Professional Documents
Culture Documents
I
t might be argued that the most recent period when they began to list individual points for treating
of concerted innovation in the history of specific symptoms. This tendency to list points to treat
acupuncture was marked by the publication 400 symptoms served to simplify acupuncture practice,
years ago of Yang Ji Zhou's (^^M) Great Compendium but in the process disconnected it from its foundation
of Acupuncture and Moxibustion {$J:^~Xf& Zlien ]i in the living, dynamic system of channel theory.
D Cheng). First presented in 1601, Yang's work In order for the modern practitioner to more
represents the final stage in the process of collection deeply appreciate the mindset of the authors of
and synthesis that characterised acupuncture during classical texts, it is important to bring certain aspects
the Ming dynasty (1368-1644 CE).' This work became of classical channel theory back into the clinic. The
the core textbook for acupuncture practitioners until following article will highlight three features of this
the middle of the 20th century. With this text and process:
others of the classical era, students learned largely
through the recitation of memorised 'odes' (S f). I have argued in other articles that early acupuncture
Characterised by a rhythm akin to the rhyming practitioners used palpation as a diagnostic tool far
couplets of English poetry, this literary device more than modern textbooks describe.' In contrast
served to facilitate the assimilation of information by to the approach often used by modern practitioners
students at a time where written texts were a luxury wherein points are palpated to look for precise
not all could attain, due both to their cost and limited location just before needling, it seems that many
availabililty. early acupuncturists were palpating the channels as
While the 20th century has seen a veritable explosion a fundamental part of their diagnosis. By palpating
of the availability of written texts on acupuncture, along the pathways, we can more readily discern
some of the core concepts inherent in foundational problems with entire channels. This can then be
texts such as the Great Compendium have been lost. combined with information from other signs and
One example of this is the tendency of the odes to symptoms to create a channel-based diagnosis.
describe the treatment of representative symptoms
with pairs of points. In order to maintain conciseness As noted above, when proceeding from diagnosis to
and rhythm in the odes, more complex patterns were treatment, texts such as the Great Compendium tended
narrowed down to single symptoms, and two or to list points in pairs instead of singly. The concept
more points were often listed for treatment. For Ming that synergistic pairs might have greater effects
dynasty readers, the representative symptom would than the use of single points provides an extremely
be shorthand for a pattern of disease, which would useful clinical strategy. By thinking of points in pairs,
necessarily be defined by other concomitant signs we can avoid the tendency to create acupuncture
and symptoms. The idea that diagnosis of disease formulas by simply combining individual points
involved the careful analysis of symptom patterns based on their unique 'functions'. Instead, we can
was by that time a core tenet of Chinese medicine.^ affect the entire channel system through the strategic
Unfortunately, most texts written during the 20th combination of points from multiple channels.
Point-Pair Synergy: Theory and Practice in the Treatment of Immune Disorders Journal of Chinese Medicine Number 96 June 2011
The Lung-Kidney and defensive qi Thefluiids within the Sanjiao are the medium through
wi q)
which the Kidney commands the Lung. //
Classical anatomy and defensive qi
The discussion of the Kidney and Lung in the Inner 'The Lung unites with the Large Intestine; the Large i
Classic is more complex than some textbooks might Intestine links to the skin. The Heart unites with :
have us believe. Most importantly, when one begins the Small Intestine; the Small Intestine links to the |
to delve into their relationship, it becomes impossible vessels. The Liver unites with the Gall Bladder; the I
to take a view of the physiology involved which only Gall Bladder links to the sinews. The Spleen unites I
includes these two organs. Of course, in a system in with the Stomach, the Stomach links to the flesh, i
which everything is related, this is always the case. The Kidney unites with the Sanjiao and Bladder; the |
However, in the case of the Lung and Kidney the Sanjiao and Bladder link to the interstices and fine i
