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WHY MOXING ZHI YIN CAN CORRECT FETAL MALPOSITION?. E. Peluffo
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COSMOLOGICAL ORIGINS OF THE OBVERSE-REVERSE ZANG FU PAIRING IN CHINESE MEDICINE. E. Peluffo
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CHINESE DIETETICS AND NUTRENOMICS, POSSIBLE POINTS OF CONVERGENCE. E. Peluffo
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THE PAIRING OF HEART AND SMALL INTESTINE XIN XIAO CHANG XIANG BIAO LI. E. Peluffo
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ORIENTAL MEDICINES E. Peluffo
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SHEN HUN PO. E. Peluffo
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THE WEST AND THE EAST: Reciprocal attraction?. E. Peluffo
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THE FAR EAST IN THE WORKS OF C.DEBUSSY AND G.PUCCINI. Professor H. Urbon
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CHEEK BONE IN CHINESE MEDICINE. E. Peluffo
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ZHUANG Zi,THE VOID, MINGMEN, TANZHONG. E. Peluffo
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ZHUANGZI III. YANG SHENG ZHU. E. Peluffo
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PI WEI XIANG BIAO LI AND THE TRAJECTORY OF ZUYANGMING. E. Peluffo
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WHY MOXING ZHI YIN CAN CORRECT FETAL MALPOSITION? E. Peluffo - DOWNLOAD PDF VERSION>

ABSTRACT

Numerous are the medical works, both Eastern and Westerns, which describe the jiu fa (moxibustion) technique of the BL67 zhiyin point (reaching yin) in order to correct a poor presentation of the fetus and thus facilitate normal delivery.

However, they do not develop an explanation of the Chinese medical theoretical basis that leads to such therapeutical decision, nor is it mentioned what Neijing Suwen Lingshu teaches us about which is the energy path through which the heat applied to the small toe -BL67- leads to a correction of the fetal position aiming for an eutocic delivery.

This paper, by founding itself on the Chinese Medicine classic thought attempts to clarify the energetic dynamisms that explain the therapeutical choice of applying moxa to the BL67 point in order to correct the fetus malpresentation.


KEY WORDS

Pregnancy, fetus, malposition, moxabustion, zushaoyin, zutaiyang, zhiyin, chongmai, renmai.


INTRODUCTION

Conception, the first step in gestation carries all the energy and the blood from the whole organism to focus on the maternal womb to nourish the new being. The whole body pulls towards the yin, the uterus, whose essential role is to nourish the embryo under chongmai and renmai1 direction.


ENERGETIC MOVEMENT

In the beginning, in the conception, yin must be very strong to be able to start something, a form

…The conception of man is a condensation of the vital energy; its condensation is life, its dispersion, death.2

Suwen 6 tells us that for the appearance of the form, the yin springs first before anything else sees light, because life operates in the dark and wet, in the earth core, in the mother with her hidden and nutritious matrix.

The initial form with yin roots springs in a yin environment, yin in the yin (shaoyin) but life pushes and this sprout soon has an offspring who pushes itself upwards, a calling from the sky that pulls from the earth towards its light and heat. It keeps its form and roots, and approaches light and heat, the yang in the yin (taiyang) not forgetting that the sky covers and incubates and this allows the energies to remain in the earth and condensate themselves, and thus since the earth carries and holds the sky up it attracts towards itself, the interchange between both of them can be accomplished.3

The expression bao zhong defines, in the human being, a function common to both sexes as a utility which is protective of the original life of each being, this function is linked to kidney and to mingmen, and to the uterus and to the core of the protective covers of life as well, a place where it is said that two extraordinary meridians are generated: chongmai and renmai, and sometimes dumai too (Lingshu 65). Suwen 33 teaches that the vital circulations of the uterus depend (shu)on the heart and connect (luo) with baozhong.

The presentation of each one of the three yang great meridians is operated from the yin meridian already coupled. The first yin meridian is determined in relation to the sprout formed in the yin and it is shaoyin, the kidney meridian that upholds that sprout which is considered by Suwen 6 as the foundation of everything built in the being, the foundation of life, everything emerges from it. The ideogram shen kidney contains the idea of reproduction, of procreation and secondarily of testicle.

From shaoyin arises taiyang its opposite and complementary, that is to say the carrier of yang energies that joins with shaoyin to give water element its double yinyang dynamism.

As for the omnipresent water, main factor in the origin of life, we can say there are three ways of acting upon liquid: gravity (sliding down along slopes) pressure (geyser) and dynamizing heat (in this case: moxa). Yin y yang get together at St.30 Qi Chong (impetuous qi) where chongmai connects with the kidney meridian to ascend together towards the thorax, and also from there another branch descends along the inner side of the thigh and leg running down counterstreaming the kidney meridian to the inner malleolus to reach to the sole of the foot where B67 and K1 reunite.

Chongmai ascends again together with kidney. We can also see that the basic energetic activity of chongmai from the moment of fecundation is also multiple and extensive in the gestation of a new being either independently or in contact with other seminal meridians. In the perineum where the ancestral muscle zongjin resides, shaoyin, taiyin, yangming, renmai and chongmai get together. Daimai relates with muscles and tendons whose tonicity is commanded by that one from zongjin.

We can see the profound interconnection of the energetic network and its intense participation in the turning of the fetus towards eutocity.

Lingshu 54 explains to us that the place from where the meridian breath (the function) starts is called root and the place where it arrives to is the knot. And thus taiyang roots (begins) in Bladder 67 zhi yin and knots (concentrates) in the eye mingmen gate of the light.5 The BL1 point is called jingming bright eye. Zhiyin corresponds to the source and jingming to the manifestation of the meridian energy.

Zhiyin is jing point (well) that is to say it is the point where the energy polarizes, in this case, from yang toyin and ascends in the meridian.

Lingshu 9 title is Zhongshi “The End and the Beginning” highlighting in that way that the circulation never stops, it ends and begins again, endlessly. This is another proof of the Western inaccuracy when naming with correlative numbers the acupuncture points instead of pointing out-knowing the meaning of the names which illustrate functions.

The expression “end and beginning” was also the title of a chapter in a now lost, ancient classic whose text said: “... determining the yin and the yang concerns to the end and the beginning of the meridians needed to be known in order to be able to tone up and disperse”.6 Let’s briefly remember the zutaiyang path from the nape: one branch starts from tian zhu BL10 (heaven window point) descends to the shoulder blades, continues through the back of the body, branches out in the spleen and reunites with huantiao GB 30.

It goes on through the external side of thigh and leg and finishes in the small toe (Zhiyin BL67) where the yang from bladder reaches the yin (we are in the foot) of its coupled kidney through a branch that starting from BL67 reaches yongquan KI 1 (spring fountain). In BL67 it emerges the energetic “function” of zutaiyang (BL), metal point generator of water, tonification point of the energy of the Bladder Meridian.

According to the Chinese medical energetic dynamic, the embryo is associated to the ancestral energy and with kidney zushaoyin (Suwen 6) that sets life in motion, in all its aspects, both physical and spiritual. Zushaoyin pairs up with zutaiyang, bladder meridian.

The fetal malposition is a result of an imbalance of the relationship between kidney (external) and bladder (internal).7 Knowing the paths and length of the meridians, towards the interior they successively establish their dependence from the 5 zang and towards the exterior they communicate with each one of the 6 fu8 bowels. (Ling shu 10)

But shaoyin is not alone; it is accompanied by the extraordinary meridians emanating from kidney and bladder. Chong mai sea of blood rules the circulation of blood and passes the kidney energy from depth to surface. It transports the ancestral energy departing from kidney and in a common trunk with CV (yin) and -GV (yang).

Renmai, source of yin inside the body, supports all yin aspects of female physiology due to the particular way in which the female body uses blood. The first month of pregnancy is called shi xing, beginning of the form, which zujueyin (liver) holds because jueyin rules blood and during the first month blood flows with difficulty, the change makes it not longer to flow towards the exterior and so it needs support from zujueyin. Suwen 1 says: when a woman becomes pregnant renmai and chongmai start something new they have always had the potential to do.

From week 28 and until week 40, the spontaneous rotation of the fetus towards eutocic positions is expected.

Difficulties in the presentation of a fetus for delivery (complete or feet first breech position, face presentation...) originate in an insufficient maternal energy and blood. However, medical papers about moxibustion on BL67 barely, or just do not, describe the mother status, they do not give data on her energetic situation. The fetal malpresentation is the main diagnostic datum the doctors inform of, so that they can confirm the successful therapeutic evidence and statistic.

It is the author opinion that it would be interesting as a clinic verification of the Chinese medical reasoning on this acupuncture therapy, that knowing there are three yang meridians descending the energy from the head to the foot and in order to complete the diagnosis, an energy evaluation of the patient was carried out, to verify, for example, if she suffers from cephalea (BL10 is the upper meeting point of the divergent bladder and kidney meridians) and/or if she has cold feet (palpate pedis pulse) which would indicate a blockage, that is to say the absence of energetic descension in the meridians, specially BL and GB and/or ST too. They are sign-symptoms which would abound in the explanation of the physiopathology of the process, whose therapeutic correction BL.67 moxar indicates so as to correct the energy flux in the mother and also the position of the fetus.

Neijin Suwen tells us that the moxar heats the cold, tonifies the void, fires up the insufficient energy. Likewise, Chinese medical studies9 indicate that moxibustion in BL67 significantly reduces the electrical resistance of the auricular points of “uterus”, “sanjiao” and “endocrine”, so it can be deduced that moxar regularizes the “uterus” and “endocrine” functions already recognized by Chinese medicine since moxa stimulates both the suprarenal cortex and the uterus activity. Accordingly, the suprarenal cortex relaunches the uterine activity and increases the fetus movements and therefore its heart rate, all dynamic factors favoring the correction of the non cephalic position.

There is a diversity of techniques in terms of time and frequency of the treatment with moxa at BL67 but whatever the standard used, heating the metal point in bladder meridian leads to a tonification of the phase water represented by the kidney-bladder pair.

Guanzi 3910 deals with the fetus development from the cosmological point of view:

…a human being is water, when the essence jing and the energy qi from woman and man get together, water flows between them and assumes a form… In the fifth month of gestation the fetus is fully formed and in the tenth month (lunar) is born.

It is not referring to the water element (which also participates in the liquids of the organism) but to the large amount of blood present in the human body and to the fact that it flows creating life, similarly to water does on earth, as a sort of intermediary between the formless and that which has form, because water, having no definite form, acquires the shape of whatever contains it and thus, life starts.

The ideogram shui, water in Chinese culture shows a current expressed by a yang central continuous line, the strength to move forward surrounded by yin movable lines that facilitate the perception of the water substance. Yin makes yang appear in its inner core and contains it and yang works the yin from inside and makes it fruitful.11

Water is the quintessential image of yin, the first of the five elements; water is the kidneys, base of the vital tension and source of life.


CONCLUSIONS

Both cosmologically and energetically, water is first and primordial, fire does not dominate water, it just heats it up; water is indestructible. The KI-BL pair represents the water phase of the energy movement. From BL67 the breath flow goes to K1 yongquan (spring fountain) wood point of the meridian and here we can see the connection with jueyin (liver) mentioned above. Wood is starting phase of the energy flow in the wuxing system; the setting in motion of tendons, muscles, vessels depends on it. We know that water is cold (as opposite to blood that heats up the whole body) but regardless of being cold it is alive, it carries fire inside, Hydrogen is an explosive gas bombs are made of. Water, that moves the whole time, contains the yinyang double aspect that manifests life, the yin and yang from the kidneys whose task (fertilize and facilitate the vital impulse from the deep) it represents.

The moxibustion “heats the water” so as it flows through this bladder, kidney, liver circuit (heat dynamizes), the mother’s blood, and its energy gets mobilized as well as the child’s, and this process of physiological energetic reconduction, would explain the fact that the fetal position gets corrected.



REFERENCES

Groupe de Recherche de la province de Jiang Xi (RPC). Explorations cliniques et observations expérimentales de version par moxibustion appliquée aux ponts ZHIYIN BL67. Le Mensuel du Médecin Acupuncteur. Octobre 1980, Nº 75:171

Kespi, Jean-Marc. Acunpuncture. Maisonneuve. 1982:217

Ling Shu.Pivot Merveilleux. Traduction & commentaires C.Milsky & Gilles Andrès Éditions La Tisserande Paris 2009

Rochat de la Vallée, E. Les 101 Notions-Clés de la Médecine Chinoise. Guy Trédaniel Ëditeur. París 2009

Rochat de la Vallée, E. Pregnancy and Gestation in Chinese Classical Texts. Monkey Press. London 2007

Rochat de la Vallée, E. Père Claude Larre. Su Wen Les 11 premiers traités. Maisonneuve Éditeur Moulins lès Metz. 1993

Wang Wenshi. Hospital Popular Nº 4, Shenyang. Le Mensuel du Médecin Acupuncteur. Octobre 1980, Nº 75:173

Zhuang Zi. Maestro Chuang Tsé. XXII. Traducción, introducción y notas de Iñaki Preciado Idoeta. Kairós, Barcelona 2007



NOTES

1) Kespi Jean-Marc Acupuncture. Maisonneuve. 1982:217

2) Zhuang Zi. Maestro Chuang Tsé. XXII. Traducción, introducción y notas de Iñaki Preciado Idoeta. Kairós. Barcelons 2007:220

3) Rochat de la Vallée, E. Père Claude Larre. Suwen. Les 11 premiers traités. Maisonneuve. ëditeur. Moulins lès Metz 1993:205

4) Ling Shu , Pivot Merveilleux. Traduction &commentaries C. Milsky &Gilles Andrès. Ëditions La Tisserande >Paris 2009:49

5) This ming means light and not command.

6) Ling Shu. Pivot Merveilleux. Traduction & commentaries. C. Milsky & Gilles Andrès. Ëditions La Tisserande Paris 2009:78

7) Wang Wenshi. Hospital Popular Nº 4. Shenyang, Le Mensuel du Médicin Acupuncteur. Octobre 1980, Nº 75:173

8) Ling Shu. Pivot Merveilleux. Traduction & commentaries C. Milsky & Gilles Andrès. Editions La Tisserande Paris 2009:93

9) Groupe de Recherche de la province de Jiang Xi (RPC) Exploration cliniques et observationsexpérimentales de version par moxibustion appliquée aux ponts ZHIYIN V 67. Le Mensuel du Médecin Acupuncteur Octobre 1980, N2 75:171

10) Rochat de la Vallée, E. Pregnancy and Gestation in Chinese Classical Texts. Monkey Press. London 2007 :10

11) Rochat de la Vallée, E. Les 101 Notion-Clés de la Médicine Chinoise. Guy Trédaniel Ëditeur. Paris 2009:124


COSMOLOGICAL ORIGINS OF THE OBVERSE-REVERSE ZANG FU PAIRING IN CHINESE MEDICINE. E. Peluffo - DOWNLOAD PDF VERSION>

Published online. December 2014 in SciRes http://www.scirp.org/journal/cm>

http:// dx.dol.org/10.4236/cm.2014.54032>


ABSTRACT

Most of the rich philosophical and scientific concepts which nurtured the Chinese thought we know today, was developed during the troubled final end of the era before ours, from V to II centuries.

After reading reputed sinologists work on the cosmological origin and subsequent evolution of the Chinese concept of parallelism-pairing in poetry, literature, mathematic and other disciplines and since it is a tradition that all branches of knowledge in China are based on the development of those initiatory thoughts, the author asked herself if such knowings on the cosmological genesis of the parallelism concept could also be applied to Chinese medicine, science that describes its coupled in pairs structures and functions, simply based on yinyang, matrix of all pairings. Therefore, this paper proposes to apply those foundations, to explain the pairing of dynamisms in Medicine.

This work starts out from the oracular inscriptions in ancient times, cosmological basis of these ideas and their applications to Chinese literature and from there translates this approach to the study of the pairings described by Chinese medicine, and thanks to which blood-energy circulation (qi-xue) occurs in human beings. Organic and functional pairs described by Chinese medicine are the basic element to understand the concept of health and disease, and this paper is about the cosmological roots of those pairings, the cosmic resonance influence and numerology influence in them, and the whole is illustrated both through the description of the biao li pair, different from nei wai, and the functional relationship between these two couples.


KEYWORDS: Chinese medicine, cosmology, oracles, parallelism, pairing, yinyang, biao li, nei wai, zang fu.


INTRODUCTION

“one Yin, one Yang, that’s the Dao

Yi Jing Xi Ci Between the subtle celestial yang and the dense earthy yin, ten thousand combinations impregnated by all movements of life move, explains Su Wen 51 because everything that exists is a particular composition of yin yang. And thus, the Chinese civilization tells us once and again that the process of pairing is natural, that is to say under the laws of universe from the origin to the end of times and according to expert voices, this immanence was an effective way to ensure the perdurability of all aspect of the authoritarian imperial regime and its consequences.2

Whichever the reason, from the yinyang dynamisms, Chinese medicine pairs up, energetically couples and pairs up organs with bowels zangfu and the corresponding meridians establish the biao li relationship, obverse and reverse of each couple, building basis for an important guide-theory for clinical practice.

There are classic treatises where parallelism is analyzed as an important rhetoric way of Chinese literature3 and contemporary studies describing the notion of parallelism in Chinese mathematics too.4 Thus, knowing about the existence of energetic-organic pairings in Chinese medicine, we hereby shall inquire about the reasoning which led from the cosmological parallelism to the medical organ-function pairs and the coupling of meridians in Acupuncture.


CHINESE VISION OF THE WORLD

Chinese thought gives us a vision of the world based on the pairing among other concepts. And by using this word we want to describe becomingness or a process which starts from a duality in permanent interaction: opposition and complementariness as a result of a parallelism that in ancient times was already shown by oracular inscriptions from the second BC millennium. These inscriptions, considered the origin of Chinese writing, essentially constitute the embryonic written expression of Eastern thought.

Parallelism (para= near, close to, allos=other, alien) is not just a simple formal operation to distribute and align without modifying the paired members, procedure which, being concepts threaded in a two-to-two basis without any possibility of change, would reflect a symmetry solely geometrical and therefore static.5

To the Chinese tradition, the pairing is a basic dynamism, conceptually opposite and complementary which allows existence, subject the author has already considered in one of her previous books.6 This is not to say that Western culture had not elaborate concepts on antinomic contrapositions, but to point out that it had and has always been done in the West on an excluding basis of rigid and limiting antithesis: either it exists or it does not exist.

Chinese intuition perceives the real as a dynamic process starting from a binomial of phenomena in constant interaction because opposition and complementarity are presented as a generalized bipolarity and “parallelism” is both initial and dynamic: ever since the originator Yin Yang, Heaven and Earth have been coupled cosmological realities which encourage and regulate each other. As Wang Fuzhi says the initial harmony7 (Dao) already contains the opposition-complementarity relationship which is the quintessential pairing of yin yang for which the rest-movement alternation within constitutes its own conception and it is not a consequence of the pairing because what would the factor (external) initiating that dynamism be if it were not originated by the original interaction of the pair? The Chinese thinker did not conceive “creation” as a development of succession: first the sky, then the earth and after that man or as a progression according to which Tai Yi as an originator would gradually separate itself and progressively heaven and earth would be born from the original chaos.8 Instead of that, Chinese philosophy gives us the notion of Dao, a word that among other terms, some Western sinologists translate as “process” (immanent laws) in opposition to “creation.”

Then, what was the reflection? Heaven and Earth represent the oppositional archetype, and they could not exist as two isolated halves. This interdependency is not only territorial but it is at the basis of all experiences, either because one element conditioned the other (high-low, back-forward) or because both substitute each other: move-be still; be born-die… Each term in the pair depends on the other one and communicates with it, which means that one does not exist except through its relationship with the other.

Consequences arising from this correlation are used to elaborate all knowledge or knowing: no reality can be unilaterally and individually considered because everything that is real is perceived through the understanding of the relationships which bind and make the couples. Nothing exists isolated but by mutual implication; talking about one is talking simultaneously about the other and thus the parallelism or pairing relationship is neither exterior nor subaltern but rather what intrinsically makes existence. There is nothing existing outside this couple relationship which expresses a duality in unity mode. Tai Yi, the unity, is named by two characters.

The omnipresent expressions of parallelism in Chinese culture show a way of reflecting, of reasoning, a way of conceiving the universe according to the intuitive Chinese grasping of reality, a way of nature observation, a way of the real perceived as a becoming which elapses from a duality of elements in constant interaction.

Not surprisingly, physicians, scholars trained in this conception of cosmos and nature reasoned that applying it to the energetic dynamisms they described for the organic functionality in the human being.


DIVINATIONAL ORACLES

To show evidence of this, we go back to those oracular inscriptions where a “literary” parallelism of writing can be found in what sinologists call now symmetrical divinations in plastromancy (on turtle shells) and scapulomancy (bovine scapula) practiced by the Yin people and later by the Shang in the second century BC. As there are no other ancient divination treaties it is not possible to trace the original features of the archaic method.

It is clear that the tortoise shells drawings provided a picture of the cosmos which conditioned the writing on both sides of the midline: parallelism and symmetry.

I hope this brief historical introduction serves to facilitate the understanding of both the origin and the development of the parallelism-symmetry notion (antinomy-complementarity) in the attempt to explain the origin of the concept of energetic pairing of viscera and their meridians in Chinese Medicine.

Parallelism is “literary” in the broadest sense of the adjective, i.e. textual, and it is also included in the most disparate extra-literary subjects, in Mathematics or Medicine because these are texts in which the physician, the mathematician, or... the scholars in general, registered their theoretical and/or practical reasoning. Certainly, the conception of parallelism is primarily manifested in literary creation because the first texts already gave testimony of elementary impressions of parallelism which are considered spontaneous, natural as expressed by Liu Xie (465-522) in his presentation of this subject.9

Moreover, parallelism in China is the representation of a principle derived from its conception of the world, i.e. it is a cosmological figure and its production was greatly contributed to by Yi Jing, divinatory practice with a specific cosmological basis of its culture which does not constitute a simple technique to just predict but a procedure to decipher the course of things because it seeks to clarify the hidden meaning of the events where the subject of the consultation lies.10

From the initial parallelism comes the pairing of things which, as F. Jullien very well says, constitutes the basis which allows the understanding of the chance to exist11, because nothing takes place in isolation, everything has access to existence through pairs. The turtle shell, rounded on top (heaven) and square at the bottom (earth) resembles the universe, not that it just represents the universe, it is the universe; a reduced model of the universe thanks to its identity in shape and longevity to the animal which embodies a fundamental virtue of cosmos: its duration. That is, making a query to the turtle was making it to the very universe itself, even when it was preferred to use the plastron (consultation was on earthly matters) rather than the dorsal portion. Both parts have a fixed number of geometrical patterns that favours a parallel evaluation of them. One first consequence seems to have been that both sides of the plastron, external and internal, naturally led to the yinyang notion: one turtle, two possibilities, the millenary uniduality of Chinese reflection. The shell drawings allowed the symmetrical distribution of the inscriptions marked by the red-hot awl on the ink smeared shell. It is said without hesitation, that this technique conditioned the ulterior written expression, specially poetry, and canonical literature as well, among the latter Nei Jing Su Wen Ling Shu, the great classical medical text.




Figure 1: Turtle shell

Figure 2: Cracked shell after a double question. Wu Ding period. XV century BC12


In Chinese language the interrogative form does not exist, nor does the inversion of subject and verb which specifies an interrogative form: “Are you here?” and the modern question mark does not exist either, nor do the words “yes” and “no” natural consequence of this Chinese form of asking. Simplifying, in Chinese language questions are made by an affirmative double sentence-question: “we do this/ we don’t do this” and the answer is made by using the already used verb preceded, or not, by negation according to the chosen option: “we do this/we don’t do this.”

We can see that ever from interrogation there is symmetry, a parallelism which reveals a way of thinking with no absolute rules. And this double, dualistic way of questioning was scrupulously applied from the early divination spellings. The bilateral symmetry of the turtle shell led to consider that a hypothetical event always has two sides and that it is very important to consider them both, there is no yin without yang or yang without yin. And the matchable elements are the ten thousand things, everything that exists because everything exists in the very simple One of uniduality.

We said that, etymologically, parallelism comes from the idea of getting closer to the other and in the medical subject at hand, parallelism becomes pairing, i.e. approaching, and staying together in a complementary and opposite interchange, a bipolarity where the dynamic effect of parallelism is manifested from the very beginning.

Chinese medicine describes the parallel path of the main meridians on the surface, symmetrically mirror-like duplicated on both sides of the two mid lines of the body. Acupuncture maps only show the “visible” obverse which, according to Chinese thought is necessarily paired up with the hidden reverse, that of the nexus between organs and coupled meridians and the zang fu among themselves, as well as the relationship between internal and external nei wai.

Ling Shu 11 show us the broad meaning of jingluo

…through the jingmai and the five zang and six fu the body armonizes itself with the dao in heaven…

which also defines the anatomical three -dimensionality of human being.

Illustrations with meridians do not reveal the total fullness of the network of relationships woven among meridians and with the internal side of the body thus not favouring the understanding of the anatomical and functional vision of the qixue flow (energy blood) basic concept in health and in sickness. So, how are the body components related? How do energy and blood circulate? How does the therapeutic function of Acupuncture take place? The biao li pair gives us answers.

As our interest is to look for the conceptual roots of the biao li pairing of zang fu inside the cosmological notions, we highlight the information provided by the oracle studies on the origins of this way of reflection in China since the mantic practices have influenced the evolution of the Chinese reasoning.

Concepts arisen from the observation of cosmos-nature slowly impose themselves as intellectual movement in IV-III centuries and culminate their maturation during the early part of Han dynasty in II century B.C with the formalization of the basis of what would be the subsequent “nature philosophy.” It is in this time when the yin yang school (parallelism paradigm) which specially deals with the relationship Heaven-Man, arises.

In Zuozhuan, first year of Duke Zhao, He, the physician, lists the six breaths of Heaven: Yin Yang (shade-sun) wind, rain, darkness, lights which also inhabit the human body and whose harmonious interrelationship the doctor has to keep.13

It is precisely at this time (IV-III centuries) when yin yang transform themselves, cleaved themselves from the initial group and turn to represent the two primary energies which constitute the uniduality, matrix to all binomials.

Chinese medicine as a discipline emerged during the Warring States (Zhou dynasty), period called“Different Teachers, one Hundred Schools,” intense and very fertile philosophical and scientific movement in which the “Academy of Jixia gate” that typified the naturalist thought stood out; teachers from all over China went there to teach under imperial patronage. Its most prominent member due to his cosmologic naturalism, Zou Yan (305-240) was counselor to sovereigns eager to increase their political prestige.14

And these teachings had a strong influence on the theoretical development of Neijing Su Wen Ling Shu.


BIAO LI BINDING

Numerous are the ways of pairing described in Chinese Medicine based on the variety of dynamic yinyang. In this case we are going to focus on the biao li pair.

As Su Wen 6 explains in his “Separations and Reunions of Yin and Yang,” it is through the biao li binding that six pairs of meridians whose members resonates each one with the same change phase (wuxing): L.GB.wood, H-SI.fire, St-Sp earth, Lu-LI metal, and K-B water.

These pairs respond to human influences (li) or cosmos ones (biao) following the wuxing phases, pacing universe and man dynamism. Each movement responds to a coupled li meridian and a biao meridian. Thus we have two sources of influence, the one from man, and the one from universe: what comes from man resonates on li meridians and what comes from the universe does it on biao meridians, therefore biao is an interior-exterior notion which expresses the relationships between two coupled meridians and their organs in the interior of a same element. Su Wen 25 says that man lives in a body that will never leave yin yang.

Biao li is an intra-systemic bond in a close system (the human body) because it functions between the two coupled viscera in each pair. In the organism, li represents the internal system (zang) and biao, the external (fu) and they are distinguished because obverse biao subordinates to reverse li. Biao is the outer lining of the body while Li is the interior of such lining. In Biao the idea of manifestation is expressed and in Li the hidden life one, that which from the interior, from the depth, will show up in the surface going up through the organic layers, and through that same path what is on the surface will go back to the interior.15

The obverse-reverse biao li binding is different from nei wai inside-outside pair. The latter describes an inter-systemic bond: human body is a system and the external environment is a different one, and there are ties between them; nei wai16 ties which evoke those nexus in the internal areas of vitality (zangfu) with more external areas, the meridians paths. In turn, nei wai and biao li are related because the biao li interchanges arise from the nei wai spatial dynamic so allowing to distinguish visible starting from invisible, to perceive what is active in the latent, to get to the structures through the manifestations as Suwen 5 says.

Let’s make it clear that biao li indicates movements of life whereas nei wai (inside-outside) is closer to topographic references.

Among the cosmological roots, we cannot ignore the concept of resonance which is at the innermost core of Chinese cosmology and which appears in various texts from the “Warring States” period and the Empire (III and II centuries): all things and beings pertaining to analog categories vibrate, resonate in unison, correspond.

