Thoughts along the way

The Herbal Playbook

2010-03-15T20:33:00.006+08:00

Having done my full education here in China, I have tried with varying degrees of success to live up to expectations set for domestic students. While my theoretical understanding of the medicine and diagnostic skills are quite strong in relation to my peers, most Chinese students kick my butt when it comes to rote memorization of prescriptions and acupuncture points.

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.

The Power of Place

2010-03-15T16:55:00.008+08:00

After a couple weeks spent lounging about the beautiful beaches of SE Asia, I returned to Beijing and some fresh perspective on this place that has become so familiar, but yet never quite home for me. The characteristics of the physical environment, cultural identity, and lifestyle habits of its residents combine to give 'The Big Dumpling', as we affectionately refer to the capital city, its own unique energy dynamic that we all feel the effects of in one way or another.

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.

What Has Been Lost (Pt. 1)

2010-01-26T14:11:00.015+08:00

The following post is based on recent lectures I attended at the Kundawell Institue by Professor Xu MingTang, an internationally recognized master of Qigong and energetic healing. Many thanks.

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...

脉法: What's Up with Pulse Anyway

2009-12-03T21:11:00.008+08:00

The following is an excerpt from 彭子益’s 圆运动古中医学, The Ancient Chinese Medicine of Circular Movement by Qing Dynasty physician and scholar of ancient Chinese medical theory PengZiYi. This book is currently being recommended by some of the great doctors of the modern PRC as an introduction to the true practice of Chinese medicine based on the understanding of cyclical energy flow within the body.

I have come back to the chapter on pulse diagnosis following the recent AWB training session in Shanghai in an attempt to flesh out and further understand the principles of Jacques’ pulse diagnosis. It is interesting that in comparing the two, I have found them almost identical in their theoretical reasoning and very similar in technique, thus indicating a common source somewhat removed from the common understanding/explanation of pulse diagnosis in modern TCM circles.

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…

学脉之法，一曰脉位，一曰指法，一曰脉象，一曰脉理。明白脉位与指法，然后能捐除自己的成见，看清脉来的真象。脉象脉理，必须于普通学法之中，有系统以贯之。

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.

指法与脉位

自来诊脉两手分诊。圆运动学的诊脉，必须两手合诊，因整个圆运动的消息，须两手合诊…又须三指斜下，次指按在寸脉的浮部，中指按在关脉的中部，名指按在尺脉的沉部。沉部在骨，中部在肉，浮部在皮。斜下者，中指比次指重，名指比中指重…是为三部诊法。若三指不分轻重，便不合寸关尺三部脉的本位。三部之法之中，又有九侯之法。三部九侯者，一部三侯，三部九侯。下指诊脉，不可将指头死按脉上，就如用眼睛看物，却把眼睛珠放在物上，如何能将所看之物看得明白。三部九侯指法无差。

诊脉动称为看脉，不如将看字改为听字，能将听字的意义体会有得，则诊脉必有聪明过人之处。听字比看字静得多，看是我去看他，听是听他来告我，必能听而后得整个认识也…先将指头审查九个字地位，以侯脉来，指头与脉见面之后，仍不听脉，仍只审查九个字地位，有意无意之中，听出脉的病点来，然后继续搜求，由合听而分听，由分听而合听，整个脉体即是整个人体的河图。由合以求分，便知病之所在，由分以求合，便得处方的结果。总而言之，不可由我去找脉，须侯脉来告我。我去找脉，我便有成见了，就得不着脉的真象了。

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.

The Science of One

2009-03-04T17:16:00.004+08:00

If you stop for a moment to consider the sheer volume and scope of information you are expected to master as a student and practitioner of Chinese medicine, it can be dizzying to say the least. From herbal properties and combinations, to acupuncture points and treatment protocols, to anatomical knowledge and diagnostic tools, your bookshelf quickly fills with a collection of intimidatingly thick volumes that ramble on for hundreds of pages with several thousand years of differing opinions on nearly every aspect of the practice.

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:

夫物芸芸,各复归其根.
归根曰静,静曰复命.
复命曰常,知常曰明.
不知常,妄作凶.
知常容,容乃公.

(refer to http://www.yellowbridge.com/onlinelit/daodejing.php for a nice comparison of English translations)

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:

阴阳者，数之可十，推之可百，数之可千，推之可万，万之大不可胜数，然其要一也.

《素问・阴阳离合论》

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":

为学日益，为道日损．
损之又损，以至于无为．
无为而无不为．

I find this passage particularly relevant as I get into my final semester of book learning here at the university, where knowledge reigns and understanding often gets left by the wayside. The work that lies ahead for me is to deconstruct the system that has been downloaded to me over the past 4 years, to understand the why. Why is this particular acupuncture protocol the accepted standard for a particular illness?; Why does this combination of herbs produce this effect? It's this deconstructionist approach to learning that I think separates learning from scholarship and imitation from mastery.