Inner Classic describes a relationship that can only hairs.' " I
be fully understood by considering other structures
within the classical model. For example, the second Note that this section associates the Kidney not with i
chapter of the Divine Pivot (sfli Ling SJiU) states that,the bones but instead with the interstices (jJli chu It) \
'Shaoyang is associated with the Kidney; the Kidney and fine hairs at the surface of the body. More is said i
rises to connect with the Lung and [the Kidney] thus about this subject in a somewhat difficult passage i
commands both organs, " Here we have a few concepts later in the same chaptei; where the relationship of i
that are not generally described in modern texts. the Kidney to the bones is highlighted and then i
Namely, that the Kidney is associated with Shaoyang immediately followed by an analysis of the structure :
(as opposed to Shaoyin) and is said to somehow of the 'Sanjiao-Bladder': i
'command' ()|# Jiang) both that channel and the Lung,
The Ming dynasty author of the Classified Classic (M 'The Kidney links to the bones. The dense 1
M. Li jTng), Zhang Jng Yu, asserts that this section of 'pattern-spaces' \m\ /;] and thick skin [is where] the i
the Inner Classic is describing a relationship wherein Sanjiao-Bladder is thick. The open-loose spaces \c \
the Sanjiao in particular (a Shaoyang organ) has a /(] and thin skin are where the Sanjiao-Bladder is i
crucial role to play in the Lung-Kidney relationship.' light. [Where the] interstices \cou-\\\ are dredged, the !
Zhang also reminds us that the Sanjiao channel, like Sanjiao-Bladder is relaxed-loose. [Where the] skin is 1
the Kidney channel, has a branch that spreads across tight and there are not fine hairs, the Sanjiao-Bladder i
the Lungs in the chest. The physiological implications is tight. [Where/when] the fine hairs are beautiful I
of this three-organ system are complex and are woven and open, the Sanjiao-Bladder is straight [in |
into the concepts of both defensive qi and fluid place]. [Where/when] there are few fine hairs, the i
metabolism in the classical model. For example, we Sanjiao-bladder is knotted.' '^ i
might remember that the Sanjiao is a major pathway
of fluids in the body while the Lung and Kidney play a What should we make of this passage? In a modern
fundamental role in fluid metabolism. Thus the fluids sense, it seems to be saying something about the
within the Sanjiao are the medium through which the quality of the fascia and connective tissues within
Kidney commands the Lung. Consequently, some and just below the skin surface. The 'looseness' of
problems with the Lung-Kidney relationship may these tissues implies an open circulation of nutrition
come from a lack of free movement in the pathways and fluids that give rise to abundant hairs (think of
of the Sanjiao. We will see later how expanding upon the fine fuzz of hair seen on the arms of a child). In
these ideas can both inform our treatment strategies this section, the Sanjiao-Bladder is thus associated
for defensive qi pathology, and help us to analyse with the quality and health of the tissue just under
palpated findings along the channel pathways. the surface of the skin - a quality which is easily
Chapter 17 of the Divine Pivot has some other palpated. If we take the two passages above together,
interesting things to say about the relationship of it seems that the Inner Classic is implying a direct
the Lung, Kidney and Sanjiao. In the process, it adds resonance between these tissues, the Kidney and the
another layer to the discussion above. Most of us are bones - as if the Kidney is connecting through from
familiar with the saying that the Lung is associated the very depth of bones all the way to the hairs on
with the skin and, in other chapters of the Inner Classic, the skin via these other structures. Not only that:
this is stated fairly forth rightly.'" However, Divine because both the Bladder and Sanjiao are pathways
Pivot 17 asserts that the relationship of yin organs for fluid circulation, their ability to maintain proper
with aspects of the surface anatomy is mediated by texture and function depends on stimulus from the
their paired yang organs: Kidney. These sections of the Inner Classic also bring
Point-Pair Synergy: Theory and Practice in the Treatment of immune Disorders Journal of Chinese Medicine Number 96 June 2011
to mind the idea in Chinese medicine which asserts is what is meant by "defensive comes from the lower
that external pathogens can move into the body when
the surface is not properly maintained, i.e. when the
interstices do not open and close properly. Might this Those advocating the upper burner as the source of