“Surveying Obscurities” Huainanzi17 chapter 6 deals with the ganying phenomenon whose existence scholars accept but cannot clearly explain. They describe it as an affinity vibration in the qi strength/force field which goes through the cosmos and it is not just physical resonance but emotional as well as intentional, therefore human actions have clear and predictable effects on the natural world. Hence, observing Dao and ruling properly lead to human happiness and celestial harmony. That is to say that not being clear about what it is but its existence confirmed, it claims that each thing is emulated in another one, in that which is analog due to its form or category. Resonances were not and are not abstract, there is always a material substrate for them to happen, and Chinese thinkers attribute field effects (generate energy and drive it) to everything that is alive in nature. This resonance contributes to the visceral functional pairing confirmed by anatomical relationship.18

These correspondences between macro and micro cosmos, between Heaven and Man realms thanks to resonance are not reduced to a simple parallelism, they pose a “vibrational” bond of mutual correspondence whose nature is defined by the yinyang relationship and which, according to Huainanzi reciprocally activates each other because they share the same breath. Qi (vital breath) is a cosmological notion that covers everything and if yinyang binomial is vital in its dynamism is because it is ruled by the resonance principle activated by qi.

And here we have one of the most endeared themes in the Chinese thought, the numerical game already mentioned by Lao Zi 42.19

The way generates the one,

The one generates the two,

The two generates the three,

The three generates all beings….

The yinyang pairing is met not by two elements but by three because the complementary alternation of two energies generates a third one: the moving force encouraged by duality. Yinyang parallelism without the three (emblem of motion) would be self enclosed repeating itself, without functionality: railroads gain sense with the presence of a train. With the three an infinitely transformable “parallelism” opens up. Chinese thought whether of Taoist or Confucian nuance, has always crossed Heaven-Earth influxes, and than crossing is the three conceived to go from duality to the ternary relationship that opens the field of the becoming. Thus the biao li pair obtains its dynamism, its “three” from qi, the cosmic breath thanks to which all circulations in the body operate.


CONCLUSIONS

Ever since its first manifestations in divinatory oracles, three millennia previous to our era, the Chinese vision of cosmos-nature facilitates the elaboration of the parallelism concept which evolves towards pairing, a notion that together with resonance phenomenon permeates all Chinese culture since literature - initial for­- and we believe it also serves Medicine whose practice simply confirms the success of this theoretical approach that this Medicine adopts recognizing pairs in a sustained and resonant energetic exchange, in health and in sickness. As an example, the biao li binomial represents the use in medical practice of the millenarian Chinese conception of pairing as a form of existential dynamism.


REFERENCES

Billeter, J. F. Contre François Jullien. Editions Allia. Paris 2006

Chemla, Karine. Qu'apporte la prise en compte dans l'étude du parallelism de mathematiques textes chinois? Extrême-Orient Extrême-Occident 11.PUV Paris VIII / EX 1989

Cheng, Anne. "A Yin an Yang, telle est la Voie: les origines du paralelisme cosmological dasn la pensée chinoise" Extrême-Orient Extrême-Occident 11.PUV Paris VIII / EX 1989

Gernet, Jacques.La Raison sur la philosophie des Choses.Essai Wang Fuzhi (from 1619 to 1692. Nrf Éditions Gallimard, Paris 2005

Javary, Cyrille J. D. Le Discours de la Tortue. Découvrir la Pensee Chinoise au Fil du Yi Jing. Albin Michel. Paris 2003

François Jullien. Une vision du monde fondée sur l’appariement: enjeux philosophiques textueles (a partir de Wang Fuzhi). Extrême-Orient Extrême-Occident 11.PUV Paris VIII/EX 1989

Lao Zi. Tao Te Ching. Anne-Hélène Version Suarez. Siruela. Madrid 2003

Liu Xie. El Corazón de la Literatura y el Cincelado de Dragones. Traducción y notas de Relinque Eleta,A. De Guante Blanco/Comares. Granada 1995

Major, J: S. Queen, SA Meyer, A.S. Roth, H.D. The Huainanzi. Columbia University Press.New York 2010

Neal, Edward. Introduction to Neijing Classical Acupuncture Part I: History and Basic Principles. The Journal of Chinese Medicine No. 2012 London 100.October

Peluffo, E. Medicina China.Claves Teóricas. Miraguano ediciones. Madrid 2013

Peluffo, E. Chinese Medicine Vol 2.Nº 4 December 2011 y Chinese Medicine Vol 5 Nº1.March 2014 http://www.scirp.org/journal/cm

Rochat de la Vallée, E Père Larre, Su Wen, Les 11 premiers traités. Maisonneuve. Moulin lès Metz.1993.

Schatz, J, Larre, C. Rochat de la Vallée, E. Les séminaires Europeenne de l'École d'Acupuncture. Éditions Su Wen S.A.S. Milano 1979



NOTES

1) Rochat de la Vallée, E Père Larre,C Su Wen, Les 11 premiers traités.Maisonneuve,Moulín lès Metz.1993: 123

2) Billeter, J.F. Contre François Jullien. Editions Allia Paris 2006 :18

3) Liu Xie . El Corazón de la Literatura y el Cincelado de Dragones. Traducción y notas de Relinque Eleta, A. De Guante Blanco/Comares Granada 1995

4) Chempla, Karine. Qu’ Apporte la prise en compte du parallelism dans l’etude de textes mathématiques chinois? Extrême-Orient Extrême-Occident 11.PUV Paris VIII/EX 1989 :53-75

5) Jullien François. Une vision du monde fondée sur l’appariement: enjeux philosophiques textueles (a partir de Wang Fuzhi) Extrême-Orient Extrême-Occident 11. PUV Paris VIII/EX 1989 : 45-52

6) Peluffo, E. Medicina China. Claves teóricas Miraguano Ediciones. Madrid 2013 :115

7) Gernet, Jacques. La Raison des Choses.Essai sur la philosophie de Wang Fuzhi (1619-1692) Nrf Ëditions Gallimard,Paris 2005

8) Gernet, Jacques La Raison des Choses. Essai sur la philosophie de Wang Fuzhi 1619-1692 Nrf ëditions Gallimard, Paris 2005

9) Liu Xie op.cit :239

10) Cheng, Anne. “un Yin, un Yang , telle est la Voie:les origines cosmologiques du paralelisme dasn la pensée chinoise” .Extrême-Orient Extrême-Occident 11.PUV Paris VIII/EX 1989: 35-43

11) Jullien, François. Op. Cit. : 45-52

12) Javary, Cyrille J. D. Le discourse de la tortue. Découvrir la Pensée Chinoise au Fil du Yi Jing. Albin Michel Paris 2003:93

13) Cheng, Anne op.cit:37

14) Neal, Edward Introduction to Neijing Classical Acupuncture Part 1: History and Basic Principles. The Journal of Chinese Medicine Nº 100. October 2012. London.:5-14

15) Schatz, J, Larre,C.Rochat de la Vallée. Les seminaires de l’Ecole Europeenne d’Acupuncture.ëditions Su Wen s.a.s. Milano. 1979. III. 21

16) Peluffo, E. op. Cit :151

17) Major, J.S. Queen, S.A. Meyer, A.S. Roth, H.D. The Huainanzi Columbia University Press New York 2010:207

18) Peluffo, E. Chinese Medicine Vol 2.Nº 4 December 2011 y Chinese Medicine Vol 5 Ni. March 2014 http://www.scirp.org/journal/cm

19) Lao Zi. Tao Te King Version Anne-Helène Suarez. Siruela Madrid 2003.


CHINESE DIETETICS AND NUTRENOMICS, POSSIBLE POINTS OF CONVERGENCE. E. Peluffo - DOWNLOAD PDF VERSION>


AUTHORS AND WORKPLACE

Laura Quilesa,*MD, PhD , Electra Peluffob MD, PhD

a Department of Anatomy and Human Embryology. Faculty of Medicine and Dentistry. University of Valencia, Spain.

b Master in Naturopathic Medicine, Homeopathy and Acupuncture. Department of Botany. Pharmacy Faculty. University of Valencia, Spain.

e-mail: laura.quiles@uv.es>


ABSTRACT

Chinese Dietetics versatility is a useful resource at both preventive and therapeutic levels. However, since it is founded on qualitative criteria of food, it is difficult for Western dietitians to assimilate Chinese Dietetics. Therefore, it would be useful to find common ground between both dietary theories. Recent advances in Nutrigenomics such as research on gene regulation by nutrients and discovery of new nutrient entities (i.e. xenomiRs), offer a potential molecular explanation to well established empirical concepts from Chinese Dietetics.


KEYWORDS: Dietetics - Traditional Chinese Medicine - Nutrigenomics - MicroRNAs.


INTRODUCTION

The rapid transformation of dietary habits that have occurred in the West in recent decades has meant a progressive abandonment of traditional food habits, which added to a growing supply of an each time bigger proportion of industrially processed food, has led to the gradual loss of people’s natural instinct towards a correct eating. On the contrary, rather than by its healthiness, food which is part of the diet nowadays tends to be chosen by its pleasant taste or the appealing sensations advertised. To a population largely confused about healthy eating principles we have to add the misinforming effect exerted by the periodic appearance of new dietary regimes, many of them of dubious recommendation. As a result of these circumstances, it is noticed a growing prevalence of different chronic pathologies largely related to incorrect nutritional habits This alarming sanitary situation is artistically reflected in the Chinese aphorism that reads: “We dig our graves with our own teeth” a phrase that also illustrates, clearly, the importance Chinese Medicine confers to diet as one of its basic pillars, and at the same level as tuina, acupuncture, fitotherapy or chi-kung. Therefore, it is of interest and it is the objective of this paper to try to bring this discipline closer to Western therapists, looking for possible coincidences that may relate the fundamental principles of the millenary Chinese diet therapy to current conclusions reached by new lines of research in nutrition, many of which seem to converge in their findings with the ancient Chinese principles.


CHINESE DIETETICS

The phrase “Do not eat just for pleasure although you can find it. Eat to be stronger. Eat to preserve the life heaven has given to you” is attributed to Kôngzi - Confucius (551- 479 B.C). Also in his Analects precise references about how to eat (Lún Yû 10-8) can be found. It is towards this pursuit of health and longevity through alimentation that Chinese dietetic is oriented. Proof of this are the ancient Chinese Pharmacopoeia and Diet Therapy treaties which have reached our days, such as the text “On Valuable Prescriptions” where Sun Simiao (581-682) devotes a full chapter to diet therapy entitled “Therapy by food” or the book “Essential Dietary Rules” where the Imperial Physician and Dietician Hu Sihui includes guidelines to maintain health through a proper nutricion, or the Bencao Gangmu “Compendium of Materia Medica” written by Lî Shízhen (1518-1593) in which Chinese fitotherapy and diet therapy are systematized. Although ancient, the ancestral principles of Chinese dietetics persist, even today, fully rooted in the Chinese culture. On the contrary, the West has forgotten a similar tradition shown in Hippocratic texts from V-IV B.C which have lost all practical effects and are only valued by historians of medicine. In this case, we are referring to Diet Treaties 17 and 18 and general pathological writing specially “On Airs, Water, and Places.”

The very old Eastern dietetics roots its basic pillars in the principle of balance between the yinyang of foods and the organism. It is a fundamentally preventive medicine. Sun Simiao, one of the greatest imperial physicians in Tang Dynasty already pointed to the use of Pharmacopeia only when Dietetics is insufficient1, although Chinese dietetics is also a valuable resource in the treatment of diseases once they are established.

The main advantage of this old nutritional system consists of its great flexibility and adaptability so that the diet is designed in each case according to the physiological needs and the nature of each person, adapting it both to their energy state and their environment conditions by choosing those foods which promote the natural energy flow inherent to each season and to each place, compensating therefore the effects of the climate agents. Thus, each diet dynamically adapts itself to the needs of each individual according to their age, state of energy, time of the year, and even to the hours of the day.

This versatility makes the energetic dietary into a preventive and therapeutic resource of inestimable value capable of being applied to any of the diverse existing culinary cultures. However, while its implantation in the East is old, in the West therapists who implement their treatments with proper dietetic guidelines tailored to each patient are scarce compared with those who apply other techniques of Chinese medicine with higher extension and acceptance. This lack of assimilation of the nutritional knowledge distinctive of Easter tradition may be partly attributed to its methodological divergence from the comparatively recent Western dietotherapy. While in the West nutritional therapy designs its diets based on a quantitative criterion of food based on its caloric supply and its macronutrients and micronutrients ratio, Chinese dietetics distinguish itself from the Western one by applying a qualitative criterion: a balanced diet is not necessarily one that contents the right amount of calories and nutrients, but that one that helps to keep the yinyang balance of the organism providing those foods whose energy qualities are the appropriate ones. In order to achieve this it is necessary to know the properties of each food as well as those of their combinations, also taking into account the seasons of the year, the cooking method used and the geographical location.


COMPARATIVE APPROACHES: NUTRIGENOMICS AND CHINESE DIETETICS

The complexity of the principles on which Chinese dietetics is based, has to be added to the existing distance between its way of expressing concepts and the analytical ways of Western thought. On the other hand, the indications that traditional Chinese dietetic systems have, could very well contribute to guide researches currently under way in the nutrition field. This could be the case in recent researches carried out about the effects exerted on the organism by the microRNAs present in food, named xenomiRs, which recently have shown themselves as a new nutritional compound with metabolic implications similar to those observed by Chinese dietetics.

MicroRNAs are small fragments of 20-30 pairs of nitrogenated basis (Carthew and Sontheiheimer, 2009) present in (all) organisms from viruses and bacteria to plants, fungus, and animals.2 They circulate through micro vesicles in the serum and plasma of human beings and animals3 and modulate various critical metabolic processes4 including cell differentiation, maintenance of tissue identity5, cell proliferation, apoptosis, intracellular communication6, and immune response against viruses and bacteria.7 Thus, the deregulation of microRNAs has been related to the development of various types of cancer8, metabolic diseases both cerebral9 and infectious. The most interesting question raised by the study of microRNAs is whether the microRNAs present in food, or xenomiRs, can fully access to the interior of the organism affecting the genetic and metabolic regulation.


PROMISING RESULTS OBSERVED

According to its qualitative characteristics, Chinese diet therapy classifies food into different categories which are linked among themselves when it comes to recommend a specific diet. The main classification is established based on the more yin or more yang nature of the food, but this categorization is associated with others based on the four energies, the five elements or the five flavors and the movement of the qi that food arouses in the organism.

Huang Di Nei Jing Ling Shu says: “Toxic drugs10 fight the pathogenic factors, the five cereals nourish the body, the five fruits help the body, meat from the five animals benefits the body, and the five vegetables complement the body. When eaten together, they fill the vital substances11” (Ling Su 56) because each flavor that gets into the body joins its viscera selectively, thus increasing the qi, normal product from the transformation process of food, but too much of the same thing is cause of disease12(Ling Shu 63)

The five flavors plus the four energies (cold, cool, warm, and hot) are the basis of culinary combinations and of Chinese Pharmatherapy as well. The flavors make the qualities of the essences which compose a being or a food.

The theory of the five elements is reflected at food level in the five flavors13 (sour, bitter, sweet, hot, and salty) because each of them has the properties able to specifically influence in their corresponding viscera-organ (zang-fu) and subsidiary meridians. Thus, acid corresponds to wood and favors the liver and the gallbladder, bitter to the fire (heart-small intestine), sweet to earth (spleen-pancreas and stomach), hot to metal (lungs-large intestine) and salty to water (kidney and bladder) (Su Wen 23-150-2) Regarding this classification it has to be taken into account that the term “flavor” refers to the nature of the food and not necessary to its palatability. In practice, a healthy regime will provide a balanced equilibrium of the five flavors, whereas the excessive consumption of a certain flavor will turn out harmful for its specific zang-fu as well as for its tissues and associated meridians, and for the energetic flow in the body.

This qualitative Chinese concept of the action of foods which seems completely oblivious to the quantitative principles of the classic western dietetics could begin to establish inclusive connections in the principles belonging to a young science, the Nutrigenomic, branch of the Genetic Epidemiology that integrates Genetic and Nutrition.14 Neither genetics on their own, nor the study of environmental factors applied to nutrition by themselves, can explain the causes and development of chronic diseases15 that is why Nutrigenomics seeks to facilitate a genetic and molecular comprehension of how nutrients influence the balance between health and sickness, altering the expression and/or the structure of the genetic expression. This new science, which focuses its studies in the molecular mechanisms underlying in different genetic responses of each individual to diet factors, can be summarized in the following points: diet components act on the human genome whether direct or indirectly altering the expression or structure of genes; under certain circumstances and in certain individuals, diet can be a serious risk factor of suffering disease; some diet regulated genes are involved in the onset, incidence, progress and severity of chronic diseases; to what extent diet influence in the health-sickness balance depends on the genetic information of each individual; the diet intervention based on the knowledge of nutritional requirements, nutritional state and genotype could be used to prevent, mitigate or cure chronic diseases.16

In the field of Nutrigenomic, it has been proved that beyond their nutritional roles, nutrients are capable of modifying the genetic expression and the function of target cells therefore affecting multiple fundamental biologic processes. An example of this effect caused by micronutrients is the implication of Vitamin A in the regulation, by adaptive thermogenesis, of levels of body fat by means of UCPs proteins activation.17 Likewise, this effect of direct genetic regulation has been observed in macronutrients, especially in lipids which are involved, for instance, in the regulation of a lipid profile based on the amount of fat ingested18 or the type of fat19 present in diet.

In this regard, given the existence of interaction of the macronutrients and micronutrients with specific actions on the genetic regulation as well as on the endogenous production of microRNAs20 it could be said that the specific proportion/ratio in macronutrients, vitamins and minerals of each food would give a plausible explanation of its specific quality of action in the field of Chinese pentacoordination zang-fu.

However, in Chinese diet therapy, in addition to the five flavors, a sixth flavor is recognized, the insipid or Dan which does not correspond to any element or zang-fu. The insipid is rather a lightness that can/may indicate a sublimation of the five flavors.21 In this context and following the Chinese thought, the concept of insipidness lacks antinomy, basic yinyang complementation, because insipid contains the other five flavors. It is the fullness, the neutral and undifferentiated background of things, that is to say: the center.22 It is in this concept where Chinese dietetics seems to find its parallelism with the most recent and revolutionary discovery carried out in Nutrigenomic field: the effect of exogenous microRNAs or xenomiRs in the genetic expression of living beings/creatures.

In 2012, Zhang L et al. discovered that the microRNAs in plants were transferred to blood and tissues through ingest and that once inside the organism they performed the same functions as endogenous microRNAs, regulating the genetic expression and therefore, the cellular function of specific target organs. This same process also occurs in the case of xenomiRs coming from animal alimentary sources, but the great similarity of these animal xenomiRs with those in human organism makes them much more difficult to detect and study.23

And that is the reason why xenomiRs can be considered as a new micronutrient, at the same level as vitamins and minerals24 playing an active role in genetic modulation. Given that human diet is extremely varied and includes different proportions of multiple species of plants and animals25 according to each geographic area, and since plants encode hundreds of thousands of xenomiRs, science is currently working to determine how many of these xenomiRs have a potential as a regulator of the genetic expression. Likewise, it could also be deducted that this specific effect on the modulation of the metabolism inherent to xenomiRs, would also allow integration with the Chinese traditional classification of foods according to the movement of the qi they arise in the body.

On the other hand, it has been observed that the processing and cooking, as it occurs with other micronutrients, may affect the amount of xenomiRs present in plants26 and also it is currently being studied which culinary techniques in each case affect which xenomiRs and to what extent. It is interesting to note how, in a similar way, in Chinese diet therapy apart from each food qualities, the cooking method is also taken into account27 (Rochat de la Vallée & Père Larre, 1993) the same occurs with the changes in flavor and nature that take place during preparation, given that each culinary technique may have an influence on the qi of the food thus making it vary its nature to the point of conditioning a different therapeutic or preventive use, which will depend on the season of the year or the energetic state of each person.

Generally, Chinese dietetics, both with preventive and therapeutic purposes, tend to use combinations of foods, which according to their properties give raise to various types of combinations classified according to the “ 7 consequences” theory, including from the insulated use of food to synergistic combinations. Combinations of: Interpotenciation type (xiang xu) between foods of the same nature which reach a mutual reinforcement of their effects, Interassistance (xiang xi) when adding an auxiliary food that reinforces the main food effect or, on the contrary antagonistic combinations such as Inhibition (xiang wei) where a food decreases the effect of another one or Incompatibility (xiang fan) or those combinations banned because of their possible harmful effects. It would be advisable to carefully analyze those combination between foods described since ancient times in the East when facing the design of future researches on predictable interactions that xenomiRs from different food may have in their effects.


CONCLUSIONS

It is very important to point out and highlight the solidity and full validity of ancestral Chinese knowledge which, when analyzed from an analytical point of view, reveals the successful proof of its empiric knowledge thus finding its scientific foundation so necessary to Western thought.

In the same way that the recent discovery of the functioning of the xenomiRs in food contributes to provide a molecular explanation to empiric aspects of Chinese dietetics, it can also be deducted that traditional indications from Chinese dietetics could be useful when planning future researches in Nutrigenomic field. So, in this way, the confluence between the explanations inherent to ancestral Chinese dietetics and modern Nutrigenomics contribute to a more accurate comprehension in the West of the principles of Chinese dietetics, away from the biomedical way of thinking.

Ultimately, both sides of thought finally lead to the same reflection: the ecosystem we live in is interconnected and species are not isolated, rather they are interrelated to each other. There is a communication among all living organisms and between organisms and their habitat and this is a fact that must lead the principles in dietetics.

This possible confluence between the millennial Chinese dietetics and new researches in Nutrigenomics field is forcing a major digging into the possible convergence between the two systems, in order to provide a molecular basis to empiric Chinese theories as well as to give direction to future researches in Nutrigenomic field from the claims of Chinese dietetics, essentially based on the longstanding conviction that man-microcosm reproduces the macrocosm.


CONFLICT OF INTERESTS

The authors claim not to have any conflict of interest.


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30.) Ryu MS, Langkamp-Henken B, Chang SM, Shankar MN, Cousins RJ. Genomic analysis, cytokine expression, and microRNA profiling reveal biomarkers of human dietary zinc depletion and homeostasis. Proc Natl Acad Sci U S A. 2011 Dec 27;108(52):20970-5. doi: 10.1073/pnas.1117207108.

31.) Davis CD, Ross SA. Evidence for dietary regulation of microRNA expression in cancer cells. Nutr Rev. 2008 Aug;66(8):477-82. doi: 10.1111/j.1753-4887.2008.00080.x.

32.) Rochat de la Vallée, E. Les 101 Notions-Cles de la Médecine Chinoise. Guy Trédanietl Éditions. Paris 2009 : 212.

33.) Jullien François. Elogio de lo Insípido. Siruela. Madrid 1998.

34.) Zhang L, Hou D, Chen X, Li D, Zhu L, Zhang Y, Li J, Bian Z, Liang X, Cai X, Yin Y, Wang C, Zhang T, Zhu D, Zhang D, Xu J, Chen Q, Ba Y, Liu J, Wang Q, Chen J, Wang J, Wang M, Zhang Q, Zhang J, Zen K, Zhang CY. Exogenous plant MIR168a specifically targets mammalian LDLRAP1: evidence of cross-kingdom regulation by microRNA. Cell Res. 2012 Jan;22(1):107-26. doi: 10.1038/cr.2011.158.

35.) Zhang HS, Wu TC, Sang WW, Ruan Z. MiR-217 is involved in Tat-induced HIV-1 long terminal repeat (LTR) transactivation by down-regulation of SIRT1. Biochim Biophys Acta. 2012 May;1823(5):1017-23. doi: 10.1016/j.bbamcr.2012.02.014.

36.) Rajagopalan R, Vaucheret H, Trejo J, Bartel DP. A diverse and evolutionarily fluid set of microRNAs in Arabidopsis thaliana. Genes Dev. 2006 Dec 15;20(24):3407-25.

37.) Chen X, Ba Y, Ma L, Cai X, Yin Y, Wang K, Guo J, Zhang Y, Chen J, Guo X, Li Q, Li X, Wang W, Zhang Y, Wang J, Jiang X, Xiang Y, Xu C, Zheng P, Zhang J, Li R, Zhang H, Shang X, Gong T, Ning G, Wang J, Zen K, Zhang J, Zhang CY. Characterization of microRNAs in serum: a novel class of biomarkers for diagnosis of cancer and other diseases. Cell Res. 2008 Oct;18(10):997-1006. doi: 10.1038/cr.2008.282.



NOTES

1) Flaws,Bob. 2002

2) Carthew RW y Sontheiheimer EJ, 2009; Lee HC et al, 2010; Janga SC and Vallabhaneni S, 2011.

3) Chen X et al, 2008; Mitchell PS et al, 2008; Arroyo JD et al, 2011; Turchinovich A et al, 2011; Turchinovich A et al, 2012; Zhang Y et al, 2010.

4) Bartel DP, 2004.

5) Bartel DP, 2004; He L y Hannon GJ, 2004.

6) Valadi H et al, 2007; Zhang Y et al, 2010; Witwer KW et al, 2013.

7) Ding SW y Voinnet O, 2007.

8) Suh SO et al, 2011; Lujambio A et al, 2007; Lujambio A y Esteller M, 2009; Li Y et al, 2012.

9) Weiland M et al, 2012; Calin GA, 2006, Esquela-Kerscher A y Slack FJ, 2006.

10) Toxic not in its absolute meaning but as something harmful but whose use should not be banned since they can play the role of beneficial stimulants and they are part of the composition of numerous therapeutic indications.

11) Ling Shu 56. Versión de Milsky,C & Andrès, G. Édition La Tisserande. Paris 2009: 313

12) Ibid63 : 335

13) Rochat de la Vallée, E & Père Larre,C.Su Wen.Les 11 Premoers Traités. Maisonneuve,1993 :308

14) Ordovás JM et al, 2004

15) Sing CF et al, 2003

16) Kaput J et al, 2004

17) Bonet ML et al, 2003

18) Ordovas JM et al, 2002

19) Warodomwichit D et al, 2009

20) Ross SA and Davis CD, 2011; Ryu MS et al, 2011; Davis CD and Ross SA, 2008

21) Rochat de la Vallée E, Les 101 Notions-Clés de la Médecine Chinoise. Guy Trédaniel Éditeur 2009 :212

22) Jullien F, 1998

23) Zhang HS et al, 2012

24) Zhang L et al, 2012

25) Rajagopalan R et al, 2006

26) Zhang L et al, 2012; Chen X et al, 2010.

27) Rochat de la Vallée, E.& Père Larre, C. Su Wen Les 11 premiers Traités. Maisonneuve 1993 :134


SHEN HUN PO. E. Peluffo - DOWNLOAD PDF VERSION>

SHEN (mental energy, spirit, soul…) resides in the heart, which is why it is so important in Chinese medicine as well as in other medicinal practices. We can say in passing that this way of thinking is not uncommon in the West insofar as in Paracelso’s hermetical medicine the mind is situated in the highest part of the right auricle.
Shen is harboured in the heart, and if we have emotions that upset the heart our mind loses harmony. It is one of the reasons that the Taoists sought to liberate themselves from their emotions in order to achieve a strong Shen. The liver is also involved as it is responsible for harmonizing emotions and you cannot separate Shen from the brain, the special organ that controls the mind, another name for Shen.

In acupuncture, each viscera is characterized by a tendency towards a specific action, which differentiates itself from others and so defines its function in the body. They resemble that which to us is known as “vegetative souls” corresponding with “sensitive souls” not exactly the same but close. Each individual is unique, and no one else, through Shen. According to Chinese thinking Shen is not an abstraction, it is a reality which determines unique characteristics in each individual, Shen shapes that which will be the individual. One of the meanings of Shen is the type of “aspect” the person has, that is to say how Shen applies to spiritual and organic conditions. It is only through the heart that the shen of each zang arrives at its designated organ, as the sovereign is inside his ministers represented by them. For the Chinese, of all the human activities the most important is the shen. They represent an expression that designates the general phenomena of human life, its conscious and subconscious activity. It picks out the individuality of each organ. Harbouring Shen gives the heart the knowledge as to all that happens in the organism. In China there are five sacred mountains, but in reality they are assumed to be distributed throughout the earth (China was the world) those that were considered the support of the earth. There was one in each cardinal point and the fifth in the center which had a ritual importance.

In these the monarchs made requests, prayed to the Heavens and made sacrifices because the spirits lived in these. Tai, that of the East, was the creator of human beings, controlled the duration of life and corresponded to spring and even in this day and age it has sacred connotations. It was the principal place to summon the spirits of hun and those of po. The mountain of the West represented autumn and the death of nature as part of the life cycle of human beings. It is important to highlight that the school of wuxing did not value life and death in a positive or negative way as the main object was the harmonic equilibrium among the cosmic forces.

Po is translated as the soul, a sensitive terrestrial soul, vigour, spirit, a physical manifestation of a sensitive soul, and hun also like soul, as the vital source of a human being, mood. It is the human soul produced by the progressive condensation of air breathed in; the Taoists considered Hun as one of the three main essentials, that after death was kept alive with offerings from the living. It is always a risk to speak of the spirit as for an occidental the idea of a spirit is different from that of an oriental. For occidentals the soul is one and indivisible but for a Chinese, if as we have mentioned has the idea of Shen as a force and energy that forms an individual in the widest sense of the term, from this Shen more specific concepts are derived to designate those particular elements which form an integral part of a human being.

We speak on one hand, of the body po, flesh and bones and on the other hun, a spiritual element by which hun and po show the composition of man. Lingshu 8 says: that which moves with Shen actively giving form is Hun which implies the existence of a global Shen; the potential capacity to structure is represented by po.