The Horary Cycle and our Body’s Natural Rhythms

2009-03-04T11:34:00.007+08:00

The following article has been translated and adapted from a posting on 中国中医网.

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.

Yin or Yang, Left or Right??

2009-03-04T10:49:00.001+08:00

In an attempt to lay to rest a recurring question on the positions of Yin and Yang in pulse diagnosis, and in human physiology as a whole, I would like to offer an excerpt from LiShiZhen's The Lakeside Master's Study of the Pulse.

《濒湖脉学》李时珍
心肝居左，肺脾居右，肾与命门居两尺部。魂魄谷神，皆见寸口。左主司官，右主司府。左大顺男，右大顺女，本命扶命，男左女右。

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.

Homecoming

2009-03-02T19:40:00.006+08:00

So after a several month hiatus from blogging that saw the passing of another season of final exams and a brief, but intense, detour into the world of business development (which has been truly fascinating from the perspective of amateur sociological exploration into the nature of office work), I am pleased to be returning here to focus on things a little closer to heart.

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..."

A Few Words of Thanks

2008-11-25T11:15:00.006+08:00

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...

『静坐与心身平衡』 "Meditation: Balancing the Body and Mind

2008-11-02T21:56:00.007+08:00

Many thanks to my great friend and teacher, Dr. LiXin of the Shanghai Insight ACM Training center, for this contribution on the practice of meditation and its relationship to Chinese medical practice. For more information check out their website at http://www.insightacm.com/home.aspx.

身心本为一家，魂魄志意为用，魂魄者，先天本能也，志意者，后天社会程序也，亦习得本能，习惯反射也。

心者，神也，本原也，非志意之思维逻辑分析判断，此神经系统表浅功能，亦非欲望情感情绪感受，此躯体觉受身心反应模式耳。

古贤云，神总统魂魄，兼赅志意。是知魂魄志意，乃身与意两个层次之活动，维生致用之工具耳，非本原也。

奈何人之于此，只知身心，不知有神，或以躯壳感受，欲望冲击，情感振荡为我之存在，或以性格突显，思维精密，分析逻辑为我之真实，故而为物所攥，为外所牵引，失其本原，心荡神移，惮散不收，故而身心困顿，此诸病源头，亦疗疾根本也。

古人有言，与生之道，无非两者，外求之途，远离生乐；安心之道，返朴归真。

欲求身心安宁，必先认得方向，但从内观，勿觅他途。静候傻等，耐得性情，是为入门之阶。须知人之有神，如衡器有中，身心之振荡不安，如衡器遇着外力冲撞，不需时刻扶持，强力矫正，当放稳身心，避开外力，观其上下，任其左右，自会平常。

内观者，观身之感受，意之变动，外之振荡与内之交互作用，久久熟悉，细致入微，可知不在身，亦不在意，气质变化，精神光明，通于无穷，身可调，心可安。

游子回家，当家作主。

The body and mind are fundamentally one and the same. The hun, po, zhi, and yi are its manifest applications. The hun and po compose an individual's pre-natal instincts; the zhi and yi represent post-natal societal order. Constant application obtains instinct, a form of conditioned response.

The mind is another name for the spirit. This is the individual's original nature, not the logical, analytic thought process of the zhi and yi; this represents nothing more than the shallow workings of the nervous system. The spirit is also not the desires and emotions we feel; these are nothing more than the heart's response to the sensory experiences of the body.

The ancients say, the spirit unifies the hun and po, and completes the zhi and yi. This is the realization that the hun, po, zhi, yi represent two levels of physical and mental activity, the tools for preserving life, not the source of life itself.

How then do we come closer to the realization of truth? We commonly recognize the existense of the body and mind, and neglect that of the spirit. Desires arise from the sensory experiences of the physical body, and result in a wavering of emotion that we mistakenly identify with as self-existence; or in embracing our individuality and depth of reasoning, we accept the results of our analytic thought processes as self-truth. We grasp to our material creations, and our attention is stretched ever-further outwards, away from the source. The mind wavers and the spirit wanders, restlessly, we scatter ourselves without gathering until the mind and body suffer from exhaustion. This is the source of illness and accordingly, the root of its treatment.

The ancients say that there are but two ways in which to live: the path of outward seeking that leads one further from peace of mind, and the path of calming the mind, through which one turns inward to rediscover original nature.

