The Attuning and the Corrective
"Self-immune disease, or auto-immune disease, is characterized by the fact that immune cells (T-type lymphocytes and antibodies) lose their immune tolerance and attack cells and tissues of the body itself instead of attacking external, or foreign, invaders. Auto-immune diseases affect over 5% of the population and are one of the chief causes of morbidity and death among fertility aged women" [Yehuda Shoenfeld, autoimmunologist, "Profession in the Making", medical booklet 10, Volume 148].
"There are close to eighty diseases classified as autoimmune disease."
Above we see the classification of conventional medicine for "autoimmune disease". How does Chinese medicine classify autoimmune diseases as a whole? As far as I know, there is no parallel or a similar Chinese medicine classification for autoimmune diseases as a group. In most cases, descriptions of diseases from pre 20th century texts do not give enough information in order to make an analogy with diseases in their modern classifications (please refer to an good article on the topic by Subhuti Dharmananda: itmonline.org/arts/autoimmune.html ).
The character for disease in Chinese medicine is 病, Bing, or 疾, Ji. "Disease" is "any disease condition of the body or part of the body that can be named." For example: "Cholera" (huo luan), or "malaria" (nue ji). I put the name of the disease in quotations so that we will remember that despite the translation ("malaria", "cholera"), we are not necessarily talking about a disease identical to malaria or cholera according to their classification in conventional medical literature.
Differing from "disease" (Bing), there is a term in Chinese medicine called syndrome, or pattern (證, Zheng). A syndrome is a "disease manifestation which indicates the ailment's nature, location and etiology". "Disease" can be characterized by various syndromes".
There are a number of diseases in Chinese medicine that can be interpreted as, but not only as, a clinical picture of autoimmune disease. The most prominent among them is Impediment 痹, Bi, which may point to a clinical picture of arthritis.
In Chinese medicine, the treatment is individualistic. The diagnosis is carried out by looking at "signs and symptoms" which indicate a syndrome, or use is of the terminology of the five phases, or yin and yang, but not according to disease as is in conventional classification.
There are close to eighty autoimmune diseases, different from one another by the clinical picture they produce. Each of these diseases may be close to or similar to one of many Chinese "diseases", and will receive a number of different diagnoses (syndromes) in the terminology of Chinese medicine; what is referred to as 'differential diagnosis'. In addition, in the treatment of a certain disease (Chinese), each patient will receive a diagnosis specific to them. It is possible that this diagnosis will be different than that of their friend with the "same" ailment. For this reason I remind myself again and again, remind my patients and students as well, that our specialization as practitioners of Chinese medicine is not a specialization in one disease or another, but in human beings. In the western culture in which we live, this reminder is the most important for those who want to treat with a medicine whose roots are affixed in a completely different culture.
From the conventional medicine definition we can see that the origin of the problem in autoimmune disease is in the immune system of the body. Let us explore the term "immune system".
"The immune system is a complex collection of organs, cells and molecules, which developed during the evolution of vertebrates and has earned an advantage for those organisms in which it developed. The function of the immune system is to defend the body against pathogenic microorganisms such as bacterium, viruses, different fungi and parasites, as well as toxins and cancerous developments. Between the different parts of the immune system, there is a reciprocal relationship which allows them to work in a synchronized and coordinated way against foreign substances which are a threat to the body".
This is the conventional medicine definition. This definition will not be significantly different when put in Chinese medicine's terms for defining the ability of the body to defend itself. In Chinese medicine there is the term the "defensive qi", 衛 氣 , Wei qi. The ability of the body to defend itself, through the defensive qi as well as other means, is related to all 11 organs (or the three burners – or in others words the sum total of all the functions of the internal organs), the 6 yang meridians, the 12 tendinomuscular meridians, and the eight extraordinary meridians).
It would not be wrong to add to the list the connecting meridians, the divergent meridians, and the 6 Yin meridians. In short, the whole body needs to function in a harmonious way in order to allow adequate defense.
Some of the organs and the meridians are directly related to the "defensive qi", 衛 氣, Wei qi, whereas part of them will influence it indirectly, just as Yin influences Yang.
This article can easily be extended to a full semester wherein the depth of the different aspects of the body's defense is taught according to ancient Chinese medicine. In this article I will shortly mention the principle organs and meridians which touch upon the process of defending the body. Finally I will expand briefly on the function of the Dan ("Gallbladder"), whom I will call by the nickname "the attuning and the correcting".
"Defensive Qi", Wei qi, 衛 氣 :
It is important to understand the defensive qi as a complimenting idea to the idea called "the nutritive qi", Ying qi, 營 氣. Together they compose a pair of Yin and Yang.
