Wu Guan (5 facial zones of one must examine: _ first Jue Ding (frontal space) which must be large developed. _ then Ming Tang (nose) which must be raised and _ next, Fan Bi (cheek and in front of the ear) which well set out. _ and finally, the 4 sides of the face, ear pinna and must be solid, raised and very thick like a demarcation of which protects Ming Tang located in the center.

observation), and well generous. must be

236.

chin which protection

If the 5 colors of these regions are normal and if the placement of Wu Guan is well-aligned, the individual can live 100 years. Acupuncture is very effective in this type of man; his blood and his energy are in abundance, his muscles are firm and intact. This is why acupuncture is apt to treat his maladies.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph demonstrates the diagnostic elements of the face, among which are found

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Ming Tang. The word Jue designates the inter-eyebrow space, and Ding, the middle of the forehead. Ming Tang designates the nose. The area situated above the cheekbone and in front of the ear is called Fan Bi. The concordance of the morphology of these areas and colors of the face is the indicator of longevity. In the event of disease, one must base one’s judgment on the colors to choose it or the channels to needle. Effectiveness is immediate.

II - N.V.N.: After discerning the 5 facial zones (Wu Guan 1 - Jue Ding

五官), one must examine:

闕定), area located between the inter-eyebrow space and forehead, where

(

the points Eshong (PC 2) and Yintang (PC 4) are found.

明堂 ), zone which extends from the base of the tip of the nose, where

2 - Ming Tang (

the points Shangen (PC 4), Gan (point of the liver), Pi (point of the spleen), Wei (point of the stomach) and Dan (point of the gallbladder) are found.

蕃蔽 ), zone which extends from the cheek to the front of the ear, where

3 - Fan Bi (

the points Lungxue (PC 11), Tingxue (PN 13), Tingling (PN 14), Tinggong (PC 15) are found. 4 - The outline of the face, there comprising the ear and chin, where the points Dihe (PC 19), Fengyan (PC 13) are found.

237.

As for the other points of the principal channels and the other “outside-channel” points, they are mentioned in our “Medecine Traditionelle Chinoise”, N.V.N. Edition. Note, however, that the points of the principal channels are the “doors of entry/exit, ascent/descent” of Ying (nutritive), while the “outside-channel” points are the sites of concentration of Jing (quintessence) energy of the 5 organs/6 bowels.

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Figure 65: The 5 facial zones of observation (Wu Guan).

PARAGRAPH 3 Huangdi: “Do you wish to also inform me about Wu Qi Bo:

Guan ? ”

“_ The nose is the guan of the lung _ the eyes are the g u a n of the liver _ the mouth and lips are the g u a n of the spleen _ the tongue is the guan of the heart _ the ears are the guan of the kidney.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

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238.

“The lung, located in the interior, sends its energy to the nose to control respiration. As a result, the nose is the Guan of the lung. The liver, located in the interior, sends its energy to the eyes to discern the 5 colors. As a result, the eyes are the Guan of the liver. The spleen, located in the interior, sends its energy to the mouth and lips to absorb the 5 cereals (Wu Gu). As a result, the lips and mouth are the Guan of the spleen. The heart, located in the interior, sends its energy to the tongue to discern the 5 flavors. As a result, the tongue is the Guan of the heart. The kidney. located in the interior, sends its energy to the ears to tune into the 5 sounds. As a result, the ears are the Guan of the kidney.” (3)

PARAGRAPH 4 Huangdi: “Based on Wu Guan (5 facial zones), what diagnosis can one establish?” Qi Bo:

are

“Those of the diseases of the 5 organs:

_ In diseases of the lung, respiration is difficult and the nostrils dilated. _ In diseases of the liver, the ocular canthii are bluish in color. _ In diseases of the spleen, the mouth and lips are yellowish.

_ In diseases of the heart, the tongue is rolled up and retracted and the cheeks are pinkish red. _ In diseases of the kidney, the cheekbones and middle of the forehead are blackish.”

EXPLANATIONS AND COMMENTARIES

239.

I - Ma Shi explains:

“Wu Guan (5 facial zones) are the sites of examination of the5 organs, and examination of the colors of Wu Guan allows the determination of the diseases of the 5 organs. The relationship between the 5 organs and the facial zones therefore have an obvious diagnostic and therapeutic value.” 3. Here, the word “Guan” designates the 5 sense organs.

II - N.V.N.: We present below a table of physiologic and pathologic relationships of the 5 organs and Wu Guan (sense organs).

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5 Organs and 5 Orifices

Pathophysiologic Modifications

Normal Functions

Lung Nose

Distinction of 5 odors (olfaction)

Difficult respiration and nasal obstruction (in the event of disturbance of the energy of the lung)

Liver Eyes

Distinction of 5 colors (vision)

Red eyes (in the event of attack of liver channel)

Spleen Mouth and Lips

Distinction of 5 cereals (taste)

Anorexia and dull taste (in event of disequilibrium of the Spleen-Stomach system)

Heart Tongue

Distinction of 5 sapors (taste and speech)

Kidney Ears

Distinction of 5 sounds (hearing)

Red tongue (in event of disturbance of the Fire of the Heart) Sensation of heavy head and spermatorrhea (in the event weakness of the energy of the kidney)

PARAGRAPH 5 Huangdi: “Where do the 5 Mai come from? How do the 5 Colors manifest? In

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some cases, the colors are normal, but the disease worsens; how so?” Qi Bo:

240.

“ Wu Guan (5 facial zones) are poorly delineated. Jue (intereyebrow space) and Ding (forehead) are not developed enough; Ming Tang (nose) (cheekbone and in front of the ear) is not clear enough; the 4 sides (contour) of the face wear away and the lower part of the face is devoid of chin... . In such an individual, longevity is not assured and diseases are generally fatal.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “The question posed: “Where do the 5 Mai come from? How do the Luo of the Wu Guan manifest?...” reveals that it is a question here of an area of energetic physiology not understood by Huangdi. Qi Bo responds: “In individuals whose Wu Guan are poorly delineated and Jue Ding not developed enough... even in the absence of disease, their health is faltering. Accordingly, it is more serious when they are affected by diseases.” II - N.V.N.: The modern version of the question posed by Huangdi is slightly different.

PARAGRAPH 6 Huangdi: “The 5 colors appearing at Ming Tang are intended to examine the energy of the 5 organs. Are the top and bottom, left and right of it (Ming Tang: nose) also sites responding to the bodily forms?” Qi Bo:

“The 5 organs are located at the center (Ming Tang: nose). The left and right, top and bottom (of Ming Tang, nose) exactly correspond to the different parts located in the interior of the body.” EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “Ming Tang designates the nose at the sides of which are found the zones of the 5 organs and 6 bowels. This wishes to say that the 5 colors manifest at Ming Tang and the energy of the organs/bowels appears following an specific order in the other parts of the face. (Figure 66) This chapter studies the relationships of the Santai (3 powers: Heaven-Earth-Man), while Chapter 49 (“The Five Colors”) gives dissertation on the energy and color of the 5 organs and 6 bowels with the purpose of evaluating the benignness or seriousness of the disease.” 241.

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Figure 66: Zones of appearance of the colors of the 5 organs and 6 bowels. no 242/243.

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CHAPTER XXXVIII Contrary and Favorable Fat and Thin (Ni Sun Fi Xu)

The object of study of Chapter 38 of the Lingshu is the orientation of treatment according to the build of the individual (fat or thin). In the fat, the circulation of blood and energy is generally slow. Needling must be deep and the needle left in place a long time. In the thin, the blood is generally purified and the energy, active. Needling must be superficial and the needle left in place only for a short time. In individuals of medium build, the energy and blood are generally balanced and harmonious. Needling must be neither deep nor superficial. In children whose skin and flesh are still weak and thin, the blood and energy are barely formed; implantation and removal of the little needles must be rapid, and it is not recommended to leave the needle in place. Based on these data, treatment conforming to these rules is favorable; and the opposite is unfavorable. In addition to these data on the practice of acupuncture, Chapter 38 stresses the orientation of the circulatory paths of the Jingluo, in particular the system of Yin-Yang, Blood-Energy, Top-Bottom relationships able to be contrary or favorable and whose comprehension permits facilitating diagnostic and therapeutic reasoning. This is why this chapter is entitled: “Contrary and Favorable; Thin and Fat”. It consists of 10 paragraphs.

PARAGRAPH 1

244.

Huangdi: “I have heard you speak many times with clarity on the Dao of Acupuncture. It seems to me that the Dao that you have submitted is a

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variable Dao which responds rigid and unchangeable Dao. experience or else from your observations of the natural

to each disease with efficacy and not a Does this Dao originate your personal impulse of the heart in the course of world?”

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “Chapter 38 of the Lingshu studies the copious and thin morphology of the body and the pure and impure state of the blood and energy of the human being responding to the Celestial Dao which is favorable or unfavorable. The phrase “impulse of the heart in the course of observations of the natural world” defines the therapeutic Dao established by the sages which consits of joining together the variation of celestial and terrestrial phenomena with those of “human affairs” “.

PARAGRAPH

2

Qi Bo:

“The Dao of the sages is founded on the observation of the top which responds to Heaven (astronomy), of the bottom which represents Earth (geology) and of the middle which corresponds to “human affairs” following precise rules of measurement and following the particular method of calculation in order to transmit it to future generations. This is why the carpenter cannot determine length without either “Chi” (foot) or “Cun” (inch) (1) or establish a horizontal plane without the string blackened in ink. Similarly, the worker cannot draw a circle without a compass or trace a square without the brace. Using these tools is to obey the “natural laws”, a method easy to follow and transmit to posterity, which consists of determining the reason of contrary and favorable (2). ” Huangdi: “ H o w are

these

“natural

laws”?” 245.

Qi Bo:

“During drilling to a certain depth, water can gush out on its own without being aided by the force of man. Similarly, as soon as one digs a

1. Unit of length. 2. This phrase, difficult to decipher, is known from different versions according to translators.

channel to drain water, the water circulates freely. These two examples define the slippery and rough natures of the energy, the pure and impure natures of the blood and the favorable and unfavorable natures of the movement of the energy.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The Dao of Heaven and Earth, originating from natural phenomena, difficult to comprehend, does not leave the “square-circle” sphere. The phrases “during drilling of a well...” and “one digs a channel...” denote that the movements can be contrary or favorable.”

II - Ma Shi comments:

“This paragraph explains the natural reason of acupuncture. The Dao of acupuncture of the sages of long ago respond to Santai (three geniuses: Heaven-Earth-Man) (3). This Dao has been established according to a precise method of creation of the instruments of measurement and number, a method which has been transmitted to us. Therefore, it is natural for a worker to use “Chi” (foot) and “Cun” (inch), string blackened with ink, compass and brace in order to measure length and width, the surface plane, square and circle... . All that comes from the reason of nature. As a result, everything is easy; it is the same for the contrary and the favorable. In exactly following this rule, it is like “one achieves drilling a well or digging a channel”, the water runs dry and the path is freed. Why these examples? Because the energy of the human being is sometimes rough, sometimes slippery, the blood is sometimes pure, sometimes impure and the circulation of the energy is sometimes contrary, sometimes favorable. Everything obeys the rules of nature.”

III - N.V.N.: According to Oriental tradition, the compass and brace, circle and square are the symbols of harmony of Heaven and Earth. This is not to say that Earth is “square” and Heaven is “round” (4). It is a question of a common expression of the Far East to designate the balance of the natural world. According to the rules of Contrary-Favorable, the energy of Earth goes toward the left and that of Heaven is directed toward the right. This paragraph develops the analogy of drilling a well and digging a channel with the effects of acupuncture.

3. In 1967, with Chambrault, we designated it under the name “Three Powers”. 4. In this way, the expression “mother is round and son is square” designates normal childbirth.

PARAGRAPH 3

246.

Huangdi: “I would like to know about the amount of needlings applied in individuals of white color and black color, in fat and thin, in adults and children.”

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Qi Bo:

“In the adult in the strength of age, blood and energy are abundant, skin and flesh are firm. When he is attacked by perverse energy, needling must be deep and the needle, left in place. In the fat of marked build, the shoulders and axilla are large, the flesh of the neck is thin, the thick skin is of dark color, the fleshy lips are curved toward the bottom, the blood is black and impure, the energy is rough and s l o w . This type of man is generally ambitious and egotistical. Needling must also be deep and the needle, left in place a long time; the number of needles used is higher than in the previous case.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph explains the technique of needling in the fat individual. The term “amount of needlings” calls up the number, higher or less high, of points to needle. As for the phrase “needling must be deep, the needle, left in place”, it concerns the needling technique applied in fat individuals. In ambitious individuals, the needling is that which is utilized in the fat, but the number of points used is greater and the duration of posing the needle is longer.”

II - Zhang Shi comments: “Shoulders and axilla are large” as if they stretched out toward the 4 cardinal points. The nucha and neck are controlled by the Taiyang (Bl). Black color is the color of the energy of Taiyang (Bl) in a state of fullness (5). 247. The lips are the sites of exteriorization of the energy of Spleen-Earth. The phrase “the blood is black and impure” designates the sluggish state of the pure

water. The ambitious man ignores the Dao of neutrality (Zhong Hua).”

5. Taiyang = Water = Kidney = Black.

PARAGRAPH 4 Huangdi: “How do you needle the thin?” Qi Bo:

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“In the thin, the skin is thin and the color is pale; the flesh is withered and the lips are thinned out; the voice is weak; the blood is pure and essential energy is slippery; the energy is easily exposed to escape, and the blood, naturally exhausted. In this case, needling is superficial and removal of the needle is rapid.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi comments: “This paragraph shows the needling technique applied to thin individuals: superficial needling and rapid retreat of the needle.” II - N.V.N.: In thin persons, the lips are thinned and the voice is weakened because the blood and energy are in a state of insufficiency. As a result, the number of needles used must not be excessive at the risk of provoking escape of the energy and depletion of the blood.

PARAGRAPH 5 Huangdi: “How do you needle individuals of normal build?” Qi Bo:

“First, examine the skin and color which is white or black, then apply an appropriate technique. In genuine and honest individuals, the blood and energy are well-balanced; needling must not be lower or higher than the usual number.” EXPLANATIONS AND COMMENTARIES

248.

I - Ma Shi explains: “Individuals of normal build are neither fat nor thin. If they present with a skin of whitish color, needling is that which is advised for the thin. In contrast, if their skin is of blackish color, needling is that practiced in the fat. Among individuals of medium build, one must distinguish those who are good and generous and those who are ambitious and deceitful. Concerning the good and generous, needling must not be too deep and the needle must not be left in place for too long a time as in the fat. This needling must not any more superficial and the removal of the needle must not be any more rapid than that perfomed in the thin. This means to say that in them, one must apply without error the usual number of needlings.” II - N.V.N.: 1 - According to Zhang Jing Yue, “only genuine and generous individuals are worthy of being called “normal man”. As a result, the principle of needling according to the normal number (deep or superficial needling) is specially reserved for them.

2 - Standardization of the depth of implantation of the needle has been specified in

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Chapter 12 (“River Ways”) of this classic. It is primarily based on: _ the topography of the channel and especially on the transmissible point to use, _ the evolutive nature of the disease _ and the reactive phenomena of the individual.

PARAGRAPH 6 Huangdi: “How do you needle valiant individuals of large bone structure?” Qi Bo:

“In valiant individuals of large bone structure, the muscles are hard and the joints are solid. If they have an imposing manner, weighty and slow, their energy is rough and their blood impure. Needling must be deep and the needle left in place a long time. In contrast, if they have an active and light manner, their energy is slippery and their blood is pure; needling must be superficial and removal of the needle rapid.” EXPLANATIONS AND COMMENTARIES

249.

Ma Shi explains: “This paragraph concerns the method of needling practiced in young valorous people of large bone structure, among which one distinguishes two types of men: _ muscular men of colossal build with slow activity whose blood is impure and energy is coarse. In them, needling is deep and the needle is left in place as in the fat. _ muscular men with agile movements whose blood is pure and energy slippery. In them, needling is superficial and the removal of the needle rapid as in the thin.”

PARAGRAPH 7 Huangdi: “How do you needle children?” Qi Bo:

“In children, the muscles are still soft, the blood is not very abundant and energy, still weak. The Hao type needle is then used; needling is superficial and removal of the needle, rapid. One can practice two sessions in a day.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “The Hao type needle designates the No. 7 needle of the group of the “9 Needles”. Because of the young age, needling is superificial and removal of the needle, rapid. Because the needling is superficial and removal rapid, one can perform two sessions per day, but

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the needling must not be deep and the needle must not be left in place.” II - Zhang Shi comments: “This paragraph concerns the needling of children whose source energy is not yet completely defined; the flesh is still tender, the blood not very abundant and energy, still weak. Infants bear the name Ying. 250. In boys eight years old and girls of seven years of age, the energy of the kidney is found in a state of plethora; the teeth change and hair grows long. In men of 4X8=32 years and women of 4X7=28 years of age, the bones and joints are hard and strong, the flesh and muscles are well developed. Therefore, the bodily form, blood and energy, although they were maintained by the cereal energy (acquired, a posteriori energy), have their root at the level of the Yuan Qi (original, innate, a priori energy). One needles children two times per day because one aims to open the route of production/growth of Yin and Yang, of the blood and energy.”

PARAGRAPH 8 Huangdi: “What do you mean by “during drilling to a certain depth, the water gushes forth without being aided by the force of man?” Qi Bo:

“If the blood is pure and energy slippery, rapid dispersion causes exhaustion of the energy.” Huangdi: “What does it mean “as soon as one digs a channel to drain the water, the water can circulate freely.” Qi Bo: can

“If the blood is disturbed and the energy, rough, rapid dispersion aerate the channels.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“This paragraph analyzes the two examples cited in Paragraph 2. The phrase “During drilling to a certain depth, the water can gush forth without being aided by the force of man” is an example illustrating the effect of dispersion applied in an individual whose blood is pure and energy slippery (that is to say, in an individual in good health). Dispersion is an unfavorable act that exhausts the energy. In contrast, the phrase “to dig a channel to drain the water” is an example illustrating the effect of dispersion done in an individual whose blood is impure and energy rough (characteristics responsible for obstructive phenomena). This dispersion is a favorable act which areates the channels. The two methods of dispersion are therefore copied exactly from natural rules.”

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251.

PARAGRAPH 9 Huangdi: “How do you distinguish the contrary and favorable circulation of the 12 channels?” Qi Bo:

“The 3 Yin channels of the hand go from the thorax to the hand and the 3 Yang channels of the hand from the hand to the head. The 3 Yang channels of the foot go from the head to the foot and the 3 Yin channels of the foot from the foot to the abdomen.” EXPLANATIONS AND COOMENTARIES I - Zhang Shi explains:

“The object of this paragraph is to demonstrate the circulation of the 3 Yin and 3 Yang channels of the hand and foot according to their favorable and unfavorable orientation in order to respond to the 12 Jing Shui (rivers) of the energy of Earth (Di Qi).”

II - N.V.N.: This paragraph is the conclusion of Chapter 10 (“Vessels-Channels”) of this classic concerning the direction of the circulation of the 12 Jingmai (see table and figure following).

Table Direction of the circulation of the 12 Jingmai

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Channels

Direction of circulation

Hand Taiyin (Lu)

From thorax to hand

Hand Yangming (LI)

From hand to head

Foot Yangming (St)

From head to foot

Foot Taiyin (Sp)

From foot to abdomen

Hand Shaoyin (He)

From thorax to hand

Hand Taiyang (SI)

From hand to head

Foot Taiyang (Bl)

From head to foot

Foot Shaoyin (Ki)

From foot to thorax

Hand Jueyin (XB)

From thorax to hand

Hand Shaoyang (SJ)

From hand to head

Foot Shaoyang (GB)

From head to foot

Foot Jueyin (Li)

From foot to abdomen (> head)



   

252. The direction of the circulation of the 12 Jingmai can be synthesized in the following diagram:

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Figure 67: The 12 Jingmai and their circulation. 253.

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Figure 68: Circadian cycle of the 3 Yin and 3 Yang of the foot and hand.

PARAGRAPH 10 Huangdi: “Only the Foot Shaoyin (Ki) is endowed with a vessel directed toward the bottom. Is this that?”

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Qi Bo:

“This is not that. There is the Chongmai named Sea of the 5 organs/6 bowels . The 5 organs and 6 bowels are maintained by the Chongmai. It is directed toward the top and comes back out at the throat where it is flows down into the Yang channels. At the lower abdomen, it possesses a vessel which inserts itself into Qiji ( Qichong-St 30 ), then from there it runs alongside the inner thigh and penetrates into the popliteal crease and edges its way toward the internal surface of the leg to permeate the 3 Yin channels to behind the internal malleolus where the Great Luo of the kidney is found, bearing the name Dachong (Ki 4) . At this level, its numerous branches work their way toward the top of the foot and penetrate into the space of the great toe where they permeate and heat up the muscles and tendons. 254.

In the event of stagnation of these little vessels, the artery (pedal) stops beating and the absence of pulse at the level of the top of the foot is the indicator of Jue Ni (afflux), origin of cold (of the feet).” Huangdi: “On what do you base your judgment in saying that?” Qi Bo:

“We base our judgment on questioning and palpation of the pulse (of the pedal artery). In the event of absence of stasis, the artery continues to beat. In this way, we know how to understand the reason of the favorable and u n f a v o r a b l e . ” Huangdi: “The Dao of acupuncture put forward by the sages is profound! It is more luminous than the sun and moon, more subtle than Hao and Li ( 6 ) ... . Without you, no one could explain this Dao.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph concerns the trajectory of the Chongmai. Chongmai is the “sea” of the 5 organs and 6 bowels because it maintains them in blood and energy. Its descending trajectory starts at Qiji (Qichong- St 30), runs alongside the inner thigh to the popliteal crease, contacts the internal surface of the leg to the point Dachong (Ki 4), located behind the internal malleolus where numerous branches leave from:

6. “Hao” = centimeter; “Li” = millimeter.

_ ascending branches which go up to the leg saturating the 3 Yin channels (liver, spleen and kidney) _ and branches which reach the top of the foot and pass to the point Yongquan (Ki 1) on the one hand, and on the other hand, to the space of the great toe saturating the Luo in order to heat up the muscles and tendons. In the event of stasis at the level of these branches, the absence of beating of the artery

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(pedal) signals a contrary afflux (Jue Ni), responsible for cold feet. But which criteria explains that? It is based on the information compared with the patient before examining the pulse. If the artery (pedal) stops beating, it is an unfavorable sign; the opposite is favorable. The absence or presence of energetic afflux at the level of the foot is therefore easy to diagnose.” 256... II - N.V.N.: In relation to the Chongmai, we mention the explanation of Ma Zong Sai of the Tang Dynasty: “The Chongmai constitutes a path called “contrary-favorable” conducting the Xue Qi (Blood-Energy) as easily toward the interior (organs, bowels) as toward the exterior (skin, flesh, muscles). It is named in this manner because the blood and energy that it conducts circulates at the same time within the channels and outside the channels. In the first case, it circulates in the same direction as the Jingmai, and in the second case, in the opposite direction. This circulation agrees with the Dao of the celestial movements.

The blood and energy originating from the metabolism of the Cereal-Water (Shui Gu) floods the 5 organs and 6 bowels. They are brought toward the epidermo-dermal system by the route of the Chongmai (Figure 70). The energy of the Shaoyin (Ki) is none other than the a priori Jing (innate energy or Tong Qi) associated with the a posteriori Jing (acquired energy) of the Chongmai whose vital role is to saturate the 3 Yin (Taiyin, Jueyin and Shaoyin). The descending branch of the Chongmai brings this associated energy toward the top of the foot to the tip of the great toe to reach the Luomai in order to heat up the flesh, muscles and bones. In total, the build of the human being is linked to the state of maintainance of the blood and energetic system dependent on the Chongmai and Shaoyin (Ki).”

255...

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Figure 70: Ascending and descending vessel of the Chongmai. From 1 to 5: circulatory direction of the principal trajectory. 257.

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CHAPTER XXXIX Study on Blood Stasis at the Level of the Blood Luo (Xue Luo Lun)

Xue means blood. Luo means Luo vessel. Xue Luo implies the sense of blood stasis in the Luo. The basic object of Chapter 39 of the Lingshu seeks to: _ establish the difference between needling the Luo and the method of bleeding. _ to discover the causes of blood stagnation, _ to present the method of examination of the Luo in order to avoid errors during clinical practice. This chapter, centered on the needling of the Luo and on the dispersion of the blood, is therefore entitled: “Study on Blood Stasis in the Blood Luo” (Xue Luo Lun). Ma Shi writes: “This chapter studies the localization of perverse energy at the level of the blood and Luo and the principle of treatment.” This chapter consists of 10 paragraphs.

PARAGRAPH 1 Huangdi questions Qi Bo: “Do you wish to give me information about the localization of the curious perverse energy (Ji Xie) not localizing within the Jingmai (principal channels)?”

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Qi Bo:

“It stagnates at the level of the Xue (blood) and Luo (secondary vessels).”

258.

EXPLANATIONS COMMENTARIES I - Zhang Shi explains: “Chapter 63 (“Discourse on Needling on the Opposite Side”) of the Suwen states: “Perverse energy infiltrates into the pilo-cutaneous system and penetrates into the Sunluo (little branches of the Luo). Not having the ability to reach the Jingmai (principal channels), it passes to the Luomai (secondary vessels) to provoke the curious diseases (Qi Bing).” For this reason, Qi Bo answers Huangdi: “It stagnates at the level of the Luo.” II - N.V.N.: Perverse energy is called curious because it does not stagnate in the Jingmai, but at the level of the Luomai which induces the diseases also called “curious”. Here, the words Xue Luo designate blood stasis within the Sun Luo (little branches of the Luo located in the skin). The previous chapter (Ch. 38: “Distinction of the 5 Types of Liquid Retention”) is centered on the study of the exteriorization of Xue (blood), Qi (energy) and Jing (energetic quintessence) of the 5 organs/6 bowels via the route of the Chongmai. This chapter studies the exteriorization of blood and energy via the route of the Luomai.

PARAGRAPH 2 Huangdi: “Why does the individual come down with fainting during the needling of the Luomai?” Why does the blood spurt out to the exterior during removal of the needle? Why does black and turbid blood flow out in small amount? Why does the blood obtained by needling the Xue Luo contain an abundance of liquid substance? Why is swelling produced at the level of the needling as soon as the needle is removed? 259. Why is either a small or very abundant flow of blood during the needling of the Xue Luo accompanied by a pale white color of the facies? Why, after removal of the needle, is the individual agitated despite the absence of change of the color? Why does the individual not stagger during an abundant outflow of

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blood? I would like to the know the reasons.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Here, Xue Luo designates the collection of Luomai and Sunluo located in the epidermdermal space. At this level, the accumulation of energy and blood impedes the circulation of the exterior toward the interior and of the interior toward the exterior.” II - N.V.N.: Huangdi’s questions pose a crucial problem in the practice of acupuncture, that of poor acupuncture, of problems caused by the placing or removal of the needle and the bleeding of the point of impact. It is imperative to grasp the importance of this paragrph in order to prevent regrettable needling reactions.

PARAGRAPH 3 Qi Bo replies: “In the fullness of the energy with emptiness of blood, needling the Xue Luo is responsible for fainting. In concomitant fullness of blood and energy with predominance of Yin Qi (Yin energy), needling the Xue Luo provokes a spurting out of blood. But this spurting out of blood is absent in the case of accumulation of Yang Qi (Yang energy) and in the case of black and turbid blood.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The interior of the Jingmai and the epidermo-dermal space are provided with blood and energy grouped together into Yin and Yang. The Jingmai are Yin in relation to the epidermo-dermal spaces which are Yang. 260. 1. In the case of fullness of the energy and emptiness of blood, needling the Xue Luo to disperse the energy is the cause of simultaneous escape of Yin and Yang, hence fainting.

2. Concomitant fullness of the blood and energy designates the plethoric state of Yin and Yang located at the exterior and in the interior of the channels. As a result, Yin Qi (located within the interior of the channels) is in excess, and the blood (located at the exterior of the channels) is “slippery” and “active”. This is why the blood spurts out during needling. In contrast, in the case of chronic accumulation of Yang Qi (located within the interior of the channels), if one does not disperse it, the blood becomes black and turbid and does not spurt out during needling.”

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II - N.V.N.: In stagnation or accumulation of Yang Qi, the blood is black and turbid because it is no longer activated by the energy.

PARAGRAPH 4 “During absorption of drinks, the liquid substance saturates the Luomai before it is transformed into blood. This is why the blood obtained by needling the Xue Luo contain a great amount of liquid substance. If this liquid substance does not come from a recent absorption of drinks, it is the indicator of retention of water within the organism which, in the long run, becomes transformed into edema.”

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “The organic liquid originates from food metabolism. It reaches the skin and saturates the Luomai which unites with the Jingmai. But at the skin, the blood and energy arrive via other routes. In other words, this chapter is based on acupuncture to stress the importance of the ideas “Beginning-Ending” and “EntryExit” of Yin and Yang, of blood and energy. That our readers may have the ability to realize the profound meaning of the text!”

PARAGRAPH 5 “Yin energy accumulating in the Yang part originates from the Luomai. This is why, during needling, the energy exteriorizes before the blood and provokes swelling.” EXPLANATIONS AND COMMENTARIES

261.

Zhang Shi explains: “This paragraph studies the stagnation of blood and energy in the Yang part of the body. The Dai Luo (Great luo) and Sun Luo (little branches of the Luo), located in the dermal layer, originate from the Jingmai (principal channels) which are Yin in their relationship to the epidermal system, which is Yang. The energy of the 5 organs/6 bowels accumulating within the Yang region, that is to say, within the epidermal (skin) region, originates therefore from the Dai Luo and Sun Luo. Therefore, during needling of the Luo, if the energy drains off before the blood, the blood remains in place and provokes swelling.”

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PARAGRAPH 6 “After a new combination of Yin and Yang, while their reunion is still not definitive, if one hastens to utilize dispersion, Yin and Yang escape, interior and exterior become separated, hence pale and green color of the facies.” EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“This paragraph completes the previous one and stresses the importance of the reunion of Yin and Yang, of exterior (Li) and interior (Biao). The skin and hair are at the exterior and the Jingmai, in the interior. Yang Qi (Yang energy of the exterior) harmonizes with Yin Qi (Yin energy of the interior). Such is the path of reunion of Yin and Yang, of interior and exterior. At the beginning of the function of Yin and Yang, their reunion is still precarious. This is why needling in dispersion is the cause of their escape, leaving behind them a separation of the interior and exterior, hence absence of color or pale green color of the facies.”

PARAGRAPH 7

262.

“During needling, abundant bleeding does not cause a change in color, but rather anxiety, because needling the Luo (secondary vessels) has caused an emptiness at the level of the Jing (principle channels) which respond to Yin. As a result, the escape of Yin is the cause of the anxiety.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Simultaneous escape of Yin and Yang with change of the color is due to bleeding provoked at the level of the skin and Luomai. If the bleeding is abundant without change in color, it is because needling the Luo has caused an emptiness at the level of the Jing (principal channels). The vessel-channels (Jingmai) are controlled by the heart and blood, by the Xin Bao (XB). This is why abundant bleeding performed at the level of the vessels is the cause of anxiety.”

II - N.V.N.: During needling of the Luo, an abundant bleeding without change in color, but with a sensation of anxiety and agitation, is due to the emptiness of the Jing (principal channels). The Jing are in relationship with the Yin (blood) part of the 5 organs. As a result, the emptiness of the Jing causes that of the organs, and in the emptiness of the organs, Yin escapes, hence anxiety and agitation.

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It is noted that anxiety is never accompanied by nausea (!) but by agitation (turmoil) in spite of some translations which distort the Lingshu.

PARAGRAPH 8 “The meeting of Yin and Yang can cause Bi disease (obstruction: algopaesthesia). This is due to an engorgement of the Jing (principal channel) in the interior and an overflowing of the Luo (secondary vessels) at the exterior. Yin and Yang are simultaneously in excess; in this case, an identical abundant bleeding does not cause emptiness of the energy.” EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

“1. Interior is Yin and exterior is Yang; Jing and Luo are Yin and the skin and hair are Yang... . This information allows explanation of the movements of Entry/Exit and the Combination/ Union natures of Yin and Yang. 263. The energy and blood at the level of the skin carry out movements from the exterior toward the interior to saturate first the Sunluo (energetic capillaries) and Luomai (secondary vessels) and secondly, the Jingmai (principal channels). Conversely, from the interior toward the exterior, the movements of Blood/Energy are carried out from the Yin part, that is to say, from the organs/bowels, in order to spread into the Jingmai, then from the Jingmai into Luomai and Sunluo, and finally from the Sunluo to the skin. Such is the phenomenon called combination of the interior and exterior, of Yin and Yang,. 2. If Yin and Yang are simultaneously in excess and their union causes an obstruction (Bi) in the “interior-exterior” (epidermo-dermal) space, an identical abundant bleeding does not provoke a state of emptiness of the energy. Chu Ze Gong has pronounced: “The phrase “the meeting of Yin and Yang can be transformed into Bi disease” cited in this paragraph has the same meaning as that mentioned in the previous paragraph. In effect, because the combination of Yin and Yang is harmonious, their circulation operates perfectly. In contrast, if, despite this combination, it produces phenomena of stagnation, they are responsible for Bi disease. The totality of Chapter 39 is devoted to the phenomena of “Beginning/Ending-Entry/Exit” of the Jingmai and Blood/Energy. This is why Huangdi questions about “abundant bleeding of the Luo without causing emptiness of the energy” and Qi Bo replies:“The Combination/Union of Yin and Yang can cause Bi disease”. As a result, this Bi disease cited in the paragraph is not caused by exogenous factors.”” II - N.V.N.: Bi diseases (algoparesthesias) are of two types of exogenous origin and endogenous origin. In the two cases, dispersion is logical.

