Acupuncture treatment, regardless of the style employed, is aimed at reestablishing balance and harmony to the organism–whether the focus is on Qi and Blood, Yin and Yang, the Five Elements, the Officials, the Organs, the Meridians, or the Body/Mind/Spirit as a whole. It is for that reason that acupuncture is spoken of as a “holistic” modality, in contrast to Western medical treatment which at times can lose sight of the patient as a whole in the process of extirpating his disease. Of course an enlightened and sensitive Western medical practitioner is least likely to commit this type of “error” while there are no shortage of acupuncture practitioners whose own “blind-spots” leave them far short of the goal of holism, so I do not wish to paint a picture in which one type of practice is seen as superior to another—I view them as essentially complementary, and have merely attempted to help the reader understand their differences.
Thus, in summary, the Circle can be seen as encompassing the various steps in the theory and practice of acupuncture. Steps one through five move through the various preclinical disciplines while six through eight carry this movement forward into clinical practice. At each level of the Circle there is a natural correspondence between the left and the right. Thus, we start out at step one with a general philosophy and system of belief which is unitary—both from the perspective of the Dao on which it is based and from the point of view of Qi, the unitary matter-energy which is the practical basis for acupuncture treatment. At step two there are twelve vital functions which correspond to the twelve Principal Meridians of step three. These first three steps can be thought of as describing the condition of the normal human being, free from disease or disorder of any sort. At step four a perturbing force is introduced which produces a corresponding pathological reaction at step five. Thus the equator of the Circle represents the development of an illness. This can either be spontaneously resolved in which case there is a reversion to the top half of the Circle, or the illness may persist untreated in which case we remain at the equator, or finally, medical help may be sought in which case we descend to steps six and seven. Here, an examination is carried out and based on the findings a diagnosis is determined. All the prior steps are now focussed on selecting and carrying out the proper acupuncture treatment at step eight which if successful will restore the perturbed Qi to a state of balance and thereby return the patient to health in the top half of the Circle (Fig.11). This process is predicated on the assumption that when the Qi is in a completely balanced and harmonious state, the organism will heal itself from whatever previous illness it experienced. This is not the place to try to validate acupuncture therapy in a scientific manner, however, there is an enormous body of clinical material supporting such a belief in the efficacy of acupuncture.(9) The implication that any form of pathology is potentially reversible if its energetic basis can be fully determined and if the principles of the regulation of Qi can be understood deeply enough is indeed a challenging one. The next chapter will delve a little deeper into the types of knowledge and skill that allow practitioners of TCM and LA to come closer to this common goal. It will present an overview of how each style, first TCM and then LA approaches each category of the Circle and integrates them in the process of treatment so that the reader will be able to identify which tradition’s teachings are being described in the historical analysis which follows. I’d like to mention here my conviction that neither style of acupuncture is better nor more effective than the other, but that each is only as good as the training and skill of its practitioners. Ultimately, both styles evolved from the same source and are best seen as brother and sister rather than as competitors for the truth.
Figure 11: LEVELS OF THE CIRCLE
The model depicted in Figure 8 is expanded to indicate the regions concerned with healthy functioning, the development of “diseases,” and the recovery of health through medical intervention.
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TCM and LA
TCM developed in China under the guiding light of dialectical materialism. As such, it has needed to reject those historical aspects of TOM that reflected spiritual issues, especially practices and attitudes derived from the shamanistic roots of TOM. Essentially it has focussed on somatic complaints and relegated most complaints of mental, emotional and spiritual distress to the realm of politics. Of course there are exceptions to this generalization, but it is a useful distinction in getting a “feel” for TCM.
In keeping with the notion of dialectics, TCM’s basic organizing theory is that of Yin and Yang which are themselves a pair of opposites whose mutual attraction, interpentration and self-transformation underlie all developmental processes. The strict meanings of the terms Yin and Yang are surprisingly simple: Yin depicts the shady side and Yang the sunny side of a hill. By implication, all that is cold, dark, wet and inactive exhibits Yin qualities, while all that is hot, bright, dry and active expresses Yang qualities (Fig.12). In a state of health, Yin and Yang ebb and flow harmoniously, and continuously keep each other and themselves in balance. At the level of basic constituents, this bipartite model is used to describe even the Qi itself: Qi is Yang with respect to Blood, but at the same time Qi is Yin with respect to Spirit. Thus, it’s essential to keep in mind that Yin and Yang are relative terms and one must always know the context in order to understand their specific meanings. Figure (13) shows the relationships of the five basic bodily constituents and how they are related to each other in Yin/Yang terms.
Figure 12: A COMPARISON OF YIN & YANG
The intuitive appreciation of the differences between the terms in these two columns provides a better understanding of Yin and Yang than would a strict definition.