In order to calm the mind and body, we must first orient ourselves directionally. We must look inward, without distraction, to sit idly and simply wait patiently for the wavering of emotion to pass. This is the doorway from which the path begins. We must remember that the body and mind are supported by the spirit just like the two sides of a balance are supported by its frame. This capricious, unsettled condition of the mind and body is similar to the see-sawing movements of a balance when weight is first applied. There is no need to remedy the situation through the use of brute strength. Instead, we must learn to escape from this 'weight' by setting the mind and body free, by observing above and below, accepting the right and left, and allow it to fall into a state of balance.

Looking inward we must observe the sensory experiences of the body and the movements of intention. By becoming intimate with the internal effects of external stimuli down to the finest detail we can see that our true nature is not in the body, nor is it in consciousness. The energy of the body shifts, the jing and the spirit become clear, allowing the body to regulate itself and the mind to be at ease.

The wandering child returns to become master of the home.

Joy....No Strings Attached

2008-10-12T11:41:00.007+08:00

In a brief departure from the more objective, hard lines of the formal TCM theory of previous posts, I would like to share some recent insights into the more spiritual or psychological elements of the practice.

Critics of the tradition say that even if one recognizes the validity of TCM, its basic theoretical system has evolved very little in comparison with other forms of science and technology over the centuries. Therefore, it is hopelessly out of touch with the state of modern man and the high-paced lives we now live. And while I would counter that much like the underlying principles of nature itself, the tenants of existential truth remain constant in spite of the passage of time (as opposed to mere theory), this question is worth consideration in the ways that we apply TCM in the modern era.

This question of how TCM techniques need to be adapted to man, the modern animal, first arose in regards to the use of ShangHanLun prescriptions. Thanks to some fortuitous archeological discoveries over the last 20 years, particularly the uncovering of many medical treasures in the MaWangDui Catacombs, we now know the exact modern equivalents for common measurements of the Han dynasty. As a handful of enlightened practitioners nodded their heads in vindication, the collective jaw of the TCM world gaped in astonishment to learn that there is hard evidence to prove that one liang was equal to approximately 15 grams! By this standard the primary weapon of choice in ZhangZhongJing's herbal arsenal, GuiZhiTang, would call for a startling 45 grams of GuiZhi!

This type of a prescription represents a far cry from the slow and often subtle adjustments that TCM is widely known for in the modern day. Each ShangHanLun prescription is designed to completely reorient the SanJiao Qi structure of the patient from a downward slide into illness back to the path of physical (and psychological) harmony. It is safe to assume that the diagnostic confidence of the caregiver to calmly proceed and "smack his patient upside the head with a slightly blunted axe" as one ShangHan expert so eloquently described it, had to be nothing short of absolute (which is also why it comes as no surprise that such a large portion of the ShangHanLun is devoted to correcting misdiagnoses). In other words, this type of medical practice demanded an extreme level of clarity not only on behalf of the practitioner, but also on behalf of the patient.

Yes, the patient. Contemplation of the larger signifcance of the ShangHanLun suggests that people of this era were also incredibly "clear" in the way they got ill, and by means of logical extension, very "clear" in the way they lived. By this I mean that they are free from much of the psychological muddle, and resulting physical degeneration, that we of the modern world tend to suffer from. Most of which, ironically enough, is of our own design. I am by no means saying that their lives were stress free. However, they stressed over simple matters of great importance and, in contrast to our own lives, largely out of their own control. Thus, in order to appease the external powers that be as well as the anxiety within their own hearts, cultures developed devotional practice. The simple act of prayer in whatever form is an opportunity for the individual to understand what is most important to them and in turn to give voice to these emotions in a straight-forward, well-defined manner. If you have traveled extensively in under-developed rural areas of the world and experienced this "refreshing simplicity" or "joy of poverty" first hand, you probably know exactly what I am talking about.

In contrast, a vast majority of modern men and women lead "lives of quiet desperation", to borrow Therau's insightful observation of his city-dwelling contemporaries. Our lives today are characterized by an on-going internal dialogue often over matters that in the larger scheme of things, are of little import. This continual "mental chatter" from which so many of us seem unable to escape has a profound impact on our health over time. According to NeiJing theory, the spleen is the domain of the 意 yi, or intention. This intention is the directed application of the 志 zhi, or the unfocused primal will of the human system that resides within the shadowy confines of the kidney system. In addition to its physical transformative function in directing digestion and assimilation of food, the spleen also works on a psychological level as well, drawing out the will from the recesses of the kidney system and transforming it into conscious thought. This is the meaning behind the spleen's associated emotional state of 思 si, or contemplation.

This type of contemplation is often synonymous with 忧 you in the Chinese language, a character that can be translated as worry or anxiety, a problem Western culture is only too familiar with. We often liken this unfettered mental wandering, or anxiety, to a "mental haze", a metaphor I find quite interesting in its proximity to TCM theory. Overly taxing the transformative properties of the spleen through excessive contemplation, leads to spleen yang deficiency, and in turn, qi stagnation and the rise of 湿 shi, or dampness, in the middle burner. In other words, haze.