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Huangdi: “How does one examine them?” Qi Bo:

“In fullness, the Xue Luo are firm and of red color and are 264. arranged by length and width, at the top and at the bottom, without fixed localization; sometimes they are fine like needles, sometimes they are large like chopsticks... . One must disperse them according to the rules and not get the wrong “number” (1) of needlings of the Luo. To do the opposite is to provoke the above-noted signs.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph concerns the routes of entry and exit of the blood and energy at the level of the Jingmai. 1. The terms “In fullness... firm and red” denote the abundant aspect of the blood. The terms “...in length and width, at the top and at the bottom, without fixed location...” indicate the circulatory state of the blood and energy. “...fine like needles” explains the stagnant state of the blood within the Sunluo and “large like chopsticks”, the stagnant state of the blood of the Jingmai. 2. Here, the word number implies the idea of “rhythmic movements” transmitted by the blood and energetic vessels during their “entry” and “exit”. The movements of exiting are carried out from the Jingmai (principal channels), then from the Luomai (secondary vessels) and finally from the Sunluo (energetic capillaries). The opposite needling, that is to say, needling done first at the Sunluo, then at the Luomai and finally at the Jingmai, is an erroneous needling able to provoke the above-noted signs, loss of consciousness, escaping of Yin, difficult respiration, anxiety and agitation... .”

II - Ma Shi states: “This paragraph explains the method of examination of blood stases at the level of the Jingluo (principal channels and secondary vessels) whose ideal therapeutic technique is dispersion which consists of tilting the needle to perform movements called “in opposition”. This technique conforms to the “number” technique cited in the text. In contrast, the opposite technique can cause unfavorable signs like fainting, spurting out of blood, swelling... “.

1. “Du Xo” in pinyin.

III - N.V.N.: Blood stases at the level of the Jingluo, particularly the Sunluo, very common in clinic, are the precursory signs of numerous disease. For this reason, Ma Shi stresses the best method of dispersion of the Luo according to the technique called “in opposition”. (see Figure 71 below). 265.

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Figure 71: “In opposition” technique in the needling of the Luo. (stick countercurrent to the circulation)

PARAGRAPH 10 Huangdi: “During needling, the needle is hugged tightly by the flesh. Why?” Qi Bo:

“In contact with Re Qi (heat energy), the needle is warmed up and provokes a tightening of the flesh (around the needle) with sensation of solidity (at the point).” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“The energy of the 3 Yang (Taiyang, Shaoyang and Yangming) governs the external part of the body. Re Qi (heat energy) responds to the Yang energy. 266. In contact with the heat, the needle is warmed up and provokes a reaction at the level of the flesh which solidly clasps the needle. In all cases of stasis and accumulation at the level of the Luo, the ideal method is dispersion. If the needling is only applied on the flesh, it causes the clasping of the needle which impedes the effectiveness of this method.” II - N.V.N.:

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This phenomenon of clasping the needle is encountered daily in practice. In order to free the needle, it suffices to execute a tapping with the finger on the shaft/handle of the needle.

267.

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CHAPTER XL Yin and Yang - Pure and Impure (Yin Yang Qing Zhuo)

Chapter 40 of the Lingshu discourses on the properties and actions of the pure energy and impure energy of the human organism. The pouring out of the pure into the Yin (organ) and of the impure into the Yang (bowel), and the existence of the pure within the impure and of the impure within the pure, constitute the theme of this study. The mixture of pure and impure and change in the “top-bottom” pole are the causal conditions of the perturbation of the energy. Based on the nature of these two energies, pure and impure, Qi Bo presents the therapeutic method known as “correspondant” to Huangdi. This chapter, having for an object the study of pure and impure energy as a function of Yin and Yang, it is entitled: “Yin and Yang; Pure and Impure” (Yin Yang Qing Zhuo). This chapter consists of 6 paragraphs.

PARAGRAPH 1 Huangdi: “I have heard something about the analogy between the 12 Jingmai of the human being and the 12 great rivers of the earth. But rivers differ in color and are distinguished by the pure state and impure state of their water.

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In the human being, blood and energy form “one whole”. How then do you liken them with the 12 rivers?” Qi Bo:

“If blood and energy form “one whole”, men of this world will be unified. How therefore could discord arise?” 268.

Huangdi: “My question concerns the blood state and energetic state of the human organism and not the affairs of men of this world.” Qi Bo:

“Energetic disturbances of the organism are comparable to the “disturbances of humanity” (Lun Ren). These two disturbances stem from the same principle.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This passage discourses on the reciprocal offensive of Yin and Yang, of pure and impure. In the human being, the 12 Jingmai respond to the exterior, to the 12 river routes, and in the interior, to the 5 organs/6 bowels. The rivers are distinguished by their color and the state of purity of their water. When an individual presents disturbances of the energy, one can deduce that other men can experience the same disturbances. It concerns here the theory known as the “sole principle”.

II - Ma Shi comments: “In the human being, blood and energy cannot form a single unity. This is why disturbances of energy exist. Chapter 12 (“River Ways”) of the Lingshu specifies: “The feet and hands are endowed with 3 Yin and 3 Yang (Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin) forming the 12 Jingmai which respond to the 12 river routes. Therefore, for example: _ the Foot Taiyang (Bl) unites at the exterior with the river named Qing Shui (Pure Water), and at the interior, with the bladder. _ the Foot Shaoyang (GB) unites at the exterior with the river named Wei Shui (Fragrant Water), and in the interior, with the gallbladder, etc ... . Therefore, the 12 Jingmai unite with the 5 Movements and the 5 Movements are divided into 5 colors... . Because the 12 Jingmai respond to the 12 rivers of different colors, the state of purity of their energy is also different. As a result, in the living being, if the blood and energy could merge into a single unity without being divided into pure and impure components, it would be impossible to compare them to the 12 rivers of the Earth. This is why Qi Bo concludes: “The energy and blood of the human being cannot merge into a single unity. If this was not this way, the men of this planet could unite and there would no longer be dissentions which dishonor the human race. 269. And Qi Bo adds: “Disturbances of the energy in a living being can be related in others”. In short, Qi Bo expresses the principle of unity of action of the pure and impure energy.”

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III - N.V.N.: The words Yin and Yang used in this chapter designate Yin channels and Yang channels. Yin channels receive the pure energy, and Yang channels, impure energy. The pure energy and impure energy belong to Heaven (respiration) and Earth (digestion). In the organism, that of Heaven carries out movements of descent and that of Earth, movements of ascent. The mixture of these two energies bears the name dyscrasia, necessary to the production and transformation of the energy of the body.

PARAGRAPH 2 Huangdi: “I would like you to inform me about the pure energy (Qing Qi) of the human being.” Qi Bo:

“Man receives the cereal energy (Gu Qi) know as impure energy and celestial energy (Tian Qi) known as pure energy. The pure flows down/pours out√ into Yin and the impure into Yang. The impure follows the pure to reach the top (lung and heart) and the pure follows the impure to reach the bottom (liver and kidney). The reciprocal interference of pure and impure bears the name energetic dyscrasia (Lun Qi).” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “In the first place, the 6 bowels belonging to the “impure” group receive the cereal energy; then this cereal energy becomes transformed into sophisticated and subtle energy which exteriorizes at the level of the laryngo-pharyngeal system. 270. This sophisticated and subtle energy will be gathered next by the 5 organs. As a result, the 5 organs belong to the “pure” group.”

II - N.V.N.: 1 - According to Zhang Jing Yue, there exists two types of energy in the human organism: impure energy (or cereal energy) and pure energy (or celestial energy). Thes two types of energy bear the name Chen Qi (original energy). According to Chapter 75 (“Effect of Needling on the Source Energy and Perverse Energy”) of this classic “Chen Qi is celestial energy asociated with cereal energy intended to give magnitude/extent in the form (bodily).” 2 - The larynx governs the celestial energy. The pure energy of Heaven leaves therefore from the larynx and inserts/projects itself into Yin, that is to say, the organs. The pharynx governs the terrestrial energy. The impure energy of the cereals therefore leaves from the pharynx and projects itself into Yang, that is to say, the bowels. The route by which the impure energy follows the pure energy is conducted from the interior toward the exterior. As a result, the impure energy is directed toward the top. The route by which the pure energy follows the impure energy is conducted from the

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exterior toward the interior. As a result, the pure energy is directed toward the bottom. The one ascends and the other descends. They cross and necessarily fuse. Their union and interference bear the name energetic dyscrasia (Lun Qi).

Figure 1: Phenomena of ascent and descent of the pure and impure energy within the organism and the phenomenon of energetic dyscrasia.

PARAGRAPH 3

Huangdi: “Yin is pure and Yang is impure. But within the impure, there is pure, and within the pure, there is the impure. How therefore do you differentiate the pure and impure?”

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Qi Bo: way:

“In

general,

energetic

differentiation

is

done

in

the

following

_ first, the pure energy inserts into the lung and the impure energy accumulates within the stomach. _ second, the pure energy of the stomach is directed toward the mouth and the impure energy of the lung inserts into the Jing (channels) and accumulates in the “sea” (Hai).” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “The site of reception of the celestial energy is pure and the pure inserts into Yin (lung organ), and the site of reception of the cereal energy is impure and the impure accumulates within Yang (stomach bowel). After metabolization: _ the pure energy of the stomach reaches the mouth _ and the impure energy of the lung is directed toward the channels and accumulates within Qihai (CV 6) and Tanzhong (CV 17). As a result, the differentiation of pure and impure manifests without cessation, in every moment, within our organism.”

II - Zhang Shi comments: “This paragraph speaks on the correlations between man and the energy of Heaven and Earth. a - Heaven is pure, Earth is impure. Their energy ascends and descends provoking interferences/conjunctions. This is why, within the impure there is the pure, and within the pure there is the impure. It is the same in the living being.

b - The lung (Taiyin) responds to Heaven, and the stomach (Yangming) belongs to “CenterEarth”. As a result, the pure ascends and is directed toward the lung; and the impure descends and accumulates in the stomach. Such are the routes of ascent and descent of pure and impure. c - Nevertheless, within the impure, there is the pure. As a result, after metabolization, the pure energy of the stomach reaches the top and exteriorizes at the mouth, the mouth and nose being the doors of entry and exit of the energy. Such is the place where the impure energy of the cereals becomes transformed into pure energy; it reaches the top to regularize the respiratory movements in order to respond to the movements of closing/opening of Heaven and Earth. 272.. d - Within the pure, there is the impure. As a result, after metabolization, the impure energy of the lung descends and inserts into the channels (Jing), and in the interior it accumulates within the “seas” (Hai). Furthermore, the first directs the source of pure water, site of production of the Xin-Ye (organic liquid)... . The word Sea (Hai) designates “sea of pure energy” (quintessence: Jing) directed by the Xiajiao (LJ), site of interference/conjunction of Yin and Yang, of pure and impure of the entire organism.”

III - N.V.N.:

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The previous paragraph uses the words Tian Qi (energy of Heaven) and Gu Qi (energy of cereals) to mark the distinction between the pure and impure. This paragraph employs the terms “the pure is in the impure and the impure is in the pure” to mark the differentiation between the circulatory routes of the pure energy and that of the impure energy, _ because the pure energy has the nature of emergence, it pours out into the lung, _ and because the impure energy has the nature of submergence, it accumulates within the stomach. Nevertheless, since in the impure remains the pure, the pure energy, released at the level of the stomach, reaches the top and exteriorizes via the mouth; it is intended to unblock the respiratory route and liquid route. Similarly, since in the pure remains the impure, the impure energy, released at the level of the lung, reaches the bottom and flows out into the channels in order to transform into Xue (blood), Ying (or Rong: nutritive energy) and Wei (defensive energy). The “seas” of energy are three in number (Figure 71): _ Qihai (sea of energy): CV 6 _ Shang Qihai (upper sea of energy): other name Tanzhong (CV 17) _ Xia Qihai (lower sea of energy): other name Guanyuan (CV 4).

273....

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Figure 71: The 3 Seas of Energy

PARAGRAPH 4

272....

Huangdi: “All Yang channels are impure. Which is the most?” Qi Bo:

255

“The Hand Taiyang (SI) receives more of the impure energy than

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the

other

other

Yang

channels.

The Hand Taiyin (Lu) receives more of the pure energy than the Yin channels.

The pure energy reaches the top and is directed toward the “orifices”. The impure energy reaches the bottom and is directed toward the channels. (Sp)

All the Yin channels receive pure energy, except the Foot Taiyin which receives impure energy,”

EXPLANATIONS AND COMMENTARIES

274.

I - Ma Shi explains: “1 - All the Yang channels receive impure energy. Among the Yang channels, the Hand Taiyang (SI) is more impure than the others because the work of breaking down the food, which has already started in the stomach, continues in the small intestine.

2 - All the Yin channels receive the pure energy. Among the Yin channels, the Hand Taiyin (Lu) is more pure than the others because the lung organ, like a protective umbrella, only receives the pure energy. This is why the pure energy of the lung reaches the top and is directed toward the “orifices”. As for the impure energy, it reaches the bottom and gathers at Qihai (CV 6) and at Tanzhong (CV 17). 3 - It is true that all the Yin channels receive pure energy, except the Foot Taiyin (Sp) because the spleen organ is intimately linked to the stomach. In other words, the stomach needs the spleen to fulfill its digestive functions.”

II - N.V.N.: The small intestine receives the barely purified products coming from the stomach. In other words, the Hand Taiyang (SI) only receives the impure energy coming from Yang. The lung is a protective cap of the collection of the system of 5 organs/6 bowels, site of outflowing of the pure energy, therefore “pure site” of the pure. In other words, the Hand Taiyin (Lu) only receives the pure energy coming from Yin. “The pure energy reaches the top and is directed toward the orifices” means that the pure part of the energy of the stomach ascends and exteriorizes via the buccal route. As for the impure part, it descends and reaches the channels. The stomach receives the food products; the spleen receives the energy of these products. In other words, the Foot Taiyin (Sp) only receives the impure energy; but this is the impure part of the pure. Yang Yuan Re concludes: “The Hand Taiyang (Lu) responds to Heaven; as a result, it is the only one which receives the pure energy. The Foot Taiyin (Sp) responds to Earth; this is why it is the only one which receives the impure energy.

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PARAGRAPH 5 Huangdi: “What is the method of treatment of the pure energy and impure energy?” 275.

Qi Bo:

“The pure energy is necessarily slippery (Hua) and the impure energy is inevitably rough (Se) . Such are the natures of the pure energy and impure energy. In therapy, it is advised to deeply needle the Yin channels and leave the needle in place a long time, and to needle the Yang channels superficially and rapidly remove the needle. In the event of fusion of the pure and impure, one must base one’s judgment on the Ba Gua (eight temero-spatial signs) (1) and Wu Xing (5 Movements) (2) in order to harmonize them.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“In therapy, one must distinguish the Yin channels and Yang channels. The pure energy belongs to Yin; Yin channels are pure and their energy slippery (Hua). The impure energy belongs to Yang; Yang channels are impure and their energy rough (Se). Such are the natural characteristics of the energy. Yin responds to interior and deep. This is why needling the Yin channels must be deep and the needle left in place a long time. Yang responds to exterior and superficial. This is why needling the Yang channels must be superficial and the needle rapidly removed. The fusion of pure and impure is characterized by the phenomena of non-descent of the impure energy and non-ascent of the pure energy. In that case, it is advised to apply the law of the 5 Movements (Wu Xing) or the rules of the “8 tempero-spatial signs” (Ba Gua) in needling the Yang channels superficially and rapidly removing the needles or in needling the Yin channels deeply and allowing the needle to remain in place a long time. But this technique is only used in certain fortuitous cases and does not constitute a generalized rule.”

1. “Trigram” (!?). 2. “5 elements” (!?).

II - N.V.N.: The nature of the pure energy is to be slippery and active, and that of the impure energy, rough and passive. Treatment consists of harmonizing the natures of these two energies according to the localization of the disease using the method known as “correspondant” of deep or superficiial needling.

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In this way, for example: 276. _ In the case of the organ (Yin), the disease is deep; needling must be deep and the needle left in place a long time. _ In the case of the bowel (Yang), the disease is superficial; needling must be superficial and the needle rapidly removed. _ In the case of fusion of pure and impure energy, the treatment must be a function of the location (external/internal, superficial/deep) and the benigness or seriousness of the disease.

277.

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CHAPTER XLI Correlations Between Yin-Yang and the “Sun-Moon” System (days and months) (Yin Yang He Yua Ye)

Chapter 41 of the Lingshu is based on the Yin and Yang natures to explain that 1 - in space, _ Heaven is Yang _ Earth is Yin _ Sun is Yang _ Moon is Yin. 2 - in the human being, _ the part which extends from the lumbar region to the top responds to Heaven, therefore to Yang corresponding to the sun, _ the part which extends from the lumbar region to the bottom responds to Earth, therefore to Yin corresponding to the moon. 3 - from this information, _ being Yang, the 10 Celestial Trunks (Tian Gen) respond to the 10 channels of the 2 hands (left and right), _ being Yin, the 12 Terrestrial Branches (Di Chi) respond to the 12 channels of the 2 feet, _ during the 2 seasons winter-spring, the energy of man is predominantly at the left, _ and during the 2 seasons summer-fall, the energy of man is predominantly at the right. For this reason, in clinical practice, _ unilateral needling is advised against, _ and needling the channels responding to the 10 Celestial Trunks and 12 Terrestrial Branches is also advised against, to not risk injuring the original energy (Yuan Qi). Briefly, the key object of this chapter is based on the solar and lunar movements to explain the emptiness and fullness, growth and decline of Yin and Yang and the relationship between the Yin and Yang channels of the foot and hand, hence the title: “Correlations Between Yin and Yang and the “Sun-Moon” System”. This chapter consists of 7 paragraphs.

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PARAGRAPH 1 Huangdi: “I have heard it said that Heaven responds to Yang and that Earth responds to Yin; that the sun is Yang and the moon is Yin. What are the concordances in man?” Qi Bo:

“The region which extend from the lumbars to the top belongs to Heaven and that which extends from the lumbars to the bottom responds to Earth. As a result, Heaven is Yang and Earth is Yin. The 12 Jingmai (channels-vessels) of the foot respond to the “12 moons” (= 12 months) and the moon is created from water (1). This is why what is located at the bottom belongs to Yin. The 10 digits (of the hand) respond to the “10 suns” (= 10 days) and the sun governs fire ( 2 ) . This is why what is at the top belongs to Yang.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“1 - What contains an abundance of Yang energy belongs to Heaven, and what contains an abundance of Yin energy belongs to Earth. The union of these two energies is called “man”. This is why the energy of the upper half of the body responds to that of Heaven, and the energy of the lower half of the body responds to that of Earth. The sun responds to Fire and the Earth, to Water. Man comes from the “Fire” energy and “Water” energy of Heaven and Earth which create the bodily form. As a result, the upper half of the body belongs to Yang and responds to the sun, and the lower half belongs to Yin and responds to the moon. 2 - The 10 days respond to the 10 trunks (Gen) of Heaven and the 12 months respond to the 12 branches (Chi) of Earth. This is why the 12 Jingmai (channels) of the foot respond to the 12 months (or “12 moons”) and the 10 digits of the hand respond to the 10 days (or “10 suns”). 3 - In total, the human being is created a priori by “Water” energy and “Fire” energy. For this reason, man unites with Heaven and with Earth.”

1 and 2. The translation is literal. These expressions are very common in Oriental literature. See further on.

II - N.V.N.: 1. The word moon designates month because the lunar appearance is monthly, and the word sun designates day because the solar appearance is daily. According to the Oriental calendar (lunar-solar calendar), _ the “12 moons” (or 12 months) are represented by the 12 Terestrial Branches (Chi): Zi, Chou, Yin, Mao, Chen, Si, Wu, Wei, Shen, You, Xu and Hai. These 12 months represent the year.

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_ the “10 suns” (or 10 days) are represented by the 10 Celestial Trunks (Gen): Jia, Yi, Bing, Ding, Wou, Ji, Geng, Xin, Ren and Gui. These 10 days represent one week. (3) 2. The 12 Jingmai of the 2 feet (Yin) designate the 3 Yin and 3 Yang: Foot Taiyang, Foot Shaoyang, Foot Yangming, Foot Taiyin, Foot Jueyin and Foot Shaoyin. These 12 Jingmai respond to the “12 moons” (12 months) and to the 12 Terrestrial Branches (Yin). The 10 digits of the 2 hands (Yang) respond to the “10 suns” (10 days) and to the week of 10 days (lunar-solar calendar) because they are situated above the lumbar region. 3. Zhang Jing Yue furnishes these observations: “The sun is a Yang star; this is why it governs Fire. The moon is a Yin star; this is why it is created from Water. The sun responds to Yang whose number is 5, an odd number, multiplied by 2 (2X5=10). This is why a week is composed of “10 suns” (10 days). The moon is Yin whose number is 6, an even number, multipled by 2 (6X2=12). This is why a year is composed of 12 “moons” (12 months). Our ancestors used the 12 Terrestrial Branches (Chi) to record the 12 months of the year. When their energy (sun and moon) unites with that of man, the area located above the lumbars is Yang, and that located below the lumbars is Yin. The hands, located above the lumbars, are therefore Yang, and the 10 fingers respond to the “10 suns” (10 days). The feet, located below the lumbars, therefore are Yin and are supplied by the 12 Jingmai to repond to the “12 moons” (12 months).” 280.

PARAGRAPH 2 Huangdi: “ How do they agree with the vessels?’ Qi Bo:

“1 - Yin (III) responds to the 1st month of start of the birth of Yang; it governs the Shaoyang (GB) channel of the left foot. Wei (VIII) responds to the 6th month; it governs the Shaoyang (GB) channel of the right foot. Mao (IV) responds to the 2nd month; it governs the Taiyang (Bl) channel of the left foot. Wu (VII) responds to the 5th month; it governs the Taiyang (Bl) channel of the right foot. 3. Not to be confused with the 7 day week of the Gregorian calendar. In other words, for Orientals, one month is composed of 3 weeks of 10 days.

Chen (V) responds to the 3rd month; it governs the Yangming (St) channel of the left foot. Si (VI) responds to the 4th month; it governs the Yangming (St) channel of the right foot. These latter two Yang channels unite at the anterior part of the

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body. This is why they bear the name Yangming

(luminous/bright

Yang).

2 - Shen (IX) responds to the 7th month; it governs the Shaoyin (Ki) channel of the right foot. Chou (II) responds to the 12th month; it governs the Shaoyin (Ki) channel of the left foot. You (X) responds to the 8th month; it governs the Taiyin (Sp) channel of the right foot. Zi (I) responds to the 11th month; it governs the Taiyin (Sp) channel of the left foot. Xu (XI) responds to the 9th month; it governs the Jueyin (Li) channel of the right foot. Hai (XII) responds to the 10th month; it governs the Jueyin (Li) channel of the left foot. The latter two Yin channels are the sites of termination of the Yin energy. This is why they bear the name Jueyin (terminal Yin).”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The first half of the year is Yang; it governs the Taiyang and Shaoyang. The second half of the year is Yin; it governs the Shaoyin and Jueyin. In uniting, the 2 Yang become transformed into light, hence the name Yangming (luminous/ bright Yang). In the terminal phase, the 2 Yin unite and bear the name Jueyin (Terminal Yin).” 281. II - Ma Shi explains: “This paragraph demonstrates the concordance of the 12 channels of the foot (Zu) and 12 Terrestrial Branches (Chi) due to their association with Yin. It is true that the 12 months reponding to the 12 Terrestrial Branches are Yin. But, _ the period which extends from the 1st to the 6th month is Yang in Yin, _ and the period which extends from the 7th to the 12th month is Yin in Yin.

1 - First half of the year: The 1st, 2nd and 3rd months are Shaoyang in Yin. This is why they respond to the 3 Yang channels of the left foot. The 4th, 5th and 6th months are Taiyang in Yin; this is why they respond to the 3 Yang channels of the right foot. Because, _ the 1st month reponding to Yin (IIIrd Terrestrial Branch), period of birth of Shaoyang, governs the Shaoyang channel of the left foot, that is to say, the energy of the vessel of the gallbladder. _ the 6th month responding to Wei (VIIIth Terrestrial Branch) governs the Shaoyang channel of the right foot (at the 4th toe), site where the energy begins to circulate. _ the 2nd month responding to Mao (IVth Terrestrial Branch) governs the Taiyang of the

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left foot. The Taiyang therefore results from the “Shao” (little) movement toward the Tai (Great) movement belonging to the energy of the vessel of the bladder. _ the 5th month responding to Wu (VIIth Terrestrial Branch) governs the Taiyang of the right foot (at the tip of the 5th toe), site of conduction of the energy. _ the 3rd month responding to Chen (Vth Terrestrial branch) governs the Yangming of the left foot, that is to say, the energy of the energetic vessel of the stomach. _ the 4th month responding to Si (VIth Terrestrial Branch) governs the Yangming of the right foot (at the tip of the 2nd toe), site of conduction of the energy. These latter two channels bear the name Yangming because the 3rd and 4th months are intermediary months in relation to the 1st, 2nd, 5th and 6th months and because they unite at the anterior part of the body.

2 - Second half of the year: The 7th, 8th and 9th months are Yin in Yin. They correspond therefore to the 3 Yin channels of the right foot. The 10th, 11th and 12th months represent the period of decline of Yin and the period of birth of Yang. They therefore correspond to the 3 Yin channels of the left foot. Because, _ the 7th month responding to Shen (IXth Terrestrial Branch), period of the birth of the Yin energy, governs the Shaoyin of the right foot, that is to say, the place where the energy of the kidney circulates. 282. _ the 12th month responding to Chou (IInd Terrestrial Branch) governs the Shaoyin of the left foot. (The region which extends from the sole of the foot to the internal malleolus is the site of conduction of the energy). _ the 8th month responding to You (Xth Terrestrial Branch) governs the Taiyin of the right foot, site of commencement of the energy. _ the 11th month responding to Zi (Ist Terrestrial Branch) governs the Taiyin of the left foot (located at the internal ungual angle of the big toe), site of conduction of the energy. _ the 9th month responding to Xu (XIth Terrestrial Branch) governs the Jueyin of the right foot, that is to say, the site where the energy of the liver channels begins to circulate. _ the 10th month responding to Hai (XIIth Terrestrial Branch) governs the Jueyin of the left foot (that is to say, the external ungual angle of the big toe), site of conduction of the energy. The Jueyin is named in this manner because the 7th and 8th months are the period of birth of the Yin energy and the 11th and 12th months are the period of birth of the Yang energy. It is only at the 9th and 10th months that the 2 Yin energies near their end. The word Jueyin means end (termination)”.

III - N.V.N.: This difficult paragraph merits clarification and more analytical development. 1 - This chapter 41, following Yin and Yang, explains that: _ Heaven is Yang, _ Earth is Yin, _ Sun (day) is Yang, _ Moon (month) is Yin. According to this same Yin and Yang information in man: _ the upper half of the body is Yang, _ the lower half of the body is Yin. Applying this Yin-Yang information to Gen-Chi (trunks and branches):

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_ the 10 Celestial Trunks, which represent the week of “10 days”, are Yang. _ the 12 Terrestrial Branches, which represent the 12 months, are Yin. By deduction, _ The feet and 12 months are Yin... . This is why the object of study of this Paragraph 2 is to explain the part located at the bottom of the body responding to Yin and to comment on the relationship existing between the 12 channels of the 2 feet and the 12 Terrestrial Branches (which represent the 12 months). As for the following paragraph (Paragraph 3), it is devoted to the study of the upper part of the body responding to Yang and comments on the relationship between the 10 channels of the 2 hands and the 10 Celestial Trunks (which represent the “week of 10 days”). 283. 2 - The word “Yin”

(寅) designates one of the 12 Terrestrial Branches (Chi).

The ancients used the 12 Terrestrial Branches beginning with the character Yin and associating it with the 12 months giving each a symbol. This combination bears the name Yue Jian (“lunar” symbols or symbols of the months). The symbols of the 12 months are: Yin (III) : symbol of the 1st month (January) Mao (IV) : symbol of the 2nd month (February) Chen (V) : symbol of the 3rd month (March) Si (VI) : symbol of the 4th month (April) Wu (VII) : symbol of the 5th month (May) Wei (VIII) : symbol of the 6th month (June) Shen (IX) : symbol of the 7th month (July) You (X) : symbol of the 8th month (August) Xu (XI) : symbol of the 9th month (September) Hai (XII) : symbol of the 10th month (October) Zi (I) : symbol of the 11th month (Novenber) Chou (II) : symbol of the 12th month (December). These symbols, determined by star observation, are always used by Orientals. The learned of antiquity, observing the phenomena of solar and lunar circumduction, have noted that: _ each year, from the winter solstice (11th lunar month), the days gradually become longer and nights progressively shorter. These phenomena are called “progression of Yang and regression of Yin”. _ each year, from the summer solstice (5th lunar month), the days gradually become shorter and nights progressively longer. These phenomena are called “progression of Yin and regression of Yang”. In other words, from the 11th month (lunar) to the 5th month of the following year, that is to say, from winter to summer (in passing spring), “Yin being maximal, Yang is born”. This is the period of transformation of insufficient movements of Yin into excessive movements. In order to explain the gradual regression of Yin from Jue (end, termination), from Tai (great) and from Shao (little), one bases one’s knowledge on the notion of “decline/growth” of Yin and Yang, on the site of displacement of Yang from the left and on the site of displacement of Yin from the right, associating them with the 2 seasons “winter-spring” and with the 12 Jingmai of the left foot, _ the 10th month governs the Jueyin (Li) of the left foot, _ the 11th month governs the Taiyin (Sp) of the left foot, _ the 12th month governs the Shaoyin (Ki) of the left foot.

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a - Upon the arrival of spring, the energy progressively develops from Shao (little), from Tai (great) and from Ming (luminosity) to maximal fullness: _ the 1st month governs the Shaoyang (GB) of the left foot, 284. _ the 2nd month governs the Taiyang (Bl) of the left foot, _ the 3rd month governs the Yangming (St) of the left foot. b - Summer is Yang. From summer to fall, the Yin energy gradually develops and Yang energy regresses. This is why the two seasons “summer-fall” unite with the 12 Jingmai of the right foot: _ the 4th month governs the Yangming (St) of the right foot, _ the 5th month governs the Taiyang (Bl) of the right foot, _ the 6th month governs the Shaoyang (GB) of the right foot. This phenomenon explains that in summer the regression of Yang energy is gradually carried out from Ming (luminosity), from Tai (great), and from Shao (little). c - In Fall, the Yin energy is goes progressively into fullness: _ the 7th month governs the Shaoyin (Ki) of the right foot, _ the 8th month governs the Taiyin (Sp) of the right foot, _ the 9th month governs the Jueyin (Li) of the right foot. This gradual progression of the Yin energy is therefore carried out in the fall, from Shao (little), from Tai (big) and from Jue (end, termination). In total, Paragraph 2 comments on the intermediary of the 12 Jingmai of the left foot and right foot associated with the 12 months and 4 seasons, the phenomena of emptiness and fullness of the 12 channels of the human being according to “decline-growth” of the natural world. 3 - Emptiness and fullness of Yin and Yang take place in the course of one year and constitute the true core/root of the problem of the relationship known as “opposition/ complementarity”, a problem resolved by the ancients thanks to the method of calculation by numbers. In this manner: a _ the 1st month and 6th month govern the Shaoyang of the 2 feet. One obtains the number: 1 + 6 = 7 _ the 2nd month and 5th month govern the Taiyang of the 2 feet. One obtains the number: 2+5=7 _ the 3rd month and 4th month govern the Yangming of the 2 feet. One obtains the number: 3 + 4 = 7. These are the compatible natures of the 1st half of the year. b - Upon the arrival of the second half of the year, the same calculation is used: _ the 7th and 12th months govern the Shaoyin of the 2 feet. One obtains the number: 7 + 12 = 19 _ the 8th and 11th months govern the Taiyin of the 2 feet. One obtains the number: 8 + 11 = 19 _ the 9th and 10th months govern the Jueyin of the 2 feet. One obtains the number: 9 + 10 = 19. From this number, 19, if one removes the number 12 of the twelve months of the year, one obtains the number 7, equivalent to the number 7 of the first half of the year. 4 - In light of facilitating understanding and use, we present below a table of coordinates of the 12 channels in relationship to the 12 months. 285.

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Table of the 12 channels of the foot associated with the 12 months.

Channels

Lunar Symbols (12 Terrestrial Branches)

Month

10th month

Left Foot Jueyin (Li)

Hai (XII) - Xu (XI)

9th month

Right Foot Jueyin (Li)

11th month

Left Foot Taiyin (Sp)

Zi (I) - You (X)

8th month

Right Foot Taiyin (Sp)

12th month

Left Foot Shaoyin (Ki)

Chou (II) - Shen (IX)

7th month

Right Foot Shaoyin (Ki)

1st month

Left Foot Shaoyang (GB)

Yin (III) - Wu (VIII)

6th month

Right Foot Shaoyang (GB)

2nd month

Left Foot Taiyang (Bl)

Mao (IV) - Wu (VII)

5th month

Right Foot Taiyang (Bl)

3rd month

Left Foot Yangming (St)

Chen (V) - Si (VI)

4th month

Right Foot Yangming (St)

Month

Channels

COMMENTS: According to the experiences of our ancient masters, it is strictly forbidden to needle the channels at the moment when they respond to the 12 months. Example: in the month of January, do not needle the points of the channel of the left Foot Shaoyang (GB) because needling the Jingmai responding to the lunar symbols could injure the essential energy (see further on, Paragraph 6).

