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The shaping of our bodies Infuences in the formation of fesh and skin

By Peter Torssell The Spleen builds form Spleen qi exuberance means a superabundance of the physical body.2 In all their settlements, the bodily capacities of the people are Earth is the basis of form. Spleen and Stomach sure to be according to the heaven and earthly infuences, as create physical form by transforming food and drink into flesh. As stated in classical cold or hot, dry or moist. texts and confirmed in practice, the form 1 – Li Ji (Book of Rites) of your body reflects the condition of one’s Spleen. Su Wen (Basic Questions) chapter 44 From the treasurehouse of Chinese medicine and classical “The treatise on wilting” offers this: “Spleen books we fnd universal ideas about how we are shaped qi heat causes dryness of the stomach and as humans, and how to use insights about food regulation thirst, numbness of the flesh and flesh wilting.”3 and other daily habits to maintain our balance in the face Li Dongyuan wrote in the Pi Wei Lun of constant change. In Chinese thinking there is an obvious (Treatise on the Spleen and Stomach) that: interconnectedness between man and his surroundings, and “When the Spleen and Stomach qi is empty, this article will focus on how this connection defnes and it causes inability to eat and emaciation, or shapes the body. Thanks to Chinese correlative cosmology, reduced eating and obesity.”4 we understand that the body and skin manifest a constitutional Sun Simiao discussed the flavours (wei) as a metaphor for nourishment and its effect: tendency, but not a static one. We live in our bodies, whether “The physical form (xing) receives the flavours they are healthy or sick. Chinese medicine theory, its terms in order to achieve completion. If the flavours such as qi, yin and yang, and its categorisation of signs and of foods are not harmonised, the physical symptoms, gives us tools to stay healthy and to shape those form will be spoiled. This is the reason why bodies in the way we wish. These tools allow us to choose the the sage first employs nutritional interdictions a proper food, drink and activity to achieve our goals. Two organ (shi jin) in order to preserve his nature. systems are key to shaping the body: the Spleen and Lungs. a. Sun Simiao (581-682) legendary scholar of medicine portrayed as god of medicine. The quote

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In addition to the influence of the Spleen smelly armpits, they would almost certainly on the form of the body, there are also find no evidence for such effects. But when constitutional influences. As Ye Tianshi we approach the aetiology of reflux and observed: “When patients present with a body smells in a different way—a correlative sombre red skin colour and emaciation way—it is not unreasonable to consider such with solid flesh, their constitutional body is effects. These two patients have differently yang.”5 I view the constitution as not just the structured bodies, providing differing inherited body but also the influence of the circumstances for the interaction of those environment in which people live, another foods with their Spleens. Chinese medical aspect of heaven and earth. concepts and terminology are a useful way to appreciate the correlations between patients, Correlation is not causation their bodies and the food they eat. Just because two things occur together does not mean that one caused the other; The body as blood and fuids correlation does not mean causation. Medical Zhu Danxi wrote: “A fat person is abundant science with its causal analytic paradigm in dampness, while a thin person is abundant discounts correlation, but correlative in fire.”6 In the correlative frame of Chinese thinking has its uses. The body, the earth, medicine, humans are microcosmic mirrors water, climate, geography, food, desires and of heaven and earth. The body is associated psychological character all correlate, and so with earth while the mind is associated with Chinese medicine sets cause and effect in a heaven. In other terms, the body is water different light. The way the body is affected and the mind is fire. “Earth is the anchor for by food is a concrete example of how this heaven” is equivalent to saying “the body is type of thinking can apply. the anchor for the mind (shen)” and is also While the Spleen builds form, this is not equivalent to saying “water is the anchor of just cause-and-effect moving in a single fire”. direction, as the body also influences the It’s important to remember that not only Spleen. Because the Spleen and the body are members of a pair correlating with each influence one another, this renders the other, but that in correlative thinking the efforts of Western reductive science and opposite member in a pair can switch places causal analytical thinking to establish one with another opposite—so considering defined effect from one defined cause rather earth-heaven and water-fire, earth can control complicated to achieve. For example, foods fire and not be regarded only as in opposition can have different effects depending on the to heaven. With the pairs movement-stillness situation. One man who was obese could and heat-cold, movement could control cold, not eat rice because it gave him reflux, but and stillness could control heat. after he lost weight, exercised into a fit state Keeping the same relationship, we can and generally felt better, he could eat rice change the terms to blood and qi. An without problem. A young, alert, thinly built important saying in Chinese medicine is that n Peter Torssell (Bachelor girl suffered from headaches, and her mother Blood is the mother of qi; qi is the commander of Chinese Medicine, reported that she had recently developed of blood.b Pathological changes of material Jiangxi University of smelly armpits. I recommended that she kinds will often be expressed as changes of TCM) has been a prac- eat more carrots and potatoes and within blood or fluids, such as regarding tumours titioner in Sollentuna, a week the smell had disappeared. It is not as stagnations of blood or phlegm. Looking outside Stockholm, since that carrots and potatoes are specifically at a body gives fundamental clues to the 1988. He is also Head indicated for resolving smelly armpits but in condition of the blood. Zhang Jiebin wrote: of Studies and teacher certain circumstances they could have this at Akupunkturakademin effect. If controlled studies were done on Abundance and exuberance of the muscles in Stockholm. He is cur- whether rice causes reflux, or potatoes cure and flesh ... whenever there is form or rently working with pre- substance in the human body all depends senting food as medicine is translated by Ute Engelhardt in “Dietetics in Tang from classical Chinese China and the frst extant works of materia dietetica” b. This statement does not appear as a whole in medicine, and in 2000 (2001) Innovation in Chinese Medicine, Cambridge early texts, but its component parts “qi is the leader published a book on the University Press. In her translation of wei she used the of blood” and “blood is the mother of qi” appear word “sapor” instead of “favour”. separately in a variety of texts. subject (in Swedish).