YINYANG
feminine, interior, cold inactive, night, moon falling, water, the Earth heavy, dark, damp masculine, exterior, hot active, day, sun rising, fire, Heaven light, bright, dry
deficient, front, decreasing excess, back, increasing
Blood, the Zang, stationary Qi, the Fu, moving
sedating, material stimulating, energetic
In its strictest sense, Qi is a specific one of the five basic constituents, while in a broader sense Qi can also be used to refer to all five at once. Thus, not only Yin and Yang, but even Qi changes its meaning depending on context. This close connection between the concepts of Qi, Yin and Yang is illustrated by the similarity in ancient Chinese characters for these three terms (Fig.14)(10).
The materialistic approach of TCM which operates from category one of the Circle, is immediately felt at category two, where the twelve basic functions are expressed as Solid and Hollow Organs(11). Thus these twelve Organs are understood in terms of their relationships to the basic bodily constituents. For example, the Lungs rule the Qi and adjust the Fluid Channels while the Liver stores the Blood and smooths the flow of Qi. Because the Organs have these physical roles to play, illnesses are frequently seen as being manifestations of disorder in carrying out these functions. At the level of category three, the acupuncture Points are often classified in terms of their effects on the basic constituents, such as Points for regulating the Blood and other Points for tonifying the Qi. In category four, the main etiological factors are the six climatic excesses: Wind, Cold, Damp, Dryness, Heat and Fire. While it is acknowledged that emotional upsets can be a cause of illness, there is no systematic application of this knowledge to how emotions affect the categories on other levels of the Circle, information that by comparison is well articulated for the climatic excesses. As mentioned, physical pathologies such as Phlegm or Stagnant Blood are often specified as explanations of the disease mechanism in category five and are seen as resulting partly from retention and transformation of one or more of the preceding six factors. These etiologic and pathologic factors can be identified by the observant practitioner during the examination which is category six. For example, Stagnant Blood manifests as purple discoloration on the surface of the body, particularly on the tongue, and is characterized by severe stabbing pains, worse from pressure and aggravated at night, and presents a puls
e which is hesitant or choppy in quality (Fig.15). Thus one of the tasks of diagnosis, in category seven, is to determine by examination which of the various etiological and/or pathological factors are present. Such a determination is made by looking for a typical pattern, as for example the pattern of Stagnant Blood just described. This type of pattern discrimination is not used just to identify the etiologic and pathologic factors, but also to determine the location and other attributes of the disease process. The most common diagnostic rubric employed in TCM is referred to as the Eight Principles, which is shorthand for the Eight Principles for Discriminating Patterns(12) and it is this attempt to discriminate patterns which is characteristic of all diagnoses in TOM. The Eight Principles are: Hot, Cold, Excess, Deficient, Exterior, Interior, Yin and Yang. It is clear that a diagnosis restricted to these eight patterns alone would however be incomplete, as we need to know which aspect of the organism is being affected. Thus, in addition to discriminating which of the eight patterns are present, the diagnosis also needs to discriminate which Organs or Meridians are involved. For example a simple, yet complete TCM diagnosis in a patient presenting with chronic diarrhea, abdominal bloating, pale tongue and an empty pulse might be Deficiency of Qi of the Spleen—which is an Interior, Deficient, Cold and Yin pattern (Fig.16). This amount of diagnostic specificity allows for the selection of an appropriate acupuncture treatment prescription in category eight of the Circle. A typical protocol for the pattern just described might be to insert needles at the following acupuncture Points: Stomach 36, Spleen 3, Conception Vessel 12 and Bladder 20 (Fig.17). The needles would be manipulated with tonifying technique(13) and left in place for about 20 minutes. This or a similar protocol might be repeated frequently over the course of a few weeks, after which it would be expected that the diarrhea would have stopped and the tongue and pulse findings would have shifted in the direction of normality. Should this not be the case, it would be grounds for reevaluating the initial examination and diagnosis. When the symptoms have resolved, and the pulse and tongue findings are more normal, the patient would be considered “cured” and be given specific advice as to lifestyle–in this case diet in particular–so as to avoid a recurrence.
Figure 13: YIN & YANG OF THE BASIC SUBSTANCES The five Basic Substances participate in two trinities: a homeostatic metabolic process governed by Qi, Blood and Fluids, and an evolutionary developmental process governed by Essence, Qi and Spirit. Each can be described in Yin/Yang terms.
Figure 14: ANCIENT CHINESE CHARACTERS
for Qi, Yin & Yang share which indicates some kind of vapor or unseen force, and which has become the modern Chinese character for Qi itself. Where Yin and Yang have symbols for the moon and sun respectively, Qi has the symbol for rice, the physical basis for energy. (See Faubert, page 22)
Figure 15: STAGNANT BLOOD.
This patient’s tongue shows a prominent ecchymotic spot on the edge which is indicative of Blood stagnation.
Figure 16: DEFICIENCY OF QI OF THE SPLEEN.
The typical appearance of the tongue in this condition is shown: a pale tongue body with a thin white coat.
Figure 17: TREATMENT FOR DEFICIENT SPLEEN QI
There is no single “correct” treatment, but rather a range of possibilities for each condition, and the practitioner must choose the best one for the individual patient. This illustration shows a seven needle treatment that promotes balance between left and right, front and back, upper and lower and Yin and Yang Meridians, while tonifying the Qi of the Spleen.
