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Treatment of meningitis

  1. Acupuncture wise, you can bleed ST 40, BL 40, San zhong/ three weights, and PC 3. You can needle Zheng jin and Lung 7.

All these point regions are implicated for brain disease.

ST 40 and San zhong/ three weights are yangming/ shaoyang points to help treat phlegm fire in the brain and systemic blood stasis. St 40 the luo point also treats dampness of the spleen, and Suwen 74 tells us that spasms and head stiffness belongs to dampness 諸痙項強,皆屬於濕. And dampness is the qi of the spleen 諸濕….皆屬於脾. Sanzhong and yangming help treat dampness in sanjiao, connective tissue/ meninges in the brain.

BL 40 and PC 3 help treat blood heat and infectious disease. BL 40 alternative name is called the blood xi cleft, 血 . Also treats disease in the brain because a branch of foot taiyang enters and nets with the brain 其直者,從巔入絡腦 (Lingshu 10).
PC 3, the water of fire, helps cool disease at the blood level of jueyin. Pericardium is the upper axis of foot jueyin, which enters the brain/ top of the head. Also Pericardium 6 is applicable because Lingshu 10 tells us that vacuity symptoms of the Luo mai causes head rigidity 虛則為頭強.

Zhengjin and Lung 7 are guiding points to taiyang/ back of the neck.

Meningitis is therefore seen as a disease of Taiyang, yangming, Shaoyang, and jueyin. One can say even Taiyin because of the dampness. But its a hot dampness so we treat through yangming and shaoyang. But what led to susceptibility was the weak zhong qi.

Taiyang and Jueyin because they affect the brain are both full of blood.

Here are formulas that would treat meningitis and have been historically used for epidemic encephalitis. Bai hu tang would be the first in the list, if there is dampness then Bai hu jia cang zhu tang, can even think of adding Qiang huo for wind dampness in Taiyang. One has to go high on the shi gao (50 grams-200 grams). High cang zhu might also be needed.

Another important yangming strategy and for infectious disease is to purge yangming, bowels, so Da cheng qi tang. But if its really febrile, Tao he cheng qi tang, since it treats abscess and purulence. It can treat purulence in the brain, since the brain is a called an extraordinary bowel 腦髓…名曰奇恆之府. So one can open the bowels below to treat the bowels above. Da cheng qi tang treats more the qi layer while Tao he cheng qi tang is focused more on the blood than DCQT.
If its very yang excess, one can even purge with Da huang mu dan pi tang (here there is more blood heat than Tao he cheng qi tang), hene why THCQT has gui zhi and DHMDPT has mu dan pi, one is to warm and move the static blood, another cools and moves the static blood. Not to say THCQT does not clear heat, all yangming methods do, the difference is that in THQT there is some yin cold within yangming that is basically now trapping the yang so one needs to warm within the cooling approach.

With that train of thought, also Bai hu jia gui zhi tang, technically a hot malaria formula per the Jingui, it can be used for all viral infectious disease. Gui zhi also helps treat the taiyang aspect of meninigitis.

Another formula used is Ge gen tang, which treats stiffness in the neck. Its been used for brain disease in fact. Also the cold malaria formula chai hu gui zhi gan jiang is the equivalent of the Tung point, San zhong. It has tian hua fen and mu li to flush phlegm heat in shaoyang, and gui zhi and gan jiang to warm and guide to taiyang and taiyin so yang and yin open, and chai hu to guide to the brain. Huang qin to clear the fire in the upper jiao.

Since we are talking of viral diseases, we need to think about shaoyang and jueyin. Shaoyang particularly for lurking disease.

Xiao chai hu tang comes to mind, especially Xiao chai hu tang minus Ban xia plus Tian hua fen and mu li to incorporate Gua lou mu li san.

But since we are opening the bowels, Da chai hu tang is important to think about. Chai hu jia long gu mu li tang also is an important consideration and opens the bowels (all open bowels methods I’ve mentioned are Da huang methods).

A Wenbing formula one should think about is Chai hu da yuan yin, this treat lurking disease in shaoyang, which includes the connective tissue of the brain.

Huang lian jie du tang is another consideration, for fire toxin. San huang xie xin tang also treats all heat in the orifices, usually manifesting as bleeding, like intracranial bleeding, but bleeding is not necessary, since that’s just a sign of hot blood due to yangming.
Of course, this can also be heat in the blood layer, and one can use Xi jiao di huang tang, or the jueyin formula, Sheng ma bie jia tang. Sheng ma treats the most pestilent of fire toxins in the blood, bie jia (the turtle) has correspondance with the brain, the tissue of shaoyin. The brain like the turtle has a shell, the cranium. So biejia can move static blood in the brain while protecting it through its simultaneous nourishing and invigorating properties of the deep yin.

That all comes to mind.

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CM perspective on chewing

Not chewing enough is yangming weakness that can depending on your congenital fire in your middle burner lead to taiyin and taiyang weakness.

Yangming is about 合 closure, which pertains to mastication and chewing, earth governs the mouth. Nanjing 44 speaks about the 5 gates of the digestive tract. The lips being the first gate, called the flying gate. The teeth is the door gate, the epiglottis is the absorption gate, etc, all the way to the anus/ po men.
然:唇為飛門,齒為戶門,會厭為吸門,胃為賁門,太倉下口為幽門,太腸小腸會為闌門,下極為魄門,故曰七衝門也。

Besides the lips and teeth, what’s important to note is the zang fu mentioned (stomach, and the intestines/ tai chang and xiao chang). This is yangming and taiyang. Yangming is about earth and metal, they even mention po men which is the gate of po, the lungs house the Po.

