Академический Документы
Профессиональный Документы
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N.V.N. Edition
Translated from the French by Edward S. Garbacz, MD With Additional Commentary by Sean Christiaan Marshall, D. Ac.
Jung Tao School of Classical Chinese Medicine - 2002
7.
Understanding the meaning of the Dao of Acupuncture is like becoming liberated from doubt, like awakening from a drunken state, like coming clearly out of a sleep. In contrast, those who do not understand the Dao remain mute before their patient; and mistakenly understanding, sufficiently enough, the cause of the evolution of the disease, he gropes along in the darkness in order to attempt discovering a solution... .
no 8/9.
INTRODUCTION
We complete, finally, Volume II of the Lingshu which has demanded of us a sum of efforts and comprehension of several years. It was initially planned to split this work up into two volumes, but the abundance of commentaries has lead us to publish it in three works. This very old book, this cult book, has been subject over the centuries to numerous translations, transcriptions, discussions and analyses. There exists then inevitable archaisms and inherent linguistic difficulties in the evolution of the language, unrecognizable social and literary habits, customs/habits/type , climate, the pathology and philosophy of this time. We must appreciate the exact measure, placing it constantly in the context of the era; we must nullify the traps of what is left unsaid, allusions, hierarchical terms, obscure analogies and maxim phrases . In this manner, up to the present, none of the modern translations of the Lingshu, also deserving fut-elle, have statisfied us. One demands on the part of the translator to be an eminent historian and literary sinologist, and, above all, a grounded/grassroots/practical acupuncturist de terrain, rich in his own experience and an acupuncturist of culture/knowledge saturated with the great Chinese medical classics. Indeed, our work is not perfect; it presents/sets out again more or less, of uncertainties; most certainly we hope that physicians of the next generation will be able to improve it. But present-day physicians will be able to draw interesting teachings on the pathophysiology and therapeutics of Acupuncture/Moxabustion, to fill the gaps, to perfect the practice of acupuncture and to be urged to carry out research work according to the criteria of modern science, entirely respecting Daoist mind/ spirit/ thinking.
This 2nd volume consists of Books IV and V. Book IV consists of 7 chapters and develops various themes:
10.
_ Etiology, classification, therapeutics and prognostics of the extravagant and capricious syndromes of certain diseases of Yin and Yang nature (Yin Madnesses and Yang Madnesses). _ Diseases of Heat etiology and treatment: hemiplegia, quadriplegia, cutaneous pain, facial edema, limb spasms, ostealgia, deafness, bruxism, headaches, epistaxis, etc. _ Diseases of Afflux etiology and treatment: 9 types of cardialgia, 9 types of headache, deafness and buzzing, spinal pain, lumbalgias, gonalgias, nuchal pain, tonsillitis, epistaxis, disorders of behavior, disorders of diuresis, abdominal pains, limb flaccidity, etc. _ Erratic pain and cyclic pain and the therapeutic techniques of Top-Bottom and Left/Right-Right/Left. _ Singular diseases and treatment: yawning, hiccups, grief, trembling from cold, eructations, sneezing, muscular laxity, passage of tears, sialorrhea, sighing, tinnitus, biting the tongue ... .
_ Attitudes of the sage: men of state and physicians. Favorable and unfavorable problems of Yin and Yang and problems of attachment to life and fear of death. _ Fundamental characteristics of the energy: ^6 Energies, Jing (quintessence), Qi (energy), Xin (interstitial liquids), Ye (viscous liquids), Xue (blood) and Mai (vessels). _ Studies of the 4 Seas and their transmittable points: Sea of Cereal Water, Sea of the Jingmai, Sea of Energy and Sea of Marrow. _ Five disorders of the energy and unfavorable phenomena of Yin and Yang. Method of conduction of the energy (Dao Qi). _ Etiology, classification, diagnosis and therapy of the intumescences. _ Five facial zones (Wu Guan) and the constant principles of examination of the complexions/colors. _ Treatment according to the build of the individual. _ Blood stasis and treatment. _ Properties of the pure and impure energy of the human organism. _ Solar and lunar movements in the determination of emptiness and fullness, growth and decline, of Yin and Yang. _ Acupuncture and the evolution of the disease according to the chains of production and destruction of the law of the 5 Movements. _ Analysis of the different types of dreams and treatment. _ Conformity of the energy of the body with that of the day divided into 4 seasonal periods and therapeutic principles of the Wu Shu (5 Shu antique points). _ Mechanism of triggering of disease as a function of the state of the musculoskeletal and epidermo-dermal systems. _ Favorable and unfavorable states of the 5 organs/6 bowels as a function of anatomic aspects (morphology, disposition ...). _ Basic principles of medical reasoning of Acupuncture and Moxabustion.
11.
In this way, present-day acupuncture physicians saturated with scientific knowledge must work out of these ancient texts, knowing how with respect the archaic and magical aspects which saturate ipso facto Chinese thought of more than 3000 years beforehand and in drawing from new elements in order to, paradoxically, modernize the practice of their art. Scientific thinking and fundamental Chinese thinking are not contradictory. They are the perfect representation of the duality of the world. They are like Yin and Yang; they are at once opposed, indivisible and complementary. To possess these two modes of thought, these two types of medical knowledge, is to pose, more than every other, a serene, critical and universal look at medicine. The reading of the Lingshu remains one of the first acts to accomplish in order to reach there.
no 12/13.
Book IV
Book IV consists of 7 chapters: Chapter 22: Yin Madness and Yang Madness (Dian Kuang) Chapter 23: Diseases of Heat (Re Bing) Chapter 24: Diseases of Afflux (Jue Bing) Chapter 25: Causes of Disease (Bing Ben) Chapter 26: Various Diseases (Za Bing) Chapter 27: Erratic and Cyclic Pains (Zhou Bi) Chapter 28: Oral Questions (Kou Wen)
no 14/15.
CHAPTER XXII
Yin Madnesses and Yang Madnesses (Dian Kuang)
Chapter 22 of the Lingshu is devoted to the study of the Yin-Madnesses and the Yang-Madnesses (Dian Kuang). Pathological approaches to these illnesses are grouped together in several phases from which the syndromes are classified and treated according to the principle of choice of the channels as a function of the 4 seasons. The causes of Calm Madnesses and Agitated Madnesses are not beyond the scope of sadness, chagrin, fear, fright, worry, excessive joy, orientation of the essential energy toward insufficiency, digestive disturbance... and treatment must be based on deep analysis of the syndromes. This chapter of the Lingshu does not deal with mental disorders. The term Dian Kuang does not in any way signify manic-depressive psychoses, but madnesses in the sense of designating the excessive and capricious prodromes of some illnesses of Yin nature and Yang nature and, particularly, illnesses called Contrary Afflux (Jue Ni). This chapter consists of 22 paragraphs.
PARAGRAPH 1
The ocular angle split toward the external part of the cheekbone is Wai Zi (external canthus of the eye), and the angle directed toward the side of the nose, Wei Zi (internal canthus of the eye). The upper eyelid belongs to Wai Zi, and the lower eyelid, to Nei Zi. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
16.
The energy of Taiyin controls the maintenance of the canthii of the eyes, that of Taiyang involves the upper eyelid and that of the Yangming, the lower eyelid. Therefore, to speak of the upper eyelid belonging to Wai Zi and the lower eyelid belonging to Nei Zi is to speak of the energy of Taiyang and Yangming also controlling the canthii of the eye. The Hand Taiyin (Lu) responds to Heaven and Foot Taiyin (Bl), to Earth. Taiyang controls the opening (of the eye) and Yangming, the closing. The energy of Heaven and that of Earth lights the day and darkens the night. Such is the response of man to day and night, to the opening and closing, of Heaven and Earth. During one respiration, the opening and closing are intended to respond to the expiratory movement, inspiratory movement and the clepsydra. Is the energy of opening and that of closing are not evident, Yin energy and Yang energy are without distinction, Shen (mental) and Chi (will) lose their connection in growing dark, and transform into Dian Kuang (Yin Madnesses and Yang Madnesses). This is why treatment of these illnesses especially consists of needling the points of the Taiyang, Taiyin and Yangming channels of the foot and hand.
II - Ma Shi clarifies:
Paragraph 1 demonstrates the external energetic morphology of the eye because the eyes are the sites of manifestaion of the Jing Shen (pure energy and mental) of the organs and bowels and because examination of the Shen at the level of the eyes constitutes the first diagnostic action in the illnesses called Yin Madnesses/Yang Madnesses.
III - N.V.N.: The external energetic morphology of the eye can be diagrammed in the following fashion: 17.
PARAGRAPH 2
At its start, the Dian illness (Yin Madnesses) manifests by the following signs: _ sadness _ feeling of heaviness of the head and headaches _ gaze fixed toward the top and redness of the eyes. At a more advanced degree: _ anxiety, restlessness Examine well Tian Ding (1) and needle the points belonging to the Taiyang, Yangming and Taiyin; stop treatment as soon as the complexion changes. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
The Dian illnesses (Yin Madnesses) and Kuang illnesses (Yang Madnesses) are due to an obstruction of the Yin and Yang energy of the bottom, causing an afflux toward the top. Shaoyin is a priori (innate) Water-Fire and Taiyin is a posteriori (acquired) Earth... . The Water-Fire energy of Heaven and Earth must be balanced above and down below; the opposite is synonymous with illness.
1. Frontal area (forehead).
The Jing (quintessence) of Water is the Chi (will) and the Jing of Fire is the Shen 18. (mental). When the Shen and Chi are not at ease, they manifest as sadness. Fixed upward gaze and redness of the eyes are phenomena due to an afflux of the energy of the heart. Anxiety, restlessness is the result of the contrary flow (afflux- Jue Ni) of the energy encroaching on Taiyang and Yangming and also on Jueyin (XB). To examine Tian Ding is to observe the complexion (Heaven) located in the inter-eyebrow space. The upper half of the body is Yang and is controlled by the Hand Taiyin (Lu) and Hand Yangming (LI). This is why needling these two channels permits purifying the energy of this part of the body; and needling the Hand Taiyang (SI) permits cooling the Jueyin (XB) to suppress the anxiety. The heart controls the blood. As a result, during needling, the change in color of the blood (complexion) is a sign attesting that the Shen Qi (mental energy) is purified, the determining condition of cure of the Dian illnesses (Calm Madnesses).
II - Ma Shi clarifies:
From this paragraph to Paragraph 8, study is centered on the classification of the Dian illnesses whose beginning signs are demonstrated in Paragraphs 2, 3 and 4. The Hand Taiyang (SI), Hand Yangming (LI) and Hand Taiyin (Lu) are the 3 specific channels in the treatment of the beginning signs of the Dian illnesses (Yin Madnesses).
III - N.V.N.: The points of these 3 channels recommended by Zhang Jing Yue (1563-1640 A.D.) are: 1 - Hand Taiyang (SI): _ Zhizheng (SI 7), Luo point (needle depth 0.3 cun, moxa 3 times) and Xiaohai (SI 8), He point (needle depth 0.2 cun, moxa 3 times) 2 - Hand Yangming (St): _ Pianli (LI 6), Luo point (needle depth 0.5 cun, moxa 3 times) and Wenliu (LI 7), Xi point (needle depth 0.3 cun, moxa 3 times). 3 - Hand Taiyin (Lu): _ Taiyuan (Lu 9), Luo point (needle depth 0.2 cun, moxa 3 times) and Lieque (Lu 7), Luo point (needle depth 0.2 cun, moxa 7 times).
PARAGRAPH 3
signs
19.
At its start, the Dian illness (Yin madnesses) manifests by such as: _ deviation of the mouth and moaning _ dyspnea _ palpitations and fear.
Examine the Hand Yangming (LI) and Hand Taiyang (SI) and needle the left side if the right side is tense or the right side if the left is tense; stop treatment as soon as the complexion changes.
10
With deviation of the mouth accompanied by moaning or dyspnea, palpitations and fear... one must needle the Hand Yanging (LI) and Hand Taiyang (SI). The tension is not pathologic if it is bilateral; it becomes so when it manifests on a single side. This is why one needles the side opposite the affected side and interrupts the needling upon change of the complexion.
II - Zhang Shi states:
This paragraph demonstrates the mechanism of obstruction/afflux of the energy, causing disturbances of opening and closing , determinant factors of the Dian illnesses. Tears, cries and fear originate from disturbances of the energy of Taiyang. Dyspnea is due to the impurity of the energy of Yangming. Yet, the energy of Taiyang governs opening and that of Yangming, closing. This is why the above-cited pathologic signs originate from these two channels. Ma Men Zung states: The Hand Taiyang (SI) constitutes the external system of the heart and the Hand Yangming (LI), the external system of the lung. As a result, tears and fear originate from the heart and dyspnea, from the lung. Tears, anxiety, dyspnea therefore result from the impurity of the energy of the opening and closing. In this case, the illness localizing at the exterior goes to reach the interior. (2)
III - N.V.N.: The notions of closing-opening-hinge have been many a time demonstrated and described in our works since 1965. Their complete assimilation permits the appreciation of the permanent mobility of the energy of the 3 Yang, Taiyang, Shaoyang, Yangming, from which all energetic pathology result.
PARAGRAPH 4
20.
At its start, the Dian illness (Yin madnesses) manifest in the first place by stiffness of the body, then by spinal pain. Needle the Foot Taiyang (Bl), Foot Yangming (St), Foot Taiyin (Sp) and Hand Taiyang (SI); interrupt the needling as soon as the complexion changes.
11
Spinal pain comes from the encroachment of the cold energy on Earth. This is why one must needle the Foot Taiyang (Bl), Foot Yangming (St) and Foot Taiyin (Sp). According to Liang Zhen: The previous 3 paragraphs (2, 3, 4) only broach the starting phase of Jue Ni (Obstruction/Contrary Afflux) at the level of the Taiyin, Taiyang and Yangming channels, that is to say, at the level of the energetic layers and not the anatomic layers. The illnesses still within the energetic layers can easily be purified and dispersed. They become incurable from their penetration into the anatomic layers. As a result, the Dian illnesses localizing in the bones, muscles... are usually fatal. (3) The good physician treats the prodromes, while the poor physician waits until illnesses are declared before applying therapy.
II - N.V.N.: a - Translations into Western language have completely changed the spirit of the text. Here, it concerns stiffness of the body with spinal pain due to an obstruction/afflux of the energy and not epilepsy (!). b - The points recommended by Zhang Jing Yue are: 1 - Foot Taiyang (Bl): Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61) and Jinmen (Bl 63). 2 - Foot Yangming (St): Sanli (St 36) and Jiexi (St 41). 3 - Foot Taiyin (Sp): Yinbai (Sp 1) and Gongsun (Sp 4). 4 - Hand Yangming (LI): Pianli (LI 6) and Wenliu (LI 7).
PARAGRAPH 5
In the struggle against the Dian illnesses, the physician is advised to be at the bedside of the patient often in order to observe the evolution of the disease and determine the channel to needle. 21. During the crisis, one must carefully study the channel affected and practice bleeding. The blood conserved in a gourd will coagulate by the next crisis; if not, apply 20 moxas to the coccyx. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: This paragraph shows the therapy of the Dian iillnesses according to the principle of distinction of the water energy and fire energy, of the energy of Heaven and energy of Earth. The Fire of Taiyang is the Sun. The Water of Taiyin is the Earth. During bleeding to diagnostic and therapeutic ends, it is recommended to conserve the blood in a container made of the skin of gourd and observe the phenoenon of coagulation. Coagulation of blood comes from the passage of the energy of the afflux toward the Hand Taiyin (Lu) and Hand Taiyang (SI) conforming to the sensitivity of the energy of the Taiyang within the natural world.
3. This phrase corroborates our opinion on the misinterpretation of the old translation of the term Dian Kuang.
12
In contrast, non-coagulation results from the deep penetration of the energy of the afflux into Earth-Water. This is why one must apply 20 moxas to Changqiang (GV 1). The Neijing said: When the vessels are retained at the bottom, one must apply moxabustion. In our case, the illness is maintained at the level of 2 channels, Foot Taiyang (Bl) and Foot Taiyin (Sp). One must then apply moxabustion at the level of the coccyx, site of reunion of the 3 vessels: Taiyang (Bl), Taiyin (Sp) and Dumai (GV),
Figure 2: Changqiang (GV 1): reunion-meeting point of the 4 vessels (CV, GV, Taiyang, Taiyin).
PARAGRAPH 6
Dian of the bones (Gu Dian) is an ailment deeply reaching the bones and marrows. The clinical signs are: _ blockage and swelling of the Shu (kinetic) points and of the areas of distribution of the flesh, etc... _ weight loss _ sweating and anxiety _ frothy vomiting _ flowing out of the energy toward the bottom. The illness is incurable.
22.
13
Here, it concerns illness of the Foot Shaoyin (Ki) contaminating the Hand Shaoyin (He). Frothy vomiting is due to the ascent of the energy toward the top, rising up to the exterior. The kidney is the source organ of the production of the vital energy. The energy flowing out toward the bottom belongs to the Shaoyin. Therefore, one witnesses a phenomenon of concomitant escape of Yin and Yang, from the bottom and top. The illness is therefore incurable and the text does not propose treatment. This paragraph and the following two deal with material illnesses (having form: Xing), that is to say, illnesses at the level of the bones and muscles. This is why one does not speak of Yin and Yang of Tai (Yang) and of Shao (Yin).
PARAGRAPH 7
Dian of the muscles (Jin Dian) is an ailment which deeply reaches the muscles and is characterized by such signs as: _ asthenia _ spasm _ rapid and changing (Da) pulse. It is advised to needle Dazhu (Bl 11) belonging to the great vesselchannel of the neck. If these signs are accompanied by frothy vomiting and flowing out of the energy toward the bottom, the illness is incurable.
The pulse is always changing (Da) in Jin Dian. 23. The Foot Taiyang (Bl) maintains the muscles in water. This is why one needles Danzhu (Bl 11), located in the 1st intercostal space, 1.5 cun to the side of the 1st dorsal vertebral apophysis, to 0.5 cun depth and apply 7 moxas. Vomiting and flowing out of the energy toward the bottom... denotes that illnesses of the organs/bowels are material illnesses having escape of the energy as a consequence.
II - N.V.N.:
Danzhu (Bl 11), reunion point of the bones is not only specific on the treatment of bony ailments, but also in the treatment of neuro-psychiatric illnesses, particularly psychasthenia.
14
Figure 3: Dazhu (Bl 11): reunion-meeting point of 3 vessels: Foot Taiyang, Hand Taiyang, Hand Shaoyang.
PARAGRAPH 8
Dian of the vessels (Mai Dian) is characterized by a sudden fall. The vessels at the level of the 4 limbs are edematous and lax and the pulse is full. One must urgently practice bleeding by acupuncture. If the pulse is not full, one must perform moxabustion at the Taiyang located at the neck, at Daimai (GB 26), 3 cun from the lumbar vertebrae and at the dorsal Shu points of the region of the distribution of the flesh.
24.
If these signs are accompanied by frothy vomiting and flowing out of the energy toward the bottom, the illness is curable.
15
16
PARAGRAPH 9
Kuang The rapid evolution of Dian (Yin madness) illness, like that of (Yang madness), is fatal, therefore incurable.
PARAGRAPH 10
26.
Kuang (Yang madness) illness starts first with sadness, then forgetfulness, anger and fear. Everthing comes from preoccupation and hunger. Treatment consists of needling the Hand Taiyin (Lu) and Hand Yangming (LI) until the change of color of the blood and also the Foot Taiyin (Sp) and Foot Yangming (St).
From this paragraph, the study is centered on Kuang illnesses organized into emptiness and fullness types. ... first with sadness because the illness is secondary to the insufficiency of the kidney. ... then forgetfulness and fear because the Shen-Chi (mental/will) is in emptiness. ... anger comes from the emptiness of the liver with afflux of Yang (of the liver). Liver-Wood and Shen-Chi are created by the kidney. This Kuang illness always originates, on the one hand, from a state of mind in the grip of obsession qui anxiety or disturbance until moral suffering, and, other the hand, from a state of starvation. Worries, sadness... injure the lung and hunger slows the production of Cereal Jing (Gu Jing), hence insufficiency of the Jing of the Kidney. In this case, the insufficiency of Yin causes the fullness of Yang, determining factor of Kuang. One must needle in dispersion the Hand Taiyin (Lu) and Hand Yangming (LI) to combat
17
blood stasis and exterminate the afflux phenomenon. The two channels, Foot Taiyin (Sp) and Foot Yangming (St), must be needled in tonification to augment the production of the Cereal Jing with the goal of maintaining the energy of the kidney. In the majority of cases, the Dian illnesses are due to the fullness of Yin, and the Kuang illnesses, to the emptiness of Yin. Bian Que (alias Qin Yue Ren-500 A.D.) said: The concomitance of Yin (Zhong Yin) manifests by Dian, and the comcomitance of Yang, by Kuang. These phenomena of concomitance are due to the emptiness of Yin with fullness of Yang or from the emptiness of Yang with fullness of Yin.. This means to say that if Yin is in emptiness, Yang is in fullness; one then must disperse Yang and tonify Yin. In pratice, one must always recall that the Jing Qi (Yin Quintessence) is produced by the Yangming (St) and that the Yang Qi (Yang energy) has its source in Yin. Such is one of the aspects of the reciprocal relationship of Yin and Yang. Understanding the antagonistic and complementary aspects of these 2 phenomena (Yin and Yang) permits advancing onto the true path of medicine. 27. II - N.V.N.:
We recall again the teaching of Zhang Jing Yue: The insufficiency of Shen (Mental) is the cause of anxiety; preoccupation and disturbance of the Hun (vegetative soul) cause immoderate ambitions. The Jing (quintessence) then is found in shortage. Chi (will) in a disturbed state is the cause of forgetfulness. Invasion of the energy of the liver on the spleen causes anger and fits of rage. The insufficiency of blood is the cause of fear. All these signs originate from anxiety and hunger, which injures the energy of the organs. It is then advised to needle: _ Taiyuan (Lu 9) and Lieque (Lu 7) of the Hand Taiyin (Lu) _ Pianli (LI 6) and Wenliu (LI 7) of the Hand Yangming (LI) _ Yinbai (Sp 1) and Gongsun (Sp 4) of the Foot Taiyin (Sp) _ Sanli (St 36) and Jiexi (St 41) of the Foot Yangming (St) and leave the needles in place until the change of the complexion.
PARAGRAPH 11
In the Kuang illness starting with such signs as _ insomnia and anorexia _ self-satisfaction and certainty noble _ screaming and insults _ agitation day and night,
of
being
skillful,
intelligent
and
one must needle the Hand Yangming (LI), Hand Taiyang (SI) and Hand Taiyin (Lu). Moreover, one must examine the sublingual area of the neck and the Hand Shaoyin (He) in order to perform needling in the event of fullness.
18
PARAGRAPH 12
Kuang characterized by: _ logorrhea ( 5 ) _ fear _ groundless laughter _ obsession with music and singing _ erring ways, bad habits is due to fright. Hand
29.
One must needle the Hand Yangming (LI), Hand Taiyang (SI) and Taiyin (Lu).
4. This point has a vessel which goes to the base of the tongue. 5. Pathologically incoherent, repetitious speech; incessant or compulsive talkativeness.
19
Here, Kuang illness first manifests at the kidney, then reaches the heart, triggering fear. Yin in an empty state and Yang in a full state becomes indicated by logorrhea and panic. The classics stated: Fullness of the enery of the heart becomes characterized by logorrhea, and emptiness, by sadness. In the event of fullness, Xin-Chi (heart-will) is compressed. This is why the individual likes to sing and listen to music to become calm. The combined disturbances of Shen and Chi direct the individual to run aimlessly. Treatment consists of needling the Hand Taiyang (SI) to purify the heart in a state of fullness and the Hand Yangming (LI) and Hand Taiyin (Lu) to maintain the kidney in a state of emptiness.
PARAGRAPH 13
Kuang characterized by hallucinations
is due to the loss of the energy. One must needle the Hand Taiyang (SI), Hand Yangming (LI), Hand Taiyin (Lu) and Foot Taiyin (Sp) and the 2 sides of the chin. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: Here, Kuang is due to the insufficiency of the energy of the kidney causing the emptiness of the energy of the heart. Above and down below, Fire (heart) energy and Water (kidney) energy support one another and become tempered. This is why the insufficiency of the kidney energy provokes the emptiness of the heart with appearance of the above-cited signs. It is recommended to needle the points of the Hand Taiyang (SI), Hand Taiyin (Lu) and Hand Yangming (LI) to purify hallucinations and to tonify Foot Taiyin (Sp) and Foot Yangming (St) to augment the production of the cereal energy (Gu Qi) because the 5 organs need the energy of Yangming to develop their functions. 30. The kidney is a water organ. It receives the Jing Qi (pure energy; quintessence) of the 5 organs (Figure 5). The energy (6) forms from Jing (quintessence). This classic has mentioned: The energy of the stomach ascends toward the top and projects into the lung. One part of this energy, via the pharyngeal route, rises up toward the head. On the one hand, it becomes exteriorized at the orifices (5 sense organs) and, on the other hand, it reaches the 2 sides of the chin up to the head. Here, our masters of old did not speak of the Foot Yangming (St), but mentioned the 2 sides of the chin to designate the facial portion of the Foot Yangming linked to the Shangjiao (UJ) and Zhongjiao (MJ).
6. Here, this indicates essential or vital energy.
20
II - N.V.N.: The explanation of Zhang Shi allows us to understand the important role of reception of the Jing of the 5 organs at the level of the kidney (Figure 5).
21
PARAGRAPH 14
Kuang manifesting by such signs as:
31.
_ bulimia _ visual hallucinations _ silent laughing come from elation. One must needle first the Foot Taiyin (Sp), Foot Taiyang (Bl) and Foot Yangming (St) and then secondly the Hand Taiyin (Lu), Hand Taiyang (SI) and Hand Yangming (LI). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
1 - Excessive joy injures the Xin (heart) and Chi (will) causing the Xu Kuang (Kuang in a state of emptiness). Bulimia is due to emptiness of the energy of the heart and visual hallucinations, to the emptiness of Shen Qi (mental energy). 2 - During penetration of nutritional energy into the stomach, the impure energy reaches the heart. This is why one must first tonify the Foot Taiyin (Sp) and Foot Yangming (St) to maintain the Jing (quintessence) of the heart and the Foot Taiyang (Bl) to activate the production of organic liquid in order to temper the Shen Qi; then secondly needle the Hand Taiyang (SI) and Hand Yangming (LI) to disseminate the Kuang syndrome. 3 - In illnesses caused by the Foot Shaoyin (Ki), one must first needle the channels of the foot, and in the illnesses caused by the Hand Shaoyin (He), one must do the opposite. This is a marvelously effective method to reestablish the exchange of the energy of the top and bottom.
II - N.V.N.: We have also noted in the Nanjing: During escaping of Yang, the individual perceives demons, and during escaping of Yin, vision is disturbed.
PARAGRAPH 15
If Kuang is not as serious as in the previous case, it is advised to needle the 2 Ququan (Li 8) (left and right) at the side of an artery. If they are in fullness, one must make them bleed by acupuncture and cure is virtually instantaneous. If this is not the case, one must apply 20 moxas to the coccyx.
22
32.
Here it concerns a general study of Kuang during its first manifestations, being able to be cured by needling the point Ququan (Li 8). In summary, the Kuang illness originates from emptiness or fullness of the energy of the heart. In contrast, if it is due to the emptiness or fullness of the energy of the kidney, Water reaches Wood then arrives at Fire. This is why, at the starting phase of the Kuang illness without signs of sadness, fear, anger, visual hallucinations... cure can be obtained on the field by needling the poing Ququan (Li 8) because the disturbance manifests at the level of the energy of the liver without touching the Shen Qi. If cure is slowed, the application of 20 moxas to the coccyx is recommended to eliminate the pathogenic energy of the liver by the lower route.
PARAGRAPH 16
In Feng Ni (contrary afflux of wind) manifesting by such signs as _ sudden edema of the 4 limbs _ trembling with cold _ anxiety during hunger _ displeasure during satiety
one must needle the Hand Taiyin (Lu) and its external and internal relationships, the Foot Shaoyin (Ki) and Foot Yangming (St). If the individual feels cold in the muscles, one must needle the Y i n g - s t r e a m points, and if he feels cold in the bones, the Jing-well and Jingriver p o i n t s . EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
Jue (afflux) is a massive arrival of energy, triggering factor of the Dian illness. 1 - The kidney is a water organ and wind is a force susceptible to displace the mass of water in the form of waves. As a result, Feng Ni (contrary afflux of wind) implies a massive attack of wind provoking a contrary flow (afflux/Jue Ni) of the water energy of the Foot Shaoyin (Ki), hence sudden edema of the 4 limbs with shivers. 2 -Wind injures kidney water and causes emptiness of the heart energy (according ot he inhibitory law of the 5 movements). This is why the subject is anxious and annoyed when hungry. If perverse Wind-Wood injures the Center-Earth (spleen and stomach), the individual is usually agitated and angered when his appetite is satisfied. 33. 3 - To needle the system of external-internal, Yin-Yang relationship of the Hand Taiyin (Lu) is to liberate the perverse wind, and to needle the Foot Shaoyin (Ki) and Foot Yangming (St) is to harmonize the contrary afflux (Ni), thereby warming up the cooled energy.
23
4 - To speak of cold of the flesh is to explain that the cold energy has reached the dermal system. Therefore, one must needle the Ying-Fire points in order to warm up the flesh and muscles conforming to the principle according to which Earth (spleen) governs heat and fire (heart) maintains Earth. The term cold in the bones implies that the perverse energy is still found within the water organ (kidney). One then must needle the Jing-well point to disperse (7) the perverse energy. 5 - Chu Ma Rong has said: To needle the external and internal realationship of the Hand Taiyin (Lu) is to perform a provoked sweat, as is made by Herba Ephedrae (Ma Huang), with the purpose of aerating the sweat glands, associated with Semen Armeniaca amarae (Xingren) to maintain Lung-Metal, because the aeration permits the energy of the interior to diffuse to the exterior.
PARAGRAPH 17
In Jue Ni (contrary afflux) with such signs as: _ _ _ _ _ cold feet sensation of bursting of the thorax lancinating pain of the abdomen annoyance and anorexia large or small, steady or rapid pulse,
if the body is hot, one must needle the Foot Shaoyin (Ki) if the body is cool, one must needle the Foot Yangming (St). one In the event of coolness, one must tonify, and in the event of heat, must disperse.
This paragraph explains contrary afflux (Jue Ni) of the energy of the Foot Shaoyin (Ki). 1 - The kidney organ sends out a large vessel which exteriorizes at the point Qijie (other name Qichong-St 30). This vessel descends, runs alongside the inner thigh, arrives at the knee, reaches the internal malleolus and penetrates into the sole of the foot. For this reason, at the time of the contrary afflux of the energy of the kidney, the soles of the feet are icy cold. 2 - Sensation of bursting of the thorax... is due to a gathering of the energy which, from the abdomen, affluxes toward the heart and thorax. 34. 3 - The basic substance of the blood vessels come from the kidney... . The large or small, regular or rapid pulse results from the engorgement of the Jingmai following an contrary afflux of the energy of the kidney.
24
4 - The kidney is the source organ of the vital energy. The body is warm because the phenomenon called fullness-contrary afflux intervenes; one must disperse Foot Shaoyin (Ki). In contrast, the body is cold because the phenomenon called emptiness-contrary afflux intervenes; one must tonify Foot Yangming (St) to maintain the Jing (quintessence) of the kidney organ. 5 - The previous Paragraph 16 demonstrated the syndrome of afflux of external origin (Jue); this one deals with the syndrome of afflux of internal origin. These affluxes are the primary causes of the Dian illnesses. This is why the treatment of the Jue syndromes (afflux) constitutes a preventive method of these illnesses called Yin Madnesses (Dian).
II - N.V.N.: 1 - Regarding the choice of points, Zhang Jing Yue recommends: _ Yongquan (Ki 1) and Rangu (Ki 2) of the Foot Shaoyin (Ki) and _ Lidui (St 45) and Neiting (St 44) of the Foot Yangming (St). These points are specific in the treatment of Jue Ni (contrary afflux). 2 - The large vessel (cited above by Zhang Shi), which exteriorizes at the point Qichong (St 30) and reaches the inner thigh to the sole of the foot, is the descending branch of the Chongmai (Firgure 6).
25
PARAGRAPH 18
In Jue Ni (contrary afflux) characterized by such signs as: _ _ _ swelling and abdominal fullness boborygmi thoracic fullness with respiratory
35.
difficulty,
one must needle the sub-thoracic points, at the two hypochondria, at the place where the cough responds to pressure of the hand, and the dorsal Shu (Bei Shu) points at the place where the patient experiences relief with the pressure of the fingers.
This paragrph explains the illness caused by Jue Ni at the level of Taiyin and Yangming. Swelling and abdominal fullness indicate Jue Ni at the level of the Foot Taiyin (Sp) and Foot Yangming (St). Boborygmi indicates the presence of Jue Ni at the level of the Hand Yangming (LI). Thoracic fullness with difficulty breathing explains the evolution of Jue Ni toward the Hand Taiyin (Lu). The points located at the two hypochondria are none other than Zhongfu (Lu 1) and Yunmen (Lu 2) of the Hand Taiyin (Lu).
II - N.V.N.: The sub-thoracic points mentioned, at the two hypochondria, do not belong to the Hand Taiyin (Lu) but to the Foot Jueyin (Li). According to Zhang Jing Yue, it concerns Zhangmen (Li 13) and Qimen (Li 14). Ma Shi also had spoken of these.