5 - The explanation of Zhang Jing Yue is the following: 286. “This paragraph demonstrates the 12 Terrestrial Branches (Chi) responding to Yin. The 2 feet are also Yin. As a result, the 12 channels of the foot correspond to the “12 moons” (12 months). In one year, the 1st half is Yang; this is why it is associated with the 6 Yang channels of the foot. The 2nd half is Yin; this is why it is associated with the 6 Yin channels of the foot. The feet of the human being are also divided into Yin and Yang: left is Yang and right is

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Yin. Comparing Yin and Yang of the 2nd half of the year and Yin and Yang of the 2 feet, one notices that: a - The 1st, 2nd and 3rd months belong to Yang in Yang. It concerns the phenomena of gradual progression of Yang. This is why the 1st month (January) is called Month of Birth of Yang. First, Yang progresses to the left side, then to the right side. As a result, _ the 1st month governs the left Foot Shaoyang _ the 2nd month governs the left Foot Taiyang _ the 3rd month governs the Left Foot Yangming. b - The 4th, 5th and 6th months belong to Yin in Yang. It concerns the phases of gradual decline of Yang and progressive birth of Yin. This is why: _ the 4th month governs the right Foot Yangming _ the 5th month governs the right Foot Taiyang _ the 6th month governs the right Foot Shaoyang. During one year, the Yang energy reunites between the 2 months, Chen (V) and Si (VI), belonging to the 1st half of the year. This phase is named Union of 2 Yang in front (4) and has the name “Yangming” implying the sense of maximal fullness of Yang. c - The 7th. 8th and 9th month belongs to Yin in Yin. As a result, the 7th month is the month of birth of Yin. First, Yin progresses to the right side , then to the left side, This is why: _ the 7th month governs the right Foot Shaoyin _ the 8th month governs the right Foot Taiyin _ the 9th month governs the right Foot Jueyin. d - The 10th, 11th and 12th month belongs to Yang in Yin. This is the phases of gradual regression of Yin and gradual progression of Yang. This is why: _ the 10th month governs the left Foot Jueyin _ the 11th month governs the left Foot Taiyin _ the 12th month governs the left Foot Shaoyin. Nevertheless, in one year, the Yin energy reunites between the 2 months, Xu (XI) and Hai (XII), of the second half of the year. This reunion bears the name Crossing of 2 Yin at the End. Here, the Yin energy is in maximal fullness Such are the methods of calculation of emptiness and fullness of Yin and Yang during one year. This is why: _ the 1st and 6th months reunite 287. _ the 2nd and 5th months reunite _ the 3rd and 4th months reunite and the Yangming energy reunites “in front” _ the 7th and 12th months reunite _ the 8th and 11th months reunite _ the 9th and 10th months reunite and the Jueyin energy reunites “behind” (5).” 4. Here, the term “in front” designates the 1st half of the year. 5. Here, the term “behind” designates the 2nd half of the year.

COMMENTS: All the above-cited notions differ from what we call “Jueyin-Wind-Wood”, “YangmingDryness-Metal”, etc... because: 1 - According to Zhang Shi: “The 6 energies govern the annual energies:

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_ _ _ _ _ _

the 1st energy is Jueyin-Wind-Wood the 2nd energy is Shaoyin-Fire-Imperial the 3rd energy is Shaoyang-Fire-Ministerial the 4th energy is Taiyin-Humidity-Earth the 5th energy is Yangming-Dryness-Metal and the “central” energy is Taiyang-Cold-Water”.

2 - According to Chapter 2 (“Harmonization of the Mental Energy by the 4 Seasons”) of the Suwen:

“Shaoyang governs spring Taiyang governs summer Taiyin governs autumn Shaoyin governs winter.” 3 - From Chapter 49 (“Explanation on the Vessels”) of the Suwen, we read: “a - Yin (III) raises up/increases the Taiyang Chen (V) raises up/increases√ the Jueyin Wu (VII) raises up/increases the Yangming Shen (IX) raises up/increases the Shaoyang Xu (XI) raises up/increases the Shaoyin Zi (I) raises up/increases the Taiyin.

b - Yin-Wei (III-VIII) governs the Shaoyang Mao-Wu (IV-VII) governs the Taiyang Chen-Si (V-VI) governs the Yangming Shen-Chou (IX-XII) governs the Shaoyin You-Zi (X-I) governs the Taiyin Xu-Hai (XI-XII) governs the Jueyin.” 4 - From Chapter 21 (“Special Study on the Jingmai”) of the Suwen: “Liver-Wood governs spring Heart-Fire governs summer Spleen-Earth govens end of summer Lung-Metal governs autumn Kidney-Water governs winter. (6)

288.

5 - From Chapter 16 (“Importance of Examination of the End of the “Jing””) of the Suwen: “At the 1st and 2nd months, the energy of man is found at the liver; at the 3rd and 4th months, the energy of man is found at the spleen, etc. ...”. 6 - From Chapter 71 (“Great Study on the Preparation of the Cyclic Recording of the 6 Energetic Sources”) of the Suwen:

6. Here, the words “Wood, Fire, Earth, Metal, Water” respond to the “5 Movements” a posteriori.

“Zi-Wu (I-VII) belong to the Shaoyin Chou-Wei (II-VIII) belong to the Taiyin Yin-Shen (III-IX) belong to the Shaoyang Mao-You (IV-X) belong to the Yangming Chen-Xu (V-XI) belong to the Taiyang Si-Hai (VI-XII) belong to the Jueyin.”

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Moreover, the organs/bowels being associated with the 10 Celestial Trunks: Zi-Jia (I-1) responds to Shaoyang-Gallbladder Chou-Yi (II-2) responds to Jueyin-Liver Yin-Xin (III-8) responds to Taiyin-Lung Mao-Geng (IV-7) responds to Yangming-Large Intestine Chen-Wu (V-5) responds to Yangming-Stomach Si-Ji (VI-6) responds to Taiyin-Spleen Wu-Bing (VII-3) responds to Taiyang-Small Intestine Wei-Ding (VIII-4) responds to Shaoyin-Heart Shen-Ren (IX-9) responds to Taiyang-Bladder You-Gui (X-10) responds to Shaoyin-Kidney Xu (XI) responds to the Xin Bao Luo (XB) Hai (XII) responds to the Sanjiao (SJ).” 7 - From Chapter 48 (“Dissertation on the Great Singularities”) of the Lingshu: “Renying (left radial pulse) responds to spring-summer: _ the 1st fullness is found at the Shaoyang _ the 2nd fullness is found at the Taiyang _ the 3rd fullness is found at the Yangming. Qi Kou (right radial pulse) responds to autumn-winter: _ the 1st fullness is found at the Jueyin _ the 2nd fullness is found at the Shaoyin _ the 3rd fullness is found at the Taiyin.” 8 - From Chapter 7 (“Special Study on Yin and Yang”) of the Suwen: “Shaoyang is the first Yang Yangming is the second Yang Taiyang is the third Yang.” In brief, Yin and Yang are considered as emblems endowed with indefinite evocative power because “Yin and Yang have name but not form; count ten, but judge a thousand, count a thousand, but judge a hundred thousand” (Lingshu, Chapter 21 (“Diseases of Cold and Heat”)).

PARAGRAPH 3

289.

“ Jia (1) governs the Hand Shaoyang of the left side. Ji (6) governs the Hand Shaoyang of the right side. Yi (2) governs the Hand Taiyang of the left side. Wu (5) governs the Hand Taiyang of the right side.

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Bing (3) governs the Hand Yangming of the left side. Ding (4) governs the Hand Yangming of the right side. (The union of 2 fires is called “ Y a n g m i n g ” ) . Geng (7) governs the Hand Shaoyin of the right side. Gui (10) governs the Hand Shaoyin of the left side. Xin (8) governs the Hand Taiyin of the right side. Ren (9) governs the Hand Taiyin of the left side.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“The 10 digits (hand) are associated with the “10 days” and “10 Celestial Trunks” because all these elements are of Yang nature. But the days which extend from Jia (1) to Ji (6) are Yang in Yang, and the days which extend from Geng (7) to Gui (10) are the Yin in Yin. This is why: _ Jia (1) responds to the Hand Shaoyang of the left side. _ Ji (6) responds to the Hand Shaoyang of the right side. _ Yi (2) responds to the Hand Taiyang of the left side _ Wu (5) responds to the Hand Taiyang of the right side (these 2 latter movements progress from “Shao” to “Tai”). _ Bing (3) responds to the Hand Yangming of the left side. _ Ding (4) responds to the Hand Yangming of the right side. The name “Yangming” is the result of the union of the 2 fires, fire of the 2 Yang channels: “Shao” and “Tai”. _ Geng (7) responds to the Hand Shaoyin of the right side. _ Gui (10) responds to the Hand Shaoyin of the left side. _ Xin (8) responds ot the Hand Taiyin of the right side. _ Ren (9) responds to the Hand Taiyin of the left side. Such are the correlations between the 10 digits (hand) and 10 Celestial Trunks.”

II - N.V.N.: The previous paragraph concerns the correlations between the 12 Terrestrial Branches (representing the 12 months of the year) and the 12 channels of the foot, while this one shows the correlations between the 10 Celestial Trunks (representing the 10 days of the week) (7) and the 10 channels of the hand. As in the previous case, the ideas of interrelationships of the 4 seasons and 5 Movements are indispensible to understand that the 10 Celestial Trunks can represent the 10 days of the week and be related to the 4 seasons of the year. 7. Not to be confused with the 7 days of the week. See page 260 and Footnote 3.

In this manner, _ Jia-Yi (1-2) responds to Wood and governs spring _ Bing-Ding (3-4) responds to Fire and governs summer _ Wu-Ji (5-6) reponds to Earth and governs end of summer. (These “Days-Seasons” movements belonging to the 1st half of the year are Yang). _ Geng-Xin (7-8) responds to Metal and governs autumn

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290.

_ Ren-Gui (9-10) responds to Water and governs winter. (These “Days-Seasons” movements belonging to the 2nd half of the year are Yin). As a result, a - during spring and summer, the Yang energy of the month gradually progresses toward fullness and the first 6 Celestial Trunks (Jia, Yi, Bing, Ding, Wu, Ji) respond to the 6 Yang channels of the hand, b - and during autumn and winter, the Yin energy of the month gradually progresses toward fullness and the last 4 Celestial Trunks (Geng, Xin, Ren, Gui) respond to the 6 Yin channels of the hand. This method of calculation differs slightly from the usual method which consists of utilizing the numbers responding to the 10 Celestial Trunks in order to explain the phenomena of Emptiness/Fullness, Progression/Decline of Yin and Yang. Because, based on the chronological order of the 10 Celestial Trunks: _ Jia has for number, 1 _ Yi has for number, 2 _ Bing has for number, 3 _ Ding has for number, 4 _ Wu has for number, 5 _ Ji has for number, 6 _ Geng has for number. 7 _ Xin has for number, 8 _ Ren has for number, 9 _ Gui has for number, 10. 1 - The first 10 trunks, from Jia to Ji, from 1 to 6, are Yang and respond to the 6 Yang channels of the hand because they represent the seasons: spring, summer and end of summer, namely: a - 1 (Jia) governs the Hand Shaoyang of the left side, and 6 (Ji), the Hand Shaoyang of the right side. Associating the 2 numbers, one obtains: 1 + 6 = 7 b - 2 (Yi) governs the Hand Taiyang of the left side, and 5 (Wu), the Hand Taiyang of the right side. Associating the 2 numbers, one obtains: 2 + 5 = 7 c - 3 (Bing) governs the Hand Yangming of the left side, and 4 (Ding), the Hand Yangming of the right side. Associating the 2 numbers, one obtains: 3 + 4 = 7. 291. 2 - As for the 4 other trunks (Geng, Xin, Ren, Gui), they represent autumn and winter. They are therefore Yin and respond to the 4 Yin channels of the hand, namely: a - 7 (Geng) governs the Hand Shaoyin of the right side, and 10 (Gui), the Hand Shaoyin of the left side. Adding the 2 numbers, one obtains: 7 + 10 = 17 b - 8 (Xin) governs the Hand Taiyin of the right side, and 9 (Ren), the Hand Taiyin of the left side. Adding the 2 numbers, one obtains: 8 + 9 = 17 If one takes away 10 (number of the week of 10 days) from 17, one obtains: 17 - 10 = 7, identical number after addition of the numbers of the 12 Terrestrial Branches (see above). In total, the association of the 10 Celestial Trunks with the 10 channels of the hand permits explanation of the phenomena of Emptiness/Fullness, Decline/Growth of Yin and Yang. 3 - Question: “Why is the Jueyin not cited in this parargraph? The response of the celebrated Zhang Jing Yue (1563-1640 AD) is the following: “If, at the foot (Zu), Jueyin is mentioned and not at the hand, this is because “Zu” (foot)

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concerns the year with its 6 energies and “Shou” (hand) concerns the day, particularly the 10 days of the week with their 5 Movements. This is also because Jueyin designates the Xin Bao Luo (XB) making up an integral part of the heart organ.” Chu Zi Gong adds: “Upon examination of the numbers of “He Du” and “Lu Shu” (of the I Jing) (8), the number 5 is at the center and governs Yang. And upon examination of the “5 Movements”, Wood and Fire belong to Yang, and Metal and Water, to Yin.”

We present below a table of correlations between the 10 Celestial Trunks and 10 channels of the hand:

Chronological Order of the Celestial Trunks

10 Trunks

Channels of the Left Side

Chronological Order of the Celestial Trunks

10 Trunks

Channels of the Right Side

9

Ren

Hand Taiyin

8

Xin

Hand Taiyin

10

Gui

Hand Shaoyin

7

Geng

Hand Shaoyin

1

Jia

Hand Shaoyang

6

Ji

Hand Shaoyang

2

Yi

Hand Taiyang

5

Wu

Hand Taiyang

3

Bing

Hand Yangming

4

Ding

Hand Yangming

REMARKS: Following the experiences of our ancient masters, it is strictly advised against to needle the channel at the time when it responds to the “10 days of the week” (10 Celestial Trunks) in order not to risk injuring the essential energy. (see Paragraph 6)

8. “Classic of Changes”.

PARAGRAPH 4

292.

“This is why, _ the Yang channels of the foot belong to the Shaoyang in Yin and the Yin channels of the foot, to the Taiyin in Yin.

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_ the Yang channels of the hand belong to the Taiyang in Yang, and the Yin channels of the hand, to the Shaoyin in Yang. In total, above the lumbar region is Yang and below the lumbar region is Yin.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph discourses on Yin and Yang of the hand and foot and on the phenomena of Yang in Yang and Yin in Yang. The previous paragraph shows Yin and Yang of “Tai” (great) and “Shou” (little) divided into left/right, while this one studies Yin and Yang of Tai and Shou divided into top/bottom, because it concerns the relationship of the energy of the “6 Unions”. “Above the lumbar region is Yang and below the lumbar region is Yin” explains the determination of the localization of the Yin and Yang channels of the hand provided with Yin and that of the Yin and Yang channels of the foot provided with Yang during the crossing of the energy at the top and at the bottom.” II - N.V.N.: Among the 12 channels, _ those located at the bottom, at the foot, are Yin. At the maximal state of Yin, Yang begins to manifest. As a result, the Yang channels of the foot are Shaoyang (little Yang) in Yin _ and those located at the top, at the hand, are Yang. At the maximal state of Yang, Yin begins to manifest. As a result, the Yin channels of the hand are Shaoyin (little Yin) in Yang. Zhang Jing Yue clarifies: “This paragraph discourses on the theory of “2 Principles and 4 Aspects” (Liang YiSi Zuang) (9) concerning the absence of Taiyang in Yin and of Taiyin in Yang. Because, _ if Zu (foot) belongs to Yin, Yang in Yin is none other than Taiyin (great Yin) _ and if Shou (hand) belongs to Yang, Yin in Yang is none other than Shaoyin (little Yin) and Yang in Yang is none other than Taiyang (great Yang). 293.

This is why above and below the lumbar region permits distinguishing Yin and Yang in order to associate the hand with the 10 Celestial Trunks and the feet with the 12 Terrestrial Branches. In this way, the 3 Yin and 3 Yang have their association.” In total, in this paragraph, we witness the presence of Yin in Yang at the level above the lumbar region and the presence of Yang in Yin at the level below the lumbar region.

9. Theory cited in the I Jing (Classic of Changes).

PARAGRAPH 5 “Among the 5 organs, _ the heart is Taiyang (great Yang) in Yang _ the lung is Shaoyin (little Yin) in Yang

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_ the liver is Shaoyang (little Yang) in Yin _ the spleen is Zhiyin (arrival of Yin) in Yin _ the kidney is Taiyin (great Yin) in Yin. ”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The heart belongs to Fire and responds to the sun. This is why it is Taiyang in Yang. The lung, being situated at the top, belongs to Metal. This is why it is Shaoyin in Yang. The liver, being situated below, belongs to Wood. This is why it is Shaoyang in Yin. The kidney, being at the bottom, belongs to Water. This is why it is Taiyin in Yin. The spleen, being at the center, governs Kun ( ) and Earth. This is why it is Zhiyin in Yin. It is a question here of the organs belonging to Yin, but within Yin, there is Yang.”

II - Ma Shi comments: “This Paragraph summarizes the relationships of the 10 Celestial Trunks (Gen) and 12 Terrestrial Branches (Chi) with the feet and hands cited in the two previous paragraphs. Left and right are endowed with Yin and Yang, with “Shao” (little) and “Tai” (great) and the organs also have their Yin and Yang, their “Shao” and their “Tai”. 294.

a - In the case of the 12 Jingmai responding to the 12 months (of the year) and to the 12 Terretsrial Branches: _ the 1st month responds to the left Foot Shaoyang _ the 2nd month, to the left Foot Taiyang _ the 3rd month, to the left Foot Yangming _ the 4th month, to the right Foot Yangming _ the 5th month, to the right Foot Taiyang _ the 6th month, to the right Foot Shaoyang. Such are the Yang channels belonging to “Zu” (foot) which is Yin and have the name Shaoyang in Yin. _ the 7th month, to the right Foot Shaoyin _ the 8th month, to the right Foot Taiyin _ the 9th month, to the right Foot Jueyin _ the 10th month, to the left Foot Jueyin _ the 11th month, to the left Foot Taiyin _ the 12th month, to the left Foot Shaoyin. These Yin channels belong to “Zu” (foot) which is Yin and have the name Taiyin in Yin. b - In the case of the 10 digits (hands) responding to the 10 days (of the week) and to the 10 Celestial Trunks, _ the day Jia (1) governs the left Hand Shaoyang _ the day Ji (6),the right Hand Shaoyang _ the day Yi (2), the left Hand Taiyang _ the day Wu (5), the right Hand Taiyang _ the day Bing (3), the left Hand Yangming _ the day Ding (4), the right Hand Yangming. These Yang channels belonging to “Shou” (hand) which is Yang, named Taiyang in Yang. _ the day Geng (7) governs the right Hand Shaoyin _ the day Gui (10), the left Hand Shaoyin

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_ the day Xin (8), the right Hand Taiyin _ the day Ren (9), the left Hand Taiyin. These Yin channels belonging to “Shou” (hand) which is Yang, named Shaoyin in Yin. c - This dualism concerning above and below the lumbar region is met up with again at the feet and hands which respond to Yin and Yang, but relates also to the 5 organs: _ the heart and lung located above the diaphragm are Yang. But the heart being “Mu Zang” (organ of “male” nature) (10) is Taiyang in Yang, and the lung being “Xin Zang” (organ of “female” nature) (11) is Shaoyin in Yang. _ the spleen, liver and kidney located below the diaphragm are Yin. But the liver being “Mu Zang” (organ of “male” nature) is Shaoyang in Yin; the spleen being “Xin Zang” (organ of “female” nature) is Zhiyin in Yin; and the kidney also being “Xin Zang” is Taiyin in Yin. 295. Such is the deep meaning of the combination of Yin and Yang: _ in Yin, there is Yang _ in Yang, there is Yin _ in Yin, there is “Tai” (great) and “Shao” (little) _ in Yang, there is also “Tai” and “Shao”.

III - N.V.N.: In the first approach, this paragraph appears arduous even for the initiated of acpuncture. An interpretation more adapted to our current mindset can be proposed. In considering the relations of foot/hand, Yin/Yang, Tai/Shao (great/little), top/bottom, cited in the previous paragraphs, with the 5 organs, _ the heart responds to Fire. Fire being Yang, the heart is Yang and located in the thorax, also Yang. It is concerns then Yang located in Yang. One calls it Taiyang (great Yang) in Yang. _ the lung responds to Metal and Metal governs autumn, season during which the Yin energy gradually progreses. As a result, the lung belongs to Yin; but the lung is located in the thorax which is Yang. One names it Shaoyin (little Yin) in Yang. _ the liver responds to Wood and Wood govern spring, season during which the Yang energy gradually progresses. As a result, the liver belongs to Yang, but its location is found below the diaphragm which is Yin. It is nicknamed Shaoyang (little Yang) in Yin. _ the spleen responds to Earth and Earth is located in the “center”, called “Zhiyin” (arrival of Yin) because the spleen organ is found in the abdomen which is Yin. Therefore, the spleen is Zhiyin in Yin. _ the kidney responds to Water and Water governs winter belonging to Yin. The kidney is located in the abdomen which is Yin. It is a question therefore of Yin in Yin. One gives it the name Taiyin (great Yin) in Yin. Knowledge of these names is necessary to the comprehension of Oriental energetic medicine. 10 and 11. See explanation in Linshu, Chapter 44 (“Conformity of Human Energy with that of the Day Divided into Four Seasonal Periods”).

Zhang Jing Yue concludes: “Among the 5 organs, _ the heart and lung are Yang because they are located above the diaprhagm and their channels belong to the hand (Shou) _ the liver, spleen and kidney are Yin because they are found below the diaphragm and

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their channels belong to the foot (Zu). But within Yin and within Yang, one distinguishes other Yin and other Yang similar to Yin and Yang of the foot and hand cited above. This is why, it is said in Chapter 4 (“Pathological Forms of Attack of the Organs and Bowels by Perverse Energy”) of this classic: “The heart belongs to Yang in Yang The lung belongs to Yin in Yang The kidney belongs to Yin in Yin The liver belongs to Yang in Yin The spleen belongs to Zhiyin in Yin.” 296.

PARAGRAPH 6 Huangdi: “How should one treat?” Qi Bo:

“In the 1st, 2nd and 3rd months (lunar), Ren Qi (human energy) (12) is found at the left; one must not needle the Yang channels of the left foot. In the 4th, 5th and 6th months, the human energy is found at the right; one must not needle the Yang channels of the right foot. In the 7th, 8th and 9th months, the human energy is found at the right; one must not needle the Yin channels of the right foot. In the 10th, 11th and 12th months, the human energy is found at the left; one must not needle the Yin channels of the left foot.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“1 - This paragraph demonstrates the correlation between the 12 channels of the foot and the 12 months of the year and prudence in therapeutic practice which follows that. _ During the 1st, 2nd and 3rd months, it is advised against to needle the 3 Yang channels of the left foot: Foot Shaoyang (GB) Foot Taiyang (Bl) Foot Yangming (St) because during this period, the essential energy of man is plethoric at the level of these channels.

12. Designated original or essential energy (Yuan Qi).

_ During the 4th, 5th and 6th months, it is advised against to needle the 3 Yang channels of the right foot: Foot Yangming (St) Foot Taiyang (Bl) Foot Shaoyang (GB)

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because during this period the essential energy of man is plethoric at the level of these channels. _ During the 7th, 8th and 9th months, it is advised against to needle the 3 Yin channels of the right foot: Foot Shaoyin (Ki) Foot Taiyin (Sp) Foot Jueyin (Li) because during this period, the essential energy of man is plethoric at the level of these channels. _ During the 10th, 11th and 12th months, it is advised against to needle the 3 Yin channels of the left foot: 297. Foot Jueyin (Li) Foot Taiyin (Sp) Foot Shaoyin (Ki) because during this period, the essential energy of man is plethoric at the level of these 3 channels. 2 - It is the same in the correlation between the 10 channels of the hand and 10 days (of the week) where the practice of acupuncture must be performed with caution. In this manner, _ on the days Jia (1), Yi (2) and Bing (3), it is advised against to needle the Yang channels of the left hand: Hand Shaoyang (SJ) Hand Taiyang (SI) Hand Yangming (LI) _ on the days Ding (4), Wu (5) and Ji (6), it is advised against to needle the Yang channels of the right hand: Hand Yangming (LI) Hand Taiyang (SI) Hand Shaoyang (SJ) _ on the days Geng (7) and Xin (8), it is advised against to needle the Yin channels of the right hand: Hand Shaoyin (He) Hand Taiyin (Lu) _ on the days Ren (9) and Gui (10), it is advised against to needle the Yin channels of the left hand: Hand Shaoyin (He) Hand Taiyin (Lu).” II - N.V.N.:

人气) designates the essential energy of the living being.

1. Human energy or Ren Qi (

In the course of the 2 seasons, winter and spring, the essential energy is plethoric at the left, and in the course of the 2 seasons summer and autumn, it is plethoric at the right. This is why, in order not to injure the energy of man, it is advised against to needle: _ the channels of the left foot during winter and spring _ the channels of the right foot during summer and autumn. Therefore, for example: _ In the 1st month (lunar), needling the Shaoyang (GB) channel of the left foot is advised against _ In the 2nd month, needling the Taiyang (Bl) channel of the left foot is advised against. _ In the 3rd month, needling the Yangming (St) channel of the left foot is advised against,

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etc... . 298. 2 - In this paragraph, Huangdi asks a question about the therapeutic principles of emptiness and fullness of Yin and Yang during the year (4 seasons) and Qi Bo’s response, only concerning the Yin and Yang channels of the 2 feet, can be interpreted in the following way: a - The Yang energy goes from left to right. _ During the 3 months of spring (1st, 2nd and 3rd), because the essential energy of man is found to the left, successively at the level of the Foot Shaoyang (GB), Foot Taiyang (Bl) and Foot Yangming (St), needling of these 3 Yang channels of the left foot is advised against. _ During the 3 months of summer (4th, 5th and 6th), because the essential energy is found at the right, successively at the level of the Foot Yangming (St), Foot Taiyang (Bl) and Foot Shaoyang (GB), needling of these 3 Yang channels of the right foot is advised against. b - The Yin energy goes from right to left. _ During the 3 months of autumn (7th, 8th and 9th), because the essential energy is found at the right, successively at the level of the Foot Shaoyin (Ki), Foot Taiyin (Sp) and Foot Jueyin (Li), needling these 3 Yin channels of the right foot is advised against. _ During the 3 months of winter (10th, 11th and 12th), because the essential energy is found at the left, successively at the Foot Jueytin (Li), Foot Taiyin (Sp) and Foot Shaoyin (Ki), needling of these 3 Yin channels of the left foot is advised against.

3 - This therapy of the 3 Yin and 3 Yang of the foot as a function of the “sun-moon” system (that is to say: days/months and trunks/branches) is very valued by traditional acupuncturists of our times. We present below 2 therapeutic tables of this method accompanied by a diagram of the era (Figures 74 and 75):

TABLE I Yang channels of the 2 feet (Yang energy goes from left to right)

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Month

Left Channels

Month

Right Channels

1st month

Foot Shaoyang (GB)

6th month

Foot Shaoyang (GB)

2nd month

Foot Taiyang (Bl)

5th month

Foot Taiyang (Bl)

3rd month

Foot Yangming (St)

4th month

Foot Yangming (St)

299. TABLE II Yin channels of the 2 feet (Yin energy goes from right to left)

Month

279

Left Channels

Month

Right Channels

7th month

Foot Shaoyin (Ki)

12th month

Foot Shaoyin (Ki)

8th month

Foot Taiyin (Sp)

11th month

Foot Taiyin (Sp)

9th month

Foot Jueyin (Li)

10th month

Foot Jueyin (Li)

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Figure 74: Evolution of the 3 Yin and 3 Yang at the level of the 2 feet. 301...

4 - The contraindications to needling the Yin and Yang channels of the 2 hands as a function of the “10 days of the week” (10 Celestial Trunks) are established in the following fashion: 300....

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1. Yang Channels of the 2 Hands (Yang energy goes from left to right)

Days

Left Channels

Days

Right Channels

1 - Jia

Hand Shaoyang (SJ)

6 - Ji

Hand Shaoyang (SJ)

2 - Yi

Hand Taiyang (SI)

5 - Wu

Hand Taiyang (SI)

3 - Bing

Hand Yangming (LI)

4 - Ding

Hand Yangming (LI)

2. Yin Channels of the 2 Hands (Yin energy goes from right to left)

Days

Left Channels

Days

7 - Geng

Hand Shaoyin (He)

10 - Gui

8 - Xin

Hand Taiyin (Lu)

9 - Ren

Right Channels

Hand Shaoyin (He) Hand Taiyin (Lu)

NOTES: 1 - The reason for the absence of the Xin Bao Luo (XB) had been furnished by Ma Shi (see above). 2 - Chu Zi Gong states: “The 2 energies, Yin and Yang, start at the feet, then they go from bottom upward, For this reason, in this paragraph, Qi Bo only speaks of the channels of the foot, neglecting those of the hand, because everything must begin by its source.”

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Figure 75: Evolution of the 3 Yin and 3 Yang at the level of the hands.

PARAGRAPH 7

300...

Huangdi: “Within the 5 Movements, East responds to Jia, to Yi and to Wood which governs spring; spring corrresponds to the color green which responds to the liver and the liver is represented by the Jueyin (Li) of the foot. But you have just spoken of Jia responding to the Shaoyang (SJ) of the hand, therefore not agreeing with the data that I just cited. Why?” 301....

Qi Bo:

“It is a question here of Yin and Yang of Heaven and of Earth and not of Yin and Yang of the 4 seasons and the 5 Movements endowed with a very specific chronologic order. What’s more, Yin and Yang have name but not form. This is why, count 10 but judge 100; count a thousand but judge one hundred thousand... . This is the true meaning.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“In the division of Yin and Yang of the 4 seasons and 5 Movements, Jia (1st trunk) and

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Yi (2nd trunk) respond to Wood-Liver, and in the division of Yin and Yang of Heaven and Earth, Sanjiao (SJ) responds to Jia (Ist trunk) and Shen (IXth branch) because the Sanjiao (SJ) is represented by the Shaoyang. 302. As a result, Yin and Yang are divided into “name” and “type” in order to designate association/membership and not inevitably morphology. To count up to 10 is to utilize Yin and Yang; to judge 100 is to again count in the scope of Yin and Yang; to divide into 1000 or 10,000 is always to judge in the scope of Yin and Yang... . In this manner, the transformations of Yin and Yang are infinite.”

II - N.V.N.: The rules (Dao) of transformations of Yin and Yang of the natural world (Heaven and Earth) are much more complex than that of the 4 Seasons and 5 Movements. Zhang Jing Yue writes notably: “Hands and feet, trunks and branches are gathered together into top/bottom, left/right, large/small (Tai and Shao) with the purpose of discerning emptiness and fullness. Jia (1st trunk) is classified first of the spatio-temporal components; this is why it governs the Shaoyang (SJ) of the left hand and does not follow the order of the 5 Movements and 4 seasons as often indicated when we speak of “Jueyin-Wood-Liver”. Moreover, the Dao of Yin and Yang has only “name” and not form; it is utilized up to 10, 1,000, 10,000 times... all the modifications and transformations are derived from this Dao. Therefore, we cannot exclude the Dao from the study of mutagenesis.” (13)

13. “Judge 10, judge 100...” are facts mentioned in Chapters 6 (“Separation and Reunion of Yin and Yang“) and 67 (“Great Discourse on the Circumduction of the 5 Movements“) of the Suwen - N.V.N. Edition.

303.

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CHAPTER

XLII

Evolution of the Disease (Bing Chuang)

Chapter 42 of the Lingshu has the study of the evolution of disease of the organs according to the law of the 5 Movements for its objective. In diseases evolving following the chains of production, acupuncture is strictly advised. In contrast, in diseases evolving following the chains of destruction, acupuncture is not indicated. Ma Shi expresses: “During the infiltration of Great Energy (Daqi) (1) into the organism, the disease manifests first at a specific organ; then it evolves over an anticipated time toward another organ... .” Therefore, this chapter, concerning the transmission of disease of the 5 organs following the law of the 5 Movements, is entitled: “Evolution of the Disease” (Bing Chuang). It consists of 9 paragraphs.

1. Here, the term “great energy” designates the perverse energy which goes straight into the organ or bowel. It is a question of perverse energy of great virulence.

PARAGRAPH 1 Huangdi: “You have instructed me on the use of the “9 Needles” and, in studying the other techniques myself, I have noticed that energetic

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exercises, massage, moxabustion, application of plasters and poultices, fumigation, heated needle, medicinal decoction... are also used. Are these specialties used separately or together in the same patient?”

304.

Qi Bo:

“To speak of a therapeutic technique is to speak of a particular branch of medicine applied to one type of patient and not to the group of patients.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph discourses on the superficial and deep layers of the human body whose blood and energy can be in emptiness or fullness. As a result, each technique (qigong, massage, acupuncture, moxabustion, phytotherapy...) concerns an area which is appropriate to it. The term “evolution of the disease” implies the sense of successive aggression/ progression of perverse energy at the level of the epidermo-dermal system, the system of Jingluo (principal and sceondary channels) and the system of Zangfu (organs and bowels). When perverse energy is found at the level of the vessels-channels (Jingmai), flesh, muscles and bones, it is advised to use acupuncture to chase it out. During progression of perverse energy to the interior, it is advised to use the method of conduction of the energy (qigong: energetic exercises) to chase it out. In the event of deep penetration of perverse energy, heated poultices are used to direct it to the exterior. In the event of deep penetration of perverse energy with emptiness of the essential energy, it is advised to prescribe sweet-flavored medicines. In the event of fullness, toxic medicines are recommended. in the event of stasis, moxabustion is used to “open the way”. This is why each specialized therapy treats a group of individuals with the same disease and not different diseases. In conclusion, progression/transmission of the disease can be superficial or deep, and the treatment must be applied with flexibility in each particular case as a function of the evolutive process of the disease.”