This connection between anxiety, or stress, and symptoms of spleen deficiency such as lack of appetite, lethargy, irregular bowel movements, hyperactive dreaming, etc. is something that we can all attest to through personal experience. It is one of the most important factors in determining the general state of deficiency that most modern people find themselves living in today. While our material standards of health have improved greatly, the complications of modern life leave many of us in need of a vacation from our own minds. And to return to the original thread of this post and the applications of TCM in the modern era, I would therefore propose that the lack of clarity in the way many of us now live, and consequently, the way in which we become ill, requires a more subtle application of techniques such as ShangHan prescriptions. An initial strong blow from the herbal hatchet should be followed by some exacting scalpel work in order to clear accumulated "junk" within the energetic system. And while Fuzi and GanJiang go a long way to helping patients find relief from symptoms, unless the underlying psychological cause of anxiety is resolved, a true cure is very difficult to attain. Thus, the theory espoused by most TCM texts that illnesses associated with dampness are prone to chronic relapse.

It is therefore, vitally essential that a patient become involved in the healing process through the creation of what I refer to as "joy with no strings attached". This is the simple ability to create and maintain a feeling of pure joy in our daily lives independent of external conditions. We all know and have experienced this state of mind briefly from time to time, when, suddenly, we are confident and relaxed, unattached to the outcome of whatever the situation we find ourselves in, and for a fleeting moment, the worries of life seem to melt away into a feeling of pure calm. Then, without warning, it is gone and we find ourselves trying to recreate it through memory, recounting it to our friends and loved ones. And in doing so, only succeed in putting more and more distance between us and that moment of happiness.

The problem then, is how to create this feeling with any regularity in our daily lives, a question that I believe is a uniquely individual one that lies at the very heart of the healing process. Our role as practitioners is to encourage and foster this process, to stimulate the 君火 junhuo, of the heart system such that the spirit may flourish. If we liken this process of contemplation as an opening of the energetic system, through which mental and physical energy is slowly bled out into the world at large, then psychological sustainability requires a counterbalancing process of closing, or as Sogyal Rinpoche says in The Tibetan Book of Living and Dying, one of "welcoming the mind home". When the mind is absent and at rest such as when we sleep, meditate, or become fully engrossed in physical exercise, the intention is directed inwardly, thus activating the post-natal power of the stomach/spleen system to replenish kidney essence, rather than constantly depleting it. Just like the circular energy dynamics of the natural world, we too must complete the circle of energy flow in our everyday lives or risk suffering the consequences of one-way living.

二零零八年九月廿一

Essentials of Qi Dynamics: Part 1

2008-10-07T14:09:00.012+08:00

In preparation for forthcoming translations from Peng ZiYi's The Circular Dynamics of Ancient Chinese Medicine, I would first like to 'get down on paper' some key aspects of classical Chinese thought that have been relegated to the fringes of modern TCM education. Considering that the ancient world view of the Chinese lies at the very heart of the conceptual framework of TCM, I believe it is worth re-examining some concepts that are familiar to most of us, through the lens of traditional qi dynamics.

In the opening lines of his chapter on TCM theory, Peng writes: “欲学中医须先认识十二经名词的所以然。欲认识名词，须先认识阴阳五行六气的所以然，欲认识阴阳五行六气，须先认识二十四节气地面上所受太阳射到的热降沉升浮中的圆运动。”
-Those who would like to study Chinese medicine must first understand the reasoning for the names of the 12 meridians; in order to understand the names of the 12 meridians, one must first understand the concepts of Yin/Yang, Wu Xing, and Liu Qi; and in order to understand these concepts of Yin/Yang, Wu Xing, and Liu Qi, one must first understand the concept of the 24 jieqi and the circular movement of the sun's energy as it strikes the earth, the point which corresponds to "center", and descends, sinks, rises and floats.

Seeing these words on page 1 of the text, I knew this book was going to fundamentally change my understanding of TCM as I recalled my 'Basic TCM Theory' instructor's offhand dismissal of my question regarding the names of the meridians as essentially "insignificant" several years earlier. And here is Peng ZiYi placing this very question in the opening lines of his book, stressing its tantamount importance!