The hun control the mental human essences because they were air above all (yang in the yang and also yang in respect to po) and they return to the air in which they remain after death. It is also something that governs the instincts and nature of every person. Po on the contrary heads towards earth (yin in the yin) because of its control of fluids, of flesh and bones essentially earth into which it will enter again after death; it had above all power over emotions. Hun represents the forces that model personality and po the structure that permits the fulfillment of psychic functions. Each organ has its soul. They appear in this way in the Classics although in truth hun and po do not appear in ancient medical texts. Later they will change from being one hun and one po to three hun and seven po. This is interpreted that three Hun is a reference to the social relations of man: sovereign/subject , father/son, husband/wife. The seven po elements refer to the seven orifices of the body and therefore to the senses and the seven emotions that were described in that era: anger, hate, happiness, desire, sadness, fear. If illness presented itself it was because some hun or po was missing and one would die if the ten abandoned man, so it was evident that life and health were the harmonious amalgam of the ten elements.

As the hun after death is left wandering in the air and the po in similar circumstances comes back to earth, this gives root to postmortem filial piety, to the cult of the ancestors and the funereal monuments for the dead to dwell in so that their hun and po would not disperse and thus would serve as beneficial souls, intermediaries between their descendents and the Heavens. Behind the idea of the spirit in every organ, the hun soul is directly subject to Shen and corresponds to the liver, vegetative soul whose model puts all the dynamic organic in motion, it commands the rise, the breaking away, the creation. Under hun are imagination, planned thought, dreams, intelligence and meditation.

Po, vegetative soul of the lungs, spiritual natural force of the lungs, bound to the essences, possesses the necessary energy to conduct and look after all this mechanism. Po governs the descent, the harnessing of the elements, all that which is related to instinct and to the automatic care of the body. At the same time it is a hieroglyphic, which in astronomy defines the dark invisible portion of the moon. Functionally the lung is united to the large intestine and this is because po also is made up of a residue of vitality whose waste matters are eliminated through the anus which is called the gate of po, thus coinciding with the return of the po’s to earth, in comparison with the hun’s which go into the air. Any illness or malaise is directly implicated to Shen or the spirit. If we speak of energy we have to speak also of the soul or spirit of Shen, a form of energy complimentary to material energy. We will remember the Jing Essence, the Qi Energy and the third “treasure” the Shen Spirit, where the human conscience takes root and altogether are part of the individual; there is no mind/body dichotomy in Chinese thought. The harmonious Shen keeps the mind clear and the will firm, it reacts reasonably to the surroundings, there are no irrational thoughts or incoherent actions.

References:

Cochran, Warren “History and Philosophy of TCM”. Spring Semester 2002.Sidney University of Technology. College of TCM

González González,Roberto y Yan Jianhua “Medicina Tradicional China”,Grijalbo, México 1996

Matsumoto, Kiiko, Birch, Stephen “Hara Diagnosis: Reflections on the Sea”, Paradigm Publications. Brookline,Massachusetts,1988

Lavier,Jacques, “Histoire,Doctrine et Pratique de l’Acupuncture Chinoise”, Tchou Éditeur,1966.

Marmori,F y Chen Yue Ling, traductores de “Origen de la Medicina China” Porkert, Manfred. “The Theoretical Foundations of Chinese Medicine. Systems of Correspondence”. The MIT Press.Cambridge Massachusetts, 1973

Rochat de la Vallée,E. “SUWEN Les 11 Premiers Traités”. Maissonneuve. París 1993

“The Mawangdui Medical Manuscripts” Translation and Study Donald J.Harper. Kegan Paul International, London and New York 1998

Tomoyoshi Saito. “The Beginning of Acupuncture”.EJOM.vol 4 Nº1 Summer 2002

Unschuld, Paul, “Huang Di Nei Jing Su Wen”. University of California Press.Berkeley 2003

Unschuld, Paul, “Chinese Medicine”. Paradigm Publications. Massachusetts. 1998

Veith, Ilza “The Yellow Emperor’s Classic of Internal Medicine”.University of California Press. Berkeley and Los Angeles.1949

THE WEST AND THE EAST: Reciprocal attraction? - DOWNLOAD PDF VERSION>

Cartography:
The division of Orient/Occident from the cartographic point of view of in a planisphere form is, shall we say, “Ptolemaic”, the earth flat; but the earth is spherical, it is difficult to determine where the orient starts or where the occident ends, to this end we are helped by the Greenwich meridian but it’s clear that the concept is dynamic. Ptolemy divided the world into seven climates in a latitudinal sense subdivided in ten longitudinal sections. In China we are presented with the planisphere in a different manner, most correctly, in accordance with their idea of the world. China is the Empire of the Centre and they assumed that they were situated in the middle of the Four Seas surrounded by four barbaric populations. In one of the legendary versions Huang Di one of the three founder Emperors of Chinese lineage, was born from the spontaneous fusion of the Yin Yang energy in the autocreation of the world: later he, in his time, created the first men from statuettes of clay exposed to cosmic breath during 300 years to acquaint them with the four cardinal points thus permitting the explanation of the different appearance of men according to their geographic origin, by light and other climatic factors that they were affected by. Asia, for Europeans, is the Orient – and to get there one has to go past the Near East, the Middle East and finally the Far East -, and Europe remains the Occident, that territory bathed by the Atlantic, a definition which eliminates nothing less than Italy, Greece and others. This taking into account the nomenclature and kinds of differences that exist between both “sides”. In dictionaries it is said that the Occident is the place where, in the equinoxes, the sun sets (although we all know that the sun neither rises or sets it is the earth that turns) and the Orient is the point in the equinoxes where the sun rises, which perhaps is valid for agriculture, astronomy, fishing, aviation and most surely many other things. The Greek way of thinking, the Ionic, of which we are more knowledgeable, had its source in Asia Minor and received clear Indo-Iranian influences in that epoch, but in reality it is a conventional Occidental way of thinking which influences medicine and other things. At present some of the countries in this zone are trying hard to incorporate themselves into Europe, which is resisted because traditionally Turkey is further away from the European frontiers, and Europe is the Occident. The political frontiers are limiting, even sterilizing, although they don’t halt the influences which pass from one side to another, like the wind, the pollen, epidemics, languages, thoughts and this makes it difficult to determine exclusively which thought or idea belongs solely in one place. Despite the fact that it is old fashioned to use the parallelism/opposition both geographically and soci-culturally between the Orient and Occident, the theme requires constant explanations about how each one interprets this aspect. For me it is more of a form to get closer to the traditional yinyang of the Chinese, where everything is relative. This partition does nothing but share in the wise decision of oriental thinking when it maintains that everything divides in two to carry out its action and get back to a unit; in this case the planet earth or theoretically the paradigmatic opposite/complimentary of all the elements of daily life. To have obscurity at night the sun which illuminates the day has to leave, but the sun doesn’t leave, it is shining in another zone of the globe. We only recognize evil because we know there is good and so we can carry on until infinity with concrete themes and practices or theories and abstracts. Apart from the astronomic division in terrestrial meridians that establish correspondent spaces, between us if you wish to see the Orient as that site where religions are polytheist while in the West they are monotheist, or according to the British, that the Orient starts at the line that demarcates Palestine, which is converted into the occidental protective flank of its Indian colony of the Far East, or in the question of cultures or civilizations all that is in the planisphere in European style that stays to the right of Iran is the Orient and all to the left the Occident ;or is the Orient all places original sin is unknown which is the fundamental myth of the Occident …that is to say imprecise mobile references. Occident Occident: comes from the Latin occidere, to fall. It is the Cardinal point of the horizon where the sun sets in the equinoctial days. Place on earth or of the terrestrial sphere with respect to the other with which it is compared falls where the sun sets. Occidental: It is said where the planets position themselves after the sun sets. . In sociology all which is bathed by the Atlantic Freemasonry: the side of the lodge where the vigilantes are. History: a group of European nations of the West in opposition to those situated in the East, after the Second World War, the countries allied to the United States against the Soviet block. These definitions coincide with those that support that it is the Occident that looks at and is bathed in the Atlantic. The Occidental part of the Roman Empire since the partition of the Empire as a result of measures taken by Diocleciano which are associated with the power of Maximilian, but the real division happened with the death of Teodosio (395 A.D.) between Honorio (Occident) and Arcadio (Orient) The Empire of the Occident lasted until 476, when Odoacro overthrew RomuloAugusto. The imperial idea survived the disappearance of the Empire and was established by Pope Leon III, in favour of Charlemagne who was acclaimed Emperor of the Occident. Orient From oriens, participle of orior, that which is born or appears again. The point where the sun was born in the equinoctial days. Group of ancient countries situated in the East in relation to the occidental part of Europe (covers Asia, Egypt and including a part of Europe) The Roman Empire of the Orient is the Byzantine Empire In reality, that which we find isn’t, as Huntington maintains,(which seems to me erroneous)a collision of civilizations, for me it is much more Weltanschaung: a vision of the world, a concept of the world, a feeling of life, ideology, ideas, that which helps us with the rich interchange between one and another. In a certain way and in many aspects now we are living it as a daily experience. That of the Occident and the Orient is and isn’t cartography and lends itself to many other readings. It’s clear that sometimes east/west opinions are represented with a receptivity/power attitude. The Occident, in its way, aspires to dominate nature and thus its scientific attitude; science in essence isn’t only an explication of natural phenomenon but also discovering its laws and applying them transforming the means to serve man better. Life for the Occident is evolution and progress, a straight line. The Orient centres on revolution, permanent changes that come back to the starting point or near to it, relations associated between elements, a circle. But it isn’t so clear that the Occident is the path to follow, there are drawbacks, one doesn’t dominate nature in many aspects. In medicine, which has made a giant leap since the second half of the XIX century, there have appeared “new” illnesses which in a certain fashion are transformations of the previous “extinct ones” or, those that have been dominated return, and all generally in an atmosphere of apocalyptic fear of uncontrollable epidemics for which immediate cures are sought.. Humility is not learnt, arrogance places its stamp. Interchange It is said that Occidentals tired and decadent, anxious to anaesthetize their emotions, look for salvation, wisdom, the spirituality of the Orient and to even creating the term Orientalism which appears to denote the form in which the non occidental is presented before us in order that we can get the most of it and suppress that which doesn’t suit us, above all in political contexts.. Also it has been suggested less critically that Orientalism is formed by the distinct forms in which the West uses the Asian way of thinking to resolve its own kinds of problems … and it is said that something or someone has occidentalized themselves by an external form or its customs: dress, speed, illuminated advertisements, soft drinks, personal income, mediocre music with local influences, round eyes… in some occidental cities with a strong Asiatic immigration one can find newspaper advertisements for surgery on oriental eyes to give them an Occidental look. In turn it is also maintained that, in exchange, Asiatics look for our technology and material well-being, our ability in promotion. I don’t agree much with this. China since ancient times exported occidental products elaborated with their technology and I find it difficult to think that the Japanese or the Koreans only look for technology in Europe, when we enjoy a multitude of inventions coming from these places, they look for ideas to contrast with their own. Countries of great industrial development like U.K. or U.S. value the brains of Hindus and Chinese for computer astrophysics and other complex sciences although it is clear that actually the principal parts of technology were created and made in the occident. We could agree that if wasn’t for the numerical Indian and Arab notation much of European progress in science and technology would not have taken place. How could one do calculus using European Roman numerals? We know that the earth is spherical, that is to say it’s not possible to isolate one territory from another, ideas arrive and more so now in this world of communication and voyages. Also Europe originated spiritual movements which were later expressed in its art, its philosophy, its literature, its religion … nor is incense, which is so “oriental”, exclusively from the Orient, but these contributions were always marked by the perpetual dispute between theological spiritualism (gods, angels, spirits… ) an inheritance from the Jews, Egyptians Babylonians and the materialistic mechanism of the atom and the void of rationalist Greeks. (Needham Joseph, Dentro de los Cuarto Mares, XXI century, 1975). It happens that one system as much as another presents holes, large areas which don’t offer explanations or solutions to many problems which the public and /or students point out in their search, and these vacant spaces used to serve, as in the case of acupuncture in the twentieth century, to absorb techniques, ideas, focuses which come to fill these deficiencies. Or referring to the sanitary situation in China at the end of the19th century and beginning of the 20th occidental medicine could have been introduced in that country. We should recognize that in the last 500 years the Occident has predominated over the other half of the world, in initiative, technology, imperialism. When we say Occident we clearly mean the countries bathed by the Atlantic whose progress comes from the great power that they exercise over nature ever since the scientific renaissance movement. And in some way the pendulum looks as if it wants to return to the ancient position of a lost equilibrium, later maybe, to the predominance of the Orientals? In the Far East it seems that humanity matters more than the person, on the other hand in the Occident identity, individualism is beyond the knowledge of many. We look to the orient as an exotic space, colonial and able to be colonized and the fear of “the other” induces us to try to dominate them. It gives the impression that the Orient, near, middle and far each time looks at us more closely so we can observe the “other” through ourselves, experimenting, always asking ourselves how to understand them. Origins These reflections take us far in space and time and we should annotate them in space and time. When we speak of the Occident we refer to Europe, which is more homogenized despite its diversities. Its culture, simplified, comes from two roots, Greek and Hebrew and its religion, with a variation of rites and differences in the interpretation of the texts is Christianity. These roots in turn were nurtured by previous cultures, Egypt, Babylon … The Greek roots being pagan, do not speak of the Being, because it exists in everything. The Greeks did not recognize the nothing, nothing doesn’t exist, everything flows, nothing can emerge from where there is nothing, but what there is negates the nothing. On the other hand the Hebrew or Jewish roots give us a creator, which is not creation and so the nothing existed before this as opposed to a creator, and man –his child- the only objective of In the orient there is not a homogenized philosophy, ethic and /or religious order: Taoism, Buddhism, Confucianism, Brahmanism, Sintoism are not the same because of the different nuances. This limits us to China where all these forms of ethics have coexisted. Religious structures, the composition of society and its habits, ecology and many more factors are the product of a great many of all types of dynamics and also religions condition the form of capturing the realities surrounding the inhabitants of a zone. There are millions of people who continue to think according to the Greeks of the past and there are, who knows, millions more who continue reacting in accord with the Taoist concepts and or Confucians of the orient. M. Heidegger in one of his writings mentions that “the confrontation with Asiatics was, for the Greeks, a fertile necessity, today it is for us, in a completely different way and in much greater dimensions, what will decide the future of Europe, and of what we call the occidental world. And you encounter, as in my case, two types of actual medicine which, who knows, in the past were not so remote. The greater mobility and the undoubted facility of movements allow that anyone who wants to could get to know the other. This in general brings preconceived concepts, common prejudices that inevitably condition what we see. And if the spirit is tolerant and intellectually lively the judgment will be positive.. .these Orientals !… And I imagine that they would say these Occidentals!… A definition of what signifies being Occidental isn’t easy because above all it escapes imprecise racial limits. For example Australians in the middle of the Pacific are Occidentals when a little more to the north you find Indonesian archipelagoes inhabited by people of an oriental race, religion and customs that we visit with Occidental interest for its exoticness. The economic factor is no small issue, as apart from the Japanese, Orientals don’t come to see what we have here, they can’t, if they come it’s because they are attracted by the commercial and labour possibilities, for the well-being of the Occident which is enviable, above all that of the enviable occidentals, since there are legions of people in that part of the world who cannot be envied. Cultural and Social Fabrics The individual attitude reflects a collective attitude, intrinsic characteristics of every community, every social group and the reverse. I don’t have the arrogance to want to define the concept of culture, but to reason a little about this will help us to understand each other. Culture leads us to etymological relatives, cult (worship), cultivation… Every one individually and in all societies are confronted by “the unknown” “the other” which at the very least awakens curiosity, distrust, astonishment. We try to control this new host, this new surrounding, the unknown, the mysterious. To this end an effort is necessary. If it involves a group, guidelines should be established and laws passed to enforce events and relationships in order to co-exist. In societies a pact and an organization are established which determine acts and official communication: the cult (sometimes even sacrificial) to communicate with “the other”. This is all very well but it won’t advance if we don’t cultivate these rites and that signifies rules that should call for periodic reiteration. So with the cult and cultivation of these we establish customs that convert into tradition, transmission, culture. Included in this are beliefs, religions with their collective and individual components. If a “religion” doesn’t initiate its followers in the first place into the “knowing of oneself” it will only be a system of politically useful beliefs and cults that will obtain that which is looked for from the people but is sterile in other ways. In a closer Orient, with Islam resisted strongly by us, civilization and culture assimilates into a tree, roots, trunk foliage, they say specifically that the foliage is the variety of Islam, leaves to communicate with the exterior, be pollinated, and if this foliage is cut all the tree could die. Metaphors that we would like to be reality. I can’t speak of philosophy. But I am capable of knowing that the Chinese thinking is far from the European rationalism of Descartes, although we consider Descartes a “newcomer” in the large history of Occidental thought , which imposed the cogito ergo sum, so influential and not always for the good, in the theory and practice of medicine. The Chinese thinker is more of a sage, erudite, learned (Confucian) and a good connoisseur (Taoist) of life and nature. To the Chinese in ancient times it was clear that knowledge in itself did not serve as simple conjecture, but rather that its utility lies in helping to understand life itself and establish rules of behaviour that facilitate it. Large and detailed psychological studies of groups of Occidentals, of Orientals and emigrants in one or the other place who keep strong social ties with their origins, show the differences; in the Occident it is necessary to measure everything and furthermore show it. However, although this isn’t bad, it occurred to me that differences are born with the world so it is impossible that everything is equal in all places because when it is day here it is night there and it is as well the following day, this circumstance establishes differences, and it conditions, because it occurs during millenniums, so that even as much as we go on learning co-existence or the closeness of both hemispheres and their interchanges are not new. I would like to give some guidelines that can help us understand the differences in thought and also language and in many other cultural expressions, using the term culture with the idea, as I said from the beginning, of transmitting cultivation to the cult. We as Occidental inheritors of Greek thought do not accept contradiction, we cannot accept it, it’s either black or white and in medicine doctors live with the opposites benign/malignant for example or acute/chronic, something cannot be one thing and the opposite at the same time. I know little of philosophy but I understand that this attitude derives from the thinking of Aristotle who established categories that subdivided the thinking and knowledge that existed in that epoch. It was the Greeks who were great observers of nature but their interpretation of this differs from that of the Chinese. It is a lineal way of thinking, of cause and effect that gives rise to this or that occurring for some reason. However in Greece there were some very original thinkers like Democrito who in his Fragment 9 maintains:” we in reality know nothing true, only the changes which are produced according to the disposition of the body and that which is introduced into it or offers resistance”. A shared thought with other fellow Orientals. Between the Chinese, as far as we understand, things are not like this. Firstly, contradiction is essential; if all were equal there would be no dynamism, movement, interchange. In the Greek classic Heraclito of Efeso the concept of contraries is assimilated into a dialectical notion of reality, but the idea didn’t get transcendence despite its originality in that epoch. The observation of nature indicates to the Chinese the circulation and return of movement, things move and have the tendency to regress, spring always comes back, for example, or the polar star turns in the sky according to a rhythm which will be the same each year as it was in the previous year, man is born, grows, reproduces, dies… This dynamism has maximums and minimums, we could call tides, which is a clear example of what is meant. If the Greeks think in a straight line, the Chinese do in a circle, almost I would say in a spiral, things turn, go away and return not perhaps to the same place but very close. The idea of a being without its counterpart of Non-being doesn’t exist nor the idea of above without under. This theme leads to more differences. The Occidental in his environment looks at objects, stresses individuality, the Greeks established democracy to realize the role of the individual, there are social relations and relatives but personal interest represses the rest. The Oriental looks globally and associates with environments, for him relationship is important, he associates with nature as well as society, he doesn’t place importance on objects, it’s an overall look, details will come later, if they arise. These forms of looking at one another establish, for example, a type of writing and on the other hand the writer teaches one to look in a manner convenient to him. All civilizations begin by expressing themselves with small drawings, ideograms but only China, Japan and Korea emphasize the conservation of this form of writing and lectures. Curiously despite the resistance that the ideograms unleashed in the Occident (the French alphabetized Vietnamese hieroglyphics, few colonial functionaries knew the local language) they copied these. I know it isn’t the same but ideograms are signals, syntheses, indications, like those that we see in airports, railways, public places, graphics without words explaining a service. Airplanes shown facing upwards leaving, airplanes facing downwards arriving, and anything else we want to interpret.. It is clear that this system between us does not permit abstract concepts, the truth, the patience, justice, liberty … but surely this was how many ideograms developed. That is to say with a global view, it incorporates, it grasps a message. In Occidental language it has to be spelled out, to look at one letter after another, usage accelerates the process, but studies of the theme show that before a painting, the oriental looks at the whole, at best he is not capable of recording or describing details, but the Occidental cannot talk of the relation between levels without describing objects. When Nissan wanted to make itself known in the States they put advertisements on T.V. of landscapes, trees, stones, very attractive places where one could drive to in a car and at the end of the ad came a brief image of the car. But what increased by a lot was the sale of trees, rocks and bamboo but not sales of the car. A lesson for the Japanese. Social relations in the Orient are very intense, among other reasons, in my opinion it is because there are so many inhabitants it makes individualism and to pass unnoticed very difficult. One has of necessity to take heed of the other. In the Occident we look for isolation, the island lost in the sea where there is only us and no one else. The Chinese look for the circle, the family, the neighborhood, the district, the city… For the Chinese the concept of change is basic, nothing is permanent; the only permanent thing is change. When Chinese medicine occupied itself with the organism, its structure and composition, it was given priority and described in great detail, the study of the movements of energy, that is to say the function, the processes, the physiology, more than anatomy which cannot be described when it is isolated from the dynamic Yinyang and Wuxing. Naturally, despite its theoretical content, both concepts are linked to material organic elements, the base for the development of physiology. Yinyang are the opposite and complementary terms of unidualism, they are two but form a unit which, if broken, signifies the disappearance of that which is represented. Wuxing, which means five phases, are the five movements of energy inside nature (and as well inside the human body) during the year and in every moment of the day, that is to say, action movement. And as Prof. Gustavo Pis-Diez so finely defined in a personal communication “ anatomy in China is “a verb” and in Greece a “noun”. Where the sustained thinks itself separated from the sustainer. Regarding this statement, which I share, maybe a brief comparative digression on nouns and verbs is helpful as seen from Greek culture and Chinese thinking. The Greeks, with Aristotle as champion, classified the world in a n attributes they passed as belonging to the same class, which came to be called horizontal thinking. But for the Chinese things fell into one classification when they were influencing one another through resonance. For example in the system of the five phases the categories of autumn, west, drought, metal and white all influenced each other and as so belonged to the same class and are represented vertically, vertical thinking. If the climate changed everything else changed as well. It was the similarity between classes and not the similarity between individuals that interested the Orientals, they were not preoccupied with the relation between an individual of a class ( fish) with the class in toto (vertebrates). In one of his writings Zhuang Zi tells us “.. to classify or limit knowledge breaks down greater knowledge”. The Chinese conceived the world as composed of continuous substances, so a relation of opposition between part/whole made sense. For the Greeks the world was composed of objects so that they encountered it natural an individual/class connection. That is to say when they knew that an object belonged to a specific category that possessed a specific attribute it could be deduced that other objects of the same class shared the same attribute. As Richard Nisbett so relevantly exemplified in The Geography of Thought (N.B.London 2003), if a mammal has a liver it is reasonable to think that all mammals have them. To center oneself on the categorization in the Greek fashion of one/many, brings by inference the knowledge beginning from the category individual/class but it doesn’t fit in with the representation part/whole. Objects in themselves were not the unit of analysis for the Chinese, they were their interrelation, mutual influence and resonance (verb, action). In regard to this Jorge L.Borges (Otras Inquisiciones, El Idioma Analitico de John Wilkins, Alianza Emece, Madrid. 1960) he attributes to a Chinese encyclopedia Emporio Celestial de Conocimientos Benévolos, that animals are divided into those that a) belonged to the Emperor; b) embalmed; c) trained; d) sucklings; e) sirens; f) fabulous; g) dogs on the loose; h) also included in this classification; i) those that agitate as if crazy; j) innumerable; k) that are drawn with a fine camelhair brush; l) etcetera; m) that have just broken a jar; n) that from afar look like flies. This is an impossible product of an Aristotlian Greek mind because these animals do not share any similar attributes to constitute a classification. . The above mentioned brings one to understand the large lists of questions related between them, the result of the movements between the five Wuxing phases. I could enumerate many other psychological studies or stories of individual or collective observations and answers which assert these differences, but maybe it would be convenient if I keep to the theme which was proposed to me by the organization of the Conferences of the Solstices: Is there a reciprocal attraction, that is mirrored between the Orient and the Occident? Is it true that there exists attraction between both worlds that focuses on the reality in a disparate form? There are individual sensitivities, but some people keep trapped in Occidental forms or the opposite, which seems more common, that the sensitive Occidental tries to understand the Oriental form of thinking and life different to ours. I see that multitudes travel in planes, boats, traveling kms, in long uncomfortable voyages to sunbathe when the sun also shines here, to see, buy and return satisfied to their house, very satisfied with their lifestyle. And all in exchange for anonymity, rest without anyone annoying them. I believe that among the Japanese, who are economically the most stable and at this point of time do not travel to emigrate, the same thing occurs. At the moment the countries of the extreme east are on the route to Occidentalism but without involving their essences, that is to say copying, they imitate to survive, and from what I could confirm, they try to fulfill in an exterior way, they see themselves committed to this, globalization is an economic reality and the economy is all powerful. The U.S. designed the Japanese constitution after the 2nd war, but the great democracy of the North had to necessarily include the monarchy into the system, it would not have been viable in any other way. And to copy does not appear to be in itself censurable because to copy one has to learn, understand the theory of that which is being copied and as learning is not static it follows that frontiers of knowledge will be amplified. In China copies have always been made, say of famous paintings, with the intention of attaining the same excellence as the original, if one is capable of reproducing such, if it is to the level of the grandmaster then it is emulated, it is perpetuated. Also in the Occident roman strategies were criticized for “appropriating” visual Greek culture and this critical attitude impeded for a long time the appreciation of the artistic merits of the Romans. Roman copies, exact or freehand not only reproduced Greek works, but also parodied them, referring to and above all emulating them in successful rivalry. Now in China they continue copying at an industrial level and they maintain that intellectual ownership should be, for example, that car manufacturers pay for the rights of design to the horses or to the carts. In every way there is an intense battle going on for the payment of rights. The interchange became more active at the end of the XVI century, with the Jesuits as prominent protagonists. The attempt at evangelization was not successful, it also triggered off various controversies in the Vatican. Finally the transcendental spirituality of the Orient came to resemble the meditation and trances of our mystic Catholics. For example the “quietism” of Miguel de Molinos, who was persecuted and died in prison because he encouraged introspection minimizing the observance of the rituals of the Catholic church, which was considered a “nihilist” deviation. That is to say he eliminated the theological fundamentals; looking at it from religion and from the vantage point of “correct thinking” this deviation is the essence of oriental doctrines. To resume it appears that “quietism” questions the hierarchy of the church and even more resembles the oriental doctrines where there is no creator, nor origin: beliefs without god. This circumstance coincided with the disapproval to the attitude of the Jesuits because in order to assimilate they attempted to participate in civic-religious rites of the Chinese, The Chinese Lord Of the Heavens was not the equivalent of the Catholic Lord of the Heavens. They reproached them that in forcing the Chinese texts they wanted to find in themselves an equivalent of God the Creator which characterized Christianity. That is to say our foundations (notions of truth, being, evolution) are not comparable, there are other ways of thinking, to which was added the concept of void that impregnates the oriental philosophies. The Occident fled from the void, as if it signified lack of foundations, the loss of theological tutorage of a Christian God who assured these foundations as a reference. Following this loss of tutelage, the world of Reason developed apparently equally sound which appears to have substituted theological ministry. But Reason opened new perspectives, new perplexities. The horror vacui continues to horrify. There were important dichotomies in the XVII and XVIII centuries when the physic notion of void was accepted after the definitions of Torricelli, Galileo, Newton , but the intellectuals, laity or religious, could not accept the void as it was accepted in the Middle Ages, there was no room in the cosmos for the Void, the void was impossible. For the Orientals only nothingness and the void constituted the principle of all things. In the Occident fear of losing confidence in absolute truths, or in secure foundations, is a eurocentric critical attitude, the product of ignorance and leads to nihilism, which is a reproachable flight before the horror of nothing. All these truths, which are not universal, will lose their equilibrium if we approach the orient. How can you convince an oriental that he should repent for original sin when not only has he not committed this but has never heard of it? There are numerous Occidental thinkers who are attracted by Oriental concepts, they try to understand and interpret the similarities and differences between the two worlds. It is clear that when one looks for something outside one’s habitual environment it is because this environment is not satisfying ones needs.. The Taoists constitute of a sort of “anarchism” that observes nature: if one fell ill it was because one had transgressed some natural law and to be cured one had to follow the rhythm of nature. Many times they were considered irresponsible and lazy but it wasn’t so, they respected the natural environment in which they lived, sometimes very isolated. Great observers, botanists, zoologists and artists copied them imitating the animal and vegetable life in which they lived. With ideas that they believed similar, the hippie movement of the 60’s headed en masse to the orient looking for the sources. There was no need to travel, the source is in oneself, the hippies looked for the forms, the wrappings. The Confucians understood that man could govern and be governed through laws and rules some of which were taken from nature but others were adapted to daily reality, establishing an order which facilitated life, above all that of the governing class. A society with a social scale, where each one fulfilled his job respecting order. They are the inventors of competitive exams, theirs was an ethical system governed by morals. Buddhism came 200 years after Christ to a China in a moment of decadence, grave economic crisis and a government distanced from its people submerged in misery. Buddhism maintained equality and reincarnation into better lives. It’s not surprising that there would have been followers in a society so castigated. But the upper classes also approved, maintaining Buddhist monasteries so that rebellions were not fomented which the Taoists, more independent, didn’t have any qualms in supporting if they found it necessary. Indian texts were translated despite their complexity and abstractionism. But in many ways they coincided with Taoist ideas and these were translated amalgamating Buddhist notions to the corresponding Taoist ones. Essentially both schools coincided with their search for liberation, liberating oneself from oneself in reality from what we are not: separate individuals. If the self never existed it could not die because it didn’t exist, so the fear of dying loses sense. It is true that the Chinese spirit is more concrete and the Indian more abstract. That which the Indians called sunya, void, the Chinese call wu and nivana/samsara passes to become wuwei/you wei. Although the Chinese put greater importance in practical meditation manuals. For us in the Occident to meditate is to concentrate on a certain object and to focus mental activity around it. For the Oriental it is the contrary, not to focus, to let thoughts turn like a carrousel of pictures that go disappearing one after the other. I would like to define the theme recounting my personal experience regarding oriental thought, and in my case, everything relates to medicine, on how medicine is linked to culture Apart from having lived in Peking I might not have been interested in Chinese medicine and on the supposition that this interest was satisfied it could be that I would not have preserved and practiced this knowledge. What attracted me? I was attracted by the fertile idea of complementary opposites, the unidualism, the concept that all is relative, that the absolute is Tao which is further away from the differences and embraces them all. This questions God, who, if he is infinitely good, should confront the world, infinitely bad, then he loses his quality of absoluteness. God and the World form a clashing duality. It is attractive to try and free oneself from that which, inherited from the Greeks, we do not find appropriate to our position, the intolerance before the contradiction, we Occidentals desire precise definitions, fixed, and in life, step by step although if one is neither doctor or philosopher we realize this is not possible. That everything is alternative that nothing is forever, for subtle changes but in the end changes, that things go but return, or on the other hand, that eternity is a temporal instant and not of infinite duration And to understand Chinese medicine one has to understand yinyang, one of a pair of complementary opposites, a normal form of Chinese thinking, that is to say the acceptance of a creative contradiction, live, an expression of a natural reality. Day, night, cold, heat, humidity, drought, health, sickness… The practice of applying the thought of yinyang in daily life is another thing, it is difficult to understand, to integrate it into daily reality, and when it comes to applying a diagnosis and treatment for a sick person, the effort is great. The opportunity to simultaneously practice both medicines enriched me, it permitted me to choose which technique was the most adequate at that precise moment. I find this possibility very creative and it makes for better results. We can compare this with the position of a medical intern who has to refer a patient to surgery. He can do no more for the patient, it needs another technician, surgery will treat his illness. And nobody considers this process irregular; the same attitude should be taken in regard to doctors who practice complementary medicines. If it was a yinyang situation, as we previously described about the Orient and the Occident that are the opposite faces to the same reality, we all have a frontal plane, that of the face, chest, abdomen and we have a posterior plane, the nape, shoulder, buttocks. And all this constitutes a single person, a single anatomy. For my sensitivity and way of thinking I make use of this method of thought which remains attractive and with the years I am hardly conscious of applying it in every moment of my life, in the beginning I incorporated it as an exercise but with practice it becomes incorporated into one’s personality. It isn’t arrogance, on the contrary, or I try for it not to be, it is the humility of being able to practice something studied with much effort and be able to give a service. Another factor that adds to the attraction of the orient for me is the concept of void, which seems very abstract and difficult to conceive but studied and applied is very creative both in medicine and all orders of life. We see the Greek and Chinese perspective on this theme as I have come to understand. It took more than 20 centuries, from the V century B.C. until XVII A.D., for the Occident to accept the atomic theories of Leucipo and his disciple Democrito. Both philosophers attempted to explain reality based on a different conception of the Being and the void. That which IS is corporal, this makes more firm than before the identity between Being and corporality and following Meliso of Samos in his Fragment 8 “if indeed there were many beings , it is necessary that these many were similar to one”; despite this was written to uphold the oneness of Being it was converted in a manner to argue the opposite. Democrito considered the plurality of Being perfectly possible with identical characteristics which unite them. And so as the matter is uniform, only one multiple physis. There exist infinite indivisible (a-tomo) particles of one being. But what separates this “being” distributed in miniscule units? The answer: the void. The void is not because it is not corporal, but at the same time it exists. The void is a non-being related to the being that consists of atoms, and as the void exists it should have the same rights as a solid. With it the qualitative differences in beings are due to the distinct proportions of atoms of which they are composed. That is to say atomists conceived the existence of a unique original matter scattered in infinite particles separated by the vacuum that co-exists with the matter, atom particles which group together or separate by chance, by mechanical forces, but it isn’t a mixture, it is related to continuity. For Eleatic atomists who accept the Ionic conception that this movement was a normal happening, it was the void that made possible the movement and with this it was explained why objects did or did not move. It is a constant process that originated an infinity of distinct worlds given that the atoms are infinite in number, and as such there is no reason that they form one world. We see how fertile was the conception of the idea of the atom and the void, which were very advanced theories for that epoch. Indian Buddhism, imported into China and adapted and modified by Taoism, had luck in its new country because the Taoists already supported the concept of the void, which is not nothing and at the same time is. Of all the Buddhist schools it was the “Doctrina del Vacio” which had the widest repercussion in China. The void is not a reality in itself but more a negative definition that we know as nirvana is a state of vacuity, without mental production, with an interior silence, it is a reality which one tries to attain. We talked before about the nothing that the Greeks did not accept and the Hebrews acknowledged, and consequently the Christians. But for the Chinese the nothing IS, not ordered, full of potential, everything comes from nothing. The void also exists, look in the dictionary and see that void as a noun is that which contains nothing, as such it infers the existence of a container, it is a noun with the face of an adjective. This is how the Chinese define it, the void of the vessel is that which makes the vessel accomplish its function. The utility of the flute resides in its holes, the void. And so I understood the circulation of blood, or the digestion, the language of the arterial pulse in the wrist, to give some easy examples. The concept of the void, is to me, more of a sensation than an idea, as if one could capture it more through feelings than reason, that they are contrary although complimentary. In an exercise of the imagination think of the void not like a negative place but like a constant and living place, alive because it is a space where breath surges, grows and is constant because being there always permits mutations, the void never changes, it is the center of vital strengths where they are born and recreated to carry out a harmonious and lasting mutation. Heidegger, a well known Occidental philosopher, who is translated in Japan, confronted himself with the concept of void as meditating in the varied idea of vacuity, language has to help us to communicate, vacuity is the Buddhist insubstantiality which establishes a difference between vacuity and nothing but not the negative nothing of the Occidental philosophers which the Orientals call nullity, but as the Asians think: the total present with all its processes and contradictions. Apart from theories and beliefs and elaborate abstracts, the knowledge of nature does not belong to any specific person, one who wants to take control of the world will lose it. It is impossible to keep advances secret, the improvements brought by modern Occidental civilization, and the Asians strive to reach these levels, sometimes in large leaps; therefore the Occident should be disposed to share all the treasures and progressions that there are on earth and to learn with humility numerous concepts which the orient is capable of teaching. Borges, on one occasion, surely in an agnostic moment said that “god is probably something towards which the universe is attracted to ”and “an evolutionary channeling towards perfection.” You manage to love god at the final process of cosmic creation, as an end of a well-trodden road and not before having lived.