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on the blood. For instance, if blood Bodily guide to treatment strategy declines, the form will wither.” 7 The patient cases of Zhu Danxi are described concisely, notably without mentioning If this strong frm body Li Dongyuan made this comment on a tongue diagnosis but often including an is healthy, it is infused quote in the Nei Jing about the connection observation about the patient’s body and ‘‘with qi in adequate between the flesh and blood: character. An example is the following where amounts and Zhu applies turnip as a way of opening the considered a strong Turbid yin forms the earth... penetrates the circulation in a strong patient: constitution. But when five viscera, nourishes the blood vessels, something is material moistens the skin and fattens the muscles, Replete both in form and complexion ... and heavy, it carries flesh and sinews. This is what is meant by relying too much on his sturdy (physique) (the statement) that blood produces flesh.8 and his ability to eat undaunted, he defied the risk of stagnating. any prohibition ...then I told him to eat Fluids and blood are the material aspects only gruel with cooked turnip. that make up the body, and they should be in balance with qi. A thinner body is a type of In the Pi Wei Lun chapter 13, Li Dongyuan yin deficiency, and due to the imbalance with describes the same principle in cases of food qi will have a tendency towards fire. At the stagnation: same time, thinking analogically, thin people will also tend to other yang phenomena such Food damage is damage by tangible as dryness and wind. On the other hand, an substance. A mild case calls for dispersion obese body has an exuberance of yin in the and transformation through reducing food form of damp phlegm. So a thin body is a intake. Only severe cases call for ejection type of dryness that is lacking fluids, while and precipitation. a strong, firm body has sufficient blood. If this strong firm body is healthy, it is infused Whenever there is ample physical form, with qi in adequate amounts and considered there must be enough qi present for a strong constitution. But when something circulation and transformation. When there is material and heavy, it carries the risk of is insufficient physical form, a different stagnating. Having a lot of blood/yin must strategy is required. Zhu Danxi wrote: be balanced by enough qi/yang to ensure a free and regulated flow. In the west and north the earth qi is high The quote opening this article, from the and thick and the people have strong and Book of Rites, describes how the bodily sturdy physiques ... People in the south capacities of people vary according to heaven and east or those with blood and qi not and earthly influences. In our interplay replenished...should know that in the west with the surroundings we are affected by and north, opening what is bound must be environmental conditions. In Chinese made the rule, while in the east and south medicine, dampness is related to the Spleen the rule is to moisten dryness. and dryness to the Lungs. Unlike coldness, dryness and heat, which are immaterial, The people of the south and east, where dampness is substantial, and thus must be it is more common to have qi and blood balanced by enough yang factors such as deficiency, will tend to be leaner and more heat and dryness and the movement and fragile, and therefore need to be moistened. transformative ability of qi. Zhang Jiebin summarises my point elegantly: Robust northerners, soft southerners The availability of food will depend on Humans have yin and yang, namely qi and where we live (earth) and at what time we blood. Yang governs qi, therefore, if qi is want to eat (heaven), i.e. at which season of complete, the spirit is effulgent. Yin governs the year. These factors also affect us in other blood, hence if blood is exuberant the body ways, shaping our bodies and cultures. Yin- will be strong. These are just the things yang thinking has always been arranged into upon which one’s life depends.9 subcategories such as heat/cold, dryness/ moisture and strength/weakness. We see

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that the amount and balance of yin and yang such acrid and hot things in order to boost have to be appropriately contained for proper their yang qi. (However) the north-western strength and firmness. regions are high, mountainous, windy In Chinese mythology there is a story of and cold, the pores of the people there are how one of the heavenly pillars was destroyed, tightly closed (couli zhimi) so that their so that the heavens have tilted ever since in a sweat and ye fluids are secure within, and north-west/south-east direction. In a yin-yang their yang qi is complete and full. It is not dichotomy, north and west are yin directions, appropriate for them to eat black pepper, opposite to the yang directions of south and ginger and such acrid and hot things that east. In China, the deserts and mountains would commonly boost their yang qi. are in the north and west, while the sea is in the south and east. The climate of the north- One will also generally see more cooling west is cold and dry, both factors having a foods such as fruits and vegetables contracting nature. The south-east is relatively consumed in the south-east to counteract hot and damp, both climates having an the hot climate, and more warming foods expanding nature for opposite reasons: heat such as animal products in the north-west expands due to force and dampness expands to counteract the cold climate. This is to due to lack of force. This is seen in big tongues, achieve yin-yang balance for each region, as made bigger by dampness, which also opens Wang Lun explains in “On different methods the pores. Subjected to the cold and dry of being regionally appropriate”: climate of the north-west, the pores close and yang is kept inside following this contracting People say that the qi of the south-east is movement. When subjected to heat and hot (so it is) appropriate to prescribe cold dampness the pores open, which leads to an medicines; the qi of the north-west is cold outward movement as yang leaves the centre. (so it is) appropriate to prescribe warm In the north-west this tends to result in people medicines. However, why is it that these with bigger, stronger bodies with firmer skin days south-eastern people often consume and flesh, and in the south-east in smaller, black pepper, ginger and cassia bark, (yet weaker and more fragile people with looser we) do not see them get sick, yet north- skin and flesh. western people avoid consuming acrid and The heavier, stronger people in the north- hot substances such as black pepper and west have more blood and qi, but because of ginger? This is because although it is hot this also tend towards fullness and blockage, in the south-east, the land is low lying and which is most often helped by opening up for damper; acrid and hot foods and drugs can movement, instead of an enriching method as also expel the dampness. Although it is cold counselled by Zhu Danxi. On the other hand, in the north-west, the land is mountainous the people of the south-east are more slender and drier; acrid and hot foods and drugs and need to be strengthened and moistened can conversely exacerbate the dryness. with enriching fluids such as blood. The bigger constitutions are ideally purged Su Wen chapter 12 points out the importance and dispersed while the smaller constitutions of individualising treatment. are strengthened and moistened. This becomes a more tricky issue when there Huang Di asked: “When physicians treat is a mixture of yin and yang influences at diseases, an identical disease may be treated the same time; traditional wisdom reveals differently in each case and can always be aspects of this regulation as explained by healed. How is that?” Xue Ji: Qi Bo’s response points out differences in The south-eastern regions are low lying, physical features depending on geographical damp and hot; the pores of the people there location. The first thing we do when meeting are loosely opened (couli shutong), so their patients is to observe them. Qi Bo gives the sweat and ye fluids drain out and their yang example of western China where people eat qi is depleted within. Thus, it is appropriate rich food, are overweight and have diseases for them to eat black pepper, ginger and emerge that must be treated with toxic drugs.

