For example, those serious about herbal medical work are expected to memorize all 113 prescriptions from the ShangHanLun and their single-herb compositions. Certainly the emphasis in reading the text is on the prescriptions, with less attention given to extracting implied physiology/pathology and individual herbal properties through comparison of individual pattern diagnoses, a deductive reading process I have learned from Dr. LiXin and others (examples to follow).
As my focus shifts to clinical work though, I can see the importance of having such a readily available knowledge base to work from. I've heard that memorization is a learned skill that can be mastered with the help of a bit of strategy. In any case, it is an area I am going to try and put some work into over the next couple months.
Weather-wise, Beijing is not likely to be considered for a Club Med location any time soon. While there are 4 distinct seasons, its dry and windy in winter, dusty and prone to sandstorms in Spring, and deathly hot and stuffy come Summer. The brief Fall season is often the best month or two of the year when blue skies prevail and temperatures become more pleasant. Overall, the climate grinds on the body's yin element, often depleting blood and fluids and affecting the spleen/stomach balance of dampness and dryness. The strong presence of both wind and summer dampness also have a definite effect on the liver/gall bladder dynamic as well.
Overall, the earth here feels tired as water-tables become depleted and dust from the Gobi sails into town on high winds out of the dry northwest. It is not a place where Mother Nature lovingly embraces life, but rather one of stark and rugged beauty where resources can be short and the struggle to survive fierce.
The cultural landscape is characterized by the remnants of times long past, memories that live on deep in the identity of the people here. To that has been added the destructive, tumultuous forces of modern history, mass population increase and the breakneck pace of development. The result - as interesting as it is hard to define. It can be both ruthless and unforgiving at times, while somehow maintain a straight-forward naivety and endearing quality that makes it, well, almost charming.
This all culminates and is reflected in the patients I see everyday in clinic. The city dwelling population of China is quickly eating and sedentating themselves into Western pathologies at an alarming pace. Heart disease, cancer and diabetes are all raging their ugly heads faster than medicine, whether modern or traditional, can chop them down. A people constantly on edge, Beijingers have taken high-blood pressure to new levels, with the resulting strokes so common that it has become almost a right of passage among aging men who have smoked the heavy smokes and indulged in the white lightning much of their adult lives. Respiratory infections flare up throughout the winter months among the aged population as a coal haze lingers over the city, making it hard for the sun to fight its way through many days.
And then there are the effects of uninterrupted stimulation on the mind and spirit. Overwhelming anxiety and depression are becoming more and more common along with insomnia and its long term side effects. Aging is not dependent upon the body's ability to conduct the more yang processes of life, but ultimately upon its ability to gather and store at an energetic level - the ability to rest both physically and mentally. The perceived need to be one step ahead of the crowd, to push forward despite competition and adversity, to win one's own piece of the modern miracle is where many people find themselves nowadays, a state not so conducive to maintaining peace of mind.
The literature of Ancient China is full of stories where as modern readers, it is difficult to know where to draw the line between historic fact and creative embellishment. Legend surrounding the Warring States Period physician, BianQue (扁鹊）, is one such example. From the Han Dynasty historian SiMaQian (司马迁）, we have The Chronicle of BianQue (扁鹊传） that survives in its original form to this day, some 2,000 years later, where portions of it have become required reading in high school currciulums throughout the country. His name is so inextricably linked to the practice of traditional Chinese medicine in the minds of the Han people that when I mention my interest in the topic, more often than not, "Ah, you mean like BianQue!" is the response I get with raised eyebrows, and a little chuckle.
ZhangZhongJing (张仲景）, author of the ShangHanLun and original old-skool guru of Chinese medicine, placed BianQue sqaurely in the opening lines of his introduction contrasting BianQue's style with that of his Han Dynasty contemporaries, saying: Each time I read over the story of BianQue and the Duke of Qi, I can't help but be overcome by his remarkable diagnostic abilities. At the same time, I find it strange that contemporary scholars of the world today don't apply themselves with all their heart to the study of medicine in order to treat the maladies of lords and princes, not to mention their own families.