Therefore, it comes to my next point how breathing is very important to digesting. The smell of food already begins to help produce saliva, and saliva is spleen fluid. There is digestive enzymes in saliva for carbohydrates (which are yin/ material building foods). The rate you breathe also affects how fast you swallow since calmly breathing can affect your nervous system (wood). If you are breathing shallowly and rapidly, this affects the air going in your mouth and nose (depending if you are mouth breathing or not, that’s another factor of digestion). Mouth breathing can impact your long-term jaw health. Any malocclusion of your teeth and bite can greatly impact your chewing. Suwen 61 says the kidneys is the stomach gateway 腎者,胃之關也. This is not just organ related, like in edema or ascites, but what’s implied is tissue correspondence. Teeth (kidney) and stomach/ mouth relationship. Li Shi Zhen said the nose is the orifice of mingmen, so depending how you are breathing during your food, what Ayurveda calls Sattvic or Tamasic behavior, can impact the rate of air coursing through your system. Swallowing a bunch of air isn’t good, but also if you breathe calm and deep then it relaxes and expands your diaphragm and ribs, causing good descencion. This is metal controlling wood (nervous system). The relaxation breathe sends signals to your brain (liver vessel penetrates the brain) so your body can be in a parasympathetic state and not think you are in danger while eating which sends blood away from the digestive organs. The liver stores/ hoards the blood. Then if you don’t calmy breathe then wood stirs, besides acid reflux and such where qi is going up instead of down, wood stirs stomach fire, But in this case the stomach fire causing you to be restless and anxious while you are eating so you eat and chew rapidly without masticating. So you swallow air and food in one gulp almost. The food doesn’t become liquid, which lessens the burden on your digestive tract.

Also chewing is not jusy about the teeth, but the purpose of chewing food into liquid almost is so your tongue can properly roll the food down your epiglotis, which is one of the gates. So the food doesn’t doesn’t go into your windpipe and lungs. The epiglottis responds to swallowing in this way because of tiny sensitive nerve endings in the mouth and throat that surround and coat the epiglottis. All of those nerve endings help the brain know when to swallow, and have a role in other functions like breathing, eating, sleeping and talking. When you swallow, your mouth analyzes the liquid or the food that you’re preparing to swallow, and all of that analysis gets communicated to your brain in a lightning quick fashion. As your tongue pushes the material to the back of the throat, the nerve endings collect that information, send it to the brain, and the brain sends out its program for swallowi

The tongue is also a muscle, so its ruled by earth. But it also has tendons, if your tongue tied for example, that can affect your chewing and breathing, and your TMJ health. Chewing improperly can be a jaw joint issue. You masticate quickly because possibly your yangming masseter muscles and inflamed and tight. But obviously the tongue is the blossom of the heart. So the tongue proper motion should be a mindful thing as well. The proper motion of the tongue, by the way, is a wave like motion that propels food down your digestive tract, you shouldn’t use your buccal muscles too much. So you should train yourself to learn proper swallowing patterns if you haven’t.

This brings me to the point of mindfulness. The tongue and the mind that is governed by fire/ heart. You should enjoy what you eat, you should be present. Because then fire can generate earth (good appetite and digestive fire in the stomach and small intestine) and then also control the breath/ metal and descension of food down the alimentary canal. Speaking of fire, its also important that your small intestine fire is strong, since most absorption happens here (no leaky gut and such) so you can seperate the pure from the turbid, and the turbid isn’t going into your blood. Same thing with stomach acid health.

Lastly, sitting down, which is the motion related to earth is important. If you eat standing up or even sitting down but watching TV or on your phone, then this all impacts the way you will chew, breathe, and digest.

I’ll consider all that.

The treatment and the various causes of fever

Fever is the body’s normal and intrinsic response to a variety of conditions, the most common of which is an infection. For instance, although a chronic low-grade fever is a symptom for a variety of cancers, particularly blood and lymph cancers, the resolution of cancers has been reported when high fevers have been spiked after inducing hyperthermia (high body temperature) as means to treat cancer. It is as if the low-grade fevers is the body’s mechanistic attempt to treat itself, but without success. It is only when fever is induced at high enough levels that certain diseases can be treated. Unfortunately, not everyone can survive such a raise in body temperature, so it is not a panacea for everyone since one needs to actually be able to survive the hyperthermic event. Those who did survive, for example, often go into mini-comas/ unconsciousness lasting for a few days and if they do wake up then often the cancer is in remission. Therefore, fever is the body’s attempt to clean house, i.e. a self-corrective rectification of physiology, an immunological expression back to normalcy.

Clinically those with an immunological compromise such as those with Lyme disease, Chronic Fatigue, to HIV, and other viral conditions often report the sensation of low-grade fever. This is because the body is attempting to combat the virus without success, making the person feel chronically feverish, the temperature, if taken, may even be slightly elevated, usually not pass 100 degrees. But even if it isn’t elevated, they might still feel feverish, what’s important is the subjective sensation they are experiencing. In biomedicine, to categorize a fever as a fever then the body temperature must be elevated more than normal, whereas in CM the subjective sensation is just as clinically valid than just an objective flux; we call this 发热 heat effusion. The subjective and objective are both considered as important signs to what is happening, one can be having an external event without objective signs of heat, line 3 of the treatise of Cold/ external damage says in Taiyang disease, whether there is already heat effusion or whether there is not yet heat effusion 太陽病,或已發熱,或未發熱….. This line tells us that heat effusion isn’t a necessary sign for external damage, this is important because certain individuals who are immunologically compromised often do not have normal spikes in temperatures, like the elderly or those with autoimmune or endocrine imbalances.

We also see clinically that not everyone has the same normal bodily temperature, i.e. normothermia. Some people with cold and frail constitution and/ or endocrine imbalance (like those with hypothyroid disorder) often have lower body temperatures and so a raise in temperature for them might be in the range of normal to slightly elevated in someone with standard body temperature. So it can be misleading and one might be thinking they are not spiking a fever, since their temperature is in the normal range, but for their starting baseline it is not normal.