Zhangmen (Li 13) is located below the tip of the 11th rib. This is the Mu point of the spleen and reunion point of the energy of the organs. The Nanjing states: The energy of the 5 organs reunites at Zhangmen (Li 13). Ailments of the organs are treated with this point. The Dacheng adds: This point treats boborygmi, swelling/abdominal fullness... . Qimen (Li 14) is located 3.5 cun to the side of Juque (CV 14), in the 6th intercostal space (Figure 7).
26
36.
Figure 7: Localization of Zhangmen (Li 13), Qimen (Li 14), Dabao (Sp 21) and Riyue (GB 24).
PARAGRAPH 19
When the interior is obstructed, the illness manifests by oligoanuria. One must needle the Foot Taiyang (Bl) and Foot Shaoyin (Ki), as well as the point at the coccyx, with long needles. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
In this paragraph, the energy of Jue Ni does not gather at the top, but at the bottom, hence oligo-anuria. One must needle the Foot Shaoyin (Ki) and Foot Taiyang (Bl) and the point located at the coccyx in order to disseminate the afflux, thereby favoring diuresis.
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II - N.V.N.: 37. The points favoring diuresis recommended by Zhang Jing Yue are: _ Yongquan (Ki 1) and Jiaoxin (Ki 8) of the Foot Shaoyin (Ki) and _ Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61), Jinmen (Bl 63) of Foot Taiyang (Bl). The point located at the coccyx is Changqiang (GV 1). (8)
PARAGRAPH 20
In the Jue Ni syndromes, one must needle the Taiyin and Jueyin. In serious cases, it is advised to add the Shaoyin and Yangming. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
This paragraph justifies the treatment of the Jue Ni syndromes. Because, when the energy of the afflux of the energy of the Foot Shaoyin (Ki) arrives in abundance at the heart to trigger the Dian Kuang (Yin Madnesses and Yang Madnesses), one must needle the Jueyin because the water energy maintains Liver-Wood and, from there, it reaches Heart-Fire. This is why, at the start of the illness, one must needle Ququan (Li 8) (9). If the case is serious, one must disperse the Foot Shaoyin (Ki).
II - Ma Shi states:
In the Jue Ni syndromes, it is advised to needle Foot Taiyin (Sp) and Foot Jueyin (Li). In serious cases, add Foot Shaoyin (Ki) and Foot Yangming (St) (Ex: Fuliu- Ki 7, Jiexi- St 41, etc.).
PARAGRAPH 21
In syndromes of such signs as: insufficiency of the energy characterized by
_ chills _ shortness of breath and cracked voice _ arthralgia _ sensation of heaviness of the body _ fatigue of the limbs with trouble moving, one must tonify the Foot Shaoyin (Ki).
8. All of these points are described in MTC- NVN Edition. 9. Ququan (Li 8) is the He point of the Foot Jueyin (Li) which responds to water.
28
38.
I - Zhang Shi explains: This paragraph concerns the insufficiency syndrome of the energy of the Foot Shaoyin (Ki), determining factor of the triggering of the illness called Xu Ni (Emptiness-Contrary Afflux). The heart governs speech and the lung, the voice. But they become manifest due to the active energy (Dong Qi) (10) of the kidney. As a result, in the insufficiency of the energy of the kidney, speech is no longer possesses its connected nature (11). In this case, it is advised to urgently tonify the Foot Shaoyin (Ki), that is to say, the root energy (source energy). II - N.V.N.: According to Zhang Jing Yue, this illness is due to emptiness of the Jing (quintessence) of the kidney, causing a contrary flow (Jue Ni), hence the necessity to tonify the Foot Shaoyin (Ki).
PARAGRAPH 22
Short respiration is synonymous with a more or less prolonged suspension of respiration (apnea). It is gasping for breath with poorer effort. One must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo (blood capillaries). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
This paragraph justifies the reascent of the energy in a state of loss, susceptible to triggering the syndrome called Emptiness-Yang Madnesses (Xu Kuang), while the previous one demonstrates the syndrome of loss of the energy of the Foot Shaoyin (Ki), that is to say, the syndrome of insufficiency of the energy located down below. Short respiration originates from the energy in a state of insufficiency down below with encroachment on the top. Thus, one must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo.
II - N.V.N.: Paragraph 22 and the previous one concern the emptiness of the energy. One does not tonify the Hand Taiyin (Lu) (mother of energy) but the Foot Shaoyin (Ki) (source of the energy) because Yang has its origin in Yin and energy is created from Jing (quintessence). Therefore, the search for the root of the illness represents a primary phase in Oriental medicine, necessary before any therapy.
10. The active energy is a very mobile, very dynamic energy which, at every moment, changes direction. 11. Difficulty forming sentences.
29
39.
CHAPTER XXIII
Diseases of Heat (Re Bing) (1)
Chapter 23 is devoted to the diseases of heat: classification and description of diseases, therapy and prognosis. The methods of needling of the different forms of the diseases of heat and their contraindications are clearly set forth. The description of the diseases of heat at the level of the different anatomic layers (skin, flesh, muscles, blood and vessels, tendons and bones) is based on the principles of the 5 Movements at the level of the channels (liver, heart, spleen, lung and kidney) in order to determine the therapeutic rules by acupuncture, The 59 energetic anti-heat points are mentioned. This chapter consists of 28 paragraphs.
PARAGRAPH 1
In the syndrome Tian Ku (hemiplegia) ( 1 ) , characterized by a painful paralysis of half of the body, without change in language and without disturbance of will (Chi), the disease is localized in the demarcation of the flesh (epidermo-dermal system); one must employ great needling in order to tonify the essential energy in a state of insufficiency and to disperse the perverse energy in a state of excess.
1. In any event, Re Bing cannot be translated as febrile diseases.
30
40.
Chapter 23 studies the diseases of heat of three different etiologies: _ exogenous etiology, caused by an infiltration of Wind-Cold _ endogenous etiology, following a syndrome of heat at the level of the 5 organs _ mixed etiology, resulting from simultaneous disequilibrium of the interior and exterior, of Yin and Yang, of the essential energy and perverse energy. Paragraph 1 concerns the disease of heat of external origin. Here, perverse Wind-Cold infiltrates into half of the body. Ying (nutritive) energy and Wei (defensive) energy grow weak, the source energy escapes and the perverse energy inserts itself alone, triggering Tian Ku (hemiplegia), with disturbance of motility and pain. The heart governs speech, and the kidney, Chi (will). Therefore, absence of change in language and disturbance of will indicates that the interior is intact and that the perverse energy is localized only at the exterior. One must then use the great needling method (Ju Zhen) to tonify the essential energy and disperse the perverse energy.
II - N.V.N.: _ Regarding Tian Ku (hemiplegia), complementary studies are developed in the Suwen (Chapters 3 (Relationship of the Vital Energy with that of Heaven), 7 (Special Study on Yin and Yang), 42 (Dissertation on Wind), 48 (Dissertation on the Great Singularities), 75 (Discourse on the Illustrious Teaching) and 77 (Analysis of the 5 Errors) - N.V.N. Edition). _ Great Needling cannot be translated as a large needle because it concerns here an acupuncture technique opposite to that called needling in opposition (Mu Zhen) (see Suwen, Ch. 63 (Disocurse on Needling on the Opposite Side). One can therefore not correctly translate Oriental medical classics like the Neijing without being an acupuncturist. The Great Needling used in the treatment of hemiplegia of external origin consists of needling points of the side affected to reestablish the circulation of the Jingluo and harmonize the blood and energy.
PARAGRAPH 2
In Fei (quadriplegia), the paralysis of the 4 limbs is not painful. If the Chi (will) is not totally altered and if the voice is not very 41. weak, the disease is curable. In contrast, it is incurable if there is anarthria. This disease first starts at Yang, then it reaches Yin. One must first treat Yang and secondly, Yin. The needling done on Yang must be superficial.
31
The Fei disease (quadriplegia) belongs to the Feng-Re (Wind-Heat) group. The non-painful nature of the paralysis indicates that perverse energy has not yet reached the interior. Wind-Wood deteriorates the Center-Earth; the spleen maintains the Zi (intelligence) and governs the 4 limbs. As a result, the integrity of the Zi in the paralysis of the 4 limbs denotes that the perverse energy becomes localized only in the mid-external, mid-internal area and that the source energy is not yet altered. Weakness of the voice announces that the perverse energy disturbs the essential energy. The disease, which is still found at the energetic level, is curable. In contrast, the presence of anarthria is a sign revealing the disease located at the level of the organ, therefore difficult to treat. The exterior is Yang, the interior is Yin. The disease manifests in the first place in the area of demarcation of the flesh (Yang), and in the second place, in the interior (Yin). One must consequently first needle Yang then Yin.
Superficial needling permits evacuation of the perverse energy localizing at the exterior.
II - Ma Shi teaches:
This paragraph demonstrates the needling method against Fei disease (quadriplegia). The previous paragraph concerns painful paralysis and this one, non-painful paralysis. The previous paragraph speaks of paralysis of the hemi-body, and this one, of paralysis of the 4 limbs. Tian Ku (hemiplegia) and Fei (quadriplegia) therefore are two different diseases. Non-aggravation of the disturbance of the Shen (mental) and Chi (will), weakness of voice and perceptiveness of mind are indicators of the curability of the disease. In contrast, in the case of aggravation of the disturbance of the Shen and Chi with anarthria, the disease is incurable. One must clearly specify the level of attack of the peverse energy in order to perform appropriate treatment. Because, if the disease starts in the first place by the Yang channels and in the second place by the Yin channels, one must needle first the Yang channels, then the Yin channels. The needling must be superficial because Yang is found at the exterior. 42. The text mentions neither the disease starting via the Yin channels then evolving toward the Yang channels nor the needling done at the Yin channels before the Yang channels nor deeper needling, probably because the disease starting via the Yin channels is incurable.
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PARAGRAPH 3
In the heat disease evolving for 3 days, where the Qi Kou pulse (right radial pulse) is calm and Renying (left radial pulse) is agitated, one must needle the points of the Yang channels, choosing among the 59 (anti-heat) Points to evacuate the perverse heat and favor perspiration, all in respecting the principle render the Yin channels full to tonify the insufficiency. are In the case of too high a fever where the Yin pulse and Yang pulse calm, needling is expressly advised against.
If acupuncture is still judged possible, the needling must be immediate because, even without provoked sweating, the perverse energy can be eliminated to the exterior. To say not to needle is it evoke a fatal syndrome.
In the heat disease evolving over 3 days, the perverse energy comes to cross the 3 Yang channels and goes to reach the 3 Yin channels. The expression Qi Kou is calm and Renying is agitated indicates that perverse energy lodges in Yang and still has not reached Yin. One must then needle the Yang channels. The 59 Points (anti-heat) possess at one time the power to evacuate and to sudorificate. The principle to render full the Yin channels to tonify insufficiency implies not letting the perverse energy insert itself into the Yin channels in a state of insufficiency. In the case of too high a fever where the Yin and Yang pulses are calm, the essential energy of the 3 Yang channels and 3 Yin channels are in a state of emptiness; therefore, the prognosis is fatal and acupuncture is useless. In contrast, in the case where acupuncture is judged still to be possible, needling must be immediate to evacuate the perverse energy by the sweat gland route when it is found in the Yang part (of the body) or in order to excrete it via the low route. Such is the therapeutic principle of serious disease caused by perverse heat without alteration of the essential energy. 43. Zhang Yai Chi has said: The heat diseases are of the Shanghan type (evolutive diseases of cold). In effect, they evolve following the 6 channels, and, on the 7th day, they return to their point of departure. The disease is specifically energetic; this is why diagnosis is performed at Qi Kou and Renying.
Without sweating, one must excrete it by the low route has the same meaning as that of the phrase drawn from the Suwen: In the disease of heat of less than 3 days, only sudorification is advised. When it exceeds 3 days, only purgation is indicated. (2)
2. Also see Evolutive Diseases of the 3 Yin and 3 Yang (According to the Shanghan Lun) N.V.N. Edition.
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II - Ma Shi teaches:
The theme of Paragraphs 3 to 21 is devoted to the diseases of heat. In this paragraph, the signs and pulses are in aggreement; it is advised to needle to provoke sweating so as to expel the perverse energy. If the pulse and signs are not in aggreement, acupuncture is useless. In the heat disease of more than 3 days, Qi Kou is calm and Renying is agitated because the Yang channels are affected. In the case where the signs and pulses are in aggreement, one must needle the Yang channels to disperse the perverse energy. In contrast, in slightly elevated fever, if the Qi Kou pulse is calm and Renying is agitated and if Yin channels and Yang channels are simultaneously calm, the signs and pulses are not in aggreement; the prognosis is fatal and needling is without purpose. Because the perverse energy is in fullness, the pulse is agitated. The fullness of perverse energy with very high fever is the indicator of the insufficiency of the essential energy; a pulse which is no longer agitated is a fatal sign
PARAGRAPH 4
In the disease of heat greater than 7-8 days with Mai Kou (radial pulse) agitated, dyspnea and short respiration, it is advised to urgently needle; sweating is spontaneous. The needling is performed at the level of the thumb.
44.
I - Ma Shi explains: In this paragraph, the signs and pulse of the disease of heat are clearly emphasized. It is advised to needle the Hand Taiyin (Lu). Because, in the disease of heat exceeding 7-8 days with Mai Kou agitated, dyspnea and short respiration, one must employ the technique of sudorification by needling the point Shaoshang (Lu 11), clearly most indicated. II - Zhang Shi clarifies: Here, although the heat disease lasts for 7-8 days, the perverse energy is still located at the exterior; one must needle urgently to evacuate it because its non-liberation by the 8th day marks its imminent progression toward the Yin channels, the serious phase of the disease. Agitation of Mai Kou associated with dyspnea and short respiration are warning signs of the persistence of the peverse energy within the external energetic layers. As a result, it is advised to disperse Shaoshang (Lu 11) to excrete the perverse energy by the sweat gland route. III - N.V.N.: According to You Ba Rong, needling the point Shaoshang (Lu 11) has the same sudorific effect as Herba Ephedra (Mahuang). (3)
3. See Wording 35 of the Shanghan Lun of Zhang Zhongjing, translated under the title Evolutive Diseases of the 3 Yin and 3 Yang - N.V.N. Edition.
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PARAGRAPH 5
signs In the disease of heat greater than 7-8 days, revealed by such as: _ galloping and small pulse _ hematuria _ and dryness of the mouth,
death follows in 1 day and a half. If the pulse is changing (Da), death follows in 1 day. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
This paragraph demonstrates the case of non-liberation of the disease of heat evolving toward the Shaoyin (He), therefore of fatal prognosis. On the 7th day, the disease ends its progression at the level of the 6 channels (3 Yin and 3 Yang) and returns to its point of departure. On the 8th day, the non-liberation of perverse heat marks a new evolutive cycle of the disease. The small and galloping pulse of the Shaoyin (He) (4) responds to Ministerial Fire. 45. Hematuria indicates the localization of the disease at the level of the Water Organ responding to the Foot Shaoyin (Ki). Dryness of the mouth indicates the localization of the heat disease at the level of Imperial Fire responding to the Hand Shaoyin (He). Evaluation of death at 1 day and a half expresses the fatal occurrence in the period of time occurring between 1 and 2 days, moment of the disappearance of Yin energy and of Yang energy, of water and fire. The pulse starts at the kidney, but it is controlled by the heart. The changing (Da) pulse signals the exhaustion of the energy of the lower part of the body, hence death in 1 day.
II - N.V.N.: The Da pulse (5) cannot be translated as large pulse but as changing pulse because this pulse assumes an intermittent nature (a more or less long stop between several beats). Generally, the changing (Da) pulse is the indicator of the evolution of the disease toward worsening or improvement of the disease.
4. Here it must mean Hand Jueyin (XB). 5. See explanation in the Maijing (Classic of Pulses) of Wang Shu He - N.V.N. Edition, and also in Chapter 29 (Teachings Transmitted by the Masters) of this classic (Volume II).
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PARAGRAPH 6
as: After sweating, if the heat disease still presents with such signs _ agitated pulse _ dyspnea _ and fever, needling the cutaneous areas is advised against. If the dyspnea worsens, it is death. EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
After sweating, the pulse is still agitated because the too virulent Yang-Heat is not eliminated via the sweat gland route. Dyspnea and fever are the signs revealing the evolution of the disease toward the interior. Acupuncture performed at the skin is useless, therefore advised against. The aggravation of the dyspnea reveals the state of fullness of the perverse energy lodged in the interior, provoking disturbances of the Yin energy and Yang energy, hence the lethal prognosis. 46.
PARAGRAPH 7
In the disease of heat exceeding 7-8 days and manifesting by a non-agitated or agitated pulse but without diffuse and rapid nature, sweating is spontaneously produced at the end of 3 days. If sweating does not appear at the end of 3 days, death follow on the 4th day. During the period of absence of sweating, needling the sweat gland area is not advised.
36
In contrast, the absence of sweating after 3 days of waiting... is due to the fullness of the Yang-Heat (perverse) and to the exhaustion of the Yang energy (of the body). This is why death follows on the 4th day... . If the previous paragraph studies the heat disease localizing at the exterior which, in spite of sweating, progresses toward the interior, this one has for its object the localization of the perverse energy in the Yin part, determining factor of spontaneous sweating. Therefore, sweating provoked there is useless. This study allows comprehension that Yang can penetrate within Yin and that Yin can exit from Yang.
PARAGRAPH 8
In the disease of heat manifesting by such signs as: _ cutaneous pain _ nasal obstruction _ edema of the face, one must use Chan type needles (No. 1) ( 6 ) and needles according to the technique of the 59 points (anti-heat). In the event of nasal ulceration, one must treat the lung and needle the skin. In the absence of a result, one must treat Fire, that is to say, the heart.
47.
This paragraph concerns the case of fixation of perverse energy at the level of the skin, hence the necessity of needling this area. In the absence of results, the heart must be tonified to accentuate its triumphant action over the lung. The lung responds to Metal and links with the skin. The disease of heat starts at the skin with nasal obstruction and heavy sensation of the eyelids, evoking facial edema; one must then needle the skin to expel the perverse heat. To needle the skin implies inevitably to needle the skin without injuring the flesh. Nasal ulceration is an ailment of the skin and to needle the skin consists of acting on the energy of the lung (because it unites with the skin). If that proves ineffective, one must act on Fire, that is to say the heart, because tonifying the heart amounts to augmenting the potential of Fire and diminishing that of Metal. To act thusly is to repel the perverse heat lodged in the lung.
Paragraph 8 and the following ones deals with heat diseases localized in the interior (organs).
37
From the fact that the diseases are located at the level of the organs, one must always examine the skin, vessels, flesh, muscles and bones, that is to say, the corresponding anatomic and energetic layers. If the diseases persist, it is recommended to apply the inhibitory method. Cutaneous pain and nasal obstruction are signs revealing the presence of heat at the level of the lung and the needles are of the Chan (No. 1) type in aggreement with the method of the 59 points (anti-heat). In the more serious forms, in particular nasal ulcerations, one must always look for the cause at the level of the lung. If the treatment proves ineffective, the cause is looked for again at the level of Fire-Heart because the heart can triumph over Metal (Figure 8) because, in the interior, the 5 organs unite with the energy of the 5 organs, and at the exterior, they respond to the 5 anatomic layers. In short, in disturbances of the energy at the level of the corresponding anatomic areas, One must first treat the exterior, then, in the event of failure, utilze the Inhibitory Method of the 5 Movements, conforming to the principle according to which One must first treat the summit, then the root.
48.
Figure 8: Treatment of the heat disease at the level of the anatomic layer belonging to the lung by the inhibitory method.
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PARAGRAPH 9
In the diseases of heat manifesting by such signs as: _ _ _ _ skin rough to the touch asthenia and fever sadness dryness of the lips and throat,
one must needle the Mai ( 7 ) with the No. 1 (Chan type) needle according to the method of the 59 (anti-heat) points . In the event of swelling of the skin, dryness of the mouth and cold sweat, one must treat the heart. If the disease does not regress, one must treat at the level of water, that is to say, the kidney.
This paragraph shows the case of localization of perverse heat within the Luo following an primary attack of the Mai (vessels). Treatment consists of needling these latter. If the disease does not regress, one must tonify the kidney to triumph over the heart. 49. Because the vessels (blood) being the seat of the disease, one must treat them in evacuating the perverse heat, respecting the principle which stipulates During the needling the vessels, do not injure the flesh. In this case, No. 1 needles are recommended to needle the points among the group of 59 points (anti-heat). In the presence of other accompanying signs, such as swelling of the skin, dryness of the mouth, cold sweat..., the disease is always seated at the level of the Mai and the organ to treat is only the heart. If the disease does not regress, one must treat at the level of water, that is to say, kidney, because tonification of the kidney permits augmentation of the potential of Water, thereby reducing that of Fire, that is to say, the syndrome of heat. (Figure 9)
II - Zhang Shi specifies:
This paragraph demonstrates the case of localization of heat at the level of the Xin Bao Luo (XB), with clinical manifestations at the level of the Xue Mai (blood vessels). The Jing (channels) and Mai (blood vessels) are the circulatory routes of Ying (nutritive energy) and blood, sites of development of Yin and Yang. When Fire is in fullness, the heart is perturbed, and when Fire rises up toward the top, the lips and mouth become dry. The treatment consists of using Chan (No. 1) type needles to disperse the heat at the level of the vessels according to the method of the 59 (anti-heat) points.
39
Figure 9: Treatment of the heat disease at the level of the anatomic layer responding to Xin Bao (XB).
PARAGRAPH 10
In the diseases of heat with such signs as: _ dryness of the throat _ abundant drinking _ fright _ difficulty rising out of bed, the affliction is seated at the dermal (flesh) system. of
50.
One must utilize needle No. 6 (Yuan Li) according to the method 59 points (anti-heat).
If a blue vessel appears at the internal canthus of the eye, one must aim for the spleen to treat the flesh. If the disease does not regress, one must treat Wood, that is to say, the liver.
40
II - Zhang Shi clarifies: The laryngo-pharyngeal apparatus (throat) responds to the energy of Heaven, and the stomach, to that of Earth. During the course of the heat disease, the individual feels the need the constantly drink. This phenomenon is due to a rising up of the heat of the spleen (Earth) toward the stomach, also provoking the sudden arrival of a state of fright. The spleen governs the dermal system (flesh) and the 4 limbs. As a result, during the heat disease, there is a difficulty standing up. It is therefore advised to needle the energy belonging to the flesh according to the method of the 59 points (anti-heat) with the No. 6 (Yuan Li) type of needle to disperse the heat. 51.
Figure 10: Treatment of the heat disease at the level of the anatomic layers responding to the spleen.
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PARAGRAPH 11
In the diseases of heat characterized by such signs as: _ pale greenish facies _ encephalgia _ agitation of the limbs, one must needle the osteo-tendinous insertions of Si Ni (4 limbs) with No. 4 (Feng type) needles. If the muscles are paralyzed and accompanied by shedding unmastered tears, one must needle the liver to treat the muscles. If the disease does not regress, treatment at the level of Metal, that is to say, the lung, is imposed. EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
The liver responds to Wood and governs the muscles and tendons. Pale and greenish facies is the color of the liver. Encephalgia comes from attack of the liver by perverse heat which infiltrates into the Dumai (GV) at the level of the brain. Agitation of the 4 limbs indicates excess of heat of the liver which reaches the spleen, organ governing the 4 limbs. 52. In the majority of cases, ailments of Wood ( liver) manifest at the level of the muscles of the 4 limbs. It is then advised to needle the muscles and tendons with a No. 4 (Feng) type needle to evacuate the perverse heat in accordance with the principle according to which do not injure the bones in needling the muscles. Paralysis of the muscles and the unstoppable outflowing of tears denotes that the disease is found in the liver. This is why one must aim for the liver in order to treat the muscles. If the disease does not regress, one must treat at the level of Metal, that is to say, the lung. Because, tonifying the lung consists of increasing the potential of the energy of the lung, thereby diminishing that of the liver (by inhibitory action according to the law of the 5 Movements), hence regression of the perverse heat (located at the level of the liver) (Figure 11).
The greenish complexion is the pathologic color of the liver. A vessel from the liver reaches the top of the cranium and penetrates into the brain. The attack of this vessel by perverse heat is the cause of encephalgia. The energy of the muscles and tendons starts at the Jing-well point (Jing: spring-woodliver-muscle), located at the tip of the fingers and toes and, following the channels, reaches the 4 limbs. This is why, when the muscels are affected by heat, the 4 limbs are agitated.
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Figure 11: Treatment of the heat disease at the level of the anatomic layers responding to the liver.
PARAGRAPH 12
In the heat diseases characterized by such signs as: _ frequent shudders _ spasm and laxity of the muscles _ Kuang (Yang Madnesses),
53....
one must needle the Mai (vessels) with the No. 4 needle to urgently disperse the excess. In contrast, in Dian (Yin Madnesses) with falling out of hair, one must aim for the heart to treat the blood. In the event of failure, one must treat at the level of water, that is to say, the kidney.
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This paragraph concerns the heat disease located in the heart. The heart responds to Fire and governs the blood vessels (Xue Mai). In heat disease, frequent shudders denotes excess of the pathogenic energy of the heart. Spasm and laxity of the limbs indicates the production of wind by maximal heat. Kuang (Yang Madness) results from a strong virulence of perverse energy. This is why it is advised to utilize No. 4 (Feng type) needles to disperse the perverse energy in a state of excess at the level of the blood vessels. When the Xue Mai (blood vessels) are affected, the affected blood has as a consequence Dian (Yin Madness) and falling out of the hair. As a result, one must aim for the heart to treat the madness and falling of hair. If the treatment proves ineffective, one must then treat at the level of Kidney-Water because tonifying the kidney amounts to augmenting the potential of Water to suppress Fire. (Figure 12)
54.
Figure 12:
Treatment of heat disease at the level of the anatomic layers belonging to the heart.
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PARAGRAPH 13
In the heat disease revealed by the following signs: _ sensation of heaviness of the body _ bones pains _ diminished auditive ability _ obscuring of vision with tendency to close the eyes, one must needle the bones with No. 4 needles according to the method of the 59 Points (anti-heat). In _ _ _ the presence of accompanying signs such as: anorexia bruxomania (bruxism) blue venules on the ear,
53...
one must aim for the kidney to treat the bones. If the treatment proves ineffective, one must resort to Earth, that is to say, to the spleen. EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains: Here, the disease of heat is located at the kidney. The kidney governs Water and unites with the bones. In the heat disease, sensation of heaviness of the body, bone pains, weakness of hearing, obscuring of vision with tendency to close the eyes are the signs revealing disease located in the bones. Treatment consists of utilizing Feng (No. 4) type needles to needle the points chosen among the 59 (anti-heat) Points and tonifying the bones. If the subject furthermore presents anorexia and bruxism associated with appearance of a little blue vessel on the ears, the disease always is located at the bones, and one must treat the kidney. If the disease does not improve, one must aim for the spleen because tonifying the spleen permits the acceleration of the production of Earth to repress Water. Cure is, thus, obtained. (Figure 13) 55. II - Zhang Shi clarifies: The kidney is the source-producer of the energy. The sensation of heaviness of the body denotes attack of the energy by heat. The kidney governs the bones. Consequently, attack of the energy of the kidney manifests by bone pains. The kidney governs the ears. Deafness is caused by a contrary afflux (Jue Ni) of the energy of the kidney. The disease localizing at the Shaoyin (Ki), the subject has the tendency to close his eyes (somnolence). Anorexia is a sign of fullness of the energy of the kidney. The Neijing said: The internal perturbation of the kidney causes hunger, but the individual refuses to eat. Heat in a state of fullness is a triggering factor of bruxism. The teeth are surplus parts of the bones, and the ears are the sites of exteriorization of the energy of the kidney. This is why in
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Figure 13: Treatment of disease of heat at the level of the anatomic layers belonging to the kidney.
the event of bruxism and the appearance of little vessels on the ear, one must treat the kidney. In the absence of results, one must always have recourse to Earth, that is to say, to the spleen, because needling Spleen-Earth has the objective of triumphing over Water. The 5 organs represent the material, anatomic forms and their 5 Movements the immaterial, energetic aspects. When the energy is affected, the disease always reaches the exterior at the level of the skin, flesh, muscles and bones. The first therapeutic act is therefore the treatment of the exterior; nevertheless, in the event of inefficacy, treatment must be oriented toward the interior, at the level of the 5 organs, that is to say, at the level of the energy of the 5 Movements. 56.
PARAGRAPH 14
In the heat diseases characterized by such signs as: _ inability to localize the pain _ deafness _ dryness of the mouth, the fever is elevated at the time of the orientation of Yang toward victory, and trembling from cold (chills) appears at the time of the orientation of Yin toward victory. In this case, heat is located in the marrow; the disease is fatal, therefore incurable.
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PARAGRAPH 15
The heat disease characterized by such signs as: _ headaches _ painful tension extending from Neokong (GB 19) to eyes and mouth _ epistaxis is due to the afflux of heat (Jue Re). One must use No. 3 (Ti) type needles and needle as a function of emptiness and fullness. This disease can be responsible for syndromes of Cold-Heat and hemorrhoids. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: 57.
Here, it is a matter of external heat which enters into battle against the heat of the liver at the summit of the cranium, hence headaches of the vortex. Painful tension at the level of the eyes and mouth is due to the afflux of heat of the liver toward Naokong (GB 19), where a vessel leaves from toward the face (Figure 14). Frequent epistaxis denotes an overheating of the vessel of the liver at the level of the face and nose (Figure 14). The non-liberation of wind heat and that of the heat of digestive origin are the principal causes of ulcerations and hemorrhoids. Recall that the struggle between the external heat and internal heat can be located either at the energetic layers (without disturbance of the channels) or at the level of the channels (without disturbance of the energetic layers). But, at every moment, disturbance of the channels can affect the energetic layers and vice versa; such is the case of ulcerations and hemorrhoids cited in this paragraph.
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II - N.V.N.: The explanation of Zhang Shi has enriched the understanding of the energetic physiology of the liver and gallbladder at the level of the face (Fig. 14).
Figure 14: Cranio-facial vessels of the Foot Jueyin (Li) and Foot Shaoyang (GB).
58.
PARAGRAPH 16
In the heat disease characterized by such signs as: _ sensation of heaviness of the body _ sensation of heat in the intestines, one must utilize No. 4 (Feng type) needles and needle the Shustream point, located in the space of the toes, and the Luo point of the stomach. Cure is, as a result, obtained.
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The spleen governs the flesh (dermal) system of the 4 limbs. This is why, during the infiltration of perverse energy into the spleen, the limbs are heavy. The large intestine and small intestine belong to the stomach. During the penetration of perverse heat into the stomach, the intestines are affected (overheated). In this case, one must use the needles of the Feng (No. 4) type and needle the Shu-stream point of the stomach, which is Xiangu (St 43), the point located in the space of the toe, Neiting (St 44), and the Luo point of the stomach, Fenlong (St 40). Such is the method of going in search of the energy of the Jing (channel) and of the Luo (Longitudinal Luo) of the stomach in the goal of excreting the perverse energy.
II - Zhang Shi clarifies: The sensation of heaviness of the body denotes the infiltration of heat into Stomach-Earth (Spleen) with sensation of heat in the intestines. Needles of the Feng (No. 4) type are used to needle the Shu point of the stomach channel, Xiangu (St 43 - needle depth 0.5 cun, left in during 7 expirations, moxa 3 times) and the points Lidui (St 45) and Neiting (St 44). This procedure aims for the evacuation of perverse heat via the energy of the stomach. III - N.V.N.: The points recommended by Zhang and Ma are different, but their action on the perverse heat is evident. In this manner, therapeutic formulae in acupuncture are not rigid; they vary according to the reasoning of the practitioner.
PARAGRAPH 17
In the heat disease characterized by such signs as: _ _ intense umbilical pain sensation of thoracic and hypochondrial fullness,
59.
one must needle Yongquan (Ki 1) and Yinlingquan (Sp 9) with No. 4 needles and also the point of the throat. EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains: Intense umbilical pain with thoraco-hypochondrial fullness denotes attack of the Foot Taiyin (Sp) and Foot Yangming (St) by perverse heat. Teament consists of dispersing Yongquan (Ki 1) and Yinlingquan (Sp 9) and also Lianquan (CV 23), located at the middle of the neck below the larynx II - Zhang Shi specifies: Here, it concerns a case of struggle of the heat of the external part of the body against that of the heart.
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The Neijing said: When the umbilical region is painful, the disease bears the name Fuliang (8). In other words, when umbilical pains are of heat etiology, the active energy (Dong Qi) of the heart accumulates in the subcardiac region and transforms into Fuliang. The afflux of the heat of the heart taking place in the interior is the cause of thoracohypochondrial fullness. It is then advised to needle Yongquan (Ki 1) and Yinlingquan (Sp 9). To needle Yongquan (Ki 1) is to utilize the Water energy of the kidney in order to temper the Fire of the heart, and to needle Yinlingquan (Sp 9) is to utilize the Center-Earth energy (Spleen) to dissolve the energetic mass (Fuliang) concealed in the supraumbilical region. Moreover, it is advised to use the No. 4 needle and puncture the point of the throat to disperse the heat from the subcardiac region. This point is none other than Lianquan (CV 23).