Let us then begin with this question of the 24 jieqi, or "24 qi periods" of the traditional Chinese calendar. This is the earliest meaning of the character qi, simply a period of 15 days. Based upon the subtle characteristics of each season, beginning with Spring, the year is broken down as follows: 立春LiChun (Beginning of Spring), 雨水YuShui, 惊蛰JingZhe, 春分ChunFen (Mid-Spring)，清明QingMing，谷雨GuYu，立夏LiXia (Beginning of Summer)，小满XiaoMan，芒种MangZhong，夏至XiaZhi (Summer Solstice)，小暑XiaoShu，大暑DaShu，立秋LiQiu (Beginning of Autumn)，处暑ChuShu，白露BaiLu，秋分QiuFen (Mid-Autumn)，寒露HanLu，霜降ShuangJiang，立冬LiDong (Beginning of Winter)，小雪XiaoXue，大雪DaXue，冬至DongZhi (Winter Solstice)，小寒XiaoHan，大寒DaHan

Each season has its associated direction and dynamic motion. In keeping with the above image of the sun's energy reaching the earth, we can follow the cycle of energy through the four seasons. The warmth of the summer sun reaches the surface, a point in three dimensional space we will refer to as "center", and during Autumn is absorbed into the earth in an action known as "descending". This energy continues to descend into the earth, where it meets with water deep within the ground and is stored as potential energy during Winter through an action known as "sinking/condensing". As Spring approaches, energy begins to rise toward the surface in an action known as "ascending". It eventually reaches the earth's surface and is returned to the Summer sky in a movement known as "floating". This process is represented in the illustration above.

Each motion is associated with a season as well as a direction. The Winter Solstice lies at true North and represents the transition from sinking to ascending. Ascending continues to grow in strength until its climax at LiChun waning as it approaches Mid-Spring, where it transitions to floating, and so on through the cycle. It is important to remember that this cycle traces the movement of the sun's heat, or in other words, YangQi, through its annual progession. Therefore, at Mid-Autumn and Mid-Spring, the amount of heat above and below the surface are relatively equal, while the Summer and Winter Solstices represent the apex of heat both above and below respectively. Peng informs us that this central dividing line on the human body is 2 cun above the belly button, or XiaWanXue(RN10).

The last 2 lines of this section are particularly worth noting. He states: "热性本来升浮，不能降沉，热之降沉，秋气收敛之力降沉之也。热降，为生物有生之始，热不降，为生物致死之因。"
-Heat naturally ascends and floats and cannot descend and sink of its own. Therefore, the descending and sinking motion of heat depends upon the gathering power of Autumn qi. Descending heat is the basis for all life; if heat does not descend, the organism will die.

This line of thought leads directly to a fundamentally different understanding of Yin/Yang and WuXing theory. The left half of this diagram represents the process of Yang as heat stored dormant beneath the ground begins to move and ascend; the right half, the process of yin, where heat that has reached its apex of motion begins to slow and descend. This also corrects the common misunderstanding of WuXing. Often translated as "five elements", as we see from this diagram, the character 行 xing refers to the dynamic properties of each element, and so may be better translated as "five motions".

Though seemingly very abstract, returning this concept of motion to TCM is crucial to eventually understanding the clinical applications of various herbs and acupuncture techniques. This is an analogy that can be directly applied to the understanding of the human system. Each of the five organ systems has its associated action. Illness is thus a manifestation of the breakdown in this dynamic model. Treatment is simply a matter of identifying the breakdown in movement and applying proper therapy to restore it to an even, harmonious state. We must break free from the Western notion of medical materialism and begin to envision TCM as an energetic science that places the human system within this larger natural context.

More on qi dynamics and the theories of Peng ZiYi to follow.

二零零八年九月初八　・　寒露

Zheng QinAn's "Exposition on the Nature of 'ShangHan'"

2008-10-07T13:44:00.003+08:00

From ZhengQinAn's Collected Works

Chapter entitled "伤寒溯源解", or "Exposition on the Nature of 'ShangHan'"
Note: The two characters 伤寒 from the title of the classic work by Zhang ZhongJing can be literally translated as "damage or injury" and "cold", a concept that Zheng QinAn broadens to explain the physiological breakdown in energy flow through the invasion of a pathogenic factor, as we will see below. This is radically different from the way it is commonly rendered in English as referring to the resulting "febrile disease"

仲景为医林之祖,著《伤寒》一书，以开波世津梁，提出三阳三阴，包含乾坤二气之妙，后贤始有步趋。注家日多，纷纷聚讼，舍本逐末，以至于今，故读《伤寒》书者寡矣，亦并不知伤寒何所取义也。即注伤寒者，亦只是照原文敷衍几句，并未道及伤寒宗旨，与万病不出伤寒宗旨，教后人何由得入仲景之门，余特直解之。夫曰伤寒者，邪伤于寒水之经也，太阳为三阳三阴之首，居于寒水之地，其卦为坎，坎中一阳，即人身立极真种子，至尊无二，故称之曰太阳,如天之日也。太阳从水中而出，子时一阳发动，真机运行，自下而上，自内而外，散水精之气于周身，无时无刻无息不运行也。故《经》云："膀胱者州都之官,津液藏焉, 气化则能出焉。"气化二字，乃伤寒书一部的真机。要知气化行于外，从皮肤毛窍而出水气，气化行于内，从溺管而出水气。外出者，轻清之气，如天之雾露也；内出者，重浊之气，如沟XX之流水也。