Line 7 of the Shang han lun says “In those where there is heat effusion and aversion to cold, this is emanating from yang, and those without heat [but with] aversion to cold, this is emanating from yin. 病有發熱惡寒者,發於陽也;無熱惡寒者,發於陰也
This passage has several meanings, first of all yang and yin here can pertain to the yang and yin stages (taiyang-yangming-shaoyang as yang and taiyin, shaoyin, and jueyin as yin). Commentators state that yang here can pertain more specifically to Taiyang and yin pertains to shaoyin.
What’s more we can say since this is speaking about Taiyang disease, that this yang and yin is pertaining to a yang or yin pattern of Taiyang, whether the surface is closed or open and causing a fever. That’s all valid ways of interpreting the line and clinically useful.

Now, let us begin breaking down the various causes and treatment of fever. This is a summation of the 16 methods of abating fever from the famous 20th century physician, Qin Bo Wei 秦伯未, in his anthology of medical essays collated in Qin Bo Wei Yi Wen Ji 秦伯未医文椺.

What is important to notate that Qin Bo Wei was a synthesist from the Meng he tradition, so his ideas spans many CM schools of thought and is not limited to one.

His 16 methods of abating fever 退热 are as followed:

1. Diaphoresis
2. Harmonization of ying and wei/ constructive and nutritive
3. Clearing the stomach
4. Freeing the stool
5. Ejection/ vomiting
6. Harmonization
7. Joint resolution of exterior and interior
8. Clearing and transforming damp-heat
9. Clearing the constructive and resolving fire toxins
10. Soothing depression
11. Dispelling stasis and abscess
12. Abduction and dispersal (for food stasis and gan accumulation)
13. Combatting Malaria
14. Averting epidemic
15. Warming the channels and supplementing qi/ yang
16. Enriching yin and/ or blood

Now, within these 16 categorical methods, each one can be broken down further. Just because one needs to diaphorese, doesn’t mean one uses Ma huang tang without the formula presentation. There has to be tha pathophysiology for one to use those medicinals. Within diaphoresis, one needs to differentiate the cause, from wind-heat to wind-cold, to summerheat, to autumn warmth dryness to autumn cool dryness, to external damage causing feverish illness (such as mumps, gingival swelling, peridontitis with chills and fever, throat moth/ tonsilitis, infection the ear/ middle and inner ear to mastoiditis, etc). All require different formula, even though they are technically under the banner of diaphoresis. So that’s number one. So representative formulas include, but are not limited to, Yin qiao san, Sang ju yin, Xiang su yin, Shen zhu san, sang xing tang, xing su yin, chai hu ge gen tang, xie huang san, xi gan san, gan jie she gan tang.

Number 2 is Gui zhi tang essentially, where the surface is open, and there is sweating/ moist skin, due to wind strike.

Number 3 is a yangming method of treating, i.e. Bai hu tang and its variants, that’s yangming channel involvement. But if there is yangming fire/ toxicity with possible qi level bleeding one can use Da huang huang lian xie xin tang or huang lian jie du tang.

Number 4 and 5 are purgation methods, where one either expelling from above or from below (Gua di san and Zhi zi chi tang to induce vomiting, to the Cheng qi tangs variants to precipitate from below).

Number 6 is the method of treating the half-exterior and half-interior so Xiao chai hu tang and its variants. Interestingly, Qin Bo Wei puts Huo xiang zheng qi san in this category.

Number 7 is the treatment of joint resolution exterior and interior. This is not to be confused with half-exterior and half-interior since that is an actual layer. Here there is damage at Taiyang/ yangming with some taiyin approach. But can be a triple yang approach with some interior approach. Representative approaches include San huang shi gao tang, chai hu sheng ma tang, chai ge jie ji tang, and fang feng tong shen san.

Number 8 is the treatment of damp-heat or damp-cold that basically obstructs the san jiao, yangming, or taiyin domain. This oppressive dampness causes the spleen and to not be able to raise the clear yang and leads to easy contraction of evils in the exterior with wei qi disharmony. Formulas include San ren tang, gan lu xiao du dan, shen xi dan, yin chen hao tang. One can include here the methods of freeing up the bladder, such as Wuling san, which might have fever since the Qi hua of tai yang is blocked since the inhibited urination is causing Tai yang to heat up. One can also include th other formulas with jaundice, which all have some combination of dampheat and blood stasis, particularly Mahuang lian qiao chi xiao dou tang.

Number 9 is the treatment of ying and xue level, ala Wen bing 4 levels. Formulas include the 3 treasures for loss of conscousness due to evils in the pericardium (Zi xue dan, an gong niu huang wan, zhi bao dan), to macule transforming formulas Hua ban tang, to ying level formulas- Qing ying tang, to xue level- Xi jiao di huang tang. Also can be both qi and blood level, i.e. Yu nu jian and zhu ye liu bang tang.

Number 10 is the coursing of liver qi and unbinding depression. This is emotionally caused pyrogenic events, methods includes Xiao yao san, si ni san, yue ju wan, and hua gan jian. It is important to notate the long-term depression causes desiccation of fluids and flesh; this can lead to chronic fevers as the body’s qi circulation is chronically impeded the ability of zheng qi to fight off xie qi is impeded as well as the ability to nourish the body’s spirit-mind is hampered, this is linked with Zhu Dan Xi 6 depression theory as well.

Number 11 is the recognition of blood stasis and pus/ abscess causing fever. This is interlinked with the idea of infection. Formulas include Tao he cheng qi tang and Da huang mu dan pi tang to Tao si xiao chai hu tang, wu wei xiao du yin, Zhen ren huo ming yin, to more deficient causes of flesh putrification and welling-abscess such as Huang qi jian zhong tang, Shi Liu wei liu qi yin, Qian jin nei tuo san, Tuo li xiao du yin, Nei bu huang qi tang, etc. Pretty much any formula that treats abscess can treat this fever. Albeit, it is more likely excess causes will lead to fever.

Number 12 is for treatment of food accumulation, gan disorder worm accumulation, gu disorder, and dysentery. All these can cause fever, albeit as Qin states “fever in early stages dysentery is not considered a serious condition” since its a normal and expected progression of the disease. Now fever in long-term dysentery and diarrhea is quite concerning since it can lead to blood exhaustion and yin-yang separation.