II - N.V.N.: This paragraph relates different therapeutic methods, in a very general fashion, to groups of diseases. Traditional medicine therefore can specialize in one of these branches of medicine such as qigong, massage, acupuncture/moxabustion, phytotherapy... exactly knowing their indications, but without ignoring others.

PARAGRAPH 2

305.

Huangdi: “I have already heard you explain the “knot” and “ankle” of Yin and Yang, the reason for emptiness and fullness, the consequence of disequilibrium of the essential energy and the different types of

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difficult-to-treat diseases... . I would like you to tell me about: _ the transformation of the disease _ the transmission of the perverse energy _ and the exhaustion of the essential energy which are the principal factors of therapeutic difficulty.” Qi Bo:

“Your question is most pertinent! The Dao (of medicine) is luminous like Riu Jing (clear as day) and dark like Ya Ming (black as night, eyes closed) . To practice the Dao and to know how to follow it is an effort of the Shen (mental). To follow the Dao and attain total knowledge is also the fruit of Shen. In this way, the art of the Shen must be inscribed onto bamboo tablets in order to transmit it to posterity and not keep it for ones family and children.” Huangdi: “What does Riu Jing (clear as day) s i g n i f y ? ” Qi Bo:

“This expression implies the sense of perfect understanding of the law of transformation of Yin and Yang like a sudden response to a difficult question, like awakening after drunkeness.” Huangdi: “What does Ya Ming (black as night) s i g n i f y ? ” Qi Bo:

“This expression stresses the state of silence and insensibility of the individual as if he was his shadow. This state causes other states: falling out of body and head hair, opening of the pores, instability of the essential energy, overflowing of perverse energy throughout the entire body... .This perverse energy follows the blood route and route of the channels to the organ to provoke abdominal pains... . This state can last and survival become impossible.” EXPLANATIONS AND COOMENTARIES

306.

I - Zhang Shi explains: “1 - This paragraph discourses on the simultaneous attack of the Xing (bodily form) and Shen (mental) with fatal prognosis. The knot and ankle of Yin and Yang designate the skin, hair and dermal (flesh) system belonging to Yang, and the blood and vessels belonging to Yin. The dermal system is the site of communication/reunion of Yuan Qi (orignal or essential energy) and Chen Qi (source energy) belonging to the Sanjiao (SJ), while Xue (blood) and Mai (vessels) are the sites of holding of the Shen (mental). Here, emptiness and fullness designates the insufficient and excessive states of the blood and energy. The epidermo-dermal system being resistant, Yuan Qi and Chen Qi are in communication, Xue and Mai are in harmony. In this case, the perverse energy cannot infiltrate into the organism. In contrast, if the epidermo-dermal system is in insufficiency, the perverse energy can penetrate

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deeply to the organ causing difficult survival. Qi Bo proposes to inscribe the Art of Shen onto the tablets of bamboo in order to transmit it for posterity and not to egotistically keep it for himself and his children because the will of care for the Shen Qi is the consciousness of perfection for all human beings. As for the disruption of organic systems like falling out of the body and head hair, dilatation of the epidermo-dermal system... it is due to disintegration of the essential energy.

2 - Some diseases are curable as long as the perverse energy is still found within the inter-epidermodermal spaces, without infiltrating into the blood and vessels and without affecting the organs. It is then recommended to carefully localize the perverse energy and treat it accordingly: _ treatment at the level of the skin and hair _ treatment at the level of the flesh (dermis) _ treatment at the level of the Jingmai _ treatment at the level of the 5 organs... . Life is menaced when perverse energy affects the organs. When the disease evolves in discontinuous fashion, it is life; in contrast, when it progresses toward the area called “victorious”, the disease becomes difficult to treat. Anarchic evolution of the disease due to the exhaustion or defeat of the essential energy is fatal. 307. By the laws of Yin and Yang, one can solve all pathological problems thanks to the Shen (mental). The experience of our masters, who knew how to respect the Dao, mimicked Yin and Yang, searched for harmony according to the “Eight Tempero-spatial Signs” (Bagua) and the “Five Movements” (Wu Xing), followed digestive hygiene, travelled with moderation, avoided overwork... confirms it. In this case, Jing (energetic quintessence), Qi (energy), and Shen (mental) remain in perfect state and man can attain “celestial age”, that is to say, 100 years. “Mute like a carp; numb as if the body didn’t exist” are expressions designating individuals ignorant of the Dao; their tissue fibers are distended and dilated, their blood and vessels are in “emptiness/loss”... . The epidermo-dermal layer is the site of aeration/union of Yuan Qi (original or essential energy and Chen Qi (source energy) of the Sanjiao (SJ). This is why, during infiltration, the perverse energy overflows the inter-tissue spaces and propagates toward the Xue-Mai (blood and vessels), then from there toward the organs and bowels. The overflowing of perverse energy into the epidermo-dermal spaces is injurous to the Qi (energy), and its evolution toward the Xue-Mai is armful to the Shen (mental). As a result, the simultaneous attack of Qi and Shen means death. This is why our masters would teach: “Pinpoint the moment to avoid the vicious perverse energy and “pirate-wind” (Feng Xie). Levelheadedness and firm assurance of the Jing Shen (quintessence and mental) are the principal agents against disease. In this way, the art of preserving life (2) must be inscribed onto bamboo tablets destined for posterity.”

2. This art is practiced in Vietnam.

II - Ma Shi comments:

“The word Shen (mental), according to the context, has several meanings: _ Shen is the corollary of Xing (bodily form); it controls the collection of Jing (quintessence) of the entire organism (Suwen, Chapter 26 (“Incidence of the Eight Principal Rhthyms on Human Energy”).

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_ Shen can be in excess or insufficiency (Suwen, Chapter 62 (“Discourse on the Regulation of the Energetic Routes”). _ The articulations are the sites of going/return and entry/exit of the Shen (Lingshu, Chapter 1 (“9 Needles and 12 Yuan”)). _ The meeting of the 2 Jing (ovum and sperm) forms the Shen. Fright and reflection injure the Shen (Suwen, Chapter 8 (“Temple of Sacred Books”)). _ The needling method used by the “great worker” comes from Shen (Suwen, Chapter 26). _ To direct the Shen is the marvellous method employed by “great workers” (Lingshu, Chapter 9 (“Beginning and Ending”)). _ During needling, the “great worker” aims to preserve the Shen (Lingshu, Chapter 1). _ During needling, one must observe the Shen Qi (mental energy) of the patient (Suwen, Chapter 25 (“Safeguarding Life and Preserving Integrity”)). _ That which maintains the Shen with finesse, knows perfectly the thin form and fat form, Ying (nutritive energy) and Wei (defensive energy), emptiness and fullness of the Xue (blood) and of the Qi (energy) (Suwen, Chapter 26). _ To temper the Shen is the chief act of all acupuncturists (Lingshu, Chapter 3 (“Explanations of the Little Needles”)). _ Perfect knowledge of the evolution of the disease is called Shen” (Lingshu, Chapter 4 (“Pathological Forms of Attack of the Organs and Bowels by Perverse Energy”)). _ The incommensurability of Yin and Yang is named “Shen” (Suwen, Chapter 71 (“Great Study on the Preparation of Cyclic Recording of the 6 Energetic Sources”)). The word Shen utilized in this chapter encompasses Jing (quintessence) and Shen, the method of the “heart” (Xin Fa: psychology) and the method of the needles intended for acupuncturists. One must possess the Jing Shen to be able to correctly apply these different methods which constitute what one calls the maneuvers of point of acupuncture. Therefore, to understand the meaning of the Dao is like being liberated from doubt, like awakening from drunkeness, like coming lucidly out of sleep. In contrast, one who does not understand the Dao remains “mute” before his patient; sufficiently lacking understanding of the cause and evolution of the disease, he gropes along by trial and error “into darkness” attempting to discover a solution... .”

PARAGRAPH 3 Huangdi: “During the infiltration of “great energy” (Daqi) (3) into the organ, how does the disease evolve?”

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Qi Bo:

“When the disease manifests first at the heart, a day later, it passes to the lung; three days later, it reaches the liver; five days later, it affects the spleen. At this phase, if the disease is not cured, at the end of three days, it is death. In winter, death follows midnight, and in summer, noon.” EXPLANATIONS AND COMMENTARIES

309.

I - Zhang Shi explains: “a - This paragraph concerns the infiltration of Daqi (great energy) into the organs. Its evolution into the “non-victorious” zone, that is to say, following the inhibitory chains, is fatal because the 5 organs are maintained by the energy created by the “5 Movements of Earth” and the “5 circumductions of Heaven”. This is why life depends on the chain of production, and death, on the chain of destruction.

b - “The disease first manifest at the heart. A day later, it passes to the lung; 3 days later, it reaches the liver; 5 days later, it affects the spleen...”. This evoultion follows the “nonvictorious” route (inhibitory route or destructive route). As a result, after 3 days, if the disease is not cured, it is death (see Figure 76). c - The heart is the Fire organ. Winter governs water. Summer governs Fire. This is why, _ in winter, death follows at midnight because this is the victorious time of Water and the moment of defeat of Fire _ in summer, death follows at noon because this is the maximal time of Fire which “burns” the heart.”

II - Ma Shi instructs: “a - This paragraph explains the evolution of Great Energy (perverse energy in a state of great virulence) at the level of the 5 organs following the destructive chains of the law of the 5 Movements. When the Great Energy manifests first at the heart organ, it is the origin of cardialgia with liberation of Fire which encroaches on Metal. This is why, 1 day after the infiltration of Daqi, the disease reaches the lung with cough and dyspnea. Three day later, that is to say, 4 days after the infiltration of Daqi at the level of the heart, the lung frees it Metal which encroaches on Wood. The liver is therefore affected with thoracic oppression and hypochondralgia. Five days later, that is to say, 9 days after infiltration of Daqi at the level of the heart, the liver liberates its Wood which encroaches on Earth. The attack of Spleen-Earth is signaled by 3. Here, “great energy” designates the perverse energy in a very virulent state.

signs of obstruction (energetic and blood) with sensation of heaviness and pain of the body. If after 3 days the disease is not cured, death occurs. In winter, death follows at midnight because winter responds to Water and Water at a maximal state destroys the Fire of the heart. In summer, death follows at noon because summer responds to Fire and Fire at a maximal state exhausts the energy of the heart.

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310. b - According to Chapter 19 (“Perfect Mechanism of the Pure Energy of the Organs”) of the Suwen, “during the evolution of the disease following the destructive chains of the law of the 5 Movements, massage, hydrotherapy, phytotherapy, acupuncture/moxabustion... constitute the principal therapeutic methods to save the patient”. This is why the phrase “after 3 days, if the disease is not cured, it is death” implies that there is the possibility of curing disease of the organs by the above-noted techniques (see Paragraph 1). The end of this paragraph mentions the fatal periods of the evolutive disease of the 5 organs during which acupuncture is advised against because this technique is reserved for disorders of the energy and not disorders of the form.”

III - N.V.N.: Disturbances of the energy (Yang) always cause disturbances of the form (Yin) and vice versa. As a consequence, in disturbances of the organ, moxabustion (at the level of the Back Shu points) is imperative, and in disturbances of the energy of the organ at the level of the corresponding anatomic layers, acupuncture is absolutely recommended (at the level of the Wu Shu: 5 Shu Antique points). We present below the diagram of the evolution of the fatal periods of the disease of the heart of exogenous origin (Figure 76):

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Figure 76: Disease of the Heart: Its evolution and fatal hours.

PARAGRAPH 4

311.

“When the disease manifests primarily at the lung, 3 days later, it evolves toward the liver; 1 day later, it passes to the spleen; 5 days later, it reaches the stomach. If 10 days later the disease is not cured, it is death. In winter, death follows sunset, and in summer, sunrise.”

EXPLANATIONS AND COMMENTARIES I -Zhang Shi explains: “The lung governs the energy. At sunrise, the energy begins to grow, and at its setting, to withdraw. In winter, at sunset, the energy reaches the interior in a state of emptiness, and in summer, at sunrise, the energy reaches the exterior also in a state of emptiness. Here, the text relates winter to summer without addressing spring and autumn because the energy of these two seasons represents that of the 4 seasons belonging to Cold and Heat. Midnight and noon represent Yin and Yang grouped together as Zi-Wu (I-VII). The rising and setting of the sun represents Yin and Yang growing apart from Mao-Yu (V-X). One, three and five days are the durations of evolution of the disease at the level of the 5 organs. Odd numbers belong to Heaven because the 5 organs are created by the “5 Movements” of

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the Earth whose root comes from the “10 Celestial Trunks” (Gen)”.

II - Ma Shi states: “The disease manifests first at the lung with appearance of cough and dyspnea; 3 days later, Metal encroaches on Wood and triggers disease of the liver with appearance of thoracic oppression and hypochondralgia.

_ 1 day later, that is to say, 4 days after the infiiltration of Daqi into the lung, Wood encroaches on Earth to trigger disease of the spleen with sensation of heaviness and pain of the body. _ 5 days later, that is to say, 9 days after infiltration of Daqi, the diseasae progresses toward the stomach with appearance of abdominal bloating. _ 10 days later, that is to say, 19 days after infiltration of Daqi, if the disease is not cured, death follows. 312. In winter, sunset intervenes at the Shen hour (IX: 15h-17h) belonging to Metal. But here Metal in a state of maximal insufficiency does not play any role. Therefore, in winter, death follows at sunset. In summer, the rising of the sun intervenes at the Yin hour (III: 3h-5h) belonging to Wood, which in a state of maximal plethora creates Fire which encroaches on Metal-Lung in a state of insufficiency. Therefore, in summer, death follows at sunrise.”

III - N.V.N.: We present below the diagram concerning the evolution and fatal periods of the disease of the lung (Figure 77):

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Figure 77: Disease of the lung: Its evolution and fatal periods.

PARAGRAPH 5 “When the disease manifests first at the liver, 3 days later, it passes to the spleen; 5 days later, it reaches the stomach; 3 days later it evolves toward the kidney. If, after 3 days, the disease is not cured, death follows in winter at sunset, and in summer, at sunrise.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The primary manifestation of the disease of the liver is signaled by dizziness of the eyes with sensation of heaviness of the head and oppression/fullness of the hypochondria. _ 3 days later, Wood encroaches on Earth and the disease evolves toward the spleen with appearance of sensation of heaviness and pain of the body. _ 5 days later, that is to say, 8 days after infiltration of Daqi into the liver, the disease of the spleen passes to the stomach bowel with abdominal bloating. _ 3 days later, that is to say, 11 days after infiltration of Daqi, Earth encroaches on Water to trigger abdominal pains, ostealgia... . These signs are explained by:

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- on the one hand, the existence of the Shenmai (vessel-channel of the kidney) which starts at the foot, runs alongside the calf, arrives at the popliteal crease, penetrates into the anus, follows the spine, passes to the kidney organ and reaches the bladder (4)... - and on the other hand, the presence of the “palace of the kidney” at the level of the lumbar vertebrae. _ 3 days later, that is to say, 14 days after the infiltration of Daqi, if the disease is not cured, it is death. In winter, sunset intervenes at the Shen hour (IX: 15h-17h). Because the plethora of Metal causes the shortage of Wood, death follows in winter, at sunset. In summer, death follows at the Mao hour (IV: 5h- 7h), hour of breakfast, despite the presence of plethora of the Wood.”

II - N.V.N.: We present below the diagram concerning the evolution and fatal periods of the disease of the liver (Figue 78):

4. See Figure 34, (“Foot Shaoyin (Ki): circulatory direction of the energy’) in Chapter 10 (“VesselsChannels’) in Volume I of the Lingshu- N.V.N. Edition.

314.

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Figure 78: Disease of the liver: Its evolution and fatal periods.

PARAGRAPH 6 “When the disease manifests first at the spleen, 1 day after, it reaches the stomach; 2 days later, it passes to the kidney; 3 days later, it evolves toward the region where Lu Pangguang (tendinomuscular channel of the bladder) is found. If 10 days later the disease is not cured, it is death. In winter, death follows during sleep after dusk, and in summer, at the hour of the evening meal.” EXPLANATIONS AND COMMENTARIES: I - Ma Shi explains: “In winter, Ren Qi (human energy) is calm at the Hai hour (21h-23h) during which Earth cannot triumph over Water. This is why death follows during sleep after dusk. In summer, death follows the hour of the evening mael, that is to say, at the moment when

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Wood comes to encroach on Earth.

II - N.V.N.: We present below the diagram concerning the evolution and fatal periods of the disease of the spleen (Figure 79):

PARAGRAPH 7

Figure 79: Disease of the spleen: Its evolution and fatal periods.

“When the disease manifests first at the stomach, 5 days later, it passes to the kidney; 3 days later, it evolves toward the region where Lu Pangguang (tendino-muscular channel of the bladder) is found; 5 days later, it propagates to the heart; If 2 days later the disease is not cured,

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it is death. In winter, death follows at midnight, and in summer, at the close of the day.” EXPLANATIONS AND COMMENTARIES

316.

I - Zhang Shi explains:

“Chapter 56 (“Discourse on the Cutaneous Territories”) of the Suwen also has described the evolution and fatal hours of the disease of the stomach: “Attack of the stomach manifests by swelling/fullness of the epigastric region; 5 days later, by lower abdominal pains, lumbalgia, spinal pain and ostealgia of the lower limb; 3 days later, by pain at the level of Lu Jin (Lu Pangguang: tendino-muscular channels of the bladder) of the dorsal region with dysuria; 5 days later, by a sensation of heaviness and pain of the body; 2 days later, if the disease is not cured, it is death... . In winter, death follows at midnight, and in summer, at the end of the day.” In this manner, because the manifestations of the disease take place first at the stomach, the clinical signs are: bloating and epigastric pain, _ 5 days later, it passes to the kidney. The clinical signs are: pelvic pains, lumbalgia, spinal pain and ostealgia of the lower limb. _ 3 days later, it reaches Lu Pangguang (tendino-muscular channel of the bladder), hence dorso-lumbar pains. _ 5 days later, it progresses toward the heart, hence sensation of heaviness of the body because the heart and blood vessels make the muscles and bones supple and assure joint movements. “Two” is the number of production of Fire, and “6” is the number of realization of Water. Death on the 2nd day (of the disease) is due to the exhaustion of the production of Fire, and death on the 6th day is due to the encroacment of Water on Fire. In winter, death follows at midnight, that is to say, at the moment when Water (Yin) is in a maximal plethoric state, and in summer, at the end of the day because the production of the energy of the Taiyang (Water) is completely exhausted... .”

II - Ma Shi instructs:

“The signs of atttack of the stomach are swelling and sensation of weight of the supraumbilical region. _ 5 days later, the disease passes to the kidney with appearance of lumbalgis, spinal pain and ostealgia of the lower limb. _ 3 days later, that is to say, 8 days after the infiltration of Daqi at the level of the stomach, the disease reaches the bladder organ and causes pains at “Lu Pangguang” and dysuria. _ 5 days later, that is to say, 13 days after the infiltration of Daqi, the disease evolves toward the heart with appearance of cardialgia. _ 2 days later, that is to say, 15 days after the infiltration of Daqi, if the disease is not cured, it is death. In winter, death follows at midnight at the Zi hour (I: 23h-1h), period during which Earth does not triumph over Water, and in summer, in afternoon, period of insufficiency of “Earth” energy.”

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III - N.V.N.: We present below the diagram of the evolution and fatal periods of the disease of the stomach (Figure 80): 317.

PARAGRAPH 8

Figure 80: Disease of the Stomach: its evolution and fatal periods.

“The disease manifests first at the kidney; 3 days later, it passes to Lu Pangguang; 3 days later, it reaches the heart; 3 days later, it passes to the small intestine. If, 3 days later, the disease is not cured, it is death.

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In winter, death follows at first light, and in summer, at dusk.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“In the previous paragraph, the disease is found at the heart, hence heavy body... . Here, it is concerns an evolution of disease of the bladder toward the heart and from the heart toward the small intestine, hence stomach swelling. 318. In winter, first light represents the period of plethora of Wood responding to Yin-Mao (III-IV: 3h-5h). The plethora of Wood causes an evacuation of the “Water’ energy. In summer, dusk is the predominant period of “Earth” energy. Earth encroaches on Water; 3 days later, the production of “Water” energy and “Fire” energy is annihilated; but on the 2nd day, only the production of “Fire” energy is destroyed. During the course of the disease, death can arise before the exhaustion of the energy of the organ or after evolution of the disease. Sometimes, therefore, some words of the Suwen and Lingshu are placed in a different context. Our kindly readers must take this into account.”

II - N.V.N.: We present below the diagram of evolution and fatal periods of the disease of the kidney (Figure 81):

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Figure 81: Disease of the kidney: its evolution and fatal periods.

PARAGRAPH 9

319.

“The disease manifests first at the bladder. 5 days later, it passes to the kidney; 1 day later, it reaches the small intestine; 1 day later, it evolves toward the heart. If, 2 days later, the disease is not cure, it is death. In winter, death follows at the crow of the cock (dawn), and in summer, at the fall of night.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“a - The disease is found in the bladder, hence dysuria. _ 5 days later, it reaches the kidney, hence swelling of the lower abdomen, lumbalgia,

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spinal pain and ostealgia of the lower limb. _ 1 day later, it passes to the small intestine, hence adbominal bloating. _ 1 1/2 days later, it evolves toward the heart, hence cardialgia and sensation of weight of the body. _ 2 days later, if the disease is not cured, it is death. Like the previous paragraph, in winter death follows at dawn, and in summer, at dusk. b - Chapter 42 of the Lingshu (“Evolution of the Disease”) discourses on the evolution of the disease of the 5 organs and also that of the stomach and bladder because: _ the stomach is the “sea” of Shui Gu (Water-Cereals: foods), source of production of the energy of the 5 organs. _ Taiyang (Bl) is a bowel which governs the energy of all Yang channels.”

II - Ma Shi comments:

“Dysuria is the sign of attack of the bladder. _ 5 days later, the disease reaches the kidney to trigger such signs as lumbalgia, spinal pain, ostealgia of the lower limbs. _ 1 day later, that is to say, 6 days after infiltration of perverse energy (Daqi) into the bladder, Water arrives and encroaches on Fire to trigger disease of the small intestine, hence pelvic swelling. _ 1 1/2 days later, that is to say, 7 days after infiltration of Daqi, the disease passes to the heart, hence cardialgia and sensation of weight of the body. _ 2 days later, that is to say, 9 days after infiltration of Daqi, if the disease is not cured, it is death. In winter, death follows at cock’s crow at the Chou hour (II: 1h-3h), period of encroachment of “Chuo-Earth” on Water. In summer, death follows the afternoon at the Shen hour (IX: 15h-17h), period of insuficiency of Metal which no longer produces Water.” 320.

III - N.V.N.: We present below the diagram of evolution and fatal periods of the disease of the baldder (Figure 82):

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Figure 82: Disease of the Bladder: Its evolution and fatal periods.

PARAGRAPH 10 “The evolution of disease of the 5 organs cited above, based on successive progression (according to the destructive chains of the law of the 5 Movements), permits determining the periods of decrease during which acupuncture is in vain. In contrast, in the evolutions known as “Jian 1, 2, 3, 4, or 5 Zang” (interval of 1, 2, 3, or 4 organs), acupuncture is indicated.” EXPLANATIONS AND COMMENTARIES

321.

I -Zhang Shi explains: “1 - Chapter 19 of the Suwen (“Perfect Mechanism of the Pure Energy of the Organs”) states: “The 5 organs are linked together and their diseases evolve following a very specific order.” As a result, when the organs are affected, their diseases evolve toward the site of “victory”. Death follows when the disease evolves toward the site of “non-victory”. During the fatal period, acupuncture is therefore in vain.

2 - The term “Jian 1 Zang” (Interval of 1 organ) designates, for example: _ the evolution of the disease from the heart toward the liver _ the evolution of the disease of the lung toward the spleen. It concerns the evolutions known as “from son to mother” (following the chain of contempt of the law of the 5 Movements). 3 - The term Jian 2 Zang designates, for example: _ the disease of the heart evolving toward the spleen

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_ the disease of the lung evolving toward the kidney. These evolutions are known as “from mother to son” (according to the chain of stimulation of the law of the 5 Movements). 4 - The term Jian 3 Zang designates, for example: _ the disease of the heart evolving toward the kidney _ the disease of the lung evolving toward the heart. Here, it concerns the evolutions following the route known as “non-victorious” (according to the chain of revolt of the law of the 5 Movements). 5 - The term Jian 4 Zang designates, for example, the evolution of the disease of the organ toward the bowel, then again toward another organ. In the evolutions of the “Jian” type, acupuncture is recommended.”

II - N.V.N.: This paragraph distinguishes two types of evolution of disease of the organs according to the law of the 5 Movements: _ evolution according to the chains of production (stimulation and revolt) _ evolution according to the chains of destruction (inhibition and encroachment). 1 - The evolutions of the 5 organs according to the “chains of production” and “revolt” are: _ disease of the heart evolving toward the spleen (Fire produces Earth) or toward the liver (Fire revolts against Wood) _ disease of the spleen evolving toward the lung (Earth produces Metal) or toward the heart (Earth revolts against Fire) _ disease of the lung evolving toward the kidney (Metal produces Water) or toward the spleen (Metal revolts against Earth) _ disease of the kidney evolving toward the liver (Water produces Wood) or toward the lung (Water revolts against Metal). In these evolutions known as Jian Zang (evolution by interval) or “Mother-Son”, acupuncture is expressly recommended. 2 - The evolutions of the 5 organs according to the “chains of destruction” are fatal (see Figures 76-82). This is why the text states that, in those cases, acupuncture is pointless.

no 322/323.

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CHAPTER XLIII Overflowing of Perverse Energy and the Manifestations of Dreams (Zan Xie Fa Meng)

During the infiltration of perverse energy into the organism, its overflowing causes disturbances at the level of the organs and bowels and perturbs the Hun (vegetative soul) and Po (sensitive soul). These phenomena cause agitated sleep by evocative dreams. This is why analysis of the different types of dreams permits diagnosis of the state of emptiness and the state of fullness of the energy of the organs and bowels in order “to choose points according to the corresponding channels” to therapeutic ends. Therefore, in the case of fullness, dispersion is rigorously advised, and in the case of emptiness, tonification is expressly indicated. In total, the objective of Chapter 43 of the Lingshu is to give dissertation on the pathological process of dreams caused by an oveflowing of perverse energy at the level of the organs and bowels. According to Ma Shi: “The title of Chapter 43 is linked to the phrase “The overflowing of perverse energy and the manifestation of dreams” contained in this chapter.” It consists of 2 paragraphs.

PARAGRAPH 1 Huangdi: “Please inform me about the process of overflowing of perverse energy.” 324.

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Qi Bo:

“At the time of its infiltration into the organism, true perverse energy (Sheng Xie) still does not have a fixed localization. It overflows the organs without remaining there, follows the Ying (nutritive energy) and Wei (defensive energy), rises up with the Hun (vegetative soul) and Po (sensitive soul) and brings about agitated sleep by dreams. When it overflows the bowel, the exterior is in excess, and the interior, in insufficiency. When it overflows the organ, the interior is in excess, and the exterior, in insuficiency.” Huangdi: “Does the excess and insufficiency possess a form?” Qi Bo:

“The Yin energy being in fullness, the individual dreams of floundering with terror in the Great Water (Da Shui). The Yang energy being in fullness, the individual dreams of Great Fire (Da Hua) and destruction by fire. Yin and Yang being simultaneously in fullness, the individual dreams of massacres. The The In a In a

top being in fullness, the individual dreams of flying. bottom being in fullness, the individual dreams of falling. state of extreme hunger, the individual dreams of possession. state of satiety, the individual dreams of donation.

The energy of the liver being in fullness, the individual dreams of a state of irritability and anger. The energy of the lung being in fullness, the individual dreams of fright and lamentations, or else of flying away and leaping. The energy of the heart being in fullness, the individual dreams of laughter and fear. The energy of the spleen being in fullness, the individual dreams of music and singing, or else of a sensation of heaviness of the body with inability to move. The energy of the kidney being in fullness, the individual dreams of breaking his spine. In the presence of these 12 states of fullness, dispersion permits spontaneous elimination of the dreams.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

325.

“1. The term “overflowing of perverse energy” (Zan Xie) does not designate an overflowing caused by another specific type of perverse energy, but by the “true” perverse energies (Sheng

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Xie) which are none other than cold, heat, dryness, humidity... and which will be presented in the following chapter. During its infiltration, the perverse energy still has no fixed localization; it overflows the interior at the level of the organs and bowels. This process of overflowing is found again in the previous chapter concerning “the penetration of Daqi (Great Energy) into the heart.” Because it does not have a very specific localization, this perverse energy follows the Ying (nutritive energy) and Wei (defensive energy) and rises up with the Po (sensitive soul) and Hun (vegetative soul) to provoke an agitated sleep, factor in the production of dreams. 2. The bowel is Yang and responds to the exterior. The organ is Yin and responds to the interior. This is why: _ when the perverse energy overflows the bowel, the exterior is in excess, and the interior, in insufficiency, _ and when the perverse energy overflows the organ, the interior is in excess, and the exterior, in insufficiency. 3. Yin Qi (Yin energy) designates Ying Qi (nutritive energy). Ying Qi being in excess, the individual dreams that he is floundering with terror in the Great Water (Da Shui) because the Great Water is Yin. Yang Qi (Yang energy) designates Wei Qi (defensive energy). Wei Qi being in excess, the individual dreams of Great Fire (Da Hua) and destruction by fire because the Great Fire is Yang. In the concommitant fullness of Yin and Yang, that is to say, of Ying and Wei, the interior and exterior are simultaneously in excess. In that case, Yin and Yang battle between themselves, hence dreams of massacres. 4. The cephalic part respond to Yang. As a result, the perverse energy being in fullness at the top part of the body, the individual dreams of flying and jumping. The lower limbs respond to Yin. As a result, the perverse energy being n fullness at the lower part of the body, the individual dreams he is falling. Similarly, in a state of hunger, the individual dreams of capture (possession), and in a state of satiety, the individual dreams of offerings (donation). 5. Perverse energy at the level of the liver being in fullness, the individual dreams of anger and irritablity because disorder of the Hun (vegetative soul) responds to anger. Perverse energy at the level of the lung being in fullness, the individual dreams in fright or lamentations, or else of flying or jumping because insufficiency of the lung responds to other pethologic signs. Perverse energy at the level of the heart being in fullness, the individual dreams of laughter or anguish because the “voice” of the heart manifests by laughter, and disorder of its energy, by anguish and preoccupation. 326. Perverse energy at the level of the spleen being in fullness, the individual dreams of music and song, or also of sensation of heaviness of the body with inability to move because the “voice” of the spleen and “song” of its energy govern the “flesh” system. Perverse energy at the level of the kidney being in fullness, the individual dreams of breaking the spine because the lumbar region is the “palace” of the kidney. 6. The 12 excessive states cited are at the origin of dreams. Therefore, the analytic study of dreams allows determining the site of overflowing of perverse energy at the level of a given bowel or organ in order to disperse the corresponding channel. Cure is immediate.”

II - N.V.N.:

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According to Zhang Jing Yue, dreams are only produced when perverse energy is still found in an imprecise state of mutation/progession characterized by an overflowing without fixed localization. In the interior, it overflows the internal organs and disturbs the areas belonging to Ying and Wei, to Po and Hun (sensitive soul and vegetative soul). As a result, dreams are of different types depending on the site of overflowing of the perverse energy, and treatment then is very simple (see explanation of Ma Shi above).

PARAGRAPH 2 “Jue Qi (energy of contrary afflux), being the guest (Ke), lodged in the heart, the individual dream of hills and mountains, of smoke and flame. The guest being lodged in the lung, the individual dreams of bizarre metal objects. The guest being lodged in the liver, the individual dreams of mountains, forest and vegetation. The guest being lodged in the spleen, the individual dreams of large hills and vast swamps, of houses in ruin from wind and rain. The guest being lodged in the kidney, the individual dreams of descending into abysses or of being immersed in water. walks

The guest being lodged in the bladder, the individual dreams of and trips.

eating

The guest being lodged in the stomach, the individual dreams of and drinking.

The guest being lodged in the large intestine, the individual dreams of fields and rice paddies. The guest being lodged in the small intestine, the individual dreams of streets and boulevards full of people. trial

The guest being lodged in the gallbladder, the individual dreams of or suicide by hari-kari. 327.

The guest being lodged in Yin Qi (genitals), the individual dreams of coitus. The guest being lodged in the nucha, the individual dreams of decapitation. The guest being lodged in the leg, the individual dreams of inability to walk despite his efforts and to be obliged to live in a deep cave.

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of

The guest being lodged in the arm or thigh, the individual dreams prostration and prayer.