III - N.V.N.: 1. The explanation of Zhang Jing Yue is quite simple: When the heat affluxes toward the route of the Foot Shaoyin (Ki), it is the origin of umbilical pains, and when it affluxes toward the route of the Foot Taiyin (Sp), it is the cause of thoraco-hypochondrial fullness. This is why it is advised to utilize No. 4 needles and puncture Yongquan (Ki 1) and Yinlingquan (Sp 9). As for the point of the throat, this designates Lianquan (CV 23). 2. Lianquan (CV 23) is the meeting-reunion point (9) of the two vessels, Renmai (CV) and Yinwei. According to the Da Cheng, This point is located at the middle of the neck below the pharynx. Lift up the head to locate this point; moxa 3 times, needling to a depth of 0.3 cun; disperse as soon as the energy arrives (10). 60. And according to the Lingshu, Lingquan (CV 23) and Rugen (St 18) form the route of delivery/transporting of the organic liquid... . Lingquan (CV 23) gives off a vessel at the base of the tongue; as a result, it is specific in the treatment of thirst. (Figure 15)
8. It concerns an accumulation of the active energy (Dong Qi) of the heart concealed in the supra-umbilical region (see Difficulty 16 of the Nanjing de Bian Que). 9. See this group of points in M.T.C. - N.V.N. Edition. 10. See Art and Practice of Acupuncture and Moxabustion According to the Zhen Jiu Da Cheng N.V.N. Edition.
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Figure 15: Lianquan (CV 23), point of dispersion of the afflux of heat of the Foot Shaoyin (Ki).
PARAGRAPH 18
In the disease of heat characterized by sweating or the presence of a pulse favorable to sweating, dispersion of the points Yuji (Lu 10), Taiyuan (Lu 9), Dadun (Sp 2) and Yinbai (Sp 1) favor the regression of the heat, and their tonification facilitates perspiration. If the sweating is excessive, one must stop it by needling the points located at Huan Mai (transversal vessels), above the internal malleolus.
61.
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_ dispersion of the Hand Taiyin (Lu) acts in favor of the regression of the heat _ tonification of the Foot Taiyin (Sp) favors production of organic liquid, hence sweating. The point located at Huan Mai designates Sanyinjiao (Sp 6). From this point, the energy is secreted to the exterior, bringing with it sweating. As a result, needling this point is intended to direct the energy toward the depths (to the interior), therefore to curb sweating.
II - N.V.N.: Clinically, the treatment of excessive sweating is extremely dificult. Zhang Shi furnishes the means of combatting this illness.
PARAGRAPH 19
In the disease of the heat, sweating associated with a full and agitated pulse results from an excessive weakness of the Yin vessels; this is death. life. In contrast, if the sweating is associated with a calm pulse, this is
The recapitulation of the above-cited paragraphs ends with the following conclusion: Sudorification is a therapy for all diseases of heat localizing at the exterior or in the interior. Sweating associated with an agitated and full pulse indicates the progression of the heat toward the interior. Despite sweating, this heat remains confined at the level of the channels which are overheated to the extreme. The prognosis is then fatal. Sweating associated with a calm pulse indicates that the heat is purified (liberated). The prognosis is then favorable. 62.
II - N.V.N.: The axioms applied in this paragraph, highly prized in Oriental medicine, are the following: 1. 2. 3. 4. 5. The maximal emptiness of Yin and the isolation of Yang are fatal. Evacuation of perverse energy via the sweat gland route is favorable. Yang is responsible for the full and non-full state of the pulse. Yin is responsible for sweating and non-sweating. Physiologic, pathologic, diagnostic and therapeutic problems are always posed as a function of the presence or absence of Yin because: _ Yin is the source-producer of the vital energy _ and the escape of the energy always originates from insufficiency of the source.
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PARAGRAPH 20
In the diseases of heat, acupuncture is contraindicated in the following 9 syndromes: 1. 2. 3. 4. 5. 6. Absence of sweating, red cheekbones, hiccups and nausea. Diarrhea and excessive fullness of the abdomen. Dimming of vision and persistence of fever. In the elderly and children: fever and abdominal fullness. Absence of sweating, vomiting, melena and hematuria. Ulceration and necrosis of the base of the tongue and persistence of fever. 7. Cough, epitaxis and absence of sweating, or else sweating but respecting the feet. 8. Latent heat in the marrow. 9. Fever, body stiffness, ophisthotonus, spasmodic cramps of the limbs. These 9 syndromes are fatal, thus prohibited from acupuncture. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: 1. Absence of sweating explains the non-exteriorization of perverse heat via the sweat gland route. Red cheekbones indicates the excess of heat at the level of the 5 organs (11). 63. Nausea comes from the confrontation of 2 energies, external heat and internal heat, in the area of the center (12), causing the insufficiency of the energy of the stomach. 2. Diarrhea and abdominal fullness denote a strong evacuation of the essential energy and organic liquid and the presence of an accumulation of perverse heat in the area of the center. 3. Dimming of vision and persistence of fever are the results of the presence of an excessive mass of heat injuring the interior just as well as the exterior. 4. In the elderly and children affected by heat disease, the main signs are fever and abdominal fullness resulting from the state of exhaustion of the blood and energy in the elderly and from the state of incomplete formation of Yin and Yang in children. In them, abdominal fullness is due to the afflux of the heat toward the center (Spleen/Stomach) without possibility of being exteriorized. 5. Absence of sweating, melena and hematuria indicate the non-liberation of heat to the exterior and attack of the Yin channels in the interior.
11. In Chapter 32 (Acupuncture and the Diseases of Heat) of the Suwen, we read: _ In the heat disease of the liver, the left cheek turns red first. _ In the heat disease of the heart, the forehead turns red first. _ In the heat disease of the spleen, the nose turns red first. _ In the heat disease of the lung, the right cheek turns red first. _ In the heat disease of the kidney, the 2 cheeks turn red first. 12. Designates the Zhongjiao (Middle Jiao).
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6. Ulceration of the base of the tongue and persistence of fever gives evidence of the presence of heat in the Yin channels. 7. Cough, epistaxis... denotes the presence of heat at the level of the lung with compression of the vessels. Because the lung, governing skin and hairs, is the site dassistance of all the vessels; perverse heat must be evacuated via the route of sweating controlled by the lung. Thus, absence of sweating is due to exhaustion of the energy of the top part of the body, or else sweating not affecting the feet, because of the exhaustion of the energy of the lower part of the body. 8. Heat in the marrow indicates that the kidney is in peril. 9. Fever, body stiffness, ophisthotonus, spasmodic cramps... are signs revealing the localization of perverse heat in Taiyang with exhaustion of kidney energy. This is the fatal phase. The Taiyang (Bl) and Shaoyin (Ki) are the productive sources of Yin energy and Yang energy. As a result, therapy is aimed at treating the energy, that is to say, at augmenting its potential mass and at establishing its equilibrium in order to eliminate the perverse energy. But in the 9 syndromes cited above, the perverse heat is extremely virulent and the essential energy is near total exhaustion. This is why acupuncture is in vain. II - N.V.N.: 64. The pathologic process of these 9 fatal syndromes studied by Zhang Jing Yue (1563-1640 A.D.) is the following: 1. Absence of sweating is due to the weakness of Yin characterized by reddness of the cheeks.
Hiccups and nausea indicate the penetration of heat into the Yangming, causing great emptiness of the stomach. As a result, the root is in maximal emptiness; life is impossible.
2. Diarrhea and maximal fullness of the abdomen comes from the defeat of the energy of the spleen during its confrontation with the perverse heat. Death is inevitable. 3. The Jing (quintessence) energy of the 5 organs and 6 bowels reaches the top and maintains the brain and, particularly, the ocular system. As a result, the depletion of Jing is the cause of dimming of vision and death. 4. In elderly and children, the energy of the spleen is the source of life. When perverse heat reaches the spleen organ, death is certain. 5. Absence of sweating is due to the emptiness of Yin. It is associated with nausea and hemorrhages... . When Yin is seriously affected by perverse heat, death is inescapable. 6, The liver, heart and spleen have their vessels linked to the root of the tongue (Figure 16). Necrosis of the tongue muscles, following an overheating of the perverse heat, indicates the destruction of the 3 Yin; death is inevitable. 65. 7. The localization of perverse heat within the lung channel is one of the determining conditions of disruptions of Yin-Blood. If sweating is absent or if sweating does not reach the lower limbs, it denotes the depletion of the Source-Yin. Death ensues. 8. The marrow originates from the materialization of the Jing Qi of the Zhi Yin (arrival at Yin). Deep infiltration of the perverse heat overheats the marow and provokes the exhaustion of the kidney energy. Death results.
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9. Stiffness of the spine, ophisthotonus, spasmodic cramps... are due to the transformation of maximal heat into wind which destorys Yin-Blood. Death is incontestable.
PARAGRAPH 21
The 59 Points cited in the previous paragraphs are: _ at the external and internal ungual angles of the fingers: 3 points, that is, (3 + 3) X 2 = 12 points for the 2 hands. _ in the interdigital spaces of the hand; 4 points, that is, 4 X 2 = 8 points for the 3 hands. _ in the interdigital spaces of the foot: 4 points, that is, 4 X 2 = 8 points for the the 2 feet. _ 1 cun inside the anterior root of the hair and outside the anteroposterior midline of the cranium: 3 points, that is, 6 points for 2 sides. _ still 3 cun more inside the boundary of the hair: 5 points, that is, 10 points for the 2 sides. _ in front of and behind the ear: 2 points, that is, 4 points for the 2 ears. On the head: 1 point on the summit 1 point, Xinhui (GV 22) 1 point below the mouth 1 point on the nucha
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1 point in front of and behind the implantation of the hair, that is, 2 points 1 point, Lingquan (CV 23) 2 points, Fengchi (GB 20) 2 points, Tianzhu (Bl 10). EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains: This paragraph studies the locations of the 59 Points. a - The 6 points located at the ungual angles of the fingers are: Shaoshang (Lu 11) Shangyang (LI 1) Guanchong (SJ 1) Zhongchong (XB 9) Shaoze (SI 1) Shaochong (He 9) that is, 6 X 2 = 12 Jing points of the bilateral channels of the 2 hands.
66.
b - In each interdigital space: 1 point, that is, 4 X 2 = 8 points for the 2 hands and 8 points for the 2 feet, totalling 16 points. (13) c - The 6 points located 1 cun inside the root of the hair and outside the antero-posterior midine of the cranium are: 2 points, Wuchu (Bl 5) 2 points, Chengguang (Bl 6) 2 points, Tongtian (Bl 7). d - The 10 points located 3 cun beyond the root of the hair are: 2 points, Linqi (GB 15) 2 points, Muchuang (B 16) 2 points, Zhengying (GB 17) 2 points, Chengling (GB 18) 2 points, Naokong (GB 19). e - The 4 points located in front of and behind the ear are: 2 points, Tinghui (GB 2) 2 points, Wangu (GB 12). f - The 11 points located on the head, neck and nucha are: 1 point, Baihui (GV 20) 1 point, Shangxing (GV 23) 1 point, Xinhui (GV 22) 1 point, Chengting (GV 24) 1 point, Yamen (GV 15) 1 point, Lianquan (CV 23) 1 point, Fengfu (GV 16) 2 points, Fengchi (GB 20) 2 points, Tianzhu (Bl 10).
13. The author does not mention the name of the points. See explanation below.
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II - N.V.N.: 1. The interdigital points cited in this paragraph were the object of numerous controversies over the centuries. According to Zhang Jing Yue, the interdigital points used would not be the Curious Points (outside-channels), Baxie (Eight Demons- PC 167) and Bafeng (Eight Winds- PC 137) (14), but the kinetic (Shu) points of the channels. These points are all located behind the metacarpo-phalangeal joints. These points are: _ Houzi (SI 3), Zhongzhu (SJ 3), Sanjian (LI 3) and Shaofu (He 8) for the hand _ Shugu (Bl 65), Linqi (GB 41), Xiangu (St 43) and Taibai (Sp 3) for the foot. 67. We lean toward this thesis of Zhang Jing Yue. 2. Recall that in the Suwen Chapter 61(Study on the Water-Heat Points) (Volume IIIN.V.N. Edition), the 59 Points are specific in the treatment of the diseases of water and that those cited in this chapter are intended to treat the diseases of heat. These diseases are not the same, therefore the technique of needling is different (15).
PARAGRAPH 22
In the fullness of the energy in the thorax with dyspnea, one must needle the Foot Taiyin (Sp) at the tip of the great toe, one He leaf width from the internal ungual angle. In the event of cold, leave the needle in place a long time, and in the event of heat rapidly remove it. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
The previous paragraphs concern: _ first the diseases of heat of external origin and internal origin _ then those caused by the confrontation of the perverse heat and essential heat. These diseases take place in the energetic layers and not in the channels. In contrast, this Paragraph 22 describes the disease of heat of external (perverse) origin at the level of the 3 Yin channels and 3 Yang channels. This is why it is advised to needle the Jing points of the hands and feet and the Xue Luo (blood capillaries). The Taiyin is Center-Earth (Sp). The energy of afflux reaches the top as easily as the bottom. The Foot Taiyin (Sp) circulates from the bottom upward and is directed toward the heart.
14. See Chapter of the Curious Points in M.T.C.-N.V.N. edition. 15. Also read Chapters 31 (Diseases of Heat), 32 (Acupuncture and the Heat Diseases) and 33 (Commentaries on Heat Diseases) of the Suwen (Book IX, Volume III).
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The fullness of the energy within the thorax with dyspnea originates from the aflux of the energy of the spleen channel toward the top. One must needle Yinbai (Sp 1) in order to bring the spleen energy back toward the bottom. Relief is immediate.
II - Ma Shi clarifies:
This Paragraph 22 and the following ones deal with various diseases unrelated to the diseases of heat. This paragraph shows the therapeutic technique of the syndromes belonging to the energy. In the fullness of the energy with dyspnea, the disease is located at the top part of the body; one must treat the bottom, that is to say needle Yinbai (Sp 1). 68. If this disease is of cold etiology, it is advised to leave the needle in place a long time in order to make the heat of the body return to combat the perverse cold. In contrast, if it is a question of the disease of heat origin, one must remove the needle rapidly to make the organic cold return; stop needling as soon as the energy descends.
III - N.V.N.: The teaching of Zhang Jing Yue is the following: In internal cold, the energy arrives slowly and the needles are left in place a long time, and in internal heat, the energy arrives rapidly and the needles are promptly removed.
PARAGRAPH 23
In Xin Shan (compression/blockage of the heart energy) with intense pains, one must needle the Foot Taiyin (Sp) and the Foot Jueyin (Li) and bleed the Xue Luo (blood capillaries).
The Foot Taiyin (Sp) of the lower abdomen projects into the heart; the Foot Jueyin (Li) links up to the genitals, arrives at the lower abdomen, crosses the diaphragm and flows down into the lung... . Xin Shan therefore originates from the disturbances of the energy of the Foot Taiyin (Sp) and Foot Jueyin (Li) which affluxes toward the heart... . This is why it is advised to needle the Foot Taiyin (Sp) and Foot Jueyin (Li) located at the bottom (of the feet) and to eliminate the perverse energy by bleeding the Xue Luo. This technique assures cure of the painful syndrome of the heart (cardialgia).
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PARAGRAPH 24
In Hou Bi (algoparesthesias) characterized by such signs as: of the laryngo-pharyngeal organs
_ tongue retraction 69. _ mouth dryness _ anxiousness and cardialgia _ pain of the innner arm with inability to lift the hand to head, one must needle the tip of the ring finger, one He leaf width from the internal ungual angle. ( 1 6 ) EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
The Xin Bao Luo (XB) starts in the thorax. Above, it communicates with the heart, and down below, with the Sanjiao (SJ). This is why: _ in disturbances of the Xin Bao (XB), the heart is anxious and painful _ and at the time of rising up of Ministerial Fire toward the top, the laryngo-pharyngeal system is blocked and painful, the tongue is retracted and the mouth is dry. One must needle the Jing point located at the tip of the 4th finger, Guanchong (SJ 1), to eliminate the Ministerial Fire. In this way, cure is assured.
PARAGRAPH 25
In reddness and pain of the eyes starting at the internal canthus of the eye, one must needle the Yinqiao.
The internal canthus of the eye belongs to Jingming (Bl 1). One must needle the Yinqiao: implies the sense of needling its point of departure which is Zhaohai (Ki 6), conforming to the principle according to which the disease being at the top, one must needle the bottom; and in tonifying Yin, Yang will move back... .
II - Zhang Shi clarifies:
Here, it is a matter of a clinical example explaining that, at the time of infiltration of perverse energy into the 3 Yang channels, the disease can locate either at the upper or lower part of the body or at the middle part. 70.
16. Energetic description.
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When the eyes are red and painful and the internal canthus of the eye is affected first, the disease belongs to the Foot Taiyang (Bl) and is seated at the upper part of the body. The Foot Taiyang (Bl) starts at the internal canthus of the eye, where it unites with the Yinqiao and Yangqiao, at the point Jingming (Bl 1). This is why one needle the Yinqiao, that is to say, the point Zhaohai (Ki 6), in order to purify Yang-Heat.
PARAGRAPH 26
In Feng Jing (cramps of wind origin), the body is in ophisthotonus; one must needle the Foot Taiyang (Bl) at the middle of the popliteal crease and bled the Xue Luo (blood capillaries). In the event of cold in the interior, one must needle Sanli (St 36).
In diseases belonging to the Yang, the body cannot be flexed forward (orthotonus), and in the diseases belonging to the Yin, the body cannot be bent backwards (ophisthotonus). The Foot Taiyang (Bl) runs along the side of the spine. When it is affected by wind, the muscles and vessels become retracted and the body is in ophisthotonus. This is why one must needle Weizhong (Bl 40) and bleed the Xue Luo (blood capillaries) at the level of the popliteal crease; it is also advised to needle Sanli (St 36) because the Jingmai, blood and energy are produced by the Yangming. This point has a therapeutic action on Feng Han (Wind-Cold).
PARAGRAPH 27
In the Bi Long syndrome (urinary retention by obstruction), it is advised to needle the Yinqiao and the region of the 3 Hairs and bleed the Xue Luo (blood capillaries).
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II - Ma Shi clarifies: The bladder and kidney constituting the Yin-Yang, Internal-External system, it is advised to needle Zhaohai (Ki 6), point of departure of the Yinqiao, and Dadun (Li 1) because the kidney attends to the aeration of the organs and the liver controls the free circulaton of the energy.
PARAGRAPH 28
If men, affected by a large abdomen ( 1 7 ) , and women affected by nausea and vomiting like the beginning of pregnancy, feel a sensation of laxity of the lumbars and break of the spine with anorexia... one must first bleed Yongquan (Ki 1) by acupuncture, then examine well the top of the foot and also practice bleeding at the vessels in a state of fullness. EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
This paragraph shows the treatment of diseases of swelling/compression. Sensation of laxity of the lumbars and break of the spine... denotes the upper localization of the disease. It is then advised to needle the lower part of the body; first bleed Yongquan (Ki 1) by acupuncture, then carefully examine the top of the foot belonging to the Foot Yangming (St). In the event of the presence of Xue Luo (blood capillaries), one must also make them bleed.
II - Zhang Shi concludes:
The totality of this chapter deals with diseases of internal etiology with external manifestations. This paragraph is the conclusion of the chapter. It is centered on the essential energy of the exterior and interior because diseases located in the interior or at the exterior always perturb Yin and Yang, blood and energy. Yin and Yang, blood and energy originating from a posteriori Jing Gu (cereal or acquired energy) have for their root a priori Jing Qi (innate or ancestral energy). 72. The circulatory route in the interior and at the exterior of the a priori Jing Qi is controlled by the kidney, and that of the a posteriori Jing Qi, by the stomach. At the subumbilical region, Dandian (18) designates Qihai (CV 6- Sea of Energy) and Bao Zhong (19), Guanyuan (CV 4- Barrier of the Source). The first corresponds to the boy and the second, to the girl. This is why large abdomen in men originates from energetic stasis, and nausea and vomiting in women originates from blood stasis. The body is controlled by the spleen and stomach. The lumbar vertebrae constitute the palace of the kidney. Anorexia is the result of the afflux of the energy of the stomach. In this case, it is a matter of a perturbation of the essential energy of the interior and exterior caused by the presence of perverse energy localizing at the same time in the interior and at the exterior. It is then advised to bleed Yongquan (Ki 1) and the Xue Luo (blood capillaries) of the top of the foot
17. As in beri-beri and scurvy. 18. Rice field. 19. Uterus.
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(belonging to Yangming) by acupuncture in order to aerate the blood and energy in the interior as well as at the exterior. In this manner, understanding the circulatory routes of entering and exiting of the essential energy is critical in acupuncture practice with the prupose of assuring equilibrium of blood and energy, thereby cure of the disease.
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73.
CHAPTER XXIV
Diseases of Afflux (Jue Bing)
This chapter is basically centered on the study of the afflux of cold (Han Jue). As a result, it differs slightly from Chapter 45 (Essay on Affluxess) of the Suwen. It consists of 22 paragraphs.
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PARAGRAPH 1
signs In the headaches caused by afflux (Jue) characterized by such as: _ facial edema _ anxiety of the heart (agitation), it is advised to needle Foot Yangming (St) and Foot Taiyin (Sp). EXPLANATIONS AND COMMENTARIES
Zhang Shi explains: 74. 1. This chapter is devoted to the phenomena of afflux of the energy of the 5 organs, determining factors of numerous illnesses, hence the title of this chapter: Diseases of Afflux. 2. In this paragraph, the energy of Yangming reaches the face and flows to the head to trigger headache and facial edema. The perturbation of Yangming causes that of the heart, hence anxiety. This is why, in this type of headache, one should needle the Foot Yangming (St). But as the change in the energy of Yangming depends on that of the Taiyin, one must also needle the Foot Taiyin (Sp). (Figure 17) Here, the afflux occurs in the energetic zone and not in the channels.
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PARAGRAPH 2
In the headaches caused by afflux (Jue) characterized by the following signs: _ pain at the level of the cranial vessels, _ sadness and crying (with tears), examine these vessels and, in the event of fullness, make them bleed by acupuncture, then balance the Foot Jueyin (Li).
75.
Figure 18 Headaches of origin of the afflux of the energy of Foot Jueyin (Li).
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PARAGRAPH 3
76.
In headaches caused by afflux (Jue) characterized by intense pains of fixed location ( 1 ) , it is advised to disperse the 5 lines above the head, that is to say, the 5 points of each line. In the first place, needle the Hand Shaoyin (He), and in the second place, the Foot Shaoyin (Ki).
Paragraph 3 demonstrates the case of afflux of the energy of the Foot Shaoyin (Ki) toward the cranium, then from there into the Foot Taiyang (Bl) to trigger headache (Figure 19). The 5 cranial lines designate: 1. The midline and its 5 points: Shangxing (GV 23) Xinhui (GV 22) Qianding (GV 21) Baihui (GV 20) Houding (GV 19). 2. The 2nd (lateral) line and its 5 points (that is, 10 points for the 2 sides): Wuchu (Bl 5) Chengguang (Bl 6) Tongtian (Bl 7) Luoque (Bl 8) Yuzhen (Bl 9). 3. The 3rd (lateral) line and its 5 points (that is, 10 points for the 2 sides): Linqi (GB 15) Muchuang (GB 16) Zhengying (GB 17) Chengling (GB 18) Naoking (GB 19). The Shaoyin and Taiyang govern the Water-Fire system. Top and bottom, summit and root unite...; this is why it is advised, in the first place, to disperse the Foot Taiyang (Bl) (that is to say, the points indicated above), then, in the second place, to needle the Hand Shaoyin (He) before the Foot Shaoyin (Ki).
II - N.V.N.: The points of the 5 cranial lines cited above make up part of the group of 59 Points already mentioned in the previous chapter. These points are specific in the treatment of afflux of heat at the level of the cranium.
1. According to later ancient editions: vertigo and sensation of heaviness of the head.
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According to Zhang Jing Yue: To needle first the Hand Shaoyin (He) is to evacuate the heat (Fire) in a state of afflux located to the South, and to needle the Foot Shaoyin (Ki) is to activate the production of Water located to the North to equilibrate water and fire, Yin and Yang of the cephalic region. 77.
Figure 19 Headache of origin of the afflux of the energy of the Foot Shaoyin (Ki).
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PARAGRAPH 4
In headaches caused by afflux (Jue) characterized by such signs as: _ frequent forgetfulness _ pains not detectable upon pressure of the fingers,
it is advised to needle first the artery located to the right and left of the face, then the Foot Taiyin (Sp). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
78.
This paragraph demonstrates the case of afflux of the energy of the Foot Taiyin (Sp) affecting first the cephalic region, then the vessels of the head and face, which induces headache (Figure 20). The spleen governs thought (Yi). When the energy of this organ affluxes toward the top, the Shen (mental) and Chi (will) become unclear, and Yi loses its power of memorization, hence frequent forgetfulness. The head governs the energy of Heaven, and the spleen, that of Earth. Pains not detectable upon pressure of the fingers denotes that the energy of the spleen affluxes toward the top and invades that of Heaven. It is then advised to first disperse the artery at the left and right of the head and face to evacuate the energy of afflux, then needle and harmonize the Foot Taiyin (Sp).
II - N.V.N.: Interpretation of the commentaries of Zhang Jing Yue furnishes us with interesting clarifications: The spleen governs thought and disturbances of thought are the cause of forgetfulness. Pain undetectable by finger pressure implies that they are not of fixed localization. The arteries of the face designate the Yangming (St). After bleeding these arteries one must needle the Foot Taiyin (Sp) to tonify the energy of the spleen.
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PARAGRAPH 5
79.
In headaches caused by afflux (Jue) manifest first by nuchalgia and secondly by lumbalgia, one must needle first Tianzhu (Bl 10) , then the other points of the Foot Taiyang (Bl).
80.
Here, it is a matter of headache due to afflux of the energy of Foot Taiyang (Bl). The bladder channel circulates from the head to the nucha, then to the lumbars. This is why this type of headache is followed by nuchalgia and lumbalgia (Figure 21). This afflux occurs originally within the energetic layer and secondarily in the channels. It is then advised to first needle Tianzhu (Bl 10)to eliminate the afflux phenomenon, then the points of the Foot Taiyang (Bl) in the goal of regulation.
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PARAGRAPH 6
as: ear, In headaches due to afflux (Jue) manifesting by the such signs _ intense ache of the head 81. _ heating up and tension of anterior and posterior vessels of the
one must first bleed these vessels by acupuncture, then needle the points of the Foot Shaoyang (GB).
70
The Shaoyang governs Ministerial Fire. This fire affluxes to the head (hence intense pains) and warms up the Luomai of the anterior and posterior parts of the ear (hence tension of these Luo). It is then advised to evacuate the contaminated blood in these Luomai before balancing the energy of Foot Shaoyang (GB). This paragraph and the previous 5 demonstrate the phenomenon of afflux of the energy of the the 3 Yin and 3 Yang, determining factors of headaches of endogenous etiology and not of exogenous etiology caused by perverse energy.
PARAGRAPH 7
The true headache, characterized by extremely intense pains invading the entire brain with cold feet and hands reaching the joints, is incurable, therefore, fatal. EXPLANATONS AND CMMENTARIES
I - Zhang Shi explains: True headaches are not headaches due to the afflux of the energy of the 3 Yin and 3 Yang (endogenous origin), but headaches caused by perverse energy at the level of the brain.
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The head is the site of reunion of all Yang channels, and the brain is the sea of the Jing (2) of the marrow. The arms and legs are icy cold to the joints (elbows and knees) because the source energy is seriously affected by perverse cold. The disease is fatal, therefore, incurable.
II - N.V.N.: a) According to Zhang Jing Yue, there exists two types of headaches: 1. Headaches caused by the afflux of the energy which are curable. 82. 2. Headaches caused by the deep infiltration of cold-wind at the level of the brain (encephalgias) which are incurable and fatal. According to this author, the head is the site of gathering of all the Yang channels, and the hands and feet are the roots of the Yang channels. violent pains of the head reveal destruction of the Yang energy by perverse energy at the level of the brain. b) In the Nanjing, Bianque adds: During the course of its infiltration, cold-wind, at the level of the 3 Yang of the hand, is the origin of the afflux responsible for headaches. When it penetrates into the brain, it provokes true headaches. (Figure 23)
2. The term Jing designates pure energy (quintessence) which maintains the brain and marrow.
72
PARAGRAPH 8
Headaches of traumatic origin are not treated by kinetic (Shu) points because the viscous blood is in a state of stagnation in the interior. In contrast, if the muscles are not seriously affected, local needling can be done at the painful sites. But in these cases, needling the points at a distance is strictly advised against. EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
This paragraph concerns headaches secondary to trauma. The Shu (kinetic) points (3) are contraindicated because the headache is of anatomic and non-energetic origin. In a general way, against the pains of the head, one needles the points of the bottom (hands and feet) because the afflux of the energy reaches the top. This technique is founded on the theories of the Top-Bottom, Bottom-Top circulation of the energy. In post-traumatic headaches, the pain does not come from the energy, but from the blood. Therefore, in these cases, treatment consists of only needling local painful points and not the distal points (points of the Wu Shu or Shu Antique group).
PARAGRAPH 9
In certain headaches, acupuncture is advised against. In this way, in Dai Bi syndromes (great obstructions), the pain is permanent and needling is aimed only at easing and not curing. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: Dai Bi is an ailment due to concomitant infiltration of 3 perverse energies: wind, cold and humidity. If the pain is permanent, it is advised to perform the technique of oblique (subcutaneous) needling at the level of the cranial muscles and bones in the goal of relieving and not curing because of the penetration and too deep fixation of these 3 perverse energies. Therefore, the kinetic (Shu) points at a distance are not effective in obtaining a total cure. II - N.V.N.: In practice, the cure of some types of headaches treated by acupuncture proves to be incomplete because they are secondary to a serious syndrome called Dai Bi (great obstruction). But, if the cure is, in effect, incomplete, relief of the pain is the rule. In this blatant case, the anti-pain effect of acupuncture, more than any other medicine, cannot lay claim to such a success.
3. Here, the term Shu does not designate the Shu antique (or Wu Shu) points, but the energetic points, in endless movement (kinetic), belonging to the channels.
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PARAGRAPH 10
84.
In hemicrania caused by cold, it is advised to first needle the points of the Hand Shaoyang (SJ) and Hand Yangming (LI), then those of the Foot Shaoyang (GB) and Foot Yangming (St).
PARAGRAPH 11
signs Pains of the heart caused by afflux (Jue) characterized by such as: _ pain radiating toward the back _ frequent spasmodic movements _ a feeling of being stabbed in the back to the heart _ stooped back and inability stand upright, bear the name cardialgia of renal afflux origin.
Needle Jinggu (Bl 64) and Kunlun (Bl 60) ; in absence of amelioration, add Rangu (Ki 2).
85.
From Paragraph 11 to Paragraph 17, study is centered on the phenomenon of afflux of the energy of the organs, origin of cardialgias. The energy source of the organs is linked to the heart, and the heart receives the energy of the blood vessels (Xue Mai). The afflux of the energy of the other 4 organs follows this route to reach the heart and trigger cardialgia. The back is Yang. The heart is Taiyang in Yang. As a result, the pain radiates from the
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heart toward the back and from the back toward the heart. The back and heart are therefore in relationship; when the pulse of the heart is too rapid, the individual has the feeling of being stabbed in the back to the heart. The kidney has a vessel which links up to the spine and from the spine to the heart. By this spinal route, the energy of the kidney flows down into the heart. Because of the heart pains, the individual stoops forward with inability to extend backwards. This pain is due to the afflux of the energy of the kidney toward the heart. Needling the points Jinggu (Bl 64) and Kunlun (Bl 60) constitutes the method of utilization of Fu-Yang (Yang of the bowel) to battle against the afflux of Yin-Zang (Yin of the organ). As soon as the needle is removed, if the patient is not relieved, one must add Rangu (Ki 2). This study is centered only on the afflux of the energy of the organ encroaching on the Jingmai, without relation to the 6 energies (4). This is why the words Taiyang and Shaoyin are not evoked but only their points.
II. N.V.N.: 1. All the channels (Jingmai) are linked to the heart. An attack on one of these channels is enough so that the circulation of the channel becomes chaotic in flowing to the heart. The encroachment of this energy of afflux on the heart provokes pain of this organ called cardialgia of afflux. This paragraph and the following ones (12 through 15) deal with cardialgias of afflux origin. 2. Zhang Jing Yue describes: ... From the inner thigh, the Foot Shaoyin (Ki) penetrates into the perineum, reaches the anterior side of the lumbar spine and arrives at the kidney. Another vertical vessel leaves the kidney, crosses the liver and diaphragm and penetrates into the lung. Stooping of the back is a stance provoked by pains of the stabbing type, piercing the heart by way of the back. This painful phenomenon is due to the encroachment of the energy of the kidney upon the heart, hence the name cardialgia of renal afflux. (Figure 24) The kidney and bladder constitute the system of relation internal-external, Yin-Yang. For this reason, treatment consists of needling Jinggu (Bl 64) and Kunlun (Bl 60), and if the pain persists, adding Rangu (Ki 2). 86. 3. The energetic relations of the kidney and heart, explained by Zhang Shi and Zhang Jing Yue, can be synthesized in the diagram below:
4. 6 energies designates the 6 channels: Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin.
75
PARAGRAPH 12
as: Pains of the heart due to afflux (Jue) characterized by such signs _ abdominal swelling _ thoracic fullness _ aggravation of the pain (during the bout) are cardialgia of gastric origin. It is advised to needle Dadu (Sp 2) and Taibai (Sp 3).
87...
76
The spleen and stomach are linked by the Yin-Yang system. The spleen aids the stomach in metabolizing the food products and distributing the energy of the organism. This is why it is advised to needle Dadu (Sp 2) and Taibai (Sp 3) of the Foot Taiyin (Sp) to disseminate the energy of the afflux of the stomach. 88... Chen Yu Gong has written: In the preceding paragraph, the bowel is used to disperse the organ, while in this paragraph, it is the organ which is used to disperse the bowel. The exploitation of this energetic relation is, therefor,e a marvelous method. On the other hand, the energy and blood are products of the stomach; this is why the texts emphasizes the role of the stomach among the 5 organs.