Number 13 is the various methods of combating malaria. Now there are various types of malaria within the nosolgical classification with CM, there is: Heat malaria, cold malaria, taxation malaria, glomus/lump malaria/ mother of malaria, male malaria, female malaria, and various types of different kind of malarias that happen in different times (intermittent malarias that occur every two days instead of daily events). I wrote an extensive breakdown of malaria from a Classical perspective here: https://www.facebook.com/ivan.zavala.732/posts/2555161534546817?comment_tracking=%7B%22tn%22%3A%22O%22%7D

Formula for malaria include: Chai hu gui zhi gan jiang tang, Bai hu jia gui tang, Chai hu qu ban xia jia gua lou tang, Gui zhi huang tang, Shu qi san, Qi bao yin, Chan shan yin, Chai po tang, Bie jia wan, Chai hu xiong gui tang.

Number 14 is abating fever by averting epidemic. This is now in the realm of treating infectious disease in different bodily layers: Da Yuan Yin, Pu ji xiao du yin, Sheng ma ge gen tang, Sheng ma bie jia tang are examples of this.

Number 15 is treating both shaoyin and taiyang at the same time, this is taiyang cold contraction when one is shaoyin yang deficient. One cannot induce sweating here with gui zhi-ma huang approaches, but instead one has to use Fu zi ma huang approaches. Ma huang is not a taiyang based herb, but Taiyin since it opens the lungs. It is gui zhi and sheng jiang that causes ma huang to have a strong diaphoretic effect. So representative formula is Ma huang fu zi xi xin tang and Ma huang fu zi gan cao tang. Also tong mai si ni tang for yang seperating from yin causing false heat. If the patient is weak due to a weak constitution one can use Yu ping feng san and Shu yu wan to help the patient ward off the hundred wind illnesses. These last two formulas are more for those with tendency to external contraction, but not with resent contracture.

Bu zhong qi yi tang is also her for qi deficiency fever and yin fire fever/ internal damage fever.

Lastly, number 16 is fever caused blood and/ or yin deficiency. The formulas are Qing gu san, qin jiao bie jia san, qin jiao fu lei tang, dang gui bu xue tang, gui zhi ren shen tang, xiao jian zhong tang, ren shen bai du san, Wei rui tang (for underlying yin deficiency with cold contracture). SHL tells us that those whose throat is dry and parched we cannot effuse sweat 咽喉乾燥者,不可發汗, it also tells us we cannot sweat those with death of blood 亡血家,不可發汗. Sweating these patients will lead to severe yang and blood collapse and further fluid dessication, and possible death since one is summoning yang to the surface from a yangless root, expediating yin-yang seperation.

That’s all folks.

Inflammation and consciousness

Two of the greatest clinical presentations that Western medicine treats is inflammation and infectious disease. However, their greatest efficacy in treating inflammation and even infectious disease is when these conditions are acute. Once the disease becomes a chronic inflammatory condition, for the most part, there is only the masking of symptoms through immunosuppressive drugs, such as steroidal medication and even immuno-biologic medication. And while this can be life-saving, they are not a long-term solution for those who suffer chronic inflammation.

It is said the disease of modern man is chronic, recalcitrant, degenerative disease. These diseases are typically marked by chronic low-grade inflammation, which while not life-threatening per se, they cause afflictions characterized by long-term pain and suffering.

Speaking of inflammation, often it is seen as a hot type of state. Inflammation is characterized by rubor (redness), calor (heat), dolor (pain), and tumor (swelling). Often the knee-jerk reaction when we see this is to try to cool it and suppress it. It is hot, so we want to cool it. And, of course, that is a valid treatment approach when appropriate. But without asking oneself why the inflammation is happening and the mechanism behind it, one is stuck treating the manifestation but not the underlying cause. While yes, there might be the heat that’s apparent, the reason this heat is manifesting is that there is lack of circulation due to vasoconstriction (due to a cold pattern). Heat is a type of yang manifestation, but the reason yang is appearing doesn’t mean that it is a yang disease but might be that yang is stuck.

In Classical Chinese medicine, for example, “inflammation typically results from yin-level blockage that obstructs the free circulation of yang. When yang accumulates it generates regional heat syndromes. In Western medicine, this accumulation of heat is called inflammation (source: Ed Neal MD)”.
In other words, inflammation is a response. If we only treat inflammation as the problem we are missing a great piece of the clinical puzzle which is the underlying factors driving the inflammation.

CM recognizes that inflammation is largely a circulatory issue due to lack of bodily immuno-awareness. Blood is what brings about the healing immunological factors that initiate the cascade of healing. By suppressing inflammation or even fever (antipyretic medication) we can be delaying healing and full-resolution. Inflammation is a lack of immunological awareness and expression. Either the immune system is over-reacting or under-reacting. Relatively recent scientific research is investigating the connection between the immune system and the brain, even chronic depression is being viewed as a chronic low-grade brain inflammation, and not simply as a neurochemical imbalance.

And while there are various ways the immune system and the brain are connected, such as neuroendocrine dysfunction, larger nervous system dysfunction, problems with the microbiota–gut–brain axis, etc. And so when the body’s self-healing mechanism is disrupted (a mechanism which relies on intrinsic circulatory, immunological, and nervous system regulatory processes), then the potentiality to heal is compromised. Therefore, the job of the clinician is to restore the body’s own self-healing process. It is this process, for example, when the skin suffers a cut the healthy body responds with platelets and clotting factors that initiate bleeding to stop and for the wound to begin sealing as the hemostasis phase is finished.

But the mechanism that initiates this response to happen is the body responding through intrinsic healing mechanisms. What initiates this mechanism is the body perceiving there is something immunologically wrong so it can begin the somatic attempt to heal the issue. In Chinese medicine, we call this intrinsic healing mechanism the Shen/ awareness 神. We say the Shen is the blood and we also say this shen awareness is the righteous qi 正氣 of the body which fights off evil qi that makes us sick. So what can block the shen which is a yang type of force are yin-obstructions due to a diminishing of the metabolic fire of the body, as well as an obstruction at the level of this yang circulatory force of life due to an inability to regain healthy homeostasis after an initial immunological response.