THE FAR EAST IN THE WORKS OF CLAUDE DEBUSSY AND GIACOMMO PUCCINI - DOWNLOAD PDF VERSION>

Claude Debussy, among the circle of painters and friends in the plastic arts to which he belonged and frequented by preference, maintained a relationship with Camille Claudel (1864-1943) the student and model of August Rodin. Camille, as well as her brother Paul Claudel, passed on to Debussy their enthusiasm and fascination for the culture of the Far East, feelings which were intensified more by articles on China written by his friend Victor Segalen. Debussy used musical elements from the Far East in “Pagodas” one of the three typical pieces by the composer who, without any thematic relation between them, composed “Estampes” considered the first complete, stylistically mature work for the piano and at the same time the first with poetic titles. We know that pagodas are temples in the form of a tower of various (several) superimposed floors narrowing vertical to the top.

In the “World Exhibition” in Paris 1889 and also in 1900 Debussy heard, for the first time, a “gamelan” group from Java and immediately felt enthusiastic and inspired by this music which was unrecognized in Europe and started to incorporate these new musical elements into his compositions.
The “gamelan” orchestra typically composed of an instrumental model, consisting of various types of gongs, metal cymbals and tambourines. Its tonal system, contrary to the European tonal system divides the octave into five intervals and not eight. Fundamentally they use two kinds of scales: Slendro and Pelog which to European ears are heard like pentatonics or whole tones.
Also typical is its musical structure: simplified, we could describe this style saying that the bass instruments play long tones, thus forming a foundation , the central instruments execute moderate notes while the high pitched instruments realize agile and rapid notes, and Debussy consequently used these elements in “Pagodas”.

In the first two beats one can recognize optically the form of a pagoda. The higher voices in the course of the fragment develop in a linear movement of great extension over various octaves until the end of the piece is reached. Due to the almost exclusive use of the pentatonics the piece acquires a very static character, a character that intensifies exceedingly because of the use of repeated ostinatos that is to say on account of the numerous repetitions of the motives.

We also encounter oriental musical elements in the works of Puccini. His operas “Madame Butterfly” and “Turandot” stand out especially for this reason. The composer, a native of Luca, had an enormous interest in Japanese musical techniques and wanted to delve deeply into understanding these. The wife of the Japanese ambassador, who in 1902 was in neighboring Viareggio, acquainted him with the Nipponese culture and also sang songs of her country to him.

In Milan he met with Sado Jacco a Japanese singer of tragedies whom he asked to recite different texts so that he could familiarize himself with the sound of the language and he also looked for books, scores and a large quantity of records. With great patience he dedicated himself to acquiring the technique of this difficult notation. We could presume that the score of Butterfly overflows with Japanese melodies but it is not so. He only used six Japanese original melodies of which he selected some parts. So,for example, the horns and violins are only heard in the second part of the Japanese national hymn at the entrance of the imperial commissary and the official of the civil registry at the wedding of Cho- Cho-Sans.

A passage of the popular song “My Prince” appears as the theme of Prince Yamadori, and Puccini briefly cites a reason on the Japanese song of spring in the orchestral postlude of the first act when Butterfly and Pinkerton enter the house. For the oboe and violins he used the complete melody of the song “Cherry Blossom” and takes an original citation from the popular melody “Nihon Bashi” while friends congratulate Butterfly and she tells them that from this moment she is called Madame F.B. Pinkerton. To finish, at the beginning of the second act an ancient Japanese religious melody underlines the oration of Suzuki “Izagi,Izanami…” It is really admirable how with such artistic ability Puccini used these oriental elements to create local colour. But why do so many passages of the scores sound typically Nipponese? Because its form relies on the peculiarities of Japanese music. The contemporaries of Puccini used principally the entire tonal scale to produce the exotic colour sonore. He himself profited with this successfully in the theme of Scarpia in his opera “Tosca” although in “Butterfly” he however used this recourse very economically. For instance in the scene with uncle Bonzo in the first act. But almost always it is the pentatonic and the characteristic jumps in the third minors which achieve the oriental colour. Often he also used long pedal tones and parallel chords which accentuated even more this special atmosphere.

We cannot finish without mentioning what subtle instrumentation achieves in giving an exotic touch to this magnificent composition. Puccini did not use the “Japanese flute” or the typical “koto” of strings. Only bells, gong and metalophon were useful to achieve this effect accompanied by a delicate and clear instrumentation which, heeding especially to the sound of the winds, backs up this exotic atmosphere with success.


CHEEK BONE IN CHINESE MEDICINE - DOWNLOAD PDF VERSION>

International Acupunture Magazine. Barcelona June - September 2009 Electra Peluffo

CHEEK BONE IN CHINESE MEDICINE

Abstract

For Chinese Medicine, the zigomatic bone (cheek bone) and its variations in shape and color are, at the same time, clinical diagnosis markers and a predictive tool of health/sickness. Both anatomy-physiology and semiological quotations mentioned in Nei Jing Suwen Lingshu are studied here. Key Words

Bone- Zigomatic bone – Cheek bone- Classical Chinese medicine reference books Introduction and Goals The temporomandibular joint is relevant in biomedicine; therefore we consider that reviewing the ancient Chinese medicine books contents is an excellent tool of anatomy-physiological and semiological knowledge

Nei Jing Suwen Lingshu provides the information this paper is based upon, taking into account the relevance of bones role in classical Chinese medicine morpho-physiology. Chapter 11 of Suwen, sums up the description of body organization and, mentioning them only once, explains about qi heng zhi fu –extraordinary viscera with lasting activity- extraordinary organs also known as curious organs.

All further reference to these organs found in other texts, are more or less accurate quotings from this Suwen chapter. Extraordinary viscera are fu-viscera which function as zang organs, that is to say with yin quality because they store but they do not evacuate. Such viscera are: nao-brain, sui-marrow, gu-bone, blood vessels-xue mai, gall bladder-dan and uterus-zi gong. They constitute a six- viscerum group which form yinyang pairs in the three levels Heaven- Man- Earth, following a water-fire archetypical combination.

In Heaven, the symbol of macro and microcosmic life order brain and marrow are paired up. The brain represents both fire and water; fire through the heart where Shen, the spirit, is located, and water through the kidneys because they produce the Marrow The Earth gathers bones and mai-vessels. Suwen 23 states that bones are ruled by the kidneywater pair. The skeleton is a rigid and protective structure which holds brain and marrows, kidneys and heart and inner genitals and such structure remains after death as the genealogical lineage foundation of human beings. Fire comes from mai (vessels/blood/heart) At Man level we find the gallbladder-fire, this viscerum is the one in charge of managing both beginnings and decisions and is related to gestation, therefore linked to the uterus which protective membranes are, as water is, source of change.

Gall bladder and gestational dynamics (bao, another word for uterus) belong to the man realm. Chinese language is metaphorical and so are the words it uses, that is the reason for the expression gestational dynamics since it talks not only about uterine fecundation but also about the bao in men, a creational function rather than an anatomical organ. The gall bladder is a decision-making organ and so it takes care of gestation, both physical and spiritual. Among these six extraordinary organs we are going to focus now on gu-bone which is related to bone and vertebral marrow and any other tissue contained in a bone. When using the term gu, Chinese refer to alive bones and not to isolated bones. The ideogram which represents this idea talks about bones coated with flesh because they are able to function just due to its union with muscles and tendons.

The definition of bone in ancient Chinese medical dictionaries points out that bone is that which can be found in the depth of flesh, the frame that holds the organism, the trunk of the tree; it also states that it has both a protective and a dynamic function; protective in head, thorax and pelvis and dynamic because it allows the body movements. The anatomical functional metaphor shows that everything that flows needs to be guided; as the stones guide the river stream so the bones- due to their firmness- guide liquids, blood, essences and energy.

The sinogram gu is the radical base of other characters as well and in ancient graphic representations gu is part of sui-marrow. The relationship between bone and marrow gets established by the common source of the kidneys essences producing marrow, which in its turn, nourishes the bones; they form a yinyang pair, the inner and the outer, the hard and the soft, constituting the body structure, the natural duration of life. Several bones are worth noting in the human body, some of them are: gao-gu eminent bone protruding from the mingmen region, the gate of life, second lumbar vertebrae; dazhui…big vertebrae, the seventh cervical vertebrae as well as quan ….cheek bone or zigomatic arch formed by the zigoma and the malar bone; the S I 18 point called quan liao where the three yang tendinomuscular meridians of the foot meet and both arm tai yang and shao yang. Also worth mentioning in the cheek bone area are: the prominent bone below the eye, and finally jia che gu (vehicle, supporting structure and transport of teeth) which refers to the jaw joint, the area before the ears related to E6 point.

Anatomical and clinical information on the Zigomatic bone can be found in NeiJing, this bone is considered to be the root of all bones: it protrudes and is the most standing out bone before reaching the cranium, it also gives support to the eye and Ling Shu 46 says that “the cheek bone shows us the proportion of the whole body right from the face” The Zigomatic area, with its changes in color, clinically marks health or disease. Suwen 32 says that when it shows a blackish color, clearly different from the forehead or other parts of the face color, a kidney condition is revealed; if it’s red the information points to heart pathologies. Because of yang predominance due to insufficient kidney water, everything damaging the kidneys, especially cold, will have its repercussion for bones and marrows. Excess of heat in spleen will produce a heavy head in first place and then sore cheeks and pain in both jaws.

If reddish tone is moving downwards from cheeks to the cheek bones, an important abdominal congestion is marked; if color comes upwards from behind the zigoma, hypochondrium pain is marked and if it comes from above the arch, pathology is located at diaphragmatic level. Suwen 42 describes the Wind in the Kidneys and mentions that it can be diagnosed through the presence of coal black skin especially on cheek bones among other symptoms. Ling Shu 49 when talking about the semiology of diseases related to the four limbs highlights the cheek bone as a shoulder reference, and we have already mentioned that both TR and ID meet under the zigoma.

The central area of the cheek is related to pathology in large intestine while the area below the cheek bone (kidney diseases) reflexes umbilical area suffering. Cheek bone prominence and size indicate the strength of the individual and its natural completion. Lingshu points out that when the physical body is solid and the cheek bone does not stand out as preeminent, the skeleton is too small and a person with an over small skeleton will die at a young age. Watching a person’s face we may realize how long he/she will live, if the bones around the ear are flat and depressed and they do not reach the muscle in front of it, this individual will die before reaching the age of thirty.

Conclusions

In order to design a prognosis and a treatment in the practice it is really important to know the semiological data clinical observation bring us. Classical Chinese medicine books constitute a constant and detailed information source when dealing with a health-sickness approach. Their reading and their study are at the base for professional training for Medicine Doctors both in Asia and Europe.
Unlike what happens with their contemporary counterparts in western medicine where respectful reading of Classical books is confined to both medicine historians and medicine scholars, reference books dating from Ancient China are a day-to-day tool for the new generations of health professionals in their formation and training.

Data and quoting brought to us by such books constitute excellent guidance for clinical practice and, in my opinion, this is so because they explain the conceptual theoretical basis of the Chinese medicine which has not lost the philosophical references it is based upon.

Bibliography
(1) Unschuld, P. Huang Di Nei Jing Su Wen. Nature, Knowledge, Imaginery in an Ancient Chinese Medical Text. University of California Press. Berkeley Los Angeles London 2003.

(2) Larre, Claude. Rochat de la Vallée. Su Wen Les 11 Premiers Traités. Maisonneuve. France 1993.

(3) Peluffo, Electra. Apuntes de Medicina China. Miraguano Ediciones. Madrid 2003

(4) Kespi, Jean-Marc. L’Homme et ses Symboles en Médecine Traditionnelle Chinoise. Albin Michel. Paris 2002.

(5) Larre, Claude. Rochat de la Vallée, E. The Extraordinary Fu . Monkey Press London 2003

(6) Larre, Claude. Rochat de la Vallée. Su Wen Les 11 Premiers Traités. Maisonneuve. France 1993.

(7) Larre, Claude. Rochat de la Vallée, E. The Extraordinary Fu . Monkey Press London 2003

(8) Wiseman, Nigel. Feng, Ye. A Practical Dictionary of Chinese Medicine. Paradigm Publications. Brookline Massachusetts 1998

(9) Lingshu, (Eje Espiritual) versión de García, Julio. JGEdiciones. Madrid 2002

(10) Suwen (Preguntas Sencillas), versión de García, Julio. JGEdiciones. Madrid 2005

(11) Idem

(12) Lingshu (Eje Espirutal), versión de García, Julio. JGEdiciones. Madrid 2002

(13) Idem

ZHUANG Zi,THE VOID, MINGMEN, TANZHONG - DOWNLOAD PDF VERSION>

University of Valencia. Acupunture Master 2º Foro FEIAP. Valencia. September 2008

ABSTRACT

In Chinese Medicine, the silent and constant flow of the energies indicates the health of the bodymind. One of the variants of the energy flow arises from the relationship between the fundamental notion of void (represented by more than one sinogram) and two anatomical spaces mingmen and tanzhog, whose existence is suggested by Zhuang Zi in Qiwulum he second chapter of his work. The present paper studies the terms of that relationship from the description of the siesta of Nan Guo Zi Qi who moves energies in his harmonious breathing. Since the Chinese admit breath and its dynamisms as a fundamental reality, the void will never lack so harmonically balanced energies that are imperceptible… once again the void.

1- ZHUANG ZI’s QIWULUN
Nan Guo Zi Qi

We know that both in Classical Greek culture and in Ancient China, medicine was a part of philosophy from which the practitioners obtained many of their theoretical foundations. Thus, the wise thinkers when addressing the nature included the study of the human body both in health and disease interweaving the different elements of the universe in their conceptions. It is common that classical Chinese texts, whether philosophical, literary, historical or technical, approach issues directly linked to the human body and its functions -medicine in any case- or that after being interpreted, notions applicable to medical subjects can be obtained from them. In order to do so and in this particular case, comes to my assistance Zhuang Zi, whose work reflects the close relationship that thinkers of the time had with the conception of nature and therefore with men. Numerous are the statements, sometimes symbolic some other times metaphorical and also direct ones, result of observations on natural phenomena or geographical details linked to morphophysiological characteristic of men or its emotional-moral modalities, which allow their concepts to be applied to Chinese medicine contents.

From the inner chapters, reputed as authentic, I would like to distinguish here Qiwulun, the second, that allows me to study the concept of void (which was also conceived by Greeks who were, approximately, contemporary of Zhuang Zi) void needed for the energetic dynamisms of the body and, thus, explaining the functionality of the mingmen and tanzhong spaces. Zhuangzi translations show his sensibility before the subtlety of sense in language and the beauty of this language as well, and on behalf of our logic, surely not like his, his texts cannot be enclosed in a fixed frame, therefore translations of the title of this chapter from Zhuang Zi into our language differ according to the translators. Thus, in this redaction we will use different versions as appropriate for the understanding of the text, we find all translations useful since, without ignoring the different senses of Qiwulun, we reflect on which of them, in every given moment, helps us in our work. To the characteristics of the Chinese language the characteristics of the author, philosopher and poet are added.

Qi has the sense of equal, from the same rank, to make equal, to reach an agreement…Wu means object, everything perceived as real. Lun •is dissertation, gathering texts to compare them, meditate upon them and develop them. In this way, according to one version the chapter is called “everything returns to the same” due to its proximity to Lao Zi II which affirms that everything goes back to the sameness when it reaches the unity from where everything proceeds.

2. VOID

When describing the nap of his character Nan Guo Zi Qi, Zhuang Zi suggests the existence of mingmen and tanzhong through the Taoist notion that the formless can acquired form through the movements of breaths in those functional areas without organicity which process a high charge of energy.

Nan Guo Zi Qi was napping in an almost ecstatic state; his disciple Yen Cheng Zi Yu, watching the scene, was restless because he did not recognize the one who had been napping the day before, surely it was his Master but not in his habitual state, familiar to Yen. Zi Qi with his back (yang) against a footstool attached to the ground (yin) and his abdomen-chest (yin) receiving light and heat from the sun (yang) breathed placidly, exhaling a mild blow that proved he was alive. There is a space between these two organic referents (back/chest-abdomen) through which subtle breaths and energies can flow. To exhale a mild breath is expressed by the ideogram xu which, when prived of his right side (kou mouth) is read xu as well but with the meaning of void. This sinogram is one of those ones used in medical texts to express void in the sense of a space of circulation: we can see on the upper side of the character an uncultivated surface, naked, that favours the passage of the wind, the circulation of breaths between heaven and earth; the lower part shows small sprouts coming from the ground surface which are really tiny because the lack of obstacles is important.

The silent and undisturbed regular breaths represented by Zi Qi breathing which when circulating make use of the void of the organism so as conceive life, creating it through its movement and keeping it alive as well. Another ideogram to express void is chong that has, on the left hand side, the semantic element of water that talks about the passage of the fluid par excellence, constituent basis of life. And on the right hand side, appears zhong, square target which indicates that the fluid is captured rightly and with strength, an arrow that reaches the target. And lastly the void kong •phonetically very sonorous, as if resounding in an empty hollow, void, the one from the blue vault where the universal breaths move and which Tao Te King equals to a never exhausted bellow. Nowadays, among us, void is synonym to nearly nothing; very little says the notion of void to a western spirit and when it does, it is in a negative sense. To the Chinese if something is empty is because what was there before is not there any longer or because the place is filled with something imperceptible, or that being emptied out awaits being treaded or filled up again. Naturally, it is very difficult in our language to find another suggestive term capable of substituting the word void, especially when talking about more abstract significances. The void means inane (empty, unoccupied) as Lucretius named the emptiness “namque est in rebus inane” (“because inside the things exists the void”): “So, there is an impalpable space, imperceptible, unoccupied, not rendered, and virgin. But, in reality, is the container empty? Let us remember that Democritus imagined the void to be that which allows the movement between atoms, and their rest as well.

In order to create a harmonious, balanced current the yinyang breaths should flow without a single squeak in the empty space for that matter determined. This completed flowing is health, that is to say, it is not an absence but a serene, regular trade of energies in the organism. He who is healthy perceives no symptoms, but when disharmony-disease appears, becomes aware of the imbalance. A very simple explanation of the presence and role of the void is given by the flight of a kite which by stopping the wind with its sail creates, on the opposite side, a void that drives the kite upwards. A number of functional roles in our daily life presuppose the void, concept which makes me understand blood circulation: each systole drives a contents in a container which once emptied, awaits (diastole); the pleural space (virtual) uses the void, created by its negative pressure to cooperate in both blood and lymph return; appetite occurs when by evacuating the rectum, stomach has room for more, and so many other activities of our physiology.

China gives special resonance to the generational void, fertile ground for grandfather-grandson relationship. The void between father and son is scarce, particularly during the youth of both of them, they are very close; the void existing between grandfather and grandchild is much bigger. Whatever is said between grandfather and grandson resonates differently, creative void that allows dynamisms. The Greek thinkers participate of this concept. Let us remember Heraclitus who spoke about opposites that become the other due to their mutual convertibility: awake/asleep for instance and young/old. The latter does not seem to be reconvertible even though Heraclitus mentions it because he shares the idea that the grandson is the continuation of the family lineage and therefore, the first grandson was named after his grandfather. We clearly see that vacuity is, in no way, absence or something that does not exist but quite the opposite, even though sometimes we cannot perceive the content. Let us remember, as an example, that the ball in very popular games does not contain anything, it is empty despite having the effectiveness of the vacuity: it is never completely depleted. Let us see the fruitful Greek conception of the idea of atoms and void which postulated quite advanced theories for the time, approximately coeval with the writings of Zhuang Zi. The West took over twenty centuries, from V century B.C. until XVII A.D., to accept the atomic theories of Leucippus and his disciple Democritus. Both philosophers try to explain reality based on a different way of conceiving Being and Not Being-.
What is is corporeal, and this affirms the identity between being and corporeity and Democritus considers perfectly possible the plurality of the being with identical characteristics to the one, that is to say the atomists conceived the existence of one sole original matter dispersed in infinite particles separated (by the void) particles-atoms which group together or separate randomly through mechanic forces, not in mixture but in a contiguity relation. Because what separates the tiny units of this being so distributed in atoms is the void which coexists with matter. The void is not, because it is not corporeal, but at the same time it does not fail to exist.

The void is a not-being related to the being that atoms are and, since void there is, it enjoys the same rights as the plenty. Movement was a normal fact and what made the movement possible was the void and through that, it was already explained why the objects move as well as why they do not move. It is a constant process which originates multitude of different worlds because atoms are infinite in number and therefore there is not any reason for them to form a single world. Democritus had come to conclude that, conventionally we say colour, sweetness, clarity but actually, there are just atoms and void. By Democritus time, the idea of the man as a microcosmos has been accepted not in the Chinese sense of man as the reflection of the environment but as anthropocentrism when cosmology and its variations (wind, light, heat, night, rain, seasons) are taken so as to explain their influences on health.

In Fragment 9, Democritus states that “we really do not know anything true but only the changes produced according to the disposition of the body and what is introduced into it or offers resistance to it”. Thought that is shareable with any other eastern equivalent. In China the void, a notion most cultivated by Taoists, lies in the center, in the most intimate core, in the place where vital forces raise and are harmonically processed, that is to say the center as the origin, therefore the void, the empty space which is nothing other than energy. The idea of empty space is shared, in its abstraction, between Greeks and Chinese even when for Chinese it is wider and more dynamic than the Greek mechanicist approach, useful for their purposes. We know that Chinese thinking works upon complementarities, so in order to speak about void, its yinyang opposite plenitude, has to be considered. Pairs of antonyms do not establish a dualistic disjunctive way of thinking but a ternary one because the breath circulates bonding together both terms. The creative relation is the third member. That is why we write yinyang and not yin/yang, the slash (western) suggests an excluding opposition. Talking about this and without leaving Qiwulun, Yancheng the disciple asks the Master who is already awake, how he could turn his body into a dry trunk (yin) and his mind into dead ashes (yang) and the answer says that it is possible in the loss of the individual Self in benefit of the universal Self. Ziqi, due to ecstasy, manages to penetrate the void that is nothing else other than a metaphor of Dao.

