20 Introduction to Neijing Classical Part II: Clinical Theory Journal of Chinese Medicine • Number 102 • June 2013

Introduction to Neijing Classical Acupuncture Part II: Clinical Theory

Abstract By: Edward Neal As outlined in Part I of this article, the theories and practices of Neijing classical acupuncture are radically different from the type of acupuncture commonly practised today. In essence, Neijing classical acupuncture is Keywords: a form of clinical surgery, the goal of which is to restore the body’s circulatory pathways and tissue planes to a Acupuncture, state of dynamic balance. In its clinical application, Neijing classical acupuncture is a physician-level skill built Neijing, classical, upon a sophisticated understanding of the innate patterns of nature and an in-depth knowledge of the structure history, basic and physiology of the human body. Neijing classical acupuncture does not depend on point-action theory - the principles conceptual framework that dominates most current thinking in modern acupuncture - for its therapeutic efficacy. Rather, the goal of Neijing classical acupuncture is to regulate the different tissue planes of the body in order to restore the free circulation of blood, and in doing so allow the body to return to its original state of balance and innate self-healing.

I. Background theoretical descriptions of acupuncture were outlined The detailed writings laid down in the original texts in the original medical texts where their core principles of Chinese medicine during the later Warring States period (475-221 BCE) and Western Han Dynasty (206 that is the least understood today.3 BCE-9 CE) represent a comprehensive theoretical system that has stood the test of time for over two History of the Lingshu family of texts millennia. To date, no other system has come close to displacing these foundational ideas from their therapy were set down in the Suwen preeminent position. Despite this, in part due to the & Lingshu (Yellow Emperor’s Inner Classic Plain Questions literary purges of the Qin Dynasty (221-206 BCE), as & Divine Pivot).4,5 Of these, the Huangdi Neijing Lingshu early as the Western Han Dynasty (206B CE-9 CE) emphasises the principles of acupuncture practice and theory.6 The title ‘Lingshu’ is one of several names used previous periods.1 Early medical commentaries such to describe a collection of writings on acupuncture as the already display that were either similar or identical in content. Other fundamental misunderstandings of basic Neijing (Inner common names used to describe these texts include Classic) medical theory.2 Historical commentaries the Zhenjing (Needling Classic), Jiujuan (Nine Rolls) and written over subsequent dynasties commonly display Jiu Ling Jing (Nine Divine Classic), amongst others. 7,8,9 and political contexts of the times in which they preface to 's Shanghan Zabing Lun were written. Further, medical training in China has (Treatise on Cold Damage and Miscellaneous Diseases, historically been handed down through a combination Eastern Han Dynasty 220 CE), in which the author training systems that display a wide variety of skill, Later, during the Three Kingdoms period (220-280 clinical understanding and system biases. Taken as a composite whole, the development of acupuncture portions of his seminal treatise, the Zhenjiu Jiayi Jing practice is not easily summed up by a simple narrative. (The Systematic Classic on Acupuncture and Moxibustion) Thus, whilst it is perhaps easy to imagine the evolution from passages taken directly from the Zhenjing of acupuncture as being something that has progressed (Needling Classic).11 smoothly from the primitive to the sophisticated, the truth is somewhat more complex. Critically, while term Lingshu is found in Bing’s revision of the advancements have been made in both practice and Neijing, which was completed in the in experience, the most comprehensive clinical and 762 CE. Later, during widespread editing of medical Journal of Chinese Medicine • Number 102 • June 2013 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory 21

manuscripts that occurred in the Northern Song (960- that of being a cultural treasure that was emblematic of 1127 CE), the Lingshu text was found to be incomplete. traditional culture and values.18 Importantly, all of these Because of this, the Song court requested the return of a copy previously loaned to the Goryeo Emperor in Korea in 1091 CE. In 1093 the Song Emperor decreed that the (a practice that continues to this day). In the end, these Lingshu views led to the construction of the widely disseminated of all physicians.12 The earliest extant version of the Lingshu medical practice that is known today as ‘TCM’ (traditional was published by the Gulin Shutang () publishing Chinese medicine).19 house in the Yuan Dynasty (1271-1368 CE) and is housed in Although generally structured on Chinese medical the National Library in Beijing. During the neo-classical revival of the Northern Song medicine, in most cases the medicine the world now knows as TCM bears little resemblance to the style of medicine effort to counter a perceived deterioration in medical care practised by classically trained physicians of earlier and return medical practice to its classical roots. During this generations. TCM itself evolved as a hybrid expression of time the imperial court physician (987-1067 various training programmes aimed at educating Chinese CE) constructed two well-known life-sized bronze statues, students of Western medicine and practising biomedical complete with internal organs and acupuncture points.13 physicians in the basic principles of Chinese medicine.20 It was also during this period that imperial medical At the request of the Chinese government, senior Chinese physicians prepared course materials - abbreviated by were instituted. Thus while medical scholarship during the necessity in both theoretical content and complexity - to be succeeded in resurrecting and augmenting used to explain fundamental concepts of Chinese medicine concepts of classical scholarship, it also contributed to an to those not versed in its practice. These courses presented orthodoxy of medical practice that persists to the current day.14,15,16 side-stepping the complex medical theories that had served During the Ming Dynasty (1368-1644 CE), the system as the foundation of Chinese medical practice for over 2000 of point-based acupuncture theory was elaborated in Zhen Jiu Jie Yao training programmes that initially made its way to the West (Acupuncture and Moxibustion Topics and Essentials) by Gao through the writings of different Western authors. These Wu, the Zhen Jiu Wen Dui (Acupuncture and Moxibustion Questions and Answers) by Wang Ji and the Zhen Jiu Da to the concept of a ‘traditional Chinese medicine’.21 While Cheng (Great Compendium of Acupuncture and Moxibustion) Western readers believed that they were being given a by Yang Jizhou. glimpse into the practices of an ancient culture, they were By the latter half of the Qing Dynasty (1644-1911 CE) the in fact being introduced to an educational curriculum developed to teach Chinese medicine to Chinese physicians in both stature and quality. By 1822 the government ordered trained in Western medicine during the 1950’s and 60’s. In that the departments of acupuncture and moxibustion be a bizarre pedagogical twist, the theories and practice of closed within the imperial clinics, although its practice TCM achieved such status and popularity in the West that 17 they were eventually reimported back into China, largely displacing the study of the classics and traditional medical The development of TCM theory in the early 1980’s.22 Following the succession of the PRC (People’s Republic of China) in 1949, the Communist government took a II. Clinical principles of Neijing classical variety of positions with regard to traditional Chinese acupuncture In contemporary practice, acupuncture therapy is currently by conventions of the late imperial period - continued to understood to be an adjunctive therapy indicated for the be practised, the government agenda was dominated by treatment of a variety of common - but non-life threatening several sociopolitical concerns, including a perceived need - diseases such as general pain disorders, paralysis, insomnia, psychological disorders, migraine headaches, pressing public healthcare demands, limited healthcare digestive disorders and stress.23,24 However, it is important it was seen to be the primary medical intervention for and political and cultural pressures to retain traditional the treatment of patients with critical and life-threatening illnesses.25 Most clinical descriptions found within the of the government varied from describing traditional Neijing describe medical conditions that today would be medicine as something outdated and superstitious to found in modern hospital in-patient wards, emergency 22 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory Journal of Chinese Medicine • Number 102 • June 2013