The reversal of degenerative diseases begins by repairing the immune system’s expression and allowing the body’s own intrinsic mechanism to happen. If we get stuck on the sign of inflammation, we are blinded by the sign (the form) and lose sight of the mechanism behind the form. The needling classic says, the coarse [practioner] safeguards the form, the superior one safeguards the spirit/ awareness, the coarse one safeguards the gate, the superior one safeguards the mechanism 麤守形,上守神。麤守關,上守機.

So by understanding all of this, it is why using cold and suppresive medicine for inflammation as the only method of treatment is missing a big chunk of the puzzle, which is why in CM we often use warm and hot therapies for inflammation and are cautious of just using cold medicine without awarenss of the risks involved in regard to its effect on circulation and healing long-term.

5 phase space-time continuum

When we speak about Wu xing 五行 we often speak of them as individual states. Granted, we speak about them always in relation to each other as a collective unit and not as a sole independent state, we nevertheless tend to think of each phase as its own separate entity. For example, we are conditioned to think that the systematic correspondence of the metal phase pertains to autumn, to dryness, to the lungs and large intestine, to harvest 收, to the exterior (i..e the skin), etc. But the 5 phase is not just individual states, but spatial and temporal continuums that exist within each other.

This idea already is presented to us, for example, the 5 shu/ transporting points for each channel is categorized accordingly to a phase. So there is the water point of the fire channel, there is the wood point, there is even a fire point of the fire channel. Then there’s also different type of fire channels, there is shaoyang fire channel (san jiao), there is jueyin fire channel (pericardium), and there is shaoyin fire channel (the heart). There is even the herbal equivalent of this acupuncture 5 phase system. The Fuxing Jue/ Tang Ye Jing shows how each phase has a 5 phase herb within it. So gui zhi is the wood herb of the wood category, chuan/ hua jiao is the fire herb of wood, jiang/ ginger is the earth of wood, xi xin is the metal of wood, and fu zi is the water of wood. You can read more on this here (written by my CM colleague, Joshua Park): https://chinesemedicinecentral.com/a-brief-introduction-to…/

Now, my other CM physician colleague, Michael Brown, and I were discussing the seasonal aspect of this. So when autumn begins, that’s the spring/ wood of autumn. When autumn is at its peak, that’s the summer/ fire of autumn. When the season is stable, that’s the earth. When the season is ending that’s the winter, and autumn of autumn is when the season is declining, as well the host qi of the season itself, dryness.

But the idea extends further than this, all 5 viscera and even the 6 bowels have the qi of all other phases. The lungs have fire within them, i.e. gan cao gan jiang tang is for lung yang deficiency causing lung atrophy. The lungs also have winter, they have deep yin blood that can become vacuous, tuberculosis is an example of a disease that consumes the lung yin/ lung blood, a person begins to cough and expectorate blood as consumptions happen, the physical material lung structure is the winter aspect. The lungs are decaying, i.e. dying, which signify winter. And so on with each phase.

Even the tissue associated with an organ has all 5 phases within it. The tongue even though is the sprout of the heart, the muscle itself is the earth phase. The earth controls the muscles of the body, the tongue is a muscle. The mouth that surrounds the tongue belongs to earth. The tongue is also suspended by tendons, that’s the wood phase. The teeth which belong to water protect and shield the tongue. The tongue should lay on top of the palate, to affect bone/ i.e. maxilla, that’s earth controlling water within fire, since the tongue is orifice of the heart.
The tongue is the beginning of the digestive tract, salivary amylase is in the saliva of our mouth’s (even though that’s earth to digest sweets), the tongue propulsion of the food bolus down the alimentary canal is metal. The digestive tract belongs to yangming, the downward motion from mouth to the rectum belongs to metal. The tongue begins this motion. Every motion within a tissue has the 5 phases acting (that’s space-time in action).
The ability for the tongue to form words that’s the shen, that’s the brain. Often, speech impediments are reconfigured and cured by fixing a person’s psyche/ mind. The shen which is fire is what gives the orifice the ability to sense and have function. In this case, the fire emperor of the heart expresses itself through the tongue, through the voice. The emperor needs to voice his command. Now, the ability to taste, that’s earth. The tastebuds are earth, since taste belongs to the spleen. Now if someone has a bitter scorched taste, that’s a fire taste of earth. The ability to speak and form words that is the shen ming 神明, the shen brightness. Incoherent speech is always a bad sign of health. It is a sign the emperor has gone mad, 狂 kuang, the word madness in Chinese is the image of the emperor acting like a rabid dog.

The tissues of the body also have the 5 phase interposed. The blood that circulates into the bone, that’s fire within water. Bone belongs to water and the blood is fire. Avascular necrosis is when fire within water relationship has gone awry. The fluids around the bone is spleen, like synovial fluids. Wood is what attaches bone to bone and bone to muscle, i.e. the ligaments and tendons, the sinews 筋. Metal is the space around the bones, that gives bones ability to breathe essentially and be saturated by nutrients. There needs to be space for there to be qi flow. The Neijing says the lungs govern qi. The lung is the vacuous space, i.e void, that holds matter in place. Bone is the yin structure. Lung is yin within yang. The metal space around the bone is yin within yang. Pathologically, metal within water, can become distorted in cases of skeletal pneumaticity is the presence of air spaces within bones, intraosseous air, can even form intraosseous air lesions.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020306/
Another pathological distortion of metal in the water tissue is when there is not enough space within joints, there is subluxation. There is all this cracking (which is wind wood), but due to dryness because of no flow. Lungs govern qi. The lessening of an enclosed space is also a pathology of metal. Less space then bones rub and there is wear and tear. Space allows qi to flow.

Now even the growth and breakdown cycle of the bone is governed by this 5 phase temporal-spatial aspect. The osteoblast and osteoclast dynamic can be seen as outgrowths from this.