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He contrasts this with the way the people of from violence or loss of vitality through central China “eat diverse (foods) and are dissipation. As soon as someone falls sick, never fatigued”. To treat with toxic drugs is they use a bitter cold, clearing formula to That Ren Shen did to attack disease drastically, and could harm throw it out, and quickly return the patient not gain the same patients, comparable to the harsh effects of to health and spirits. As for southern ‘‘popularity in the West some modern medicines and the drastic diets people, their constitutions are soft and as the East might that might be fitting for overweight Western fragile, the pores of their flesh are loose and patients with multiple ailments and diseases. shallow, they indulge in food and drink refect constitutional Historically there are many stories of and have excessive desires, all of which is differences. Tea encounters between Westerners and East completely different to northerners. To treat may be more Asians describing the Westerners having illnesses in the south, it is best to take as generally suitable for bigger and stronger bodies and the East the root the use of (formulas) to nourish Westerners as it opens Asians as being smaller. the inner qi.21 up circulation. During the 17th century, Ren Shen (Ginseng Radix), a famed strengthening herb, was in Materia medicas such huge demand that it almost ruined It is interesting to see how the ideas of the the Japanese economy. In contrast, Great body and its tissues are correlated with yin, Britain’s economy was almost overturned fluids and blood in classical herbal books. due to Chinese tea exports.20 That Ren Shen A closer look at two of the most important did not gain the same popularity in the materia medica written at different times in West as the East might reflect constitutional Chinese history, the Shen Nong Ben Cao Jing differences. Tea may be more generally (Divine Farmer’s Materia Medica) and the suitable for Westerners as it opens up Ben Cao Gang Mu (Compendium of Materia circulation. From a constitutional viewpoint, Medica), reveals varying descriptions of herb it makes sense that the Western medical actions. For example, the earlier text, the Shen tradition did not have the same development Nong Ben Cao Jing, described the qualities of of tonics as the Chinese tradition.c When Hu Ma (Sesami Semen nigrum, also known as the Western world was exposed to Chinese Zhi Ma) as having a sweet flavour, moistening herbal medicines, Ren Shen (Ginseng Radix) or enriching the blood to treat emaciation, was not especially requested but Da Huang making one fat, promoting the growth of (Rhei Radix et Rhizoma), a strong purgative muscles and flesh, fortifying teeth and hair, for full conditions, became popular. promoting the beard, fortifying sinews North China also contrasts with South and bones and replenishing brain marrow. China in constitutional types. The stronger “Protracted taking may make the body light northern types call more for purging fullness, and prolong life.”22 Ye Tianshi in the later and the southerners more for nourishing materia medica explained its actions thus: deficiency. Hanson cites the physician Zhu Bishan: Yin is the guardian of the centre. Damaged centre is damaged yin blood. The Lungs Northern wind and qi are turbid and thick, are the source of transformation of fluids, constitutions are powerful and robust, and the Spleen controls the blood and the combined with their simple and generous Heart governs the blood. Sesame enters natures and frugal diets, no one suffers the Spleen, Lungs and Heart. It is sweet and balanced and therefore boosts the c. When studying old and new books on the subject of Western herbal medicine, it is clear that blood. For that reason, it rules damaged a difference exists between Chinese medicine’s centre. The Spleen governs the muscles categorisation of strengthening and the Western and flesh. The sweet flavour moistens the tradition. Even though the West does use the word “tonic”, it is not as clearly indicated for defciency Spleen. Therefore (sesame) rules vacuity states as in Chinese medicine. Defciency is not clearly and emaciation... Sesame is enriching and defned in the West. In my search for strengthening moistening, therefore it supplements the herbs in the West, for example, I found arctic root 23 (Hong Jing Tian, Rhodiola rosea), which has been five zang. used in Sweden for a long time and is referred to by Linnaeus but is not regarded as strengthening. When Another example from the Shen Nong the Chinese co-opted it from Tibetan medicine it was categorised among the strengthening herbs. Ben Cao Jing is of Huo Ma Ren (Cannabis

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Semen) described as a sweet herb that opposed to those with thick skin and firm “supplements the centre ... makes you fat, flesh. He summarises, “Tight pores at once strong and never senile”.24 The Ben Cao Gang signified and assured vitality, demarcating Closed pores ensure Mu and other later sources described both and safeguarding self from the surrounding that yang and fuids 27 Hei Zhi Ma (Sesami Semen nigrum) and chaos.” will stay inside and Huo Ma Ren (Cannabis Semen) in terms Su Wen chapter 3 has a description of how ” not be lost. This type of moistening the five zang or muscles. The food builds the foundation for the organs action of moistening, nourishing blood and and leads to perfect health, which involves of concentration yin, and guarding the centre takes physical the skin being sufficiently closed: generally correlates expression in fat, muscles, flesh, hair, teeth, with the creation of etc., which are all yin, and become a basis for If one carefully balances the five flavours, material substance yang—a light body, long life, strength, and a the bones are upright and the sinews are clear mind. Hei Zhi Ma is described as “the soft. As a result, qi and blood flow, and the black drug [that] functions on the Kidneys interstices are closed.28 and moistens dryness”. Li Shizhen referred to Wang Haogu when he wrote that Huo Ma Closed pores ensure that yang and fluids Ren “should be used to moisten dryness” and will stay inside and not be lost. This type of to Cheng Wuji when he wrote that “it relieves concentration generally correlates with the strained Spleen and moistens dryness”.25 creation of material substance in Chinese thinking. Elisabeth Rochat de la Vallée wrote Tight or loose pores in A Study of Qi that “form requires substance A patient’s constitution is an important and essences. The beginning of form is the criterion for deciding on treatment yin concentration and condensation of qi, and disease prevention. The external which allows substance to appear.”29 environmental factors of heat, cold, dryness Closing inward is a yin movement, while and dampness can have an impact on the opening outward is yang, exemplified by the whole person. Whether the pores are tightly sweating triggered by hot, damp climates. closed or loosely open strongly contributes The yang movement corresponds to the to the shaping of the body, which implies movement of life and joy, and we can see that the Lungs are an important organ. here an example of yin creating yang, bodily form creating the conditions for yang, blood Humans make a trio with heaven and earth. being the mother of qi. But of course yang The reasons can be explained. When there will in turn create yin, as in the case of is gradual moistening below, it produces well-regulated pores that are dependent on reeds and water plants above... When it is enough qi. Thus, when observing a person, hot, the enrichment of rain stays above, so the body and personality reflect the most the roots and stem have less sap. Human fundamental idea of classical Chinese qi is located on the exterior, so the skin is cosmology, that the world consists of yin relaxed, the interstices are open, blood and qi (concentrating movements) and yang qi qi are reduced, a lot of sweat is discharged, (dispersing movements). and the skin is muddy and marshy. When it is cold, the earth is frosty and water freezes. The Lung Human qi is located on the inside, so the The pores and skin are associated with skin is dense, the interstices are closed, the Lung, which has a special relationship sweat is not emitted, qi and blood are with the Spleen and Stomach, and is strong, and the flesh is hard and rough. of importance in shaping the physical – Ling Shu (Spiritual Pivot) 75 26 body. This relationship is understood in dermatology. The involvement of the Spleen Even though the pores have the ability to is needed to produce new skin—as far back open and close, to be closed is more often as Guan Zi (7th century BCE) the production associated with health as this preserves the of skin is correlated with earth/centre—so yang and the fluids. To Kuriyama, Ling Shu 50 in the Chinese dietary system, for example, explains that those with thin skin and flabby yellow foods may be recommended to treat flesh will be susceptible to external wind, as and prevent wrinkles.