The story ZhangJongJing refers to is one that has come down through the ages in SiMaQian's Chronicle that begins with the Duke of the Kingdom of Qi inviting BianQue to be his guest at court. Upon his arrival, BianQue informed the Duke that he has an illness taking hold within the surface level of his body, but the Duke replied simply that he is in perfect health. Five days later, BianQue returned for an audience and told the Lord that the illness has now moved deeper into the blood, but still the Lord did not listen. Upon their third meeting，BianQue stated that the illness has now taken hold in the stomach and colon, still to no avail. Five days later, BianQue returned once again and after taking one look at the Duke, turned heels and ran without a word. When the Duke's messenger came after him he said: At first, the Duke's illness was within the interstitial spaces where herbal reduction and acupressure with warm stones could reach; next, it was in the blood and treatable with acupuncture; at the time of my last visit, his illness was in the stomach and colon where alcohol decoctions can be effective; now, the illness has reached the marrow where not even the power of the Supernatural can reach. There was no point in imploring him to allow me to treat him. Sure enough, five days later, the Duke fell ill and sent for BianQue, who was nowhere to be found. Soon after, the Duke died.
In other pieces of the text, we see BianQue bringing the Prince of Guo back from a deep coma when even the King's own doctors had abandoned hope and left him for dead. In this episode, much to the bewilderment of the palace guards, he insisted the Prince was still alive before even laying eyes on him! We are told that at a young age BianQue was given a special formula and instructions from an old Master before his death that gave him the ability to perceive people's internal organ function, making his diagnostic skills all but infallable.
The overall picture we get of BianQue from his biography is that he was a man of unusual talent, able to directly perceive the pathological disorders of his patients, often in cases where he did not have the opportunity to complete even the most cursory diagnosis! Modern readers of these feats, while holding BianQue in high esteem, consider them no more than tall tales exagerrated through hundreds of years of retelling. But are they？ Often, stories of high antiquity speak through allegory, that while not 100% historically accurate, hide a deep and powerful message beneath the veil of images so extraordinary as to be inconceivable to the rational mind.
Certainly, if there is one thing that these past years spent studying ancient medicine have shown me, it is that not all facets of reality adhere to the principles of the rational mind alone. BianQue, and his order of practitioners, are often referred to as caoyi (草医）, or grassroots doctors. This is in opposition to the yuyi (御医) or imperial physicians of the various courts and schools of the many competing nation states. While the caoyi spent their time learning through practice, often under very harsh conditions among the people and their natural environment, the yuyi lived sequestered at court, attempting to systematize knowledge that had come down to them through books alone. While originally springing from the same source, over time, we see the development of a division in the ranks of medical practitioners - the more experiential and insightful practice of the caoyi, rooted in folk practices and observance of nature, and the rational, more intellectual practice of the yuyi who lived in close contact with the intelligencia and heart of the political power structure.
To be continued...
I have come back to the chapter on pulse diagnosis following the recent AWB training session in
These readings are the initial steps toward a personal goal of beefing-up my own rudimentary understanding of pulse diagnosis, which as Peng indicates requires a highly integrated study approach that permeates all aspects of the medicine. Stay tuned for more commentaries, translations and with any luck, major epiphanies, as the journey continues…
Trans: The study of pulse diagnosis consists of pulse position, finger technique, pulse patterns and pulse theory. After understanding pulse position and finger technique, you should abandon all preconceptions in order to clearly grasp the true pattern of the pulse. It is important to have a system for the study of pulse patterns and pulse theory within the course of your ordinary studies in order to form a more integrated understanding.
On FingerTechnique and Pulse Position
From times long past, pulse diagnosis has been performed on each of the two arms separately. According to circular movement theory, pulse diagnosis must be performed on both arms simultaneously in order to fully observe information regarding the circular movement of the body as a whole…It is also necessary to use downward diagonal placement of the three fingers. The index finger is pressed to the superficial level of the cun position, the middle finger is pressed to the mid-level of the guan position, and the fourth finger is pressed to the deep level of the chi position. The deep level corresponds to the bones, the mid-level to the muscles, and the superficial level to the skin. Downward diagonal reading means the pressure applied by the middle finger is greater than that of the index finger and the pressure applied by the fourth finger is stronger than the middle finger. This is the three position method of diagnosis. If the three fingers are not differentiated according to varying degrees of pressure, they will not correspond to the fundamental positioning of the cun, guan, and chi pulses. In addition to the three positions, there are also the nine indications, each position containing three indications, making nine in total.When performing pulse diagnosis, the fingers cannot rest stiffly on the pulse. The process is similar to placing one’s line of sight on a distant object, adjusting one’s focus or angle until the object is comprehended. Three position nine indication pulse diagnosis is much the same.