also therefore be somehow connected with Kidney defensive qi assert that the section cited above draws
function? from an Inner Classic text which has been corrupted
over the centuries. This is a plausible argument given
The source of defensive qi that the Chinese characters for 'lower' (~F) and 'upper'
Having established a more precise description of the (_h) are extremely similar. One might imagine a copyist
structures associated with defensive qi, we turn our in the fourth century misplacing a line in an important
attention to a section a few chapters later in the Divine copy of the Inner Classic. In fact, another lesser-known
Pivot, where an assertion is made that is at odds with Han dynasty text from the Inner Classic tradition, the
some modern textbooks: Creat Simplicity {JK'M Ti Su), makes this argument
all the more plausible when it states that 'constructive
'The Yellow Emperor states: I would like to hear comes from the middle burner and defensive from the
about the movements of constructive-defensive; from upper burner'."" Furthermore, other sections of the
where do they come and go? Inner Classic describe a warming qi that emanates from
Qi Bo states: Constructive comes from the middle the upper burner and travels to the surface, which
burner, defensive comes from the lower burner.'" some associate with defensive qi."^ This is the gist of
[Divine Pivot 18] the argument taken up by later authors who coalesce
around the idea that the upper burner (and thus the
The assertion that defensive qi arises from the lower Lung) is more associated with defensive qi.'"
burner is immediately followed by a statement about It should be acknowledged that this article is not
the Sanjiao: attempting to comprehensively explore the equally
fascinating and physiologically important discussion
'The Yellow Emperor asks: From where does the of the interplay of constructive-defensive in the Inner
Sanjiao emerge? Classic. Chapter 18 of the text is wholly devoted
Qibo replies: The upper burner emerges from the to the subject. Titled 'The Arising and Return of
upper aspect (mouth) of the stomach and goes upward Constructive-Defensive', this chapter states that:
with the throat; it links [through] the diaphragm to
spread throughout the chest..' '" 'Humanity receives qi through grains. Crains enter
the Stomach and are transmitted by the Lung. The
The order and rhythm of the text is important here. five zang and six fu organs all use [this] received qi.
Having just asserted that defensive qi comes from the Its clear [aspect] becomes the constructive while its
lower burner, the text reminds us that the Sanjiao also turbid [aspect] becomes defensive ... Therefore Taiyin
spreads across the chest. Once more the theme of the rules the inside while Taiyang rules the outside.' "
Sanjiao connecting the Lung and Kidney is repeated
- this time in the context of defensive qi. The passage The assertion that the source of both constructive
stating that defensive qi comes from the lower burner and defensive involves the assimilation of post-natal
has inspired debate for at least 1000 years. In general, grains also, of course, necessitates consideration
one can trace a shift in thinking over the centuries of the Spleen-Stomach. This chapter describes
from an emphasis on the lower burner as the source of constructive and defensive as a kind of yin-yang
defensive qi to a more generalised (but still debated) pair. Constructive is described as moving inside the
acceptance in many modern texts of the upper burner vessels, and the active (turbid) nature of defensive
as its source. The pivot of this change seems to be leads it to the outside of the vessels. Like qi and blood,
around the Ming dynasty when the text cited above, the two draw from one another. In the case of the skin
the Classified Classic, made a concise argument in and associated structures discussed above, a healthy
favour of the lower burner: glow must come not only from the Lung-Kidney axis
but also from an abundance of blood generated by
'The root of a person is basically essence and qi. Qi the Taiyin Spleen. Thus Taiyin rules the generation of
is yang and yang must arise from yin. Essence is yin constructive-defensive on the inside, while Taiyang
and yin must arise from yang. Constructive basically rules their opening toward the outside. Consequently,
belongs to yin and must come from the Lung then even if the Kidney is the source of defensive qi, it is
move downwards. Defensive is basically yang and certainly fortified by the assimilation of post-natal qi
must come from the Kidney and move upwards. This by the Taiyin Lung and Spleen.