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The Lung has the highest physical position houses the po, which controls lower animal of the organs, and the skin is the exterior urges such as having sex and emptying the border of the body; both have a yang bowels. During the Han dynasty, the rulers Lung and Stomach resonance with heaven. Movements between reasoned that a harmonious and flourishing both act in the body the exterior and the centre, inwards and kingdom was based on sufficiently meeting ‘‘like markets, places of outwards, have close connections to Lung people’s fundamental needs, and that they gathering of products and Spleen-Stomach, and are manifestations would be satisfied as long as they did not go for distribution. of the healthy regulation of ying and wei qi. I hungry or cold.30 believe that the failure of this regulation is the To control the desires to a level of being main contributor to the modern epidemic of content with enough food or clothing allergic/atopic diseases. and housing requires the harmony of The Lung has a close relationship with Spleen-Stomach in eating and the Lungs in the Stomach. Lung and Stomach both act in protecting from the external climate. This the body like markets, places of gathering results not only in individual harmony but of products for distribution. They are both also has resonant effects on the entire society. connected with yin, as both need enough yin fluids to function and to provide the rest The human body is precious (because) it of the body with yin. A deficiency in either is inherited from one’s parents. Yet there organ could be expressed as thirst. The fluids are no end of cases where the body is manifest differently in the two organs; the damaged for the sake of the mouth, because Lung fluids, being closer to heaven, will be a person has a body, hunger and thirst in the form of steam, a thinner yin, whereas arise repeatedly, and one does have to eat those in the lower position of the Stomach and drink in order to continue their life. will be thicker, such as denser water or food. (However), one can see that in the muddle- Lung and Stomach have the highest physical headed the indulgence in good tastes leads positions in their respective organ systems, to excess of the five flavours from which which produces the yin motion downwards. diseases spring up like swarms.31 The descent of qi and fluids by Lung and Stomach provides the main impetus for the We have feelings, needs and preferences qi of the rest of the fu organs to descend, such as hunger, thirst, desire for warmth, and is also associated with clearing turbidity dislike of wind, etc., and fulfilling those from the body, which manifests as being able desires gives us feelings of satisfaction, to empty the bowels and urinate. relaxation and harmony. Not having enough The Lung and Spleen share the same to eat or lacking protection from wind and channel, taiyin, which supports the cold will endanger our lives, but the opposite production and distribution of qi and fluids. also poses dangers. To be able to eat and drink “We get air from heaven and food from the excessively, and to be protected from external earth” the Chinese saying goes, pointing stress, is not so apparently nor immediately to the work of the Lung and Spleen on the dangerous because it is often connected with postnatal essences and also their taiyin feelings of satisfaction and joy. But Chinese characteristic of opening to the outside. medical and philosophical literature warns Lack of fluids manifests in the exterior as insistently against this, even though to wrinkles, dryness, thinness, tightness and avoid satiety may seem counterintuitive. sunkenness, as opposed to moisture that Moderation is something to be learned and exhibits as clear, damp, thick, flabby and understood. Important advice is to avoid filled-out tissues and skin. excessive desires and overindulgence.

Urges, desires and moderation If one is controlled by one’s cravings and Breathing, eating and drinking are desires, then he will certainly lose what is fundamental survival behaviours that put natural within. the Lung, Stomach and Spleen in the realm – Lu Shi Chun Qiu of bodily urges and desires. Just as the Spleen (Spring and Autumn Annals) is the “vulgar” zang that is associated with the lower fu dealing with digestion, the Lung When one reaches the point of

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overindulgence, he refuses, so there is no original nature,34 the opposite to wastage. way for illness to arise. Some examples of jie used in classical books: – Zuo Zhuan (Commentary of Zuo) The Lung, which is To set limits (jie) for our physical and connected to po and The body’s needs, urges and desires are emotional desires, that is wisdom. to sensing what the also specific and one can learn how to use – Guan Zi 11 ” body needs to survive, them to regulate the qi and blood. They may include preferences, like preferring hot tea To open and close, that is what jie (close) is also connected to to water, or rice and beans to a lamb stew, means. the ability to put a or even choosing to eat hamburgers with – Han Shu 235 stop at the limit. potato chips and cola! Such preferences are a body’s call for regulation. Even when Just as the modern West regards a person junk food is preferred, we can interpret this with an exaggerated interest in material as a diagnostic signal and assist a person things, fashion, appearances, sex or good to choose something healthier. The same food to be “shallow”, early classical Chinese applies to protecting our bodies. Rather than had similar thoughts about external and choosing simple clothes or shelter from the internal hierarchical values. cold and rain, if one prefers certain specific According to Zhuang Zi, nourishing the fabrics and colours, special designer clothing internal and not the external, or nourishing brands, or a bigger and more luxurious the external via the internal, is the right house with a garden and swimming pool, path to understanding real needs. Generally, this indicates the danger of excessive desires desires are associated with the sensory and increased urges. We should stop before surfaces of the body, notably situated away the point of excess is reached. from the heart-mind—the nose, eyes, ears, The Lung, which is connected to po and to mouth and fingers.36 The classics warned sensing what the body needs to survive, is against over-nourishing the external and also connected to the ability to put a stop at forgetting the internal. the limit. It is related to autumn, the season of gathering, and to the hard element of metal Longing and desire cause the qi of man to which cuts off what is not needed to maintain be dispersed, and liking and loathing cause our integrity. The emotion associated with the the heart of man to be weary. 37 Lung, bei, sorrow, is etymologically built – Huai Nan Zi 7 on the idea of stopping the natural expansive movement of the Heart. Sorrow is close to If you know when to stop, you’ll suffer no feelings such as longing, missing and being harm. And in this way you can last a long unsatisfied, which naturally links to desires. time. Su Wen chapter eight on the functions of the – Dao De Jing 44 organs says this about the Lung: An early idea from Daoism was that The Lung is the official functioning exaggerated desires connect to an abundance as chancellor and mentor. Order and that must be expelled. This excess could be moderation (zhi jie) stem from it.32 called “the three worms” or “the three death- bringers”. A way to expel them was through Unschuld translates the word jie as the right dietary regimen that resulted in moderation. The character is an image of a independence from material things, luxury, bamboo knot, and it could also mean joint, rich foods and alcohol.38 In this light it is easy acupuncture points, moral integrity, qi, to understand Zhu Danxi’s warning on how rhythm, climate period, a section, or within easily the constitutional strength of children limits. Fruehauf has shown that this word is can be undermined: often used in terms for restraint especially in areas of food and emotions.33 Rochat de la Some women are ignorant and do not Vallée points out that jie is not a constraint know better than to satisfy all the child’s that inhibits and bridles, but an embodiment wishes. Out of fear that the child will cry, of the natural rhythm of life, a return to the it will be denied nothing ... therefore it is

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common that the children of the rich are the most yang flavour related to these three affected by many diseases and when they organs, as it moves and circulates qi to be able grow up they have soft and fragile sinews to transform and move fluids. The other two The sweet and salty and bones.39 flavours, the sweet of the Spleen and the salty favours are the most of the Kidneys, are also engaged in regulating ‘‘manipulated, refned Axis for regulation of fuids and body the fluids, moistening and nourishing the and synthesised in In death, yin and yang separate, and the yin body. Tao Hongjing combines sweet and modern fast food body is all that remains. The hun leaves and salty flavours to moisten dryness.41 products, which in the po stays to transform the body back to The sweet and salty flavours are the most my opinion hugely earth. After death there is only the skin manipulated, refined and synthesised in contributes to chronic enveloping the flesh and bones, which are modern fast food products, which in my the tissues related to the Lung, Spleen and opinion hugely contributes to chronic disease and illnesses Kidneys, the three organs most connected to disease and illnesses connected to the connected to the yin. In Chinese anatomical order, from above Western lifestyle. Since they regulate the Western lifestyle. to below, from external to the deepest: Spleen and Kidneys, which provide us with the essences, the consequences of changes in quality and quantity of sweet and salty Vertical Horizontal flavours in our foods is seen in the constant Above & below External & internal reconstruction of our bodies.