Although the verb “to look” is often used in referring to pulse diagnosis, however, the verb “to listen” may be much more appropriate. If you are able to experientially grasp the meaning of this character “to listen”, you will certainly become more skilled than the average person in pulse diagnosis. The process of listening is much quieter than that of looking. Looking involves movement away from oneself in order to see something, while listening involves the movement of some information toward oneself. We must be able to listen in order to gain a complete understanding. First, use the fingers to investigate the status of the nine indications, waiting for the pulse to come to you. The pulse and fingers meet, and yet we still do not listen to the pulse; simply remain examining the status of the nine indications in a relaxed state between consciousness and unconsciousness, listening for the point of disease within the pulse. As you continue seeking, listen to all indications in symphony and then split individually; listen to each indication individually and then again in symphony. The pulse pattern as a whole is like the individual’s unique River Picture. Seeking individuation among the symphony will allow you to locate the point of illness, while listening to the symphony of the pulse as the sum of its individual parts will allow you to determine the appropriate prescription. In summary, you cannot go searching for the pulse. Instead you must wait for the pulse to come to you. Going searching for the pulse implies that you have preconceptions that will prevent you from obtaining the true pattern of the pulse.
In a modern world where specialization and differentiation are considered the hallmark of a well-developed 'science', it is easy to get caught up in this habit of acquiring information in the same way we have been trained to do since first launching into our academic careers with the baby-steps of our ABC's. This undertaking that spans decades is akin to a mental journey far out and away from the mind center and is characteristic of the fundamental stage of learning. There comes a point, however, where our orientation should begin to shift, and having familiarized ourselves with the material reality of the concepts of Chinese medicine, we begin to return to the root of true wisdom. In Ch. 16 of the LaoZi, "归根: Returning to the Root" we learn:
The theme of this passage rings through in Ch. 6 of the NeiJing where the ever-patient QiBo responds to a question by HuangDi regarding the nature of Yin and Yang, with:
This concept of grasping the singular, essential nature that runs through all of the seemingly disparate elements of TCM is something that we must always be conscious of in our study and practice. Unfortunately, as I come upon the half-way point of my fourth year of formal TCM education, I am yet to have a single professor tell us what this mysterious, all pervasive concept is. It took an unassuming, older gentleman from Switzerland and 2 weeks of reminding to come to the concrete, unshakable realization that the answer is so simple as to be overlooked and can be summed up in a single word: ENERGY.
To quote briefly from Jacques Pialoux's Guide to Acupuncture and Moxibustion we can outline this concept of energy according to its modern scientific attributes as "the product of various interactions (nuclear, electromagnetic, and gravitational) in the form of motion, or vibration. It is characterized by: frequency (its quality), amplitude or power (its quantity), and its direction (including both where it originates from and the destination it is moving toward)."
YuanQi! Of course we talk about qi with incredible frequency as we study TCM; we throw the term around so flexibly that it becomes an ethereal, abstract concept somehow removed from the reality of the human body. I hear professors and doctors mold the term to fit any situation; to explain any problem, and have come to the opinion that if traditional medicine is to continue to gain strength as a viable means of healthcare in the modern world, we as practitioners must hold ourselves to the same strict standards as other scientists. Our treatment protocols should be centered around the simple questions contained within the definition for energy: what is it?, where is it coming from?, where is it moving to?, does this represent a physiological or pathological function of energy?
As LaoZi states, we must become clear in our understanding of the fundamental principles of the matter at hand, lest we act carelessly. As for how we do this, I think the conversation takes a clear turn away from the academic toward the esoteric in passages such as Ch. 48 "忘知: Forgetting Knowledge":
In Ancient times, the Chinese separated the day into 12 periods of time based on the motion of the sun through the Heavens, each two hours in length. Each individual period became intimately associated with one of the 5 zang/6 fu organs, its corresponding meridian and its physiological functions. Below are further details of this system as it relates to human physiology and basic suggestions for promoting health through proper daily rhythm.