Journal of Chinese Medicine Number 96 June 2011 Point-Pair Synergy: Theory and Practice in the Treatment of Immune Disorders
or there may be significant thickening of the fascia around texts for helping to stabilise the exterior by regulating
Wigun SJ-5 and ZhTgu SJ-6. In some cases we might sweating - which indicates an affinity for the skin. Thus
think of such changes being an indicator of deficiency heat both the five phase associations of these two points (as
arising from damaged yin in the other 'pivot' (Shaoyin), described earlier) and the directions from the Classic of
as described above. In others, it is indicative of stagnation Difficulties point to a tendency of these points to facilitate
in the sinew vessels of the Shaoyang areas of the upper the Lung-Kidney connection. More specifically, the pair
back and neck, and thus careful clinical distinctions must has been found to be particularly useful in cases where
be made. In general, when reflecting serious internal there is a deficiency of yin (of the Lung and/or Kidney)
inflammation, the changes tend to be bilateral. leading to an improper autoimmune response. Another
way of expressing this is that communication between
For any given patient, the relative involvement of these the depth of Kidneys and the skin surface is compromised
three channels can vary considerably. Palpation of the due to problems with fluid metabolism.
channels is therefore crucial to determining the best Channel palpation can help us to determine when
treatment. For example, in chronic systemic patterns this pair might be most effective. The most important
involving heat throughout the body, one might expect the determining factor seems to be the nature of palpated
Sanjiao to be involved. However, one occasionally finds on change in the area of Flia KID-7. When there is
palpation that the channel is completely unremarkable. In significant deficiency of the Kidney accompanied by
these cases, one must consider the possibility that the heat inflammation, the area of Flia KID-7 becomes swollen,
is deeper (often in the internally-paired Jueyin channel). On full and often quite painful. Sometimes one may feel a
the other hand, some patients who have chronic seasonal kind of oedematous pillow-shaped swelling in this area.
allergies have relatively minor changes along their Lung The more obvious the change, the more likely that Chz
channels. In these cases, palpation reveals instead that LU-5 and Flia KID-7 will be helpful. On the other hand,
the Shaoyang Sanjiao and Call Bladder channels are when this area of the Kidney channel is unremarkable,
much more involved. At times, especially in very weak one might explore some of the other theoretical
patients, it is difficult to find any helpful changes along implications described above by palpating carefully.
the channels at all. For these patients, it is as if the channel Thus the development of a treatment strategy for various
system is simply not able to mount a response. In many autoimmune conditions might involve the use of the Chz
cases however, the pathodynamic tends to revolve around lAJ-5-Flia KID-7 point pair. However, if we consider the
these three channels and their associated organs. ways that these organs interact with the Sanjiao, Spleen
and Large Intestine, we might find ourselves resolving to
Chz LU-5 and Fli KID-7 use unexpected, but effective, combinations of points from
In light of the information presented above we can begin other channels. The key is to bring the channel system
to consider how best to use the Chz LU-5 - Flia KID-7 to life in one's own mind while keeping one's hands on
point pair. The effectiveness of this pair for a wide range the patient. Once one begins palpating, one never knows
of defensive qi patterns must be evaluated in the context what might be found.