3. MINGMEN and TANZHONG

Here we talk about two spaces inside the thoracic – abdominal cavity that process breaths: mingmen “the gate of life or the gate of fate”, between both kidneys at the second lumbar vertebrae level, residence of the original energy yuanqi capable to generate a new being; and tanzhong “center of the chest” that takes a position which is equivalent to the former but in the upper part of the esplacnic cavity between the two lungs. In the constant search of the yinyang harmony, needed for function, mingmen work (there is no organ) is ascribed only to the right kidney yang, hormonal, and not to the left kidney yin, urinary. In mingmen resides yuan the source, the origin of every human being and that is the reason why it is a region where energies, quite mobile, get transformed, evolve: door of life, that is to say that life and its activities depend on mingmen and on the dynamic of qi (energies), both in the kidney area. Dumai 4 is the acupuncture point mingmen. Qu Lifang’s illustration below, explains the vibratory field between kidneys, where the energetic axe linking mingmen with tanzhong is clearly shown.

Journal of Chinese Medicine.Nº 40/sept.1992 The constant interrelationship between theory and practice is manifested, for instance in the Tai Ji Quan positions, in the exercise of holding the ball of energy which covers the area round the navel up to the thorax on the sternum zone. Access to tanzhong “in the middle of chest” is gained through the acupuncture point renmai 17, important place of energy interchange and resonance of the heart between 2nd. 3rd and 4th intercostal spaces as well, area covered by three points of acupuncture: RM 17, 18 and 19 which, from the center of the sternum relate with the major arterial, venous and lymphatic vessels. Through tanzhong passes zongqi, the ancestral energy that mediates between the genetic lineage we come from and the singular being each one of us is; this energy is also known as thoracic energy because it is stored in the center of the thorax, center that is no other than tanzhong. Here we are facing the zones where yuanqi and zongqi are processed, initial biological energies, fundamental ones. Tanzhong also known as shanzhong, center or sea of upper energy, also conveys the meaning of container with fat-tan - fat that smells. Shan means “ram smell”. Usually, tan the fat, whether in cholesterol form or in lymph form, as well as the membranous tissues (peritoneum, aponeurosis, pleurae) tend to have a strong and particular odour. The mediastinum is an important crossroad of organic elements, membranes and lymphatics.

In Suwen 8 it is explained that “The liver system is the Office of the General, planning is its product. The gall bladder is the office of the Fair Correctors (judges) who issue decisions. Shanzhong is the Minister counselor who rules the office and the transmission of the messages of happiness sent to the monarch”. These two spaces –without organicity but indispensable- are symmetric, tanzhong between the two lungs and mingmen between both kidneys, only functional, with a large mobile energetic charge, one in the thorax and the other in the abdomen; just like the parallelism between the two places which stand out when contemplating the description of Zi Qi nap told by Zhuang Zi in his Qiwulun, for which “The leveling which makes things equivalent” is at this point of our work, the proper translation.

Mingmen is the conception of an abstract function ruled by the element fire and without a corresponding organ. It is a “presence” justified by its action, without a precise organicity and without equivalence in the anatomical or physiological concepts of Western medicine. Here, in this place resides yuan, principle, source, energetic origin of the human being in the conception from which a new being arises from chaos. Yuan •means original, firstly, raw, like a water spring sprouting in the mountains. Ming means order, destiny, and the order that configures the life of man, the one who designs the destiny of each and all energies. Men •u20204 is gate, door. In reality, mingmen is the archaic remembrance of the anterior heaven in the posterior one and this memory is topographically equivalent to the navel that is the place from where the fetus absorbs the breath which nourishes his body. Chongmai to reach, to attain, crossroad- is a meridian born in the small pelvis together with other two meridians dumai and renmai jointly described with an image of vegetal nature: a trunk and three branches which together, administer weiqi , the defensive energy protecting abdomen, thorax, back. Furthermore, chongmai as vertical axis is adjoined to daimai that transversally fastens to it, leaving both attached to the spinal column. Thus we have four extraordinary meridians running through the trunk and the head. Let us remember that this area of the small pelvis which reunites the four extra meridians is the one that is mentioned in the Zhuangzi as a space of free flow of energies represented in the nap of Nan Guo Zi Qi.

Tanzhong, center of the chest (in the center of the chest) is symmetric to mingmen gate of life (in the center of the abdomen). This is clearly related to the Taoist concept of void that is what allows energetic flows and interchanges and so, when heaven and earth transfer their most delicate essences for a new being to arise, there is a new biological reality in the established development. For Embryology – science that provides the scheme for the functioning of life- the conception is the beginning where biologically, the body is accompanied by the simultaneous development of a psychic movement; no Chinese will ever come up with the idea of separating the soul from the body, or the man from the universe or the adult being from his-her intrauterine life. Naturally, without complications, the body is the self, the own self.

Let us remember the description in China of chaos-cosmos through the existence of two heavens which show the models of the universe. Mingmen belongs to the anterior heaven (previous) the one before origin-conception, where statically lie all the cosmic matters or essential innate energies (heaven, earth, water, fire) later used in the conception. Out of this, arises the notion that the relationship between kidney and mingmen is that of water with fire, opposites but complementary elements, mutually needing and interinfluencing each other and are the origin of yinyang (water and fire) Strength and vital capacity depend on the two kidneys, the place where wisdom, willpower and reproductive function seat. Mingmen is a region, a place between both kidneys where the principle of conservation and preservation of jing vital essence and of qi inborn energy, are found. The combination of both of them composes a firm embryological organizer where heart (fire) and kidneys (water) constitute an axis around which revolves the genesis of the individual; in this genesis participate mingmen and yuanqi the original subtle energy both mental, due to being linked to heart and hereditary as well through the kidneys. Traditionally, kidneys constitute the meeting point of authentic yin yang, or what is the same of water and fire (archetypical) previous to conception. Mingmen is not an organ but a field of strength for life, the place where resides the hereditary charge that will ensure the development of the individual from conception to death; it is the seat of the original breaths (yuanqi) where primeval yin yang conjugate and the one that materializes itself for treatment in dumai 4.

From Qiwulun we rescue the description of the universal movement of the energies that explains the dynamisms in the two spaces of the body we are talking about here. Even though is that second chapter in the Zhuang Zi the one which inspires this work, in the third one called Yangshengzhu “Nurturing the Vital Principle”, the notion of void is anatomically mentioned: Ding the cook, slaughters an ox utilizing the interstices (the void) that exist between the components of the animal. If there were not interstice between parts, whichever they may be, there would not be movement. The world of the Chinese thinking, whether it be technical, literary, philosophical, provides useful concepts to different branches of knowledge, among them Medicine; the process is very fertile because it preserves, nowadays, the possibility of the existence of valid interpretation of ancient texts so as to apply them to modern reflection. This can be helpful in understanding important concepts involved in our work.

BLIOGRAFÍA
Bernabé, A.2001. De Tales a Demócrito, Fragmentos Presocráticos. Alianza Editorial. Madrid

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Larre, C. Flûtes et Champignons. Institut Ricci.Paris

Lucrecio 1961. De la Naturaleza. Versión de Eduardo Valentí. Ediciones Alma Mater Barcelona.

Maspero, Henri. 2000. El Taoismo y las Religiones Chinas Trotta Madrid

Sanpedro, José Luis. 2006 La Sonrisa Etrusca. debols!llo. Barcelona

Schatz,J 1994. Aperçus de Médecine Chinoise Traditionnelle Desclée de Brouwer Paris

Suwen. 2005 versión de García,J. JG Ediciones. Madrid.

Tao Te King. 1998. Versión Anne-Hélène Suarez. Ediciones Siruela. Madrid

Tung May P.M. 1994. Symbolic Meanings of the Body in Chinese Culture and “Somatization”. Culture, Medicine and Psychiatry 18.

Zhuang Zi, 1998. Los capítulos Interiores. Versión de González España P. y Pastor-Ferrer J.C. Trotta. Madrid

Dr. Electra Peluffo. MD. PhD
Faculty of Medicine. Universidad de Valencia (Spain).
E-mail: acupuntura@electrapeluffo.com
Published on line in Chinese Medicine.2011 Vol.2 Nº 4. www.scirp.org/journal/cm>

Abstract

This paper investigates the reasoning, based on both Chinese and Western medical data, which will lead to an understanding of the relation of the heart and small intestine, organs which Chinese Medicine, in the Fire energy phase, link both functionally and anatomically. The direct relationship between the liver and the gall bladder and betwwen the kidneys and the bladder is recognised and accepted in both Chinese and Western Medicine. This is not the case with the pairings which in Eastern morphophisiology are formed by the heart and small intestine and the lungs and large intestine.These pairings are not recognised in Western Medicine. The writer in her dual capacity of Doctor of Western Medicine and acupuncturist is investigating the reasons why in Chinese Medicine the heart and small intestine and their meridians form a relation which couples them.

For this the comparative method was used between data from Western anatomy which demonstrate the interorganic and functional relation between the small intestine and the heart and the Chinese energy dynamic of the corresponding zangfu and jingluo. Biomedicine which does not relate the heart with the small intestine brings in the materiality of its anatomic descriptions which are valuable for the interpretation of Oriental Medicine. This interrelation between the two organs and their meridians are well explicated in Chinese Medicine whose traditional concepts in this respect are corroborated by Western anatomical descriptions which, nevertheless, do not admit the functional-organic coupling of the heart and small intestine.

Keywords: Organic pairing. Chinese Medicine. Nan Jing. Classic of Difficulties. Heart. Small Intestine. Thoracic duct.

1. Introduction

Zangfu process the functions which are linked to the essentials energies: breathing and eating. Zangfu constitute functional units of coupled pairs. They are dynamisms which because they are located in certain areas of the body, induce to associate them with the organs seen from a Western view. But such coincidence is not complete since the functions described in China are not restrained to a certain area and they significantly exceed the correspondent topography. Each Zangfu pair is just one more yingyang couple. The heart-small intestine pair shares the fire movement with another "organic" pair of imprecise anatomic base and untranslatable name despite various attempts of European languages to do so, it is xinbaoluo-sanjiao: difficult to define and whose presence we shall try to interpret. Chinese Medicine for its fire phase links, both functionally and anatomically, the heart with the small intestine and during the metal phase the lungs with the large intestine. Nanjing difficulty 35[1] describes: "The 5 viscera each have a place... and the bowels are close together, only the heart and lungs are removed at a distance from the small and large intestines." And gives reasons for this: the heart is responsible for nutrition and the lungs for defence, and both communicate and move (tong - xing) the yang energy and that is why they are located in the yang area at the top of the trunk. Both intestines transmit the yin energy downwards and therefore they are located in the lower part (yin) Likewise, the small intestine anatomically is central, as the heart is, and the large one is lateral as lungs are. The small intestine is the bowel (fu) of abundance, receives the surplus of the bowels and the large intestine is the bowel (fu) of transmition and drainage of this surplus.

2. Function and Energetics of the Heart in Chinese Medicine.

In Chinese Medicine four names or expressions define the wide cardio-circulatory function 1.heart xin 2. centre of chest (tanzhong) mediastinum 3. that by which the heart commands (xinzhu) and 4. mesh which surrounds the heart (xinbaoluo). Heart xin is the Emperor; the great chief of the body since it supervises and controls all the organic sectors and due to its functions, irrigates and nurtures even the tiniest corners of the organism through its circulation. This dynamic involves the movement of organic liquids, notably the blood and lymph. It is important to understand the Chinese meaning of the term xue, blood, which is not only the red liquid that runs through arteries and veins but, rather it designates all kinds of body secretions, hormonal secretions included as well as the transformations produced in the interior of the body. Acupuncture point RM 17 renmai 17 (tanzhong "in the middle of the chest" ) is a very important place of exchange of energies and at the same time the area where the heart resonates between the 2nd, 3rd and 4th intercostal spaces hosting three acupuncture points: RM 17, 18 and 19 which in the centre of the sternum relate to large vessels. Through tanzhong [2] runs the ancestral energy (zongqi) that mediates between the genetic lineage we come from and the singular being we are, and which is also known as thoracic energy since it is stored in the centre of the chest, centre which is none other than tanzhong, even though in fact more than being the centre of the chest it is the chest as a centre [3]. Ancestral energy (zongqi) comes up here through the large stomach luo vessel (xuli) which anatomically we think corresponds to the lymphatic circuit of the small intestine. Tanzhong centre or sea of upper energy (also called shanzhong) has also the meaning of a container filled with fat that smells (shan means ram smell) Tan the fat whether it be in cholesterol or lymph form tends to have a strong and particular odour.

The variation in names of structures, points and functions is traditional in Chinese Medicine. Professor Huang in his thorough book [4] on imagery and artwork of meridians and acupuncture points tells us that as a result of the fact that numerous and diverse schools of acupuncture of the past -the author here thinks something similar is happening nowadays- developed different theories and practices, the same name could refer to different points, different points could correspond to the same name, and moreover, numerous old point locations are currently unknown. There are more meanings of tan: bile, gall. Tan is also the inner lining of an object, e.g. the bladder of a football bladder [5] (metaphor of the thorax here?) which would suggest a membrane (pericardial, endocardial, pleural) A link between all meanings and denominations is established when Lingshu 35 [6] says that tanzhong is the Imperial palace of that by which the heart commands, that is none other than the above mentioned xinzhu, that by which the heart commands.

The phase fire (huo) along with heart and small intestine has two other organs or functions: xinbaoluo pericardium (imprecise translation) and triple heater (sanjiao) term which also has a difficult univocal translation to our European languages. As it happens heart and xinbaoluo (possibly pericardium) work in unison as a single circulatory organ, and thus the four names we have analyzed above actually refer to the same functional notion of interchangeable anatomical basis. When treating with acupuncture it is often advised not to use points of the heart meridian but rather use the xinbaoluo ones "so as not to disturb the emperor" [7] since both tracts points treat very similar symptoms. The author understands that xinbaoluo is a function associated to xin heart and through it to the small intestine, but since in yinyang structure it is impossible to be without a pair, xinbaoluo gets paired up with sanjiao which is a nearby visceral system, neighbouring in topography and with an anatomical base of membranes and envelopes related to the pericardium membrane. Xinzhu another name for xinbaoluo (the protective wrapping of the heart and hence its importance) refers to another facet of its function because zhu is the one who holds the authority, decides, administers, reigns, rules, that is the mastery the heart exercises as holder of the sovereign fire (jun huo) .

Xin is heart, bao is to wrap, to contain, to take control and luo is net, mesh, therefore xinbaoluo is a ramification which inside the fire movement is minister fire (xiang huo) Xinbaoluo is the function by which the hearts rules, not only there on the site but in the distance as well. Because of the latter Lavier [8] suggests the analogy of xinbaoluo with the sympathetic system relating sanjiao with the parasympathetic one. Nanjing 25 [9] when dealing with the subject of xinbaoluo-sanjiao couple insists on the fact that both have a name but not form because the pairing combines firstly visceral systems and secondly circulatory tracts (meridians). This matter about having no form is not new because before linking sanjiao with xinbaoluo, the first one was ascribed to mingmen, the immaterial energetic area between the two kidneys where the ancestral energy moves. In the constant search of the necessary harmony that this function needs, the working of the mingmen area (there is no organ) is generally attributed to the hormonal yang right kidney whereas the yin left kidney is urinary. In mingmen resides the source (yuan) the origin of every human being and that is the reason why it is a region where energies, quite mobile, get transformed and evolve. Sanjiao originates in that source, mingmen. We have just described two symmetrical spaces: tanzhong between the two lungs and mingmen between the two kidneys, without organicity, only functional, with an important energy charge of great mobility, one at the top of the splanchnic cavity-thorax and another one in the lower part, the pelvic area.

3. Anatomy and Physiology of Heart-Small Intestine Pair

The explanation of the relationship between heart and small intestine has, in the author's opinion, anatomical foundations from Chinese Medicine with outstanding physiological bases and we also have, along with the Chinese background, anatomical reasons recognized in the West. Irrigation, the blood perfusion of the small intestine was and is very prominent; practically the blood is in direct contact with the bowels content; that is to say that from the duodenum (which is part of the stomach according to the Chinese medical thought) everything is blood and quil (lymph). In Histology the intestinal villus contains an arteriole, a venule, a quil vessel, a nerve.

intestinal virus

Both Heart and Small Intestine belong to the movement fire, heart the emperor (imperial fire) expresses itself upward, towards the sky and its pair the small intestine catalyzes downward the ashes of what was burnt on the way up. H. and SI. share this energy phase with xinbaoluo and sanjiao, exceptional circumstance since each phase is covered by only one pair of organs. But, the fact is that movement fire is divided into two hierarchies: sovereign fire and minister fire and each visceral pair corresponds to a category. Wu Yun movements (wood, fire...) are five. Liu Qi climatic energies (wind, heat, dampness...) add to six. Both combined form the Wu Yun Liu Qi theory also known to simplify, as Yun Qi. In this way one of the six energies would remain without organic representation. Then, it is likely that the unfolding of the fire phase arose from the search for symmetry in order to keep the pairings. Both Suwen not mentioning even once the name xinbaoluo and Lingshu doing it only in reference to meridians or acupuncture support the hypothesis that fire was duplicated only for organ pairing reasons[11] . What both books (Suwen 8 and Lingshu 35) repeatedly mention is the place-point tanzhong we saw above attributed to renmai 17 but functionally related to xinbaoluo. The author personally thinks that although there seems to be no organ to link it to xinbaoluo, it seems to be a place for tanzhong (the mediastinum) as there is a without-organ place between both kidneys for mingmen, a function closely related with xinbaoluo and sanjiao. Places and spaces are also Anatomy.

At the same time, it is not clear whether the Chinese described a specific organic substrate for xinbaoluo which although not an organ is generally associated with the heart for its topography, the similarity of clinical symptoms and its pairing with sanjiao, its yang complement in this fire movement and whose organic base would be the system of membranes of the thoraco-abdominal cavity (pleura, peritoneum, aponeurosis, fascias, mesentery, diaphragm) The membrane serving as a yin counterpart of these sanjiao envelopes would be xinbaoluo, thus it is named pericardium in many texts. This elaboration of the subject adds reasons to the pairing of the heart and the small intestine because, if the pericardium is closely associated to the heart and most part of the peritoneum (sanjiao) to the small intestine, both membranes belong to the same fire movement and therefore its functions (and meridians) fit together. The author personally has doubts: if sanjiao is pleura and peritoneum (parietal, visceral) what is the reason for it not being the pericardial membrane as well? That is to say: does sanjiao need a parietal support to be itself? Would it lack that support in the pericardium? Or is this morphofunctional pair a necessity in ancient China to explain organic material (membranes) which they empirically checked at the thoraco-abdominal cavity but could not attribute to any specific viscera? Li Chan wrote Yi Xue Ju Men (Introduction to Medical Studies) in 1575 [12] and one of its paragraphs can shed light on the subject as it is clear that the author attended dissections and describes what can be recognized as the fibrous external layer of the pericardium and assigns the inner serous layer to the cardiac system: "The yellow -or brown- fatty substance (huang chih) that spreads and envelopes (the heart) belongs to the cardiac system. Outside this spreading fatty substance there is a fine sinewy silk- fiber -like membrane connected to the lung system and to the cardiac and pulmonary systems; this is the Envelope Junction xin pao" Sivin, translator of the Chinese text into English, warns that Li Chan writes uterus (bao) and not wrapping (pao) the ideographs have similar components and are, of course, homophones. It is not easy to write Chinese using only phonetics.

Let us remember that also for Galen the pericardium is analogous to the protective structures (peritoneum and meninges [13] ) due to its two layers which, overlapped at the base of the heart, allow its free contractility. In morphophisiology it is comprehensible, for instance, that the liver gets coupled with the gall bladder but what is not clear is the harmonization of the heart with the small intestine. Each pair of coupled organs has its inner yin aspect, the heart here, and its outer yang aspect, here the small intestine. Being coupled, their meridians have attached and opposite routes; the heart from the axillary gap, through the palmar ulnar side of the arm and hand to the little finger, and the small intestine through the dorsal cubital edge of hand and arm from the small finger to the face. In Chinese Medicine they are so related that one of the branches of the heart meridian goes straight to the small intestine; and this one after edging the scapula penetrates deeply from the scapular waist to the heart where it ramifies. Figures 2 & 3.

heart meridian

meridian

In her investigations, the author confirmed an anatomical fact not usually taken into account, which seldom appears in Anatomy charts and which helped her to understand the relation heart-small intestine: the thoracic duct. Herophilos, in Hellenistic Greece, described and named the duodenum, ( duodenum whose length is measured in twelve-finger units, but for the purposes of this paper the author would like to highlight Herophilos' description of the chyliferous vessels (chylo=liquid, humour) which were later more precisely distinguished by Erasistratus but forgotten until two thousand years later when Gasparo Aselli [14] (1581-1626) rescued this study. (Figure 1) Chinese Medicine gives the lymphatic network functional importance of a first order as a circulatory system for a matter which from the intestine where it has its origin until it plunges into the heart cooperates in the production of blood.

Sodeman [15] explains: "the lymphatic system is older that the venous one because in the primitive philogenetic levels the whole blood goes straight from the small vessels to the tisular spaces [...] blood and other components of the tisular liquid then enter the lymphatic type vessels that go back to the heart as a whole. In higher animals some of these vessels stayed as lymphatic vessels whereas in others they transformed themselves into less porous tubes: capillary and veins" The great stomach luo vessel (xuli) (Figure 4) already appears, although a single time, in Suwen 18 (13 in some versions) "Xuli passes through the diaphragm and connects with the lung collateral channel luo; leaves from below the left breast where its pulsing, the pulsing of the ancestral energy, can be felt (zong qi)" [16]. This point corresponds to S18 rugen (base of the breast) For Schatz et al [17] xuli is an embrionic luo consecrated to nutrition.

xuli

One translation of xuli is "inner void" inner in the endo [18] sense, although the author can see in dictionaries other possibilities of interpretation related to the term xu in Chinese Medicine: free circulation [19] which then would read "free inner circulation" linking this to the concept of void as space for the interchange of energies, whichever those energies might be. According to Unschuld[20] Chinese and Japanese philologists are trying to find a sense for the phrase xuli, a subject which is still under discussion and, although the author does not want to force a meaning ascribing it to the Greek chyloi, is close to a possible parallelism between this Chinese description of xuli and the circulation of lymph, including the thoracic duct.

 The route of the small intestine meridian and the stomach in Chinese anatomy can explain why the author considers that the xuli stomach vessel is related to the chyliferous vessels and the thoracic duct: is known that the thoracic duct comes directly from the small intestine (Pecquet's cistern) Loaded with lymph, it empties itself into the right auricule which is no other that the dilatation of the left subclavian vein which together with the left internal jugular forms the vena cava superior. The small intestine empties its processed content directly into the right heart which sends it to the lung and from there to the left heart and general circulation (Chinese Medicine states that the heart commands the blood that nourishes all the organs) It should not be forgotten that blood in Chinese language involves all the nutritious liquids, among which the lymph stands out. For more interorganic relations, let us say that point Bladder 22 in the lumbar region, point to treat the sanjiao pathology, is located between the L1 and L2 vertebrae where, from the inside, Pecquet's cistern rests. The meridian system is clearly conceived as a network linking the functions of all the organic structures. There have been attempts to relate the thoracic duct with the meridian remmai as mentioned by Maspero [21] in a text where he identifies the ren "vena" with the thoracic lymphatic channel. Meridians, although they were conceived by the Chinese as invisible energetic routes, do not represent the author's idea of the thoracic duct as an actual organ.

  3.1 Anatomy of the Intestinal Blood Circulation 

It may be useful to know the description that Chinese Medicine doctors did of both intestines. They differentiated with certainty the small intestine from the large one, and they also analyzed the vascular patterns that nourished both of them to deduce their respective functions. Let us remember that one way to interpret the meridians is to assimilate them to the routes of vessels and/or nerves.  The small intestine starts, according to Chinese Medicine, in, gate of darkness (you men) pyloric region which comprises the duodenum and the jejunum (Figure 5). The large intestine, which they called wide, shared the ileum with the small bowel as far as the, gate of interception region (lan men) ileocecal valve that in other texts [22] is cited as guan men, name of the point Stomach 22 on both sides of the ventral midline, 2 cun above

xuli

and out of the navel and serves to treat low digestive disorders. Ling Shu 31 [23] describes its Anatomy: "The small intestine rests from the back on the vertebral column, on the left it twists and makes 16 loops in superposed layers, approaching the large intestine and turning backwards, it rests on the navel" The navel ventrally corresponds to the second lumbar vertebrae, where adheres to and fixes the mesentery that holds the Pecquet's cistern [24].

Large intestine includes the left half of the transverse, the descending colon, the sigmoid, the rectum, and anus from western nomenclature. This apparently strange division of the intestine comes from the way of distributing the circulation that irrigates this part of the digestive tract The author would like to re-state the fact that the itinerary of both blood and energy (meridians) depended on vascular routes, and in this particular case jejunum, ileum, caecum and transverse colon united because they were supplied by the superior mesenteric artery whereas the Chinese "wide" intestine would get blood from collaterals to the inferior mesenteric artery. This description would point to the practice of dissections. Each intestine had a different task: the small intestine would rule the digestion process because it absorbed nutrients and digestive juices and, since the wide bowel only absorbed water, it was considered that it would control not exactly the quality but rather the quantity of the organic liquids.

3.2 Meridians

The paths of the meridians, another way of explaining the Anatomy in China, express relationships among viscera. The internal path of the meridian of the heart from its origins in the middle of the heart (literally in the centre of the heart) but not penetrating it, rather lies on the "heart support" - the pericardium xinbaoluo, probably the aorta and some other large vessels going in and out of the heart- and along with them crosses through the diaphragm, passes to the mesenteric artery and branches out in the small intestine which is spirally enveloped by it. Another branch coming out of the heart too outlines the sides of the oesophagus and ascends up to the eye ("to the support of the eye") probably the optic nerve where it connects with the peripheral tissues of the eyeball and continues to the brain. The external path: the meridian itself leads off from the heart, goes through the lung and into the axilla in whose pit lies jiquan the first point H1. It goes along the arm through the palmar surface radial side next to the meridian xinbaoluo on some paths that coincide with the angina pectoris clinics.

The ideograph for heart (xin) is said to show the heart body: above the aorta, in the middle the viscera and to the sides a synthesis of the pericardium. In Chinese Medicine the heart is principal: "it is the chief of the five zang and the six fu and therein lies Shen the spirit". The Classics explain that "if the heart is attacked, the Shen go and if the Shen go, then it is death" "The heart is the trunk where life gets rooted" "All the blood depends on the heart"[26]. Its functioning is expressed in the mouth, at the tip of the tongue, in the speech. The pre-eminence of the heart is due to the fact that it is the residence of mental energy (shen). By the way, let us say that this concept is not strange to the West where for the hermetic medicine practised by Paracelsus [27] among others, mind is located at the highest part of the right auricle.

Meridians are a speculative product of Chinese thought in its application to both body and Medicine. Nanjing35 [28] already explains that the small intestine as a highly vascularised organ (see histological illustration) is the red intestine (movement fire) the large bowel is white intestine (metal) the gall bladder is the green intestine (wood) stomach is the yellow intestine (earth) and the bladder the black one (water) The external path of the small intestine meridian - energetically yang- starts at the little finger external ungual angle, continues along the cubital side of the hand, ascends by the posterior external side of the arm, then by the posterior axillary fold, after that it goes to the supraclavicular pit and enters the thorax to interact with the heart, descends along the oesophagus, crosses the diaphragm, reaches the stomach and finally the small intestine. A branch leaves the small intestine to join the stomach at the S39 point.

The picture (Figure 3) clearly shows how the SI meridian enters the supraclavicular pit, moves towards the thorax to spirally envelope the heart as well as the oesophagus and the stomach where it comes in contact with the intragastric material, beginning of the quil that will transport the above mentioned xuli, the stomach luo large vessel Nanjing 35 shows in a detailed way that the small intestine has a dynamic relation with the RM 9 point, renmai 9 shui fen -water partition or water separation - point which located on the midline of the abdomen slightly above the navel, regulates the abdominal vasomotricity and is also related to renmai 10 xiawan "the place of the small intestine" [29]. The small intestine receives water and food from the stomach and during digestion proceeds to separate clear from turbid. The clear are the interstitial liquids, the turbid are the dregs that will move to the large bowel to be evacuated. It is understood what turbid is, and the clear points towards the bowel absorption that will transport the noble materials from the limpho-sanguineum circuit once they have been passed through the liver.