The Zi Period, 子时: Maintaining Yang Qi through Sleep
11pm to 1am is the period when Yin energy is at its height. Yin energy directly correlates to the physiological process of sleep. Therefore, we should be soundly asleep during this period. Just getting into bed during these hours, reading, watching television, or struggling to fall asleep is not an efficient use of this time.
The Gallbladder meridian is most active during the Zi period. According to the law of transformation of Yin and Yang (extreme Yin produces Yang; extreme Yang produces Yin), the gallbladder is responsible for giving birth to the first Yang energy of the 24 hour cycle. This Yang energy in its infantile state is highly vulnerable. Therefore, we must protect and allow it to grow through proper sleep.
The Niu Period, 丑时: Production of Blood by the Liver
1am to 3am is the period when the liver is most active. The liver, and its corresponding meridian, are responsible for stimulating new growth, further strengthening the Yang qi released by the gallbladder. The liver carries out its physiological functions of filtering toxins and producing blood during this time. Extensive clinical observation has shown that many patients who suffer from liver disease are fond of staying up late into the night. This deprives their liver of adequate opportunity to complete its tasks, and over time, leads to illness.
The Yin Period, 寅时: The Ideal Time for Measuring the Pulse
The morning from 3am to 5am is known as the “peaceful dawn”. During this time, the energy of the Heavens is approaching a state of equality; the relative state of Yin and Yang begin to come into balance. The lungs are most active during this period. As the day begins to break, the pulses most accurately reflect the state of the individual. One can note whether the pulse is stiff or tight. For those over 40 with a stiff pulse, there is a high correlation with high blood pressure; for those in their twenties or thirties with a tight pulse, it is likely that they are under a great deal of stress at work or suffering from a heightened level of general anxiety. A pulse that is both stiff and tight is known as a “wiry” pulse, often characteristic of high cholesterol and arteriosclerosis.
The Mao Period, 卯时: Drink a Glass of Water, Clear the Body of Toxins
The large intestine is most active during this period from 5am to 7am. It is important to begin the day at this time with a glass of warm water on an empty stomach. This is particularly effective for individuals who suffer from chronic constipation. As the energy of the large intestine begins to grow stronger, the water helps act as a catalyst to stimulate peristalsis, thus eliminating toxins from the body. The toxins contained within our stool compose about 50% of the total toxins of our entire body. The Mao period represents “the opening of the heavenly gate”, corresponds to the second month of the lunar calendar, when life, fueled by the growing force of Yang energy, emerges from the Earth, thus making it the ideal time for vacating the bowels.
The Chen Period, 辰时: Balancing the Nutrition of the Morning Meal
The stomach is most active during the Chen period, from 7am to 9am. We should take out morning meal at this time, thus making use of the abundant energy of the stomach. Breakfast should include some form of animal-based protein, including eggs or other breakfast meats.
The Si Period, 巳时: The First Optimal Period for Work or Study
9am to 11am is the time dominated by the spleen. The spleen is responsible for assimilation and transport of nutrients. This is the period of the day when brain activity is at its peak, making it the first ‘golden’ period of the day, ideal for study or work. However, this productivity and effectiveness is dependent upon having eaten a healthy breakfast. The spleen processes and assimilates food digested by the stomach, converting it to the energy that drives our various physical and mental activities. It is also the best time of the day for seniors to exercise.
The Wu Period, 午时: A Quick Nap to Fortify Yang Qi
The Heart channel is most active during this period from 11am to 1pm. During this time, we should follow lunch with a brief period of rest. According to the principles of transformation of Yin and Yang, Yang energy has reached its apex. The NeiJing tells us that Yin is associated with the interior and sleep, while Yang governs the exterior and waking hours. Therefore, by following the midday meal with a brief period of rest, we can further this transition of Yang to Yin. This is especially important for Yang deficient people to fortify their Yang energy with a longer period of sleep. For the rest of us, a half hour of rest should be sufficient to protect the Heart energy and Yang qi.