of the Lung-Kidney-Sanjiao-skin relationship described
above. As stated earlier, this is not by any means the Conclusion
only pair used in the treatment of these very complex The process by which theory, palpation and historical
conditions. Insight into the question of when to use this texts can be used to shape clinical strategy - as
point pair is provided in the Classic of Difficulties. Keeping demonstrated by this article - might be summarised as
in mind that Chz LU-5 is the he-sea point of the Lung follows:
channel, we should note that the 68th chapter describes
he-sea points as treating 'qi counterflow and diarrhoea' 1. The most important prerequisite for developing
(AiMiS cji ni r xi). Thus the well-known ability of this flexibility in the practice of acupuncture involves
point to clear heat draws from the mechanism described paying attention to what one is feeling with one's hands
above regarding md xing sin gSn tang (Ephedra, Apricot in the clinic. Chinese medicine requires that each of us
Kernel, Cypsum, and Licorice Decoction). Chz LU-5 develops diagnostic skills using our own senses - this
facilitates a reversal of upward counterflow of Lung qi is the foundation upon which every clinical encounter
so that it moves in its proper downward direction. The must rest. The history of Chinese medicine provides
downward movement of Lung qi stabilises the function of a wealth of strategies for developing awareness of
the Large Intestine. Next, consider that Flia KID-7 is the our patients through self-cultivation, and hard-won
jing-river point of the Kidney channel. The same chapter technologies for interpreting and categorising
from the Classic of Difficulties describes jing-river points information which we can see, feel, sense and smell. No
as treating 'wheezing, coughing, heat and cold' (HfiinJ^Jl; matter which approaches we choose to emphasise, this
^ chun k han r). Flia KID-7 is well known in classical is always the starting place.
12 Point-Pair Synergy: Theory and Practice in the Treatment of Immune Disorders Journal of Chinese Medicine Number 96 June 2011
2, Some kind of relationship with a textual tradition is Most importantly, the flexibility of thought gained by
required, through which we can test, evaluate and using this process for our most difficult patients will
develop the provisional conclusions we constantly improve clinical results. Not only that, it allows us to
draw from the patterns we perceive in our patients. use the strengths of our tradition so that we do not
This is the process described above, in which a noted move towards a future where specific points are always
pattern of changes along the channels of patients with indicated for certain diseases. Instead, future protocols
immune dysfunction led to mining the Inner Classic may suggest three or four channels commonly involved
for insight. This text and its associated commentaries in a given complaint... followed by a reminder to figure it
throughout the centuries thus provide a theoretical out for oneself.
foundation for first understanding and then expanding
upon classical theory in the modern clinic.^'' ]ason D. Robertson, MS, L.Ac, graduated from the American
3. Once we are familiar with the system described in College of Traditional Chinese Medicine in 2000. Mr. Robertson
foundational texts, we can begin to innovate. Such continues to translate for Dr. Wang Ju-Yi in Beijing, and lectures
around the US and in Europe. He has a private practice in Seattle
innovation is at the root of the frustrating answer we
(USA) and is a member of the core faculty at the Seattle Institute
may have received when we ask our teachers, 'Which of Oriental Medicine. A brief video showing Jason Robertson
point do you use to treat X?', When the question is explaining some of the concepts outlined in this article from the
asked, many experienced practitioners begin to run Chinese Medicine Database is available at www.youtube.com/
through a variety of patterns that might give rise to watch?v=aCOAvr-UTXA.
the symptom or disease in question. Their answer thus
often begins with the phrase, 'Well that depends,.,'.
Endnotes Zhang Jng Yu states that, 'Amongst the organs "On the Divine Pivot discussion of Defensive Qi
[this mention of Shaoyang] corresponds to the Emerging from the tJpper Jiao". journal of The
1 The process of systmatisation in the Ming began Sanjiao, often called the orphan organ.' (MMi Beijing University of Chinese Medicine 3, 19-20. (
with the 1439 publication by Xu Feng (fll) of W'tti'a'Hif^ ElMK^f zng f you xing h sanjiao
theCompleteWorksofAcupunctureand Moxibustion yu g f)
{i[1k^'^ Zhen i D Qun), was continued by
Gao Wu ( S J K ) in the 1529 text A Collection of 10 For example. Divine Pivot chapter 5 (,^lM) 18 See, for example the Classic of Holding to the Center
Gems in Acupuncture and Moxibustion (tl"^JE^ describes a more direct relationship between the {<^'M.Si ZhOng Cng jmg) attributed to Hua Tuo
Zhen Ji J YJng), and culminated with the 1601 Taiyin Lung and the skin. (*f) from the Eastern Han (25-220 CE), the
publication of the Great Compendium. 11 Arcane Essentials from the Imperial Library {!>\-a
tiSS Wai Tai Mi Yo) by Wang Tao (iif) in the
2 For example, the 610 CE Sui dynasty text General Tang dynasty (618-907)) and Essen (a/PrescrpoHS
Treatise on the Causes and Manifestations of All
Disease {ttif'MMA Zh Bing Yuan Hau Ln)
m Worth a Thousand Gold Pieces for Every Emergency
(^^.^A'SiJ Bei j< Qian jm Yo Fang) by Sun
by Chao Yuan Fang (tUc^ff) is a compilation 12 Simiao ( 4 S i l ) in the Song dynasty (960-1279).