II. N.V.N.: According to Zhang Jing Yue, in cardialgia of gastric origin, one needles the points of the spleen because the Foot Taiyin (Sp) has a relationship with the Foot Yangming (St). His explanation is the following: The Foot Yangming (St) descends from the supra-clavicular fossa (Quepen) toward the stomach and divides into two branches: one reaches the spleen and the other, the inner abdominal wall. This is the reason for which one needles Dadu (Sp 2) and Taibai (Sp 3) in order to evacuate the energy of the afflux of the stomach at the level of the heart, thereby combatting cardialgia due to gastric afflux. (Figure 25)
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87...
88...
PARAGRAPH 13
Pain of the heart caused by afflux (Jue), pain like the sting of a needle, characterized by its intensity, bears the name cardialgia of splenic origin. It is advised to needle Rangu (Ki 2) and Taixi (Ki 3).
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II. N.V.N.: The validity of Taixi (Ki 3) and Rangu (Ki 2) in cardialgia of splenic origin has provoked numerous controversies, hence that given by Zhang Shi. But confirmation of the use of these points in the treatment of this ailment is indisputable. Zhang Jing Yue demonstrates it in this manner: A vessel of the spleen reaches the heart. When the function of metabolization and distribution of the energy of the spleen is found in a state of breakdown, this energy affluxes towards the heart to trigger a cardialgia of the needle-sting type. Therapeutically, the text advocates Rangu (Ki 2) and Taixi (Ki 3) of the Foot Shaoyin (Ki). For what reasons? Because, upon meeting the cold energy, the humid energy stagnates. This humid energy is then associated with the cold and affluxes to the heart. One must therefore needle the points of the kidney to disperse the cold of the heart, thereby combatting the afflux of the energy of the spleen, causal condition of cardialgia of spleen origin. (Figure 26) Clinically, in cardialgias of the needle-sting type, needling Rangu (Ki 2) and Taixi (Ki 3) always gives very good results.
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PARAGRAPH 14
signs Pain of the heart caused by afflux (Jue) characterized by such as: _ cadaveric color, greyish facies _ difficulty breathing deeply during the day bears the name hepatic cardialgia. One must needle Xingjian (Li 2) and Taichong (Li 3). EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
The liver governs the complexion and belongs to the energy of spring/birth. Because the energy of the liver surges back toward the top, the complexion is greyish, calling to mind a cadaver. 90. When the liver is affected, the energy of the gallbladder is also found in a state of afflux. This is why, during the day, deep breathing is impossible. The afflux of the energy of the liver towards the heart is the cause of cardialgia of hepatic origin. it is advised to needle Xingjian (Li 2) and Taichong (Li 3) in order to disseminate the energy in a state of afflux. (Figure 27)
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PARAGRAPH 15
signs Pain of the heart caused by afflux (Jue) characterized by such as: _ sensation of the body suspended in air while stretching in bed _ worsening of the pain during physical activity _ absence of color in the face bears the name cardialgia of pulmonary origin. One must needle Yuji (Lu 10) and Taiyuan (Lu 9).
The lung governs the totality of the energy of the body. Sensation of suspension of the body... denotes the presence of afflux blocked and swollen in the interior (in the thorax) with possibility of exteriorizing to the external part of the body. Because the afflux occurs in the interior, the pain worsens during physical activity. 91. The heart unites with the vessels and manifests at the exterior through the complexion. The lung is the umbrella protector of the heart. This ailment is therefore due to an afflux which descends from the top. that is to say, from the lung toward the heart, preventing the energy of the heart from reaching the exterior, hence absence of change of the color of the facies. (Figure 28) It is advised to needle Yuji (Lu 10) and Taiyuan (Lu 9) in order to eliminate the afflux phenomenon toward the heart.
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PARAGRAPH 16
In true pain of the heart, characterized by greenish color ( 5 ) of the limbs up to the joints, if the bout is triggered in the morning, death follows in the evening, and if it is triggered in the evening, death follows in the morning. EXPLANATIONS AND COMMENTARIES
I. Zhang Shi explains: The heart is sovereign organ; the Shen Ming (mental clarity) comes from there. For this reason, the heart is rarely attacked by perverse energy. If the source energy of the organ is affected, death is immediate. 92. Cold and heat are energies of Heaven; green and red are the colors of the 5 Movements (Wu Xing). In true pains of the head, cold of the limbs reaches the joints, and in true pains of the heart, the greenish color of the limbs reaches the joints; these two cases are fatal. II. N.V.N.: According to Zhang Jing Yue, the true cardialgias result from a massive infiltration of perverse energy into the sovereign heart. Death is therefore instantaneous; the word greenish implies the sense of cold.
PARAGRAPH 17
Pains of the heart not within the scope of acupuncture are those that are characterized by the massive presence of stagnated energy in the interior. The Shu (kinetic) points are not indicated. EXPLANATIONS AND COMMENTARIES
I. Zhang Shi explains: This paragraph demonstrates cardialgia via afflux of the energy of the 5 organs abundantly concentrated in the interior and not by afflux of the energy at the level of the channels. In other words, it is a matter of afflux following an excessive fullness of the energy of the 5 organs accumulated in the form of a mass in the interior and not of afflux of the energy via the routes of the channels. The afflux of the energy coming from the channels and the afflux of the energy coming from the mass (tumor) toward the heart to provoke cardialgia are of different natures. This is why the choice of points (kinetic-shu) is not indicated. II. N.V.N.: According to Zhang Jing Yue, the type of cardialgia cited in this paragraph is an ailment originating from an energetic gathering-accumulation (stasis) or blood stagnation located in the interior. Consequently, this cardialgia cannot be cured by acupuncture.
5. Greenish color had been changed to cooling/chilled in later editions. See explanation of Zhang Jing Yue.
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PARAGRAPH 18
In parasitosis (Zhong Jia, Jiao Hui) ( 6 ) , the little needles are advised against.
93.
_ The fullness and pain are sometimes at the upper part, sometimes at the lower part, of the abdomen, or sometimes the absence of pain, _ the sensation of intra-abdominal heat, _ thirst and sialorrhea are the signs revealing parasitosis. With the hand, firmly support the painful mass without displacing it and needle with large needle, then leave the needle in place. Removal of the needle is only executed upon the total disappearance of the movements of intra-abdominal displacement. Persistent fullness and abdominal pain indicate the formation of the mass of the lines which is directed from the bottom upward.
This paragraph defines Zhong Jia (parasitic mass) and Jia Hui (reunion of lines) and thier potential to trigger cardialgia. Jiao Hui designates the reunion of lines in the interior of the intestines and stomach. It is responsible for cardialgia because the energy of the bowels communicates with that of the heart. Zhong Jia is a mobile mass, parasitic, formed at the exterior of the intestines and stomach. It is also the origin of cardialgia because the heart governs the Shen Ming and possesses its palace of protection against attacks coming from the exterior. The little needles are ineffective because the lines neither pass by the routes of the Luomai nor by the routes of the channels (Jingmai). These types of lines gather in the intraabdominal spaces. Their morbidity is the origin of the pain and abdominal fullness, and their pause produces a remission period of calm. Pains of parasitic origin are therefore intermittent. These lines develop in the milieu Humidity-Heat, hence sensation of intra-abdominal heat. Because the site of development of these lines is heated up, the individual is thirsty. During mobility of the lines, the point Lianquan (CV 24) opens, hence sialorrhea. In presence of the classification cited above, one must think of Jiao Hui (accumulation of the lines) and treat it according to recommended techniques.
II. N.V.N.: In the treatment of parasitosis, needling is oblique, that is to say, subdermal.
6. Numerous Chinese and Vietnamese texts, translated by Zhong Xia, translated it as an immoblie mass of blood and energy. One must read Zhong Jia (false mass or mobile mass) to be loyal to the text.
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PARAGRAPH 19
94.
In deafness, one must needle the point which responds inside the ear, ( 7 ) and in buzzing of the ear, the artery in front of the ear ( 8 ) . In otalgias of pyogenic etiology, needling is advised against. If the ear is locked by cerumen, a dimunition in auditory ability is generally observed. In the event of deafness, first needle the ungual angle of the ring finger, and, secondly, the point of the hand and that of the foot. In the event of buzzing, needle the tip of the middle finger. If the buzzing is on the right, needle the left side; if it is on the left, needle the right side. First needle the hands, then the feet.
This paragraph demonstrates the case of afflux of the energy of the channel. From the foot, it passes to the hand, and from the hand, it reaches the head. 1. When the afflux occurs at the top part (from the hand toward the head) causing deafness and buzzing, one must first needle the Luomai located around the ear. (Figure 29) In contrast, during the afflux coming from the bottom, one should needle, in the first place, the Jing-well points of the hand, and, in the second place, those of the feet because the phenomenon of afflux originally has a site at the bottom (feet), secondarily at the top (hands) and definitely at the head (ears). In other words, for the afflux of the energy of the bottom (feet) to be able to trigger deafness and ringing in the ears, it is necessary that it pass first to the channels of the hand, then to those of the head, before reaching the ear. (Figure 29) Otalgia of pyogenic etiology and the dimunition of auditory acuity by cerumen do not have any relation to the energy of the Jingmai. This is why needling is not indicated. 2. The point at the tip of the ring finger is Guanchong (SJ 1), the point at the tip of the middle finger is Zhongchong (XB 9) and that of the tip of the great toe is Dadun (Li 1). The vessels of the 3 Yin channels of the foot and hand do not get to the head and neither pass from right to left nor left to right. Here, it concerns only the afflux of the energy toward the top to trigger deafness and ringing in the ear. 3. The ear is the orifice of the kidney. Jueyin governs spring, and Shaoyang is the birth energy. 95.... Jueyin and Shaoyang are created by the water of the kidney organ. When this energy, in forming, is in a state of afflux, the orifice of the mother organ (kidney) is obstructed. This is why one must needle the Jing-well points of the hand, sites of manifestation of the energy of the channels.
7. Tinggong (SI 19). 8. Ermen (SJ 21).
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4. The previous paragraphs study headaches caused by the afflux of the energy, contaminating the channels (Jingmai), and cardialgias provoked by the afflux of the energy at the level of the organs, contaminating the vessels (Mai), following the routes of intercommunication of organs/bowels-channels/energies. 96.... In contrast, this paragraph studies the afflux of the energy at the level of the Jingluo (principal and secondary channels) and at the level of the energetic layers. In the 1st case, one must needle the points from which the Luo (vessels of ramification) emanate, and in the 2nd case, the Jing-well points of the foot and hand... so as to favor the circulation of the energy. Such are the rules called Union-Separation of the channels and energies. Yin and Yang enter and exit; cold and heat go and come. These energies all originate from Earth; therefore, from the foot, they reach the top. Needle first Yang, then Yin, because the energy goes from the bottom upward, and needle first the hand, then the foot, because the energy goes from the foot to the hand. (Figure 29)
95....
Figure 29 Processes triggering deafness and ringing of the ear and their treatment _ afflux of the energy from the hand toward the head: Ermen (SJ 21) and Tinggong (SI 19), from where leave the Luo toward the interior of the ear. _ afflux of the energy from the foot toward the hand, then toward the head: Guanchong (SJ 1), Zhongchong (XB 9), Dadun (Li 1), activator points of the circulation of the energy of the channel.
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PARAGRAPH 20
96...
In the case of difficulty raising the thigh, it is advised that the patient go into the lateral decubitus position in order to needle the middle of the hip joint with the Yuan Li type needle, the large needle being advised against. EXPLANATIONS AND COMMENTAIRES
I. Ma Shi explains: The word thigh designates the coxo-femoral (hip) joint. The patient being in the lateral decubitus position, the effected limb held in flexion and the sound limb stretched out, needle, with the Yuan Li-type needle, the point Huantiao (GB 30), belonging to the Foot Shaoyang (GB), 2 cun deep, during one expiration and apply 3 moxas. The large needle is prohibited. (Figure 30)
II. Zhang Shi clarifies: 97. The thigh cannot be lifted because the energy of Shaoyang is in afflux down below. In priciple, the needling of Huantiao (GB 30) must be deep (2-3 cun). But here, the afflux occurs in the energetic layer and not in the channel; this is why the needling is superficial, epidermo-dermal, in order to activate the circulation of the energy. Deep needling up to the channel is not necessary.
PARAGRAPH 21
In intestinal hemorrhages, it is advised to needle Ququan (Li 8) .
II. Zhang Shi clarifies: 1. Jueyin (Li) governs the blood. Hemorrhages are due to the energy of Jueyin in a state of afflux circulating in the channels. Ququan (Li 8), belonging to the Foot Jueyin (Li), has an obvious anti-hemorrhagic action. 2. The energy belongs to Yang, and blood, to Yin. The top responds to Yang, bottom to Yin. When the energy circulating toward the top affluxes toward the Jingluo, it is the origin of the obstruction of the energy (Bi), of deafness and ringing in the ears. In contrast, when it circulates toward the bottom and affluxes toward the Jingluo, it causes intestinal bleeding.
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PARAGRAPH 22
Feng Bi (algoparesthesia of wind origin) is characterized by such signs as: _ latent and chronic pains _ feet alternately frozen as during a walk on ice or hot as during a bath in hot water _ massive infiltration of perverse energy at the level of the thighs and legs 98. _ anxiety and headache _ sometimes, vomiting _ sometimes, anguish and sensation of oppression _ vertigo following sweating. In the chronic state: _ dizziness and vertigo _ mental instabilty: successive states of sadness, joy, fear, _ short breathing (apnea) and melancholy, death follows in 3 years.
2. Following the law of Yin-Yang, Yin and Yang gather together into 3 Yin and 3 Yang responding to the Jingmai of the foot and hand. Water and Fire represent Yin and Yang. The heart and kidney are the organs responding to Water and Fire. When the afflux of the wind floods the top and bottom and reaches the organs, the disease is incurable. In this case, the application of the method of purification (9) damages the fire of the Xin Bao (XB), and the applicaton of the method of calorification (10) injures the Yin of the kidney organ (Kidney Yin). This is why Feng Bi is a difficult disease to treat. When the afflux of the wind reaches the lower part of the body, the feet are ice cold because they are affected by the Cold-Water energy. And when it reaches the upper part of the body, the feet are hot because they are affected by the Heat-Fire energy. When the afflux of the wind goes from the top downward, the thigh and legs are affected, and when it goes from the bottom upward, the head is affected. The fickle, inconstant signs of vomiting, anguish... indicate that sometimes the afflux of the wind takes place at the center (Spleen-Stomach).
9. Method consisting of using the medicines of refridgerating or refreshing nature or the energetic anti-heat points. 10. Method consisting of using medicines of calorific or warming nature or the energetic anti-cold points. See MTC- NVN Edition.
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All vessels gather together at the eyes. Dizziness and amblyopia indicate, therefore, the overflowing of the afflux of the wind at the level of the blood zone of the Jingmai. Sweating is due to the afflux of the wind toward the energetic zone of the skin-sweat gland system. 99. The Jing (quintessence) of Water is Chi (will), and the Jing of Fire, Shen (mental). These two psychologic energies afflux toward the eyes, hence dizziness. Joy belongs to the heart, and fear, to the kidney. These inconstant signs of sadness, joy, fear... indicate the instability of the Shen of the heart and Chi of the Kidney. Short breathing also originates from the disturbance of the energy of the kidney, and sadness (without joy), from disturbance of the heart.
The disease localizing at Yang bears the name Feng (Wind), and that localizing at Yin, the name Bi (obstruction and pain). When Yin and Yang are disturbed together, the disease bears the name Feng Bi. In Feng Bi, perverse energy overflows and diffuses everywhere: _ below, it affects the feet, hence sometimes icy, sometimes hot feet _ above, it arrives at the head and eyes, hence headache, dizziness _ at the exterior, it reaches the skin and sweat glands, hence sweating _ in the interior, it is the origin of short breathing (apnea) and instability of the Shen. Feng Bi is therefore a syndrome due to the dysharmony of Yin and Yang, to circulatory disturbances of the energy of the 5 organs, to the loss of connection of Ying (nutritive energy) and Wei (defensive energy) and to the the simultaneous defeat of the blood and energy. This is why death follows in 3 years.
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no 100/101.
CHAPTER XXV
Causes of Disease (Bing Ben)
Chapter 25 of the Lingshu demonstrates the therapeutic rules following the principles of Summit-Root (Jiao Ben). These methods have the basic objective of adapting the treatment to the characteristics of the disease: _ to its etiology (Root) or to its symptomatology (Summit) _ to its seriousness or to its benignness _ to its acute, subacute or chronic nature. These two words, Summit (Jiao) and Root (Ben), must be taken in the larger sense. They can, in effect, have different acceptances, according to the point of view considered: _ in the development of the disease, the word Root corresponds to cause, and the word Summit, to symptoms; _ in a disease association, Root designates the disease which originally appears, and Summit, that which follows secondarily; _ in the determination of the location of the disease, Root applies to deep attack (attack of the interior), and Summit corresponds to superficial attack (attack of the exterior). In practice, faced with the diversity of clinical forms, we must apply these two therapeutic principles with flexibility and discernment because experience has demonstrated the existence of cases which necessitate treatment of the Root (etiologic treatment) or treatment of the Summit (symptomatic treatment). Ma Shi has said: This Chapter 25 of the Lingshu is like Chapter 73 (Study on the Origin of Disease) of the Suwen. Generally, treatment must be, before all, etiologic because that is the logic of all therapy. In the Lingshu, Summit-Root and the evolution of the disease constitute two different chapters, while in the Suwen, they make up only
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one.
PARAGRAPH 1
102.
In disease prior to afflux (Jue), one must treat, in the first place, the root ( B e n ). root. In afflux prior to disease, one must treat, in the first place, the
In the attack of cold prior to disease, one must treat, in the first place, the root. root. the In the disease prior to cold, one must treat, in the first place, the
In attack of heat prior to disease, one must treat, in the first place, root.
This paragraph define the words Jiao and Ben (Summit and Root), Biao and Li (exterior and interior) and their use therapeutically. 1. ... prior to the afflux; ... prior to cold; .. prior to heat implies the effect on the organism before attack of the 6 perverse energies. Disease prior to afflux designates the pathologic state (disease) of the individual preceding the triggering of the phenomenon of afflux. As a result, one must treat, as a matter of priority, the root-disease. Afflux prior to disease implies the primary attack of the 6 perverse (cosmic) energies with perturbation of Yin and Yang of the body, responsible for the phenomena of the afflux, triggering factor of the disease. As a result, one must treat first the perverse root-energy. Cold prior to disease implies attack by an infiltration of perverse (cosmic) cold before the appearance of the syndromes of the 6 channels. As a result, one must treat, in the first place, the perverse root-cold. Disease prior to the cold implies the attack of the body before the appearance of the cold syndrome. As a result, one must treat in the first place the root-disease. Heat prior to the disease implies attack by an infiltration of perverse (cosmic) heat before the appearance of other syndromes. As a result, one must treat first the perverse root-heat. 2. The 6 energies of Heaven are cold, wind, heat, humidity, dryness and fire. The 6 energies of Heaven designate the 6 channels, that is to say, the 3 Yin and 3 Yang: Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin. 103. Yin and Yang of the human being unite with the 6 energies of Heaven. As a result, the root disease can contaminate the summit disease and vice versa. In this paragraph, root designates the primary disease, and the summit, the secondary
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PARAGRAPH 2
In diarrhea prior to another disease, one must treat and harmonize the root (Ben) before taking an interest in the ailment itself. In disease prior to bloating/abdominal fullness, one must urgently treat the summit (Jiao). In disease prior to diarrhea, one must treat the root ( B e n ) . In bloating/abdominal fullness prior to anxiety, one must treat the root ( B e n ) .
1. Diarrhea is an ailment belonging to the spleen and stomach. The spleen governs the 4 limbs and the dermal system (flesh). ... another disease designates that of the spleen, with disturbances at the 4 limbs and other parts of the body. This is why one must, in the first place, treat the root and harmonize the Spleen-Stomach system before becoming preoccupied with other diseases. 2. Bloating/abdominal fullness (Zhong Man) originates from disturbances of the spleen and stomach. In disease prior to the bloating/abdominal fullness, one must treat in the first place, the summit (Jiao) which is the Zhong Man, then secondly, the root of the disease. 104. 3. In disease prior to the diarrhea, one must first treat the root; the diarrhea stops spontaneously. 4. Zhong Man (bloating/abdominal fullness) prior to disturbances of the heart (anxiety) is due to afflux of the energy of the spleen toward the heart. This is why one must, in the first place,
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PARAGRAPH 3
Sometimes, because of the presence of the energy-guest (Ke Qi ) or because of the presence of customary active energy (Dong Qi ) , the disease is characterized by signs of dysuria of difficult defecation; one must urgently treat the summit ( J i a o ) . In contrast, in case of absence of these signs, one must treat the root( B e n ) . EXPLANATIONS AND COMMENTARIES
I. Zhang Shi explains:
The energy-guest (Ke Qi) designates the group of 6 irregular energies of Heaven, and the customary active energy (Dong Qi), the group of 6 regular energies of Heaven. Diseases can be caused either by guest perverse energy (Ke Qi) or by active customary perverse energy (Dong Qi). Therefore, these perverse energies are harmful to the essential energy of the body. Disturbances of metabolism of the essential energy are the causes of dysuria and difficult defecation; one must treat urgently the summit (Jiao). If diuresis and defecation are normal, one must treat the root (Ben).
II. N.V.N.: The words Ke Qi (energy-guest) and Dong Qi (customary active energy) merit more precise definition: 105. 1. Ke Qi designates an intrusive type of energy of man which infiltrates into the organism in inconstant fashion. This is a disordered energy of the 4 seasons. Ex: cold in summer, heat in spring... . 2. Dong Qi designates, in a general way, the normal climatic energy of the 4 seasons like: _ the warmth of spring (Chuan Wen) _ the heat of summer (Xia Re) _ the freashness, coolness of autumn (Zu Liang) _ the cold of winter (Dong Han). The variation of these seasonal energies is cyclic and constant.
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PARAGRAPH 4
In the state of excess (fullness), the disease progresses from root toward summit; one must treat first the root, and secondly, the summit. In the state of insufficiency (emptiness), the disease evolves from summit to root; one must treat first the summit, and secondly, the root. One must meticulously evaluate the benignity and seriousness of the disease in order to harmonize them. In the benign case, one must treat at one time the perverse energy and essential energy, and in the serious case, one must treat them separately. Dysuria and difficult defecation being prior to another disease, one must treat the root.
This paragraph studies Jiao (summit) and Ben (root) of Yin and Yang and the 6 energies. Chapter 68 (Great Presentation on the Secret of Six) of the Suwen states: _ The top of Shaoyang belongs to the fire energy _ The top of Yangming belongs to the dryness energy _ The top of Taiyang belongs to the cold energy _ The top of Jueyin belongs to the wind energy _ The top of Shaoyin belongs to the heat energy _ The top of Taiyin belongs to the humidity energy.
106. These energies are the roots below which are found the summits. In other words, wind, cold, heat, humidity, dryness and fire are the 6 energies responding to the roots, and the 6 energies of the 3 Yin and 3 Yang (Taiyang, Shaoyang, Yangming, Taiyin, Jueyin and Shaoyin) respond to the summits.
1. In states of excess... designates the perverse energy in a state of fullness. In states of emptiness designates the state of emptiness of the essential energy. The disease in a state of fullness progresses from the root to the summit, and the treatment must be carried out, in the first place, at the level of the energy of the root, that is to say, at the level of wind, cold, heat, dryness, humidity, fire; then, in the second place, at the level of the summit, that is to say, at the level of the 3 Yin and 3 Yang (Taiyang, Shaoyang,... Taiyin, Jueyin...). In other words, one must first dipserse the perverse energy and only later tonify the essential energy. In contrast, the disease in a state of emptiness progresses from summit toward root. One must, as a matter of priority, harmonize Yin and Yang, then secondly, the energy of the root. Such are the fundamental rules of therapy according to root and summit, perverse energy and essential energy, emptiness and fullness. 2. ... treat at one time the perverse energy and essential energy means that the
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dispersion of perverse energy must be associated with the tonification of essential energy. 3. ... treat separately implies to treat the case of perverse energy only in a state of fullness or the case of the essential energy only in emptiness. Treatment is aimed then only at the state of fullness of the perverse energy or at the state of emptiness of the essential energy. 4. In the case of dysuria and difficult defecation prior to another disease, one must treat only the root, that is to say, the dysuria and difficult defecation.
II. N.V.N.: In general practice, the physician is often confronted by concrete pathological situations which can be extremely complex and of infinite diversity. Faced with all these situations, it is important to discern the Summit and Root before assuming a therapeutic decision. Deep knowledge of the notions of Root and Summit permit differentiating the essential from the secondary, establishing a hierarchy of morbid symptoms, detecting the mechanism which drives the cause of the symptoms and applying, as a result, a rational therapy. 107. In this regard, Qi Bo clarifies: _ If disturbances of the energy are secondary to a disease, one must first treat the Root. _ If a disease is secondary to disturbances of the energy, one must first treat the Root. _ If signs of cold are secondary to a disease, one must first treat the Root. _ If a disease is secondary to that of heat, one must first treat the Root. _ If a disease is the result of diarrhea, one must treat the Root, beginning first to reestablish liquid equilibrium, then treat the disease.
_ If abdominal flatulence is the result of a disease, one must first treat the Summit. _ If diarrhea is the reult of a disease, one must first treat the Summit. _ If upset stomach is the result of abdominal flatulence, one must first treat the Summit. _ Faced with a disease with disturbances of evacuation of matter and urine, one must urgently treat the Summit. _ Faced with a disease of fullness, with signs of attack of the Root evolving toward signs of attack of the Summit, one must first treat the Root, then the Summit. _ Faced with a disease of emptiness, with signs of attack of of the Summit evolving toward the Root, one must first treat the Summit, then the Root, taking into account the benignity or seriousness of the ailment in order to apply a treatment of harmonization: _ If the disease is benign, treat Summit and Root together. _ If the disease is serious, treat Summit and Root together. _ Faced with a secondary disease from distrubances of evacuation of matter and urine, one must treat, as a matter of urgence, the Root.
This assertion means to say that treatment must be etiologic as much as possible. Nevertheless, there are diseases of acute pace necessitating urgent symptomatic treatment. This illustrates the second general principle according to which: One must treat the Summit at once in acute cases, and the Root in subacute and chronic cases. In summary, the method of Summit and Root is basically founded on the differentiation of acute, subacute and chronic states on the one hand, and on the seriousness or benignness of the disease on the other hand. If the Summit is more acute than the Root, one must first treat the
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Summit. If the Root is more acute than the Summit, one must first treat the Root. The discernment of Summit and Root is therefore of prime importance in therapeutic management. This importance has been stressed in the Suwen: To know the notions of Summit and Root is to have the power to cure all diseases. To misjudge these notions is to introduce regrettable errors.
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no 108/109.
CHAPTER XXVI
Various Diseases (Za Bing)
Chapter 26 of the Lingshu studies various sydromes of afflux etiology (Jue): _ spinal pain, facial edema, dysphasia, boborygmi, salivation, gonadal pain, tonsillitis, Fever-Chills, odontalgia, deafness, epistaxis, lumbalgia, dyspnea, behavioral disturbances (anger, joy,...), lower maxillary pains, nuchalgia, disturbances of diuresis, cardialgias, abdominal pains, limb flaccidity, hiccups... . The classification and description of the disease, diagnosis and therapy are shown explicitly. Because the scope of study is heterogenous, this chapter is entitled: Various Diseases (Za Bing). This chapter contains 28 paragraphs.
PARAGRAPH 1
In the Jue (afflux) syndrome causing spinal pain radiating up to the top of the cranium, with sweating and heaviness of the head, diminished visual acuity and lumbar stiffness, it is advised to needle the Xue Luo (blood vessels) located at the popliteal crease, belonging to the Taiyang (Bl).
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The energy of the Taiyang channel controls the external layer of the body. The perverse energy attacks the Taiyang, causing a opposite flow of the energy of this channel characterized by the signs noted above. One must needle the Xue Luo (blood capillaries) of the popliteal crease to evacuate the perverse energy. 110. II - N.V.N.:
Among the 6 channels (3 Yin, 3 Yang), the Taiyang is the most exposed to the exterior. As a result, the attack of perverse energy at the level of the epidermo-dermal layer always perturbs the energy of Taiyang whose afflux is the origin of spinal pain, headache of the vertex, sensation of heaviness of the head, dizziness of the eyes, lumbar stiffness... . It is the reason for which Qi Bo in the first place presents the disturbances of the Taiyang, always characterized by the presence of Xue Luo (blood capillaries) at the popliteal crease which one must bleed.
PARAGRAPH 2
In the Jue (afflux) syndrome characterized by thoracic fullness with edema of the face, puffiness of the lips and severe dysphasia, or aphasia in the serious case, one must needle the Foot Yangming (St). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
The Foot Yangming (St) vessel starts at the side of the nasal ala, _ ascends toward the forehead in passing the internal canthus of the eye, _ redescends and encircles the lips, _ penetrates into the laryngo-phayrngeal apparatus, _ arrives at the point Quepen (St 12), _ reaches the diaphragm... . The text also stipulates: When perverse energy attacks the face, it descends by the route of the Yangming. During attack of the perverse energy at the level of the epidermo-dermal layer of the facial region, it expresses by face swelling. It descends by the route of the Yangming also implies the creation of thoracic fullness and puffiness of the lips. The laryngeal system is the path of ascent and descent of the energy, and the Yangming vessel follows this route. This is why, in the event of afllux, the energetic system of this region is disturbed, hence severe dysphasia or aphasia in the serious case. It is then advised to needle the Foot Yangming (St) in view of dispersing the perverse energy.
II - N.V.N.: 111.
According to Ma Shi and Zhang Jing Yue, this pufiness of the lips is always accompanied by salivation. Here, the dysphasia is due to disturbances of the circulation of the energy of the Yangming
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at the level of the laryngo-pharyngeal organs. This is why one must choose the points of the Foot Yangming. According to the Dacheng (1), in facial edema with disturbance of speech, one must needle Jiexi (St 41) and Neiting (St 44).
PARAGRAPH 3
In the case of afflux of the energy toward the laryngopharyngeal system with dysphasia, accompanied by cold hands and feet and dysuria, one must needle the Foot Shaoyin (Ki).
The Foot Shaoyin (Ki) vessel ascends toward the laryngo-pharyngeal system and attaches to the base of the tongue. As a result, afflux of the energy toward the throat is the cause of the dysphasia. The kidney is the source organ of the production of the energy. When this energy affluxes toward the top, the feet and hands are cold. The kidney exteriorizes at anterior Yin (genitals) and at posterior Yin (anus). Its disturbances always cause dysuria and difficult defecation. One must needle the Foot Shaoyin (Ki) to normalize the circulation of the energy in a state of aflux.
II - N.V.N.: Here, it is a question of another type of dysphasia, accompanied by coolness of the feet and hands with dysuria and difficult defecation. As for treatment, the Dacheng proposes needling the Jing-river point (Fuliu-Ki 7).
PARAGRAPH 4
In the syndrome of afflux (Jue) characterized by boborygmi, with stagnation of cold energy causing gurglings and constipation, one must needle the Foot Taiyin (Sp). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
The abdomen enters into the Spleen-Stomach sphere. Boborygmi originates from the afflux of the energy occuring in the abdomen. Taiyin responding to Humidity-Earth is Zhi Yin (arrival of Yin) in Yin. Therefore, gurglings are provoked by Water-Humidity movements.
112.
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1. See Art and Practice of Acupuncture/Moxabustion According to Dacheng - N.V.N. Edition, Vol. II.
The energy of Earth (Spleen) does not ascend and that of Heaven (Stomach) does not descend, hence difficult defecation. As a result, one must needle the Taiyin to eliminate the phenomenon of contrary afflux.
II - N.V.N.: The Dacheng proposes the Jing-well point (Yinbai- Sp 1) and Yuan point (Taibai- Sp 3).
PARAGRAPH 5
In dryness of the laryngo-pharyngeal system (throat) with the sensation of heat in the mouth and thick salivation, one must needle the Foot Shaoyin (Ki).
Here, perverse energy offends the energy of Shaoyin, provoking an afflux at the lower part of the body. The water energy of the kidney and fire energy of the heart communicate. When the kidney is disturbed by perverse energy, the energy of Shaoyin (Ki) affluxes toward the bottom and cannot be directed to the top to enter in relationship with that the heart, hence fullness of fire with dryness of throat, hot mouth and thick and sticky salivation. It is advised to needle the Foot Shaoyin (Ki) to suppress the phenomenon of aflux in order to accelerate the movements of ascent of water toward fire. (Figure 31)
II - N.V.N.: The Dacheng proposes the Jing-well point (Yongquan-Ki 1) of the Foot Shaoyin. 113.
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Figure 31: Process of triggering dryness of the tongue and its treatment (Yongquan- Ki 1 and Taixi- Ki 3)
PARAGRAPH 6
In gonalgia, one must needle Dubi (St 35) with the type 6 needle (Yuan Li) every 2 days. This large needle, resembling a long hair of the tail of the buffalo, is well adapted to needling the knee, without any doubt.
Here, perverse energy infiltrates into the Foot Yangming (St) channel and provokes gonalgia. It is then advised to use a large and long needle of the Yuan Li (No. 6) type, resembling a hair of buffalos tail. ... without any doubt also implies that one must needle the point of the energy when the perverse energy is found in the energetic layer to create a state of flow, and the point of the
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channel when the perverse energy is found within the Jingmai. II - N.V.N.: 1 - The point of the energy described by Zhang Shi is the A Shi (painful) point or the curious point, site of concentration of the Jing energy (Quintessence) of the corresponding organ/bowel. Ex: Yingtang (PC 3) is the site of concentration of the Jing of the lung. 114. 2 - The point of the channel is the point of the channel itself, site of concentration of Ying (nutritive) energy. Ex: Taiyuan (Lu 9) is one of the points of concentration of Ying energy, belonging to the channel of the lung.