The guest being lodged in the bladder and rectum, the individual dreams of loss of urine and feces. These 15 states are due to insufficiency. Tonification is recommended and normalization is immediate.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “Jue Qi (energy of afflux) of endogenous origin (Yin-Yang, joy-anger, diet, psychoaffective behavior) will be presented in the following chapter. The “guest” perverse energy localizing in the heart, the individual dreams of fire, mountains and forest because the heart responds to Fire. The “guest” perverse energy localizing in the lung, the individual dreams of flying and metalllic objects of strange forms because the lung responds to Metal. The “guest” perverse energy localizing in the liver, the individual dreams of forests and vegetation because the liver responds to Wood. The “guest” perverse energy localizing in the spleen, the individual dreams of elevated hills and vast swamps, houses in ruin from wind and rain because the spleen responds to Earth. The “guest” perverse energy localizing in the kidney, the individual dreams of great chasms and diving into water because the kidney responds to Water. The “guest” perverse energy localizing in the bladder, the individual dreams of voyages because the bladder channel travels up and down the nucha, back, lumbar region and calf. The “guest” perverse energy localizing in the stomach, the individual dreams of eating and drinking because the stoamch plays a role in food reception. The “guest” perverse energy localizing in the large intestine, the individual dreams of rice paddies because the large intestine is an organ of transit which is wide and winding evoking the image of rice paddies. The “guest” perverse energy localizing in the small intestine, the individual dreams of streets and passage ways of movement and gathering because the small intestine is an organ that evokes the image of an animated place where food products accumulate. 328. The “guest” perverse energy localizing in the gallbladder, the individual dreams of trials and committing hari-kari because Wood (GB) encroaches on Earth (Sp) and injures the flesh. The “guest” perverse energy localizing in Yin Qi (Yin Energy--->>>> genitals), the individual dreams of coitus because Yin Qi belongs to the productive organ of “sexual power”. The “guest” perverse energy localizing in the nucha, the individual dreams of decapitation because the nucha is injured. The “guest” perverse energy localizing in the leg, the individual dreams that he is not able to walk despite his efforts and of staying in caves because the leg is injured. The “guest” perverse energy localizing in the forearm and in the thigh, the individual dreams of kneeling down and praying because these movements require use of the limbs. The “guest” perverse energy localizing in Bao-Xu, the individual dreams of urinary incontinence because Bao-Xu is the inner wall of the bladder.

These 15 types of dreams are provoked by a state of emptiness. In effect, when the perverse energy becomes situated in the bowel, insufficiency occurs in the interior, and when perverse energy becomes situated in the organ, insufficiency occurs at the exterior. In the event

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of dreaming, carefully analyze the energetic state of the bowel or organ affected in order to apply the method of tonification. If the dreaming originates from disturbance of the organ, one must tonify the bowel, and if it originates from disturbance of the bowel, one must tonify the organ. Cure is, in this manner, assured.”

329.

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CHAPTER XLIV Conformity of Human Energy with that of the Day Divided into Four Seasonal Periods (Shun Qi Ye Re Si She)

Climatic energy during a day, comparable to that of the 4 seasons, is divided into 4 periods with the purpose of explaining the phenomena of progression/ regression of disease during 24 hours. Because, _ in the morning, as in spring, the essential energy of the body begins to be born and become manifest, hence regression of disease and lucidity of the patient. _ at noon, as in summer, the essential energy of the body is found in a state of maximal plethora, hence nearly total regression of the disease and relative tranquility of the patient. _ in the evening, as in autumn, the essential energy of the body begins to become concentrated and to get back to the interior, hence awakening of perverse energy and manifestation of the disease. _ at midnight, as in winter, the essential energy of the body is preserved in the interior at the level of the organ, hence invasion of perverse energy into the entire body and worsening of the disease. In summary, the object of Chapter 44 of the Lingshu is the determination, according to the change of the evolutive state of the disease of the organs/bowels conforming to the energy of the 4 seasons, of the principles of the Wu Shu (5 Shu Antique points), hence the title “Conformity of Human Energy with that of the Day Divided into Four Seasonal Periods” (Shun Qi Ye Re Si She). Zhang Shi notes: “This Chapter 44 of the Lingshu discourses on the phenomena of entry /exit of the Yang energy during one day and one night in the human being responding to the 4 seasonal periods: birth, growth, concentration and preservation. Within the interior, the 5 organs govern the 5 Movements, and at the exterior, they are associated with Wood, Fire, Earth, Metal and Water. Therefore, the causes of disease do not come out of the endogenous and exogenous sphere.” Chapter 44 consists of 5 paragraphs.

PARAGRAPH 1

330.

Huangdi: “At the start, the 100 diseases are all of dryness, humidity, cold, heat, wind and rain, Yin and Yang, joy and anger, digestive disorder or disturbance of psychoaffective behavior origin. Each group possesses a characteristic

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pathologic form and each syndrome caused by disturbances of the internal organ has a name which is appropriate to it. All this is known; but in the majority of cases, the disease improves at dawn, becomes calm in the morning, intensifies in the evening and worsens at night. Why is that?” Qi Bo: 4

“This is due to the influence of the energy (climatic) of the seasons.”

Huangdi: “Please inform me about the energy of the 4 seasons.” Qi Bo:

“Spring is born, summer grows, autumn concentrates and winter preserves. Such are the natural rules of the climatic energy. It is the same in the human being. Because, in dividing the day (of 24 hours) into 4 seasonal periods: _ morning is spring _ noon is summer _ setting of the sun is autumn _ middle of the night is winter. In the morning, the energy of man comes to be born, pathogenic energy regresses, hence lucidty of the patient. At noon, the energy of man is in full rapid expansion and can triumph over the perverse energy, hence the calmness of the patient. In the evening, the energy of man begins to grow weaker, and the perverse energy, to be born, hence intensification of the disease. At midnight, the energy of man becomes overshadowed (preserved) and perverse energy dominates the entire body, hence the worsening of the disease.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Generally, all diseases are initiated by an infiltration of perverse energy or by an internal perturbation. Dryness, humidity, cold, heat, wind, rain... belong to the group of external agressions. Yin and Yang, joy and anger, digestive disturbance and disorder of psychoaffective behavior... belong to the group of internal perturbations. 331. Perverse energy, in perturbing the organ, provokes reactive symptomatology. Because of the differentiation of the organs, the symptomatology is different. Despite this difference, in the majority if cases, the patient remains alert in the morning, calm during the day, his weakness increased when the evening comes and worsens following night.

Huangdi has uncertainty about this subject and Qi Bo puts forward: “In one day (of 24 hours)

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_ _ _ _

dawn is spring noon is summer dusk is autumn the middle of the night is winter.

In the living being, energy designates Wei Qi (defensive energy) responding to Yang. In early morning, it manifests at the point Jingming (Bl 1) belonging to the Taiyang of the ocular region; then from there, it is directed toward the Yang channels of the foot and hand... . This defensive energy manifests at dawn during which the pathogenic energy (perverse energy) cannot struggle against the Wei Qi, hence the state of alertness of the patient. At noon, Wei Qi is progressively enhanced and can defeat the perverse energy, hence the calm state of the patient. When evening comes, Wei Qi having traveled up and down the Yang channels, the Yang (Wei Qi) returns to be directed toward the Yin channels and begins to grow weaker. In this way, the pathogenic energy could defeat the Wei Qi and begins to grow, hence intensification of the disease. In the middle of the night, Wei Qi leaves the Yin channels and flows down into the organs; the perverse energy alone occupies the entire organism, hence aggravation of the disease.”

II - N.V.N.: According to Zhang Jing Yue, 1 - Spring is born designates the movement of ascent of the Yang energy. Summer grows designates the movement of plethora of the Yang energy. Autumn concentrates designates the movement of descent of the Yang energy. Winter preserves designates the movement of retreat of the Yang energy. They are the natural movements of the energy which are calculated by the ascent and descent of the Yang energy 2 - The interference of the solar and terrestrial movements create the 4 seasons according to the ascent and descent of the Yin energy and Yang energy. Because, _ after the Zi hour (23h-1h), the sun rises and reaches the left direction; the rising of the sun is Yang, _ after the Wou hour (11h-13h), the sun descends and follows the right direction; the setting of the sun is Yin. 332. One year (of 4 seasons) is formed by the great energetic cycle, and one day (of 24 hours), by the little energetic cycle according to the principle of ascent and descent of the Yang energy. Therefore, one day, like one year, is divided into “4 seasonal periods”: _ at dawn, the sun is found at the Yin-Mao (3h-7h) hour, Yang goes from the bottom upward and that of man follows this movement of ascent, period during which the pathogenic energy grows weaker, hence the state of lucidity of the patient. _ at noon, the sun is found at the Si-Wu (9h-13h) hour, the Yang energy goes from the east toward the top; the energetic potential of the human being follows this movement and is found in full plethoric phase and can triumph over the pathogenic energy, hence the state of calmness of the patient. _ In the evening, the sun is found at the Shen-You (15h-19h) hour; the Yang energy is at its decline and begins its descent; that of man follows this movement and begins to grow weaker and the perverse energy gradually tends towards fullness, hence the intensification of the disease. _ At midnight, the sun is found at the Xu-Hai (19h-23h) hour; the Yang energy is directed toward the bottom; that of man follows this movement and becomes latent within the organs, the

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pathogenic energy is found in a state of maximal fullness, hence the worsening of the disease.” In summary, the power of the offensive of the perverse energy depends on the state of emptiness or fullness of the essential energy of the body. Here, the essential energy designates Wei Qi (defensive energy, Yang energy of the body). It “ascends”, following the Yang movement; this is life; it “descends”, following the Yin movement; this is death. The energy of Heaven and that of man are therefore analogical.

PARAGRAPH 2 Huangdi: “Sometimes, the daily phases of the evolution of the disease are not in agreement with the 4 seasons. Why?” Qi Bo:

“This evolution does not follow the movements of the 4 is the organ itself which governs the disease. This occurs at during which the energy of the organ cannot dominate any Triggering of the disease takes place then at the triumphant the energy of the 5 organs.” Huangdi: “What

is

the

seasons. It the hours more. hours of

treatment?”

Qi Bo:

“In agreement with celestial time, one can determine the diseases according to the timetable. The one who follows the favorable principle is a skillful doctor and the one who treats according to the contrary principle is a poor doctor.” 333. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph concerns endogenous causes of disease (Yin, Yang, joy, anger, digestive disorder...), that is to say, the causes which take birth at the level of the organs themselves. This phenomenon takes place at the hours during which the energy of the organ cannot triumph any more. This is why the triggering of endogenous disease takes place at the triumphant hours of the 5 organs. 1 - The hours during which the energy of the 5 organs cannot defeat longer are the following: _ Disease of the liver cannot defeat the “Metal” energy at the hours Shen (15h-17h) and You (17h-19h). _ Disease of the heart cannot defeat the “Water” energy at the hours Hai (21h-23h) and Zi (23h-1h), _ Disease of the spleen cannot defeat the “Wood” energy at the hours Yin (3h-5h) and Mao (5h-7h). _ Disease of the lung cannot defeat the “Fire” energy at the hours Si (9h-11h) and Wu (11h-13h).

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_ Disease of the kidney cannot defeat the “Earth” energy at the hours Chen (7h-9h), Xu (19h-21h), Chou (1h-3h) and Wei (13h-15h). 2. The triumphant hours during which the triggering of the disease take place are: _ Disease of the liver begins at the hours Chen (7h-9h), Xu (19h-21h), Chou (1h-3h) and Wei (13h-15h). _ Disease of the heart begins at the hours Shen (15h-17h) and You (17h-19h). _ Disease of the spleen begins at the hours Hai (21h-23h) and Zi (23h-1h). _ Disease of the lung begins at the hours Yin (3h-5h) and Mao (5h-7h). _ Disease of the kidney begins at the hours Si (9h-11h) and Wu (11h-13h). Therefore, an excellent doctor conforms to those timetables to maintain the energy of the 5 Movements and foresee the hour of triggering of the disease. This information is ignored by the poor doctor.”

II - Ma Shi comments: “This paragraph discourses on the evolutive phases of the disease which do not conform to the 4 seasons. 1 - According to Qi Bo, this non-conformity is due to the energy of the organ which itself governs the disease and not that of the 4 seasons. Therefore, for example: _ The disease of the spleen cannot triumph over the “Wood” energy of the morning, _ The disease of the lung cannot triumph over the “Fire” energy of midday, 334. _ The disease of the liver cannot triumph over the “”Metal” energy of the evening, _ The disease of the heart cannot triumph over the “Water” energy of midnight, the disease worsens.

2 - In contrast, when the energy of the organ attains triumph over the energy of the 4 seasons, such as: _ the energy of the lung having ability to triumph over Wood of the morning, _ the energy of the kidney having ability to triumph over Fire of midday, _ the energy of the heart having ability to triumph over Metal of evening, _ the energy of the spleen having ability to triumph over Water of midnight, the patient is alert and calm. 3 - Therefore, in therapy, it is advised to conform to the 4 seasons. Therefore, for example: _ When the disease of the spleen cannot triumph over the “Wood” energy of morning, one must tonify the spleen and disperse the liver. _ When the disease of the lung cannot triumph over the “Fire” energy of midday, one must tonify the lung and disperse the heart. _ When the disease of the liver cannot triumph over the “Metal” energy of evening, one must tonify the liver and disperse the lung. _ When the disease of the heart cannot triumph over the “Water” energy of midnight, one must tonify the heart and disperse the kidney. These treatments are in agreement with the 4 seasons. Poor doctors ignore this information.” III - N.V.N.: The non-conformity of transformation/modification of the disease with the 4 seasons is encountered especially in pathology of the organs responding to the 5 Movements. When the 5 Movements of the energy of the organs are inhibited by the 5 Movements of the energy of the day (see the timetables cited by Ma Shi), the disease worsens. In contrast, the disease improves when the 5 Movements of the energy of the organs manages to inhibit the

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5 Movements of the day. Therefore, the state of seriousness of the disease can be evaluated according to the excess or insufficiency of the energy (climatic) of the natural world on the one hand, and on the other hand, according to the emptiness or fullness of Yin and Yang of the patient. These notions are known in the West and make up an integrated part of the teaching program of traditional Chinese medicine.

PARAGRAPH 3

335.

Huangdi: “Exactly! I have heard it said that acupuncture consists of 5 transformations in order to respond to the Wu Shu (5 Shu Antique points). Do you wish to inform me about this number?” Qi Bo:

“Man has at his disposal 5 organs and the organs possess 5 transformations. The 5 transformations respond to the Wu Shu, hence 5 X 5 = 25 shu in order to respond to the “5 seasons”. Huangdi: “I desire that you explain to me the 5 transformations.” Qi Bo:

“The liver is a Mu Zang (“male” organ of Yang nature). It responds to the color green, spring, the musical note J i a o , to sour flavor and the day Jia-Ji (1-2). The heart is a Mu Zang. It responds to the color red, summer, the note C h i, to bitter flavor and the day Bing-Ding (3-4). The spleen is a Xin Zang (“female” organ of Yin nature). It responds to the color yellow, end of summer, the note G o n g , to sweet flavor and the day Wu-Ji (5-6). The lung is a Xin Zang. It responds to the color white, autumn, the note S h a n g , spicy flavor and the day Geng-Xin (7-8). The kidney is a Xin Zang. It responds to the color black, winter, the note Y u , to salty flavor and the day Ren-Gui (9-10). Such are the 5 transformations of the 5 organs.” Huangdi: “How do you use the Wu Shu? ” Qi Bo:

“The organ reponds to winter. In winter one must needle the J i n g well p o i n t . The color responds to spring. In spring, one must needle the Y i n g spring point. The season responds to summer. In summer, one must needle the Shu-stream point. The musical sound responds to end of summer. At end of summer, one must needle the Jing-river p o i n t .

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The flavor responds to autumn. In autumn, one must needle the He-sea point. Such are the 5 transformations which govern the Wu shu. ”

336.

EXPLANATIONS AND COMMENTARIES I - Ma shi explains: “This paragraph concerns the needling of the 5 organs each possessing 5 transformations which respond to the 5 Shu (Wu Shu = 5 Shu Antique points).

1 - The different methods bear the name “transformations”. The Wu Shu are: Jing-well, Ying-spring, Shu-stream, Jing-river and He-sea. The needling of the 5 organs, each consisting of 5 transformations, is therefore different: _ The liver is Yang in Yin, and the heart, Yang in Yang. This is why these two organs are named Mu Zang (“male” organs or Yang organs). _ The spleen is Zhiyin in Yin; the lung is Yin in Yang, and the kidney is Yin in Yin, hence the name Xin Zang (“female” organs or Yin organs). _ The colors, flavors, seasons, musical notes and days are different components, hence the name of “5 transformations”. 2 - But the key is to explain the correspondance between the 5 transformations and 5 Wu Shu.

a - The 5 organs respond to winter. This is why, in pathology of the organs one must use the Jing-well point of the organs. Examples: _ for the liver, use the point Dadun (Li 1) _ for the heart, the point Shaochong (He 9). b - The colors respond to spring. This is why, in pathology of colors one must use the Ying-spring point of the 5 organs. Examples: _ for the liver, use the point Xingjian (Li 2) _ for the heart, use the point Shaofu (He 8). c - The seasons respond to summer. This is why, in benign or serious pathology one must use the Shu-stream point of the 5 organs. Examples: _ for the liver, use the point Taichong (Li 3) _ for the heart, use the point Shenmen (He 7). d - The sounds respond to the end of summer. This is why, in pathology of sounds (voice), one must use the Jing-river point. Examples: _ for the liver, ose the point Zhongfeng (Li 4) _ for the heart, use the point Lingdao (He 4). e - The flavors respond to autumn. This is why, in pathology of the flavors and in digestive illnesses, one must use the He-sea point. Examples: _ for the liver, use the point Quguan (Li 8) _ for the heart, use the point Shaohai (He 3). Such is the reason by which the text states: “The 5 transformations govern the Wu Shu (5 Shu) and 5 X 5 = 25 Shu in order to respond to the 5 seasons.”

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II - Zhang Shi concludes:

“In the course of the year, _ in spring, needle the Ying point _ in summer, the Shu point _ at end of summer, the Jing point _ in autumn, the He point _ in winter, the Jing point.”

III - N.V.N.: 1 - This paragraph is of vital importance in understanding certain symbolic data of Oriental energetic medicine without which acupuncture would no longer make sense. a - The Liver responds to Wood in the cycle of the 5 Movements. It is Shaoyang in Yin and constitutes the Yang organ (of “male” nature, called Mu Zang). It corresponds to _ the color green in the gamut of colors _ spring in the cycle of the 5 seasons _ the note Jiao in the pentatonic scale _ the day Jia-Yi (1-2) in the cycle of the 10 Celestial Trunks _ sour in the gamut of the 5 sapors _ chicken in the animal kingdom _ millet in the vegetable kingdom _ the number 8 in the numeric system _ the “Wood” planet (Jupiter, Xue Jing) in the constellation system _ stench in the gamut of 5 odors _ tears in the area of the 5 secretions.

b - The Heart responds to Fire in the cycle of the 5 Movements. It is the Taiyang in Yang and constitutes the Yang organ (of “male” nature, called Mu Zang). It corresponds to: 338. _ the color red in the gamut of 5 colors _ summer in the cycle of the 5 seasons _ the note Chi in the pentatonic scale _ the day Bing-Ding (3-4) in the cycle of the 10 Celestial Trunks _ bitter in the gamut of 5 sapors _ goat in the animal kingdom _ sticky rice in the vegetable kingdom _ the number 7 in the numeric system _ the “Fire” planet (Mars, Ying Hua) in the constellation system _ burnt in the gamut of 5 odors _ sweat in the area of secretions. c - The Spleen responds to Earth in the cycle of the 5 Movements. It is the Zhiyin in Yin and constitutes the Yin organ (of “female” nature, called Xin Zang). It corresponds to: _ the color yellow in the gamut of 5 colors _ end of summer in the cycle of the 5 seasons _ the note Gong in the pentatonic scale

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_ _ _ _ _ _ _ _

the day Wu-Ji (5-6) in the cycle of the 10 Celestial Trunks sweet in the gamut of 5 sapors buffalo in the animal kingdom rice in the vegetable kingdom the number 5 in the numeric system the “Earth” planet (Saturn, Chan Jing) in the constellation system perfume in the gamut of 5 odors saliva in the domain of the 5 secretions.

d - The Lung responds to Metal in the cycle of the 5 Movements. It is the Shaoyin in Yang and constitutes the Yin organ (of “female” nature, called Xin Zang). It corresponds to: _ the color white in the gamut of 5 colors _ autumn in the cycle of 5 seasons _ the note Shang in the pentatonic scale _ the day Geng-Xin in the cycle of the 10 Celestial Trunks _ spicy in the gamut of 5 sapors _ the horse in the animal kingdom _ wheat in the vegetable kingdom 339. _ the number 9 in the numeric system _ the “Metal” planet (Venus, Tai Bai) in the constellation system _ the odor of fish in the gamut of 5 odors _ nasal mucus in the domain on the 5 secretions.

e - The Kidney responds to Water in the cycle of the 5 Movements. It is the Taiyin in Yin and constitutes the Yin organ (of “female” nature, called Xin Zang). It corresponds to: _ the color black in the gamut of 5 colors _ winter in the cycle of the 5 seasons _ the note Yu in the pentatonic scale _ the day Ren-Gui (9-10) of the cycle of the 10 Celestial Trunks _ salty in the gamut of 5 sapors _ pork in the animal kingdom _ the bean in the vegetable kingdom _ the number 6 in the numeric system _ the “Water” planet (Mercury, Shen Jing) in the constellation system _ fetid in the gamut of the 5 odors _ dribble in the domain of the 5 secretions.

In summary, the 5 organs correspond to the 5 Movements. The heart and liver are Yang, while the lung, spleen and kidney are Yin. These Yin-Yang data are encountered in daily acupuncture practice. They permit solving all etiologic, diagnostic, therapeutic and dietetic problems. 2 - This paragraph is based on the transformations/modifications of seasonal energy of the natural world in order to explain the use of the Wu Shu (5 Shu Antique) points. Therefore, for example: a - The 5 organs respond to winter, period of closing-conservation. Jing-well means source of water whose rate of flow is comparable to the birth of Yang

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during winter. The illnesses of the 5 organs have the same phenomena of closing-conservation (stagnation) as that of winter and one must supress via the Jing-well point due to its anti-stasis and deobstructing action at the level of the organ. b - The 5 colors (complexions) respond to spring, period of multicolor flowerings of the plant world. Ying-spring means current of water leaving the source whose rate of flow, still weak, is comparable to the energy of springtime which progressively grows. In this manner, the start of the illness with change in complexion, marking off the blossoming of spring, must be treated by the Ying-spring point due to its anti-febrile action and its basic regularizing action on the circulation of blood and energy. These two examples explain: _ on the one hand, the therapeutic effect of the Jing-well and Ying-spring points of the Yin channels... _ and, on the other hand, the technique, well known in the Orient, known as “dispersing the son in the event of fullness” (see further on). 340.

PARAGRAPH 4 Huangdi: “At what place does the Yuan point unite to form the Lu Shu (group of 6 Shu points?” Qi Bo:

“The Yuan points do not respond to the “5 seasons”. They unite with the Jing (channels) (1) to form a complete number of 6 X 6 = 36 Shu.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph concerns the Yuan point of the 6 bowels not responding to the 5 seasons. Because, 1 - Spring responds to Wood Summer, to Fire End of summer, to Earth Autumn, to Metal Winter, to Water. Such are the correspondances between the 5 Seasons and 5 Movements.

1. Here, the word “Jing” designates channel and not Jing-river point, which makes one aware of the dificulty in translating the Lingshu into popular, in particular Western, language.

2 - The liver responds to Wood The heart, to Fire The spleen, to Earth The lung, to Metal The kidney, to Water. Such are the correspondances between the 5 organs and 5 Movements.

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341.

3 - The Jing-well point responds to Wood The Yins-spring point, to Fire The Shu-stream point, to Earth The Jing-river point, to Metal The He-sea point, to Water. Such are the correspondances between the Wu Shu and 5 Movements. 4 - The 6 bowels each possess a Yuan point not responding to the 5 seasons, but uniting with the Jing (channel) in order to form a complete number of 6 X 6 = 36 Shu. 5 - Wood, Fire, Earth, Metal and Water are the 5 Movements of Earth which create the 5 organs. These 5 Movements of Earth are transformed into 6 energies of Heaven which apply to the 6 bowels and respond to Wood, to Fire, to Earth, to Metal, to Water and to Imperial Fire. Therefore, it is thanks to the 5 Movements that Imperial Fire is radiant and Ministerial Fire keeps careful watch over and attends to the throne. In summary, in the group of 6 energies, there are two fires which involve the 6 bowels. This is the reason why the 6 bowels each possess a group of Lu Shu (6 Shu points), forming, in this manner, the complete number of 6 X 6 = 36 Shu. In order to respond to the number of the 5 Movements (5 X 5 = 25), Jing-Fire is united with Yuan-Fire (2). Such are the principles of Separation/Reunion and the marvellous rules of Transformation of the 5 Movements of Heaven and Earth.”

II - Ma Shi comments:

“Huangdi has doubt about the absence of the Yuan point at the level of the channel of the organs and about the treatment of the Wu Shu (5 Shu points) points by acupuncture excluding the Yuan point. Then where is the Yuan point found? Qi Bo responds to him that the Jing, Ying, Shu, Jing and He points all correspond to the 5 seasons, except the Yuan point of the 6 bowels. This is why, therapeutically, particularly in the pathology of the bowels, one uses the Yuan point located on the corresponding Jing (channel). In this way, for example, in disease of the large intestine, in order to perform the treatment is to employ the point Hegu (LI 4) of the Hand Yangming channel to respond to the number of the Lu Shu (6 Shu point: 6 X 6 = 36).”

III - N.V.N.: While the previous paragraph is only devoted to the 5 organs (Wu Zang) and to the group of 5 Shu points (Wu Shu), this paragraph broaches the Yuan point of the group of 6 Shu points of the 6 bowels and its use. 2. This thesis of Zhang Shi did not conform to the spirit of the text. See the following page.

The word Jing cited in the text posed several problems for commentators of the Lingshu, particularly Oriental physicians specializing in phytotherapy, failing to know acupuncture and moxabustion. According to Zhang Shi and Nguyen Tu Sieu (1884-1950), in order to respond to the 5 seasons and, therefore, to the 5 Movements, the Yuan-Fire point is associated with Jing-Fire. Here is their explanation:

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“At the end of summer, one neddles the Jing-river point of the Yang channel because it unites with the Yuan point to respond to the 5 seasons. Therefore, the Jing-river point used to replace the Yuan point, practiced to this day, is not in agreement with the spirit of the Lingshu.” But this explantion is based on a mistake because this paragraph does not concern the Jing-river point but rather the Jing (channel). The explanation of Ma Shi (see above) is the most plausible and most loyal to the original text of the Lingshu. For better comprehension of the meaning of the Yuan point, it suffices to consult: _ Chapters 1 (“9 Needles and 12 Yuan”) and 2 (“Origin of the Shu Antique Points”) of this classic (3), _ Difficulty 66 of the Nanjing _ and the different wordings of the Da Cheng (4). In conclusion, _ on the Yin channel, the Yuan point unites with the Shu point due to its Yin action. _ on the Yang channel, the Yuan point is separate from the Shu point due to its Yang action. These Yin and Yang actions (according to the theory known as Separation/Union) are perfectly integrated in the West.

PARAGRAPH 5 Huangdi: “What is the meaning of o r g a n which responds to winter, season which responds to summer, sound which responds to the end of summer, flavor which responds to a u t u m n and color which responds to spring?” Qi Bo:

“In disease located within the organ, one must needle the Jing-well point. In disease manifesting by a change of complexion, one must needle the Ying-spring p o i n t . 343.

In disease manifesting sometimes by signs of improvement, sometimes by signs of worsening, one must needle the Shu-stream p o i n t . In disease manifesting by a change of voice, one must needle the Jing-river p o i n t . In the fullness of the Jing (channels) with presence of Xue (blood), the disease is located in the stomach with signs of digestive disorder; one must needle the He-sea point. This is why it is said: “The sapors govern the He points”.

3. See “Huangdi Neijing Lingshu”, Volume I, N.V.N. Edition. 4. Da Cheng, published as “Art and Practice of Acupuncture and Moxabustion”, N.V.N. Edition.

All these manifestations have the name “5

Transformations”. ”

EXPLANATIONS AND COMMENTARIES

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I - Zhang Shi explains: “The previous paragraph demonstrates the affinities of the energy of the 5 organs with that of the 5 seasons responding to the 5 Shu (Wu Shu) points which each have an appropriate action, while this paragraph deals with the combination of the 5 organs and 5 Shu (Wu Shu) in determination of therapy.

1 - The organ is Yin and is found in the interior. As a result, in disease of the Kidney organ, one must needle the Jing-well point of the Foot Shaoyin (Ki) responding to Spring-WoodLiver to activate the energy of the kidney into a state of “conservation” (stagnation), that is to say, into a state of slowing down or arrest. 2 - The Liver organ respond to spring which governs the 5 colors. As a result, in disease with change of complexion, one must needle the Ying-spring point of the Foot Jueyin (Li) responding to Summer-Fire-Heart. 3 - In disease signaled sometimes by signs of improvement, sometimes by signs of aggravation (index of activity of the Fire-Heart), with change of Shen (mental), one must needle the Shu-stream point of the Hand Shaoyin (He) responding to End of Summer-Earth-Spleen. 4 - The Spleen organ govern Earth and responds to the number 5 and the musical note Gong. For this reason, in diseases of the spleen with change of voice, one must needle the Jingriver point of the Foot Taiyin (Sp), responding to Autumn-Metal-Lung. 5 - The Lung and Stomach respond to the “Metal” energy of autumn. During liquid absorption, the “good substance” (5) reaches the lung, and during food absorption the “good” substance passes to the Mai (vessels) and Jing (channels) which all link up to the lung because the lung is: _ the site of “presentation of respect to the king” (6) 344. _ site where the Jing (lung quintessence) goes into movement toward the skin and hair _ and the site of conduction of the energy toward the 6 bowels in order to communicate with the 5 organs. In other words, metabolized food substances at the level of the stomach are conducted by the energy of the lung first toward the bowels then toward the different organs in order to be transformed into Ying (nutritive energy) and Wei (defensive energy), Xue (blood)and Mai (vessels). This is why, in order to diagnose an illness located in the stomach, it is necessary that the channels be in fullness resulting from an accumulation of blood due to a digestive disorder hindering the energetic movements of the lung. In the Lingshu and Suwen, the study of the 5 organs is always accompanied by that of the stomach because the stomach is the foundation of the 5 organs.”

5. It concerns the liquid Jing (water quintessence) and of the food/nutritive Jing (quintessence of cereals). 6. Site of gathering of all the energetic vessels of the body; site of determination of the energetic state: radial pulse.

II - N.V.N.: 1. In delving deeply into the physiologic context of this paragraph, we note that it is matter of an explanatory study of the points of dispersion of the 5 organs: _ Jing-well, point of dispersion of the kidney, which is Yongquan- Ki 1

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_ _ _ _

Ying-spring, point of dispersion of the liver, which is Xingjian- Li 2 Shu-stream, point of dispersion of the heart, which is Shenmen- He 7 Jing-river, point of dispersion of the spleen, which is Shangqiu- Sp 5 He-sea, point of dispersion of the lung, which is Chize- Lu 5.

2. The energetic movements of these 5 Shu points (Wu Shu) obey the laws of the 5 Movements and 5 Seasons. Therefore, it concerns a demonstration of the technique known as “disperse the son in the event of fullness”. Example: in fullness of the liver, one must disperse the point Xingjian (Li 2) of the Foot Jueyin (Li), Ying-spring point, which responds to the heart, son of liver (see Figure 83). 3. We present below: _ a relative diagram of the formation of Ying (nutritive energy), Wei (defensive energy), Xue (blood) and Qi (energy) from the stomach according to the explanation of Zhang Shi and a descriptive table of the 5 organs and 5 transformations responding to the number 5 X 5 = 25 Shu intended for research and use of the acupuncture rules cited in this paragraph. 345.

Figure 83: Method of dispersion according to the technique “disperse the son in the event of fullness”

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Figure 84: Formation of Ying/Wei and Xue/Qi from the stomach.

346.

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Summary table of the 5 Organs and 5 Transformations responding to the 5 Shu points (Wu Shu)

5 Transform’s

5 Seasons

5 Shu

Liver Channel

Heart Channel

Spleen Channel

Lung Channel

Kidney Channel

Organs

Winter

Jing

Li 1 Dadun

He 9 Shaochong

Sp 1 Yinbai

Lu 11 Shaochang

Ki 1 Yongquan

Colors

Spring

Ying

Li 2 Xingjian

He 8 Shaofu

Sp 2 Daidu

Lu 10 Yuji

Ki 2 Rangu

Seasons

Summer

Shu

Li 3 Taichong

He 7 Shenmen

Sp 3 Taibai

Lu 7 Taiyuan

Ki 3 Taixi

Sounds

End of Summer

Jing

Li 4 Zhongfeng

He 4 Lingdao

Sp 5 Shangqiu

Lu 8 Jingqu

Ki 7 Fuliu

Sapors

Autumn

He

Li 8 Ququan

He 3 Shaohai

Sp 9 Yinlingquan

Lu 5 Chize

Ki 10 Yingu

347.

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CHAPTER XLV Evaluation of the Exterior (Wai Zui)

Wai

外

Zui

檇 implies the sense of estimation, evaluation and appreciation.

means exterior.

Chapter 45 of the Lingshu comments on the Dao (principle) of acupuncture, in particular the Dao of diagnosis of external and internal, superficial and deep diseases. Because the commentaries do not leave the context of Yin-Yang, the pathological changes of the internal organs (Yin) can be evaluated by external manifestations (Yang), “as quick as the resonance of the sound of the drum, as spontaneous as the shadow cast by the sun and moon and as faithful as the reflection of shimmering water.” In brief, this chapter emphasizes again the importance of the Dao in diagnosis applied to the appreciation of internal illnesses by external manifestations and of external illnesses by internal manifestations, hence the title: “Evaluation of the Exterior” (Wai Zui). Ma Shi writes: “The content of this chapter brings up the phrase “Si Nei, Zui Wai” , hence the title of this chapter.” Chapter 45 consists of a single paragraph.

Huangdi: “I have heard your explanations about the 9 chapters concerning the “9 Needles”. In general, I have been able to grasp the importance of the method and understand, without going into detail, its meaning. 348.