Lung Skin Ancient theories in modern times The Chinese ideas are that external Heart Mai factors, choices of food and internal desires Spleen Flesh contribute to the shaping of our bodies, and Liver Jin that all these build the foundation for future Kidneys Bones health or disease. From moment to moment, what we are, do and feel makes a difference. Do these ideas still apply in modern times? The skin, flesh and bones are clearly material Li Zhongzi in Yi Zong Bi Du (Essential form but the mai and jin are more functional. Readings from Our Medical Ancestors) says: Mai is the regulated flow of qi and blood and jin is the utilisation (contraction and relaxation) In general, the wealthy and noble labour of the flesh so that the body can move. So their minds, and the poor and ignoble mai and jin are more yang, relating to the two labour their bodies. The wealthy and noble more yang-related zang, and need yin blood feed themselves rich foods and grains; the to function properly. The “yang tissues” are poor and ignoble fill themselves with sprouts found in between the “yin tissues” displaying and beans... Those who labour their minds an interchange between yin and yang: bone to have depleted centre, weak sinews and brittle jin to flesh to mai to skin. This naturally puts bones. Those who labour their bodies have the Spleen and flesh in the centre, emphasising full centres, strong bones and powerful the central importance of the earth element in sinews. Those who feed themselves on rich harmonising and nourishing the other four. fare always have delicate organ systems. Another presentation of a slightly different Those who fill themselves on sprouts and order is: bone, jin, mai, flesh and skin.40 Here beans always have strong organ systems. flesh and skin are a pair, being neither too Those who live in winding buildings with loose nor too firm. broad hallways have loose pores so that the The three organs that manifest the most six pathogenic factors can reside (in their yin tissues are those that regulate the fluids bodies). Those who live in thatched huts of the body: Kidneys in the lower jiao, Spleen in alleyways have tight pores so that the in the middle jiao and Lung in the upper external pathogens have a hard time getting jiao. The upper jiao is portrayed as an area of (into their bodies). Thus, the maladies of clouds, below which are more watery, dense the wealthy and noble are well suited to and heavier areas. The flavour relating to (prescriptions) that restore zheng (qi that has the Lung is acrid, and correspondingly it is been depleted) and the maladies of the poor

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and ignoble will benefit from (prescriptions) to a breeze (wei feng) at this time, they will that attack xie (qi).42 suffer from arthralgia due to stagnation of blood.45 To understand how Qi Bo in Ling Shu 18 says: to treat complicated Rochat de la Vallée explains that this is modern patients, I As for strong men, their qi and blood is in someone of the upper class, who does not ” believe Su Wen 77 full power, their flesh is oily, their qi flows move around physically but eats fine tasting, is as important now freely (qi dao tong), the circulation of ying sweet and fatty foods in large quantities.46 This and wei occurs normally; this is why they weakens the bones, muscles and sinews, and as it was when it was are full of vitality in the day and they sleep causes the skin to be flabby and loose. Wei qi written. well at night. As for old men, their qi and cannot close and open the pores in a regulated blood is in decline, their flesh dries out, way. The person is deficient in yang. their qi flows with difficulty, the qi of the All this is observable today, but modern five zang fight with each other, their ying choices and lifestyle factors are more declines and becomes scarce while their wei diverse. Our lifestyle is somewhat similar to qi is drained on the inside. This is why they descriptions of southern people in ancient are without vitality in the day and they do China living indulgent lives filled with not sleep at night.43 leisure time, like the wealthy, sensitive nobles who laboured only their minds. On the other These “old men” could be a fairly typical hand, there are some with strong physiques patient of any age or gender of today whose who choose a lifestyle similar to a northern blood is deficient at the same time as their person, with a simple diet, controlled desires qi is unregulated, manifesting in symptoms and displaying great discipline in physical such as pains and stiffness of the body, training. There are also many combinations frequent colds, fatigue, and feeling tense and of this, such as the young men who uninspired during daytime while having idealise having strong bodies, so they build insomnia at night. their muscles to an extreme while taking Zhu Danxi described another scenario supplements like protein powders, yet also common for modern people: thin people sit around watching television or playing tend to tension while obese people have computer games; young men who are used different weaknesses: to having their way, don’t want to work for a living, are indulgent in their desires and When the major sinews become flaccid irregular in their habits of sleep, alcohol or and shortened, this is heat damaging the sweets. blood which is no longer able to nourish At the same time, there is less likelihood the sinews. As a result hypertonicity arises. of having to live in extreme climates due When the minor sinews become relaxed to modern inventions like central heating, and lengthened, this is dampness damaging air-conditioning and electricity. Traditional the sinews which are no longer able to foods have been replaced by new ways of bind the bones. As a result atonic weakness eating and environmental pollution has an arises.44 impact. Is classical Chinese medicine useful in sorting out the more complicated patients Optimal strength should be neither too of a modern, high-tech society? Without hard because of dryness nor too soft because doubt, the answer is yes; these complexities of moisture. The Jin Guo Yao Lue, clause 6-1, are well suited to holistic systems like says this about exhaustion: Chinese medicine. To understand how to treat complicated What is the cause of arthralgia due to modern patients, I believe Su Wen 77 is blood stagnation (xue bi)? Persons who live as important now as it was when it was lives of leisure generally have weak bones written. It addresses a physician’s success and and rich flesh and muscle. After working for how to avoid failure. The physician needs a short period of time, they feel tired and to understand lifestyle factors, especially begin to sweat. When they lie in bed they around eating habits and the general toss and turn frequently. If they are exposed mentality of the patient. And as pointed out

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in Su Wen 12 and elsewhere, the body type and sleep apnoea51 —many of these related to is an important part of the diagnosis. This metabolic syndrome.52 Getting enough yang classical Chinese thinking is conclusively in the form of sunlight or physical movement What about those useful for modern patients. (preferably simultaneously as movement northern areas where in the outdoors) can prevent many of these ‘‘darkness prevails for The evidence base problems. The beginning stage of our bodies’ most of the year? Although these fundamental Chinese conversion of sunlight into vitamin D is These are colder areas ideas are time-tested, we often still need to when light hits the cholesterol circulating so the skin tightens verify them within the modern paradigm of in the periphery.53 This means that we and yang remains scientific materialism that holds biochemical must have enough cholesterol to synthesise in the centre. As a explanations in the highest regard. When we vitamin D and it also means that cholesterol look, we can find a huge number of scientific levels tend to be higher during the winter.54 consequence, the studies on the effect on the body of light, But what about those northern areas where digestion is stronger, darkness, temperature and food that verify darkness prevails for most of the year? These often shown by a big these ancient ideas. are colder areas so the skin tightens and yang appetite. This makes Taking the idea of body as blood and fluids, remains in the centre. As a consequence, the possible the digestion older men have 21 per cent lower plasma digestion is stronger, often shown by a big of rich, nourishing volume and 28 per cent lower red blood cell appetite. This makes possible the digestion foods such as animal volume than healthy young men.47 Yet actually of rich, nourishing and more difficult-to- fats and protein. 70 per cent of this lowered volume can be due digest foods such as animal fats and protein. to simple lack of exercise, as seen when other Here is where nature offers the best food studies compared fit older men with sedentary sources of vitamin D in the most available older men.48 Further, when exercising, the heat form. Vitamin D is a fat-soluble vitamin and regulation by sweating depends on body size; the foods with the highest content will also a smaller body sweats less.48 provide fats, cholesterol and other fat-soluble The blood circulation between the vitamins that cooperate to generate health peripheral and central parts of the body effects and to reduce toxicity. Among the best can vary by more than 50 per cent as a sources of vitamin D are strengthening foods consequence of stimuli at the skin such as such as eel, sardines, salmon, egg, pork, sunlight, and vascular dilation increases after shrimps, lamb and cream.55 heat exposure. The blood that circulates in When darkness sets in at the evening, we the skin contains lots of different substances start producing the hormone melatonin to like hormones, affected by different prepare for sleep. Melatonin is associated wavelengths of light. Growth hormone, with lots of other effects such as decreasing thyroxine, progesterone, testosterone and energy production from the mitochondria, cortisol are all affected differently depending increasing cell regeneration, acting as a on time of day and season. cortisol-antagonist, etc.56, 57 This means that Another example of sunlight’s influence too much light as with the “light pollution” is that energy production from the of cities or inside homes has physiological mitochondria is increased from the infrared consequences, not only affecting sleep part of the light spectrum.49 A closer look at quality. Generally, we can see yin-effects from the well-established effect of sunlight shows having sufficient melatonin and sleep. Food a relationship to vitamin D and to melatonin also has an effect on melatonin levels, which production. We know that the effect of is resonant with Chinese ideas. Higher skin exposure to sunlight leads to stronger vegetable intake is associated with higher bones via vitamin D. We can see this as an melatonin levels and more meat consumption example of yang leading to transformation with lower melatonin production.58, 59 Fruit and to stimulation of yin in the depths, or we and vegetables have varying effects on can see it as stimulation of the Lung (skin, melatonin. One study found that pineapple metal) to nourish the child, Kidneys (bones, raised the levels the most.60 water). Deficiency of vitamin D correlates When we take a closer look at some effects with many chronic problems and ailments of heat and cold, we have to be aware that such as tiredness, depression, diabetes, there is both a direct effect of exposure to obesity, hypertension, cancer, heart disease these climates and also a reactive effect that