PARAGRAPH 7
In tonsillitis with aphonia, one must needle the Foot Yangming (St), and in tonsillitis without aphonia, the Hand Yangming (LI).
Tonsillitis is an ailment caused by perverse energy at the level of the throat and is characterized by inflammation with edema. The Foot Yangming (St) circulates in this region. As a result, perverse energy prevents circulation, hence tonsilltitis with aphonia. The Hand Yangming (LI) circulates a small distance from this region. In its attack, the voice remains normal. This is why, in case of tonsillitis without aphonia, one must needle the Hand Yangming (LI) (Figure 32)
Figure 32:
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PARAGRAPH 8
Circulation of the Hand and Foot Yangming (LI and St) at the level of the laryngo-pharynx.
In the disease of Fever-Chills with absence of thirst, characterized by a bout every 2 days, one must needle the Foot Yangming (St). In contrast, in the disease of Fever and chills with thirst, characterized by a daily bout, one must needle Hand Yangming (LI). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: Perverse energy (of fever-chills) follows the Jingmai and penetrates deeply within the interior of the body. As it infiltrates into the Yin part, it cannot get back to the exterior, hence a bout every 2 days. The Foot Yangming (St) vessel arrives at the stomach and passes to the spleen to respond to the terrestrial energy of the lower region of the body. Its circulatory route is distant, hence a bout every 2 days. Since Earth responds to Yin, thirst is absent. In this case, one must needle the Foot Yangming (St). The Hand Yangming (LI) vessel originates from the large intestine, links to the lung and responds to the celestial energy of the upper region of the body. Its circulatory route is therefore nearby, hence a daily bout. Since Heaven responds to Yang, thirst is present. In that case, one must needle the Hand Yangming (LI). (Figure 33) II - N.V.N.: The Dacheng proposes the Shu-stream point (Sanjian- LI 3) of the Hand Yangming (LI). 115.
Figure 33:
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PARAGRAPH 9
Circulation of the Hand and Foot Yangming (LI and St) 116.
If in odontalgia, cold drinks are not feared, needle the Foot Yangming (St). In contrast, if in odontalgia, cold drinks are rejected, needle the Hand Yangming (LI).
II - N.V.N.: Dental pains without fear of cold drinks are generally due to Fullness-Heat of the Foot Yangming (St).Dispersion of this channel is therefore indicated. In contrast, dental pains with fear of cold drinks are generally due to Emptiness-Cold. As a result, tonification of this channel of Hand Yangming (LI) is necessary.
PARAGRAPH 10
In dimunition of auditory acuity without otalgia, one must needle the Foot Shaoyang (GB), and in dimunition of auditory acuity with otalgia, one must needle the Hand Yangming (LI).
PARAGRAPH 11
In continous epistaxis with blood clot, one must needle the Foot Taiyang (Bl), and in epistaxis without blood clot, needle the Hand Taiyang (SI). 117. If the epistaxis persists, one must needle Wangu (SI 4) ; without result, needle Weizhong (Bl 40) .
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The Foot Taiyang (Bl) responds to water (cold). As a result, epistaxis forms a blood clot. The Hand Taiyang (SI) responds to fire (heat). As a result, epistaxis is without blood clot. Here, it is a question of a case of infiltration of perverse energy within the energetic layer causing an anarchic circulation of the Yang Luo (Superficial Luo of the nasal mucosa). This is why it is advised to needle the Hand and Foot Taiyang (SI and Bl) to activate the energetic circulation, thereby stopping the epistaxis; without result, one must needle Wangu (SI 4) and bleed Weizhong (Bl 40). (Figure 34)
PARAGRAPH 12
In lumbalgia with sensation of cold at the lumbar area, one must needle the Foot Taiyang (Bl) and the Foot Yangming (St). In lumbalgia without sensation of cold at the lumbar area, one must needle the Foot Jueyin (Li). 118. Foot In lumbalgia with inability to flex and extend, one must needle the Shaoyang (GB).
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Taiyang and Yangming govern, respectively, Cold-Water and Coolness-Metal energies. As a result, in lumbalgia with cold sensation, one must needle the Foot Taiyang (Bl) and Foot Yangming (St). Jueyin/Wind-Wood governs the energy and unites with the transformed fire (Ministerial Fire) of Shaoyang; this is why in lumbalgia with sensation of heat, one must needle Jueyin (Li). Lumbalgia preventing flexion and extension of the body originates from the rupture of the hinge of the Shaoyang; this is why one must needle the Foot Shaoyang (GB).
II - N.V.N.: The explanation of Zhang Jing Yue is more practical: In lumbalgia with sensation of cold at the lumbars, one must needle the Yangming in order to drive the perverse Yin out into the Yang layer of the body. In lumbalgia with sensation of heat at the lumbars, one must needle the Jueyin to drive out the Wind-Heat infiltrating within the Yin. The Shaoyang vessel circulates the length of the two lateral sides of the body; this is why, in inability of extension and flexion of the body, one must needle the Foot Shaoyang.
PARAGRAPH 13
In sensation of heat in the abdomen with dyspnea, one must needle the Foot Shaoyin (Ki) and bleed Weizhong (Bl 40) . EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
The Foot Shaoyin (Ki) vessel is directed toward the top, crosses the diaphragm, projects into the thorax, penetrates within the lung and attaches to the heart. The syndrome of abdominal heat is due to an opposite flow (afflux- Jue Ni) of the Shaooyin that cannot communicate with the heart. Therefore, one must needle the Foot Shaoyin (Ki) and bleed Weizhong (Bl 40).
PARAGRAPH 14
119.
In the case of excessive joy and anger with anorexia and weak voice, one must needle the Foot Shaoyin (Ki), and in the case of anger with logorrhea (2), needle the Foot Shaoyang (GB).
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2.
Too much joy harms the heart, and too much anger harms the liver. Under the action of the stomach, foods are transformed into Jing Qi (pure energy) which diffuses toward the heart and liver. As a result, disordered digestion can provoke a contrary afflux of the energy of the heart and liver, responsible for anorexia. The number 5 responds to Yin (voice) and Yin governs the end of summer; when the energy of the liver and that of the heart are in a state of contrary afflux, the energy of the center (Zhong Qi: spleen) is disturbed and the voice gradually grows weaker. One must needle the Foot Taiyin (Sp) to ventilate the circulation of the energy of the spleen in order to activate food metabolism and acentuate the tone of the voice. The liver governs speech (therefore also the voice). Anger with logorrhea is due to a strong ascent of the energy of Jueyin. As a result, one must needle the Shaoyang (GB) to ventilate the energy of the liver.
PARAGRAPH 15
In pains of the lower maxilla, one must needle the Hand Yangming (LI) and bleed the vessels in a state of fullness. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
A vessel of the Hand Yangming (LI) leaves Quepen (St 12), reaches the neck and arrives at the cheekbone... . The Foot Yangming (St) reaches the ocular system, redescends to the cheekbone, penetrates into the gums, reaches Daying (St 5), where it divides into two branches: _ one branch descends toward Renying (St 9) _ another branch rejoins Jiache (St 6), passes in front of the ear, arrives at the temporal region, where Xiaguan (GB 3) occurs, and terminates at Touwei (St 8). As a result, during lower maxillary pain, one must needle the Hand Yangming (LI) and the vessel in a state of fullness.
II - Ma Shi states: 120.
Here, the words lower maxillary includes the cheekbone and temporal region, that is to say, the region of passage of the Foot Yangming (St). To needle the Hand Yangming (LI), that is to say, the point Shangyang (LI 1), and bleed the vessel in a state of fullness, that is to say, needle and bleed Jiache (St 6), located above and in front of the lower angle, on the masseter. (Figure 35)
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PARAGRAPH 16
In nuchalgia with stiffness preventing flexion and extension of the neck, one must needle the Foot Taiyang (Bl); if the head can neither turn to the right nor left, one must needle the Hand Taiyang (SI). EXPLANATIONS AND COMENTARIES
I - Zhang Shi explains:
From the nucha, the Foot Taiyang (Bl) follows a trajectory parallel to the spine to the lumbar vertebrae. Therefore, in case of disturbances preventing flexion and extension of the neck, one must needle the Foot Taiyang (Bl). Once reaching to the posterior part of the shoulder joint, the Hand Taiyang (SI) projects
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into Dazhui (GV 14), then redescends to Quepen (St 12) in the supraclavicular fossa... . As a result, in case of disturbance preventing movements of rotation of the head, one must needle the Hand Taiyang (SI). II - N.V.N.: 121. According to the Dacheng (3), in cervicalgia with torticollis, _ To needle the Foot Taiyang (Bl) is to needle the Shu and Ying points of the bladder channel: Shugu (Bl 65), responding to the Wind-Wood movement Tinggu (Bl 66), responding to the Cold-Water movement _ and To needle the Hand Taiyang (SI) is to needle the Jing-well and Xi points of the small intestine channel: Shaoze (SI 1), responding to the Metal-Lung movement Yanglao (SI 6), point of unblocking.
PARAGRAPH 17
In fullness/swelling of the lower abdomen with surging of the energy toward the stomach and heart, sometimes sensation of fever, sometimes sensation of chill, and disturbance of diuresis, one must needle the Foot Jueyin (Li). In abdominal fullness with constipation, surging of the energy toward the thorax and laryngo-pharyngeal system, dyspnea and loud breathing, one must needle the Foot Shaoyin (Ki). In abdominal fullness with dyspepsia, boborygmi and difficult defecation, one must needle the Foot Taiyin (Sp). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: This paragraph describes the phenomenon of afflux of the energy of the 3 Yin (Jueyin, Shaoyin, Taiyin) manifesting at the lower part of the body, triggering factor of the syndrome of abdominal fullness.
a - The Foot Jueyin (Li) reaches the lower abdomen, arrives at the stomach, crosses the diaphragm... . As a result, the afflux of the energy of this channel is at the origin of fullness/ swelling of the lower abdomen. Because this afflux is directed toward the top, it arrives at the stomach and heart. Jueyin makes up part of maximal Yin in which is born first Yang, hence sensation of fever and chills. The liver governs all phenomena of secretion of the organism. Therefore, disturbances of diuresis originate from the afflux of the energy of Jueyin. b - The kidney is the door of the stomach. It becomes exteriorized at the level of the 2 Yin (anterior Yin- urethra; posterior Yin- anus). The fullness/swelling of the lower abdomen is due to the closure of this door at the time of the contrary afflux of the energy of the kidney. The kidney has a vessel which crosses the diaphragm, penetrates into the lung and arrives at the laryngo-pharyngeal organs... . This is why the afflux of the kidney energy at the level of
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122.
3. See Art and Practice of Acupuncture and Moxabustion According to the Dacheng - NVN Edition.
c - The Foot Taiyin (Sp) governs the movements and transformations of the cereal water. Because the energy is in a state of afflux, the abdomen is in fullness. Boborygmi, dysuria and constipation must be treated at the level of the points of the 3 Yin of the foot to combat this afflux.
II - N.V.N.: _ In fullness of the lower abdomen with dysuria, the Dacheng proposes needling Taichong (Li 3), Yuan point corresponding to the Earth-Spleen movement. _ In abdominal fullness with constipation, the Dacheng advises needling Taixi (Ki 3), Yuan point of the kidney channel. _ In abdominal fullness with dyspepsia, the Dacheng proposes the point Taibai (Sp 3), Yuan point of the spleen channel.
PARAGRAPH 18
In heart pains radiating toward the lumbar region with nausea, one must needle the Foot Shaoyin (Ki).
The lumbar region is the external palace of the kidney organ. The kidney and stomach have a relationship of union-transformation between Wu (Vth Celestial Trunk-Hill/Earth) and Qui (Xth Celestal Trunk-Stream/Water). Pains of the heart radiating to the lumbar region with sensations of nausea are due to the ascent (afflux) of the energy of the kidney toward the heart. One must treat at the level of the Foot Shaoyin (Ki).
II - Ma Shi states:
Here, it is a question of the afflux of perverse energy of the kidney toward the heart.
III - N.V.N.: To stop this afflux, the Dacheng proposes Yuanquan (Ki 1), Jing-well point of the kidney, responding to the movement Wood-Liver.
In pains of the heart with abdominal bloating, cutaneous chill and difficult defecation, one must needle the Foot Taiyin (Sp). EXPLANATIONS AND COMMENTARIES
123.
I - Zhang Shi explains: The Taiyin is Zhiyin (extreme Yin) in Yin. Yin designates cold. The non-metabolization of this energy by that of the spleen (Earth) is at the origin of abdominal bloating with sensation of cold and diffcult defecation. Here, it is a question of a syndrome of Obstruction/Cold of the spleen energy causing the heart pains. This is why one must needle the channel affected (spleen) to eliminate the afflux phenomenon.
II - N.V.N.: The Dacheng proposes Yinbai (Sp 1), Jing-well point of the spleen channel, corresponding to the movement Wood-Liver, to combat the phenomenon of afflux of the energy of the spleen (Earth).
PARAGRAPH 20
In pains of the heart with dorsal radiation and respiratory difficulty, it is advised to needle the Foot Shaoyin (Ki); without result, one must add the Hand Shaoyang (SJ). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: A vessel leaves from the kidney organ, crosses the diaphragm, penetrates into the lung and links with the heart. As a result, pains of the heart with dorsal radiation and respiratory difficulty are due to an afflux of the energy of Shaoyin which occurs at this upper part of the body (thorax). This is why one must needle the Foot Shaoyin (Ki). Treatment proves to be ineffective when this afflux starts at the level of the kidney organ which is the source organ of the Shaoyang (SJ).The energy of Sanjiao (SJ) diffuses into the thorax. For this reason, one must needle also the Hand Shaoyang (SJ) to combat the aflux of the energy of the kidney. II - N.V.N.: Here, treatment consists of first needling Rongquan (Ki 1). If it gives no result, add Guanchong (SJ 1), Jing-well point, responding to the movement Metal-Lung.
PARAGRAPH 21
In pains of the heart, sometimes radiating toward the lower abdomen with pelvic fullness, dysuria and dificult defecation, sometimes
110
regaining the top, one must needle the Foot Jueyin (Li). EXPLANATIONS AND COMMENTARIES
124.
Zhang Shi explains: Pains of the heart radiating toward the lower abdomen with pelvic fullness are due to the afflux of the energy of the Jing (channel) of Jueyin (Li). In contrast, pains declaring sometimes at the top, sometimes at the bottom, with dysuria and difficult defecation, originate from the afflux of the energy of the Luo (secondary vessels, energetic branches) of the Jueyin (Li). As a result, the phenomenon of afflux of Jueyin simultaneously involve the Jing and Luo of the Jueyin (Li). This is why one must needle the channel of the Jueyin (Li) to reestablish the circulation of its energy.
PARAGRAPH 22
In pains of the heart with short respiration (hypopnea), one must needle the Hand Taiyin (Lu).
PARAGRAPH 23
In pains of the heart, one must look for the point located to the side of the 9th dorsal vertbrae that one massages (with the finger) before needling. After removal of the needle, perform the same acts of massage and the pains disappear immediately. If there is no amelioration, massage and needle the points located above and below the point needled; as soon as the Deqi (obtaining the energy) arrives, the pains disappear, as if by magic.
125...
111
This paragraph concludes the previous 5 concerning the 5 types of cardialgias provoked by the reascent of the energy of the 5 organs. The point located to the side of the 9th dorsal vertebrae designates Hunmen (Bl 47), 1.5 cun outside of Ganshu (Bl 18). The Hun (vegetative soul) of the liver organ and Shen (mental) of the heart organ follow one another and execute the movements of entry and exit. This is why it is advised to needle Hunmen (Bl 47) to aerate the energy of the heart. Massage before needling and massage again after needling are the acts of conduction and aeration of the energy permitting cure of pains of the heart. The point located above the needled point (Bl 47) is Geguan (Bl 46), 1.5 cun to the side of Geshu (Bl 17), and the point located below the point needled is Yanggang (Bl 48), 1.5 cun to the side of Ganshu (Bl 19). The energy of the heart and that of the liver are propelled toward the exterior by the diaphragmatic movements. This is why, in the event of non-cure, one must massage and needle these two points, Geguan (Bl 46) and Yanggang (Bl 48) to aerate the Xin-Shen (mental of the heart) and Liver-Hun (vegetative soul of the liver).
II - Ma Shi adds: In pains of the heart, it is also advised to choose the point located below the spinal process of the 9th dorsal vertebra, that is to say Jinsuo (GV 8), belonging to the Dumai (GV). To obtain cure, one must massage before needling. If this technique does not give a result, one must again massage and needle below the spinous process of the 8th dorsal vertebrae (absence of energetic point) or below the spinal process of the 10th dorsal vertebrae (absence of energetic point); cure is immediate. (Figure 36) 126...
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PARAGRAPH 24
Figure 36: Treatment of cardialgias due to the reascent of the energy of the organs. _ Treatment of Zhang Shi : Bl 47 or 46 and 48. _ Treatment of Ma Shi : GV 8 or the Ashi point located above or below GV 8. 125...
In maxillary pain, one must needle and bleed Q u y e (other name Jiache- St 6) of the Foot Yangming (St); the pains cease immediately. If they do not disappear, one must add Renying (St 9); cure is immediate. EXPLANATIONS AND COMMENTARIES
126...
Ma Shi explains: The point Jiache (St 6), located at the inferior maxillary angle, is sourrounded by capillaries, hence the name Quye (section of passage of capillaries). If one succeeds in bleding it, the pains cease immediately. If not, needling Renying (St 9) assures cure. Recall that the left radial pulse also carries the name Renying. (Figure 37)
PARAGRAPH 25
When the contrary afflux is triggered toward the top, one must needle the point located in the intercostal space and the arterial point at the bottom of the thorax.
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direction toward the top. Intercostal spaces of the thorax are the sites of passage of the Foot Yangming (St). Therefore, needling the energetic points located in these sites permits reestablishing the normal circulation of this channel toward the top. II - Ma shi comments: In the contrary flow toward the top, one must needle the point located in the intercostal space, Yingchuang (St 16), belonging to the Yangming (St), and the arterial point of the thorax, Tanzhong (CV 17), belonging to Renmai (CV).
III - N.V.N.: But according to Zhang Jing Yue: The point located in the intercostal space is designated Wuyi (St 15) and the arterial point is none other than Zhongfu (Lu 1). The energetic points proposed by Ma Shi and Zhang Jing Yue to treat contrary afflux toward the top do not result from the same reasoning. Dan Pa Yuan Jian gives evidence that the commentaries of these two authors are incorrect and this was transmitted by the following remark: Tanzhong (CV 17) is not located by an artery and Zhongfu (Lu 1) is not located at the bottom of the thorax... . This is truly strange... . These words were related to qualification of documentation and research. Note, however, that the intercostal spaces and thorax are highy vascularized by numerous vessels and capillaries originating particularly from the mammary artery; all the energetic points of this region are therefore surounded by capillaries.
PARAGRAPH 26
In abdominal pains, one must first needle pressure) the artery located to the left and right is often immediate. If the pains do not cease, one massage Qijie (other name Qichong-St 30 ); cure is
128.
then massage (by of the umbilicus; cure must needle and then instantaneous.
The Foot Yangming (St) descends vertically to the breast, then redirects inside and passes to the side of the umbilicus to penetrate into the groin at the point Qijie (Qichong) St 30, point of entry/exit of the energy. Abdominal pains come from the afflux/obstruction of the energy of Yangming. This is why one must needle and massage the arterial point, Tianshu (St 25). If the pains do not disappear, one must stick and massage Qijie (St 30) in the goal of bringing the energy toward the exterior (to the skin). At Qijie (St 30), the energy of the Yangming becomes exteriorized to the skin; then after having irrigated the epidermo-dermal system, it returns to this point to complete its circulatory cycle.
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II - N.V.N.: According to Zhang Jing Yue (1563-1640 A.D.), Huangshu (Ki 16), located 1 cun to the side of the umbilicus, also plays an important role in the treatment of abdominal pains (Figure 38)
PARAGRAPH 27
129.
In Wei-Jue (limb flaccidity). it is advised to tie up the 4 limbs of the patient and liberate them upon the appearance of a sensation of irritation. This method must be performed 2 times per day; the sensation gradually returns at the end of 10 days. Repeat the process until definitive cure. EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
The preceding paragraphs demonstrate the case of stoppage of the movements of descent of the energy of the Yangming caused by the phenomenon of contrary afflux, while this one studies the case of non-distribution of the energy of Yangming at the level of the 4 limbs, repsonsible for
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the disease Wei-Jue. _ Wei implies the sense of flacidity of the limbs without force. _ Jue cold, icy limbs. The method of tying, hand and foot, the limbs is based on the conduction of the energy.
PARAGRAPH 28
To stop hiccups, one scratches the nostrils of the patient with the aid of a straw with the purpose of provoking sneezing; or else one plugs up the nostrils of the patient with the aid of fingers so as to prevent respiration; or also one provokes a great fright in the patient. The result is immediate.
The Yangming (St) receives the energy of the cereals and, via the route of the Taiyin (Sp), it conducts it toward the lung which, in turn, spreads it toward the epidermo-dermal system. The lung, disturbed by energetic afflux, redirects this cereal energy toward the stomach which provokes a concommitant afflux at the level of these organs. The energy of Yangming is restrained from becoming exteriorized by the laryngo-pharyngeal route, hence hiccups.
II - N.V.N.: In conclusion, Chapter 26 demonstrates the causes of various diseases brought on by the afflux of the energy, by the afflux of the channel or also by concommitant afflux of the energy and channel. The study begins with the Taiyin and ends with the Yangming because: _ the Taiyin governs Yang Qi (Yang energies) _ and the Yangming is the production source of Xue-Qi (blood-energy). 130.
Diseases do not leave the etiologic sphere endogenous-exogenous and are all able to provoke contrary afflux phenomena (Jue Ni) of the blood and of the energy. Since the majority of diseases are of obstruction/afflux origin, the causes and syndromes cited in this chapter and the previous ones constitute a base of clinical research of energetic medicine to diagnostic and therapeutic purpose.
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131.
CHAPTER XXVII
Erratic and Cyclic Pains
(Zhu Bi)
Zhu signifies cycle, implying the cyclic circulation of the 12 Jingmai. Bi signifies pain and paresthesia (algoparesthesia)/obstruction.
Chapter 27 of the Lingshu demonstrates the etio-pathologic process of Bi, in particular, of Zhu Bi (pain and paresthesia of the cyclic circulation of the Jingmai) and of Zong Bi (pain and paresthesia of the Dai Luo = great secondary vessels). Zhu Bi is always preceded by a phenomenon of Jue Ni (contrary afflux), and Zong Bi, by a phenomenon of blockage. In the first case, the therapeutic technique called Top-Bottom/Bottom-Top is is expressly advised, and in the second case, the therapeutic technique called Left-Right/Right-Left (needling on the opposite side) is indicated. Ma Shi writes: This Chapter 27 studies the progression of pain following the Jing and the Luo, hence the name Zhu Bi. It is advised to consult Chapter 43 (Discourse on Obstructions) of the Suwen to complete our knowledge. This chapter comprises 6 paragraphs.
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PARAGRAPH 1
Huangdi questions Qi Bo: Within the organism, Zhu Bi follows the path of the vessels (channels) and reaches the top or bottom, the left or right of the body. Are these pains located within the vessels or the flesh? Why do they move? Sometimes the shifting of these pains is so rapid that one hasnt time to put the needle in; sometimes the treatment isnt yet performed then these pains have already disappeared... . Why? Qi Bo replies: It is a matter of the Bi Syndrome (pain/obstruction) and not of the Zhu Bi Syndrome (pain/obstruction of the cyclic circulation).
132.
This chapter shows the entanglement of the Jingmai (principal channels) and Luomai (secondary vessels). The Jingmai are the 12 channels belonging to the organs and bowels traveling the top and bottom of the body, while the Luomai are the large vessels leaving from Yin toward Yang. from Yang toward Yin, from left toward right and from right toward left. Bi (pain/obstruction) is an ailment caused by the fusion of 3 perverse energies (wind, cold, dampness) which gather in the cutaneo-dermal spaces and flow out into the Dai Luo (Great Luos), hence the name Zong Bi (Bi of the extended space). When these perverse energies become directed into the Jingmai (principal channels) the phenomenon called Jue Ni (contrary afflux) arises, causing Zhu Bi (Bi of the cyclic circulation). The cyclic and erratic nature of the pain brought up by Huangdi is based on Yin and Yang, on blood and energy, on superficial and deep, on skin and flesh and on Jingmai and Luomai. This is why, to reply to the question posed by Huangdi, Qi Bo distinguishes two types of Bi: Zong Bi and Zhu Bi.
II - N.V.N.: The word Bi designates a sensation of joint and muscular pain, heaviness and numbness. It is a question, therefore, of an algoparestheia. The Suwen, Chapter 15 (Important Theory Inscribed on Jade), states: The energy which the human being receives originates from the cereals. The place where the cereals arrive is the stomach. The stomach is then the sea of the Cereal Water, of the Blood and Energy. The paths by which the stomach releases these nutritive substances has the name
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Jing Sui (deep paths) which constitute the system of Dai Luo. In other words, the blood and energy released by the stomach spreads into the epidermodermal system via the paths of the Dai Luo. Therefore, when perverse energy becomes seated in the skin and flesh, it infiltrates into the Dai Luo to activate Zong Bi. 133.
PARAGRAPH 2
Huangdi: How does Zong Bi m a i n f e s t ? Qi Bo: Zong Bi manifests successively in different areas. Cured at one place, it passes to another place, from left to right, right to left... its presence is therefore not felt everywhere at the same time. Huangdi: Good! Qi Bo: How do you needle it?
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Although the pain has disappeared due to acupuncture, one must repeat the same procedure at the original place affected to avoid relapse. EXPLANATIONS AND COMMENTARIES
134.
I - Zhang Shi explains: ... successively in different areas implies the overflowing of perverse energy toward the Dai Luo. The pain changes place constantly; it is therefore not a generalized pain. In Zong Bi (pain/obstruction of the Dai Luo), the pain always manifests in the area opposite to that of the illness. The illness being at the left, the pain localizes at the right and vice versa. This is why, therapeutically, one must needle not only the painful point, but also the site where the illness originally localized. II - N.V.N.: In practice, it is necessary to reinforce the energy of the body. Therefore, the treatment of Zong Bi consists not only of dispersing painful points (A Shi), but also tonifying the Yangming.
PARAGRAPH 3
Huangdi: How does Zhu Bi m a n i f e s t ? Qi Bo: Zhu Bi takes place within the vessels-channels. It evolves toward the top or bottom, following the direction of these vessels, without going through the left or the right, at successive, specific spots. Huangdi: How do you needle it? Qi Bo: If the vessel affected goes from above downward, it is necessary, in the first place, to needle the bottom in to curb the progression of the illness, and in the second place, the top, to evacuate it toward the exterior. Similarly, if the vessel affected is directed from below upward, it is necessary, in the first place, to needle the top to curb the evolution of the illness, and, in the second place, the bottom, to evacuate it toward the exterior.
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This paragraph concerns the therapeutic technique of Zhu Bi. As indicated by its name, this ailment occurs within the vessels-channels (Jingmai) to evolve toward the top or the bottom according to the direction of these vessels-channels. Zhu Bi differs, therefore, from Zong Bi. Therapeutically, if the illness belongs to the descending vessel, it is advised to needle first the painful spot located down below to stop its progression, then the painful point located above to eliminate the source of the illness, thereby preventing it again reaching the bottom. The same treatment, but reversed, is reserved for the ascending vessel. For this reason, technique called Top-Bottom or Bottom-Top is expressly advised in the treatment of Zhu Bi. As for the technique called Left-Right or Right-Left, it is reserved for the treatment of the Zong Bi Syndrome. 135.
II - N.V.N.: It is also recommended to consult Chapter 63 (Discourse on Needling on the Opposite Side) of the Suwen, concerning needling of the opposite side (Mu Ci) and great needling (Ju Ci), to better understand this subtlety of acupuncture practice.
PARAGRAPH 4
Huangdi: Good! name? What are the causes of these pains and what justifies their
Qi Bo Once lodged within the dermis, the 3 perverse energies WindCold-Damp force the organic liquid to be transformed into scum (Bo). Upon encountering the cold, these scums become concentrated and provoke the breaking up of the flesh fibers, hence pain. Then the XinShen (Heart-Mental) gathers at this spot (painful), bringing heat there which eases the pain. The phenomenon of afflux (Jue) appears during relief of the pain which is revealed by Bi whose manifestations come to be added EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
Shen designates the Qi (energy) of the body. Qi brings heat and the heat relieves the pain, but it does not cure it, hence the appearance of the phenomenon of Jue Ni (contrary afflux). The 3 perverse energies, Wind-Cold-Damp, then follow the blood and energetic (channels) vessels and progress toward the top or bottom. It is, therefore, a matter of the pains of the Zhu Bi type.
This paragraph explains the etiopathological process of the Zhu Bi syndrome. The 3 perverse energies, Wind-Cold-Damp, infiltrate into the carnal spaces and flow toward the
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vessels-channels to trigger the phenomenon of Jue Ni (afflux), responsible for Zhu Bi. The scums (Bo) are the viscous substances released during the confrontation of WindCold-Damp and the organic liquid.
PARAGRAPH 5
136.
Huangdi: Right! Summarizing, the syndrome of Zhu Bi is not located at the organs, but at the exterior, within the distribution of the flesh, preventing the source energy (Zhen Qi) from following its cycle, hence the name Zhu Bi. This is why, to treat the Zhu Bi syndromes, it is necessary to examine the state of emptiness or fullness of the channels of the bottom (foot) and the state of blood stagnation at the level of the Dai Luo or the state of their weakening caused by emptiness, then circulate the blood and energy by acupuncture or by the application of poultices and activate their circulation in the event of spasm.
a - Generally, when perverse energy infiltrates within the organism, it lodges in the skin and body hair. If it doesnt go away, it provokes the opening of the pores and penetrates into the dermis. If one doesnt drive it out, it flows out into the Jingmai which link to the organs. But here, it is a matter of a concomitant penetration of 3 perverse energies, Wind-ColdDamp, into the dermis. These energies flow down into the Jingmai to provoke there the phenomenon of Jue Ni (contrary afflux) and trigger the syndrome Zhu Bi (blockage of the cyclic circulation). It is why Huangdi stresses: This syndrome does not become seated in the organs... . b - When perverse energy becomes located within the dermis, the dermis goes into fullness, and the Jingmai are empty. Similarly, when Jue Ni occurs in the Jingmai, these are in fullness, and the dermal part is in emptiness. Therefore, it is necessary to examine well the emptiness and fullness in order to tonify or disperse. Such is the therapeutic conduct of the syndrome Zhu Bi (Figures 40 and 41). c - ...blood stasis within the Dai Luo implies the presence of perverse energy in these vessels. ...weakening caused by emptiness indicates that the energy of the Luo in a state of emptiness is retained in the interior (channel). d - Poultices are medicinal preparations applied onto the skin to combat pains or inflammations. They have the power to evacuate perverse energy held in the interior. In the presence of spasm or laxity, massage therapy is strongly advised to activate the circulation of energy and blood. It is well urilized in this type of illness.
II - N.V.N.: The thesis of Zhang Shi can be diagrammed in the following manner:
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137.
------>> Disperse painful (A Shi) points and the opposite points (technique of needling on the opposite side) ------>> Tonify the corresponding Jingmai
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--------->> Disperse the affected channel (Technique of needling Top-Bottom and Bottom-Top) --------->> Tonify blood and energy of the body at the level of Yangming
PARAGRAPH 6
Huangdi: Good. I have grasped the meaning of the term Zhu Bi and the l o c a l i z a t i o n of this illness. The rules of the 9 Needles are explicit and easy to apply; they shed light on the syndromes of the 12 Jingmai and of Yin-Yang.
Huangdi underscores that the 9 Needles is an easy and rational method which instructs on Yin and Yang, blood and energy of the organism. But how to determine front and back, entry and
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exit, according to the Great Dao of Heaven and Earth? The scholar judges them after the actions of acupuncture. Only in this way do we not commit ungratefulness regarding our learned ones of long ago. 139.
CHAPTER XXVIII
Oral Questions (Kou Wen)
This chapter of the Lingshu demonstrates the etiology, classification and descriptions and therapy of the 12 diseases at the level of the orifices (eyes, nose, ears, mouth) caused by the 12 perverse energies called singular (Jie Xi). Called singular perverse energies, these perverse energies differ from the usual perverse energies (6 cosmic energies, 7 psycho-affective components, food intoxication...). These singular diseases (Ji Bing) (1) are not well developed in the ancient books (before the period of Huangdi). Their understanding originates from an oral transmission from the master teaching of Qi Bo. This is why this chapter is entitled: Oral Questions (Kou Wen). Chapter 28 consists of 15 paragraphs.
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PARAGRAPH 1
Free from all imperial obligations, Huangdi dismissed his advisors and posed this question to Qi Bo: I have heard you speak of the Classic of 9 Needles and study in extensive fashion the favorable and unfavorable problems of Yin and Yang and of the 6 channels (3 Yin and 3 Yang). Now, I want you instruct me on the Oral Questions (Kou Wen). Qi Bo moved, bowed his head respectfully and, hands crossed, replied: Your request is most pertinent! It is a matter here of oral transmissions handed down by our ancestors. Huangdi: I would like to be enlightened on this subject. Qi Bo: 100 Diseases all have for origin wind or rain, cold or heat, Yin or Yang, joy or anger, diet or psycho-affective behavior, great fear or sudden fright... . In these cases, _ _ _ _ _ _ _ blood and energy separate Yin and Yang grow weaker Jing and Luo become exhausted the circulatory routes are blocked Wei (defensive) energy stagnates the Jingmai are in emptiness energy and blood are in disequilibrium... .