rooms, intensive care units and hospice settings.26 Further, Similar to the Mawangdui medical manuscripts, in the at the time these texts were written, no tertiary medical Neijing the preeminent circulatory pathways of the human backup existed. Frequently, all that stood between a body are described as being ‘mai’ vessels (see Figure 1).28 In patient’s death or survival were the skills and experience of Chinese, the character ‘mai’ () is a basic anatomical term the acupuncture physician. That these practices persisted portions of the original mai vessel pathways can still be mass casualties of war and periods of great morbidity and traced within the modern acupuncture channel system, mortality suggests that at the very least they are worthy of closer scrutiny and research.27 original course descriptions. The acupuncture channel The basic principles of the clinical practice of Neijing systems now widely taught and used in clinical practice all classical acupuncture may be summarised as follows: have their origin in the descriptions of mai vessel pathways found in Chapter 10 (Jingmai , Channels and Vessels) Principle #1 of the Lingshu. Within these passages the terminology of the mai vessel is clearly evident; taking the Lung pathway as an example:

‘’ (Literally, ‘Lung; hand; taiyin’s; ‘The Lung hand taiyin ( greater yin) mai vessel originates mai vessel; arises; in/from; middle; jiao.’; or stated more from zhongjiao ( middle burner). Descending, it nets clearly, ‘The mai vessel of the Lung hand taiyin arises from with the Large Intestine and then returns to pass weikou ( the middle burner.’)29,30 stomach mouth). It then ascends through the diaphragm and joins with the Lungs.’ In modern times, any references to mai vessels and the rich - Lingshu Chapter 10 impart are generally omitted from English translations of Chinese source texts, and they are rarely recognised as being a part of Chinese medicine theory.

In this illustration, the Lung mai vessel is shown where it exits the axilla in the region of the axillary artery. In the Neijing this region was called ‘Tianfu’ ( heavenly palace). Tianfu is now the name of the modern acupuncture point LU-3. [image from http:// en.wikipedia.org/wiki/File:Gray523.png]

Figure 1: In the Neijing the primary circulatory pathways of the body were described in terms of mai (blood) vessels. Later, the mai vessel system evolved to become the twelve primary channels. [image courtesy of Getty Images]. Journal of Chinese Medicine • Number 102 • June 2013 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory 23

Classical Chinese blood circulation Biomedical blood circulation Blood is circulated by the Lungs. Blood is circulated by the heart. Blood flows through a continuous loop of mai vessel pathways, Blood cycles back and forth between the arteries, capillary beds, passing back and forth between the exterior and interior of the veins, lungs and heart. body. Blood forms from the products of digestion and respiration. Blood results from haematopoietic stem cells derived from bone marrow. Blood vessels are called ‘mai’ () vessels. Blood vessels are differentiated into arteries, veins and capillaries. Mai vessels communicate freely with local tissue planes, similar to Arteries and veins are viewed as closed systems that communicate the communication that occurs between a river and its riverbank. with the body’s tissue planes via terminal capillary beds. Blood flows either from earth to heaven (a mu wood circulation) Blood flow is differentiated into arterial and venous circulation. or from heaven to earth (a jin metal circulation).

Principle #2 Principle #3 ‘.’ (). ‘The mai vessels are the fu ( - Suwen Chapter 17 ‘ ‘.’ .’ ‘The Heart joins with the mai vessels.’ ‘It is through the twelve jingmai (channels and vessels) - Suwen Chapter 10 that human beings are born and [are able to live their] lives. Within them illnesses arise, illnesses are cured and illnesses As stated above, the character ‘mai’ ) is a relatively worsen. When beginning their study of jingluo, the lower- straightforward anatomical term that means ‘blood vessel’. 31,32,33 level physician believes this knowledge is something Therefore, the mai vessel pathways described in the Neijing easily acquired. It is the superior physician [alone] who represent a comprehensive and straightforward description of the early Chinese conception of human blood circulation - Lingshu Chapter 11 (see Figure 2).34,35,36 In these descriptions, blood has its origin in the products of digestion in the middle burner. In modern TCM the term ‘jingluo’ () is commonly translated as ‘channels and collaterals’. It is a term typically the Liver and Heart via collateral circulations. A majority used to describe the basic pathways of the acupuncture of this ‘proto-blood’ then circulates to the Lungs where channel network and its associated structures. However, it is vitalised by the qi of the atmosphere to become fully as is often true of the key terms in Chinese medical terminology, the term jingluo contains both primary and secondary meanings.39 by a variety of anatomical, theoretical and physiological jingluo describes generic patterns of nature’s growth concerns.37,38 Several key factors serve to differentiate cycles. Only secondarily do these terms describe discrete classical and modern conceptions of blood circulation (see anatomical structures of the human body. Table 1). For the authors of the Neijing the free circulation of blood within the mai vessel pathways was the end goal of each acupuncture treatment; it was not (with few exceptions) the activation of individual acupuncture points 24 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory Journal of Chinese Medicine • Number 102 • June 2013

patterns found in nature as well as to structural patterns that traverse the fascial body running centrifugally from the interior/centre to the exterior/surface, are diffuse in nature and do not cross the major joints of the body.43 In terms of classical anatomy, these basic patterns exist whether one is speaking of the different divisions of fascial plane anatomy or the circulation of blood (mai) vessels. When the authors of the Neijing desired to focus their discourse on the circulation of blood, they simply added the qualifying term ‘mai’ to the basic descriptors of longitudinal and horizontal patterning to form the composite terms ‘jingmai’ () and ‘luomai’ ().

In Neijing terminology, generic yang patterns of development are called ‘jing’ ( longitudinal patterning). Yang patterns of growth develop in longitudinal or vertical patterns, have a supportive same character jing () is used to describe longitudinal divisions within the body’s fascial planes. These connective tissue pathways are now called ‘acupuncture channels’ (although many modern channel pathways have en.wikipedia.org/wiki/File:Redwood_National_Park,_fog_in_the_forest.jpg]