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prepares us for the next time we encounter suggested explanations.72 References these stress stimuli. Although the Chinese dread cold as Bencao Gangmu (Compendium of Materia Medica, first published In a hot climate the blood vessels dilate a climatic factor, they have also pointed 1595) translation Foreign and the blood flow increases in the skin, out its positive effects. One effect of being Languages Press, Beijing, 2003. which leads to sweating. This dissipates subjected to cold is a significant increase in Daodejing (The classic of the way and virtue) from pre-Han times. 61 73 some core heat and the direct effect is a norepinephrine (noradrenaline). Acting One of the foundational texts of raised heart-rate but the reaction in the as both neurotransmitter and hormone, Daoism. long run leads to a lower pulse rate, similar increased levels of norepinephrine have Guanzi. A pre-Han philosophical classic. Guanzi 11 is translated by 62 to the effect of aerobic exercises. There is several effects: blood vessels constrict, which Heiner Fruehauf in “Etymological a biological observation that the lower the helps to conserve heat, the substance acts as analysis of the defining quote on 63, 64, 65 the lung official in chapter eight heart-rate, the longer we will live, which a signal molecule to increase the synthesis of the Huangdi Neijing Suwen” in could be interpreted in Chinese medicine of mitochondria in the fatty tissues, which www.classicalchinesemedicine.org. as having enough yin to support yang, even produces energy and heat as a by-product, and Hanshu 2 is a translation by Heiner 66 Fruehauf in “Etymological analysis independent of physical fitness. One study it also decreases inflammation and alleviates of the defining quote on the lung about whether foods could have the effect pain and depression.74 As it helps us to resist official in chapter eight of the of lowering the pulse found that beans and cold, we can view its effect as yang being kept Huangdi Neijing Suwen” in www. 67 classicalchinesemedicine.org lentils actually did just as well as exercise. in the centre. To be able to live in a dark, cold Huainanzi. A Han dynasty eclectic The scientific findings of dissipated core environment, nature provides us with strong philosophical classic heat and a lowered pulse rate correspond circulation of the body and a content mind. Jingui Yaolue (Synopsis of prescriptions of the golden well with the Chinese idea of less internal The production of energy from our cells chamber) by Zhang Zhongjing. yang. This tends to lead to reduced appetite (the mitochondria produce ATP) uses sugars, One of the classical herbal books and decreased digestive strength, which fatty acids or amino acids (protein building from the end of Han dynasty. The 67 quote about xu lao (exhaustion), makes eating lighter “qi foods” preferable. stones) as fuel, producing heat at the same Clause 6-1 is translated by Luo These are the foods that nature offers in time as a by-product (thermogenesis).75 Xiwen. abundance in hotter areas or seasons, Proteins produce the most heat and animal Li Zhongzi (1588-1655). Ming dynasty physician. generally vegetables and fruits. Grains, root proteins and fats are traditionally the foods Lushi chunqiu (Spring and autumn vegetables and fruits all mature into having most available for people living in colder annals) 240 BCE. the sweet taste although having different areas, during colder seasons. Among proteins, Tao Hongjing (456-536). A Daoist types of sugars. Apart from many of these animal compared to vegetable protein leads physician and alchemist. Wang Lun (1484-1521) who wrote foods containing high water content, their to more thermogenesis with implications of Mingyi Zazhu (Miscellanious sugars assist in re-moistening the body, both raised metabolism.76 This links to a tendency writings by enlightened physicians) translated by Marta Hanson in according to Chinese medicine and modern for raised activity levels and weight loss in “Northern purgatives, southern physiology. When nature has this type of obese people.77, 78 Eating animal protein is restoratives: Ming medical “opening” movement stimulated by heat, also linked with increased muscle mass and a regionalism”. Xue Ji (1487-1559) famous for we see it even down at the cellular level. In reduction in the muscle loss that occurs with Wenbu-medicine (strengthen and heat there is an increased insulin sensitivity, age.79, 80, 81, 82 warming) translated by Marta which lowers the raised levels of blood sugar Fat tissues are of three types: white, brown Hanson in “Northern purgatives, southern restoratives: Ming and insulin resulting from eating these high and beige. Brown adipocytes have more iron- medical regionalism”. sugar-content foods.68 containing mitochondria that give them Zhu Bishan physician of the 14th A hot climate generates a warm, expansive the darker colour. White adipocytes store century. Zuozhuan (Commentary of Zuo); qi movement similar to exercise or the fat, brown produce heat and the beige lie a classical philosophical text from consumption of spices. Experiments have embedded in white fat and can be triggered 4th century BCE. shown a similar effect on a peptide called to produce energy and heat depending on Zhuangzi. A foundational text of Daoism written by Zhuangzi (369 dynorphin as a result of intense exercise, stimuli. The less brown fat we have, the more BC – c. 286 BC). sauna bathing or eating chili.70, 71 The obese and sensitive to cold we become. The discomfort felt during these activities is older we get, the less brown fat we have.83, 84 So, linked to the release of dynorphin. This by increasing internal yang, we will produce is followed by an upregulation of beta- more brown fat. If we exercise enough and endorphin which gives feelings of comfort, eat the right foods to become lean and strong satisfaction and even euphoria. The outward enough and subject ourselves to cold, we qi movement is related to different types stimulate production of brown fat.d of joy in Chinese medicine and when experiments have shown an anti-depressant d. We can relate brown fat to the water element and taiyang. It is found in highly vascularized deposits in effect of heat, beta-endorphins are one of the consistent anatomical locations, such as between the