140.
These phenomena, not conforming to the general rules, are wellknown to you. But there exists diseases called singular not occuring at the level of the channels; permit me, therefore, to submit them to you.
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external causes are wind, cold, heat... and the internal causes are anger, fear... . These components injure Ying (nutritive energy) and Wei (defensive energy), Qi (energy) and Xue (blood), Yin and Yang and the Jingmai (principal channels). But there are singular diseases (Ji Bing) which are neither due to one nor the other of these two causes.
PARAGRAPH 2
Huangdi: Which Qi Bo:
energy
is
responsible
for
yawning?
141.
Wei energy circulates in the Yang part of the body during the day, and during the night, in the Yin part. Yin govern night, and night, sleep.
Yang governs the movements of ascent, and Yin, the movements of descent. This is why, when and the Yang energy is Yin toward the top, but double attraction is at the not Yin the Yin energy is still conserved at the bottom yet completely exhausted, Yang attracts the redirects it back toward the bottom. This origin of repetitive yawning.
When the Yang energy is at its end, the Yin energy is in fullness, hence closure of the eyes (sleepiness), and when the Yin energy is at its end, the Yang energy is in fullness, hence opening of the eyes (wakefulness). One must disperse the Foot Shaoyin (Ki) and tonify Foot Taiyang (Bl).
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the Foot Shaoyin (Ki) is attacked by the perverse energy called singular (Ji Xie); this is why, one must disperse Zhaohai (Ki 6) of the Yinqiao. Similarly, because the Yangqiao is in emptiness, yawning is also frequent; one must tonify Shenmai (Bl 62). II - N.V.N.: 142.
Zhong Jing Yue (1563-1640 A.D.) concludes: Excess of Yin (Ying) and insufficiency of Yang (Wei) cause yawning. It is recommended to disperse Zhaohai (Ki 6), site of departure of the Yinqiao, and tonify Shenmai (Bl 62), site of departure of the Yangqiao.
Figure 43: Phenomena of attraction of Yin (Ying) and Yang (Wei): yawning.
PARAGRAPH 3
Huangdi: In man, Qi Bo: which energy is responsible for hiccups (Yue)?
Foods penetrate into the stomach and the energy of the stomach flows into the lung. When latent cold energy localized in the stomach mixes together with the cereal energy, the essential energy and perverse energy confront one another and provoke phenomena of contrary flow (affluxJue Ni), exteriorizing and emitting a noise by the gastric route, the hiccup.
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One must tonify the Hand Taiyin (Lu) and disperse the Foot Shaoyin (Ki). EXPLANATIONS AND COMMENTARIES
I -Ma Shi explains: 143.
This paragraph explains the etiopathologic mechanism of hiccups and its treatment. Under the action of the stomach, the cereal energy is transformed into extremely fluid energy which flows into the lungs; then from the lungs it reaches the 5 organs and 6 bowels. The meeting of the cold energy in a latent state in the stomach and of the cereal energy is the cause of the confrontation of the essential and perverse energies. The essential energy designates the energy of the stomach, and the perverse energy the cold coming from the kidney. These two energies become concentrated and afflux toward the top, hence hiccups. It is advised to tonity the Hand Taiyin (Lu) and disperse the Foot Shaoyin (Ki).
II - Zhang Shi states:
a - The stomach is the sea of the cereal energy. The lung responds to Heaven and governs the pilo-cutaneous system. The cereal energy penetrates first into the stomach, then it reaches the lung. The lung controls the vessles and directs the Jing Qi (energetic quintessence) toward the skin and body hair. In this way, the vessels and the pilo-cutaneous system receive the Jing Qi and bring it toward the bowels . (Figure 44) b - The lung is primarily affected by cold which is found there in the latent state. This cold perverse is awakened by the cereal energy which bring it toward the stomach. The confrontation of the essential (gastric) energy and perverse energy induces a contrary flow (afflux/Jue Ni) which is ejected to the exterior because the stomach cannot tolerate this type of attack, hence repetitive hiccup. c - The kidney responding to Zhi Yin (extreme Yin) is rich in water. The lung responds to the Taiyin (Lu). The Shaoyin (Ki) responding to the pulse of winter has its root (Ben) at the kidney organ and its peak (Jiao) at the lung organ. As a result, the kidney and lung play the role of conserving the water component. In other words, the Cold-Water route of the bottom (kidney) communicates with that of Heaven (lung). This is why it is advised: _ to needle in tonification the Hand Taiyin (Lu) to maintain the Yang energy of Heaven _ and to needle in dispersion the Foot Shaoyin (Ki) to attract the cold perverse toward the bottom. The cold perverse and cold originate from the kidney. 144. d - This paragraph establishes an analogy between the organic functions (of the human being) and that of the phenomena of the exterior (Heaven-Earth, Yin-Yang). In this chapter, the perverse energy designates a type of auto-productive energy called singular and non-perverse originating from the exterior (wind, cold, heat...).
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III - N.V.N.: The pathophysiology and treatment of hiccups described in this chapter is most instructive. The conclusion of Zhang Jing Yue summarizes them perfectly: 1 - The Hand Taiyin is the energetic route of the lung. The Foot Shaoyin is the energetic route of the kidney. The afflux of cold from the bottom toward the top is at the origin of hiccups. For this reason, at the top, one must tonify the lung to increase its potential, and at the bottom, disperse the kidney so that the cold can follow the Water movement to be metabolized. 2 - The peak (Jiao) of the hiccup is located in the stomach, but its root (Ben) is found in the kidney. Generally, one distinguishes two types of hiccup: hiccup-fullness and hiccup-emptiness (or hiccup-cold and hiccup-heat). This paragraph concerns hiccup of the Emptiness-Cold type.
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Figure 44: Formation and circulation of the Jing of the lung (according to Zhang Shi). 145.
Figure 45: Etiopathologic mechanism of the hiccup During digestion, the cereal energy attracts the cold located in the lung toward the stomach according to the Mother-Son system, triggering Hiccup.
PARAGRAPH 4
Huangdi: Which Qi Bo: is the energy responsible for sorrow?
The fullness of Yin energy and emptiness of Yang energy, the rapidity of Yin energy and slowness of Yang energy, the excess of Yin energy and insufficiency of Yang energy are the principal causes of sorrow. One must tonify Foot Taiyang (Bl) and disperse Foot Shaoyin (Ki).
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I - Ma Shi explains: This paragraph explains the pathologic process of sorrow and its treatment. Compassion without tears has the name sorrow. Clinically, during sorrow, the Yin energy is in fullness and its movements are rapid, while the Yang energy is in emptiness and its movements are slow. Treatment consists of tonifying Yang and dispersing Yin. Tonification of Yang is done at the point of exit of the Yangqiao, that is to say Shenmai (Bl 62), and dispersion of Yin, at the point of exit of the Yinqiao, Zhaohai (Ki 6). 146. II - N.V.N.: The energy which perturbs the psycho-affective components belongs to Yin. Here, it is a matter of a syndrome of fullness of Yin/emptiness of Yang.
PARAGRAPH 5
Huangdi: Which Qi Bo: is the energy responsible for trembling from cold?
When perverse cold energy is localized within the skin, the Yin energy is in fullness and Yang energy, in emptiness, hence trembling from of cold. One must needle the Yang channels in tonification.
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According to Zhang Jing Yue, to tonify the Yang channels corresponds to needling the Yuan and He points of these channels and the point of exit of the Yangqiao (Shenmai- Bl 62). (2)
2. The action of these points is described in MTC - N.V.N. Edition.
PARAGRAPH 6
Huangdi: Which Qi Bo: is the energy responsible for eructations?
147.
Perverse cold energy located in the stomach causes a contrary flow (afflux- Jue Ni) which diffuses from the bottom upward and exteriorizes via the gastric route, hence eructations. One must tonify the Foot Taiyin (Sp) and Foot Yangming (St). Another theory proposes tonification of Mei Ban (named Zanzhu - Bl 2) . EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
Because perverse cold is located in the stomach, a contrary flow spreads from the bottom upward. Exteriorization of this afflux takes place from the stomach, hence eructations. One must tonify Foot Taiyin (Sp) and Foot Yangming (St) to heat them up. It is also advised to needle the Foot Taiyang (Bl) at the point Mei Ban (Bl 2), also called Zanzhu (Bl 2).
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Figure 47 : Etiopathogenic processes of eructation. II - Zhang Shi comment: 148. The kidney is a water-organ and the cold is found above the Taiyang. Hiccup is due to the presence of cold energy in the latent state in the lung (coming from the kidney), while eructation also originates from cold energy (coming from the kidney), but lodged within the stomach. Dispersion of the cold energy at the level of Shaoyin (Ki) and tonification of the Yang energy of Taiyang are different, but have the same meaning.
III - N.V.N.: This paragraph (concerning eructation) and Paragraph 3 (concerning hiccups) raise the same problem of the presence of cold in the stomach. In the first case (eructations), the perverse cold comes directly from the kidney. According to Zhang Jing Yue, this singular perverse energy is compared to a guest who comes to arrive. Its location is found at the stomach. In the second case (hiccups), the cold energy also comes from the kidney, but it remains in the latent state in the lung (see Paragraph 3). Its location is therefore deep. The choice of points and channels cited in the text is justified by the mechanism of activation of the illness.
PARAGRAPH 7
Huangdi: Which Qi Bo: is energy responsible for sneeze?
In harmony, the Yang energy fills the heart, invades the nose and comes back out via the nostrils, hence sneeze. One must tonify the Foot Taiyang (Bl) at the point Mei Ban (ZanzhuBl 2). Another theory proposes the point Mei Shang (Meichong-Bl 3). EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains: Yang energy, when it is peaceful and favorable, fills the heart and gathers at the nose, hence sneeze. Mei Shang designates Meichong (Bl 3), having the same action as Zanzhu (Bl 2), point to needle to 0.3 cun depth; leave the needle in during 6 expirations and apply 3 moxas. II - N.V.N.: 1 - According to Zhang Jing Yue, sneezing can also be due to the presence of Wind-Cold at the level of the pilo-cutaneous system preventing the Yang energy from reaching the exterior. It is obliged to follow the nasal route. As a result, sneezing originates from the noisy manifestation of the Yang energy of the body.
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149. 2 - The presence of cold in the abdomen causing the emptiness of Yang can prevent some individuals from sneezing, despite their desire. As a result, in the chronic emptiness of Yang, sneezing is a good sign of recuperation of the Yang energy. 3 - In emptiness of Yang of the bottom with sneezing, tonification of Zanzhu (Bl 2) or Meichong (Bl 3) is advised because the Taiyang (Bl) and kidney constitute the Yin-Yang, Interior-Exterior system. This technique constitutes what one calls Tonification of Yang in Yin (See Chapter 23 (Discourse on the Five Energies) of the Suwen).
PARAGRAPH 8
Huangdi: Which energy is responsible for Qi Tuo (energetic relaxation; muscular laxity. Qi Bo: Emptiness of the stomach causes that of the vessels, responsible for muscular atony. In individuals affected by this illness who indulge in sexual relations, the Yuan Qi (energy source) can not be recuperated, hence muscular laxity. Look for the location of the illness and tonify the interdermal spaces locally. 150. EXPLANATIONS AND COMMENTARIES
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I- Ma Shi explains: Qi Tuo designates a diminution of tonicity or elasticity of the muscles and tendons of the neck, back and limbs, hence head tilted to one side and curved back. II - Zhang Shi states: The muscles and vessels take their source from the stomach bowel and are maintained by Water-Cereal. This is why the deterioration of the energy of Yangming is the principal cause of muscular laxity. The Yangming humidifies Tongjin (system of reunion of the muscles making up the genital muscles). In the event of muscular laxity, one must tonify the intramuscular spaces of the affected area, the Yangming.
PARAGRAPH 9
Huangdi: What is the energy responsible for outflowing of tears during sorrow? Qi Bo: The heart is the sovereign organ of the 5 organs and 6 bowels. The face is the site of gathering of the Sun Mai (little energetico-blood capillaries) and of the Shang Ye (upper liquid routes). During compassion, sadness, sorrow,... the heart is agitated and s h a k e s the 5 organs and 6 bowels which, in their turn, influence the Sun Mai. Agitation of these latter open the Shang Ye and tears flow out freely. The organic liquid (Ye) is an aqueous substance humidifying the Jing Qi (quintessence of the energy) of the orifices. The unremitting outflow of tears is one of the causes of depletion of the organic liquid, hence diminution of visual acuity (amblyopia). This phenomenon bears the name Duo Jing (abduction of Jing energy). One must tonify the point Tianzhu (Bl 10) located at the neck. EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains: Crying with tears has its root at the heart. The heart governs the 5 organs and 6 bowels. The face is the site of reunion of the Sun Mai and Ye Qi (energetic-liquid routes). The mouth and nose are the doors and windows of Qi (energy). This is why, during psycho-affective disturbances (sorrow, sadness...), agitation of the heart causes a series of agitations of the 5 organs and 6 bowels which, in their turn, have repercussions on the Sun Mai and provoke the opening of the liquid routes located at the level of the face, hence tears, rhinorrhea, sialorrhea... . The Ye (organic liquid) of the face has the function of humidifying the Jing (quintessence) of the orifices. As a result, an incessant outflow of tears is one of the causes of amblyopia. This 151.
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ailment is due to the phenomenon called Duo Jing (usurpation of Jing). One must tonify Tianzhu (Bl 10) located 0.5 cun above the edge of the hairline of the nucha and 1.3 cun to the side of Yamen (GV 15); needle depth 0.2 cun; left in during 6 expirations; apply 7 moxas. II - N.V.N.: The mechanism of the production of tears during sorrow can be diagrammed in the following fashion:
PARAGRAPH 10
Huangdi: What Qi Bo: energy is responsible for sighing?
152.
During anxiety, the cardiac system retracts and provokes contraction of the energetic routes with circulatory hindrance. result, sighs are respiratory movements intended to reestablish circulation of the energy. It is advised to tonify the Hand Shaoyin (He), Xin Bao (XB) Shaoyang (GB) and leave the needles in place. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: This paragraph concerns the respiratory movements simultaneously controlled by Tong Qi (thoracic energy or a priori energy) located in the Shangjiao (Upper Jiao- UJ) and by Sheng Qi (birth energy) located in the Xiajiao (Lower Jiao- LJ). (Figure 50)
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Tong Qi is conserved within the thorax, reaches the laryngo-pharyngeal system and is directed toward the vessels of the heart to accomplish respiratory function. During anxiety, the cardiovascular system retracts and causes depletion of the energetic and blood routes. Sighs then are respiratory movements necessary for the reactivation of the energetic circulation. Sheng Qi is constantly in liason with Tong Qi via the action of the Sanjiao (SJ). Treatment consists of tonifying the Hand Shaoyin (He), Xin Bao (XB) and Foot Shaoyang (GB). In other words, this therapeutic is aimed at tonifying the energy created by the kidney (that is to say, that of the Shaoyang (GB), according to the mother-son law) and at reestablishing the liason of this energy (GB) with that of the heart and Xin Bao (XB). Moreover, to tonify the Hand Shaoyin (He) and Xin Bao (XB) is to aerate the Shangjiao (UJ); and to tonify the Foot Shaoyang (GB) and leave the needle in permanently is to activate the reascent of Sheng Qi from the Xiajiao (LJ) toward the Shangjiao (UJ) to reestablish their liason, thereby combatting sighs.
II - N.V.N.: The explanation of Zhang Shi can be diagrammed in the following fashion: 153.
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PARAGRAPH 11
Huangdi: What Qi Bo: is
the
energy
responsible
for
sialorrhea?
During food absorption, if the stomach is affected by heat, it awakens the lines (intestinal) causing the movements of descent of the energy of the stomach. Above, the point Lianquan (CV 23: source of saliva) opens, hence sialorrhea. One must tonify the Foot Shaoyin (Ki).
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PARAGRAPH 12
Huangdi: What Qi Bo: energy is
responsible
for
tinnitus?
The interior of the ear is the site of reunion of numerous Sun Mai (energetic-blood capillaries) coming from the 12 Jingmai (principal channels). When the stomach is in emptiness, these capillary vessels are also in emptiness and cause a depletion of blood and energy at the level of the ear, hence tinnitus. 155. One must tonify Ge Zhu Ren (Shangguan-GB 3) and the point located at the tip of the thumb, at the place where the flesh is close to the nail.
This paragraph concerns the production of blood and energy at the level of SpleenStomach under the propulsion of the energy of the kidney. The lung is the site where all the Jingmai of the organism intervene; it also controls all the Sun Mai (little energetic-blood capillaries) of the orifices. The ear is one of the sites of gathering of all these Sun Mai, whose blood and energy originate from the Water-Cereal (Shui Gu: foods). Consequently, when the stomach is in emptiness, it automatically causes emptiness at the level of the Sun Mai with outflowing of the energy toward the bottom, hence depletion of blood and energy at the level of the ear responsible for tinnitus. It is advised to tonify Ge Zhu Ren (GB 3) to provoke reascent of the energy which flows out toward the bottom.
II - Ma Shi comments;
This paragraph explains the etiopathologic process of tinnitus and its treatment. The ear is the site of reunion of the Sun Mai, maintained by the energy of the stomach. This is why, when the stomach is in emptiness, the Sun Mai of the ear are deprived of blood and energy, hence tinnitus. It is advised to tonify Ge Zhu Ren (GB 3), also called Shangguan (GB 3), point located in front of the ear on the upper edge of the zygomatic arch, in a crease which is formed by opening the mouth; needle depth 0.1 cun (do not exceed), left in permanently during 7 expirations, moxa 3 times. It is also advised to tonify the point located at the external ungual angle of the thumb (energetic description), at a distance from the nail equal to the thickness of a Gao (chive) leaf; needle depth 0.1 cun, left in during 3 expirations, moxabustion advised against. (3)
III - N.V.N.: 1 - Ge Zhu Ren (GB 3) is the point of reunion-meeting of the Foot Shaoyang (GB) and Hand
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This point can be chosen in the event of disturbances of the energy of the channels of the Sanjiao (SJ), gallbladder and stomach, causing tinnitus or temporary deafness. Tonification and dispersion of this point must be performed according to the emptiness and fullness of the illness. Ge Zhu Ren (GB 3) is located on the upper edge of the zygomatic arch, just above Xianquan (St 7). 2 - Ying (nutritive energy) and Wei (defensive energy) have their root at the level of the acquired energy (Water-Cereal); their activity and their relationship are controlled by the innate (ancestral) energy located at the level of the Xiajiao (LJ= Kidney-Liver). For this reason, _ in Paragraph 10, the energy of Shaoyin (Ki) reaches the top to unite with the Tong Qi (innate or thoracic energy) in order to control the respiratory movements. _ in Paragraph 11, the energy of Shaoyin (Ki) reaches the top to unite with the Yangming (St) in order to control food metabolism. _ in Paragraph 12, the energy of Shaoyin (Ki) reaches the top (at the face) to unite with the Sun Mai in order to control the auditory system. In short, the energy of the kidney controls: _ cardiopulmonary movements, _ digestive movements _ and auditory movements. (Figure 52)
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PARAGRAPH 13
Figure 52: Systems of control of the kidney (after Paragraphs 10, 11 and 12). 157.
Huangdi: What energy is responsible for biting of the tongue? Qi Bo: An opposite flow (afflux- Jue Ni) of the energy, together with the ascent of the energy of Zhongjiao (MJ), can be at the origin of this affliction. When it concerns the energy of Shaoyin (Ki), biting occurs at the level of the tongue; when it concerns the energy of Shaoyang (GB), the biting occurs at the level of the cheek; when it concerns the energy of Yangming (St), biting occurs at the level of the lips. One must observe the site of biting and tonify the corresponding channel.
1 - The cereal energy, distilled at the level of the Zhongjiao (MJ), is an a posteriori energy having its source at the Xiajiao (LJ), belonging to a priori Yin-Yang . The energy of the Zhongjaio (MJ) and that of the Xiajiao (LJ) reunited to perform their circulatory movements. 2 - The teeth are created by the energy of the kidney. The Shaoyin (Ki) possesses vessels which branch to the base of the tongue. The Shaoyang (GB) possesses vessels which distribute to the cheek. The Yangming (St) possesses vessels which encircle the lips. 3 - When the kidney energy contracts and affluxes toward the top following that of the Zhongjiao (MJ), the tongue goes outside the teeth, the lips press against the teeth, the cheeks become stuck between the teeth... . In summary, this paragraph has taken for an example biting the tongue in order to explain the dependence of the a priori energy on the circulation of blood and energy of the Yangming (St).
II - N.V.N.: According to Zhang Jing Yue, _ the contrary afflux (Jue Ni) of the energy toward the top always causes an overflowing of blood and energy to create the diseases called singular (Ji Bing) whose location is very specific; _ the base of the tongue is the site of branching of the energy of Shaoyin (Ki) 158. _ the ear and cheeks are the sites where the energy of the Shaoyang (GB) circulates _ the mouth and lips are the sites encircled by branches of the energy of Yangming (St) The afflux of each of these energies passes therefore into a specific zone; one assists then
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in the bites of various types. Besides these bites, other ailments, like inflammations and itching sensations, are also distinguished.
PARAGRAPH 14
The 12 illnesses cited above are caused by an ascent of perverse energy called singular (Ji Xie) toward the orifices. This is why an insufficiency always manifests at the place where the illness is seated. Therefore, _ the insufficiency of the energy of the top part of the body is a sign of a malnutrition of the brain, hence buzzing in the ears, head tilted toward the shoulder, diminution of visual acuity... . _ the insufficiency of the energy of the center (Zhongjiao- MJ) is characterized by a change in stool (diarrhea or constipation) with boborygmi... . _ the insufficiency of the energy of Xiajiao (LJ) is manifest by atrophic impotence (Wei) (5) with cold limbs, anxiety... . 159. One must tonify underneath and behind the external malleolus and leave the needle in place.
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5. Do not confuse the defensive Wei energy with the Wei disease (atrophic impotence) which has the same pronounciation but different ideograms.
This paragraph shows the general conclusion of the 12 illnesses cited in this chapter, illnesses caused by a defect in maintainance of the orifices (ears, nose, mouth, eyes) by the organic liquid. Perverse energy is referred to as singular when it comes neither from the exterior (wind, cold, heat...) nor from the interior (psychoaffective components). It is a question of phenomena of non-irrigation of organic liquid at the level of the orifices. This is why the place where the singular illness is seated always is indicated by an organic liquid deficiency. This information clearly explains that inactivity of the essential energy is the at origin of the production of the singular perverse energy. Therefore, _ the insufficiency of cerebral energy (cerebral Jing), with ear buzzing, encephalgia, amblyopia, etc., originates from the deficiency of essential energy at the top part of the body. _ disorders of defecation (diarrhea or constipation) are a consequence of the deficiency of central energy (Zhong Qi= energy of Zhongjiao- MJ). _ atrophic impotences with cold limbs (Wei Jue) result from the deficiency of the energy of the Xiajiao (LJ), and anxieties originate from rupture of the Top-Bottom (Heart-Kidney) connection. It is recommended to tonify the point located below and behind the external malleolus, Kunlun (Bl 60), and allow the needle to remain in place up to the arrival of the Deqi because: _ the Taiyang (Bl) belongs to the 3 Yang which responds to Heaven (cephalic part) _ Kunlun (Bl 60) is the point of departure of the organic liquid toward the top.
PARAGRAPH 15
Huangdi: How must one treat these singular diseases? Qi Bo:
160.
The kidney governs yawning; one must needle Foot Shaoyin (Ki). The lung governs hiccups; one must needle Hand Taiyin (Lu) and Shaoyin (Ki).
Foot
Sorrow (with or without tears) results from the exhaustion of Yin and Yang; one must tonify Foot Taiyang (Bl), disperse Foot Shaoyin (Ki) and tonify the Yang channels. In eructations, tonify the Foot Taiyin (Sp) and Foot Yangming (St). In sneezing, tonify the Foot Taiyang (Bl) at Mei Ban (Zanzhu- Bl 2).
144
In joint laxity, one must tonify the spot where the illness is located. In tearing and rhinorrhea, tonify Tianzhu (Bl 10), located outside the trapezius tendon, above the edge of the hairline. In sighing, tonify Hand Shaoyin (He), Xin Bao Luo (XB) and Foot Shaoyang (GB) and leave the needle in place. In ptyalism ( 6 ) , tonify the Foot Shaoyin (Ki). In the tinnituses, tonify Ge Zhu Ren (Shangguan- GB 3) and the point located at the external ungual angle (7) of the thumb. In tongue biting, look for the location of the illness and tonify the corresponding channel. In dizziness of the eyes with head tilted to the side, tonify under the external malleolus and leave the needle in place. In the atrophic impotences (Wei) with cold limbs (Wei Jue) and anxiety, needle the point located 2 cun from the tip of the great toe. Another theory proposes the point located below the external malleolus and leave the needle in place.
The previous paragraphs analyze the deficiency of moistening of the orifices by the organic liquid metabolized at the level of the bladder, causing an insufficiency of the energy of Shangjiao (UJ), Zhongjiao (MJ) and Xiajiao (LJ). 1 - This paragraph studies the illnesses caused by the 12 perverse energies called singular (Ji Xie) treated by the methods of tonification and dispersion of Yin and Yang. 161. The bladder receives the liquid substances coming from the organs and bowels in order to transform them into organic liquid. These will be conducted toward the stomach and spleen whose role is to redistribute this same organic liquid necessary to their functioning. Such is the role of reciprocal exchanges of the bladder. This is why, in the above-cited ailments, treatment must be performed as a function of the location of the singular perverse energy. 2 - The point located 2 cun from the tip of the great toe designates Taibai (Sp 3), Earth point of the spleen organ. 3 - This paragraph studies the liquid substance of the Taiyang (Bl) whose energy circulates not only toward the exterior (skin, flesh) but also toward the heart by the route of the Zhongjiao (MJ) and Shangjiao (UJ). For this reason, in the event of insuficiency of the energy of the top part of the body, one must tonify Kunlun (Bl 60), and in the event of the insufficiency of the bottom part of the body, causing rupture of the connection of Zhongjiao (MJ) with the heart, one must needle Taibai (Sp 3) to activate the circulation of the Earth energy. In all cases, the Water energy of Taiyang (Bl) always constitutes the source of control, hence the theory of utilization of the point behind and below the external malleolus.
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6. Excessive secretion of saliva (sialorrhea). 7. Energetic description. It concerns the point Shaoshang (Lu 11).
II - N.V.N.: This paragraph recapitulates the causes and treatments of the 12 singular illnesses cited in this Chapter 28. We conclude the following: Ying (nutritive energy) and Wei (defensive energy) have their root at the level of the acquired energy (a posteriori: Water-Cereal); their activity and their relationship are managed by the innate energy (a priori: ancestral energy) located at the level of the Xiajiao (LJ) (Ki-Li). For this reason, _ in Paragraph 10, the energy of the Shaoyin (Ki) reaches the top to unite with the Tongqi in order to optimize the control of respiratory and cardiac movements. _ in Paragraph 11, the energy of the Shaoyin (Ki) is directed toward the top to unite with the Yangming (St) to optimize the control of the metabolic modifications of Water-Cereal (foods). _ in Paragraph 12, the energy of the Shaoyin (Ki) is transported toward the top to unite with the Sun Mai (little energetic-blood capillaries) in order to go in relation with the 100 Vessels. _ in Paragraph 13, the energy of the Shaoyin (Ki) can afflux toward the top to provoke tongue biting... . Perturbations of the energy of the Xiajiao (LJ), that is to say, of the kidney, therefore play an important role in the activation of the diseases called singular. In acupuncture and moxabustion, etiopathologic data of the energy of the kidney are fundamental in the choice of points and channels. We present below a summary table of diseases caused by the singular perverse energies:
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147
Etiopathology
Treatment
Attraction of Yin (Ying) and Yang (Wei) Disperse Foot Shaoyin (Ki) and tonify Foot Taiyang (Bl) Confrontation of latent cold energy and cereal energy in the stomach Fullness and rapidity of Yin energy; emptiness and slowness of Yang energy Tonify Hand Taiyin (Lu) and disperse Foot Shaoyin (Ki) Tonify Foot Taiyang (Bl) and disperse Foot Saoyin (Ki) Tonify the Yang channels Tonify of Foot Taiyin (Sp) and Foot Yangming (St); other theory: Tonify Meichong - Bl 3
Chills/Shivers Fullness of Yin and Yang in the (trembling from cold) pilo-cutaneous system Eructations Presence of cold energy in the stomach
Emptiness of stomach energy and Jingmai Locally tonify region affected Gathering of Yang energy at the nose Tonify Foot Taiyang (Bl) at the point Zanzhu - Bl 2 Tonify Foot Taiyang (Bl) at the point Tianzhu - Bl 10 Tonify Hand Shaoyin (He), Xin Bao Luo (XB), Hand Shaoyang (GB); leave the needle in place
Overflowing of tears Opening of Shang Ye (upper liquid during sorrow; routes) during agitation of the heart rhinorrhea Sighing Retraction of cardiac system and shrinkage of the energetic routes
Rupture of relation of Foot Shaoyin (Ki) Tonify Foot Shaoyin (Ki) and stomach Depletion of blood and energy of Sun Mai Tonify Ge Zhu Ren (GB 3) and of the ears Shaoshang - Lu 11 Afflux of energy of Shaoyin (Ki): biting of tongue Afflux of energy of Shaoyang (GB): Tonify the corresponding channel biting of cheek Afflux of energy of Yangming (St): biting of lips Insufficiency of the energy of the cephalic region Tonify Kunlun - Bl 60
Weakness of limbs, Insufficiency of the energy of the lower cold limbs or region thoracic oppression
Tonify point located 2 cun from the tip of the great toe (Taibai-Sp 3)
163.
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Book V
Book V consists of 18 chapters:
Chapter 29: Teaching Transmitted by the Masters (Si Chuang) Chapter 30: Fundamental Characteristics of the Energy (Jue Qi) Chapter 31: Intestines and Stomach (Chang Wei) Chapter 32: Normal Man Faced with a Shortage of Cereals (Bing Ben Ju Gu) Chapter 33: Study of the Seas (Hai Lun) Chapter 34: The Five Disturbances (Wu Luan) Chapter 35: Study on Intumescences (Zhang Lun) Chapter 36: Distinction of the Five Types of Liquid Retention (Wu Lung Xin Ye Bie) Chapter 37 Five Approvals and Five Emissaries (Wu Zue Wu Chu) Chapter 38: Contrary and Favorable
164.
149
Fat and Thin (Ni Sun Fi Xu) Chapter 39: Study on Blood Stasis at the Level of the Blood Luo (Xue Luo Lun) Chapter 40: Of Yin and Yang, Of Pure and Impure (Yin Yang Qing Zhuo) Chapter 41: Correlation Between Yin-Yang and the Sun-Moon System (Days and Months) (Yin Yang He Yua Ye) Chapter 42: Evolution of the Illness (Bing Chuang) Chapter 43: Overflowing of Perverse Energy and Manifestation of Dreams (Zan Xie Fa Meng) Chapter 44: Conformity of Human Energy with that of the Day Divided Into Four Seasonal Periods (Shun Qi Ye Si She) Chapter 45: Evaluation of the Exterior (Wai Zui) Chapter 46: The Five Transformations (Wu Bian) Chapter 47: Constitutional Characteristics of the Organs (Ban Zang) Chapter 48: Prohibition and Submission (Gan Fu)
165.
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CHAPTER XXIX
Teaching Transmitted by the Masters (Si Chuang)
The term Si Chuang implies the sense of transmission of knowledge of the past to future generations, according to the Dao of High Morality and of Modern Social Awareness in order to administer the country, govern the people and direct the family. Chapter 29 of the Lingshu is therefore exceptional because it brings together the attitude of man in regard to perfection, organization of the family and administration of the country with that of the Oriental physician vis a vis his patient. This chapter is composed of 3 parts: 1 - Attitude of the sages: men of state and medicine 2 - Favorable and Unfavorable problems of the pathologic process of cold and heat, of Yin and Yang and problems of attachment to life and fear of death. 3 - Relationships between the bodily form (Xing) and the Di Qi (energy of the Earth = where man lives). These relationships manifest at the exterior at the level of Xing (form) and Qi (energy). This chapter consists of 6 paragraphs.
Huangdi: I have heard it said that you have in your possession mnemonics never described in the books. I would like to hear you on this subject in order to inspire me to _ _ _ _ _ _ in Qi Bo: Govern the country Treat the body Preserve the Hundred Families of diseases Harmonize the top and bottom Permeate myself with charity Spare future generations from preoccupations perpetuating them.
166.
Your request is most sagacious! Because to guide the people or look after the body, manage a great enterprise or direct a little affair, to govern the entire country or lead a family is to not follow the contrary process (Ni) but uniquely the favorable process (Shun). The favorable process applies not only to Yin and Yang, to the Jing (channels) and to the Mai (vessels), but also to the people who like to live as they please... . Huangdi: When one penetrates into a country, one must wonder about the customs; when one is accepted into a family, one must wonder about the rituals; when one examines a patient, one must wonder about adequate therapeutic methods.
This paragraph shows the fundamental principles of governing the country, running the family and leading the people. By these principles, great physicians model their therapeutic methods. _ Favorable implies the sense of harmony. _ Favorable and unfavorable of the energy applies to the midifications of Yin and Yang, cold and heat. _When one penetrates into a country, one must wonder about the customs, etc... represents the rules of the principles of governing the country and guiding the people. _ To govern the country can only be entrusted to men whose conduct conforms to the laws of moral and duty. It is the same in the choice of the physician in order to treat the patient.
PARAGRAPH 2
167.