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Use of the “9 Needles” as a function of their name and number, beginning with 1 and ending with 9, certainly has another more profound meaning which escapes me. As a result, I have still not grasped well its true Dao (principles, rules) because in the Dao of needling, among the 9 Needles, _ _ _ _

the the The the

small cannot large cannot deep is like top (surface,

go to the deep remain at the surface the bottom that cannot be perceived supeficial) is as if it cannot be covered... .

This is so subtle and fine, so vast and immense that one does not know the end. I know that all this conforms to the Dao of modification/ transformation of Heaven and Earth and to “human affairs”. But, faced with the complexity of the problem, I would like to gather all this dense (like hair) information in order to establish a summary outline of the whole. Is it possible?” Qi Bo:

“Your question is most pertinent! Obviously, the Dao is not intended only for the practice of acupuncture, but also for the art of governing a country.” Huangdi: “ I wish to know the Dao of needling and not the art of governing a country.” Qi Bo:

“Governing a country also requires the Dao. If not, how can one analyze affairs of state, be they are large or small, simple or complex?” Huangdi: “Please explain to me more clearly.” Qi Bo:

“Take, for example, the sun and moon, water and reflection, drum and resonance. The brightness of sun and moon does not allow the shadow to escape; the purity of shimmering water does not allow the image to be eclipsed; the resonance of the drum does not allow the sound to be lost. Similarly, the disturbance of the interior always causes a response at the exterior. To understand these facts is to grasp the meaning of the Dao.” Huangdi: “Your explanation is clear. They are luminous reflections which can neither be masked nor concealed because they are not contrary to the reason of Yin and Yang. Therefore, to gather them in order to examine them and to examine them in order to experiment is to know the effect of the shimmering water which does not allow the image to escape. If the 5 Sounds are not clear, the 5 Colors will be blurred and the 5 Organs will be disturbed and mixed up without the ability to determine the cause.

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349.

In this manner, the correlations between the interior and exterior are like sticks and drum, sound and echo, shadow and image... . This is why: “To examine that which is removed is to determine the exterior in order to appreciate the interior, and to examine that which is nearby is to determine the interior in order to evaluate the exterior.” Such is the miraculous Dao of Yin and Yang, of Heaven and Earth which one must never forget. Please record it in the Ling Lan ( 1 ) . ” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph demonstrates the “node” and “ankle” of the “9 Needles”. One must be very perceptive in order to consolidate them. The words small and large, top and deep, vast and immense are explantory terms so subtle that one cannot limit them. Above, the 9 Needles respond to the Dao of Heaven and to the 4 seasons; in the middle, they respond to “human affairs”. If one does not understand their “node” and “ankle”, one will never be able to master the heart of the problem. This is why Huangdi stresses the difficult points to better understand them. Qi Bo responds to him: “It is obvious that the Dao of acupuncture is this way; it is the same for the Dao of governing a country. It is necessary to be used in such a way that “large, small, top and deep” is gathered like the brightness of sun and moon of which one must not ignore the shadow, like the purity of shimmering water of which one must not ignore the reflection and like the resonance of the drum of which one must not ignore the echo... . This is why a slight disturbance is sufficient to bring about a response, and understanding is immediate.” With a little clarity, one perfectly understands the sense of Huangdi’s words to better discern Yin and Yang. They link up: _ in man, the brightness of Yin and Yang, even a little intense, cannot be concealed. It cannot be concealed because it conforms to the dialectic of Yin and Yang. It exists then only to gather Yin and Yang to examine and experiment according to their own particular law. One will perceive that Yin and Yang is like shimmering water which does not allow the image to fade. Therefore, from the 5 Sounds and 5 Colors, one can determine with precision the state of the 5 Organs. But if the 5 Sounds are not clear and 5 colors are not distinct, Yin and Yang cannot be appreciated thoroughly and the 5 organs are indiscernable with no possibility of defining the cause. This is why it is indispensable to understand the reason of the relationship between the interior (Li) and exterior (Biao), a relationship as quick as that of sticks and drum or that of sound and echo.

1. Name of the national library of that era.

350.

As a result, the voice and complexions, hidden manifestations, that is to say, at the external part of the body, can serve as elements of appreciation of the states of the organs located in the interior. Conversely, the 5 organs of nearby manifestations, that is to say, located in the interior, can serve as elements of determination of that which passes to the exterior of the body, there comprising voice and complexion. Such is the miraculous Dao of Yin and Yang, of Heaven and Earth, which one must not neglect.”

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II - N.V.N.: Chapter 45 of the Lingshu stresses the importance of the relationship of interior (Li) and exterior (Biao) in the matter of diagnosis of Oriental energetic medicine. Modern translation of this chapter into popular and Western language is slightly different from the original text of the Tang Dynasty (613-906 A.D.).

351.

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CHAPTER XLVI The Five Transformations (Wu Bian)

The process of triggering of disease, although of external etiology, depends on the constitutional state of the individual. Chapter 46 of the Lingshu takes as analogous reasoning the 5 types of trees of different fragility which are permanently under the influence of the natural world (wind, rain, fog...) and whose lesions are different. These seasonal climatic influences upon the plant world are superimposable upon those of the human being. The 5 types of disease cited in this chapter are examples serving to demonstrate the mechanism of triggering of the disease as a function of the state of the musculo-skeletal and epidermo-glandular systems. The object of this chapter concerns the study of the 5 types of transformation of disease, hence the title: “The Five Transformations” (Wu Bian). This chapter consists of 7 paragraphs.

PARAGRAPH 1 Huangdi questions Shaoyu: “I have understood that the “100 Diseases”, at their start, are all caused by wind, rain, cold, heat... which infiltrate into the pores of the hairs to the dermal layer. At this stage, the curious perverse energy (1)

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is driven back to the exterior, or else it remains there to trigger: _ _ _ _ _

either or the or the or the or the

the syndrome of Feng Zung (Wind-Edema) syndrome of Jiao Dan (polydipsia and emaciation) syndrome of Han Re ( C o l d - H e a t ) syndrome of Liu Bi ( a l g o p a r e s t h e s i a ) syndrome of Ji Ju ( a c c u m u l a t i o n - g a t h e r i n g ) .

352.

This curious pervese energy diffuses abundantly into the organism provided one is able to evaluate the quantity. I would like to understand the reasons. Why can a same disease of the same origin manifesting at the same time present different clinical forms? Is it that Heaven has created the wind to punish man?” Shaoyu responds: “The “wind” energy of Heaven has not been created against the “100 Families”. Its movements of distribution are equitable and just. Those who know how to prevent it risk nothing. The wind aims at no none, but man by his imprudence allows himself to be grasped by the wind.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph discourses on different clinical forms originating from the same cause. Heaven, which has created the wind, favors no one. The inequality comes from the ignorance of prevention.”

1. It is called “curious” because it does not penetrate into the channels.

PARAGRAPH 2 Huangdi: “Why is the illness of Wind (Feng) different among individuals who are simultaneously affected?”

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Shaoyu: “Your question is excellent! Permit me to split hairs in taking as an example the work of an artisan, armed with a ground axe and a sharpened knife, who cuts and pierces a tree trunk still having soft parts and hard parts. At the soft places, the work is easy; at the hard spots, the work is difficult; and at the fibrous parts (knot), the axe risks becoming chipped. Therefore, in the same tree trunk, the soft and hard parts are variably penetrable... all the more so when it involves trees of other species whose thickness of bark and density of sap are different... then each is different from the others. 353. In the plant world, there exists trees whose flowering and budding are early. At spring’s frost, the flowers fall and leaves decompose. In very sunny weather, the trees with thin bark have dried out leaves and less sap. With a prolonged rain and gloomy weather, trees with thin bark and reduced sap rot. With severe and sudden wind, trees with solid trunks have broken branches; and with the fog of autumn with violent wind, trees with robust trunks are uprooted and stripped of their foliage. The 5 plant species cited are each affected in a different fashion, all the more so when it concerns human beings.” Huangdi: “How do you postpone these events of plant species in man?” Shaoyu: “When trees are affected, only the branches are injures, but variably according to their hard or soft consistency and strength. The hard branches are relatively spared. In the human being, illnesses are often due to a loss of resistance in the osteo-medullary and epidermo-dermal systems, favoring the infiltration of perverse energy. This is why illnesses are frequent in man.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Huangdi wants to know the reason for the difference in symptomatology in individuals affected at the same time by the disease of wind. According to Shaoyu, perverse energy infiltrates more or less easily into man as a function of the fragility of his bony, glandular and pilo-cutaneous systems, like a tree trunk endowed with 2 different aspects, Yin and Yang, Hard and Soft, by which the work of the carpenter is sometimes easy, sometimes hard. The 5 species of trees cited in the text each have a specific fragility. As a result, harms caused by wind are variable. It is the same in the human being subjected to the influence of the illness of wind due to the weakness of the different layers of the body which favor the infiltration of perverse energy to the organ and bowel.”

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II - N.V.N.: We draw from the conclusion of Zhang Jing Yu: “Trees have their Yin and their Yang, their Hardness and their Softness. As a consequence, their injuries are serious or benign. It is the same in human beings. Exposed to violent wind, some individuals are affected and others not. The difference resides there.” 354.

PARAGRAPH 3 Huangdi: “Some individuals are inclined to the illness Feng Jue (afflux caused by wind). How is that?” Shaoyu: “Because the muscles are not firm and epidermo-dermal tissues loose, the individual is often affected by wind.” Huangdi: “How do you recognize that the muscles are not firm?” Shaoyu: “The muscular mass located in the “crease” (articulation) (2) is not hard and firm. It is without demarcations, that is to say, that the skin is wrinkled at this level.” The skin being wrinkled, the “flesh” (dermis) system is not very dense and is lax. This involves individuals who perspire easily.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph speaks about impenetrable skin and dermal tissue not very dense and dilated that permits perverse energy (Wind) to provoke a contrary afflux (Jue Ni) with abundant sweating. This sweating is due to an exteriorization of the Xin Ye (organic liquid) in the form of sweat crossing the epidermo-dermal spaces whose skin is already lax and whose flesh fibers are already not very dense and dilated. “The muscular mass located in the “crease” ( )” designates the muscles of the shoulder, elbow, thigh and knee which are maintained by the Taiyang (SI and Bl). When this muscular mass is no longer firm, with an epidermo-dermal system not very dense and loose, water (of the Taiyang) exteriorizes in the form of diffuse perspiration.” 2. Designates the muscles covering the large joints.

II - N.V.N.: 355. The illness of Feng Jue (afflux of wind) has been broached for the first time by Huangdi and Qi Bo in Chapters 7 (“Special Study on Yin and Yang”) and 31 (“Diseases of Heat”) of the Suwen. Chapter 35 of the Suwen (“Discourse on “Fever-Chills” Disease”) and Chapter 55 of the Lingshu (“Complementary Study on the Chapters of Depth of Needling”) have indicated on several

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occaisions not needling perspiring individuals. These assertions show that attack of Feng Jue always manifests by diffuse sweating. This sweating has two origins: _internal origin : primary weakness of the epidermo-dermal layer due to an insufficiency of Jing Qi (energetic quintessence) of the lung and spleen, and _ external origin : infiltration of perverse energy causing exteriorization of interstitial liquid. In this case, treament consists of fortifying the Taiyin (Sp and Lu) system and activating the circulation of blood to combat the wind.

PARAGRAPH 4 Huangdi: “In man, the disease of Jiao Dan (warm body, polydipsia and emaciation) ( 3 ) is common. How is that?” Shaoyu: “The insufficiency of the 5 organs often causes Jiao

Dan . ”

Huangdi: “How do you recognize that the 5 organs are in insufficiency?” Shaoyu: “Generally, individuals whose skin and flesh are soft and weak are of firm and energetic nature. These energetic individuals are easily open to irritation and anger which weakens the 5 organs and favors attack by the illness Jiao Dan ” . Huangdi: “How

to

you

recognize firmness

and

weakness?”

Shaoyu: “In these individuals, the skin is thin, the eyes often rolled 356. upward under the effect of fear or anger. Their “heart” is energetic, but often aggressive. During anger, the enegy affluxes toward the top, accumulates in the thorax and causes stagnation of the blood and energy at the level of the epidermo-dermal system. In the long run, this stagnation transforms into heat which exhausts the flesh and skin to trigger the disease Jiao Dan . This involves individuals whose nature is rough and violent and whose skin and flesh are weak.”

3. Here, Jiao Dan does not designate “thin diabetes” (?!).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

珓癉designate a form of disease of heat known as ungrateful.

“The words Jiao Dan

Fullness of this heat is at the origin of the polydipsia and emaciation.

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Chapter 4 of the Lingshu (“Pathologic Forms of Attack of the Organs by Perverse Energy”) states: “The fine and small radial pulse of the 5 organs are signs revealing the disease Jiao Dan. The 5 organs govern the production/conservation of Jing (quintessence). When the organs are weak, the Xin-Ye (interstitial liquids) become exhausted and the individual is open to the disease of Jiao Dan.” The bodily form is the site of external reunion of the energy of the 5 organs. As a result, thin skin and soft flesh indicate the weakness of the 5 organs. In summary, individuals whose skin and flesh are weak are of solid and energetic nature; that is to say, they are of weak constitution but of strong nature. Generally, their skin is thin, their eyes are deep and their energy rises up straight toward the top. This is why their “heart” is firm and energetic. But the individual of energetic nature is often open to anger, causal factor of afflux of the energy, causing a stagnation/obstruction of the energy and blood at the level of the epidermo-dermal system. This stagnation is transformed into heat which exhausts the flesh and skin and provokes the disease Jiao Dan”. II - N.V.N.: The treatment of Jiao Dan consists of calming the Shen (mental) and tonifying the 5 organs and Yangming (St).

PARAGRAPH 5 Huangdi: “In man, the disease of Han Re (Cold-Heat)

is

common.

Why?” 357.

Shaoyu: “Individuals whose bones are small and flesh soft are inclined to the disease Cold-Heat.” Huangdi: “How do you determine the large or small size of the bones, the softness and firmness of the flesh and the different colors?”

Shaoyu: “The bone of the cheek is the “root” of the entire the skeleton. When the bone of the cheek is large, the bones are large; when the bone of the cheek is small, the bones are small. Thin skin is without muscular mass; the muscles of the arm are flaccid; the color of the chin region is without sharpness and not in accord with that of the frontal region (Tian Ding). Such are the basic signs favoring attack by disease. Finally, the thinness of the skin of the arm with absence of muscular mass indicates an insufficiency of marrow. This is also an indication of the frequent unexpected onset of the disease of Cold-Heat.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph explains the frequent unexpected occurence of the disease of “Cold-Heat” (Han Re :

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and “dryness” of the marrow. In order to estimate the largeness of the bones, one must examine the bone of the cheek which serves as reference for the collection of the components of the human skeleton. In this manner, only individuals whose bones are small and fragile are susceptible to being affected by the disease of Cold-Heat. In order to determine the sufficiency or insufficiency of the marrow, one must examine the skin of the arm. If the skin is thin, the bones are small and the marrow, insufficient. This insufficiency of marrow favors the penetration of perverse energy into the brain via the points Fengfu (GV 16) and Fengchi (GB 20) because the brain is the “palace” of the marrow. As a result, the insufficiency of the marrow constitutes one of the bases of appreciating the cause of the disease of Cold-Heat (4). 358. II - Zhang Shi states: “The kidney governs the bones, and the two cheeks are the sites of exteriorization of the energy of the kidney. Therefore, the bone of the cheek serves as the basis for determination of the largeness of the collection of the bones of the body. When the bone of the cheek is large, the bones of the body are large, and when the bone of the cheek is small, the bones of the body are small. The muscular mass of the gluteal region represents the state of the energy of the collection of the flesh of the body. This is why, in the disease of Cold-Heat, the flesh of the gluteus and thigh is not abundant. The non-concordance of the color of the chin and frontal region indicates the energy of Spleen-Earth in a state of disorder. The marrows are made up of Jing Qi (energetic quintessence) of the kidney which governs the bones. Therefore, the bones are small because the marrows are insufficient. The skin and flesh are Yang in relationship to the muscles and bones which are Yin. When the bones are small and the flesh thin, Yin and Yang are simultaneously in emptiness. Yang in emptiness transforms into cold, and Yin in emptiness transforms into heat (5). As a result, individuals whose bones are small and skin thin are easily exposed to the disease Cold-Heat.” III - N.V.N.: The different clinical forms of the disease of Cold-Heat and their treatment are explicitly shown in Chapter 21 of this classic(“Diseases of Cold and Heat”) (Lingshu, Volume I- N.V.N. Ed.). Nevertheless, we emphasize a new clinical form of the disease of Cold-Heat, myelitis, cited in this paragraph due to “dryness” of the marrows, therefore due to an insufficiency of Jing (quintessence) of the 5 organs at the level of the brain. Treatment of this form of myelitis consists of utilizing: _ craniopuncture (whose technique is well known in the West) (6) to reinforce cerebral Jing (Figures 84 and 89) 4. In other words, in Oriental energetic medicine, myelitis is one of the forms of the disease of Han Re (Cold-Heat). 5. Here, Zhang Shi explains the internal cause of myelitis, one of the forms of the disease of ColdHeat. 6. At Ravenna Hospital (Italy), a craniopuncture and somatopuncture service has been created, since 1972, reserved to treat only children born handicapped.

_ and somatopuncture with the purpose of activating the production of Ying (nutrtitive energy) and Wei (defensive energy) and the formation of Jing (quintessence) at the level of the 5 organs.

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359.

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Figure 85: Craniopuncture Zones (side view). 360.

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Figure 86: Craniopuncture Zones (front view).

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Figure 87: Craniopuncture Zones (posterior view).

361.

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Figure 88: Craniopuncture Zones (top view).

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Figure 89: Formation and distribution of Jing Qi.

PARAGRAPH 5

362.

Huangdi: “How do you explain the sudden frequent occurrence of Bi disease

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(algoparesthesia)?” Shaoyu: “Individuals whose cuteneous folds are coarse and muscular masses not firm are often exposed to Bi disease.” Huangdi: “How do you determine the upper or lower localization of Bi disease?” Shaoyu: “In order to determine the upper or lower localization of Bi disease, it is sufficient to examine its state of emptiness or fullness located at the top or at the bottom, to the right or to the left.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph explains the frequency of Bi disease ( algoparesthesia) in individuals whose muscular masses are not firm and whose skin is not air-tight. The skin and flesh, muscles and bones are the external parts representing the 5 organs. Chapter 43 of the Suwen (“Discourse on Obstructions”) expresses: “The simultaneous penetration of wind, cold and humidity is the origin of Bi disease. _ Bi disease manifesting in winter is Bi of the bones. _ Bi disease manifesting in spring is Bi of the muscles. _ Bi disease manifesting in summer is Bi of the vessels. _ Bi disease manifesting at end of summer is Bi of the flesh. _ Bi disease manifesting in autumn is Bi of the skin.” Therefore, it is sufficient to examine the anatomic layers in order to determine the upper (superficial) or lower (deep) localization of the Bi disease. Bi diseases localizing in the anatomic layer belonging to the lung (skin) and heart (vessels) are of upper localization and those localizing at the anatominc layers belonging to the liver (muscles), kidney (bones) and flesh (spleen) are of lower (deep) localization.”

II - N.V.N.: Treatment of these diseases consists of dispersing the A Shi (painful) points and tonifying the corresponding channel. Also see Chapter 13 (“Tendinomuscular Channels”) of this classic (Volume I, N.V.N. Edition).

PARAGRAPH 6

363.

Huangdi: “How do you explain the sudden frequent occurrence of the disease

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of Ji Ju (accumulation/gathering)

at

the

level

of

the

intestinal

tract?”

Shaoyu: “Thin and not very brilliant skin and flaccid flesh are the signs revealing disturbances of the intestinal tract, favoring accumulation/ gathering of perverse energy, phenomenon harmful to the SpleenStomach system. Similarly, the irregularity of the cold and heat located in the inter-organ “Spleen-Stomach” space facilitates the attack of perverse energy to create a great synrome of gathering.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“This paragraph discourses on the frequency of the disease of Ji Ju

稷/稘焣

(accumulation/gathering) at the level of the intestines is due to poor functioning of the gastrointestinal tract. a - In general, individuals whose skin is thin present an insufficiency of energy. Their flesh is not firm and is no longer saturated with organic liquid which causes a distrubance at the level of the gastro-intestinal tract. Because the organic liquid, blood and energy are created at the level of the stomach and intestines, a simple disturbance of these latter is sufficient to impede the circulation of the perverse energy. This accumulates and creates the phenomenon of accumulation/gathering, harmful to the “Spleen-Stomach” system. On the other hand, a digestive disorder by cold or heat can favor the aggression of perverse energy which progressively accumulates to trigger a great syndrome of accumulation.

b - The large intestine associated with the lung governs the skin and the whole of the energetic system of the organism on the one hand, and on the other hand, the stomach associated with the spleen governs the flesh and the whole of the organic liquids of the body. As a result, the thinness of the skin and flaccidity of the muscles originates from the insufficiency of the energy and the non-saturation of organic liquid, hence opening of the cutaneous pores and scarcity of dermal fibers favoring the stagnation and accumulation of perverse energy responsible for accumulation/gathering.”

II - N.V.N.:

364.

This paragraph concerns the accumulation/gathering of the energy at the level of the intestines. The signs and symptoms and triggering process of these diseases has been defined in the Da Cheng de Yang Chi Chou (7):

7. Published under the title “Art and Practice of Acupuncture and Moxabustion (According to the Zhen Jiu Da Cheng)”, N.V.N. Edition.

“The disease can be provoked by an accumulation or gathering of the energy. The accumulation is a pathologic manifestation of Yin energy; the gathering is a pathologic manifestation of Yang energy. The first, Yin, is of a deep and immobile nature; the second, Yang, is of a superficial and mobile nature.

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The accumulation is a heterogenous accumulation of energy resulting from the pathologic process of the 5 organs, while the gathering is a heterogenous concentration of energy coming from distrubances of the 6 bowels. The accumulation, a disturbance of Yin energy, starts via a well localized pain at the top or bottom, sometimes at the top, sometimes at the bottom.”

PARAGRAPH 7 Huangdi: “I have heard something about the pathology of the form (Xing). But I would like you to inform me about its periodicity. Shaoyu: “First, one must carefully specify the year in order to determine the periods. At the period when the energy is u p p e r , cure follows; at the period when the energy is l o w e r , the disease worsens. When the period of Stoppage/Descent (Han Xia) does not follow during the year when the energy of the 5 Circumductions is impulsive (Chong) and communicative (Zong), cure inevitably follows. Here, it is form (Xing) which creates disease “knot” of the Five Tranformations.”

(Bing). Such is the

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“1 - Wind, rain, cold, heat... are the 6 energies in eternal movement. These 6 energies damage the form (Xing). This is why, each year, one must reestablish the law of the movements of the 5 Circumductions and 6 energies in order to determine pathologic phenomena. 365. In this manner, for example: a - In the Chen Xu (V-XI) year, the Taiyang is at Si Tian; the 2nd guest energy is Yangming-Dryness-Metal and the 3rd host energy is Shaoyin-Imperial Fire. In this case, the host energy triumphs over the guest energy (fire inhibits metal). This phenomenon constitutes what one calls “period of the upper energy”, factor of cure of the disease. b - In contrast, _ the 3rd guest energy being Taiyang-Cold-Water, the host energy is Shaoyang-Ministerial Fire, _ the 4th guest energy being Jueyin-Wind-Wood, the host energy is Taiyin-HumidityEarth, _ the 5th guest energy being Shaoyin-Imperial Fire, the host energy is Yangming-DrynessMetal, _ the last guest energy being Taiyin-Humidity-Earth, the host energy is Taiyang-ColdWater. In this case, the guest energy is victorious (water triumphs over fire). This phenomenon constitutes what one calls “period of the lower energy”, factor of worsening of the disease.

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2 - Wind, rain, cold, heat... are the 6 energies of Heaven in permanent mutation. When it lodges in a “guest” capacity within the organism, it is responsible for disease. At the start, reactive phenomena are external. This is why to speak of their “stoppagedescent” (Han Xia), permits explaination of their progression toward the deep and their stagnation at the level of the intestines to transform into disease of accumulation/gathering. The term “impulsive/communication” (Chong Zong) implies the sense of communication of the energy of the 5 Movements with the external layers of the body whose principal action is to dipserse the perverse energy located at the exterior. Example: During the year “Taiyang-Cold-Water” of Si Tian, the 5 Movements belong to the “Earth” movement. In this case, the energy of the 5 Movements is victorious. Therefore, the disease cannot remain in the interior. The 6 energies are at the exterior in order to respond to the 3 Yin and 3 Yang (Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin), and the 5 Movements are in the interior in order to respond to the 5 organs. Since the energy of the organ triumphs over the energy of the exterior, not creating the phenomena of Stoppage-Arrest/Descent, the disease of perverse energy remains at the exterior and will be dispersed by the impulsive/communicative action of the energy of the 5 Movements. (Figure 89) 366.

Figure 90: Impulsive action of the 5 Movements. The 6 energies govern the movements of Ascent-Descent, of Top-Bottom (from superficial to deep). As for the 5 Movements, they govern the movements of Entering-Exiting of the interior and exterior.

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3 - This paragraph studies disease as a function of morphology, responding to the 5 Transformations because the skin, flesh and sweat gland systems make up part of the form (Xing: morphology) and constitute the route of entering/exiting of Ying (nutritive energy) and Wei (defensive energy). Here, the disease belongs therefore to the form and not to the energy because, in the latter case, it must associate with Ying and Wei in order to progress toward the interior to disturb the Hun (vegetative soul) and Po (sensitive soul), then it must reach the blood vessels and infiltrate into the organs and bowels to cause internal diseases. Concerning the disease of form (Xing), and not of energy (Qi), it is distinguished only into 5 types: _ Feng Jue (afflux of wind) _ Jiao Dan (polydipsia and emaciation) _ Han Re (Cold-Heat) _ Bi (algoparesthesia) _ Ji Ju (Accumulation/Gathering). 367. These diseases of form (Bing Xing) constitute a group located within the space situated between the spleen and stomach, without affecting the organ or bowel. In contrast, if the “curious” perverse energy overflows the interior, it creates either disease of form or disease of energy. Sometimes, it stagnates in the vessels, sometimes it infiltrates into the organs and bowels. The transformation/evolution of the disease is, therefore, multiple. This is why, the first six chapters of the Shang Han Lun (8) start with a study of the energy of the 3 Yin and 3 Yang and the syndromes of the channels. Sometimes, this study only concerns the disease of form and not the disease of energy. In this manner, for example, in the chapter of the Taiyang we have noted this phrase: “The evolutive cold (9) injures the form because in Heaven it is the energy, and in Earth it is the form”. This assertion emphasizes the vital force of Heaven and Earth in the creation of form and in the determination of energy. This permits better understanding of the mystery of longevity and brevity of life.”

II - N.V.N.: 1. Zhang Jing Yue (1563-1640 A.D.) declares: “In order to determine the periodicity of the disease, it is necessary to first specify the year when the 5 Movements and 6 Energies each have a period of predominance. As a result, when the disease follows a period of “production/plethora”, that is to say, the period of “elevated” (high intensity) energy, the disease is cured. In contrast, when the disease follows a period of “degradation/inhibition”, that is to say, a period of “lower” (low intensity) energy, the disease becomes worse.”

8. Published under the title “Evolutive Diseases of 3 Yin and 3 Yang”, N.V.N. Edition. 9. Ignorant of the medical terms of Oriental medicine, some Westerners have translated the term “Shang Han” as “Harmful Cold” (!?).

2. According to Chapter 71 of the Suwen (“Great Study on the Preparation of Cyclic Recording of the 6 Energetic Sources”) : “There exists periods neither responding to that of “degradation/inhibition” nor to that of “stoppage/descent”, but to the year presenting an impulsive period (Chong) or communicative

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(Zong) period. This is why the disease can worsen or improve.” Therefore, for example: When Fire and Water simultaneously rise, Fire must dread Water, and when Metal and Wood ascend, Wood must fear Metal. In contrast, if Fire is victorious, Water will be affected; if Wood is victorious, Metal will be affected. 368. As a result, individuals whose morphology is of the Wood type can be patients in the course of the year Jia-Ji (1-6), and individuals whose morphology is of the Metal type can be patients in the course of the year Ding-Ren (4-9). These phenomena constitute what one calls “Generation of the Disease By Morphology”. Such is the “knot” of the problem of the 5 Transformations. 3 - According to the thesis of two celebrated physicians, Zhang Shi and Zhang Jing Yue, concerning: _ victory and defeat _ production and destruction _ degradation and prosperity, coordination of the Trunks (Gen), Branches (Chi) and 5 Circumductions (Wu Yun) as a function of the 5 Movements (Wu Xing) is essential for explaining the favorable (physiologic) and unfavorable (pathologic, deleterious) movements of the energy. This reasoning determines not only: _ the production and destruction of the movements by the energy _ and the production and destruction of the energy by the movements but also: _ the climatic energies of the year regrouped as “Host Energy” and “Guest Energy”. The host energy designates the energy of the period in a state of predominance. It allows explaining the normal phenomena of the 4 seasons and 24 energetic divisions. The guest energy designates the abnormal climatic energy in the course of the period of predominance. The host energy is stable, and the guest energy is unstable. They are not similar but opposite. As a result, the comparison and association of these two energies permit determining the favorable or unfavorable climatic energy of the year in order to predict their influence on the human being. If the guest energy triumphs over the host energy, the evolution is favorable (Top triumphs over Bottom) because it involves a phenomenon of abnormal transformation of weak intensity of climatic energy of the year in the human being; the disease is benign. In contrast, when the host energy triumphs over the guest energy, the evolution is unfavorable (Bottom triumphs over Top) because it involves an abnormal phenomenon of high intensity of climatic energy of the year. In the human being, the disease is serious. 4 - The “form” designates the morphology linked to the 5 Movements of the body responding to the 5 Circumductions of the year. The chains of destruction of the 5 Movements, the fullness and emptiness of the 5 Circumductions and 6 Energies, are therefore the bases of explanation of the triggering of the disease. 369.

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CHAPTER XLVII Constitutional Characteristics of the Organs (Ban Zang)

Chapter 47 of the Linshu addresses the influence of the anatomic aspects (morpholgic and disposition) of the 5 organs/6 bowels on the health of the human being. It consists of several parts: _ Role of the Xue (blood) and Qi (energy), Ying (nutritive energy) and Wei (defensive energy), Jing (quintessence) and Shen (mental ) in the life of man. _ 5 X 5 = 25 forms of the 5 organs in the activation of the disease _ 5 X 5 = 25 methods of determination of the morphology of the 5 organs to diagnostic and therapeutic ends _ correlations between the 6 bowels and “epidermo-musculo-osseous” system. Ma Shi declares in his commentaries: “The content of Chapter 47 of the Linshu resides basically in the presentation of the favorable and unfavorable, prosperous and harmful states of the 5 organs and 6 bowels, hence the title of this chapter: “Characteristics of the 5 Organs (Ban Zang)”. ” This chapter consists of 20 paragraphs.

PARAGRAPH 1 Huangdi:

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are

“ Jing (quintessence), Shen (mental), Xue (blood) and Qi the nutritive elements that maintain life.

(energy)

The Jingmai (channels-vessels) are the routes of conduction of the energy (Qi) and blood (Xue), the routes of regulation of Yin and Yang, the routes of humidification of the osteo-medullary system and routes of articular discharge. 370.

Wei Qi (defensive energy) is an energy that heats up the flesh, favoring cutaneo-glandular activities, and controls the system of opening-closing (of the pores).

Chi (will) and Yi (thought) are the energies that consolidate the Jing (quintessence) and Shen (mental) , concentrate the Hun (vegetative s o u l ) and Po (sensitive soul) , regulate Han (cold) and Re (heat) and delay joy and anger. This is why: _ When Xue (blood) and Qi (energy) are harmonized, the Jingmai circulate, enlarge the routes of Yin and Yang, consolidate the muscles and bones and facilitate joint movements. _ When Wei Qi (defensive energy) is in harmony, the flesh masses are relaxed and the skin and hair are supple. _ When Chi (will) and Yi (thought) are in harmony, Jing ( q u i n t e s s e n c e ) and Shen (mental) are united, Po (sensitive soul) and Hun (vegetative soul) come together, irritation and anger are absent and the 5 organs are protected from perverse energy. _ When Han (cold) and Re (heat) are in harmony, the 6 bowels properly fulfill their function of digestion, diseases of Feng Bi (algoparesthesia caused by wind) do not manifest, the Jingmai circulate freely and the limbs and jonts are in peace. All this concerns man in good health. The Wu Zang (5 Organs) assure the conservation of Jing (quintessence) and Shen (mental) , Xue ( b l o o d ) and Qi (energy), Hun (vegetative soul) and Po (sensitive soul). The Wu Fu (6 Bowels) harmoniously activate the liquid circulation of the organism. Human beings, without distinction, intellectuals or fools, sages or eccentrics, receive all this from Heaven. Nevertheless, some individuals enjoy “celestial longevity” with attack by perverse energy and live without becoming weak for 100 years; even exposed to wind and rain, great cold or strong heat, they are not subject to any misfortune. In contrast, other individuals, without leaving their room, cannot avoid illness. Why? What is the reason?” Qi Bo:

“Your question is most important, approachable with difficulty! In the living being, the 5 organs have the mission of participating in the

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activities of Heaven and Earth, the liveliness of Yin and Yang, the changing of the “4 seasons” and the mutations of the ”5 Movements”. But the 5 organs are, by nature, large or small, high or low, resistant or fragile, well-positioned or deviated. It is the same for the 6 bowels; they also are large or small, long or short, thick or thin, tense or relaxed. 371.