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Final thoughts to do this is through food regulation. That which humans depend on for life is The question of whether genetic or blood and qi. Either because of melancholy, environmental factors are the most dominant Guan Zi 49 says, if thick flavour, absence of sweating or influence on health and body would be the Heart is complete supplementing formulas, qi may soar answered in Chinese medicine as both, with ‘‘within, the form will be up and blood boil ... and coagulate ... emphasis placed on postnatal factors—an complete without. obstructed and inhibited.85 empowering idea. We are born with certain traits and tendencies (prenatal jing) and Chinese medicine places an individual in a then we are influenced and formed by what context where the place, time and climates, we think and feel, our activities, what we desires, feelings and food have an impact, eat, climates etc. Everything that affects our defined in correlative terms, making it health potentially also affects our form. All easier to understand how to intervene three causes of diseases (external, internal, if necessary. This article has expressed neither external nor internal) can affect the these correlative terms as yin, yang and qi. organs, but the Spleen is the organ most The two main movements of qi we have integral to the bodily form on a daily basis. discussed are inward and outward and these As we have seen, the food eaten is related fundamentally reflect the important yin- to an interplay among different organs and yang dualism of classical Chinese cosmology. other factors such as our climate and our The inward movement of qi correlates with response to climatic factors. Foremost is the yin and the accumulation that results in a heavenly influence of our heart/mind. Guan material body. The outward movement of Zi 49 says: “If the Heart is complete within, qi correlates with yang and the dispersion the form will be complete without.”86 that leads to a thinner physique. Apart from All this is very complicated, but also simple. body, yin correlates with centre, with blood, The bodily form results to a large extent from and wei (taste) as opposed to periphery and the choices we make, and our awareness of qi (put in dichotomy with both wei and with this hands us a certain amount of control blood). when needed. This article set out quoting Qi movement could be initiated from the Sun Simiao, and I will end with more of his inside by changes in attitude or choice of words on the attitude we should cultivate food, or from the outside by the climate and to protect our health: “One who is able to our efforts to protect ourselves from it. Cold realise awe and care is safe from harm.”87 Oh, and heat result in changes of qi manifesting so simple; the same mentality for having a in both body and mind. Cold firms the nice dinner party also applies to health. skin and flesh, keeping yang on the inside, creating a firm, stable individual with a Endnotes big, strong body and controlled urges. Heat 1. Legge, James, translator. (1885) Li Ji (Book of Rites), opens the skin and loosens the flesh, causing Sacred Books of the East. Oxford University Press. yang to leave the centre, creating a relaxed, 2. Zhu Bing Yuan Hou Lun (General treatise on causes and manifestations of all diseases, 610 AD). Translated more sensitive, more changeable individual by Yan Shi-Lin in Pathomechanisms of the Spleen (2008) with a slender, weaker body who tends to be Paradigm Press. more indulgent in urges and desires. 3. Su Wen chapter 44, “The treatise on wilting,” in Yan Shi-Lin, op.cit How we prevent imbalances is by having 4. Li Dongyuan. Pi Wei Lun (Treatise on the Spleen and enough restraint to build form and yang, but Stomach) translated by Yang Shou-Zhong & Li Jian-Yong. only up to a certain point, because it is also (2004) Blue Poppy Press. imperative to keep the circulation open. On 5. Ye Tianshi (1667-1746), Yan Shi-Lin, op. Cit. 6. Zhu Danxi (1281-1358) in his Ge Zhi Yu Lun (Extra the other hand, we must maintain enough Treatises Based on Investigation & Inquiry: a translation openness to permit free circulation and an by Shou-Zhong Yang), Blue Poppy Press, 1994. uninhibited sense of relaxation, but not to 7. Zhang Jiebin (1563-1640) in Jing Yue Qian Shu (The complete writings of [Zhang] Jing-Yue), translated by Yan the point of losing control and therefore of De-Xin in Aging & Blood stasis – a new TCM approach to losing essences and yang. An important way geriatrics (2004) Blue Poppy Press.) 8. Li Dongyuan, op.cit. 9. Zhang Jiebin, op. cit. shoulder blades, surrounding the kidneys, the neck and supraclavicular area, and along the spinal cord. 10. Zhu Danxi, op. cit. https://en.wikipedia.org/wiki/Brown_adipose_tissue 11. Li Dongyuan, op. cit.