152
Huangdi: What are the most adequate therapeutic principles applied to diseases? Qi Bo: The appropriate treatment of the disease of heat localizing in the interior with polydipsia (Jiao Dan) is cold, and the appropriate treatment for the disease of cold localizing in the interior is heat. Heat localizing in the stomach accelerates digestion and activates hunger with sensation of cutaneous heat of the supraumbilical area. Heat localizing in the intestines causes liquid stools evoking the appearance of watery yellow-colored rice with sensation of cold in the infraumbilical area. Cold localizing in the stomach provokes abdominal bloating. Cold localizing in the intestines causes boborygmi with postprandial diarrhea. Cold localizing in the stomach associated with heat localized in the intestines causes simultaneous abdominal bloating and diarrhea. Heat localizing in the stomach associated with cold localized in the intestines causes simultaneous hunger and abdominal pains.
2 - Heat localizing in the stomach warms up the upper part of the body, in particular Heart-Blood (Xin-Xue), giving the impression of having the Suspended Heart with feeling of hunger. 3 - The area located above the umbilicus belongs to the stomach and small intestine. As a result, the warming up of the cutaneous zone located above the umbilicus is an indicator of the attack of the small intestine by heat. 4 - Yellow-colored soft stools signals the presence of Humidity-Heat within the stomach
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PARAGRAPH 3
Huangdi: Heat within the stomach causes desire to drink cold beverages, and cold in the intestines, desire to drink warm beverages. As a function of these two phenomena of opposite nature, how do you determine an appropriate treatment? No one dares contradict arrogant and shameless princes and dukes, given over to licentiousness and debauchery, inclined to look down on others, indulging in feasting, incapable of curbing themselves. 169. Restrictions go against their will; if one allows them to satisfy their excesses, their illnesses worsen. In this case, what is the appropriate solution and what is the treatment priority? Qi Bo: These men have fear of death and wish to profit from the joys of life. It is sufficient to explain to them the disastrous consequences of the illness and the significance of supressing the excess. Although the Dao (principle) is unknown to them, they willingly accept to think things over. Huangdi: How do you treat them? Qi Bo: In spring and summer, one must first treat the summit (Jiao) and secondly, the root (Ben). In fall and winter, one must first treat the root (Ben), then the summit (Jiao). EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
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In spring and summer, the Yang energy is found at the exterior and the illness is also found at the exterior. One must first treat the summit (Jiao), then secondly, the root (Ben). In fall and winter, the Yang energy is found in the interior; the illness is also found in the interior. One must first treat the root (Ben), then the summit (Jiao). It is a question of therapeutic method according to the primary and secondary manifestations of the iillness.
II - Zhang Shi states: Here, root (Ben) implies the sense of interior (Li), and summit, exterior (Biao). The energy of spring and that of summer rises up from the interior (Li) toward the exterior (Biao). This is why one must first treat the summit (Jiao), and secondly, the root (Ben). The energy of fall and that of winter gathers in the interior. This is why one must first treat the root (Ben), then the summit (Jiao). To know the root and summit it to know how to apply a therapy to that which manifests before and that which manifests after in the goal of harmonizing the energy. This method can be taken as a model to govern the people because, in this case, it conforms to the Dao of Heaven and Earth. 170.
PARAGRAPH 4
Huangdi: What is the appropriate solution to apply in diseases which do not conform to the indications of the physician? Qi Bo: The appropriate solution is diet and dress which must be adapted to the cold and heat. The cold must not be freezing and the heat must not make the patient perspire; drinks and foods must neither be burning hot nor excessively cold. Average adaptation of the cold and heat conserves the equilibrium of the energy (essential), key factor against the intrusion of perverse energy. EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
Dress and diet, which are used daily, must be harmonized to conserve the equilibrium of Yin-Yang of the body, therefore preventing the infiltration of perverse energy into the organism. In this paragraph, cold and heat are of external origin. Therefore, foods and drinks must not be burning hot or ice cold in order to favor the equilibrium of cold and heat of the interior. The energy of the four seasons designates the cold and heat of internal origin. Therefore, upon encountering the cold, one must not undress, and upon encountering heat, one must not wait for perspiration to get cooler. To act in this manner is to balance the Yin energy and Yang energy of the interior with that of the exterior. This chapter is centered on the study of the regulation of Yin and Yang of the interior (body) and of that of the exterior (surroundings) and not that of the Yin and Yang of the Xue Mai (blood vessels). The favorable and contrary phenomena are therefore specially presented. This is why Qi Bo emphasizes counterbalanced adaptation to the cold and heat in the maintenance of
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equilibrium of the essential energy, critical factor against the intrusion of perverse energy within the organism. Heaven has its cold and its heat; man possesses his Yin and his Yang. As a result, the equilibrium of Yin-Yang of the human being can prevent the penetration of excessive cold and excessive heat of Heaven and Earth.
PARAGRAPH 5
171.
Huangdi: In the chapter Ben Zang (Constitutional Characteristics of the O r g a n s ) (1), the volume of the 5 organs and 6 bowels can be appreciated by examination of the body and form, joints and muscular prominences . But dukes and princes, who dares examine them by palpation? Qi Bo: The body and joints are the sites of exteriorization of the energy of the 5 organs; but their examination is not so easy as that of the face. Huangdi: Examination of the face can determine the state of the energy of the 5 organs. I know that. I would like to know how one can evaluate the state of the organs by examination of the joints. Qi Bo: Among the 5 organs and 6 bowels, the lung is comparable to a protective umbrella. To determine its external aspect, it is proper to evaluate the size of the shoulder and thickness of the neck. Huangdi: Good. Qi Bo: The heart is sovereign organ. Quepen (supraclavicular fossa) is its route of conduction. To determine its size, it suffices to observe the width of the clavicles and the xiphoid appendix. Huangdi: Good. Qi Bo: The liver fulfills the function of general. It prevents external aggressions. To determine its firmness, it suffices to observe the size of the eyes.
Huangdi: Good.
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Qi Bo:
The spleen controls the distribution of cereal energy into the entire body. To determine its state, it suffices to discern the favorable and unfavorable flavor perceived at the level of the tongue and lips. Huangdi: Good. Qi Bo:
172.
The kidney governs hearing. To determine its state, it suffices to distinguish the favorable and unfavorable noise perceived at the level of the ears. Huandi: Good.
173.
Huangdi: And for the 6 bowels? Qi Bo: Among the 6 bowels, the stomach represents the sea. Its contents in 5 cereals (Wu Gu) can be determined by the width of the maxillae, the thickness of the neck and development of the thorax. The prominence and length of the nose allows appreciation of the size of the large intestine. The thickness of the lips and length of Renzhong (nasolabial groove) allows evaluation of the size of the small intestine. The extent of the suborbital area allows estimating the size of the gallbladder. The exteriorization of the energy at the level of the nostrils (expiration) allows exploration of the ease of outflow of the energy of the bladder. The prominence of the bridge of the nose allows estimating the firmness of the Sanjiao (SJ). Such are the methods of observation of the 6 bowels at the level of the face. The harmonization of Top/Bottom, divided into three levels, allows explaining the good functioning of the 5 organs and 6 bowels.
This paragraph is devoted to inspection by which one can determine the morphology and functioning of the 6 bowels. The energy of the 5 organs Appears at the complexion and their morphology is reflected in the bodily form (Xing). As a result, examination of the facies allows the evaluation of the functioning of the 5 organs, and examination of the bodily form can determine their pathologic state. The nose is the orifice of the lung whose bowel is the large intestine. This is why the nose is used to judge the form and energetic state of the large intestine. The mouth is the orifice of the spleen and impure substances coming from SpleenStomach are contained in the small intestine. This is why the lips and Renzhong (nasolabial groove) are used to estimate the form and functioning of the small intestine. The eyes are the orifices of the liver. This is why the subocular area is used to appreciate the firmness of the gallbladder. 174. The bladder is the receiver organ of the organic liquid. Energetic transformation comes from there. The nostrils are the sites of exteriorization of the energy thanks to which the energy of the bladder can flow out toward the bottom. In other words, aeration of the upper orifices causes the opening of the lower orifices. The Sanjiao (SJ) is responsible for the general irrigation of the organism. The liquid
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routes are issued from there. When the circulation of the energy is congested and obstructed, the Sanjiao becomes engorged, and when the circulation of the energy is released, the liquid routes freely flow out. The uprising movement of the nostrils explains the movement of exteriorization of the energy (inspiration) whose role is to activate the functioning of the Zhongjiao (MJ) because inspiration causes the phenomenon of grasping or engagement the Zhongjiao (MJ), and expiration, the phenomenon of disengagement. These phenomena translate the mechanism of closing/ opening of the top and bottom. In summary, this paragraph studies the form (Xing) and functioning of the organs and bowels under the action of the energy, going from the interior toward the exterior and vice versa. The top and bottom of the face are divided according to 3 levels which are none other than the 3 areas responding to Heaven, Earth and Man. (Figure 54)
II - N.V.N.: 1. According to Zhang Jing Yue: The 5 organs are located in the interior, but their energetic aspect becomes manifest at the exterior. Our classic masters looked to examine the complexions/colors or bodily form (Xing) to evaluate the energetic state of the 5 organs and 6 bowels. Despite that, in practice, one must always base ones judgment on the harmonious aspect of the 3 levels of the face to appreciate the good functioning of the 5 organs and 6 bowels. 2. The harmony of the 3 levels or 3 palaces (San Ding) of the face guarantees the good health of the individual. The area which extends from the frontal hairline to Yintang (PC 3) belongs to Shang Ding (upper palace). The area which extends from Shangan (PC 4) to the tip of the nose (PC 16- Biliu) belongs to Zhong Ding (middle palace). The area which extends from Renzhong (GV 26- nasolabial groove) to the tip of the chin (PC 19- Dihe) belongs to Xia Ding (lower palace) (Figure 54). The human body also consists of 3 Palaces (Figure 55).
175.
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160
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CHAPTER
XXX
Chapter 30 of the Lingshu is directed at determining the 6 energies, Jing (quintessence), Qi (energy), Xin (interstitial fluid), Ye (viscous substance), Xue (blood) and Mai (vessel), all which arise from Cereal Jing (foods). These six acquired a posteriori energies originate therefore from the same a priori source energy (Heaven-Earth). They do not designate the structural composition of the energy divided into 6 different types. Here, the word Jue implies the sense of characterization. Because this chapter analyzes the 6 energies originating from the same source in order to understand their physiologic and pathophysiologic relationships, it is entitled: Fundamental Characteristics of the Energy (Jue Qi).
PARAGRAPH 1
Huangdi: I have heard it said that the living being is endowed with Jing and Qi, Xin and Ye, Xue and M a i . But according to me, all these energies make up only one; I do not understand the reason why one gives them six different names. EXPLANATIONS AND COMMENTARIES
178.
Zhang Shi explains: Jing and Qi, Xin and Ye, Xue and Mai are acquired substances circulating within the
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organism originating from the source energy of dietary origin called cereal. Once in the stomach, and under the action of the Zhongjiao (Middle Jiao), this source energy becomes transformed into 6 substances indispensible to the maintainece of life, hence Huangdis question to demonstrate the process of this transformation.
PARAGRAPH 2
Qi Bo: The union of 2 Shen (mental) (1) creates form (Xing) ( 2 ). The necessary element to create Xing (form) is Jing (sexual) ( 3 ) . Huangdi: What does one call Qi ( e n e r g y ) ? Qi Bo: The Shangjiao (Upper Jiao) has the function of spreading the quintessence of the 5 cereals (Wu Gu) toward the skin in order to warm it up and toward the body hair in order to humidify them like mist and rain watering the plants and herbs. This quintessence is called Q i . Huangdi: What does one call Xin (interstitial Qi Bo: liquid)?
When the tissue fibers open, sweat is excreted. This interstitial substance carries the name X i n . Huangdi: What does one call Ye (viscous Qi Bo: substance)?
Once in the stomach, foods become transformed into energy, which spreads within the entire body, and into substance, which, on the one hand, infiltrates into the osseous system to facilitate joint movements, and on the other hand, maintains the marrow and brain and gives a glowing appearance to the skin. This viscous substance carries the name Y e .
1. It is neceassary to understand the union of 2 beings (woman and man). 2. Here, the word Xing designates embryo (fetus). 3. It is a matter of sexual Jing: ovules and spermatozoa.
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The Zhongjiao (Middle Jiao) receives the energy and draws up the liquid substance which becomes transformed into thick liquid of red color called X u e . Huangdi: What does one call Mai ( v e s s e l ) ? Qi Bo: The tubular organ which protects the Ying energy and requires it to circulate following a determined direction within the entire organism is called M a i .
2. Tong Qi (4) designates a great energy (innate, ancestral, a priori energy) conserved within the Shangjiao (UJ- thorax) whose role is to control the respiratory and cardiac movements and distribute the quintessence of the 5 cereals within the entire body. For this reason, due to the action of the lung, this quintessence saturates the skin and humidifies the body hair and head hair like mist and rain permeate the thousand beings. This quintessence, activated by Tong Qi, has the name Qi (energy). 3. The viscous substance produced at the level of the interstitium of the tissue fibers and excreted to the exterior by the sweat glands in the form of sweat is called Xin (interstitial liquid). 4. At the level of the stomach, foods become transformed into energy which permeates the entire body and into viscous substance which infiltrates into the bones and muscles, marrow and brain, skin and body hair. This viscous substance is called Ye (viscous liquid). 5. Chapter 18 (Production and Reunion of Ying and Wei) of this classic specifies: The Zhongjiao (MJ) is endowed with the power of decantation and transformation (food metabolism). The viscous substance thus obtained flows down to the lung and heart and, under the action of this latter, becomes red and has the name Xue (blood). 6. Tong Qi has the property of inducing the Xue and Ying to circulate within the vessels of conduction called Mai (vessels) which spread throughout the entire body. 180.
4. Also written Dong Qi.
II - N.V.N.: 1. Here, 2 Shen designates Yin (woman) and Yang (man). The union of Yin and Yang creates form (Xing); but this creation cannot take place without Jing (sexual: ovum and sperm). In this
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manner, the text states: The necessary element to create Xing (form) is Jing (sexual). Chapter 8 (Origin of the Mental) of this classic states: The union of the 2 Jings has the name Shen, and Chapter 30, this chapter, states: The union of 2 Shen creates Xing. At first sight, these two citations can seem different; in reality, they bring out the extreme intimacy of relationship of Yin and Yang, two opposed but complementary components; it is what which one calls Dao of Union. 2. Here, Shangjiao (UJ) designates the thorax in which is stored the great energy called Tong Qi (a priori energy) or also called Chen Qi (original energy). Chapter 71 (Perverse Guest) of this same classic clarifies: Chen Qi is retained within the thorax, reaches the larynx, crosses the vessels of the heart and activates the respiratory routes. Chapter 75 (Effects of Needling on the Source Energy and Perverse Energy) of the same classic stresses: Chen Qi (original energy) is an a priori energy (Heaven, innate) associated with that of the cereals (a posteriori, acquired), intended to develop the corporeal structure. Chapter 18 (Production and Reunion of Wei) of this classic specifies: Man receives the cereal energy. This penetrates into the stomach, reaches the lung, then from there the 5 organs and 6 bowels. Therefore, it is intended for the development of the body, for warming the skin and moistening the body and head hair like the mist and the moistening dew watering and saturating the thousand beings. This force is called Qi (energy). 3. According to Zhang Jing Yue: Xin (interstitial liquid) is Yang; sweat is an excretory substance originating from Xin, and the pores are miniscule orifices of the skin whose dilation favor sweating. Ye is a viscous, thick substance; it infiltrates into the bony system to facilitate joint movements in order to activate the circulation of the Jingmai. In the interior, this substance maintains the marrow and brain, and at the exterior, it moistens the pilo-cutaneous system. In summary, Xin and Ye have the same origin, but are divided into Yin and Yang because Xin is the clarified part and Ye is the opaque part of Xin. 181. Xin becomes exteriorized to the exterior via the path of the sweat glands in the form of sweat; for this reason, it is Yang. As for Ye, it saturates the bones and tonifies the brain and marrow; it is, therefore, Yin. Chapter 36 (Distinction of the Five Types of Liquid Retention) of this classic specifies: The Sanjiao (SJ) brings the energy to the exterior in order to warm up the flesh and muscles and maintain the skin and body hair. This excretory substance has the name Xin (interstitial liquids) and the remaining non-excretory substance is called Ye (viscous liquid). The meaning of this assertion is the same as that cited above. 4. Zhang Jing Yue adds: The Zhongjiao (MJ) receives the cereal liquids (drink, food) and passes it to the Xiajiao (LJ), then from there to the intestines and kidneys where it is subjected to numerous decantations before it is conducted to the spleen. lung and heart. At the spleen, this liquid is viscous and yellow; at the lung, it is white, then at the heart it becomes red and has the name Xue (blood). (Figure 56) 5. When at the Mai (vessel), Zhang Jing Yue compares it to the pavement or embankment of a canal requiring the Ying energy to flow out following a specific direction. Naturally, Mai designates neither Qi nor Xue; the collection of Mai constitutes the paths of conduction of Ying Qi (nutritive energy) and blood.
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Figure 56:
PARAGRAPH 3
Huangdi:
Different phases of decantation of food liquid and the process of blood formation.
182.
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These 6 energies can be in excess or insufficiency. Qi can be in abundance or scarcity; marrow and brain can be in emptiness or fullness; blood can be clear or disordered ... . How can one know it? Qi Bo: The emptiness of Jing (quintessence) causes deafness;
That of Qi, amblyopia; That of Xin, dilation of the pores with abundant sweating; That of Ye, problems of joint motility with dry and withered complexion; That of marrow and brain, lancinating pain in the interior with tinnitus; That of blood, pale and dry complexion with emptiness of pulse... Such are the signs indicating emptiness of each of the 6 energies.
Ying is the Jing Qi (energetic essence), and Xue (blood) is Shen Qi (mental energy); Jing and Xue, Xin and Ye are the metabolized substances of energy; this is why they are called the 6 energies. The words clear and disordered designate the qualitative state of Ying (nutritive energy) and Wei (defensive energy). The kidney conserves the Jing and exteriorizes at the ears. The loss of Jing of the ear causes deafness. The 5 flamboyant colors perceived by the eyes are the flower substances of the energy; this is why the loss of the flower energy is the cause of amblyopia (dim vision). The pores are the orifices of the skin. Their opening favors escape of Xin signaled by abundant sweating. 183. Ye saturate the osseous system, tonify marrow and brain and humidify the pilo-cutaneous system. This is why its escape is the origin of disorders of joint motility with dryness of the hair system. The kidney governs the osteo-medullary-cerebral system. Undernourishment of the marrow and brain is the cause of ostealgia with tinnitus . The heart governs Xue and Mai. These exteriorize in the form of the complexion. For this reason, escape of blood is indicated by pale complexion and emptiness at the level of the pulses.
PARAGRAPH 4
Huangdi: How are the favorable and unfavorable moments of these
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energies
during
periods
of
predominance?
Qi Bo:
These 6 energies each have their own region. Their favorable and unfavorable moments depend on their period of predominance. But they are especially the 5 cereals and stomach, which constitute the Great Sea (source). EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains: This paragraph concerns the regions (Bu) belonging to the 6 energies among which the stomach plays the role of Great Sea. Huangdi questions on the favorable and unfavorable times of the 6 energies. According to Qi Bo, all regions of the body are equipped with 6 energies of potential and variable nature such that: _ the region of Yangming consists of an abundance of energy and blood, and that of the Taiyang, an abundance of blood but shortage of energy. _ the 5 Ye (Wu Ye): tears, rhinorrhea, sweat, urine and saliva; and the 5 Jing (quintessence of the 5 organs). Among these regions, that which respond to the period of predominance is qualified as favorable, and that which does not respond there, as unfavorable. The 6 energies are the substances originating from the 5 cereals (Wu Gu) metabolized under the action of the stomach. Thus, the stomach is the great source (Great Sea) of the energy. 184. II - N.V.N.: This paragraph merits clarification because different translations into Oriental language are not loyal to the text. 1. Here, the words Gui Tian (
predominance, therefore the favorable moment. Ex: spring and summer are the periods of predominance of Liver-Wood and Heart-Fire; autumn and winter are the periods of predominance of the Lung-Metal and Kidney-Water. Otherwise is unfavorable. The words Zian Ya ( the energy. Ex: The fullness of perverse energy and emptiness of essential energy are abnormal aspects; the excess and insufficiency of the vital energy are also abnormal aspects. 2. The 6 energies each have their specific region of distribution. Examples: _ Qi governs the skin and body hair. _ Xin manifests at the level of the pores. _ Ye permeates the osseous system and maintains the marrow and brain. _ Mai conducts the blood and energy and circulates throughout the entire body.
3. The 5 organs each possess a specific master function. Examples: _ The kidney conserves the Jing (quintessence) of the 5 organs. It is therefore the master of Jing. _ The lung controls the energy. it is therefore the master of Qi.
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_ The spleen distributes the organic liquid. It is therefore the master of Xin-Ye. _ The liver conserves the blood. It is therefore the master of Mai Xue. _ The heart regulates the circulation of blood. It is therefore the master of Mai.
4. The interpretation of this paragraph is the following: _ Question: What are the criteria for determining the emptiness and fullness of the 6 energies? _ Answer: The zones of distribution of the 6 energies are different. Each of these zones is maintained by a specific energy of the organ responding to a specific season. The emptiness and fullness of these zones serves as diagnostic and therapeutic criteria. But these 6 energies are formed during metabolic transformation at the level of the stomach. Therefore, the stomach is the Sea of Cereals, Source of Energy.
185.
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CHAPTER XXXI
Intestines and Stomach (Chang Wei)
Chapter 10 of the Lingshu is devoted to the morphologic study of the energetic organs of the digestive tract concerning the mouth, lips, teeth, tongue, pharynx, esophagus, stomach, small intestine and large intestine. The length and diameter, weight and capacity of these organs are meticulously demonstrated. In antiquity, the intestines and stomach were considered cornerstones of the organism. This is why this chapter is saved and entitled: Intestines and Stomach (Chang Wei). This chapter consists of a single paragraph.
Huangdi: I ask you to acquaint me with the digestive route of the 6 bowels, in particular the length, diameter and contents of the intestines and stomach.
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Bagao: Allow me to demonstrate to you in detail the length, diameter, circumferance and capacity of the digestive tube beginning via the path of penetration of the cereals and ending via the path of evacuation of feces. 1 The The The cun. The distance from the lips to the teeth is 9 fen. width of the mouth is 2 1/2 cun. 186. capacity of the mouth is 9 he. tongue weighs 10 liang; it length is 7 cun and width 2 1/2 cun.
The distance between the phayrnx and stomach (esophagus) is 1 chi 6 cun. 3 - The curvature of the stomach stretches out along a length of 2 chi 6 cun; its circumference is 1 chi 5 cun; its diameter is 5 cun and its capacity is 3 dou 5 sheng. 4 - The small intestine relies on support from behind by the left side of the vertebral column and follows flexuosities which are superimposed on itself. It contains digestive products which are directed into Hui Chang (large intestine). In front, it is supported by the area located above the umbilicus and forms 16 loops each of 2 1/2 cun in circumference, 8 1/2 fen in diameter and 3 zhang 3 chi in length. 5 - Hui Chang (large intestine) arises from the left side of the umbilicus, coils up and describes 16 loops each of 4 cun circumference, 1 1/3 cun diameter and 2 zhang 1 chi length. 6 - Guang Chang (sigmoid colon and rectum) is supported by the sacral region and constitute the continuation of Hui Chang. Its circumference is 8 cun, its diameter is 2 3/4 cun and its length is 8 cun. In total, from the place of reception of the cereals to the passage of secretion of feces, the intestine and stomach measures 2 zhang 4 chi 4 fen long and forms 32 loops.
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a - The superior mouth of the small intestine is the inferior mouth of the stomach. The small intestine is attached in back at the vertebral column, and in front it is held at the area above the umbilicus; it contains food wastes which fall into the Hui Chang (large intestine) and form 16 loops each of 2 1/2 cun circumference, 8 1/2 fen diameter and 3 zhang 3 chi length. b - Hui Chang designates the large intestine. Its superior mouth is the inferior mouth of the small intestine. It coils up and forms 16 loops each of 4 cun circumference, 1 1/2 cun diameter and 2 zhang 1 chi length. 187. c - Guang Chang designates the sigmoid colon and rectum. It measures 8 cun circumference, 2 1/2 cun diameter and 2 chi 8 cun in length.
II - N.V.N.: Here are the remarks of Zhang Jing Yue: The stomach can hold 2 dou of cereal and 1 dou 5 sheng of drink. The inferior mouth of the small intestine falls into Hui Chang (large intestine). The small intestine is supported above by the umbilicus, the area responding to the point Shuifen (CV 9). Hui Chang designates the large intestine whose superior mouth responds to the inferior mouth of the small intestine. In the Jia Yi Jing de Huang Fu Mi (214-282 A.D.), the length of the digestive tube is calculated from the stomach, while in this chapter of the Lingshu, the calculation is made from the mouth, hence the difference of the numbers between the two texts.
Figure 57: Esophagus, stomach and intestines as seen in the era of Huangdi. no 188/189.
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CHAPTER XXXII
Normal Man Faced with a Shortage of Cereals (Bing Ren Jue Gu)
Bing Ren signifies man in good health, normal man, and Jue Gu, the shortage of cereals (deprivation of nourishment, inanition).
Chapter 32 of the Lingshu is devoted to the study of digestion and the function of food reception of the stomach and intestines, fundamental basis of nutrition and safeguarding of life. In the man in good health, the intestines and stomach function normally. The normal state of these viscera is maintained due to well-regulated dietary hygiene. In contrast, in the case of exhaustion by shortage of nourishment, progressive diminution of the quality of contents of the intestines and stomach has the great emptiness of these viscera as a corollary; Jing Qi quintessence of the energy) and Xin-Ye (organic liquid) become progressively exhausted, hence the disappearance of nutritive phenomena ending in death. Because Chapter 32 of the Lingshu is basically directed at analyzing the causes of death in the originally healthy individual in a state of inanition during 7 days, it is entitled: Normal Man Faced with a Shortage of Cereals (Bing Ren Jue Gu). Chapter 32 consists of a single paragraph.
Huangdi: I want you to explain to me why, if he is deprived of eating and drinking, man dies at the end of 7 days?
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Bagao: Allow me to explain the cause _ the radius of the stomach is 1 its length is 2 chi 6 cun. It can hold 2 dou of cereal and 1 dou 5 sheng to you in detail: chi 5 1/2 cun; its diameter is 5 cun; 3 dou 5 sheng of cereal; generally of water suffice to fill it.
_ the Shangjiao (UJ) assures the secretion and diffusion of the Cereal Jing (pure energy originating from foods) which is light, fluid and rapid. The Xiajiao (LJ) assures the energetic decantation at the level of the intestines. _ the circumference of the small intestine is 2 1/2 cun; its diameter is 8 1/2 fen; its length is 3 zhang 3 chi; it contains 2 to 4 sheng of cereals and 6 sheng 3 1/2 he of liquid. _ the circumference of Hui Chang (large intestine) is 4 cun; its length is 2 zhang 1 chi; it contains 1 dou of cereals and 7 1/2 sheng of liquid. _ the circumference of Guang Chang (sigmoid colon and rectum) is 8 cun; its diameter is 2 3/4 cun and its length is 8 cun; it contains 9 sheng 3 1/2 he of cereals. In total, the length of the intestines and stomach is 5 zhang 8 chi 4 cun It can contain 9 dou 2 sheng 1 1/8 he of Shui Gu (Water-Cereals). Such is the number of contents of the stomach and intestines. But the process of the sequence of digestion in normal man does not take place in this fashion because, in him, filling up of the stomach is accompanied by the continuous emptiness of the intestines and the filling up of the intestines is associated with the continuous emptiness of the stomach. This succession of emptiness and fullness favors the movements of ascent and descent of Qi (energy), harmonizes the 5 organs, balances blood circulation and consolidates the Jing Shen (quintessence and mental) originating from Shui Gu (Water-Cereals). This is why the intestines and stomach continuously conserve 2 dou of cereals and 1 dou 5 sheng of water. The normal individual evacuates 2 times per day 2 1/2 sheng of feces; in one day, he eliminates 5 sheng, and in 7 days, 35 sheng, that is to say, 3 dou 5 sheng, the number indicating the exhaustion of Shui Gu retained in the intestines and stomach. As a result, the death of normal man abstaining from eating and drinking for 7 days is due to the exhaustion of water and cereals, of Jing (energetic quintessence) and Xin-Ye (organic liquid). EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains: 190.
The 5 organs and 6 bowels, the form and the body, Jing and Shen, Qi (energy) and Xue
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(blood) are maintained by Shui Gu (Water-Cereals). Therefore, the depletion of this latter is the cause of destruction of the Xing (form) and Qi (energy).
II - N.V.N: Some diseases do not kill at the end of 7 days of deprivation of eating and drinking because the Shui Gu retained within the stomach and intestines is not completely eliminated.
191.
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CHAPTER XXXIII
Study of the Seas (Hai Lun)
Hai means Sea, site of reunion of 100 rivers. In Oriental language, all movements of gathering or reunion bear the name Hai. For example: Ren Hai (human sea). Chapter 33 defines 4 words, Stomach, Chongmai, Tanzhong (CV 17) and Brain, which are not only the source sites of Jing Shen (quintessence-mental) and Qi Xue (energy-blood), but also the sites of reunion/gathering of Ying ( nutritive energy) and Wei (defensive energy), Qi (energy) and Xue (blood) and the 12 Jingmai (channels-vessels).
The reunion of the 4 vital substances, marrows, blood, energy, Water-Cereals (Shui Gu), bears the name 4 human seas. These 4 human seas respond to the 4 cosmic seas which are the 4 cardinal points: East, West, North and South. The classification and description of diseases and therapy of the excess and insufficiency of these 4 seas are explicitly developed. Because these 4 seas of man are taken as the object of this study, this chapter is entitled: Study of the Seas (Hai Lun). This chapter consists of 7 paragraphs.
PARAGRAPH 1
Huangdi: I have understood in the rules of acupuncture that one must
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never separate Ying (nutritive energy), W e i (blood) and Qi (energy). In the interior, the organs and bowels, and at the exterior, they system. Yet, now you link them to the 4 Seas for me. Qi Bo:
(defensive energy), X u e 12 Jingmai unite with the link up with the articular (Si Hai). Please clarify this
192.
Man also has at his disposal 4 Seas and 12 Jing Shui (waterways, rivers). The Jing Shui flow down into the seas responding to the 4 cardinal points, East, West, North, South, hence the name 4 Seas. Huangdi: How does man respond to the 4 Seas? Qi Bo:
Man possesses a Sea of Marrow, Sea of Blood, Sea of Energy and Sea of Water-Cereals to respond to the 4 Seas of Heaven and Earth. Huangdi: Your explanation is very significant. In short, you have united Man with Heaven and Earth. Do you want to inform me of their realtionships? Qi Bo: One must first go very deeply into the notions of Yin and Y a n g (channels), Biao and Li (exterior, interior) of the 5 organs and 6 bowels and the localization of the Ying-Shu points ( 1 ) to be able to determine the 4 Seas. Huangdi: How does one determine them? Qi Bo: The stomach is the Sea of Shui Gu (Water-Cereals). Its Shu point (2) of the top is Qi Jie (other name Qichong-St 30) and that of the bottom is Sanli (St 36). The Chongmai is the Sea of Blood of the 12 channels. Its Shu point of the top is Dazhu (Bl 11) and those of the bottom are the points Shanglian (St 37) and Xialian (St 39).
1. Here, the term Ying-Shu represents the group of points called Wu Shu (5 Shu antique points). 2. Here the word Shu designates the energetic or transmittable point.
Tanzhong (CV 17) is the Sea of Energy. Its Shu point of the top is found above and below Zhu Gu (cervical vertebra) (3) and that of the bottom is Renying (St 9). The brain is the Sea of Marrow. Its Shu point of the top is
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Baihui (GV 20) and that of the bottom is Fengfu (GV 16). EXPLANATIONS AND COMMENTARIES
193.
I - Ma Shi explains: This paragraph gives dissertation on the existence of 4 Seas in human beings. The Earth has at its disposal 12 great routes of water called 12 Jing Shui (rivers), all flowing out toward the sea, responding to those of Heaven, divided into West, East, North and South (4 cardinal points). This is why on does not speak of 12 seas, but only 4 seas.
1. The stomach is the Sea of Shui Gu (Water-Cereals). Its Shu (kinetic or transmittable) point of the top is Qijie (Qichong- St 30), located 5 cun below Tianshu (St 25); needle depth 0.3 cun, left in place during 7 expirations, dispersed immediately upon the arrival of the energy (De Qi), apply 3 moxas. Its Shu point of the bottom is Zu Sanli (St 36): needle depth 0.3 cun, left in place during 7 expirations, dipserse immediately upon the arrival of the energy, apply numerous moxas (sometimes up to 100). 2. The Chongmai is the Sea of Blood of the 12 Jingmai. Its Shu point of the top is Dazhu (Bl 11); needle depth 0.3 cun, left in place during 7 expirations, moxabustion prohibited. Its Shu points of the bottom are Shangjuxu (other name Shanglian-St 37) and Xiajuxu (other name Xialian-St 39). For the first, needle to a depth of 0.3 cun and apply 7 moxas; for the second, needle to a depth of 0.3 cun and apply 48 moxas. 3. Tanzhong (CV 17) is the Sea of the Energy. Its posterior Shu points above and below the cervical spine (Zhu Gu) designate Yamen (GV 15) and Dazhui (GV 14); needle to a depth of 0.3 cun, left in place during 6 expirations, apply 7 moxas. It anterior Shu point is Renying (St 9); needling and moxabustion prohibited. 4. The brain is the Sea of Marrow. Its Shu point at the top is Baihui (GV 20); needle to 0.2 cun depth, apply 7 moxas. Its Shu point of the bottom is Fengfu (GV 16); needle to 0.3 cun depth, moxa prohibited. To localize this point, have the patient speak quickly and stongly; the point swells; it is located 1 cun above the edge of the hairline, in a crease.