The Wei Period, 未时: Protect Blood Vessels by Drinking Water
1pm to 3pm is the time of the Small Intestine. At this time, the small intestine completes the absorption and assimilation of nutrients from digested food matter. The blood stream is now laden with the nutritional building blocks of life, a state somewhat analogous to the crowded streets of rush hour traffic. At this time, we should drink a glass of warm water or tea in order to help dilute the blood and promote circulation. This can help protect vessel walls from the excessive strain of nutrient-rich blood.
The Shen Period, 申时: The Second Optimal Period for Work or Study
The period from 3pm to 5pm is the second golden period for concentration of the day, when the urinary bladder is most active. The small intestine has completed its assimilation of nutrients and made them available for consumption by the brain, making it easier to carry out high-concentration oriented tasks.
The You Period, 酉时: The Best Time for Preventing Kidney Trouble
The kidneys are most active during the You period, from 5pm to 7pm. Drinking another glass of warm, clear fluids at this time assists the kidneys in filtering toxins from the body, helping prevent afflictions such as kidney stones and bladder infections.
The Xu Period, 戌时: The Third Optimal Period for Work or Study
The period from 7pm to 9pm is governed by the pericardium. At this time in the day, the heart energy relaxes into an eased flow, ushering in the third golden period for work or study of the day. It is also an ideal time to go for an after-dinner walk or get in some other form of exercise. As the pericardium hour draws to a close, finish it off with another glass of water or non-caffeinated tea to maintain proper circulation.
The Hai Period, 亥时: Preparing to Rest
The SanJiao, or triple burner, is most active during the hours of 9pm to 11pm. At this time, our day should slowly begin to draw to a close. Computers, TV’s and cell phones should slowly be retired for the day to allow the mind time to settle into a restive state. It is an ideal time for pleasure reading, enjoying some light music, quiet meditation, or sharing intimate time together with a partner.
Trans: The heart and liver reside on the left, the lungs and spleen reside on the right, the kidneys and mingmen at the chi position. The hun, po, gu(1), and shen are all present within the cunkou pulses. The left control the zang organs, and the right control the fu sacs. The left strongly follows the male, the right strongly follows the female, each supporting its own innate nature, the masculine on the left and feminine on the right.
(1)谷gu: literally means "the valley" and is commonly used in classical texts to allude to food stuffs and digested nutrients as processed by the stomach
Simply proceeding one step forward in the order of allegorical associations, we can clearly see the masculine, or Yang, element on the left side and the feminine, or Yin, on the right. This is in keeping with the general movements of the qi mechanism as presented in the NeiJing, for example， “肝生于左，肺藏于右。” ("The liver arises on the left and the lungs store on the right.") 《素问·刺禁论》. Here we see the active process of creation on the left and the more passive process of storing associated with the right.
This post is actually more than just a little closer to heart, in fact, as I recount my most recent personal experience with the medicine and the astounding results it can produce when done with careful precision. About a week and a half ago, I noticed that the skin around the cuticles of my right hand had begun to look very dry and soon afterward, actually begun to peel. This was accompanied by the skin on my right palm, beginning around 劳宫 (PC8) and radiating outward until my entire palm had become red and slightly irritated as the young layers of skin beneath were exposed. Yes, another of those strange, slightly annoying, yet in no way life-threatening health problems that plague long-term residents of Beijing.
In addition, I had been sleeping somewhat restlessly, whether due to my own internal imbalance or the effects of the warmer Spring-like weather on my young male cat, it is difficult to say. Regardless, I found myself waking almost every morning from a vivid dream cycle just shy of 7 o'clock. This coupled with somewhat unpredictable bowel movements got me to thinking, though it wasn't until yesterday during my conversation with Sylvie Hu, our AWB representative here in Beijing and a wonderful resource on all things acupuncture related, that I finally began to connect the dots.
She suggested a simple, yet elegant (as AWB protocols tend to be) treatment: Tonify 合谷 (LI4), 曲池(LI11)，天枢(ST25); Disperse 大陵(PC7)，太溪(KI3).
