March 2014 NAJOM A Discussion of Differences Channel treat its own disease symptom patterns? eye system,” the Divergent Channel “travels along Is there a difference between the indications of the throat, and emerges to the face.” Between Hand Shao Yin the Heart and Pericardium channels? It is a meaningful exercise to conduct a compara- and Hand Jue Yin Channel An answer to these questions can be approached tive analysis between the channel pathways to Indications from two perspectives – a theoretical perspective, understand the disease symptom patterns, and and from the standard textbook explanation. From the indication and actions of the points of these these two sources, the indications for the Hand two channels. by Wang Hong Min Shao Yin and hand Jue Yin channels are very similar and are related to the heart, chest, and psycho- Advisor: Wang Ju-yi 2. Anatomy and Physiology of emotional disorders, including illnesses related the Heart to the channel pathways. In addition, from recent clinical research there are reports that use both The heart is a hollow viscera and the cardiac wall Abstract Heart and Pericardium channel points to treat heart is comprised of three membrane layers – from the disease. Rarely is further research conducted to interior to the exterior they are the endocardium, The Nei-Jing cites indications governed by the distinguish between these channels. myocardium and epicardium. The structure of the Hand Shao Yin Heart Channel and Hand Jue Yin endocardium includes the endothelium, subendo- Pericardium Channel. The author developed an Wang Ju-yi’s descriptions of the unique structures thelial layer, endothecium, and subendocardium. understanding of the indications governed by of channels include the concept that each chan- The subendocardium contains the branches of the these two channels from an integration of Applied nel has its own specific pathway and that each heart’s conductivity system. The endocardium Channel Theory and modern medicine. Analysis of channel is a crevice existing between different protrudes in the internal cavity to form the heart modern medicine’s anatomical descriptions of the tissue layers. Channels are thus connected with valves, which prevents reversal of blood flow heart’s structure, its connections with channels, a specific Zang-Fu, and have a related regulatory between the atrium and ventricle. and unique characteristics of the physiology and effect. Dr. Wang proved these concepts through The myocardium is comprised of myocardial fibers; pathology and from clinical observation helped continuous clinical application and the collection the muscle fibers have a rich supply of capillaries. with the formation of this understanding. The of large quantities of case studies. A portion of the muscle fibers of the atrium release author believes that detailed analysis of the The application of channel examination helps to atrial natriuretic peptide, which has the functions findings from channel examination together with distinguish between these two channels, since of draining urine, releasing sodium, dilating the clear study of the mechanism of cardiac disorders abnormal channel changes on the Hand Shao blood vessels and lowering blood pressure. provides acupuncture guidance in the treatment Yin and hand Jue Yin channels reflect different of heart disease. disorders. Channel examination clarifies the dif- The epicardium is the part of the pericardium and is the serous layer. It is comprised of connective Key Words: Hand Shao Yin, Hand Jue Yin, channel ference between the two channels, and clarifies tissue and mesothelium. The epicardium is where examination the symptom pattern structures related to heart disease. Thus, proper differentiation will serve as the coronary arteries and veins are distributed. Differentiation between the points of the Heart an important guide in the future for the treatment From the heart’s anatomy and physiology one Channel and Pericardium Channel has been of heart disease in clinical acupuncture. learns that there is a physiological and functional researched throughout the history of Chinese relationship between the cardiac muscle’s three medical acupuncture. In Chapter 71 of the Divine In order to consider this topic from different per- layers and with the heart’s rhythmic conductivity, Pivot it states, “the Yellow Emperor asks: why is the spectives, the author will conduct an analysis of the supply of blood to the myocardium, and the Hand Shao Yin channel the only channel without the Heart Channel and Pericardium Channel – by regulation of the pressure of the blood vessels. points? Qi-bo answers: the Shao Yin, is the Heart analyzing the unique structures of these two The endocardium and heart’s rhythm has a cor- Channel. The Heart is the sovereign of the Five channels and modern medicine’s research on responding relationship, while the vasculature Zang and Six Fu; it stores Essence and Spirit. The the heart’s anatomy, physiology, and pathology. system of the heart and the epicardium have a Heart is solid and sturdy – pathogens are unable to In addition, Wang Ju-yi’s clinical case studies will close relationship. invade it. However, if pathogens invade the Heart, be used as clinical evidence. then it will be injured. Harm