According to basic Neijing medical theory all living things are seen as being primary expressions of the universal yinyang breath.40 As living things grow and mature they are seen to evolve along both lines of patterning. In a generic sense, yang patterns of development are called ‘jing’ longitudinal patterns). Yang patterns are concrete, In Neijing terminology, generic yin patterns of vertical manner (see Figure 3). Yin patterns of development development are called ‘luo’ (horizontal network patterning). In contrast are generically called ‘luo’ (horizontal network patterns). to yang patterns, yin patterns develop as a series of horizontal networks that In contrast to yang patterns, yin patterns are more diffuse, jingluo theory, the same character ‘luo’) is used to describe the divisions harder to identify as discrete structures and develop as of the body’s connective tissue planes that move from the centre to the surface of the extremities and do not cross the major joints of the body. [image from networks of horizontal branching structures (see Figure https://en.wikipedia.org/wiki/File:Hedera_canariensis_ Gomera.jpg] 4).41 Out of this basic dichotomy of generic developmental growth patterns arises a comprehensive and theoretically coherent construction and understanding of human Since shared generic patterns were seen to exist in both anatomy. the human body and the natural world, direct correlations In Neijing medical theory – as in the vast majority of classical Chinese philosophical thought – ontological patterning (li ) is seen to be primary and manifestations way, within the body’s anatomy, mai vessel circulation of that patterning (xing ) are seen to be secondary. In the same way, ancient Chinese physicians/scientists understood generic patterns of nature to be primary, and longitudinally they are referred to as ‘jing’ patterns. When discrete anatomical descriptions of the human body to be secondary. Thus, while a complex variety of anatomical ‘luo’ patterns. This style of correlative thinking is evident in terms are used within the Neijing, they are all seen to Lingshu Chapter 12 (Jingshui Channel Waters), where develop from a few basic patterns of nature. a direct correlation is made between the patterns of the In the anatomical terminology of the Neijing, the character twelve primary mai vessels of the body and twelve of the ‘jing’ () refers both to generic developmental patterns that primary bodies of water of ancient China (see Table 2 and occur in nature and also to structural patterns of the fascial Figure 5).44 Here, the patterns of the greater macrocosm and body that longitudinally traverse the bodies structures the inner anatomical landscape are both understood to be passing through the major joints of the body.42 Likewise, formed upon a shared template. the term ‘luo’ () refers both to generic horizontal network Journal of Chinese Medicine • Number 102 • June 2013 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory 25

Primary mai vessel Lingshu water Within the body, the six primary longitudinal mai vessel correspondence the body’s tissue-plane anatomy. In nature, a watershed is Lung Huang He (Yellow River) Large Intestine Jiang He (Yangtze River) Stomach Ocean and Seas () Spleen Lakes and Marshes ( ) fauna, different variations in soil and mineral composition Heart Ji river () and a complex system of tributaries and central Small Intestine Huai river () watercourses. In a similar way each of the six anatomical Bladder Qing river () zones described in the Neijing contain distinct regional Kidney Ru river () tissue-plane features such as tendons, blood vessels, bones, Xinzhu (Heart Ruler) Zhang river () skin and fat (see Figure 6). Sanjiao Ta river () Gall Bladder Wei river () Liver Mian river ()

LingshuIn Lingshu Chapter 12 each primary mai vessel is matched to one of the bodies of water in ancient China. of others been lost or altered.

Because all of the anatomical structures of the human body are seen to form from different combinations of yinyang growth patterns, the term ‘jingluo’ () is a comprehensive term that describes the entire three-dimensional anatomy of the human body. Neijing jingluo theory greatly exceeds the anatomical accuracy and clinical relevance.45 Importantly, because classical jingluo theory offers a description of Historically, the the human body that is grounded in anatomical reality, it Yellow River has been described as the geographic heart of China. Known as provides a bridge to Western biomedicine that has been the Tibetan plateau to enrich the agricultural regions of the Yellow River lacking in modern descriptions of Chinese medicine. basin. In the Lingshu the Yellow River is correlated with the Lung mai vessel. In both cases, these pathways carry nutrient rich material into their respective circulations. [image from https://en.wikipedia.org/wiki/ File:Hukou_ Principle #4 Waterfall.jpg] The ancient Chinese physician/scientists carefully observed the manifestations of nature and the effects that ‘ the waxing and waning cycles of yin and yang had on the human body. They saw that as the physical universe moves .’ through different states of cyclical change, the body mirrors ‘In regards to the separation and reunion of the three yang: and tracks these changes with reciprocal motions of its taiyang opens (), yangming closes () and shaoyang own. Similar to the movements of plants and vegetation, pivots (). These three jing () should not contend and the human body was seen to open and close in relation defeat one another. When this happens [yang] cannot to basic cycles of yinyang expansion and contraction. In circulate within the exterior. [Together] they are called “one addition, a fundamental tenet of yinyang theory is that yang” … In regards to the separation and reunion of the nature’s circulations are tidal in quality, moving back and three yin: taiyin opens (), jueyin closes () and shaoyin forth between two positions of polar opposition (see Figure pivots (). These three jing () should not contend and 7). In this process, three primary axes of variable motion defeat one another. When this happens [yin] cannot sink deeply within the interior. [Together] they are called “one called ‘kai’ ( opening), ‘he’ ( closing) and ‘shu’ yin”. Yin and yang move in an unending pattern, moving pivoting). and transforming in a circle without end.’ - Suwen Chapter 6 26 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory Journal of Chinese Medicine • Number 102 • June 2013

Within the Neijing, each mai vessel course traverses distinct tissue planes containing fat, fascia, sinews, collateral blood that opens, closes and rotates in response to the daily cycles of the sun, the vessels, skin and bone etc. Each of the different layers of the body’s tissue human body also moves through the primary motions of ‘opening’, ‘closing’ planes are formed on a shared pattern template, although their manifestation and ‘pivoting’. [image from http://en.wikipedia.org/wiki/File:Iglesia_de_ varies depending on the type of body tissue being expressed. [image from Nuestra_Señora_de_La_ Blanca,_Cardejón,_España,_2012-09-01,_DD_02. http://en.wikipedia.org/wiki/ Magnetic_resonance_imaging] JPG]

Three primary degrees of change moving in two polar Principle #5 opposite directions yields a total of six primary qualities of motion within nature and the human body. In Neijing medical theory, each of the body’s anatomical watershed zones has governance over one of these primary axes of change. In the Neijing, the names of the anatomical regions which govern these movements are called shaoyang ( ‘ lesser yang), yangming (yang illumination), taiyang ( .’ greater yang), jueyin ( reverting yin), shaoyin ( ‘Man has three hundred and sixty physical demarcations lesser yin) and taiyin (greater yin). Many clinicians (jie ). These correspond to the numerical patterns of and students are familiar with these basic terms, although their original meanings are not widely appreciated or the material substance of earth. Above there are ears, eyes understood (see Table 3). and mental intelligence. These correspond to the sun and the moon. The body has surface depressions, openings, terrain patterns and mai vessels. These resemble the river valleys (chuan gu [of the earth].’ - Chunqiu Fanlu Roll Thirteen (Spring and Autumn Exuberant Dew Annals, Western Han Dynasty)