By contrast, LA, incorporating material from all over the Orient as well as from the West, was systematized in England with an emphasis on just those aspects of TOM which were rejected by TCM in China. Of central importance in this regard is the role of Spirit, which is seen as the true captain of the assemblage making up a human being: Body, Mind and Spirit. Many passages from the classics of TOM attest to this primacy, e.g.,“The Yellow Emperor asked Qi Bo saying, ”The laws of acupuncture dictate that needling should be, first and foremost, based upon the Spirit .. . . “(14)
Just what is implied by the term Spirit can however, only be hinted at, but never fully articulated. In another passage,“Qi Bo answered: Let me explain the Spirit. What is the Spirit? The Spirit cannot be heard with the ear. The eye must be brilliant of perception and the Heart must be open and attentive, and then the Spirit is suddenly revealed through one’s own consciousness. It cannot be expressed through the mouth; only the Heart can express all that can be looked upon. If one pays close attention, one may suddenly know it but one can just as suddenly lose this knowledge. But the Spirit becomes clear to man as though the wind has blown away the cloud”(15).
Many aspects of LA reflect this emphasis on the Spirit. These include everything from enumerating specific acupuncture Points which have a special power to affect the Spirit, to a coordinated acupuncture protocol for exorcizing cases of spiritual “possession.” As we shall see, historically demonology and exorcism have traditionally been a part of acupuncture, probably reflecting the practitioners’ early forebears who were the shamen in ancient China. Closely tied to its emphasis on Spirit is a recognition of the importance of the mind and emotions in health and illness. These are incorporated in LA as part of the Five Element theory which I am about to discuss, but I want to point out first that this attention to thoughts and feelings, that is, the inner life of human beings, is probably the greatest attraction of LA for Westerners. Of course it is understandable that such a focus on the subtleties of each individual’s intellectual and emotional life might seem to be incompatible with the political situation in China, and could easily account for its absence from TCM. The Five Element theory provides an excellent organizing tool, going back to category one, for LA’s focus on the Spirit, Mind and Emotions. Five Element theory is a bit more complex than Yin/Yang theory, so I’ll present a few more details of it application. Like Yin and Yang, the Five Elements(16) can in the first place be thought of as a mechanism for classifying all phenomena into separate categories, each of which share some kind of mutual resonance, much as do cold, dark and wet in the classification called Yin (Fig.18). The Five Elements are Wood, Fire, Earth, Metal and Water. So, for example, Wind, Spring, the Liver, green, sour and rancid are all associated by resonance with the element Wood. There are various sequences in which the Elements occur with respect to different phenomena relating to acupuncture. The most common sequence, which I have given, is called the Creative cycle and repeats itself endlessly (Fig.19). Because in category two, the Twelve Organs are correlated to the Five Elements, this Creative cycle is invoked to explain how the Liver, for example, supports and nourishes the Heart, which in turn nourishes the Spleen (Fig.20), etc.
There is also a Control cycle in which the Elements and their associated Organs inhibit or restrain each other as in Figure 21.
Figure 18: CORRELATES OF THE FIVE ELEMENTS.
Not all compilations of the Five Element associations are in agreement, this list reflecting the associations that are made in LA. The most controversial entries are the colors for Wood (often stated to be Blue-Green) and Water (often stated to be Black) and the emotion for Earth (often stated to be pensiveness).
Figure 19: THE CREATIVE CYCLE OF THE FIVE ELEMENTS
This cycle flows clockwise (the apparent direction of the sun through the Heavens) and illustrates how each Element engenders the succeeding Element, much as a parent creates (and nourishes) a child. Thus, an alternate name for the relationships depicted in this cycle is the“Law of Mother-Son.”
Figure 20: THE CREATIVE CYCLE OF THE ZANG ORGANS
In the language of the Law of Mother-Son, for example, the Lungs are the Mother of the Kidneys and the Son of the Spleen, while the Kidneys are the Son of the Lungs and the Mother of the Liver.
Figure 21: THE CONTROL CYCLE OF THE FIVE ELEMENTS (A) & THE ZANG ORGANS (B)
Each Element or Organ controls the one located two positions further along in a clockwise direction, and is in turn controlled
by the one located two positions prior in a counter-clockwise direction. For example, Fire controls Metal, but is controlled by Water; the Liver controls the Spleen, but is controlled by the Lungs.
Of course whole books can be written on Five Element theory, but for present purposes, I just want to introduce enough information from its core concepts, since it is the basic organizing theory of LA in category one, to allow the reader to appreciate the history which follows. At category two I have been referring to the Organs, but I ought here to call them the Officials, which is the term used in LA. It is derived from Chapter Eight of the Su Wen which compares the functions of the human organism to the administration of a state. Thus, the twelve Officials are:
Figure 22: THE TWELVE OFFICIALS
as administrators of the human “state.”
In the Footsteps of the Yellow Emperor Page 3