to the heart leads to The anatomical and physiological structure of the loss of Spirit, which results in death. Therefore, 1. A Comparison of the heart is the foundation for heart disease, which whenever there are pathogens that invade the Pericardium and Heart channel helps in the analysis of the difference between Heart, they are in the collaterals of the Pericardium. pathways indications of the Heart and Pericardium channels. The ‘collaterals of the Pericardium’ is the channel These two channels have connections with the that governs the Heart. Hence, the Heart Channel 3. Common Heart Disorders does not have acupuncture points.” heart, chest, and throat. The difference being that the Heart Channel’s Divergent Channel “travels In clinical practice, the common heart disorders One can see that in the time of the Nei Jing, the along the throat,” and its Channel Sinew “binds involve three main categories. The first category indications of the Heart Channel and Pericardium with the chest,” while the Pericardium Channel’s is related to a poor supply of blood to the myo- Channel were not differentiated. According to the regular channel “travels along the chest,” its Di- cardium (myocardial ischemia), which leads to perspective “the Heart is the emperor,” and from vergent Channel “enters the chest,” and “travels symptoms of discomfort in the heart region and the philosophical-cultural belief that “others will along the throat.” Another main difference is the angina pectoris. This type of disorder is the result protect the emperor from harm,” the description of Heart Channel comes “from the heart system,” of a decrease in blood supply to the heart, which Pericardium Channel points to treat heart disease “attaches to the throat” and connects with the leads to a decrease in the supply of oxygen to the has over 2,000 years of history. Can the Heart 11 NAJOM volume 21 number 60 heart. Energy metabolism of the myocardium is EKG, which revealed myocardial ischemia. PC-6 Case Study Three abnormal and is unable to support the normal was needled, which achieved immediate relief. Patient: Mr. Wang, 47-year-old actor. The patient functions of the heart. The most common cause of Although there are many reports of the use of had heart palpitations for two months as well as myocardial ischemia is coronary atherosclerosis, PC-6 to treat myocardial ischemia, this case em- shortness of breath and difficulty breathing. He which causes stenosis of the coronary vessels or phasizes the important connection between the had a history of rheumatoid heart disease for over blockage. abnormal channel change on the Hand Jue Yin 20 years. Two months earlier, while filming for a The second category refers to the irregular rhythms Channel and the clinical results. The results were television show, he suffered from fatigue, which led of the conductivity of the heart, which can mani- not only immediate, but also illustrate the direct to heart failure and severe abdominal edema. Tests fest as tachycardia, bradycardia, and arrythmia. relationship between the Pericardium Channel showed the patient had mitral regurgitation and This can be a result of congenital heart disease, and myocardial ischemia. heart failure. As an inpatient in a local hospital, he myocardial disease, heart valvular disease, or received diuretics that relieved his symptoms. He When there are abnormalities with heart rate (ar- myocarditis. was advised to have a heart-valve replacement, but rhythmia), heart valvular disease, or psychological the patient preferred to try conservative treatment The third category is related to heart valvular disorders, oftentimes abnormal changes will be first. Channel examination found Hand Shao Yin, diseases. Seventy-five percent of rheumatic fevers found on the Hand Shao Yin Heart Channel. The Hand Jue Yin, Foot Shao Yin and Foot Yang Ming can infect the heart, leading to possible injury of Hand Shao Yin Heart Channel is used to treat these channel abnormalities. There was edema in his the myocardium, endocardium, pericardium, and disorders with effective results. Treatment of such ankles. His tongue coating was thick and greasy heart valves. Rheumatic endocarditis can lead to disorders with Pericardium Channel points, on and his pulse thin and rapid. Point selection: HT-3, valvular disease. the other hand, has proven to be not as effective. HT-7, KI-10, KI-3, ST-40. 4. Clinical results of the Heart Case Study Two Treatment 2: The patient’s heart palpitation was significantly relieved, the edema in the foot also Channel and Pericardium Patient: Niva, 53-year-old female, Israeli. The showed improvement. There was no significant Channel patient suffered from sleep apnea and hyperten- change in his shortness of breath or tongue sion for six years. Her blood pressure was 150/100 Analysis of the heart’s anatomy and its pathophysi- coating. Point selection was the same as the first mmHg. She had intermittent vertigo. Channel ology reveals that the supply of blood to the heart formula, but with added ST-36. examination found abnormalities on the Foot has a direct relationship with the epicardium. In Shao Yin and Foot Tai Yang channels. Her pulse Treatment 3: Tenderness at HT-3 was significantly addition, the epicardium is the