Watershed Action Directional root Mai vessel watershed Taiyin () Opens the interior Spleen (lower) Lung (upper) Spleen mai vessel (lower) Lung mai vessel (upper) Jueyin () Closes the interior Liver (lower) Xinzhu (upper) Liver mai vessel (lower) Xinzhu mai vessel (upper) Shaoyin () Pivots the interior Kidney (lower) Heart (upper) Kidney mai vessel (lower) Heart mai vessel (upper) Taiyang () Opens the exterior Bladder (lower) Small Intestine Bladder mai vessel (lower) (upper) Small Intestine mai vessel (upper) Yangming () Closes the exterior Stomach (lower) Large Stomach mai vessel (lower) Intestine (upper) Large Intestine mai vessel (upper) Shaoyang () Pivots the exterior Gall Bladder (lower) Sanjiao Gall Bladder mai vessel (lower) (upper) Sanjiao mai vessel (upper)

In the Neijing Journal of Chinese Medicine • Number 102 • June 2013 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory 27

Chinese name Original meaning Modern point Quepen Region between the clavicle and scapula ST-12 Tianfu Pulsation of the axillary artery LU-3 Qijie Region where major vessels pass through the groin ST-30 (now called Qichong) Futu Front of the quadriceps muscle ST-32 Wangu Mastoid process GB-12 Renying Carotid artery ST-9

NeijingIn many cases, modern acupuncture point names that are taken from Neijing descriptions were originally understood to be broader anatomical and functional areas of the body.

In the majority of cases, anatomical terms now used to example of xue-surface depressions that exert a unique describe singular acupuncture points were originally understood as being broader functional regions of the body’s the zang organs). With the exception of the ‘benshu’ (root anatomy (see Table 4).46 Research into the use of anatomical shu ), topographical xue regions were not named terms within the Neijing validates this point of view. To give although their locations were noted. one example, the anatomical term Quepen (open basin) is now the name of the modern acupuncture point ST-12, Principle #8 located in the supraclavicular fossa, four cun lateral to the midline of the body.47 However, studies of how this term was used in the Neijing shows that fourteen distinct anatomical structures pass through the region named Quepen. Such ‘ types of analysis show that when the authors of the Neijing used anatomical terms such as Quepen, they were most often describing broader areas of the body’s anatomy (here .’ the region between the clavicle and scapula that demarcates ‘Gather the qi and reside within a still place. Attend to the the opening between the thorax and the head). It was only comings and going of the shen. Shut the doors and windows; later, as point-action theory came to the forefront, that these take care not to dispel the hun or the po. Concentrate the descriptions were re-interpreted to become singular isolated intention, align the shen and harmonise the jing qi (). acupuncture points. Be as one who cannot hear another’s voice. Gather the Surface depressions possessing qualities roughly jing (), align it with the shen (). Align the will and the equivalent to modern acupuncture points were described in the Neijing. These regions were named either by the transform the shen ... This is the meaning of deqi ().’ generic term ‘xue’ earth cavern) or by a special case - Lingshu Chapter 9 term ‘shu’ ( Examinations of different needling techniques found within ‘ the Neijing shows that, with few notable exceptions, the ‘The qi of the foot taiyang mai vessel emerges through authors of the Neijing were not overly concerned with the seventy-eight xue.’ concepts of point-action theory.48 For example, of twenty-six - Suwen Chapter 59 different needling techniques described in Lingshu Chapter 7 (Guanzhen In Neijing medical theory, a ‘xue’ is an area of surface make any mention of acupuncture point regions.49 The rest thinning where the qi of an underlying mai vessel emerges of these passages give detailed advice on how to restore the to the surface of the body. In contrast, the term ‘shu’ ( body’s mai vessel circulation by regulating different levels of the body’s tissue-plane anatomy and provides strategies ( for dealing with different types of tissue-plane pathology. the general qualities of xue depressions, but which also In classical acupuncture, it was this singular focus on the region of the human body. For example, the ‘benshu’ (root point of all therapeutic interventions, not the activation shu ) regions, located between the elbows and knees therapeutic actions.50 28 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory Journal of Chinese Medicine • Number 102 • June 2013

Principle #9 ).

‘.’ of acupuncture is that its practice must be rooted in shen.”’ - Lingshu Chapter 8

‘ ‘The essential thing when using the needle is never to forget the shen.’ - Lingshu Chapter 73 (): In the Neijing, the term shen The original authors of the Neijing were unequivocal about observable laws of the physical universe do not apply. When yin and one thing, that the practice of acupuncture is based upon yang forces achieve a certain dynamic tension and equilibrium a shift occurs that allows the light of shenming to emanate. Shenming is a special generative force around which life processes organise themselves. In classical Chinese, the lights of the celestial bodies and the organising statements on this matter, few modern practitioners force of the human body are both called ‘shenming’. Because shenming is believed to be the prerequisite for the organisation of all life, it is also the generative force that heals and repairs the body. Shenming is carried meaning in a clinically relevant way. As has been discussed previously, most important terms in Chinese medicine the originators of acupuncture focused the restoration of mai vessel circulation.[image from http://upload.wikimedia.org/wikipedia/ possess both primary and secondary meanings; primary commons/6/62/ Starsinthesky.jpg ] manifestations of these principles.51 The special relationship In other words, most manifestations found in nature can that exists between principle and practice is outlined in be described in terms of observable patterns of yin and Lingshu Chapter 48: Neijing describes another dimension of space/time that transcends the normal ‘ observable manifestations of nature; this dimension is called ‘shen’.53 Within the Neijing various terms are used to ‘In regards to the correct method of learning, it is like tying describe different qualities of shen. Used as a singular term, things in a bag. If a bag is full but has not been tied shut, the character ‘shen’ refers to a unique quality of space/ its contents will spill out. If a method is known but has time that transcends the normal observable laws of nature. not been summarised into [its essential principles] it is impossible to [understand] this method through the shen.’52 special quality of organising force that is called ‘shenming’ ( shen illumination). In nature, shenming arises when In modern TCM the term ‘shen’ () is most commonly both yin and yang come into a unique state of dynamic translated as ‘spirit’. It is a term generally used to describe tension and equilibrium. When this occurs, life processes basic qualities of vitality and intelligence. It is also spontaneously begin to form themselves. Conversely, sometimes used to indicate a certain ephemeral quality when the special relationship between yin and yang is lost, between practitioner and patient that is believed to be the organising force of shenming is extinguished and the essential for the therapeutic effect of acupuncture treatment. associated life processes cease to exist. Thus, the special quality of shenming is seen to be a basic prerequisite for all manifestations of the term ‘shen’ and do not describe its life processes and, as such, it is seen to contain the original primary meaning. In contrast, in the Neijing template upon which life originally forms itself. in the birth of stars within a stellar nebula (see Figure description in Suwen Chapter 66: 8). As a new star begins its life, cosmic dust collects and contracts under the prevailing contracting forces of yin. ‘.’ As matter condenses inwards, yang forces oppose this ‘The process of a thing becoming is called hua () original contraction with an outward expansion. When transformation. The process of a thing reaching its the two oppositional forces reach a critical state, a nuclear completion is called bian () transformation. Aspects of fusion reaction occurs and a new star is born. The star then yin and yang that cannot be measured are called shen.’ departs the stellar nebula to begin its mature life cycle as - Suwen Chapter 66 the centre of an organised life process (i.e. a solar system). Conversely, when the mature star reaches the end of its life, Journal of Chinese Medicine • Number 102 • June 2013 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory 29