Another example is the abdomen. The abdomen to earth, but the aorta within the abdomen is fire. In chong mai pathology, you get all these pulsations around the umbilicus, you get all this ben tun, and all this qi surging up. The person gets anxiety, even a possible heart attack or aortic aneurysm. That’s a fire within earth tissue. The connective tissue in the abdomen is wood tissue, the omentum and mesentery, for example, is shaoyang wood. The hollow space within the abdomen is shaoyang fire san jiao where yuan qi courses. In summary, I’m saying this 5 phase continuum happens on the histological level, and even on the biological spectrum.

One should look at anatomical texts to understand this connection. For example, throughout the following anatomical description of the abdominal cavity, one should categorize each histological tissue happening with the terrestrial anatomical domain of earth, the abdomen, to understand the histological 5 phase image. The following anatomical description comes from certain sections of the “Mesenteric Principles of Gastrointestinal Surgery: Basic and Applied Science”, which is a good book to help us understand how surgeons use certain divisional planes to track where they are structurally at during surgery. By the way anasthesia in an area that induces numbness (no shen/ sensation/ awareness) is an issue of fire within a phase. Abdominal numbnes or surgical cut of a blood vessel in the abdomen or bleedin internally in the abdomen is a fire phase issue within the earth.
Anyways, histologically, to give a histological analysis of this 5 phase continuum and its histological classification, this is an example of why the mesentery is shaoyang. Su wen chapter 44 tells us 肝主身之筋膜 the liver rules the body’s tendinous membranes. Connective tissue is called jin mo 筋膜. Jin is tendon, mo is membrane, a sheathe, like the Wen bing idea of mo yuan 膜原, which Wen bing doctors classify as an anatomical structure of san jiao. In their eyes, this source membrane is actually the physical structure of San jiao. This san jiao mo yuan idea is really an innovation from the Neijing. San jiao is shao yang which is still on the spectrum of GB- wood. Mo yuan is also related to Gao huang and yang bo (which are actually discussed in Ling shu 1 as having source points) the Gao is below Jiu wei, by the zyphoid process. We know Gao huang is that fatty membrane below the heart, where the disease is intractable, according to a pre-Nei jing story of Bian Que. And the yang bo 脖胦 of Ling shu is below the navel, around Ren 4-6, where yuan qi emanates. Some even affiliate yang bo with the mesentery.

Now, to give an anatomical image, and you can see how san jiao tissue (ministerial fire) arises from sovereign fire (abdominal aorta). Because the root of the mesentery arises from the anterior surface of the abdominal aorta (fire), just inferior to the celiac trunk, with close continuity to the small intestine (fire) and the vertebral column (du mai). It is formed by a double layer of peritoneium, a serous membrane (taiyin-earth) which lines the body cavities. The mesentery’s peritoneal folds can be seen as external-internal space of san jiao, the mesentery is formed by the double fold of the peritoneum. The mesentery been found in the splenic (earth connection) and hepatic flexures (wood) along with peritoneal and omentum attachments. Some histological findings of the mesentery classify it separately then just purely fascia. It’s not true fascia in the anatomical sense. Just like san jiao is the formless organ. The mesenteric continuity goes to the appendix (yangming earth, treated with Da huang mu dan pi tang, yangming formula), to the transverse and sigmoid mesocolon to the mesorectum (all yangming). What’s more adipocytes lobules within the body of the mesocolon are separated by fibrous septae, connective tissue branches, arising from submesothelial connective tissue. Where apposed to the retroperitoneum, two mesothelial layers separate the mesocolon and underlying retroperitoneum. Between these is Toldt’s fascia, a discrete layer of connective tissue with lymphatic channels. In other words, Toldst fascia forms wherever mesentery attaches to the retroperitoneum. Within the mesentery, the lattice (the connective tissue) encases the vessels. The cuff where the lattice connects with underlying fascia to form adventia around the blood vessel (fire).

My point is that this anatomical description can be seen through 5 phase classification happening within the anatomical terrain of a phase, i..e abdomen in this example. Or it can be seen anywhere in the body, when the lungs have a blood clot, lung embolism, that’s a fire (blood clot) within metal zang issue.
These are 5 phase continuum examples, they happen seasonally, viscerally, anatomically, sensory, functionally and physiologically, etc. One simply has to see them.

SW chapter 23 revisited, 《素問 – Suwen》, Chapter 23 《宣明五氣》 藏所惡:心惡熱,肺惡寒,肝惡風,脾惡濕,腎惡燥,是謂五惡。 There is five aversion: Heart dislike the heat [熱], Lung dislike the cold [寒], Liver dislike the wind [風], Spleen dislike the dampness [濕], Kidney dislike the dryness [燥], It seems like Kidney’s and Lung’s aversion is exchanged. Is it a typo or the fact? When I see from a different perspective angle, the exchange makes sense too. Any opinion?

Kidney water can be consumed by dryness. It is why in the SHL, in the shaoyin chapter there are urgently purge lines with Da cheng qi tang.
1. 少陰病,得之二三日,口燥咽乾者,急下之,宜大承氣湯。
2. 少陰病,自利清水,色純青,心下必痛,口乾燥者,急下之,宜大承氣湯。
3. 少陰病,六七日,腹脹不大便者,急下之,宜大承氣湯。

There is urgently purge lines in the Yangming chapter as well.
1. 傷寒六七日,目中不了了,睛不和,無表裏證,大便難,身微熱者,此為實也。急下之,宜大承氣湯。
2. 陽明,發熱汗多者,急下之,宜大承氣湯.
3. 發汗不解,腹滿痛者,急下之,宜大承氣湯。

We urgently purge dry yangming because dryness below in the lower burner can dry out kidney essence and liver blood. Hot intestines/ metal starts steaming water strongly therefore consuming it.
Wenbing authors classified Yangming fu level pathologies and yin vacuity of liver and kidney as both lower burner pathologies. So they can be interlinked.
Even the Jingui taxation formula, Da huang zhe chong wan, has Rhubard to work on that yangming dryness consuming and drying the blood.