of over 1700 diseases types, all categorised by
careful differentiation of diseases using symptom 19 AS-TS, 'BiAT-W
patterns in the way espoused two hundred years
previously in the Treatise on Damage by Cold {iU
13
'MWi Shang Han Ln). 20 For a more detailed discussion of ministerial fire
3 For a more detailed overview of palpation as please see pp.128-132 in Applied Channel Theory
14
a diagnostic process please see Wang, J.Y. & in Chinese Medicine.
Robertson, J.D. (2007). "Channel Palpation". 21 The Explanation of Collected Medical Formulae ( B
journal of Chinese Medicine. 83,18-24. iJiMyj Fang Ji Jie) by Wang Ang (ffi B ) in the
15 i Qing dynasty (1682) is the origin of the oft-quoted
4 Ibid. p.l8
'Lung is the upper source of water. Kidney is the
5 For example, in the Great Compendium {^\'jk.~)\)tL lowersourceofwater'WMyKZ-tWi, ^fy/KZ
Zhen ji D Cheng) a favorite section of Dr. Wang's TIS). Thus this phrase is reasonably recent in the
is the Ode to 100 Symptoms (WiK Bai Zheng
16
ma history of Chinese medicine. On the other hand,
F). This ode, which contains many excellent :EH^f<. The Huang the concept that the Sanjiao is a 'ditch' comes
point pairs, was originally found in A Collection Di Ni jing Ti Su ('rteSiclf) attributed to from chapter 8 of Basic Questions (UFcSJ S Wen)
of Gems in Acupuncture and Moxibustion (i^M Yng Shng Shan ( t l i j : # ) is one of the four which states that, 'The triple burner has the office
J Zhn ji j Ytng). extant Inner Classic texts. The text, thought to of ditch design; the water pathways issue from
6 For a detailed introduction to Dr. Wang's most have been written around 650 CE was lost for
common point pairs please see chapter 20 of 12 centuries only to resurface when a copy was
located in a temple in Japan in the 18th century. 22 For an excellent discussion of the theory
Wang, J.Y. & Robertson, J.D. (2008). Applied
Besides the more famous Ling Siifl and S Wen, that Kidney deficiency is at the root of many
Channel Theory in Chinese Medicine. Seattle:
the fourth of these Inner Classic texts is known autoimmune patterns see: Hou, W.Z, Xu, C.P. &
Eastland Press.
as the Ming Tang (BflS). The quote regarding Wang, H.J. (2011). Treating Autoimmune Disease
7 Maciocia prefers 'grasp', Wiseman chooses the source of defensive qi comes from a chapter with Chinese Medicine. London: Elsevier
'absorb' and Eastland Press advocates 'accept'. titled On Constructive and Defensive Qi 23 Author's clinic notes August 2002 from
the paediatrics department at the Chengdu
{sho yng sh shn, shn shng Han fi, g jing 17 See t tJni versity of Chinese Medicine with Dr. Su Shu
Hng zng ). Mffi Rong.
For an excellent article highlighting important
9 Specifically, in the Classified Classic {^t^. Lijmg) points along thepath of this upper burner /lower 24 For many, the most helpful commentary is cited
discussion of this section of the Inner Classic, burner debate see Dong, S.P. & Zhang, N. (2004). above - The Classified Classic of Zhang jie Bin.
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