the star is extinguished, the solar system ceases to exist and its elements resolve back into the fabric of space-time. Edward Neal, MD, LAc, has been actively involved in the practice In the Neijing, the Heart is understood to be the anatomical and teaching of Chinese medicine for over 20 years. Originally trained equivalent of the sun. As described in Suwen Chapter 8: acupuncture with Dr. Anita Cignolini of Milan, Italy. Formerly an Associate Professor in the Department of Classical Chinese Medicine ‘ .’ at the National College of Natural Medicine in Portland, Oregon and founding director of the International Society for the Study of Classical () emanates from it’. Acupuncture (ISSCA), Dr. Neal is currently a Senior Researcher at the Xinglin Institute, a multi-disciplinary research and educational Within the Neijing, mai (blood) vessels were understood institute dedicated to the study of early Chinese medical texts with to be direct emissaries of the heart. Because of this special the express purpose of identifying classical treatment strategies that can be used to address a variety of global healthcare challenges. More relationship, the governing illumination of shenming is information about Dr. Neal and his work can be found at www. also believed to circulate within the three-dimensional edwardneal.com. jingluo body via the mai vessel circulation. When the mai vessel circulation is restored during a classical acupuncture treatment, the organising force of shenming is thus restored to the different parts of the human body. When this occurs, the body is able to re-form itself along the template of its Endnotes original inception and spontaneously bring itself back 1. See Neal, E. (2012). ‘ into health and balance. From the perspective of Neijing ‘Introduction to Neijing .’ ‘The Lung Classical Acupuncture Part I: emerges from Shaoshang. classical acupuncture, it was this restoration of mai vessel History and Basic Principles’. Shaoshang is located at the circulation along with the circulation of the organising The Journal of Chinese Medicine, inner tip of the thumb. It is jing 100, pp.5-14 (well) wood ().’ force of shenming that was seen as the primary goal of all classical acupuncture treatments, and in classical terms 2. Perhaps one of the most In Neijing terminology, wood these processes were understood to underlie the therapeutic ( ) and metal ) are terms of Neijing medical theory found used to describe different in the Nanjing concerns the qualities of circulation and primary role of the benshu Summary () point regions. In the circulation describes motion Neijing classical acupuncture is a sophisticated form of Neijing, the benshu regions are that expands outwards and areas located distal to the the heavens. Metal circulation circulation through the entire three-dimensional tissue elbows and knees that have a describes motion that contracts planes of the human body. Its clinical practice is based upon zang organs. These regions heavens to the earth. Within a deep understanding of the innate patterns of nature and were identified using the these passages the Neijing uses an in-depth knowledge of human anatomy and physiology. sequential nomenclature jing well), ying (rivulet), to indicate to the reader: a) As originally described, Neijing classical acupuncture had shu ( influence region), the location of the origin (or little to do with point-action theory, which constitutes the jing ( channel) and he terminus) of a given mai main theoretical framework of most modern acupuncture ( convergence). On yang vessel pathway (i.e. the jing pathways, an additional well region) and b) the practice and education. As originally described, Neijing region was defined as the primary direction of the mai classical acupuncture was a physician-level skill indicated yuan ( source) region (on vessel circulation (i.e. yang yin pathways the yuan-source mai vessels have a descending for the treatment of critical and life-threatening illnesses. regions are synonymous with or ‘metal’ circulation, and yin Although many of the original principles of acupuncture the shu [] regions). In Lingshu vessels have an ascending practice have now been forgotten, these theories and Chapter 2 (‘Root Shu’) the or ‘wood’ circulation). Later text passages that describe in the Nanjing, these terms practices were written down and remain accessible today these regions all begin with a through research and study. The information contained description of a jing-well region ) followed by the qualifying term ‘wood’ ( ) or ‘metal' (). For a yin channel is a ‘wood point’, the practice of Chinese medicine and make valuable example: contributions to a wide variety of global healthcare issues. is a ‘metal point’, the second ‘ point is a ‘water point’ etc.). This clinical treatment. .’ ‘The Stomach in turn became the theoretical emerges from Lidui. Lidui is basis for a variety of different located lateral to the big toe at schools of acupuncture (e.g. the inner tip of the second toe. different schools of Japanese It is jing (well) metal ( ).’ acupuncture, Worsley-style five element acupuncture Similarly, for a corresponding etc.) and became a basic tenet yin pathway we see a of modern TCM education. comparable passage: However, this interpretation 30 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory Journal of Chinese Medicine • Number 102 • June 2013