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12. Zhu Danxi, op. cit. blood volumes contribute to the increased diabetes mellitus: a randomized controlled trial.” 13. Hanson, Marta. “Northern purgatives, cardiovascular performance of endurance-trained Arch Intern Med. 2012 Nov 26;172(21):1653-60. southern restoratives: Ming medical regionalism” older men.” Journal of Applied Physiology, August 68. When qi is in dichotomy with wei. See my Asian Medicine 2.2 (2006): 115-170. 1998, Vol. 85 No. 2, 484-489. article in Journal of Chinese Medicine “How to 14. ibid. 49. Notley, Sean R. et al. (2017) “Variations in regulate yin yang through diet.” 15. ibid. body morphology explain sex differences in 69. Percivalle Patrick, op. cit. thermoeffector function during compensable heat 16. ibid. 70. Narita M., et al. (2003) “1171-9. Heterologous stress,” Experimental Physiology, 30 March 2017. 17. Su Wen (Basic Questions) Han dynasty, mu-opioid receptor adaptation by repeated 50. Alexander Wunsch, MD, Wismar University, translated by Unschuld and Tessenow, University stimulation of kappa-opioid receptor: up- Germany, in a lecture “Why the sun is necessary of California Press, 2011. regulation of G-protein activation and for optimal health” 9-10/12-14. www.uscd.tv antinociception.” J Neurochem. 2003 Jun;85(5) 18. ibid. 51. Zaidi, Sarfraz, “Power of Vitamin D”. 71. Percivalle Patrick, op. cit. 19. Cameron, Nigel, “Barbarians and mandarins”. 52. Florentin M1, Elisaf MS, Mikhailidis DP, 72. Koltyn KF., et al (1992) “Changes in mood 20. Kuriyama Shigehisa, “The Geography of Liberopoulos EN. “Vitamin D and metabolic state following whole-body hyperthermia.” Int J Ginseng and the Strange Alchemy of Needs.” syndrome: is there a link? “ Curr Pharm Des. 2010 Hyperthermia. 1992 May-Jun;8(3):305-7. 21. Yi Xue Zhen Chuan written by Gao Shishi in Oct;16(30): 3417-34. 73. Percivalle Patrick, Rhonda. “Cold shocking Qing dynasty. 53. Masterjohn, Chris via http://www.cholesterol- the body—exploring cryotherapy, cold-water 22. Shen Nong Ben Cao Jing translated by Yang and-health.com/Vitamin-D.html. I have written immersion, and cold stress.” Shou-zhong. a simplified statement. He explains; “When 74. ibid. 23. ibid. sunshine in the UV-B spectrum strikes the 75. Per B Mikkelsen et al. (2000) “Effect of skin, it converts a substance in the skin called 24. ibid. fat-reduced diets on 24-h energy expenditure: 7-dehydrocholesterol into vitamin D3.” 25. Li Shizhen, Bencao Gangmu (Compendium of comparisons between animal protein, vegetable Materia Medica, 6 vols.) (2003) Foreign Languages 54. Ockene I et al (2004) “Seasonal variation in protein, and carbohydrate1,2,3,” Am J Clin Nutr Press. serum cholesterol levels: treatment implications Nov 2000 vol.72, No.5, 1135-1141. http://ajcn. 26. Lingshu 75; translation by Lorraine Wilcox and possible mechanisms.” Arch Intern Med. 2004 nutrition.org/content/72/5/1135.full Apr 26;164(8): 863-70. from “Medicine and the Changes have the same 76. ibid. 55. Zaidi, op. cit. source”. Medicinal Roots magazine. Fall 2016. 77. Dominik H Pesta and Varman T Samuel 27. Kuriyama Shigehisa, “The expressiveness of 56. Wunsch, op. cit. (2014) “High-protein diet for reducing body the body.” 57. http://www.ncbi.nlm.nih.gov/pmc/articles/ fat: mechanisms and possible caveats” Nutr 28. Su Wen, op. cit. PMC3377831. Melatonin in Ageing and Disease Metab (Lond). 2014; 11:53. Published online 2014 29. Rochat de la Vallée, Elisabeth, A Study of Qi. —Multiple Consequences of Reduced Secretion, Nov 19. doi: 10.1186/1743-7075-11-53 PMCID: 30. Watson, Burton. “The economic order” in Options and Limits of Treatment. PMC4258944 Sources of Chinese Tradition volume one. 58. Nagato C. et al (2005) “Association 78. J. A. Levine and C. M. Kotz. “NEAT—non- 31. Zhu Danxi, op. cit. of vegetable intake with urinary exercise activity thermogenesis—egocentric & 6-sulfotoxymelatonin level.” Cancer Epidemiol 32. Su Wen op. cit. geocentric environmental factors vs biological Biomarker Prev. 2005;14(5):1333-5, regulation” Acta Physiologica Scandinavica 33. Fruehauf, Heiner. “Etymological analysis of 59. Schernhammer E. S. et al. (2009) “Dietary Volume 184, Issue 4, pp. 309–318, Article first the defining quote on the Lung official in chapter correlates of urinary 6-sulfatoxymelatonin published online: 15 July 2005 doi: 10.1111/j.1365- eight of the Huangdi neijing suwen” concentration in the Nurses’Health Study 201X.2005.01467.x 34. Personal communication with Elisabeth cohorts.” Am J Clin Nutr. 2009:90(4):975-85 79. Pennings B., et al. (1998) “Minced beef is more Rochat de la Vallée. 60. Johns N.P., et al (2013) “Dietary intake of rapidly digested and absorbed than beef steak, 35. Fruehauf, op. cit. melatonin from tropical fruit altered urinary resulting in greater postprandial protein retention 36. Fox Brindley, Erica, “Music, cosmology, and excretion of 6-sulfatoxymelatonin in healthy in older men. “ Am J Clin Nutr. 2013 Jul;98(1):121- the politics of harmony in early China.” She volunteers.” J Agric Food Chem. 2013 Jan 8. doi: 10.3945/ajcn.112.051201. Epub 2013 May 1. describes this in Xing zi ming chu (Human nature 30;61(4):913-9. doi: 10.1021/jf300359a. Epub 2013 80. Lord C, Chaput JP, Aubertin-Leheudre M, emerges from heavenly mandate) a 4th century Jan 17. Labonté M, “Dietary animal protein intake: BCE text. 61. Percivalle Patrick, Rhonda. “Hyperthermic association with muscle mass index in older 37. Bromley, Michelle; Hill, Sandra; Hext, Alan. conditioning in increasing endurance, muscle women.” Research Centre on Aging, Geriatric (2010) Jing Shen: A Translation of Huainanzi mass, and neurogenesis. Institute of Sherbrooke University, Québec, chapter seven. 62. ibid. Canada. The Journal of Nutrition, Health & Aging 38. Arthur, Shawn, “Early daoist dietary practices.” 63. Levine HJ. (1997) “Rest heart rate and [2007, 11(5):383-387] 39. Zhu Danxi, op. cit. life expectancy.” J Am Coll Cardiol. 1997 81. Campbell WW., et al. (1999) “Effects of 40. Personal communication with Elisabeth Oct;30(4):1104-6. an omnivorous diet compared with a lacto- Rochat de la Vallée. 64. Cooney MT, et al. (2010) “Elevated resting ovovegetarian diet on resistance training-induced 41. Tao Hongjing (451-536 AC) wrote in Fu Xing heart rate is an independent risk factor for changes in body composition and skeletal Jue about this system from the Yiyin Tangye cardiovascular disease in healthy men and muscle in older men.” Am J Clin Nutr. 1999 Jing that the combination salty and sweet is for women.” Am Heart J. 2010 Apr;159(4):612-619.e3. Dec;70(6):1032-9. dryness and pungent and salty is for stagnation. doi: 10.1016/j.ahj.2009.12.029. 82. Aubertin-Leheudre M, Adlercreutz H. (2009) Thanks to Zhang Hui, personal communication. 65. (27) Graham S. Hillis, et al (2012) “Resting “Relationship between animal protein intake 42. Hanson, op. cit. Heart Rate and the Risk of Microvascular and muscle mass index in healthy women.” Br J Nutr. 2009 Dec;102(12):1803-10. doi: 10.1017/ 43. Ling Shu 18 citation: Feb. 2015, Stockholm at Complications in Patients With Type 2 Diabetes S0007114509991310. Akupunkturakademin, seminar by Elisabeth Mellitus” J Am Heart Assoc. 2012 October; 1(5): Rochat de la Vallée on Ageing and Longevity. e002832. Published online 2012 October 25. doi: 83. Percivalle Patrick, Rhonda. “Cold shocking the body— exploring cryotherapy, cold-water 44. Zhu Danxi, op. cit. 10.1161/JAHA.112.002832 immersion, and cold stress.” 45. Jin Gui Yao Lue citation: Feb. 2014, Stockholm 66. Jensen MT., et al. (2013) “Elevated resting heart 84. Bland, Jeffrey S. The Disease Delusion, p. 254- at Akupunkturakademin, seminar by Elisabeth rate, physical fitness and all-cause mortality: 255. Rochat de la Vallée on Taxation and Exhaustion. a 16-year follow-up in the Copenhagen Male Study.” Heart, 2013 Jun;99(12):882-7. doi: 10.1136/ 85. Zhu Danxi op. cit. 46. ibid. heartjnl-2012-303375. Epub 2013 Apr 17. 86. Larre, Claude, Rochat de la Vallee, Elisabeth, 47. Davy KP1, Seals DR.(1985) “Total blood 67. Jenkins DJ., et al. (2012) “Effect of legumes as “The Heart – in Ling Shu 8,” p 85. volume in healthy young and older men.” Journal part of a low glycemic index diet on glycemic of Applied Physiology, May 1994; 76(5): 2059-62. 87. Kohn, Livia. “Daoist dietetics—Food for control and cardiovascular risk factors in type 2 immortality”. 48. James M. Hagberg et al (1998) “Expanded

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