same as the peri- was deep and thin, with a premature heartbeat. reduced, and the patient’s heart palpitations were cardium, which in terms of channels belongs to almost completely relieved. The patient was also the Hand Jue Yin Pericardium Channel. Abnormal Point Selection: HT-3, KI-10. prescribed Chinese herbs – Gan cao fu mai tang heart rate and heart valvular disease are related Treatment 2: Pulse diagnosis found the premature – for two weeks, which helped his recovery. Two to the endocardium, which belongs to the Hand heartbeat had disappeared, the pulse was also weeks later he was able to return to work. Shao Yin Heart Channel. stronger. The patient’s blood pressure lowered The patient had heart valvular disease for over From clinical observation, Wang Ju-yi discovered to 130/90mmHg. 20 years. Channel examination found changes on the Pericardium is related to the lack of supply The patient sought treatment for her sleep apnea both the Shao Yin and Jue Yin channels. In addition of blood to the cardiac muscles (coronary heart and snoring. According to the physiological con- to heart palpitations, the patient also felt pain disease, hypertension). In addition, channel nections in Chinese medical Zang-Fu theory, this at the anterior heart region. The reason for the examination also often finds abnormalities condition should be related to the Lung. However, myocardial ischemia was rooted in the valvular on the Hand Jue Yin Pericardium Channel for channel examination found changes only on the issue. Therefore, the Heart Shao Yin channel disorders related to the supply of blood to the Heart Channel. The patient also had an irregular was selected as the main channel for treatment. cardiac muscles. heart rate, which was related to the Hand Shao When the patient received Western medical According to Wang Ju-yi’s Applied Channel Theory, Yin Heart Channel. The hand and Foot Shao Yin treatment, his condition was more severe with one must first examine the channels to discover channel’s He-Sea Points helped to regulate the poor prognosis. However, through acupuncture which channel is involved with the disease. Once communication between the Heart and Kidney. and herbal treatments, the patient’s symptoms this is determined, points can be selected. In It regulated impairment of the qi mechanism of improved quickly. clinical practice, each individual case is complex the Shao Yin Channel, and communicated the and there are many causes of heart disease. One Fire and Water, which led to effective results. Case Study Four must meticulously examine the channels in order After five treatments, the patient’s snoring and Patient: Mrs. Sun, 56 years old. Her first treatment to derive a correct diagnosis, essential for achiev- sleep apnea showed significant improvement, was in October 2010. At the time, she had chest ing effective clinical results. her blood pressure was 120/80 mmHg, and the oppression, heart palpitations, and arrhythmia. vertigo did not recur. Ultrasound results revealed mitral stenosis and Case Study One Professor Wang has many clinical case studies of regurgitation. Western medical doctors advised Patient: Mr. X, 50-year-old male. When Dr. Wang effectively treating patients suffering from similar surgery. Channel examination found Hand Shao was lecturing at the People’s University Hospital, symptoms. Is acupuncture effective at treating Yin and Hand Jue Yin channel abnormalities. Chan- a student suddenly felt chest oppression and had chronic and severe heart organ disorders? The nel examination found the problem was related difficulty breathing. Channel examination found following two case studies are examples of these to the Shao Yin and Jue Yin channels. HT-3, HT-7, abnormal changes on the Pericardium Channel. types of disorders. and LU-9 were selected. Results were immediate The patient was advised to immediately have an and dramatic. Over one month’s treatment her

12 March 2014 NAJOM symptoms were stable, and she was able to carry The Tail Wags the Dog: pulse. Because of the TCM model, in many modern on with her normal lifestyle. Chinese acupuncture clinics, points are chosen Developments in Oriental without careful palpation of the body surface. Conclusion Medicine Outside China In addition to palpation, Dr. Wang also strongly advocates an integration of the physiological The above case studies reveal that our previous un- and a New Beijing model/qi transformation (气化 qìhuà) described derstanding of the Heart Channel and Pericardium Phenomenon in classical texts when considering treatment Channel, from both a theoretical and clinical basis, strategies. Thus the size, texture, and depth of has not been clear. This includes the understanding palpated changes along particular channels helps by Jason D. Robertson of their pathways and connections, including their to shape acupuncture protocols designed to effect different physiological and pathological symptom physiological shifts best understood by the six- patterns. Only through detailed channel examina- As others in this issue have mentioned, a group of level model most commonly associated with the tion can we further develop our understanding students, scholars, and government officials met Treatise on Cold Damage (伤寒论Shāng hán