Classic texts are precise in their description "The small intestine is responsible for receiving and filling up, and the transformed goes out". Sheng filling up refers to an intense physiological activity taking place in the contact surfaces of the bowel villus. The product of this is the transfer of the material so processed to the blood and lymph circulation and to the large intestine as well. For ancient texts the motility of the small bowel "mixes and transports", that is what we call peristaltism. To make reference to the separation between clear and turbid they use the terms press and sift [30]. There are more data to help understand the relationship heart-small intestine. Let us remember that in embryology heart and small intestine are formed in the same movement between the 3rd and 4th weeks when the primitive bowel is defined and both cardiac tubes[31] join together. The jejuno-ileon is the result of the anterior portion of the primitive intestine [32]

4. Conclusion.

There are Eastern and Western anatomical reasons as well as energetic ones from Chinese Medicine which explain the forming of the heart-small intestine pair. This anatomo-functional approach describes the abstract speculative aspects as well as the concrete ones, generally Taoist in origin, on which Chinese Medicine bases its conception of the human body as well as its inter relationships. Western culture reasons in a different way, and does not take part in an integrative conception of the body, rather it fractions the human body in apparatus with scarce mutual functional connectivity. However, researching and trying to bring together these two conceptions, Western Anatomy has available data to complement the explanation of the Eastern idea.

Chinese theoretical-practical notions are the product of a fine and thorough clinical and anatomical observation interested in justifying the integration of organ-function zang with organ-function fu at every energy state according to the yinyang principle and qi dynamics, which proves the morphophysiologycal interadjustment between the naturalistic theoretical conception of the body according to secular Chinese Medicine.

5. References

Introduction:

[1] Nanjing, versión J. García. JGEdiciones.Madrid 2003 : 69

Function and Energetics of the Heart in Chinese Medicine:

[2] R. González and Yan Jianhua, Medicina Tradicional China.Grijalbo.México 1996 : 452
[3] C.Larre & E.Rochat de la Vallée, The Secret Treatise of the Spitirual Orchid. Monkey Press,London 2003 : 97
[4] Huang Long Xiang. An Illustrated Book on the Historical Development of Chinese Acupuncture.ISBN 7-5436-2177-0.XinTao Shangdong 2003
[5] Diccionario Español de la Lengua China. Espasa Calpe. Madrid 1977
[6] Ling Shu, versión de J. García. JGEdiciones. Madrid 2002
[7] D. Sussmann, Acupuntura Teoría y Práctica.Ed.Kier Buenos Aires 1968 : 215
[8] J. Lavier, Histoire, Doctrine et Pratique de l'Acupuncture Chinoise.Tchou Éditeur.Genève1966: 83
[9] B. Flaws, The Classic of Difficulties.Blue Poppy Press.Boulder, CO 2004 : 57

Anatomy and Physiology of Heart-Small Intestine Pair:

[10] Imagen de Biblioteca Digital de la Universidad de Chile
[11] M. Porkert, The Theoretical Foundations of Chinese Medicine The MIT Press.Cambridge Massachussetts and London England.1974 : 56
[12] N. Sivin. Traditional Medicine in Contemporary China.Center for Chinese Studies.University of Michigan.Ann Arbor:128
[13] R. E. Siegel, Galen´s System of Physiology and Medicine S-Karger.Basel New York 1968: 31
[14]C. Singer, A Short History of Anatomy from Greeks to Harvey Dover Publications Inc.New York 1957 : 29
[15] W. Sodeman, Jr. and W. Sodeman, Fisiopatología Clínica. Interamericana México 1978: 154
[16] Su Wen Preguntas Sencillas, traducción de J.García.JGE ediciones 2005 : 97
[17] J. Schatz and C. Larre and E. Rochat, .Aperçus de Médecine Traditionnelle Chinoise.Desclée de Brouwer. Paris 1994 : 172
[18] R. González and Yan Jianhua. Medicina Tradicional China.Grijalbo.México 1996 : 494
[19] Dictionaire Ricci de Caracteres Chinois .Instituts Ricci Paris Taipei Desclée de Brouwer.1999
[20] P.Unschuld, Huang Di Nei Jing Su Wen. University of California Press.Berkeley Los Angeles London, 2003 : 126
[21] H. Maspero, El Taoísmo y las Religiones Chinas. Trotta Mafrid 2000 : 463- 464.

Anatomy of the Intestinal Blood Circulation:

[22] D. Kendall, Dao of Chinese Medicine. Oxford University Press. 2002 : 41
[23] Ling Shu. (Eje Espiritual) versión de J.García..JGEdiciones. Madrid 2002 : 179
[24] L. Testut, Compendio de Anatomía Descriptiva. Salvat y Cia. Barcelona, 1917 : 315
[25] Neijing, versión de Ilza Veith.University of California Press.Berkeley Los Angeles London 1972

Meridians:

[26] E. Rochat de la Vallée and C. Larre, Su Wen Les 11 Premiers Traités.Maisonneuve Institut Ricci 1993 : 3
[27] E. Marié, Introduction à la Médecine Hermetique à Travers l'Oeuvre de Paracelse. Éditions Paracelse. Vitré 1988
[28] Nanjing, versión de J.García. JGE Ediciones. Madrid 2003 : 71
[29] Lei Jing Tu Yi, lIlustrated Wings to the Canon of Categories. In K.Matsumoto, and S.Birch.Hara Diagnosis:Reflections on the the Sea.: 55
[31] E. Peluffo, Apuntes de Medicina China. Miraguano Ediciones Madrid 2003 : 83
[32] J. Langman, Embriología Médica.Editorial Médica Panamericana. Buenos Aires 1982 : 167



Course on line "Natural Therapies". Summer 2011 Salamanca University Courses.

Professor Dr.Juan Antonio Rodriguez Sanchez


ORIENTAL MEDICINES

Dr.Electra Peluffo.MD PhD

 

INTRODUCTION.


Medicine is the expression of a culture, perhaps the most complete and alive one due to its constant and multiple links with both Nature and society; we use Medicine to obtain information about what and how certain ancient societies thought and how they put that thought into practice. There have been cultures prior to what we call now Western cultures and whose Medicine constitute individualized practical-theory corpus. We cannot forget here the pre-Columbian Medicines, those from Asia Minor, and many others; the Eastern medical thinking and its implementation clearly represents those differentiated corpus which at present a non-negligible number of doctors recognizes and accepts in the Western world, where Medicine based on Western science and rationality – the Biomedicine- seems to posses even now the exclusive ethnocentric monopoly in order to explain and treat diseases.

Medicine was born with man and in Ancient times the art of healing was in the hands of priests and of philosophers as well, because theorize about philosophy was the previous step to any profession or activity; you had to study philosophy first to become a mathematician, a geometer, a doctor…As Roy Porter1 says “religion and philosophy are products of the human endeavour to face body and soul, individually and collectively, to afflictions and death”.

Hippocratic was the concept of vis naturae medicatrix, the first truly natural therapy: the healing Nature. Allowing the body to express, to voice its complaints – symptoms viewed as defensive activity of the organism- and letting Nature correct, harmonize. The body tends to balance, to health because the organism is more than the sick body- which the doctor momentarily sees. To this doctor, when acting, health is the basic concept which leads him or her. Without the notion of health the notion of sickness cannot be understood. Among other influences, naturalism- certain way of understanding Nature and whose explanations cannot be analyzed here- and its way of observation and analyzes gave birth to traditional Medicines among which Egyptian, Persian, Greek Roman, Indian, Chinese ones stick out as big conceptions of wisdom.


NATURAL THERAPIES

 

Therapy, the therapeutic, the treatment we are examining here is- to my view - a part and not the initial one, of a medical act; it is just a section non independent from the total process we call Medicine. We know that way before medical texts recorded on whichever material, there were healers, healers with apprentices (a good teacher when repeating the old is able to find something new in it) therefore many of these techniques are the general result of empiricism that might find some shelter in repeated evidence although it is difficult to put on a same level as other therapies, being this a product of a reasoning whose theory focus is the base of the action. Therefore when we refer to therapies natural or not. Are we forgetting that any of them- according to current knowledge, has to belong to a system of thought that supports and at the same time explains itself? A therapy isolated from a global medical context lacks basis and without it, thinking of it as a healing chance is random and uncertain.

As H. Sigerist argued Medicine should be guided by a theory because if not medical doctrine cannot be transmitted from master to pupil even though in biomedical training theorization is not specially highlighted. When teaching Medicine those subjects concerning philosophical formation should be recovered, taken into account again since they would help give foundation and explanation to the constant evolution of theoretical thinking paradigms.

Among natural therapies we can find undoubtedly effective Medicine modalities such as Homeopathy whose reasoning in an organicistic and mechanistic time, proposed an attitude where functionality and psychophysical corporal oneness of the patient is highlighted Its remedies generally come from natural elements ( vegetal, animal, mineral, all biologic components) partially or fully manipulated and diluted in proportions which are inexistent or unable to be checked in Nature so can we say they keep their quality of being natural? This question does not attempt in any way to diminish the accomplishments of Homeopathy.

Same thing occurs with Acupuncture, one of the therapeutic variants of Chinese Medicine about which we should explain why placing a metal needle in a certain point in the skin is a natural way of treating diseases. This is not the case with moxibustion, Eastern as well, and whose natural core is accepted since it approaches different pathologies with no other intermediation but the heat coming from the combustion of dried and powdered leaves from a commonly used plant, however a diagnosis should be made and this treatment decided upon.

Then, to my understanding, it seems that we should clearly define what the term natural wants to imply so as to be able to differently name other healing practices which effectiveness and not efficiency is not being questioned but, we really reiterate the question about whether removing symptoms is healing. It is not wise to group techniques under the label of “natural therapies” as if they were similar therapeutic forms and not only similar but interchangeable ones since- in praxis- it is not unusual that if one fails then we use another one or we overlap techniques, this last one being a quite common practice which cannot be considered an integrative one. I believe it is not only a conceptual subject but a semantic one or about precision in the divulging vocabulary issue.

The adjective “natural” quite overused among us and, in my view, not clear enough to be used in Medicine has lead those doctors who prefer this professional variant over calling “naturist” the Medicine they carry out, and in doing so willing to differentiate themselves from other type of practitioners who call themselves “naturopaths” or having a degree in “naturopathy”, terms which is not clear whether they refer to natural diseases or to Nature ones? This statement suggests one question to me: is the current qualification of certain therapies as natural not lagging from post-renacentists schools in Modern Age, time of great breakthroughs in Botany and other natural sciences. It could also be thought that it is an attempt to separate them –almost underestimate them- from Biomedicine, realm where the drugs produced in laboratories, “artificially” if you will, is preponderant and enjoys an unbeatable social prestige and legitimacy.



CONFUCIUS AND SOCRATES.

All these reminds me that, since remote times, the proper adequacy between “names” and the “realities” they try to describe, is a Chinese civilization demand. At the end of the Han dynasty in II BC century as a legacy of the Confucius ethic endures the doctrine of the names mingjiao in which the interest was focused in the adequacy between the required functions and the innate ability to exercise them.

This Confucian ethics occurs in the well known answer Confucius gave to Jing the Duke of Qi a question on the art of governing. The Master answered “to rule is to persist in the righteousness.” where zheng rather than governing or managing suggests ordering the world like the doctor cares-cures a sick organism which restores its lost harmony in that way. This theory and then the required practice was named “name rectification” that is “that the sovereign acts like a sovereign, the minister as a minister, the father as father and the child as a child” 5 , this along with the previous postulate makes clear the necessity of certain adequacy between the name and the reality in a two-ways path, that is to say acting on the name to apply it just to the reality which represents it or deserves to do so and, at the same time, acting on the reality of the object in such a way it coincides with the recognized name.

This worry was not limited to Chinese history and philosophy; it is represented in the Greco Hellenic ancient times as well. In the Cratilo Dialogue, Socrates wished the words were in harmony with the things they designated although he recognized this was rarely accomplished, that the denomination is not only far from being perfect but also leaves a big part unjustified. A fragment of that Socrates dialogue has been preserved and he states:

how realities are to be learned or discovered is, perhaps, too great for you or me to determine but it is worthwhile having at least reached to this conclusion: that they are to be learned and looked for much better through themselves rather than through the names”

This brief comparative recount between cultures helps me express my disagreement with the denomination “natural therapies” which names among technical practices of limited professional application other rather evolved Medicines, Medicine of ancient roots and which constitute in themselves individualized medical bodies, namely as an example in Far East the always alive and evolutive Indian and Chinese Medicines


EAST WEST.


The healing caring of the body is a cultural and civilization act, and so the initial medical stories from East and West show archetypal mythical components extracted from the observation of Nature (man in it) speculatively imagined in order to cover emotional or psychological targets seeking regularity: if a phenomenon was regularly repeated it could be controlled, anticipated, neutralized. That was the case with planetary movements, water, fire, predictable meteors, and even the unpredictable ones.

Given that taking care of the body, in whichever manner, is a cultural act, it is not appropriated to reduce its study or explanation to a mere catalogue of healing acts or exercises whether they are either spontaneous or deliberate. Every dynamism or movement comes from an intention, the same act can result in different intentions which should be interpreted through, and according to the life style each culture shows. Nowadays it is easy to access to all of them given the possibility of sharing and interchanging modern life allows. The great Eastern options, pre-cartesians, according to which body and soul are inseparable, still stand for themselves, therefore both conceptual positions diverge: one that considers the expansion of the human body (athletics: the Socratic ideal of considering the best man that one who manages to be good and beautiful: kalós kai agathós) as a necessary model that satisfies by itself and another one that states that material development is a hindrance for spiritual progress (ascetics). Both lead to different definitions of the concept of health although the training and exercising of the body is a comprehensive, natural therapeutic way, which in these two cases and by different motivations leads to different attitudes as well. Except among Stoics, ascetics had little evolution in the Greek Latin civilization, but its role has been relevant as a supportive base for the great ancient religions, Christianity being one of them. In the East simple acts such as dance, games, baths, meals, have had a sacred origin even though they are considered laical or secular nowadays due to the losing of their ascetic character, even though they are still carried out in a search which is very similar to the Western “mens sana in corpore sano.”

For the Chinese thought the body, unit of functions and constant transformations with clear patterns, doing and undoing itself (analogue and incipient concept of metabolism because what supports them are different concepts) this notion is also valid for other disciplines, for example mathematics, about which Chinese thought they could not strictly represent a world which evolves imperceptibly and constantly ; which is to say that they were able to capture the limit of the abstraction as a tool of knowing, useful for the technical matter but not for the essence being this one pure dynamism.

This dynamic idea of the development of the body which Chinese and Indian culture share, perhaps much later served as a base for the German Naturphilosophie that considers the organism as “ productivity and at the same time product through its intimate becoming “as well explains Montiel when saying that the pathology obtained from the observation of the patient (valuable in itself) cannot be the only starting point of the medical theory, Physiology, that is to say health, must be conceptually taken into account.


FEATURES.

Western and Eastern Medicine differ, as sample and example, in something as basic as the approach to the body constitution and the speculations about its functioning emerging from philosophical elements which might have been similar in the beginning to later evolve in a very different way in one hemisphere or the other.

Following Suzuki, we cannot forget that Eastern people love their so close Nature so much that they feel one with it and that Western people tend to draw away from it because they think it does not have much to do with human being except when it is to use this Nature in its desirable aspects or to modify those aspects deemed undesirable.

Medicine in India is a complex of healing practices which origin can be traced back to 1500 BC. when the Arian invasion of Hindustan was registered.

From those times come the texts which allow us to get to know the Ayurvedic Medicine ( veda knowledge and ayus span of life) From religious ascetic books and from purely medical other ones we get the Vedic rites which teach us how we can optimally use that span of life given by Nature, how to behave in both private, and public life. Ayurvedic as such, is applied basically to medical issues; therefore it is justified to talk about Ayurvedic Medicine which would have more of the diaita-Greek diet than of modern Medicine.

I stress the fact about respect for ancient times so as to describe the significance of using these long standing basic notions which are still in force. On the one hand we have the Traditional Chinese Medicine based in past times, in tradition, the best of which was figuratively already obtained, figuratively because what is transmitted through tradition is timeless and on the other hand, the Western Medicine which being devoted to progress still thinks that its golden days are still to come. We need to remember that tradition is not made of uses and customs, tradition is related by definition with arche, the principle.

Regarding denominations, by and by we are accepting that the adjective “traditional” which still qualifies the Chinese Medicine is losing supporters and reasons for it, even inside China where, for example, in Beijing the Beijing University of Traditional Chinese Medicine shortened its name to Beijing University of Chinese Medicine It is clear that because of routine, ignorance, comfort, vested interests or due to differentiating arrogance - the only Medicine is the Western Medicine- the West is trying to keep the term “traditional” to name Chinese Medicine even though we cannot find any other Medicine from or in China other than the one that is practiced and exported today, which includes everything we currently know and everything that has endured down the years. Anyway, Biomedicine also roots itself in long ago established traditions, relegated now though.


ENCOUNTER BETWEEN EAST AND WEST.


What the West found in the XIX century in its expedition towards the East, was the remainings of a multitude of techniques, practices, beliefs, superstitions, the whole based on an amazing array of medical concepts already registered since hundreds of years before in very explicative texts. These texts were quite similar to their Greek Roman contemporaries in the description of sufferings and the answers given to them, therefore it is difficult to understand the dichotomy, the opposition, the given “alternative” of being just complementary which intended to be established between Western and Asian Medicine both in the past and in present times, and the attempt to “integrate” Chinese therapeutic criteria in Western diagnosis modes.

Medicine is a word derived from Latin term mederi: to heal, to care, which is what Chinese, Japanese, Korean and Indian doctors do as well.

It is true that there is a quite spread stream in China which attempts to integrate both medical ways with texts where this possibility of interchange and technical combination is indicated, even though at the same time they make it clear that Chinese Medicine comes from a holistic concept of the body as a whole unit harmonious with the environment in contrast to the Western contribution, deeply related with the modern knowledge of science and technology.

As an example I would say that the concept of void in the East is just crucial. Greeks described and accepted the notion of void as a dialectic of reality which explained the movement in the being/self, but in the West then and to the present day and in many different ways void is assimilated with nothing, being this latter concept horrifying in Nature, an inheritance from the Christian explanation according to which the Supreme Maker could not have left places without creation in them, everything was planned then, then, what about void, the nothingness?

For Chinese and Indians and for cultures related to both of them, the void is the engine, the motor of energies, the space-origin where everything that is possible flows, the point to come back to in order to rebirth. Without void there is no movement, there is no space available to conceive, to create, to be born, to grow. The four elements which according to Indians form the body: earth, water, fire, and wind have no real existence for Buddhists; we depend on them but they do not belong to us, everything is void including these four elements... That which Indians call wind, is in China called qi, breath, energy, it might be something material but lacking a specific visible form.

It is not the breath in respiration or in atmosphere but the strength manifested in daily life due to its power and effectiveness. As an example let us say that the acupuncturist Chinese doctor encourages the patient to remove all that presses or compresses the flowing of qi in his/her body and therefore prevents the void: wrist watch, socks, and belt. Because otherwise how can the doctor manipulate the circulating energy?

Therefore, if the initial knowledge obtained through the direct uptake of the human organism is elaborated in a different way, it is nor surprising that the conceptual consequences before pathology-illness are also diversified. Both of them see and perceive the same but they process that which was seen and perceived according to their own culture so it becomes the same and the other at the same time. Acupuncture is a clear example of this, it gives us something almost amazing, being able to diagnose and treat internal disorders through actions taken on the external –skin, flesh- successfully moving into practice the theoretical conception of the body, whether healthy or sick, as a constant flow of inside-outside-inside relations.

Eastern scholars did the same as the Greek did and in the same coeval times that originated the naturalist thought (allegedly naïve in many aspects) they based their Medicine on: they watched the daily life of heaven and earth and translated the knowledge thus learned to the every day of human beings, both individually and socially. The concept originated there and now was also product of the influence of other cultures and notions survived or died according to their adequacy or lack of it, to the various and different schools of thoughts which allow the understanding of history, since they translate in their own particular way the conflicts from that time. During all times, social, material and legal conditions have had their influence on the different expressive forms, and the personal circumstances and characteristics of each thinker have great importance for this matter: a speculative temperament is not the same as the one from a man of action: Galen was no Plato nor Confucius was Zhuang Zi.

The variation was in how they interpreted what was watched, what they looked for, which conclusions they came to, which of them were accepted and prospered and which were discarded and why. One example will clarify this point: Anaxímenes of Miletus, versed on the influent Indo-Iranian culture of the times, along with Anaximander talks about a material principle which dominated aer (air) and which contained all the qualities of the mysterious to apeiron although it was not exactly our air, but rather a vapour-steam perceived when moving or felt as cold or hot. This eternal vapour is extended all over the universe and its capacity to move and change things is infinite, it is inexhaustible because aer is for the world as the breath is for the human being: vital, vivifying. This concept of air as a participant matrix in all things was unsuccessful among the Greek naturalism and also in its somehow derived pneuma, this latter notion was much more limited and was just applied to the human physiology and long survived in the Western medical thought.

This Greek aer, global and comprehensive notion of diffuse application in macro and micro cosmos was called qi in China, ideograph formed by steam and food, etymology similar to that for physai ek ton perittomaton (vapours from food) but the paths followed by both notions differed in many aspects. Pneuma left traces in Pneumology medical speciality which studies the pulmonary pathophysiology but in China qi continues today explaining the movements and biological dynamism in the whole universe: the energy, the vapour, the breath, the breathing, basic concepts to the human being existence from its conception as an individual being. In Chinese Medicine texts, written in Spanish, the qi notion that has permeated due to its conceptual roots the whole Chinese thought along the centuries, is used without translating once its meaning has been explained, as many other terms with difficult or impossible translation into Western languages.

The qi movements are biased in relative yinyang gradations that are complementary because they are opposite forces: there is no above without below. Yingyang represents the gradual developments of start-beginning, fullness and decadence and extinction in all aspects; from the most simple and obvious ones such as the course of the Sun along the day or the year to more subtle dynamisms not immediately seen such as the ageing process.

This complementary opposites synthesized in the yinyang dynamism are not exclusive to Chinese philosophy, because India Yoga Schools as well also describe the dvandva opposite pairs among which the balance is sought. And so are formed pairs or couples constantly held by its dual relationships since they have something from earth and something from heaven (both matrix elements) and because every single thing arises due to the duality effect. Thus making evident some of the conceptual differences the East stands before the Western logic thinking for which opposites or differences are excluding. Western metaphysics points out that a phenomenon either exists or does not exist, nothing could be what it is and its contrary, antithesis are rigid: either healthy or sick and the Chinese consider that health-sickness is not an antithetic pair but a gradual expression of a process since each state, each thing, each phenomenon contains the kernel of yin or its contrary complement, the one from yang.



CONCEPTUAL CONTRASTS.


Consequences of this conceptual position, deeply rooted in the Eastern knowledge, applied in our case to Medicine, determine as an example that a disease will not be seen as the effect of a cause which took place in the past because each event is considered as the interaction of an active yang force and of a structuring-constructive yin whose predominant individual characteristics determine the Nature of the event. In this way the fact explained in the West as a product of a cause prior to it, in China it is thought as the interaction of the two opposite and complementary forces of the energy principle which concurs in the moment. That which among us is designed as object or thing in the East will be considered as the consummation of a series of past actions or effects that can only be found in the past: changes in the human body are the result of long standing functional or pathological developments. Everything is interacting dynamism, interactive; change is the only permanent thing. The same energy can manifest itself by means of several different effects depending on its interaction with an object: the sun illuminates, evaporates, dries up, heats up, makes fruit ripe, darkens the skin, facilitates plants photosynthesis, i.e. it is the particularity of the object what defines the Nature of the interaction.

Our ancient Western thinkers, or nearly Western given the multiple and big influences that Greek and Helens received from Egypt, Asia Minor and from India as well had these reasonings and knowledges that over the centuries were changing their paradigms, their epistemology, from the Medicine by the patient bed side towards Hospital Medicine (anatomopathology, necropsies) up to the present laboratory (chemical and radiological) techno Medicine which turned allopathic doctors away from the initial naturalistic roots.

Somehow, Eastern Medicines keep the bidimentional scheme symptomdisease which occur at the same level since the diagnosis is based on the medical record without searching for a precise location of the diseases inside the body because organic pathology was not known , in any case the ”pathological” ones in terms of quality or quantity were the energies. This may be one of the reasons why the Chinese did not develop surgery techniques, nor did the Indians and perhaps in this culture social issues such as castes system were added. In both civilizations philosophical or religious influences also set the pace of medical caring: Confucianism in China teaches that the body we were given by our parents should return clean and whole to the very much respected realm of death.

In India the pure/impure concept of Brahmanism (any contact with the body whether dead or alive was a transgression) structured the rites, sacrifices, and distinctions between communities and classes which is why outside the religious-elitist circles doctors-healers and ascetics coincided in the transmission of a practical knowledge over time.

The arrival in India of British Colonist (XVII century) led to a hospital and laboratory Medicine and began a search for a third dimension which added to the symptom-disease scheme the search for a sign, that is to say the pathology inside the body .Sick people were no longer seen, instead sickness was seen.


MEDICINE: WESTERN-EASTERN.


It is not about comparing the origin-evolution of allopathic Medicine with the Eastern Chinese and Indian Medicines, without forgetting the very prominent Japanese, Korean and Tibetan ( derived from Chinese one) Medicines. There were many points in common between them both in the philosophical and practical background which have been disappearing for all kind of reasons. For the Eastern practices the geoclimate differences mark the variants, apart from the undeniable mutual interinfluence of these aspects and therefore I do not wish to nor would it be truth, to present these Medicines from the East as a unity because although they share many approaches and -“de-approaches”-the assessment which can be done nowadays after long evolution and influences differ from one to the other. They are alive; their bases are still being interpreted both within each country and by scholars from other latitudes, which lead to considerate them as more or less successful autonomous medical corpus.

It is due to certain rigidity that it’s not easily understood in the West that neither Chinese nor Ayurvedic Medicine –the most widespread among us- would deploy anatomical knowledge like the Westerns. As we said before, their formulations before a persona and its diseases are culturally different before Biomedicine, which isolates the health psychic and physical components as elements independent one from the other, since Western Medicine conceives the body as solid and self confined while in East Asia the body is fluid and penetrable, engaged in a continuous exchange with the natural and social environment.

The body-spirit duality is, in the Far East, a triad: body, soul (breath) spirit (consciousness) and the body is assumed to be a micro cosmos in harmony with the universe-macro cosmos. Yogis say that rather than having a body we are in a body. Thus explaining diseases (as Greeks did) through humours and organic halite and their way to combine with the outside and with the inside. And as Edelstein would state it is clear that such approach makes it unnecessary to take into account inner organs or their forms or characteristics.

The human being interacts with Nature, and thus Chinese assimilate the energy from organs to that one of a natural component: the liver to wood, the heart to fire, the spleen to earth, lungs to metal and kidneys to water. It is clear that in order to get to this during a long time there were many steps both conditioned and disputed by the already mentioned theoretical postulates from each school, by politics which wouldn’t accept for example that certain dynasty has the fertilizing but at the same time flooding water element as a symbolic banner, instead of the fire element that illuminates although it scorches everything…

Same thing can be said about Ayurvedic Medicine, canvas on which all explanations and all battles among the different dissident schools are registered and where an influential religious aspect is added.

These Medicines do not have the modern scientific sense, they are discourses on health, interpretative schemes on the relationship between man and universe. It cannot be assured that they did not have a pre-scientific bias because as for the Greeks, their conceptions, as research topics, came from a repeated observation of nature and the order in it and from this observation they concluded that nature phenomena repeated themselves under the same conditions and without changes. The human spirit must conform to the experience to be able to mentally capture phenomena .

We have previously announced that the Eastern human body is not conceived in any likeness to the Western one... It is much more than structures, separated although linked the ones to the others by mechanical means which by facilitating its interfunctioning composed the Greek soma. The physical conception and the body approach in the East is a result of a difficult understanding among bio doctors who, many times before the comparative approach, capture and analyze and even “discover” their own anatomic concepts as if it were the first time. They teach us Bio Medicine –which is not only Anatomy even though from its conception other aspects of medical duty are derived- self limiting knowledge, with little openness and conceptual flexibility; and since we are beforehand predisposed to think that “we are right and our thing is the best one” when in the same faculties/schools it is intended to teach other Medicines, the student finds difficulties in reconciling both notions. An example: the liver, linked to the gall bladder is a viscera located in the right hypochondrium although for the Taoist Chinese conceptually and due to consistency with the philosophical foundation they are based on, the liver whose function is perceived throughout the whole body, is ideally located in the left hypochondrium; therefore it is difficult to understand certain organic functions which, being abstract, are also exchanged with those from other viscera. Both in the West and in the East, kidneys and liver are obviously and respectively related to the bladder and the gall bladder, but how can we accept, as the Chinese Medicine claims, that the heart is paired up with the small intestine and the lungs with the large one? However, we accept -with a condescending gesture though- that the ancient Greek Roman Medicine related organs because the concept of basic elements was not enough to explain the organicity and its interrelationships (not everything was structural matter) so it conceived various dynameis linked to the elements. And it also paired up the humours: blood with dark bile, phlegm with yellow bile because each humour had the quality of one of the elements of the physis: air, earth, water, fire22.