A bit of crafty ambidextrous work on myself (as I still rely on the clumsiness of physical needling), an extended evening meditation and a great night's sleep have yielded some truly remarkable results. The peeling has stopped, and even seems to have begun to replenish itself across my entire palm and fingertips. A small victory, I know, but astonishing, nonetheless.
So what are the forces at work here? Sylvie explained that skin conditions such as this, including some rashes, excezema, and even psoriasis, are intimately related to the functioning of the Large Intestine and its ability to remove toxins from the body as well as the adequate strength of surface Yang enenrgy to retain internal energy from oozing to the surface. The digestive issues and the early rising, coincidentally during the Mao period of the horary cycle, further confirm this line of thought. The location along the Pericardium channel and the restless sleeping are generally indicative of excess energy in the Heart and Pericardium, thus the need to disperse 大陵，the Yuan and Earth Shu point of this channel. 天枢, or "Heavenly Pivot" is known to coordinate the respective digestive and assimilative/excretive functions of the upper and lower digestive tract, and has also been proven effective in treating various psychological conditions. All said, an incredibly useful point to investigate.
This basic treatment, tonifying 后溪(SI3) and 外关（SJ5) when necessary, can be used as a basic formulation of points for treating skin problems resulting from an accumulation of toxins in the body. For bowel irregularity marked by uncontrollable, painful spasms, combine with dispersal of 三间(LI3), or tonify 大肠俞(BL25) for constipation resulting from Large Intestine deficiency. These treatments may also require the patient to adjust their diet where needed. The more severe the skin condition, the stricter the diet should be, beginning with the elimination of fatty foods and alcohol and ending with all dairy and meat products.
The presentation, however, is secondary to the underlying pathology. Patients with Large Intestine deficiency and a build-up of toxins within the blood may also present with various allergies, for example. Constipation may be the result of disharmony between the Spleen and Stomach, or engorging of the Liver - it's all so wonderfully, frustratingly possible.
To conclude with a simple observation I hope you have already hit upon by this point, "Yes, acupuncture is very cool..."
After 2 weeks of almost total retreat in a classical furniture warehouse/showroom on the outskirts of Shanghai, I have returned back to Beijing with much to think about. I will, undoubtedly, be posting insights gained from this amazing Acupuncture Without Borders training workshop for some time to come, as I grapple to assimilate the mountain of information that was delved out over almost 90 hrs of classroom lecture and practice.
But first, I would like to begin with a few brief words of gratitude to those who made this training program such a success. First, many thanks to Drs. LiXin and Jason Yang of Insight ACM for hosting the program, and to all of their students who so warmly welcomed us to Shanghai. Thanks to AnLi for such a great place to stay and the wicked classroom setup, replete with antique Chinese furniture and delicious meals and snacks throughout the course. And cheers to all the fellow participants, especially my roommates who toughed out the cold together with me and made it a truly enjoyable learning experience, with long, heated discussions about the nature of Chinese medicine deep into the night. It was everything that a Chinese medical education should be.
Most importanly, I would like to thank Silvie and Claudine from AWB for assisting, MeiLing for her tireless translation work, and of course, our chief instructor, Mr. Jacques Pialoux. The direct and open way in which he shared his insights into the nature of Chinese medicine and the Book of Changes pieced together from 50 years of clinical experience was truly something amazing. He left me puzzled, intrigued, and at times, frustrated and exhausted. But more than anything, his concise presentation of such a comprehensive system of energy flow and acupuncture has challenged me out of the complacent, materialistic mindset of modern TCM I was in danger of sinking further into. The practice of acupuncture is first and foremost, an investigation into the subtle energy structure of the human system and its relationship to the awesome power of nature. And as such, it needs to be undertaken with an equally subtle, discerning mind. This is the only way we can ever hope to raise ourselves up to the level of the ancient creators of this art and apply the knowledge we have been left.
So what then, is acupuncture? Such a simple question; yet one I feel that few can truly answer. These past 2 weeks represent Jacques answer to a lifetime spent asking that very question - and a truly awesome, inspiring answer it is. I look forward to pulling it all apart and working my way through the many ideas that are now floating around in my still slightly-numbed consciousness and putting them into practice.
Further posts to come soon...