Furthermore, the Suwen is not the only one that states this lung and cold relationship. Nanjing 49 says: Cold forms and cold drinks cause damage to the lungs. 形寒飲冷則傷肺.
Cold causes the lung to close, it’s why acrid is associated the lungs. Since the lungs should open to regulate the pores. Cold damage, for example, a ma huang tang pattern causes no sweat. So we use bitter ma huang and xing ren to open and descend the lungs which are close from cold damage, hence panting.

What’s interesting is Nanjing 49 associates damage to the Kidneys not with dryness, but inappropriate exposure to dampness and water 久坐濕地,強力入水則傷腎. The kidneys cannot be too dry or wet. Zhen wu tang for example has bai shao, bai zhu and fu ling. Fu zi tang has bai shao and ren shen to generate yin and bai zhu and fu ling to percolate water.

Clinically this idea of cold kidney water causing dryness is important. And the idea of using acrid to moisten the kidneys. Its why acrid hot medicines like Fu zi can be used for certain skin conditions and also dryness above like in Sjogren’s. When there is a lot of cold water, then yang cannot enter it and steam this water to the upper burner. Fu zi like sunshine penetrates the cold water accumulation below and mists the water to the upper burner, quenching the dryness.

We already see this idea in formulas like Wuling san, where acrid warm gui zhi is used to activate the qi hua of the bladder and small intestine, lower burner, and the fire below is reinvigorated and thirst is quenched. Major symptom for Wu ling san is thirst/ xiao ke.

Now it doesn’t have to be hot and warm acrid medicinals, cool and acrid medicinals can also moisten the kidneys. Not medicines like Bo he, but more so medicines like Mu dan pi. Its why Mu dan pi is used in kidney essence taxation formulas like Shen qi wan (腎氣丸) or Kidney Qi Pill, also known as cui shi ba wei wan (崔氏八味丸, Dr. Cui’s Eight Ingredient Pill) or ba wei di huang wan (八味地黄丸, Eight Ingredient Rehmannia Pill). This multi-name formula is for Xu lao, vacuity taxation 虛勞腰痛,少腹拘急,小便不利者,八味腎氣丸主之。《血痹虛勞病脈證并治》
This formula is for kidney dryness of water since its biggest ingredient is 8 liang of qian di huang 乾地黃八兩. But it also has 1 liang of acrid hot fu zi and gui zhi 桂枝,附子,炮,各一兩 improve kidney function to metabolize water, which is why the kidneys are dry in the first place. And then 3 liang of acrid cool mu dan pi to flush kidney water into the blood, to cool it.

Shen qi wan also treats thirst/ xiao ke 男子消渴,小便反多,以飲一斗,小便一斗,腎氣丸主之。Xiao ke/ thirst is a jueyin symptom 厥陰之為病,消渴,氣上衝心,心中疼熱. So by moving kidney water we moisten wood.

We see the principle of using acrid in Wenjing tang which has lip and mouth dryness 唇口乾燥 which is the defining symptom that tells us there is blood stasis in the lower abdomen 瘀血在少腹不去. 何以知之?其證唇口乾燥,故知之
We know a branch of the liver mai encircles the inside of the mouth 環唇內 according to Ling shu 10. And so for Wenjing, ZZJ has acrid wu zhu yu, gui zhi, mu dan pi, chuang xiong, ban xia, sheng jiang. Its primarily an acrid moving formula, and Wen jing tang also besides the dryness in the lips and mouth also has heat effusions in the evenings, and also the palms of the hands are vexingly hot 暮即發熱,手掌煩熱 and we are using all acrid hot medicinals, except for mu dan pi. This formula targets jueyin, that’s why there is also diarrhea that happens 10 times a day 下利數十日不止. There is heat above and cold below. Or better said, yang above (heat and dryness) due to yin below (cold static blood).

So sometimes acrid is not just to transform and steam cold water below to moisten above, but also to move static blood that is causing dryness above.

Dryness and dampness exist on a continuum. Often when there is dryness somewhere, there is dampness or water somewhere else. This is why the forearm diagnosis chapter of the Ling shu tells us that when the cubit skin feels like dried fish scales, this is water [dissipating 泆?] rheum 尺膚麤如枯魚之鱗者,水泆飲也.

So rheum and water can cause dryness, fluid dysfunction. Another example is the Jin gui pathology of Yellow sweat 黄汗, which can cause the body to have scales 黃汗之病,兩脛自冷,假令發熱,此屬歷節。食已汗出,又身常暮盜汗出者,此勞氣也。若汗出已,反發熱者,久久其身必甲錯. 《水氣病脈證并治》Yellow sweat is a type of water qi, its classified by ZZJ with the rest of the water diseases (wind water, skin water, true water, stone water, and yellow sweat) “病有風水、有皮水、有正水、有石水、有黃汗”
The formula used is Huang qi gui zhi tang which is gui zhi tang plus Huang qi. Huang qi here is used for the water causing the body scales. Although Huang qi is sweet and warm 味甘微溫, the point is that its function of diurese 利尿 is linked with its ability to treat sores 主治癰疽久敗瘡,排膿止痛,大風癩疾,五痔鼠瘺. That’s why Huang qi is in skin water and wind water formulas (Fang ji huang qi tang, and Fang ji fu ling tang).

So sometimes we use acrid hot medicines to circulate and transform water, sometimes we use acrid cool medicines to circulate kidney water to moisten blood dryness (jueyin blood), sometimes we use acrid medicines to move static yin below (blood stasis or cold water), and sometimes we use other water transforming medicinals to treat dryness.

It truly makes sense, because Chinese medicine is a medicine about circulation. The Annals of Lü Buwei 呂氏春秋 says 流水不腐,戶樞不蠹,動也。形氣亦然,形不動則精不流,精不流則氣鬱。Flowing waters do not stagnate and door hinges do not get eaten by insects. Because they move. The body’s qi is also like this. If the jing does not flow, then the qi constraints.