The 25 forms of the 5 organs are different from one another and can be favorable or unfavorable, prosperous or h a r m f u l . Allow me to submit to you their physiologic orientations.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“1 - The preceding chapter revolves around the appearance of diseases as a function of the consistency and thickness of the pilo-cutaneous system, while this chapter discourses upon the appearance of disease as a function of the configuration and size of the 5 organs and 6 bowels. 2 - Ying (nutritive energy) and Wei (defensive energy) are energetic substances elaborated at the level of the 5 organs and 6 bowels. Vessels and flesh, muscles and bones are external reunions (Wai He) of the 5 organs and 6 bowels. Jing (quintessence) and Shen (mental), Hun (vegetative soul) and Po (sensitive soul) are also energetic substances elaborated and conserved at the level of the 5 organs and 6 bowels. Xin Ye (organic liquid), originating from the Shui-Gu (Water-Cereal), are metabolites elaborated at the level of the 6 bowels. This is why, when Xue (blood) and Qi (energy), Jing (quintessence) and Shen (mental) are in harmony, the 5 organs are protected from perverse energy. 3 - Some individuals, because of the form and consistency of their organs and bowels, can live a long time without becoming weak even exposed to wind and rain, to cold and heat... . In contrast, others, without leaving their room and without any familial or social problems, are not spared from illness... . This difference originates from the configuration (morphology and disposition) of their organs and bowels responsible for phenomena called “favorable and unfavorable, prosperous and harmful”. 4 - The thickness and size of the 5 organs and 6 bowels depend on the influence of Yin energy and Yang energy of the “4 Seasons” and “5 Movements”. As a result, it is necessary that they be sound and well-positioned, solid and stable in order to harmonize with the energy of Heaven and Earth.”

II - N.V.N.: This paragraph demonstrates the basic components of Oriental energetic illness:

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372.

_ _ _ _ _ _ _

Jing and Shen (Quintessence and Mental) Xue and Qi (Blood and Energy) Chi and Yi (Will and Reflection) Hun and Po (Vegetative and Sensitive Souls) Jing and Luo (Principal and Ssecondary Routes) Ying and Wei (Nutritive and Defensive Energies: Acquired Energies, a posteriori) Ting Qi (Innate Energy, a priori).

These energies and their paths of conduction are permanently regulated by the Xin Ye (organic, interstitial liquids). Without their deepened understanding, the practice of acupuncture is pernicious and does not give the expected result. According to Zhang Jing Yue: “The human organism takes Xue and Qi as basic elements, and Jing and Shen as tools to maintain and protect life.”

PARAGRAPH 2 “The heart is s m a l l , its energy is peaceful. It is hard to attack by perverse energy, but easily disturbed by preoccupations. In contrast, the heart is l a r g e ; torments do not bother it, but it is easily attacked by perverse energy. The heart is in an high position ; its energy encroaches on the lung; the individual is anxious and struck with amnesia. It is hard for him to express himself. In contrast, the heart in a low position is easily exposed to “cold” energy and the individual is vulnerable to verbal intimidations. The heart is h a r d ; its energy is calm and solid. In contrast, the soft heart is often exposed to the illness Jiao Dan-Re Zhong” ( 1 ) . The heart is s t r a i g h t ; it energy is harmonious and the individual is not easily diseased. In contrast, the heart is d e v i a t e d , Shen (mental) is not assured and the individual is disloyal and deceitful, treacherous.”

EXPLANATIONS AND COOMMENTARIES I - Ma Shi explains:

“This paragraph speaks on the favorable and unfavorable, prosperous and harmful states of the heart. 373. 1 - Because the heart is small, the Shen Qi (mental energy) becomes concentrated. Therefore, perverse energy cannot attack it. But because of its small size, it is often disturbed by psychological and social factors. 1. “Polydipsia/emaciation with overheating of the Zhongjiao (Middle Jiao)”.

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Similarly, because the heart is large, the Shen Qi is plethoric. Therefore, worries do not trouble it. But in the plethoric state, the Shen Qi scatters to the exterior and is easily exposed to attack by perverse energy. 2 - The lung is the “cover” of the heart. If the heart is located high, it is pressed against the lung. The energetic system is then blocked, the “orifice” of the heart and that of the lung are obstructed, hence anxiety and amnesia. The patient opens the mouth to express himself with difficulty because the heart governs speech and the lung governs the voice. 3 - The soft heart is easily exposed to the illness of Jiao Dan/Re Zhong. Here is Qi Bo’s explanation (see Chapter 4 of this classic: “Pathologic Forms of Attack on the Organs by Perverse Energy”) (2): “All 5 organs can be affected by the illness Jiao Dan because the 5 organs, receptors of Jing (quintessence) are soft and incapable of producing the Xin Ye (organic liquid).” Therefore, it is preferable to have a heart neither too small nor too large, neither high nor low, hard rather than soft, straight rather than bent... . Such a heart is favorable to the cure of diseases, even serious ones.”

II - N.V.N.: 1 - This paragraph presents aspects of the heart and their pathophysiologic consequences. The conclusion of Zhang Jing Yue (1583-1640 A.D.) summarizes it perfectly: “_ The small heart is easily exposed to psychoaffective problems. _ The big heart is fragile and easily exposed to attack by perverse energy. _ The heart in an elevated position encroaches on the energy of the lung and often causes problems at the level of the “orifices”. _ The heart in a low position inhibits Yang energy and the Shen (mental) is not comforted. _ The soft heart facilitates the mobilization of Fire and renders the Shen fickle.” 2 - Recall that the word Energy (Qi) regarding the heart organ encompasses not only the notion of Ying Qi, nutritive energy, directed by the Hand Shaoyin (He), but also Jing, pure energy or energetic quintessence, elaborated by by this organ. The Jing Qi of the heart is composed of: _ Anatomic Jing which governs the vessels _ Sensorial Jing which governs vocal ability _ Psychologic Jing which governs the Shen (mental).

374.

These Jing are directed toward the spinal canal to maintain the marrows and brain by the route of the kidney (Figure 91).

2. See “Huangdi Neijing Lingshu”, Volume I, N.V.N. Edition.

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Figure 91: External and internal functions of the Jing Qi of the heart.

PARAGRAPH 3 “With a s m a l l lung, the individual has little need to drink; asthma

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and thirst are rare. In contrast, with a large lung, the individual has a great need to drink; thoracic (Hung Bi) and laryngeal (Hou Bi) pains are common, as is the ascent of the energy. 375.

The lung in a high position often causes contrary ascents of the energy (Jue Ni) and the individual is obliged to shrug his shoulders to breath and cough. In contrast, the lung in a low position is pressed against the inner epigastric wall and often causes hypochondralgia.

The lung is h a r d , the ascent of the energy and cough are rare. In contrast, the soft lung is easily exposed to the illness Jiao Dan (polydipsia/emaciation). The lung is s t r a i g h t , its energy circulates harmoniously and illnesses are rare. In contrast, the inclined lung usually favors unilateral thoracalgia.”

EXPLANATIONS AND COMMENTARIES “This paragraph concerns the favorable and unfavorable, prosperous and harmful states of the lung organ. 1 - The lung governs the regulation of the liquid routes. In this way, the small lung has little need of liquid and the large lung has a great need. The lung resides within the thorax and its energy exteriorizes at the larynx to control respiration. As a result, the small lung does not cause asthmatic illnesses and the large lung is often exposed to thoracic and laryngeal pains and to Jue Ni (contrary afflux of the energy). 2 - The lung governs the energetic system. As a result, if it is located high, the energy easily flows toward the top (afflux), hence cough. If it is located low, it leans against the diaphragm and epigastrium and exercises a compression on the blood and energetic vessels, hence costal pain with blockage of the points of exit of the energy of the lung. These points are Zhongfu (Lu 1) and Yumen (Lu 2). 3 - The hard lung does not cause the ascent of the energy, hence absence of cough. In contrast, the soft lung is often exposed to Jiao Dan (poydipsia/emaciation), responsible for numerous illnesses. 4 - The lung govern Qi (energy) and Qi shelters Po (sensitive soul). Therefore, if the lung is straight, Shen (mental) and Qi (energy) are harmonious and prevent all infiltrations of perverse energy into the organism. In contrast, is it is deviated, it is causes unilateral thoracalgia.”

II - N.V.N.: 1 - This paragraph concerns then the relationships between the anatomic components

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(volume, location, consistency and direction) of the lung and a particular pathology. These are the favorable or unfavorable states. We can summarize these relationships in the following manner: 376. _ the small lung is not exposed to asthmatic diseases _ the large lung often causes thoracic and laryngeal pain and dyspnea _ the lung located high often causes cough _ the lung located low often causes intercostal neuralgias _ the hard lung causes neither cough nor dyspnea _ the soft lung is often exposed to polydipsia _ the deviated lung is often the cause of thoracalgia. 2 - Recall that the word Energy (Qi) regarding the lung organ encompasses not only the notion of Ying Qi, nutritive energy, directed by the Hand Taiyin (Lu), but also Jing Qi, pure energy or energetic quintessence, elaborated by this organ. The Jing Qi of the lung is composed of: _ Anatomic Jing which governs the pilo-cutaneous system _ Sensorial Jing which governs olfaction _ Psychologic Jing which is Po (sensitive soul). These Jing are directed toward the spinal canal to maintain the marrows and brain via the route of the kidney (Figure 92).

PARAGRAPH 4

Figure 92: External and internal functions of the Jing Qi of the lung. 377.

“The liver is s m a l l , its energy is peaceful and does not cause

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subcostal illness. In contrast, the large liver compresses the region near the stomach with repercussions on the esophageal and pharyngeal systems which provoke a sensation of thoraco-diaphragmatic fullness/ oppression with hypochondralgia. The sensation “Xu Ben” comes in favorable

liver in a high position compresses its own vessels to trigger a of oppression of the hypochondria, a sensation dubbed (unilateral oppression). In contrast, the liver in a low position contact with the stomach and leaves behind it an empty space to the infiltration of perverse energy.

The hard and firm liver is peaceful; its energy is not exposed to attack by perverse energy. In contrast, the soft and weak liver often causes the illness Jiao Dan (polydipsia-emaciation) favorable to the aggression of perverse energy. The liver is w e l l - p o s i t i o n e d ( s t r a i g h t / s o u n d ) , its energy is harmonious and is not exposed to the attack of perverse energy. In contrast, the liver in an inclined and deviated position often causes hypochondralgias.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph discourses on the favorable and unfavorable, prosperous and harmful states of the liver organ. The high liver compresses the internal portions of the Jingmai (principal channels) and Jing Bie (distinct channel) of the Foot Jueyin (Li) and provokes phenomena of stagnation/ obstruction of the top (thorax) with discomfort in the subcostal region at the bottom (hypochondria). These phenomena bear the name Xu Ben (unilateral oppression).”

II - Zhang Shi comments:

“The liver is located to the right of the stomach. As a result, the big liver compresses the stomach which, as a resulting reaction, provokes a sensation of discomfort at the level of the pharyngeal apparatus. The liver is found underneath the diaphragm. This is why, the big liver often causes a sensation of discomfort at the center of the diaphragm with pains of the hypochondrial and ischio-iliac regions. 378. The vessel channel (internal vessel) of the liver traverses the diaphragm and projects into the lung. Ths is why the liver located high squeezes up against the lung and causes distrubances of the costo-iliac region. This syndrome bears the name Xu Ben (unilateral oppression). In contrast, the liver located low is pressed against the stomach and causes an emptiness at the level of the subcostal and iliac regions, favorable to the entry and exit of perverse energy. The liver conserves the blood and the blood shelters the Hun (vegetative soul). As a result, when the liver is properly positioned (straight), the Shen (mental) and Chi (will) are balanced, and when the liver is inclined and deviated, the hypochondria and coxo-femoral joint are painful.”

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III - N.V.N.: 1 - This paragraph concerns then the relationship between the anatomic elements (volume, location, consistency and direction) of the liver and a particular pathology. These are the favorable and unfavorable states of the liver. 2 - Ma Shi’s explanation can be diagramed in the following fashion (Figure 93):

Figure 93: Internal vessels of the liver (principal and distinct vessels). 3 - Recall that the word Energy (Qi) regarding the liver organ encompasses not only the notion of Ying Qi, nutrtitive energy, directed by the Foot Jueyin (Li), but also the Jing, pure energy or energetuc quintessence, elaborated by this organ.

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The Jing Qi of the liver is composed of: 379. _ Anatomic Jing which governs the neuro-muscular system _ Sensorial Jing which govern visual ability _ Psychologic Jing which is Hun (vegetative soul). These Jing are conducted toward the marrows and brain via the route of the kidney (Figure 94).

PARAGRAPH 5

Figure 94: External and internal functions of the Jing Qi of the liver.

“The spleen is s m a l l , its energy is peaceful and hard to disturb by

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perverse energy. In contrast, the large spleen protrudes into the subcostal flesh mass (hypochondria) and causes pains preventing the speeding up of gait. The spleen in a high position provokes subcostal pains with radiation to the lower edge of the false ribs. In contrast, the spleen in a low position, directed toward the bottom and pressed against the large intestine, is easily exposed to aggression by perverse energy. 380.

The spleen is firm and resistant , its energy is hard to attack by perverse energy. In contrast, the soft and weak spleen is easily exposed to Jiao Dan (polydipsia/emaciation), factor favorable to the infiltration of perverse energy. The spleen is well-positioned (straight), its energy is harmonious and hard to disturb by perverse energy. In contrast, the spleen in an inclined position often causes abdominal fullness or bloating.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph shows the favorable and uunfavorable, prosperous and harmful state of the spleen organ.”

II - Zhang Shi comments:

“1 - The spleen responds to Center-Earth and governs the 4 sides of the body. In this way, the small spleen harmoniously preserves its Jing (quintessence) without being perturbed by perverse energy. The spleen is located in the abdomen under the left part of the diaphragm. Therefore, the big spleen is found blocked in the fleah region between the subcostal region and iliac crest, hence hypochondralgia. The spleen governs the 4 limbs. This is why the big spleen prevents rapid walking. 2 - The thorax is located above this flesh region (hypochondria). Therefore, the spleen in a high position can cause pains at the level of the false ribs. In contrast, the spleen in a low position squeezes up against the large intestine and leaves behind it an emptiness which easily exposes it to agression by perverse energy. 3 - The spleen of firm and resistant consistency is endowed with a well-balanced energy. Therefore, perverse energy cannot attack it. In contrast, the spleen of soft and weak consistency is easily exposed to Jiao Dan (polydipsia/emaciation) and attack by perverse energy. 4 - The spleen is the dwelling place of Yi (thought) and thought lodges in the Ying Qi (nutritive energy). If the spleen is properly positioned (in a correct direction), Shen-Chi (Mental and Will) are balanced. In contrast, the spleen in an inclined position is easily exposed to abdominal bloating or meteorism.” (3) III - N.V.N.:

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1 - This paragraph concerns then the relationship between the anatomic elements (volume, location, consistency and direction) of the spleen and a particular pathology of this organ. 381. 2 - Recall that the word “Energy” (Qi) of the spleen organ includes not only the notion of Ying Qi, nutritive energy, conducted by the Foot Taiyin (Sp), but also the Jing Qi, pure energy or energetic quintessence elaborated by this organ. The Jing Qi of the spleen is composed of: _ Anatomic Jing which governs the dermal system _ Sensorial Jing which governs gustatory ability _ Psychologic Jing which is Yi (thought, reflexion). These Jing are directed toward the spinal canal via the route of the kidney (Figure 94) to maintain the marrows and brain.

Figure 95: External and internal functions of the Jing Qi of the spleen. 3. Presence of gas in the abdominal cavity.

PARAGRAPH 6 “The kidney is small; its energy is peaceful and hard to perturb by

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perverse energy. In contrast, the large kidney often causes lumbar pains with difficulty bending down forward or backward and is easily exposed to attack by perverse energy. 382.

The kidney in a high position often causes dorso-lumbar pains with difficulty bending over forward or backward. In contrast, the kidney in a low position often causes lumbo-sacral pains with difficulty bending over forward or backward, hence the appearance of the syndrome He Shan (ectopia). The firm and resistant kidney does not cause dorso-lumbar pains. In contrast, the soft and weak kidney is easily exposed to the Jiao Dan illness (polydipsia/emaciation) and to attack by perverse energy. The well-positioned (straight) kidney is balanced, therefore difficult to perturb. In contrast, the kidney in an inclined position often causes lumbalgia and coccydynia. In total, the 25 problems cited above are particular pathologic manifestations often encountered in the human being.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph discourses on the favorable and unfavorable, prosperous and harmful states of the energy of the kidney organ. Paragraphs 2, 3, 4, 5 and this one speak of 25 abnormalities of the 5 organs of the human being. These abnormalities are: _ large and small _ top and bottom _ hard and soft _ straight and inclined _ tense and relaxed That is to say, a total of 5 X 5 = 25 abnormalities.”

II - Zhang Shi comments:

“1 - The large kidney often causes lumbalgias because the lumbar region is the “palace” of the kidney. The lumbar region and spine constitute the great articular system of the body. This is why dorsalgia, lumbalgia and sacro-coccydynia prevent movements of flexion and extension of the body. He Shan (ectopia) designates an abnormality of location of the testicles (controlled by the kidneys). The testicles, either grow smaller or grow larger, evoking the image of the pose of the fox before its prey. The kidney is the receptor organ of the Jing (quintessence) of the 5 organs. Psychologic Jing of the kidney is Chi (will). As a result, the well-positioned (straight position) kidney is the indicator of balance of Shen-Chi (mental-will). In this case, the kidney is hard to perturb. In contrast, the kidney in an inclined position often causes lumbalgia and sacro-coccydynia.

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383. 2 - The exterior of the body is the site of reunion of the Jing energy (anatomic Jing) of the 5 organs. As a result, if the skin is thin with not very dense tissue fibers, wind, rain, cold, heat... easily infiltrate into the pilo-cutaneous system and sweat gland system to trigger the disease of the exterior of the body. Here, the “6 cosmic perverse energies” are the cause. Jointly, if the 5 organs are of soft and weak consistency or in an inclined or deviated position, the above cited 25 disturbances appear.”

III - N.V.N.: 1 - Paragraph 6 concerns the relationship between the anatomic elements (volume, location, consistency and direction) of the kidney and a particular pathology. These are the favorable and unfavorable states. 2 - The word Energy (Qi) regarding the kidney organ not only encompasses the notion of Ying Qi, nutrtitive energy, directed by the Foot Shaoyin (Ki), but also Jing Qi, pure energy or energetic quintessence, elaborated by this organ. The Jing Qi of the kidney is composed of: _ Anatomic Jing which governs the osteo-medullary system _ Sensorial Jing which governs auditive ability _ Psychologic Jing which is Chi (will) _ Sexual Jing which governs sperm and egg _ Liquid Jing which delays the energetic system _ Thermal Jing which controls organic cold and heat. These Jing, like those coming from the other 4 organs, are all conducted toward the spinal canal to maintain the marrows and brain and toward the corresponding anatomic region (Fig. 96).

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Figure 96: Kidney: receptor and distributor organ of the Jing Qi.

PARAGRAPH 7

384.

Huangdi:

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“How do you recognize all this?” Qi Bo:

“In individuals with red facies,

_ endowed with fine and densely-packed cutaneous folds, the heart is s m a l l _ endowed with thick and spaced-out cutaneous folds, the heart is large _ devoid of xiphoid, the heart is in a high position _ endowed with a short and small xiphoid, the heart is in a low position _ endowed with a long and thick xiphoid, the heart is of firm and resistant consistency _ endowed with a short and thin xiphoid, the heart is of soft and weak consistency _ endowed with a xiphoid directed vertically toward the bottom, the heart is properly positioned (straight) _ endowed with a xiphoid deviated to one side, the heart is in an inclined position. ”

EXPLANATIONS AND COMMENTARIES Ma shi explains: “This paragraph discourses on the favorable and unfavorable, prosperous and harmful states of the heart organ as a function of color, cutaneous folds and xiphoid appendage.”

PARAGRAPH 8 “In

individuals

with

a

white

facies,

_ endowed with fine and densely-packed cutaneous folds, the lung is s m a l l _ endowed with thick and spaced-out cutaneous folds, the lung is large _ endowed with large shoulders and a developed thorax with deep creases of the neck (suprasternal notch), the lung is in a high position _ endowed with straight axilla and enlarged rib cage, the lung is in a low position _ endowed with large shoulders with flared back, the lung is s o l i d _ endowed with straight shoulders with narrow back, the lung is frail and soft _ endowed with large shoulders with lateral side of the thorax well- developed, the lung is w e l l - p o s i t i o n e d _ endowed with deformed and spaced-out ribs, the lung is in an inclined position. ”

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385.

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“This paragraph discourses on the determination of the favorable and unfavorable, prosperous and harmful states of the lung organ by observation of the color of the facies, cutaneous folds, shoulders, thorax, back, axilla and the shape of the rib cage.”

PARAGRAPH 9 “In

individuals

with

a

greenish

facies,

_ endowed with fine and densely-packed cutaneous folds, the liver is s m a l l _ endowed with thick and spaced-out cutaneous folds, the liver is large _ endowed with a large bust and developed rib cage, the liver is in a high position _ endowed with a sunken rib cage, the liver is in a low position _ endowed with a well-developed thorax and hypochondria, the liver is firm and resistant _ endowed with a weak and fragile hypochonrdia, the liver is soft and frail _ endowed with a harmonious thorax and abdomen, the liver is well-positioned _ endowed with a deformed and spaced-out rib cage, the liver is in an inclined position. ”

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“This paragraph discourses on the determination of the favorable and unfavorable, prosperous and harmful states of the liver organ by observation of the facies, cutaneous folds, rib cage, hypochondria, thorax and abdomen.”

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“In

individuals

_ endowed spleen is s m a l l _ endowed large _ endowed _ endowed low position _ endowed is f i r m _ endowed fragile _ endowed well-positioned _ endowed position.”

with

a

yellow

facies,

with fine and densely-packed cutaneous folds, the with thick and spaced-out cutaneous folds, the spleen is with curved lips, the spleen is in a high position 386. with lips relaxed toward the bottom, the spleen is in a with lips of hard and resistant consistency, the spleen with big lips of flaccid consistency, the spleen is with even supra- and sub-labial parts, the spleen is with deviated lips, the spleen is in an inclined

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph discourses on the determination of favorable and unfavorable, prosperous and harmful states of the spleen organ by observations of cutaneous folds and lips.” II - N.V.N.: The relationship between the spleen and lips are specified by Zhang Jing Yue: “The energy of the spleen is in communication with the mouth. As a result, all states, prosperous or harmful, of the spleen organ are studied according ot the morphology of the lips.”

PARAGRAPH 11 “In

individuals

of

blackish

facies,

_ endowed with fine and densely-packed cutaneous folds, the kidney is s m a l l _ endowed with thick and spaced-out cutaneous folds, the kidney is large _ endowed with raised ears, the kidney is in a high position _ endowed with retroauricular area crease, the kidney is in a low position _ endowed with thick ears, the kidney is firm and resistant _ endowed with thin and fragile ears, the kidney is soft and weak _ endowed with large ears directed toward the front below the point Jiache (St 6), the kidney is properly positioned _ endowed with poorly positioned ears, one side higher than the other, the kidney is in an inclined position. ” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

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“This paragraph discourses on the determination of the favorable and unfavorable, prosperous and harmful states of the kidney organ as a function of cutaneous folds and ears.” II - N.V.N.: 387. The relationship between the kidney and the ears are taught by Zhang Jing Yue: “The energy of the kidney is in communication with the ears. Therefore, all states, prosperous or harmful, of the kidney organ are studied according to the morphology of the ears.”

PARAGRAPH 12 “Finely examine these various characteristics and we will be in peace. To neglect them is to cure diseases with difficulty.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph is the epilogue of the preceding 11 paragraphs concerning the 25 characteristic modifications of the 5 organs, modifications often neglected in clinical practice.”

PARAGRAPH 13 Huangdi: “That is correct! But these notions are not those which I would like to question you about. I simply want to understand the conditions allowing the human being to be spared disease and to live to the “celestial” age (100 years). Some individuals are always in good health despite worries and fears and despite exposure to great cold and strong heat. In contrast, other individuals, without leaving their room and without fear or worry, are not able to avoid illness. Why? I would like to understand the cause.” Qi Bo:

“The 5 organs and 6 bowels are sites where the perverse energy is sheltered from. If the 5 organs are s m a l l , illnesses are rare, but the individual is often exposed to anxiety and fear. 388.

If the 5 organs are l a r g e , activities are slow and lessened and the individual is often exposed to lack of concern. If the 5 organs are in a high position, the individual likes to fulfill high functions and looks to increase his capacity to work.

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If the 5 organs are in a low position, the individual is dedicated to liitle jobs directed by others. If the 5 organs are solid and firm, the individual is spared from illness. If the 5 organs are soft and weak, the individual cannot avoid illness. noble

If the 5 organs are well-positioned, the individual is of kind and nature and easily attracts sympathy.

If the 5 organs are in an inclined position, the individual is treacherous and disloyal.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph is based on the favorable and unfavorable, prosperous and harmful states of the 5 organs to explain attack and non-attack by disease.”

PARAGRAPH 14 Huangdi: “I would like to hear you regarding the correlations of the 6 bowels.” Qi Bo:

“The lung is linked to the large intestine. The large intestine and lung respond to the skin. The heart is linked to the small intestine. The small intestine and heart respond to the vessels. The liver is linked to the galbladder. The gallbladder and liver respond to the muscles and tendons. The spleen is linked to the stomach. The stomach and spleen respond to the flesh (dermis). The kidney is linked to the Sanjiao (SJ) and bladder. The Sanjiao, bladder and kidney respond to the sweat gland and hair systems.”

EXPLANATIONS AND COMMENTARIES

389.

I - Zhang Shi explains:

“The 5 organs are Yin and the 6 bowels are Yang. Their union/liason evokes the image of that of male and female. In the interior, the 5 organs unite with the 6 bowels, and at the exterior, the 6 bowels respond to the bodily form. In other words, Yin is found in the interior and Yang, at the exterior; it is sufficient to observe the components uniting at the exterior (such as skin, vessels, muscles

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and bones...) in order to determine the size and thickness of the 6 bowels. Among the 5 organs, the kidney is linked to the Sanjiao (SJ).”

II - N.V.N.: Here, the word Sanjiao (SJ) designates the Xiajiao (Lower Jiao) because the Xiajiao governs the “Liver-Kidney” system. Zhang Jing Yue teaches us: “The kidney governs the osteo-medullary system. But here, it is linked to the bladder and Sanjiao (SJ) and responds to the sweat gland and hair systems. Why? The answer is found in Chapter 46 of this classic (“The 5 Transformations”): “The Sanjiao (SJ) produces energy intended to heat up the flesh and develop the pilo-cutaneous system... .”

PARAGRAPH 15 Huangdi: “What Qi Bo:

precisely

are

these

correlations?”

“The lung responds to the skin.

If the skin If the skin If the skin thick and long. If the skin If the skin If the skin knotted.”

is t h i c k , the large intestine is thick. is thin, the large intestine is thin. is s u p p l e with a large abdomen, the large intestine is is tense, the large intestine is tense and short. is smooth, the large intestine is straight. and flesh are densely-packed, the large intestine is

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph discourses on the examination of the skin in the determination of the state of the large intestine.” 390. II - Zhang Shi comments: “The previous paragraph speaks about the unions/relationships of the organ and bowel, and the bowel responds to form (Xing). In this paragraph, the organ governs form (Xing), but form responds to the bowel. It, therefore, concerns an explanation of the realtionships/unions of the interior and exterior as a function of Yin and Yang.”

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“The heart responds to the vessels. If the skin is thick, the vessels are thick. If the vessels are thick, the small intestine is also thick. If the skin is t h i n , the vessels are thin. If the vessels are thin, the small intestine is also thin. If the skin is s u p p l e , the vessels are supple. If the vessels are s u p p l e , the small intestine is large and long. If the skin is t h i n with fine and small vessels, the small intestine is small and short. If the Yang vessels (blood capillaries visible in the skin) are tortuous, the small intestine is knotted.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the determination of the morphologic state of the small intestine as a function of the skin.” II - Zhang Shi comments: “The heart is in Yin-Yang, Interior-Exterior relationship with the small intestine. But the heart responds to the vessels. Therefore, the morhologic state of the small intestine can be determined as a function of the vessels located in the skin.”

PARAGRAPH 17 “The spleen responds to the flesh (dermis). 391.

If the flesh is firm and thick, the stomach is thick and large. If the flesh is soft and thin, the stomach is thin and small. If the flesh is not in harmony with the body, the stomach is in a low position (gastric ptosis) and Xia Wan (pylorus) is straight and narrow. If the flesh is devoid of rough surfaces, the stomach is tense and straight. If the flesh bears numerous granules, the stomach is knotted and Shang Wan (cardia) is narrow with distrubance of food passage.”

EXPLANATIONS AND COMMENTARIES Ma Shi explains:

“This paragraph shows the correlation between the morphologic state of the stomach with that of the flesh (dermis).”

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“The kidney responds to the bones. If the skin is thick and endowed with numerous, very tightlypacked cutaneous folds, the Sanjiao (SJ) and bladder are t h i c k . If the skin is t h i n and endowed with not very densely-packed cutaneous folds, the Sanjiao (SJ) and bladder are s o f t . If Cou Li (sweat gland system) is s p a r s e , the Sanjiao (SJ) and bladder are s l o w . If the skin is tense and devoid of hair, the Sanjiao (SJ) and bladder are h u r r i e d . If the hairs are shiny and thick, the Sanjiao (SJ) and bladder are straight. If folds are rare, the Sanjiao (SJ) and bladder are k n o t t e d . ” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph speaks on the determination of the energetic and morphologic state of the Sanjiao (SJ) and bladder as a function of the pilo-cutaneous system and cutaneous folds. This paragraph emphasizes that the Sanjiao (SJ) can be thin or thick, slow or hurried, straight or knotted which gives a material form to this bowel. Also, in the San Pen Feng (4), we read: 392. “The Sanjiao (SJ) becomes materialized in the form of a fatty membrane as big as a hand, located below the right kidney and to the side of the bladder, from where two whitish-colored vessels leave from running alongside the vertebral column to end up in the brain. These vessels are visible to the naked eye, hence the theory: “Sanjiao: bowel of the right kidney - Bladder: bowel of the left kidney”.” But according to Chapter 18 of this classic (“Production and Reunion of Ying and Wei”) and the Nanjing (“Difficult Problems of Medicine” of Qin Yue Ren, 500 A.D.), the Sanjiao (SJ) is clearly a bowel which has name but not form.” (5)

II - N.V.N.: We leave to the anatomists the concern of confirming or rejecting the thesis of San Pen Feng. This white membrane of the Sanjiao (SJ) can be presented in the form of the diagram below:

4. Name of an ancient medical book. 5. This idea contradicts the thesis of San Pen Feng, a thesis which is popular with certain Oriental and Western acupuncturists.

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Figure 97: Membrane of the Sanjiao (SJ) and its two vessels (according to the thesis of San Pen Feng).

PARAGRAPH 19

393.

Huangdi:

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“Thickness and thinness, beauty and ugliness always manifests by an apparent form. Do you wish to inform me about the triggering of disease which results?” Qi Bo:

“Carefully observe the external correspondances to appreciate the state of the internal organs. It is in this manner that one can recognize diseases which result.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph speaks on the appreciation of the correspondances located at the exterior in the determination of disease which manifest in the interior.”

II - N.V.N.: This paragraph stresses inspection, one of the four indissociable elements of observation, which permits reconstructing the history of the patient and establishing the diagnosis. Inspection allows detecting interior activities via knowledge of exterior manifestations. It is founded on the principle that all that manifests at the exterior is the expression of what occurs in the interior. It bears on the mental, colors and morphology.

no 394/395.

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CHAPTER XLVIII Prohibition and Submission (Gan Fu)

Chapter 48 of the Lingshu speaks on the general laws or basic principles of medical reasoning of Acupuncture and Moxabustion. Namely, 1 - In the first place, the necessity to totally master the Jingmai and energetic (Shu) points, the physiology and therapeutic principles of energetic medicine before embarking into research. 2 - In the second place, the necessity to possess a great practical value obeying the important rules of diagnosis and therapy of Acupuncture and Moxabustion. It is in this manner that our old masters affirm: “Efficacy of treatment depends on the quality of choice of the therapeutic principles.” The word prohibition (

灨 √) encompasses the sense of banning the use of

contrary methods of therapeutic principles. The word submission (

服 ) implies the sense of obligation to submit to, to

respect the therapeutic Dao. This chapter is the synthetic study of diagnosis and therapy of Acupuncture and Moxabustion. It underscores the importance of the term “Prohibition and Submission” (Gan Fu). This chapter consists of 6 paragraphs.

PARAGRAPH 1 Leigong

375

addresses

396.

Huangdi:

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“Since I have had the honor of being your disciple, I am devoted day and night, to going deeply into the 60 chapters of the “9 Needles” ( 1 ) , but I have still not grasped the entire scope. Chapter 45 (of this classic) says: “One must gather them in order to establish a synthetic scheme”. I do not know what that wishes to say. The Dao of the 9 Needles is so great that nothing can be greater. Its extrinsic aspect is so large that nothing larger can cover it. Its subtlety is so fine that nothing can be finer. Its intrinsic aspect is so small that nothing smaller can be preserved in the interior. Its great size and smallness reach the maximal degree so that: _ the top does not have a summit _ the bottom does not have a bottom end. All these states are immeasurable. How can one envision gathering them together to form a whole? The intellectual capacity of each individual varies. Some people are more capable, more intelligent and more reflective; others, like me, must supply much effort to study and do not achieve complete understanding. I fear that in some generations no one will want to completely assimilate these difficult texts of medicine, and I dread that they will be lost for posterity and disappear between sons and grandsons. This is why I dare ask you which are the essential points of these texts?” Huangdi responds: “Your question is excellent! This is a subject for which our masters have taken an oath in blood to forbid teaching only to some privileged. You hope to follow the rules; it is necessary to observe the ritual abstinences ( 2 ) . ” Leigong, after a new/fresh reference, stands up and says: “Your disciple obeys you.” After 3 days of abstinence, Leigong returns close to Huangdi and declames to him: “Today is the Sheng Yang day (Prime Day). I ask to take the oath.” Huangdi accompanies Leigong into the room of abstinence, cutting his arm, rubbing his mouth with his blood and declares: “Today is the Sheng Yang day, day to drink of blood for the transmission of the methods (of acupuncture). Curse on those who perjure this oath!” 397.