contradicts basic five phase principles set down within the and Los Angeles: University of 14. During the Song Dynasty, theory: In five phase theory original source texts (roughly California Press. official bureaus for medical wood and metal represent two 220 CE-1911 CE); 3) Post-1949 9. As noted in Part I of this administration, medical intermediate circulations that medicine in China, in which article, medical texts such education and medical editing exist between the opposing two combined Western medicine/ as the Lingshu most likely were established. It was during ) and water ( TCM training programs for represent composites of pre- this time that imperial medical they do not describe qualities of Chinese medicine physicians Han and Han classical texts motion that occur at the origins of were developed; and 4) Post- that survived the Qin Dynasty with the Imperial College that these circulations. Further, these 1949 medicine in the West, in literary purge. These were oversaw the national education interpretations do not correlate which the exported amalgam likely compiled, re-compiled system. with the way that these terms of TCM was taught and spread and added to by scholars of were used in the source material. throughout the world. subsequent dynasties until For example, in the Neijing it is 15. For a general overview of the consensus editions emerged medical changes that occurred clearly stated that all jing-well that then became part of the regions of the body correspond 4. In Chinese medicine, the during the Song Dynasty see term ‘classical’ is a somewhat canon of medical literature; for Goldschmidt, A. (2011). The with the season of Winter (and more on this issue see Neal, E. thus the Northern direction and confusing term that is used in Evolution of Chinese Medicine: a variety of ways. Historically, (2012). ‘Introduction to Neijing Song Dynasty, 960-1200. London the phase of water). This also Classical Acupuncture Part I: follows logically from yinyang this term is used to describe the and New York: Routledge chronological period starting History and Basic Principles’. Curzon. theory (jing-well regions are The Journal of Chinese Medicine, the areas of the body where somewhere prior to the Zhanguo (Warring States) period of 100, pp.5-14. mai vessel circulations either 16. These advancements were aided terminate their existence or have the Dynasty to the end of the Eastern Han by the invention of their origin (i.e. the Lung mai 10. It is also possible that the print by Sheng in 1040 CE. Dynasty (approximately 500 Needling Classic was referenced at the Lung jing-well region, the BCE-220 CE). Various schools of - although not by name - in Large Intestine mai vessel has acupuncture also use this term Ban Gu’s inventory of the Han 17. During the latter half of the Qing its origin at the Large Intestine to distinguish their practices imperial library undertaken in dynasty (1644-1911CE) there from modern ‘TCM-style’ was a general deterioration of phase theory, the Winter season acupuncture. It is also used account, a reference is made to societal conditions caused by is the time of both terminal loosely to indicate ‘the ancient eighteen rolls (juan) of a Huangdi epidemics, natural disasters, cessation of life and embryonic art of Chinese medicine’. For Neijing Suwen. It is possible that civil strife (upwards of 20 origination. Thus, the original the purposes of this article the million people died during the descriptions found within the term ‘classical’ is used in two Suwen and the second nine to Taiping rebellion alone), the First Neijing not only correspond distinct ways. Firstly, it refers to a Needling Classic. and Second and Opium Wars, with observable laws of nature various foreign occupations but are also consistent with basic as described above. Secondly, and the Boxer Rebellion. 11. According to Huang Fu Mi, it is a used to describe a set A significant proportion of the Zhenjiu Jiayi Jing (Systematic Practitioners of Nanjing-based of clinical practices based on China’s citizens lived in abject Classic on Acupuncture and styles may counter by citing Warring States and Han Dynasty poverty and severely unsanitary Moxibustion) was a compilation medical texts that utilise the conditions. Given the basic formed from three primary texts, demonstrate the effectiveness of theories of yinyang directional standard of living experienced the Suwen (Plain Questions), a particular system. However, science (see the rest of this article by the average individual, it is Zhenjing (Needling Classic) and because the benshu regions exert for explanation). perhaps understandable why Mingtang Kongxue Zhenjiu policies aimed at modernisation Zhiyao (Essentials on Needling the internal organs of the body, and against traditional practices 5. Although other descriptions of and Moxibustion of the Illuminated they were recognised as being were advocated. acupuncture practice existed in Chamber), the latter of which has some of the most clinically texts such as the Mawangdui been lost. medical manuscripts, these 18. See Taylor, K. (2005). Chinese any type of treatment given in descriptions do not provide the Medicine in Early Communist these regions would be expected level of detail found within the 12. Lu, Gwei-djen & Needham, J. China, 1945-1963: A Medicine of to produce some sort of clinical Lingshu. (2002). Celestial Lancets: A History Revolution. (Needham Research results. Here, the question is not and Rationale of Acupuncture and Institute Series). London: whether these areas are clinically Moxa. London and New York: Routledge Curzon significant, but rather what 6. This distinction is not absolute; Routledge. might be the effects of therapy the Neijing Suwen also contains if these regions were used as a number of passages related to 19. The term ‘TCM’ was first originally described within the acupuncture practice, and the 13. These bronze statues were used in the Chinese Medical classical source texts. Neijing Lingshu contains many constructed with passageways Journal in 1955 – a journal passages related to basic medical that were filled with liquid. published primarily for non- theory. Chinese readers. There exists no 3. For general purposes, the recognised acupunture comparable term in the Chinese evolution of Chinese medicine points and sealed with wax. language. In modern China, can roughly be divided into four 7. To avoid confusion, in this To successfully pass their Chinese medicine is simply basic phases of development: article, all of the different names examinations, students were known as zhongyi ( Chinese 1) The period of the Warring of the Lingshu family of texts will required to insert needles at medicine). States and Han Dynasty, during be referred to either by the title pre-determined locations, thus which the first principles of ‘Lingshu’ or by the more generic acupuncture practice and term ‘Needling Classic’. point. Concurrently with this, 20. These were the programmes Naturalist philosophy were Wang completed a three-volume known as Xiyi Xuexi Zhongyi first set down (475 BCE-220 8. For more on the history of the (‘Western Doctors CE); 2) The post-Han Imperial Lingshu text see Sivin, N. ‘Huang of acupuncture points entitled Study Chinese Medicine). For period, during which a Ti Nei Ching ,’ in Loewe, Tongren Shuxue Zhenjiu Tujing further analysis see Taylor, variety of different theoretical M. ed. (1993). Early Chinese Texts: (Illustrations of the Bronze Man K. (2005). Chinese Medicine in schools arose from the basic A Bibliographical Guide. Berkeley Acupuncture and Moxibustion Early Communist China, 1945- Points). 1963: A Medicine of Revolution. Journal of Chinese Medicine • Number 102 • June 2013 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory 31