Therefore, the usage of acrid medicines can move the water of life, which is the kidney water phase. Bitter helps consolidate the water back into the kidney (like Di huang) since chapter 《藏氣法時論》of the Suwne says bitter firms 苦堅. Sour helps 酸收 collect and astringe essentially, its why Shan zhu yu and Shan yao are in Shen qi wan. Also why wu wei zi helps essence. Sour tonifes metal, which inherently collects, to engender water. Sweet helps tonify earth to control kidney water (Huang qi). And acrid help kidney function in general. And by improving kidney function it treats kidney cold, dryness, heat, water, etc (as long as its the appropriate scenario). Shouldn’t be using acrid hot medicines for kidney yin and liver blood vacuity patterns due to warm disease, that’s more in the realm of needing sweet salty instead, ala san jia fu mai tang/ three shell decoction to restore the pulse.

I read unsubstantial fire within unsubstantial water as a definition for Mingmen?

Where did you read mingmen as unsubstantial fire within unsubstantial water? I understand why they say this, since they call San jiao where yuan qi circulates as the organ without form 無形. But I wouldn’t call yuan qi as unsubstantial fire 無火; I think that is a misunderstanding of what mingmen is. Mingmen is a by-product of Kan and Li, water and fire, but it is not less or more substantial than sovereign fire. It is Xiang huo 相火/ ministerial fire, which is a manifestation of Jun huo (sovereign/ monarch fire 君火). If anything Jun huo is the one that is more unsubstantial since it a manifestation of heaven and earth, Qian and kun. Qian and kun are the otherwordly forces that merge to unify spirit and matter (jing and shen). Ling shu 54 says: 何失而死,何得而生?歧伯曰:以母為基,以父為楯;失神者死,得神者生也.

Here they talk about how one loses and attains death and life, the chapter is literally about the years [allotted by] heaven 《天年》It is about the human lifespan. And in this passage, they talk about the mother as the foundation and the father as the shield. Yes, part of this is talking about genetics, intercourse, and procreation; the coming together of man and women. But as in heaven as on earth. The physical act of a man and woman is just the tangible representation of a greater cosmic force of heaven and earth clashing together. This is all represented in Lingshu 8 where it says Heaven in me is virtue. Earth in me is called qi. When virtue flows and qi nears, then there’s life. Therefore when life’s arrival is called Jing. Shen is two jing mutually contending. 天之在我者德也,地之在我者氣也。德流氣薄而生者也。故生之來謂之精;兩精相搏謂之神. Notice that heaven and earth are mentioned first as these greater principles that become represented in the body (as me) as manifest Virtue and Qi. Hence, Dao De Jing. De is the way to put into practice Dao. So, therefore, procreation is just a way for men and women to put into practice heaven and earth merging. Daode Jing 25 says “人法地,地法天,天法道,道法自然” Human follow the way of earth, earth follows the way of heaven, heaven follows the way of Dao, and Dao follows the way of itself/ spontaneity/ nature.

Why do I bring all this up? I am not veering off course, I say this as representations that Kan and Li is a manifestation of Qian and Kun. Ministerial fire is a manifestation of Sovereign fire. Remember there is a Legalist influence in the medicine and the Zang fu hierarchy as exemplified in Suwen 8, where all the organs are given a role of an official. While Xiang huo and Jun huo are technical terms that come into being in the Wu yun liu qi chapters of the Suwen, this only further reinforces the heavenly influence that is implicated. Xiang huo in the Suwen is related to shaoyang 少陽相火. Just like Yuan qi is related to shaoyang/ san jiao in the Nanjing. Ergo, the big difference is that Yuan qi and mingmen are technical Nanjing terms which while are referred to as places where the shen and jing reside, and the place where yuan qi ties into 命門者,諸神精之所舍,原氣之所繫也, one big thing you ought to notice is that they use the term Yuan 原 vs. the other Yuan character 元。I am saying that the former yuan, which is used in the context of mingmen and all that, refers to primordial yuan qi (the latter yuan) that has embedded into the body’s shaoyin and is now combusted into fire and water principle that is now circulating through shaoyang.
That is one big difference is that ministerial fire and yuan qi circulates, while sovereign fire doesn’t in the body. In the heaven it certainly does, hence Wu yun liu qi movements. The emperor doesn’t move, but its minister certainly does.

This is why Lingshu 8 classifies the lungs as minister 肺者,相傅之官, since when metal is impaired then wood shaoyang is also impaired causing ministerial fire to get stuck. Metal and wood descending and ascenscion dynamic is hampered causing yuan qi mechanism to not circulate leading to flares. Hence, why the formula Sini san which is now classified as a shaoyang pivot formula is in the shaoyin chapter of the Shang han lun. This is an issue of the up and down pivot mechanism of wood and metal, leading to shaoyang pivot dysfunction and the ministerial fire within the fluids to unable to warm them causing si ni/ counterflow. This mechanism is the same why in the Tang Yejing, the formula Huang qin tang is called Minor yin dawn decoction, 黄芩汤则从小阴旦汤, since this minor yin dawn is referring to an early dawn where fire is expressed too rapidly during shaoyang time where fire arises from blood into the fluids, from the zang into the fu, from the night into the morning. 小阴旦汤,治天行,身热,汗出,头目痛,腹中痛,干呕,下痢者。All these symptoms are replete heat symptoms (body heat, sweating, head and eye pain, abdominal pain, dry retching, lower dysentery) that happen in the morning. The beginning of the day symbolizes spring, shao yang. It is when yang begins, the word dan 旦 in XYDT means dawn, daybreak, morning. And the simplified character for gallbladder is 胆, which is dan with the organ radical added in the left. The morning is shao yang. Xiao chai hu tang plus bai shao is Da yin dan tang, this is also an issue of shaoyang pivoting too quickly, but DYDT has to do more with the shaoyang qi mechanism, and Xiao yin dan tang more with the shaoyang fire manifestation without the qi stagnation.

Anyways, my larger point is that I wouldn’t classify yuan qi as unsubstantial even though it is technically circulating in what is called a formless organ. Although, I don’t personally think the word formless organ does not mean it doesn exist, its just not a Fu that is in one place, like the stomach, but all over.