太阳之气化无乘，一切外邪，无由得入，太阳之气化偶衰，无论何节何侯中不正之气干之，必先从毛窍而入，闭其太阳运行外出之气机，而太阳之经证即作，故曰伤寒。今人只知冬月为伤寒，不知一年三百六十日，日日皆有伤寒。太阳为六经之首，初为外邪所侵，邪尚未盛，正未大衰，此际但能按定太阳经旋治，邪可立去，正可立复。因近来不按经旋治，用药不当，邪不即去，正气日衰，邪气日盛，势必渐渐入内，故有传经不传腑，传腑不传经，二阳并病，三阳并病，两感为病，渐入厥阴，邪苟未罢，又复传至太阳，迁延日久，变证百出，邪盛正衰，酿成阴阳脱绝，种种危候，仲景立三百九十七法，一百一十三方，以匡其失，而扶其正。

As one of the founding fathers of Chinese medicine, Zhang ZhongJing authored the ShangHanLun as a tool for the clinical treatment of human afflictions. He outlined the three Yang/three Yin meridian theory of diagnosis, representing the subtleties of Qian and Kun(1), so that generations of physicians to come might deepen their understanding of medicine. Over time, there have been many commentaries, all with different opinions that argue over key points of the original text. The overall result has been to branch out away from its original meaning, so that now there are few people who even bother to read the ShangHanLun, and those that do, are confounded as to how to understand its true meaning. In their perfunctory work on the text itself, these commentators have failed to grasp the deeper essence of the ShangHanLun, which extends to all forms of disease. How, then, can those who come after gain access to the genius of Zhang ZhongJing? I shall explain here in no uncertain terms.

The concept of 'shanghan' begins with the introduction of a pathogen to the meridian of cold and water. The TaiYang meridian lies at the head of the three Yang and three Yin channels, and is the domain of cold and water. Its associated trigram is Kan, whose single Yang element is the primary source of all human life. In this, it resembles the awesome life-giving power of the sun and is thus referred to as 'TaiYang'(2). The sun rises out of the water and during the Zi period, the single Yang element comes to life, and the dynamics of the qi mechanism begin, moving upwards and outwards, it spreads water and essence to the surface of the body, constantly moving without rest. The NeiJing states, "The bladder is the official of the central capital, fluids are stored there and emerge with qi transformation."(3) This process of "qi transformation" lies at the heart of the ShangHanLun. One must be familiar with the process of qi transformation in the surface of the body, where water vapor is expelled from the skin and pores; and with qi transformation in the interior of the body where water is expelled through the urinary ducts. Vapor at the surface of the body is light, arid qi, much like mist or fog; water expelled from within the body is heavy and turbid, much like the flow of a drainage stream.

If the qi transformation of the TaiYang meridian remains unimpaired, then there is no avenues through which pathogenic qi may enter the body. When TaiYang qi transformation is weakened, no matter what the season or time of day, pathogenic qi will invade. It must first enter through the pores and block the expulsion process of TaiYang qi transformation. This leads to the development of the TaiYang meridian condition, thus, referred to as 'shanghan'.(4) Practitioners today believe that cold damge is limited to only the winter months, and do not realize that it can occur at any time throughout the year. The TaiYang meridian is the first of the six meridian stages to be afflicted by cold damage. At this stage, the pathogen is still relatively weak and the vital qi (zheng qi) is still very strong. If the practitioner is able to correctly diagnose and provide treatment according to the TaiYang meridian condition, the pathogen can be immediately dispelled and zheng qi can immediately recover. However, because people no longer practice this system of meridian diagnosis, they use herbs incorrectly and the pathogen is not dispelled, thus further weakening zheng qi and increasing the strength of the pathogen. The illness will gradually grow deeper and transform from meridian to meridian or from fu to fu, leading to an overlapping TaiYang, YangMing complex, TaiYang, YangMing, ShaoYang complex, or simultaneous complex of two meridians. Eventually, it reaches the JueYin stage, with its roots still intact, it reemerges at the TaiYang stage and slowly over time develops into various diseases. In the end, this leads to the separation of Yin and Yang and various life-theatening conditions. Therefore, Zhang ZhongJing established the 397 methods and 113 prescriptions of the ShangHanLun in order to dispell pathogens and tonify zheng qi.