Leigong bows his head again and says: “Your disciple is committed.” 1. Name of an ancient book, today lost. 2. The rules of ritual abstinence of the Buddhist religion are 3 in number: for 3 days, one eats no meat, drinks no alcohol and abstains from sexual relations.

Huangdi then grasps him by the arm with the left hand and from the right hand transmits to him the works of medicine while saying to him:

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“You must be very attentive to the study of acupuncture. You must delve deeply into the Jingmai, the system of routes of conduction of blood and energy within the entire organism. One must then know their length and diameter, as well as the quantity of blood and energy contained in each of them. In diseases localizing in the interior, one must needle the Jingmai which are linked to the 5 organs, and in diseases localizing at the exterior, one must needle the Jingmai which have a relationship with the 6 bowels. But the basic point is to examine the state of the Wei (defensive) energy because insufficiency of Wei energy is the cause of the “100 Diseases”. Moreover, one must also examine the emptiness and fullness of the disease in order to regulate them by the methods of dispersion or tonification. If the disease is seated in the Blood Luo, one must disperse the blood stasis because the elimination of the perverse energy via the blood route avoids the worsening of the disease.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

“Chapter 45 speaks on the methods of the “9 Needles”. They must be unified in order to respond to the “Celestial Path” (Tian Dao), hence the title “Evaluation of the Exterior” which means: the celestial path evolving to the exterior, within the cosmos, being able to serve as a basis for evaluating the interior. Chapter 45 unifies the blood and energy that one can examine at Renying (left radial pulse) and at Qi Kou (right radial pulse) with the purpose of determining the transformations of the 6 Energies (of the exterior) and the evolutions of the diseases of the 5 organs/6 bowels (of the interior), hence the saying: “_ Acupuncture method begins with the Jingmai, routes of conduction of blood and energy. _ One must clearly know their measurement and contents. _ Diseases localizing in the interior must be treated at the level of the 5 organs. _ Diseases localizing at the exterior must be treated at the level of the 6 bowels. _ One must clearly discern the state of the Wei energy, cause of “100 Diseases”.” This saying concerns the attack of perverse energy, first at the level of the pilocutaneous system, then at the level of the energetic layers where the Luomai (secondary vessels) are found, and finally at the level of the organs/bowels by the route of the Jingmai (principal channels). For this reason, one must disperse the blood Luo in order to excrete the toxic blood (in a state of stasis and congestion) because the Luomai are situated in the epidermo-dermal space, site of reunion of blood and energy. 398. This is why one must clearly discern the blood Luo in order to excrete the toxic blood in the goal of preventing the perverse energy from infiltrating into the Jingmai, therefore into the organs/ bowels, to create many more serious illnesses. Emptiness and Fullness are words exclusively designating the emptiness (insufficiency) and fullness (excess) of blood and energy. When the perverse energy is found within the energetic

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level, the energy is in fullness, and the blood, in emptiness; and when the perverse energy is found within the blood level, the blood in is fullness and the energy, in emptiness. Therefore, one must clearly discern the “root” and “summit” in order to regulate them.”

II - Ma Shi comments:

“This paragraph discourses on the marvelous methods of acupuncture whose essential point is to begin by the Jingmai... . (3) The “knot” and “hinge” of acupuncture begins via the Jingmai which are the routes of conduction of blood and energy. The 5 organs are located in the internal part. This is why, when they are affected, one must needle the Yin channels which belong and respond to the interior. The 6 bowels correspond to the external part; for this reason, when they are affected, one must needle the Yang channels which belong and respond to the exterior. Ying Qi (nutritive energy), of Yin nature, follows the Tong Qi (a priori energy) to be transported to the interior of the channels. Wei Qi (defensive energy), of Yang nature, circulates within the epidermo-dermal space. As a result, one must clearly discern the Wei Qi because it is the “mother” of the 100 diseases. The “100 Diseases” have their state of emptiness and fullness whose appreciation is based on the examination of Renying (left radial pulse) and Qi Kou (right radial pulse). Therefore, to tonify the essential energy in the event of emptiness and to disperse the perverse energy in the event of fullness is to apply the “method of regulation”. The blood Luo appear on the occurence of diseases. These will be cured once the toxic blood (congested) is eliminated by the “method of bleeding.”

III - N.V.N.:

399.

The oath of Huangdi and that of Hippocrates expresses the same principle of professional code of medical ethics: “To serve the people and remain loyal to the masters.”

3. It is the same for phytotherapy.

PARAGRAPH 2 378

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Leigong: “I have, for a long time, clearly understood these facts; but I still do not know how to make the “ s y n t h e s i s ” . ” Huangdi: “The “synthesis” resembles the gathering together of objects into the same sack. If the sack is full and not closed, the objects are ejected. Similarly, the information known, without synthesis, the Shen appears mysterious.” Leigong: “Please tell me, the ignorant that I am, if the method of recapitulation can be made before the integral knowledge of medicine. (4)” Huangdi: “Recapitulation before total acquistion of medical information is only worthy of a simple physician not meriting the title of “universal physician”.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph recommends to recapitulate once the knowledge is acquired because the synthesis is like the ties of a sack. If the sack is full but it is not closed, there is ejection. Failing to appreciate the synthesis is equivalent to neglecting the essential points; the mind cannot concentrate there and the disease cannot be cured. Leigong acknowledges to be of limited capacity, but Huangdi desires to make him a “universal master”. For the future, one must begin by the study of the Jingmai.”

II - N.V.N.:

400.

This paragraph brings out the necessity of gathering together, analyzing, synthesizing, then recapitulating all the theories of acupuncture. This synthetic work permits verifying the analysis to diagnostic and therapeutic ends. Therefore, whether in modern scientific medicine or the energetic medicine of antiquity, we again see the same reasoning.

4. The modern interpretation of this passage is not loyal to the spirit of the text.

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Leigong: “Please give me information about the meaning of “Gong” (role, task, skill of the physician)?” Huangdi: “Cun Kou (mouth of 1 cun) governs the interior, and Renying (human reception), the exterior. Their movements of arrival and departure are even like two ropes of equal length. In spring and in summer, Renying is slightly changing (Da); in autumn and in winter, Cun Kou is also slightly changing (Da). Such is the pulse of the normal being.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph gives discourse on the pulse of Renying and Cun Kou, each possessing their specificity. They unites with the 4 seasons to provoke disease. Cun Kou of the right wrist corresponds to the point Taiyuan (Lu 9), 1 cun from the point Yuji (Lu 10), hence its name Cun Kou (mouth at 1 cun). From the fact that the energy of the channels gathers at this point, the pulse is called Qi Kou (mouth of energy). “Cun Kou governs the interior” implies the sense of reunion of the 6 Yin channels of the hand and foot which manifests at this level.” (5)

II - Zhang Shi states:

“Disease manifests at the place of exchange of blood and energy: either at the level of the blood or energy, or at the level of the pulse (left or right). (6) The word changing (Da) implies then the sense of alternating modification of blood and energy, hence the name changing (Da) pulse.”

III - N.V.N.:

401.

This paragraph speaks on the specificity of the two Cun Kou (mouths of 1 cun; radial pulses): that of the right is called Qi Kou (mouth of the energy) and that of the left, Renying (human reception) or Mai Kou (mouth of the vessels). The explanation of Zhang Jing Yue (1563-1640 A.D.) is the following: “Taiyin (Lu) conducts the energy located at the level of the organs (Yin). As a result, Cun Kou of the right wrist governs the interior (Yin). Yangming (St) conducts the energy located at the level of the bowels (Yang). As a result, Cun Kou of the left wrist or Renying (or also Mai Kou) governs the exterior (Yang). 5. For this reason, the word “Cun Kou” means Radial Pulse. The right radial pulse has the name Qi Kou, and the left radial pulse, the name Mai Kou or Renying. 6. In other words, Cun Kou of the right wrist governs energy, and that of the left, blood.

Cun Kou (of the right side) and Renying (of the left side) constitute a system of “Yin-Yang/ Interior-Exterior” relationship possessing alternating movements of “going-returning”. When

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these movements are of the same rhythm, the pulses are called harmonious. This is why: _ in spring and summer (which are Yang), Renying (of the left side) governing the exterior must also assume the character Wei Da (slightly changing). _ in autumn and winter (which are Yin), Cun Kou (of the right side) governing the interior must also assume the character Wei Da (slightly changing). In summary, according to the context, one cannot translate the word Renying as carotid pulse because it neither enters into the scope of the law of the 5 Movements nor into the scope of “Yin-Yang/Interior-Exterior” relationships. Here, Renying (human reception) implies the sense of site of reception or welcome of the “blood” component, indispensable to human life, coming from the heart, liver and kidney which are maintained by the route of the Yangming of the stomach.

PARAGRAPH 4 “If Renying (left radial pulse) is 1 times larger ( 7 ) than that of Cun Kou (right radial pulse), the disease is found at the Foot Shaoyang (GB). If it is 1 times larger and impetuous (agitated), the disease is found at the Hand Shaoyang (SJ). If Renying is 2 times larger than that of Cun Kou ( 8 ) , the disease is localized in the Foot Taiyang (Bl); if it is 2 times larger and i m p e t u o u s , the disease is found at the Hand Taiyang (SI). If Renying is 3 times larger than that of Cun Kou, the disease is found at the Foot Yangming (St); if it is 3 times larger and i m p e t u o u s the disease is localized at the Hang Yangming (LI). • The full pulse indicates heat. • The empty pulse, cold. 402. • The h u r r i e d pulse, painful Bi (algoparesthesia). • The c h a n g i n g pulse, a sudden evolution toward seriousness or improvement of the disease. • Disperse in the event of f u l l n e s s , and tonify in the event of emptiness. • Needle the A Shi (painful) points located in the flesh in the event of a hurried pulse. • Bleed the blood Luo or prescribe medicines in the event of a changing pulse. • Use moxabustion in the event of a s l o w p u l s e . • Choose the points of the channels (Jingmai) in the event of diseases of neither full nor empty type. This method is dubbed “Jing Ci” (treatment via the channels).

7. That is to say, larger by one scale in relation to that of Cun Kou. 8. That is to say, larger by 2 scales in relation to that of Cun Kou, ... etc.

Renying 4 times larger than Cun Kou, at the same time c h a n g i n g and r a p i d , is a “Yi Yang” (Distraction of Yang) phenomenon

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corresponding to the syndrome “Wai Ge” (isolation of the exterior) whose prognosis is fatal. As a result, one must carefully discern the “root” and “summit”, cold and heat in order to recognize disease of the organs and bowels.” EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “a - Renying 1 times larger than Cun Kou signals disease belonging to the Foot Shaoyang (GB). If it assumes a more agitated nature, the disease is found at the Hand Shaoyang (SJ). Renying 2 times larger than Cun Kou signals disease belonging to the Foot Taiyang (Bl). If it assumes a more agitated nature, the disease is found at the Hand Taiyang (SI). Renying 3 times larger than Con Kou signals disease belonging to the Foot Yangming (St). If it assumes a more agitated nature, the disease is found at the Hand Yangming (LI).

b - Generally, at Renying, _ the full and large pulse is the indicator of the presence of phenomena of heat (fever) _ the empty and weak pulse signals the presence of phenomena of cold (chills) _ the hurried pulse signals painful “Bi” (algoparesthesia) _ the changing pulse signals the presence of disease sometimes worsened, sometimes improved. 403. c - As for treatment, _ in the syndromes of excess, the pulse is full and large; one must use dispersion _ in syndromes of insufficiency, the pulse is empty and weak; one must use tonification _ in syndromes of pain, the pulse is hurried; one must needle the A Shi points located in the flesh _ in the case of the changing (Da) pulse, one must needle and bleed the blood Luo. Medicines can reinforce the action of acupuncture _ in the case of the slow pulse, the blood stagnates in the interior. One must employ the method of moxabustion to heat up the “cooled down” blood located in the deep layers _ in the case of disease of the “neither full nor empty” type, perverse energy continues to persist within the Jingluo; one must treat the appropriate channels. This method has the name Jing Ci (treament by the channels) _ in the case of Renying 1 times larger than Cun Kou, one must disperse the gallbladder in order to tonify the liver, and in the case of Renying 2 times larger than Cun Kou, one must disperse the bladder in order to tonify the kidney. In these 2 cases, one needles only the gallbladder without affecting the liver and the bladder without affecting the kidney. In summary, this method consisting only of treating the channel affected without intervening on the other channels is also dubbed Jing Ci (“Treatment via the Channel”). _ in the case of Renying 4 times larger than Cun Kou, at the same time changing (Da) and rapid (Shuo), the Yang pulse is in maximal fullness and bears the name Yi Yang (“Distraction of Yang”) corresponding to the syndrome of Wai Ge (“Separation of the Exterior”), that is to say, to the syndrome of separation of the Yin channels with inability to carry out movements toward the exterior. This syndrome is fatal. Therefore, during treatment, one must discern the “root” and “summit”. Disease manifesting first is the root and that manifesting secondly is the summit. One must also disecern the cold and heat in order to determine the state of the disease at the level of the organs and bowels.” III - N.V.N.:

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This paragraph discourses on Renying (left radial pulse) in being based: _ on its energetic potential in relation to Cun Kou (right radial pulse) _ on its pulsologic qualities: full and empty, hurried and changing _ and on the therapeutic principles: tonification and dispersion, acupuncture and moxabustion to determine the diagnosis, prognosis and treatment of the 3 Yang: Taiyang (SI/Bl), Shaoyang (SJ/GB) and Yangming (LI/St). The phenomena of “Distraction of Yang” (Yi Yang) and “Isolation of the Exterior” (Wai Ge) are also dealt with. Zhang Jing Yue concludes: “The hurried pulse signals Zhong Bi (algoparesthesia). This is why one must needle the painful points of the flesh (A Shi). The changing (Da) pulse is due to a dyscrasia of blood and energy. This is why one must needle and bleed the blood Luo and, at the same time, prescribe enegetico-blood regulatory medicines. 404. The slow (checked) pulse is due to the presence of cold. As a result, moxabustion is expressly advised. In the cases devoid of signs of emptiness and fullness of blood and energy, perverse energy stagnates within the Jingluo; one must use the technique known as “needle according to the channel” or prescribe appropriate medicines.”

PARAGRAPH 5 “If the pulse of Cun Kou (right radial pulse) is 1 times larger than Renying (left radial pulse), the disease is localized at the Foot Jueyin (Li); if it is 1 time larger and impetuous (agitated), the disease is found at the Hand Jueyin (Xin Bao: XB). If the pulse of Cun Kou is 2 times larger than Renying, the disease is found at the Foot Shaoyin (Ki); if it is 2 times larger and i m p e t u o u s , the disease is localized at the Hand Shaoyin (He). If the pulse of Cun Kou is 3 times larger than Renying, the disease is at the Foot Taiyin (Sp); if it is 2 times larger and i m p e t u o u s , the disease is found at the Hand Taiyin (Lu). • The full pulse indicates abdominal swelling/bloating, cold in the interior (Han Zhong) and dyspepsia. The e m p t y pulse indicates heat in the interior (Re Zhong), diarrhea, asthenia and change in the color of urine. The h u r r i e d pulse

indicates

painful

“Bi”

(algoparesthesia).

The changing (Da) pulse indicates the intermittent nature of the disease. • Disperse in the event of fullness. Tonify in the event of e m p t i n e s s .

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Practice acupuncture first, then moxabustion, in the event of a hurried pulse. Needle and bleed the blood Luo before applying the method of regulation in the event of a changing (Da) p u l s e . Apply only moxabustion in the event of a slow pulse. The s l o w pulse is due to the presence of blood stasis in the interior of the vessels. Because there is stagnation, moxabustion is expressly recommended. In disease of the type “neither empty nor full” , one must needle the appropriate channel or channels. This technique bears the name “Jing Ci” (treatment by channels). 405.

• If Cun Kou is 4 times larger than Renying, it has the name Neiguan (internal barrier). In the case of Neiguan, the pulse is changing (Da) and rapid, the outcome is fatal and treatment impossible. This is why one must carefully discern “ r o o t ” and “ s u m m i t ” , the heat and cold, during investigations of diseases of the organs and bowels.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“1 - If Cun Kou is 1 time larger than Renying, the disease is located at the Foot Jueyin (Li). If it assumes a more agitated (impetuous) nature, the disease is found at the Hand Jueyin (XB: Xin Bao). If Cun Kou is 2 times larger than Renying, the disease is located at the Foot Shaoyin (Ki). If it assumes a more agitated nature, the disease is found at the Hand Shaoyin (He). If Cun Kou is 3 times larger than Renying, the disease is located at the Foot Taiyin (Sp). If it assumes a more agitated nature, the disease is found at the Hand Taiyin (Lu).

2 - Generally: _ the full pulse belonging to the Yin channels indicates: • bloating/abdominal fullness • presence in cold in the stomach • indigestion... . _ the empty pulse belonging to the Yin channels indicates: • presence of heat in the interior • disturbances of transit • shortage of energy (asthenia) • change in color of urine. _ the hurried pulse belonging to the Yin channels indicates painful Bi (algoparesthesia). _ the changing (Da) pulse belonging to the Yin channels indicates the intermittent nature of the disease. 3 - Therapeutically, _ in the event of the full pulse, disperse the involved channel

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_ in the event of the empty pulse, tonify the corresponding channel _ in the event of the hurried pulse, needle the painful points of the flesh (A Shi) and discern the channel involved to apply first acupuncture then moxabustion (9) _ in the event of the changing (Da) pulse, needle and bleed the blood Luo and prescribe additionally phytotherapy 406. _ in the event of the delayed pulse, practice only moxabustion because the delayed pulse is due to a blood accumulation in the interior of the vessels _ in the event of disease of “neither empty nor fullness” type, needle the corresponding channel or channels, apply moxabustion or prescribe medicines. The collection of these methods has the name Jing Ci (treatment by channels). 4 - If Cun Kou is 4 times larger than Renying, at the same time changing and rapid, it denotes a maximal fullness of the Yin channels having the name Neiguan (internal barrier), which is none other than the syndrome of “isolation of the 6 Yang channels” not being able to reach the interior, a syndrome called Wai Ge (“separation of the exterior”) whose prognosis is fatal. Therefore, in the presence of the above-cited diseases, it is advised to clearly discern the root and summit, cold and heat, in order to diagnose with exactitude the diseases of the organs and bowels.”

II - N.V.N.: 1 - Renying (left radial pulse) is intended to determine the diagnosis, prognosis and treatment of the 3 Yang: _ Taiyang _ Shaoyang _ Yangming, while Cun Kou (more precisely, Qi Kou: right radial pulse) is intended to determine the diagnosis, prognosis and treatment of the 3 Yin: _ Taiyin _ Jueyin _ Shaoyin. Therefore, when it is a question of determining the energetic state of the 5 organs and 6 bowels, _ Cun Kou (right radial pulse) controls the Lung/Large Intestine, Spleen/Stomach and Kidney Yang/Sanjiao (SJ) systems _ Renying (left radial pulse) controls the Heart (Xin Bao)/Small Intestine, Liver/Gallbladder and Kidney Yin/Bladder systems because the 5 organs and 6 bowels respond to the 5 Movements and 3 Yin/3 Yang, to the 6 Energies (Figure 97). 407.... Zhang Jing Yue explains: “ _ Renying and Cun Kou constitute a system of “Yin-Yang, Interior-Exterior” relationship. This is why, _ the previous paragraph clarified that Renying (left radial pulse) 1 time larger than Cun Kou is the indicator of disease localizing at the Foot Shaoyang (GB), while this one informs that Cun Kou (right radial pulse) 1 time larger than Renying indicates disease localizing at the Foot Jueyin (Li). This originates from the external/internal relationship of the gallbladder and liver. 9. This technique belongs to the treatment of the tendinomuscular channels. See Lingshu, Vol. I.

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Figure 98: The 5 Movements at the level of Renying and Qi Kou.

_ the previous paragraph clarified that Renying 1 time larger than Cun Kou and agitated is the indicator of disease located at the Hand Shaoyang (SJ), while this one informs that Cun Kou 1 times larger than Renying and agitated, indicates disease localizing at the Hand Jueyin (XB). This originates from the external and internal relationship of the Sanjiao (SJ) and Xin Bao (XB). It is the same for the other pulses.” 2 - Here it concerns Cun Kou (right radial pulse). When it is in excess, the exterior is in fullness and interior, in emptiness, hence:

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_ abdominal bloating and fullness _ “cold” in the interior _ dyspepsia... . If it is in insufficiency, the Yin-Root is in emptiness, hence _ “heat” in the interior _ liquid stools _ change in the color of urine.

408.

3 - The hurried pulse indicates the presence of cold. This is why one must first needle, then apply moxabustion, to facilitate the aeration of the channels and expulsion of the cold perverse. The delayed pulse (pulse whose energy is curbed, checked, slowed down in depth) indicates a stoppage of cold at the level of the blood layer, hence stasis of the blood. This is why, in this case, moxabustion is expressly recommended.

PARAGRAPH 6 “One must clearly understand Ying (nutritive energy) and Shu (energetic points) to be able to hand down to a large number the Great Methods which consists of: _ dispersing fullness _ tonifying emptiness _ practicing Acupuncture/Moxabustion and prescribing medicines in the event of the hurried (Jin) p u l s e _ using only moxabustion in the event of the delayed (Huan) p u l s e _ acting on the channels in the event of “neither empty nor full.” Therefore, to speak of Jing Ci (treatment by channels) is to use phytotherapy and acupuncture/moxabustion at the same time. If the pulse is h u r r i e d , add massage therapy. If the pulse is changing (Da) and weak (Ruo), one must advise the patient to rest and avoid overwork.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains:

“This paragraph emphasizes the importance of the synthesis of medical ideas. In general, the physician must obviously understand not only the chapters concerning the Jingmai, but also the chapters on the Shu (energetic) points of the channels and the significance of the words Jing, Ying, Shu, Jing and He... . He will then be able to transmit these notions to a “great number” (of his disciples) as they are written in the text: “To disperse in the event of fullness, etc... . The words “great number” have already been clarified in Chapter 12 of this classic (“River Ways”- Jing Shui). The text puts forth: 409. _ “Disperse in the event of fullness”. This means to say: disperse only without tonifying.

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_ “Tonify in the event of emptiness”. This means to say: tonify only without dispersing. _ “The hurried pulse is indicated by painful Bi (algoparesthesia). One must apply acupuncture, moxabustion or phytotherapy”. That means to say: utilize one of these 3 methods. _ “Use only moxabustion in the event of the hurried pulse; and in the event of “neither empty nor full” treat according to the channels...”. That means: once the Yang channel is chosen, one does not treat the Yin channel and vice versa. This method is named “Jing Ci” (treatment by channel). It is a question of the Great Methods, of the “Knots” and “Hinges” from the synthesis of Chapter 45 (“Evaluation of the Exterior”) of this classic. Only in this way will one be able to declare himself “Grand Master”. To apply therapy with insufficient knowledge is as if one studied the Ba Gua (Eight Tempero-spatial Signs) (10) before having assimilated the Jingmai (channel system). One then is only an average physician. Such are the Great Methods known as “synthesis” formed by an “oath in blood” by Huangdi and Leigong. The secret of the practice of medicine is contained there. Only acupuncture is addressed, but the methods of tonification and dispersion used in phytotherapy are similar. Chapters 2, 9, 10 and 48 (“Origin of the Shu Points”, “Beginning and Ending”, “ChannelsVessels”, “Prohibition and Submission”) are fundamental and invaluable chapters of medical literature. It is tragic that subsequent generations have neglected this study, which leads the current medical world toward “the darkness of night without end”... . What desolation!”

II - Zhang Shi comments: “1 - This paragraph discourses on Yin and Yang and the 6 Energies (11). At the exterior, it unites with the 6 channels of the foot and hand, and in the interior, with the 5 organs and 6 bowels, either combined or diversified, and either localizing in the interior or at the exterior. Renying and Cun Kou are intended to detemine the state of the “6 Energies” (organic) (12) located at the exterior, outside the channels. “In the case of the delayed pulse, apply moxabustion”. This means to say that stagnation of the energy is found at the exterior and not within the channels. This is why it is said: “Carefully discern the Wei (defensive) energy, the “mother” of the 100 diseases”. 410. Wei energy is directed toward the epidermo-dermal system, therefore to the exterior, and toward the membranous system protecting the organs and bowels, therefore toward the interior. The 6 organic energies and the Wei energy circulate together within the epidermo-dermal spaces. The energy stagnates in the interior because it remains at the level of the membranes. This is why the text advises: “Carefully discern the “root” and “summit” to verify the pathologic state of the organs”. To act in this manner is to consider the interior as “root” and the exterior as “summit”, the blood as “root” and the energy as “summit”, with the purpose of determining the localization of the disease, either at the level of the energy (energetic layers) or at the level of the channels, either at the exterior or in the interior. Because, _ diseases can be localized in the energetic layers with or without disturbance of the channels. _ sometimes, it stagnates within the interior with or without disturbance of the organs/bowels.

10. Ba Gua has been erroneously translated as “trigrams”. (!?) 11. Here, it is matter of the 6 organic energies elaborated at the level of the 5 organs. 12. In other words, the living being, like the cosmos, is endowed with 6 energies: cold, heat, fire, humidity, wind and dryness

Such are the relations between the 6 Energies (organic), the system of Jingmai (channels) and the Zangfu (orgnas/bowels). They can combine or become more diverse, become localized

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within the interior or at the exterior. 2 - The hurried pulse indicates painful Bi. This means to say that the disease localizing in the form (bodily: Xing) injures the energy (Qi). _ The changing (Da) pulse indicates the aggravation or amelioration of the disease. This is due to a recent penetration of perverse energy into the vessels. The 6 Energies (organic) are elaborated at the level of the organs, then they reach the exterior at the level of the pilocutaneous system where they fuse in order to penetrate into the systems of the Luomai via the route of the Sunluo, and finally into the system of organs/bowels via the route of Ying (nutritive energy) directed by the Jingmai. In this way, the 6 Energies of the human body carry out perpetual movements of entering and exiting, of combining and separating. “In spring and summer, Renying is slightly changing (Da); in autumn and winter, Cun Kou is also slightly changing (Da).” This involves the 6 Energies circulating outside the vessels. “If the pulse is changing (Da) and weak, the patient desires calm...”. This results from the effect of fusion of the blood and energy. 3 - In the cases of Zhongfeng (direct attack of wind: apoplexy) and of Shanghan (evolutive disease of cold), the 6 Energies evolve together to return to the point of departure at the end of 7 days (13). These concern the disease of the 6 Energies without relation to that of the channels. 411. In cases of disease evolving over 1 or 2 days, the appearance of signs of nausea/vomiting and diarrhea... is indicator of the presence of a deep stagnation at the level of the bowels. Sometimes, in some diseases evolving barely over 1 -2 days, the early manifestations of the signs of hallucinations, delerium, polypnea, agitation... indicate a deep stagnation at the level of the protective membranes of the organs and bowels; the prognosis is grave. Because, _ if “the guest” is still found at the exterior of the organ, it is life. _ if “the guest” infiltrates into the interior of the organ, it is death. _ if “the guest” remains in the organ whose source energy is still solid, it is life. _ if the source energy of the organ is perturbed with signs such as hallucinations, delerium, agitation... it is death. This is why it is said: “When the disease localizes at the level of the 5 organs, the disease is between life and death”. In some disease of Shanghan with appearance of syndromes treated by Rhizoma Coptidis (Huanglian), Colla Asini (Ejiao)... the ailment is found first in the energetic layers, then secondly within the system of channels. Once within the channels, it cannot penetrate into the organ, but into the bowel (14). If the perverse energy evolves via the route of the blood vessels with appearance of signs of abdominal pains with descending radiation, the outcome can be fatal or the patient hard to save. 4 - In the event of diffuse propagation of perverse energy, the disease is very complex: _ it can evolve during 1-2 days _ it can directly penetrate into the channels _ it can reach the bowels directly or by the intermediate of the organs. Sometimes, despite a chronic state, it comes to a halt at the level of the Qi (energy) and Xing (form, matter) without reaching the interior. This is due to a state of virulence of the perverse energy and a state of emptiness or fullness of the essential energy (source energy). 13. See “Evolutive Disease of Cold” (Shanghan Lun), N.V.N. Edition. 14. This idea has been shown many a time in R.F. M.T.C. and in M.T.C., N.V.N. Editions.

In conclusion, Chapter 48 of the Lingshu speaks on the union/separation and on the movements of entering/exiting of the blood and energy in order to carry a prognosis of benignness

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or seriousness and on the fatal or favorable outcome of the disease. This is of prime importance for medicine. In this way, Huangdi imposes on Leigong to observe the rules of abstinence (of the Buddhist religion) before transmitting to him the most perfect notions of medicine. Only the physician who understands the movements of entering and exiting of the essential energy can appreciate the depth of the attack of perverse energy. Treat as soon as the disease appears and take good care so the disease does not declare itself. Do not allow the perverse energy the opportunity to penetrate deeply into the organism, leading to the appearance of a syndrome that is impossible to treat. Such is the perfect action of the practitioner understanding the Dao.”

412. III - N.V.N.: In conclusion, the deepened understanding of the Jingmai and points, energetic physiology and “8 Rules” of diagnosis, are indispensable if one wishes to employ the “Great Methods” of acupuncture and moxabustion. These Great Methods are: _ dispersion, used only in the case of fullness _tonification, used only in the case of emptiness _ Acupuncture/Moxabustion can be associated with the prescription of medicines (Oriental or Western) in the case of the hurried pulse _ Moxabustion, used only in the case of the delayed pulse _ Acupuncture, used only in the case of the disease of “neither empty nor full” type with the method known as Jing Ci (treatment by channel). Gao Shi clarifies: “Chapter 45 (“Evaluation of the Exterior”) speaks on the union of Qi (energy) and Xing (form), while this Chapter 48 treats the union of Qi (energy) and Xue (blood). Chapter 46 (“Five Transformations”) speaks on disease localizing at the Xing (form) and not at the Qi (energy). Chapter 47 (“Constitutional Characteristics of the Organs”) speaks on diseases localized at the Zangfu (organs/bowels) and not at the Qi (energy). The chapters concerning the problem of Ni Jue (contrary afflux) deal with the diseases localizing at the Qi (energy), diseases localizing at Xue (blood) and diseases of Qi-Xue (Blood/Energy). Such are the routes of Separation/Union, routes of infinite change of Yin and Yang.”

TABLE

OF

CONTENTS

413.

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Introduction............................................................................................................... 9 Book

IV Chapter 22 : Yin Madnesses and Yang Madnesses...................................... 15 (Dian Kuang) Chapter 23 : Diseases of Heat........................................................................... 39 (Re Bing) Chapter 24 : Diseases of Afflux....................................................................... 73 (Jue Bing) Chapter 25 : Causes of Disease....................................................................... 101 (Bing Ben) Chapter 26 : Various diseases........................................................................ 109 (Za Bing) Chapter 27 : Erratic and Cyclic Pains.......................................................... 131 (Zhu Bi) Chapter 28 : Oral Questions............................................................................ 139 (Kou Wen) Book V Chapter 29 : Teaching Transmitted by the Masters.................................. 165 (Si Chuang) Chapter 30 : Fundamental Characteristics of the Energy....................... 177 (Jue Qi) Chapter 31 : Intestines and Stomach........................................................... 185 (Chang Wei) Chapter 32 : Normal Man Faced with a Shortage of Cereals................... 189 (Bing Ren Jue Gu) Chapter 33 : Study of the Seas....................................................................... 191 (Hai Lun) Chapter 34 : The 5 Disturbances................................................................... 205 (Wu Luan) Chapter 35 : Study on Intumescence........................................................... 213 (Zhang Lun) Chapter 36 : Distinction of the 5 Types of Liquid Retention................... 223 (Wu Lung Xin Ye Bie) Chapter 37 : 5 Approvals and 5 Emmisaries............................................... 233 (Wu Zue Wu Chu) Chapter 38 : Contrary and Favorable. Fat and Thin................................. 243 (Ni Sun Fi Xu) Chapter 39 : Study on Stasis at the Level of the Blood Luo...................... 257 (Xue Luo Lun) Chapter 40 : Of Yin and Yang. Of Pure and Impure.................................. 267 (Yin Yang Qing Zhuo) Chapter 41 : Correlations Between Yin-Yang and the Sun-Moon” System (Days and Months).............................. 277 (Yin Yang He Yua Ye) Chapter 42 : Evolution of the Disease.......................................................... 303 (Bing Chuang) Chapter 43 : Overflowing of Perverse Energy and the Manifestation of Dreams....................................................... 323 (Zan Xie Fa Meng) Chapter 44 : Conformity of Human Energy with that of the Day

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Divided into Four “Seasonal” Periods................................ 329 (Shun Qi Ye Si She) Chapter 45 : Evaluation of the Exterior..................................................... 347 (Wai Zui) Chapter 46 : The 5 Transformations........................................................... 351 (Wu Bian) Chapter 47 : Constitutional Characteristics of the Organs..................... 369 (Ban Zang) Chapter 48 : Prohibition and Submission................................................. 395 (Gan Fu) Table of Contents................................................................................................. 413

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