The essence of the Nan Jing's teachings on health
by Z'ev Rosenberg
The Lantern: Volume V, Issue 2 - Article #1
This may not be obvious to the majority of Chinese medical practitioners in the West. Despite laudable enthusiasm for Asian methods of healing, without immersion in Chinese medical history and classical medical literature, it is impossible to escape the broad-based incursion of biomedical ideas and sciences into the very core of training and practice. Even in China and other Asian countries, this transformation has been progressing steadily for over 100 years. It is interesting that even though many Western students and health professionals profess a strong interest in Asian studies, they can only relate to a Chinese medicine that has already been somewhat made over in the image of Western medicine, including disease classification, diagnostic tests, and the very manner in which one interprets signs, symptoms and the phenomenon itself.
This quandary is easy to understand. Without exposure to and immersion in classical theory, one remains too influenced by biomedicine, which dominates world practice and discourse in medicine, to see otherwise. It takes a tremendous amount of discipline, including lifestyle along with study, in order to practise an essentially pre-modern approach to medicine. It takes experience and craft to apply this medicine in turn to modern problems effectively.
In doing so, there is no need to reject biomedicine. One needs simply to be clear in one’s own mind what is systematically Chinese medicine and what is biomedicine. It is like having a Macbook computer with two operating systems, OS X (Macintosh) and Vista (Microsoft Windows). One’s hard disk is partitioned for each system, and one chooses to “boot up” with one or the other. In this way, confusion is avoided.
The key thread in the Nan Jing is pattern recognition, which is the basis of Chinese medical diagnosis. The aspiring physician is trained to use all of the senses to get a complete picture of the patient’s patterns, using sound, colour, vessel diagnosis/pulse, tongue, odour and inquiry. One then synthesises the sensory data into patterns, and gets a sense of the overall condition of the patient. The physician determines the relationship of notable symptoms to each other, including the jing shen/effusion of personality and emotions that the patient manifests. Then the physician looks at external influences, including weather, climate, season, social influences, family influences, medications, diet, modes of thought, personal outlook on life, modes of dress, home and public life, and profession. The daily rhythms of sleep, waking, diet, exercise, strength or weakness, clear thinking and mental fatigue, and emotional cycles all need to be examined as well. The overall “construct” of pattern differentiation then leads to treatment strategy.
The physician will not only choose appropriate acupuncture points and herbal treatments, but also lifestyle, diet, the order of daily life, and any other required modalities of medical treatment. We also need to determine what the patient’s own resources are, in terms of qi, blood, essence and spirit. These resources can be either initiated and mobilised from within if possible, or we may need to use “replacement therapies”. Acupuncture and moxibustion work with the “internal pharmacy” to synchronise the production of essential essences to nourish and maintain the body and mind.
Sometimes the patient will have the necessary resources to heal themselves, but cannot access them due to ignorance, stagnation or stasis, inappropriate behavior, or self-destructive tendencies. Sometimes the body’s self-correcting mechanisms may make the patient very uncomfortable, so the patient resorts to overeating, junk food, alcohol or other responses to unconsciously interrupt this otherwise healthy response.
If the body and mind are depleted through taxation, we will need to use bu fa/supplementation therapies to strengthen the patient. This can be anything from herbal prescriptions to supplement qi, nourish yin or blood, to specific foods, supplements or medications (such as thyroid or other hormones). It can also include behavioural therapy, such as dressing in beautiful clothes, sitting regularly by a waterfall, or putting flower arrangements in one’s home. All of these will nourish yin qi, and enhance peace of mind, cool fire, and enhance femininity.
If there is an aggressive disease process out of control, whether a psychological emotional disorder or physical disease such as cancer, stronger, more attacking therapies (gong fa) may be called for, from strong herbal medicines to toxic drugs and surgery. In terms of medical history, we need to be aware how past traumas and emotional shocks, past illnesses and reactions to medical treatment contribute to the present pattern complex.
Most chronic intricate disorders are the result of a multiplicity of factors that combine and produce disease, such as constitutional weaknesses, drug toxicity (vaccinations, birth control pills, long-term use of antibiotics or steroids), changes at puberty or during pregnancy, and emotional traumas.
The Nan Jing provides maps for understanding all of these potential influences and transformations from balanced homeostasis to a condition of discord. In turn, it also provides treatment strategies for restoring balance and healing disease patterns.
Reading the body through channel theory
Just by observing the patient, we can learn so much about their condition. The natural tendency for a person is to accentuate their strengths and hide or ignore their weaknesses. We see this tendency to compensate in the structure of their body, their behavior, the way they walk and speak/communicate, the clothing they wear, their perfume, and the sound of their voice.