The defensive qi is the Yang aspect, the "turbid" aspect of the Qi. Reflecting on the character 衛 which is defines as "military defensive power", teaches that a significant quality of the defensive qi is movement and dynamism. "Dynamism and movement" are Yang qualities. The meaning is simple and critical: in order for the defensive qi to function properly, there needs to be enough Yang, enough heat, in the body. As practitioners, the decisive majority of the patients we see harm their Yang, weaken their internal fire, as a result of incorrect and consistent use of air conditioning and refrigerators, as a result of overworking for hours and days. This means that the aspects and functions of the yang in the body, amongst them the defensive qi, tend to be harmed due to the modern lifestyle.
The close connection between the ability of defense of the body and the Yang qualities is well expressed in chapter 3 of the Su Wen. For example:
"The Yang qi is like the sun in the sky. If (yang) 'loses its position' life is disrupted and things lose their brilliance. The correct connection with Heaven depends on the shining of the sun. In this way, the yang rises and promises defense, 衛, in the external areas."
Chapter 76 of the Ling Shu describes the flow of the defensive qi, and here as well a great connection between the movement of the sun and that of the circulation of the defensive qi is expressed. We are taught that the defensive qi is in the external areas of the body during the day and at night enters back into the yin, internal areas.
SHEN, 腎 ("Kidneys"):
Chapter 18 of the Ling Shu teaches that the defensive qi originates in the lower burner, as opposed to the nutritive qi which flows from the middle burner.
Chapter 8 of the Nan Jing teaches that the "vital qi which moves between the kidneys is called the "winds" which protect from pathogens, 守 邪 之 神 , shou xie zhi shen."
We understand that the origin of the power of the defensive qi is from the fire in the lower burner, or in other words, from KIDNEY-Yang.
One of the defining qualities of the autoimmune diseases is that they are chronic. This means that there is always a condition of deficiency. In most cases, it is a deficiency of the yang of the "kidneys", which is caused by the reasons mentioned earlier. It is interesting to see that women suffer three times more than men from autoimmune diseases. In women the yang is slighter, gentler and more vulnerable than it is in men. A well-known example is that women are more sensitive to cold as are men. Furthermore, women use more yang of the "kidneys" (heat) for the monthly menses and for pregnancy.
In chapter 8 of the Su Wen we learn that GAN, the "liver", is "the general of the armed forces."
The Emperor (XIN, the "heart") needs a strong assistant that is able to resist any attack from the external, and if necessary also to depress an internal revolt. This is the essential function of the GAN according to chapter 8 of the Su Wen. There is in GAN the potential for an aggressive display of power, according to the assessment of circumstances and its ability of foresight. The power of GAN is actually the expression of the real power – the hidden power of the SHEN ("kidneys"). From here we can understand that the GAN has a central role in the mechanism of autoimmune disease; there is an erroneous tendency to think that autoimmune disease exists as an excess reaction of the immune system, or an "irrational" reaction of the system. Actually, we are talking about activity of the immune system that is "normal", however, due to a tragic mistake; the system attacks parts of the body as though they are pathogens. Clearly in this case, there is a need to check in with the army's general to see what went wrong.
Xin, 心 ("Heart"):
Xin is the ultimate expression of yang in the body. As the "Emperor", it has responsibility for everything that occurs in the body, but its responsibility is doubled for everything that relates to the function and movement of yang in the body. Always when there is a problem with the Yang Qi, especially if it is a chronic problem, we will want to check what is happening with the Xin. The idea is that Xin controls the expressed Yang, for example, in chapter 52 of the Su Wen. There it is said that "Xin takes charge of the exterior of the body, biao, 表. This is the power of the fire that allows prosperity and the bringing of Qi up to the most external places. The fire of the XIN is part of the mechanism of the upper warmer which is responsible for the bringing of the defensive Qi and the nutritive Qi to every place in the body. More specifically, the defensive qi goes to the more external places whereas the nutritive Qi more to the internal areas. More information on Xin's part in the process can be found in chapter 39 of the Su Wen, for example.
In addition, and still in relation to chapter 39 of the Su Wen, Xin has control of the entirety of our mental and emotional worlds. The connection between XIN, the Yang qi of the body, and our mental world explains how it is that many diseases come about, according to the Chinese medicine outlook, as a result of incorrect movement on the mental-emotional level. Mental weakness can be a factor which allows penetration and intensification of a pathogen both on a chronic level as well as on an acute level; sometimes only a "small shock" is needed in order to take the whole body out of balance.