(Needham Research Institute oedema. Similarly, from Lingshu passes along the inner aspect of their theoretical conception. Series). Routledge Curzon. Chapter 9: Thus, while some aspects its tip.’ of the classical description 21. For example, Nanjing Academy ‘ modern description, they were of TCM (ed.) (1958). Outline of 30. At the time of the Neijing the theoretically and conceptually TCM . Beijing: .’ ‘In shaoyang structures of the human body different. That this is so should Renmin weisheng chubanshe, death there is deafness and a were studied through medical not be surprising. In fact, the and Health Unit of the Logistics loosening of the one hundred dissections and were observed description of human blood Department of the Guangzhou joints. The system of the eyes in battlefield medicine and circulation posed a particularly Army (ed.) (1972). Revised is exhausted. When the system the various medical situations thorny scientific problem in Outline of TCM of the eyes is exhausted, in one found in agrarian life. the West. It was not until 1628 . Beijing: Renmin Weisheng and a half days the patient dies. when William Harvey wrote Chubanshe. When the complexion turns pale Exercitatio Anatomica de Motu blue-green and white, the person 31. While classical texts such as Cordis et Sanguinis in Animalibus will die.’ the Neijing can be complex, 22. For more see Fruehauf, H. multi-layered documents open (Anatomical Exercise on the Motion (1999). ‘Chinese Medicine in to interpretation, the concept of the Heart and Blood in Living Crisis: Science, Politics and Such conditions will be seen that mai vessels represent blood Beings) that Western physicians the Making of TCM’. Journal of in hospice care when a dying vessels is not ambiguous. The had an accurate description of Chinese Medicine, 61, 6-14. patient becomes obtunded, word ‘mai’ itself means ‘blood blood circulation. develops flaccidity and vessel’, the role of mai vessels is nystagmus. to ‘carry the blood’, the stirring 23. For a current list of acupuncture 35. In Chinese medicine, a lack of mai vessels describes the indications recommended by of understanding as to the pulsation of arteries, mai vessels the World Health Organisation nature of mai vessels poses a 27. It is also true that bad traditional are seen as a direct extention variety of theoretical problems. medical practices have persisted of the heart, the act of taking a medicinedocs/en/d/Js4926e/5. For example, in Chinese over time, so it is critical that pulse literally translated means html.> [accessed 13/05/2013] medicine education, students classical medical techniques ‘to assess a mai vessel’ etc. are also evaluated and tested in are routinely taught that ‘blood a manner similar to any other is the mother of qi’ ( 24. In modern China, the majority of medical therapy. 32. Within the Neijing no qualitative ) and ‘qi is the commander hospital-based therapies involve distinction is made between of blood’ (). Such the prescription of herbal arteries and veins, both are sayings have little meaning if formulas. In these settings, 28. Some descriptions of mai described under the term ‘mai the acupuncture channel system acupuncture is typically viewed vessel circulation and pathology vessel’. is understood as being a series as an auxiliary form of therapy found in the Lingshu show a of disembodied circulation indicated for the treatment striking resemblance (or are pathways. However, if the identical) to descriptions found 33. The idea that the term ‘mai’ original acupuncture pathways pain syndromes, post-stroke within the Mawangdui medical represents blood vessels is are understood to be mai vessels, paralysis, migraine headaches manuscripts, suggesting that not new, it has simply been such statements have a clear and Bell’s palsy, etc. these two texts at least partially unused and forgotten. In fact, and definite meaning with share a similar origin, or until the latter half of the strong and immediate clinical evolved within parallel medical twentieth century, authors implications. 25. Although herbal therapies traditions. such as and were known at the time of the others wrote clearly about these Neijing, few prescriptions were relationships - see Lu, Gwei-Djen 36. The descriptions of mai vessel 29. The full passage reads: ‘ & Needham, J. (2002). Celestial circulation also make a direct prominently within the text. Lancets: A History and Rationale and tangible bridge between of Acupuncture and Moxa. London Chinese medicine and Western biomedicine in a way that does 26. For example, from Suwen and New York: Routledge. not undermine or weaken the Chapter 61: original theoretical observations .’ ‘The 34. In the discourse of Chinese of Chinese medicine or classical ‘ lung hand taiyin mai vessel medicine, it is an oft-heard Naturalist philosophy. .’ arises at zhongjiao middle phrase that acupuncture ‘With regards to water diseases: burner]. Descending, it nets with channels specifically do not 37 As one example, in the classical within the lower body there will the large intestine. Turning back describe the circulation of blood. description of blood circulation be swellings within the fu organs it crosses weikou stomach For example, it is commonly it is the Lungs not the Heart that and distention of the abdomen. mouth]. Crossing the diaphragm noted that modern acupuncture moves the blood circulation. When the upper body is affected it joins with the lungs. From the channels do not follow the network of the lungs it passes course of the vascular pathways laterally to emerge from beneath one cannot lie down. Here, both of the human body. However, 38 In Chinese medicine, the tidal the axilla. Descending it follows the outer manifestation and the these arguments ignore basic variations of the mai vessel the inner aspect of the arm root have been affected by the historical facts: a) The mai circulation are often erroneously crossing in front of shaoyin [ same illness. Therefore, [water vessel pathways described in the described as being a ‘Chinese lesser yin] and xinzhu [ diseases] when within the lungs Neijing medicine organ clock’. In heart ruler]. Crossing through altered since their original actuality, the diurnal circulation the elbow it crosses the inner within the kidneys cause water descriptions. In fact, many of represented in these depictions aspect of the forearm and moves swellings.’ the original pathways described portrays the 24-hour tidal beneath the edge of shanggu [ within the Neijing coincide variations within the body’s upper bone]. Entering cunkou closely with known human mai vessel circulation – not the Such a description might [ inch mouth], it ascends yu vascular pathways. b) The circulation within the internal be recognised by a Western classical description of blood organs themselves. According medicine-trained physician as circulation differs from the to the Neijing, the zang internal right- and left-sided heart failure of the thumb. A [second] branch modern description because organs represent the deepest with ascites and pulmonary divides behind the wrist and these two systems differ in depots of seasonal/directional 32 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory Journal of Chinese Medicine • Number 102 • June 2013

jing (essence). As such, they classical the anatomical medical theory, it has become anything we consider soiled. The are always associated with the structures that are most closely a somewhat common practice sensitivity of the lungs to insult five cardinal directions and associated with the concept to attempt to construct is such that people with weak their corresponding times (e.g. of the modern acupuncture theoretical approaches to lungs often feel tainted in life or the Kidney always corresponds channel. acupuncture based on elaborate like they are ‘damaged goods’. to the direction of the North interpretations of point name However, virtue lives purely and the time of midnight, the symbolism and the concepts of within each of us untouched by 43. The term ‘luo’ () is also used Lungs always correspond to the point-action theory. Although any event in life. In fact, heaven direction of the West and the time possibly well intentioned, these can only ever see the highest in which mai vessels communicate of sunset etc.). In contrast, the attempts often stand directly at us. For only the virtue we have with internal organs, when they diurnal tidal circulation of the odds with basic classical medical cultivated during life ascends make a ‘netting’ or ‘web-like’ Kidney mai vessel (for example) theory. To give one example; to heaven upon death to join connection. is understood to be particularly Tianfu ( heavenly palace) the light of the moon, stars and strong during the two-hour time is currently the name of the sun ... This point may truly period of you 44. For example see Gray, E. (2010). modern acupuncture point enable us to forgive, let go of and seven o’clock in the evening Jingshui and the Rivers of Ancient LU-3 located three cun below the past, and be receptive to the and the circulation of the Lung China. Master’s Thesis. National the axillary fold on the radial guidance of divine inspiration mai vessel is understood to be College of Natural Medicine aspect of the biceps brachii so we can move ahead in life strongest during the time of Library. Portland, Oregon. tendon. However, as originally less burdened.’ - from Jarrett, yin described, Tianfu was seen as L. (2003). The Clinical Practice of o’clock in the morning. Here, being a broader anatomical zone Chinese Medicine. Stockbridge, two separate chronobiological 45. Although not entirely consistent found along the taiyin Lung MA: Spirit Path Press, pp.575- systems are basically confused with contemporary Western mai vessel pathway where the 576. – one based on the circulation of anatomical descriptions, Neijing vessel exits the chest at the region the internal zang organs (which anatomical descriptions add of the stirring of the axillary associates with the primary valuable information related artery (now the location of the Or: cardinal directions and their to the form and function of modern point Jiquan HE- 1). the human body by including corresponding seasonal times) The Lingshu gives us a relatively ‘[The point] Tianfu ... expresses descriptions of how the body and one based on mai vessel tidal straightforward description of the functional dynamic of the performs and is experienced circulation (which describes the this region: number three. Zhongfu, Lu-1 at rest and in motion and how varying degrees of tidal strength represents the taiyin source in the body responds to different within the human mai vessel the state of heavenly oneness, types of impairment and clinical ’ circulation over a 24-hr period). where the ore of the lung metal therapy. In contrast, Western ‘The stirring mai vessel within In modern Chinese medical is still concealed within the anatomical descriptions are the axilla is the hand taiyin mai education, these two systems womb of the earth. Yunmen primarily static, describing vessel. Its name is ‘Tianfu’.’ are often poorly understood. LU-2 introduces the emergence different structures of a non- of lung qi at the border between living body. 39 See Neal, E. (2012). ‘Introduction In the Neijing, Tianfu describes lung heaven and spleen earth, to Neijing Classical Acupuncture an important anatomical region in the form of earth/metal Part I: History and Basic 46. The benshu (root shu) that resides at the demarcation amalgam. Tianfu Principles’. Journal of Chinese regions of the extremities being zone between the upper and represents the taiyin essence in Medicine, 100, pp.5-14. the most notable exception. lower regions of the body (hence its pure metal state – ready to be its name ‘heavenly palace’). used for ceremonial purposes To a classical acupuncturist, at the imperial court, ritually 40 Ibid. 47. Deadman, P. Al-Khafaji, M. & this area would have been of imbuing the kingdom with the Baker, K. (2007). A Manual of substantial importance because promise of material splendor Acupuncture Hove: Journal of it is located at the outflow ... [Tianfu] conjures up images 41 In the Neijing, any circulatory Chinese Medicine Publications. source of the Lung mai vessel of an ancient Shangri-La, a pathways that flowed circulation. In turn, the Lung central paradise surrounded horizontally from the interior mai vessel circulation resides by beautiful sites in all four to the exterior surface of the 48. Point-action theory is the at the headwater source of the directions ... [Tianfu] is typically extremities were called ‘luo’ theoretical foundation of most entire mai vessel circulation of described as ‘the land where pathways. This included modern TCM acupuncture the body. Thus, any impairment fertile earth, arable lands, descriptions of what are now practice. In this system, an here can potentially cause a prosperous people and exquisite understood in Western medicine acupuncture point is understood disturbance in the mai vessel chariots abound ... a Heavenly as being peripheral capillary circulation of the entire body. In Treasury with taiyin attributes beds. In Neijing theory, these effects that are ‘activated’ when contrast, others have a great deal areas were understood to be the point is correctly needled. more to say about the unique facilitate the connection to a male important potential reservoirs qualities of the point ‘Tianfu’, ancestor in Heaven, who is really of chronic disease and important 49. The two primary exceptions for example: the swarthy Earth Mother in pathways traversed by external are the use of the benshu () heavenly guise... where common pathogens. In TCM theory, the point regions to treat disorders postnatal wine is upgraded to meaning of the term ‘luo’ is ‘Lu-3 ‘Heavenly Palace’ of the internal zang organs, and the noble, champagne-like elixir now most often truncated to Tianfu ... The pathology of of life ...’’ - from Fruehauf, H. simply refer to the region of the the metal element is that once regions to treat disorders of the (2002). ‘The Science of Symbols: ‘luo point’ – one small subset inspiration and self-worth are fu organs. Exploring a Forgotten Gateway within the larger concept of ‘luo’ to Chinese Medicine (Part Two)’. pathways. the worst in ourselves and The Journal of Chinese Medicine, 69 others. The lungs’ virtue of pp.20-26. connecting to essence is thus 42. Jing () longitudinal fascial 50. Perhaps, due to a basic distorted into perfectionism These are just a few examples circulation pathways represent misunderstanding of Neijing and disdain for anyone or from two well- k n o w n Journal of Chinese Medicine • Number 102 • June 2013 Introduction to Neijing Classical Acupuncture Part II: Clinical Theory 33