One can also diagnose utilising the shape of the hand, face, nose, ears, and other body structures, or by examining relationship between proportions of height to width, front to back, upper to lower body. The Nan Jing tells us a great deal about these tendencies through channel theory.
The well-known five phase correspondences associate colours, symptoms, sounds, odours, emotions with each phase, which are expressed in specific channel correspondences. A person with large bulging eyes, bright and clear with an intense stare, has repletion of the foot jue yin channel associated with the Liver, as the Liver sends an internal channel to the eyes.
This type of Liver repletion can be dangerous, indicating a violent, angry individual or overly influential leader (think of Charles Manson). A person with small eyes, dim vision, without bright spirit emanating from the eyes, tends to have vacuity of the foot jue yin channel. In turn, they will be less passionate, not wish to stand out in the crowd or to serve in leadership positions. Studying these correspondences allows us to see our patients in new ways and leads to comprehensive diagnosis and treatment plans.
What is a death pulse?
Every channel and viscera/bowel forms a continuum. A viscera or bowel can be seen as a solidification of the literal channel, and each channel has the potential of life and death, or growth and decay.
Death in Chinese medicine is not necessarily clinical death of the body, but decline of the associated channel/viscera/bowel. In the Nan Jing, this is called “severance of the vessels”, discussed primarily in Difficult Issues 8 and 12. If the qi cannot circulate/communicate freely through the channel system, specific viscera, bowels or channels may be “cut off”, and therefore wither and die. The Nan Jing describes this as leaves and flowers wilting eventually after the root is cut.
When specific channels/viscera/bowels are cut off, other viscera, bowels and channels become replete to compensate for loss of systemic balance in the body leading to chronic illnesses. Decline of visceral qi can be seen in two ways in the pulse. First, the pulse position is fragmented, as if it has holes or is flaking away, as in a se mai/scattered (choppy) pulse. Secondly, a visceral pulse, without Stomach qi to soften it (see Difficult Issue 15), indicates impending “death” of the viscera/bowel and its channel.
The Stomach (and Spleen) qi is associated with the ying or construction qi, which gives pliability, suppleness and substance to the pulse. Difficulty 15 says that “in springtime, a pulse that is slightly wiry is ping/level. If it is mostly wiry and the Stomach qi is scanty, this is called diseased. However, bowstring with no Stomach qi is called a death pulse. In spring, the Stomach qi is the root.”
The same descriptions apply to the other seasonal pulses discussed in Difficulty 15, including the hair-pulse for the Lungs and autumn, stone-like pulse in winter, and hook-like pulse in summer. The Stomach qi is always the root of the healthy seasonal pulse.
What is chaotic qi?
The Han dynasty Chinese scholars and physicians observed natural phenomena as part of a system that could be orderly or chaotic. In Confucian thought, humanity existed as an interface between heaven and earth, and therefore contributed to potential order and chaos through right or wrong action and behavior.
The fields of medicine and ethics prescribed codes of behaviour to cultivate order, and therefore health, in global systems, from the cosmos to the growth of food crops. Humanity, in other words, had a strong influence beyond its own sphere into all realms of existence.
Observing waves in the ocean, we see sometimes that they can be smooth, regular, and peaceful in their movement. Sometimes the water is clear, sometimes murky. Sometimes they are choppy, rippling, with no apparent order. They respond to both local and distant conditions, storms, fronts, seasonal shifts, currents and crosscurrents. The pulse allows us to read the “waves” of the body. They can be regular in sets, smooth, flowing without obstruction, indicating orderly qi and blood flow, meaning good health. Or, they can reflect chaos in the mind/body system, showing choppiness, scattering, irregularity or counterflow, repletion of qi in specific channels, vacuity in another. Once we have a sense of what a level or normal pulse is (it will vary from patient to patient, determined by their bodily constitution), we can then determine how far the patient’s health has veered off course.
It is really quite simple what the Nan Jing wishes to teach us; the author(s) of the text and its commentators over the centuries simply want us to perceive changes on both a local and global scale that influence health and disease.
This is very different from the technical approach of biomedicine. The Nan Jing’s methodology is truly a form of “sensitivity training”, in which one gains the ability to observe and synthesise what we see into a coherent diagnosis and clinical picture. These abilities require not only clinical practice as a feedback system, but a different form of study that trains us to see phenomena according to yin and yang, wu xing/five phase, six channels, and wu yun liu qi/five movements and six qi. It is less reliant on data sets than biomedicine, and more of a process-oriented approach that tracks change in a predictable manner.
Then the root of disease can be revealed, and we can then move a mountain with a feather.