PI, 脾 ("Spleen"):
In chapter 29 of the Ling Shu it is said: "Pi ("spleen") controls defense, 衛 !"
In chapter 36 of the Ling Shu it is said: "Pi is defense 衛".
For the most part Pi is related to the Nutritive qi, Ying qi (chapter 8 of the Ling Shu, for example). The nutritive qi is the yin partner of the defensive qi, and they influence each other. Pi has tight relations with Xin ("heart") and with Fei ("lungs") in the upper warmer which work to bring the defense qi and the nutritive qi to every place, thus they take care that there will not be any space for pathogenic qi. Pi has a coupled relationship (husband-wife) with Gan, the general. Pi also has a coupled relationship with Wei, together they receive and transform the food which is used as the building blocks for production of the defensive qi and the nutritive qi.
Pi of course takes care of the renewal and nourishment of all the five Zang organs, including SHEN ("Kidneys"). Thus, from its central position and function, Pi controls defense. No defense functions properly without a stable center.
FEI, 肺 ("Lungs"):
Fei has a general control of the qi, as it is stated in chapter 10 of the Su Wen, for example. It has a tight connection with the external areas of the body – skin and body hair. These areas are richer in defensive qi, and they make up the first line of defense against external pathogens.
Fei, together with Xin, sends nourishment and defense to the whole body, from its position in the upper warmer. From this point of view, it is said in chapter 35 of the Nan Jing that XIN is related more to nourishment – due to its control of the blood, and Fei is related more to defense – due to its control of the qi. Fei has a strong and important influence on SHEN, GAN, PI, XIN and WEI, with all that entails in relation to the ability to defend the body.
WEI, 胃 ("Stomach"):
Wei is the large sea that receives into it the grains and is responsible for the refinement process which produces the defense qi and the nutritive qi. As we have seen, in order for the defensive qi to receive the resilience necessary for defense, it needs the heat of the lower warmer. The initial processing of the raw materials (the grains) is under the authority of the WEI. We can say that WEI takes care of the quantity of qi, and SHEN takes care of the quality of qi, as defensive qi.
The six yang meridians:
In chapter 43 of the Su Wen it is said that the defensive qi does not enter into the meridians, however, in chapter 76 of the Ling Shu, in describing the flow of the defensive qi during the day, it is said that every morning the defensive qi flows from the eyes, along the six yang meridians, up until the Well points. Even if the defensive qi does not flow in the meridians, it flows alongside them, external to them, and dependent on the flow of nutritive qi within them. From this description of the defensive qi, we understand that the yang meridians have a more direct connection with the defensive qi. The yang meridians are more related to the external areas of the body, these areas make up the "territory" of the defensive qi.
Jing Jin, 經 筋, (the muscle meridians):
In modern texts, for example Giovanni Maciocia's great book "The Channels of Acupuncture", page 286, or the important book of Elisabeth Rochat de la Vallee, Claude Larre and more: "Survey of TCM", page 124, states that "in the muscles meridians flows the defensive qi" I do not know of any classical source that describes flow of defensive qi in the muscle meridians. After consulting with Elisabeth Rochat de la Valee, I reached the conclusion that one should not necessarily conclude that defensive qi flows in the muscle meridians. One can find reasons and arguments for and against this interpretation.
Du mai, 督 脈:
This "meridian" is considered as the "father" of all the yang meridians. It gives the primal principle and the basis for all the yang functions and to all the yang qualities in the body. In relation to the defensive qi the point 命 門 – Ming Men – GV4 is especially important. This point influences the area that constitutes the qualitative source of the defensive qi. It will give the basic yang support and the model for production of defensive qi, the yang "stamp". Beyond GV-4, almost every point of the Du mai, and of course opening of the meridian (SI-3 + BL-62), will influence one or another aspect of the defensive qi.
Yang Qiao mai, 陽 蹺 脈:
This "meridian" overseas all of the yang qi movement in the body. It works harmoniously together with the Yin Qiao Mai in order to regulate the changes and transitions from yin to yang and from yang to yin, on every level. In relation to defensive qi, it is the regulation of circulation during the day in the external areas of the body, and the regulation of the circulation during the night in the internal areas of the body – the passage between the five zang. The Yang Qiao mai is more important in the passage from yang to yin, as opposed to the Yin Qiao mai where, according to interpretation, is responsible for bringing the defensive qi back to the eyes.