II - Zhang Shi clarifies:
Heaven governs fertilization and Earth determines form (Xing). As a result, the bodily form of the human being responds to the 4 Seas and the 12 Jing Shui (rivers) of Earth. The energy of Heaven and that of Earth communicate with each other thanks to the presence of the Qi Jie (energetic routes), located at the summit of the cranium, at the middle of the thorax, abdomen and lower limbs. Via these routes, the energy of the channels ascends and descends, enters and exits.
3. According to Ma Shi, the top and bottom of the cervical spine designate the points
194. 1. The stomach is the Sea of Shu Gu (Water-Cereals). Its Shu point of the top is Qichong (Qijie-St 30); its energy reaches the abdomen and stops at the back Shu point (Weishu Bl 21), then it redescends to Zu Sanli (St 36). In summary, the Sea of Water-Cereals (Shui Gu) extends toward the top to go into relationship with the Tian Qi (energy of Heaven) and toward the bottom to communicate with the
Yamen (GV 15) and Dazhui (GV 14).
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Jing Shui (rivers) of the Earth. 2. The Chongmai is the Sea of Shui of the 12 channels. From its Shu point, its energy goes up to the point Dazhu (Bl 11), then from there it descends to the points Juxu Shanglian (St 37) and Juxu Xialian (St 39) in order to follow the energetic route (Jie) of the leg. Such is the energetic route of the Chongmai which, at the exterior, communicates with Heaven and in the interior goes into relation with the Jing Shui (routes of water/?waterways) of the Earth. 3. Tanzhong (CV 17) represents the thoracic region in which is located the Tong Qi (a priori energy). Its posterior Shu points are found above and below Zhu Gu (cervical spine), that is to say, at the points Yamen (GV 15) and Dazhui (GV 14), and its anterior Shu point is Renying (St 9). 4. The bones have their marrow and the brain is the site of reunion of the marrows. This is why the marrows belong to the brain and the brain is the Sea of Marrow. The Sea of Marrow extends from the summit of the cranium toward the occipital region, that is to say, from the point Baihui (GV 20) to the point Fengfu (GV 16), belonging to the Dumai (GV), which form the upper/lower, anterior/posterior routes, control the movements of rotation of the body and constitute a type of cap of protection.
III - N.V.N.: Summarizing, the human being is endowed with 4 Seas: 1 - The Sea of Water-Cereals is controlled by the stomach. From Qichong (St 30), it extends toward the dorsal region to the point Weishu (Bl 21), then toward the lower limbs, to the point Sanli (St 36) (Figure 58). 2 - The Sea of the 12 Jingmai is controlled by the Chongmai. It extends from the dorsal region, from the point Dazhu (Bl 11), toward the lower limbs, to the points Shanglian (St 37) and Xialian (St 39) (Figure 59). 3 - The Sea of Energy is controlled by Tanzhong (CV 17). It extends from the area of the cervical spine from the points Yamen (GV 15) and Dazhui (GV 14) toward the anterior area of the neck to the point Renying (St 9) (Figure 60). 4 - The Sea of Marrows is controlled by Xuanzhong (GB 39) and Jugu (LI 16). It extends from the top of the cranium toward the occipital base, that is to say, from the point Baihui (GV 20) to the point Fengfu (GV 16) (Figure 61).
195.
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Figure 58: Extent of the Sea of Water-Cereals and its transmittable points. 196.
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Figure 59: Extent of the Sea of the 12 Jingmai and its transmittable points. Note: The Chongmai is intrathoraco-abdominal. 197.
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Figure 60: Extent of the Sea of Energy and its transmittable points. 198.
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PARAGRAPH 2
Figure 61: Extent of the Sea of Marrows and its transmittable points. 199.
Huangdi: The 4 Seas each have a benefit and a detriment, a blossoming and a decline. How is that?
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Qi Bo:
In the favorable state, the 4 Seas bloom, and in the unfavorable state, they decline. To know how to balance them is to favor them; ignoring the regulation is to injure them.
In man, to maintain the 4 Seas in the normal state is to maintain life. Therefore, one must understand clearly that the Dao of Regulation is salutory to the maintenance of the body.
PARAGRAPH 3
Huangdi: How are the favorable and unfavorable states of the 4 Seas? Qi Bo: When the Sea of Energy is in excess, the thorax is filled with Qi (energy), respiration is rapid and the face suddenly becomes red. voice In contrast, when it is in insufficiency, the thorax loses Qi and the grows weaker.
PARAGRAPH 4
When the Sea of Blood is in excess, the subject has the feeling of having a large body, without thinking of a disease.
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In contrast, when it is in insufficiency, the subject has the sensation having a small body, without ability to localize the disease. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
The Chongmai possesses two large vessels: _ a vessel leaving the interior of the uterus to reach the back. It concerns a vessel called Sea of 12 Jingmai (Figure 61) _ and a vessel emerging at the exterior to reach the thorax where it diffuses toward the skin. It concerns the principal trajectory of the curious channel Chongmai (Figure 62). This is why, in the event of stagnation or fullness of blood of the Chongmai, the subject has the feeling of having a large body, and in the event of emptiness, having a small body.
II - N.V.N.: Recall however that the Chongmai possesses another vessel descending toward the internal surface of the lower limb (Figure 62). Zhang Jing Yue clarifies: The bodily form is maintained by the blood. As a result, the excess of blood expresses as a sensation of heaviness of the body with slow motion of walking, and its insufficiency, by a sensation of weight loss with thoracic compression. These two syndromes make up part of the group of diseases caused by a dysharmony of the Sea of Blood. Diseases of the blood are of slow evolution; this is why the subject ignores that he is ill.
PARAGRAPH 5
202...
When the Sea of Water-Cereals (Shui Gu) is in excess, the abdomen is in fullness, and when it is in insufficiency, the subject feels a sensation of hunger but refuses to eat.
Excess of the energy of the stomach expresses as bloating/abdominal fullness (4) and its insufficiency by a sensation of hunger with anorexia.
201.
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PARAGRAPH 6
Figure 62: The Chongmai and its two vessels: postero-internal and antero-external. 202...
When the Sea of Marrows is in excess, the body is light and is carried well; the force of work is above normal. In contrast, when it is in insufficiency, the subject complains of
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headache, buzzings of the ear. dull pain within the bones of the leg, dizziness of the eyes and bodily asthenia. EXPLANATIONS AND COMMENTARIES
Ma Shi explains:
Sufficiency of the Sea of Marrows expresses by the solidness of the body... and longevity. In contrast, its insufficiency causes vertigo and buzzings, lancinating pains of the calves, headaches and diziness, panic and amblyopia, limb weakness and desire to go to sleep... signs, among others, of brevity of life.
PARAGRAPH 7
Huangdi: I have faithfully heard the words on excess (of the 4 Seas). How does one balance them? Qi Bo: and insufficiency
203.
One must thoroughly examine the Shu (kinetic or transmittable) points in order to harmonize the emptiness and fullness; one must avoid what is harmful and follow that which is favorable because the opposite worsens the disease. Huangdi: Good. EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
Thorough examination of the Shu points cited above permits knowing the existence of the routes of communication of the 4 Seas united to the channels and that of the channels to the energy of the exterior. When one achieves harmonization of emptiness and fullness, excess and insuficiency immediately go into regulation. The word harmful designates unfavorable phenomena causing worsening of the disturbances of the energy of the channels, and the word favorable implies the sense of improvement of these disturbances.
II - Ma Shi clarifies:
In the method of harmonization, exact localization of the Shu (kinetic or transmittable points) of the 4 Seas is always profitable and never harmful; it is always favorable and never contrary. The harmonization of the 4 Seas consists of utilizing the method of tonification or
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dispersion. In the event of emptiness, it is necessary to tonify, and in the event of fullness, one should disperse. These methods are always beneficial and never injurous; they are always favorable and never unfavorable.
III - N.V.N.: In conclusion, in the treatment of disturbances of the 4 Seas (marrow, blood, energy, Water-Cereals), the classification and description of signs and symptoms and localization of kinetic and transmittable Shu points located above and below are necessary to determine the emptiness and fullness in order to apply the method of tonification in the event of emptiness and dispersion in the event of fullness. In practice, one must always avoid the creation of Emptiness-emptiness/Fullnessfullness phenomena to not bring about deliterious, serious diseases. In this manner, Zhang Jing Yue says: One must carefully examine the Shu points cited in this chapter. In the event of emptiness, do not accentuate the emptiness, and in the event of fullness, do not accentuate the fullness to avoid worsening the disease.
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205.
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CHAPTER XXXIV
The Five Disturbances (Wu Luan)
Chapter 34 of the Lingshu is devoted to the study and treatment of The 5 disturbances: _ _ _ _ _ Disturbances Disturbances Disturbances Disturbances Disturbances of of of of of the the the the the energy energy energy energy energy at the level of the heart at the level of the lung at the level of the stomach and intestines at the level of the limbs at the level of the head.
These disturbances are caused by: _ a perturbation of the energy of the organs/bowels and that of the Jingmai _ unfavorable phenomena of the circulation at the level of Yin and Yang _ circulatory dysharmony of Ying (nutritive energy) and Wei (defensive energy). Zhang Jing Yue (1563-1640 A.D.) clarifies: The disturbances cited in this Chapter 34 are recent disturbances and not chronic disturbances of the blood and energy. The energy manifests according to the law of the 5 Movements, hence the title The Five Disturbances. This chapter consists of 3 paragraphs.
PARAGRAPH 1
Huangdi: The 12 Jingmai are distinguished into 5 Movements and divided into 4 Seasons. What are their disturbances and how does one treat them?
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Qi Bo:
The 5 Movements follow a very specific order; the 4 Seasons have their divisions (climatic). To be in conformity with these movements and seasons creates peace; the opposite create disturbances. Huangdi: What do you mean by conformity? Qi Bo:
206.
The 12 Jingmai respond to the 12 months. The 12 months are divided into 4 seasons. The 4 seasons are spring, summer, fall and winter. Each of these seasons has a different Qi (different climate). Ying (nutritive energy) and Wei (defensive energy) follow them; Yin and Yang are in harmony; pure and impure do not mix... . As a result, they are in conformity with the 5 Movements and the 4 Seasons. Huangdi: The pure energy responds to Yang; instead of rising toward the top, it is attracted toward the bottom which is Yin. The impure energy responds to Yin; instead of falling toward the bottom, it is attracted toward the top which is Yang. Ying (nutritive) energy belongs to Yin; instead of circulating in conformity with the Jingmai, it is found within the Yang part. Wei (defensive) energy belongs to Yang; instead of following the normal rules of circulation, it is found within Yin. These abnormal placements of the energy cause disturbances at the level of the thorax which are none other than the Great Inconveniences. This is why: _ at the level of the heart, the energetic disturbances are: sadness, closed mouth (deep silence), lowered head and agitation of the tongue, _ at the level of the lung, the energetic disturbances are: difficult respiration, unexpected shaking of the head, hands pressed against the thorax, _ at the level of the stomach and intestines, the energetic disturbances are: diarrhea and vomiting, limbs _ at the level of the leg, the energetic disturbances are: ice cold
_ at the level of the head, the energetic disturbances are: contrary afflux (Jue Ni) with sensation of heaviness of the head, dizzy spells and syncope. EXPLANATIONS AND COMMENTARIES
207.
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Ma Shi explains:
Man has his 5 disturbances which manifest by different signs. His Jingmai unite to with the 4 seasons; they are then in conformity with the laws of the natural world. The pure energy must rise up toward the top and reach the Yang part even thought it is found at the Yin part. The impure energy must be attracted toward the bottom and reach the Yin part even though it is found at the Yang part. Ying energy is of Yin nature; it is the source-substance for the production of Jing (quintessence) and must follow the Tong Qi (a priori energy) in order to circulate correctly within the Jingmai. Wei energy is of Yang nature; it is nimble in its movements and must circulate within the fleshly spaces (epidermis, dermis and muscles). In the event of disturbance of the circulation of Ying and Wei, Pure and Impure fuse and cause disturbances in thorax. Therefore, the phenomena of non-conformity to the 5 Movements and to the 4 Seasons are factors of disturbance, responsible for numerous displeasures, such as: _ disturbances at the level of the heart _ disturbances at the level of the lung _ disturbances at the level of the stomach and intestines _ disturbances at the level of the arms and legs _ disturbances at the level of the head whose specific signs are explicitly presented.
PARAGRAPH 2
Huangdi: What are the specific methods of treating these 5 disturbances? Qi Bo Since there exist routes of entry (of the perverse energy), there are surely routes of exit. To know these routes is to be able to acquire the precise method of maintaining the body. Huangdi: Good. I would like you to inform me about these routes. Qi Bo: In disturbances of the energy at the Shu point of the Hand Shaoyin (He) (XB). In disturbances of the energy at Ying point of the Hand Taiyin (Lu) and the level of the heart, needle and Shu point of the Hand Jueyin the level of the lung, needle the Shu point of the Foot Shaoyin(Ki).
208.
In disturbances of the energy at the level of the intestines and stomach, needle the Shu point of the Foot Taiyin (Sp) and Shu point of the Foot Yangming (St). In the absence of results, add Zu Sanli (St 36).
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In disturbances at the level of the head, needle Tianzhu (Bl 10) and Dazhu (Bl 11) of the Foot Taiyang (Bl); in absence of results, add the Ying and Shu points of the Foot Taiyang (Bl). In disturbances at the level of the arm and leg, first bleed the Xue Luo (blood capillaries), then needle the Ying and Shu points of Yangming (LI and St) and Shaoyang (SJ and GB). EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
This paragraph presents acupuncture techniques against the 5 disturbances. The word routes designates the trajectories of the Jingmai. A route of arrival certainly has its route of departure. Knowledge of these routes is therefore invaluable to the method of evacuation of perverse energy and to that of the conservation of the body. In practice, all physicians, acupuncturists or herbalists, must know the Summit (Jiao) and Root (Ben) of the disease, use the corresponding Jingmai with precision and especially discern in precise fashion the essential energy and perverse energy. Such is the key method of therapy. This is why: 1 - In disturbances of the energy at the level of the heart, one should needle: _ the Shu point of the Hand Shaoyin (He), Shenmen (He 7): needle depth 0.3 cun, left in place during 7 expirations and 7 moxas, _ and the Shu point of the Hand Jueyin (XB), Daling (XB 7): needle depth 0.5 cun, left in place during 7 expirations and 3 moxas. 2 - In disturbances of the energy at the level of the lung, one should needle: _ the Ying point of the Hand Taiyin (Lu), Yuji (Lu 10): needle depth 0.1 cun, left in place during 3 expirations and 3 moxas, _ and the Shu point of the Foot Shaoyin (Ki), Taixi (Ki 3): needle depth 0.3 cun, left in place during 7 expirations and 3 moxas. 209. 3 - In disturbances of the energy at the level of stomach and intestines, one should needle: _ the Shu point of the Foot Taiyin (Sp), Taibai (Sp 3): needle depth 0.1 cun, left in during 3 expirations and 3 moxas, _ and the Shu point of the Foot Yangming (St), Xiangu (St 43): needle depth 0.5 cun, left in place during 7 expirations and 3 moxas. In the absence of results, add Zu Sanli (St 36). 4 - In disturbances of the energy at the level of the head, one must needle: _ the point Tianzhu (Bl 10) of the Foot Taiyang (Bl): needle depth 0.2 cun, left in during 3 expirations, disperse during 5 inspirations and 7 moxas, _ and the point Dazhu (Bl 11) of the same channel. In the absence of results, add: a - the Ying point of this channel, Tonggu (Bl 66): needle depth 0.2 cun, left in place during 5 expirations and 3 moxas, b - and the Shu point, Shugu (Bl 65): needle depth 0.3 cun, left in during 2 expirations and 3 moxas.
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5 - In disturbances of the energy at the level of the arms and legs, one must: _ first bleed the blood capillaries (Xue Luo) of these regions _ then at the forearm, needle: a - the Ying point of the Hand Yangming (LI), Erjian (LI 2): needle depth 0.3 cun, left in place during 6 expirations and 3 moxas, b - the Ying point of the Hand Shaoyang (SJ), Yemen (SJ 2): needle depth 0.2 cun, left in place during 3 expirations and 3 moxas, c - the Shu point of the same channel, Zhongzhu (SJ 3): needle depth 0.2 cun, left in place during 3 expirations and 3 moxas, _ and finally, at the foot, needle: a - the Ying point of the Foot Yangming (St), Neiting (St 44): needle depth 0.3 cun, left in place during 10 expirations and 3 moxas, b - the Shu point of the same channel, Xiangu (St 43): needle depth 0.5 cun, left in place during 7 expirations and 3 moxas. c - the Ying point of the Foot Shaoyang (GB), Xiaxi (GB 43): needle depth 0.3 cun, left in place during 3 expirations and 3 moxas, d - and the Shu point of this channel, Lingqi (GB 41): needle depth 0.2 cun, left in place during 5 expirations and 3 moxas. 210.
III - N.V.N.: This paragraph gives information on the method of utilization of the Wu Shu (5 Shu antique) points in the treatment of the 5 disturbances, in particular the Ying and Shu points of the Yin and Yang channels as a function of the 5 Movements and 4 Seasons. The disturbances cited in this chapter are of endogenous origin (energetic perturbations). 1 - In disturbances of the energy of the heart (Fire-Heat), one must needle the Shu-Yuan points (Shu-Yuan= Humidity-Earth) of the Hand Shaoyin (He) and Hand Jueyin (XB) (to temper them), that is to say, the points Shemen (He 7) and Daling (XB 7). 2 - In disturbances of the energy of the lung (Metal-Dryness), one must needle the Ying point (Ying= Fire-Heat) of the Hand Taiyin (Lu) and Shu-Yuan point (Shu-Yuan= Earth-Humidity) of the Foot Taiyin (Sp) to reestablish the equilibrium of Water-Fire so as to maintain the coolness of this organ, that is to say, the points Yuji (Lu 10) and Taixi (Ki 3). 3 - In disturbances of the energy of the stomach and intestines (Dryness), one must needle the Shu-Yuan point (Shu-Yuan=Earth-Humidity) of the Foot Taiyin (Sp) and the Shu point (Shu= Spring-cool Wind) of the Foot Yangming (St) to reestablish the Yin-Yang equilibrium in order to maintain the coolness at the level of these viscera, that is to say, the points Taibai (Sp 3) and Xiangu (St 43). In the absence of results, add the He point (He= Humidity-Earth) of the Foot Yangming (St), that is to say, Zu Sanli (St 36). 4 - In disturbances of the energy of the head (site of gathering of the 3 Yang channels of the body: Taiyang, Shaoyang and Yangming, channels which bring water toward the cranium), one must reestablish the Yin-Yang circulation of this region via Tianzhu (Bl 10) and Dazhu (Bl 11). In the absence of results, one must needle the distal points located on the foot, that is to say, the Ying points (Ying= Winter-Water) and the Shu point (Shu= Spring-Wood-Wind) of the Foot Taiyang (Bl) to activate the Water movement toward the cranium, that is to say, the points Tonggu (Bl 66) and Shugu (Bl 65).
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5 - In the disturbances of the energy at the level of the arm, one must needle the Ying (Ying= Winter-Water) and Shu (Shu= Spring-Wood-Wind) points of the Hand Shaoyang (SJ) to which one adds the Ying of the Hand Yangming (LI), that is to say, the points Erjian (LI 2), Yemen (SJ 2) and Zhongzhu (SJ 3). In disturbances of the energy of the leg, one must needle the Ying (Ying= Winter-Water) and Shu (Shu= Spring-Wood-Wind) of the Foot Shaoyang (GB) to which one adds the Ying point of the Foot Yangming (St), that is to say, the points Neiting (St 44), Xiangu (St 43) and Linqi (GB 41).
PARAGRAPH 3
Huangdi: How are tonification and dispersion applied in these cases? Qi Bo:
211.
Slow movements of progession and slow movements of retreat transmitted to the needle constitute Dao Qi (method of conduction of the energy). To tonify is to conduct the essential energy, and to disperse is to conduct the perverse energy. Tonification and dispersion are not based on content and form, but their essential goal is to conserve and maintain the Jing Qi (quintessence of the energy). This therapeutic method bears the name Dong Jing (synchronization of the energy). It does not concern a treatment of excess or of insufficiency of the Water-Cereal energy (Shui Gu), but only a method of conduction of the rebel energy. Huangdi: That the Dao (of medicine) is clearly worthy! Your dissertation is most explicit. I wish that it be transcribed onto the table of jade with the title Treatment of the Disturbances.
II - N.V.N.:
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Dao Qi (method of conduction of the energy) is fundamental in the daily practice of acupuncture. This chapter seeks to resolve the problem of circulatory disturbances of the energy (non-conforming circulation, therefore contrary). It sets aside the case of emptiness or fullness, excess or insufficiency.
212. Table: Use of the Wu-Shu points (5 Shu Antique points) in the treatment of the 5 Disturbances of endogenous origin.
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213.
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CHAPTER XXXV
Study on Intumescence (Zhang Lun)
`Chapter 35 of the Lingshu analyzes the causes, syndromes, etiopathologic process, diagnosis and therapy of the intumescences.
The intumescences (swellings) are grouped together as: _ _ _ _ _ _ pulsologic intumescence pulmonary intumescence hepatic intumescence splenic intumescence gastric imtumescence vesicular intumscence, etc... .
Because this chapter seeks to resolve the problem of turgescence, it is entitled: Study on Intumescence (Zhang Lun). Chapter 35 consists of 8 paragraphs.
PARAGRAPH 1
Huangdi: The pulse responds to Cun Kou (radial pulse). How does it reflect the diseases of intumescence?
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Qi Bo:
The large, hard and rough pulse belongs to the disease of intumescence. Huangdi: How do you know if the intumescence is situated at the level of the organs and bowels? Qi Bo: Yin responds to the organ and Yang, to the bowel.
214.
PARAGRAPH 2
Huangdi: Is Qi (energy) responsible for the intumescence found within the interior of the Xue Mai (blood vessels) or within the interior of the organs and bowels? Qi Bo: All three (blood vessels, organs and bowels) are affected by it, but are not the principal sites of intumescence. Huangdi: I would like you to inform me about the principal sites of intumescence. Qi Bo: Intumescence manifests outside the organs and bowels. It widens the thorax and hypochondria and provokes distention at the level of the skin, hence the name i n t u m e s c e n c e .
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215. In this paragraph, the disease is purely energetic. It hampers anatomic components like the blood vessels, organs and bowels, hence the phrase All three are affected by it. These anatomic components are not the sites where intumescence is located. In the interior, it seeps its way into the inter-visceral sites, and at the exterior, into the epidermodermal spaces, hence the name intumescence-- that is to say, swelling associated with the energy without anatomic lesion.
PARAGRAPH 3
Huangdi: The organs and bowels located in the interior of the thorax and abdomen are like precious objects conserved in a box. They each have a name and different location and dwell in the same place. But within the same area, the energy manifests by different syndromes. I would like to know the cause. (Qi Bos response has been lost). EXPLANATIONS AND COMMENTARIES
Ma Shi emphasizes: Huangdis question should have been accompanied by Qi Bos response. What a shame it was lost!
PARAGRAPH 4
Huangdi: I have still not completely understood. Explain it to me again. Qi Bo: and Luo The thorax and abdomen are the protective walls of the organs bowels.
Tanzhong (middle of the thorax- CV 17) is the palace of the Xin Bao (XB).
The stomach is the granary.
216.
The pharynx and small intestine are routes of dietary conduction. The 5 openings of the stomach call to mind the 5 doors of the house of the people of long ago.
Lianquan (honest, upright door- CV 23) and Yu Ying (other name Yutang-CV 18) are the routes of organic liquid.
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area
This is why the 5 organs and 6 bowels each have a well-delineated and their pathologic manifestations are different.
Ying Qi (nutritive energy) follows the Mai (vessels) and Wei (defensive energy), circulating in the opposite direction, causes swelling of the vessels (Mai Zhang). Wei Qi circulating following the Mai (vessels) becomes directed toward the carnal spaces and provokes swelling of the skin (Fu Zhang).
It is advised to disperse Sanli (St 36) . In the case of acute intumescence, disperse once, and in the chronic case, disperse 3 times. The skillfulness of the practitioner consists of dispersing on the field without being concerned about emptiness and fullness. EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains: a - This paragraph concerns the principal localization of the disease of intumescence. This disease is the result of a circulation in the opposite direction of Wei Qi (defensive energy). Faced with such a case, one must immediately disperse Sanli (St 36).
b - Diseases of intumescence are localized neither in the interior of the vessels (Mai) nor in the interior of the organs and bowels (Zang-Fu). First, they occur outside the organs and bowels, that is to say, in the inter-visceral spaces, then they move away from there to reach the interior of the thorax. It is as a result of this that the skin becomes swollen. In other words, the skin is the principal site of turgescence (swelling). c - The organs and bowels are located in the same places, in the interior of the thorax and abdomen. But their pathologic manifestations are different because of their different delimitation or marked boundaries Therefore: _ the thorax and abdomen are considered protective walls of the organs and bowels, _ Tanzhong (CV 17), as the palace of the Xin Bao Luo (XB), _ the stomach, as granary, _ the pharynx and small intestine, as routes of food conduction/expulsion, _ the 5 doors of the stomach, as 5 doors of the house of people of long ago, _ Lianquan (CV 23) and Yutang (CV 18), as the routes of the Xin-Ye (interstitial liquid). d - The delimitation of the areas belonging to the 5 organs and 6 bowels is therefore clearly stated. It allows explanation of the difference between the pathologic manifestations of the organs and bowels. 217. e - Diseases of intumescence are not caused by Ying Qi (nutritive energy) but only by Wei Qi (defensive energy) because Ying Qi, endowed with Yin nature specialized in the conduction of Jing Qi (energetic quintessence), is permanently guided by Tong Qi (innate, a priori energy). As a result, Ying Qi can never be responsible for intumescence. But Wei Qi, circulating in the opposite direction, follows the Mai (vessels) and infiltrates into the carnel spaces to trigger first turgescence of the vessels (Mai Zhang), then progressively cutaneous turgescence (Fu Zhang). f - The stomach is the sea (of food) of the organs and bowels, and Sanli (St 36) is its He
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point. This is why one must disperse Sanli (St 36) one time in the acute case and three times in the chronic case without concern for emptiness and fullness. The dispersion must be performed on the field as soon as the disease appears. Yang Yuan Re put forward: The contrary circulation of the energy always causes the disappearance of the system of production/growth. In chronic cases, it is certain that the disease is found in the state of emptiness and the disappearance can only be performed in the presence of the obstruction of the energetic routes. If the doors are obstructed, one must open them; if the windows are sealed shut, one must release them; if the essential energy is insufficient, one must tonify it. To tonify, disperse and release at once is the right method of treating intumescence. In recent diseases, the energy is not yet in the state of emptiness; a single battle suffices in order to defeat, a single stick suffices to cure. Zhu Ying Nian concludes: One must admit that numerous practitioners only know the method of dispersion in the treatment of intumescence and totally ignore the routes of communication and doors of Entry/Exit of the energy. And yet, once the knowledge of these doors/windows and routes of communication are mastered, nothing appears difficult. As a result, to attain the root (of energetic medicine), one must very attentively read the texts of the Neijing.
II - N.V.N.: The term 5 doors of the stomach designates the 5 routes of access which are: Yi Hou (throat), Bi Men (cardia), Wou Men (fundus), Lan Men (pylorus) and Po Men (door of the soul). In other words, the stomach profits from 5 routes of communication: _ laryngo-pharyngeal route _ cardiac route _ intestinal route _ hepato-renal route _ pulmonary route. 218. Zhang Ying Yue summarizes: The pure energy responds to Ying Qi (nutritive energy) . Ying circulates within the Jingmai. This energy is subtle and specific; it cannot cause the syndrome of intumescence. The impure energy responds to Wei Qi (defensive energy). Wei circulates outside the channels; this energy is nimble and volatile; it circulates within the flesh spaces. As a result, turgescence is primarily due to disturbances of the circulation of Wei. First, it circulates within the channels to provoke Mai Zhang (swelling of the vessels), then it penetrates into the flesh spaces to trigger Fu Zhang (swelling of the skin). Sanli (St 36) belongs to the Foot Yangming (St). Yangming is the sea of the 5 organs and 6 bowels; it governs the flesh system. This is why in diseases of intumescence, Sanli (St 36) is used in dispersion, and the number of punctures depends on the chronicity of the disease.
PARAGRAPH 5
Huangdi: Please inform me about the disease of intumescence. Qi Bo:
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Intumescence of the heart manifests by anxiety with short respiration and agitation during sleep. Intumescence of the lung is characterized by flatulence with dyspnea and cough. Intumescence of the liver is indicated by hypochondrial fullness with pain radiating toward the lower abdomen. Intumescence of the spleen is characterized by frequent vomiting with fatiguability of the limbs and a feeling of heaviness of the body, inability to dress oneself and agitation during sleep. Intumescence of the kidney manifests by abdominal bloating/ oppression radiating toward the back with dull pain at the level of the lumbar region and thighs. As for intumescence of the 6 bowels, the clinical signs are: _ swelling of the s t o m a c h : abdominal fullness, gastralgia, perception of a burnt odor, anorexia and difficulty defecating. _ swelling of the large intestine : boborygmi and abdominal pain. In winter, secondary attack of cold triggers diarrhea with undigested food. _ swelling of the small intestine : fullness/oppression of the lower abdomen and pain radiating toward the lumbar region. _ swelling of the b l a d d e r : lower abdominal fullness and difficult micturition. carnal _ swelling of the Sanjiao (SJ) : fullness of the energy within the spaces with sensation of softening on palpation. 219.
1 - This paragraph demonstrates the contrary circulation of Wei Qi in the interior of the walls (thorax and abdomen) at the level of the 5 organs and 6 bowels, responsible for intumescence whose symptomatology always starts as functional signs (energetic, therefore immaterial), slowly evolving toward anatomic signs (organic, therefore material). Treatment of diseases of swelling (intumescence) consists of clarifying the notion of favorable/contrary because to disperse emptiness and tonifying fullness is to separate the Shen of the body; to aid the perverse energy and forget the essential energy is to disturb the source (energetic). In this way, little workers commit serious errors in the practice of medicine and attribute their fault to the celestial order (destiny). As for skillful workers, they tonify the emptiness and disperse the fullness, that is to say, they make the Shen return and fill the
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emptiness. 2 - Regarding the circulation, the term favorable/contrary is applied to the Ying energy circulating in the interior of the Jingmai and to the Wei energy circulating at the exterior (of the Jingmai). The former circulates in one direction and the latter in another direction, hence the notion of favorable/contrary. To fill the emptiness implies that, at the exterior, one must not allow the Jingmai, skin and pores enter a state of emptiness, and in the interior, one must augment the potential of the Shen Qi (mental energy) of the 5 organs and 6 bowels. This method is invaluable for great workers. 3 - The phrase ...without concern for emptiness and fullness, one must disperse on the field cited in the previous paragraph and the phrase ...tonify emptiness and disperse fullness mentioned in this paragraph denote that one must clearly discern the perverse energy and essential energy in order to carry out tonification or dispersion. Sages of long ago went to much trouble for future generations. Such is the profound meaning of the text.
PARAGRAPH 6
Huangdi: How is intumescence produced? And what is its cause? Qi Bo:
220.
In the organism, the Wei energy circulates with Ying energy within the carnal spaces. This circulation is in the same direction or opposite direction, Yin and Yang follow each other. Celestial harmony is therefore obtained; the 5 organs succeed one another following the rhythm of the 4 seasons; Wu Gu (5 cereals) are then assimilated. If Jue Qi (afflux of the energy) takes place down below, Ying and Wei stagnate, the cold energy flows counter-current toward the top and confronts the original energy (Yuan Qi or source energy) and they become indissociable, hence the formation of stasis responsible for intumescence. EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
This paragraph demonstrates the process of occurrence of the disease of intumescence. In the organism, Wei energy circulates during the day within the zones belonging to the Yang channels, and at night, in the zones belonging to the Yin channels. Like the vessels (Mai), it circulates within the carnal (flesh) spaces; it enters there, it leaves from there, always in the same direction or opposite direction, all in responding to Yin and Yang (night and day). The circulatory movements of the Wei energy are, therefore, in harmony with the energy of Heaven and Earth, a harmony which favors the potentialization of the energy of the 5 organs following the order of the 4 seasons and facilitating the assimilation of the 5 cereals (Wu Gu). If Jue Qi (afflux of the energy) occurs at the bottom, Ying and Wei no longer obey the normal rules of circulation; perverse cold rises from below upward. The original energy and perverse energy confront one another and provoke stagnation which becomes transformed into the
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disease of intumescence.
II - N.V.N.: Here, the term 4 seasons designates the period determined by the movements of insufficiency and excess during the day comparable to the 4 seasons: morning = spring noon = summer evening = autumn night = winter In this way, in one day (24 hours), Ying and Wei, energy and blood obey the rules of progressive activity.
PARAGRAPH 7
221.
Huangdi: Correct. But by what criteria does one base ones judgment in order not to triumph? Qi Bo: It is sufficient to reunite Ying and Wei to Chen Qi (original or innate energy, also called Yuan Qi: energy source, or Tong Qi: a priori energy). These 3 reunions permit clear comprehension of the cause of Jue Ni.
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The phrase