The Chinese doctor in order to research, understand and know philosophy, pathology and to take therapeutic decisions and evaluate its results uses:

a) the medical history in which it is relevant the time of the year and the weather both currently and when the discomfort started; b) general observation of the patient and specially of the tongue; c) palpation of pulse, thorax and abdomen and d) in the case of Acupuncture the palpation of points and meridians as well to precisely discern the quality and the quantity both of the patient and also of the disease yinyang because everything is increasing-decreasing dynamism, flowing, mutation, transformation, nothing stops in the Universe nor it does in the human being or in the dialectically qualified yin or yang processes, everything is dynamic. So we understand that inside the organism fluxes, gradations from most to least, form least to most, from inside to outside and from outside to inside are established. The same diagnosis is valid to treat with different methods, deeply interrelated and based on the same principles: herbs, other biological products, qigong, acupuncture, tuina, dietetics…

This description of a medical Chinese act does not seem complementary to one of allopathic Medicine but simply another way of approaching physiology which will consistently derive in its consequence: another therapeutic form.

It can’t be ignored that part of the success and global diffusion of Chinese Medicine is due to the existence of diagnosis and therapeutic hiatus or voids for which Medicine has no answers yet and it is understandable that necessity indicates and also allows paths so that therapies can introduce themselves through those voids, therapies that because of the instability and hesitations produced in qualifiers, are given adjectives like: “unconventional, complementary, alternative, natural, soft, sweet…” It should be noted that apart from the public acceptance of the so called natural, it is constantly increasing the quantity as well as the quality that enshrined scientific areas dedicate to investigation of the medical reality that other health-disease approaches offer with likewise different solutions. The results are becoming more and more encouraging because they facilitate the disappearance of pre-judices, the subject requires it.

I also have to mention that in our country the training deficiencies of those who practice natural therapies without a degree or qualification in the health field are slowly being corrected. Those who instruct this community are noticing that training must provide theoretical foundation so that the students are able to understand the basis of what they are doing and they have between their hands thus their curricula are incorporating subjects of both technical and ethical relevance. Because of everything here said, we think that the hierarchical rating of other medical forms different from Biomedicine is going to be fading away at the same pace we accept the latter is not the only valid one, because having scientific knowledge which explain the development of other forms of thinking about Medicine, it will get enriched by incorporating other methods. This imposes the inclusion in the various sanitary branches of academic teaching planning of all concepts and practical applications of that which, even without any justification, is unitarily presented as natural therapies. Natural Therapies which are, in essence, medical acts based on documented professional knowledge that gives responsibility- in all senses- to those who practice them. And thus it won’t be necessary to look for appellatives, denominations, calificatives, because everything will be Medicine and its variants, since all things considered, there is no such thing as “no natural” Medicine; the singularity and specificity of Biomedicine lies in the method by which it produces knowledge, because its object is as natural as that from acupuncture or homeopathy.


Bibliography. References

Edelstein, L. Ancient Medicine.Temkim O. Temkim.L Editors.Baltimore and London The Johns Hopkins University Press 1987

Jayanta Bhattacharya. The Knowledge of Anatomy and Health in Ayurveda and Modern Medicine: Colonial Confrontation and its Outcome.ea journal Vol.1Nº1August 2009 : 2

Lain Entralgo, P. El Cuerpo Humano.Oriente y Grecia Antigua.Espasa Universidad. Madrid 1987

Leys,Simon.Analects of Confucius.Translation and Notes. W.W.Norton & Company.New York London 1997

Martzloff, J.C. Les Mathématiques Chinoises.En Aperçus de Civilisation Chinoise.Les Dossier du Grand Ricci.Desclée de Brouwer Instituts Ricci. Paris 2003

Montiel,Luis. Filosofía de la Ciencia Médica en el Romanticismo Alemán.La propuesta de Ignaz Dollinger (1770-1841)para el Estudio de la Fisiología. Medicina e Historia N70-1997

Nan Huai-Chin. Yi King Sagesse & Santé. Gut Trédaniel Éditeur.Paris 1994

Peluffo,E. Idea del Cuerpo en Occidente y Oriente. Miraguano Ediciones. Madrid 2009 Porter,Roy.Breve Historia de la Medicina de la Antigüedad hasta Nuestros Días. Taurus Madrid 2003

Porkert,Manfred with Ullmann, Christian. Chinese Medicine. Henry Holt and Company.New York.1982

Prost,André. Prefacio en Brelet,Claudine Médecines du Monde. Robert Laffont. Paris 2002

Sigerist, H. The Great Doctors: A Biographical History of Medicine. Doubleday,New York 1912

Smith T.V. De Tales a San Agustín. Ediciones Peuser.Buenos Aires 1955

Suzuki, Daisetz T. Conferencia sobre Budismo Zen en Budismo y Psicoanálisis..Mexico FCE 1982

Unschuld,Paul. Chinese Medicine.Paradigm Publiations.Brookline, Massachusetts. 1998

Unschuld,Paul.Huang Di Nei Jing Su Wen.University of California Press.Berkeley Los Angeles London.2003

Wang Ju-Yi, Robertson,Jason D. Applied Channel Theory in Chinese Medicine.Eastland Press,Seattle : 2008

Zhang Junwen,Bai Yongquan,Chen Longshun Integrating Chinese and Western Medicine.A Handbook for Practitioners. Foreign Languages Press. Beijing 1993.




ZHUANGZI III YANG SHENG ZHU

A MEDICAL READING
Dra.Electra Peluffo MD. PhD
Master Course of Acupuncture
Faculty of Medicine. University of Valencia

This Yangshengzhu short story is composed of fables that allow you to analyze the relationship among literature and medical themes still in force because Zhuangzi texts transmit us concepts and reflections on his time and ancient Chinese traditions as well reflected in nowadays medicine.


Objectives: Bring to light concepts, data, and information which come from Ancient Classic text and can be applied both to the teaching and to the practice of current Chinese medicine.


Method: To do this we studied different Spanish, English, and French translations of Zhuanzi, Chapter III, YANGSHENGZHU, Nourishing the Vital Principle, so as to reinterpret in an analytical manner the text of interest seeking to locate medical references in it.


ABSTRACT:


Yangsheng, Caring for personal life (body- mind unit) arises from the principles of filial piety coming from the certainty that the world beyond the grave was so true in the Heaven as the world of living was on Earth, though sometimes it was doubted that the dead knew what was happening on Earth.

The first parable reflects on our human condition, whose limitations should be recognized and not exceeded so as not to get exhausted when the sought unlimited knowledge cannot be reached: a mental hygiene leads to a healthy emotional system. Yangsheng means keeping the Original Breath and make it circulate through the body.


Therefore, Zhuangzi III advises to remain in du, the center, site of the void full of energies. The center du points to the middle line which runs through the back of the body: the extraordinary vessel dumai called governor because it both oversees and watches (there is an eye on the lower part of the sinogram). This message promotes the proper use of knowledge, which must be limited to that what serves peace of spirit.


Center and void are the foundation of health and disease, no activity is possible without the void, which means potentiality. This idea connects the first fable with the second one where Ding the cook explains his professional skills through the void.


Ding narrates how he uses his body while cutting up an ox. All the movements Ding does and describes and his observations about the ox he is chopping up, serve me to link animal anatomy and human anatomy. Taoist Ding no longer sees the ox, he rather feels it, and more than on anatomy he talks about functions, dynamics: he stands, watches, moves slowly, slithers the knife and the ox drops to the ground.


The third fable introduces us to a crippled man: the Commander of the Right who has only one foot. Is it congenital, heaven work, or acquired, man made?


It is important to clarify his disability: if it is acquired it would mean that the subject failed to keep all life elements together in order to preserve it, proof of little wisdom. If congenital, it shows an internal failure which prevents the subject from being virtuous; he lacks the essences needed to invigorate breaths. The Heaven always does things right and makes a one-footed subject perfect, the perfection of a “onefooted”, unipies.


Next parable speaks on the pheasant that nourishes its life walking while eating and drinking: it prefers freedom to a “safe” cage. Nature is nourishing its life and that happens only in freedom. Zhi is a homophone of zhi, knowledge.


The last parable is about the mourning of the death of Lao Dan: Qin Shi voices out three cries and withdraws. In China, three ritually marks periods of testing and passage, from birth to death. Three lamentations are the symbolic minimum to accompany the passage of the diseased. Life has been lived and its bunch of energy disintegrates, it’s not Lao Dan any more, its now part of universal life. In Medical theory, three describes, among other things, the three main sources of energy.


KEY WORDS: Zhuang Zi, life nourishing, Chinese medicine, Taoism, void, center, extraordinary vessels.


INTRODUCTION


I took part in FEIAP Valencia 2008 meeting with a communication based on Qi Wu Lun, second of Zhuangzi inner chapters through which and with cautious modesty I dared to link literature, thought and medicine in China where the unitary medicine -perception of the body mind both in health and in disease- always drew from philosophical thought. And from there, its theoretical foundations are taken, foundations still in force for the study, comprehension, and practical use of Chinese Medicine.


This time I would like to repeat that gesture and relate the interinfluence of thought-literature-medicine in China and its tight coexistence, interpreting at the same time the medical information I find in the Zhuangzi third chapter, Yang Sheng Zhu “Nourishing the Vital Principle”.


This short text (mutilated?) is composed of fables containing data which allow me to analyze the relationship between the philosophical-literary reflection and subjects of Medicine from the author times still in force nowadays. Zhuangzi is a primary source of the Taoist thought intellection of its time, not only of the Taoist one since its stories can coincide and also differ with the sustained by other coeval or previous schools.



  • 1. Vital Principle


    Yang Sheng, caring for your personal life, for natural qualities (body-spirit unit) was a practice born out of the filial piety derived from the certainty that the world of the dead that existed beyond the grave was as true in Heaven as the world of living ones was on Earth. However, at times doubts arouse about whether the dead knew, whether they were aware, of what was happening on Earth.


    Mo Zi 1dedicated Chapter 31 of his work to silence those who did not believe that the dead and their spirit “existed” and, not only that but considered sacrificial ceremonials a waste of time and food. For MoZi (V century BC) these ceremonies helped gather people together and improved relationships between neighbors. But, the uncertainty about whether the dead had the capacity to know what was thought about them on Earth, still remained. Those asking this -the hedonists2 -shifted their attention from spirits to the living bodies: it was better to enjoy all the possibilities in life regardless of postmortem reputation we would leave. They called their doctrine Yang Sheng: nurture, nourish life and the living as opposite to nourishing the dead.


    And for Hedonists, what most nourishes life is the happiness obtained through the freedom of fulfilling desires, although for many of them this was not so elementary or simple since there were guidelines such as those in the 8th chapter of Ben Shen (Root Spirit) classical text Ling Shu3 which help us to wisely preserve full health so as to avoid the attack of evil energy and live long without declining. Thus Yang Sheng is equivalent to observe the four seasons and know how to adapt to cold and heat, to harmonize joy and anger to be quiet both at rest and activity, to regulate yingyang and to balance firmness and softness. This capacity or skill leads to the capacity for well living: we must cultivate, indefinitely, what was given to us by Heaven. Chapter 8 of Su Wen4, another medicine classic, also points out that in order to achieve longevity the 12 Governments (our 12 organs and their energetic vessels among which, the heart is the sovereign) must be coordinated among themselves and keep harmonious under mandate, zhu. One of zhu meanings5 is to be the master of-in your own home.


    Zhuang Zi names his text Yang Sheng Zu. All wellbeing advises need a master who inspires (methodizes?) vital dynamism6 and, for us humans, this mastery is exerted by our own heart, our guide in life. As parallel situation, in our society this is the task of the Emperor, the heart of the State.


    Those were turbulent times,(IV century BC) each philosophical school- Confucian, forensic, Mohism and others proposed a concrete plan of action to reform both the individual and the society and thus getting to rid the world of all its evils7 through reasonable solutions and achieve social, political and ethical reforms with them. But Zhuang Zi influenced or not by his social and cultural background and, of course, by his personality, only proposes an essentially mystical answer under the imprint of the Taoist School he represents: individually get free from the world. The word freedom may summarize the central theme of Zhuangzi.


  • 2. First Parable. Center and Void


    The first Yang Sheng Zhu parable already provides us with data regarding Medicine. It reflects on our human condition, whose limitations should be recognized and we should not try to overpass them so we do not risk exhausting ourselves when the pursued unlimited knowledge is not achieved.


    Lao Zi XXXII tells us:

    …” know that it is time to stop.

    Only by knowing when it is time to stop can danger be avoided


    And in order to do so, Zhuangzi III recommends that we remain at the center where the plenty of energy void resides: we must reject the fame that might come from doing good and the punishment for doing evil, it is at the center where life can be preserved. Different translations coincide when considering center du a reference to the middle central line that runs along the back of the body: du mai, the extraordinary vessel named governor, oversees and watches (there is an eye on the lower part of the sinogram). Dumai stimulates and controls the flow of the yang energy of the organism.


    Dumai starts at lower abdomen and exteriorizes at the perineum, from where climbing up the spine reaches the cranium to finish, always along the central line, at the superior maxillary gum. It describes a primary axis for Taoist exercises of longevity, which is to say we are in front of the central line, the one which guides life. Due both to its path and to some symptoms of its pathology8, it is associated with central nervous system although for authors who insist that vessels follow blood paths dumai would not be anything else but the aorta. In his essential study on the eight extraordinary vessels, Li Shi Zhen9 shows his interest in the inner alchemy, in the spiritual growth –yang sheng- when considering du, ren (conception) and chong (crossroads) mai the most important vessels among the eight ones. We will be back on qi jing ba mai , extraordinary vessels.


    Chinese Medicine, through its unitarism inside pluralism, unifies organic and mental emotional life so Zhuangzi, (well-documented original source of Taoist reflections that continues to present day being the foundation of this Medicine), suggests in the first part of Chapter III nourishing the vital principle which is a sort of mental hygiene leading to a healthy emotional system including Confucian filial piety, because it is the whole taking care of the integrity of the individual what makes us live long. The message is aimed at the good use of knowledge which should be limited to those fields serving peace of spirit. Accept life as Heaven grants it to us. In order to do so, he mentions good and evil, as shan and e, that what is considered good or evil in our world. In the text both good and evil point us to the skills helping us to stay alive without ignoring the fact that to nurture life we should focus on vacuity, that is to say follow the Dao of nature. Both the concept of center and void are precious to classical Chinese reasoning particularly in Medicine.


    The void is the most divulged thing in the world since no activity is possible without a void, empty space. It means potentiality, availability, possibility and this idea links the first fable with the second one where Ding the cook explains his trade skills through the Taoist concept of void.


    In several of his short stories, Zhuang Zi uses analogies with craftsmen and artists: the carpenter, the cook, the swimmer who does not analyze the course of action because their excellence in terms of expertise is just part of themselves. They act instinctively, spontaneously and without knowing How or Why they achieve success, metaphor of an utter free of purpose journey during which there is enjoyment but not clinging to joy, so guides us Dao.

    “Each joint has an empty space”10 tells us Ding, knowing the natural structures that give form and life to organisms. This empty space is not an absence, it is dynamism of energy communications; both breaths and spirits go through it when behavior does not deviate, and that is what clears way for the edge of the cook’s knife. Ding dominates the void 8 and the story suggests that this is so because he has nurtured his life through his trade, exploring the functioning of things more than the techniques. Is this the zhu of the title?


    The void11 Ding makes use of, reminds me of the reasoning of a player with the Spanish Football Team the day before playing the final match where they would win the World Championship, he said:

    “Before, I used to go to the ball more often. Now, I’m more concerned about the space than about the ball” Carles Puyol. El País, 10-VII-10

    Whether having read or not Zhuang Zi, he who knows his trade coincides in the mastery of understanding and dominating the void...


    In Chinese Medicine the concept of void is essential to understand the movements of both energy and breaths, both in health and sickness. Thanks to the ungraspable void the free circulation of visible and invisible blows, an equivalent of health because its blockage leads to disease. Center and void, so precious to Taoist Zhuang Zi, are the foundation of the concept of health (and disease) in Chinese Medicine.


  • 3. Second parable. Ding the cook.


    Because of the descriptive detail of European anatomy, western science often points out the scarce anatomical precision of Chinese Medicine texts. In my opinion this is so because eastern people watch and see the body not to highlight organs, shapes, sizes, weights but to calibrate the functioning (invisible) of those viscera, which role they play and how they do that and what relationships run between them. Zhuangzi makes a detailed account of the use Ding gives to several parts of his body during the process of dissecting the ox.


    The wu ideogram things, beings, everything existing between Heaven and earth are formed by niu the radical for bovid, one among the ten thousand beings. It is cow, ox, buffalo.. If horses point us to the Heaven, ox terrestrial quadruped helps farmers and quietly rest in swamps, water holes..it belongs to Earth. Riding the ox, Lao Zi disappears through the West gate ,on it he leaves this world.


    It is well known that for the Chinese the unit, base to plurality lies in Nature and everything has its equivalent in the different realms, we all look alike once variants are accepted. So I will make use of the movements Ding the cook describes and does to relate animal and human anatomy. Clearly, we are on Earth, in the yin, the materiality. So, in both bodies joints, arteries, tendons, bones, unions, interstices, hands, feet, knees, shoulders are rendered dislocating the conjunct which was alive before to offer it to the Gods in a one-to-one dance: sang-lin ( dance of mulberry trees) and jing-shou (feathered head) were popular dances at the time when the author lived. Rather than an anatomical description- because the Taoist Ding no longer sees the ox, he knows it by intuition, he dominates (zhu) the animal ­– the story thrives on functions, movements, dynamisms: it raises, watches around carefully, moves slowly, uses his knife very slowly until the ox who does not know it is dead12 (the ox had no time to realize it would die13) drops to the ground. The sensory perceptions correspond to the cook’s apprentice who can only see the ox but through the repetition of movements, Ding reaches an unconscious perception, he does not see the animal any longer, rather he conceives it14: a gesture constantly practiced becomes unconscious because mastery of gesture means safer and more fundamental knowledge 15

    have all lived/experienced the learning stages.


    Ding, skilled artisan cook, interrupts his work to tell his action, he puts the knife aside (there is no possible concentration in two actions at the same time) and while describing the quartering of an ox he shows his master how to act in order to nourish life keeping, at the same time, the used tool for nineteen years. This is not the only time Zhuang Zi mentions number 19 in his writings. Nineteen is the sum of 10 and 9, both totality numbers, what may symbolize a long time or a complete, completed cycle, and in any case is here a metaphor for longevity – if not immortality- which is one of the objectives of nurturing the vital principle.


    The cook explains that after the initial difficulty (reference to Zhun, Yi Jing 3?) and since he managed to master his craft, he has long lived without losses.

    In essence, Nourishing the Vital Principle means keeping the Original Breath and making it circulate through the body. For some Taoist Schools yangsheng is synonym of embrionary breathing exercises tai xi, holding the air the longest possible time so as to keep our own embryo alive, the embryo we carry in xiadantian our lower abdomen.16 And if the results of this respiratory technique are not reached, at least it will also be a way of protecting the vital  breath.


    But the yangsheng Ding who illustrates us about while slaughtering the ox, show us an example of someone who follows Dao and absorbs, without a voluntary purpose, the celestial breath, the original energy: wisdom and talent nourish spirit, life. Zhuang Zi proposes something less material as opposed to the multitude of physical methods, which he does not exclude since our bodies must be fit. But the spiritual practices, the nourishing of the spirit, the ecstasies, and the mystic union with dao will lead us to immortality or at least to longevity17.


    However, we can say that other schools of similar antiquity practiced and still do, static ways of nurturing life originated by opposed positions to those of the above mentioned hedonists. Han Fei Zi18 (III century B.C), without recognizing any practical value, describes the cult which promotes quietism, wuwei. Politically or philosophically he might be right, but medically, the zhang zhuang –upright post- apparently static practice (everything is inner movement, energy never stops) can provide the same whole benefits as “active” exercises can do19 .


    Ding details all the possible obstacles he avoids and how he has managed to smoothly accomplish his task, and in the final paragraph he specifies its task when, during dissection, he must face a complicated site: with extreme caution he watches attentively focusing his sight in what he has in his hands, he works very slowly moving his knife (dao homophone of Dao) with the greatest subtlety until the ox drops to the ground. Standing still and satisfied he looks around while shan dao (thoroughly) wipes off his knife and puts it away.


    In this second part of Chapter III, medicine subjects such as human anatomy and animal anatomy can be linked, as well as surgery techniques, how to carve up a body without hurting organs or other body elements. The width of the knife blade is almost non existent, hence the importance of having the intuition of the hollow he is about to penetrate.


    plunging that what has no thickness into that what is hollow”20

    although 19 years has passed.


    The gesture of taking care of our own integrity is instinctive, and thanks to the experience of repeated conscious gestures, taking care of our spirits adds to that and we reach a synergetic mastery involving a greater consciousness of one’s self (zhu) than of the object, in this case the ox.

    Let’s not forget that Medicine, in China, is the science of healing, therefore those parts/pieces of Zhuangzi III can make us reflect on the medical activity as well. We will see that analyzing the third Yang Sheng Zhu story.


  • 4. Third Parable. The crippled.

    Watching through medical eyes, we can find analyzing material in the third fable as well, even though there are numerous authors who considered this part of the chapter as a later interpolation due to the difficulty to fit it into the treated matter. As Jean Levi21 points out, we can attribute a thousand different meanings to Zhuang Zi fables because they evoke series of images and associations which have concentrical repercussion in our consciousness, like a stone thrown into a serene quiet lake.


    The third fable introduces us to a crippled man: a Commander of the right who has only one foot. Poem XXXI from Lao Zi states that in times of peace among the well born the left hand side is the place of honor but in war times this gets reversed and the honor place is on the right hand side22. Rites of god omen circumvallation were performed watching South. In civilian life clockwise and in war times counterclockwise and that was important because it is Heaven ways to prefer the right: the Moon and the Sun travel towards the West and it is the way of the Earth to prefer the left, rivers in China flow towards the East 23.


    The disability of the commander, is it congenital? Is it the Heaven’s work or acquired and manmade? To describe his disability, the commander uses the character du: simply, lonesome, unique, only one (foot) which is homophone to du, the central line we mentioned at the beginning of the text. It is important to determine whether the origin of his incapacity was heavenly forced or was acquired because in this later case it would mean that he failed to keep together the elements of life: keeping a cohesive force is part of the conservation of life; he who does not know how to care of himself will not know how to assume the responsibility of his task 24. An incomplete body is proof of little wisdom, integrity was not preserved.


    Amputation in ancient China was a common punishment for improper behavior. Of course for a Taoist, bad behavior is only so in the eyes of the world, for him there is no such thing as good or bad conduct.


    But, if disability is congenital we are facing an internal deficiency that would prevent us from being virtuous due to lack of essences. Essences that design the body through the energetic dynamism of the breaths. And this essential weakness, doesn’t it entail the weakness of spirit expressions which render him to be unfit for virtuosity?

    Although the reason why Heaven expresses its aversion, depriving this man of his foot may sound incomprehensible, there is no fault on its side; it is just a malformation and Heaven can not be accused of imperfection or incompleteness Whatever Heaven does it is well done and if it has create a one foot being, it has made it perfect, with the unipies “onefooted” perfection.

    But, if amputation comes from men, lacking that what Heaven originally granted to him, then there is fault; he did not have skills or ability in living.

    Congenital malformation does not imply guilt or shame because it was Heaven decision that this occurred, but if it is acquired it is just normal that it shocks whoever is narrating the episode because something Heaven has originally granted has gone missing. He is at fault; he has not known how to cultivate his life among men.


    Chinese Acupuncture describes and makes therapeutical use of a very ancestral system of vessels, basic and previous to the rest of formations whether visible or not. I am referring to qi jing ba mai circuit formed by eight extraordinary vessels (also called marvelous vessels due to the wonders they do) already mentioned in the first part of this work to explain the concept of center represented in the body – and in the text- by dumai.


    Extraordinary vessels are part of the most primitive constitution of the being and they represent the purest stimulation of life Heaven can grant, Heaven that creates the invisible power of life, and when something invisible works for life it is just normal wonderful traits are attributed to them. According to Li Shi Zhen 25 (1518-1593) we have to proceed from the outside to the inside; the most elementary forms of the anterior Heaven qi, must be controlled before facing the fundamental dynamics of life. Internal growth/cultivation cannot happen in the void, a physical subtract has to exist, a physical subtract that gives form to the primordial qi and this form has to be regulated on a daily basis of cultivating it. Acupunctural treatments through extraordinary vessels26 which frequently correct structural problems, especially those congenital ones such as right and left imbalance, limbs length difference, postural deviation, show that body structure is inseparable from the energy and its movements.

    In qi jing ba mai, the qi character in its oldest mention, refers to a gibbous man, someone laterally deformed, disabled due to a physical deformity, so in the practice and by treatment with qijingbamai the correction of problems of static is sought to be corrected as well malformations and their consequences. I do not want to imply here that these treatments can manage to rebuild the missing foot in Zhuang Zi fable.

    Accept what Heaven sends us and be fully contented with it: each living being has what is needed to fulfill his destiny, that’s the lesson this disabled man teaches us.

  • 5. Fourth Parable. The pheasant.

    This is a parable about a pheasant that walks to eat and drink and so nourishes his life, a pheasant which prefers its freedom to be kept in a cage. All Nature nourishes your life and for the Taoists this can only happen in freedom. We are reminded of this by the title Dao De Jing where de is what Confucians, seekers of the ideal of moral perfection, call virtue; for Taoists this is power cultivated to obtain a perfect autonomy leading to a perfect state of health.

    He Guan Zi (III century B.C) the Pheasant feather Cap Master can give us some clues. He Guan Zi embellished his hat (guan) with pheasant feathers (he) which at that time (IV century B.C) connotated more military virtues than Taoist Ascetics. It is from pheasants, recognized for their combativity, that King Wu Ling of Zhao (III century B.C.) took the design of the emblem for his elite soldiers: carry pheasant feathers on his waistline27, he would wear them himself.

    The pheasant from this parable nourishes his life in freedom.

    Pronunciation of zhi, pheasant is the same as that of knowledge. The swamp pheasant flies straight without any deviation, looking for that which takes care of his physical life; he eats and drinks every precise number of steps -10 shi + 100 bai – respectively, symbolic value figures. Dietary instructions from yang sheng techniques. We have already mentioned that shi (10) represents totality, and bai (100) multiple of ten symbolically expresses an important conjunct of things differentiated by names, function, shape.. 28. It is interesting to highlight that for Shuowen 29 Dictionary, in bai character the horizontal stroke crowning a nose, represents the blows coming out from it in the middle of the face. It would be the gesture of pointing to your own nose to self identification. For the pheasant it may mean that he nourishes himself, both his body and his spirit. We know that in China unity presides the vital functioning, everything goes together and simultaneously. The bird prefers to feed himself and fly, metaphor of the spirit that soars towards the Heaven which he could not do locked in a cage even if his food was secured. Yang sheng is the pheasant choice. Holistic Taoist health.

    M. Granet in his book La Pensée Chinoise explains that bodyspirit is the Chinese conception of spirit reached through the enrichment of corporal organic life 30 by constant transformation of energy and thus shen spirit would be the result of the higher organization of energy.

    6. Fifth Parable.

    The mourning for the death of Lao Dan.

    His friend Qin Shi emits three cries and departs. In China, three ritually marks testing periods or passages, from birth to death. In this case, three moans is the symbolic minimum to accompany the passage of the deceased. His life has been fulfilled, his bundle of energy has fallen apart, he identifies now with Heaven and spirits, he is not Lao Dan any longer, he nourished his life rightly, and he participates in universal life now. Number three in Chinese medical theories describes, among other things, the three main forms of life elaborated in the three fields of the body cinnabar: jing (the substances we posses), energies qi (activity in itself) and the spirits shen (resulting from the superior organization of energy) They are three potencies which constitute the body, the world and the universe. An order of three which facilitates the emerging of anything, whatever it may be, everything; different from the Greek dualistic concept of body/spirit Western Medicine acts upon.

    I include the description of a death and its corresponding mourning in a medical approach towards Zhuangzi because Taoists consider and accept death as a part of life process, alternating phases. We know where life comes from as much as we know where death goes to. The caring for life never stops, after death the nurturing of life does not stop because man is as vast as Heaven and as Earth in Dao’s manner, because if it wouldn’t then it would not be, Great.

    Lao Zi XXV 31

    ....There are four portions of greatness, and one belongs to the king.

    The ways of men are conditioned by those of earth.

    The way of earth, by those of heaven.

    The ways of heaven by those of Tao,

    and the ways of Tao by the Self-so

    CONCLUSIONS

    This reading on yangsheng – nurturing life – from Zhuangzi describes inner processes to be in harmony with Nature, with the external world and the society and give us guidance to follow and solutions to achieve it: the practice of tai ji quan, qi gong, zhan zhuang healthy exercises, dieting and breathing exercises as well and advise on how to conduct our lives so as to lead a more pleasant and productive emotional life. Personally, knowing theoretical foundations, I find meaning in the practice – inseparable from them- of certain acupuncture techniques and of the vision of human bodymind The world of Chinese thought allows us to interrelate technique, literature, and philosophy and thus provides quite useful concepts to the different branches of knowledge, particularly Medicine. This material keeps its multi-secular cultural heritage, therefore the analysis of ancient texts either philosophical or literary ones becomes quite fertile because, with a renewed interpretation it is possible to demonstrate the validity of those concepts that at present and sticking to Medicine, are applicable to the modern reflection on the comprehension of that of interest in our activity.