Yang Wei mai, 陽 維 脈:
This is the "meridian" which ties together and regulates all the yang qi and the yang functions, in the yang and external areas of the body. These are precisely the areas that make up the territory of the defensive qi. If we compare, in order to hone our understanding, it is succinctly stated that BL-62 will activate the defensive qi, and if needed will also help it to move from the yang to the yin, whereas TH-5 will gather and regulate the defensive qi thus uniting and strengthening its defensive ability.
Yin Qiao mai, 陰 蹺 脈:
As mentioned, its principle importance in relation to the defensive qi is its bringing it back, from the feet to the eyes at end of each cycle, and to work harmoniously with the Yang Qiao mai.
Ren mai, 任 脈/ San Jiao, 三 焦 ("three warmers")
San Jiao, "the three warmers", are a kind of summary and unity of all the functions in the body. Each warmer has its own "alarm point" which is located on the Ren mai. The reason for this is very interesting but this is not the place to expand on that.
Each warmer has a specific relationship with the defensive qi:
The lower warmer (CV-7) is the source of the defensive qi. The fire of the lower burner is that which gives it the power for its being.
The middle warmer (CV-12) allows the refinement process of the qi of the grains, and from there the purer qi will become the nutritive qi, and the more turbid qi will descend down to the lower burner in order to turn into the defensive qi.
The upper warmer (CV-17) allows the "dispersal" of the nutritive qi and the defensive qi to all parts of the body.
DAN, 膽, ("Gall Bladder"):
The quality of the Qi of DAN is very similar to the quality of the defensive qi. This quality reflects a strong movement, quick and vigorously forward. A common nickname for the defensive qi is "the bold qi", for example in chapter 43 of the Su Wen. One of the interpretations of the character 膽, DAN ("Gall Bladder") is courage! DAN's quality is to give expression to the powers hidden in the SHEN ("Kidneys"). These powers have yang aspects – for example the defensive qi, the bones, and Yin aspects – for example the "bone marrow" (Sui, 髓). This quality of DAN is the reason it is said in chapter 9 of the Su Wen that "11 organs receive the ability to reach decisions from DAN". In DAN there is pure qi, very close to the source, powerful qi, similar to the defensive qi. Not only does it give the correct direction, to each one of the organs, it even has the ability to correct the direction, to return to the correct direction, when a certain qi or another diverges from the right way, from the original way. Thus, in this article, I nicknamed DAN as the "attuning and the corrective".
We explained before about the special function of the GAN ("Liver") as the "chief of staff of the military". In chapter 47 of the Su Wen we are told a very interesting thing: GAN is indeed the general, however it depends on DAN for decision making! From all that was said up to now, we understand that DAN has a critical function in all that relates to the correct functioning of the defensive qi. We will examine this relationship through reflecting on a number of its acupuncture points, for example:
GB-9, Tiang Chong, 天 衝: The character衝 means "bold and wild". 天 is "nature". GB-9 is a point that knows to emphasize the nature of DAN as a bold and strong qi which gives the fundamental power, and the courage, to carry out a task. When we treat sick people, and especially in chronic, prolonged diseases, we need to make sure there is in them "the fighting spirit" that will allow the coming out back to the healthy pathway. This point will get us closer to this higher goal! We should remember that the defensive qi is the "bold qi".
GB-17, Zheng Ying, 正 營: The character正 is regular, normal and also to correct. 營 is the same character as in Ying qi, nutritive qi. In the name of the point an idea of a very primal building is expressed, to give a norm to the building process, and if necessary, to also correct it. The building here is on the most primal level. It can refer to building of qi of one quality or another, also to building of thoughts, or dreams (sub-conscious). I will use this point to correct basic physiological processes in the body, or in the spirit of the person. This kind of primal injury we will find in many cases of autoimmune disease, or other difficult diseases such as certain cancerous diseases.
GB-38, Yang Fu, 陽 輔: The character 陽: Yang – the partner of Yin. The character 輔: to aid, help, complete. The name - "Yang Support" reminds us that GB-38 is the Fire point, and brings a general idea of support of the yang power of DAN. GB-38 gives the power, supports the circulation of defensive qi to the external areas which are called, as one of the alternative names of this point: Fen Rou, 分 肉, "Divisions of the Flesh", and also to the internal areas – tendons and bones. From this yang power, said George Soulie De Morant about this point, that it is "the principle point for treating the joints"! And thus, strengthening of the point will greatly benefit successful treatment of disease such as arthritis.
Avihai Wolczak is a practitioner and teacher of Ancient Chinese Medicine, researcher, student and teacher of the ancient Chinese texts. He teaches the course "Golden Gate" in Tel Aviv, Israel.
Translated from Hebrew by Osi Geva.
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