proponents of this style of Here, both examples attempt to innate difference in competency thinking, many other such impart a sense of theoretical and or job skill. Rather, it refers examples of this type of approach can be found within borrowing from the concepts education and an approach the profession of Chinese of popular psychology and to clinical thinking in which a medicine. new-age spirituality, the second practitioner is able to deal with While it is true that, especially by invoking multiple images of clinical complexity through in Pre-Han China, written poetic symbolism. Both infer a an understanding of basic character glyphs were connection to classical medicine principle. In contrast, auxillary understood to have supra- and the original ‘spirit’ of healthcare primarily functions linguistic meanings and carry Chinese medicine; both fail to on a system of basic algorhythmic a degree of talismanic power, convey a basic understanding of pattern recognition. From this being direct representations classical Chinese medical theory. perspective, most contemporary of the basic patterns of nature, Most importantly, the Huangdi Chinese medical practice can interpretations such as these fail Neijing and other classical be seen to exist as a type of on multiple levels to accurately medical texts were not written auxilliary healthcare that is convey basic concepts of classical as treatises on contemporary currently not being practised at medical theory or provide psychology, nor were they a physician level of care. clinically relevant information. written with the intention Just a few of the inaccuracies of being read in the style of 52. The full passage reads: found within these brief classical poetry (a style in passage include: a) Originally which complex symbolism and the name Tianfu did not refer hidden context are an accepted part of the literary genre). on the modern Lung channel. Instead, the Neijing and similar ‘In regards to the Rather it described an important correct method of learning, it anatomical zone located within and foremost medical texts is like tying things in a bag. If the axilla; b) Tianfu was not written by clinical practitioners a bag is full but has not been originally ‘the third point on tied shut, its contents will spill the Lung channel’, because medical information to future out. If a method is known but points were not numbered in generations. In the opinion of has not been summarised into this way; so any mention of the author, two basic possibilities [its essential principles] it is such numerical symbolism in exist in relation to the practice impossible to [understand] this context is spurious; c) The of Chinese medicine: either this method through the shen.’ names Zhongfu and Yunmen Chinese medicine represents Lei Gong said, ‘What of those were not classical point names an authentic and valuable of lesser ability who tie their mentioned in the Neijing at all medical practice which should bags before they are full?’ but rather came into existence be preserved and studied, or it The Yellow Emperor said, in later dynasties; and d) Tianfu represents an elaborate type of ‘Those whose bags are not full, was originally described as placebo. If it is the former, then yet expound their knowledge being located in the region of the the basic principles and theories anyway, believe themselves to pulsation of the axillary artery of the medicine matter greatly (now the area of the modern and it is crucial to understand point Jiquan HE-1). Therefore, if them and get them right. If a modern practitioner chooses to however, Chinese medicine needle the modern point Tianfu exists only as an elaborate type 53. In 1905, a Swiss patent clerk () LU-3 for the indications of placebo, where any type named Albert Einstein made listed above (for example to of theory can be found valid, a similar observation in his activate ‘luminous objects that then ultimately it is not worth paper ‘Zur Elektrodynamik facilitate the connection to a much collective time or effort bewegter Körper’ (‘On the male ancestor in Heaven’, or to (except perhaps as a study Electrodynamics of Moving ‘enable us to forgive, let go of of the phenomena of placebo Bodies’), in which he described the past, and be receptive to the medicine). Perhaps the time his theory of general relativity guidance of divine inspiration’), has come in the evolution of and the changes that the they are in actuality treating Chinese medicine when it is physical universe undergoes as an area that was originally now acceptable to question phenomena approach the speed described as being located what constitutes appropriate of light. on the Large Intestine mai levels of scholarship and hold pathway not the Lung mai investigators accountable to pathway. Further, with few basic levels of research. exceptions, the clinical practice of Neijing classical acupuncture did not rely on point-action 51. In clinical medicine this theory; therefore attempts distinction becomes critical, to construct overly-wrought because it is through an descriptions from the symbolic understanding of principle interpretations of acupuncture that a demarcation is made point names are inconsistent between physician and non- with the way these regions physician levels of care. Here were originally understood or the term ‘physician’ does not used in the classical source texts. refer to any type of licensure or training, nor does it describe an