lùn). of the mechanisms of heart disease. Our clinical for three days last August in Beijing. The meeting, This is obviously a complex subject.2 results will improve, which will greatly strengthen perhaps intentionally scheduled on the ‘warm- our confidence in treating severe illnesses. As each In any case, I would propose that the phenomenon est days’ of the traditional lunar-solar calendar, individual’s case and disease pattern is different, of groups of non-Chinese students flocking to a explored various aspects of the work of profes- my understanding and thinking of this question small private clinic in Beijing is part of a larger sor Wang Ju-yi (王居易). One of many interesting is still deficient. I hope that along with my fellow international trend arising from the excellent aspects of this unusual gathering was the promi- acupuncture colleagues we can work together to manual techniques developed in Japan, Europe, nence of foreign nationals in what would normally discuss and refine our understanding. and the US during the last half-century in par- be a quintessentially Chinese event. After all, the ticular. Foreign students seem to recognize in Dr. symposium was called as a means of broadening Wang a natural link to what they know to be a more Wang Hong-min graduated from the Beijing and deepening research into a very ancient Chinese embodied acupuncture. In many of these systems University of Chinese Medicine’s Acupuncture concept – that of acupuncture channel theory.1 of acupuncture outside of China, the channels and and Tuina Program in 1991 and completed her On the first day of the event, the vice-minister of master’s degree in 2004. Since 1991 she has been points have long been a discernable reality to be health for the Beijing Special Administrative Zone an associate professor of Acupuncture and Tuina felt with the hands. Of course, this was also likely gave a speech that directly addressed the unusual at the Beijing School of the Blind. the case for countless generations of practitioners make-up of the gathered crowd: in pre-modern China. It is this broad trend of grow- “Approximately five years ago, those of us at ing interest and skill with manual diagnosis, and the Beijing Ministry of Health began hearing Dr. Wang’s place within that trend, that I would reports about this retired doctor who had a like to address in the following pages. constant flow of foreign students coming to his clinic. Given his evident popularity, we The Development of Dr. Wang wondered why we hadn’t heard much about Ju-yi Moxafrica is a UK Professor Wang. This was my first encounter Wang Ju-yi has had an envious position as both registered charity with what can only be termed the “Wang Ju-Yi Phenomenon.” This phenomenon seems to be an observer of and participant in the major trends researching the a naturally occurring response to some very of 20th-century Chinese medicine. A graduate of the very first class from the Beijing College of potential of direct moxa significant ideas and techniques. In fact, the very presence of many foreign acupuncturists Traditional Chinese Medicine in 1962, Dr. Wang to treat TB. is the reason we are here today. We have been was trained by some of the early luminaries of stimulated by their interest to catch up in learn- the modern era. Studying herbal formulas with We are training African health workers in ing from and documenting Dr. Wang’s work. doctors like Jiāo Shú Dé (焦树德) and acupuncture a simple moxa protocol for daily use on TB If we’re not careful, it may be that Chinese with Wāng Lè Tíng (王乐亭) he was fortunate to patients to monitor outcomes. Work has students will someday have to go abroad to experience Chinese medicine in the era just before 3 started in Uganda and South Africa with study acupuncture of this type!” the development of what we now call “TCM.” In further developments planned this year. other words, he is a product of that short time in The reasons for the Dr. Wang ‘phenomenon’ are the late 1950s and early 1960s when acupuncture We need donations, ideas, volunteers. varied and have been long-developing but might was taught by practitioners with roots in family Contact us: [email protected] or be succinctly described as part of an international lineages that included a firm foundation on clas- http://www.moxafrica.org/ movement to raise the importance of palpation as sical texts; when herbs and acupuncture were a core diagnostic tool in the practice of acupunc- taught together in China. While giving credit to this ture. It is Dr. Wang’s opinion (based on research unique education, Dr. Wang continues to maintain into classical texts) that palpation along channel that his greatest teachers have nevertheless been pathways can be found in the earliest records of patients. As Dr. Wang himself recounts, “In those acupuncture practice. This would be in contrast early days after graduation, I still often read the to the more common so-called ‘TCM’ approach to classical texts and had no idea what they were acupuncture wherein diagnosis is made mainly by talking about! Only upon reading and re-reading the asking of questions and palpation of the radial in the presence of actual clinical cases did certain

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