(1) The two trigrams from the Book of Changes representing pure Yang and pure Yin repsectively.
(2) In addition to its Chinese medical meaning of the 'greater Yang' channel, TaiYang also means 'sun'.
(3) This passage from the NeiJing is and often quoted piece used to explain the formation and excretion of urinｅ. However, if you carefully consider it under the lense that Zheng QinAn has provided here, this emergence of fluids is not referring merely to urination. It points to the transformation of water into light, arid qi that is then transported to the surface and extremities of the body primarily through the TaiYang meridian and eventually excreted through the skin.This clearly explains why patients suffering from Yang qi deficiency have frequent, clear urinations. dry mouth and constant thirst, dry skin etc. - the driving force of qi transformation is insufficient and therefore fluids are passed directly out of the body without reaching the TaiYang meridian.
(4) Zheng QinAn uses the parallelism of this passage to indicate that the 'han' or 'cold' being damaged does not refer to the external pathogen as is commonly mistaken. It refers, instead, to the basic cold nature of the TaiYang meridian and the damage that is incurred upon the dynamics of the TaiYang qi mechanism. Therefore the first stage of all illnesses, regardless of the nature of the external pathogen, falls by necessity within the scope of 'shanghan'. This point is essential for cutting through the ongoing debate of modern TCM over cold-wind invasion versus warm-wind invasion. The nature of the pathogen is secondary in regards to its effect on the qi mechanism of the patient. According to Zheng QinAn, what is referred to as 'WenBing' is nothing more than the transmission of this damage to the qi mechanism from the initial TaiYang stage to that of the YangMing stage.

二零零八年重阳节

The Current State of TCM in China

2008-10-07T13:11:00.000+08:00

Returning for my 4th year as an undergraduate student in the Department of Acupuncture and TuiNa of the Beijing University of Traditional Chinese Medicine this past week, I have once again come face to face with the abysmal state of institutional TCM education here in modern China. Don't get me wrong - I am not sure that it is any better anywhere else in the world, as I know many curricula and textbooks are modeled after this very system. But after a summer spent working with several realized practitioners, it is both shocking and disappointing to see what TCM has been reduced to under the Chinese Ministry of Health's grand scheme for the 'Modernization of TCM'. In my opinion, this is nothing but an empty title used to conceal the true agenda, which is undoubtedly the subjugation of TCM to Western biomedical standard, that in all essence, has stripped away the spirit of one of the oldest extant systems of medicine and doomed one of the truly miraculous accomplishments of human culture to the dustbin of our collective future.

In a recent audacious letter to President Hu Jintao, Lv BinKui, one of the founders of the modern TCM curriculum, expressed his frustrations with the present condition of state oversight. He eloquently gives voice to the dismay that I have heard expressed in many circles (far removed from academia) here in China. As a veteran of Maoist era politics, a respected veteran of the Japanese War, and a reknowned physician who has worked within the system his entire life, his letter lends a certain gravity to opinions that have hitherto seemed to fall on deaf ears. Below are some selections together with my translation...

"对文物保护有整旧如旧、原汁原味的要求，这个要求，同样适用于中医药学。现今，卫生部等部委对中医药采取了以现代化的道路去改造它，要对中医药进行创新，这将给中医药的原汁原味彻底破掉，这是个错误的路线。中医药学在现今，不存在创新的问题，而只有继承、发扬和提高之路。原因很简单，中医药学在高等教育上已完全被西医化，继承都已经成为问题，如何去创新？"
-There is a duty in protecting our cultural heritage to maintain its original flavor and integrity that must be applied to Traditional Chinese Medicine. The present proposition of the Ministry of Health and its associated committees for the modernization of TCM and its alteration is a mistake in policy that has completely destroyed the integrity of our medical tradition. There is no such question of 'modernization' in the present state of TCM, there is only those of succession, implementation and improvement. The reason is quite simple. TCM has been completely Western medicalized under he modern educational system, its very succession has already become a problem, let alone a question of 'modernization'.

"由于中医药学在中国人心目中有着极其重要的地位，是中国人的民族感情的促发剂。当今，中国在世界的影响开始增大，在许多国家政府以及人民也开始承认和接纳中医...消灭中医药学,这不光是广大中医药从业者所不能容忍的，一旦真相大白，全中国人民也是不能容忍的。故针对当今这种打着发展中医药学，中医现代化的旗号... 党中央及中央政府应当顺应中医药界以及中国人民的心声，采取有利于中医药自身发展的行政措施，即将中西医在行政上分开，各自独立管理..."
-Due to the paramount importance that TCM holds in the collective spirit of the Chinese people, it is truly an emotional catalyst for the people of this country. As China's influence continues to increase on the international scene and as the governments and peoples of many countries begin to recognize TCM, its extinction is something that is not only unacceptable to the extensice network of TCM practitioners, but is also unacceptable to the country as a whole. In developing TCM under the flag of 'modernization', the central Party and government should enact policies that are in touch with the TCM community as well as the voices of the Chinese people. This should include policies that will enable TCM to develop organically of its own accord, completely separating the government and administration of Western and Chinese medicines.