    REFERENCES

     

    A Chinese-English Dictionary . Foreign Languages Press. Beijing 1996

    Billeter J.F.Etudes sur Tchouang-Tseu. Allia.Paris 2006

    BilleterJ.F. Cuatro Lecturas sobre Zhuang Zi. Biblioteca de Ensayo.Siruela.Madrid. 2003

    Chace, Ch.and Shima, Miki. An Exposition on the Eight Extraordinary Vessels. Acupuncture, Alchemy and Herbal Medicine. Eastland Press, Seattle, 2010

    Ho-Ko uan-Tseu , Le Maître à la Crête de Faisan. Précis de Domination. Éditions Allia.paris 2008

    Lao Zi. Tao te King. Versión Anne-Hélène Suarez.ediciones Siruela.Madrid 2003

    Larre, C. Rochat la Vallée, e. Zhuangzi - La Conduite de la Vie.De Vide en Vide. Institut Ricci. Brouwer Desclée, Paris 1995

    Levi, Jean. Propos Intempestifs sur le Tchouan-Tseu .Éditions Allia. Paris 2007

    Ling Shu. Ben Shen.Versión García J. JG Ediciones. Madrid 2002

    Matsumoto, K & Birch, S. Extraordinary Vessels. Paradigm Publications.Brookline, Massachusetts.1986

    Preciado Idoeta, I. Zhuang Zi "Maestro Chuang Tse".Editorial Kairos, Barcelona 2007

    Rochat de la Vallée, e. La Symbolique de Nombres. Desclée de Brouwer. Paris 2006

    Tchouang-Tseu (Zhuang Zi).LesTablettes Intérieures. Traducción de Jean-François Rollin. Librairie Séguier-Michel Chandeigne.1988

    Waley, Arthur.A Study of the Tao Te Ching and its Place in Chinese Thought.Grove Weidenfeld.New York 1958.

    Waley, Arthur. El Camino y su Poder. El Tao Te Ching y su Lugar en el Pensamiento Chino. Editorial Kier. Buenos Aires 1979

    Watson Burton. Zhuang Zi Basic Writings. Columbia University Press New York 2003

    Watson, Burton. Mo Tzu Basic Writings. Columbia University Press. New York and London 1963

    Xu Shen. Shuowen Jiezi. Version Rochat de la Vallée, E. Institut Ricci, Paris 1981

    Yu Yong Nian. El Arte de Nutrir la Vida. Discovery Publisher. Lexington, KY.2012



    1> Watson Burton. Mo Tzu Basic Writings Columbia University Press. New York and London 1963 :94

    2> Waley, Arthur .A Study of the Tao Te Ching and its Place in Chinese Thought..Grove Weidenfeld..New York 1958 :40

    3> Ling Shu. Ben Shen.Versión García J.JG Ediciones.Madrid 2002 : 68

    4> Rochat de la Vallée,E.Pere Larre. Su Wen.Les Once Premiers Traités. Maisonneuve. 1993: 251

    5> A Chinese-English Dictionary. Foreign Languages Press.Beijing 1996

    6> Larre,C. Rochat la Vallée,E. Zhuangzi-La Conduite de la Vie. De Vide en Vide. Institut Ricci. Desclée de Brouwer Paris 1995 :18

    7> Watson Burton. Zhuang Zi Basic Writings. Columbia University Press New York 2003 : 3

    8> Larre,C. and Rochat de la Vallée,E. Spleen and Stomach. Monkey Press. London 2004:24

    9> Chace,Ch and Shima, Miki. An Exposition on the Eight Extraordinary Vessels. Acupuncture, Alchemy and Herbal Medicine.

    10> Larre,C. Rochat de la Vallée,E. Zhuangzi-La Conduite de la Vie. De Vide en Vide. Institut Ricci. Desclée de Brouwer Paris 1995:38

    11> ibid: 55

    12> Preciado Idoeta,I. Zhuang Zi “Maestro Chuang TSé”.Editorial Kairos, Barcelona 2007 : 352

    13> Tchouang Tseu (Zhuang Zi).LesTablettes Intérieures. Traducción de Jean-François Rollin.Librairie Séguier-Michel

    14> Larre,C. Rochat de la Vallée,E. Zhuangzi-La Conduite de la Vie. De Vide en Vide. Institut Ricci. Desclée de Brouwer Paris 1995:105

    15> Billeter J.F. Cuatro Lecturas sobre Zhuang Zi. Biblioteca de Ensayo. Siruela. Madrid. 2003

    16> Liu Xie.El Corazón de la Literatura y el Cincelado de Dragones.Versión de Relingque A. de Guante Blanco/Comares. Granada 1995 :276

    17> Larre,C. Rochat de la Vallée,E. Zhuangzi-La Conduite de la Vie. De Vide en Vide. Institut Ricci. Desclée de Brouwer Paris 1995:13

    18> Waley, Arthur .A Study of the Tao Te Ching and its Place in Chinese Thought.Grove Weidenfeld..New York 1958 : 43

    19> Yu Yong Nian. El Arte de Nutrir la Vida. Discovery Publisher. Lexington,KY.2012

    20> Zhuang Zi“Maestro Chuang Tsé”.Traducción de Preciado Idoeta, I. Editorial Kairós Barcelona 1996 :55

    21> Levi,Jean.Propos Intempestifs sur le Tchouan-Tseu.Ëditions Allia. París 2007

    22> Waley,Arthur. El Camino y su Poder. El Tao Te Ching y su Lugar en el Pensamiento Chino. Editorial Kier. Buenos Aires 1979 :140.

    23> Ibid : 184

    24> Larre,C. Rochat de la Vallée,E. Zhuangzi-La Conduite de la Vie. De Vide en Vide. Institut Ricci. Desclée de Brouwer Paris 1995:74

    25> hace,Ch. and Shima, Miki. An Exposition on the Eight Extraordinary Vessels. Acupuncture, Alchemy and Herbal Medicine. Eastland Press, Seattle 2010 .

    26> Matsumoto,K & Birch,S. Extraordinary Vessels.Paradigm Publications.Brookline,Massachusetts.!986:16

    27> Ho-Kouan-Tseu, Le Maître à la Crête de Faisan. Précis de Domination. Éditions Allia.París 2008

    28> Rochat de la Vallée,E. La Symbolique de Nombres. Desclée de Brouwer. París 2006:178

    29> Xu Shen.Shuowen Jiezi. Versión Rochat de la Vallée,E. Institut Ricci,París 1981

    30> Billeter J.F.Études sur Tchouang-Tseu. Allia.Paris 2006 :208

    31> Lao Zi.Tao te King.Versión de Anne-Hélène Suárez. Ediciones Siruela. .Madrid 2003:79

    Dr.Electra Peluffo MD. Ph D Zhuang Zi III and Chinese Medicine


  • > Chinese Medicine, 2014, 5, 7-15

    Published Online March 2014 in SciRes.
    http://www.scirp.org/journal/cm>
    http://dx.doi.org/10.4236/cm.2014.51002>


    Pi Wei Xiang Biao Li and the Trajectory of Zuyangming

    Electra Peluffo

    Faculty of Medicine, Universidad de Valencia, Valencia, Spain Email: acupuntura@electrapeluffo.com

    Received 9 January 2014; revised 10 February 2014; accepted 23 February 2014

    Copyright © 2014 by author and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/>


    Abstract

    In this paper, it is studied the reason why Zuyangming (stomach meridian) travels the body through yin territory in contrast with the other eleven main meridians governed by the quantitative-qualitative yinyang synchronicity of meridians and territories to discover. Zuyangming meets this principle only partially (in face and leg) and that’s the reason, for this exception in the thoraco, why abdominal trajectory is attempted to be deciphered here. Ancient traditional medical texts describe the internal and external routes of meridians and the relations between the spleensto- mach pair, which Su Wen 8 transforms into spleenstomach , mentioning the membranous binding (connective tissue today) which unifies both viscera. In addition, the embryological studies of the human fetus provided information on yuan source of life and the development of tissues (fascia and membranes) during fetal organic evolution, allowing us to understand many of the classical ideas about life, health and disease. Reflections in this paper conclude that zuyangming internalizes its resplendent yang energy, and thus compensates for the predominant presence of yin energy (yin organs in yin territory), keeping the inter organic harmony of energy blows.


    Keywords

    Zuyangming; Zutaiyin; Stomach and Spleen Meridians; Membranes; Connective Tissue; Su Wen ; Ling Shu ; Shang Han Lun ; Nan Jing



    1. Introduction

    The author started studying Chinese Medicine under Professor Ye Chenggu at Guan An Men Hospital in Beijing between 1965 and 1967, time during which the subject concerning this study already caught her attention. Subsequently, in 1982 she attended classes individually, at that same Hospital, under the direction of Professor Gao Lishan with whom she consulted the difference shown by the stomach meridian along its path. Dr Gao pointed out that the question itself revealed a clear understanding of the energetic physiology of the Chinese Medicine. However, it was only after long years of practice and studies on Classic Medicine text that the author was able to develop a hypothesis about why the stomach meridian does not follow the yinyang rule of territorial distribution.



    Working Hipothesis

    Ancient Chinese Medical texts provide detailed information, both theoretical and practical, on meridians and their trajectories; these data when elaborated, allow us to develop a hypothesis that explains the reasons why the stomach meridian path differs from the yinyang rule governing the energetic channels trajectories.

    The Medicine Classics revealed the interorganic physical relationship through membranes (currently known as connective tissue) between the members of the pair linking spleen and stomach as shown in the internal path of the respective meridians and their functions, concepts accepted until now.

    This work emphasizes the Chinese classic conception of energy and cosmic resonance, as well as the rela- tionship between the yangming (the innermost of the yang energy levels) and taiyin ( the outermost of yin levels) which shows the bond not only material, anatomical but also functional; being the principle of complementary opposition, so dear to Chinese thought, fully respected.

    The thoraco abdominal cavity (anterior face of the body and therefore yin ) is home to almost all the zang fu (organs and viscera) that give the area a greater yin energy charge, which according to our hypothesis, is sought to get counteracted by the presence of hollow and peristaltic yang bowels whose main representative is the sto- mach yangming , resplendent energy, energy that is internalized when getting in contact with taiyin .



    2. Material and Method

    Analytical reading of chapters deals with the subject in both ancient and modern translations-interpretations of Classics: Su Wen, Ling Shu, Nan Jing, Huai Nan Zi and Shang Han Lun, listed in References.



    3. Zuyangming Trayectory

    Stomach meridian, zuyangming , starts in the nose through which it goes up and down, covers the upper gums and teeth, comes in front of the ears and rises up to the scalp; this journey through the face allows it to include all the organs of the senses. It goes down to the neck (St.9) and shoulder along the horizontal branch of the jawbone and turns towards the spine to meet the yang meridians in GV.14. After that it reaches the clavicle, and from there one branch penetrates the anterior trunk and moves forward crossing the diaphragm so as to, in CV13, enter the stomach and keep descending until the groin among yin meridians (all of them with an ascending direction) and returning to yang areas, travelling along thigh, leg and foot (2nd and 3rd toe) ( Figures 1-3 ).

    The twelve main meridians get together or pair up to form the six levels of energy that exchange their breaths. Out of this confluence six energetical dynamics are born, among them yangming-taiyin [1] spleenstomach which is the one before us today.

    Zuyangming—stomach— is shining yang , radiant and being the innermost of all yang meridians in the six energetic levels concept, gets to contact coupled zutaiyin (spleen) to interchange their opposite and complementary energies.







    Internal Routes of Zuyangming and Zutaiyin

    The inner route of Zuyangming is told to us by Ling Shu 10: “... in Quepen (St.12), one branch descends along the thorax and spirally envelops the spleen. Another branch begins at the stomach exit and descends through the stomach lining until St.30 Qichong (also Qijie ) [2] . When mentioning the lining of the stomach, is it referring to mesentery, hypodermic fascia?
Almost all texts accept Ling Shu version except Lei Jing Tu Yi ( Classics of Categories ) which details that the

    branch going down through the abdomen cover, descends slightly laterally to the kidney meridian, and begins at the same level as Huangshu Kid.16, right by the navel [3]> . Both references correspond to yin transits.

    There is a difference in language regarding the energetical relationship between an organ and its meridian and with coupled organ and meridian. If it is said that the meridian belongs or penetrates ( shu ) certain organ that means the meridian is completely rooted in it, in a reciprocal relation of mutual belonging. For instance, the liver and the liver meridian constitute a whole like a basin between a river and its lakes, inseparable.

    The relationship between the inner trajectory of a meridian and the paired organ which it spirally envelopes ( luo ) is different. The connection is not so intimate any more, the river contours, envelopes a rock, it does not penetrate it: stomach spirally [4] envelopes around the spleen. And also spleen spirally envelopes ( luo ) stomach ( Figures 4 and 5 ).

    Wang Bing (710-804) in his Su Wen compilation says “ zuyangming [5] , stomach vessel, descends through the diaphragm, touches the stomach and envelopes the spleen...” This spiral connection as it is told in the Classics is established by membranes, sheaths. Su Wen 29 in its final lines describes the connection between spleen and stomach through tissues and membranes that keep the two organs attached so that body fluids jin ye , can circulate through both of them.

    And thus, the density of the spleenstomach relationship is highlighted thanks to the membranes that gather them together with the same density of relationships on earth, so intimate they reach physical contact, and that enables the control of that which flows between those two membranes.

    When the Emperor asks Su Wen 29 [6] -whether the jin ye actually go through this kind of tissue or membrane to reach the entire body and specially until the viscera, Qi Bo answers that zutaiyin (spleen) runs through the stomach and establishes a shu dependency relationship with the spleen (penetrates it) and a luo relationship with the throat (envelopes it). Thus, taiyin makes the qi circulate in the three yin levels: tai , shao and jueyin .

    Zuyangming is the obverse movement biao , that is towards the outside, is the sea of the 5 zang and the 6 fu , responsible for the circulation of qi through the three yang levels: tai, shao and yangming .

    Clear is the responsibility of spleenstomach in front of the six great meridians, three yin , and three yang and also in front of the twelve main meridians.

    Spleen and stomach interact so as to share the circulatory function of the yin yang meridians because although it is assured in Su Wen 29 that both zang and fu get qi through the yangming (stomach makes jinye - body fluids-circulate) this would not happen without the intervention of the spleen, that makes this simultaneous yangyin movement irrigate the whole body.















































    4. Membranes. Yuan: Source, Origin

    Chinese people paid attention to human embryology because they were interested in concepts such as “begin- ning, root, origin” ...many Chinese ideographs imply the notion of origin or root or basic part: yuan source, basic idea in the source theory in Ling Shu 1 and in Nan Jing 66. They wanted to know where things came from, the source or origin of life, and embryology gave them an essential information, because fetal organic development and its connective tissues, fascias, membranes allowed them to understand many of the classic ideas upon life, health and illness [7] . This evolution of the embryo was already announced in Huai Nan Zi 7 [8] which describes the human being development based on a previous text, Guan Zi [9] from IV century BC where membranes and mesenteric fascias were not discussed as shown in Huai Nan Zi.

    These mentions of the Classics show that, from ancient times, the anatomical presence of the interorganic membranes linking spleen and stomach together with their internal trajectories were well known.

    The connective tissue is a versatile organic system, quite widespread and omnipresent which, being both well known and well analyzed by modern medicine, interconnects all parts of human body in each level, from the macro to microscopic one and can be found even in the simplest of the organelles, in each cell and in each texture or body framework.

    Of greater importance for Eastern medicine—both theoretical and practical—are the now known properties these tissues show: to generate energy and to conduct it.

    The Chinese conceived and sensed the energy of the qi watching the winds and their movements both in time and space.

    Ganying , the cosmic resonance, the stimulus and the response to stimulus, is an essential ingredient in the Chinese thought. Resonances were not, are not abstract, there is always a material subtract so that they can occur. Joseph Needham [10] highlights the Chinese predilection for “action from a distance.”

    It is registered that in China in the year 132 an apparatus to detect earthquakes was designed, that device used the concept of action from a distance, the resonance already mentioned in Huai Nan Zi chapter 6 as a purely vibrational phenomenon of the qi [11] . Knowing these data, it is not noteworthy that Chinese attributed field effects—to generate and to drive energy—to the connective tissue and its numerous variants in the body.



    5. Western Conception, Eastern Conception

    Let us start from the acceptance that Chinese medicine is a complete and independent medical system.
We the Western medicine doctors, are instructed (taught and learned) through topics of learning in which Anatomy, organs, materiality have an undoubted predominance. And by this, please do not understand that I am suggesting that Physiology should not be studied; on the contrary a lot of it, all of it should be studied! But we have to accept that the Western comprehension of the Eastern way of presenting the body and its functioning is always interfered by our outstanding organic references which, for instance, lead to translate the names of the meridians using organ denominations whereas the original Chinese medicine defines them using their topography (hand or foot), quality ( yin yang ) and quantity ( tai , shao , jue ). Confusion prevails, even admitting that Eastern concepts are difficult to translate and to explain especially if homologation with our way of thinking is sought [12] .



    6. Classical Texts

    Classical texts provide data which explain this territorial “anomaly” of zuyangming transiting through yin areas.

    Su Wen 8 narrates the dialog between Huang Di and Qi Bo describing how is this set arranged; it is an interdependent set form by the six fu (viscera) and the five zang (organs) totaling eleven elements although twelve are mentioned: heart, lung, liver, gall bladder, tanzhong , spleen , stomach , large intestine, small intestine, kid- neys, sanjiao , bladder. When we join spleenstomach together they are reduced to eleven.

    The bond between the spleenstomach pair is unique because they share dynamism: rise and fall, reception and distribution, dryness and humidity whereas all the other zangfu perform only one function for each viscus. Spleenstomach being in the sixth place of the organic list of eleven, ranks in the central position (the earth) that is to say the center framed by five function-organs from above and other five from below leaving the spleen quite close to the yang function of the six fu . It is interesting to note that spleenstomach is needed for zangfu , yinyang , meridians, blood, essences and qi renewals, that is why earth in central place means that it does not take a special place but it is in all places which can be hinge or pivot between two qualities of qi [13] .

    The same Chapter 8 of Suwen [14] states that spleenstomach constitutes the silo and the barn from where the five flavors will emerge. Spleenstomach collects and distributes as well, without losing sight that between these two movements the transformations—digestion and assimilation—are developed.

    Let us remember that in this enumerative list, the fifth place is for tan zhong , the sea of energy, where xuli , great stomach luo , pours. Tan zhong constitutes a knot of life in the center of the chest, a concentration of qi energy that gets distributed along all the meridians; this task explains why tanzhong (nurtured by xuli, great stomach luo ) is in the fifth position, the center place, unity-meeting of life. It makes sense that piwei is in the sixth place because six corresponds with the maintenance of life. The sixth place, in this case the one in the middle, is to nurture the six fu from an already established space. Number six is what shares, it is the organized flow.

    The dynamism of spleenstomach is similar to that of cang lin storage places and barns, as can be read in Su Wen as we mentioned above. It is interesting to decipher the meaning of these two sinograms, understanding them will bring us closer to the spleenstomach unitary function we are talking about here: cang is the place where a large amount of grain is placed, the silo, as in a gathering, a meeting, a being together, the grain is ar- ranged for its shared cooking and in taking [15] .

    Lin is the place where the grain is taken (barn) to be kept and then distributed, a double process: collect from distribute to. And this double process (rise and fall) also represents the double aspects of the piwei pair. Surely, spleenstomach , a pair that balances in the central area (middle triple warmer) constitutes the best example of the earth-heaven interrelation of organs, of the earth-heaven dialectic within a visceral set.

    And from this singularity we know that stomach wei is basically [16] yang , a fu which transforms and trans- ports towards others fu and that spleen bi is a zang that storages and produces essences to be distributed, and it is added to the fu group because of its capacity to transform, promote, distribute and transport like the five fu but in a zang manner: storing and elevating the clear and pure thus called “root of storages and barns”. For Chinese medicine, a zang rather than being a visceral mass or an organ is a movement, a dynamic, a quality of energies, one of the ways of running one of the five polarities needed for the establishment and the maintenance of existence, one of the five wu xing phases.

    Cang lin expresses the double task of collecting and distributing to the desired place whenever it is needed. The spleen distributes the afflux of body liquids, essences and nurturing elements toward flesh and towards the 4 limbs which host the twelve meridians trajectories, that is to say to the whole body. This double aspect function is unique and helps us to understand that spleen works as a zang storing and elaborating the essences which then distributes to the whole body and that stomach has a fu task transforming and transporting to other fu . Thus spleenstomach is a center between the exterior and the interior with the help of other viscera, because there is no dynamism that can work by its own.

    According to Nei Jing theory, yang rises and forms the heaven and yin descends to form the earth. This definition can help us to clarify the “biology” of the meridians whose external route, generally more or less vertical, show us a route, let us say only material, because what is important is the direction in which the energy circulates inside them, the content and the sense of circulation in the paths rather than the “pipelining”, that is to say the dynamics of it, the function.

    We mentioned above that wei is mainly yang in its function and thus its energy descends. The Chinese thought develops the concept of complementary opposite which, in essence, is telling us that a yang element carries in itself ( and seeks to carry) a portion of yin , being the reverse also true. So, yang stomach has a yin component, the spleen, its pair, which it interchanges and shares functions with. The stomach meridian zuyangming starts in the head and descends until the feet, yang route that, in part, runs through yin territory. The spleen meridian z utaiyin starts in the feet and ascends along the inner face of the leg until the thorax, yin route and territory. Along the road they relate and interchange energy through their functions. Should this be possible if zuyangming circulated in the body in an “orthodox” way through the back or flank, both yang terri- tories?

    In Suwen 9 it is assured that the spleen together with the stomach and intestines (large and small) plus the triple heater and the bladder constitute the roots of silos and barns, the residence of the reconstruction [17] . At its base, all depends on taiyin , freely communicated with the earthy energies. Spleen is zang , but this description places it in the fu group and so spleenstomach represents a unit which does not appear in other organic pairs. This unit which differentiates spleenstomach is also expressed in its meridians that run very close in thorax and abdomen, despite of the different zang fu categorization of the organs they represent and the different circulato- ry direction. Spleen ascends and stomach descends.

    The stomach is a yang store and barn: it receives food, breaks it into nutritious essences which still in the process of differentiating the five flavors, get sent to the spleen, it also commands the descent of waste to be eliminated through the intestines, sanjiao and bladder. It is fu but it also works as a zang because it absorbs, stores and processes. Stomach fu and spleen zang , yinyang pair of complementary opposites, show-in my opi- nion-more complementarity than opposition.

    Su Wen 29 mentions the biao li obverse-reverse relation of zutaiyin-zuyangming because the spleenstomach is not an outside-inside bond ( nei-wai ) but the dynamism which facilitates the connections between the inner and the outer. The inner is the heaven in each of us which we do not have access to, and the outer is appearance and everything around it, the world [18] . It is important to understand the difference between nei-wai and biao-li , complex perhaps but very enriching. The physical has a external wai space to its disposal and everything not related to space is inner or interior, nei . They are yin -yang forms, spleen and stomach beat together, and because of that Suwen 8 presents them as spleenstomach . They are very close together despite being different, or maybe just because of that, one is yin and commands the lower part and the other one, yang , commands the upper part, this could seem opposite to the ascent-descent movement of each one which actually refers to the movement of empting and filling, filling and emptying, one after the other as is the case with the annual seasons: in spring-summer yang ascends and yin descends and in fall-winter yin ascends and yang descends. This dynamism is specifically represented in the body by the complementary alternation of the spleenstomach function, prototype of the yinyang link, heavenearth . The only way to put heaven and earth in contact is that heaven descends energies and earth ascends them. In this topic at hand, the earth is represented by the stomach that rules the centri- fugal dynamism of descent and by the spleen which commands the centripetal movement of ascent.

    This was already announced by Lao Zi in Dao De Jing [19] II

    ...high and low determine one another , but always through wuwei , that is without a manifested “action,” because if it were product of a voluntary acting it would mean that something descended because the opposite ascended.

    In the trunk, the diaphragm determines the boundary between upper yang and lower yin ( yang above and yin below) and also the lumbar spine in some cases, the sacrum can have a yin quality in spite of belonging to a yang space. The interior or inner side of the body corresponds to yin and the exterior one to yang .

    In the trunk, zuyangming (St. earth phase) runs through yin territory along a path parallel to the one of zushaoyin (K. water phase) and not far from zujueyin (Liv wood phase). Registered is the anecdote of doctor Liu Zi who, when treating a patient, missed the stomach meridian and mistakenly jabbed the needle into the liver one, quite close in thorax and abdomen [20] .

    In the face, stomach meridian is clearly located in the less yang area where it controls all the sensory organs. Also in the leg it gets close to yin , considering the tibia edge as a border line between the yin and yang areas.

    In the energy levels distribution, yangming is the innermost of the external and carries its strength and brightness to the yin . Its connection with GV.14 reinforces its yang which decreases from top down, and is needed by St. in its exchange with yin spleen and it is also needed to supply Large Intestine, xuli (its great luo vessel) and tangzhong , to nourish the lung and also to make energy available for its long route.

    Stomach, sea of liquids and cereals, is one of the four seas: brain is sea of marrows, tanzhong is sea of energy and chong mai , sea of the twelve meridians and the blood but...attention, please! in the series of seas stomach is the only fu , all the rest are zang , that is yin .

    All these connections demonstrate how difficult is to talk of one meridian alone for it is never isolated: its raison d être is to belong to an energy network.

    Knowing the energy network the meridians weave to establish deep interorganic relationship, allows us to understand the inseparable links between organs, viscera, meridians and their functions, so constituting an indivisible whole. This body framework is a characteristic approach of Chinese Medicine which addresses the body as a unit where each part represents the whole and vice versa, not giving the anatomical either/or functional division that Western medicine describes isolating ones from others and hence, their functions.

    The net or mesh meridians (and the whole organism is a meridian) weave allows to maintain the organic functional union, there are no individualities, everything is one, unity prevails.

    Yangming is yang , powerful and bright like the sun. Its function is not exteriorized but, on the contrary, it closes towards the interior to penetrate the yin to which it brings its richness and splendor. This movement explains why, in texts, yangming is frequently described as the “interior of the exterior” of the body: the digestive body tract is exterior because it receives food and expels the rest outside after digesting it; yangming (stomach-large intestine) is the level in which the ingested solids and liquids are taken to the yin organs to be transformed. The intermediate step to do that is regulated by the hinge level shaoyang (GB-TW) which joins the digestive process in toto where yangming represents movement and homeostatic balance in the internal digestion paths.



    7. Complementary Opposition.

    Shan Hang Lun classic text says that yangming interiorizes towards the yin as much energy as blood because it corresponds to the deepest level of the yang meridians and offers its strength and dynamism: moving, processing, moving the chyle forward, absorbing essences. For all of these, it needs taiyin (Sp) which, in association with humidity balances out yangming affinity for dryness. Taiying and yangming deal with the delicate and labile stability that characterizes the digestive process and, generally, the whole organism. Yangming , with plenty of blood and energy contributes to dry the organs up and prevent humidity which is not only the impregnation of fluids but also a temperature parameter: humidity is cold, dryness is hot therefore these two yangming-taiyin energies balance out each other.

    Yangming is one of a dry-hot nature and does not want dryness. Taiyin (cold and humid) does not want humidity and is afraid of humidity because it is rooted in earth and in humidity itself, and so it is understandable that desires some dryness, the one its pair, the stomach, can give. Humidity affects circulation, blocks it, this explains why the spleen cannot carry on with its task of transport and distribution. At flesh level, humidity produces edema and flabbiness.



    At the same time, stomach escapes from dryness because its own dry nature needs humidity and liquids to perform its fermentation, maceration and transformation tasks. Suwen 4 summarizes saying that spleenstomach are not very cold, not very hot, not very dry and not very humid.

    In this dynamism, we must not forget the participation of chongmai meridian which ascends from St.30 joined to the kidney meridian making use of the solid and liquid substances which gastric physiology provides.



    8. Conclusions

    There is a territorial categorization that governs the network of the meridians paths.
Thorax, abdomen, and pelvis (thoracoabdominal region) host almost the totality of yin organs and yang viscera and all the yin foot and hand meridians run the area, and this circumstance gives a yin energetic predominance to the area.
I understand that zuyangming in its shinning condition takes its breath to areas with yin predominance so as

    to maintain dynamic balances. Stomach is the sea of liquids and cereals, yin material. That is to say, that zuyangming with its route of shinning yang re-harmonizes the yin excess in the mentioned territory.

    According to the description of the meridian internal routes made by classic medicine doctors, membranes joining stomach and spleen keep the unity of those which thus fulfill their mission, described since ancient times. They are well defined functions executed by spleenstomach that share yinyang activities: receive, process, store, dry, and moisten.

    Nowadays, a decisive role among the action ways of acupuncture is attributed to the connective tissue in its wide variety (membranes included). This does nothing else but confirms the capacity of observation and syncretism of ancient Chinese scholars.

    These certainties and reviews transmitted by the Chinese classics, portray, explain what is perceived in the interior of the body (anatomy) and what is acknowledged in organic systemic functions (physiology) in accordance with the role of each organ and each organic pair, always according to the Chinese concept of organism.

    Anyway, the spleenstomach exception confirms the yinyang territorial categorization rule for the meridians trajectories according to the functions of the zang fu whose energies they drive.



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