Some of Dr. Lv's ideas for solving the current crisis:
"首先将中医药的教育权从教育部移交给新的中医药行政部门"
-First and foremost, the administration of TCM education is to be handed over from the Ministry of Education to a newly formed Ministry of TCM Administration.
"确立中医药和西医药在行政上，医疗上，地位上的平等原则及法律，使它们在为人民治病上获得同等地位"
-Confirm the equal legal, medical and social standing of both Western and Chinese medicines as legitimate resources for the treatment of illness.

He continues with a provocative indictment of the current state of TCM, which he describes as “最危险的时候”, "its most critical hour":
"在中医药学的教育上，西医化已成为事实，并且中医药学理论被否定，大学里培养出来的学生，已不会用中医的望闻问切方法来诊断疾病了，大多学生毕业后，根本不相信中医，可见中医药学在教育上已到了后继无人的境地了"
-The Western medicalization of the TCM educational system is already a reality with much of Chinese medical theory negated. Graduates of this system can no longer use the basic TCM diagnostic techniques of observing, listening,questioning and palpating. In fact, most students don't even believe in TCM. leading to a state where there is noone to inherit the lineage of TCM.
"贬低中医药学的学术地位，以及在中医药学教育上的随意性，使中医药学成为一部分人骗医的招牌。如有关部门举办的针灸学习班，时间只有1～3个月，就可以拿到盖有卫生部大章的结业证书，很多学员拿此在国外开起了诊所……，败坏了中医药学的名声"
-The lowering of standards and general indiscrimate nature of the TCM educational system has led to TCM being heralded as a group of con artists. Certain acupuncture courses require only 1-3 months of education in order to obtain a certificate of proficiency from the Ministry of Eduication. Many 'graduates' of such courses than use such a certificate to practice medicine abroad, tarnishing the reputation of TCM.
"现今中医药学的管理权已被各大部委瓜分...造成中医药学在管理上多头而无序，并且大多部委全是不懂中医药学的人在管"
-The administrative power over TCM has already been divided among the larger branches of government, creating a problem of too many administrative heads with no order or structure. In the end, the majority are being managed by people who do not understand TCM.
"《执业医师法》规定，必须有4年以上医学院校的学历者，方能参加资格考试，而中医药界大量的医师均没有这种学历，基本上是学徒出身，造成大量的中医师失去了行医资格"
-Medical licensing law mandates only candidates with at least 4 years of formal academic training in medicine may apply for the licensing examination. However, a large percentage of TCM practitioners have no such formal academic background having been instructed completely through apprenticeship, thus leading to a large number of TCM doctors with no license to legally practice medicine.
"中医师临床用的自制药是每个中医师都必须掌握的技术，而对中医师自配药的限制，约束了中医师治病的手脚."
-The clinical preparation of prescriptions is a basic skill that all TCM doctors are required to master. External limitations on these prescriptions handcuffs practitioners.

And on the letter continues at some length. You can find a full copy of the letter in the original Chinese here http://bbs.puretcm.com/viewthread.php?tid=756.

As a member of the Chinese medical community and a product of its problematic educational system, I have confounded myself over these points for some time now. Like many others TCM practicitions, I believe that if Chinese medicine is to survive intact, it will take a considerable effort on behalf of the current younger generation to recognize a modern TCM education for what it is, and essentially, discard it in favor of something more substantial. One must question everything presented in the classroom, and seek answers in places often overlooked or discarded as too problematic. Like most everything in this era of quick-fixes, the modern TCM educational system offers us a simplified and standardized approach to questions that run much deeper than most students, or professors for that matter, are willing to go.

The situation, though, is not without hope. The whisperings of a domestic revival in the true arts of China are beginning to be heard. At the forefront of this movement are a host of seasoned veterans with knowledge to pass on as well as a handful of young practitioners who are delving deep into the Classics and proving them more relevant than ever to our modern pandemic of afflictions. The adoption of many Eastern philosphies of wellness in Western countries and its subsequent reimportation to Asia is also playing a role in clearing the dust from the storehouse of cultural know-how. Western students are bringing a much needed injection of genuine interest and respect for these paths that makes them seem all the more valuable in the eyes of many Chinese.

This blog will be my own small contribution to the development of TCM in the modern era. It will chronicle some of the difficulties and triumphs as I forge ahead on my own path in the TCM world of mainland China. While entirely subject to my own prejudices and shortcomings, with any luck my opinions contained here will challenge textbook explanations, fill in some spaces in theoretical framework and practical application as well as provide a venue for discussion to further the natural arts of healing and understanding.

2008年八月廿四